11-0925 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
4W7WTC 000A925
79225 HIGHWAY 111
600 -020 -014 -
STRUCTURES OTHER THAN
REGIONAL COMMERCIAL
3000
Tjht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760)'777-7011
INSPECTIONS (760) 777-7153
Owner:
GARFF PROPERTIES -LA QUINTA LLC
405 S. MAIN STREET #1200
BUILDINGS SALT LAKE CITY, UT 84111
Architect or Engineer:
Contractor:
CERTIFIED SIGN
J
Date: 10/06/11
P.o. Box 4s O E 2 ' L
SUN CITY, CA 92586 OCT
I(951) 92 8 -2484
Lic. No.: 751584 CITY OPI,11►INT4
RUfiN ICE r);:FT.
---------------------=--------------------------------------------=------------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C45 'c nse No.: 751584 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: �• �- actor: 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier SECURITY NATL Policy Number SWC1004695
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the L or Code, I s twith co m ly with those provisions.
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).: e: to lD l' pplicant:
1 _ 1 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. .
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am. exclusively contracting with licensed contractors to construct the project (Sec. ' IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the '
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.l. whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , 8.&P.C. for this reason - 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
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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address: +
LQPERMIT
• 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 to enter upon the above-mentioned property for 'w, nn pur
$ate: 10 nature (Applicant or Agent): �i�
Application Number . . . 11-00000925
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee 54.00 Plan Check Fee
35.10
Issue Date . . . . J Valuation . . .
. 3000
Expiration Date 4/03/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
9.00
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Expiration Date 4/03/12
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) ILLUMINATED MONUMENT SIGN,
PER SA # 2011-1529. "CHEVROLET/CADILLAC. .
2010 CODES.
----------------------------------------------------------------------------
• Other Fees . . . . . . . BLDG STDS ADMIN (SB1473•)
..1.00
ENERGY REVIEW FEE
3.51
Fee summary Charged Paid Credited
Due
Permit Fee Total 84.00 .00 .00
84.00.
Plan Check Total 35.10 .00 .00
35.10
Other Fee Total 4.51 .00 .00
4.51
Grand Total 123.61 .00 .00
123.61
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0 011LICV & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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SITE PLAN
.Certificate of Compliance (Sign:Lightin)
(Page L of 4) . SLTG-1C .
Project Name:
I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
EJ This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Date: .
t
Project Address:
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
% - ? N vii •tom . l l
Name:
("TA -
Location of Sign . OCbatdoor Signs ❑ Indoor Signs
77 -Company:
Phase of Sign Construction -EUew Signs ❑ Sign Alterations
Gt=(LT 1E /E-
Type oIghting Control Q�New Lighting Controls ❑ Replaced Lighting Controls
❑ Not Installing Lighting Controls
This Certificate of Compliance includes the following components (check all that apply)
City/State/Zip:
❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power
A Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this may be a C 10, C45 or other eligible'person)
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 California Business and Professions Code to accept responsibility for the lighting design.
EJ 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.
The 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. ti
Name:
("TA -
Signa
77 -Company:
Phone
Gt=(LT 1E /E-
Address: f'v '(3oL� �S
License ny 1 ber (may be contractor's lic #)
S �✓j
City/State/Zip:
Date
Responsible Person's Name:
2-50
2. Installation Certificate (to be signed by responsible person after installation)
4Per6itt number
F.r xr3 <i
enc ;
ekedby/Datef
i(Enforcement
(Enforcement A ,Use f
Agency Use
Installation Declaration statement
0 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.
0 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.
0 I certify that the requirements detailed on this Certificate of Compliance have been met.
❑ I will ensure that a completed, signed copy of this Installation Certificate shall be posted a av wi h th building
permit(s) issued for the building, and made available to the enforcement agency for aI e� p cTivn.i►un erstand
that a signed copy of this Installation Certificate is required to be included w' oct e�tt�oii=E'b�t{i]+d fovi c to the
building owner at occupancy. , Q
Company Name:
Responsible Person's Name:
Responsible rson's S gnn re
F
License number (may be contractor's lic #)
Date Signed:
Position With' ompany: V
T
2008 Nonresidential Compliance Forms October 2010
4
Certificate of Compliance (Sign Lighting) (Page 2 of 4)'_ SLTG-1C
Project Name:
Date:
r— ��v �Ji'O l LLQ L—�1 I R-.
10'
3. Mandatory Sign Lighting Controls
NOTES:
1. The same 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 responsibility for 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:
1
1 have responsibility for installing the sign lighting controls
N
❑ Yes, complete parts 3a and 3b of this form 0No, complete part 3a of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
'el
❑ Yes ONO
3
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
❑ Yes ZrNo
NA
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
❑ Yes -,P'No
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
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
Yes ❑ No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG- I C is responsible for
the sign lighting control requirements, that person shall answer all of the following questions:
-complyingwith
If there are construction documents, indicate where on the building plans the
ma datory measures (sign lighting control) note block can be located:
1
§133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the
Y
N
NA
applicable requirements of § 119.
❑
❑
§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.
'el
❑
❑
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
N
NA
sign tewer by a minimum of 65 percent during nighttime hours.
❑
I ❑
Exceptionf -U §133(x)3. Signs illuminated for less than one hour per day during daylight hours.
Y
NA
'Er
❑
3
Exception 2 to §133(a)3` ' tdoor 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.
❑
§133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
Y
N
N/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when
❑
❑
4
receiving a demand res ouse si nal that is sent out by the local utility.
Exception to §133'(A)4. EMC required by a health or life safety statue, ordinance, or regulation, including
Y
NA
but not limited to exit si r',artd!trafftc signs.
❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance. (Sign lihtin) Pa e3 of4)- SLTG-1C . '.
Project Name:
Date:
4.. Maximum Allowed Lighting Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 5
of this Certificate of Compliance if there are signs using the S ecific lighting sources method of co liance)
A
B
C
D E I F G
H
I
J
0
Allowed Watts
Desi
Complies?
W s
Y/N
a>
to 0
>
0
D
V1
V
U
a o
W b
Q i+ ¢'
cd
V1
o
o
w
w
Field
T
N
a
Inspector
rn
z
o
?n
�? x
II
—� W
o
Check that
o
¢
U
Sign
0.
Complies
Description
✓
❑
❑
Ov
r
0
❑
❑
❑
❑
A
Symbol or code used on the pl6s when plans are required) and other documents.
B
A narrative description of th si n, or location of sign on the building; and the location of sign on construction documents.
OPTIONAL - Check this b only if this sign has a permanent, pre-printed, factory -installed, ENERGY VERIFIED label, confirming that
the sign complies with th Section 148 of the California 2008 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power
he only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized
method of comZcompliance.
C
by Underwriterries (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National
Standards Institrdance with ISO/IEC 1701 I. Surveillance by the Accredited Certification Body shall be an ongoing annual
inspection progd out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY
VERIFIED labs `D' through 'I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional
method to valid An ENERGY VERIFIED label is not needed for compliance.
D
The sign areaA area's uare feet.
E
List "I" if tV sign is intemally illuminated. List "E" if the si n is externally illuminated.
F
Allowed 4kts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E.
G
Multiply e square footage in column D times the allowed Lighting Power Density LPD = watts) in column F.
H
Show t116 total installed watts in the sign, as determined according to the applicable provisions of § 130(d ore .
Enter Y if the number in column H is less than orequal to the number in column G. Otherwise, the sign does not comply.
J
This pagc doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Com liance Si n Li htin (Page 4 of 4 SLTG-IC
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 Compliance if there are signs using the maximum allowed li ghting power method of compliance)
A
B
C
D
E
OPTIONAL
Field
ENERGY
Specific light source used for
Inspector
Symbol
VERIFIED
compliance
Check that
or
Description
label
Shall include only lighting
Sign
Code
(see instructions
technologies listed below
Complies
below)
List all that apply
+-KI�rM f_N
❑
10
❑
❑
❑
❑
❑
❑
❑
A
Symbol
or code used on the plans when plans are required) and
other documents.
B
A narrative description of the sign, 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.
I
High pressure sodium lamps
1
Pulse start or ceramic metal halide lamps served by a ballast with >_ 88% efficiency
Pulse start metal halide lamps that are < 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast
3
with ? 80% efficiency
4
Neon or cold cathode lamps with transformer or power supply efficiency>_ 75% with rated output current < 50 mA
S
Neon or cold cathode lamps with transformer or ower supply efficiency>_ 68% with rated output current > 50 mA
I)
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
Com act 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
This page
doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010