11-1345 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T '4a Q
-4bt 4
Application'Number.=- 11-000013451---
Property Address: 78788 HIGHWAY 111
APN: 643-080-015- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 9500
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 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: B License No.: 835985
Date: /'' 7-! 2— CContractor.
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).:
(_) 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:
CVWD
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/12
P O BOX 1058
COACHELLA, CA 92236 (� QffNTA
rANNContractor: IINSITE TELECOM INCCIiYQFa.Af;iJi
521 W. BR IARDALE AVENUE Ty 0F� ' �
ORANGE, CA 92865 ;''t''
(714)282-0663
Lic. No.: 835985
-----------------------------------------------
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 LUMBERMEND INS Policy Number 416951
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 shall forthwith comply with those provisions.
Date: 4—/7-1c7- Applicant:
WARNING: FAILURE TO SECURE RKERS' 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.
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 propert for inspection purposes.
Date: -�'/7 /Z - Signature (Applicant or Agent): r
Application Number 11-00001345
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . . 117.00 Plan Check
Fee
76.05
Issue Date . . . . Valuation
. . . .
9500
Expiration Date 7/15/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00.. 9.0000 THOU BLDG 2,001-25,000
-----------------------------
72.00
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 15.00 Plan Check
Fee
3.75
Issue Date Valuation
. . . .
0
Expiration Date 7/15/12
Qty Unit Charge Per
Extension .
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACEMENT OF 3 EXIST. PANEL ANTENNAS
AND INSTALLATION OF 6 ANTENNAS ON
EXISTING VERIZON WIRELESS MONO PALM.
PLANS PER TIA-222-G STANDARD BY
ENGINEER: L. SCOTT BETANCOURT SE 4296.
2010 CODES MUP 2011-1034.
-----------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW.FEE
7.61
HOURLY PLAN CHECK
98.00
STRONG MOTION (SMI)
- COM
2.00
Fee summary Charged Paid Credited
---------- ------- -
Due
----------------- ----------
Permit Fee Total 132.00 .00
.00
132.00
Plan Check Total - 79.80 .00
.00
79.80
Other•Fee Total• 108.61 .00
.00
108.61.
Grand Total 320.41 .00
.00
320.41
'1
LQPERMIT
Bin. #
Of, • .
Cly}/ Lauin
Qta
Building at Safety Aivision
P.O. Box 1504,78-495 Calle Tampico
La.Writa, CA 92253 -:(760) 777-7012
I Building Permit Application and Tracking Sheet
Permit #
g
ProjectAddress: }� (l (Alltrll6iOiII S(
-
Owner's Name:. I' V►A��e'K� Ivi�s{Tt L
A. P. Number. GL(S ^ C)f�)b _ 0.1
Address: Q 5
Legal Description: ajtcE(, A
City, ST, Zip: COO 4T CO -
Contractor
Contractor. -' eco
Telephone: Q - 39 (6 - Z6, 5 I
Address:Sa
Project Description: (4 ke- fblZ U ke Re' AcE'MetA
City, ST, Zip:i f 2 S
0f- (1 /577/J(o PAYU�
telephone: i _ ,t -0663`"
City Lic. #
t"TL�/lRfiS IYUS 661 O
C(o� NEW FAt4e-n Aou-�&-xwrt-5 G j
State Lie. # :
ArcL, E°grDesign F0,044 k boot 5.
-XIA5 35
Address: Zrz0 .t:,(, jA) 6 tl> A(
City., ST, Zip: 7U Cot `�0 7 a 0
Telephone: Gi U ^
Construction Type:. V-13 Occupancy: S.-2
Project type (circle one): New Add'n ter Repair Demo
Sq, Ft.: #Stories: # Units: --�
State Lic. #: --Qi(p LI
Name of Contact Person: J 0 DDE�'S1�U
Telephone # of Contact Person: 1 L( -7.3Q - (D60
Estimated Value of Project Q G380 SQ
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACMG
PERMIT FEES'
Plan Sets
3
Plan Cheek submitted
It. Amount
Structural Coles
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Cheek Balance
Title 24 Glee.
Plana picked up
Construction
Flood plain plan
Pians resubmitted • .
Mecbariical
Grading plan
V Review, ready for correctio issue
-Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.ALL
H.O.A. Approval
Plana resubmitted
Grading
IN HOUSE:-
''' Review; ready for eorreedonsllssne
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr,
Date of permit issue , rq
School Fees '
I! UJill
'DEC 2 0 2011
Total Permit Fees
A.
21 / 3
010m,/�/�"��-27-11-
•'/4:SEzcu.,4pp• .
13.... _/ ri m do.. 4T�� ,Q F,l Yah 14111 dAAf- A�sAP .dA& 4AAJ
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA,CALIFORNIA 92253
To: Greg Butler, Building & Safety Manager
From: Les Johnson, Director -Planning
Permit #:
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-701 1
To CDD:1 Z ' Z® ' I�
`Due Date: i Z ' 21 • It
Status: I37 Cy-
Building Flans Approval
(This is an approval to issue a Building Permit)
The Planning Department has reviewed the Building Plans for the following
project:
Description: A�W& -is CELL Towex
Address or General Location: 78-0450 4AAAJ 5" dow-0-p 0bo
Applicant Contact:
The Planning Department finds that:
O ...these Building Plans do not require Planning Department approval.
..these Building Plans are approved by the Planning Department.
O ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Planning Department for review.
Les Jo
n, Director -Planning
Date
elVed
DEC 2 f
City of La QL,*Jt6
Planning-nepartnarvf
EsGil Corporation
In (Partnership with Government for Building Safety
DATE: 1/9/2012
JURISDICTION: City of La Quinta
PLAN CHECK NO.: 11-1345
PROJECT ADDRESS: 78-888 Highway 111 '
SET: I
PROJECT NAME: Verizon Wireless "La Quinta Retail" MTX 44
❑ APPLICANT
❑ JURIS.
❑ PLAN REVIEWER
❑ FILE
11
® The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
❑ The plans transmitted herewith will substantially comply with the jurisdiction's codes
when minor deficiencies identified below are resolved and checked by building department staff.
❑ The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
❑ The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
❑ The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
❑ The applicant's copy of the check list has been sent to:
® EsGil Corporation staff did not advise the applicant that the plan check has been completed.
❑ EsGil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: ) Email:
Mail Telephone Fax In Person
® REMARKS: structural review only
By: David Yao ' Enclosures:
EsGil Corporation
❑ GA ❑ EJ ❑ PC 1/4
Fax #:
JAN 10 2012
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576