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BSIG2014-1021LICENSED 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, anddImy License is in full force and effect. License Class: C45 License No.: 84 5 Da contracto 1f ` OWNER -BUIL ER ECLARATION I hereby affirm under penalty of perjury at I m exempt from the Contractor's State License Law for the following reason (Sec. S, 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 basi3 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).: ( J 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 iiot 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 c'instruct 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 exenipt under Sec. B.&P.C. for this reason JI Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the jierformance of the work for which this permit is issued (Sec. 3097, Civ. C.). ij Lenc.er's Name: Lencer's Address: �r r II' 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 th wo k for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Secti 00 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: _ 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: LZ ApplicaWS'C WARNING: FAILURE TO SECURE WORENSATIONCOVERAG S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 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. Date: p t—I-) I I Signature (Applicant or r 78•-495 CALLS TAMPICO � VOICE (760) 777-7125 LA'QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 I COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT • �I Date: 10/22/2014 Apjilication Number: BSIG2014-1021 Owner: Property Address: ')`1(-1 4 -RUR lQ I t ( tL (1� MB EVANSTON SHERMAN API4: 2901 BUTTERFIELD ROAD Aplilication Description: "THE HABIT" (2) INTERNALLY-ILLUNINATED BUILDING SIGNS OAKBROOK, IL 60523 � Property Zoning: Q Ap;lication Valuation: $2,200.00 G7 N z Sz~ Applicant: Contractor: as PREMIER SIGNS PREMIER SIGNS o S 7157 OLD 215 FRONTAGE RD 7197 OLD 215 FRONTAGE 0 MC RENO VALLEY, CA 92553 MORENO VALLEY, CA 925 3 O z • - (951)697-8889 Llc. No.: 844145 ;r --------------------------------------------------------------------------------------------- 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, anddImy License is in full force and effect. License Class: C45 License No.: 84 5 Da contracto 1f ` OWNER -BUIL ER ECLARATION I hereby affirm under penalty of perjury at I m exempt from the Contractor's State License Law for the following reason (Sec. S, 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 basi3 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).: ( J 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 iiot 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 c'instruct 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 exenipt under Sec. B.&P.C. for this reason JI Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the jierformance of the work for which this permit is issued (Sec. 3097, Civ. C.). ij Lenc.er's Name: Lencer's Address: �r r II' 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 th wo k for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Secti 00 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: _ 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: LZ ApplicaWS'C WARNING: FAILURE TO SECURE WORENSATIONCOVERAG S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 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. Date: p t—I-) I I Signature (Applicant or bin # Qty of La Quin to Building 81:' 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: I Cl l -14C .Owner's Name: 4. P. Number: Address: 201 Q� R City, ST, Zip: (3 _ '1 L V)S IS Telephone: Legal Description: Contractor: Address:I U U 21 Project Description: City, ST, Zip: CA A9 "fele h ne• o — P 1 � 1 r S Cn°1 �• State Lic. # : !+ City Lie. #t Arch., Engr., Designer: Address: City., ST, Zip: Telephone: % i» Construction Type: Occupancy: Lic. #: Addrtate oJe hP e n N w n Alter Repair r Demo Name of Contact Person:Sq. Ft.: 3 # Stories: ( # Units: Telephone # of Contact P o : Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE iv Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. 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 2°d 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:- 3" Review, ready for correctionsrissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 j� PAID BY METHOD RECEIPT # CHECK # CLTD BY j� DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 I� PAID BY METHOD RECEIPT # . CHECK # CLTD BY Total Paid for ELECTRICAL: $48.34 $0.00 ' DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, EA ADDITIONAL 101-0000-42404 0 $24.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE %AIALL/AWNING SIGN, EA ADDITIONAL PC 101-0000-42600 0 $24.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY F DESCRIPTION IL ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, FIRST 101-0000-42404 0 $24.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, FIRST PC 101-0000-42600 0 $87.02 $0.00 f PAID BY . METHOD RECEIPT # CHECK # CLTD BY Total Paid forSIGN: $161.00 $0.00 TOTALS:00