9602-125 (SFD)LICENSED CONTRACTOR --DECLARATi0h
I heraby.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 and effect. t, .'^-
J�ryrJ.J,� ll�tt"!Oh
! License Lic. CIQA-s I Date F .
ate,;. �' SignatureofContract{or '�f''
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 theproperty; am exclusively contracting with licensed
contractors to construct,the project'(Sec. 7044, Business & Professionals Code).
() I em exempt under Section•. B&P, .'for this reason
Date Signatureof Owner
"WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty'of perjury one of the following declarations:
O 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 '6f 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 secti9p1999driot409 completed if the permit valuaticn;,is f41L$ , ,90 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 thp'" workIers' compensatio/ro ions of�Section 3700 of the Labor
Code, I sh f fort' compl wi those provisions r
/Applicant r t+,, Zrf✓
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 resusof I' ' rp�iC�iti� agrees to, & shall, indemnify
& hold harmless the City of a & Iocars, agents and employees,.
2. Any permitissued 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 epresentatives of this City to enter upon the
above-mentioned property for ins tion pu(poses.-
r Signature(Owns►/Ager ' f/v�il! / u�FG� r DaEs.,l ri�7 la�
ALC t,
BUILDING PERMIT.'. PERMIT*
DATE
VALUATION $241.83,924JLOT
TRACT 2H1V PHASE I
JOB SITE ADDRESS ,
APN
OWNER
CONTRACTOR'
RANCHO C,P1P1"+"{'/lNt ,L7E,VV�3.PhE .
C:CL! It3'--
%. t t UlN.{'A CA, 92233 IV
(014i3Q5-%/55 CBL# 1,069
(61 �)5611'-1 08R
,DESIGNERtENGINEER
BRG A.RC ITEQ'1'S
26 C01W03, YVFl5 PARKGA ;
USE OF PERMIT{la( J.{. { AIti.1Lfi i11 r1 C.%,ktv`li
!.-;'1 THE "FFtiATAWE C:C)1..i:WE10N -1'C#A %1F,8T
PLAN 24 ;.
FEE. DESCRIPTION
FEES
t U31'OM C0NS!':RL=10N U72.00 S.f
PORCq/13AT1.0 ;:. 3 364.00 SF
GARAOt%CAR:I"(Wr _ 577.00 SF
F
:IE�3" ITI ATl� D �C"C7�'�' d1E' C21V`'i`A1;tJG"L'Yt�iV
Lwo,t3 il.LU'-.
I7L!kN CBECi!s FEE - ` 101, -MO -439-31'8 ' $921.68
ivi�va•rasurrr.�nres frac t(Jt-L�1Y0^�tAm't?4.
Min 04ANICAL I`RE 101 -OW -421-000 $89.50
ELECTRICAL .1 --FE 1014*0 4.20-000 $111.55 .
PI:mftNot FIS 1.01«ono-410,06f) 1;179,x�
r me3xat ivic� et�r�,r v�sr» - z�Lc; +c1 101.000.241-000 6".10
01?J%DING FMX .101.-000423-60 $x20.00
INFRASTRUCTURE FEE .. 225 -WO -443-342. 85.332.45
MRT IN PI,ACTS -REST X01 - -755-0W
c
SI.Jl3 7'UTAL CONSI'RI.:CTIQN AND PLAN CHECK
$8;62.5.7.3
LESS PRE -'AID FEES
$0.'00
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION -RECORD
F OPERATION
it
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 loG
Final
Final41j
BLOCKWALL A P VALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APR ALS
Gas Test
Electric Final
Waste Lines 8
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans-17.O.K
for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas),
ELECTRICAL AP ROVALS
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)
COMMENTS:
M
an
i Q auinta
ut to stn s P int iion.
This Certificate issued pursuant to the requirement's of Section 306 o . f the .Uniform Building ,
Code certifying that at the time of issuance this 'structure was in compliance with the various
ordinances of the .City regulating building construction or use. For the -following;
BUILDING ADDRESS 55-532, southern hills
Use Classification SFD Bldg. Permit No. 9602-125
Group R-3 Type Conitruction V19 Fire Zone Use Z04 R 3
-..Owner of BuildingKqT. LAND_:? 2! - - —.Address -56-1 4 0 Paas RT. -%7n
By. ngjjrF PP.T.T-ErPTF.R
Date: 10-15-96
Building Official
POST IN A CONSPICUOUS PLACIE