0009-094 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapterj,(commencing with Section 7000) of Division 3 of the Business and
F'toessiio mis Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
2P71 3 6 C45 D38 C10 04/3tiVU
Date �'/ � V Signature of Contractor 1 r'Yir rte ,% , t `Ffo
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 theFproperty, 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).
O 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
performa6ce of the work for which this permit is issued. .
( ) 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 STATE ISD Policy No. $424837-90
(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 shall forthwith comply with those provisions.
Date: - " Applicant 7'��'?
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
of the Labor Code, interest and attorney's fees.
IMPORTANT {Application is hereby made to the Director of Building and Safety'I
for a permit subject to the conditions and restrictions set forth .on his x
application. a
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 inspection purposes.
Signature (Owner/Agent) � _�� `�`%� 'a �' W � �"::;LDate
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 00W'0�`� TRACT
�(�/9 p �y�
09/19420C
09/1942 C �P.H4V1.\l.i/5J
JOB SITE
ADDRESS W949 HIGHWAY 111 WfrE HE
APN -
1 OWNER ,•
CONTRACTOR / DESIGNER / EN (NEER
.it.1 0RT' UA iNIS
w1iff; CT L SIGN CO.
..50-94 9 YUGHW AY 111
46120 CAU10UN
LA QUTAiT'A C.A. 92253
i1 Lyfo CA 92201
(760)347-3566 (,Bid# 223
USE OF PERMIT
CfE"N.�.' %A3..1; XW- DING
(I) INTZFiNALLY ILLUMINATED ELLC`.TRIC SION (`•illi C%e, FACE) (20
AMP) ONLY AS PER APPROVED .FLAN -MUST COM1,V WITH COMM.
DEVELOPMIPHT RFQUI.RFMLN'fiS CASE 2000.513
VALUJkTION 2000100 s
COsr OF CO.N RUCTION
�j,�yV,���yy�,qy'y• y� ��,ff••��,,::••� �ty-p �yy'� �EMA
rA:sdGf,�9,G'.4 A!.E , SVAIL}�y,1.l:LF Y
.
BLECTWCAL FEE 101.000.42"00 &30100
x
4 '
SUB-TOTIAL CO:PTgl'RlXWON AtM PLAN' Ck11?t:l
$10.00
I;.RSS PRE -PAID FES 3
$0,00
r'OiAz, "mvu s -1)IVO ►
PA e
L
Von
SEP .19 2000
RECEIPT
DATE
'11
'BY /1� , ��`
.
DATE FINALED
INSPECTOR
A. I
•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
i
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
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:
I
IMPERIAL
SIGN CO., INC
46 120 CALHOUN STREET
IN0I0,CA92201
760 347-3566
FA(X (760) 347-0343
CONTRACTOR5 LIC.#
207136, C45,C10, C61
BU51NE55 NAME: Resort Real Estate
DATE 8/31/2000
DESCRIPTION OF WORK:
ofia� unpublished drawing,
INFERIAL SIGN. k Is submitted
fersonal use In connection with a
ng WannsdforVou by IMPERIAL
nottoWshowntoarryoneout-
:your
srganization, nor Is It to W repro•
Md or exhibited In any fashion.
WORKMANS COMP x
1424837-99
C U 5TO M E R NAME: Jim Smith
DRAWN BY
ALDERT TCRRE5
MAIC. AOORE55 : 50-949 Washington Ste. #1E
PHONE NIiMBER
771.0599
CITY LICENSE #
815
J0B LOCAlION:
FA77N��R
LANDLORD APPROVAL
R esortR ea(Estate
(touted Cut-out letter to read:
Resort Real Estate
Back with Dlack/White Alex and
trim with gold vinyl
A RE -INSPECTION FEE Of $30
WILL BE CMIMM if THE AppROVEO
PLANS AND 100 CARD ARE NOT OP! C
THE SfTE f0k A SCHEOULED
tNSPMMK,
110oa01411=1 0,�e
10'
ApRroved b1C 20 Peso
O Planning Commission
O City Council
O Community Dev. Dept.
Initials -
Case No. -----
Exhibit ----
O With Conditions
City of La Quinta
Community Development Department
78-495 Calle Tampico
La Quinta, California 9f253
(760) 777-7125 FAX: (760) 777-7155
OFFICE USE ONLY
Case No. ? Dn&
Da Recvd.
Fe. ,
Related Apps.:
APPLICATION FOR SIGN PERMIT APPROVAL
SIGN PERMIT applications are reviewed and approved by the Community Development Director pursuant to
Chapter 9.160, of the Zoning Code. The purpose of the review is to ensure the minimum sign standards are met,
preserve the City's appearance, and provide businesses with effective signs and reduce traffic hazards, and promote
the public's public health, safety, and welfare by minimizing visual competition among signs.
APPLICANT C)= "i 1+4 ( A L �<� /k,--
(Print)
MAILING ADDRESS 5_6 — ?4? yI/•45 f1 x,11rj�%-Phone'No. �j 956,
CITY, STATE, ZIP: et Qy Fax No. S? 4 % — 6 34,3
PROPERTY OWNER (If different):
(Print)
MAILINGADDRESS: PhoneNo. 3
r�
CITY, STATE, ZIP: Fax No.
NAME OF BUSINESS/COM EX SIGN(S) IS REQUESTED FOR:
SIGN(S) LOCATION: '20 ( Q
TYPE OF SIGN(S): 1. CL 4
❑ Permanent sign in residential district �0 D
❑ Permanent sign in nonresidential district / /
❑ Temporary sign (5 or more signs)
❑ Semi-permanent sign , v
❑ Planned sign program (requires Planning Commission approval) c vol
❑ Sign Program Amendments
LEGAL DESCRIPTION (LOT & TRACT OR A.P.N.):
R
A 14\form.419 Final 10/28/97
., SUBMISSION REQUIREMENTS:
O Sign plans (see separate plan submittal requirements sheet).
0 Filing fee for` Sign Permit. If filing multiple applications, the most expensive application will be charged
full fee, with remaining related applications discounted 50% for each.
nA {
NAME OF APPLICANT 1►1 ate co 0a, A�''/
(Please Print)
SIGNATURE OF APPLICANT DATE
NAME OF PROPERTY OWNER
(Please Print)
##SIGNATURE OF PROPERTY OWNERS) q
IF NOT SAME AS APPLICANT: DATE `/ D -4 C
DATE
(Separate written authority by owner to submit application may be provided)
NOTE: FALSE OR MISLEADING INFORMATION GIVEN IN THIS APPLICATION SHALL, BE
GROUNDS FOR DENYING APPLICATION.
## Signature of property owner/agent of owner provides consent or authorization to erect sign(s) as
proposed.
A 14\form.419 Final 10/28/97
SIGN PLAN SUBMITTAL REQUIREMENTS
N,.Sign plans to include all information necessary to determine acceptability as follows:
❑ Site plan showing location of sign(s).
❑ Building elevation plan showing location of sign(s) including size on entire mounting surface (side
of building, etc.)
❑ Cross-section through sign (including depth, .transformer location, etc.)
❑ Description and sample of materials & colors.
❑ Type of illumination, if any.
❑ Approximate sign value.
❑ Sign program
PAV
A 14\form.419 Final 10/28/97