0105-035 (ELEC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
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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 # s Lic. Class Exp. Date
1
L-45 4? .911131 0/211L
Date,',. .E Signature of Contractof
OWNER -BUILDER DECLARATION
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.
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 Policy No.
(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,ior 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: ` 'VIApplicant-IN
—Wd-r'KhT 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 forinspectionpurposes.
Signature (Owner/Agent. -r' �' Date
BUILDING PERMIT PERMITp
DATE VALUATIO LOT 0105-M 2 TRATT s
ADDRESS 78 JOB SITE
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APN
"+,�✓ .L'nBi.T,u.:.AV �..LT b Fgyp•.
... ..
OWNER
CONTRACTOR / DESIGNER / ENGINEER
B TZKYS BMA G1!'CU,'I�t
.l+ .311 BION %:iiMP1 4Y •
7�__1411R.."UP AY' 111
1436 MERRY AVY-2nTe
.I;,Jk U.i.G�F..M Gla 92753
LGS:P�TtfBY",H CA 90813
[f/J
134 366 CWAJ
USE OF PERMIT
'ELJ7 1 P- Ct;
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
BLOCKWALL APPROVALS
POOLS - SPAS
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 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
Q.F.I.
moke Detectors
Temp. Use of Power
final
Utility Notice (Perm) f7
COMMENTS:
SITE PLAN-----
urrm IEVIL
\ 01R<� srt�c N
in
NOT TO SCALE
Approves
❑ Planning CowdesIM
❑ City Council
-'-'tl Community � Dept,.
initia b , 1A}fti..�..
Case No. :5& WOI-5q'g
Exhibit
❑ With Cond4k=..M.___,.
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�,r ADDRESS: APPROVED BY: ScALE: AS NOTED ��/� of on ,;Gnco.
noon RUBIO'S BAJA GRILL DESIGNER: RATHA 0.
�iGl'1c;o. 78445 HIGHWAY 111 #B DATE: 10 -17 - 00 1436 CHERRY AVE. UNIT C
LA QUINTA, CA 92253 LONG BEACH, CA 90813
STATE LIC. N0.629097 SALES REP: BILL SHEET: OE: TEL(562) 434-M FAM562) 434 -IM
CITY
BUILDIN
AP
FOR C
DATE _ 5/.�
FILE NAMES:
LAQUINTA.AI
LAQUINTA.JPG
eso #
F LA QU
& SAFETY DEPT
,RovE
VSTRUCTION
8y
UTH ELEVATION
0
N
SCALE: 1/2" = 1'-0"
8,-0«
1 9'-10" 1
+2V-6
+9•-0•
+3•�-
34'-2"
S/F INTERNALLY ILLUMINATED CHANNEL LETTERS & PAN -CHANNEL
PLAQUE.
SPECIFICATIONS: LETTERS TO BE 3/16" THICK WHITE ACRYLIC PLASTIC,
WITH #230-126 EMERALD GREEN VINYL OVERLAY, EDGE WITH 3/4" THICK
EMERALD GREEN TRIM . CAPS. RETURN TO BE PAINTED "MATTHEWS
LILAC SWISH 71 A -2P".
"BAJA GRILL" TO BE 1/8" THICK ALUMINUM PLAQUE FACE,
PAINTED TO MATCH #230-53 CARDINAL RED VINYL "LIGHT BOX" TO BE
3 3/8" DEEP SHEET METAL CABINET PAINTED TO MATCH BUILDING.
o "COPY"' TO BE 1/2" CLEAR ACRYLIC PUSH-THRU, WITH #230-20 WHITE
VINYL OVERLAY. "INSIDE CAB" TO HAVE WHITE NEON GRID TO ILLUMINATE
COPY.
ALL CONSTRUCTIONS & WIRING TO BE UL. LISTED APPROVED 13MM.
NEON GAS SYSTEM.
PROJECT
C
1436 CHERRY
AVE. UNITE C
LONG BEACH
CA 90813
TEL -(562) 434-6366
FAX -(562) 434-1843
Will IMT
RUBIO'S BAJA GRILL
78445 HIGHWAY "1 #13-1
LA GUINTA, CA 92253
SOKHON PHAN
1/8" = 1'-0"
SALES REP
FILE NAME
SHEET
03-26-01
8aJ4 4RiLt
WEST ELEVATION
4
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SCALE: 1/2"
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Isiencal
1436 CHERRY
AVE. UNITE C
LONG BEACH
S/F INTERNALLY ILLUMINATED CHANNEL LETTERS & PAN -CHANNEL CA 90813
PLAQUE. TEL(562) 434-6366
SPECIFICATIONS: LETTERS TO BE 3/16" THICK WHITE ACRYLIC PLASTIC, FAX -(562) 434-1843
WITH #230-126 EMERALD GREEN VINYL OVERLAY, EDGE WITH 3/4" THICK wil 1 B
EMERALD GREEN TRIM CAPS. RETURN TO BE PAINTED "MATTHEWS RUBIO'S BAJA GRILL
13-1
LILAC SWISH .71 A -2P".
78"S UIWA, cA 922W
"BAJA GRILL" TO BE 1/8" THICK ALUMINUM PLAQUE FACE,
PAINTED TO MATCH #230-53 CARDINAL RED VINYL "LIGHT BOX" TO BE
3 3/8" DEEP SHEET METAL CABINET PAINTED TO MATCH BUILDING.
"COPY" TO BE 1/2" CLEAR ACRYLIC PUSH-THRU, WITH #230-20 WHITE
VINYL OVERLAY. "INSIDE CAB" TO HAVE WHITE NEON GRID TO ILLUMINATE SOKHON PHAN
COPY. """" eN l 11. F T" n. E w n IED4X- r ft
ALL CONSTRUCTIONS & WIRING TO BE UL. LISTED APPROVED 13MM.
NEON GAS SYSTEM.
1/8" = T-0"
1 80'-6" 28'-0" 1 1
SALES REP
FILE NAME
SHEET
DATE
gala 4Ritt
�TNORTH ELEVATION
�C ulilc)s�
C
6'-6"
' S/F InterKaffv Iffuminatea Cfjannel Letter & Pan - Cljannel
Specification: Letters 'Ib Be 3116" Tf icf Wf ite Acrofic Plastic, Witt #23o-126 Emeraf a Green
Vingf OverfaV, Edge W4 3/4" Taj 4 Emeralb Green Trim Caps. Return To Be Painted
11A attf ews Ic SH4 71 A -2-P".
• Baja Grill - To Be 1/8" TGliclt Aluminum Plaque
• Face - Painted Tb Matcb #23o -S3 Carainaf Rea Vin291
' Light Box - Tb Be 3 3/8" Deep Sf eet Metaf Cabinet Painted
To Matcf Building.
Copra - Tb Be I/2" Clear Acrgf is Push-T'lj Witl #230-20
Wf ite vin f Overlap.
' Insibe C1- Tb Have Wf ite Neon Grid To Illuminate Copra.
d,aL;,e L SO sRMrr,
All Constructions & Wiring To Be UL. Listed Approved 13MM Neon Gas SSstem.
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TEL(562) 434-6366
FAX:(562) 434-1843
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78445 HIGHWAY 111 #B-1
LA OUINTA, CA 92253
SOKHON PHAN
1/8dd = 1'-0
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09-29-00
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1436 CHERRY
AVE. UNITE C
LONG BEACH
CA 90813
TEL(562) 434-6366
FAX:(562) 434-1843
RUBIO'S BAJA GRILL
78445 HIGHWAY 111 #B-1
LA OUINTA, CA 92253
SOKHON PHAN
1/8dd = 1'-0
4
6
BILL
RULAQUING
SHEET
09-29-00
Rubios.i�