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9602-078 (SFD): "LICENSED CONTRACTOR DECLAR4ATION 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 and effect. -1;971)-15 / Z'r I ! c?r License # . LIC. Class 1 Exp. Date / Date .,Y� 91SignatureofContract6r 14�/e 3 o-''�:�'., I11641 _71177111117 v" OWNER -BUILDER DECLARATION d I hereby affirm that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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). O I am exempt under Section B&P.C. for this reason Date Signature of Owner i 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. we: Carrier Policy No. (This sectionAheed o`,t�ge completed if the permit valuatigAi$.f0f($ ,9P. QO 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, andeagree that if. I should become subject to a workers' compensation provisions of'Sect'on 3700 of -the -Labor Code, I shg l forthxyith comply w�ith"'thesePr9yisions., 7 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer .to criminal,, penalties and civil fines up to $106,000, 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 be 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 resul)'ofis`appl�iction agrees to, &shall, indemnify & hold harmless the City of jnddul �V_eJls, ((9 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, representatives of this City to enter upon the above-mentioned property for mspecti n` p imposes. Signature (Owner/Ager .s 1, N�1� i % �._ Date G' A"' _-BUILDING PERMIT PERMIT�s � wo� . DATE GI .bl VALUATION 0 /6 ;q; '• U LOT TRACT X.014" JOB SITE ADDRESS '54-755 6WLvt::J�i) �'t:i5�'' APN 769^450-045 OWNER CONTRACTOR RANCHO CAUST.tANaDF1?LO?WI, . ii7 i1V 4C/�AVV.iiL Y3:p�CO ilA\VfsL^wYd©i 13KR.: 'J0.7A _AJN'Ew CA 922ti4. i (61 )345-77555 t -;til.# 069 0 1!;)345- 1755 DESIGNER/ENGINEER 171992 ALTl.'TCHML SOUTH USE OF PERNTi1TVGi I., , k's'►1V11L . , -17 V EKTU INN + 1R'0a "Fk C (71d -00711 '.l'kfl R i HR COL LEC'FICgN AXPGA WE&[' PRA13F 1 FL.A'�i' 3-A ; ' FEE DESCRIPTION FEES 1,�.R.Ct•'UPALTff) + z4K,�10SF n_A.RAGEtcARt~'owr 527.00 Sr, `I t 037('IMA,TED Q:osa dr cO`lvls`.6`.3R:fCTION '264;442,74 PERIWT FEE SUMMARY !, A -N CREC:tC FB F, $82.3.27 , CONSTRUCTION FEE 101-000-4.18-004 $1,007.00 W014Aa;i CAi.; .(->; $92.00 &EC RICAL FhT- 2:01-000.420-000 $153.79 '11-11 1iv. ONO FEE 10-0004194)00. $167:23. STfOI'G A-11-071CIN f"HE -: 5I 101,000-.24,11-000 $24.44 ORADINO''038 .101.000,423.000 a20.rki INT: RAi T Rt:lCYU1 E :r'M 22_5-00(1-443-142 $4,5Z6.64 tiRT W PUBLIC P11ACHS - l ESiC: 702-000-2555-Oi)0 'C) IM T1tUC't'IO.N AND PLAN COECK U ; LESS PRE -PAID FEES $0.00. FEe 21 199 z L PERMIT FEW, S'i3i3E NOW $7,071.50. RECEIPT' DATE BY DATE RNALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROI LS 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 BLOCKWALL P 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 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 ILEncapsulation 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: M