Loading...
0403-353 (SIGN)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 5:3955 12 C45 -Date Signature of Contractor `---- '—� 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. ( ) 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 rTATE YWiD . Policy No.. 4 d8DOODIOD (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, andagree that if I should become subject to,the workers' compensation provisions of Section 3700 of the Labor Code;>I shall forthwith C'O'mply C'o'mplywith those provisions. Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil `Iines 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 f whose request and for whose benefit work is performed under or pursuant to .I 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 r construction, and hereby authorize representatives' of this City to enter upon/ the above-mentioned property for inspection•purposes. f signature (Owner/Agent) 4 - Datelft� r BUILDINGT.ERMIT ()3/,g4rZ�0C VALUATION Lv� LOT PERMIT # TRACT 1"19 36 JOB ADDRESS 7S-4.50 . i(.�a'1:�.WA 1..11 I APN OWNER 78-3310 HWT 1111 L&; U NTA USE OF PERMIT MTW�"-7�. AWROLTS V.ALUAT1014 C"%. 92=3 CONTRACTOR/DESIGNER/ENGINEER 20361 HERVANA CTE2CLE :t.l:sfFi+O.FcBT CA 92t 30 (949'158-1000 CB1.4 1.800ion is ESUVAIED COR, OF CONSTRUMOPT CONSTRUCTION IT17. 1011.000 418-000 $41,00 MAR 2 4 2004 —ail3TA CITY OF T COT CC 98n --z (,_v NT AMD PT..AN 1 `I.1E•L . RECEIPT DATE S� - ,r g`� f`, DATEf�gL� INSPECTOV .1,I0,00 T41.00 .$0.00 S41.0D I& 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 BLOCKWALCAPPROVAL§ steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond.Seam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I 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 Wain Service Sub Panels Exterior Receptacles G.F.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: - 'al OF LA QUINTA IILDING & SAFETY DEPT. `PROVED "'M CONSTRUCTION Am - --_ I *ern A EXISTING MULTI -TENANT MONUMENT Scale: Apprx. 1/2"=1'-0" plr•�117O�1O1��1 20361 Hermana Circle Lake Forest, CA 92630 (949) 458-1000 PHONE (949) 458-3530 Fa; b-8" THICK &prov__ g ® Planning Commission >-Councii -�:om►n Dev. Dept. Initials Case No. Exhibit El With Conditions l TARBELL RIltors t, Date Reso # I_� EXISTING MULTI -TENANT MONUMENT PHOTO Not To Scale OAII Yarbell Realt®r , - o Lu VI.AIIVN: La Quinta ADDRESS: DATE: OZ/ C 3705 BRANIY ISA/ SALES: DC �` (U L) Underwriters Laboratory, Inc. NOTE. This is un uriginul drowinq, created by Promotional Signs, It is submitted for your P.,use in connection with a Promotionaroiectbeing planned for you by l Signs. It is not to be shown to anyone outside your epoducedr, :.piedltorr exhibited in any fashion. Any printed colors on drawinq are approximate. REVISIONS: A03,02/0-4 A 03/03/04 ® 03/04/04 A03(11/04 PAGE: OF /� i Contractors LiC. #636512 APO 3'-5" MAX. 12" X -------------------RBL � 44" SIGN AREA N j LO CHANNEL LETTERS WITH "HALO"EL, — EFFECT ILLUMINATION 0 _ v � ---------------- R --- e --- a- -or ---- 1" THICK PLEX - ITEM A - TENANT SIGN FOR EXISTING MULTI -TENANT MONUMENT Scale: 1-1/2`=1'-0` TARBELL : REVERSE PAN CHANNEL LETTERS FABRICATED FROM .090 ALUMINUM FACES AND 3" DEEP RETURNS TO BE PAINTED RED 2793-278 11 3" 6 REAR RACEWAY FABRICATED FROM ALUM., WITH VISIBLE DISCONNECT SWITCH. PAINT T/M "STONE". 1 II 211 SIMULATED STONE RIGID METAL CONDUIT MONUMENT FACE TO EXISTING J -BOX BELOW ITEM A - TENANT SIGN / MONUMENT PROFILE Scale: 1-1/2"=1'-0" TYPICAL REVERSE CHANNEL LETTERS INSTALLATION WITH LED ILLUMINATION 1 ALUMINUM BAFFLE INTERNAL WHITE L.E.D. ILLUMINATION TO HALO ONTO MONUMENT BEHIND LETTERS TO BE INSTALLED PIN -MOUNTED 1" OFF SIMULATED STONE LED MONUMENT FACE ALUMINUM REALTOR: 1" THICK PLEX PAINTED RED 2793-278 LETTERS TO BE INSTALLED PIN -Mf ff_d_bW STONRAIR MONUMENT FACE. © Planning CowAVesim ,»,M,!! DRAIN HOLE City COuncd . w�+••■+..w INr.,.r•■.... SIGN REQUIRES REAR RACEWAY. PAINT INTERIOR OF .Ommu� om 6 LETTER WHITE Initials i Case NGi,/.'.1..HEETMETAL SCREWS (MINIMUM 4 PER LETTER) Exhibit M With Condition*,.. ,.�.«..�t..w Promotional 20361 Hermana Circle Lake Forest, CA 92630 (949) 458-1000 PHONE (949) 458-3530 FAX SPACER L T rbell Realtors E Quinta uL drawing, cmatod by Promotional RFVISIONS: CONCEITC 3705 Dom'°'" JW 'AE' DC /26/04 I L T NOTE: This is an original uL drawing, cmatod by Promotional RFVISIONS: PAGF: us1sD Signa. It is submittcd for your personal use in connection with a Q 03/02/04 n Underwriters proiect being planned for you by A 03/03/04 ` Laboratory, Inc. Promotional Signs. It is not to be shown to anyone outside your ®03/04/04 OF Contractors Li C. organization, nor is it to be used, reproduced, copied or exhibited & 03/11/04 /'� ` #636512 in any fashion. Any printed colors on drowinq are approximate.