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07-1526 (SIGN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00001526 Property Address: 46520 WASHINGTON ST STE APN: 643-020-999-3 -30903 Application description: SIGN " Property Zoning:. REGIONAL COMMERCIAL Application valuation: 18000 Applicant: Architect or Engineer: - �!'�GitiGv BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: WASHINGTON 111 LTD C/O JACK TARR 30240 RANCHO VIEJO SAN JUAN CAPISTRAN( Contractor: LOREN ELECTRIC SIG] 12226 COAST DRIVE WHITTIER, CA 90601 (562)946-7545 LiC. No.: 455415 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/23/07 LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION - I hereby affirm under -penalty of perjury that I am ' and rcv ions Chapter 9 (commencing with I hereby affirm under penalty of perjury one of -the following declarations: Section 7000�°f Division 3 of the Business an e s ode nd License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Clasf C4 No 455415 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is �'" issued. ` ( Date: ntractor: _ 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 -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 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 he 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 contractors) licensed pursuant to the Contractors' State License Law.). ( ) 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: LQPER IIT r insurance carrier and policy number are:. Carrier REDWOOD FIRE Policy Number W7437608 I certify that, in the performance of the work for which this permit is issued, I shall not employ any .personin any manner so as to become sub' ct to the workers' compensation'laws of California, d agree that, if I should beco b' 'workers' compensation provisions of Section _._ 700 of - the /ILabor Code, I o co i hose provisions. TDatlicant: _ WARNING: FAILURE TO SECU41AKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN. EMPLOYER TO CRI (NAL 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 Quinta, its officers, agents and employees for any actor 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 Xn tion of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that tis correct. 1 agree to comply with all city and county ordinances and state laws relating to buhereby a orize representatives of this courR toe ter upon the above-mentioned propes Date: ignature (Applicant or Agent): Application Number . . . 07=00001526 Permit . . ELEC-ELECTRICAL SIGN Additional desc . Permit Fee 45.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 11/19/07. Qty_ Unit Charge Per Extension BASE FEE 15.00 2.00 15.0000 EA ELEC SIGN 1ST CIRCUIT 30.00 Special Notes.and Comments PICK UP STIX SIGN 4 TOTAL PER-MUP Other Fees . . . . . STRONG MOTION ('SMI) - COM 3.78 Fee summary Charged Paid Credited Due Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total .00 .00 .00 .00. Other Fee Total 3.78 :00 .00 3..78 Grand'Total 48.78 .00 .00 48.78 . LQPERIMIT _ Bin # City of La Quinta Building U 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:' J Owner's Name:227 A. P. Number: Address: Legal Description: Contractor: ��/� City, ST, Zip: C�ZZ�I Telephone: Ze —3fdz - Address: / Z 2 Project Description: City, ST, Zip: - O � Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer: le La 02/ Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: c. Construction Type: iyimere mss/ Occupancy: Project type (circle on ew Add'n Alter Repair Demo Sq. Ft.: �i7i�� # Stories: =#Units. Telephone # of Contact Person: 27—r Estimated Value of Project: 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 Energy Calcs. Plans picked up Construction Flood plain plan Plans. resubmitted Mechanical Gradin rd Review, ready forcorrectionsrssueElectrical ,],,plan* tactor List Called Contact Person Plumbing eed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '`" Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees �G-7L� iy �;,��3 �2�N •��%�9 l�t�.SL