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I heriby ' sfflr'm— Un Adir ponalty,of pejUlry that ),Arn licensed under provjslonja7�"
1-tichioter.O'(c6m'M66clhg'wkh,SWW 1000) of DvIslon-3 of the Business and,
Professionals Code; andIn'tull force and effect. e`,
Udeha# ELie ela,,_
Date
T, I
ate
"76.: Signature of Contractor
OWNER-18111111LDEPtSEC&A N,
I here6y affirm 6lder. penalty of perjury that I am'exempt .from'the CbntractoeS
License Law for the'following,reason:
t) - 1, as owner of the- -p'roperty, br• my -employees *wIth'wages as their sole
,compensation, will do the,work, and the structure is not Intendedor offered for
sale (Sec. 7044, Business & Professionals Code).'
),,I; -as owner of the"proporty,,am exclus.iVely-contnictirij with licensed
contractors to' , constnict- the 'project 1.(Sec. 7044: 'Business &. Prof6ssionalS*
)A am exempt under;fSectignTB&P.C.fifor thls7riision
�81griaty--!!-
Date• re of * Owner.
WORKER'S COMPENSATION DECLARATION,
1,here by. affirm under'penalty, of pdrju�y one of the following dedarationi: -
I have and will Maintain d certificate of consent to self -insure for workers'
compensation, as provided foir}bV Sibtl6n 3 00 ofthe Labor Code, f6rthe
,p orminc*,O't'Mov�drkf6riihldhihl'sper�nitigissued.'.
r have and will, maintain W9.. YW compensation,. Iniurance, as required by
on *6 of the Labor Code, for the .patformarice-of the work for which this -
pen-ilt Is lsiu6d.W.y' workers".6omp6ndation Insurance carrier & policy no. aie:..',
Carriernift . . , . -I' . . ,,Policy No. . I I
(Thii section need not, be completed ffeffnitvaluation is for $100.00 or, less).
O I certify thqt 16th4 pprforiiIince ofthe, twork for which this permit Is Issued,'
Pt f #
8VILDING.VERMlr
A. ..11A
ONT
0Sj96MVAWAT10N- j .mcr..
JOB SITE'
ADDRESS �c
Ap�
OWNERf
CONTRACTOR DESIGNER I ENOINFER
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67455 EASIT PAW,CMYON DIUVE-.-
��QCWA
CAnMV"L CM CA #"a
('760)025411r. (XIA 401
USE OF PERMIT
U&MOOP WI11V 0ASS A MATMIJAL. Sj" N** , 544-n J i 71
54-M CIAX I"
07MATM CO" CW CONMWE",
24"00
MOM i= AWMA*V
RER"F= $moo
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FINANCEIDEff-2-L-a-il.,
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WrAL PIMM FM
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RECEIPT
[
O�TE;/
BY
DATE FINA
.r eL
PELT 6
I
7
INSPECTION RECORD
OPERATION Q
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Seeks
Unclergrourx! Dtxft
Form & F000np
Ducts,
Slab Grade
Return Air
Steel 4
CombLation Air
Roof Deck -Agw4lal_
Eximistfans
O.K to Wrap
F.A.U.
Framing
Compressor
Insutatim
vents
7 Fireplac* P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Una
P" Wag Firewall
Exterior Lath
Drywafl - Int. Lath
4
Final
Final
scacm�
BLOCKWALL APPROVALS
POOLS -SPAS
Stei,4 V.
Set Backs
Electric Bond
Footings
Win Drain
Bond Beam
Approval to Cover
Equiprnent Location.
Underground Electric
Underground P". Test
Final
CAm Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Otft
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sevier Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Poft
Gas Test
Appliances
Final
Final
Wily Notice (Gm)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F,J.
Smoke Detectors
Temp. Use of Power
Final
Utility ice (Perm)
17
COMMEN.Q.