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0301-315 (BLDG)( co V W ®C� W �c� OZ Z0oo F -to WC-) � Z M Lr) N ©� aUQ — Z T Q cr O 0 J J ca < 60 � LO et Z r,a g �wcn�cv %.vw I nAV I vn UCI.LAMAI IUIV I her 7�`ffirm under penalty of perjury that I am licensed under provisions of Chap (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Ki 31 x 2 B DTIC• 3/31/0.3 Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 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). c) 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. fbr this reason 'Date i. ti Signature of Owner- t WORKER'S COMPENSATION DECL RATION 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. (a) 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 aTAVI' • FOND Policy No. 11�op}tl'tJITf'Afi?�I1 � (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 to become subject to the workers' compensation laws of California, andagree that if I should become subject to the workers' compensation previsions of `Section 3 -00 of the Labor Code, I shall forthwith comply with those provisions. /f Date: / N/ �,Applicant- ,,`=-- =— T � Warning: Failure to secure Workers' Compensationr coverage is unlav4ful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quanta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work. is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application arid state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representajives of this City to enter upon the above-mentioned property f 'r insp/ectior�%prirposes. "Signature (Owner/Agent):. �' �1 "%' "• ` Date;' ;ii 's 4 /; , Olt BUILDING PERMITPERMIT�#�-�DATE VALUATION LOT t TRACT V JOB SITE ADDRESS ��xIS. C$iA'!Et!'I®i -I� APN OWNER CONTRACTOR/DESIGNER/EN (NEER I iR tiJi 9'C kC� i1TI Fr2't`I f�%. ASSOC, WC :G1<"L T? C•il�+lKXM, CONTRA<C°I`Q I'C.M 1060 2533 SOUTH C'OAT'I' I-0 31.1v;AY S'I'11, 250 1..At. UINTA CSA 92253 ("ARIA. 'L3X'M? 9EA, C.A. .rJ'i{:etP (160)635.1010 USE OF PERMIT GUM -RAJ- AJ- BUIL' l[M410 BLl7s:f ]tx: 5 33>8.11, 55.654 i:§- 6. V_CX, TARY a1•i R fC'1MR.A.I.MODIACA.V014S VAi,UAT) l+l_ 14,000.1101.,E KNITMAUT C'`C grDIP Ct?NS"1'AnK71100 2�,EXiX;,(DO C`•ONS'f'F;.iit"V ON 1R: 101-000-419-000 $153.0 a'7'k,OIAC'r lO�CI�'IC32d GI 1t • liEStFa 101-Oi3E3-2A1-CA'BC) $1.40 s•: EB o3 1003 ! . ?f C"Y OF LAv FINANE DEPT SUki •MTAL 0014 TlRUL 1. ON AND P.T At4' C5 -%+::.fa: � 140,40 11i33 F'Ti3 -PA.1b W- M Vt 00 : I'OTAL PERMIT 17";b UV POW: RECEIPT DATE BY" E FI LED INSPE R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE -7 INSPECTOR 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 bents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final ' Final _ I BLOCKWALL APPROVALS POOLS - SPAS steel Set Racks Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Ll Gas Piping PLUMBING APPROVALS O Gas Electric Final Waste Lines , Heater Final _ Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX, for Finish Plaster Sewer Lateral _ Pool Cover _ Sewer Connection Encapsulatio;1 Gas Piping 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. • oke Detectors emp. Use of Power Final Utility Notice (Perm) COMENTS: