0002-121 (SFD)LICENSED CONTRACTOR DECLARATION_
I hereby affirm under penalty of perjury that I am licensed under.provisiong 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.
License # Lic.'Class Exp..Date
07131i20i
-Al L'Signature of don r
Date Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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 isnot or offered for'
sale (Sec. 7044, Business & Professionals Code).
1, as owner "of the, property, am, exclusively contracting with licensed
contractors, to' construct the,. project ect (Sec. 7044,, Business- Professionals
Code).
O I am exempt under Section B&P.C. for this reason
Date' Signatur6 of -Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under; penalty* of perjury one -of thei 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.,
lhave 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 & poii6y no.. are:
Carrier Tol.icy No.,,
SIXIM 17UND
(This section need . not . be v completed if the permit valuation is for, $100:00 or less).
O I certify that in the performance of the work for which this . permit
mit 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 thatjf,[-Spoulcl become
subject to the workbrs' cor�pensation,provisiohs'of Section 3700'of the Labor
with comply with th9se provisio n S'_
'ode, I shad forthwith - I "I .. — I
Date: Applicant
Warning: Failure to secure Worke, ua-m-�ensation coverage' is unlawful,and
shall subject anemployer 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
sult of thisapplicaton agrees�to, & shall, indemnify
& hold harmless the, City of La duinta, its ,officers; agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is n6t'commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 clays. 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 alliCity, and State laws relating to the building
construction, and hereby authorize representatives of:this City to enter upon
the above-mentioned property for inspection-pu poses.
BUILDING PERMIT P ERMIT #
DATE VALUATION
$240.117.10 LOT 212. TRACT
JOB SITEAPN
ADDRESS 4&SM VISTA CAIACO I "9_110"19,
OWNER
PO B*:x71
LAQUIN'f.A. CA, .,92.253
USE OF PERMIT
SfieXCALF—FAMILY D'ArCLUNG
CONTRACTOR / DESIGNER / ENGINEER
SPARIKS CONSTRIUCTIrION"
70-295 RANCHO LAI QUNT.A.D.R. -
UQUTNTA CA 92253
(Y60)771-1941 CBLY, 29%
Virt-D,-LOT22,PLANE20ft- PMalri- DGE S NOT INCLUDE.- BLOCK WALLS OR
100_799 PCIAN CA*;G9 FEE ftpllaf)ON FOR MULTIAX,' ISSUANCE 01,
SAME PLAN TYPE,
CUSTOM C."MTRUC17VION Z9 N1.110 SIF
470.00 9F
rt.4;'f MIATITED COST.01iCOVSTRUC1110N
PERWT KiRSUANA10V
CONSTRUCTION :Ffx
'101-000-41.8-000
RL . AN C. i � Q 3CK '47F,
101 -*00-4319-318
$2311-1211
1VM CT, TAN'. --,,'%L ME
VA -wo-A, lc*!. It - 04010
S130 50
i
aE'CWZ1C ALEY.G.
PIsUltiiliiNC PSE
10.1-000-419-000
S, 175.75
STROINQ N10-TONFIM - REM,
=VINNG r -LT,
101OM423,000
xx vmo PER IMP.A&V 10
AXV fNPU11L1C PLACES -RF—SIC 701.-OW255-000
3300,24
ST f -TOTAI.t.CONIFIRUCTION AND PLAN Uzi ECK
LESS PR&PAJD FEES
S4,142,03
$0.00
:Y0T1AL.Pk.,R-N1J-r verus Due NOW S4MZ�03
,EIPT DATE Y"/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
` f
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
.eA21
F.A.U.
Framing
J
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 /d
Final O D
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 Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final - _p
Utility Notice (Perm)
COMMENTS: