07-0166 (SIGN)0
tom;
P.O. BOX 1504
78-495 CALLE TAMPICO
LA Q.UINTA, CALIFORNIA 92253
Application Number: 07-0000.0.1.6.6
Property Address: 46480 WASHINGTON -ST STE 1
APN: 643-020-999-3 -30903 -
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL.
Application valuation: 8000
Applicant`.
Architect or. Engineer:
---––----------–-
LICENSED CONTRACTOR'S DECLARATION
4 4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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. "
License Class: D42 C45 icense No.: 830131/884104
Date: 1](0/407 Cont .
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 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 ISec.
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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
-1 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:
WASHINGTON 111 LTD
C/O JACK TARR
30240 RANCHO VIEJO RD. STE.
SAN JUAN CAPISTRANO, CA 92fi
Contractor:
SIGNARAMA
41945 BOARDWALK, -'L"-
PALM
L"PALM DESERT,.CA 92211 '
(760)776-9907
Lic. No.: 830131/884104
VOICE (760) 777-7012
FAX (760) 777-7011'
INSPECTIONS (760) 777-7153
Date: 1/18/07
B
D Q �
JAN 18 2001
CITY OF LA QUINTA
FINANCE 05PT
WORKER'S COMPENSATION DECLARATION
Thereby affirm under penalty of perjury one of the following declarations:
I have and will maintain 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 WAUSAU INS CO Policy Number WCJZ91442878016
_ I certify that, in the performance of the work for "which this permit is issued, I shall not employ any
person in anymanner sous 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
3700 of the Labor Code I.sha�ll�ith o ply with those. provisions.
Date:.:. ' It, O. • APPlicant:.."' -
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 they
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 construction, a hereby authorize representatives
'of this county to enter upon the above-mentioned pr for '/�spection pur S.S.
D� � ate: -W. - �7Signaturei(Applicapt or Agent):
Application Number . . . . . 07-00000166
Permit .. . . . ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee 33.00 Plan .Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
- Expiration Date 7/17/07
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 INTERNALLY ILLUMINATED CHANNEL
LETTER SIGNS FOR "YUMMI YOGURT"PER
SA06-1088
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
LQPERMrr ..
Bin #
1
City of La Quints
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico C'
La Quinta, CA 92253 - (760) 777-7012]
Building Permit Application and Tracking Sheet p Wh
Permit #
Project Address:* - f �.�
Owner's Name: p� tVgjk C�o
A. P. Number:
Address: Cr Can Lout 4p—
Legal Description:
City, ST, Zip: �u
Contractor: t na <rQ �
Telephone: "?60- s - -74f,00
Address: I-}' _ t f ®ctW4 #
Project Description:
City, ST, Zip: q I/1n bele!
✓` a;
Telephone• 7 6 Q
State Lic. # : $ �{ (
City Lic. #:
e Q�� . �Or Yu rm h", i O K IT
Arch., Engr.,' Designer: �3 e - f f G- C % 0M vk�)
Stm r"e— + d,0 kle Q {t1
�i�
Address: Ifk ' i �9a ✓� Uia(.:C
City, ST, Zip. n q \
Telephone:
State Lic. #: $ Lt 1 ® q-
Name of Contact Person:SG2 �L SO
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: 7`16 — q 0
Estimated Value of Project: p(0c
APPLICANT: DO NOT WRITE.BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2°d Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
Ud 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
CERTIFICATE OF COMPLIANCE
(Part 1 of 2)
01 -TGA -6-1
❑ OLTG-I-C
Certificate of Compliance. Required on plans for all submittals for outdoor lighting. Part 2 of 2 may be incorporated in
schedules on the plans.
PROJECT NAME
c.� M rri u r�
1. Use LTG -1-C if the project consists solely of indoor signs
DATE
1 8® 6
PROJECT ADDRESS
L` 6 /
Q j
(% VV�s�I oYL fit;
S•i�t� ,�
Building Permit
checked bv/Da7e-
Enforcement Agency Use
PRINCIPAL DESIGNER-LIGHTINGTELEP
-F E i, CLCLeS : h rrL
ONE
NO 776 - 0 7
DOCLIVENTATION AUTHOR
3 e.f-f G (-cL !GL S t V -a Q
TELEPHONE
760 p o7
7
GENERAL INFORMATION
signs.
DATE OF PLANS
OUTDOOR LIGHTING ZONE✓ One ❑ LZ1 ❑ LZ2 ❑ LZ3
❑ LZ4
FUNCTION TYPE
❑ OUTDOOR LIGHTING OUTDOOR SIGNS
❑ INDOOR SIGNS
PHASE OF CONSTRUCTION
❑ NEW CONSTRUCTION ❑ ADDITIONS
❑ ALTERATIONS
STATEMENT OF COMPLIANCE
I nis c:ernticate of Uompuance lists outdoor lighting system specifications need to comply with Title 24, Parts 1 and 6 of the California Code of Regulations.
This certificate applies only to building lighting requirements.
The documentation preparer hereby certifies that the documentation is accurate and complete.
TION AUTHOR
The Principal Lighting Designer h9feby certifies tftf the proposed outdoor lighting and signs design represented in this set of construction documents is
consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application.
The proposed building has been designed to meet the lighting requirements contained in the applicable parts of Sections 110, 119,130 through 132, 146,
and 149 of Title 24, Part 6. Please ✓ One:
❑ I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions 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 I am a licensed architect.
® 1 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 for its preparation; and that I am a licensed contractor performing this work.
❑ 1 affirm that I am eligible under the prov&ons of Division 3 of the Business and.Professions Code to sign this document because it pertains to a
structure or type of work described as exempt pursuant,to Business and Professions Code Sections 5537,5538 and 6737.1.
and Professions Code are Drinted in full in
DA
�WMV&101219
INSTRUCTIONS TO APPLICANT OUTDOOR LIGHTING COMPLIANCE & WORKSHEETS (✓ box if worksheet is included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential
Manual published by the California Energy Commission.
❑ OLTG-I-C
Certificate of Compliance. Required on plans for all submittals for outdoor lighting. Part 2 of 2 may be incorporated in
schedules on the plans.
Either LTG -1-C or OLTG-1-C may be used for signs as follows:
1. Use LTG -1-C if the project consists solely of indoor signs
2. Use LTG -1 -C if the project consists of indoor lighting, and outdoor or indoor signs, but no other outdoor lighting.
3. Use OLTG-I-C if the project consists solely of outdoor signs
4. Use OLTG-I-C if the project consists of outdoor lighting, and indoor or outdoor signs, but no other indoor lighting
❑ OLTG-2-C
LIGHTING COMPLIANCE SUMMARY. Applicable Parts required for ALL outdoor lighting allowbrices (Except for Signs)
❑ OLTG-3-C
AREA CALCULATIONS WORKSHEETS. Applicable parts required for all outdoor area calculations.
OLTG 4-C
SIGN LIGHTING COMPLIANCE. Required for all internally and externally illuminated signs, for both indoor and outdoor
signs.
2005 Nonresidential Compliance Forms March 2005
CERTIFICATE OF COMPLIANCE (Part 2 of 2) OLTG-1-C
PROJECT NAME
YUn�YVX 1 �O (4rfi
Lighting Schedules on Plans Show tha 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)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)
91 Not Applicable
❑ 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
Time Switch/Photosensor, etc
AREA CONTROLLED
NOTE TO
FIELD
civic- -o
Si r, V
/A1uto
R .M .Jw�+Ct�v
0✓`e �641 S-
2005
2005 Nonresidential Compliance Forms March 2005
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