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BRES2018-0009a 73-4Z.CAL1FQ.�i:.TAMP1Co D a w LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT - BUILDING PERMIT Permit Type/Subtype: Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: FRANCISCO NAVA 555 WS 1ST ONTARIO, CA 91762 BUILDING RESIDENTIAL/DWELLING - SINGLE FAMILY DETACHED BRES2018-0009 53200 AVENIDA NAVARRO 774065009 NAVA RESIDENCE / COVE / NEW SFD $108,901.50 LICENSED CONTRACTOR'S DECLARATION 1 -hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county thatrequires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the.basis for the le ed exemption. Any violation of Section 7031.5 by any applicant for a permit ects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1, 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 and Professions Code: The'Contractors' State License Law does not apply'to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he e did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to nstruct the project. (Sec. 7044, Business and Professions Code: The Contractors' State . Lice a Law does not apply to an owner of property who builds or improves thereon, nd ho contracts for the projects with a contractor(s) licensed pursuant to the actors' State License Law.). I am exept under Sec. B.&P.C. for this reason �/ Date: Owner: `'%G� ` 1 CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:- 3/13/2018 Owner: FRANCISCO NAVA 555 WS IST ONTARIO, CA 91762 Contractor: OWNER / BU•LDER Llc. No.: WORKER'S COMPENSATION DECLARATION' I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3-00 of the Labor Code, for the performance of the work for which this permit is issued. _ I have 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. workers' compensation insurance carrier and policy number are: Car Policy Number: _ 1 certify that in the performance cf the work for which this permit is issued, I s I not employ any person in any manner -o as to become subject to the workers' compensation laws of California, and agree -hat, if I should become subject to the workers' COon nsation provisions of Sectior 3700 of the Labor Code, I shall forthwith comply wit thos provisions. Date Applica (�� r WARD NG:AILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to fie Building Official for a permit subject to the conditions and restrictions set forth on ills 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, the owner, anc the applicant, each agrees to, and shall defend, indemnify and hold harmless the Cityof La Quinta, its officers, agents, and employees for any actor omission related to -he work being performed under or following issuance of this permit. 2. Any permit issued as a result of this appli:ation 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 s -.ate that the above information is correct. I agree to comply with all city and county ordi lances and state laws relating to building construction, and hereby authorize representz tives of Acityer uponthe above- mentioned pr erty for inspection purposes. Date: Signature (Applicant or Agent Date: 3/13/2018 Application Number: , BRES2018-0009 Owner: Properiq Address "-'53200 AVENIDA NAVARRO FRANCISCO NAVA APN: 774065009 555 WS 1ST Application Description: NAVA RESIDENCE / COVE / NEW SFD. ONTARIO, CA 91762 Property Zoning: Application Valuation: $108,901.50 Applicant: Contractor: FRANCISCO NAVA OWNER/BUILDER- WNER/BUILDER-555 555WS 1ST . ONTARIO, CA 91762 , Llc. No.: Detail: 1,671 NEW SINGLE FAMILY DWELLING - [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2016 CALIFORNIA BUILDING CODES :4k FINANCIAL INFORMATION ::.a; <DESLRIRTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $5.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:. $5.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - CIVIC CENTER 252-0000-43200 0 $942.00 DESCRIPTION ACCOUNT QTY. AMOUNT DIF - COMMUNITY CENTERS 254-0000-43200 0 $102.95 DESCRIPTION ACCOUNT QTY AMOUNT DIF - COMMUNITY CENTERS 254-0000-43200 0 $26.05 DESCRIPTION ACCOUNT QTY AMOUNT DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - LIBRARIES 253-0000-43200 0 $344.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARKS/REC 251-0000-43200 0 $2,048.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF -STREET MAINTENANCE 255-0000-43200 0 $116.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE 101-0000-42403 0 $26.01 Total Paid for. ELECTRICAL: $26.01 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $26.52 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $10.92 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $156.04 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $51.49 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $244.97 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $39.01 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD 101-0000-42402 0 $13.00 DESCRIPTION ACCOUNT QTY AMOUNT _. —EXHAUST HOOD PC 101-0000-42600 � 0 $5.20 DESCRIPTION ACCOUNT QTY AMO.UNT FURNACE- 101-0000-42402 0 $39.01 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $26.00 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $10.40 Total Paid for MECI-ANICAL: $184.64 DESCRIPTION ACCOUNT Qw AMOUNT 101-0000-42600 ($518.00) DESCRIPTION ACCOUNT QTY AMOUNT MULTI -SPECIES RESIDENTIAL 8.1-14 UNITS - 2017 UPDATE 101-0000-20310 0 $518.00 Total Paid for MULTI -SPECIES RESIDENTIAL: $0.00 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PERMIT 101-0000-42400 0 $531.28 Total Paid for NEW CONSTRUCTION PERMIT: $531.28 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,034.88 Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,034.88 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK DEPOSIT—RESIDENTIAL 101-0000-42600 1 $750.00 Total Paid for PLAN CHECK DEPOSIT - RESMENTIAL: $750.00 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $18.20 DESCRIPTION ACCOUNT QTY AMOUNT FIXTUREITRAP 101-0000-42401 0 $130.00 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $130.00 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $39.01 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $13.00 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.80 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $13.00 --DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-000042600 0 $13.00 Total Paid for PLUMBING FEES: $416.03 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-000042416 0 $20.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $20.00 DESCRIPTION ACCOUNT QTY AMOUNT 101-0000-42600 ($11.80) DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $11.80 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT 101-0000-42600 ($220.20) DESCRIPTION ACCOUNT QTY AMOUNT SINGLE FAMILY DETACHED 224-0000-20320 0 $220.20 DESCRIPTION ACCOUNT QTY AMOUNT SINGLE FAMILY DETACHED 224-0000-20320 0 $1,617.24 Total Paid for TUMF - RESIDENTIAL: $1,617.24 �+ — CAk:\4 ofrb, DE'SERA, PERMIT # `� P 6009 PLAN LOCATION: Project Address: 3 J I�L�� Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #:Offl Applicant Name: C+ i C1AJ 4-VA- Address: City, ST, Zip: 06JI—PrI21 D o A- "l 1-71 7- Telephone: ��Q goo'/ � 70 10 Emai1: DD ^' /� -f-htQK fVby Oq I ��.G'�� Valuation of Project S Contractor Name: New SFD Construction: Address: � (� �� Conditioned Space // 1 C ? SF City, St, Zip Garage L� SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: City Bus Lic: Arch/Eng Name: C� LS 1 r& C-r-/ Construction Type: Occupancy: Address: I 0j 1 Grading: City, St, Zip ms &R--" ok . I Z Telephone: Wo -9 4 -0 -S -5-2CJ Bedrooms: Stories: # Units: Email: C LS it'kat 0I I tel-AU, Dm State Lic: City Bus Lic: Property Owner's Name: �i� G �J New Commercial / Tenant Improvements: Address: f Building SF City, ST, Zip C Type: Occupancy: Telephone: 5;' . Aj CALLE TAMPICO LA QUINTA, CA 92253 - 760-777-7000 ■ OFFICE USE ONLY # Submittal Req'd Ree'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License Date: 3/13/2018 No.: 18-00884-1 Owner: Francisco Nava Address: 555 WS 1st City: Ontario Type: Single Family Residential Lot # Street No. 53-200 Comments: CERTIFICATE OF COMPLIANCE �HtiFiEp s Desert Sands Unified School District y 00 47950 Dune Palms Road IA6E"M",ON',k Vs La Quinta, CA 92253 r Wouw wEus 00 ��10-1�� T (760)771-8515 .Z `piA �io'"y� Email: Jurisdiction: La Quinta Tract #: Street Name Sq. Feet APN Permit No. Avenida Navarro 1671 774-065-009 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacement mobile homes. It has been determined that the above -named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fess imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $3.48 X 1671 S.F. or $5,815.08 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued. Fees Paid By: CC/Chase/Fran,g.1s: Check No.: 10389316394_ Nava Telephone: Bank Name/Recipient of Certificate Funding: Residential By Scott L. Bailey Superintendent Fee Collected/ Exempted by: Arianne Catano Certificate Fees Due: $5,815.08 Original Payment(s) Rec'd: $0.00 �� New Payment Rec'd: $5,815.08 �� Over/under: $0.00 NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90-day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL. Building Permit Number: Project Description: SFR :. --- Exempt: (Materials may con i rdous wastes and are not subject to recycling provisions) Construction Debris Management Plan Plan Submittal Date 3/13/2018 Job Site Owner's N Number, Street, or PO City, State, Postal ( Owner's Phone Nur Owner's E-Mail Add Project Manager's Name Project Manager's Phone Number Project Manager's E-mail Address Builder / Contractor Number, Street or PO Box City, State, Postal Code Project Square City Approval By Date of City Approval 53-200 Avd. Navarro Nava, Francisco 585 W. I Street Ontario, CA 91762 RECEIVED 909-815-7010 MAR � 3 Francisco Nava DEVELOPME COMMUNITY Nava, Francisco 555 W. I Street Ontario, CA 91762 Materials To Be Discarded: Product Tons Trash 3.17 Not recyclable Asphalt 0.00 Recyclable Brick/Block 0.00 Recyclable Cardboard 0.55 Recyclable Commingled 0.00 Recyclable Concrete Recyclable Drywall LEM RecyclableDonated / Reuse* Recyclable `Describe Items Product Tons Masonry (broken) 0.00 Plaster 0.33 Scrap Metal 0.00 Tile (floor) 0.28 Tile (roof) 0.00 Wood 4.18 Landscape Debris 0.00 Totals: Recycle Trash Projected Diversion: 5.6 1 3.2 63.7% I understand it Is the property owner's responsibility to submit copies of weight tickets or receipts to the District Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the Debris Management Plan (DMP) for the above named project shall guarantee that at least 60% of the jobsite waste Is diverted from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining materials generated from the first day of the project through the completion of the project in accordance with this plan. This DMP is issued in the name of the property owner(s) and shall remain their property throughout the construction and/or demolition project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still issued in the name of the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the DMP are adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through bi-m❑nthi reports• If self -hauling, all refuse material from this project site must be taken to an a4roved rgcycler or transfer Ov�+f�er 1 Developer 1 Pro'lect Manager / Superintendant D::, RECEIVED MAR 13 2018 Q"OF LA (JUINTA ITY I)EVELOP ENT P.D. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OVVNER'S ACKNOWLEDGMENT" AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signs you understand or verb this information. hi-1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. * 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 1N 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my � Own. +i 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. k5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal Iaw. 1-6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds sin'gle-farnily rest dential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor, �8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. �1J 9. I understand I may obtain more information regarding my obligations as an "employer" Emm the Internal Revenue ervice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-3 2 1 -CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. �j_10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party Ie ally and financially �onsible for proposed construction activity at the following address: <520 MA 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as.well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AITMOPJZATION OF AGENT TO ACT ON PROPERTY OWNER'S BE1[UL F Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: `�f� �f CITY OF LA• Q.UINTA SUB-CONT ;ACTOR LIST JOB ADD RESS5� 2[a[J hLW_1 + � � PERMIT NUMBER OWNERS _ � Qy �BUILD1=f� G This form shall be posted on the jab with III0 BuildilIjcion Cara at Inspgtall times in z r. nspicuous pl_a�c. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work- Failure to comply will result in a stoppage of work and/or the voidance of building permit- For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. >: Traclr ! Clarsi[ic;iiiai) :. ..::::-: -- C;nr�Er:�ctnr: .-. Slate.Cantractar's:Lveerosr,.:-; , Workers Cc n�Is4ii_,s. Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8} {xxxxxx) (xx/xx/xx) (e.g. state'Fund, CalComp) (Format Varies) (xxlxx/xx)• (xxxx} (xxlxx/xx) EARTHWORK (C :121. GM111CRETl '( 81 FRAMING STRUCT. STEEL (C-51.).:.;.. MASONRY (C-29) PLUMBING (G-3,6) �J �1 r C.A`CH -PLASTER:{C=3 �1 � J bRYWALL M-J). e FiVAC {C_2a)::: 1:LECTRICA (C 1a): - .110Orli+l,G,{C-39)` SHEET META (c=43). - - -- — FLOORING (C=15) r3LAZING (C-17)-:. . SEWAGr DISF'. (C-42) F'AJNTIN.G (C-33). CERAMIC TILE (C- -F5.�* -- CAmN.F-Ts (C-w. - — FENCING (C-13) -- L-ANOSCAi'.ING (C-27}: - PO 0L (C-(5 ) - - —