0004-025 (MISC)~ LICENSED CONTRACTOR DECLARATION
I hereby, affirm under penalty of perjury that I am licensed under provisions of
Chapterl,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 Signature of Contractor—
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjurythat 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 theowerAv am exclusively contraciinq 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.
SZ-ion
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 SAFE INS CO. Policy No. , CM6312M
(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 jhat if I should become
subject to the workers' compensation provisions df/Section) 3700 of the Labor
Dode, I shall forthwith comply with those%pro'i. ns.{(
ate: /h f 'A . Applicant %'�� •''�� 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; 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 with all City, and State laws relating to the building_-:,`*
construction, and hereby authorize representatives of this City to enter upon.":-
the
pon:the above-mentioned property f - rI nspection purposes.
/ lf� '! I
,Signature (Owner/Agen!r�rJ `_ Date's/��l,rl"
I/ �l P BUILDING PERMIT PERMIT#
rlf1
DATE VALUATION LOT, TRACT
$42,.40
JOB SITE
APN
ADDRESS
!0-200 VtS.i'.tl BOMA
OWNER
CONTRACTOR/DESIGNER/ENGINEER
KOL 1 LA QU NTA.MOM'
CO1�'U�, mow gupl-jORT So Vlui .S
49-499 E1 MATHOVd'!'MDRIV
P.O. BQX- 3166 � R
1.AQ-01ffhk CA 92233
PALIb DEZERT CA 97760 _
- MIX e
J(a 4
�
USE OF PERMIT
P .
SPPC1AL INSPECTION POP, TEMPt3'RARYTEN`C INSTALL 44.00 RW , .
4-21.09
°t)i rig
WA
CANOPY 3,200,100 Si!AJT�y ®rLJQUI
'F.
EMiVItlIM COgr OF COIiSnWC3:10N 42;1W0,00
FERA tltT M, Si AM"Y
TEMP CONSTRUCTION TRA11.0 101-000- 423.000 $200,00
'0TAL C01` KX- UCM0N A1` D PLAW C:H"r:C K $200.00
1Y7
,U..B-
LF33 PR E -PAM 1♦Er $0.00
TOTA:t:. F.1! Y' i''l�'.:.1.+�S)YOF. i'1'OW $2.00.00 .
zl
RECEIPT
DATE BY
DATE FINALED
INSPECTOR
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 !
BLOC KWALt PPROVAL
POOLS - SPAS
Steel
Sc,'. 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
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:
DATE:
4/3/00
TIME:
PM
PAGES:
3 in _&ding This One
FAX:
777-7011
ATTN:
Greg gutter
City of La Quints ,
Buildin
RE: Shade Canopy_for_La_Quinta Resort private conventionYgroup, Dunes Clubhouse
't Uinta CA 92253
Parking Lot, 50 - 200�Vista Bonita,�La�� _ _��._�...� .
y 1
'Dear Greg; .
Set: April 7
Usage: Lunch on April 11; 12, 15,16, 19, 20
Strike: April 21
Group: GenerahMotors, private convention group, 80 ppl: flow `
Shade Canopy for golfers lunches
Canopy Size:40'X80'
Sidewall on one side for additional shade,purposes
Fent stakes at every pole; every ten feet into asphalt
-
Marilyn Betzler
Entertainment Plus Talent Agency.
J
P.O.. Box 3166 ;
Palm Desert,.CA 92261
760-398-2000 x723 r ,.
cell 760 - 861 - 6409
Installer: C.S.S. Inc. dba Entertainment Plus Talent Agency
r
P.O, Box 3166
d Palm Desert, CA 92261,
760 — 398 — 2000, x-23.
cell 760 - 861 - 6409 _
P.O. Box 3166 • Palm' Desert, Ca. 92261, • 760-398.2000 •, Fax 760.398-4055
www.cssevents.com E -Mail mail®cssevents.com
i ..
pmject r/pO (circle one):. view Add;m Aitcr Moir Dm4p A
a Units:
Esuat1w Value of PMjia-.
' " FiestEe Plus II Features (30'and 40'Systlenw)
New Prarne design allows interchangeable parts and
Faspin- simplified Installation.
Portable 9 permanent i
It's expandable, it's secure.
Expand the 30' or 40' Fiesta® Plus 0
with confidence. When you add a middle
section, the Fiesta Plus 11 remains sturdy
enough to expand to 30' x 60' on the 30' Tn ased Rafters' and
unit or to 40'x 80' on the 40' unit. 2"9nodised aluminum
Upright braces, crossbars, and trussed tubing, most
aebing setet -up on
rafters maintain the frame's sturdiness. the market.
Expandable Top Specifications
• 15 oz. vinyl -laminated fabric, standard.
e Stainless steel buckles on tops.
• Stripes or solid colors.
• Proven heat shield with exclusive SUPERWHIT&O
• Reinforced corners.
a Wall rope standard, for hanging walls.
• Clear tops and skylights available.
'Trussed rafters on 40'syatem only,
'7't Rugged, Interchangeable Frame;
Simplified Installation . rArner
• Twominch anodized aluminum tubing.. Upright
a Trussed rafters on the 40' system make
Fiesta® Plus U the most secure set-up
on the market. lutennedlal
• Fast pinning system replaces nuts & bolts Rafter
for quick assembly.
• Zinc -plated steel base plates. Baked enamel 1
finish on weldments.
• Guy ropes and 42" steel stakes, standard.
. 20' middle sections, standard for 40' system
(10' standard for 30'system),
• On the 30' system: Pave height - 7',
Center height -14'6", Pitch - 7'6".
. On the 40' system: Eave height - 7',
Center height - IT, Pitch -10'.
a Adjustable uprights - T to 9'6" on the 30'and 40' systems
Andhw products incorporate superior design features andWM10 best within rhe
parameters grout lmftdio% Teni& hone been desigrted and manufactured by
Anc w1 durtries In since 1892 and have Wllhslaod the moat adverse dimatic
coadftiam when erected and maintained in doco dow with i 0aliolion i UMIc-
Irons p autdad, L.caution, soy eonmdonk and k cA of malate me can here a
ueryaduerse effec& even on the best installation and product flnrhemmore. we
nreommend dhat the tent not be occupied or used durbV sett m weatherr ft
advise and It is understood that It could be unsafe to use this product under such
adi eese conditions or if the provided installation kLftctioru are not followed.
�,
Fiesta Plus H 150'Festa Plus 11
I we ..
top) (3 -piece top)
The unique peak weldment
adds superior strength to
the Fiesta Plus H
1 �t
Intelmedlate
Weldment
9
flak Rumeni
Corner Weldment
Tough steel wefdments and
Amchork unique fosrpinnfng
systcm are used for
easy asaembEy
&aCf/Fave
Weldment
ff
BMWUpr%bi
Re=vable
Cevsa Cables
V,,�Uprlght Brace
Guys & stakes
40' x 60'
Fiestam Plus n
Baked Enamel
Weldments
Durable Rnlsh on all weldrmnls
marches other frame components and
prevents rust
t
P)coPYRIGHr 1993 Mchor h duauha lair
sos,u. sc.ham.wu haK
Frame Lift
?he FSesra frame lift is
recommended for reduced
Installation time and
efficiency.
wain..
812/867.2421
FAX 818/867-0547
Production Funtles: sx1pf�O01m:
IN 3477
1=001P ton. Evansvale,iN 47 7i0@,=.
1111111!/IlM
Rapld/Et�po.wc
Statim Satfs�dlon Since 1892