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0202-127 (BLCK)z c ++ ` '+ � � � ^ � � �� � �'"�~� ��—s.�^�*~�..-+ �o'�;��� �.��'=p ' LICENSED CONTRACTOR DECLARATION U�eeUyaffinn under penalty of perjury that | mn |kmned undo provisions of ^Chapm,9 (mmmenoing with Section 7000) of Division 3 of the Business -and Professionals Codo.and myLioo?»aiainfuU�nmand o*e�. ' , uvn�e # �' ` - uo.u/mm, Exp. Da� ' 734470 . A' 041301?1( "Date '.�214"12 Signature of Contractor,( OWNER -BUILDER DE no I hereby affirm under penalty of perjury that I am exempt 'from the Contractor's License Law foe ��,fdlowngreason: 1, as owner of the property, or my employees with wages as their sole Workers'compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) 1 1 �as' owner of the prope . rty, am exclusively contracting with licensed 6oritra�tdrs'io 6onstriJc'Cthe. project (Sec. 7044, Business & Professionals I am exempt 6nder Section L, B&P.C. for this reason Date. Signature of Owner WORKER'S COMPENSATION DECLARATION i 'h&eby. affirm 'under penalty. of perjury one of. the following decilarations: I have and will maintain a certificate of consent to self -insure for workersi compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit'is issued. , (- j' 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 -Policy No. (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'sh611 not employ any person in any manner so as to become subject to the --m,_ ' subject to the workers' compensation provisions -of Section 3700 6f the Labor in Se 0�66, I shall forthwith comply with tho a rovisions Warning: Failure to secure Woek/ws7Corm�rpe,n-s—atf4ii��covet�r;aige 1�unlawful and shall subject anemployer to Criminal penalties and divil i 'es-upto $100,000;, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, . � IMPORTANT Application is hereby made to the Director ofBuilding 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. Ahy 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 �:p�rmit, or cessation of work for 180 days will subject permit to cancellation. | Certify that nhave read this application and state that the above information ia oonem.|agnnaoocomply with all City, and State laws relating oothe building oonstmmion, and ooneuyomxonze representatives o,this City to onm, upon the above' montiuned ��ponyfo, inspection ~�~_.- ,-'�...°—., PERMIT # BUILDINGPERMIT DATE VALUATION LOT TRACT JOB SITE APN OWNER CONTRACTOR DESIGNER EN61NEER P01=777 9 0?.001XfffR LAM LAL QITMA CA 92253 BUMMADDIM2 'CA 92201 USE OF PERMIT 6 FT. WALL LF 4 FT, WALL X'SMIAM Con OF COMMUC110N C0.42MUCTION YES 01 -000-41 S-000' C _KD PIAN CMICK FEM $0,00 of: ukaulftM FROM _�ECEIPT DATE DATE FINALED INSPECTION RECORD OPERATION DATE INSPECTOR OPER#TION 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 8 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 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: GFSTR/90 *1990 ETI PAGE OF CLIENT ENGINEER ETLJOB NUMBER, LOCA ON A��­ T DATE: T P A�4. TEST., EQUIP :IASSET*i. CALIBRATION: DATE:� .4 FIELD DATA SWITC H BOA RD M AN U F .Fl.O�, ACTUE RX UL,NO MAINOVIRCURRENT DEVICE MFGR ❑ CIRCUIT BREAKER FUSED SWITCH TYPE 0., fde49f+,/CAT. NO. CURRENT RATING'- SYSTEM VOLTAGE VOLTAGE RATING GROUND FAULT SYSTEM MFGR. EI2;`NEUTRAL'RAP 'RER0 -GROUND -SEQUENCE -.,ST. _M_' MODEL CAT.NO.F!+ftK-UP RANGE:' TIME RANGE SENSOR/C.T. LZS554 illcxz, 2joc> c, G'IrL 10 zLfo - AS FOUND SETTING PICKUPPICKUP AS LEFT SETTING 00 I- SETTINGS SUPPLIED BY CURRENT CURRENT TIME INSPEiCTION SERVICE ENTRANCE CONDUCTORS MAIN BONDING JUMPER GRO NO ELECT RD DE*CON DUCTO R CZ - PERPHASEs7o AWG 0 MCM NEUTRAL -GROUND LOCATION CONTROL POWER TRANSFORMER CORRECT ❑ INCORRECT ❑ CORRECTED BYCONTRACTOR VA MO ITOR/TEST PANEL OPERATION OTHER CORRECT ❑INCORRECT ❑ CORRECTED1 'M ELECTRICAL'TESTS BREAKER/SWITCH REACTION TIME (RT) REDUCED VOLTAGE TEST (55% RATED VOLTAGE)'-- 19SECONDS ❑ CYCLESCORRECT El INCORRECT PICK-UP CURRENT PICK-UP CYRRENT MINUS 25.% (4zk AMPS) AMPS Is NO TRIP (CORRECT) ❑ TRIP (INCORRECT) SYSTEM NEUTRAL INSULATION RESISTANCE TO GROUND OTHER MEGOHMS PRIMARY CURRENT PERCENT TOTAL REACTION RELAY MFGR. AMPERE -TURNS. PICK-UP TIME TIME TIME TOLERANCE TIME -CURRENT xD T3 CALIBRATION TESTS ,REMARKS Gr F S 4 .5 T 0—; r-,- .i <.-r, f,- r ,l/ 7 7 75- GFSTR/90 *1990 ETI PAGE OF ., ., aiy'rtt -'F'+zyr ii �S� c `1--.�:^Y�! v'S���+.C,.' : ,i r .? �'4t` �..:-...-'O' �, ::,T+=v-.,*t.-'��•.•sd�r��-5-..=L"1.��*y��3.�d�ru'°.L .{�i`'ir"r� ...'.. r�.. �.,'�-'i?f.�� *'l�••+'�' ..':�-�: ,41'�S�a+L'� ' •`3543 -^;s " u'*tS'i. " .c*3. Y- r .3 t�• `i'k a__ r v. t sa' �,`r,-, _.- + (s v+. rc a' tr 'tl:,.X•e.. 4':'S.[`�i.xri='a �7,:, .� 3q <r a.•. c r .n:.•7 rizsM1 i t' »'#-t' t� ;'S>••.L� f ° •t ,y^" e t � ��kr� +�� s j K �.'•:,.*f r ,r ','-a••4"A• e aw: 7a --'�1 �� �, .'rVct� ,:1qS+P�,:"J; "rn is Fi.) r„r,-• '''<h"w !r 1,'v'�' a,*.,.'�v•`�' e r •-.. „�' b '!R •,t,, •er• `$ i'-t•:.•,�esC t'` t,.'i4r' !y ,�,5 (Y�^' ..•,.'�j �_.`ei�� n,+"�• ^r.x,•: 1`.,>y..o•,'nv *"uft.'`1 7' e;;= -f <- i .Ty �k ,d.4+.. .�1=- r TV .'-d^-'t;A•* >ro'r .Y+Ss.'+.. an Y.i- :.•t 7.A N'S y ,.. tXi'-j,�,.t T+v. l l f'.�'•,• , 444! 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''�'" 'A,7' ^,�X�.i�.a`�as� �"""'�'-'-"t'Y•..a a:a'� �. �+ r,#, <J;1, ~� C�ft GROUND *F,.AULT �SY.STEM�yT - r� t :{ z { Ra ;,� 'a-F:5�7anJ'r.,% r''z'' »:!'tit a.. ♦ a „ < y. ➢ {5` s'�".,'..6 - s ?-t r '�-F'i.� ..r• S.n. h' .r. _ t ;. .H �.�-,s , �•.,,,�.....��.� •,< � �,� . - � k ; = �. ,�. �� • , ; � "TEST• REP,ORT.�r�,�-� . �>:. �,�, � �� �• x �.L�.. ,.. •- p; wr :e,. � .:: at �y�,.p.-� ,s 9. a �` .,,5 ..rte � � �.arm•�;,,v'S.r+�•i-{'Fi+�rY�.:..e��..�w,�+.,.�� i •yt.r�r•�r_, .. 4 N+ems'°� •":a.�t-^v'•� e:.'�s:�-. ? . s .kr,ti_�v:.iG...mki'.i-++�i.sy�,::-:,'...rk.-`..'�.,9 �3''.'�J� n.-•..?..h�'�.a;.,,.�...+i::,a�?to.�.ai:'�Fiity..s'-.+r,,,.. c-•..XF��.'�•e le"�si�.:,1ti�5`: - :.� t ENGINEER. y'�' I:1 B U'M�j�jQ}�' •` LOC,•,��iY y -•F1, "Af1��= 'r WITNESSst�� M"� All N- i - DATE­�x� "s SWITCHGEAR DESIGNATION: TEST EQUIP ASSE # CALIBRATIO.N DATE. .xa �..��..�.,:,'�' "��,.y:t•*s,�es.�::tr��r... r� ®wub®� Nisar_: SWITCHBOARD MANUFACTURER*+ SHOP ORDER`NO. ti �,-: ,s r ..tom r. d ky Fa+..c 4 a'-:••-. i _ �_E• L •_ r � , aIEfS9-.9-7 _ MAIN OVERCURRENT T.DEVICE t", - _V - .j. CIRCUIT -BREAKER ❑ FUSED SWITCH MFGR i•`": v'`' � fifes` V.5, . J TYPE ';T', +z4SIT MODEL/CAT.-NO. ' CURRENT RATING% 11QOa SYSTEM VOLTAGE '.. .. VOLTAGE RATING .• ' GROUND FAULT SYSTEM 'LL:S I OA lt„ ❑NEUTRAL -GROUND STRAP ❑Z WO'SeMUENCE MFGR. �i�ir�L'IJ.S MODEL ..ZHT E1 . CAT..NO. �1 �... PICK-UP RANGE �f l "' c� *` TIME RANGE SENSOR/C.T. AS FOUND SETTING i PICKUP ENT.ry TIME t AS 4ET-�•T"SETTING PICK UpCUR CURRENT �0 / &TIME a e SETTINGS SUPPLIED BY �rc... `4+r�r�.,�'C.��r- • • -. SERVICE ENTRANCE CONDUCTORS:' '-+. MAIN BO DING JUMPER +,b�–z - A�. PER PHASE GROUND ELECTRODE CONDUCTOR:'= y AWG ❑ MCM jNEEUUTRAL-GROUND LOCATION m0RRECTr ❑ INCORRECT ❑ CORRECTEDBYCONTRACTOR CONTROL� ,V JOWER TRANSFORMER VA - MONITOR/TEST PANEL OPERATION S, ( OTHER C-1 CORRECT ❑ INCORRECT ❑ CO RECTED ELECTRIC BREAKER/SWITCH REACTION TIME (RT).:: -%` ❑ CYCLES AL,TESTS jREDqcED VOLTAGE TEST (55% RATED VOLTAGE)[ASECONDS �❑ CORRECT ❑ INCORRECT PICK-UP RRENT '� -4 - AMPS PICK-UP CCUj RRENT MINUS 25°6 AMPS) LT NO TRIP (CORRECT) ❑ TRIP (INCORRECT) SYSTEM NEUTRAL INSULATION RESISTANCE TO GROUND "> /4=�O P MEGOHMS OTHER ��L��„ r <D K ' PRIMARY CURRENT PERCENT TOTAL ` ' REACTION RELAY MFGR. ` AMPERE -TURNS PICK-UP TIME TIME TIME TOLERANCE ` 9 j /©� f a 9 e - . ± y� •�� d� TIME CURRENT CALIBRATION a�d �) r `T i o TESTS REMARKS GFSTR/90- --- - - - - - -- — - -- `a'=M. 01990 ETI _ — y PAGE OF`