9810-110 (ELEC)LICENSED CONTRACTOR DECLARATION
> I.hert!3Y 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
2071:a(i C4,5 C,61 C 10 4/30/99
,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 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.
(X) 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 (( 4 FUND Policy No. JAI V18-17-98
(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 11 should become
subject to the workers' compensation provisions of Section 3700 of the Labor.
Code, I shall forthwith comply with tho e rovisionS.
VD'ate: i'2/5;P"fA Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and,.,
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and"Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person ate
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
--2. Any permit -issued -as-a•result of -this -application becomesnulland void -if—
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction', and hereby authorize representatives of this City to enter upon ;
the bove-mentioned propertyfor inspection urposes.,. i Y0 /
;Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#g,-1~)fP CONTROL#
DATE 1g)/, f!)8 VALUATION S2;990.1)0 LOT, TRACT
8469
s
JOB SITE
ADDRESS 78,561) HIGHWAY 121. #1-3APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
NUCH AEf,:
IMP'E fUAL SfC'N CO.
78600 P -I i"3Kti:! t Y I It
S -120 C: i' LHOUN
LAQUPPI'PA CA 922:
PNCIO CA 9'22101.(760)347-3566
(j 60)3try7..3566 f:.d��} AP,yy
� LIY_J
USE OF PERMIT
.EI. EC`.'i U"; ::KPI'�d' FOR iVt%LNUSKAS EYE WS"UTU E - C AAiN171
1,E 1."1:0 S PER_0k'F9t0VA1. BY. COMibfU110TY
VALUATION 2,990.00L.$
.- Ct.ST1AINIT11.".) CCi4>ZT Olt' �:�3iV�a a°'ld.vC"a'a€�.R
- :2.�".•i3.`�tD
qq � pp qq. �y[yy r vet �ryq
E1,£:C'lRICAL ai ' POI -000420 -NO �.►w.cso
lam
-
N P 'COTA.T, C'>C)iRSTR1Jr_M0 �l AND MLAN! C�'iErK
515.0(1
L LESS PRE-PATIOlaFES
$0.00
01
V`
AN 1
'
RECEIPT +„
DATE
BY :
DATE FINALED
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
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 i
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
f
Final
Utility Notice (Perm)
COMMENTS:
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OF L-
Ul
& SAF ETY DEPARTMENT
CONDITIONALLY
AtCEPTEDFOR CONS(RUCTION
sUaJMTT0 INSTALLATION AS PER
AND ALL APPLICABL COM -6
BY
Listed tube support per
manufacturer's instructions.
NEC 600-4; L'b).
Neon tube pe; manufacturer's
instructions. NEC 600-41(a).
Listed grass cup mounted upright,
horizontal or upright to drain in damn
or rel focations. See dvrg C3A for
assembly instructions. NEC 600 -42(b) -
Spacing per NEC 6DO 41(c).
Profeetion of neon tubing.
NEC 600-9 (a), (b) and (c).
Listed electrode connection
enclosure such as listed glass
cup mounted upright and listed
canduif plug assembly. See
dugs C3 and C313 for assembhf
instructions. NEC 60912.
Seal building penetr,
with applicable budding cc
Manufacturer's Name
Address
DATE:
VOLTAGE:
AMPERES:
No. LAMPS:- -- -- --
Nlarkings per NEC 690.4
n
eteCtrlcai source
10.5.
tisconnect switch in primary to be Whin sight (maximum 5011.) of sign.
nterpret transformer enclosure to be part of sign.)
10-6.
ex (metal shorn). NEC 60D.32
'TO cable (minimum t05°C). NEC 60D -321b)
g C6 and C7 for detail requirements.
Imetalfic see dwg C6A and C7A.
id transformer enclosure with sheet metal cover.
0-7, 600.3 & 60D-9.
1-1,'2 in. minimum. NEC 600-32(e).
At damp, wet 'or outdoor tocations all raoevray fittings and banes
must be areatherproof and include drain holes. NEC 6C0.9 & 600-9(d).
Listed transformer' (NEC 600-23).-
Accessibility.
09-23):Accessibility. NEC 600.21.
casteners'a reouired by local jurisdiction.
�1 hereon may ba
reproouccd or used n any form or by any mcans - grapllo, era.Uoni:, cc mc-charical, _
including photocopyhg, rewrdirg. rapiN. or inrorwvOinslcrage and relsiaeal syslo ns
-without -oTiften permission cf the publisher, eocW, dW simile conies of incNidual
pages may be made by a bona fide eleeAcal sgn hstallal5Dn Erm for the sde purpose
of yfvAding gtirance on the insla Wion of el drical signs or outline lighting, xithcut
the pernision of ft puVisher.
Installation of nonlisted o0line lighfing
(As per NEC Section 6DD-3)
F=IELD INSTALLED SKELETON TUBING
INDOOR OR OUTDOOR GLASS CUPS —
AND CONDUIT PLUG ASSEMBLY
Date: April 1996
fAEIA NEC-TSDwg. No.
ON
ui
r}f
BUILDING & SAFETY DEPAWMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABi.E ODES
o/,946 BY