9907-518 (ELEC)_ 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 -
"397002 C -t 1251i20i /
Date lb" 97 'Signature of ConDsa�^XVVNItract �'
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).
O I arnexempt under Section B&P.C. for this reason
Date ` (�" �3 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.
(,VKI have and will maintain wrkers' 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 insuiance'carrier.& policy no. are:
Cartier' . ' Policy No.
17F.1 ,1074t'CO>vYI, Sf1 (hfl93;fx3tS35
(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.1 should become-
subject to the workers"compensation pr visio sof Sectio 3700 of the Labor
Code h 1 o,RCiWith comply with se�irov,si0 S.
Date' Applicant
Warning: Failure to secure Wo'rke'rs' 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
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 propI. rty for ins cti purposes.
Signa urt a (Owner/Agent) t "�Date
M
PERMIT #
BUILDING PERMIT 7-519
DATE VALUATION LOT LOT TRACT
• i
JOB SITE
ADDRESS 76-9" I��T�iiOCE A F ERNANDO APN '\
OWNER
I
tbI(. E UKLE1A.
76-990.AV.?bilD!•t. FRKMAe'► DO
USE OF PERMIT
v i ii.,I1MIGN
CONTRACTOR / DESIGNER / ENGINEER
COVE
H ECIRIC,INC.
77824RbL1JrDR
PA -L ki Dri9H RT C.A. 92211
(619)3.41-006 CSXJ. 79
I'SP09.00 LS
k
ESTIA"IED COST OF WNSTRUCTION,
PERNIff "M SUMMARY
f!'f."CITIUC•JAL FFE 101-000-420-000
1 iCI1�C'LA(N(,' 1`'�y"- 'a
TE)°w,Pui10ar VE*.'s n't.17E jvoW
RECEIPT DATE BYZ.,✓y DATE FINALED INSPECTOR `
SAI an/nf l
y,T� 01)
$3.44o
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam -
Approval to Cover
Equipment Location
;:.
Underground Electric
'Underground Pibg. Test
Final r
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
COMMENTS:
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)
1999 12:53 FAX 7605884087 MARRAKESH CC 002
July 13, 1999
0
P. Michael Ukleja
76-990 Avenida Fernando
La Quinta, CA 92253
Dear Mr. Ukleja,
CP Dove 64e -c.
A(c
Per the verbal request made to this office by your caretaker, Mr. Bill Hays, the Board of
Directors for Los Estados Homeowners Association has approved the installation of a
temporary power pole at the property listed above. Please be advised that every effort
should be made to keep said pole as inconspicuous as possible. Please also be advised
that said approval is only for the duration of electrical repairs to your home. The power
pole must be removed as soon as possible upon completion of the renovations.
Please don't hesitate to call me if there is anything I can do to assist you in this matter.
Sincerely,
J Baker for Carol Calhoun, Property Manager for,
Los Estados Homeowners Association
Professional Community Management / Desert Resort Management
Post Office Box 4772 • Palm Desert, CA 922614772
73.550 Alessandro, Suite 5 Palm Desert, California (760) 346-1161 PAX (760) 346.9918
C
07,•15'/1999 12:33 FAX 7605664087 MARRAKESH CC
07/15/1999 11:26 17603607895 COVE ELECTRIC INC
�O1
PAGE 02
OVE 77-524 WII&At VrNs
CTRICi
C Palm Desert, CA 92211
1
i1C060) 36"M
. Fax: (M) 380-7896
ema& p1mds+taCOVE-ELEC7RIC.com
www.COVE-ELF-C'rMC.com
July 14, 1999
Mick Ukloja
76.990 Avenida Feniando
La'Quinuk CA 92253
Atter Bill Mays
Subject: Temporary Power Pedestal
We am. phased to offer the following proposal:
1.. Fur" neco>isary trenching and backfill.
2. Furnish tenial and ilnseeltmion of (1) 100 znp 120/240 volt temporary power pedeatal.
3. Furnish and instal[ necessary PVC owwW fivm I.I.D.'s transformer to new power
>?edc"•
4. Furnish and install (1) 60 amp load center.
5. Furnish aid install necessary conduit and wiring from new power pedestal to new load
center.
6. Furnish necessary councctions from new load cuter to existins pool elscbical.
7. Furnish city Dern k and schedule in_speadons.
8. Furnish scheduling of powor coanecdfon with L.I.D.
Far the rum of: S11M.00 .
QUALIFICATIONS
for inconveade
1. We excludc any rupoasib ty aee caused by this work
2'. We exclude any pre-wia tlg electrical p roans found while performing this work.
3. We mdude any local power company fes®.
CAVE ELECTRIC, INC.
JACK DERMAN l>-
Service Mabegar $off N1� CK L114�, jo,
JD/cjk
hays