9602-123 (SFD)V A41
LICENSED CONTRACTOR DECLARATION
I hereby affirm 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 an / r d effect. r`t3 ' l' 114!/96
/�.
License # f Lic. Class /! 1Exp: Date
ate i; r7/ Signatureof Contr ctd �/ �/ jc' • ra ��., -
OWNER=BUILDER DECLARATION
I hereby affirm that I am exempt- from the Contractors 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
r 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 ., Policy No.
(This sectionfiaeed4i.61 66 completed if the permit valuation is-f641(00T1)0 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 pro)n'sion�of Section,.3700 of the Labor.
Code, I shalliforthwith comply wi thoseiprovisions-- l
ate: ,•,•',> �' 4r 1 lAPPIi� r/,4 Al' -1 �. 42'y f .cif
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall'
subject an employe_ r 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 resultiof thisfapplication agrees to, &shall, indemnify
& hold harmless the City of f dklt 4 ' - Wpfficers, 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 in'spec purp s~es. f
Signature(Owner/ entAr" If %'" l iFi/r F Data, 1
/
ALCA
DINGTERMIT
PERM IT-A60z,1z3
.�: z%ARU11.
MIX
ry
DATE '°
VALUATION '"x ""
LOT TRACT
_'
JOB SITE ADDRESS 5 q6 Soil 11.it9A;WN '�t19 il.1n,
APN '1 e619-"13-iD�.7
OWNER
CONTRACTOR
itANC.I CJ CAP.jS'1'li �idt! liE�p�..1..011R1t`R,
K SL 1,AN D 11
79657 COLjAi''1'. Y CLU'D DR fi 2!)
56.140 PGA BLVD.
tiEWMA DUNES CA 9;Z2o
LA (7VKFA CA. 92253
(619)345-7755 CBL-# 1969
(619)'564-1483
OESIGNER/ENGINEER
��tza a�?rT.ta�rrr^r,a
26 CORPORA:M PARK
USE OF PERMIT;1NULE FAMILYDWELL1NU
12 ONE CA W114
THF, W10TAGF, COLLACT1ON - POA WI ST ,
PLAN 2-C
`FEE DESCRIPTION
FEES
CUS'1'om C0 TRU(,"`7IVYX, Z, 72.00 SI
.l ORCHIP� 364.00 SF
GAPA.OE/CAR[I'ORT 674.00 Sr,
ESTIMATE'D CAST OF d:63tvMUCTION
24 ..8,04,00
PERMIT FEE SiUAMINRY
MAN OTECK 11% 10.1-000-439-:3.18 $921.67 `
CONSTRUCTION ME 101-000.418-000
NIEC HAN.1'C AL RE 101-000-421-000
HL..EC1 RICAL P:EE 1.01-(500 420 400 Sl7 52
1�t,UXIA.1t4c FrX 301-000419-000.. $t79 s
S`i OIU`("v 'sb1+'�` i1C2v FEE -1' 1p I � 000-241—W. V4.1 tf'
GRATA N0 .lei i0I-rt3ti-4' 3 JUU irt).(3t)
Sr+t A +t�rc rrr it t 1:E 225-000-443-342 $5,331.5
AWr N- PI-TIMC PILA0,13 - 1x68M '70! -000 -X55 -01N.)
SUB -TOTAL, f :ONS 'RUC110N AND PLAN CHECK
$8,224.69
LESS PRF -PAID RES
$f5:00
TOTAL PERMIT FEES DUE NO
RECEIPT
DATE
BV
DATE FINALED
INSPECTOR
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 APP OVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location.
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING A P VALS
Gas Test
Electric Final
Waste Lines Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection &V
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
Final
Utility Notice (Perm)