0205-102 (RR)L-1 k. "14 Zor-Lo toVi4 I MA#.; I Un LjA;%.,LAriAi 1UN
I; hereby ' ' penalty
* ' ' ' d,Under provisions 6f��;
m*.,undbt�penaty-,'of:'p-eg-urh j:amlicense
T,t at
of466-Busineiss andA
J-1-Pr6fessionals C-6cle-,"and, my '06en4'is�,Irilull for6biiid'iffect.
, 1 , C
b6ensi# E
Date
X124573:'
41
Signature
,of
-1 xll
OWNEREIUI
LDER DEC ON
exempt from the Contractor's
41 Kereby.Oirm-
under r'pebalty of,perjury that am exam
L er�Ise�L& i6rj66`.f6IIi5wIng- reason:,.'
Ic w
kees�With wages as their sole
1,-,is"ovi�ei.-6i,the"pioperty, or,.'my employ
, . ~,;compensation; . will do the mork, and the structure is not intended or offered for
*sale ( eca7044461siness &,Professionals Code).',,
am
'eec�xclu7sively contracting r with licensed
contracto S to, .644, Business &,Prof essibrials
- - S'
'k U j dfthe project (
p
M
LW exempt underSections,' B&P.C.for -this reason
C\11' Dlate�,.
"1 �1 Signature ofx Owner
cli
WORKER'S COMPENSATION DECLARATION
Z
jECLARATI Nz
I, ereby,,,'Affirinilly. of folloWing-d6clarations::
?�O I have and will ,ft]inderl. penalty' A ' ' " " "
�,OTVperjury),one
�Cohj'e�tLto
6IAti(na'Ce'rtifi&ate",Of self -insure for 'workers'
.14
,c,o,Tpenc;atione,-�-aslprovidodfor bi,,Si;cti6n"3760 of the Gabor Cod6,.'for the
"M
a qoraqncpe,of the Work for Whi 1h ifilis'ppirmitis issued
ve andwill t maintain w6rkers'. compensation . insurance, as required by,
on.3700of:the Labo�, ddethe performance of ihe,work for
which this
it
I U Y'Workers', corno-ensation. insurance camer.&'poficy no. are:,
'tr_ 0
0 CY N
Policy
5
4g� (This sec�ion need not be completed if the permit valuation is f6r $100.00'or,ldss
Ofl certify that in the work f --which this permit is issui�d,-'
performance of the or
4:11 - shall .,not:erni I
r in any manner so-as.16 become subject to the
if I
-.-,wor erstcom ; I-
1�1 . ns i, California and agr66 th4t6ecorne',',
U
,
,
compensation
_p_r'6visions of, Section 3700 of"th
Labor
6W!Vshall forthwith'compIYwith those
'EDatappIc.
Am it
ibjfiii6s_66 to.$100 000 :
'ect_ajn',empIoy0 in
Mo'tlia ot,of',"compensat'io'n',,,'8a ffii a_g'BSa's`pro_'vIded for in Section 3706
abor Codejflhtdr6ifand'
attorneys 'fees ..... - -4.
UNT Applicatlori)S hereby 'made't67-the —bire-"c-t-or-'bf,B6ilding and Safety
36rmittsuibject _to1.:th6 +conditlofiS"-7and -,restii6tions'. set' forth on his
,
tion'
ch,,jpeF66n%0ohMho" behalf this.6pplication'is made & each person at
e.requeswand forwhose benefit work is performed under or pursuant to.
)dhnIt issued asthis ap
, resultpf plic-aton agrees to, &'SKAII, Indemnify
.0;1 Wiernle"s's"41hi �'Clty 'of l_i,:Qu'Inta,-.Its officers, agents and employees.
becomes null and void If
is�notj,comme=6d w ro Within'180 180 + days f ' m- datei'bf issuance of such
,
it, 6r,cessation :of - work 'f*o-c',180'days will subject permit to cancellation.
that]',hav6lbad this application arid state that thbove information Is
a
I
. ,greetb.comp� ;. -,ly,w�1.ift all City,,arid State la 's. relatin`g -to the building
* we�ik
ctlon;t.`and . hereby ,,a`i,uth6 rize representatives * of this City to enter upon
ve-mentioned property for inspection pdrpose'..
7!-
.V 7=7�77
•
rjAgent)
ire, (Owne Date
PERMIT #
UIEDINGRERMITV,
DATE'A T'IVALUATION'��;j' i"' JQ LOT X
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR DESIGNER ENGINEERJif.4-
d
K"Vy"117 RMIDERf LAW 1HODOMMRS
i"At"R, MA OTC
P, V• -.mix -I wo
67-555 Xh,�TPAL4 C'ANY0N,:DR1Vr%
1.A (Wffi-TA
CAIVURDRAL MY . t X
(70)325^91.11. MLO 4611
USE OF PERMIT
GENERALHIJILDINO
:R&Ft(XW.Wn'H CLASS A MA'VHRW�S� BLID0. 8: 54491,
r14--432154
'VALUMON
101-CM419-M . $:30.1W
MAY
CITY0FLAQUINTA
FINANCE DEPT-'
31,T&TOTA1, CONSTRUCTWN AM PLAIq ClIECK
1.188 PRE-PA113 RAM
IWAR, PF.RAIXT YFAS A QW
4
RECEIPT
DATE
Z-2
BY
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
j)
Steel
Combustion Air
Roof Deck -0
O.K to Wrap
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party all Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA S
Steel
POOLS - SPAS
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'