9607-053 (ELEC)LICENSED CONTRACTOR DECLARATION PERMIT# CONTROL#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT 9 3
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Chapter commencin with Section 7000 of Division 3 of the Business and 9607-053 9
p 9.(commencing ) d DATE VALUATION LOT TRACT
N W Professionals Code, and my License is in full force and effect. 7/I1106 t.OlNl.Oq
O Z) M License # Lic. Class Exp. Date
JOB SITE APN
O `r I+.>�1R ADDRESS �fi-775 CA1btFU i'ALI1�S 643-199-0I3
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Z ate211 7 Signature of Contractor /l l r' " "' OWNER CONTRACTOR / DESIGNER / ENGINEER
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LLI W
OWNER-BUILDER DECLARATION FILED II & DEBORAH ('C)VEI,Y WOOD ELUII` IC'
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 40775 CAMEO PALMS DR 444 W PAIAI S1'REIN'
~ U) License Law for the following reason: LA f?IIINTA CA AI:I'AI)RNA ('A 141001
Z_ ( ) I, as owner of the property, or my employees with wages as their sole ( 81P,791.3410 CRL0
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals NLE('iRICAI,
Code).
cY)() I am exempt under Section , B&P.C. for this reason U110RADE MSTINO 100 AbiN SES(VICM TO 200 AMP
N Date Signature of Owner
ON
IL Q WORKER'S COMPENSATION DECLARATION
t:t.�NYI<Al.'f AAtI►I�Ni 1.tM►t►+ifl t.3
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self-insure for workers'
X w L= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
ED Q I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
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Z permit is issued. My workers' compensation insurance carrier & policy no. are: I�;STIMATEID COST OF CONSTRU( UION I,t1t1(1.Oi)
Carrier Policy No.
aD 5 )ICKMIT E FF, SUMMARY
r, C) i~'t.I:C"IR i(". AL PT-.E 101-000-420.000 V15(1
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: ;11'71 OK Applicant
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 SUR-TOTAL COMITM JC TION AND PLAN CHECK $33 V
whose request and for whose benefit work is performed under or pursuant to LESS PRE-PAID FEES $0.00
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 D 0 All, PER10IT FI IT,«S 01%, NOW S33"
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. JUL
I certify that I have read this application and state that the above information is (( 18 1996
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 it By
the above-mentioned property for inspection purposes.
j, RECEIPT - '-- - DA ._BY DATE FI ED INSPECTOR
Signature (Owner/Agent), r�l` `t+- Date" 7Z �T--
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail 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 I I
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
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:
78-495 CALLE .TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 24, 1997
Fred H & Deborah Covely
46-775 Cameo Palms
La Quinta, CA., 92253
RE: Electrical Permit #3719
Dear Mr. & Mrs. Covely
The purpose of this letter is to inform you that your Electrical Permit #3719, for the project at
46-775 Cameo Palms, has expired. In accordance with 1994 UBC section 106.4.4, no further
work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder. .
Please contact us at your earliest convenience. prior to 10 working days to resolve -this issue, and,
for any questions you may have.
Sincerely,
Mark Harold
Buildi & Safety Manager
Daniel P. Crawford r.
Building Inspector I
d
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 �J