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9602-119 (SFD)LICENSED CONTRACTOR DECLARATION 1 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 and effect. '197�(,J-5_ r' ^y License # Lia C?as3� ,� Date f>�yZf ate'ig nature of 066trcto.l1L Da -.At_. - OWNER -BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's 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 pioject•(Sec. 7044, Business & Professionals Code). ( ) I 'am exempt under Section B&P.C. for this reason' Date SignatureofOwner t 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 provide8'f or by Section 3700`of the Labor Code,. for the ich this permit is issued. performance of the work for wh () 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 se<ipn eedirfotsb� completed if the permit valuations pyc$1Ltm:90 or less). () I certify that in the performance of the work for which this permit is issued, :4 shall not employ any,.person in any manner so as to becomesubject to the workers' compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Coide, I shall forlhwith com/pl�,with those/provi ionsf r1` late: e7leil Applicant 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. --IMP,ORTANT 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 resuq/,%! its appli on- �i rees to, &shall, indemnify,- 10 hold harmless the City of IidialrwiiVel1s4iaoffic�rs; 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 dayswill subject permit to cancellation. Z ' 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 sinspection purposes. .' Signature (Owner/ aril) ftoFXls 7i'ly,'�Ard' Data ALC # BUILDING PERMIT PERAAIT 602 DATE . 2123/96 VALUATION $286j$3.401 LOT' 0y TRACT' ' . `. '2...R4y JOB SITE ADDRESSAPN MRRN WILLS 7619-440.045 OWNER CONTRACTOR tANCHO CAPISTRAWO DEVEI,011%4f'� L.1i1'vI,l:i ,ti' .,- j'- '�9yV� 't \yVT�li3'�D'U lr..lrtii! 5,.7�i. "2 - 56-1�3ii'PGAl:LVD. 13E;Ri4�1L7�1DL�l'E5. CA 9220I LA QLUN`)'A CA 92283 (619)345-7755 CHLEk 1,969 (4()19�t?a^!©?� DESIGNER/ENGINEER BLIG ARCF T-ECT'S CORPORKrE T AkK USE OF PERWTjUNkjL.,b 1-AM.l Y OWELLINU 26 � .A 09 pfd �}�q i.� 'nTH HOU iAt3js C0J...laE J10N - POA W 63T MAN 3-C " FEE DESCRIPTIOR FEES x. CLIVIXIM LOIvSTRUC'171014 3,44:1.00 S1; P0R1C1.9/PKfT4 SF 4519.00 – ' GAftAK3E/C'ATtPQitT '� SKIM ,Sf , FsTmi' TED3 COSH' 00 CONSTRUCTION 2'.16,483.40 .� ERAN 11'.D EE SUMMARY.^ PLAN CHECK ,wIM CC):+fS'f`.€ UCl ON Ff31: 1014if3()418-000 S1,294.00 f CCVANIeAL Fri' S 101-000421-000 S124,00 MEC11111c iv.. FEE Pf,tti�f�tt4€;t r't:�. .1.�1.-A(fi>••41�-0!111 �2.11,�.,�. ' a' . `::Lair t ilii a't ft31ti.FE33 - IUNI113 10,1-000-241"000 528.61 ' iA.ifINO`1 er'. 1014DO-423-Gti4 21t.ts0 R4H.R.AS FRtJC'f VRE P -EE 22.5_00-443=342 S6;0t30.0fi M f,N• ), L 1, L.: 13 - �..�1M 70.• 00-�•,_.5-M Sit SUI1=.R'OMV, CC N.Si* .T i0N AND PLAN C.'14ECK S9,392.37 CESS PRE -PAID BEES $0.00 TOTAL $r'F_WtT_FE.' ! S .Q) Q.l r: NOW / RECEIPT DATE BY FINALE FINAL INSPECTOR V 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 Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Ao Final Final BLOCKWAL PP OVALS 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 VALS 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 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) COMMENTS: