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0202-007 (MISC)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 f 2(9 l 6 CA5 D38 CIO 0030/21t Date ''t 0 cf Signature of Contractor 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 I-S IME FUND Policy No. (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. % 1•••� p ate: 2� r `' Applicant'—/ r 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, damagesasprovided 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 ?f whose request and for whose benefit work is performed under or pursuant tp 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) +.,.. _ BUILDING PERMIT PERMT# , DATE VALUATION LOT (Y TRACT JOB SITEI APN ADDRESSRESS 5 o • -OWNER CONTRACTOR/DESIGNER/EN (NEER YMPF—Mi ,, BIG. 01 CC}. X.238AQU, H `Ch7.Y 99,117 M 10 CA 92201, (i60)347,3566 MIN 22.3 USE OF PERMIT. S 10 VERM1,T PER w. L 001.600 VAL[l.Fh`i"1014 SV0.01D 3,43, f r ds i~ tagl xy CONS` RUID ION E LEICTIMCALPEIZ 01 -000-420-000 • i � 911S> .0MA.t. "!017 �Q'R€,1'4'.`:� 1M hN"f;� P1. W MI ?UCo $93.00 Mi. NO MUM Yf?Xkl%7 DU KVW i� FEB 01 2002��' CITYOFLAQUIN A RECEIPT DATE " '" 8 = f! DATE FINALED INSPECTOR ;�rtd 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 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 iter 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: City of La Quints Community Development Department 78-495 .Calle Tampico La Quinta, California 92253 (760) 777-7125 FAX: (760) 777-7155 OFFICCE USE ONLY Case No:.7k2�— 6, C Date Reovd. Z ( OZ Fee: C>Q — 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 W ,fZ V ROSS Yyl eaQ(� St I -Gbr G� &a o 1 ( rint)avlraW . MAILING ADDRESS O C )q- O V /L) Phone No. 2* 7" 3s 66 - CITY, STATE, ZIP: h d C A 9 a 5" 3 Fax No. 34 ? -"O 3 4 3 PROPERTY OWNER If different : 4,,S e- rr S'c (Print) MAILINGADDRESS: �— PhoneNo. CITY, STATE, ZIP:Fax No. 5"7 S wI� # 3� I NAME -OF BUSINESS/COMPLEX SIGN(S) IS REQUESTED FOR: L 4 Q ut, A-- 0. co 0 -Z SIGNS) LOCATION: r o 4 C _ m1i KP-Ak Sig-Kl a TYPE OF SIGN(S): G ✓J�►�l gaw`t tng b^�31 x 1 0 1 ❑ Permanent sign in residential district Permanent sign in nonresidential district Temporary sign (5 or more signs) ❑ Semi-permanent sign ❑ Planned sign program (requires Planning Commission approval) ❑ Sign Program Amendments LEGAL DESCRIPTION (LOT & TRACT OR A.P.N.): A 14\form.419 Final 10/28/97 ❑ Sign plans (see separate plan submittal requirements sheet). ❑ 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. . NAME OF APPLICANT Xma S S (Please Print SIGNATURE OF APPLICANT DATE O NAME OF PROPERTY OWNER D L (Please Print) ##SIGNATURE OF PROPERTY OWNER(S) IF NOT SAME AS APPLICANT: S e DATE i h C -c e-(4 m w 1 (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. 1 A l Worm.419 Final 10/28/97 IMPERIAL SIGN CO. INC 1 46-120 CALHOUN STREET INDIO, CA 92201 /60 347-3560 (� ) FAX (760) 347-0343 CONTRACTORS LIC.# 207136, C45,C10, C61 BUSINESS NAME: DATE: 3- -2001 DESCRIPTION OF WORK. an original unpublished drawing, by IMPERIAL SIGN It is submitted r personal use in connection with e being planned for you by IMPERIAL is not to be shown to anyone out - organization, nor is it to be repro- fduced,copied or exhibited in any fashion. WORKMANS COMP # 1424837-99 CUSTOMER NAME: �-� �'� ���'� ► DRAWN BY ALBERT TORRES _ C MAIL ADDRE55 : �j J 7 $ '3 a O PHONE NUMBER CITY LICEN5E # 815 JOB LOCATION: {-�t,v y %%� FAX NUMBER U A LANDLORD APP OVALur Sf ECIFICATIONS: 22" Illuminated Channel Letters 14" Illuminated Channel Ietter5 Flex Face: Custom P>lack/White Keturn5: Black Trim -cap: Gold TranSformer5 to be remotely mounted behind facia required. flower to be by others Lettering to be mounted flush to wall, on facia bands. 0 This is a original unpublished drawing by IMPERIAL SIGN, It is not to be shown to anyone outside your organization, nor is it to be reproduced copied, or exhibited in any fashion / 10'-599+— CITY OF LA QUINTA BUILDING & SAFETY DEPT, N APPROVED Nstewart, FOR GONW" D u n i rl g oA�Y/Llocation c ange timtle escrowLb� ue o ul Ing - Structural Support 11'-4"+- 55 00[.ft. Im ma--r-kaa Cine ii'_mmnana.