08-1569 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4bt 4 4 4"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: r 08-00001569 f" ��—R- Owner:
Property Address: f46660 WASHINGTON ST STE 4 WASHINGTON 111 LTD
APN> '.643-020-999-3 — 30903 - C/O JACK TARR
Application description: SIGN 30240 RANCHO VIEJO 'RD
Property Zoning: REGIONAL COMMERCIAL SAN JUAN CAPISTRANO,
Application valuation: 5300
Applicant:
. STE. B
CA 92675
Contractor:
Architect or Engineer: BLAKE SIGN COMPANY INC
i, 11661 SEABOARD CIR
STANTON, CA 90680
(714)891-5682 506LiC. No..::506422
LICENSED CONTRACTOR'S DECLARATION
I here;700of
der enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with -
SectioDi sion 3 of the Busi sessionals Code, and my License is in full force and effect.
LicensLicense No.: 506422
Cyrffractor:
OWNE -8 ILDER 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).:
(_) 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
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, 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , BAP.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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-.7011
INSPECTIONS (760) 777-7153
Date: 9/16/08
• Q
t OF LA QUI T.
Cri ..sIPF W�
WORKER'S 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 of 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 number are:
Carrier STATE FUND Policy Number 1581808
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
on in any manner s to become subject to the orkers' compensation laws of California,
p
erson
agree that, if I o ome s o the ers' compensation provisions of Section
0 of the Lab C de, I h rth ' om with those provisions.
at/D e:cant:
WARNING: FAILURE TO SECURE WORKERS' COMPE ATION COVERAGE 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.
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 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 bove information is correct. I -agree to comply with all
city a c unty rdinanc .s and ate laws relating to i din constr do nd hereby authorize representatives
of is co my enter upon eabove-mentioned pr pe ection r oses.
Date: gnature (Applicant or Agent)
LQPERA1IT
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
�JI v Owner's Name:
Permit #
Project Address:U
A. P. Number:
g1.1� Q�
Address: 1. b V L (S .
Legal Description:
City, ST, Zip: s
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Contractor: VplV_J,5 A6t t— 7
Telephone: "
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Address: b Y�
Project Description:
City, ST, Zip: iv\ Ca 06
(A /q 1, WU VVI
Telephone Iet I l gs-L
City Lic. #:
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State Lic. # : S^(] 6 %�
Arch., Engr., Designer:
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i �dj �� -WA
Address:
City, ST, Zip:
Telephone: r
State Lic. #:
Name of Contact Person: ti t.�lJ L�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact PersonD 0 8 I UZ Estimated Value of Project: CFO
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMTT 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
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2'" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" 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