0401-346 (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 # L i c. C Ws -r, Exp. Date
81 -Ot
�(Y71 � r) �C�<�D54; lkq 04/3 2C
Wate I 9U 2 0' ' ignature of Contractor---�
�S
WNER-lBUILDERQESLA,,,RA1]_0N,
I her:bjy affirm 7undeorpenalty'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 their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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:
Cartier STATE FUND . Policy No. 142.4 07-02
(This section need not be completed if the permit valuation is for $100.00 or less).
L) -Il 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
lode I ;hall foA
C W comply with th 1provisions.
t
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 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 compl�rwith al'l*'City, and State laws relating to the building
construction, and here, �v aaffiNnfe representatives of this City to enter upon
the above-mentioned pr erty f -I sp
pction purposes.
Signature (Owner/Agent) Dath,�, I
—7
PERMIT#
BUI LDING PERMIT
- "1-346
DATE VALUATION LOT TRACT
jos SITE V
ADDRESS 79405 MIG)TWAY3,11 WTXF I &49F C4 —1V
APN
I -
OWNER
CONTRACTOR I DESIGNER / EN R
ST AMDKO T3r--VU,0PWMkTr CO.
TWERML WGN Co.
3856VIADOIZEE,
46126 CALHOUN
MhPiNADMA EET CA .00292
N010 CA 92201
(760)-M7-3566 CBIP 223
USE OF PERMIT
MWEVICAL
va.w.nucAl, slaw PERRIT (SURP CITY .1�QUEEZE)
VALUIA11011 2,00,09 1.0
CONSTRUCTION FEE, 101-000-418-000
EUC-TRICAT, I Olt -000-420-000
D
JAN 2 6 2004JIJ
__14
CITY OF LA QUINTA
N
FINA MCE DEPT.
SUB -TOTAL CONSTRUCTION AIT.O. PLAN CHI'M
$60.75
LT0 S P R S - P AUD F. 6T- S
$0,00
TOITAL PEUTMIT.Frylyl!"S MYEANOW
$0175
4
RECEIPT
BY
DATE PA
Ow
IN
I SWO
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
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 I
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)
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) 1,9410100,
w
-IMPERIA
c IG N CO.,INC.
a II R ■ g a °
46-120 CALHOUN ST. INDIO, CA 92201
(760) 347 3566 FAX (760) 347-0343
This is a o� ERI unpublished drawing,
created by IMPERIAL SIGN. It is a submitted
for your personal use in connection with a
project being planned for your by IMPERIAL
SIGN. It is not to be shown to anyone out.
side your organization, nor is it to be repro-
duced, copied, or exhibited in any fashion.
CONTRACTORS LIC. #
207136, cas,clo,csl
COMPANY:
SURF CITY SQUEEZE
PHONE: 760 347-1400
()
ADDRESS: CITY:
79-405 HM 111 SPACE #1 LA QUINTA CA.
WORKMANS COMP #
1424837-99
CITY:
JOB ADDREss: HV
VY HY 111 SPACE #1 LA QUINTA CA.
CITY LICENSE #
00223
JOB REF:
1 DAN POOL
FAX:
J
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE !�a� BY.,._.
VINYL COLOR AS SHOWN
—9'-63/4"
CIIN4'—
AUeeie
MAGENTA VINYL
SQ. FT. 18.5 +,-
SIGN PROGRAM INFORMATION
TENANT STOREFRONT WIDTH = 15 FT Aoved by at
MAX SIGN AREA 15 X 1.5 = 22.5 SQ. FT - 3%a nnine COR1fTIlSSIOt1
MAX SIGN LENGTH 15 X.7 10.5 FT Cit
MAX LETTER HEIGHT = 30" Y Council
ommunit Dev. Dept.
Initials
Case No. -
T—J
Exhibit
O With Conditions
METHOD OF ATTACHMENT
Imperial Sign Company
Channel Letters Specifications
(Flush Mounted)
20 AMP 120 VOLT PRIMARY ELECTRIC;
CIRCUIT (PROVIDED BY OTHER5)
air" �iE;•
TKIMCAP
METAL KETURN5
PLEXIGLA5 FACE M •• 1 f
illi'tiil�
5TANDARD GLA55 NEON TUBE 5UPPORT "far
W
aP
METAL BACK
NEON TUBING 4iiij� O
ELECTROBITS NEON CONNECTORS h �`j l'`A
W/P JUNCTION BOX (PROVIDED 5Y OTHEK5)
' •Hiii'
HI VOLTAGE GTO WIRE FEED THRU BUSHING ` :4 r�u'
'/z" CONDUIT CONNECTER
120 VOLT PRIMARY WIRING WITHIN
CONDUIT CONNECTER THRU
WALL TO TKAN5FORMEK
METAL RACEWAY WITH
IN5ULATED DISCONNECT 5WITCH —
IN END OF RACEWAY
3/8" X 2'/z" LAG 5CREW5 OR
#10 X 2" 5M5, OR 3/0" X 4"
TOGGLE 13OLT5 - A5 REQUIRED
1/4' DIA WEEP HOLE5 & COVEK5 A5
REQUIRED
EXTERIOR LETTER INSTALLATION / INTERIOR SECONDARY WIRING
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/18/03
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AMIGO. DEVELOPMENT CO. T( L a uinta
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Q'ulnta;'.CA' 92263 '� row
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it' 700)1n7-7680 ko La Quinta, CA
• (10017717686
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