0203-002 (SIGN)LICENSED CONTRACTOR" DECLARATION
I hereby affirm under penalty of perjury that.l am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
F,.Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
6£6� a y.d°3;1lt
e
;!'DatSignature 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'SrCOMPENSATION 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.
(EhI 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 PolicyNo.
(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.
r Daie: ✓�x° +� _'% Applicant :V✓ Leff +,d. �'.
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.
;sS gnature (Owner/Agent) �"��%" ' Date
BUILDING PERMIT PERMITk
0203- OZ
�.
DATE 2V,%LUATION '�Ta�4 � OTS -� "� s�- �= PRACT
JOB SITE
ADDRESS 79-49
APN _
OWNER
CONTRACTOR/DESIGNER/EN (NEER
N-101 ASC OITRA(TIMP200 R
20.928 (.'WM1M'R0MD
A>W1:lT!-AHUS CA. 91301
'W.AL14M.' Qlk 91799
USE OF PERMIT
77 ph qqrr��yy
t .01 nSI , 6.,,13 J°0r ' UV46, 9 IIJ L)N UIV11,103 L -L. K aft
MN -532 VOR USA PVt;DUSIJIM
VALUATION 17, OWN �15
P'Lah"'.� �31.F.A°�.'.KI) 4 OYr OF C.ONS"IM'C7't:`•TION
,{y 7�'y �q'E �t y�yt, �^/ ��y y�y may, q ,L
.1Cl•d`i.S in f7Er F3U17+YiY.if'.Ry _
ifl:,i"C'Tvi,'ALnetff-CeiC-Gt{3!1iy?U.
i
k, 0 8 2002 i
MAR
ce- IFLAQUIRTA:
1A�r�T
1100. 4-
1817B-` OUL, s ON'SMtdC°i',ItAT ANDI`yLA�y
�.i4rLSpWnC
ti I;FojA PAW MRS
S
TOTAL YEIMMY YA1,43VUE.' NOW
• r
RECEIPT
DATE r'
.BY
DATE FINALED.
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 8 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 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
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
P.O. Box 1504
78-495 CALLE TAMPICO
.1�,KlngungnierIhanEver LA QUINTA, CALIFORNIA
March 7,2002
Mr. Bill Hormuth
K & B Signs, Inc.
20928 Currier Road
Walnut, CA 91789
92253
(760) 777-7000
FAX (760) 777-7101
RE: Sign Approval 2001-582; ID Signs for USA Petroleum; La Quinta Corporate Centre
In regards to the above subject, this Department has approved your application for a monument sign
and main building signs for the USA Petroleum station at the northwest corner of Dune Palms Road and
Highway 111, pursuant to the conditions as specified below and the enclosed Exhibits. The proposed
signs as conditioned are consistent with Chapter 9.160 of the Municipal Code, in that they are in
conformance with the sign provisions as conditioned for Site Development Permit 2001-695. This
approval is subject to the following conditions:
1 . The applicant is responsible for proper sign maintenance and compliance with other general sign
standards as set forth in the City's sign code (Section 9.160.030), as well as procuring any
required building permit(s).
2. Installation of the signs shall comply with approved Exhibits A, B and C and the applicable
provisions of the approved sign program for La Quinta Corporate Center.
3. This sign approval does not apply to the Java Jon's sign panel as proposed, nor to the proposed
12" x 102" building -mounted signs on the carwash structure. The carwash signs may be 12"
x 85" as permitted by the conditions for SDP 01-695. Otherwise, an amendment to the
approved Site Development Permit 2001-695 to increase the sign length from 85" to 102" is
required, with an amendment to this sign approval. The fee for these applications is $850.00.
4. The "mini mart" sign on the main building may be in white or red letters, at the applicant's
discretion. All other size and design elements of this sign shall be as shown on the approved
Exhibits.
Should you need any clarification or further information in regard to this matter, or if you have any
questions, please do not hesitate to contact me.
Very truly yours,
JERRY HERMAN
.COMMUNITY DEVELOPMENT DIRECTOR
Wallace Nesbit
Associate Planner
WN/wn
encl.
c: USA Petroleum Corporation
Code Compliance Division
File; Sign Approval 2001-582