0109-040 (ELEC),
161
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LICENSED CONTRACTOR DECLARATION
I hereby, affirm under penalty of perjury that I am licensed under provisions of
r 'hapter9, (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, avid my License is in full force and effect.
License # % Lic. Class Exp. Date
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ate G= ` _•a ..t Signature of Contractor Ott+f, fix"a f+r`+•arff`4`
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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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. _
STA.'M FUN D 470-00040
(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 p b ions. r y
,� fbate: '6 Applicant , '' >: , .11 ta%% xi,
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 applicatbn 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 /
.Signature (Owner/Agent) �fi.,.9 ;•a ra,., t,. Date.•'1e' 1,16/
BUILDING,PERMIT#
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DATETRACT
VALUATION LOT TRACT
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JOB SITE ,
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ADDRESS
OWNER ;
CONTRACTOR /DESIGNER / EN •INEER
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86.30 T-If6 rl"�TIWAY 11: 1'
303 W IWAN I.0
T-AQMWA CA 92253
ON71AWO CA 91762
(909)98 =>4632 C,`814 5849
USE OF PERMIT
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RECEIPT -
DATE
BY
DATE FINALED
INSPECTOR
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 Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. 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 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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
August 29, 2001
Mr. Ray Courtney
Ontario Neon
303 West Main Street
Ontario, California 91762
SUBJECT: SIGN APPLICATION 2001-563
Dear Mr. Courtney:
(760) 777-7000
FAX (760) 777-7101
On August 28, 2001, the Planning Commission, on a 4-1 vote, adopted Minute Motion
` 2001-014, approving your request to install 18" high, internally illuminated sign letters
for the Stater Bros. Super RX Pharmacy at 78-630 Highway 1 1 1, pursuant to Section
9.160 of the Zoning Ordinance, subject to the attached conditions. Enclosed are
approved sign exhibits that shall be submitted to the Building and Safety Department
for permit issuance. Regarding your building permit issuance application, please
contact the Building and Safety Department at 760-777-7012.
Once a building permit has been acquired, please contact the Code Compliance
Department to arrange an on-site visit during the installation of the building sign (i.e.,
24 hours in advance). They can be reached at 760-777-7050.
If you have any questions, please contact me at (760) 777-7067.
Si
ERM�4N
C MM TY 4D LOPMENT DIRECTOR
US DI L
iAss 'ciat Plan r
Enclosures
c: Community Development Director
Building and Safety Director
Code Compliance Department
Betty Sawyer, Executive Secretary
Itr SA 563 RX -51 greg
No,
h
-1
-
J
MINUTE MOTION 2001-014
CONDITIONS OF APPROVAL ADOPTED
ONE ELEVEN -LA QUINTA SHOPPING CENTER SIGN PROGRAM AMENDMENT
SIGN APPLICATION 2001-563 (ONTARIO NEON)
AUGUST 28, 2001
GENERAL
1: Sign Application 2001-563 shall expire and become null and void on August 28,
2002, unless sign is installed or an extension of time is granted by the
Community Development Director.
2. The applicant and/or property owner agrees to indemnify, defend and hold
harmless the City of La Quinta in the event of any legal claim or litigation arising
out of the City's approval of this project. The City of La Quinta shall have the
right-to'select its defense counsel in its'sole discretion.
The City shall promptly notify the applicant of any claim, action or proceeding
and shall cooperate fully in the defense.
3. A building permit shall -be obtained to install any permanent building sign
covered under this application pursuant to the exhibits on file with the
Community Development Department.
SA PC Sign503 RX coa - greg