0210-192 (ELEC)' LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of..Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License# Lic. Class '�'?. . Exp. Date
C45 n4l�
Auo,
Date �_,--,�— Signature of Contractor 6v1fx
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
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
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 SlrA"!rE FUND Policy No. nal 8iJ.,02
(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' compensaAn provisions of Section 3700 of the Labor
Code; I shall forthwith comply with'`those provisions. /
/Date: (I W ifs Applicant 1 ► XL
t �
Warning: Failure to secure Woke s' 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 andrattorney'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 applicationis made & each person at
whose request and for whose benefit work is performed under or pursuant to
any pgrmit 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,l 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 i
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 propertyNor inspection purposes.
,//Signature (Owner/Agent) 1ij /f31� ' %� Date ('K1 ti
BUILDING, PERMIT PERMIT//
DATE VALUATION ^ap,iyop LOT c,`� TRACT
JOB SITE
ADDRESS -18-4 74 HIGHWAY $ I I (D, IX 2)
APN
-TMO1 04.1
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LA QUIW A GA 921.;5.3
11`}pai IMPRM' S CA , 92262
)C10� �>� t>S t;rc.3:.rf� 3886
USE PERMIT
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2 ILLUMINATED MANI NEL ,LF;7."$. EIR `S7MIS PFA'. SA 2002.619.
"`�','lr; reit
Ellt�,ITRJCAL IPTEZ 01 _000-420-000
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REC IPI—_
DATE`
By e'er f
DATE FINALE
INZrI1
.h;
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA S
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 Lateml
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
A.�%��
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)
0
I
68895 Perez Qd building I eSuitc 18 Cathedral City Ca 92234
PaX (76c))321-2682
Ph h (760)322-6366
Wall "ries is
thickness and material
Tube Support
Neon'Mbe
Acrylic
ar lic Face
Anchor Dolls
_Prl,,rY Electrical Source
Channel e 'Transformer Can
Leff_Transformer
Drain holes If used in damp
or wet or outdoor locations Listed Flax and Listed GTO WIRE
7 fj2Ygd b
y
E3.Pianning Commission
0"City Council
kLi-�arnmunity Dev. Dept.
snit als -Ift
ase No. :5
Exhibit
r 0 With Conditions
i
v ,
U X r 11) c
1,15-4.9in
ITY OF LA QUINTA
lee.UILDING & SAFETY DEPT. East-a-flonRE-INSPECTION FEE OF $30
APPROVED WILL BE CHARGED IF THE APPROVED
FOR CONSTRUCTION PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
rE- /0 INSPECTION.
.NO EXCEPTIONS!
All Ideas designs '
b =a,
And were
In count
aw III E�
314—Wff–s
prowing Cv
esented
Toftne Neon.And
for use on
Lft afivillir
fN=ame
ROD FkZ
Customer
pnt
None of syucn "'
be used b or d
Customer
LWN 6119 W -JC
—Anprovalo
RW 9MVP —natip.
for any pu i
I
and
or
or I
68895 Perez Ind Building I Suite 18 Cathedral City Ca 92234
0:,'�face19 Ph (76o)322-6366 Fax (760)321-2682
War varlas In
thickness and material
Tubs Supppor! � —
i Naon TYrbs
Acrylic Face
��l►nahor Bogs
rimary BlsotWoal Source
Channel Leffer T►anaformerCan
Ttansformer
r
West Elevation
9�lnt vowq
starneir
CA I 9M roce Annrnvw
Drain holes If used in damp """!;A
\
or Wet or outdoor locations Uoted Flex and Usted OTO WIRD
CITY i CSF LA QVINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE_—___.
16in uxifU®
15M
An ideas designs arrangf¢ements and
ree�ppresented by this drawin are own4
Kloflne NeonAud were crated vol
for use on and in connection
with th
None of such ides, designs, arranger
be used by or disclosed_ to anv verson,
or
or