0304-366 (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
Date. �' Signature of Contractor .?)J
j v s
k t J
!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.
( ) 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 ST.A3 ZF1.1ND Policy No. 1424937.02
-,(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 fQQrthw'th comply witNti compensation,
provisions.
f Date: ,r11 k ely �IAV /Applicant` f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal -penalties and civil fines up' to $100,Oo0, 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 i§'
correct. I agree to comply,%withall City; and State laws relating.to the building
construction, and hereby�autho raze representatives of this City to enter upon
the above-mentioned property o� Inspection purposes.
Signature (Owner/Agent) L ��f Date
.0 . BEADING PERMIT PERMITN
0304-366.
t VALUATION . LOT TRACT ?
_DATE
JOB SITE
ADDRESS a 1722, 1110FIWAY II}
APN
� �� v'�i�•�I,��
OWNER
CONTRACTOR/DESIGNER/ENGINEER
3?AIM Ai7SM.c i
YAOMI, L SIGN CO.
78-722 TTWY 111 r
46120 C:A1,,ii.CTi3N
LAQTJDrIA Com. 92253
%TD10 CA 9.22031
Q60)3.47-3566 CRUZ ?.23
USE OF PERMIT
WWRILANEOUS
RELOCATION OF 1LLU1d1T4ATZDS1G-N PAR SA 2003-693
VALUATION 2..700.00 LS
ESMIATED COST OF GO1v TRIETMON
2;stJClo)
PERM 16'rX SUWL44ARV'
ELECTRICAL FEE 101-900-420-000 $30.00
SUB—TOT AI.', =MRIAMN AIM 'PLAN Cl -DECK
$30.00
URSO PRE -PAID IT83,
NOW
F/ AN
[RECEIPT
DATE
r
BY �_s
,D TE FISED O
` 5�
INSPECTOR
PA
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
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
OX 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 z.—�
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final p
�41
Utility Notice (Perm) t,
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
April 23, 2003
(760).777-7000
FAX '(760) 777-7 101
Mr. Jim Engle
Imperial Sign Company —y
46-120 Calhoun Q
Indio, CA 92201 I
lI
SUBJECT: SIGN APPLICATION 2003-695
Dear Mr. Engle:
The Community Development Department hereby approves your request for a building sign per
the attached exhibits for Red Robin.jbe proposed sign is consistent with the Zoning Code and
the approved sign program. The approval is subject to the following conditions:
1. The sign shall be centered i.e. with equal margins on the top and bottom of the fascia
wall identified for placement of the sign.
2. Patch and paint stucco to match wall in location where the existing sign will be removed.
3. A building permit shall be obtained from the Building and Safety Department prior to
installation, if required.
Should you have any questions, please contact me at (760) 777-7065.
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DEPARTMENT
Fred M. Baker, AICP
Principal Planner
enclosure
c: Building and Safety Department
Code Enforcement
P:\FRED\SA 03-695 app Itr.wpd
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