0205-074 (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. r"
License fl Lic. Class Exp. Date
U61 19 045 0,; 1 1213 M210
Date ' j �'Z Signature of Contractor
d.w r �s-
T
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 Policy No.
2.21,942=12114
(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 %f Section 3700 of the Labor
• : Code, shallforthwith comply withjh6s'� provislo S.
Date: a ✓.� a� Applicant__
: 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.
,Vicertify that l have read this application and state that the above information is
correct';I`agreetfo comply with all City, and State laws relating to the building
construction, and' h eby authorize representatives of this City to enter upon
the above-mentioned propertyfo"r inspection purposes.
Signature (Owner/Agent) 514 Date�4�? °' IL
BOIL�DI►NG PERMIT PERMIT//
; ~
DATE S-- • VACfU'}ATI ION1 LOT f TRACT
.
JOB SITE
APN
ADDRESS
79 -50 BANGUI tt AV 1.1 .1
649-M!447
OWNER 4
CONTRACTOR / DESIGNER / ENGINEER
'735 :�s�.I�F 0010MY S AR �' 9-2 .
]: ? ids C /07-99
SAN FRANC-19CO CA �45 41,11
RIVERS�"1,�. E. €A 92513
USE O33FHQlPERMIT
y
R�1f L'id.�id:.fsl,,lsJ�6Sa�y„OY6Y
i
'MMUWNT 2fit4PYR.tsDAR110UMEMNr.
C014 fRUMON RX : 01-OW4 .& -OW MAO
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�'RX PAID YR�:ST S
vY3.f1
MI AY 13 20 UZ
CITY OF LAQUINTA
FINANCEDEPT
RECEIPT
DATE �77
e' ',l,J''/1
BY
DA A
INSPECTOR
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
F•rral
BLOCKWALL APPROVALS
z
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover _
Equipment Location
r
Underground Electric
Underground Pibg. Test
Fi al
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
kMater Piping
Plumbing Final
Numbing 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
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
z
w-
D IG
-! 241.46
I
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7
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km..�1`7
L 5 16 20
GR PKC VALE
2'x92' CANOPY '
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N
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p7i N
19
00
CV
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Chevron
no
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1.5
Fan Fey "
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STUCCO TO MATCH CANOPY
DUNN EDWARDS #174 "SCDON4't
SIGN 1
NO & SAFEFY b-:
;TDR VE
i { , 'ON TRUOTION
SIGN SCHEDULE
NQ. DESCRIPTION ILLUM, STATUS AREA QUANTITY TOTAL
I C-45 MONUMENT Y P 45.60 1 49.60
TOTAL SIGN SQUARE FOOTAGE (S.F.) = 48,C
STATU5 LEGEND; P=PROPOSED E^EXISTING R-REPLACI4 EXISTING
REVISIONS I G
NO. DATE I DR. I WVRE
SERVICE STATION 20-08 8
79-513 HWY. 111 & DUNE PALMS K.
LA QUINTA, CA
Q.--,
Chevron
DATE: C4 15 D2
DRAwN 8Y: GRI4
SCALE. 1 "-20.-D"
FILENAME: 210828SN2
CALCULATIONS
#i4 REBAR
SIDE" ELEVATION
i -43
PERIVETER BACKGROUND � 2:�
GY-210 GREY
-STREET -4
S{DE LETTERS
BK-10-5 BLACK ! i
WH-835-5 WHITE
WELD CAP (TYP.1 --_�_
STRIPE
EL-370-S BLUE
2A
STRIAE 1
RE-60-5 RED #
1
i
MASONRY
EASE ,& COLUMN---�. 1
STEf4 SUPPORT
GY-210 OARK GREY
nNISH ORADE •-I
CONCRETE FOOTING
MONUMENT SIGN
RE
8.-5
! a GIaasoli e Self .dery
�� I1 U EADED 121101
�
. Lus
LII'hILEAUED � lo
1- 4 I
SUgREME
"4,
I UNLEADED
1.� • A Ref I DIESEL N:0.2 14 1109
Lv
r,-r
go -OEM
wig
- SIGN CADINET
GY-21 GREY
LP5 BACKGROUND
-BL-70-5 BLUE
- RULE LINE
RE-60-S RED
- GRAPHICS
WH-835-S WHITE
-%2 >E83
co
STEEL COLUMNS (2) -
GY-210 11K_ GREY �
A°C BACKGROUND j
GY-210 GREY o
on
� GRAPHICS `
WH-635-S WHITE � jl
k � cwr
0
i
�1
1 I I I I i
�L---------------^^�----4 -4-
I
I I I I I I I I I
II I
II II
�I 2C I�
I I
II II
II 12"xI6" CONCRETE Il
1 l `00TI N{,
Li
I
,_0„0
TYP
FRONT ELF ATI N
#4 RCOAR a
5" 0-C. VERTICAL
(2) #4 REBAR
r
I
SCALE:1 /2" -V-D'
MASON COLU-AN
SECTION
SCALE: 1 1 f2' - 1'•-0'
�k-
(4) #4 REBAR
#3 TIES 0 16"0.C,
DRILL AND TAP
COLUMN THIS
bEND FOR
3/6d x 1' LG.
BOLT
14I'
3/80 x I- LG.
C-45 SIGN BOX
T5-8 x 2 x 3/16'
PAINT CK. GRAY (GY-210)
f.
SECTION C
SCALE: 1 1 /2" - V-D`
'17CTRAL DETAILS
C--45 LP:
SIGN BOX
FACE AREl+
1LTS-8x2x>3f C
PAINT DK. GRAY (GY-210
SECTION B
SCALE: 1 1/2'' = v-0"
APC SIGN BOX
3/80 x 1" LG.
T5-8 x 2 x 311T BF,AM
WELD TO COLUMN EA. END
PAINT CK, GRAY (GY-210)
MASONRY BASE
KALLMARK:
19.4
50.
FT-
LPS:
19•4
%]_
F-r.
APO:
9.8
SO.
Fr,
TOTAL:
48.5
SO.
PT.
C-45 EL,QTRIGAL
INPQ9VATION
HALLMARK StCN
BOX
LAMPS:
(5) F4BT12
DL/Ha
LAMPS
BALLA5T5: (1) 3-LAMP
do (1)
2-LAMP BALLAST
AMPS:
3,75 AMPS
L.P.S. SIGN SOY
LAMPS:
(5) F48T12
aL/HD
LAMPS
BALLASTS: (1) 3-LAMP
& (1)
2-,..,AMP BALLAST
AMPS;
3,75 AMFS
A.P.C. SIGN BOX
(EACH)
LAMPS:
(1) F'48T 1 2
0L f H0
LAMPS
BALLASTS: (1)
StNGLE-LAMP
BALLAST
AMPS:
1.75 AMPS
TOTAL AMPS:
11.0 A►AP5
CIRCUITS REO'D.
(1) 20 AMP/120 VOLT CIRCUIT REO'0.
SIGN ATTRIBUTES
BERNARD C. ADAMS, CIVIL ENGINEER
11022 ACACIA PARKWAY, SUITE E
GARDEN GROVE, CA 92640
714 636-0294
JOBS-6160
ti
cw
70 MPH EXP. C
21.B4psf WL
41.07
A
4,07
H
B96.97
P
3550.56 mom
896.97
E P
3650,56
EM
4.07
x
1.49
SM
TS-8x2x3/16
(Sx=5.97)
FOOTING
SM
1 CO.00
S
100
B
4.25
DT
376.53
S
1 .86
A
3.94
DF
GENERAL NOTES
SAMPLE CALC .
4t� P=21.84x20-435.8
110=436.802.5=5460'#
TcxM/P=12.5' Dl-4.5
S=1 OOx2x1.33x(4,5/3)=399
A=2.34x436.8 598.5x = 5
Df-A 2(1 + 1 +(4.36xx A) =3.86
1. FLIRidIShiED BY CHEVRON U.S.A. ANQ INSTALLED 8Y SIGN CflN7RACTtR:
A. HALLMARK I.D. AND/OR PRICE AND A.P.C. SIGNS COMPLETE.
2. FURNISHED AND INSTALLED BY SIGN CONTRACTOR:
A. CDLUI N0 PLATES, ACCESS HOLES AND ACCESS COVER PLATES,
B. CONCRETE FOOTING AND REBAR.
C. TEMPORARY BRACING JIG.
0. SIGN ATTACHMENT NUTS AND BOLTS WASHER PLATE INSIDE SIGN AND BACK-UP
PLATE INSIDE COLUMN.
E. CONDUIT AND FITTINGS FROM COLUMNS THROUGH FOOTING ANCHORAGE.
F'. CONDUIT AND FITTINGS FROM SIGN RACEWAY TO COLUMN.
G. POWER AND GROUND CONDUCTORS FROM SIGN RACEWAY TO GRADE
LEVEL JUNCTION BOX INCLUDING ALL REQUIRED TERMINATIONS
INSIDE THE SIGN AND COLUMN.
H. L4MPS, TESTING AND ADJUSTMENTS.
I. BRICK VENEER & TIES.
3. CHEVRON MOS. 234 CONSTRUCTION SPECIFICATIONS TO APPLY,
4. REINFORCING = GR40 ASTM A615
5, WELDING SEQUENCE AND PROCEDURE TO BE SUCH THAT DISTORTION AND MEAT
STRESSES BE MINIMIZED. WELDS TO BE PLACED IN 1/8" MAXIMUM PASSES BY
SHIELDING ELECTRIC ARC PROCESS ACCORDING TO THE LATEST EDITION OF
SPECIFICATIONS FOR STRUCTURAL WELDING OF A.W.S.
5. DEFER TO PAINTING SPECIFICATIONS MOS 253.
7. MASONRY CONSTRUCTION I5 SLUMP STOKE.
S. SPECIAL. INSPECTION IS NOT REQUIRED.
9. ALLOWABLE SOIL "RESSURE IS 1000 P.S F.
10. ALL PIPE "Y' A.S.T.M. A-53, TYPE E OR S OR A.P.I. STANDARD 5 L GRADE B MIN_
YIELD STRENGTH 35,000 P.S.I.
11. ALL HOLES DRILLED OR PUNCHED.
12. SOIL TYPE --SAND, SILTEY SAND, CLAYEY SAND, GRAVEL AND CLAYEY GRAVEL OR ROCK.
13. FOOTING-2,500 P.S.I. CONCRETE.
14. ALL STRUCTURAL STEEL A.S.T,M. A-36 MINIMUM YIELD STRENGTH 36,000 P.S.I.
15, FABRICATION, ERECTION AND PAINTING OF STRUCTURAL STEEL SHALL CONFORM 70
STANDARD NO. 27-5-67.
16. WELDING WILL BE PERFORMED 8Y CERTIFIED WELDERS UNDER THE SUPERVISION OF A
SPECIAL INSPECTOR OR IN THE SWOP OF AN APPROVED FABRICATOR.
17, A CERTIFICATE OF FABRICATION FROM THE STOP PERFORMING THE WELLING OR A
REPORT rROM THE SPECIAL INSPECTOR DUST BE FURNISHED TO THE ,SOB INSPECTOR
PRIOR TO FRAMING APPROVAL.
18. FLAMMABILITY OF THE PLASTIC MATERIAL IN SIGN WILL COMPLY WITH THE U.B,C.
STANDARD 50-52-2--58 AND SECTION 6202(F).
19. IDENTIFYING NUMBER AND WEIGHT OF SIGN WILL BE PLAINLY PLACED ON EXTERIOR
SURFACE OF SIGN BODY A5 OUTLINED IN SECTION 6202(1).
20. PROVIDE TEMPORARY PEDESTRIAN! PROTECTION A5 OUTLINED IN CH. 44.
21. ALL STEEL 3/16 THICK AND UNDER MUST BE GALVANIZED.
22. ALL TUBE A.S.T.M. A500 GIB "B" FY-46. K.S.I.
23. ALL BOLTS A.S.T,M. A307 U.N.O.
24, ALL WORK PER CURRENT EDFTIONS OF U.B.C., UNIyORM SIGN CODE
AND N.E.C.
REVISIONS
NO. DATE DR. ' NA VRE APP,
1 05/05/94 GRq CHG'❑ SG. 7. GALC5. N/A
2 03/21/95 GRH AODFI] REBAR PER ADAMS 'r/A
3 07/13/98 VAN CHG'D REBAR _ N/A
CITY OF LA QUINTA
BULL DING & SAFETY INTIT.
APPROVED
FOR CONSTRUCTION
or4
C-45 MONUMENT SIGN
Q.-, Chevron
wo
Marketing
DATE: 09/10/92
DRAWN SY: GRH
SCALE: AS NOTED
FILENAME: C45MON DAL,