06-2793 (SIGN)4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777=7153
BUILDING PERMIT
�- Date: 7/25/06
Application Number: 06-00002793 Owner:
Property Address: 79220 HIGHWAY 111 FOURTH QUARTER PROPERTIES
APN: 649-820-999- - - 45 ANSLEY DR
Application description: SIGN NEWNAN, GA 30263
Property Zoning: REGIONAL COMMERCIAL (760) 613-3783
Application valuation: 2000 f
e
D {
Contractor. 4:
Applicant: Architect or Engineer: SWAIN SIGN, INC. JULCJ 2006
1384 E. 5TH STREET UL
ONTARIO . CA -91764 O� QUIi3iA
(909)946-0253 CITY CE ®
Lic. Noo.-: : 6643004
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 Prof ien s Code, and my License is in full force and effect.
License s: C45 cense No.: 643004
'►-25-Q��o„�
ate: J ractor:
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 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:
LQPERDIIT
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.
1 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 STATE FUND Policy Number 0019981
1 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 tha , if I should become to the workers' compensation provisions of Section
3700 of th abor Code, shall Orthwith omply with those provisions.
te:7 r2 � v� pplicant:
WARNING: FAILURE 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 actor omission related ta,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 aV county ordinances rid state laws relating to building constr 'on, and hereby authorize representatives
of clounty to enter u n the above-mentioned property f r insp coon rposes. ,
Signature (Applicant or Agent):
Application Number 06-00002793
Permit . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 39.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration.Date 1/21/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 15.0000 EA ELEC
SIGN 1ST CIRCUIT
15.00
3.00 3.0000 EA ELEC
SIGN ADDITIONAL CIRUITS
9.00
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL 4 INTERNALLY ILLUMINATED
SIGNS
ON 2 EXISTING ROC MONUMENT SIGNS
PER
SIGN APP # 06-998 AMMENDMENT 1
Fee summary Charged
-----------------
Paid Credited
Due
--------------------
Permit Fee Total 39.00
--------------------
.00 .00
39.00
Plan Check Total .00
..00 .00
.00
Grand Total 39.00
.00 .00
39.00
LQPERAIIT
CERTIFICATE OF COMPLIANCE
Part 1 of 2
OLTG-1 -C
- "I ._ ,,.,,,ti "W ,u,vy i .,qurrements.
The documentation preparer hereby Certifies that the documenlaU ac ate and com�(cle,
nr,�....�..�.,.._....._.. _ ��
f/J4:,- t" une
DAT"C',E
The Prinelpal Lighting Deal Mer herebycertffics that the
is Cortslslent with Ilse other compliance proposed -outdoor ngftling and signs design represented 1
pliance forms and worksheets, with the specifications, and with any p h n this set ubmitted Withf MMStruclion documents
oppricatlon. The proposed building has been designed to meet the Ilghttn0 requhements contained in the pp icable parts ^OfbSections With
through 132, 146, and 149 of Title 24, Part 6. Please ✓ one;
❑ I hereby affirm that I am eligible under thr, provisions of Division 3 of the Business and Professlone Code to sign this document as the person
responsible for Its preparation; and that I am licensed In the State of California as a Civil engineer or electrical engineer, or l am a Ilcen d
architect,
E
1'1
I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section 5537,2 or 6737.3 to sign this
document as the person responsible (or its preparation; and that I am a licensed contractor performing Ittls work.
I dlfiRn that I am eligible under the provlslone of Divlslon 3 of the Business and Professions Code to sign this document because It pertains to a
structure or type of work described as exempt pu ,k"LIo Business and Professions Code Sections 5537,5538 and 6737.1.
2005 Nonresidential Compliance Forms
UtRTIFICATE OF COMPLIANCE (Part 2 of 2) OLTG-1-C
PROJECT NAME:
Lighting Schedules on Plans Show that Outdoor Lightin2 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 01-TG-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 01`4
❑ Not Applicable
❑ Lighting power allowances for vehicle service station canopies on OLTG-2-C Part 4
01`4
❑ Not Applicable
KS 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 ars of Note Block for Mandatory Measure
❑ installed lighting power has been determined in accordance with § 130(c)l
❑ 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 A pllCable
All permanently installed outdoor lighting meets the Control Requirements of § 132(c)l
❑ 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
1.. .• .A!
01NI.lry S�1,E
rrx.
•
r•
.a. ; i3, �v"P, i. V 11.1'
1
2005 Nonresidentlal Compliance Forms
April 2005
Electronic Ballasts with `
U
m h
Output Frequency of
v
0
E
2OkHz or more
vii
4
t
,n
o
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CFLs not containing -
V
Medium Screw Bage
f
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p
Socuets
0
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and T8 lamps)
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i a
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w �
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U. 20
m
Neon and Cold Cathode
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Total Designed
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Sign Input watts
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Number of Ballasts
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