08-0194 (SIGN)V, . . 4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: _ _,08-00000194
Property Address: 79827 HIGHWAY 111
APN: 600 -020 -037 -
Application description: SIGN
Property Zoning: COMMERCIAL PARK
Application valuation: 10000
Tit!t 4 4iK" nrw
Architect or Engineer:
11101,4.
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: C45 License No.: 799881
Date:�j .74•a4 C ctor.
OWNER -BUILDER DECLARATION
hereby affirm under penalty o perjury hat I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, usi sand Professions Code: Any city or county that requires a permit to
construct, after, 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 _ I 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. 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: 1-C
' LQI.'ERMTT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
-----------------------------------------------
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 STATE FUND Policy Number 1711028-2007
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, I shat forthwith comjply with those provisions.
licant:
WARNING: FAI URE TO SE URE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN A N 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 ordinaEnalure
d state laws relating to building construction, and hereby authorize representatives
;�e
is/�o unty to enterhe above-mentioned property for i coon purpo
(Applicant or Agentl
Date: 4/28/08
Owner:
KOMAR INV
23 CORPORATE PLZ STE
247
NEWPORT BEACH, CA 92660
e `
D
Contractor:
n
APR 28 200
ULTRASIGNS, INC.
9025 BALBOA AVENUE
UItdTA
SAN DIEGO, CA 92123
CITY
(858)569-1400
Lic. No.: 799881
-----------------------------------------------
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 STATE FUND Policy Number 1711028-2007
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, I shat forthwith comjply with those provisions.
licant:
WARNING: FAI URE TO SE URE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN A N 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 ordinaEnalure
d state laws relating to building construction, and hereby authorize representatives
;�e
is/�o unty to enterhe above-mentioned property for i coon purpo
(Applicant or Agentl
s
Application Number . . . . . .08-00000194
Permit . . . ELEC-ELECTRICAL SIGN,
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date _. Valuation
0
Expiration Date 9/30/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
----------------------------------------------------------------------------
15.00
Permit . . . SIGN PERMIT
Additional desc ILLUM MONUMENT SIGN
Permit Fee . . . . 117.00 Plan Check Fee
76.05
Issue Date Valuation . . .
. 10000
Expiration Date 9/30/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000 THOU BLDG 2,001-25,000
72.00
----------------------------------------------------------------------------
.-Special Notes and Comments
ILLUMINATED MONUMENT SIGN (LOCATION AT
EAST OF ENTRY DRIVE)2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . ENERGY REVIEW FEE
7.61
STRONG MOTION (SMI).- COM
2.10
Fee summary Charged Paid Credited
Due
Permit Fee Total 147.00 .00 .00
147.00
Plan Check Total 76.05 .00 .00
76.05
Other Fee Total 9.71 .00 .00
9.71
Grand Total. 232.76 .00 .00
232.76
LQPERMIT .
•
CERTIFICATE OF COMPLIANCE (Part 1 of 2) OLTG-1-C
PFjOJECT NAME (y -
P MCA4- 2 r PCL 2l! -
For detailed instructions on the use of this and all Energy Efficiency Standards compliance• forms, please refer to the Nonresidential
Manual published by the Califomia Energy Commission.
DATE
PROJECT ADDRESS
ilk
incorporated in schedules on the plans.
::-:::.-::--:::r .... :.... ...... _ ..
,:. 8pdtllfYd€Rarrnit':.. ':"" ';
fmforcement'A�egcltlJse:-.. ,
P I IPALDESIGNER LIGHTING
TELEPHONE
M Ni TION A HO
TELEPHONE
GENERALINFORMATI
3. Use OLTG-1-C if the project consists solely of outdoor signs
4. Use OLTG-1-C if the project consists of outdoor lighting, and indoor or outdoor signs, but no other indoor
DATE OF PLANS J g,r D01
❑ OLTG-2-C
1 OUTDOOR LIGHTING ZONE ✓ O
1. ❑ Ln
Si ns
FUNCTION TYPE
❑ OUTDOOR LIGHTING
1116LITDOOR SIGNS ❑ INDOOR SIGNS
PHASE OF CONSTRUCTION
❑ NEW CONSTRUCTION
❑ ADDITIONS ❑ 'ALTERATIONS
'STATEMENT OF COMPLIANCE
This Certificate of Compliance lists outdoor lighting system specifications need to comply with Tltle 24, Parts 1 and 6 of the California Code of
Regulations. This certificate applies only to building lighting requirements.
The docurAntation preparer hereby certifies that the documentation Is accurate and complete.
® n
The Principal Lighting Designer hereby certifies that 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 Vern a licensed
archl .
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 for its preparation; and that I am a licensed contractor performlhg this work.
❑ I affirm that I am eligible under the provisions of Division -3 of the Business and Professions Code to sign this document because it pertains to a
s structure or type of work described as exempt pursuant to Business and Professions Code Sections 5537,5538 and 6737.1.
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 Califomia 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 OLTGA-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-1-C if the project consists solely of outdoor signs
4. Use OLTG-1-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 allowances (Except for
Si ns
❑ p
AREA CALCULATIONS WORKSHEETS. Applicable parts required for all outdoor area calculations.
SIGN LIGHTING COMPLIANCE. Required for all internally and externally illuminated signs, for both indoor and
OLTG� C
051`outdoor
signs.
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
2005 Nonresidential Compliance Forms1 111 � `� . L_"" April 2005
FOR CONSTRUCTION
nA"M LI.1 I n� tnv
CERTIFICATE OF COMPLIANCE (Part 2 of 2) OLTG4 -C
PROJECT NAME
LZIring Schedules'on Plans Show that Outdoor Lighting Meets Allowed Lighting Power
[73'l Oting 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
IJ Not Applicame
❑ Li ing power allowances for specific applications, other than vehicle seryice stations with canopies on OLTG2-C Part 3 of 4
rP�Mnf Applicable
❑ LighSmg'power allowances for vehicle service station canopies on OLTG-2-C Part 4 of 4
2"S"ign lighting compliance on OLTG-4-C
❑ Not Applicable
Mandatory Measures on Plans Show that Outdoor Lighting Meets Outdoor Lighting Controls and Equipment
indimte location on plans of Note Block for Mandato Measure
❑ Installed lighting power has been determined in accordance with § 130(c)1
U Not Appnoaoie
❑. tts either have a lamp efficacy of at least 60 lumens per watt or are
All permanently installed luminaires with lamps rated over 100 wa
contro d 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
trinnr sales. eas meet the Cutoff Requirements of § 132(b)
ianently in ailed outdoor lighting meets the Control Requirements of § 132(c)1
Jv L,y,r,,......,
❑ g g facades, parking lots, garages, canopies, and outdoor sales areas meet the Multi -Level Lighting Requirements of § 132(c)2
Not Applicable
MANDATORY AUTOMATIC CONTROLS
CO
CONTROL NTROLTYPE AREA CONTROLLED NOE�O
CONTROL LOCATION Incuroir_et�r�nt Auto Time SwitchWhotosensor, etc
G
April 2005.
2005 Nonresidential Compliance Fomts .
i For Allotted LPD use 12 watts/square —foot for Internally Illuminated Signs, and us 2.3 watts/ft for Externally Illuminated Signs.
ht sources andlmply i
Note: If an Internally Illuminated or Externally Illu
minated
to ballasts, onec, thins Iien the sign must counder Altemat ve1. However, unfiltered ae 3 in columns > signs, and )' such
as incandescent lamps, medium base sock gn
unfiltered ortions of lntemall and Extemall illuminated si ns, are not re uired to meet these Standards.
2005 Nonresidential Compliance Forms April 2005
OLTG-4-C
-OM
SIGN
LIGHTING C
LIANCE
-
DATE
-
PROJECT
E
.„ I
Alternative 2 -For Signs that ONLY use one or more of the
technologies
fisted In M through S
Altemative 1 - Lighting Power Allowances
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i For Allotted LPD use 12 watts/square —foot for Internally Illuminated Signs, and us 2.3 watts/ft for Externally Illuminated Signs.
ht sources andlmply i
Note: If an Internally Illuminated or Externally Illu
minated
to ballasts, onec, thins Iien the sign must counder Altemat ve1. However, unfiltered ae 3 in columns > signs, and )' such
as incandescent lamps, medium base sock gn
unfiltered ortions of lntemall and Extemall illuminated si ns, are not re uired to meet these Standards.
2005 Nonresidential Compliance Forms April 2005