0108-230 (SIGN)�yti ;a 1t LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I,am licensed under provisions of
'Nhapt r^9 (commencing with Section 7000) of Division 3 of the Business and
1itro�essl:onalsSn Code, and my License is in full force and effect.
f'-' ;�
4 License #' ,� Lic. Class Exp. Date
'`
ji,
Date/ I'? ?`r } Signature of Contractor VY)-{•�/ =�' -
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
Ihereby affirm under penalty of perjury one of the following declarations:
I( ) 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
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 Policy No.
BT &TH, FUND 24211,937-00
(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: <1 s `3- 1T t Applicant A, .� ,,�7
¢ . -
Waining: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 c1hys from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection. purposes.
Signature (Owner/Agent) ~ a A Y." Datec"?
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0108-730 TRACT
JOB SITE 40APN
ADDRESS
78446 :k V" .1 B.1
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TAST 1"Mt10L
Uf?@ RIAL 4e%I `YN CO.
78-446 RMY ? Y 4
46320 CPA EIMIN
1,,& QMATA CA, 92253
111010 CA 922011
(760)3471r3566 MU. 223
USE OF PERMIT
.$uA...lz°iMA.1haR07. 11-
S,I MAGM, AS PER. A PR,(N1PL7 t%LAIIS /PAST 11'RAIN YPE STAN PgR'.kAff
VALUATION its,
A" aSTNd5'JA`J.,FKD M1•ad?J.G W,F COd.Mf7836MMOV
20W .01)
Y'nlZt,'•''! RIC.t L l�2 1.1 r 101 -COD420-000
0
AUG 7 2 4,20 1
CITY OF LA QUINYA
FrMANCE DEPT.
wYt1i3-I.N:`'l" , Ci)T;,Tf UM0NAk1�.Z•�gPyyJ:�.,AN C�';1i��4ygt"y�.t�a'y'. �
$69.0
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4Ifid��e 7W�
RECEIPT -y�
DATE
BY
DATE FINALED
INSPECTOR
c
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
BLOCKWALL APPROVALS
Set Backs
Final
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Appliances
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)
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
POOLS - SPAS..
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Encapsulation w
Final
COMMENTS:
5 L" �r A, L G( -G C A�
,T T CONTRACTOR5 LIC.# 5LJ5INE55 NAME:
I P It
LAA L 207136, C45,C10, C61 V 7
SIGN CO., I���� C WORKMAN5COMP# CUSTOMER NAME:
46-120 CALHOUN 5TREET 1424837-99 MAIL ADDRESS
INDIO, CA 92201 CITY LICENSE #
(760) 347-3566
FAX (760) 347-0343 815 JOB LOCATION: - 4 4- Lgujit it
r'19
14"
PHONE N
FAX NUi
PE5CRIPTION OF WORK:
50uth
Highway 111 Elevation
41,2" X PERT PICTURE
5PECIFICATION5:
14 " Illuminated Channel Letters
Plex Face: FAST - REPwith WHITE strips pms# 2630-73
Flex Face: FRAME - 5luems# 3630-157
Returns: White Yrim-cap: White
NEON: 6500 white
Transformers to be remotely mounted behind facia required.
Power to be by others
Lettering to be mounted flush to wall, center on facia bands.
Jnlm 70 ^''—•-'-
m. raft
TafbN
This Is an original unpublished drawing,
created by IMPERIAL SIGN. It la'submkted
for your personal use In connection with a
project being planned for you by IMPERIAL
SIGN. it to not to be shown to enyone'out-
side your organization, nor Is It to be repro•
duced, copied or exhibited in any fashion.
.morrro r "�' •.
E' x.nao� n .•
\
,C
FRAMING
I`
m•ev:o.r.
iao wn
Fvmorw
SPECIFICATIONS:. `
Non- Illuminated secondary Letters
318" painted acrylic letters (SAME A5 FRAME)
to read: EXPERT PICTURE FRAMINGm�'
YNf.uR
Lettering to be mounted flush to wall, center on facia ba '-` --�------- �p
pF;y; ln. wecew rou•weea