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0109-200 (COMM) LICENSED CONTRACTOR DECLARATION PERMIT# 1 hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT I— (commencing 9 Chapter in with Section 7000 of Division 3 of the Business and l7111i�{ P ( g ) DATE VALUATION � LOT TRACT C14 W Professionals Code,and my License is in full force and effect. 141 ✓J ,�n��t�,t €►.fi O M License#'. Lic.Class Exp.Date JOB SITE dr 7 9304 AY3t,:-t0 � f32/�`�/fib' ADDRESS -!�/ 1 5 APN 76.1-720-021 I s r t1 � Si C OWNER CONTRACTOR/DESIGNER/EN INEER LLJo Z Date ; , Signature of Contractor ��• O F- OWNER-BUILDER DECLARATION �f �tJ�r•C�'� Jl', FN'C'C3WANX J U 4683 CHABC2n 11RM 100 1057 EAST JYMIAL111GHWAY A605 W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's a CA 94588 .NLAC"P.%MA GA 92670 License Law for the following reason: 17 Z ( ) I, as owner of the property, or my employees with wages as their sole (714)528-8$13 CK4 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensedQ�; g �g� contractors to construct the project (Sec. 7044, Business & Professionals Code). UN-MANNED CELLI)I Ak 1ZT,EPH . V,SITE ON M ISTRIf5'f OW. P, 133 Cl) () I am exempt under Section , B&P.C.for this reason I ', ;Cf WN UNK VENCE N Date Signature of Owner ON a) d < I WORKER'S COMPENSATION DECLARATION pr Q Z I hereby affirm under penalty of perjury one of the following declarations: ,WOOD �, 1.14 O O 1 have and will maintain a certificate of consent to self-insure for workers' V'A.LUATION 4$,9.45.0 LS -X W LL compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. m Q U ),mI'have and will maintain workers'compensation insurance,as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this ' a rn 1— permit is issued. My workers' compensation insurance carrier & policy no. are: q Z Carver VTATE FuBAY13 Policy No. 16341 3 LrYMU:$ )C`t�sT OAT �;•S��lS�Ir�i Tic"RON °l o O' 111MMUTF�i",Ft.`.GUMVIARY Q (This section need not be completed if the permit valuation is for$100.00 or less). 41111101 CHEC F. 101-000-439-3 18 $269.43 J ( ) I certify that in the performance of the work for which this permit is issued, fwCfAlS t'fZi f:1'10N M f 101-000-418-000 t ��t3,aft3 I shall not employ any person in any manner so as toj6e bme subject to the q�JFt-.,.I.WAL M F 101.000,4M(,) ) 533.5SJ workers' compensation laws of California, and agreer that it I should become subject to the workers'compensation provisions,of Secti'on;3700 of the Labor 1 3 Code, I shall orthwith comply wittog5Ns`e-pro'I,s i�ggnsit Applicant-/- r'•al,W°.4 r✓ e j Warning: Failure to secure Workers'Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to$100,000,in OCT addition to the cost of compensation,damages as provided for in Section 3706 1 8 2001 of the Labor Code,interest and alluiney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety CITY®FLAQUINTA for a permit subject to the conditions and restrictions set forth on his FINAN .DEPT. application. ; 1. Each person upon whose behalf this application is made&each person at 8,U11-•(>)AL C(UMN UCM 011 )PLAW t"HYMM whose request and for whose benefit work is performed under or pursuant to IMS PIM PAM 1 '710 $01 00 any permit issued as a result of this applicaton agrees to, &shall, indemnify - & hold harmless the City of La Quinta, its officers, agents and employees. 2.Any permit issued as a result of this application becomes null and void if :V--i L 1 TWKX.i FEES DUE NOW 0131 Y.$ 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. - - - fyapplicationE I IIIIIII VIII I I I IIII 45 I certify that I have read this and state that the above information Is ' correct. I agree to comply with all City, and State laws relating to the building + IE construction, and hereby authorize representatiJes of this City to enter upon _ the above-mentioned property .tfY is ailn purposes. -. �/ RECEIPT DATE ` { BY DA IN D INSPECTOR " Signature (Owner/Agent) . - ✓ ► Date I°�� ' j INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms&Footings Ducts Slab Grade ��/b Retum Air Steel Combustion Air Roof Deck Exhaust Fans O.K.to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans&Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall-Int.Lath Final Final /d'/ POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover fi Equipment Location Underground Electric Underground Plbg.Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K.for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: y� Final Utility Notice(Gas) ELECTRICAL APPROVALS Temp.Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles. G.F.I. Smoke Detectors Temp.Use of Power Final Utility Notice(Perm) S /Ll 8� DC16 S Bin# 0* . 1=11111 47 City Of La Quintd Building a Safe Division Safety Permit# , P.O. Box 1504, 78-495 Calle Tampico 00 La Quinta, CA 92253- (760) 777-7012 w-606 Building Permit Application and Tracking Sheet Project Address: 8 14 Owner's Name: S'�,C J „/T C S A.P.Number: -7 `7 oZ Address: l lO /-J A QJ 7- Legal Legal Description: -5e4' b w 61 L S J City,ST,Zip: 1>41-4s 4'u;U JJ C A Contractor: Tele 7 hon ��-TN .. P �- �v�� ............................................. Address: Project Description: (11 A) /ry 4' /Ai City,ST,Zip: G{///LAG 6-TS Z Telephone: M J b U � i v A G A� State Lic.# : A City Lic.#: Q 6�-Xl S, A) Arch.,Engr.,Designer: A- 9-a SD e- Address: '6vs'A'e'.Yd City,ST,Zip: U7�e d1 i✓t�� CcQ- 9 /� Tel e hone: � Construction Type: ✓ Occu an c State L :�- ic.# ': Project type circle one):: New Ad ' n Alter Repair r Demo M............... Name of Contact Person: Sq.Ft.: f,,1040 # Stories: �/� # Units: 4s— Telephone#of Contact Person: yC/ S Q 7 3 7 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted �:,I Item Amount L- Structural Calcs. Reviewed,ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Zq+3 Title 24 Calcs. Plans picked up Construction 2q.60 Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review,ready for correctionsue 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/is of Developer Impact Fee 9 Planning Approval Called Contact Person A.I.P.P. Pub.Wks.Appr Date of permit issue School Fees -- Total Permit Fees 33 l•-1 q�tl 5��/l I ✓ 0��NL ��E 9�y /ANs "t' on a.,�G,� Sl ew To 0,s, o P�c✓ 9/2 6 - /¢P�'�d•9 I . . r► YO UNG ENGINEERING SER DICES •Engineering •Architecture-Surveying-Building &Safety Services Letter of Transmittal To.- Date: Project: toq Attn: �P W.0.: Tel No.: Tract No.: We are forwarding: By Messenger By Mail Your Pickup No. of Copies Description: Comments: This Material Sent for: Your Files Per Your Request Your Review Approval X Checking At the request of: Other ' By: �� Phone # 47-1.59 Youngs Lane •Indio, CA 92201 •(760) 342-9214 Bron Young - CityLa o Uinta Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to the Building and Safety Department only after approval. Contact applicant for resolution of conditions preventing or delaying approval. Project: o Wireless/Cellular Communications Facility on Existing Lattice Tower 81-620 Avenue 58 Sprin?$CS Applicant Contact: Matt McGrath (949) 307-3794 Application / Circulation Date: f12, O, / Community Development Department Date Christine di Iorio, Planning Manager Date Public Works Department Steve Speer, Senior,Engineer Date Building and Safety Department Greg Butler, Building & Safety Manager Date &A is Isla of 2m'vsr ----------- ---------- PK- - } , # --------- fa a •. .- .. .. ..H I,, - i ., j� .. NO r 3 hl tag =11Im 3 R i . � ; .� ate•m _ .. IIIIIIIIIIIIIIIIIIIIII 48 � ^ r1 .� IE III W City of La Quinta ^� Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to the Building and Safety Department only after approval. Contact applicant for resolution of conditions preventing or delaying approval. Project: Wireless/Cellular Communications Facility on Existing Lattice Tower 81-Avenue 58 Sprint PCS Applicant Contact: Matt McGrath (949) 307-3794 Application / Circulation Date: �-- Date Community Development Department —&Usk'�'6 Christine di Iorio, Pla ning Manager D to Public Works Department Steve Speer, Senior Engineer Date Building and Safety Department Greg Butler, Building & Safety Manager Date 1 T{1 . i City Of La Quinta ., / Building&Safety Division _ Permit# � P.O. Box 1504, 78-495 Calle Tampico c �00La Quinta, CA 92253- (760) 777-7012 L d u Building Permit Application and Tracking Sheet Project Address: $�^60 6 I/dY�/G w j Owner's Name: A.P.Number: '] 6 Address: y�j C`l �� vq Isj S Td (f Legal Description: 2 Z-r -3)&1-16, L S City,ST,Zip:"1>44'14 s-4"/U U RJ Contractor: S Telephone(-).1 / .................................... Address: Project Description: b/x) q,,JXJ City,ST,Zip: (,l/j� G S L Telephone:h n P ^ o e. U 1 LJ J !� J G 7�- 7 • c i State Lic.# : h City Lic.#: 00 LJ�I _S i c� Lr I� Arch.,Engr.,Designer: /�75� /�S SG e- Address: City,ST,Zip: �J d 1 s✓�� C� �� /� Tele h ne: C P 0 YJ 7 Con t s ructi on Type: Occu an / c V P C _ State Lic.# Pr o Jec t type(circle one): New Add' n Alter Repair Demo Name of Contact Person: /�/-�� /79 e� �,��1 Sq.Ft.: 9�/U # Stories: # Units: a//I�= Telephone#of Contact Person: z/fl 7 Estimated Value of Project: J—G o c ,j APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted LI Item Amount L- Structural Calcs. Reviewed,ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review,readv 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:- ''d Review,readv for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A,I,P,P. Pub.Wks.Appr Date of permit issue School Fees 1 Total Permit Fees