11-0109 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 1lz1'11=00000109 v �-
Property Address: 46520 WASHINGTON ST STE 3
APN: 643-020-058-'- -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 2000
Tuy/4 ' 40"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WASHINGTON 111 LTD'
PO BOX 1623
PALM DESERT, CA 92261
Contractor:
Applicant: Architect or Engineer- QRS LIGHTING INC
81211, #2B INDIO BLVD
INDIO, CA.92201
(760)619-6565
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS. (760) 777-1153
Date: ' 1/31/11
k
o Q
JAN 31 2011 -
CITY OF LA QUINTA
Fi1kP:NCE DEPT.
Lic. No.: 727552
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- -'-- ----- - -^-- - —
LICENSED CONTRACTOR'S DECLARATION- WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that '' -I am licensed 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 and Professionals Code; 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 Cla : CloO License o.: 727552 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
- issued. -
ate: 3 tontractor: ._ 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 insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to 1 c=at, 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 to become 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 - an agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and -Professions Code) or 3 0 of the Labor C tall forthwith comply ' h those provisions. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 2
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: %` plicanti
1 _ 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 WARNING: AILURE TO SECURE WORKERS' COMPENSATION 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 PENALTIES 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 ($100,000). IN ADDITION TO THE 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, INTEREST, 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 1, 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 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: I"
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 information is correct. I agree to comply with all
city and coun y ordinances and state laws relating to build' �construction, and hereby au rize representatives
of this cloun to a er upon above-mentioned pro rty forins tion purposes.
Date: L �r gnature (Applicant or Agentl:
rM
LQMRMIT -
Application Number . . . . .. 11-00000109
Permit ELEC-ELECTRICAL SIGN
Additional desc
Permit Fee . . . . 30.00 Plan Check Fee
'.00
Issue Date . . . . Valuation
0
Expiration Date 7/30/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
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Special Notes and Comments
INSTALL 1 INTERNALLY ILLUMINATED CHANNEL
LETTER SIGN, PER APPROVED PLAN AND SA #
2011-1505. "LEGACY THAI CUISINE". 2010
CODES. _
-------------------------- - - -. ------------------ - - -- --
Other Fees .. BLDG STDS ADMIN (SB1473)
--
1.00
Fee. summary Charged Paid Credited
Due a•
e 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"
LQMRMIT -
Bin #
Permit # 1
�l- `V t B
PrWed Address: � C)A:010
A. P. Number:
Contractor.
City, ST, Zip: Lq/a
Telephone:7�'D �'%9..�J��
State Lic. # :Z .S,> -Z City iia 0:
Arch., Egg, Designer: d QS CL�zfi%i.��
gait: f ill Z8 -,amid ,adv;
City. ST. Zip=-i7-AW6 Gq - . % zzo i
Telephone: 706 .--4�—
State Lie. #:.
Name ofCoatw Person:
Telcphonp # of Contact peso.:
# Submittal
Plan Sets
Structural Cates.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subeonts'etor Wt
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quints —
BUNng 8C Safety Division
P.O. Box I5D4, 78-495 Ca1(e Tampion
La Quints, CA 92253 - (760) 777-7012
'Permit Application and Tracking Sheet
Owner's Mance LE�i4� ori (/�S%•✓� "
Address: `�� -r�� 30l� �JQ 96W CG
ter. ST, zip:
p'I.0 I%, •
1 Bstimatod Value of Project: 0 U
APPLICANT: DO NOT WRITE SHOW THIS LINE
Reed
Pian Cb
Called t
Plans pi
Plans"
2'! Revel
Called 1
Pians 0
Plans rr
s.a Revi
T
Called i
Date of
TRACMG
PERMIT FEES
oek submitted
item Amount
d, ready for corrections
Pint Che& Deposit
:ontact Person
Pian Check Balance
tked ap
Construction
rubmltted
Mechanical
tw, ready for correctio.s&wc
Electrical
butact Person
Plumbing
eked up
S.M.L
submitted
Grsdlng
:w, ready for wrrecdons/issne
Developer Impact Fee
:ontactPerson
------------
A.LP.P.
pertult issue
Total Permit Fees