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BRES2019-032178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: BUILDING RESIDENTIAL/ADDITION Application Number: BRES2019-0321 Property Address: 53860 AVENIDA HERRERA APN: 774164025 Application Description: MAROHN / GARAGE / CASITA ADDITION Property Zoning: Application Valuation: $18,548.00 �\ Applicant: P JAMES AND NANCY MAROHN 53860 AVENIDA HERRERA DEC 10 2019 LA QUINTA, CA 92253 CITY OF LA QUINTA DESIGN & DEVELOPMENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATION I 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 that requires 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 alleged exemption. Any violation of Section 7031.5 by any applicant for a permit s jects the applicant to a civil penalty of not more than five hundred dollars ($500).: I, as owner of the property, or my employees with wages as their sale mpensation, 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 bns he did not bu[Id ar improve For the purpose of sale.). l], as owner of the property, am exclusively contracting with licensed contractors to truct the project. (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 contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date: VZ' D'( 1 Owner � — VA CONS R� ON 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 Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/10/2019 Owner: JAMES AND NANCY MAROHN 53860 AVENIDA HERRERA LA QUINTA, CA 92253 Contractor: JAMES MAROHN - OWNER BUILDER 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 3700 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. My workers' compensation insurance carrier and policy number are: car Policy Number: _ I certify that in the performance of the work for which this permit is issued, I sh not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. f Date: 12'i 1 Applicant: 1.,L ef i WARNING: FAILURE TO SECURE WORKE COMPENSATION COVERAGE IS 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 the Building Official for a permit subject to the conditions and restrictions set forth on this 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, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application 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 state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above - mentioned property for inspection purposes. Date: Signature Signature (Applicant or Agent): 'k, Date: 12/10/2019 Application Number: BRES2019-0321 Property Address: 53860 AVENIDA HERRERA APN: 774164025 Application Description MAROHN / GARAGE / CASITA ADDITION Property Zoning: Application Valuation: $18,548.00 Applicant: JAMES AND NANCY MAROHN 53860 AVENIDA HERRERA LA QUINTA, CA 92253 Owner: JAMES AND NANCY MAROHN 53860 AVENIDA HERRERA LA QUINTA, CA 92253 Contractor: JAMES MAROHN - OWNER BUILDER Llc. No.: Detail: 367 SF ADDITION TO MAIN DWELLING WITH A NEW 876SF 3 CAR GARAGE. [ENGINEERED] THIS PERMIT DOES NOT INCLUDE REMODEL TO THE EXISTING DWELLING, OR CHANGEOUT OF EXISTING MECHANICAL EQUIPMENT OR WATER HEATERS OR ELECTRICAL PANEL UPGRADE. 2016 CALIFORNIA BUILDING CODES FINANCIAL INFORMATION DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL ADDITION, EA ADDITIONAL 500 SF 101-0000-42400 0 $207.69 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL ADDITION, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $57.96 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL ADDITION, FIRST 100 SF 101-0000-42400 0 $135.24 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL ADDITION, FIRST 100 SF PC 101-0000-42600 0 $189.98 Total Paid for ADDITION 2019: $590.87 DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($61.50) DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($62.50) DESCRIPTION ACCOUNT CITY AMOUNT HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 1 $161.00 DESCRIPTION ACCOUNT CITY AMOUNT HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 2 $322.00 DESCRIPTION ACCOUNT CITY AMOUNT HOURLY CHARGE - INTERWEST PLANS EXAMINER 101-0000-42600 1.6 $61.50 DESCRIPTION ACCOUNT CITY AMOUNT HOURLY CHARGE - INTERWEST PLANS EXAMINER 101-0000-42600 0 $98.50 DESCRIPTION ACCOUNT CITY AMOUNT HOURLY CHARGE - INTERWEST STRUCTURAL PLAN REVIEW 101-0000-42600 0.5 $62.50 Total Paid for BLDG CITY STAFF - PER HOUR: $581.50 DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, EA ADDITIONAL 1,000SF 101-0000-42403 0 $13.69 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, EA ADDITIONAL 1,000SF PC 101-0000-42600 0 $5.64 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $161.00 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, FIRST 1,000SF PC 101-0000-42600 0 $53.13 Total Paid for ELECTRICAL - NEW CONSTRUCTION 2019: $233.46 DESCRIPTION ACCOUNT CITY AMOUNT AIR HANDLER 101-0000-42402 0 $40.25 DESCRIPTION ACCOUNT CITY AMOUNT AIR HANDLER 101-0000-42402 0 $40.25 DESCRIPTION ACCOUNT CITY AMOUNT AIR HANDLER PC 101-0000-42600 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT AIR HANDLER PC 101-0000-42600 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $40.25 DESCRIPTION ACCOUNT CITY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $40.25 DESCRIPTION ACCOUNT CITY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $26.83 DESCRIPTION ACCOUNT CITY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $26.83 DESCRIPTION ACCOUNT CITY AMOUNT VENT FAN 101-0000-42402 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT VENT FAN 101-0000-42402 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT VENT FAN PC 101-0000-42600 0 $5.37 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $5.37 Total Paid for MECHANICAL 2019: $279.08 DESCRIPTION ACCOUNT CITY AMOUNT PLAN CHECK DEPOSIT - ADDITION/REMODEL 101-0000-42600 1 $125.00 Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00 DESCRIPTION ACCOUNT CITY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $40.26 DESCRIPTION ACCOUNT CITY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $40.26 DESCRIPTION ACCOUNT CITY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $40.26 DESCRIPTION ACCOUNT CITY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $40.26 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $13.42 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $8.05 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $8.05 Total Paid for PLUMBING 2019: $203.98 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-0000-42416 0 $21.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $21.00 DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($0.50) DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($0.50) DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $0.50 DESCRIPTION ACCOUNT CITY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $0.50 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 DESCRIPTION ACCOUNT CITY AMOUNT ALTERATIONS/ADDITIONS - RESIDENTIAL 101-0000-42400 0 $81.00 Total Paid for ZONING CLEARANCE - PLANNING PLAN CHECK: $81.00 ta Qail�trcv _—GE'd „j d,r DES EKI PERMIT # PLAN LOCATION: Ifs` r ,i � � u o � A � �1 � pe, kk Project Address: 53860 Aven' ae` VA-trrrf, e. Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: 4A � 0I " 6 � S Q o c, ►--- Ck Applicant Name: 1-4 s r Address: S3�Av 9Vew'A N- O-C ror'-f, r 1 City, ST, Zip: �. �r tl��ti �4 Cf} 12255 Telephone: ' Email: ' \ Valuation of Project $ Contractor Name: aLYI-Jnp aw&- New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: City Bus Lic: Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: Property Owner's Name: New Commercial / Tenant Improvements: Total Building SF Address: City, ST, Zip Construction Type: Occupancy: Telephone: Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd Req'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 CERTIFICATE OF COMPLIANCE Desert Sands Unified Scho ol District DESERT 47950 Dune Palms Road SANDS La Quinta, CA 92253 UNIFIED Date: 12/10/2019 (760)771-8515 SCHOOL No.: 19-01563-1 DISTRICT Owner: James Marohn Email: Address: 53860 Avenida Herrera Jurisdiction: La Quinta City: La Quinta Tract #: Type: New Residential Addition Lot # Street No. Street Name Sq. Feet APN Permit No. 53860 Avenida Herrera 367 774-164-025 Comments: RECEIVED DEC 10 2019 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT 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 $3.79 X 367 S.F. or $1,390.93 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: credig card 1 James Marohn Check No.: Credit / Debit Card Bank Name/Recipient of Certificate Telephone: Funding: Residential By Scott L. Bailey Superintendent Fee Collected/ Exempted by: Rodney Slagle (� / 1-IRW Certificate Fees Due: $1,390.93 Credit Card Fees Due: $327.82 Original Payment(s) Rec'd: $0.00 New Payment Rec'd: $1,418.75 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. Tdy/ 014 a" P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS 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 LM RTANT! 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 `53 2 0 AVe n.`D rr r -, 00, , C t . 53 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. OWNER'S ACKNOWLEDGMENT ANI] VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verb this information. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder' iOt 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. M;y 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. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect yself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ► l 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. i'n 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value f my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. /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. 1 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential tructures 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. 1`0'r as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any l injuries sustained by any subsequent owner(s) that result from any latent construction defects in the manship or materials. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ervi9.ee, 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- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the arty legally and financially res onsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all ppiicable laws and requirements that govern Owner -Builders as well as employers. 4v12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I e 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 agency is required to be presented when the permit is issued to verify the property tote owner's signature, /II 7r Signature of property owne "— " f 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. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF 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: r'4:1t eJF Plan Submittal Job Site Building Permit Number: 13ESUPI _03ZI Project Description: SFR Exempt: ❑ (Materials may contain hazardous wastes and are not subject to recycling provisions) Construction Debris Management Plan Owner's Name Number, Street, or PO Box City, State, Postal Code Owner's Phone Number Owners E-Mail Address Project Managers Project Managers Phone N Project Managers E-mail Ao 11/11/2019 53860 Avenida Herrera La Quinta James Allem Marohn 11 53860 Avenida Herrera La Quinta Owner Builder Same as above Builder / Contractor Number, Street or PO Box City, State, Postal Code Project Square Footagel 1,243 RECEIV F- NOV 19 2019 CITY OF LA QUI�ITA DESIGN AND DEVELOPMENT DEPARTMENT City Approval By Date of City Approval Materials Tn Be Discarded: Product Trash Asphalt Brick/Block Cardboard Commingled Concrete Drywall Donated / Reuse* *Describe Items Tons 4.50 Not recyclable 0.00 Recyclable 0.00 Recyclable 0.30 Recyclo)le 0.00 Rol�yciable 6.00 Recyclable 0.60 Recyclable 0.00 Recyclable Product Masonry (broken) Plaster Scrap Metal Tile (floor) Tile (roof) Wood Landscape Debris Totals: Recycle Trash Projected Diversion: Tons 0.00 Recyclable 0.15 Recyclable 0.17 Recyclable 2.35 Recyclable 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 65% 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-monthly reports. If self -hauling, all refuse material from this project site must be taken to an approved recycler or transfer station. er / Developer / Project Manager / Superintendant Date ,p �J CITY OF LA QUINTA SUB -CONTRACTOR, LIST JOB ADDRESS,�3S� 1 W) ��9 r4��r�� l —PERMIT NUMBER 1jrt,5Z01 1-0321 OWNER Me s q This form shall be pasted on the Zoh with the Building Inspection Card at all times in a conspicuous place. Only persons appearing rc)kv— 6 �. BUILDER on this list or their comply will result in a stoppage not an acceptable response. QI � 4VuIJW_-S-� employees are authorized to work of work and/or the voidance on this job. Any changes of building permit. For to this list must be approved each applicable trade, all information by the Building requested Division prior to below must be commencement completed of work. Failure to by applicant. "On File" is Trad..e I Classification. Contractor State Contractor's License Workers Co.mpensation.lnsur..a.nce Cit Busi.n sS,.Licer:s .. Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) .EARTHWORK (C•'I2).. Company Name �r II (JC,m S G /d h vL Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/).x/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) CONCRETE (C 8) - FRAMING :4C=5): STRUCT. STEEL X( 51) MASONRY (C-29:) PLUMB.IN;G (C-3.6) LATH, PLASTER (C=35) DRYWALL (C-9). HVAC (C=20); ELECTRICAL (C T 01 ROOFING IC •39,) SHEET NIETAI: (C43) .FLOORING (C-15) GLAZING (C-17) IN.S 1L.ATIO:N X,2) SEWAGE: DISP. (C-42.) PA NTING: G-3:3) CERAMIC TILE (.C:754:) CABINETS (C-6); FENCING (C4:3) LANDSCAPING: (C-27). r C, C, PPOL. (q-53)