11-0852 (SIGN)'d
r,
w:.
,0. BOX 1504
7FI-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: g 11_00000852. —"—
Property Address: 78570 HIGHWAY 111
APN: 604-050-037-19 -000000-
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 2500
4 144rv4ura
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WASHINGTON ADAM PARTNERSHIP
43692 PIASANO PL
TEMECULA, CA 92592
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/09/11
Contractor:
Applicant: Architect or Engineer: SIGNARAMA
41945 BOARDWALK, "L" Ln1 2011 11 !
PALM DESERT, CA 92211
(760)776-9907
//^ Lic. No.: 830131
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, d my Licenseism full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Cla s: 42 C45 License .: 830131 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
atector: 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
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 1$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.).
(_ 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.).
(_) 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:
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 manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to a workers' compensation provisions of Section
� �y 3700 of the Labo o e, shall 6rthwith co ply with those provisions.
ate: ! plicant:
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 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 correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and ereby authorize representatives
of this ty enter upon the above-mentioned pro rty ornsp L`t
io
n
purpo s.
ate:O�J Si ure (Applicant or Agent): /
Application Number .
. . . . 11-00000852
Permit . . .
ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee
30.00
Plan Check
Fee
..00
Issue Date . . . .
Valuation
.0
Expiration Date
2/05/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00* 15.0000
EA ELEC
SIGN 1ST CIRCUIT
15.00
----------------------------------------------------------------------------
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
.00
.00
.00
.00
Other Fee Total
1.00
.00
.00
1.00
Grand Total
31.00
.00
.00
31.00
LQPEPNIIT
(Sigin, Li htin
Project Name: 77
(Page 10
Datc: 6
SCTC=1C
Certificate of Com liance
Project Auuress: / ,y
tdoor igns ❑ lndoor Signs /p(
Location of Sign Ga.< Signs ❑ Sign Alterations
Phase of Sign Construction
T e of Li htin Control ew Li htin Controls O Re laced Lighting Controls7Notlin Li htin 6ontra s;.,
This Certificate of Compliance includes the following components (check all that apply)
❑ Mandatory Measures (Lighting Controls) 0 Maximum Allowed Lighting Power Lighting Sources
1. Certificate of Compliance Declaration Statement (this may be a Clo, C45 or other eligible person)
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
• 1 rr 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, Parts t 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 applic 'o .
Name: ��. /' �/ z4Signature
Phone
Company/
License number {may be.congact4l's. lie #)
Address: � ��
'S
City/State/Zip: Date
2. Installation Certificate (to be signed by responsible Person after installation)
Permit number. Checked by/Date
Enfweement AgeOCy Ute Enibrattmt Agency Use '
Installation Declaration statement
under the laws of the State of California, the information provided on this form is tine and
• I certify under penalty of perjury,
correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction.
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to a
applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the...'.
enforcement agency.
• 1 certify that the requirements detailed on this Certificate of Compliance have been met.
• 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections.?, .1 undo rstand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides'to the
building owner at occupancy.
Company Name:
Responsible Person's Name:
Responsible Person's Signature:
License number (may be contractor's lie #)
Date Signed:
Position With Company:
f
2008 Nonresidential Compliance Forms Jtrly 2010
•, v��N(i .1 tt..
e .
Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-1C
Project Name:
JAI 7vp,—.C�
Datc:
tP %�
3. Mandatory Sign Lighting C ntrols
NOTES:
1. . The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. The sn» t'e
responsible person may install both the sign and the sign lighting controls, or a different responsible person' ►mw rnstul� the'
sign lighting controls than the responsible person installing the sign.
2. /f the person responsible for installing the sign is not also responsible for the sign lighting controls, then the owner of the
sign, general contractor, or architect shall be responsible to have the sign lighting controls installed
3. ij*more than one person has responsibility for compliance, each person shall prepare and sign a Certificate of Compliance
and an installation Certificate applicable to the portion of c•onstnrction for which they are responsible; alternatively,...the
person with chiej'responsibility for c•onstnrc•tion shall prepare and sign the Certificate oJ•Compliance Declaration -Statement
or the entire constnrction. _
3a. Statements of Responsibility:
Theperson signing the Certificate of Compliance Declaration Statement shall check Yes or No for all of the following statements:
I
1 have responsibility for installing the sign lighting controls t ]
13Yes, com lete arts 3a and 3b of this form o, com lete art 3a of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
NA
❑ Yes o
3
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls,
❑
❑ Yes WNo
Exception to §133(x)2. Outdoor signs in tunnels or large covered areas that require illumination during
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and I will be
4
installing compliant sign lighting controls .
daylight hours.
❑ Yes No N!lk
❑
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and stitiietiise•else '
5
will be responsible to install compliant sign lighting controls
N
❑ Yes §XN0
3b. Mandatory Sign Lighting Controls
The person signing the Certificate of Compliance Declaration Statement shall answer all of the following questions if they are
res onsible for complying with the sign lighting control requirements.
if there are construction documents, indicate where on the building plans the
mandatory measures(sign lighting control note block can be located:
I
§l33(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the
Y N
NA
applicable requirements ofl 19.
EY❑
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
Y N
NA
2
control or an outdoor astronomical time switch, that comply with thea licable requirements of § 119.
❑
Exception to §133(x)2. Outdoor signs in tunnels or large covered areas that require illumination during
_.❑
Y
NA
daylight hours.
❑
❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
Y
N
NA
sin power by a minimum of 65 percent during ni ghttime hours.
❑
❑
❑
Exception 1 to §133(9)3. Signs illuminated for less than one hour per day during daylight hours.
Y13
"Na'
Exception 2 to §l33(a)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
Exception 3 to §133(9)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
13 NAilluminatin
signs or arts of signs.
„❑
§l33(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when
Y N N/A
4 receiving a demand response signal that is sent out by the local utility.
C...
Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including
but not limited to exit signs and traffic signs.
.O..
Y NA
inspector Notes:
❑ 13Field
2008 Nonresidential Compliance Forms
• July 2010
•
Certificate of Compliance (Sign Lighting) (Page 3 of 4 SL`O'G-1C
Project Name Datc:
4. Maximum Allowed Liehtine Po er Method of Compliance .«,.... _....
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete fait 5
..f Chic rtifiv-,tP of rmmnIinnrp if tht-rt- Aft- ciunC itCtno tht- Cnot-ifie Huhtina cnntrces method of comnliance)
A
B
C
D E F G
H
I
J.
Allowed Watts
Design
Complies'?
q
Watts
Y / N
.......
H
Wfield
o ^
C ,-,
c7
Inspector
0
v
a '
w
3
z
Check that
C*
3 3
x
�'
`'.'
Sign
c
Z
¢`�
..
3 .r_!
3
a
;. _
:Complies
>'
.5
opp
yet . ,
II II
pC,
U
Description
13
12
0
0
0
0
0
❑
0
0
A
Symbol or code used on the plans when plans are required) and other documents.
B
A narrative description of the sign, or location of sign on the buildin • and the location of sign on construction documents.
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed label, listed with Underwriters Laborato,r�.,
(UL) or other testing laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) or International `
Standards Organization (ISO) 17025 in accordance with ISO/IEC 17011 with the products produced under an ongoing inspection program
C
carried out by a Type A inspection body in accordance with ISO/IEC 17020, confirming that the sign complies with the Section 148 of the
California 2008 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power method of compliance. For signs with such a
label, columns 'D' through '1' are not required to be filled out. Note: Using a label is an optional method to validate compliance. A label is
not needed for compliance.
D
The sign area insquare feet.
E
List "I" if the sign is intemally illuminated. List "E" if the sign is externally illuminated.
F
Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E.
G
Multiply the square footage in column D times the allowed Lighting Power Density LPD = watts in column F.
H
Show the total installed watts in the si , as determined according to the applicable provisions of § 130(d ore .
L-1
I I
Enter Y if the number in column H is less than orequal to the number in column G. Otherwise, the sign does not comply.
n,:� ., _ .4....61e.... _ C:_tj
Field Inspector Notes:
T
Zvva /vonresidential Compliance Forms Judy 2010
•
Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-1C
Prajec Name: / l LDam
5. Specific Liahtine Source ethod of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete pari 4 of this
Certificate of Com liance if there are signs using the maximum allowed lighting ower method of compliance)
A
B
C
D
OPTIONAL
Specific light source used for
Field_ ..
UL
Symbol
or other
compliance
'
Inspector
lbi kWthat
or
Description
P
label
Shall include only lighting
Code
(see
instructions
technologies listed below
Sign
Cont 1149
Wow)
List all that apply
y. , ,-,
❑
D
D
❑
D
A
Symbol or code used on the plans when lans are required) and other documents.
8
A narrative description of the sixn, or location of sign on the buildin • and the location of sign on construction documents
C
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed label, listed with Underwriters,l:a" .........
ibm
(UL) or other testing laboratory accredited by the National Voluntary
Laboratory Accreditation Program (NV -AP) or International4~�
Standards Organization (ISO) 17025 in accordance with ISO/IEC 17011 with the products produced under an ongoing inspection
program
carried out by a Type A inspection body in accordance with ISO/TEC 17020, confirming that this sign complies with the Secti9n't48•df•the
California 2008 Title 24, Part 6 Standards, using the Specific Lighting
Source Method of Compliance. For signs with such a label; 'column
' D' is not required to be filled out. Note: Usinga label is an optional method to validate compliance. A label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:
List all applicable numbers 1 through 10 that
apply in column D above for each row.
! High pressure sodium lamps
2
Pulse start or ceramic metal halide lamps served by a ballast with >_ 88% efficient
3
Pulse start metal halide lamps that are:S 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast
with > 80% efficient
Neon or cold cathode lam s with transformer or power suPPlY efficient > 75% with rated Output current < 50 rnA
Neon or cold cathode tames with transformer
4
5
U
6
or power supply efficient > 68% with rated output current > 50 mA
Fluorescent lamps with a minimum color rendering index (CRI) of 80
Note: when using electronic ballasts for compliance, lamps with a CR! < 80 may be used
7
Light emitting diodes LEDs with a power supply with > 80% efficient
Single voltage LED external power supplies designed
8
to convert 120 volt AC input into lower voltage DC or AC
output, having a nameplate output power less than or equal to 250 watts,
and certified to the Energy Commission as
cuM fing with the applicable requirements of the A liance Efficiency Regulations Title 20
L
9
Compact fluorescent lamps that do not contain a medium screw base sockets E24/E26
1
10
Electronic ballasts with a fundamental output frequency > 20 kHz
E
This page
doubles as a field inspection checkGet
1 rieia inspector Notes:
2008 Nonresidential Compliance Forms
July 2010
5
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Sign De.,;criptiow
Internal y I FD in(jividtia� a,_,Ylw-faced channel Iwlors
— - --- - -- -- ------- --
Contractor's Lic #
S1GAf,A,RA_MA C45 f D42 830131
41911', 11C)ARDWAL',K, I L, L Workers Comp, #
PALM 1311, St, R I ( A 9,?�) I I 1 1640374
Material:
Letter & Logo Cabinets:
063" aluminum1 Letter faces- 25" acrylic
Colcirs:
Trim & return,,,-,: Black
Letter [ aces: "Day-Nite" (Black/White'i
Logo lace:
Yellow I 'A/hite digital print
LED rnodUIOS� WhitO
business Frontage: 30 lineal teet
Sign Area12" x 196.8" -z: 16.4 square feet
custorner. Telephone: m� i�l 88 14
Desert Oasts Healthcare Flxi /60-:00
Address:
2115 N El Gielki Rd_ Ste. C
Palm springs, CA 92262
Dwg. No.: -490-40-1-1--l-1-1-
Date: 7- - 2 - 6-1 - I --- -_ -_ Sheet I Of 1
F, k 1 t 6 c r 0. 9 9 0 7 rpp City Lic. # Designer FIH
F x 6 6 9 8 4 414466 1
Jobsitp Customer Approval,
78570 riwv III
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La Qwtrita, GA 9223 Landlord AppToval
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