09-0932 (SIGN)P O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Application Number: 09_00000932
Property Address: 79174 HIGHWAY 111 STE 102
APN: 649-820-999- -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 3000
'� - .4 4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
----- I -------------
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.
LicenseClasss: CC455 D42 Licen o.: 637739
`Date: _E&/ ' Contractor:
NER-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 _ 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 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—) 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:
LQPERMIT
Owner:
INDIAN AMERICAN
PAVILION LLC
2901 BUTTERFIELD
OAK BROOK,.IL 60
Contractor:
PARAGON SIGNS
77650 ENFIELD
PALM DESERT,
(7.60)345-3340
Lic. No.: 637739
r
LANE
CA 92211
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
9/02/09
------------------------------------------------
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.
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 SPARTA INS CO Policy Number 003WK0173
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
A3700 of the Labor Code, I shall fort) rith comply with those rtSvisions.
Date: Applicant: Applicant:
WARNING-: /FAILURE TO SECURE WORKERS' C SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES 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 co�tion,and author' presentativesof thiscocoouuntyyytto center upon the above-mentioned property for '
Oate� / Signature (Applicant or Agent):
Application Number . . . . . 09-00000932
Permit ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee. 33.00 Plan Check Fee
00
Issue Date Valuation
0
Expiration Date 3/01/10
`
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
TWO PERMANENT ILLUMINATED SIGNS PER SP
2009-1396 "FEDEX OFFICE".
----------------------------------------------------------------------------
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
LQPERMIT
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CERTIFICATE OF COMPLIANCE (Part 2 of 2) OLTG-1-C
PROJECT NAME
Li htin 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)1
❑ 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)
❑ Not Applicable
❑ All permanently installed outdoor lighting meets the Control Requirements of § 132(c)1
❑ Not Applicable
❑ 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
AT ELECTRICAL PANEL
TC -1
AUTO TIME CLOCK
SIGNS
2005 Nonresidential Compliance Forms April 2005
SIGN LIGHTING COMPLIANCE OLTG-4-C
PROJECT NAME
DATE
Alternative 1 — Lighting Power Allowances
Alternative 2 — For Signs tha ONLY use one or more of the
technologies listed in M through S
Check all that apply)
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F For Allotted LPD use 12 watts/square foot for Internally Illuminated Signs, and use 2.3 watts/ for Externally Illuminated Signs.
Note: If an Internally Illuminated or Externally Illuminated sign contains light sources and ballasts other than those included in columns (M) through (S), such
as incandescent lamps, 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.
2005 Nonresidential Compliance Forms July 2005
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