0309-285 (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 # Lia Class, Exp. Date
N
1 Date '.Signature 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'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:
Carrier Policy No.
(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••thie
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.pr� ions.
Date 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 under4r pursuant to
any permit issued as a result of this applicaton agrees to, & sh"all, 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 propertyYfor inspedtiompurposes �•
.
Signature (Owner/Agent) - •- Date F ,Y
BUILDING PERMIT FE ITfi12
DATE VALUATION LOT t} _ TRACT
JOB SITE
APN
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
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USE OF PERMIT
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RECEIPT
DATE�'
BY
DATE FI ALED
INSP OR
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' Aa
BLOCKWALL APPROV LS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Connection
Encapsulation
Gag jiping
Gas Test
Aw liances
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:
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20361 Hermana Circle
RO
Lake Forest, CA 92630
(949) 458-1000 PHONE
(949) 458-3530 FAX
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FCUEKWr..STARBUCKS': LA QUINTA VILLAGE CENTER
509.21 WASHINGTON ST. - UNIT 1— LA QUINTA - CA
08/25/08 c"c", C3309.. sem: DC Bpaaw" CL
NOTE: This is an orisinol
ori n,
REVISIONS:
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#636512
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ITEM A & B
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CHANNELS:
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SANDBLASTED WOOD BACKGROUND, RETURNS AND BACK OF SIGN TO
RACE BORDER TO BE PAINTED WHITE
proffulptimanal20361 Hermana Circle
Lake Forest, CA 92630
e (949) 453-1000 PHONE
(949) 453-3530 FAX
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE BY
VINYI
.E PAINTED GREEph To
CUFNT:
STARBUCKS
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LA QUINTA VILLAGE CENTER
=MSS:
50921 WASHINGTON ST. - UNIT 1- LA QUINTA -'CA
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08/25/08 1 c"PT. C3309 sties: DC
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REVISIONS: PAGE:
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NOTE: This is an original
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drowtng, created by RonwtioMI
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Signs. It is submitted for your
personal use in connection with o
Underwriters
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Promotiorol S Nis not to be
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shown to onyone outside your
Controctors Lic.
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#636512
in any fashion. Any printed colors
on drowinp are oaarWonlate.
REVISIONS: PAGE:
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
C
APPROVED
FOR CONSTRUCTION
DATE ----= BY -
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drawing, created bt .0ri anal
REVISIONS:
PAGE:
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Signs. h is submined for your
personal usa in conned on w th o
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2036 7 Hermana Circh
Lake Forest, CA 9263(
0 (949) 458-1000 PHOT
(949) 458-3530 FAX
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CLIENT: STARSUCKS
`ccAOOW LA QUINTA VILLAGE CENTER
'SSS 50921 WASHINGTON ST. - UNIT 1- LA QUINTA - CA
a:� 08/25/08 CONCUT. C3309 5A1� DC o " .CL.
NOTE: This is on original
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drawing, created bt .0ri anal
REVISIONS:
PAGE:
ustEa
Signs. h is submined for your
personal usa in conned on w th o
envriters
proied bail planned for you by
O1 Otioncl Signs. Nis not to be
otory, Inc.
shown b anyone outside yaw
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co dr or �iu�'t�ed,
6
36512
in arty fashion. My printed colors
on drowino are oaaro:imote.'
MELD VERIFY DIMENSIONS PRIOR TO -CONSTRUCTION
31'-7"
10'-0"
f-71
fHER TENANTS
NORTH. ELEVATION. (PARTIAL)
. SCALE: 3/16"= 1'-0n
Vptna
§TARBUCKS.n°"
[CUENT.
LA QUINTA VILLAGE CENTER
50921 WASHINGTON ST.'- UNIT 1- LA QUINTA - CA
08/25/08 `O"`�'` C3309.. DC v "" CL
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Signs �It is submmed for your
personof use in connection with o
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Underwriters
Proms bei1g Plonned for you
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Contractors Lic.
organ'voi on, nor ts it to be used
reproduced, copied or exhibWA
#636512
in orry foshbn. Any printed colors
on drowina ore opormimate. - '