12-0572 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000572
Property Address: 78752`HIGHWAY 111
APN: 643-080-039-14 -000000-
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: . 9200
c&ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PCG HIGHWAY 111,- LLC
800 N. PARK VIEW dRIVE
EL SEGUNDO, CA 90245
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/23/12
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, 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
1 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
-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, andhere authorize representatives
oof%A
f this ccounty tto/enter upon the above-mentioned property for inspecti rposes.
pate:J 1 /�8lgnature (Applicant or Agent):
Contractor: U
Applicant: Architect or Engineer:
QUIEL BROS ELEC. SIGN SVCNk7' MAY 272 SOUTH "I" STREET 3 2012
SAN BERNARDINO, CA 92410
(909)885-4476 y0 I-AQUINTA
1
LiC. No.: 217345 NANCEDEpT
-------------------------------------------------------------------------------------------------
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, gnd my License is in full force and effect..
— I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice Class: C10 C45 License t : 217345
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
•�
.[ issued.
d'I
ate ntractor: _
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
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier COMPANION PROP Policy Number CPCA15099
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall fortt comp(% with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.'5 bys57
+�
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
alt 1 n _ plicant: `1
h
1—) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
11
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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, 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
1 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
-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, andhere authorize representatives
oof%A
f this ccounty tto/enter upon the above-mentioned property for inspecti rposes.
pate:J 1 /�8lgnature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 12-00000572
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 39.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 11/19/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
3.00 3.0000 EA ELEC SIGN ADDITIONAL CIRUITS
9.00
--------------------------------------------------------7-------------------
Special Notes and Comments
4 INTERNALLY ILLUMINATED CHANNEL LETTER
SIGNS PER SA# 2012-1611 "PROVIDENT
BANK", 2010 CODES.
---------------------------------- -----------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 39.00 .00 .00
39.00
Plan Check Total .00 .00 .00•
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 40:00 .00 .00
40.00 '
City of La Quinta
-Bu110g &r Safety Division
P.O. Box 1504,78-495 Calle Tampico
Lo-Quinta, CA 92253 -:(760) 777-7012
Building Permit Application'and Tracking Sheet
Permit #�
I
Project Address:/
Z
Owners Name:. G
A. P. Number.
Address: S, 00 lq ICV-I.GI.U'
Legal Description:
City, ST, Zip:%% 90,2 q S—.
Contractor. S(.
Telephone: F�
Address: 2 1 Z Se7
Project Description:
city, ST, zip: SAto JD
Telephone: —M-, _ W Q 7.
State Lie. #: li�— 1 r7. 7j City.Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lia #: :.
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'a Alter Repair Demo
Sq: Ft.:
# Stories:
#Unit$:
Telephone # of Contact Person: �—((��
Estimated Value of Project: Q ---�
APPLICANT: DO NOT WHITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMITFEES-
Plan Sets
Plan Check submitted
Item Amount
Structural CaIM
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales.
Called Contact Person
Plan Check. Balance-
Mile 24 Cal&
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical
Grading plan
21! Review, ready for correctionsftue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Pians resubmitted
Gradlo '
IN HOUSE:-
''' Review, ready for correctiousAssue
Developer Impact Fee
Planning Approval.
Called Contact Person
A,I.P,P,
Pub. Wks. Appr
Date of permit issue
Scitodl Fees
Total Permit Fees
v�j -Z `ON 3SdO
3.ISIHX3
z 31tla0, A8
1N3 U d30 ONINNV'ld A9 A3AOUddd
VO'ViNinio v-1
L L L WH Z9L9L
NNVEI iN*301AObd
El
M1'• .,-•. ... .. 531VI 1 9665 51 3 8\fE 091 5
]099v 9 50'MV ' :9E Al 9Z IM'cJ I701N . 08 \ Ml9i608\
Certificate of Compliance
(Sign Lighting)
(Page 1 of 4) SLTG-1C
Project Name:
This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Parts 1 and 6 of the California Code of Regulations.
Provident
Bank
Date: 5/22/12
Project Address:
Signature
n 4��
Company
-:Quiel Bros Electric Sign Service Company, Inc.
78752 Hwy
111, La Quinta, CA
License number (may be contractor's lic #)
Location of Sign
13 Outdoor Signs ❑ Indoor Signs
City/State/Zip: San Bernardino, CA 92410
Phase of Sign Construction
® New Signs ❑ Sign Alterations
Responsible Person's Name: I
Type of Lighting Control
K) New Lighting Controls ❑ Replaced Lighting Controls
❑ Not Installing Lighting Controls
This Certificate' of Compliance includes the following components (check all that apply)
Date Signed:
❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power
® Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this may be a C10, 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.
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 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: Nancy K Parker
Signature
n 4��
Company
-:Quiel Bros Electric Sign Service Company, Inc.
Phone (909) 885-4476
Address: 272 South I Street
License number (may be contractor's lic #)
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand
217345
City/State/Zip: San Bernardino, CA 92410
Date 2-
2.
2. Installation Certificate (to be signed by responsible person after installation)
Permit number
Checked by/Date
(Enforcement Agency Use
(Enforcement Agency Use
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 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 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:
Quiel Bros Electric Sign Service Company, Inc.
Responsible Person's Name: I
Responsible Person's Signature:
Dave Saudargas
License number (may be contractor's lic #)
Date Signed:
Position With Company:
217345
Installation Manager
2008 Nonresidential Compliance Forms I October 2010
Certificate of Compliance (Sign Lighting) (Pae 2 SLTG-1C
Project Name: provident Bank
5/22/12
tD
3. Mandatory 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. The 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-1C shall complete Part 3a. Check Yes or No for all of the following statements:
1
I have responsibility for installing the sign lighting controls
§133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
6 Yes, complete parts 3a and 3b of this form ❑ No, complete part 3a of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
2
IN Yes ❑ No
3
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
❑
❑ Yes El No
Exception to §133(a)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
da li ht hours.
❑ Yes 12 No
12
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and someone else
L
will be responsible to install compliant sign lighting controls
N
❑ Yes ® No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1C is responsible for
complying with the sign lighting control requirements, that person shall answer all of the following questions:
If there are construction documents, indicate where on the building plans the
mandatory measures (sign lighting 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
Y
N
NA
applicable requirements of § 119.
❑
❑
ED
§133(a)1 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 requirements of § 119.
❑
®
❑
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
da li ht hours.
❑
12
§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 during 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(x)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
13
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
Y
NA
illuminating signs or parts of signs.
❑
❑
§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.
❑
❑
13
Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including
Y
NA
but not limited to exit signs and traffic signs.
❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sign Lighting) (Pae 4 of 4) SLTG-1C
Project Name:
Provident Bank
Date:
5/22/12
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 Compliance if there are signs using the maximum allowed lighting power method of compliance)
A
B
C
D
E
OPTIONAL
Field
ENERGY
Specific light source used for
Symbol
VERIFIED
compliance
Inspector
or
Description
label
Shall include only lighting
Check that
Code
(see instructions
technologies listed below
Sign
below)
List all that apply
Complies
A
(3) sets of 24" channel letters
❑
7
❑
B
(1) set of 16" channel letters
❑
7
❑
❑
❑
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 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, Part 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.
1
I High 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
5
Neon or cold cathode lamps with transformer or power supply efficiency>_ 68% with rated output current > 50 mA
D
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
com lying 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
This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
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