BSIG2015-000778-495 CALLE TAMPICO D VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
•� INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/20/2015
Application Number: BSIG2015-0007 Owner:
Property Address: 79174 HIGHWAY 111 104 INLAND AMERICAN LAQUINTA PAV
APN: 600390029 P 0 BOX 9271
Application Description: PAVILLION/JERSEY MIKE'S SUBS/(2)-ILLUMINATED•BU4LDING-SIGNS OAK BROOK, IL 92253
Property Zoning:
Application Valuation: $5,200.00 D=APR20
Applicant: Contractor:
D & S SIGNS D & S SIGNS
40410 CLYBOURNE CR rITVOFIAQUINTA 40410 CLYBOURNE CR
MURRIETA, CA 92562 N.0 'G c ^wAFniTDEPARTMENT MURRIETA, CA 92562
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my License is in full force and effect.
License Class: C45 License No.: 841704 - K-U••r�C�
Date:'4'ao .Aq1 Contractor
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 they{
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant foy/a"
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(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 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 I 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 Addres
(951)452-4956
Llc. No.: 841704
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: _ Policy Number:
cert _
I ify 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 3700 of the Labor Code, I shall forthwith
comply with those provisions. , /')I
Date: �A)LO_ 0%5 Applicant:
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 Building Official 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 city to enter upon the above-
mentioned property for inspection purposes. , nl
Date: 3-0 _.)-0(e5 Signature (Applicant or Agent)
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Monday, April 20, 2015 2:24:46 PM 2 of 2
RWYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES -
FINAL" BLD
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $0.00
WALL/AWNING SIGN,
101-0000-42404
0
$24.66
$0.00
EA ADDITIONAL
WALL/AWNING SIGN,
101-0000-42600
0
$24.66
$0.00
EA ADDITIONAL PC
WALL/AWNING SIGN,
101-0000-42404
0
$24.66
$0.00
FIRST
.'
WALL/AWNING SIGN,
101-0000-42600
0
$87.02
$0.00
FIRST PC
Total PaidforSIGN: $161.00 $0.00
TOTALS:00
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Monday, April 20, 2015 2:24:46 PM 2 of 2
RWYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES -
FINAL" BLD
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Monday, April 20, 2015 2:24:46 PM 2 of 2
RWYSTEMS
Description: PAVILLION/JERSEY MIKE'S SUBS/(2) ILLUMINATED BUILDING SIGNS
Type: SIGN
Subtype: Status: APPROVED -CONDITIONS
Applied: 4/2/2015 SKH
Approved: 4/9/2015 SKH
Parcel No: 600390029 Site Address: 79174 HIGHWAY 111 104L QUINTA CA 92253
Subdivision: PM 29351
Block: Lot: 11
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0 Zoning:
Final ed:
Valuation: $5,200.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
PLAN CHECK SUBMITTAL
RECEIVED
Details: SIGN - (2) ILLUMINATED BUILDING SIGNS PER APPROVED PLANS [SA2015-0012]. 2013 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
Printed: Monday, April 20, 2015 2:24:46 PM 1 of 2 CRE"SYSTEMS
ADDITIONAL
CHRONOLOGY TYPE
STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
PLAN CHECK SUBMITTAL
RECEIVED
STEPHANIE KHATAMI
4/2/2015
4/8/2015
PLEASE CHECK FOR BUSINESS LICENSE.
NAME TYPE
NAME
CONDITIONS
ADDRESSI
CONTACTS
CITY
STATE
ZIP PHONE FAX EMAIL
APPLICANT
D & S SIGNS 40410 CLYBOURNE CR
MURRIETA
CA
92562
CONTRACTOR
D & S SIGNS 40410 CLYBOURNE CR
MURRIETA
CA
92562
OWNER INLAND AMERICAN LAQUINTA PAV
P O BOX 9271
OAK BROOK
IL
92253
FINANCIAL INFORMATION
Printed: Monday, April 20, 2015 2:24:46 PM 1 of 2 CRE"SYSTEMS
Qin #
Permit #
- --- -- — -
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City of La Quinta
Building 8t• Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Project Address: "1 1i Ll i
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Owner's Name: SCLMQn �ad
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: `
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telephone:
Address: C)qiin LLW
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Project Description: 5 ' ( l Lrn
City, ST, Zip: tie Ir' i
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Telephone: SS2 —
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30—VS.
State Lic. # : �y
Arch., Engr., Designer:
City Lie. #;
Address:
City., ST, Zip:
Telephone:
e one
P
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Con structi n T f
o e: Occupancy:
Y P Y•
State Lie. #•
t type (circle le on New d' n Alter Repairair Demo
Name of Contact Person: �ey.`
\-�ceJL
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: O• S 1 S L— Z
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rec'd
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
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2vd 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:-
7rd 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
L
4