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07-2122 (SIGN)P:'O. BOX 1504 78-495 CALLE TAMPICO LA,QUINTA, CALIFORNIA 92253 Application; Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 07-00002122 79174 HIGHWAY 111 STE 101 649-820-999- - - SIGN �-- REGIONAL COMMERCIAL 5700 Architect or Engineer: 4 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. LicenseeCClass: C45, D42 LicenseNo.: 654238 ate: l' �% ontraaor: 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.). (_) 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: r Lender's Address LQPERMIT Owner: FOURTH QUARTER PROP 45 ANSLEY DR NEWNAN, GA 30263 (760)613-3783 Contractor: \ COAST SIGN INCORP 1500 W. EMBASSY S ANAHEIM, CA 92802 (714)520-9144 Lic. No.: 654238 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 .Date: 7/19/07 WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 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 HARTFORD SPECL Policy Number 36WNMG3210 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 become subject to the workers' compensation provisions of Section 3700 of the La Code, lshall forthwith amply with those provisions. D� WARNING: FAILURE TO SE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T WORKERS' 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. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county toenterupon the above-mentioned. prope or in ection purposes. Date?v Signature (Applicant or Agent): v V Application Number . . . . . 07-00002122 Permit . . . ELEC-ELECTRICAL SIGN Additional desc . Permit Fee . . 33.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/15/08 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 2 INTERNALLY ILLUMINATED CHANNEL LETTER SIGNS PER SA # 2007-1157,, "CHIPOTLE MEXICAN GRILL" Fee summary Charged 'Paid Credited Due ------------------------------------- Permit Fee Total 33.00 -------------------- .00 .00 33.00 Plan Check Total .00 .00 .00 .00 Grand Total 33.00 .00 .00 33.00 r' LQPERMIT ry ;, CERTIFICATE OF COMPLIANCE PROJECr NAME G� ; - --e PRO.teCr ADMSS A OR % r -1 rN l kn_ aha Part 1 of 2) REPHONE 07 :LEPiiONE 24s't OLTG-1-C Vit -o avadriw r�+ns EMatoemntp fter" Use FUNCTION TYPE ❑ OUTDO.OR LIGHTING WUTOOOR SIGNS U INDOOR SIGNS " PHASE OF CONSTRUCTION ❑ NEW CONSTRUCTION ❑ ADDITIONS ❑ ALTERATIONS RATgWff OF C011PUANCE This Csfflks% of Comp9ance Ids outdoor lighting system spedfications need to comply with Title 24. Parts 1 and 6 of the California Code of Regulations. This eertlfieete applies only to building sgiting requirements. The documentation pmparer hereby certifies that the documentation is accurate and complete. The Principal Lighting Designer hereby =ties filet the proposed outdoor lighting and airs design represented In this set of construction documents is went with the other eompllanee forms and wolahhests, with the Wedilmoons, and with any other calculations s submitted with this permit appGeatlon. The proposed building has been designed to meet the lighting requirements contained U the applicable parts of Sections 110. 116.130 through 132. 146. and 146 of Title 24, Part 6. Please V one: ❑ 1 hereby affirm that I am eligible murder the provisions of Division 3 of the Business and Professions Code to sign this document as the parson responsible for its preparation; and that I am licensed In the State of California as a civil engineer or electrical engineer. or I am a licensed architect. J 1 e I am a under the provisions of Division 3 of the Business and Professions Cade by section 5537.2 or 6737.3 to sign this document as the person responsible for Its preparation; and that I am a limes contractor perbr mi ng this work. ❑ 1 affirm that t am eroble under the provisions of Division 3 of the Business and Professions Code to sign ads document bemuse It pertains to a structure or type of work desafbed as exempt pursuant to Business and Professions Code Sections 5537.5536 and 6737.1. Itfimcno s TO APPUCANT OUTDOOR LIGHTING COMPLIANCE t WORKSHEETS IV bort It werksheat is hreludhrd) For defatted hlctruc2iorts on the use of fills and all Energy Elhdency Standards cwWfi w forms. PJ0080 refer to the NonrUsIdentfal Manuel published by the Cal/fomia Energy Comfflka rt. ❑ OLTG-I-C Centficate of Compliance. Required on plans for all submittals for outdoor lighting. Part 2 of 2 may be incorporated in schedules on the ans. Either LTG -1-C or OLTG-I-C may be used for sigma as folb": 1. Use LTG -1-C if the project consists solely of indoor signs 2. Use LTG -1-C If the projed consists of indoor fighting. and outdoor or indoor signs, but no OMer outdoor lighting. 3. Use OLTG-I-C if the project consists solely of outdoor signs 4. Use OLTG-11-C if the consists of outdoor lightinlL and indoor or outdoor signs, but no other Indoor fighting ❑ OLTG-2-C LIGHTING COMPLIANCE SUMMARY. Applicable Parts required for ALL outdoor fighting allowances (Except for Signs) ❑ OLTG-3-C AREA CALCULATIONS WORKSHEETS. Applicable parts requited for all outdoor area calculations. SIGN LIGHTING COMPLIANCE. Required for all intemally and externally iflurninated signs, for both indoor and outdoor OqLTG-" signs. 2005 Nonreslden1W Compliance Forms March 2005 Q CERTIFICATE OF COMPLIANCE . (Part 2 of 2) . 0LTG-1-C ghtina Schedules on Plans Show that Outdoor Lighting Meets Allowed Lighting Power ❑ Ligling power allowances for general site illumination on OLTG-2-C Part 1 of 4 power allowances for local ordinances or for security multipliers on OLTG-2-C Part 2 of 4 power allowances for specific applications, other than vehicle service stations with canopies on OLTG-2-C Part 3 of 4 power allowances for vehicle service station canopies on OLTG-2-C Part 4 of 4 M;-STgn fighting compliance on OLTG-4-C I ❑ Not Applicable andatory Measures on Plans Show that Outdoor Lighting Meets Outdoor Lighting Controls and Equipment ndieate k=tlon on tans of Note Block for Mandatory Measure ❑ Installed lighting power has been determined in accordance with § 130(c)t U All permanently installed luminaires with lamps rated over 100 watts either have a lamp effi control) _by a motion sensor § 132(a) cacy of at least 60 lumens per watt or are Not Applicable ❑ All Luminaires with lamps rated greater than 175 watts in hardscape areas, including parking lots, building entrances, canopies, and all FN"otApplicable es areas meet the Cutoff Requirements of § 132(b) ❑ All permanently installed outdoor lighting meets the Control Requirements of § 132(c)l &1316uilding/facades, parking lots, garages, canopies, and outdoor sales areas meet the MultN-evel Lighting Requirements of § 132(c)2 ot Applicable DATORY AUTOMATIC CONTROLS -- --- -11 _,.. • wn I RUL I Trt AREA CONTROLLED NOTE TO IDENTIFICATION Auto Time awltch/Photosennsor,, etc ` FIELD .omp►rance Forma March 2005 •; mod 1k LCM APrL ,r- e o©do©oma HIM ©v ®©� ' • HIM HIM MMM �M MEMOM ■MEMMIMIM■ ®®111011MMEMEMOMOME Him ■■oEvM1�� mm �a �MIMIMIM MEMOM 111011MM■MmimMEMM I■EINE■M1111MME MOMMIMIME HIM� �®M MMEN MM NM maimm s �� ��MIoMEoEMOM ■WEE11110 ME r rvr wumeo LPD Use 12 watWsquare foot for Internally Illuminated Signs, and us 2.3 watts/iiz for Externally Illuminated Signs Note: If an Intemalty Illuminated or Externally Illuminated sign contains light soon es and ballasts other than those Included In columns (M) through (S), such as Incendescent lumps, medium base sockets, magnetic ballasts, etc, then the sign must comply under Alternative 1. However, unfiltered signs. and unfiltered portions of Internally and Externally Illuminated signs, are not required to meet these Standards. —""MGM Forms .. Mereh 2008