10-1424 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Number.__,r.10-00001424
C:�Application
Property'Address:
79785 HIGHWAY 111 STE 101
APN:
600-020-034- - -
Application description:
SIGN
Property Zoning:
COMMERCIAL PARK
Application valuation:
2500
Applicant:
T4t�l - 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
License Class: C10 License No.: 727552
1
Date: sContractor:
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,
$500).: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.).
1 _ 1 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:
LQPERMIT
Owner:
KOMAR INV
23 CORPORATE PLZ
TENANT:JADABUG'S
NEWPORT BEACH, CA
STE 247
92660
Contractor:
QRS LIGHTING INC
81211, #2B INDIO BLVD
INDIO, CA 92201
(760)619-6565
Lic. No.: 727552
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/30/10
t""
oFc 3 0 2oto lu
LA
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 EXEMPT Policy Number EXEMPT
_ I 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
3700 of the Labor Code,, IIsshall forthwith comply with those provisions.
Date:. Jo Applicant: `1 Ol
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 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.
1 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 jjbr !9spection purposes.
(Applicant or Agent): M
Application Number . . . . . 10-00001424
Permit . . . ELEC-ELECTRICAL SIGN
Additional desc . .
Permit Fee . . . . 33.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 6/28/11
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 ILLUMINATED SIGN'S "JADABUGS BABY
BOUTIQUE" PER SP 2010-1485.
----------------------------------------------------------------------------
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
r
LQPERMIT
Bin U
City of La- Z T
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking . Sheet
Permit # n i,i
Project Address: (9, Y -WY
Owner's Name: KPV-AJ7,-
A.P.Number:
Address: � 3 <0
Legal Description:
City, ST, Zip: WZ;fAj 4,
mfl�T 4 w ek,
Contractor (0, fz
Telephone:
Address: 201V -W, blAIIEV gmfk
Project Description:
City, ST, Zip:
Tel phone:90 7� -6017 T--?-
� E&I'
State Lic. #: City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one):oew Add'n Alter Repair Demo
I
Sq. Ft.: 7—b�-41,+:4#Stories:
# Units:
Telephone # of Contact Person: %P'
Estimated Value of Project: --z- / t-00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req!d
Rec2d-
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 Calcis..
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 corrcctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
rTotal Permit Fees
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Certificate of Compliance and Field inspection Energy Checklist (Sign Lighting) (Pae z
of 2 SLTG-1 C
Date:
Protect Name: A�� � �� �� �� � � �� �1 ��� ��
�.''
Compliance Method
Maximum Allowed Lighting Power
B C D E F G H
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K
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Design Complies?
Light
Field
Allowed Watts Watts' YM
Source
1 Ins ctor
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N Description or location and plan location `"
103
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Total Sign Area:
1. Design Watts = total connected lighting load installed in the sign, including power used by lamps, ballasts, transformers, power supplies, etc.
l!ecessary.
2. 1 Fail then describe on Page 2 o the Inspection Checklist Form and take appropriate action to correct. Verify buildingplans ifnecessary, Use additional sheets i
The sins identified above; use only one or more of the following technologies: list all applicable numbers that apply in column I
above
I
High pressure sodium tarn
2
Pulse start or ceramic metal halide lamps served by a ballast with >_ 88•/ efficiency
3
Pulse start metal halide lamps that are _< 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast with >_ 80% efficiency
4
Neon or cold cathode lams with transformer or power supply efficiency >_ 75% with rated output current < 50 mA
5
Neon or cold cathode lamps with transformer or power supply efficiency ? 68% with rated output current > 50 mA
Fluorescent lamps with a minimum color rendering index (CRI) o 80
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 output, having a nameplate output power less thap
or equal to 250 watts, and
certified to the Energy Commission as complying with the applicable requirements o the Appliance Efficiency Regulations(Title 20
9
Compacifluorescent lamps that do not contain a medium screw base sockets E24/E26
10
Electronic ballasts with afundamental outpulfrequency >_ 20 kHz
Field Inspector Notes or Discrepanzies
2008 Nonresidential Compliance Forms August 2009
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