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12-1215 (SIGN), f. P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: [ 12-00001215 Property Address: 78995 HIGHWAY 111 STE APN: 643-020-056- - Application description: SIGN Property Zoning: REGIONAL COMMERCIAL Application valuation: 840 Tit!t 4 4 Q" Architect or Engineer: pla 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. Lice a Class: C45 1 License No.: 751584 ate: II I2_ontractor: Ute= 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 ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , 8.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: WASHINGTON 111 LTD 80618 DECLARATION INDIO, CA 92201 Contractor: CERTIFIED SIGN P.O. BOX 45 SUN CITY, CA 92 (951)928-2484 Lic. No.: 75158_ VOICE (760$-011 FAX (760) INSPECTIONS (760) 777-7153 Date: 10/11/12 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 TTT"' Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier SECURITY NATL Policy Number SWC1012016 _ 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 L bor Code, I shall forthwith comply with those provisions. (L ;of WARNING: FAILURE TO SECURE ORKERS' 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 Ouinta, 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 ang state laws relating to building construction, and hereby authorize representatives D�of this unty to enter upo a above-mentioned property for ' spection purposes. ✓ [( ignature (Applicant or Agent): LQPERMIT Application Number . . . . . 12-00001215 Permit . . . ELEC-ELECTRICAL SIGN Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/09/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT 15.00 ---------------------------------------------------------------------------- Special Notes and Comments INSTALL (1) INTERNALLY ILLUMINATED CHANNEL LETTER SIGN PER SA # 2012-1647. 2010 CODES. ---------------------------------------------------------------------------- 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 Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C Project Name: e Ll � GZ: TLt'�7 Date: C� •,•�.. J Project Address: 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. -7V51 5-5' 111 Signature q2 Location of Sign E,6utdoor Signs ❑ Indoor Signs Phone�`19 721- Phase of Sign Construction EV? ew Signs ❑ Sign Alterations Address: PC) ��� S ci Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls M -Kot Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) Date 9 2S XZ ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power 0,B(ecific Lighting Sources 1. Certificate of Compliance Declaration Statement (this may be a c 10, C45 or other eligible person) 9---, certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. Q/I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. 9�-- 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. Q�Phi"e 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 .��CrC- enforcement agency. Company: 4 {'l Phone�`19 721- ^ that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the Address: PC) ��� S ci License number (may be contractor's lic #) .Su,. 7515-9V City/State/Zi Com- S Date 9 2S XZ 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. 0 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 lic #) Date Signed: Position With Company: 2008 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-1C Project Name: Date: 3. Mandatory Sign Lighting Controls NOTES: 1. The some 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 responsibilityfor 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: I I have responsibility for installing the sign lighting controls §133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo ❑ Yes, complete parts3a and 3b of this form ®Io, complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 ❑ Yes ❑ No 3 Ther re no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls I ❑ fl;rYes ❑ 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 daylight hours. ❑ Yes C�No 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 I N ❑ Yes UrN- o 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 ma datory measures (sign lighting control) note block can be located: l §133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y NJ NA applicable re uirements of § 119. ❑ ❑ 0" §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 requirements of § 119. 00 I ❑ Exception to §133(a)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 I N NA sin power 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 lar, ❑ 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 illuminating signs or parts of signs. ❑ 011� §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 4 r"eceivin a demand response signal that is sent out by the local utility. ❑ ❑ 0'- Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including but Y NA not limited to exit signs and traffic signs. ❑ Field Inspector Notes: 1UU6 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-1C Project Name: Date: 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 using the maximum allowed lighting ower method of compliance) A B C D E OPTIONAL Specific light source used for Field ENERGY 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 ui ❑ ❑ ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans when plans are required) and other documents. B A narrative description of the sin 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 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 < 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 1 Electronic ballasts with a fundamental output frequency > 20 kHz E I This page doubles as a field inspection checklist. Field Inspector Notes: .ZUU6 Nonresidential Compliance Forms October 2010