BSIG2016-0022(: 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
� aw VOICE (760) 777-7125
FAX (760) 777-7011
DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/13/2016
BSIG2016-0022 ' Owner:
78825 HIGHWAY 111/� ® RM LA QUINTA
643020065 ^ 5319 UNIVERSITY STE 236
ULTA CHANNEL LETTER LL I NS IRVINE, CA 92253
$6,000.00 DEC 13 2016
Applicant: V �I�y of I A,U10Vtn
CAREY SIGN CORPORATION DM
DEPARTMENT
2871 BLUE STAR STREET DESIGN AND DEV
ANAHEIM, CA 92806
4
or.
OWNER -BUILDER 9ESXARATION
I hereby affirm under penalty of perjury that m exempt from the Contracto ' tate
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 fora i
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 isnot 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.).
U 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
Lender's Address:
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 perf
Contractor:
CAREY SIGN CORPORATION
2871 BLUE STAR STREET
ANAHEIM, CA 92806
(714)630-8414
Llc. No.: 376085
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under'penalty of perjury that I am liceZund rovisions of Chapter
9 {commencing with Section 7000} of Division 3 of the d Profess Code,
and my License is in full force and effect.'
License Class: C45 License No.: 376085
Dater /G Contract
ormance
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 COMPENSATION INSURANCE FUND Policy Number: 9071423
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 becomes bject to the workers'
compensation laws of California, and agree that, if I shout ecome subject to the
workers' compensation provisions of Section 3700 of t abor Code, I s forthwit
comply with those provisions.
Date:Applicant:
WARNING: FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLA F L,
AND SHALL SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UPOO
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 rela ' g to building
construction, and hereby authorize representatives of this city to ent upon the /
above-mentioned propert
y for inspection purposes.
Date: Signature (Applicant or Agent):
Date: 12/13/2016
Application Number:
BSIG2016-0022
Owner:
Property Address:
78825 HIGHWAY 111
RM LA QUINTA
APN:
643020065
5319 UNIVERSITY STE 236
Application Description:
ULTA CHANNEL LETTER WALL SIGNS
IRVINE, CA 92253
Property Zoning:
Application Valuation:
$6,000.00
Applicant:
Contractor:
CAREY SIGN CORPORATION
CAREY SIGN CORPORATION
2871 BLUE STAR STREET
2871 BLUE STAR STREET
ANAHEIM, CA 92806
ANAHEIM, CA 92806
(714)630-8414
---.-,-----------------------------------------------------------------------------------------
Llc. No.: 376085
Detail: (2) CHANNEL LETTER
LED SIGNS [ULTA] SIGN PERMIT NO.SA2016-0031 [MF]
2013 ENERGY AND BUILDING CODE
FINANCIAL •
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
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
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: $168.72
TOTALS: $220.38
Bin ff
City of b Qui nto
Buifding u Safety Division
nit fl 78-495 Calle Tampico
(� La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
(Project Address: Owner's Name�j ��2
A. P. Number:
Address:
Legal Description:
City, ST, Zip: /L 1p9,94,gj
.Contractor:
0 r:
S
Address: Z 7 /(pr
%?lit'/� ST�-,� ST
jDescription: /
(project
City, ST, Zip:
Tele h
Telephone: 7
P /
7 3 d
ti
State Lic. # : 3 7(,049$S' C'KS"
. City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Cons tructton Type: Occupancy:
a
-State Lic. 4
S
ProJect type(circle one): New Add'n Alter Repair.ai
r Demo.
Name of Contact Person:
Sq. Ft.:
#Stories :
#Units:
Jfthonc # of Contact Person:
Estimated Value of Project: DU7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Tit!e 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted'
Mechanical
Grading plan
2" Review, ready for corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dced
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
3" Review, ready for corrcctionstissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
t
Total Permit Fees
1W