BSIG2015-0022q
78-495 CALLE TAMPICO
WORKER'S COMPENSATION DECLARATION
LA QUINTA, CALIFORNIA 92253
Application Number:
BSIG2015-0022
Property Address:
46520W
APN:
6430200
Application Description:
WASHIN
Property Zoning:
Ff
Application Valuation:
$4,000.0
Applicant:
BEST SIGNS INC
1550 S GENE AUTRY TRAIL
PALM SPRINGS, CA 92264
VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/7/2015
Owner:
WASHINGTON 111 LTD
80618 DECLARATION AVE
=LDNnOUNTED SIGN "MY THAI" INDIO, CA 92253
AUG 0 7 2015
CITY OFLA QUINTA Contractor:
IITYDEVELOPMENTOEPARTMENT BEST SIGNS INC
1550 S GENE AUTRY TRAIL
PALM SPRINGS, CA 92264
(760)320-3042
Llc. No.: 524483
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter„
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: C45_, D42, C10 License No.: 524483
of the work for which this permit is issued.
�� IZ
I have and will maintain workers' compensation insurance, as required by
Date: Contractor: tt (G�1
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and polity number are:
OWNER -BUILDER DECLARATION
Carrier:_ Polity Number: -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the •
any structure, prior to its issuance, also requires the applicant for the permit to file
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
omply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Divisi
I
of the Business and Professions Code) or that he or she is exempt therefrom and the
Date: fth
� � App can
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant f r a
permit subjects the applicant to a civil penalty of not more than five hundred dol rs
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) 1, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
(� I, as owner of the property; am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. . B.&P.C. for this reason
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.
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 N
Lender's
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 building
construction, and hereby authorize representatives of t i to enter upon the above- .
,mentioned property for inspection purposes.
..4te:b In. Signature (Applicant or A
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FINANCIAL INFORMATION
` , t DESCRIPTION 43 ": `ACCOUNT$ { -QTY AMOUNT',
;PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 $1.00
$0.00
*Ye. PAID BY, +,r rtl '
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z ;RECEIPTt
CHECK#
CLTD BY
• CMETHOD'
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION ma ' £ i;
`'_ ACCOUNTS _�
QTY
`
, PAID
PAID DATE
,T
$AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
*"'1PAID BY ' { w -
'' ya'� METHOD` #
RECEIPT # #
``' CHECK # ` m
CLTD BY `
e
DESCRIPTION,,}
1 a ACCOIJNTxn
QTY
w r 'AMOUNT`'
PAID F k
PAID DATE
r
P•X
.;
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
'
METOD
RECEIPT #
CHECK #'BY
�CCTD BY=
_
Total Paid for ELECTRICAL: $48.34 $0.00
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DESCRIPTION
ct ii P .• sF"
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k: rT.n,F 3'
AMOUNT °
rt •1
F PAID
. ..., F.
PAID DATE'
,?_
k_ * ;s`...ti..
WALL/AWNING SIGN, FIRST
101-0000;42404
0
$24.66
$0.00
'px PAIDYBY ktra
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ESCRIPTION
�¢ PAMUNTk`nACCOUNT
AID DATE '
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i t9ei
WALL/AWNING SIGN, FIRST PC
101-0000-42600
0
$87.02
$0.00
,
=METHODm`�`
'RECEIPT
CHECK #,,;,,,CLTD
BY
;
„��
e Total Paid forSIGN: $111.68 $0.00
TOTALS:00
Description: WASHINTON PARK / TARR / (2) BUILDING MOUNTED SIGN "MY THAI"
'
Type: SIGN
Subtype: Status: APPROVED
Applied: 7/20/2015 PJU
Approved:
Parcel No: 643020060 Site Address: 46520 WASHINGTON ST STE 3 LA QUINTA,CA 92253
Subdivision: PM 32683-3 AMEND
Block: Lot:. 3' •
Issued:'
Lot Sq Ft: 0
Building Scl Ft: 0 Zoning:_
Finaled-
Valuation: $4,000.00
Occupancy Type: - Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 ' -.' No. Unites: 0
Details: TWO PERMENANT BUILDING MOUNTED INTERNALLY ILLUMINATED CHANNEL LETT SIGNS PER SPA2015-0033. 2013CEC APPROVED
PER JF.&WN.
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FINANCIAL INFORMATION
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INFORMATION
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'PAID
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' . 4?"DESCRIPTION
ss- ACCOUNT' a F t";'QTY
;AMOUNT
SPA. If). ;
PAID.DATE
?`RECEIPT #
CHECK #:
+METHOD
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BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
-
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 7$0.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $0.00
WALL/AWNING SIGN,
101-0000-42404
0
$24.66
$0.00. •
_
FIRST .�
WALL/AWNING SIGN,
101-0000-42600
0
$87.02
$0.00
FIRST PC'
-
Total Paid forSIGN: $111.68 $0.00
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INSPECTIONS
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i `• "SE IDa .:INSPECTION TYPE` _`'.' : INSPECTORk,SGHEDUCED::: COMPLETED RESULT "'. REMARKS,
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FINAL**- BLD
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PARENT PROJECTS''
REVIEWS
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Bi" #
City of La Quinta
Building &r Safety Division
�Oc=,-L2— P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
.Permit #
Project Address: 6✓4-�_If ]'N4 @IV 5 T Sit rC 3
Owner's Name: J�A.
P. Number:
Address: ?'D 7"0 RAN -!,40 l(I EJO PLD SUI M 13
Legal Description:
City, ST, Zip: �d/�^��P( 577tA-/fD,, Gfk 9' Z67S'
o. 5 S
Contractor:Telephone:1
•N�cr
S �.3
N G.
. Z 3 i
9 %
Address:f s� S . (��✓� •fW,44 L
Project Description:
City, ST, Zip: ��'CdV� SP121 �1G S G� �j2 26y
�21 SE S C N-NNEL Its - F(� �N�
Telephone: O 3 Zd _ D 2..
U U
U( M 6 N
I � r
ED r
N -
State Lic. # : S t -f g 3
City Lie. C
�. /t/f o N L1M6 NT PA-NCIS
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone:
hone:
...............
Con struction Type: Occupancy:
P• c
S P Y:
i . #•
State Lc
Add'n Alter
Repair.air Demo type (circle one) .
Name of Contact Person: at-�M 6Kd SS
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 7(O . ?- o , ,zo Z
Estimated Value -of Project: 000.
APPLICANT: DO NOT WRITE BELOW THIS LINE
il
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted t
Item
Amount
Structural Calcs.
'Reviewed, ready for corrections
Plan Check Deposit '
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 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 IIOUSE:-
Reyiew, 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