BSIG2016-002178-495 "' D
CALLE TAMPICO � VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPAR E 4 I SP NS (760) 777-7153
• ----- BUILDING PERMIT
DEC 22 2016
12/22/2016
Application Number: BSIG2016-0021 Owner: Z��6
Property Address: 78364 HIGHWAY 111 1 K STORES INC
0
APN: 604050046 S0G Ih,��,{�J Q
Application Description: CIRCLE K / CHANGE OUT LIGHTING ON MONUMENT/BUILDING MOUNTED
� 9N 53
Property Zoning: IRI EPART
Application Valuation: $8,500.00 MENT
Applicant:
PROMOTION PLUS SIGN CO INC
21034 OSBORNE ST
CANOGA PARK, CA 91304
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my License is in full force and effect.
License Class: C45 License No.: 853228
D� ate�� t 1L F Contractor:
OWNER -BUILDER 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).:
(1 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.).
(� 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 am exempt under Sec. . B.&P.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 Na
Lender's
Contractor:
PROMOTION PLUS SIGN CO INC
21034 OSBORNE ST
CANOGA PARK, CA 91304
(818)993-5406
Llc. No.: 853228
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
ued. My workers' compensation insurance carrier and policy number are:
Carrier: CYPRESS INSURANCE COMPANY Policy Number: PRWC706429
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply 'th hose pr visions.
Dater f14 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 ($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 Building Official 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 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 city to enter upon the
above-mentioned prop rty for inspection purposes.
Date:----%- li ignature-(Applicant na to
Date: 12/22/2016
Application Number:
BSIG2016-0021
Owner:
Property Address:
78364 HIGHWAY 111
CIRCLE K STORES INC
APN:
604050046
P 0 BOX 52085
Application Description:
CIRCLE K /CHANGE OUT LIGHTING ON MONUMENT/BUILDING MOUNTED
PHOENIX, AZ 92253
Property Zoning:
Application Valuation:
$8,500.00
Applicant:
3 r
Contractor:
PROMOTION PLUS.SIGN CO INC
PROMOTION PLUS SIGN CO INC
21034 OSBORNE ST
21034 OSBORNE ST
CANOGA PARK, CA 91304
CANOGA PARK, CA 91304
(818)993-5406
------------------------
i
-------------------
Llc. No.: 853228
--------------------------------------------------
Detail: REPLACE BUILDING FASCIA SIGN, STREET MONUMENT SIGN, 8 PUMP SIGNS AND CANOPY SIGN WITH MID LED CONVERSION LIGHTING
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
MONUMENT SIGN, FIRST
101-0000-42404
0
$76.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
MONUMENT SIGN, FIRST PC
101-0000-42600
0
$139.84
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/AWNING SIGN, EA ADDITIONAL
101-0000-42404
0
$25.84
DESCRIPTION -
ACCOUNT
CITY
AMOUNT
WALL/AWNING SIGN, EA ADDITIONAL PC
101-0000-42600
0
$25.84
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/AWNING SIGN, FIRST
101-0000-42404
0
i $25.84
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/AWNING SIGN, FIRST PC
101-0000-42600
0
$91.20
Total Paid for SIGN: $384.56
/77�
Permit ;;
Project Address:
Qty of La Qul.nta
Building &r Safety Division
78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Name:
A. P. Nwnher.�? Q 3
Address:
Legs( Description:p
City, ST, Zip: C�Y�7%6417-
ontract r.
C o
n
� /-
Address: 2
Project Description:
City_ ST, Zip:
_..
U . Cl a
TeleP ho C,
_
S S� L-
State Lic. # : S 2
C
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CityLie. #;..
S _ ILk h
'G�G �5- t
l� _ b�,L)._ _
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Arch., Engr., Designer:
3�
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Lib" '
Demo
Project type (circle o2NAdd'n Alter Repairair
Name of Contact Person:
S
t?�......,
Sq. Ft.: '-T—#
Stories:
# Units:
Telephone # of Contact Person:
_ Z)�-
Estimated Value of Project: 4g 4—M
APPLICANT: DO NOT WRITE BELOW THIS LINE
n
Submittal
Req'd
Rcc'd
'TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Verson
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 HOUSE:-
3" Review, ready for corrcctionstiissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
I
Total Permit Fees
Permit Number: BSIG2016-0021
Applied: 12/8/2016 Approved:
Issued: Finaled:
Status: UNDER REVIEW
Parent Permit:
Parent Project:
Details:
Permit Reviews
City of La Quinta
Description: CIRCLE K / CHANGE OUT LIGHTING ON
MONUMENT/BUILDING MOUNTED
Site Address: 78364 HIGHWAY 111
City, State Zip Code: LA QUINTA, CA 92253
Applicant: PROMOTION PLUS SIGN CO INC
Owner: CIRCLE K STORES INC -
Contractor: PROMOTION PLUS SIGN CO INC
OW&P
SENT DATE
RETURNED
DATE
DUE DATE
TYPE
CONTACT
STATUS
REMARKS
Review Group: ALL
12/8/2016
12/15/2016
1ST PLANNING (1 WK)
PLANNING BUCKET
Notes:
Review Group: BLDG 1ST (1WK)
12/8/2016
12/15/2016
1ST BLDG NS (1 WK)
BUILDING BUCKET
Notes:
PLANNING APPROVED SA2016-0069
Printed: Thursday, 08 December, 2016 1 of 1
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