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11-1170 (SIGN)P.0:3BOX 1504 78-495 CALLE TAMPICO LA 6�INTA, CALIFORNIA 92253 Application Number: C11'--00001170 - Property Address: 78640 -HIGHWAY --111 APN: 643 -220 -001 - Application description: S kc2m Property Zoning: REGIONAL COMMERCIAL Application valuation: 3500 Titit 4 e(PQ" Applicant: Architect or Engineer: (106 ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Class: D42 C45 LicenseNo.: 830131 Date:Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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).: (_) 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.). - (_) 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 contractorls) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.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 (Sec. 3097, Civ. C.)• - Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/25/11 Owner: WASHINGTON ADAM PARTNERSHIP 43692 PIASANO PL TENANT J.ROJAS DDS + A TEMECULA, CA -92592 + D Contractor: OCT 2 5 2011 SIGNARAMA 41945 BOARDWALK, "L" CITY OFLAQUINTA PALM DESERT, CA 92211 FINANCE DEPT. (760)776-9907 Lib. No.: 830131 WORKER'S COMPENSATION DECLARATION 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 and policy number are: Carrier HARTFORD CO Policy Number 198607 certify that, in the performance of the workfor 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 ll 37 0 of the Labor Mrthwith corn with those provisions. Date: /u /Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATI N 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 statethat the above i ormation is correct. I agree to comply with all city and county ordinances and state laws relating to buildii�g co truction, and hereby authorize representatives of this county/to nter upon the above-mentioned properU/for i pection purposes. Date: L /'1 1 Signature (Applicant or Agent): Application Number . . . . . 11-00001170 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 30.00 Plan Check Fee 7.50 Issue'Date . . . . Valuation . . . . 0 Expiration Date 4/22/12" Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT 15.00 ---------------------------------------------------------------------------- Special Notes and Comments ONE PERMANENTLY ILLUMINATED CHANNEL LETTER SIGN PER SP# -2011-1559 "BELLA SMILES DENISTRY" ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) " 1.00 " Fee summary Charged Paid Credited Due Permit Fee Total 3.0.00 .00 .00 30.00 Plan Check Total 7.50 .00 .00 7.50 Other Fee Total 1.00 .00 .00 1.00 Grand Total 38.50 .00 .00 38.50 r l 'LQPERMIT f o Il V Z L z ® J Z ui CL Qo,Mca LI u CAP ING WALL ENERS APPROPRIATE BUILDING SUBSTRATE ALUMINUM BACK I GAUGE STRANDED UV COATED WIRE PRIMARY ELECTRICAL ROUND I D POWER SUPPLY WW / INTERNAL GFI V ATER PROOF CONDUIT BONDING WIRE 3/16"PLEX FACE LIED LIGHTING i $,/4" DRAIN HOLES FACE ILLUMINATED FLU�SH MOUNT LED CHANNEL L ITTER (TYPICAL CONSTRUCT ON) COMPLIES WITH 2010 CA ELECTRICAL ODE, ARTICLE 600 U.L. LISTED & LABELEb Drawing No.: ED10013 Revision: B Date: 4-11-11 Drawn By: FH Approved By: RJ 'oN.A*Rq�f $VN*A TLA VALLEY'S FULL SERVICE SIGN CENTER 41-945 Boardwalk. Ste. L. Pilm Desert. 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