SIGN (04-5365)78065 Main St Ste 200
04-5365
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07 2004
4 e V "
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS .(760) 777-7153
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number
_.04-00005365 Date
7/06/04
Property Address . . . .
. 78065 MAIN ST STE 200.
. APN:
77,0-121-003-- - -
Application description
SIGN
Property Zoning..
VILLAGE COMMERCIAL
.Application valuation.:.
1500
Owner
Contractor
OLD TOWN LA QUINTA
BEST SIGNS, INC. -
NC..7:8080.,,
7:8 0 81 0_CALLE .ESTADO #200.
.1550 .S. ;:GENE. AUTRY; TRAIL
LA" QUINTA..CA . ,.
PALM SPRINGS 'CA
92264
LA:,QUINTA: CA. 922,53
STATE FUND:..
-WC. 00115012004
.03/01/05
C.SLB`;.. 524483
02./28/06
-CCC:.:
C45 -:C61 -D42
Permit ELEC-ELECTRICAL
SIGN
Additional desc
Permit Fee
30.00 Plan Check Fee
:00
Issue Date
Valuation
:0
Qty'.. Unit Charge;:Per
Extension
BASE FEE
1.00 15:0000 EA
ELEC SIGN 1ST C3RCUIT..
.1.5..00
1.5.00
Permit SIGN
PERMIT
.Additional desc..
Permit Fee
3.5.00.. Plan. Check Fee
.23
18su.e :Date .. ..
Valuation
1500
Qty Unit. Charge Per
Extension
BASE FEE15.-00
10.00 .2.0000 HND
BLDG 5.01-21'000
20.00
Special Notes and Comments
Three (3) signs per Stan Sawa
.application #2004-796
Fee summary: Charged.
Paid. Credited
Due
Permit Fee Total 65.00
.0.0. .00
65.00.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant: .
Applicant's Mailing Address:
Architect or Engineer:
VOICE(760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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
and
Clasi License r
full t
LicenseK Leffed. License No. 5 -zL' I-(L(
Date ' / (,o Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the foilowiing reason (Sea 7031.5, Business and Professions Code: An
city or county that requires a permit to construct, alter. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she Is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars. ($500).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who' builds or improves thereon, and who does the work
himself or herself or through his or her own employees, Provided that the improvemerris are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for the purpose of sale.).
(, I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contradors'
State License law does not.apply to an owner of property who builds or Improves thereon„ and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. B.3 P.C. for this reason
Date Owner
WORKERS' 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 wilt maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
iss ed• MRworkepco p n on insurance carrier and policy nurrmbgj a
Cartier S 'T 1 . r"V " Policy Number /5 Y (Q — CJ lJ t 5 (9 r
_ I certify that, in the performance of the work for which this permit is issued. l 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, l shall
forthwith comply with those provisions,
Date Applicant / CJI
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN.
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under gamont of CONSTRUCTION LENDING AGENCY
y perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related tott)e work being performed under or following issuance of this permit
2. Any permit issued as a result of flus 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 county ordinances and state laws relating to building
construction, and hereby authorize. representatives of this county to enter upon the above-awfloned property for inspection purposes.
/
Date (0/ Signature (Applicant or Agent): / V t
Application Number . . . . . 04-00005365
Plan Check Total .23 .00
Grand Total 65.23 00
Page 2
Date 7/06/04
.00 .23
.00 65.23
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
July 6, 2004
Mr. Jim Cross
Best Signs
1550 S. Gene Autry Trail
Palm Springs, CA 92264
SUBJECT: Sign Application 20047796 for Hogs Breath Inn
Dear Mr. Cross:
(7 60) 777-7000
FAX (760) 777-7101
The Community Development Department has approved the request for two
permanent wall mounted business identification signs and a pedestrian sign at 78-
065 Main Street, Suite 200 in Old Town La Quinta. Enclosed are two copies of the
approved sign exhibits for your use. The approval is subject to following conditions:
1. This sign permit is for two permanent business identification signs and a
pedestrian sign. Sign designs and locations are per approved plans attached
and on file. in the Community Development Department.
2. A building permit shall be obtained from the Building and Safety Department,
prior to the beginning of installation of the signs.
Should you have.any questions, please call me at.(760) 777-7064.
Very truly yours,
JERRY HERMAN,
Community Development Director
STAN B. SAWA
Principal Planner
enclosures
c: Greg Butler, Building and Safety Department (w/o enclosures)
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CASE NO. `. O —
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Client.
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OLD TOWN LA QUINTA
Account Representative:
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Data:
MAY 17, 2004
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Revisions: -
T`f OF. LA QUINTA-
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APPROVED
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BY
Client Approval:
aEST MONS
1550 S. Gen. Autry Trail
Palm Springs, CA 92264 ,
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Date:
MAY 17, 2004
Revisions:
CITY OF LA QUINTH
BUILDING & SAFETY DEPT.
APPROVED
FOF CONSTRUCTION
DATE _I BY
1550 S. Gene Autry Trail
Palm Springs, CA 92264
(760)320-3042
FAX 760.320-2090
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Bermuda Dunes, Ca 92201
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MAY. 17, 2004
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