0111-114 (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.
Licerise2,07
g r#y l �gLiic. Cllassgsy CExp. Date p� 7
5 D3
10
Date �1 1` Signature of Contractor ,...1 tt fid
OWNER -BUILDER DECLARATION f
1 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 vorkers' compensation insurance carrier & policy no. are:
Carver STATE FUNS Policy No. 14-7407-01
(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,_0
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: f i .'tJF Applicant /'/,. ,fit' :`'-•. -
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 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. � J
tom., ,.,
Signature (Owner/Agent) � �" t ( Date �"
- � r
_BUILDING PERMIT PERMIT #
DATE o- VALUATION LOT 0111"414 TRACT
JOB SITE
APN
ADDRESS -' i AVENIi DA LA YONDA.,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
W.D.10 CA 92201
C160)347-3566 4MOLO 223
USEOFPERMIT
$ }}
MPO'590*,+fZON SION PER SA.01.573 (A VOREWS)
VALUATION LS
El_s , 3 WCAL, tO;3 �i a w�1�34 -Q(3Ct i p.S�tj
BLEB-T(YAA•L CONVYRIFarl,CiA4• AM PLAN MLi..K
$30.00
. x+35 �?Tri�•�>�a��FSUZ
$0,00
RECEIPT
DATE7 /
BY j /
DATE F
INSPE O
' INSPECTION•RECORD_
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
s
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
i 3i
Forms & Footings
Ducts
t q
Slab Grade
Return Air
s ;_
Steel
Combustion Air
Roof Deck
Exhaust Fans g
,r•,
O.K. to Wrap
F.A.U.
}
Framing
Compressor
Insulation
�t
Vents
C�
Fireplace P.L.
Grills .
Y
Fireplace T.O.
Fans & Controls
t
Party Wall Insulation
Condensate Lines
i h
Party Wall Firewall
{
i
Exterior Lath
f
k
Drywall - Int. Lath •
n
•
3
Final
;
Final
POOLS - SPAS
y
k
BLOCKWALL APPROVALS
!j
steel
Set Backs
Electric Bond
k to
Footings
c
Main Drain
Bond Beam
Approval to Cover
s
Equipment Location
.}
Underground Electric
y
Underground Plbg. Test
final
Gas Piping
t ;
_ PLUMBING APPROVALS
?
Gas Test
i
Electric Final
-Waste Lines
Heater Final
F
Water Piping
Plumbing Final
�
Pimbing Top Out
Equipment Enclosure
.;
Shower Pans
'
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
i `s
Sewer Connection
Encapsulation
f ,y
Gas Piping
r
Gas Test
}
Appliances
Final
COMMENTS:
y
t
s
$
'
K
} 4
c.
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures r
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final V
Utility Notice (Perm)
IMPERIAL,
•
SIGN CO ,INC
46-120 CALHOU N STREET
I N DIO, CA 92201
(760) 347-3566
FAX (760) 347-0343
CONTRACTOR5LIC.#
207136, C45,C10, C61
B1-151NE55 NAME: DBA Andrews
DATE: 9-25-2001
DESCRIPTION OF WORK
an M Incl unpublished
,� drawing,
by IMPERIAL SIGN. it is submitted
for your personal use in connection with a
being planned for you by IMPERIAL
Is not to be shown to anyone out -
ur organization, nor is it to be repro -
[duced,copied or exhibited in any fashion.
CUSTOMER NAME: Ed CoSek
DRAWN BY
ALBERT TORRES
WORKMANS COMP #
1424837-99
MAIL A D D R E 55 : 45476 Ca m i n o De I Rey
PHONE NUMBER
250 1380
CITY LICENSE #
815
A LANDLORD APPROVAL
JOB LOCATION: 78-121 Aveniva La Fonda at Deee
F NUMBER
t GI -0934
Exposed Neon (13LUE) with
Blue Flat Cut Flex bkgd.
I
Mh
x❑
U Ave La
r'0 _. 04-
15-0�1-�
20 9t 20"
731/2 99 +-
G & SAFETY DEPT
A PROVED
FOR CONSTRUCTION
DATE //-itl_d ov ".1
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
Dannv Crawford
From:
Sent:
Monday, October 21, 2002 3:31 PM ,
To:
Danny Crawford
Cc:
Jerry Herman; Stan Sawa.
Subject:
Andrew's Bar Final
Monday Update -
Improvements look good, however, please ensure that the lighting in the alley is hooded and that parapet flashing is
painted. If you have any questions, I'll be back in the office on 10-28. TX
I