07-1023 (SIGN)P.O. BOX ^� VOICE (760) 777, 7012
78-495 CALLE TAMPICO FAX (760) 777-7011 `
LA QUINTA,'CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/03/07
Application Number:0'7=0A0.01023 Owner:
Property Address: 46480 WASHINGTON ST STE 2 WASHINGTON 111 LTD
APN: 643-020-999-3' -30903 - C/O JACK TARR - D
Application description: SIGN 30240 RANCHO VIEJO
Property Zoning: REGIONAL COMMERCIAL SAN JUAN CAPISTRANO, 92675 ^�01
Application valuation: 5800 M1 APR J
Contractor: ®F®UIP1T�►
Applicant: Architect or Engineer: SIGNARAMA
41945 BOARDWALK, "L"
PALM DESERT, CA 92211
(760) 776-9907
Lic. No.: 830131/884104
-----------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a icensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of. perjury one of the following declarations: "
Section 7000) of Division 3 of the Business an rofess' als C e, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License CI ss: 42 C45 Lic a No 8301,31/884104 for by Section 3700 of -the Labor Code, for the performance of the work for which this permit is
issued. "
ate: LS V C actor: - 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
OWNER -BUIL DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt fr the Contractor's State License Law for the Carrier WAUSAU INS CO Policy Number WCJZ91442878016
following reason .(Sec . 7031 .5, Business and Professio ode: Any city orcounty that requires a permit to _ _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - person in any manner so as bec me subject to the workers' compensation laws of California, "
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should b om subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3'of the Business and Professions Code) or 700 of the Labor Code, I all r it omply with those provisions. _ that he or she is exempt therefrom and the basis for the alleged exemption.. Any violation of Section 7031.5 by ll _
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: ate: V icant:
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 WARNING: FA URE TO SECURE WORKE ' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does -not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS 1$ 100,000). IN ADDITION T E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN _
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, EREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds "or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
• pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. - , B.&P.C. for this reason the owner, and the applicant, each agrees to; and shall defend, indemnify and hold harmless the City
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
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
'fortion is correct. I agree to comply with all
city and county ordinances and state laws relating to building con, and rebs authorize representatives -
of this aunty to enter upon th above-mentioned property for i oses..
ate: S ature (Applicant or Agent):
LQPERNIIT
Application Number . . . . . 07-00001023'
Permit ELEC-ELECTRICAL
SIGN
Additional desc .
Permit Fee . . . 33.00
Plan Check Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 9/30/07
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
Special Notes and Comments
2,SETS INTERNALLY ILLUMINATED CHANNEL
LETTER SIGNS PER SA#2006-1119
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 .60
33.00
LQPERNIIT
Bin #
City of La Quint'a
Building 8r 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:
(il �v
Owner's Name: Jaa
A. P. Number:
Address: 3 0
Legal Description:
Contractor:0 ton
City, ST, Zip:
`'<:::'::>:.::,
Telephone: _ ..
Address: L
Project Description:
L, 11M
City, ST, Zip:Min -1 e )
Telephone: 776_ 51907
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
P'.z•`:#:::>:::>;:;.»:::>::>.•,:;.:.<.......
State Lic. #:: :>,;:;..<!,:;::;;<;:;<;;:;•:.;::•;:.::.,
f:. ;N; : <;; ,z%i:. %.:E<:>_z`%.<...;.�kE
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
'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
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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:-
'"' 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