12-0378 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000378
Property Address:
79255 HIGHWAY 111 STE
APN:
649-030-999-8 -30420
Application description:
SIGN
Property Zoning:
REGIONAL COMMERCIAL
Application valuation:
2000
Tiht 4 4 Q"
1. Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Busine and Profes ' als Code, and my License is in full force and effect.
License Class: C45 Li nso No.: 689256
L
Date: Contractor:
• NER-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 Cade: 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 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 hp 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 (Sec. 3097, Civ. C.).
'Lender's Name:_
Lender's Address:
LQPERMIT
Owner:
STAMKO DEV CO
C/O PROVIDENT FINANCIAL MGMT
10345.W OLYMPIC BLVD 2 FL
LOS ANGELES, CA 90064
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/09/12
Contractor: D �!
RIOFINE NEON SIGN COMP INC
68895 PEREZ ROAD, I-18 AiPiRq qg
CATHEDRAL CITY, CA 92 34' 0120 G
(760)321-0484
Lic. No.: 689256 C17YOFLAOIIIRI*,t
-----------------------------------------------
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 1371851-2012
_ 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 sl ould become subject to the workers' compensation provisions of Section
3700 of the Lab h(II forth
wit comply with those provisions.
1� Date: � Applicant:
`WARNING: FAILURE TO SECUR W RKERS' COMPENSATION with
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 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 Ouinta, 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 bei ing construction, and hereby authorize representatives
of this c unty to enter upon the above-mentioned pr a 'nspec ' oses.
`Gate: Signature (Applicant ar Agent).
Application Number . . . . . 12-00000378
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date . 10/06/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
----------------------------------------------------------------------------.
Special Notes and Comments
(1) CHANNEL LETTER NEON SIGN [ALLSTATE]
SIGN APPLICATION. NUMBER: 2012-1602. 2010
CALIFORNIA BUILDING CODES.
April 9, 2012 2:22:43 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------- ----------- ----------
Due
----------------- ----------
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total .00 :00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 31.00 .00 .00
31.00
LQPERMIT
'..
B1n #
Permit #P.O-
Project Address: ��
Cit OVU- U Quinim - ' .: '. .
Bu11ding & Safety Division :.. .; .
Boy. 1504, 78-495 Ca11e Tampico
14-Quinta, CA 92253 -:(760) 777-7012
Building Permit Application* and Tracking Sheet
I Owner's Name:.
A. P. Number.
Address: p
Legal Description:
Como
40
City, ST, Zip. 22l
Telephone:
Address:
CG
Project Description:
City; ST, Zip:
'
Telepho!fl
O - ' •
P4C!ityie
j_"
C�
State Lia #:
#:
'
Arch., EW., Designers
�
Address:
J�i
City., ST, Zip:
Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
H
Submittal
Req'd
Recd
TRACICIIHG PERMITFEES-
Plan Sets
Plan Cheek submitted
Item Amount
Strgdaral Cities.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calcr.
Plans picked up
Construction
Flood plata plan
Plaits resubmitted..
Mecharitcal
Giading plan
2" Review, ready for correctionstinue
Electrical
Subcontaetor Idst
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ii.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''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
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