9808-040 (SFD)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 �nd-�
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
.416ate Signature/of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalt� of perjury that I am exempt from the Contractor's
License Law for the following reason:
1, as 6wner 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 (Soo.ro44.Business mProfessionals Cvuo.'
( ) | as o�ner of the property, am oxouo*ol�contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
I am exempt under Sectio
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one,of the following declarations:
1 have and will maintain a certificate of consent to self -insure for workers'
| ` ' compensation, osprovided for by Section orOo of the Labor Code, for the
po
rance ovmowo���wm�xm�
xV`iopod�ovod.
( � | ' have and will maintain wmnmm/compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for wmox thio
permit is. issued. My workers' compensation insurance oame,m policy no. are:
Policy No.
~�.~ �
' SI»IGlq]ND 620355-97
pnisoenoonneed not bocompleted if the permit valuation is for $1OO.00o,|e»o. .
( ).| certify that inthe performance o,the work for which this permit i5issued,
| ohoU not employ any person in any manner onaum become subject mthe
workers' compensation laws ofCalifornia, and agree that if| should beboma
subject mthe workers' compensation provisions ofSection 370oof the uoUu,
Code, | shall forthwith comi
^nuto:-41z�u1//�' xnnnoant
za�
Warning: Fai|pmmoeoumwm,mem'Componm�ionouvamno�.
un�.onu
shall subject anomp| mohmin�pona|Ueoand'oi�|hneYvpm$1OUOOV.in
addhio�m'm000u ofod�pans�io�damages aupm�daUhorinSooUb?37O8
o/the uuuo^Coue.interest and attorney's fees. v -
.
IMPORTANT Apb|icatinniohereby made mthe Director ovBuilding and Safety
for o permit subject to the conditions and restrictions set forth on his
app|ioaxioh.'
1.Each person upon whose behalf this application iomade meach person so
whose request and for whose benefit work ioperformed under o,pursuontto�
any permit issued as result ofthis appnoaxonagrees to, &ohoU. indemnify
& hold
- harmless the City ofLaQuinto.its officers, agents and employees.
2. Any permit issued as result o,this application uonomoo nun and void if
~v,x is not commenced within 1e0 days from date o/ issuance o/ such
po,mit, or cessation o/wo,x,u, 1uOdays will subject permit tocancellation.
| certify that | have read this application and state that the above information io
correct. | agree tocomply with all City, and State laws relating tothe building
construction, and hereby authori.ze representatives of this City to enter upon
the above-mentioned property for inspection
. �j
�agnamm (Owner/Agent) oate--��-��'u�
BUILDING PERMIT
D VALUATION LOT. TRACT
ATE "11413
ADDRESS 71*0 NO Did
OWNER
CONTRACTOR DESIGNER ENGINEER
CA S1225 -A
JA, QUIM CA 92233
CB0 1858
USE OF PERMIT
-NAM.)
OR POOL, PLAN MIECK FEE- Rb 75% FOR MLITIRLY. ISSUANCE OF*
AW PLAN TYPE.
POACKPATIO 160.00,8F,
GARA.00CARPOIkI 449.100 SF
PEIRMITMIEWWOMY
CON311RIUCIIAOIA FW 101-000-418-000 .50
1.01-000-439-318 98
3161,
MND I ING FEE 101n0004.234100
St)IBIOTAL CONYMUCTION AND PLAIN
$4,558 .16
~_`
INSPECTION RECUR®
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
f_
7 -gam
Underground Ducts
Forms & Footings
/
Ducts
Slab Gradeld
Q---- �--
ReturnAir
Steel
Combustion Air
Roof Deck
_
�_ g f/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing /j�rL
/
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
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
Gas Piping
Gas Test
Appliances
_��
Final
COMMENTS:
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 -
i
Final
�1
Utility Notice (Perm)