9602-056 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 79"1 of Division 3 of the Business and Professionals) Code, and my
License is in full force and effect. 6349 ti/ ldil/5
License # LiaClab
� Exp. ate
/Date 7 1 natureofContractor
.. „e.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for 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 al XrE 1'W10* Policy No. i46595
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as
,.,A subject to the
workers' compensation laws of C0lifornia, and ree that if I should become
subject to the workers' compensation prgvisigrSs of Section 3700 of the Labor
Warning: Failure to secure Wo;lkers' Compensation coverage is unlawful 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.
j
IMPORTANT Application is hereby made to the Director of Building and Safety
fora permit subject.to the conditions and restrictions set forth on his application.
1. Each person upon whose be 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
& 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 will subject permit to cancellation.
I certify,that I have read this application and stateythat the above information is
correct. I agree to comply with all City, and,,State laws relating to the building
construction, and hereby auorize represefftatives of this City to enter upon the
above-mentioned prop%W'f9f inspectionpurposes.
Date t-gAM(
ALCM
BUILDING
PERMIT
PERMIT'N� _056
DATE At . +[r
VALUATION •eyt
LOT
TRACT
JOB SITE ADDRESS 53-195 AM 3Ut kEZ
APN
OWNER
CONTRACTOR
CORONII I. CONSTRUCTION
ZEKE CORONEL
77836 AVENI:DA. MONTr ZUMA. ;�
(61.9)_%4-4604 CAS.# 2261
DESIGNEWENGINEER
USE OF PERMIT%-%-J�� �+IV L1�s `7.5 +tiPt1
f'C*11-14(1) M3A'1:I R
FEE DESCRIPTION
FEES
CUN-f-AACf XMCRUNT 000,00 LS
CGNSTRUCf 101-4
114,0M.1 FE'E' SUMMARY
K,AX CTIEiCK ME— 101-M-439-418 $69.35
::OMTKICTIONFEE 101.00041$-000 $99.00
XIECHANICAL IFFE -- P001. 1.01-000-421-000
Irt1C`f' ICALF.EE--Ft'>4°% 101-000»420-000 �is.{yt3
PLUMBING FEH --.POOL 101"000-1159.000
SLIH--TOTAL. CONSTRUCI ION AND PLAN' CHECK
$259.35
LESS PRE -:PAID FEES
$0.00
/170TAL i�Elii1�IT FEES' DUE NOW
Ipso
FEB 12 1996
Big
$259.35
�R DATE
BY
DATE FINALED
INSPECTOR
.R . W
INSPECTION RECORD
y OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BEi*s
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
/ S.
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
2
Gas Piping
3
Gas Test
Appliances
Final
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)
COMMENTS:
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SAFEVY DEPARTMENT
C OMMONALLY N
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AND ALL APPLICABLE COX&
AREA TO BE ENCUOSED
WhViWo 5 FT. mlCH FENCE.
ALL. GATES TO Sr'_ -_ SELF-CLOSING
AND SELF -LATCHING. Y
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