0303-251 (BLCK)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# yG7yh .. + yyLiic. Class Exp. Date
J
�oho•95?7,9 . J.t lYi .'i�.T 3��.�
Date 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:
( ) 1?as owner of the property, or my employees with wages :as•thelr,sole
compensation, will do the work, and the structure is not intended or offeredfor
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 S'> A E ;"'fJND Policy No. ff7l1:o19%-2tf0G
(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
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
'of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director ofl3uilding and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose; benefit work is performed under or pursuant to
any permit issued as a result "of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or'cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, 'and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection pu4rposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRAGI•
JOB SITE :9 r APN ,
ADDRESS 78_752�C7X3WA`1� I'll
x
OWNER CONTRACTOR/DESIGNER/EN (NEER
PI -7 BKRIC &7IRM 141T:I'✓.I:S TO 11T.lti 9 L ,Eti1+ cTl� t
P0MONA. CA 9!767 MMMADT C'1`- �. R CA 92561
0160}56$..39,93 COU6 2686
r'
USE OF PERMIT
TLTBF, ST0.1,•l3WNING'S'i'.RUCTURF,'MTH MM.5F3,wf'P���N�ti!!1
COMMIUNITY DEZVELOPkUNT DVT, APPROVED K,",
OAF �N� �- TRuaT
RECEIPT
"MkI TION
F9T' AT.KD C70ff `Off' Cf3MMiT—X',01i 6000
t
MAR 2 5 2633��
CITY OF LA Oiy+fo r6►
FINAHnr- r.:: . 1=
M -'3`O' AIL t;faNSTNIUCMON AMr1�T K9 C[��'' p�'yK � �* }
• DESS `'-�'�R1lFJ 8'A:vC7�bs!/. W+,/TOTAL "P.RrUffir FF -If., 9 YAM N ow $A7.00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVA S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
0 ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures -
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
MAR -20-03 'THU 10;00
P. n?
March ig, 200;3
Mr. Donald Rich
Desert Cities Development
46--,Y,53 Adams St,
La Quinta, CA 92253
(760)
- Fax i-paQe to: (7b0) 7,71-44.31 [Original mailed today]
KE: Citi' of La Quinta Requirements, for Permit Release for AN•viiings
k car' Donald:
1'lea:se accept this letter as evidence that PFF Bank & Trust agrees to the
follov,ing conditions of the City of La Quinta-s approval for release of the Permit
for Av.-nings at our branch located at 7$-752 Highway ii.i, La Quinta, CA:
(a) No signage will
(2) If ts sll be. attached to the awnings,
he awnings become discolored due to age, the-%- will be replaced
by PFF_
W'e appreciate your assistance with this security- upgrade for our Branch.
S�i�cerei�-.
Savior
J,FF Facilities Scn'ic'es
a7:\3�C�;\• _:a !;r;:r,ihe�11.;> i nnr�::�;An'nins �I I:ri�'.-u� r�T�i��CSert 4iti�,c Darr. 3-ty-c�3.duc
0ITY OF EA QUI
BUILDING & S DEPT -
APPROVED
FOR d0k RUG11C t
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PFF BANK & TRUST - La Quinta Brarch - Drive -up ATM Sun Shade Pict. 3 FEB
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