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05-3449 (ELEC) _1416 IIIIIIIIIIIIIIIIIIIIIIIII 80 • I / -- -— - IE 4 P.O. BOX 1504 - - ----_� VOICE(760)777-7012 78-495 CALLE TAMPICO FAX (760)777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/05/05 Application Number. 05-00003449 Owner: Property Address: 81364 AVENUE 54 EAST OF MADISON, LLC APN: 767-210-038- - - P,O. BOX 1482 Application description: ELECTRICAL 81-100 AVENUE 53 Property Zoning: LOW DENSITY RESIDENTIAL LA QUINTA, CA 92253 Application valuation: 35000 Contractor: Applicant: Architect or Engineer:. BRUDVIK, INC. D d 600 EUGENE ROAD „ PALM SPRINGS, CA 92264 , H (760)320-4429 LiC. No. : 482623 AUG 1 ® 2005 ---- - -- --CI FP11AF4IAAI ---- - -- - - - -------------- ---- --- ----- --------- - ------- - - ----- - - ------------- T R' DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that 1 a icens n e ions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000)of Division 3 of the Business an Prof e ' Is Co ,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided License C ss: 10 C20 C3 Lice a No.: 482623 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. att� /0 _ ntractor: 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 OWNER-BUILDER DECLARATION - insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier INS CO OF WEST Policy Number WSD215878100 following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify that,in the performance of w k f hic his permit is issued,I shall not employ any construct,alter,improve,demolish,or repair any structure;prior to its issuance,also requires the applicant for the person in any manner so as to come u ect to the workers'compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should bec me subj to the wo ters'compensation provisions of Section License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the Labor C e,I s 11 forth i comply w h those provisions� 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 subjects the applicant to a civil penalty of not more than five hundred dollars($500).: sten pplicant: (_) 1,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 and Professions Code: The WARNING: FAILURE TO SECURE WO KERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT (_1 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 1 I am exempt under Sec. ,B.&P.C.for this reason 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. Date: Owner: 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 perEciof work for 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the ab a rrect. I agree to comply with all work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to buildin conreby authorize representatives of this court ktonte;rupon the above-mentioned pro erty or . Lender's Name: Dat nature(Applicant or Agent): Lender's Address: LQPERMIT Application Number . . . . . 05-00003449 Permit ELEC-MISCELLANEOUS Additional .desc Permit Fee . . . . 52.5.0 P1an. Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date. . 1/31/06 Qty . Unit Charge Per Extension BASE FEE 15.00 1.00 37.5000 EA ELEC SVC <=600V/>200A/<=1000A 37.50 ---------------------------------------------------------------------------- Special Notes and Comments 1600 AMP GOLF IRRIGATION PUMP, SERVICE #4. Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 52 .50 .00 .00 52.50 Plan Check Total .00 .00 .00 .00 Grand Total 52.50 .00 .00 52.50 LQPERDIIT JCM Inspections 1/ IIIIIIIIIIIIIIIIIIIIIIIII 01 39725 Garand Lane Suite F ` IE Ll Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS STRUCTURAL MASONRY INSPECTION REPORT Date: O-Z3 �v Project Name: Project No: The Madison Club - Pump Station #2 06-1018 Project Address: City: Z✓ IBC 81-364 Avenue 54 La Quinta, CA Title 24 Client: Sub-Contractor: The Madison Club Sabor Masonry Other: General Contractor: Architect: Structural Engineer: Davis/Reed B. G. Structural Engineering, Inc. Slump(inches): 1 Supplier: 96'f P , t Weather: Time Sampled: '' j `� AM Mix Design: Z S i� Time in Mixer(min.): 4 AA',ti Specified Strength(PSI): z• n J Unresolved Items: Water Added @ Jobsite(gals.): !< Addmixture: Concrete Temperature(F): -7 ''` Truck#.,,7 l Ticket#: ❑� None Ambient Air Temperature(F): �j Field ID Marking: ❑ See Below Location of Sample: F , I > -t T t I ;'f ❑ No Samples Taken Description of Work Inspected: r r] U 0A 'I,7 r1 i ,V _ N r u I (^r r>I . � rii ��( � � � l6 � I't �� la (-n ./ v�r� < � �` C u � rr- ("•rr -f ��n I t 7 � ci 1 .]✓ 7 �� } / � 1 L+ A y r r rc t„rN r - 7� j � .7.1 � '•j. ! li u �.� � opt / �• � � �Lt�l �*, F-tl:� r l7I If r do lo el / r { r r A—; —7 I hereby certify that I have inspected all of the above work,unless otherwise noted,and to the best of my ability I have found this work to comply with the approved plans,specifications_applicable building laws. Final report issued at project completion. Inspector: t. Contractor's Representative: Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS STRUCTURAL MASONRY INSPECTION REPORT Date: / 0 -191- 0G, Project Name: Project No: The Madison Club - Pump Station �Z. 06-1018 Project Address: City: ❑✓ IBC -- La Quinta, CA Title 24 Client: Sub-Contractor: Ownert \ Sabor Mason Other: '�,-, tti h, C� -� Masonry General Contractor: Architect: Structural Engineer: Davis/Reed B. G. Structural Engineering, Inc. Slump(inches): Supplier: ��� . \'N \ (n , Weather: Time Sampled: Mix Design: �-- r Time in Mixer(min.): Specified Strength(PSI): Unresolved Items: Water Added @ Jobsite(gals.). T 4, t? i Addmixture: Concrete Temperature(F): Truck#: _._._ Ticket#: None Ambient Air Temperature(F): Field ID Marking: E] see Below Location of Sample: © No Samples Taken Description of Work Inspected: , , •,� , � , T�,. _ C �� Aon+,. ,+ ltd(•�_ C 1 ntl�/�1r h.1 �-1 a n` C+`yam.-♦r �r S +-47 r11r�,, `+r Cn,r1,1 . .]rl-.� (�.\ r ^r�, }'`'� �.. ,r gyp\ \ .\r ` \ r�� n �l �' I• * !�. n A, 11 . lc\ ' • k r F'��\.\ Cr, �._ rl �fC ♦r\Qf0 c^. 1 l,f h... I hereby certify that I have inspected all of the above work,unless otherwise noted,and to the best of my ability I have found this work to comply with the approved plans,specifications_applicable building laws. Final report issued at project completion. Inspector: Jack C. Millin 1 ICC Certi icition No:0842216-82 CoriiCrr�a�ctorrs Representative: Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page T oft v JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 ; INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS ` STRUCTURAL MASONRY INSPECTION REPORT Date: j/1.7 04. Project Name: Project No: The Madison Club - Pump Station #2 06-1018 Project Address: City: ❑✓ IBC 81-364 Avenue 54 La Quinta, CA F-]Title 24 Client: Sub-Contractor: The Madison Club Sabor Masonry Other: - General Contractor: Architect: Structural Engineer: Davis/Reed B.G. Structural Engineering, Inc. r Slump(inches): / Supplier: 5, (r f Weather:t t Time Sampled: 7 ;0 5/ VM. Mix Design: Time in Mixer(min.): l.�.1 �'� Specified Strength(PSI): Z 00 U Unresolved Items: Water Added @ Jobsite(gals.): Addmixture: ❑ None Concrete Temperature(F): %4° Truck#: Ticket#: Ambient Air Temperature(F): Field ID Marking: ❑ See Below Location of Sample: VA /y-( r'r+I-LA F!- 7-L, ❑ No Samples Taken Description of Work Inspected: FO u L, G .j ,!VJ ` �i v1 - ���f i,J ( .j�(• - (,lJ't l r .� -T l.+ �(r. �� ! ' ^r / .f , %iw ' !� U •� � t �7 ` 1 � t "F' .7 tr �L1/� /l�'fl /i+ rJrf . fF" s tilts t-f C� , ' s � /(7"f L 4rK /!f l �7d, r CK tr s , I" J I r 11_;q ?'i%,. L" e" �F\ , ) {�r �t1'✓ -).J ,a l-nr��iaa, �^ �, 0��-tn�' S-J 1'('1 )--/'I (A I,��.� r/x„o�..r I ` hors P:�. "Y 1-ai1.1 _F0 it �/x �:.n y P �t)-f F,l 1""115 ' (­ . '" r � ` 4r` 4 71 All 1'7 l 1tI l I-ti11- e•-.f L' '0 -1 7- r') I hereby certify that I have inspected all of the above work,unless otherwise noted,and to the best of my ability I have found this work to comply with the approved plans,specifications"applicable building laws. Final report issued at project completion. Inspector: y /� qV Contractto�r's Representattii-4:) Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of s '