9601-118 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
r W Section 7000) of Division 3 of the Business and Professionals Code, and my
O
LO
r- License is in full force and effect. y i4i2 a' & 4/31i45
n W cense # Lia Class Exp. Date ,r
Zate i Signatureofl,ontractor ; y 7 .
n i'f
r, 4
(moo F_ d) OWNER -BUILDER DECLARATION
IU 1 hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
Z ( ) 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
C0 Date Signature of Owner
LON
rn WORKER'S COMPENSATION DECLARATION
FL Q I hereby affirm under penalty of perjury one of the following declarations:
Z () I have and will maintain a certificate of consent to self -insure for workers'
4 cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W ly performance of the work for which this permit is issued.
O J J () I have and will maintain workers' compensation insurance, as required by
m Q USection 3700 of the Labor Code, for the performance of the work for which this
O CJ permit is issued. My workers' compensation insurance carrier & policy no. are:
CL LO Carrier POIICy NO.
secionedt mNb"
"his obenr1e0
0.00 or less).
n a() I certify that in the performance of the work for which this permit is issued,
O 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' compensatio�rovisions of Section 37 of the" Labor=:
Code, I shgll forthwith comply with those provisions.��f
3 Date: i� Applicant +✓`r✓`� �`r=r _ ,�✓
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
44
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 wcrk 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 forfnspection purposes.
4�ratu
re (Owner/Agent)Date
lair
v d
ALC9
BUILDING PERMIT
PERMIT
DATE I! O'PO
VALUATION 117;.i, if . l LOT TRACT
JOB SITE ADDRESS 47965 VIA NICE
APN
QWNER
CONTRACTOR
,;rlf`h°Vc C D01 N (I Tti.11SM,. j 110110
CRA -9 aitYwi-�7'i.l�.i
t► 3AN)o
C.'mijupk.m, cvrl CA fV' :i I
SAAN4(k:.FWARDW ("A 92403
t`PUr' 1041
ftp`))481
DESIGNERIENGINEER
USE OFPERMIpt)OL AN1)yO1,. SpA
P(A_A,6_-S `A ONLY
FEE DESCRIPTION
FEES
WVL, A,' )JM k>. -VA 1is009.00 I's
E+a`i.;4NV.TED COST OF c c)NSTRI.471 i0N
1:, r1000.1113
PERMIFIAWE SUMMARY
PLAN OjTCK TeFT
CONIS11RUICI'101-TP j;, 1.04'000-118- 31GLJ. ,►
MECRAMCA]. WE = P001, 101,,-000-477-0iXJ U114,00
Q
3
I,.kX_4'i`IdX AL Ff;i ,. 14JOI, 101 -IM -420-000
(4=000
PlAhMINMAX -POOL 101-000-419-1000 $27,00
CVZ
Q CI?
Z
Q
SUM COIN:,"fl3:Uf. TIOIN AND MAN 0(LICK
X363 :da)
IIESS j.j4iF-PAIj.i
10.010
TMAL li'E1tNUT FEES PILIFA0AW
5 .3jD
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
G
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final,
Util!t Notice (Perm)
COMMENTS:
T: r ^, ._•. • __ -• �--.. — .- � _ _ � .`•- '+• - s SSa.t:, _��..� .^� � �r:ys%�p+.v'e + SILL• •-iii' A "..R.. '—'fltStrl : tiif •
I.TL 1t►•4. T T$ SNAPE i;`U`� ?ERN1-Ek ^
1 L='�{L!�. .'� j� ♦�.� 'ILE ' GaR.�0' LTI1' 3
F .. - _ - ,. - _ . _ - - •a - *' -^� iei atiL_E� .I i.o1"'},•• t •�'� 1�{)I. �.'�..7TT 7v.'. ,..
_^ 1
•_ — 't —� 13A;P?YVkLL 1�°t "H 6': e�+ RAISE EW.AM 3b' 0F'.+ (r-" 7..;dila '
SPILLWAY SIZF�
p3E XX
e\/gyp LAOUINTA 1ETa 1t} rT-'=- M:lTf1¢: Np�S)��'Ar�� .fd��gh�i ems`
`1. ^'Sr• r F.W,Sal'..s.1 L - �/ IT�®� l!! F�L _-_�S .L.0 L_�1Pd .� .Tl� 4�'/� �, �IY
- ---r.. ' Tt�ii:.i?► er r' FILER RATE li)4{ 1=:LL�ti
z: WiFT �� r,A r - BUILDING & SAFETY DEPART ANT - - =HIRS
CONDITIONALLY K , R.—URN UNE i
ACCEPTED FOR ,CONSTRUCTION:.,� z�,Q.IN MAIN
j. - { s � sr13T�• �_� '� ) I; '�•'• ESi.1MME�i�W}DOFF-�1�9R.L3'�,it,CY_'
t `SUBJECTTOINSTALLATION AS PER ---
r
r ,,f i•lJ1�F. LH.4J;S $��L�ll..{�►i!}' 3-(L
• :� � /'� f� Sa'� y �•� �{ `r ��1��; w•,,ii4$L�+J=BY .�'.$�.�:.1�86`c".-- �• �
I `r` L APPLICABLE CODES R' �L'�!� 40,
• _ ! ;._,`�L�._-,�px _ �: t e ; ;._ I SPA LSLHF 100W �-
* � � � 1t' � - z ,1 x jJ_ A� � � k►if �}� �:� � 5: �� H .
4 ,� DATE BY 4 �="i t ^,' : EI F('rRtf FY S.D.C,193
I_
I,w-�E a%� ELE ,RiI: P�..�kD1�aG
>--
> i • a,. t -IL ANC COPING S.Fi_!`• _
` ' ` is='Z.
DECKING 6Y SJXC. 733 SQFT r iii
f• _ ` ,� !' 4% r l` �``'
k,
'assure C.7llTRi fat Cali�Ep ;`d57.ir'TE - � • L
E , ��`• titi r:. � F `+ar7S `i ~Yfl�� e3pzns�Ry for 0a nree to s -
!.-"' - _ `i, I H! �• 'r," i f! " {;: i t �,Z, ^ ixdtiS, SK;k'Wd!<5, C'r'h'Bt6":i•5. _ ` - i; ti
rr'7 rxment slobs, sevmr .
}�..,.• y \`-;.,•,,,f ��A' i • _ Y *� r �. - kp n%rrees-fetrces, `etait- err 'SY.•� {. !e�
i • --�%' �` \ ��' �`
DECK+rir�h �'F,.L ?. z Y9alei sc telephone hw--s I
_ � ` ;'?) 3:4°' VV C trf. F r rinl.lers. a r
S.`• - _ -�... '\ PY ' '1r U'. �M R N AIX „ a •,'�jk 3 , • � or st•r�t�s. s4lwn- '!h"�'..:5 gnat '
,.! ( '�. { . : .� 2hroemyh , reeic�tm�sar's peope t y a 'is L J
s urderst�f cx* ?at yot4 the �va?er,•
'Xr)SAL I .' r,:• have 4.-.zr*iah60es•per.7ssaan L•
4 rK! assume full.respoosibirity_1 '441
a
t ri
*saass_ 47965'VIA NTICE -
i - p' ti46',.�. � "•"'i•. Ct ' `• \•..a i��'../ .ryi .t ARL&
�L•i•.. - ` ... 4 i . �11 N'• : LA 8J.31� d .Ci.q- CA.."
-BOBCAT, z i
SP AY", .0" E
AC
kCT ..Ni6 : ek I..
- r
44` . 1 : pad I�3
K
fflilivs4l �Jiapo F",
Ow 1�oom
CrESf
i':►i:.'C SAA -- �'�:'_ a "tt4tif X%47. C4. 9260
I .t�'�.r„i .'<'. .,\.. 1 J i•�. _�; ,.„,,._..--r �> _ 'rrr >ti w_+,s3 h?sl�
•
,`tin_ - •