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BSIG2018-0005LICENSED 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.: 6430 Dat dZ Co ract 0 ER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 11, 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 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 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 Add 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 ofothiewok forwhich this permit is issued. I have and will maintain workers' compensation insurance, as required by S00 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: 9098884 _ 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 Sectio of the Labor.Code, I shall forthwith comply with those provisions. �t — d O Appl' ant: WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVER GE 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 property for inspection purposes. --) f VOICE (760) 777-7125 78-495 CALLE TAMPICO U FAX (760) 777=7011 1:11IQ ,MAXITD M132253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/22/2018 Permit Type/Subtype: SIGN/ Owner: Application Number: BSIG2018-0005 EL POLLO LOCO Property Address: 78621 HIGHWAY 111 3535 HARBOR BLVD STE 100 APN: 643220028 COSTA MESA, CA 92626 Application Description: EL POLLO LOCO SIGNS Property Zoning: Application Valuation: $15,000.00 D Applicant: Contractor: SWAIN SIGN INC SWAIN SIGN INC 1384 E FIFTH ST MAR 2 2 2018 1384 E FIFTH ST ONTARIO, CA 91764 CITY OF LA ONTARIO, CA 91764 QUINTA COMMUNITY DEVELOPMENT DEPARTMENT (909)460-2530 LIc. No.: 643004 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.: 6430 Dat dZ Co ract 0 ER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 11, 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 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 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 Add 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 ofothiewok forwhich this permit is issued. I have and will maintain workers' compensation insurance, as required by S00 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: 9098884 _ 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 Sectio of the Labor.Code, I shall forthwith comply with those provisions. �t — d O Appl' ant: WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVER GE 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 property for inspection purposes. --) Date: 3/22/2018 Application Number: BSIG2018-0005 Owner: Property lddres,=`'r•'="'I 78WIMIGHWAY 111 EL POLLO LOCC APN: 643220028 3535 HARBOR 9LVD STE 100 Application Description: EL POLLO LOCO SIGNS COSTA MESA, CA 92626 Property Zoning: Application Valuation: $15,000.00 Applicant: Contractor: SWAIN SIGN INC SWAIN SIGN INC 1384 E FIFTH ST 1384 E FIFTH ST ONTARIO, CA 91764 ONTARIO, CA 9[1764 (909)460-2530 -------------------------------------------------------------------------------------------- Llc. No.: 643004 Detail: (9)WALL7DIRECTIONAL/MENU SIGNS AND CLEARANCE BAR [2016 ENERGY; 2016 CALIFORNIA BUILDING CODESj. ' FINANCIAL •• • .DESCRIPTION ,1.. ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $26.01 Total Paid for ELECTRICAL: $52.02 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 ' Total Paid for RECORDS MANAGEMENT FEE: $10.00 ' DESCRIPTION ACCOUNT QTY AMOUNT MONUMENT SIGN, FIRST 101-0000-42404 0 $78.02 DESCRIPTION ACCOUNT QTY AMOUNT MONUMENT SIGN, FIRST PC 101-0000-42600 0 $143.56 DESCRIPTION ACCOUNT QTY' AMOUNT WALL/AWNING SIGN, EA ADDITIONAL 101-0000-42404 0 $106.12 DESCRIPTION ACCOUNT QTY AMOUNT WALL/AWNING SIGN, EA ADDITIONAL PC 101-0000-42600 0 $106.12 DESCRIPTION ACCOUNT . QTY AMOUNT WALL/AWNING SIGN, FIRST 101-0000-42404 0 $26.53 DESCRIPTION ACCOUNT QTY AMOUNT WALL/AWNING SIGN, FIRST PC • 101-0000-42600 0 $93.62 Total Paid for SIGN: $553.97 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $621.99