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0106-311 (RPL)I hereby affirm u9cler penalty of perjury thqt I �M licensed 6nd�f. provisions bf,,Chapter 9 (comr�iBncing With Section 7000) of."Division 3 of the Bbsiness,a6dProfessionals Code: and -my License is in full fdoe -Snd effect.-.!'�,�-`Li cense # Exp. DaLic. Class7 F" tel.47Date ignature of Contractor - I hereby affirr�*uincler penalty of perjury. that I am exempt from the Contract")Licen�� Law for the following reason:1,-,.,as owner. of the property, or my employees with wages as their solecompensation, will do.the work, and the structure is not intended 6r offered forsale (Sec. 7q,44, Business & Professionals Code).I,' as owner- of the property, am exclusively contracting with licensedContractors to construct the project (Sec. 7044, Business & Professionals.1 am exempt.under Section P&P.C. for this reasonDate Signature of OwnerWORKER'S COMPENSATION DECLARATION.1 hereby aff irm under penalty of perjury one, of the following declarations:)&I have and will maintain a certificate" of consent to self -insure for workers'com��nsation, -as. provided for by Section 3700- of., ihe Labor Code, for theperfb�mance of the work for whichthis pe�mit is issued.l.have and'will maintain workers' compensation, insurance, as required byC'fillon 3700 of ritheLabor Code, for the performance of the work for which this4rm.it is issuedl.`.Myiworkers' compensation insurance carrier & policy no. are:Carrier Policy No.a TATX FUND 220-01 UNIT 09"130(This section need hot be completed if the permit valuation is for $100.00 or less').I certify that i -n -the performanc6 of the work for which this permit is issued,shall not, employ any perso . n in any manner so as to become subject to theworkers' compensation laws of California, and agree that if I should becomesubject to the workers' com ensation' rovisions of Section 3700 of the Laborarni— F ilure to secure Workers' Compensation coverage is an1l wful andshall s?bjqct an employer to criminal penalties and -civil fines up to 000, inaddition-to the cost'of compensation, damages as provided for in Section 3706of:th6 Labor Code, interest and attorney's fees.IMPORTANT Application is hereby made to the Director of Building and Safetyfor a permit subject to the conditions and restrictions set forth.on his1. Each person upon Whose behalf this application is made & each person atwhose request and.-fd� whose benefit work is performed under or pursuant toany permit issued:as a -'result of this applicaton agrees to, & shall, indemnify2. Any permit issued :as. a result -6f this application becomes null and void ifwork is not commenced within 180 days from date of issuance of suchpermi or, cessation of work for 180 da s -will subject permit to cancellation.I certify that I have read'this �pplication and state that the above information isCorrect. I agree to comply with all City, and State laws relating to the buildingconstruction, and hereby apthorize representatives of this City to enter uponht Yk.0Signature (Own r/An."t V11�1WIP Date PERMIT # UILDING, PERMIT DATE �_VAL_'UATION k!!ip LOT -TRACT JOB ADDRESS APN OWNER CONTRACTOR t DESIGNER ENGINEER XATURATAEMM 55 161 'NoVam.14HUS 3 C160)569-6726 mo 52-o USE OF PERMIT POOL AND/OR SPA 17,000.00 Lo CONSTRUCTION FEE 101 -000 -418 -OW MOM ELECTRICAL 110 - POOL 1.01-00042"00 S4100 PIAMSM0 FEE - POOL 101-000-419-000 Lr 11 SEP 18 2001 NA qCE DEPT. 12W PRE -PAM FUS Saw RECEIPT PATE BY DATE FINALEb INSPECTOR , INSPECTION RECORD OPERATION ".:.�r ••I F��.CTOi OP kATION O DATE �ISPECT�R`' -.I3U-ILDING..A0 -.RGV!ALS _. _ . MECHANICAL APPROVAlS Set Backs ' Underground Ducts Forms &Footings Ducts Slab Grade - Return Air Steel Combustion Air Roof Dock Exhaust Fans O.K. to Wrap F.A.U. Framing Qq,^ripres:Vr Insulation Vents Fireplace P.L. Grills Fireplace. ,79. Fans & Controls Party Wall Insulation Condensate Lines Party Wali Firewall Exterior Lath Drywall - Int. Lath Final Final - POOLS - SPAS BLOCKWALL APPROVALS- steel Set Backs Electric Bond 9//%/l Footings Main Drain Bond Beam Approval to Cover " Equipment Location Underground Electric Uhaerground Plbg. Test w /r✓ Final Ga;,, Piping PLUMBING APPROVALS esTest •_ Electric Final - Waste Lines Heater Final Water Piping Plumbing Final Plumbing Tqp Opt... EqW ,ment Enclosure Shower Pas V.K. for Finish Plaster Sewer Lateral '. Sewer Connection Pool Cover 'Encapsulation �p/� j�—?i 'Gas Piping — Gas Test .. Appliances _ Final - COMMENTS: Utility Notice (Gas) ' ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit - Rough Wiring Law Voltage Wiring Fixtures Main Service. Sulp, Panels .. Exterior Receptacles - Cz. F.l. Smoke Detectors ` Temp. Use of Power Final Utility Notice (Perm)