06-0084 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
i 6-00000084
78982 HI`GHWAY lIL1S T E 1A
643-080-047-9 -000000-
SIGN
REGIONAL COMMERCIAL
5000 F ld3a 30
Tlit!t 4 4a Q"
rcF��or�ngineer:�
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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 Professi als Code, and my License is in full force and effect.
License Class: C45 License No.: 844145
-:Dte: `G�61`,a"-
r"acto
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):
1 _ 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.).
(_) 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 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
Owner:
ONE ELEVEN LA QUINTA
42620 CAROLINE CT STE 102
PALM DESERT, CA 92211
Contractor:
PREMIER SIGNS
12108 SEVERN WAY
RIVERSIDE, CA 92503
(951)272-6366
Lic. No.: 844145
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/10/06
----------------------------------------------—
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 and policy number are:
Carrier STATE FUND Policy Number 1828283
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
00 of the Labor Code shall f h co ly with those provisions.
P,, Applidah
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 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 this county to enter upon the above-mentioned property tprjinspectigp tf po3py
Application Number . . . . . .06-00000084
Permit SIGN PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check
Fee
.47
Issue Date . . . .
Valuation
. . .
. 5000
Expiration Date 7/09/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
----------------------------------------------------------------------------
Special Notes and Comments
TWO INTERNALLY ILLUMINATED CHANNEL
LETTER SIGNS PER SA05-941
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 72.00
----------
.00
----------
.00
72.00
Plan Check Total .47
.00
.00
.47
Grand Total 72.47
.00
.00
72.47
Bin #
Permit #
U �J
Project Address: '
A. P. Number:
Legal Description: b
Contractor:
Address:
City, ST, Zip-
Telephoner
State Lic. #
Arch., Engr., Designer-
Address:
esignerAddress:
City, ST, Zip:
Telephone: .
State Lic. #:
Name of Contact Person
Telephone # of Contact Pets(
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading, plan
Subcontactor List
Grant Deed
H.O.A. Approval
` IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of 'La Quinta
Building U Safety.Division
P.O. Box. 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -.(760) 777-7012
Building Permit Application and Tracking Sheet
LI/ Owner's Name:
Address: j
City, ST, Zip: U
Telephone:
Project Description:
Lic. #: 7�
Construction Type:
Project type (circle one): ew
Sq. Ft.: # Stories:
I. Estimated Value of Project:
APPLICANT: DO NOT WRITE.'BELOW THIS LINE
Recd TRACKING
Plan Check t
sub 'tt d
'n Alter Repair. Demo
# Units:
Date of permit issue
Total Permit Fees
FEES
Amount
ma
Reviewed, ready for corrections
Called Contact Person
Plans. picked up
Plans resubmitted
------------
2vd Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
'`" Review, ready for corrections issue
Called Contact Person
Item
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
Electrical
Plumbing .
S.M.I.
Grading
Developer Impact Fee
A.I.P.P.
Date of permit issue
Total Permit Fees
FEES
Amount
v
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3 DO CATION ;s Dear Business Owner. ,, P
I C TVLIMNS "; i t � 'wr
s Y.�i �Pfease be`aware tbht,issluancrof a bud mes'Itcense by the City does not authotxze'
ew i ;you fo conductsinesayu� a b>Alidmg o� tegent space that Gas not Leen approv_ed� '
P.
s #or occupancy by the Bultdi[�g e d Safhty,, epal cut
"If y4_u' Gave anq ques%o_n
regarding this`issue, or if you are not sure if a Certificate of Occupancy hes been`'.'
�lssued for your place of business please contact � Budding a d8 f
R w.�
r
SNE -. ,PREMIER SIGNS the L�ceesee named herein h v ngpa�dYotihe City of La Quer �Il fe
s�
aY IpYaW"-rt n «r •r. cr`�
#w ' Q iwd ,, Grequired`Iiceose=is L'ereby grantedsa�dLcensee to transact the business:trere(u p� ilp
tSADURESS 121p8NSEVERN" WAY, -"I �,-.,,setforthifortheperiodstated,in"conformity with theYrovisioosofOrdinance
i K4.2ofthis
M11 F r EZI VER$IDE (�; 92,5Q3n ��tY Tbi�S Ucensee (s issued without verification that the licensee;
ii7sub)vect to or e�tem�t from 4cepnsrng by the State of Cahfponi c r a.
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