09-0905 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
.09-00000905
78805 HIGHWAY 111
643-020-999-4 -30903 -
SIGN
REGIONAL COMMERCIAL
8500
Applicant:
e, � n �X_4Gjv�
Architect or Engineer:
/1114
/ v En�.
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of C apter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals C my�� --L--icel},�sse is in full force and effect.
License Class: C4 S ce✓se Ntr'�9� 83
Date,' J_ _Contrac
tor.
_�
OWNER -BUILDER DECLARATION
I hereby affirm under pena 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.).
(_) 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:
LQPERI%IIT
Owner:
WASHINGTON 111 LTD
C/O JACK TARR
30240 RANCHO VIEJO RD.
SAN JUAN CAPISTRANO, C
Contractor:
NW SIGN INDUSTRIES INC
360 CRIDER AVENUE
MORRISTOWN, NJ 08057
(856)802-1677
Lic. No.: 907683
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
8/25/09
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 ZURICH AMERICAN Policy Number WC819647
1 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' comjMa=oopravisions of Section
3700 of the Labor Code, I shall forthwith c W.s�pmvist[7ttS
Date fJ Applicant:—
WARNING: FAILURE TO SEC 6 KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER ' IMINAL 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 hereby authorize representatives
of this countyt enter upon the above-mentioned property for inspection purposes.
Date-
I�S Signature J Applicant or Agent): i
•Application Number 09-00000905
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee 36.00 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Expiration Date 2/21/10
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
----------------------------------------------------------------------------
Special Notes and Comments
(3)ELECTRICAL SIGN CHANGE OUT ( 2 )
_CHANNEL LETTER "CHASE" (1) LANE
DESIGNATOR PER SP 2009-1390. APPROVED
G:B.
----------7-----------------------------------------------------------------
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
WtJ s.
Chrt���►�a `117 -TeIft N DUSTRI ES
=IDENTIFY WITH QUALITY
March 27, 2009
State Permits Inc
319 Elaines Ct
Dodgeville, W( 53533
Re: Permitting Authorization - -
To Whom It May Concern:
As applicant for the signage permit, NW Sign Industries is providing this Letter of Authorization
for State Permits Inc and counterparts designated by State Permits Inc. This letter authorizes State
Permits Inc to,act on our behalf when acquiring necessary signage permits. If you.have any questions or
concerns please feel free to contact my office at 856-802-1677.
l -
a
Thank you, ;
Eric Metzger
Director of Project Management
NW Sign Industries
Corporate Headquarters
360 Crider Avenue i
Moorestown. NJ 08057 '
(P) 856-802-1677
(F) 856.802-0912
mvw.nwsignindustries.com
l
�oA*C
L.<WIGAT OF CC�MPLIY�NCt ��;�C�°[wC
PROME DATE
E IIGNER•LIGHTINGTETiON AUTHOR TELEPHONE
e �,Y
OENERALIRFORMATIOff '
DATEO PIANS cZlg 1 p 'L4 , �_Q.l7;7SIGNS
FUNcT1oN TYPE Q OUTDOOR L•1GHTINI . OUTDOOfr SIGNS Q IN6OCIR
PHASE OF CONSTRUCTION Q NEW CONSTl�UCT1ON . • Q ADDITIONS Ai TERA7lOh15 �� t
S`rACt iYl Ni 01 QQrdPL1ANGE
Thb Certificate of Cdrnprianee lists o!ridoor-lighting system'spectfications sped to comply wlthTitle 24: Parts i and 6.of the Callfomld Codi: of
Regulations. This certificate applies onty to building tighting.tequirements.
-7he documentation prrp'aterhereDycett)fios that tho documentation is accurtito and complete.
DOC MENWnON AUTHOR SIGNATU 6 DATE
The Princi al LI htin Desi ner.hereb �certifiesthat r
D 9 8 9 Y proposed outdoor lighting and signs'design'represented in this set of constriction docuuicnts
is ctinsistent With. -the clthet compliance forms and v}orksheets, viiih. We speclocations; and with any other calculations submitted with This' permit,
applic2tlon.The proposed building has•12oen designed to meet the llghfirtg requirements contajned in the applicable parts of secGvns 110, t•19,110' '
through 132, 146, and 1413 of'roe 24,.Part 6, PIOaS� ✓ :Otte.
l 1 • 1 hetebyatfirm that I ain erigible under the provisions of Oivisron 3 of the Business and Professlons Codd to sign Ihis• docurhen' a thg person
resppnsibie tot its prepatalion; and that I am -licensed in thou Stato of Califomla'ax a civil engineer or'electdical engineer, or fain a lice^sed '
• architect. - .' . .. .. - -
i affirm that 1 am'eligible under the provisions of Division•3 of Lhe Business and Professlorid Code. by seclio,,t 5537.2 or 673?.3 to sign lhib
document as the personTpsponsible for its preparation; and that 1 am a licensed contrclor performing this work.
Q I atiirm 1ha14 aJn eligible under the Pto%flslOrr of Divisive 310f the Business and-Prgfgsslon$ G`odafo sign t)i!s documentbecau a it -pertains :o a
'structure or type Qfwork descibed as exempt pursuantio-Bustness•and;?iofessfons Code Sectiond5537,5538 and 6737,1;,
These se tons ofthe, ausuless and Professions Code are Printed In full to the Nonresidential Manual.
PRINCIPA' L1GldTiNG•DESIGNER.NAME SIGN R'- `
DAi� , . LIC ffi
iifSTRUC110NSi0•Ai'Ff ICANTOtdfAO'OR 0).Tl tG COMPUAilCE-&WORKSHEET3 (✓ boxgyrorksheetts lnciudcd)
frordefa4ecf ins&ucr llons on the use of ihts apd all Energy Efl7dency Standards compfianes forms, please refer to the Nenrestdenikii
Manual pubCshad by, Me Ceflf 41a Energy CommMsion.
110 Certificate ofCompiiance. Required on plans for all submittals for outdoor lighting, part 2 of 2 may be
'Pnearporated 4n schedules -on the lans
Either LTG -•4-C o'r.OLTG-•1-C *tnay'bs Used for signs as follows:
'1: Use LTG-1-C'if the project consists'solety of indoof signs
2. •Use.LTC-1-C if the project consists of indoot R61ing, and ouliloor orfndoor sighs, but no other o6tdoor fighting.
3:.' Use Oi,7G-7-C irthe proje£t consists solely of outdoor signs
4. Use OLTGA-C if ttire project corisists of odtdoot lighting, and indoor or outddor signs, but ria other indoor
ahbtipg _
Q OL"f4-Z C'' LIGHTING COMPLIANCE=SUM MARY.'Appiicabie Parts required for A[ outdoor lighting allowance �Txcept for
SI ns
Q 'bLTG•; C 'AREA C'AWULATIONS WORKSHEETS. Applicable parts required for all outdoor area calculations.
OLTG 9 C 5lGN L4 RT{NG COMPPANCE. Requlred for:ail!eternally and externally illuminated signs, for both indoor and
L- - - -- - ogldoor signs. .:. , i
2005 Nobresfdentlal Compliance Forms - - peril 2005.
i
CERTIFICATE OF COMPLIANCE (Part 2 of 2) OLTG-1-C
PROJECT NAME
,Lighting Schedules on Plans Show that Outdoor Lighting Meets Allowed Lighting Power
❑ Lighting power allowances for general site illumination on OLTG-2-C Part 1 of 4
Not Applicable
❑ Lighting power allowances for local ordinances or for security multipliers on OLTG-2-C Part 2 of 4
Not Applicable
❑ Lighting power allowances for specific applications, other than vehicle service stations with canopies on OLTG-2-C Part 3 of 4
Not Applicable
❑ Lighting power allowances for vehicle service station canopies on OLTG-2-C Part 4 of 4
Not Applicable
Sign lighting compliance on OLTG-4-C
❑ Not Applicable
Mandatory Measures on Plans Show that Outdoor Lighting Meets Outdoor Lighting Controls and Equipment
Indicate location on plans of Note Block for Mandatory Measure
❑ Installed lighting power has been determined in accordance with § 130(c)l
Not Applicable
❑ All permanently installed luminaires with lamps rated over 100 watts either have a lamp efficacy of at least 60 lumens per watt or are
controlled by a motion sensor § 132(a)
Not Applicable
❑ All Luminaires with lamps rated greater than 175 watts in hardscape areas, including parking lots, building entrances, canopies, and
all outdoor sales areas meet the Cutoff Requirements of § 132(b)
9 Not Applicable
All permanently installed outdoor lighting meets the Control Requirements of § 132(c)l
eabl�
❑ Building facades, parking lots, garages, canopies, and outdoor sales areas meet the Multi -Level Lighting Requirements of § 132(c)2
Not Applicable
MANDATORY AUTOMATIC CONTROLS
CONTROL LOCATION
CONTROL
IDENTIFICATION
CONTROL TYPE
Auto Time Switch/Photosensor, etc
AREA CONTROLLED
NOTE TO
FIELD
n T ►i�.
,,
cw 1-111 iluel7lld/ Lxmp/lance rOrms
April 2005
m m o
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-:tom.
Sign Symbol or Code
D
WIT
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Sign Area (ftZ)
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Bin #
City of La Quinta
Building 8T Safety Division
P.O. Box 1SO4, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
O�
Project Address: {
Owner's Name: L
A. P. Number.
Address -.30 (..e
Legal Description:
Contractor:
City, ST, Zi ,IJ�A OtL,ZD
Te lePhonc.• 7
Address:
.....................................::.
Project Descriptions
City, ST, Zip:
� to
TeP0
le h ne:
State Lic. # :
Arch., Engr., Designer:
Address:
City, ST, Zip:
TeP0
le h ne: `.
State Lic. #• ?'
Name of Contact Person:
Con structi n
o Type: Occupancy:
P an cY:
Project t nPe (circle e one : New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:Estimated
Value of Project: C� v V
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.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2vd 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