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10-0083 (SIGN)
P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000083 Property Address: 78267 HIGHWAY 111 APN: 604-050-012-1 -000000- Application description: SIGN Property Zoning: COMMUNITY COMMERCIAL Application valuation: 5000 Applicant: D/ Architect or Engineer: r.vI A - BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of.the Business and Professionals e, and my License is in full force and effect. Licenselciass:D42 C45 Lic n allo.: 830131 pc 4 � � Cont or. .01 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 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 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.). ( 1 I am exempt under Sec. , BAP.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 ISec. 3097, Civ. C.). Lender's Name: Lender's Address: - LQPERMIT Owner: M & H REALTY PARTNERS C/O PETER MERLONE 353 SACRAMENTO ST 21ST SAN FRANCISCO, CA 9411 Contractor: SIGNARAMA 41945 BOARDWALK, I -L11 PALM DESERT, CA 92211 (760)776-9907 Lic. No.: 830131 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/04/10 r 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 1938607 I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become sub' ct to the workers' compensation laws of California, and agree that, if I should become subjec o the workers' compensation provisions of Section 3700 of the Labo I s all forthwith co ply with those provisions. a4 ta: �f (O A cant: WARNING: FAILU EE TURE 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 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 I have read this application and state that the above information is orr ct. I agree to comply with all city and county ordinances and state laws relating to building co struction, an here y authorize representa�tives of this co my to enter upon the above-mentioned p coon purpo as. jYd�e: 4 �O Si ure (Applicant o`Agent): Application Number . . . . . 10-00000083 Permit . . . ELEC-ELECTRICAL SIGN Additional desc . Permit Fee . . . . 33.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/03/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT 15.00 1.00 3.0000 EA ELEC SIGN ADDITIONAL CIRUITS 3.00 ---------------------------------------------------------------------7------ Special Notes and Comments 2 SETS OF LED ILLUMINATED CHANNEL LETTER SIGNS, PER SA # 2009-1423 "ELECTRIC CAR OUTLET" 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ------------------------------ Due --------------------------- Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 34.00 .00 .00 34.00 h J ik•• — I �.,.5 TL `A7o o � �'• W 1 ..� AI� © G Y Al E nn 2, a o a; 5 L �Q S L� o R ' G 4. IA N ro � M cnpp e� :..- a N u � � Q u b31 0. +�. V] x •� t ui h o 0 N y sy "+i V m N a � O m O Q U F a' J U a •n W a �j •u d � •� �� CA log 0 y u e 'V V' {,q t;•f,� .q'y:C•:{. i±'v.;k W Aa fiC y aid" e ' 4 . GN CGt a Ai u + RI V ::'t-: w c4 U a a N v w a� U A � � a , r 0- M O 9L.A G' r o V 1 I ` a`i , {) S �. ® 0 a U �j �j cNi a a• g A, 4 a d U N 4 o N o ao W U q ci w a fl Z vFi a a ri a a o vs a w F P w C9 rn C7 a o.qk n m � d A V U H V F z H Q Certificate of Compliance (Page l of 4) 0LTG-1C Project Name: C Date: 01 Project Address:,n ( a 'Zl L l+" l Total ardscape Iluminated Area: 7 $ - a6 7 t4 tri General Information Phase of Construction: ❑ New Construction Addition ❑ Alteration Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name 3e:C-C^ � n b �Cc.0 Signature Compan \ Date \ Address IF Applicable Lk CEA # 6CLV-AG -6—,k — CEPS # Ci /State/Zi ri p d-. VeS-ewl- G11"I la Phone:• 76,0--7-76- O Principal Lighting Designer's Declaration Statement ,91 am. eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. *This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, Pages 1 and 6 of the California Code of Regulations. *The design features.represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: � Signature: Company r cc Phone: ?60 ct Address: ` ✓c�wa L V-# L License # Zc:64kQ4 City/State/ ip: NN Date: �y Principal Lighting Designer's Veclaration I certify that this Certificate of Compliance documentation is accurate and complete, and accounts for all outdoor lighting power, including building mounted, pole mounted, as well as all other outdoor lighting designed for the site, and that Additional Lighting Power Allowances for Specifc Applications or Additional Lighting Power Allowances for Ordinance Requirements have not been counted more than one time for the same area, in accordance with Section 147 of the Standards. Outdoor Lighting Mandatory Measures Indicate location on building plans of Mandatory Measures Note Block: LIGHTING COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included) For detailed instructions on'the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential Manual ublished by the California Energy Commission. OLTG-1C Certificate of Compliance. All 4 pages required on plans for all submittals. ❑ OLTG-2C (Page 1 of 3) Lighting Wattage Allowances for General Hardscape, Sales Frontage, or Ornamental Lighting. Optional on plans. . ❑ OLTG-2C (Page 2 of 3) Lighting Wattage Allowances for Per Application or Per Area. Optional on plans. ❑ OLTG-2C (Page 3 of 3) Additional Lighting Power Allowance for Ordinance Requirements. Optional on plans. 2008 Nonresidential Compliance Forms August 2009 Certificate of Compliance (Page 2 of 4) 0LTG-1C COMPLIANCE FIXTURE / LIGHTING CONTROL SCHEDULE and FIELD INSPECTION CHECKLIST Project Name: Date: u INSTALLATION CERTIFICATE, OLTG-I-INST (Retain a copy and verify form is completed an signed`.) Field Inspection ❑ CERTIFICATE OF ACCEPTANCE, OLTG-2A (Retain a copy and verify form is completed and signed.) Field Inspection ❑ Luminaire Schedule Installed Watts A B C D E F G H I Name Or Item Ta t Luminaire Description See footnote below i.e.: I lam ole -to shoe -box 400 watt metal halide c %c o Nu U A ❑. � N ° CL 0 How wattage was determined o ? '� L .G 8 E y 3 9 a7 a x Field Ins ector2 ,� 5 0 '2 .M -i N 0 °O V r c y ❑ ❑ ❑ ❑ ❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Enter total into OLTG-IQ Page 4 of 4; Row H; Total Installed Watts: 1. Type of luminaire (i.e.: post top, wall pack, surface, shoe box); for non -incandescent luminaires, indicate nominal lamp wattage and lamp type (i.e.: fluorescent, incandescent, HID); ballast type (i.e.: electronic or magnetic); number of lamps and number of ballasts per luminaire. For incandescent luminaires, the luminaire wattage listed in column D shall be the maximum relamping rated wattage on a permanent factory -installed label on the luminaire, NOT the wattage of the lamp (bulb) used, in accordance with Section 130(d or e). 2. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. EXEMPT LUMINAIRES I Field Inspection ❑ Name or Symbol Description of exempt luminaires in accordance with §147 MANDATORY CONTROLS Field Inspection ❑ # Description Location # Description Location 'p- V- Exec_ oe tin SPECIAL FEATURES INSPECTION CHECKLIST (See Page 2 of 4 of OLTG-IC) The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Filed Inspector Notes or Discrepancies: 2008 Nonresidential Compliance Forms August 2009 Certificate of Compliance (Page 3 of 4) 0LTG-1C Project Name: i C � V- Date: \ A. OUTDOOR FIGHTING ZONE OUTDOOR LIGHTING ZONE: ❑ OLZ 1 ❑ OLZ 2 ❑ OLZ 3 ❑ OLZ 4 Is the Outdoor Lighting Zone: ❑ Default in accordance with §10-114, or ❑ Amended by JHA Complete the information below if the default Outdoor Lighting Zone has been amended by the local jurisdiction having authority (JHA): ❑ The site is a government designated park, recreation area, wildlife preserve, or portion thereof, and has been designated as LZ2 nr 1.7.1 in accordance with Table 10-114-A, because the site is contained within such a zone. ❑ The local jurisdiction having authority has officially adopted a change to the State Default Lighting Zone and has notified the Energy Commission by providing the materials required in §10-114(d) to the Executive Director. ❑ The adopted change is posted on the Energy Commission website. B. ADDITIONAL LIGHTING POWER ALLOWANCE FOR ORDINANCE REQUIREMENTS Are additional lighting ower allowances for ordinance in Table 147-C used? ❑ Yes ❑ No Complete the information below if additional lighting power allowances for ordinance requirements are used: ❑ The local jurisdiction having authority has officially adopted specific outdoor light levels, which are expressed as average or minimum footcandle levels, by following a public process that allowed for formal public notification, review, and comment about the proposed change. ❑ The local jurisdiction having authority which adopted specific outdoor light levels and has notified the Commission by providing the following materials required § 10-114 to the Executive Director. C. ACCEPTANCE FORMS Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system, LTG-2A. The designer is required to check the acceptance tests and list all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. ]fall the lighting system or control of a certain type requires a test, list the different lighting and the number of systems. The NA Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the. responsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements. The LTC-2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition, a Certificate ofA cceptanceforms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) of Title 24 Part 6. The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the LTC-2A for each different lighting luminaire control(s) must be provided to the owner of the building,for their records. Certificate of Acceptance Luminaires Controlled OLTG-2A' Outdoor Equipment Re uirin Testing Description Y o E e ' ° Location Lighting Acceptance Tests Sw;-f�Gt 1. Insert: OMS for Outdoor Motion Sensor,' OLSC for Outdoor Lighting Shutoff Controls; OP for Outdoor Photocontrol; ATS for Astronomical Time Switch; and, STS for Standard non-astronomical Time Switch acceptance. 2008 Nonresidential Compliance Forms August 2009 CERTIFICATE OF COMPLIANCE (Page 4 of 4) OLTG-1C Project Name: Ca t� D `� Q`� Date�� L( / e_c'�v' c. �e. l ALLOWED AND INSTALLED OUTDOOR LIGHTING POWER 2008 Nonresidential Compliance Forms August 2009 Lighting Wattage Power Allowance A NIA Lighting power allowance for general hardscape (from OLTG-2C Page .1 of 3) B Al ' Specific application lighting wattage allowance per unit length (from OLTG-2C Page 1 of 3) C IV A . Specific application wattage allowance for ornamental lighting (from OLTG-2C Page 1 of 3) D A/A Specific application wattage allowance per,application (from OLTG-2C Page 2 of 3) E Specific application lighting wattage allowance per area (from OLTG-2C Page 2 of 3) F N A Additional lighting power allowance for ordinance requirements (from OLTG-2C Page 3 of 3) G /V/A Total Allowed Wattage = Sum of rows A through F: HTotal /q Installed Watts (from Luminaire Schedule, ( from OLTG-1 C (Page 2 of 4) Complies if Installed Wattage in row H is less than or equal to the Total Installed Wattage in row G ❑ Yes ❑ No 2008 Nonresidential Compliance Forms August 2009