0210-078 (ELEC)LICENSED CONTRACTOR DECLARATION
•1=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
C#1 i t� s-Lic. Class Exp. Dr�ayteef''
AS C61
,Date r�a� Signature of Contractor � ' � F � ✓'� ���-'f
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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,y: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.
p,,(�') 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 s AT1?,1='UND Policy No. R46 il�Dl-tea
(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' compensatiopp ovisionp ofSection 3700 of the Labor
Code, I shafl fqrthwith comply wit hose�pravlsio" S
Erate: M1 !?1 Z- Applicant
Warning Failure to secure Workerpensation coverage is,unlawful and
shall subject an employer to criminal penalties and civil fines up t6,$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.•repre ent tives of this City to enter, upon
the above-mentioned propertyyfor'inspect on,,rrrposes.
Signature (Owner/Agent) r�`I ^ /t�j.'� Datef`'
BUILDING PERMIT - PERMIT #0210-0118DATE 1017 Y,+LUATIO 'r,E J LOT TRACT
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ADDRESS 78-44 IGMT 'AY 11.1. JOB SITE
APN
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OWNER CONTRACTOR / DESIGNER / EN (NEER
M &.14 PROPEXTY 1V1R,XAGJs'MM;rr B1:wr Tzm, w
1 25 515 1:$10—TY' j'3LG11F.l"1MV.'z 1;55() 't3, GINE AMR Y TRI\;UI
(1600,320-240 7 C.'BLdf 3704
USE OF PERMIT
F L E.C. uc
res T SJLN.AaXY' J11,131b INATED Stoma * P&R' A #02---M2 (]+Ti+ V Cl7.A!TI) R.Y
T al,g)
VALUATION '%swoo I's
EL-ECTRICAL 101 �000-410-00Q' %4100
MMON AND .Y.1dO O8.7l i.t.1A. '$45.00
".36. a.."VIDES DUEN-OW S45,00
G\ E �Pr1C�
s
RECEIPT DATE BY DAT E L INSPE OR
c
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
-
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAI S
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Mumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final -
Final
Utility Notice (Gas)
ELECTRICAL APPROVALSL3
Temp. Power Pale
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: '
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APPROVED BY COMMUNITY DEVELOPMENT DEPARTMEN'T
BY DATE
EXHIBIT _
CASE NO..
New Century Tittle
:.,,....�, .�y_� �,'Ira*1.i`�'a4.r"�^,,,,�i„�`,.",�j�eLti3.5:'l�iw°ii.c�'E,Y:iL.�.JS+'iF�$..°Si���r,.t'Ls�!%."::lJ°R�'1CZ.l�r+„%"���,,."A+.f'-�"�'-'T'�t•
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ALL IDEAS, DESIGNS, ARRANGEMENTS AND PLANS
INDICATED OR AND PROPERTY
OWNED BYA OF RST SIGNS,IN AND
YVELOPE SFORUSE
Rep:
file: Newcenturytitle/elevations.
gty:1
scale: 1/8"=1'.0"
3'
EON AND IN
CREATED, EVOLVEDAND EON IN
EVOLVED ANDPED FOR
I N C O R P O R A T E D
T,
CONNECTION VAIN THE SPECIFIED PROJECT. NONE B SUCH
SPECIFIED OF
IDEAS, DESIGNS,ARRANGEMENTS PLANS SHALL BE
-�--.-.-.-"'--�� "-'— '�""
`'���THE
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USEDBY OR DISCLOSED TO ANY PERSON, FIRM DR
RITTTEA FOR ANY PURPOSE PERMISSION Off OESSIGNSOINCR WITHOUT
item: Hwy. 111 facing elevation
date: 9/7/02
Jx Y
IIn
New Century Title
APPROVED BY COMMUNITY DEVELOPMENT WARM,
LDATE
EXHIBIT 3 D
CASE NO. '::-:M
1. Plexiglass face
2. Electrode Insulating Boot & GTO Sleeving
3. 13mm glass (neon)
4. Glass stand tube supports
5. Conduit lock nuts
6. Transformer - UL 2161 listed
7. 20 amp disconnect switch
8. .063 aluminum backer
9. 1/4" thru bolt w/ washer and nut backing
UL LISTING SUB # 763140-001
ARRANGEMENTS AND PLANS
INDICATED OR REPRESENTED BY THIS DRAWING ARE
ALL IDEAS, DESIGNAND PROPERTY
OWNED BY AND PROPERtt OF BESI SIGN5.INL AND WERE
Rep:
file: Newcenturytitle/elevations.
qty: 2 Sets
scale: N/a
N C O R P O R A T E D
- _
CREATED, EVOLVED AND DEVELOPED FOR USE ON AND IN
CONNECTION WITH THE SPECIFIED PROJECT. NONE OFSUCH
IDEAS, DESIGNS, ARRANGEMENTS OR PLANS SHALL BE
USED BY OR DISCLOSED MANY PERSON, FIRM OR
CORPORATIDN FOR ANY PURPOSE WHATSOEVER WITHOUT
THE WRITTEN PERMISSION OF 661516N,_,5 INC
1 PIC
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item: Letter electrical opec5.
date: 9/7/02
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WALL AT ENTRY=105 SQ. FT. / SIGN=33 SQ. FLOVED BY COMMUNITY DEVELOPMENT
21' RV DATE .1
EXHI IT
CASE N0, A
5' 30" New CenturyTitle-=10"1151,
WALL FACING HWY. 111=141 SQ. FT. / SIGN=33 SQ. FT.
23.5'
B' 30,E New Century TitleL,5"
ALLIDFlS, DESIGNS ARRANGEMENTS MD PUNS
NTE DBTTNISDRAWINGARE
INDICATEDONED BY AND R OF dRU
_ Rep:
R
.
file: Newcenturytitle/elevations.
gty:1 ea
scale: 1/4"=1',0"
(RFATED,ir
EVOLVED&NDDEVELOPE FFOEONAND N
(DNNEDONINTI THESPEtlFiEDFRI ER NONE OF SUCH
J�C
item: Letter size specs.
.
date: 9/7/02
I N C O R P O R A T E D
IDEAUSEDS DESIGNS ARRANGEMENTS 0A PIANS SHALL 8E
CORPORATIONORDRAED TO RPOSE WSON, FIRM OR
FOR
THEWRIA� �ONOFGSE RWITHOUT
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