04-5781 (ELEC)Tihf 4 4 a"
K 1504
,ALLE TAMPICO
TA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
r . . . . 04-00=0=05=781 Date
Property Address �i.3%5 ,L�HIGHWAY 111
APN: 649-030-999-5 -30420 -
Application description . . . ELECTRICAL .
Property Zoning REGIONAL COMMERCIAL
Application valuation . . . . 15000
Owner
STAMKO DEV CO'
C/O PROVIDENT FINANCIAL MGMT
10345 W OLYMPIC BLVD 2 FL
LOS ANGELES CA 90064
7/29/04
Contractor
------------------------
SIGN INDUSTRIES, INC.
1918 POTRERO AVENUE
S EL MONTE CA 91733
(626) 579-4460
WCC: STATE FUND
WC: 4780000105 04/01/05
CSLB:. 764128 06/30/05
CCC: C45
---------------------------------------=------------------------------------
Permit . . . . ELEC=MISCELLANEOUS
Additional desc
Permit Fee . . . . 60.00 Plan Check Fee 15.00
Issue Date Valuation . . . . 0
Qty, Unit Charge Per Extension
BASE FEE 15.00
3.00 15.0000 EA ELEC SIGN 1ST CIRCUIT 45.00
---------------------------------7-------7----------------------------------
Special Notes and Comments
3 INTERNALLY ILLUMINATED CHANNEL LETTER
SIGNS, PER SIGN AP 2004-802. (PETSMART,
GROOMING, BANFIELD)
Fee summary Charged
----------------- ----------
Permit Fee Total- 60.00
P1an'Check Total 15.00
Grand Total 75.00
Paid Credited Due
---------- ---------- ----------
.00 .00 60.00
.00 .00 15.00
.00 .00 75.00
P.0 Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Architect or Engineer:
7V
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: -I ' ;/-H -C
Architect or Engineer's Address:
Lic: Not:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of peijury that I am licensed unde rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
,,,,,,;zd%anc1 msy nsp is in �fullforce �and effect.
L,cen e Clas =License No. -7 Co LUr4, P)
Date 77/0-9
16
OWNER -BUILDER DECLARATION
I. hereby affirm under penalty of perjury that I am exempt from the Contractors' State Ucense 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 Contractors' 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 violabon of Secition 7031.5 by any applicant for a permit subj
the applicant to a iivil penalty of not more than five hundred dollars ($500).): ects
U 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 safe (Sec. 7044.
Business and Professions Code: The Contractors' State License Law does not apply to anowner of property who builds or improves thereon, and who does Ote work
himself or herself or 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.).
U 1, as owner of the property, am exclusively c6ntracting 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.).
U I am exempt under Sec. _, BA P.C. for this reason
Date Owner
WORKERS'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
Aof 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 numbe,�are:
Carrier Policy Number_
I certify that, in the performance of t�e 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.
9 /19
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION C&VERAGE 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of pejury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, div. C.).
Lenders Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the condifions 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. indemnity 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 cerfify 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 county I nter upon the abov, . n for inspectio purposes.
Za<te�J/—& a �VS.gnwure (Applicant . gent