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78610 HIGHWAY 111 - BUILDING PERMIT FINALLICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. 6201442 8 C8 C.20 5/3119-5 License # Lia Class_ T D Date ! —-fS1T1gnatureofContractor C OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: I, 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 & Professionals Code). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). I am exempt under Section , B&P.C. for this reason Date Signature of Owner 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 perfor ance of the work for which this permit is issued. 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 & policy no. are: Carrier CALIrORN11A C, Policy No. WC68O1f)93702 This section need not be completed if the permit valuation is for $100.00 or less). I certify that in the performance of the work for which this permit is issued, I shall 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. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 agrees to, & shall, indemnify hold harmless the City of Indian Wells, its officers, agents and employees. 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 State laws relating to the building, construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. SignatureOwner/Agent) Dabs ALC " _ BUILDING PERMIT PERMITy!5,2_124 DATE X7 ZU/• 0 VALUATION 5544 • I LOT TRACT M JOB SITE ADDRESS -7"10 II Wy '11,1, APN OWNER CONTRACTOR D SE'RT Ci'1'WS DEVELOPMENT Jan MCGOT 39725 GAIRAIIT6' LANE #A C -i. j H'aW' x I i 1 iALMivi ur:S;u,i i" Cts 9221 La, QuWa CAL 92253 619)345-2472 CBL#. Vo g DESIGNER/ENGINEER USE OF PERMIT 1Vii!'A TCI. t'Q3ti?Lt I/ilPa•uvclilrlu i FEE DESCRIPTION FEES C:(likl@+t>*iGC:IAL. >f,UUll.UO 0STIMATE D COST OF CO1+rS'4'C•t.'UC"TION 8,000.00 PF,1011TFEE SUMMARY PLAN 0 IFCK FEE 1,01.¢000-439-318 MA. 35 CONSTRUCTION f`EE 101-000-418-000 a5 9 X10 ME-CfiAWCAL ITCH 101-000-421a-000 5i EA1CTR1C..FEE 101-000-410-(100 r PLMMING IFF -111, 101-000-419-000 LO MONO'S. CMON FEE - COMM: 100-000-241.000 $1.63 MoCn Cn i CQ J D SLi33-'larAL CONSTRUCTIONAND PLAN CITECK 165.03 L1 SS PRE-PAI©I'.F.. ES 0.00 TOTA:14 _',Ed12MIT FEES DUE NOW 165.03 ri• RECEIPT DATE BY " DATE':RNALED INSPECTOR INSPECTION RECORD Y', OPERATION DATE INSPECTOR OPERATION DATE 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 F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final lg_IZ— BLOCKWALL APPROVALS POOLS -SPAS 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 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) COMMENTS: 1 7 f • Nt7w R . A EAVTY S u P P Of Ex/5T/A/4 100 AMP PP7Ltt )05T I NG i0 kE-M A -W fi Y 8' O" I I 4 y l RtLOGA7YMews'x - A 2,_3„ , Lo AMP 20 AA1 P I VCT CARPET 2d X &d' I- S Q. PT. I -- y ecoPPEXt E,tEG?"121G WRiE14lJFi97>n 81-ftJ -OFF i ilQovE Facerr-rhG Sro'uav m X99` y , TO ov7srcE w . RNzbLa N 48, 1 I. 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