11-0853 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: `0853-~
W
Property Address: 790501.�HIGHAY 111
APN: 649 -820 -999 -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 10000
T4'y" 4:�'4f�Miw
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
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.
LicenA�ass: LicenseNo.: 376085
tentractor:
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).:
(_) 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 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. , 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:
Lender's Address: .�
LQPERMIT
Owner:
FOURTH QUARTER PROPERTIES
45 ANSLEY DR
NEWNAN, GA 30263
(760)613-3783
Contractor:
CAREY SIGN CORPORATION
2871 BLUE STAR STREET
ANAHEIM, CA 92806
(714)630-8414
LiC. No.: 376085
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/09/11
-----------------------------------------------
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.
_V_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 COMPANION PROPT Policy Number C9CA12708
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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
/: C cant:
WARNING: FAIL RE 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, 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 co my o enter upon the above-mentioned property f nspection purposes.
�Dat� '� Si ature (Applicant or Agent)f�!
LQPERMIT
Application Number . . . . . 11-00000853
Permit ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 33.00. Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 2/05/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
1.00 3.0000 EA ELEC SIGN ADDITIONAL CIRUITS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL 2 SETS INTERNALLY ILLUMINATED
CHANNEL LETTER SIGNS PER SA#2011-1534
"SPROUTS" 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 33.00 .00 .00
33.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 34.00 .00 .00
34.00
Bin #
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address: ?9 S� /
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor: �',� _
City, ST, Zip:
telephone:
Address: 7�✓e +
Project Description:
City, ST, Zip:>
a. C g
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Telephone:
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State Lic. # :. �%��
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: `'�ct:.143J//�',, >4,:�,' ynx"':+r naLC„ �ti$;'f.Cr•rti'/ifAi�.$;}:.j}£; .:{.�;�;;., �h.'.
4f? K;Construction
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State Lic. #:
Name of Contact Person: a�t
Type: Occupancy:
Project type(circleone): New Add'n Alter Repair Demo
Sq. Ft.: %r # Stories: #Units:
Telephone # of Contact Person: 214f 7, 0 /
Estimated Value of Pro'
!ko COZ3.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cities.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
211 Review, ready for correctionsfissue
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
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Certificate of Compliance and Field Inspection Energy Checklist (Sign Lighting) (Page 2 of 2)
SLTG-IC
Project Name: 1
Date:
Compliance Method
Maximum Allowed Lighting
Power
A
B
C
D
E
F
G
H
I
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K
Design
Complies?
Light
Field
a�
Allowed Watts
Watts'
Y/N
Source
Ins #ore
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Descri tion or location and lan location
to
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Total Sign Area:
1. Design Watts = total connected lighting load installed in the sign, including power used by lamps, ballasts, transformers, power supplies, etc.
2. If Fail then describe on Page 1 of the Inspection Checklist Form and take appropriate action to correct. Verify building lans if necess . Use additional sheets ifnecessary.
The sign(s) identified above; use only one or more of the following technologies: list all_applicable numbers that apply in column I above
1 High pressure sodium lamps
1
Pulse start or ceramic metal halide lamps served by a ballast with >_ 88% efficiency
3
Pulse start metal halide lamps that are <_ 310 watts, are not 150 watt or 175 watt lamps, and are served by a ballast with >_ 80% efficiency
4 Neon or cold cathode lams with trans ormer or power supply efficiency >_ 75% with rated output current < 50 MA
5 Neon or cold cathode lams with trans ormer or er SWP/y efficiency >_ 68% with rated output current >_ 50 mA
6 Fluorescent lamps with a minimum color render in index (CR1 of 80
7 Light emittin diodes LEDs with apower supply with ?: 80% efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC output, having a nameplate output power less than or equal to 250 watts, and
8
certified to the Energy Commission as complying l in with the licable re uirements o the A liance E iciencv Regulations (Title 10
9 Com act uorescent lams that do not contain a medium screw base sockets (E24/E26
undamental out ut re uen >_ 10 kHz
10 Electronic ballasts with of
Field Inspector Notes or Discrepancies
August 2009
2008 Nonresidential Compliance Forms