0003-085 (ELEC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9'(bommencing 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
33W' 9' C -4S 01/3I./2ut
%Date ^ J ' Signature of Contractor { ='
s
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 Policy No.
STAT1711 rft1t;
(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
Coge`, I shall forthwith comply with those provisions..
D te: h _ Applicant r°� Warning: Failure 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 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) `'r Date .y
"i
BUILDING PERMIT PERMIT#
iillt►.i-E#�tS
DATE ovanoo VALUATION r i LOT i�AIZ TRACT 2�311R525-I
JOB SITEADDRESS 7-9-225 �HICIPWAY 111. - APN 049_03 W11
OWNER
DAVi SMA—ft .K
33191 HIGH"A" Y III
IyDAD
USE OF PERMIT
i; CONTRACTOR /DESIGNER/ ENGINEER
C1.41EF STIOF°{ CR,A r,7S
33.950 AVENUL 58
C A � 92201 lititsR.l AL
(-160)19R-0-313
LW1 K10AL
iI�T, ERNALL% M,tii4ii' ATE --D CHJ9961 LET U0. XGN t1W%ZDA)
VAi. ATIO
3%500.00 LS
ESTEMATED COST OF CONSTRUCTION
BLEC'I'R.!'CA.L V,66 101-000-420-00W) 0W) 830.00
'S
TJB-`fY-)TYAL CQ?'3 RJE;"TICI AN 0+,.AN rTt;CK.
LESS PIZE-j?la:1b F1,EC
CA 9;274
CI3tN 774
RECEIPT DATEBr_ j J� I DATE FINALED INSPECTOR
P11,00
50.00
$30.0
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
Y. -
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::
`)n/ r- �s
czo
0
'ON :)
Oo— # O E
4 �0 RVGv A8
O O NO
NOISSIWWOo' 9NINNVId AG 03AOUdd-V
V
j
-
EAST ELEVA i ION
f'' . ---- 11'-7 7/16" _.. _. •.... - _. —
ILIFIING EYFHOLI -- -- 6'-0" -•-
-- 2'-G 5/8" —
JNSi AI I_ATI0N I14%3IRUCIIJONS
1, lrx1 LIC11T S1CN 01 )ON DELIVERY.
7. IIHLRAI( SICN AND OtT..;V I -/AGF..
3. 017111 MOUNTING AND ELECTRICAL 11ULES IN WALL.
4. LIrT !;ICN INTO PIAC:F-. AND FAS'TFN TU WALL.
('04- MOUNIIN(I HARDWARE IAni..)
5. L'UNrII.CI ELFCTRICAI lO S1c.;N AND TFSt LIGHr,
6. RfMUVE0 I'MIMI AND CAIJI-K HOLES.
7. CIO�F FACE AND CI.F.AN !;KEN.
It. CI.EAM SIZE OF All IN'iIAI.IAIIOrJ 11F.nm1 .
9, IIJ':1ALLAIION 91,41-1. CONFORM 10 I'IIF NAFIONAI
F UC IPICAL GOOF. AND ANY 0 FI HUR APPI 11"AnI F
LOCAL COIJF-. . I1 IF SIGN S 111110IURE SHALL 131.
GROUNDED IN IIIE MANNF.R SPECIFIED BY 111E
N.E.C.
PT- -
sq
/W
I
7' S t 3/ i 6" 6 NI e Y DEVE-L.OPMENT DEPARTMEN g
BY dL DATE
EXHIBIT
THIS Dr!.ICNCA%LANbROVAOI?0;N01RRC17UWVoE PLACED Al
USF OR RFIISE or MIS UOCUAIENI FOR 6THER LCCAIIUNS IS
SIRJCI'I-Y PROHIRITFR WITHf.1w APPROVAI. OF THE ENGINEER.
APPROVAL IS FOR SIGN CONS1RI A31ON ONLY THE ENGINFLIt IIA:
.SIG.N__SPEC1fICA1.IONS NOT INSI'LCILU INE BUILDING 10 OrITRMINF SIIIIAI)ILI1Y UI' WALL
1. IAMNS: (2) F96T12/CW/II0 I(1 SUPPOW IHI SIGN. ACIUAL MOUNIING IIAROYVARr 10 Hr
(.3) F48117/UW/1-10
DETERMINED BY INSTALLER UR IIIL UOILUING LNGINE:ER.
7. IIM-L.AS1: (f) JEFFERSON 250-672
3. VDI. TAOF.: 12.0 VAC
4. 10JAL CONN. LOAD: 4 AMPS
5. CIRCI II IS: (1) 20 AMI'
6, SERVICE SIGN BY: HINGED FACC
7. LIMING WEIGHT - CRAIED: 370 MS,
UNCRAIEU: 288 LOS.
UESCRIPIION_Of' CHANCE
2.013
2.01 [C.1111'D OA011 P URANers, m O dt-n is W H ilii/ u./.-i..1MrRnv ,ncinro +-
—.013 R _ �.....__._ ",.n1 A0.1, all n.aLI.n.
P/N: 00-00-UO6-5792
PLASTI—LINE, INC.
P.O. (t)X 39045
_ KN,)fIVIl4l�IN�lp�U•DU/!
DSCNR: SJA_ UWG.DY: 5JA-
SCALE: N/A DATE: 3-0_00 DAFE ---
W-32. WALL SIGN INSTALL
_ CUM"_MAZdA
SHT 1 OF 11 823918'' 1
FGR CO^tiSiRUCTION ,..
3 eo ;ply ! C r.
DP=,T F - I�
139 711 r) . ..............
(REV)
VMOUNIINC. 11011 LOCATION
(6 rLACES)
ELI -C RICAL ENIRA14CE I OCArION
4 q/ 16 -j 4 .... ..
8
21 73132 4R --
(IYP) (lip) (lyl))
F LA QUINTA
FAYS4rF,, IN-5pwTi -
FOR CONST'RUCTION
DATE BY
-M-Qvtl v N-G-mip-f I 1�qjq!CAL- Y--QU�tAMW
APPRO ED B MUNITY DEVELOPMENT DEP
BY DATE 3Q
WALL
MULIFIIIWC
lY INSTALI(-
INS IAI-1 L
W F EXHIBIT
1ARD
WASE NO. Y-9-L-';ECl-'Qt4
1/2" 80LIS TIMOUGH WALL
1(1G WILTS W/L EAU' LA
3 IELOS >< PLASTI-LINE, INC.
11OLrs JW. BUX 59043
KROXYIl1F 1! 5750
_90431/?- 1/2* TOGGLE BOLTS
I)SUNN: SJAFL)WG.0Y. SJA IJ Y:
SCALE: -—. V— --�L
'—�7A ATE: 3-6-oo DATE:
W-32 WALL SIG14 INS' IALL
MAMA
Nc-lrs Wall al"PR4"I lolVall?
$lIT 2 OF 2 1