07-1333 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ;"_07-00001333 ,.
Property Address: 79024 HIGHWAY 111 STE 102
APN: 649-820-999- - -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 5000
Applicant:
I hereby affirm under penalty of perjury that I
Section 7000) of Division 3 of the Business
License Class: D42 C45
ate: �516 ntractor: :74
NER-BUILDER DECLARATION
I herebyaffirm under enalt of er'ur p1hexem t from th on r r' t Li n L w f r h p y p l yp e C t acro s S ate cr se a o r e
following reason ISec. 7031.5, Businesfessions Code: Any city or county that requires a permit to
construct, alter,' improve, demolish, or r 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 _ 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 am exempt under Sec. , B.&P.C. for this reason
Tity/.,
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
CONTRACTOR'S DECLARATION
nsed under provisions of Chapter 9 (commencing with
p&pbnals Code, and my License is in full force and effect.
LicenseNo.: 830131/884104
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:
LQPERMLT
Owner:
FOURTH QUARTER PROPERTIES
45 ANSLEY DR
NEWNAN, GA 30263
(760)613-3783
Contractor:
SIGNARAMA
41945 BOARDWALK, "L"
PALM DESERT, CA 92211
(760)776-9907
Lic. No.: 830131/884104
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/01/07
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.
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 WAUSAU INS CO Policy Number WCJZ91442878016
I certify that, in the performance of the work for which this permit is. issued, 1 shall not employ any
person in any manner so as to com Vte
orkers' compensation laws of California,
and agree that, if I should be e s jrs' compensation provisions ofSection
/3700 of the La r Code, I all withose provisions.
Date: w pplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN ION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COS F COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERES 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 yrs'pec
r,.%,m/�,a,��'bn is c t. I agree to comply with all
city and county ordinances and stat ws relating to buildiand eby authorize representatives
of this�ty, to enter upon th ove-mentioned property n pur W..
(Applicant or Agent):
LQPERMIT
Application Number . . . . . 07-00001333
--
'Permit . . ELEC-ELECTRICAL
SIGN
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration Date 10/28/07
Qty Unit Charge Per
Extension „
BASE
FEE
15.00
1.00 15.0000 EA ELEC
SIGN 1ST CIRCUIT
15.00
1.00 3.0000 EA ELEC
SIGN ADDITIONAL CIRUITS
3.00
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Special Notes and Comments
2 INTERNALLY ILLUMINATED CHANNEL
LETTER
SIGNS, PER SA#2007-1119 "Z PIZZA"
Fee summary Charged
Paid •Credited
Due
Permit Fee Total 33.00
.00 .00
33.00
Plan Check Total .00
.00 .00
.00
Grand Total 33.00.
00 .00
33.00
Bin
City of LaQ uinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building.Permit Application and Tracking Sheet
Permit #
��.
Project Address:' -�g I
Owner's Name' a L C
A. P. Number:
Address: 4 o R b4v m L n
Legal Description:
Contractor: a
Address: 4 l Ct t�GC�
City, ST, Zip:e, Vr i Cf 9a571
Telephone: g >5
ProjectDescription:
City, ST, Zip: Q 2 �'�r C
Sg-} T 21um1Y-?f/1 L' oj,,1e, .
Telephone:
City Lic. #:
State Lid. # : $ 1W
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person. Q L n e
Construction Type: Occupancy:
Project type (circle one Add'n Alter Repair Demo
Sq. Ft.:.
# Stories:
# Units:
Telephone # of Contact Person:
p 6 G
Estimated Value of Project: 0C—
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 Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs:
Plans picked up
Construction
Flood plain,plan .
Plans resubmitted
Mechanical
' Grading. plan
2"d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"d Review, ready for corrections/issueDeveloper
Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees