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0004-091 (BLCK)' r . '. _ _ ' DECLARATION ' | hereby affirm under"��»»".m perjury that | am licensed un6�pmv�onu of mmenxngwKUGooVon7OOOo/Divioion8of8mBusinaauund cPmfeaoiono|oCode, and myLicense ioinfull force and effect. License # Lm.c/ooa Exp.. Date 533670 BO6/30/2[ ate 'V Signature of 6ontractor-�q'46Z... OWNER-,OU|LDERDECLAR/TlON | hereby affirm under m'mau|omexempt from the Contractor's License Law for "_"""_.y."""=.: ~' ( ) | ��e' rty, or my employeeswith wages as their md compensation, will do the work, and the,structure is, not intended or offered for, sale (Sec. 7044, Business & Professionals Code). 1, as owner of the' property, am exclusively contracting with licens pd contractors to construct 'mo project (Sec. 7044. 8vvnaao & Professionals Code). ( ) | am.exempt under Section �� o&PC for this reason bate Signature'of 'Owner - WORKER'S COMPENSATION DECLARATION � .' I hereby affirm undo, penalty of perjury one of the following declarations: ()| have and will maintain acertificate of consent mself-insure for workdrs' onmpenvomon, as pmvmou for by Section 3700 of the Labor Couo, for the performance of the work for which this it is issued. I;h'ave and will maintain workers' compensation insurance, as required by ion 3700 of the Labor Code, for tlie performance of the work for which this pensation'ins rance carrier & policy no. are: permit is issued. My workers' com u Carrier GOLDEN EAME Policy No.' 322237 . 4-04 ' (This section ne�nmboo�p�o �U�pmm v�a�n�hx�o�um�� ( ) |no��a inthe performance !�the wom�r wmoxm�penn�io�oued. | shall nmemploy any person in anymanner ooaom u000mo subject mthe California,workers' compensation laws of that should become s ject to the workers' compensation prdVisions of Section 3700 of the Labor C(Ade, I shall forthwith comply, with those provisions. VWarning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal perfalties'and civil fines up to $100,000, in addition to the costbf compensation, damages as provided for in Section 3706 ofthe Labor Code, interest and attorney's fees. IMPORTANT xppnnmionioxe?ouvmade tnmooim�tp,o,Building and Go,�� for a permit ou�oot to the oondihonn and restrictions set forth on his upp|iouhun.' . . .. 1. Each person upon whose behalf this application is made ueach person at whose request and for whose benefit work ioperformed under orpursuant m any permit issued uuaresult of this opp|ioaxonagmonto, &ohaU, indemnify u hold harmless the City n/uaQvima..its officers, agents and employees. 2. Any permit iouuaU as a result ofthis app|ioaxion becomes nun and void if work is nutoomm'anoeuwnmn 1oodays from date of issuance of such pe,mu, or cessation ofwork for 18odays will subject l5ennutocancellation. | certify that | have read this application And state that the above information io correct. | agree mcomply with all City, and State laws relating mthe building oonstmction, and xonaUy authorize representatives *of this Q�m enter upon thboUovo'mondonodpmponyfor inopo�ionpu�0000. }1onature (Owner/Agent) —Date _6V��y� � DATE VALUATION LOT. 0004 -MI. TRACT JOB SITE APN ADDRESS 4"11) VIA LINDA OWNER CONTRACTOR DESIGNER ENGINEER (760)345-7186 CISL# 137 USE OF PERMIT 6 FT. WALL 270,00 LF PERMTrFEESUMURY CONST.RUCTIaN FEE 301-000-418-000 $90M TOTAL PEOWYNES DIN NOW RECEIPT DATE 1(B`Y 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 cco Main Drain Bond Beam q1 tZ 57 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final v 6 J 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 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 Final Utility Notice (Perm)