0106-144 (ELEC) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of
I- Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION LOT 0706-144 TRACT
cv Lu Professionals Code,and my License is in full force and effect.
p rn License# Lic.Class Exp.Date .�:;i.01)0.i ftl
.1 JOB SITE APN
d .. ' ADDRESS
N. MI i / 748171 C10H1C, j .�6 04,30/2f [DO-90.'i)I AVFIWE52 -
OZ N. Late - f e P Signature of Contractor ''� N OWNER CONTRACTOR/DESIGNER!ENGINEER
N. - o OWNER-BUILDER DECLARATION
_10 fe COUNTRY CLUB OF THE DESERT HEUCIE F7:F'CTRICA1..CONTRAC TOR,9 NC
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's FLU BOX1540 '11te 1 O ('A L. E 3f ts,it tUII E B
I' a License Law for the following reason:
Z ( ) I. as owner of the property, or my employees with wages as their sole I A QU NT 1 2253 LA CjU A CA223:z
compensation,will do the work, and the structure is not intended or offered for (760)771.555 3 (MIX 218
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 r 1..-Lfri ien., . .e
Code).
co () I am exempt under Section , B&P.C.for this reason 3PRMATION wt?,f.,!,SITE•ELECTRIC 11LRV1Cl=:•WO AMP 277/460 3)
N Date Signature of Owner
ON
d z WORKER'S COMPENSATION DECLARATION
o ccI hereby affirm under penalty of perjury one of the following declarations:
r H O ( ) I have and will maintain a certificate of consent to self-insure for workers' V•y1 I)is.'!'f01.-1 5,00100 I.
X W II- compensation, as provided for by Section 3700 of the Labor Code, for the
mDI Q performance of the work for which this permit is issued.
Q O ( ) I have and will maintain workers'compensation insurance,as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
d I—Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Canner Policy No.
6 5 R�OURAWeg Co, OP' T f11)128$425-ou 'tylfletATItD COST OF CONSTRUCTION ti,9 f.00
a
< (This section need not be completed if the permit valuation is for$100.00 or less). Ple&MIT VIM SU ARY
( ) I certify that in the performance of the work for which this permit is issued, PLA I C:H ECK FEE 101-O0O'439-'318 S15.t>0
I shall not employ any person in any manner so as to become subject to the ..LECTRICA.f VE It! 1C11-000-420-U00 S31,50
workers' compensation laws of California, and agree that if I should become •
3 subject to the workers'compensate n provisions of Section 3700 of the Labor
Code, I shall forthwith comply wit L ' ' ions.
I0 te: ; r .j Applicant q
'' Warning: Failure to secure Wor ers' Compensation coverage is unlawful and
D�
shall subject an employer to criminal penalties and civil fines up to$100,000,in JUN 1 3 �fnl1+
addition to the cost of compensation,damages as provided for in Section 3706 — 1 6NN l [9
csip,
of the Labor Code,interest and attorney's fees. I
IMPORTANT Application is hereby made to the Director of Building and Safety
irfor a permit subject to the conditions and restrictions set forth on his CITY 01 LA OUINTA
application. FINANCE DEPt
1. Each person upon whose behalf this application is made&each person at
whose request and for whose benefit work is performed under or pursuant to SUR-TOTAL CONTITRUCTION AND?L..P$ CETEcK $12.50
any permit issued as a result of this applicaton agrees to,&shall,indemnify I jr..SS P.1 -PALD FEW $D 00
& 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 TWAL PERMIT �� I '� =0
52
tpermit, 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 c�
the above-mentioned property/for inspection purposes. ' � ��� '
i F'I f RECEIPT DATE BY DATE FINALED INSPECTOR
Signature (Owner/Agent) �V,,��� F, l 1'". Dat •:• 6 -() l •
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts
Stab 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
Part Wall Firewall
Exterior Lath
Drywall-Int.Lath
Final
Final —_ --- - _
POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs I 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
- - COMMENTS:
Final
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp.Power Pole T _
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) ��f