07-2257 (SIGN)P.O.-BOX 1504
78-495 CALLE TAMPICO
SLA QUINTA, CALIFORNIA 92253
A*
Application Number: ___07-00002257_-_,,
Property Address: 79174 HIGHWAY 111 STE 102
APN: 649-820-999- - t -
1
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 4000
Applicant:
Architect or
A-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
rJ �
I
MG a % 2001-
CITY OP LA
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LICENSED CO RACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice rider rovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and a lona • ode, and my License is in full force and effect.
Licens yClaass: JC4�5 D38 C1 icense No.: 207136
Date: 7 tractor:
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 ISec. 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 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 contractors) 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: 8/07/07
Owner:
FOURTH QUARTER PROPERTIES
45 ANSLEY DR
NEWNAN, GA 30263
(760)613.-3783
Contractor:
IMPERIAL SIGN CO, INC.
46120 CALHOUN STREET
INDIO, CA 92201
(760)347-3566
Lic. No.: 207136
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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 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 1424837-2006
I certify that, in the performance of thew for which this permit is issued, I shall not employ any
person in any manner so as to beconlesubject to a workers' compensation laws of California,
and agree that, if I should becom ject to t orkers' compensation provisions of Section
Y�O�10
of the Labor Code, I sh ply with those provisions.
ate!/ ant: 1_102.61f_ Z
WARNING: FAIL C E WORKERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PES LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORIN
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 voi f work is not commenced
within 180 days from date of issuance of such permit, or cessatio f work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inf ati i rrect. I agree to comply with all
city and county ordinances and state laws relating to building co ruct d her authorize representatives
of thiV.�,Inte,
upon t above-mentioned property f nspe ur o
te: Si ature (Applicant or Agent):
E Application Number . . . . . 07=00002257
Permit ELEC-ELECTRICAL• SIGN '.
Additional desc,.
Permit Fee. 33.00 Plan Check Fee .00
Issue Date Valuation -0
E 4 t' D t 2/03/08 '
� xpira ion a e
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 (2 CIRCUITS) PER SA# 2007-1166,
"FEDEX KINKO'S"
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
LQPERM IT