0205-102 (RR)L_1--QV#0QU L.Vili i IlAk; I Un Ljr-6LAHAI lUk
ler.9 (cbr
L16ense #
. ..... 5 .1437
LLS_iA
I heidby,Affirrr
License tiw'fi
.,,,compensation
sale(Sec:,704
,
pe p"ance ofah
;UL 4, Fhavela
on:3700-of't
i,permit is Issued%
) 54 , ,a , I , Tier ITA
yy
s section neec
I'certity that,
`I:ShgIi: not'emplo,
,:`,work6rs+'compen
subject ,to;the wo
Signature of Contractor
A ION N&
er,pefialty'of"perjUry that 1 -am exempt -from the' Contractor's'
3 follow'lng'' riason: ;,�rjqz
" z. Jf,
)ithle-,-,-pr'6'perty',,,or-'m'y.employees"with .wagesias their Sole'
16 the-'w6rk-,, i�d the Structure is, not intended or offered for -
i - siness , & Pr ofe , ssidnals . -.Code).."_ r
of the, prolierty;, amiexc usiVelga'dontractihj-with'licensed
istruct ythe project (Sec: 7044„ dbsinesls A':10r6fessionals
,.der -section '," P.C. for -this reasonL_;"
LLLLSignature', of, Owner
L
IKER'S COMPENSATION DECLARATION
i,er, pepa ty"_pfperl ury,,, one: oi:�!the:following declarations:.
f! L
I maintain a certi cate..o consent to s6lf-insure for workers'
� " : I'd ji, � _L , , -§ect!'6n 217bo 46f 'the 'Labor, Code, for the
work prov ed� or,by
;for ikhi8h thispermit is Issued.'.:,
III
��ir�aIntBin_:w6rkers`co compensation insbrahc6,-as'required by
LaborC66;,. foi; the,, performance of the%work for which this
y.',.workers.compefisato-n insurance carrier & policy no. are:.
l�1dQ '� Policy No 04$4;-(AWSM9
lot 'b6 cbmpletedif e -permit. va uation, is for $100.00 or less).
tfi"_ , rf, , L ' , of the Work for ' I
,e,pe ormance which this, permit is issued,
any,Lp6r666"ih , any " manner -so as,tb become subject to the
1tI6n,IaiW6"6f "California, -and agree L that if I should become
art compensation . provisioris-•of,,Section 3700'of, /th Labor
'
Ith :comply With 'S
"Apolicant'LL-
71 M,
itning:'Fallurelto Workers' C C
se1c,ure ,. Cohens tio [�q erage is NIaWful-and.
ill; subjiict4n 6 nip llbye(to, criminal " hAltie's"iRd�ivil"fineg'uot6$100
pe 000, In:
ditI6n�to`tfiB'66S6f cor� I 04h6kt . Ion*,,.damagbs-'as`pr I ovided'for" in Section 3706
the tabor Code; 'and "aft- o'rne-y's fees:t.
PO RT ANT,--iAppIIcatI6n jgher6by'made tii�tha Director of Building'and Safety -
A'Ita.'.'the "Cip"ridition , s and �restrictions, r, set 'forth on his
r whose behalf thlsapplication Is made &'66ch person at
V , r . 'H 6se,bendfit. Work is'oerform6d under or pursuant to.
siblt' f t
iny per it issue as: a " ;0 his"a ' Ii ' ton.
pp ca -agrees to; & shall, Indemnify,
Vthold harmless the:C'Iiy..;c)f - La Quirita, its off icers,., agents"and employees.
'it , ,"i',
riy,pdrrn ,I qSL4d4sre6ultof ;thl6,.6opi,icationbecomes null and void If
V6rk,,Is,-no , t comrnenC66. wiihiri , from date of_ - issuance of such
)ermit,.or cessation of:woek for: -i 80, days -will subject permit to cancellation.
kiy4hat- I KaVi,,rireadks application dridstate that the above* information is
Tact. Degree -to c6mply.'wlth all City, 'and, State, law's relatinj,to the building
struct ,ion,- and. herebi authorize repr esentatives,ofthis City to enter upon'
460v el-mentio-hed, property for inspec . t1oh purposes
mature (Owner/Agent) �
Date
P ERMIT#
r.
BUILDINGTERMIT
UATi6144 r :, +IGT :q
.TRACT
JOB SITE :�
-0
ADDRESS'11-1pMMS. A'X,,MUi
APN
OWNER-.
CONTRACTOR/DESIGNER/EN INEER
PoA:vi ff r SIF 9 M F 9 f M L HO W ONAM R S
'DIERM-0 Sfflpf IYOF CAii06&k1 nct
P10. 801K. Iwo
67�-555 FASr PALMCANYON Dit . IVE
.1 A QM-rA
C!A AHYDA AL eery CA -4.
(76%325.9111 CRU 4611
USE OF PERMIT
ORNUAL PULDIN0
R&,EL(XW WfIll CLASS A D9MERL%1 IN- TILD 9: 54A.. 54:416
14-431. 54-443 OAKWUe
VALUATION 1.8
MWMA:#'M CW5 C OF 401VISTRUC'"ON
VMMIM FXX SUMNIA MY
MAY, 0:0 2002
C00FLAQUINTA
FINANCEOE rr
L
SMTOTAL CON917M, MIN AND RAN C4MCK
FM
IMAL PKIRMIT Fus. A)UN Now
RECEIPT
DATE
BY
D
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
TDATE
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
FA.U.
Framing
Compressor
Irmulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
—Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
I
Final
I
Final
Ad 1z
-
POOLS - SPAS
• BLOCKWALL AWROVAVS
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
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)