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9602-133 (RR)LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with W Section 7000) of Division 3 of the Business and Professionals Code, and my oco � Q Lo License is in full force and effect. , ^w��4 <� N W License # Lic. Wis'� C-1 -'�.f7 l trtilg� r- Z Date 7 _ ,.. ,: Signatureof Contractor coo F OWNER -BUILDER DECLARATION J wCD 1 hereby affirm that I am exempt from the Contractor's License Law for the Ha- following reason: U1 ( ) I, as owner of the property, or my employees with wages as their sole Z 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 Signature of Owner LON O rn WORKER'S COMPENSATION DECLARATION dQ I hereby affirm under penalty of perjury one of the following declarations: C) Z ( ) I have and will maintain a certificate of consent to self -insure for workers' u-5 cc �O compensation, as provided for by Section 3700 of the Labor Code, for the X W LL performance of the work for which this permit is issued. p _J J (�) I have and will maintain workers' compensation insurance, as required by fb JU Section 3700 of the Labor Code, for the performance of the work for which this U permit is issued. My workers' compensation insurance carrier & policy no. are: CL: 1a Carrier Policy No. �! Z (This section need not be completed if the permit valuation is for $100.00 or less). 00 a () 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 SectioW3700 of the Labor Code, I shall forthwith comply with those,prowsion �0 Date: 7 -7 G 44 Applicants 3 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 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 f/�iaction p� rposes. o Signature (Owner/Agent).p`,•», '!'�✓ / �: ` Daae• -7e ALCM BUILDING PERMIT PERMITi Ut�ea d A-u`4. DATE 2/26/96VALUATION 52,928fail LOT TRACT JOB SITE ADDRESS APN !Qi A: 7 I r. u&'3 S OWNER "— `" CONTRACTOR $ BR YANT ©IiG A tNiZAVON, INC SAY.4HPA .ROSA. COAT.', LOA. 3462 LA CAMPANI A WAY 49.991 EISENHOWER DR PALM SPRINGS CA 92262, CA 92253 1a n agn DESIGNER/ENGINEER .LEI.QUIWA. USE OF PERMIT GENT RAI. BULLDING RE-itOOF ONLY FEE DESCRIPTION FEES REROOF 2.928.001S FSTIMME1) COST OF CONSTRUC710N 2,929.04) PERMIT FE'ESUMMARY co G� F e Q m LLJ • V- ^ � M sun -TOTAL coNS'1'RCJC"I'ION AND PLAN ctir.CK $30.00 LESS PRE -PAID PlEES sA. o Te TAT, P RKIT FEM 'DUE N6V $30.00 RECEIPT DATE BY DAT? rq INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS ' MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts j Slab Grade Return Air I Steel Combustion Air Roof Deck Exhaust Fansi O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills ! Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath I Final i Final / BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond I Footings Main Drain I Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final I Waste Lines Heater Final Water Piping Plumbing Final ' Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover I Sewer Connection Encapsulation , Gas Piping Gas Test Appliances 'Final j 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: {