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9601-050 (PAT)LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Se_ -tion 7000) of Division 3 of the Business and Professionals Code, and my `License is in full force and effect. License # Lic. Class Exp. Date Date Signatureof Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License. Law for the following reason: as owner of the property, or my employees with wages as their sole 1compensation, 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 11I:f1J4L Signature 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, 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 section need not be completed if the permit valuation is for $100.00 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 the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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. 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 Indian Wells, its 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 isI 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 inspection purposes. Signature (Owner/Agent) Date A`°' BUILDING PERMIT PER MITS �fl!-►.� DATE fl�j`�}� VALUATION LOT TRACT JOB SITE ADDRESS 79-190KARA. COiJl1 Y APN OWNER CONTRACTOR : ©WRJER HUH.J31rit- KA'KTO NIS KU.POsHEE 79••190 EARA C<7M T JA QUIN"j:A CA 92253 CBL # DESIGNER/ENGINEER USE OF PER MIT.11�J'l0 w FEE DESCRIPTION FEES !}vltCiC{i't9a'iyri7 500.00 SF ES' INIA.',I.°I .I3 CONT OF CUNST,1: UC'� ION fr• 650.00 ��;; PEWNUTERSUMINIANY PLAN CHFIC : FEVE 101-000439.318 $58.50 M1111MI UCTiON. FEE 101.e()O()415.000 $90,00 NO NUrx©N FET - .Rr!.Sf» 100.000-241000 `•L, (i y SUB -'J7 rAL C;ONS'ikLJC:TIOAP,t1ND PL A►N CIiFCKC • $100.17 LESS PILE -PAID FEES o qn F $0.00 r., TO'lf'A.1L Y:LIfIt1tU'I I+'1{,E,� Il►U>u..Nf9W $8.43.17 j ,1qN 121996 By t RECEIPT I DAT w.k"" BY DATE FINALED INS r PECTOR 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 APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final _ 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 aJ 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 H Final Utility Notice (Perm) i 4 m GDIuNEGT %�l� 7 %� 55 -tAI.L 5 W I i I+ C�) %- x 5 �v PA� tsft.r Uts It vZtptciy 2x 6 24 `_Q.L_ ZYP- too! pitch I'ceetteee.s five • IDI�(c garter Spas"too ISPI+k— MAj- See %MILNt It.te Salw Spatgft &off g t tM.ttlwr of &Vat Lattice /i,.l/ 'ate - s i' saw Ngle ft"ps raral-al/c .lilt 4-16 0 rl1s.K bolt ��Ort Post grclttS aw "troll 1R9t! .a _ i M/k P`F1j-.j4R, PL. StDF e ac Posts I t tJ L WA V4 a . . . 0 0 --s I v leetia= lr f/S"a3" log ecress fate stets .t 16T •.e. below Cuff Cmt..Ia s Lodger -ftrft K le ' ' ascaer Provide le �.-r•r*..t:. ' bolt. learanc �� to ost To Concret t17 ti^ ie1• b:, Oegsr(or feltd tlecki PT DF - ' 1 ' ri' m 11. 1�4tte; to fioctie►� PogT �45E �' jilt 1 2x12.R WX7um 4-16 a molls as bo • ;:. '. t. �•• CC _W.M-4- iAl ILIEY= toed ",Am r f. C... ' LQstii, r, tis -24 ::0 �. %•R O� . . - - et it"i !)y �7 c&hy 4,�aauiKtw 4• 1 e.! 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