11-0293 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: j'11-00000293. fe _
Property Address: 8696 HIGHWAY 111
APN: 643-220-014-16 -000000-
Application description: SIGN _
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 3200
4 �GtI
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
111 LA QUINTA CENTER
C/O ROBERT P SANFORD
78060 CALLE ESTADO'
LA QUINTA, CA 9225
PARTNERS
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/22/11
Applicant: Architect or Engineer:
Contractor. �R A L� 11
COST SIGN M^'• 2?. UV
1800 W. ADAMS BLVD
LOS ANGELES, CA 90 18 Clic iA�Im
(213)385-1258 /1 adi1yr
Lic. No.: 698638
-----------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
-------------------------------------
WORKER'S COMPENSATION DECLARATION .
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals. Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C45 License No.: 698638
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date -.13 Contrac
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of.perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject totheworkers' compensation laws of California,
permit to file a signed' statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codel or
3700 of the Labor Code, I shall forthwith comply with those provisions.
• 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).:
Date: Q_ ApPlican
1 _ 1 1, 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS (s 100,000). IN ADDITION TO THE COST OF COMPENSATION, -DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to a6y permit issued as a result of this application,
( 1 1 am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 this county to enter upon the above-mentioned prop rt r for inspection purposes.
a
Date: Signa re. (Applicant or Age
Application Number . . . . 11-00000293
-Permit IELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . 30.00 Plan Check
Fee
.00
Issue Date Valuation
0
Expiration Date 9/18/11
<
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
-----------------------------------------------------------------------------
Special Notes and Comments
INSTALL (2.) TWO ILLUMINATED CHANNEL
LETTER BUILDING MOUNTED SIGNS. PER
SA-2010-1519.11METRO PCS"
------------------------------ --
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
b
LQPERMIT
Bin #
City of La.. QuInta
Building &r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 'rjg_4GU C� I� I
r 7H�/4 Owner's Name: L�rIJ7� G�rJ7
A. P. Number: Address c����
8696
Legal Description: City, ST, Zip: 1_,1.
r�I
Contractor: 4 �7 S I vJ
Telephone:
Address: r 00-0 AD5�fl Project Description:
City, ST, Zip: I—A--
Telephone: 323- %33
-
/017
State Lic. #
69 (39 � City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:#?';?; ? `*4•,'
�t22.S_"3
Construction Type:
n< YP /�%6� Occupancy:
State Lic. #: I c. •.:vr» s:.:<;>,;
Project type (circle one): 6D Add'n Alter Repair Demo
Name of Contact Person:
/t-1 Yp• eJ/AJ &fht:�F1J Sq. Ft.: �70 qi
#Stories: #Units:
Telephone # of Contact PersonZSID 42-c/'-41963 Estimated Value of Project: 3 ZpU., -{,
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd
Plan Sets Plan Check submitt
Structural Calcs. Reviewed, ready for
Truss Calcs. Called Contact Perso
Title 24 Calcs.
Plans picked up
Flood plain plan
Plans resubmitted
Grading plan
2'' Review, ready foi
Subcontactor List
Called Contact Pers4
Grant Deed
Plans picked up
H.O.A: Approval
Plans resubmitted
IN HOUSE:-
''' Review, ready for
Planning Approval
Called Contact Pers
Pub. Wks. Appr
Date of permit issue
School Fees
TRACKING PERMIT FEES
Item Amount
corrections Plan Check Deposit
n Plan Check Balance
Construction
Mechanical
corrections/issue Electrical
n Plumbing
S.M.I.
Grading
corrections/issue Developer Impact Fee
'n A.I.P.P.
Total Permit Fees
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