05-5124 (SIGN)151
P.O. BOX 1504
78-495 CALLE TAMPICO
LA .QUINTA, CALIFORNIA 92253
Application Number. 0.5i0_00`OS124-�
Property Address:7",45-?$'9T'S HIGHWAY 111 f(-�
APN: 643-020-999-6 -30903 -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 5000
Applicant:
(&'14t 4.4v Q"
Architect or'Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WASHINGTON 111 LTD
C/O JACK TARR
30240 RANCHO VIEJO RD. STE. B
Q SAN JUAN CAPISTRANO, CA 92675
NOV[ Contractor:
O % 2 2005 IMPERIAL SIGN CO, INC.
46120 CALHOUN
ITYOf LAQUINTA INDIO, CA 92201
FINANCE 012 Y (760)347-3566
Lic. No.: 207136
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UC SED ONTRACTOR'S DECLARATION
I hereby affirm under penalt f perjury tha am li en ed under provisions of Chapter 9 (commencing with
Section 000) of Divisi of the Busines a io s Code, and my License is in full force and effect.
,License la
ss: C4 C61 D3 License No.: 207136
Date TContractor:O ER -BUILDER DECLARATION
1 herepenalty 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 155001:
1 _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and J
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 1, 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.).
1 _) 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/21/05
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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 thepent the work for which this permit is issued. My workers' compensation
insurance carrier d policy n be
r are:
Carrier HRH INS Policy Number 142483705
I certify that, in t performance the work for which this permit is issued, I shall not employ any
person in a yanne to ecome subject to the workers' compensation laws of California,
and ee th t, if hould a subject to the workers' compensation provisions of Section
00 of the abor Co oethwith comply with those provisions.
A I4 _
[Date,:: :Applica
WARNING: FAILURE TO SECUR WO ER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM AL ALTIES 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 issuanceof it.
2. Any permit issued as a result of this ap cation be mes null and void if work is not commenced
within 180 days from date of issuan of such per it, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have rea is application and state at e a information is correct. I agree to comply with all
city and ounty rdirfances and state laws relating bu struction, and hereby authorize representatives
of thit my t ®ter upon the above-mentioned pro o ion purposes.
lDate: r'�—Sii§nature (Applicant or -Agent):-_
LQPERMIT
Application Number 05-00005124
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . 15.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 5/20/06
Qty Unit Charge Per Extension
BASE FEE 15.00
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Special Notes and Comments
2 INTERNALLY ILLUMINATED CHANNEL LETTER
SIGNS PER SA#05-933
Fee summary Charged Paid Credited Due
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Permit Fee Total 15.00 .00 .00 15.00
Plan Check Total .00 .00 .00 .00
Grand Total 15.00 .00 .00 15.00
Bin #
City of La Quinta
Building u Safety Division
P.O. Box 1504 78-495 Calle Tampico T
. p�
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
/
Project Address:
�5
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: ''.. ``°
i CO� I Yv
Address: LO t
City, ST, Zip:
Telephone:
Telephone:
Project Description:
State Lic. # : �- City Lic: #:
Arch., Engr., Designer:
Address: '
City, ST, Zip:
Telephone:
State Lic. #: _ °
,A^ r1
Name of Contact Person: GYv \
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person: /
Estimated Value of Project: O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan'
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees