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06-2480 (SIGN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: 79315 HIGHWAY 111 APN: 649 -030 -034 - Application description: SIGN Property Zoning: REGIONAL COMMERCIAL Application valuation: 17985 Applicant: Architect or Engineer: 4 BUILDING & SAFETY .DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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 Professionals Code, and, my License is in full force and effect. LicenseClass: C45 ,1 �} License No.: 732674 ate: `7— ��1 ontractor:ll ��1 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 oo 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 Name: Lender's Address: LQPERMIT Owner: WALMART STORES 1301 S.E. 10 ST BENTONVILLE, AR INC. 72716 Contractor: - STREET GRAPHICS INC/ 2100 SANGUINETTI LAN STOCKTON, CA 95205 (209)948-1713 Lic. No.: 732674 14 -- VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 7/14/06 D DE Eipj JUL 14 2006 CITY ori 4 1 ANNA, ----------------------------------------------- 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 is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0000682006 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 37{000 of the Labor Code, I shall forthwith comply with those provisions. ,11�ate:�`I 4�pF� plicanit WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS IWFUL, 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 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 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 1 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 Spumy to enter upon the bove-mentioned prop y for inspectnionOpunrposes oo ate: azure (Applicant or Agent): L �y\v\ Application Number . . . . 06-00002480 Permit . . . ELEC-ELECTRICAL SIGN Additional desc . Permit Fee 36.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/10/07 Qty Unit Charge Per Extension BASE FEE 15.00- 1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT 15.00 2.00 3.0000 EA ELEC ---------------------------------------------------------------------------- SIGN ADDITIONAL CIRUITS 6.00 Permit . . . SIGN PERMIT Additional desc . Permit Fee . . . . 189.00 Plan Check Fee 122.85 Issue Date . . . Valuation . . . . 17985 Expiration Date 1/10/07 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 THOU BLDG 2,001-25,000 144.00 ---------------------------------------------------------------------------- Special Notes and Comments 3 -ILLUMINATED, 7 NON=ILLUMINATED SIGNS TO SAM'S CLUB BUILDING. 2001 CBC,2004 CEC, 2005 ENERGY CODES ---------------------------------------------------------------------------- Other Fees . . . . . . ENERGY REVIEW FEE 12.29 Fee summary Charged ----------------- Paid Credited Due -------------------- Permit Fee Total 225.00 ---------- .00 ---------- .00 - - 225.00 Plan Check Total 122.85 .00 .00 122.85 Other Fee Total 12.29 .00 .00 12.29 Grand Total 360.14 .00 .00 360.14 LQPERMIT Bin # City of La Quints Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico U Quinta, CA 92253 - (760) 777-7012 -Building Permit Application and Tracking Sheet Permit # D� Project Address: r - ` Owner's Name: A. P. Number: Address: A 2,) Legal Description: Contractor: �t? �� Co City, ST, Zip: t2 2 Telephone: Address: gl pU f7�. �. Project Description: rz $ ,. City, ST, Zip: - Telephone: _ !{�_ - ,,. - L 1 �_S_ 01 tt-A State Lic. # : % L/ City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: T Sv 17 6 7 Estimated Value of Project: 5 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING . PERMIT FEES Plan Sets Plan Check submitted /� Q Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. v Plans picked up Construction S j Fiood plain plan Plans resubmitted Mechanical Grading. plan' 2°" Review, ready for correcti/issue I lectrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading fN HOUSE:- 1n° Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees r Application Inquiry Email I Nome I RewVAndow I Support I Help QCancel X Extt 0 Refresh Land in... Docum.- 1'p Application 06 -00002480o Bonds 1Property Information Application information Contractor escrow Address: 79315 HrG WAY iii Application desc: 3 -Illuminated, 7 non -Ili umin V ,`Fees; LA QUIMTA, CA 92253 Application status: Ili PLAN! CHECK I, Global balance due Location ID: 6908 Status Date: 6/22/2006 inspection history Miscellaneous inform Names Permits Plan tracldng I;: Ii Ii: ° Owner nWW: MAZOM JOE W AP11: 649-030-034- - - Alternate ID: Zoning: CR REGIMIAL COMMERCIAL Application type: SIGN Application date: 6/22/2006 Tenant name/number SAM'S CLUB 1 ......::.... :.z .... ::•: ..:....:.... :;:;...:, l Receipts Square footage calcul Structures Contractor Information Contractor Name: * OVA= Outstanding inspections Insp Schedule Confirmation Valuation calculations i< Contractor Number: Type 1D Date 11u;*er Type: --------------- ---------------------------- Status: Q ELECTRICAL PIMA Contractor Requirements Doc Nuker Q FILIAL A E EMERGY REVIEW FEE 12.29 12.29 .00 K PC PLAN CHECK FEES 122.85 122.85 .00 000000 500100 P PF PERMIT FEES- 189.00 189.00 .00 000000 $00100 P PF PERMIT FEES 36.00 36.00 00 000000 E06 00 Totals 360.14 360.14 .00 G; f