05-1687 (SIGN)0) a..
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BUILDING & SAFETY DEPARTMENT
"15'04
C 9 _ - (:760)-„777=7012
OF'f� 78 ALLE TAMPICO FAX (760) 777-70T1
6 A Q CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
p timber 05--00001687 Daae 5/03/05
o y Address 46805 DUNE PALMS RD
A 649-020-.999-A.. -02377 -
Application description SIGN
Property Zoning REGIONAL COMMERCIAL
Application valuation'. 7500
Owner Contractor
REULMAN'MARK GRAPHIC RESOURCES
4 6 - 8 05. DUNE PALMS RD: ; P.O. BOX:1770, -
LA QUINTA,,' CA .92253 LA QUINTF,, CA 92.2.53
(7.6:0) &63-0`865
WCC:, STATE FUND
WC: 164094.072005 02/01/06
CSLB.:- 617865 04/30/07 -
CCC : ,C4 5
P.O. Box 1:504 _
i'IGiICV
78-495 CALLE TAMP,ICO.
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application. Number: d J— G C 7
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (7.60:) 777-7.011
INSPECTIONS (760)777,-71.53
,
Date:
Architect or Engineer:._
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby of hmunder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000),of Division 3 of the Business and Professionals
Code, and my License is in II and effect.
License Class __ License No. /1 7 94 5L
Date -.3 -0.5' Contractor �A.�f � 1 C -SD Q,f✓ S
OWNER -BUILDER 1OECLARATION
affirm hereby arn underpenalty of perjury that i am exempt from,the Contractors' State LicenseLaw for the- following;reason (Sec. 7031 .5. iBusiness and Professions Code: Any.
city or oaunty'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, Contractors! State License Law'(Chapter 9 (commencing with Section 7000) of Division .3 of the Business
and Professions Code) or thatheort 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 acivil penalty of not more than five hundred dollars ($500).):
U 1, as ownerof the property, or my employees with wages as their sole oompensadon, will do the work,.and the structure is not Intended or offered forsale (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 or through his or her own employees, provided that the improvements are not Intended or oHered.for sale. If, however, the building or Improvement1s
sold within one year of completion, the owner-builderwill have the burden of pawing that he or she did not build or improve4or the purpose of sale.).
U I. 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 orimproves thereon, andwho contracts for the projects with a oontractor(s) licensed pursuant to -
the Contractors' State License Law,).
U I am exempt under Sec. . BA P.C. for thisreason
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of thefollowing declarations:
— have and will maintain a certificate of consent to self4nsure forworkers' compensation, as provided for bySection 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I havwand will'ma1ritain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance:of the work for which this permit is
sued. Mcneomrsation insurance carrier
Cartier X14- Policy Number
I certify that, in the performance of the work, for which this permit is issued, I shall.not employ anyperson in any manner so as to become subject tothe workers'
compensation laws of California, and agree that, if 1 should become subject -:to the workers' compensation provisions of Section 3700 of. the Labor'Code, l shall
forthwith comply with those provisions. A .
WARNING: FAILURETO SECURE`WORKERS' OC MPENSAMON COVE IS' UNLAWFUL, AND SHALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS•($100,000), I . DITION TOTHE COST'OF COMPENSATION,,,DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.):
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made 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 orpursuantto 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 Quints, its
officers, agents and,employees.for any act or omission related to the work being perforated under or following issuance of this permit.
2. Any permit ssued,as a resutt,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.
Ice* 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 this county to t on the above-mentioned property for inspection. purposes:
Date Signature (Applicant or Agent):
. --'----------------------------------- --_---------------------- ----------------
sy Application Number . . . . . 05-0000.1.687
----------------------------------------------- ------------------------ L -----------
Permit
------------------------------------ ------
Permit . . . . . ELEC-ELECTRICAL SIGN
Additional desc . .
Permit Fee . . . . 33.00 Plan Check Fee .00
I,ssue'Date . . . . Valuation . . 0
Expiration Date 10/30/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 15.0000 EA ELEC SIGN.IST CIRCUIT 15.00
1.00 3.0000 EA ELEC SIGN ADDITIONAL CIRUITS 3.00
Permit . . . . . . .S,IGN PERMIT
Additional de_sc .
Permit Fee . . . . 99.00 Plan Check Fee .00
Issue Date . . . . Valuation 7500
Expiration Date. 10/30/05
Qty Unit Charge Per Extension
BASE FEE 45.00
6.00 9.0000 THOU BLDG 2,001-25,000 54.00
Special Notes and Comments
TWO INTERNALLY ILLUMINATED CHANNEL.
LETTER SIGND PER SA 05-851
Fee summary
------------------
Permit Fee Total
Plan Check Total.
Grand Total
Charged Paid
132.00 .00
.00 .00
132.00 .'00
Credited Due
.00 132.00
.00 .00
. 00 132.00