11-0213 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-OOOOA2-1-3--s
Property Address:
50991 WASHINGTON, ST STE. 1
APN:
770-020-021- - -
Application description:
SIGN
Property Zoning:
NEIGHBORHOOD COMMERCIAL
Application valuation:
. 4000
Applicant:
Architect or Engineer:
. M
----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
License Class: C45 41Lic se No.: 271598
�tcontraac o
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 _ 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 soldwithin
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 theproject (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.).
(_ 1 I am exempt under Sec.. , BAP.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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 -
Date: 3/02/11
Owner:
TFG LQV `
3857 BIRCH ST. #496
TENANT:US BANK
NEWPORT BEACH, CA 92660
Contractor:
SUPERIOR ELECTRICL ADVRTSNGWFIN.A40E
1700 W. ANAHEIM
LONG BEACH, CA 90813(562)495-3808 Lic. No.: 271598
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 PJUB2772N06A10
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
j 370000'o'ff hh Labo Code, hall forthwith co �lyjywit�h those provisions.
�At pplicarit: i�G��'�GF�/��
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 1$100,0001. 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 construction, and hereby authorize representatives
of this county to,enter upon the above-mentioned property f inspection urp
'Date Signature ::(Applicant 'or Agent).
Application Number .
. . . . 11-00000213.
Permit ELEC-ELECTRICAL
SIGN
Additional desc .
Permit Fee
33.00 Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date
8/29/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 15.0000
EA ELEC :SIGN 1ST CIRCUIT .,
1-5.00
1:00 3.0000
EA .ELEC SIGN ADDITIONAL CIRUITS
3:00
Special Notes and Comments
.
THREE (3) SINGLE FACE
INTERNALLY -
ILLUMINATED SUSPENDED
CABINET SIGNS.PER-
SP 2011-1510 "US BANK".
------------------------------------------------------.-----------------
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
Bin #
City of La Quinta
Building 8t Safety DMslon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: V.•629' 4-67C)" - �r
Owner's Name: "M ... V LL—C.,
A. P. Number:
Address: Ses wt wzw sn - 4 4s%
Legal Description:
Contractor:XN
City, ST, Zip: Nevpz)g� CA •152
pht54e��i$ .'pt�FsLi' ID NE :<:>
Address: 7Q Wr-
Project Description:
City, ST, Zip: • 9025
Telephone
op
51K'Ar-14.
State Lic. #
City Lic. #•:
Arch., Engr., Designer:
i.. _. 4 ,1...
Address:
City, ST, Zip:
Telephone:
i$% ,• y!%
•;.;:.,;f,v;� �,G.�s�;�%>;'
Construction Type: Occupancy:
Project type (circle one):. a Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:E!JAFtV-,-Sq.
Ft.:
# Stories:
# Units:
Telephone # of Contact Person. .
Estimated Value of Project: Otoo W
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
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
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
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Certificate of Compliance (Sign Lighting)
• I certify that this Certificate of Compliance documentation is accurate and complete.
(Pagel of 2) SLTG-1C
Project Name:
1.1 Q✓
Phase of Construction
Function Type
_ New Construction LJ Addition Alteration
Outdoor Signs Indoor Signs
Project Address:
50" WArP441 JCTbM .T..-
Date:
2-15; -1)
Compliance Method Used Maximum Allowed
Lighting Power 0 Alternate Lighting Sources
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name✓✓ Si ature
I►-�
Company Dat
SU -tS; - II
Address
If applicable:
,� •
?Op W,. W.4W1tE L M ST;
CEA #
that complies with the applicable requirements of § 119.
CEPE #
Cit /State Zip
Phone:
0
5i6 S • 3
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 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.
Name:
StA
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
Company:
Phone
sin ower b a minimum of 65 percent duringnighttime hours.
?jJFOle
Addres :
License #
I M ST
Ca
City/State/Zip: P,._
1►l4o CA. 1
Sign Mandatory Measures
Indicate location on building plans of Mandatory Sign Measures Note Block:
Mandatory Sign Lighting Controls
Yes
No
1
§133(a)1. All signs with permanently connected lighting are controlled with an automatic time switch control
50
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that complies with the applicable requirements of § 119.
§133(a)2. All outdoor signs are controlled with a photo control or outdoor astronomical time switch control.
9L
0
2
Exception to §133(a)2. Outdoor signs are in tunnels or large covered areas that require illumination during
0
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.
0
0
Exception 1 to §133(a)3. Signs are illuminated for less than one hour per day during daylight hours.
0
Exception 2 to §133(a)3. Outdoor signs are in tunnels or large covered areas that require illumination
during daylight hours.
0
0
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps are used to
0
illuminated signs or arts of signs.
§133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
15 kW has a control installed is capable of reducing the lighting power by a minimum of 30 percent when
Y
N
0
N/A
receivinga 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
N/A
including but not limited to exit signs and traffic signs.
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2008 Nonresidential Compliance Forms January 2010
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INSTALLATION CERTIFICATE (Part 1 of 2) SLTG-INST
PROJECT NAME:.
DATE:
Responsibl erson's Sign
Ux�7
Installation Certificate:
Lic.#
PROJECT ADDRESS:
Building Pemtil
✓ 991 WA ep t4l ��s
12--fAV-1t
Checked e
Ag
Enforcement A enc Use
enc
GENERAL INFORMATION
DATE OF BUILDING PERMIT
I PERMIT # ,
BUILDING TYPE
Outdoor Sign
❑ Indoor Sign
PHASE OF
CONSTRUCTION
New Construction
❑ Addition —7
0 Alteration
If more than one person has responsibilityfor building construction, each person shall prepare and sign an Installation
Certificate document applicable to the portion, of construction for which they are responsible; alternatively, the person with
chief responsibilityfor construction shall prepare and sign the Installation Certificate document(s) for the entire
construction.
DECLARATION STATEMENT
• 1 certify under penalty of perjury, under.the laws of the State of California, the information provided on this form is true and correct.
• 1 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 (responsible person).
• 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for
the installation. I certify that the requirements detailed on the Certificate of Compliance that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted; or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a
signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building
owner at occupancy.
Company Name:
Enter the date of approval by enforcement agency of the Certificate of Compliance that provides
Resp//onn�sible Person's Name:
Responsibl erson's Sign
I�w� r Fn�rF�
Installation Certificate:
Lic.#
Date Signed:
Position With Company:
4C271Vf?8
12--fAV-1t
SCOPE OF RESPONSIBILITY
Enter the date of approval by enforcement agency of the Certificate of Compliance that provides
Date:
the specifications for the energy efficiency measures for the scope of responsibilityfor this
Installation Certificate:
In the table below identify all applicable construction documents that specify the requirements for the scope of
responsibility for this Installation Certificate.
Date Approved By
Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. the Enforcement
Agency
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2008 Nonresidential Compliance Forms August 2009
INSTALLATION CERTIFICATE (Part 2 of 2). SLTG-INST
In the'table below idents all applicable construction documents that speck the requirements for the scope of '
responsibility reported by this Installation Certificate (continued).
Date Approved By
Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. the.Enforcement
A enc'
2008 Nonresidential Compliance Forms
August 2009