0110-117 (ELEC)LICENSED CONTRACTOR DECLARATION'~'
I hereby affirm under penalty of perjury that I am licensed under provisions of
L- 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
2.17.
.4.5 C; 10 CA
Date! _ Signature of Contractor ' ''� °- z,:?
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._? 11111- u70.1
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:
Carver g,,P 13`:! rr`fL33' i Policy No. IM"A-0 E 03"1
(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,,.,+....,., iz--:.w � Applicant` 1: ';,'•., ,+*
—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.
� S
Signature (Owner/Agent)""„- /-� y'���' .:Date_ - •!"�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MOUTH IT 11 -KI 7EM,
M7 ZC9_R1 RT -41,14M WA 990,10
AK IIERNARDWO CA 92410
(909)885.447.6 C, VA 4439
USE OF PERMIT
dNTXP%k A1,1,Y 11LL:f;3bd1TN,N, f Z0 ur. 2i. 4',NZL. LIVIYER S YGNS 004 SEW'S
VALUATION 2100.00 Ls
EbIDIA771) CM OF CONYMMMON
Y:.�.,�+C:'i'�3C+�P�;� Y'�i � 0`► �f��rD�4�99•r<7�53 �a�,t'+�
g.
iU1
Ln_ �
Li
OCT 15:200J
CITY OF LA QUINTA
FINANCE_ DEPT
SUB-70-TAL C"f:?NZAT.r.'�T�.'�:Cf. W AND ;£'l" C:.RE
" ISM 'PRE—PAM:lcit&I
$0.00
e
RECEIPT
DATE
BY (( jj
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSUCTOR'
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
H:ste Lines
Heater Final
Water Piping
Plumbing Final -
Plombing Top Out
Equipment Enclosure
Sh.�wer Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances _
Final
41
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures y
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
)..I n():)
vquin(). t''1
12'=,43/4'
Notes:
SdUSitTl�fl'S
taiwaa�
F
STOMER OVZE, DESI N, C O
e: UMITATIONS F THE P 1NTINS PROCESS
COLORS MAY VARY ON FINISHED PRODUCT.
This original unpublished drawing Is created by and is the sole property of
uW Bros. Electric Sign Service Co, Inc., excepting only included existing Trademarics
%odcut Prints. Said drawing is submitted only in connection with a project being
planned for you and the business you represent, and is not to be exhibited to anyone
outside your organization or reproduced, or copied by anyone, unless authorization
Is obtained from an officer of QUiel Bros. Electric Sign Service Co., Inc., in writing.
GYl�O�MY ■YCAIC •10• Y�OOI�i3O� ` won a .,.w
IMIE4A11ALµ Ilii <dVgltpl ..�....
— T-0
PAN CHANNEL LETTERS and NEON CABINET SIGN SCALE: 3/4" = F-0" -
MANUFACTURE & INSTALL 2 (TWO) SETS
JENSEN'S
• ALUMINUM LETTERS, PAINT RETURNS BLACK
• BLACKIWHITE PLEX FACES
• 3/4" BLACK TRIM CAP
• ILLUMINATE WITH 15mm/30ma WHITE NEON
Revlslon
C.
By I Date Revised
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED 1
FOR CONSTRUCTION
DATE BY
FINEST FOODS -
• ALUMINUM NEON CABINET SIGN; PAINT RETURNS BLACK
• BLACK/WHITE PLEX FACES _
• WHITE OPAQUE'WIM OVERLAY
• 3/4" BLACK TRIM CAP
• ILLUMINATE WITH 15mm/30ma WHITE NEON
SIGNS BY •
SINCE 1961
Inland Empire (909)885-4476
Coachella Valley (760)347-8370 • High Desert (760)955-7446
Fax: (909)888-2239 • E -Mail: quielsigns.com
PURCHASER: Matt Zack
PHONE NUMBER: 760-770-3355
NAME: Jensen's Market
ADDRESS: H y 111 & Waohin®ton
Street - La Quinta, CA
COMP FILE: JenSens Market
(01253-B).cdr
DATE DRAWN: &-2&-01
SERVICE NUMBER: -
DRAWN BY: Art:
JOB NUMBER: -
SALESPERSON: Mike Clark
DRAWING NUMBER: 01253-8
EXISTING BUILDING ELEVATION
EXISTING BUILDING ELEVATION
SOUTH ELEVATION
NOT TO SCALE
'ROPOSED SIGN — OPTION "A"
NORTH ELEVATION
NOT TO SCALE
PROPOSED
PROPOSE[ SIGN — OPTION "B"
c ITY O F L.A (jUil TA
BUILDING & SAFETY DEPT.
ii �1]f
APP ECJ I
FOR CONSTRUCTION
DATE By ------
Notes:
I SALES PERSON'S
SICNAHIK
CUSTOMER APPROVED
SIZE, DESIGN, COLOR
Date:__
00 TO LIMITATIONS OF THE PRINTING PROCESS
COLORS MAY VARY ON FINISHED PRODUCT.
NOTE: This origincD unpublished drawing is created by and is the sale7Tr7d
of
rio
Quiel Bros. Electric Sign Service Co., Inc., excepting only included existinks itial a PURCHASER: Matt Zack PHONE NUMBER: 760-770-3355
& Woodcut Prints. Said drawing is submitted only in connection with a ng A Oiincl Drawin 25 Mike C. 8-6-01 SIGNS BY + NAME: JenSen'S Market
planned for you and the business you represent, and is not to be exhibitne B Chan e cJl n Len th 5 Mike C. -28-01outside your organization or reproduced, or copied by anyone, unless on ADDRESS: �H,yy 111& WaEhin®ton S r - a Q Linta. CA
is obtained from an officer of Quiet Bros. Electric Sign Service Co., Ing. C Add o ions .5 Mike C. 8-30-01
COMP F1LE: Jenocno Market (01253-1C).cdr
Inland Empire (909)885-4476 DATE DRAWN: 8-28-01 SERVICE NUMBER: -
[5 w vv Coachella Valley (760)347-8370 • High Desert (760)955-7446 DRAWN BY: Art JOB NUMBER: -
` Fax: (909)888-2239• E -Mail: quielsigns.com SALESPERSON: Mike Clark DRAWING NUMBER: 012537—
Revision Description Requested By Date Revised I i