11-1097 (SIGN)4
P.O. BOX 1504 VOICE (760) 777-7012
785495 CALLE TAMPICO FAX (760).777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/06/11
Application Number: 1.1;- 00001097Owner:
Property Address: 783-70—H3GHWAY 111 STE 160 MADISON PTM LA QUINTA
APN: 604-050-048- - - 7837.0 HIGHWAY 111, STE. 200
Application description: SIGN LA QUINTA, CA 92253 J d
Property Zoning: COMMUNITY COMMERCIAL
Application valuation: .3000 n c 6 �o��
Contractor: 0 T V
Applicant: Architect or Engineer: SIGNARAMA CITY (OF -#A QUINTA
41945 BOARDWALK, "Lr' FiilQAid'�
PALM DESERT, CA -92211
(760)776-9907
Lic. No.: 830131 ,
----------'----------------.------------------------
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 Code, and my License is in full farce and effect.
Licens -CI s: D42 C45 License No.: 830131
ate: : b t ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.l am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any 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 Contractor's 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).:
(_ 1 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 through his or'her own employees, provided that the
improvements 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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). .
I—) I am exempt under Sec. BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued ISec. 3097, Civ. C.). -
Lender's Name:
Lender's Address:
LQPERMIT
-------------------------------------_---------—
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.
YI 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 and policy number are:
Carrier HARTFORD CO Policy Number 198607
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 Cod I shall forthwith compI .with those provisions.
ate% licant:
WARNING: FAIL RE TO SECURE WORKERS' COMPENSAT 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 ATTORNEY'S FEES.
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 to the work being
performed under or following issuance of this permit. -
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of thi y-cou ty o enter upon the above-mentioned propert tlr i ection purposes.
aib 4 g -nature (Applicant or Agent):
Application Number . . . . . 11-00001097
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date . . . Valuation
0
Expiration Date 4/03/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
----------------------------------------------------------------------------
Special Notes and Comments
.INSTALLL (1)BUILDING MOUNTED CHANNEL
LETTER SIGN, -PER SA #2011-1556.
"CHIROPRACTOR" 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . BLDG STDS ADMIN (SB1473)
1.00
Fee -summary Charged Paid Credited
Due
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 31.00 .00 .00
31.00
Bin. #
City of La Quints
BuMpg 8t Safety Division
Perinit # e
P.O: Box 1504, '78-495 Calle Tampico
1.a.Quinta, CA' 92253 - (760) 777-7012
�1
Building Permit Application.and,Tracking Sheet
Project Address: 7 —
Q p, f I L1011-1 Owner's Name: p,Q
A. P. Number.
�)
Address: 78-Y70 H.w %l / 57.6 O
Legal Description:
City, ST, Zip:
Contractor. / G
wv�.
Telephone
Address: / — 17,11
�a r�.l l( S(,-.. L
Project Description: q ,J r.) e.L �i
City, ST, Zip: �. �, .r•�, %�cS
Telephon : /L D i 7 6-
a 7
State Lic. # : p , r
City Lic. #; T7 wSy 9)
Arch, Engr., Designer
Address:
City., ST, Zip:
Telephone:
Construction Type:. Occupancy:
State Lic, #:project
type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: t taw` #Sos: #nt;. U
Telephone # of Contact Person
,(J> % 8 —GY/-3� Estimated Value of Project;
APPLICANT: DO NOT WRITE BELOW THIS LINE
M
Submittal
Rev'd
Recd
TRACKDVG PERI4IIT FEES
Plan Sets
Pian Cheek submitted Item Amount
Structural Calces
Reviewed, ready for corrections Plan Cheek Deposit. .
Truss Cake.
Called Contact Person Pias Cheek Balance
Title 24 Calci.
Plans picked up' Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
Z•` Review, ready for correctionsfissut Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.L
H.O-A- Approval
Plans resubmitted Grading
IN HOUSE:-
''` Review; ready for correctionshmt Developer Impact Fee
Planaing Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
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124.8" APPRO -DBjY PLANNING DEPARTMENT
BY DATE ► �� �c ►
EXHIBIT
11.9"[CHIROPRACTOR
CASE NO.�
Material: Aluminum / Acrylic
Letter Depth: 5"
Face Color: Blue
Trim Corr: White
Return Color: Dark bronze
Neon: Color: White
Mounting: Flush mounted on back
Sign Description: Frontage is 16 linear feet Customer: Telephone: 760- Jobsite: Customer Approval:
119 Ai RYI:C FACED, It LWAINATED. Dr. Abel Rodriguez Fax: 760- XXXXXXXX
C1.MENS'ONAL LETTERS, Address: XXXXXXXX
Mat -IAInui A yf Len. N p,h'S'" f C.1— Rpue
Tnn L . whne R C,- DackI =e Neon I-'•.mle 78370 Highway 1 1 1 Suite 160 Landlord Approval:
"'°°"""9'FI-h"S°°La Quinta, CA 92253 South ELEVATION
TOW SIGNAGE IS 1 1 t S(3 F!.
SIGNSIGN* � � Contractor's Lic # Dw No.: 4'9783 ____ Rev.: 2nd YOUR SIGNA TURE ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT
C45 1/"830131.. C61 /D42 g AND LAYOUT, RELEASING SIGN'A*RAMA FROM RESPONSIBILITY IN REGARD
TO INCORRECT DESIGN AND INFORMATION. THE COLORS SHOWN ARE ONLY
41945 BOARDWALK, STE- L Workers Comp. # Date: 09-218-11 _ REPRESENTATI✓E OFACTUAL PMS COLOR CALL OUTS. FINAL COLORWILL
PALM DES ER T, CA 9221 1 1640374 BE MATCHED AS CLOSE AS POSSIBLE COMMENSURATE WITH MATERIALS USE:.
P H 7 6 0. 7 7 6. 9 9 O 7 City LIC. # Designer; _ PC _ THIS DESIGN IS PROPRIETARY PROPERTY AND MAY NOT BE USED WITHOUT
F X 7 6 0. 7 7 6. 9 8 4 4 97005491 __._ _ _ _ _ _ ___ _ THE EXPRESSED WRITTEN CONSENT OF SIGN`A`RAMA.
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