1913 E LA PALMA AVE (2)SIGN PERMIT NO. SGN2019-00122
TYPE OF PERMIT
New Attached to Structure Sign
DATE: 5/28/2019
JOB ADDRESS:
LEGAL DESCRIPTION:
1913 E LA PALMA AVE
PERMIT APPLICANT: ALEXIS ESTRADA
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
H E I M INSP CTION65 -626 REQUEST LINE:
QUARTER SECTION: 101
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
MARTINEZ ELECTRIC
1928 TYLER AVE UNIT F
SO EL MONTE, 91733 0000 CA
JOB DESCRIPTION: Installation of illuminated wall sign for "Dol Ex Financial Services".
VALUATION: PROCESSED BY: EGA
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following mason (Sec. 7031.5 Business and Professions Code: any city or
county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions
Code) or that he 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, as owner of 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or
through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold with one year of
completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale).
❑ I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law).
❑ I am exempt under Sec. B & P.C. for this reason:
Date: Owner.
WORKER'S COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of pedury one of the following declarations: I hereby affirm under penalty of pedury that I am licensed
❑ 1 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.
-have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code,
or the performance of the work for which this permit is issued. My workers Compensation insurance carrier
and policy are:
Carrier: EXEMPT Policy Number: EXEMPT
This section need not be completed if t he permit is for one hundred dollars ($100) or less.
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person it
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 Sermon 370q pf the Labor Code, I shall forthwith
comply with those provisions. �� ( � t 7
Date: 5/28/2019
WARNING: FAILURE TO SECUREsKORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND
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.
I CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of pe jury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec.3097.Civ.C):
Lenders Information:
I certify that I have read this applicatio nd state t at the above information is correct. I agree to comply with
all city rdi ances=end state laws rel ting t builditng nstruction, and hereby authorize representives of this
city to nter on` h above mention d pro rty f ins ction purposes.
Date: 5/28/2019
Signature of Applicant or Ado
nt
The permit shall expire by limitation and become null and void if the building or work has
not passed final inspectoin 365 days from the date of permit issunace. A new permit is
required to commence or continue work.
under provisions of chapter 9 (commencing with Section 7000)
of Divsion 3 of the Business and Professions Code.
Date: 5/28/2019
NUMBER:
BUS2000-02369
TYPE: C10
TYPE: BUS
Contractor:
EXPIRATION DATE:
1213112020
Quanity: 1" I Y I I I I" d\ I I R E
Electric Si n ( Y
INSPECTION
NOT CO I -A PLE T ED
DATE: 28
Fees paid for Permit:
Total:
574.00