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0311-257 (BLCK)LICENSED CONTRACT.OR..DECLARATION Thereby 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 Professionals Code, and my License is in full force and effect. - License # Lic. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 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 themork, and the structure is not intended or offered for sale (Sec. 7044, Business,& Professionals Code). ; ( ) 1,, as owner of the property, am exclusively contracting with IicenLsed contractors to construct the, project (Sec. 7044, Business & Professiorials . Code). / () .1 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 o4 of the following declarations: () I have and will maintain-a•certificate of consent to self -insure for workw'rsi compensation, as provided for by Section 3700 of the Labor Code, foAth6_0.-1- performance of the work for which this permit is issued. r .� ( ) 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 & policy no. are: Carrier %.Policy No.' (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 A 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, 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. Signature (Owner/Agent) Date 'BUILDING ' PERMIT . tail -2-57 DATE i� �x VALUAY6N Z. LOT J l TRACT �T JOB SITE ADDRESS 52-9W A.VMM)A 0.83REGON APN w OWNER CONTRACTOR/DESIGNER/EN (NEER ROBERT MUZ OV,7N1=;R k3T.d'ILD R 52.950 AW.NM 0BREGON U,, QUiNTA CA 92233.1 Cg11f% USE E OF PERMIT 23 LF C014BO BI.A)CK-ORNAMENTAL% fkbW 3' LVAT,T,'PyR CITY i STANDARD.? LIGHT POLE CDD APPROVAL PC,R ffb?p BAKER 20 204COC Fri . v4ru23,00 LF VALUATION 200.00 LZ f 0.l Ehr,0"1, D COST OF CONSMTRTTCai fr+37.9'a PST' ME SUMMA CONSTRUCTION PEE 101-NO.415.000 6rjl 00 ELWTRICAL FEE 101-000-42iS• 00 r NOV' 2 6 2003 7-- SVOTAL COWMEI?C7C'PkON AND PY-AN CF-TECK $30.75 1129 PO -PAM 1 L ..9 $0.00 T'OTA. i. ;t ERWT .FKES DUE NOW :ns RECEIPT DATE _ r p BY"DAT 5.G ALED INSPECTOR INSPECTION RECORD 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs In G Electric Bond _ Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg, Test Final Gas Piping PLUMBING APPROVALS aTest 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 as Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole W:iderground Conduit Rough Wiring Low Voltage Wiring Fbdures -475 Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: _ POST MOUNT FIXTURE INSTALLATION INSTRUCTIONS MODEL Please read carefully and save these ina iiu oi>,t47l o-tf1Nay need them at a later date. . CAUTION Turn off the main power at the circuit breaker before installing the fixture, in order to prevent possible shock. ,. GENERAL All electrical connections must be in accordance_ with .Iocal and National Electrical Code (N:E.C.) standards. If you are unfamiliar with proper electrical wiring connections obtain the:services of a qualified electrician. Remove -the fixture and.the mounting pa,'ckage from the box and make sure that no parts are missing by referencing the illustrations on the installation instructions. ASSEMBLY AND INSTALLATION 1: Feed the.THREADED44IPPLY.(28) and':wire into the WIRE -HOUSING (10).feedtthe THREADED STUD (1'1) through the ARM (29):Screw the ACORN.NUT (12).tighten using tlie`WRENCH'(:13).Repeat thisostep, for the remaining'two cage assemblies. Feed the'wiring 2. Feed the EXTENSIOI the }center shaft of the COLUMN (14) by s 4 e 3. Feed-thEXTENSIOI the center `shaffof.`the MIDDL=E COLUMN; 4. Feed ihe"EXTENMOI the;center, of the OAS E FIXTURE WIRES}(8) to the provided WHITE IXTURE`WIRES (9) to theprovided BLACK and the FIXTURE GROUND WIRE (4) through Attach the -WIRE HOUSING (10) to•the TOP and the FIXTURE GROUND WIRE, (4) through (-I S). Attach'the TOP COLUMN (14) to the I together. ` W - IRROUND r ' 'and he FIXTURE'6E (4).through DDLE COLUMN (15) to,the'BASE.(17) using the HEX TAP. SCREWS tto);- S. Place, Ihe,TEMPLATE`(21) over the desired installation location. Mark'the locations of the TEMRL'ATE (21) holes" Remove the TEMPLATE 6. Drill-1&',diameter holes,at the marked i6 attons ;approximately 3-1/2" through'the concrete surface. (Note: Be careful not:to;ineed'moie than 4".) Make a hole at the marked.locatioh. for the center hole. Feed the'SUPPLY WIRING (24 and '26) and the SUPPLY GROUND WIRE (S) through the -center hole., 7. Connect the WHITE EXTENSION WIRE (25) to the WHITE SUPPLYWIRE (26).and the. BLACK:EXTENSION WIRE (23) to the BLACK SUPPLY WIRE (24) using WIRE NUTS (27).Wrap'the FIXTURE GROUND WIRE(4).around the GREEN SCREW(20) and then mounted it.fitmly at the bottom of BASE(17). -Connect the FIXTURE GROUND WIRE (4) to the'SUPPLY GROUND WIRE (S)'using WIRE NUTS (27)(not included).. 8. Insert the ANCHOR ASSEMBLIES Q2) into the holes with.the threaded ends pointing upward. Placeftie BASE.(17)-over the'ANCHOR ASSEMBLIES (22)`byfeeding them through the provided holes. Make sure that all wires are properly stuffed under the BASE (17). Feed the SPLIT LOCK WASHERS (19) onto the ANCHOR ASSEMBLIES (22) and tighten the HEX NUTS (18) onto the ANCHOR ASSEMBLIES (22) until they are flush with the BASE (17). ASSEMBLY AND INSTALLATION (Continued) 9. Apply a waterproof caulk/sealant around the BASE (17) where it meets the ground. Make sure the wiring is completely sealed from any rain. 10. Carefully push the WIRE NUTS (27) into the WIRE HOUSING (10), cover the top opening with the CAP (7), Screw the FINIAL (6) into the nipple. 11. Screw a light bulb into the socket located inside of each CAGE (2). Make sure the bulbs wattage does not exceed the maximum wattage specified on the fixture label. 12. Place the TOP FOUNT (30) over the NIPPLE (32) and secure in position using TOP FINIAL (31).Place the HOOD (l) onto the CAGE (2), and secure it into position using the provided HOOD SCREWS (3). INSTALLATION IS NOW COMPLETED 31 30 32' i 1 3 .- 6 1 2 7 9 8 15 10 (�'' ; -13 29 11 16 %28 14 - 17 t; '• �_ `18 19 20 21 .25 4 �--22 27 5 2 24 1. HOOD 12. ACORN NUT 23. BLACK EXTENSION WIRE ' 2. CAGE13. WRENCH 24. $LACK SUPPLY WORE 3. HOOD SCREW 14. TOP. COLUMN 25. WHITE EXTENSION WIRE , 4. FIXTURE GROUND WIRE 15. MIDDLE COLUMN 26. WHITE SUPPLY WIRE S. SUPPLY GROUND WIRE 16. HEX TAP SCREW 27. WIRE NUT 6. FINIAL 17. BASE 28. THREADED NIPPLE 7. CAP 18. HEX NUT 29. ARM , . 8. WHITE FIXTURE WIRE 19. SPLIT LOCK WASHER. 30. TOP FOUNT 9. BLACK FIXTURE WIRE- 20. GROUND SCREW 31. TOP FINIAL 10 WIRE HOUSING 21. TEMPLATE 32. NIPPLE I (.THREADED STUD 22. ANCHOR ASSEMBLY OWNER/BUILDER INFORMATION 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. For your protection you should be aware that as "Owner/ you.are the'responsible party,of record on such a permit. Building permits aie norrequired to be signed -by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that .person applies for'the proper permit in his or. her name. - Contractors are required by law to be licensed and bonded -:by the State of California. and to have a business license from the City or County. They are also required by law` to'put their license number on all p&mits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be b, aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than.yo& immediate family, and the,work (including materials and other costs) is $200.00 or more for 'the entire project,`' and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal. income tax, withholding, federal -social security taxes, worker's compensation insurance, disability insurance costs and unemployment cornpensation.contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations underTedeiallaw, contact the Inierrial Revenue Service (and, if you wish, the U.S. SmallBusiness Adminstration). For more specific -information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial,Acciderits. If the'structure is intended for sale, property owners. who are not licenc sed ontraciors' are allowed to perform their work personally or through their own employees, without a=licensed contractor:or subconiractor only under limited conditions. A frequent practice of unlicensed persons professing io be contractors -is to ;secure an.,"Owner/Builder" building permit, erroneously implying that. the property owner, is providing his`or.tier`o. labor and material personally. Building permits are not required to be signed .by property owners unless, they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. ' Please complete and return the enclosed owner -builder verification form so that We can.confirm that you are aware of these matters. The building permit will not be issued until the verification'is returned.*:' Very truly yours, CITY OF -LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760)777-7012 FAX: C?SM77-7011 OVINE 'S SIGNATURE/DATE PROPERTY ADDRESS PERMIf NUMBS (s)