11-1256 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 411-00001256r _.,
Property Address: 78670 ' HIGHWAY ' 111
APN: 643-220-001-2 -000000-
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 1250
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
4 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C10 C45 (� License No.: 614676
1121 hl� ontractor• P. S. Sg r�
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, 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.).
(_) 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
Date: 11/21/11
Owner:
WASHINGTON ADAM PARTNERSHIP
43692 PIASANO PL
TEMECULA, CA 92592
Contractor: U
PS SERVICES INC
r �j yy
2820 E. GRETTA LANE f40t 1011
ANAHEIM, CA 92806 j C17�/(Jc
(714)683 -1120 -"al ;A'.��!�j�
LiC. No.: 614676'
-----------------------------------------------
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
�j issued.
`II have and will maintain workers' compensation insurance, as requiied 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 TRAVELERS PROP Policy Number UB5302X525
_ 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 the workers' compensation provisions of Section
/ 3700 of the Labor Code, II shall forthwith comply with those provisions.
ate: Applicant: _ _ ] e.IT�� G ✓ L (G�
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, indemnity 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of IN ounty to enter up 'the above-mentioned property forinspectionpur es.
ate: Signature (Applicant or Agent):
Application Number . . . . .•.11-00001256 -
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee 30.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 5/19/12
Qty -Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN IST CIRCUIT
15.00
Special Notes and Comments
INSTALL (1) BUILDING MOUNTED.INTERNALLY
ILLUMINATED CHANNEL LETTER SIGN PER SA #
2011-1572 "GNC LIVE WELL" 2010 CODES.
Fee summary Charged Paid Credited
----------------- ---------- ---------- ---------- ---
Due
- ------
Permit Fee Total 30.00 .00
.00
30.00
Plan Check Total .00 .00
.00
.00
Grand Total 30.00 .00
.00
30.00
i
LQPERMIT .. ..
..
Certificate of Compliance Si n Li htin
(Page 1 of 4) . SLTG-1C .
'Project Name:
Date:.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Project Address:
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
utdoor Signs ❑ Indoor Signs
Location of Signmew
enforcement agency for approval with this building permit application.
Phase of Sign Construction Signs ❑ !Sign Alterations
Signature
Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls
WNot Installing Lighting Controls
This Certificate of Compliance includes the following components (check all that apply)
Phone
❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power
gUpecific Lighting Sources
1. Certificate of Compliance Declaration Statement (this maybe a c lo, C45 or other eligible person)
G I certify under penalty of perjury, under the laws of the State of California, the information -provided on this form is true and
correct.
• I 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, Parts 1 and 6 of the Calif6mia 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
O
R�7�
Company;
Phone
Address:
License number (may be contractor's lic.#)
A. 60
City/StaterLip:Date
.
C a
t 2
2. Installation
Installation Declaration statement '
• I certify under penalty of perjury, under the laws of the State of California, the information provided.on this form is true and
correct.
• I am eligible undei 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 all
applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• . I certify that the requirements detailed on this Certificate of Compliance have been met.
• . I 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. I understand
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 tic #) Date Signed: Position With Company:
2008 Nonresidential Compliance Forms October, 2010
'Ortificate of Compliance (Sign Li btinj a e 2 of 4 SLTGIC
Project Name:
lf:
If there are construction documents, indicate where on the building plans the
3. Mandato Sign Lighting Controls
NOTES. -
1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. ire Mandatory Measures (sign lighting controls) are required for compliance with the sign -lighting Standards. If the person
responsible for installing the sign lighting power 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. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible;
alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement or the entire construction.
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1 C shall complete Part 3a. Check .Yes or No for all of the following statements:
1
I have responsibility for installing the sign lighting controls
Y
❑ Yes complete parts 3a and 3b of this form o complete part 3a of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
control, or an outdoor astronomical time switch that comply with the applicable uirements of § 119.
❑ Yes JR No
3
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
❑ Yes I f No
Y
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and §133 and.l will be
4
installing compliant sign lighting controls
❑
❑ Yes WTO
There are existing sign lighting controls that do not comply with the applicable provision of §119 and §133 and someone else
5
will be responsible to install compliant sign lighting controls
NA
❑ Yes o
3b. Mandatory Sign. Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1 C is responsible for
complyingwith the signlighting control requirements,that person shall answer all of the followingquestions:
If there are construction documents, indicate where on the building plans the
mandato measures(sign li tin control note block can be located:
1
§133(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the
p
Y
N
NA
a licable requirements of 119.
p
§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 the applicable uirements of § 119.
❑
❑
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
dayliqht hours.
❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
Y
N
NA
sign ower by a minimum of 65 percent d nighttime hours.
❑
❑
Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours.
Y
NA
3
❑
Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
Y
NA
illuminatingsigns. or arts of si s.
❑
)p
§133(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.
❑ ❑
Exception to §133(a)4. EMC required by a health -or life safety statue, ordinance, or regulation, including
Y
KA
but not limited to exit signs and traffic signs.
❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
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Ktificate of Comhlian
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(Fake 4 of 41 SLTGIC
5. Specific Lighting Source Method 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 part 4 of this
Certificate of Com liance if there are signs usin .the maximuttt allowed. lighting ower method of compliance)
A g C D
OPTIONAL '
ENERGY Specific light source used for firms
Symbol'VERIFIED compliance
or Description label Shall include only lighting
Code (see instructions technologies listed below
below) List all that apply,'
A
Symbol or code used on the plans when plans are required) and
other documents.
9-
A narrative description of the sign, or location of sip on the building; and the location of sign on. construction documents
C
OPTIONAL - Check this box only if this sign has a permanent, pre-printed; factory -installed ENERGY VERIFIED label, confirming that
this sign complies with the Section 148 of the California 2008 Title 24, PaR 6 Standards, using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized.for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label,
column `D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An
ENERGY VERIFIED 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.
1High Pressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with > 88% efficiency
3 Pulse start metal halide lamps that are <_ 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast
with >_ 80% efficiency
4 Neon or cold cathode lamps with transformer or power supply efficiency > 75% with rated output current < 50 mA
D
5 Neon or cold cathode lamps with transformer or power supply efficiency > 68% with rated output current >_ 50 mA
6 Fluorescent lamps with a minimum color rendering index (CRI) of 80
(Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may be used
7 Light emitting diodes(LEDs) with a power supply with >_ 80% efficiency
Single voltage LED external -power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 output, -having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations Title 20
9 Compact fluorescent lamps that do not contain a medium screw base sockets E24/E26
10 Electronic ballasts with a fundamental output frequency >_ 20 kHz
E I
This pagedoubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms
October 2010
Bin # ....
... CityOf La[I(i1 to
�{
Building & 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: `j _ l 0 9WV,
Owner's Name:
A. P. Number:
Address: 4
Legal Description:
City, ST, Zip: LA CA 2 2 c�
V
Contractor:'
-eX'
x
Telephone: —(— 2.-7 Z NO%>,5� ss:>+%s'vu3;tS
Address: "Z -i2-0 L
Project Description:
City, ST, Zip: A Z- SO
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Telephone: $ ,
.:...
.;y�v :.� .; • A:.;:.:.., ,,..�•;��?r�:s".x�:: .
�� G G e_ Vv ell
State Lic. # : 4
City Lic. #;
Arch., Engr.,' Designer:
Address:
City, ST, Zip.
Telephone:
Construction Type:S Occupancy:
ProJect type circle one). New Add'n Alter Repair Demo
State Lic. #:",J »:�cs''al fi��c`•'Se��• � ��,`.�
Name of Contact Person: Y
Sq. FL:
# Stories:
#Units:
Telephone # of Contact Person: 2 U
Estimated Value of Project: i `LSO , O 6
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
1rd Review, ready for corrections/issue -
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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PROJECT DATA
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III LA QUINT/ GENTER
78O UN HIGHWAY III
LA QU:N'TA, GA g2253
STORE NUMBER:
SPAGE NUMBER:
IbOq
TGD
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OWNER
LANDLORD
HVAC
MANUFACTURER
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COMMUNICATION
ARCHITECT/ENGINEER/CONSULTANT
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GNG
WA5HIN6TON ADAM5,
LLG
TRANS
GRANGOM
RSW CONSULTANTS
300 SIXTH AVENUE
46-753 ADAMS STREET
PITTSFaA DISTRICT
COMMUNICATIONS, LNG.
PROJECT MANAGEMENT DESIGN
PITT5&.R6H, PA 15222
PHONE: (412) 258-4600
FAX: (412) 338-8816
PROJECT MANAGER: PROJECT COORDINATOR:
.XJSEPH KARAFA SHARON WRiC'iT
PHONE: (4I2) 2b8-41b9 PHONE. (41211 338-8g21
LA GUIN'tA, GA g2253
TENANT GOORDINATOR:
MIC.NAEL SHOVi-IN
FMONE: (160) 34I-2212(-RE
THE TRANS COMPANY
400 F 61NE55 R
CENTER, DRIVE
PITT56LR6H, PA 15205
PHONE: (4i2) 141-3000
PHONE, (boo) a51-6335
FAX: (+2) 741-4550
BUSINE55 TELEPFOW AND DATA SYSTEM
K --N Mc tRTRY/ .FJLN OLIVA
46 EA5TMAN STREET
P.O. Box 1062
EA5TON, MA 02334
TOLL FREE: (bb8) 230-3330
230-i98q
1121I EAGLE HdLOW
-
T8248
PHONE: (210) SAN AN iON10, T 18
FAX; (210) 400 160
0273
LOCATION
MAP
CODE INFORMATION
DRAWING INDEX
KEY PLAN
H
PRO..E-GT DESCRIPTION TENANT- IMPRGVENENT - MERCANTILE STORE
J5E CRGI P GLA%FICAIKN : "' - MERCANTILE
NO.
DRAWING DESCRIPTION
-'- 6NC IBOq
SPACE NO, TBD
J
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COVER SHEET
CS-2
SGHEIXILE5
A5-1
ARCHITECTURAL SPECIFICATIONS
000PAWY LOAD CAPACITY:
5ALE5 AREA (1011) 5F, x I PER50N/30 SF. - 34 PERSONS
STOCKROOM (Fq) S.F. x I PER50N/300 SF. = 1 PERSONS
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ARCHITECTURAL SPECIFICATIONS
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TOTAL OCCUPANCY LOAD 35 PERSONS
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HIS SPECIFIED TYPE, CONSTRUCTION MEATS, METHODS, TE04MCAE" AND
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A6EN'CIES HAVING M15VIC 1"ION FOR ''FE OTY OF LA GUINEA. ALL
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PLANS AND SCIFICATtONS FOR CONSTRUCTION SHALL CONFORM
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15. 1 /4" - THREADED ROD W/ NUT
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14, FACE 5GREW (MATGH TRIM)
COLOR 51-HEDULE
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