0306-192 (ELEC) LICENSED CONTRACTOR DECLARATION PERMIT#
CO I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and co DATE VALUATION LOT 0006 t92 TRACT
(NI W Professionals Code,and my License is in full force and effect. p&/t 3,r1!,y'_ &I Ai0.9p
p = M License# Lic.Class Exp.Date
r CI in JOB SITE APN
R. W ' 476,4:t "i :81;I/' ( ADDRESS K'-6V't in DESERT WILLOW])RIVN -
Z Date / "l Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENlINEER
O r i"~
trD ~ t°D OWNER-BUILDER DECLARATION TIME WARNER CABLE. C'Ot WC COMMU}TICA"''ON CONk II i• 'I'
LL1 W r I hereby affirm under penalty of perjury that I am exempt from the Contractor's 4?•725 COQIC STREET- 36.63CI CA,'TJEDRAL.Cal['RIVE
~ W License Law for the following reason: PAL :DESERT CA 92260 CAT1l DR AL CITY C,•'a 9223d
Z ( ) I, as owner of the property, or my employees with wages as their sole (760)326 6778 :'BL# 865
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 Ia ZCYIlil!`AI.
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 100 AMP METER PIED
co () I am exempt under Section , B&P.C.for this reason
to
O N Date Signature of Owner
a)d Z WORKER'S COMPENSATION DECLARATION
o , I hereby affirm under penalty of perjury one of the following declarations: VALUATION 1,20b,0U.L3
r H O ( ) I have and will maintain a certificate of consent to self-insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
m -' Q performance of the work for which this permit is issued.
Q 0 ( ) 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
d v Z permit is issued. My workers' compensation insurance carrier & policy no. are:
co 5
Carrier :)'J' T) Ft,di) Policy No. 346-U2-0C4 2$ ESTIMA-DID COST OF CONWIRUR #TON 1,,I(r;?.f111
r O !PERMIT FEE 807.11)-1ARY
C (This section need not be completed if the permit valuation is for$100.00 or less). EL.ECTSICAIrPED'ESTM. 101-UJ04420-U00 $33.30
( ) 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
3 subject to the workers'compensation provisions of Section/3700 of the Labor
•
Code, I shall,f_orthwith comply with those provisions;,-'
•
Date: ' Applicant /�^-
Warning: Failure to secure Workers' 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
vsof the Labor Code, interest and attorney's fees.
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
application.
1.Each person upon whose behalf this application is made&each person at toJB-TOTAL,CONSTRD,MON AND MAP en€CIK $33.50
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 LESS ]�Rki'1'AII7 PFFw4 $0.00
�^Vip & hold harmless the City of La Quints, its officers, agents and employees.
2.Any permit issued as a result of this application becomes null and void if TOTAL P12t1 UT TIKES 151331:NOW $ 3 0
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 representatives of this City to enter upon
the above-mentioned property for inspection burposes. k 7/Fr/) �P 2��/r
RECEIPT DATE BY . - DATE FINALE!) INSPECTOR
Signature (Owner/Agent) Date
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 Plbg.Test
Final Gas Piping
PLUMBING APPROVALS Gas Tes
t
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)
COCHRAN COMMUNICATIONS CONSTRUCTION
36-630 Cathedral Canyon Drive
Cathedral City, CA 92234
for fN
TIME WARNER CABLE
(not to scale)
60656 (111)
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108 IID Carson Box Th. 2 . 60674 (110)
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TRENCH @
109 30"COVER
IID TRANSFORMER
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PROPOSED ' Ce
POWER , d
SUPPLY '
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IID '
- - - -
Install Double 17" X 30"
CABLE TV Carson Box Here Per IID DESERT WILLOW DR
PEDESTAL
Ka. pes 21 w