402-310 (ELEC)78010 Main St Ste 100
0402-310
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. T'
License # Lic. Class Exp. Date
440821 C10 C45 064.1120
1''
Dated li j '0 . Signature of Contractor
1.LoGt fT ' t
OWNER -BUILDER DECLARATION 111
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 1*N5UR.A1qC CL? ,1 Policy No. 155763603
(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
Code, I shall forthwith comply with those provisions.
Date: n I.//&/ /o Applicant I Im i ► t3 I t r,;4t ( i.,
}
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.
f} e ! 4
'Signature (Owner/Agent) {1i !i'Date
BUILDING PERMIT PERMIT"
01-310
DATE 1 i (VALUATION $1.20(=,.00 LOT TRACT
JOB SITE - APN—
ADDRESS 7"10 MAW W'IREFT SUIME 100
OWNER CONTRACTOR / DESIGNER / EN (NEER
OM 'i° kVN LK 4iT_iINTA.I= DMO RATE) MGM AS3OMAi'138
78.080 4.°AUXUrrADID xM.F1'. 201 1160 P`IGNEPM 'WAY "Tod"
LA QUIMA CA 9225:1 EIL (1WON CA 92020
(619)579-2229 MR 3ti i
USE OF PERMIT
TKRFF '3 HAI,.')1L,i..i1 S't.IATR`r Cff QmrL. LES Tom; S1QN% PPR
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 - IM. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
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 Unes
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: /
Finale
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 D°atectors
Temp. Use of Power
Final
Utility Notice (Perm)
P.O. Box 1504
78-495 CALLE TAMPIco (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101
March10, 2004
Mr. Steve Therriault
Integrated Sign Associates
1 160..Pioneer Way, Suite "M"
EI Cajon, CA 92020-1944
SUBJECT: Sign Application 20047767 for La Jolla Bank
Dear Mr. Therriault:
The 'Community_ Development Department has approved the request for two
permanent. wall mounted business identification signs and an ATM at 78-010`Main
Street, Suite 100.• Enclosed are two copies of the approved sign- exhibits for your
use. The approval -is subject to following conditions:
,I
1.: This sign permit is for two permanent business identification signs and an
ATM facility. Sign designs and locations are per approved plans attached
and on file in the Community Development Department.
2. A building permit shall be obtained from the Building and Safety Department,
prior to the beginning of installation of the signs.
Should you have any questions, please call me at (760) 777-7064.
Very,truly yours,
. F
OSCAR ORCI, Interim
Community Development Director
STAN B. SAWA
PrinceI PI
pa anner
enclosures
v -d •Slg n c s
( o1 [A bA UIQ_
c: Greg Butler, Building and Safety Department (w/o enclosures
p:\stan\sa 2004-767.doc
ti