9903-146 (PLBG)LICENSED C6NTRACTOR'bECLARATION
jl-hereby-'a4irm'under penalty of perjury that I am licensed under provisions of
Chapter 9 (dommencihg with, Section 7000) of -Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Li.dense # Lic. Class Exp. Date
Signature of C
Date o6tractod -
`OWNER -BUILDER DECLARATION
Fher - eby affirm,under penalty of perjury that I am exempt from the Contractor's
License Law. for the following reason:
(,. i.1 -'J; as owner of'the property, or my employees with wages as.their. sole
compensation; will do-- - themork, 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
c , oniract6r's�.tci 'construct the,project (Sec.* 7044, Buslness & Professionals
Ctide)
i f.Farn exempt under Section ,B&P.C. for this reason
Signature of Owner
""WORKER'S COMPENSATION DECLARATION
1h'er;6yaiiirrri'.under pe6,alty-of perjury one of the following declarati8ns:
`.I hav6 and will maintain a certificate of consent to self -insure for workers'
6ompen I saiion*, as provided for -by Section 3700 of the'Labor Code, for the
performance:of the work for which this permit is issued.
IaVe and will, maintain workers' compensation' insurance, as required by
h I ' - .
Section
3700 of the Labor Code, for the performance of the work for which this
is,, . Js. slued.,,My,,workers' compensation insurance carrier & policy no. are:
Carrier a Policy' No.
'00 01314'EA.Q!Ll, INS, -NVVC54800600
I L
(This section need .riot be'completed if the permit valuation is'for $100.00 or less).
'.1 certify that in the perfo.r'mance of the work for which this permit is issued.,
1: shall not employ any person in any manner er so as to become subject to. the
6rkers'.c6mpensation laws of California, and agree that if I should become
subje6t t6'the workers'. Compensation pr6visibns.of Section 3700 of the Labor
1'shall forthwith comply with-those,provisions.
Date'.:-,,2�- 11J'.Z20 Applicant
Warning: FBilure, to secure Workers' Compensation coverage is unlawful and
.1 ` -
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 attomey's,fe6s.
IMPORTANT Application is:hereby made to the Director of Building and Safety
fo . r .. al.,permit subject to the conditions. and. restrictions set forth on his
application::
.1. Each person -upon whose behalf thisapplication is made & each person at
.whose request.and for whose benefit workJ6 performed under or pursuant to
-any- permit. issued:as a, result of this applicaton agrees to,& shall. ind6mnify
�,.&',h6ld hamrilessthe City "of La QuiAfa, its officers, agents and employees.
i''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 ofsuch
permit; or cessation of work for 1180 days will subject permit to cancellation.
I certify that] have read this application and state that the above information is
Correct. kagree to,c0ply".'With 'all City, and State laws reiating to the,building
P" " , i I . U
on�truct on: and hereby a thohze representatives, of this City, to enter upon
the above -,mentioned property foi� inspection purposes.
Signature' (Own 6r/Agdn't) T Date^L.,
PERMIT#9903446
BUILDING PERMIT
DATE VALUATION LOT TRACT'
2-37 -
JOB SITE
ADDRESS —
52A4. , it., -
wNIDA VILLA
-
OWNER
CONTRACTOR DESIGNER ENGINEER
Lf`�; QVINTA RYDEE, NTLOPMENM AC4NI-C Y
ECON110
ig-494CALL43T OMPIC0.
8405 CABA UZ XN W. fN D10, CA 92201
1A,Q431brfA CA 02253
PALM DF -,114K r CA 92.2131
-4
(7fs(;l iow X79, CfRU 342
USE OF PERMIT
CONNIZAC-17 AMOU"Iff 1,430.00 LS
ESTIMATUD M5.11P OF CONSTRIRN71.10N
1,430.00
P19RAUT Ifirk.-CISUMMAM'
PIAX M—OMIC1 FEE SEWER 10JA1(3f-4.19-M)
qOTAL COWN,341�UaRONT A-M--FL-0 CHECK -
snoo
LESS RRC - P All) PUS
'ps oluet mlkv
W0,440
RECEIPT
DATE
? q�;l
BY
TATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE.
I 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
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 -
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wining
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_
ECONO SEWER SERVICES..._ _.��. A0 o WOM MEN
PALM DESS ERT, CA 92261 0 916 8
i-s�n� �w� n-ino i-scn� ins -�-itn
FAX (760) 347-4 978 , vv
TOTAL MATERIALS
e ^�
DATE 0:7/
CUSTOMER'S ORDER NO.
PHONE
MEC
C -.
HELPER
STARTING DATE
BILL TO
DATECOMPLETED WORK ERED BY
ORDER TAKEN BY
$
i �❑ No one home ❑
Total amount due ❑ To& billing to
ADDRESS
❑ DAY WORK
❑ CONTRACT:''
CITY
❑ EXTRA
JOB NAME AND LOCATION
JOB PHONE
utJGHly IIUN Ur VVUHK •YAYMtNI ItKMS Ntl 1V IJATJ rmvm VAIL VI' JLI(V14C
11/z% PER MONTH CHARGE AFTER 30 DAYS.
Signaturefor above work: or be mailed after
completion
* . I hereby acknowledge the satisfactory completion of work
of the above described work.
TOTAL MATERIALS
TOTALLABOR
PLEASE PAY FROM IS INVOICE.
NO STATEMENT WILL BE MAILED.
JAX
DATECOMPLETED WORK ERED BY
TOTAL AMOUNT
$
i �❑ No one home ❑
Total amount due ❑ To& billing to
Signaturefor above work: or be mailed after
completion
* . I hereby acknowledge the satisfactory completion of work
of the above described work.