13-1428 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00001428
51370 AVENIDA BERMUDAS
770-152-011- -
SIGN
VILLAGE COMMERCIAL
2000
c&ht 4 4 Q"
Architect or Engineer:
jw;�a� �///+
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3. of the a rmss rid Professionals Code, and my License is in full force and effect.
LicenseClass:
15 D42 C License No.: 524483
Due. I L * ontfaci
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 _ 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.).
(_ 1 1, 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:
Owner:
CAPETZ ROBERT
C/O SUN VISTA
P O BOX 1144
LA QUINTA, CA
N
92253
Contractor:
BEST SIGNS INC
1550 S. GENE AUTRY TRAIL
PALM SPRINGS, CA 92264
(760)320-3042
Lic. No.: 524483
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/07/13
tOV o 7 2013 D
OF LA
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a eertlfloate of consent to self -insure for workers' compensatlon, as provided
for by Section 3700 of the -Labor Code, for the performance of the work for which this permit is
issued.
We and will maintain workars' compensation insurance, as required by Section 3700 of the Labor
Cade, for the performance at the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier COMPANIAN PROPT Policy Number CPCA16846
_ 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, it I should be nta subject to the wge0W compensation pravlslons of Section
3700 of the Labor li forth th omply with those provisions.
Date Applicant:
WARNING: FAILURE TO SECUR W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRi NAL 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 Quints, 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 buildin con ion, and hereby authorize representatives
aly"'e ynI to enter upon the abpvei-mantluned pro y for urpbses.
Oats f 1 r Signature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 13-00001428
Permit . . . ELECTRICAL 2013
Additional desc . .
Permit Fee . . . . 35.75 Plan Check Fee
.00
Issue Date Valuation
0
Expiration Date 5/06/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA ELEC SIGNS
----------------------------------------------------------------------------
35.75
Permit . . . SOTB 2013
Additional desc . .
Permit Fee . . . . 48.62 Plan Check Fee
.00
Issue Date . . Valuation
0
Expiration Date 5/06/14
Qty Unit Charge Per
Extension
1.00 24.3100 LS MISC WALL SIGN, FIRST
24.31
1.00 24.3100 EA MISC WALL SIGN, ADDL
24.31
SpecialNotesand Comments
SIGN - (1) INTERNALLY ILLUMINTATED
BUILDING ID SIGN AND (1) NON -ILLUMINATED
MONUMENT WALL SIGN, PER APPROVED SA
2013-1740 "LUXE VACATION HOMES. 2010
CALIFORNIA BUILDING CODES.
------------------------- --------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, ELECTRICAL
47.67
PLAN CHECK, SOTB
110.11
Fee summary Charged Paid Credited
-
Due
Permit Fee Total 84.37 .00 .00
84.37
Plan Check Total .00 .00 .00
.00
Other Fee Total 158.78 .00 .00
158.78
Grand Total 243.15 .00 .00
243.15
LQPERMIT
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