BOTH2015-000278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
TIM GAINES
.18382 SLOVER AVE
BLOOMINGTON, CA 92316
T-ihr °F 1wQ"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BOTH2O15-0002
78611 HIGHWAY 111
643220007
LA QUINTA SQUARE / 40' HIGH TEMPORARY CELLTOWER
$15,000.00
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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.:
Date: ( J>4, /
Contractor:
r r
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 applicantfor a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($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.).
(_) 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.).
(� 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 Na
VOICE (760) 777-7125
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 rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sect 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and polity number are:
Carrier: Policy Number: _
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 shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 Building Official 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 city to enter upon the above-
mentioned property for inspection purposes:
Date: Ow, � Signature (Applicant or Agent .
Lender's Address: '
Date: 5/29/2015
Owner:
ACM LA QUINTA IV B LLC
1800 AVE OF THE STARS 105
LOS ANGELES, CA 92253
�a
t
o z�
Z
O
Contractor:
INLAND VALLEY CONSTRUCTION
00 Cq
18382 SLOVER AVE.
o
BLOOMINGTON, CA 92316
Q v s=
(909)875-2112
LIc. No.:
SLS
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 rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sect 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and polity number are:
Carrier: Policy Number: _
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 shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 Building Official 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 city to enter upon the above-
mentioned property for inspection purposes:
Date: Ow, � Signature (Applicant or Agent .
Lender's Address: '
; - DESCRIPTION
FINANCIAL INFORMATION
-7 "ACCOUNT.
QTY,:
AMOUNTy,
. _PAID
PAID DAT
ANTENNA, CELL/MOBILE
101-0000-42404
0
$145.03
$0.00
PAID BY • ,`
" METHOD' _T
RECEIPT #
CHECK #
CLTD BY .
R.. .DESCRIPTION*:- r
ACCOUNT ^,.,
"QTY''
AMOUNT:
PAID
PAID DATE
ANTENNA, CELL/MOBILE PC
101-0000-42600
0
$205.94
$0.00
PAID BY' ,`, F•• - 4
:: _ .METHOD
" ` • N RECEIPT #,
CHECK #
{LTD BY
Total Paid forANTENNA: $350.97 $0.00
DESCRIPTION
` ACCOUNT
QTY
>;AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
" + PAID BY ' : r
METHOD
RECEIPT # M
CHECK #
CITD BY '
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
TOTALS:00
M
11
Description: LA QUINTA SQUARE / 40' HIGH TEMPORARY CELL TOWER
Type: STRUCTURE OTHER THAN Subtype: Status: APPROVED -CONDITIONS
Applied: 5/5/2015 MFA
BUILDING
Approved: 5/28/2015 AOR
Parcel No: 643220007 Site Address: 78611 HIGHWAY 111 LA QUINTA,CA 92253
Subdivision: PM 18418 - Block: Lot: 1
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $15,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites:.0
E-MAIL
AJ ORTEGA
TEMPORARY POWER. 2013 CALIFORNIA BUILDING CODES.
23 ..
t
Details: 40' HIGH TEMPORARY CELLULAR MONOPOLE. THIS PERMIT DOES NOT INCLUDE USE OF GENERATOR, ELECTRICAL INSTALLATIONS OR
Applied to Approved
t •
J
Printed: Friday, May 29, 2015 8:11:15 AM 1 of 4
sysrrnns
ADDITIONAL 1
CHRONOLOGY
CHRONOLOGY TYPE .
STAFF NAME a
ACTION DATE
COMPLETION' DATE
NOTES .
E-MAIL
AJ ORTEGA
5/8/2015
5/8/2015
EMAIL SENT TO KURT NOTIFYING HIM THAT A DIGITAL
REVIEW HAS BEEN CREATED.
EMAIL SENT TO TIM WITH INLAND VALLEY CONSTRUCTION TO
E-MAIL
AJ ORTEGA
5/11/2015
S/11/2015
INFORM HIM OF THE NECESSARY REVISIONS, SEE ATTACHED.
1ST REVIEW NON-STRUCTURAL COMMENTS.
PERMIT READY TO ISSUE WITH VALID CONTRACTOR'S LICENSE
NOTE
AJ ORTEGA
5/28/2015
5/28/2015
CREATED IN AEC AND BUSINESS LICENSE.
PLAN CHECK COMMENTS
APPROVED WITH EXCEPTION COMMENTS RELIEVED BACK
FROM CONSULTANT
AJ ORTEGA
5/11/2015
5/11/2015
FROM ESGIL (KURT CULVER), SEE ATTACHED.
RECEIVED
PLAN CHECK COMMENTS
PLANNING COMMENTS RETRIEVED FROM BUCKET ROOM
FROM CONSULTANT
KAY HENSEL.
5/13/2015
5/13/2015
AND RETURNED TO FRONT COUNTER FOLDER.
RECEIVED
Printed: Friday, May 29, 2015 8:11:15 AM 1 of 4
sysrrnns
INSPECTIONS
CONTACTS
RESULT _• REMARKS NOTES
FINAL" BLD
NAME TYPE NAME
ADDRESSI
R CITY STATE
ZIP
PHONE
FAX
EMAIL,
APPLICANT TIM GAINES
18382 SLOVER AVE
BLOOMINGTON CA
92316
(310)277-8337
CONTRACTOR INLAND VALLEY CONSTRUCTION CO
18382 SLOVER AVE
BLOOMINGTON CA
92316
(310)277-8337
PAID
PAID DATE
OWNER ACM LA QUINTA IV B LLC
1800 AVE OF THE STARS
LOS ANGELES CA
92253
(310)277-8337
1•
r
.
105
_
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT _• REMARKS NOTES
FINAL" BLD
CLTD
DESCRIPTION
ACCOUNT
QT Y
AMOUNT
PAID
PAID DATE
RECEIPT #
•. CHECK #
METHOD
PAID BY
1•
r
-
_
BY
ANTENNA,
101-0000-42404
0
$145.03
$0.00
CELL/MOBILE
ANTENNA,
101-0000-42600
0
$205.94
$0.00
CELL/MOBILE PC
Total Paid forANTENNA: $350.97 $0.00
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
TOTALS:• 00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT _• REMARKS NOTES
FINAL" BLD
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Friday, May 29, 2015 8:11:15 AM 2 of 4 C ' •
SYSTEMS
Printed: Friday, May 29, 2015 8:11:15 AM 3 of 4 071?WlYSTEMS
NO INFORMATION WAS SUBMITTED REGARDING
THE ELECTRICAL INSTALLATION— APPLICANT
REQUIRED TO PROVIDE A PLAN SHOWING THE
ELECTRICAL REQUIREMENTS FOR THE
INSTALLATION, INCLUDING A SITE PLAN SHOWING
ALL CONDUIT RUNS AND EQUIPMENT LOCATIONS,
NON-STRUCTURAL
AJ ORTEGA
5/5/2015
5/19/2015
5/11/2015
REVISIONS REQUIRED
AND A SINGLE -LINE DIAGRAM SHOWING THE
FOLLOWING: SERVICE PANEL AND ITS AMPACITY;
GROUNDING SIZE, LOCATION AND METHOD;
CONDUIT SIZE FROM SERVICE PANEL TO
UTILIZATION EQUIPMENT; AND THE NUMBER OF
CONDUCTORS, THEIR SIZE, MATERIAL, AND
INSULATION TYPE.
* PER THE COAS FOR TUP2015-0011, ALL
SURFACE -LEVEL MECHANICAL EQUIPMENT SHALL
PLANNING
JAY WUU
5/5/2015
5/19/2015
5/12/2015
REVISIONS REQUIRED
BE SCREENED. PROPOSED SCREENING SHALL BE
REVIEWED AND APPROVED BY THE COMMUNITY
DEVELOPMENT DIRECTOR PRIOR TO ISSUANCE OF
AN ELECTRICAL RELEASE
STRUCTURAL
KURT CULVER
5/5/2015
5/19/2015
5/11/2015
REVISIONS REQUIRED
ALL DOCUMENTS HAVE BEEN SCANNED AND
ATTACHED FOR DIGITAL REVIEW
PLAN SHOWS 1-1/2" BASE PLATE PER
STRUCTURAL
AJ ORTEGA
5/11/2015
5/11/2015
5/11/2015
APPROVED
STRUCTURAL 1ST REVIEW COMMENTS BY KURT
CULVER, APPROVED WITH EXCEPTION -TERMS
SATISFIED.
Printed: Friday, May 29, 2015 8:11:15 AM 3 of 4 071?WlYSTEMS
Printed: Friday, May 29, 2015 8:11:15 AM 4 of 4
SYSTEMS
ATTACHMENTS
Attachment Type
—CREATED _.,)
aOWNER a
DESCRIPTION-°
�'PATHNAME '_
-SUB IR
ENABLED
BOTH2015-0002- 1ST
1ST SUBMITTAL
DOC5/8/2015
AJ ORTEGA
STRUCTURAL
SUBMITTAL
0 '
_
STRUCTURAL
CALCULATIONS
CALCULATIONS.pdf
DOC
5/8/2015
AJ ORTEGA
1ST SUBMITTAL PLAN .
-1ST
B613MIT
0
•
AL PLA002
SUBMITTAL PLAN.pdf
IST REVIEW
BOTH2015-0002 -1ST
5/11/2015
AJ ORTEGA '
STRUCTURAL
REVIEW STRUCTURAL
B
-DOC
,
COMMENTS (APPROVED
COMMENTS (APPROVED
WITH EXCEPTION)
WITH EXCEPTION).pdf
BOTH2O15-0002 -1ST
'
1ST REVIEW NON-.
REVIEW NOW
'DOC
5/11/2015
AJ ORTEGA
STRUCTURAL
0
STRUCTURAL
COMMENTS
COMMENTS.pdf
Printed: Friday, May 29, 2015 8:11:15 AM 4 of 4
SYSTEMS
Bin.#
City of La Quints
Building a Safety Division f�
P.O. Box 1504,78-495 Calle Tampico
La.Qtdnta, CA 92253 - (760) 777-7012
Building Permit Application and. Tracking, Sheet `
Permit #
-
Project Address:.. _ - 6 l l /� J,, J i % /
Owner's Name:. M v rL3 �^A
A- P.Number. 6 y3 - z0.-- 00
Address: 1,600 iOrVE. 7-�
Legal Description: /Z t p ,er i GG rvt
Contractor. =ti/`q A." v9 / Jr- CpA_-)S7-
Address:'
Address:' $ /Our- _. ygv,c
City, ST, Zip: [ 5k:5; A h/Geil ems. 6
Telephone: J O .. 2-77- 6>,T3-1__--
,3.3
Project Description:
City, ST, Zip: 1oopn, n t,- TONl CA 97,T16-
AJ R r.,J i -J ��+► O /
Telephone:/Z,
1)11 - B 7S�— Zt
- iv -no
State Lic. # : `/ e. &'-? t7 City Lie.
Arch., Engr., Designer
Address:J �t S /4.4 M .q n.�
rZ /4 N 7YiJ�
City., ST, Zip: 9 BA &Ji,E Z 67 6 (D
O gr iv "
Telephone: •/ " _ `1 Lei
Construction Type:. Occupancy:
project type (circle one): New AMm Alter Repair Demo
State Lic. #: - ti ZO ; aw;� :
Name of Contact Person: C Nty� M& /
Sq. Ft.: 00
#Stories: #Units:
Telephone # of Contact Person: 7/ Y -.'-9477- 5,7,C)
Estimated Valise of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd . Reed TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Calc&
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cates.
Called Contact Person Plan Check :3alance .
Title 24 Cates.
Pian' picked up Construction
Flood plain plan
Pians resubmitted Mechanical
Grading plan
2"s 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
IAY HOUSE:-
'^' Review,' ready for correcU issue Developer impact Fee
Planning Approval.
Called Contact Person AJ.P.P.
Pub. Wks. Appr
Date o t issu
School Fees
Total Permit Fees