ELEC (0210-038)57325 Madison St
0210-38
LICENSED CONTRACTOR 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
.197002 C 0 F.IC ! 17.F31iiJ4
Date Signature of Contractor, =
r f 4
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 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
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 & policy no. are:.
Carrier INaDEM-lRI) LITUA Policy No. 03•y00g3
(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, fI shall forthwith comply with those provisions.b
bate: 1/1 .7 a 171. Applicant / i w_ir
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the coriditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
J
Signature (Owner/Agent)* f , •- f If t +. Dated a ? • a
me
BUILDING PERMIT PERMIT# -
DATE 232 VALUATION =0M LOT TRACT
iA
JOB SITE
ADDRESSi$: r:r cb.L
}yy1
APN
OWN E+gR•
CONTRACTOR I DESIGNER EE+N} 1NNEE/EyR
` •, /• qq
.CinCM4 lM l. O q.J. 1111 1101 ~
,
a, o `i.C✓ :Li1L'al 1. ac, 9,f.`l c.
68-845 PWZRC:AD. SLUM 30
i787A W:i )C.NT'.-'DR
C ATHMPAT.Wf CA 92234
RNY,.Ar.2DESERT CA 9221
C160.V0150.0036 Qsil # 19
USE OF PERMIT
1N' f'.U,L NHW 200 AMP MAIV NeJMCF .f'ANE2,
il•Ai. ; . i'!"CATe y @. li L' .fir
ESYMMED COST or a[;O. FIRIUMO
l3UC #'FUCA ), PUM, 101 -000-420-0aal! DIN
D
t
OCT
CITVOF`AQUINTA I
`
i
FINANCEDEI T
19T3" 'R-IN'!+'CALCON'SURfC'.`TICS*T ` ,.AWP1.AWC-0CX
ski? 3.511
IMS ITRS-PAID ME=
$0,00
T01 AL PY,RMITMSID VE NOW
RECEIPT
DATE
/r % ("Y
BY
DATE FI AL
0 1a
INSPECTO
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
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Electric Final
Waste Lines
Heater Final
Mater 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:
:;OVE 7' -824 Wildcat Dr.
ELECTRIC Palm DesertCA 92253
d r Inc. (760) 360-0036 Tele.
(760)360-7895 Fax
traci@coveelectric. com
i
September 11, 2002
Elder Construction
68-845 Perez Road Suite 30 -
Cathedral City, Ca. 92234
Attention: Mike Allen
Subject: Electrical metered service replacement, located at 57-325 Madison Street in La Quinta
We are pleased to offer the, following proposal:
Scope of Work
1. Furnish the removal of (1) damaged existing 200 amp, 480 volt, 3 phase main service panel, to control
existing water pump or pumps.
2. Furnish and install (1) new 200 amp, 480 volt, 3 phase main service panel, in place of Item #1 above.
3. Furnish and install (3) new 200 amp, 600 volt fuses inside the existing fused disconnect.'.
4. Furnish the reconnection of all existing electrical cables to the new 200 amp, 480 volt, 3 phase main
service panel.
5. Furnish city permit and scheduling. of inspection.
6. Furnish scheduling of metering and cabling for Imperial Irrigation District.
7. Furnish power up and testing.
For the sum of. $2,940.00
QUALIFICATIONS
1. We exclude any responsibility for inconvenience caused by this work.
2..J We exclude any pre-existing electrical problems found while performing this work.
3. We exclude any local power company fees.
4. We exclude any new motor starters, motor rated heaters, motor wiring, and all labor associated .
(Additional fees must be charged- if deemed necessary.)
Respectfully yours,
COVE ELECTRIC, INC.
$&Una^
JACK DERMAN
Service Manager
JDA11
\\Cove exng\departments\Service\ 2002 Proposals\commercial\misc\Elder Const -meter svc 57-325 Madison St.doc