9704-061 (BLCK)LICENSED CONTRACT OR DECLARATIO N
I hereby.-affign under penalty of perjury that I am licensed under provisions of
Clid��&_6,Ammencing with Section 7000) of Division 3 of the Business and
Pr@f�ssl&G�Eode, and my License*is in'full force and effect.
License # Lic. Class Exp. Date,
,/Date Signature of ContrVor
OWNER -BUILDER DECLARATION.,
I hereby affirm underpenalty of pe�t��.y that I am exempt from the Contractor's
License Law for the following reason -
1, as owner of the property, oi my employees With wages as. their sole
compensation, will do the"work,- and the structure is not intended or offered for,
sale (Sec. 7044, Business & Professionals Code). I I .
1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
I am exempt under Section B&P.C. for this reason
Date Signature of. Owner'
WORKER'S COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of, the following declarations:
I have and will maintain a certificate WE6nsent.to self -insure forworke I r.s"
compensation, as provided. for by Section 3700 of,the Labor Code, for the
performance of the work for which this pqrmit is issu d!
S�ction,3700 of the Labor Cod e, for the performan6e'of th6 work for which this
pemriit is� issued. My workers' compensation insurance carrier &.policy no. . are:
Carrier Policy No..
(This section need not be completed if the permit valuation is for $100,00 or less).
I certify that in the pbrformance of the work for which this l5ermit is issbed;
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agre6 that if I should become
su6ject to the workers' compensation provisions of,S6ction 3700 of the Labor
/ de, I shall forthwith comply. with hose,provis!i�ops-f`—
Warning: Failure to secure Workers' Comp�nsatio�k coverage is unlawful and
shall subject an employerto criminal penalties and civil fines upto $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest.and attorney's fees. , .
IMPORTANT Application is hereby made mthe Director of- Building and Safety
for a pannn subject to the oonuitioho and ron��ionm am forth on :his.
application.,
1. Each person upon whose behalf this application is made & each person at
whose 'euueu'and for whose benefit Work .0performed under v.pursuant m
any permit issued 000result mthis applicaton agrees to, ushall, indemnify
& hold harmless the City m uuQuimo. its officers, agents and employees.
o.Any permit issued ooaresult o/this application becomes null, and void i,
wn,x is not commenced within 180 days from date o/ iuou�nvo of such
ponnit, nrcessation of woHx,u, 18Odays wm o6�ao!pe,minouanoonation.
I certh that I have read this application and state th * at the above information,is
Correct.' I agree to comply with 'all City, and State laws relating to the building
construction, and hereby authorize representatives. of this City to enter upon
the"above-mentioned property for inspect16w,purpos,ps.'
Ainnat
r
_
- `__�~_,
BUILDING PERMIT 97404-0611
DATE 4/11-W97 VALUATION S.1,247.0�4) LOT TRACT 4982'
JOB SITE APN
ADDRESS 48 -WO &,Vi,iAM,'V* STUERA'
OWNER CONTRACTOR DESIGNER ENGINEER
*A
USE OF PERMIT
VON
WNW
LL
I ESS PRE
UYTAU'PIERMIT FIETA DUE NOW $63.00
RECEIPT __TDATE INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
So Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)