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0205-181 (ELEC)M LO N ON U rn It d Q raCC 0 LL 0 J J mUU O d LO ,.I- Z_ obrys V J Wfl 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 592103 C10 a /f �(}}I1`Y?i Date '^° ( 0 Signature of Contractor •fir~� '� ` 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. I have and will maintain workers' compensation insurance, as required by 1 ection,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,� a. )z Policy No. W §14,* I.'1, 13 (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' compensation provisions of Section 3700 of the Labor Code, I ,s,al[ forthwith comply with those p bvisioms:-•-•••­.,•- , Date: - Applicant Warning: Failure to secure Workers' Comp'ensation•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 property for specti inon purposes. Signature (Owner/Age)' -- - Date -� PERMIT PERMIT# -BUILDING JJj 4D'2�:r•���. DATE ; A /� VALUATION LOT TRACT r ���'���•�� -" wr',/J JOB SITE APN ADDRESS 718410 C'"Jur, vsr4wa �*� F OWNER CONTRACTOR / DESIGNER / EN 1NEER LIL 08 iIMAtJLLAWF SIAL L XLW�FRIC 778-1 10 CAIS X RSTAIDO 2401 VIA M{)NTE.'irl rA, CA. 904253 PAIM OPRING114 CA— 92262 (760)3323,4r.2 C 0 4TAI USE OF PERMIT IME MICAL 1 VALIJAMH Y's F18L.ld113.13)( W QVCON 1A94AM 419g�V3'ffF'.RV�' lqy suOky "IRM MANWwNX REN 101-60b-,439-312 1 -60b -,43 -n12 CONS TROVU014 ME 1.01-000419-W U'#:x?ia d`k CAL I CITY OF LAQUINTA FINANCEDEPT. �UH-TCS',CCCNS`I`RUC:;d'ION �YL.)P'.L�AN CJ g24' $245.55 I~ iIS�I�V FEN $0.00 • W14.Ai•G M MMEMS D019 NOW RECEIPT DATE BY-- ___, ,,,,-,, , ,DAT.E..FINALED INSPECTOR jjrn 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 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: ��U t)✓ �~ G> 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) 0 BALL• N&4state Contractor's Lic•a592103 i 4piz.i-e 27, 2002 CIROS R.iztoAante 78 110 Catee E-6tado La Quin.ta, C4 IID Rzte2 (.4L 1/34-3303) 72an,3;eoAmea (UN6357P) Ex.izt.ing ze.2v.ice 2004 1P11 120/240V. CONNERCI4L L04D ' CALC1ZLA7I0N Phone: 760.323.4822 Fax: 760.323 * 3822 2401 Via Monte Vista Palm Springs, CA 92262 100% 4 i2 Condit ion ing 19. 88 KU 1500 Sq. T;L 4 waYL6 /zea 6.00 KO Oven ?..2owe2 1.04 KU Makeu12 ,4.ilL 1.12 KGl Waik--in Cooie2 3.01 W 7 Not % iatez @ 1500 watt.6 12EA 10.50 KGl 3 �2eje2.ige.zate2 tageez @ 1500 watt each 4.50 KU N-ixea 2.19 KO Oven 1.50 U) D iahwa-she2 1.56 KGl Ice - Na,ch.ine 1.44 W Co//ee Nake z 1.50 KN Rze e/z ige.2ato2 1.50 W Not Food Se2ve2 1.50 KU E,6p2ea.6o (7achine 5.00 KO 7074L 62.24 KU 62.24 KU d.iv:ided gy 120/208 v etz, th zee phase = 172. 96 amps (62,240 wattz divided gy 1.73 = . 35, 976.87 d.iv.ided gy 208 voitz = 172.96 amps c-o•an,ected .goad) . . 400 amp, 120/208 volt, thzee phaze 3eAv.icg to ge .inztag.ged. S.ince2e.gy►$-1lQ C,A�L�G CITY OF OF LA•QUINTA A RE -INSPECTION f.E� OF '$30 •SDILDING & SAFETY DEPT. Scott Ba.Lg- IlYiIIBECHARGED IFTHE APPROVED APPROVED PLANS AND JOB CARD ARt NOT ON FOR CONSTR TION THE SITE FOR A SCHEDULED INSPECTION: DATE 2062 BY ' .NO EXCEPTIONS! 1 I o ALLEY 0 R A RE-INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PIANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. A ©(CEPTION31 25' , 1 fi / °o /9'rYP lot, o 3 O 'q O O O O - � lJ {tap Arn�J i42vg Vo !T DJ I DOCle' M''N E"X/ST!/1/6 B011_01N6 RE///SE ,EAST CURB TO E41A41A1 7*E lR14Mq4/1_AR CoNF/q URAr10A1 . �.. A:'.c rf1SZ_,0 STRI PIAlq PL AA1 FOS' 78 -//0 CA E 5 rA0 0 MY CSF I► QUINM . 8U1L MQ & $Ai-MY . APPROVED �ODtO11B�{t! E3 Planning C; m MhWM ....,,, «,... oma O City Council "%"M ,.» w ,comma" Do% Dept ZMD- � Now Initials �.., ,«.,,.POO capo - Case No.,....,.M«.. Exhibit ,,,,, Fi rcH Enic�niEERS iNc. 9 with Conditions PO.130X `V5.5 /:7/-1 Al OESERr '45 fo'C_/I Silk vlJ�T'S���s/�2 CA. 9226/, 760-3.5-7667 ALLEY Aires, MLi1l M R AMEP o mo Jos $maNOT flip sAfffiaFft Ix, 0 0 0 X11 25' I r .EXIST//VG BU/,LDING Rz !/ISE E.4.s r ! G�rQB To' E,G IM l ivA T E TR/4Ng1-/4' AR C01Nbr1 URA i/oN 78 -//o C-A1./.E Esrrao0 v �PRVEY / F No. 1257 9lF Of CA`\EOL* CrTY OF IA QUINTA ISULDIN© & SAFETY DEPT. APPROVED FOR CONSTRUCTION ti !/�tz 3 I F/ rCH ENGINEERS //VG. Ro. Box mss Ri7/. M o.EsERr CA. 9226/, 76'0-911,5-7667 1 0 0 /9'Tep. lot, h 0 o � o 0 6 2 77:7// . r .EXIST//VG BU/,LDING Rz !/ISE E.4.s r ! G�rQB To' E,G IM l ivA T E TR/4Ng1-/4' AR C01Nbr1 URA i/oN 78 -//o C-A1./.E Esrrao0 v �PRVEY / F No. 1257 9lF Of CA`\EOL* CrTY OF IA QUINTA ISULDIN© & SAFETY DEPT. APPROVED FOR CONSTRUCTION ti !/�tz 3 I F/ rCH ENGINEERS //VG. Ro. Box mss Ri7/. M o.EsERr CA. 9226/, 76'0-911,5-7667