9602-122 (SFD)t ,
LICENSED CONTRACTOR DECLARATION'
I hereby affirm that I am licensed under provisions of Chapter Acommencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is .In full/force and effect. _`1 /9 13 % ,�
License / Uc.a—s ' /Exp -Date
Date, 1 j'� SignatureofCont(actor �iP' / ;f
low �. .
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 project (Sec. 7044, Business & Professionals Code):
() I am exempt under Section . B&P.C. for this reason
Date Sig �nati re of Owner
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„aslprovided for .by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
O 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 secti66rn'&&cfii&I6b completed if the permit valuatiorii0drf$ CV'00 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)he w -kers' compensationiprovisions'of Section 3700 of the Labor-
,.Code.
abor
•,Code. I sWall .fo�with comDly/with those.orovisions.
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 result -of this application agrees to, & shall, indemnify
& hold harmless the City of Ir> lay Well's 1. officers, 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, representativesrof this City to enter upon the
above-mentioned property for inspection,purposes.
Signature (Owner/Ag ) %�t% . Date
ALCM
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— BUILDING: PERMIT
PERMIT<t
DATE
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VALUATION +'r LOT
TRACT1°',
JOB SITE ADDRESS SS,479 .4”) j-�' 114.J F �.�a,H.
APN 7/ it►'A-4 , 45
OWNER
CONT
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BEi",MUDA BILINFSCA. 92-201 ;
LAtiUTA1`CA CA 92253
(619)345-7753 CS.Lff 060,
(ri (9)56,4- 1088
•
DESIGNgEIMNpGIINNEEEyR�{ry7
tCt
0BG ARCHIT'l �.TS
26 CORPOR 'H` , 31?ARK
USE Of PERMIT M-4 L, V4'%JVIIL,f 9 ! G. ,. Rks
lit.WAL CA 92114
'.I.`I` E Mi94 'Ak{.1 r. O I.;W ►'l:0N - .k't.`l11 WlS;l3'1'
FEE DESCRIPTION
FEES
{;.t:U+S'.t OA4. CON�j, UC•T,1014 3,4JW 1.00) S!:
V43411.C'iVPA .10. $19:00 Sh
<+ARA.CI - C.ARPORT 583.00 .°a r
ENTIiIKIFFM ;OST ClF CONSTRUCTION
286U.,40
ABRMyygpuEp`7pyiRV
..
PLNN (:fTFIX FEW 101-000-439-318 $110.56.9 ^
4
C,ON;3!' C"WN 17,116 1.01-00o.4.1R-060 $:1,-94.00 .
MP. 04AMC AL F a $1,24, ii
L-LEECIRI.CAL FFE 101-000-4204M $189.49
Pr tJ1t9r3IN4:t+ 101-M-4.19.000 5 13.25
`�
'1r6NG MOTION )FLI - RES€D 101,,OMZ41-000
101-000.4:2 000 r20.00
-
4 RAS t`RUC1'11RF WE 225-000443-342 56,000.00
NkT IN PUBLIC PLAC-0 - RESM 7111.000 2554JO,O $465,96
SUB-TOIAI C0N,'KMUC ON AND PLAN Ct ECK
$9,3+92.37.
LESS PRE, -PAID PEES
$10.00
'4 1
T'dMkL PIrRA UT:ARES DUE NOW
$9.392,37
RECEIPT..'
DATE
BY
DATE FlNALEO
INSPECTOR
t'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPR VALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck zloo7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 1402 4w
BLOCKWALL AP ROVALS
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 APVROYALS
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 Af
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
09
Final
Utility Notice (Perm)
COMMENTS: