10-0509 (SIGN)cA " f
P.O: BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address: .
APN:
Application description
Property Zoning:
Application valuation: '
10-00000509- -
78134 CALLE TAMPICO STE 100
770-020-012-'- -
SIGN
VILLAGE COMMERCIAL
7000
u6�,iGv
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Dater 6/11/16
Applicant: Architect or N,/
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.
LicenseClass:.
C/-/45 License No.: 250739
Date: 5�� / Q Cont or:�.
OWNER -BUILDER DECLARATION '
- I hereby affirm under penalty of perjury that 1 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, 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 (Seca 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 buildor
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 contractors) 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:
Lender's Address:
01
LQPERMIT
Owner:
HIGHLAND LA QUINTA II LLC
80 S LAKE AVE STE 660
PASADENA, CA 91101
Contractor:
YOUNG ELECTRIC SIGN COMPANY
5405 N. INDUSTRIAL PARKWAY
DEVORE, CA 92407-
(801)94-2-1359
2407(801)942-1359
Lic. No.: 250739
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.
-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 TRAVELERS INDEM Policy Number PEUB6058N81309
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 that, if I should become subject to the workers' compensation provisions of Section
3,700 of the Laost�Code, I shall forthwith coryfly with those provisions. .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, SAND 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 ate laws relating to building construction, and hereby authorize representatives
of this county to eeter upo a above-mentioned pfgQerty fOf inSpeCtion pUfpOSej1�
Application Number 10-00000509
Permit ELEC-ELECTRICAL.SIGN
Additional desc .
Permit Fee 33.00 Plan Check.Fee .
.00.
Issue Date Valuation
0
Expiration Date 12/08/10
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
2 INTERNALLY ILLUMINATED CHANNEL LETTER
'SIGNS TO BUILDING, PER SA #2010-1440.
'"DOMINO'S PIZZA" 2007 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
34.0.0
LQPERMIT
Certiftate of Compliance Sin Lighting)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
(Page 1 of 2) SLTGIC
ect Name: ,
Phase of Construction
function Type
D New Construction O Addition O Alteration
Outdoor Signs O Indoor St us
Project Address' —40127q(�A LLQ /, At Pt GO I
Date
Compliance Method Us O Maximum Allowed&U
e i4l CACI Z L 53
_ (t� ' f0
Lighting Power KAAllernate lighting Sources
Documentation Author's Declaration Statement
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
NameSignature
► w1 iD-j -, L F-
l
Company r -S 6'. CD
Date
Address /�
1 b j Z.0 ChL ` 1�j 0W ST
If applicable:
CEA N
that complies with the applicable requirements of j 119.
CEPE N
City/State/zi
► D CA q 2 2D
Phone:
y 6D �J- 3510 �o
Principal Lighting Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting
design,
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Pages I 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.
Name: J
1 OA jl-N C� L E
Sip�ature
Company : t--t--S C;^Q
l/
Phone ? 6 o 3 'rl 7 3 5'oc�
Address: L 4D 1,3 S
(~ License N r� z 2
J
City/StatelZip:
Date
Sign Mandatory Measures
Indicate location on building plans of Mandatory Sign Measures Note Block:
Mandatory Sign Lighting Controls
Yes
No
l
§133(a)l. All signs with permanently connected lighting are controlled with an automatic time switch control❑
that complies with the applicable requirements of j 119.
§133(x)2. All outdoor signs are controlled with a photo control or outdoor astronomical time switch control.
❑
2
Exception to §133(a)2. Outdoor signs are in tunnels or large covered areas that require illumination during
daylight hours.
❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
sin ower b a minimum of 65 percent duringnighttime hours.
❑
Exception I to §133(a)3. Signs are illuminated for less than one hour per day during daylight hours.
❑
3
Exception 2 to §133(a)3. Outdoor signs are in tunnels or large covered areas that require illumination
duringdaylight hours.
❑
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, or neon lamps are used to
ID
0
❑
Mode,
illuminated signs or parts of signs. L t
§133(a)4. An Electronic Message Center (EMC) having anew con ne ted lighting power load greater than
IS kW has a control installed is capable of reducing the lighting power by a minimum of 30 percent when
Y
N
NIA
4
receiving a demand response signal that is sent out by the local utility.
❑
❑
Exception to §133(a)4. The EMC is required by a health or life safety statue, ordinance, or regulation,
Y
N
NIA
including but not limited to exit signs and traffic signs.
❑
❑
2008 Nonresidential Compliance Forms August 2009
Certificate of Compliance and Field Inspection Energy Checklist (Sign Lighting) (Page 2 of 2)
SLTG-1C
Project Name:
Date:
Compliance Method
Maximum Allowed Lighting
Power
A
B
C D E F
G
H
I
i
K
0
V
O
_
t"
Description or location and plan location
Allowed Watts
Desi gn►
Watts,
Complies?
Y/N
Light
Source
Field
Ins ectorz
^
N
a
"'
o,-. p_-
_
a N Q,.N
�' �3
E E E 3 N N 3 x
o
° '� ? Q tv �' ¢ u
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fir°
3
a LL.
E V,
v v
3
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t- m
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IL.�Mu 1�E SpGpJS T�CiffD`t0rLDrr.,(
13
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
Total Sign Area:
1. Design Imalts = rota/ connected lighting load installed in the sign, including power used by lamps, ballasts, transformers, power supplies, erc.
2. /Fail then describe on Page 2 othe Inspection Checklist Form and take a n iate action to connect. I -e) A building Plans if necessat . Use additional sheets if necessary.
The sins identified above; use only one or more of the following technologies: list all applicable numbers that apply in column 1 above
I I High pressure sodium larups
2 1 Pulse start or ceramic metal halide lam s served by a ballast with > 88% efficiency
3 1 Pulse start metal halide lams that are:5 320 watts, are rwt 250 watt or 175 watt lamps. and are served by a ballast with > 80'10 efficiency
4 Neon or cold cathode lamps with transformer orposversjvqfflrciencv> 75% with eared oeriut current < 50 mA
5 Neon or cold cathode lams with transformer or power sipply efficiency > 68'/ with rated output current > 50 mA
6 Fluorescent lamps with a minimum color rendering index CRii 080
7 Light emitting diodes LEDs) with a power supply whb > 80% a ciencv
8 Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC output, having a nameplate oruput power• less than or equal to 250 walls, and
cerli ted to the Ene Commission as complyingwith the applicable requirements o the:! liance Efficiency Regulations rile 20
9 1 Conmaci fluorescent lamps that do not contain a medium screw base sockets (E24IE26
l0 1 Electronic ballasts with a rmdantewal owput-frequency _> 20 kHz
Field Inspector Notes or Discrepancies
_••••.-.•�..•��.�� .ran �„vnrpuurrsc rwrnd filfgllSt 2009
F
1 d OF LA QUIfit 1 AILDING'&"SAFE•Y�'1�u
DROVED
Fnp
tc-I rpt t�Taf,: I
DATE (9F _//'K! RV
14'-3'
_S
INSTALL -TWO (2) SETS OF CUSTOMER PROVIDED CHANNEL LETTERS
Scale: 3/8"= 1'-0" ,
Customer provided Domino's Standard channel letters to be flush -mounted to building fascia
Letters are internally illuminated with white LEDs
YESCO®
LOS ANGELES DIVISION
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San eamardino, CA 92407
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LOS ANGELES DIVISION.
5405 N. Incrust ial Parkway
U. IfomaMm, CA 92407
TOL' (909) 925.7669 Far. (909)923,%15
Y—.—
ft—. Domino's P'Nn
AAyress: 78-134 Calle Temples
SNlts 100
• La Oulnta. CA 9225.3-
Salaa E— Jamas En910
i NOTED- 0524110 Torts
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i north Suite 100
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City of LaQuinta
Building 8l' Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
i
Building Permit Application and Tracking Sheet
Permit #Q
, {;Q�
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Project Address: 1 'q l i� LL i_ —TAP l P
Owner's Name: D0 /%1 I t J ,S
A. P. Number:
Address: `I D ,3 " C- j, t -TAm Aco 0)
Legal Description:
City, ST, Zip: r ,4+A G q 2-? 5- 3
Contractor:V �F5GO Sl G/�
Tele h one:
d
P
-
Address: G f I L0 CA -L H IJ ST
Project Description: Z l (,LU.M 1 J /�T F
City, ST, Zip: I
Tele hone.
Py 35��.
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State Lic. # : City Lic. #•:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Lic. #:Sp 3
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): reW Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 1Jt{ 3 sb6
Estimated Value of Project: N Q�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
i
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