10-0173 (ELEC)P.O. BOX 1504
78-495.CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
10-00000173
78370 HIGHWAY
604 -050 -048 -
ELECTRICAL
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
t Owner:
111 STE-100 MADISON PTM LA QUINTA
- - 78370 HIGHWAY 111, STE
LA QUINTA, CA 92253
COMMUNITY COMMERCIAL
2000
Contractor:
Applicant: Architect or Engineer: SIGNARAMA
�0 41945 BOARDWALK,
/ PALM DESERT, CA
(760)776-9907
Lic. No.: 830131
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/08/10
N $
----------------------------------------------------------------------------------------7--------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am license . rider provi ' s o hapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business d Profes onals Cod U9^^dam m cense is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: D42 C45 is 0.: 0131 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor: _ 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
WNE -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).:
(_) 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 contradtor(s) licensed
pursuant to the Contractors' State License Law.).
( ) 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 (Sec. 3097, Civ. C.1.
Lender's Name: _
Lender's Address:
LQPERMIT
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, I shall not employ any
person in any maAaste s ject 5ENSATI100N,OD'rAMAGES
p anon laws.of California,
and agree that, ib' tottion provisions of Section
�J 700 of the Labions.
,O Date: J (Applicant:
WARNI G: FAILURE TO SECURE WORKERS COMPE ATIOLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COM AMAGES 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
.r within 180 days from date of issuance of such per t, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the abov nforma correct. I agree to y with a
city and county ordinances and state laws relating to building nstruction n e authori resentai
of this c{oun to ter upon the above-mentioned proper f in io po
Date: ✓�� Signatu�pplicant or Agent):
Application Number 10-00000173
Permit . . . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
7.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 9/04/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
----------------------------------------------------------------------------
Special Notes and Comments
ONE NEW ILLUMINATED CHANNEL LETTER SIGN
PER SA 2010-1430 "LIVE WELL CLINIC"
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total 7.50 .00 .00
7.50
Other Fee Total 1.00 .00 .00
1.00
Grand Total 38.50 .00 .00
38.50
Y
{
Bin #
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:CO
Owner's Name: AG 7
A. P. Number:
Address: � U Kvi --2 -0.6
Legal Description:K
City, ST, Zip:
Contractor:
Address:
Address:
Telephone: :?::�y.s,•,..:,.�:•:::?
'r`i:•Yr:
LEE--
Project Description:Pi
City, ST, Zip:. Q INt ut✓
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/
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Telephone: a h
it Y•YYY..2,:`:":.:viitv;, f':YY:••.•>`::: Y: a:•:
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/ _
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State Lic. # :
City Lic. #: i
Arch., Engr., Designer: S44 -M S �aVG
Address:
City,, ST, Zip:
Telephone:
State Lic. #: .,
Name of Contact Person: y� U
Construction Type:tJ i? Occu an°Y� A04
emo...Project type (circle one
Add'n Alter Repair D
Sq. Ft.: /3. S # Stories: N114 1 # Units: /}
Telephone # of Contact Person: —df4
Estimated Value of Project: �0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correcdonsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
i
Total Permit Fees
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Certificate of Compliance and Field Inspection Energy Checklist (Sign Lighting) (Page 2 of 2)
SLT('X-I(-'
Compliance Method
Maximum Allowed Lighting Power
Desigil
Complies'
Lig-lit
Field
Desuiption or location and plan location
Fh
To tal Si n Area:
1. Dcsi�qn Watts lotal (.0nnt,ciel,11ightin, loctd installed in thc sign. includingpowei- used b lamps, balhists, fransfin-triel-s, poiret- supplies, ew.
2.
The
sign(s) identified above; use only one or more of the followhill technologies: (list all applicable numbers that n
Pulse mtrl or ceramic metal holide lamp.s S-cri-ed bl, a hollay, with -1 88% efficiency
Pulse Viart metal halide lampv IhUt ort, <.320 ivalls. arenol 2 iO wun or 175 wati /onips. Und are Served ht a ballavt 11-ith > 80'!i, efi"icielicl
-mimilm co
Field Inspector Notes or Discrepancies
___- __—_-
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INDIVIDUAL ACRYLIC FACED
CHANNEL LETTERS. BRUSHED
ALUMINUM BACK PLATE, FLUSH
MOUNTED. BLUE & 4 COLOR PROCESS
FACES, WHITE TRIM, RETURNS & NEON.
TOTAL SIGNAGE IS 13.8 SQ FT.
LIVE WELL CLINIC
78370 HIGHWAY 111
SUITE 100
LA QUINTA, CA 92253
FRONTAGE IS 20 LINEAR FEET
SOUTH ELEVATION
4tq4S R.ld[� 5- L
ADDrovo,d By:
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�'Rll'_K SIGN �SNTF.k
(A 132211 Ph i)' qlll
-.Customer Signature
—4PHnted Name
--Property Owner
Printed Name