0208-102 (ELEC) LICENSED CONTRACTOR DECLARATION PERMIT#
1 hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
I— Chapter 9(commencingwith Section 7000) of Division 3 of the Business and �1`' l
ap rtSATE_ VALUATION LOT TRACT
N Professionals Code,and my License is in full force and effect. �i'.51ft1 ji'I1,itil
D co License# Lic.Class Exp.Date
JOB SITE 0 W r 03145 CI D Iiip , % 1P,3oim ADDRESS 7 r- ,51 112 AI�N'NUE 4? APN
� � . i " L�
Or- Date ~c W� Signature of Contractor �� OWNER CONTRACTOR/DESIGNER/ENGINEER
H o OWNER-BUILDER DECLARATION VVPIZON cOURTNEYr3 k :M..C1C INC
_iO `ti° }I f.10,411.1 urREET 272.02E3RDST
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
I— License Law for the following reason: REDLANDS CA 92373 HIGHLAND CA ' 2346
Z ( ) I, as owner of the property, or my employees with wages as their sole 0093662-5335 CM7.44 47;15
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 ELECTRICAL
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 100 AMP METER PEDESTAL.
0) () I are exempt under Section , B&P.C.for this reason
N Date Signature of Owner
O �
Q Q WORKER'S COMPENSATION DECLARATION
OQ , I hereby affirm under penalty of perjury one of the following declarations: VALUATION 7yt�,Ota 1�3
,— 1— 0 ( } I have and will maintain a certificate of consent to self-insure for workers'
x W Ii compensation, as provided for by Section 3700 of the Labor Code, for the
m —I - performance of the work for which this permit is issued.
Q U '() ) I have and will maintain workers'compensation insurance,as required by
O 0 ,, Section 3700 of the Labor Code, for the performance of the work for which this
li rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier it`ll'}:`miTy t°O, C F 1 Policy No. NWC/PD8+1-01 ESTIMATED COST OF CONSTRUCTION 7M.00
N- a PERMIT FEE b` IVIMARY
5 (This section need not be completed if the permit valuation is for$100.00 or less). ELECTRICAL FEE l 01-000-r420►-000 t31,50
( ) 1 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 Se ion 3700 of the Labor
Code, I shall forthwith comply with thgse provisions.
'Date: - '6� Applicant '•.J 41 .1-'.. 9 n /1 !Du
Warning: Failure to secure Workers'Compensation coverage is unlawful and (�shall subject an employer to criminal penalties and civil fines up to$100,000,inDi
addition to the cost of compensation,damages as provided for in Section 3701i Al 0 i cis,
of the Labor Code,interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety C�0FLAQUhNTA
for a permit subject to the conditions and restrictions set forth on hisir
EPT
application. Fl�4HCE�
1.Each person upon whose behalf this application is made&each person at S UE-TOTAL.CONSTRUCTION AND PLAtif CHECK $3 t 'St>
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 f t'F'�'1'AID FEED
��'fl
& hold harmless the City of La Ouinta, its officers, agents and employees.
2.Any permit issued as a result of this application becomes null and void if TOTAL PERMIT 1+', i, DUE 110 3}3 50
'' 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
t -. correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatk(es of this City to enter upon !
the above-mentioned property for inspection purposes. x_..,Fe l5 -7f� i
RECEIPT DATE BY DATE FINALED 1 INSPECTOR
Signature (Owner/Agent) 1.A-,Ir I -•.,._, Date ` J'4
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Back Underground Ducts
Forms&Footings Ducts
Slab Grade Return Air
Steel _ Combustion Air
Roof Deck Exhaust Fans
O.K_to Wrap F.A.U.
Framing r 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 Plbg.Test
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)
VeriZeim
Verizon Communications
Reply To:
Fernando Ahumada
OSP Coordinator
295 N.Sunrise Way
Palm Springs,CA 92262
Office: 760/778-3602
Fax 760/325-2536
CACO2NE
Date: June 3, 2002
To: Courtney Electric
27-202 East 31d St.
Highland, CA 92346
CC: Scotty Sexton
Hello Val,
Please find attached a bid sheet that will go to Scotty Sexton in Contract Administration for approval and
a copy of the work order to place a new AFC Mesa 4 Access Node. The bid is to place and connect the
electrical to the Access Node from a new Marconi Power Pedestal with an emergency socket and to clear
all Permits, meetings and Inspection.
WORK ORDER NO.: 0543-7F001 DD
LOCATION: 47T" E/O Washington St.
ADDRESS: 78-581 %Ave 47
La Quinta, CA 92243
PERMITS: Included
Questions? Please call
Thank you, -`
Fernando Ahumada
Coordinator, Palm Springs
760/778-3602
NOTE:
With proper validation �r
this form constitutes an CITY OF LA QUINTA
encroachment permit lr� rr�
APPLICATION FOR PERMIT ga
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) <'' t ~ 4,4k
M0F TO-
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit—Class III
DATE:04/30/02 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION AVENUE 47 SOUTH SIDE EAST OF WASHINGTON STREET
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION PT•AC'.F NFL) PAIR IA TN DEVICE FOR Sketch (attach construction plans if appropriate)
NEW C_ROLITH TN ARFA
DESCRIPTION OF CONSTRUCTION PT AC FMF.NT OF
POWFR PFTIFCTAT ANT PTWFR TRANSPIIRMFR PAIL
SEE ATTACHED SPECIAL CONDITIONS
DIMENSION OF INSTALLATION OR REMOVAL
SIZE
O48 XC V 3200N,IF NEEDED
APP 0OXIMAT TIME WHEN WORK WILL BEGIN
/30
APPROXIMATE TIME OF COMPLETION CE
ESTIMATED CONSTRUCTION COST$ 15'O00'00
(Including removal of all obstruction, materials,and debris,backfilling,com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees,harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
VERIZON 295 NORTH SUNRISE WAY PALM SPRINGS CA 760 864 1715
Name of Applicant(please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit—Class III
Public improvements: 3%of estimated construction costs
Private improvements: 3%of estimated construction costs
Minor Improvement Permit—Class IV:See attached schedule N 0 3649
0.00
Inspection Fee $— PERMIT VALIDATION
Permit Fee 0.00
PERMIT NO. 3649
Penalty
Cash Deposit-Surety Bond DATE APPROVED 04/26702
if required 07/31/02
EXPIRATION DATE
TOTAL: $ 0.00
DATE I D
Receipt No. _ By � �
G[!�r.
ReceiyPrl by__ Data_ Arimini r tive Authority
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JON TANDY
,ram 37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
SPECIAL INSPECTION SERVICE Fax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF 0 REINFORCED CONCRETE LI TRUCT. STEEL ASSEMBLY 0 �/
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALToTHER �+ ',� LC'
PERFORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING �jj�{�
JOB LOcATiobt d 9 6 -. _��ube LAI L IN QV C REPORT SEQUENCE NO.
TYPE OFSTRUCTURE 1 / c Io� , PERMIT NO- D f I�o DAY OF WEEK
MATERIAL DESCRIPTION r�3 ARCHITECT I P `TD�- HRS.CHARGED
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_
DATE INSPECTION GENERAL
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COPY SENT TO CLIENT 0 CONTINUE N NEXT PAGE 0 PAGE OF
CERTIFICATION OF COMPLIANCE CL .-
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF M1 URE OF REGISTERED-IN-Ws
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE $i ATl
NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED �ILATE
(� J I �3PLANS- SPECIFICATIONS. AND APPLICABLE SECTIONS OF THEGOVERNING BUILDING LAWS F REPORT REGISTER NUMBER
JON TANDY
-------- 37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
SPECIAL INSPECTION SERVICE Fax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF 0 REINFORCED CONCRETE CRUCT. STEEL ASSEMBLY ❑ �V
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALT pHER y i3fe„,yl�
PERFORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING 1��
JOB LOC ON rr�� 'REPORT SEQUENCE N0.
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TytiPE OF 5 pf'. `A-- Ct`11 ko `�� PERMI ❑:' n �� Opp! o7 Ar OF WEEK
MATERIAL DESCRIPTION A-3 e W ARCHITECT J ` {� HRS CHARGED
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f ENGINEER + O r,� -1 ASSISTANTS HRS.CHARGED
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COPY SENT TO CLIENT 0 CON ED ON NEXT PAGE 0 PAGE OF
CERTIFICATION OF COMPLIANCE
L `
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF WIE OF REG ED INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED l7 l/ 1^) 6 � ? 7
PLANS- SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE IIINiTtR
GOVERNING BUILDING LAWS ATE OF REPORT REGISTER NUMBER