10-0254 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000254',
Property Address: 78742 HIGHWAY 111 STE A
APN: 643-220-016- -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 4500
Applicant:
T,&t 4 4a Q".
Architect or Engineer:
AIA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 Cla C 5 D38 C e.. 7136
C ac / wYry
NER=BI'! LDER DECLARATION
I hereby affirm under penalty o perjur I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, usness 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.).
1 _ 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 (Sec. 3097, Civ. C.).
Lender's Name: 31 1
.
Lender's Address:
LQPERMIT
Owner:
SANFORD ROBERT P
78060 CALLE ESTADO
LA QUINTA, CA 92253
Contractor:
IMPERIAL SIGN CO, INC.
46120 CALHOUN STREET
INDIO, CA 92201
'(760)347-3566
'Lic. No.: 207136
VOICE (760)- 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/25/10
1141' %
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 H2 INS Policy Number WC001290468
_ 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 beco bj t to,the workers' compensation provisions of Section
3 00 of the �ta (rrttL�wtr rnpl i ose prtfvts
gate: /D plica
WAR ING: FAILURE TO SEC E WORKERS' PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO RIMI ALTIES 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 ildiog.construction,-and hereby authorize representatives
of this cou y to nter upon the above -men ' ned prop or inspec p
tSignature (Applicant or 0:
Application Number 10-00000254
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . 36.00 Plan Check Fee
.00
Issue'Date . . . . Valuation
0
Expiration Date 9/21/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
2.00 3.0000 EA ELEC SIGN ADDITIONAL CIRUITS
6.00.
------------------7---------------------------------------------------------
Special Notes and Comments
INSTALL 3 INTERNALLY ILLUMINATED CHANNEL
LETTER SIGNS, PER SIGN APP. #2010-1431.
"EUROPA DELI". 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
------------------------------
Due
---------------------------
Permit Fee Total 36.00 .00 .00
36.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 37.00 .00 .00
37.00
LQPERMIT
Bin #
City of La Quinta
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 # (1�
✓
Project Address: /7" `l
Owner's Name:
A. P. Number: S
Address:
Legal Description:
City, ST, Zip:
Contractor: y�j W — A4 PLJ ld
Address: f)
Telephone:
Project Description:
City, ST, Zip: ((f LIU a4LI
—
Te ne•
le h
Po .
w t�
State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
:,.,;,.;;:.;ly:.r;::<•:;::::;::;:;.
: ;:z;>.>::;:«:">!>;>.:r! ::
Construction Type: Occupancy:
State Lic. #:
Project a circle one): � type ( ) New e . Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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.
Pians 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
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''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
N
Certificate of Compliance (Page 1 of 4) 0LTG-1C
Project'Name:
Date:
Project Address:
Total Hardscape Illuminated Area:
General Information
Phase of Construction: ❑ New Construction) ❑ Addition' ❑ Alteration - 1
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate mplet .
Name A/
7U�W��
Signatu
Company r�AGD � � �^
1/
Date/
Address
ca
IF Applicable
CEA #
CEPE #
City/State/Zip
qa-c -o
Phone:
4V -3Y? �-
Principal Lighting Designer's Declaration Statement
•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, 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, workshee Iculations, plans and specifications submitted to the
enforcement agency for approval with this building permi plica '
Name: / J /��
Sig ure.
Company: IV
Phone:
License #
Address:
City/State/Zip:
Date:
Principal Lighting Designer's Declaration
❑ 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 Specific 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
published 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) OLTG-1C
COMPLIANCE FIXTURE] LIGHTING CONTROL SCHEDULIC and FIELD INSPECTION CHECKLIST
Project Name: nj . a , Y i1
TDaate'.�. 3 _ ^
INSTALLATION CERTIFICATE, OLTG-I-INST (Retain a copy and verify form is completed and signed.)
Field Inspection ❑
CERTIFICATE OF ACCEPT t NCE, 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
Luminaire Description t
See footnote below
i.e.: 1 lam ole-to shoe-box 400 watt metal halide
o
R
3 'y
U A
2
c'A
_
E
3 3
N
a�
N m
ri
How wattage
was determined
o 2
'm
-0
z
3
a
f
Ca
Field
Ins ector2
•. 5 0
'O `n °'
c¢ oa o
Q ` z ¢
as
a u,
�t
❑
❑ ❑
❑ ❑
❑
❑ ❑
❑ ❑
❑
❑ ❑
❑ ❑
❑
❑ ❑
❑ ❑
❑
❑ ❑
1
1 ❑ ❑
Enter total into OLTG-1C; Page 4 of 4;
Row H; Total Installed Watts:
I. Type of huninaire (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. I Fail then describe on Page 2 o the Inspection Checklist Form and take appropriate action to correct. Verify building plans ifnecessary.
EXEMPT LUMINAIRES I Field Inspection ❑
Name or S mbol Description of e m t luminaires in accordance with §147
MANDATORY CONTROLS Field Inspection ❑
Description Location
# Description Location
/ /ytt_ G
i/
SPECIAL FEATURES INSPECTION CHECKLIST (See Page 2 of 4 of 0LTG-1C)
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:Date:
I , 1 1
A. OUTDOOR LIGHTING 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 T.71' 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. If all 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 L TG -2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are
checked andlor filled and signed. In addition, a Certificate of Acceptance forms 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 or their records.
Certificate of Acceptance
Luminaires Controlled
OLTG-2A'
Outdoor
L N
p o
Lighting
Equipment Re uirin Testing
Description
E a
' 0 U
Location
Acceptance
Tests
1. Insert. OMS for Outdoor Mbtion 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
x.
August 2009
,
CERTIFICATE OF COMPLIANCE (Page 4 of 4) OLTG-1C
Project Name: Date:'
ALLOWED AND INSTALLED OUTDOOR LIGHTING POWER
2008 Nonresidential Compliance Forms August 2009
Lighting Wattage
Power Allowance
A
Lighting power allowance for general hardscape
(from OLTG-2C Page 1 of 3)
B
Specific application lighting wattage allowance per unit length
(from OLTG-2C Page 1 of 3)
C
Specific application wattage allowance for ornamental lighting
(from OLTG-2C Page 1 of 3)
D
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)
FAdditional
lighting power allowance for ordinance requirements
(from OLTG-2C Page 3 of 3)
G
Total Allowed Wattage = Sum of rows A through F:
HTotal
Installed Watts (from Luminaire Schedule,
( from OLTG-1C (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
Certificate of Occupancy
Building & Safety Department
This Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 of the
2007 California Building Code, certifying that, at the time of issuance, this structure was in
compliance with the provisions of the Building Code and the various ordinances of the City
regulating building construction and/or use.
BUILDING ADDRESS: 78-742 HIGHWAY 111 STE "A"
Use classification: COMM: ( EUROPA DELI) Building Permit No.: COURTESY
Occupancy Group: B
Sprinklers Installed`. YES
Building Official
Type of Construction: VN
Sprinklers Required: YES
Land Use Zone: CR
Occupant Load: 36
Owner of Building: ROBERT P SANFORD
Address: 78-060 CALLE ESTADO
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: MARCH 18, 2010