Loading...
9512-054 (RPL)ALC M LICENSED CONTRACTOR DECLARATION `•� .t I hereby affirm that I am licensed under provisions of Chapter 9 (commencin with DATE 12/fl- ,Section 7000) of Division 3 of the Business and Professionals .Code;, and my . �. ic�nse in full force and effect._ ! / JOB SITE ADDRESS License# �Uc..Class---, "Sip. Date An /'- OwNER -bate f2 lit M. <* Signatureof4ntractor J/ TIGNA0 I hereby affirm that I am exempt from the Contractor's License L.hw1for the following reason: ( ) I, as owner of the property, or 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( .) 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 of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier G�� Policy No. t�a�un. (This section need not be completed if the permit valuation 4s for $1.00.00 or less). () I certify that in the performance of the work fors which �tiiis�permit is issued, I shall not employ any person in any manner so as become subject to the G. ...... r r r workers' compensation laws' of Californ'iia`, and agreefthat if I should become subject to the workers' compensation provisions of lSection 3700 the Labor Code, I �haly fo with-cornply with those pro�yisi s'.. d Warning: Failure to secure Workers',Comp nsatiooverage is unlaw'l and shall subject an employer to criminal penalties and civil fines up to $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 to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify j & hold harmless the City of Indian Wells, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if � work is not commenced within 180 days from date of issuance of such, permit, or cessation of work for 180 days wil.i.subject permit to cancellation.//41 I certify that I have read this applic correct. I agree to comply with all construction, and hereby -authorize U it the above informati6n, �is ws relating to the building this City to enter upon the 5:1,340 AVE. KAM MAJESTIC HOMES NORTH PA.R114ET P.O. BOX 76 LA QUTI '1'A CA 92253 USE OF PERMITJOOL .AND/OR SPA TOOL .AND/OR SPA PERMITS "12-054 77X04X008 CONTRACTOR AMERICAN POLI, CO'NS'rRUCF10N 68575 Sart Felpe :Rd- caEtiedial City CA 92234 (619)329-2156 C B1, 1"r 1104 DESIGNERIENGINEER 11,640.001.5 ltsl'i'tAVV ED COST OF CONSTR3 �C ilON 1'3+'.3110'1:1`1.' FEE Si[1:MAIARY PLAN CHSC.K FEF, 101-000-439-318 $87.75 CONSTRUCTION FM tol.-W0 418-000 $1.3.00 141L'C13"ICA1, FFM -- POOL 101-00£3-421-000 $240 ]IR— WrRICAL k"EE -- POOL 10140()0420-000 $45.00 P.LUNMI['NG FEE, -- POU1: 1010(10-43.9-00(3 $27.00 SUI3-T t1iC°C)N5TWC71ON AND PLAIN CHECK $318,75 LESS PRF.-PM.D FEES $0.00 TOTAL 6'Lr�''Ril�.l`c�Fir,ES DUE NOW �:laS.73 1.1 1995 RECEIPT I PDATE [BY IDATE FINALED IINSPECTOR INSPECTION RECORD •_OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR 41, BUILDING APPROVALS MECHANICAL APPROVALS Set 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 117 1,17 f j Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Z / 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 Z?/ Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low VoRage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm)