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0303-089 (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 Date v w 'Signature of Contractor OWNER -BUILDER DECLAMATION 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 underSection , 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 workerscompensation 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 STATF F"D Policy No. 142423q-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 io/an manner so as to become subject to the workers' compensation laws l jor ia, and agree that if I should become subject to the workers' comppe sat i n rovisions of Section 3700 of the Labor Code, 1 shall forthwith Com�iy wit tube provisions. Date: Appli • ant Warning: Failure to secure6rkes jCompensation 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, indemnity & 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 ithN�ll City, and State laws relating to the building construction, and hereby �j size representatives of this City to enter upon the above-mentioned property f© in purposes. Signature (Owner/Agent);'',' J Date Kai,?j�'i7;;'r'.• .t .. [1 BUILDING PERMIT PERMIT# 4UATE t± VALUATION LOT � TRACT JOB SITE $„ ADDRESS 47-€0tt��",yAMMG^ 10M MMIF APN w OWNER y CONTRACTOR / DESIGNER / ENGINEER 11C UPMEN111 K0114 W 75.200 t;" .'ami, 46120 CA7.14C3'C:)'14 MAa wmis CA 922,10 1=0 CA 92201 (�6E7�7�3 `efj3� 225, USE O}}FFq PERMIT r[:� 0NLr' 1I,TAJ' 9.1NA,.TZ0 R1_;dt,lwZ CHA:f4W L LE`1 TFT SIC AND CYNP 11-WIPslN. TED LOGO SIM PEA &VO.694 r VALUATION 5,000,00 L's P'RI'G' FLV SiAOURY STA -Ta " . OMPUCN?XANTJP,ACHEM1, �$;30fJ..0p0fl yyF30 P6C"UpID S��� Q Q Q RECEIPTDATE �y� '71 BY DATE E ? INSP C r t.' % �." . J 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 0. 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Fi"ial 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 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 N W l ;w 1y 2 Z O Z m r m D O m O C) Z N P3 a cn m Z 0 Tb m m a z v 0 Gia 0-4 ' F . J >O� G)0 � O:� � m c v-4 v — Ea� Z Y m 7� oz m m m m m m c) Z z � z n m c r � � m z � o > m D 73 � �Tl D Z D 70 Z. U3 m r a m O < Z 10 713 r _ o m < Nr CN O CN rn a Z -yn XlZN� CA lid OO 00N�v O (4,q A / m A ^ C) C) ANEL m Z ftl CSS O z . z > z d S J3s 's N 711 mTi J C31 O r m y = O z Cn ? m Y a 7M O m 793 z � O z �r s a; a i %-Tr 19HE d _ A I �n TFl I m m a z v 0 Gia 0-4 ' F . J >O� G)0 � O:� � m c v-4 v — Ea� Z Y m 7� oz m m m m m m c) Z z � z n m c r � � m z � o > m D 73 � �Tl D Z D 70 Z. U3 m r a m O < Z 10 713 r _ o m < Nr CN O CN rn a Z -yn XlZN� CA lid OO 00N�v O (4,q A / m A ^ C) C) Q m Z ftl CSS O z m z > z C m � 711 mTi J C31 O r m y = O z Cn ? m Y a 7M O m 793 z � O z �r I� I Z rn I O CL c r e e a o qd � Ad Qn,�r o O e g;gq IL c 3 o e m • >> Or a c m !o 3 'm r m a _ mm 713 C L Z 711 mTi Z rn I O CL c r e e a o qd � Ad Qn,�r o O e g;gq IL c 3 o e m • >> Or a c m !o 3 'm r m a _ IMPERIAL � �z T IN e \t �T CO., 46-120 CACHOU N SSTREET INDIO,CA92201 (760) 347-3566 FAX (760) 347-0343 CONTRACTORS L.IC.# 207136, G45,C10, G61 BUSINESS NAME: FA L M DESERT NATIONAL DANK PAXE: 1 2003 This is an original unpublished drawing, created by IMPERIAL SIGN. It !s submitted for your persona! use !n connection with a protect being planned for you by IMPERIAL SIGN. It Is not to be shown to anyone out- side your organization,norlshtoberepro- duces, copied or -exhibited in any fashion. CUSTOME�c NAIVIE: COLIN MGDEKMOTT DRAWN BY - - r WORKMANSCOMP# 1424837-99 MAILADDKE55: 75-200CHIPFEWA PHONE NUM6EP Clfl LICENSE# 1345-01-01484 CUSTOMERA 0 LANDLORD APPROVAL JOB LOCATION: 47-000 WASHINGTON 5T. FAX PlUM6ER MANUFACTURE & INSTALL ONE LOGO 51GN CAHINET FACE: WHITE FLEX RETURNS; 24 -GA. 5/M PAINTED DK BLUE ILLUMINATION: 0500 WHITE GRID NEON (OOMA) COPY: APPLIED VINYLS `INSTALL IN DOOR WAY AREA DESIGNATED BY CLIENT. (FACIA 15 A TILE FIN15H) *POWER SUPPLIED BY OTHERS I INSTALL IN ACCORDANCE WNEC 3e 54" 00000 R ®��0 DESERT BANK PALM NATIONAL NEW LOGO CASINET 36" X 54" FTM SUNFLOWER (3630-25) PTM RUST BROWN (3630-63) FTM DARK BLUE (3630-36) N.T.S. Typical LOGO CAN Specifications 4"+ :`III Ve"6talCite Traneformer boz +. I` wldleconnect awtcch Sealant applied Installed me per UL & NEC codes W all penat ations giit . Treformer inetalled an GTO Cabk me per UL & NEC cedes w/sleeving Neon 13mm glass I!!l! 3/16" Plex Face Dieconect UL hated glass '`'! switch tube surrorto Primary power to location UL Llated boots run b,/ others add ehort etepa ,.1i Dry Wall Aluminum returns 'Method a attachment to be determolned D90 thickneee by existing wall structure., This is a original unpublished drawing created by IMPERIAL SIGN, It is submitted for your personal use in connection with a project planned for you 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