BSIG2017-000978-495 CALLE TAMPICO D �NMUCl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSIG2017-0009
Property Address: 79490 HIGHWAY 111
APN: 600390010
Application Description: USAS GAS % RETRO FIT MONUMENT SIGN
Property Zoning:
Application Valuation: $2,200.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/27/2017
Owner: S L( I`7
TESORO SIERRA PROP
P 0 BOX 592809
SAN ANTONIO, TX 92253
Applicant: /,L0 Contractor:
TRULITE SIGNS INC VISTA UNIVERSAL INC
2990 HALF MOON CT D- D 2430 AMERICAN AVE
NORCO, CA 92860 JUN 2 7 2017 HAYWARD, CA 94545
CITE irk LA (�iJINTA (510)785-6166
Llc. No.: 377939
DESIGN AND DEVE-LOPIIENT DEPARTMENT
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: –C710, C4^^5�� License No.: a3779Contractor: `
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 ) 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:
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'
Wai6—n'
s provided forbySection 3700 of the LaborCode, for the performance
which thispermitisissued. and wllmaintain workers'compensation insurance, as required by
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: 9143663
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 ec subject to the
workers' compensation provisions of! ection 0 of a Labo od d)hall forthwith
comply with those p ovisions.
D �® Appli
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 actor 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 ation is correct.
I agree to comply with all city and county ordinances andstate laws rela g to building
construction, and hereby authorize representatives of thi ' yt ent up o the above-
mentioned pjoperty for inspection purposes.
h
Date: 6/27/2017
Application Number:
BSIG2017-0009
Owner:
Property Address:
79490 HIGHWAY 111
TESORO SIERRA PROP
APN:
600390010
P 0 BOX 592809
Application Description:
USAS GAS / RETRO FIT MONUMENT SIGN
SAN ANTONIO, TX 92253
Property Zoning:
Application Valuation:
$2,200.00
Applicant:
Contractor:
TRULITE SIGNS INC
VISTA UNIVERSAL INC
2990 HALF MOON CT
2430 AMERICAN AVE
NORCO, CA 92860
HAYWARD, CA 94545
(510)785-6166
---------------------------------------------
------------------------------------------------
Llc. No.: 377939
Detail: (1) RETRO FIT LED
SIGNS [USA GAS] SIGN PERMIT N0. 2017-0018. PER 2016 CALIFORNIA BUILDING CODES.
FIRAVICIAL IRFORITIATICA
DESCRIPTION ACCOUNT CITY AMOUNT
CHANGE OF CONTR/ARCH/OWNER PROCESSING 101-0000-42600 1 $101.84
Total Paid for ADMINISTRATIVE: $101.84
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
Credit Card Fee
101-0000-43505
0
$4.91
Total Paid for Credit Card Fee: $4.91
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
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
Total Paid for SIGN: $215.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000=43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00