06-4303 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00004303
Property Address: 47350 DUNE PALMS RD
APN: 649-030-039-3 -00.0000-
Application description: SIGN
Property Zoning: COMMERCIAL PARK
Application valuation: 4500
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under 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 full force and effect.
License Class: �(C ,`tom License No- 724929:
Date: {� �tJ UOContractor: M -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of:perjury that I am exempt from the Contractor's State License Lew for the.
following reason (Sec. 7031.5, Business,anid 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 fila a signed statement that he -or she is licensed pursuant.to the provisions of ihe,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'Secbon,7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than -five hundred dollars ($500).:
I _) I, as, owrierof 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, Busineas!and Professions.Cods: 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 herselfcthrough his or her own employees, provided that the
improvementsare 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 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 or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant ;to the Contractors' State License Law:).
I—) I am exempt under Sec. , B.&P.C. for this'resson
Date: Owner:..
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a constructionlending agency for the performance of the
work for which this permit; is Issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPEBbIIT
Owner:
47350 DUNE PALM LLC
201 WILSHIRE BLVD
LA QUINTA, CA
Contractor:
SOUTHWEST'SIGN
1696 COMMERCE
CORONA, CA 928
(951)734-6275
Lie. No.,: 7249,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/18/06
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 ofthe work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the. Labor
Code, forthe performance of the work for which this,permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier. CLARENDON NAT'L Policy Number OIKR0033176
I certify that,: in the performance -of the work for which this permit is issued, I shall not employ any
parson lmany,mannerso•as to,becomssubject to the workers' compensation laws of, California,
and agree that, if I should become•subject t the workers' compensation provisions of Section
337700 of the La"e, IIsshalll forthwith ty wit those provisions.
Date: /a Applicant•.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER'TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THELABOR 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 permitissued as a result of this application,
the owner, and.the applicant, each agrees to, and shall defend, indemnify -arid hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this,permt.
2. Any permit Issued as a result of this application becomes null and void if work isnot 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! have read this application and state that the above information is'co rest. I agree to comply with all
city and county ordinances and state. laws relating to building construction, and authorize representatives
of this coup to a er upon the above-mentioned pr r inspeditn pu
Date: county
(Applicant or Agentj:
Application Number . . . 06-00004303
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date 6/16/07
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
ONE INTERNALLY ILLUMINATED CHANNEL
LETTER SIGN PER SA -2006-1065
Fee summary Charged Paid Credited Due
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Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total .00 .00 .00 .00
Grand Total 30.00 .00 .00 30.00
LQFERMIT