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0302-130 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (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 61,461) C53 9�a(RiU:1 DateSignature 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: ( ) 1, 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 STATE MHD Policy No. 046-02 A.1040 (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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Q h 10 Applicant - - 1, ... 4,e ` Warning: Failure to secure Workers' 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. 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 and 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 representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) ' .:JAZ Date AZ - BUDING PERMIT V r PERMIT# ONY2-130 DATE VALUATION m.,00G o LOT TRACT JOB SITE ADDRESS 77-745 C.Oi�TC�i,�i COURT APN OWNER CONTRACTOR / DESIGNER / EN (NEER a1'WONA IMPA9, INC MMMYRR P001B & SPAS C©UN RY OMB I1W 77��-7ry5 ,c7TU)C1 37 IC), 3OXiI ��6�L4 .CA 922,11 I.,A Qp„75T7A CA r (Mim., A S 1590 USE OF PERMIT . POOL ANDIOR SPA Pt.7L3f,.?SP .. A1,ARMW5AH.R1 R,`; SliaSFAI BE L1v PLACE AT PYX-PL(%,STFA INSPECTION, EQUIPMMT ENCU)SU 7,E NOT MC1a#1; YD, P001,,K14DK')R SPA 1g,000.till 1z A.AKD C091•CrIP C��7.i37L.6Z.F+��•.F.•O.OI .d.Ri LY'Y7Yi✓i� y�,y����yy p��gd�.Q,T �'j�^i%'j ��j,� (1 FE A�.YL.S.G.�iTi-RY.Y..V ELP Ev..++YA+iYJ.AR i PLAN F„ Hit(t K FIX 101-000-4-39-318 $10130 CON.ai'RUCT,'ON "M 101-000-418-000 V62.00 WICHAWiC,A, FEE — POOL 101.000.421 -(YY,) $24,CIO FL..ftr TRIC.A;y PUZ — POOL 101 _001-4•204*0 $45,60 PLUM FOG FEEF; ••• POOL 101-000-419.000 12,1100 rt• fel i,• X11 t 1.1 7FO $0,00 � nL.1a•� Ft1B 2 0 20un3 CITY OF L-A GUINTA rECEI DAF6 �'y� t. BY DATE FINAL DINSPECTOR Y INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE 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 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 .41 2 _ Equipment Location Underground Electric Underground Plb.g. Test ,e 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 `Sewer Connection Pool Cover Encapsulation 3 Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fudures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final - Utility Notice (Perm) P.L. L. L. P.L. r L. L. P.L.