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LICENSED CONTRACTOR 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 # Lic. Class ' Exp. Date
667057 B . 03/3'112(
Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury.that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am ex mp •under Section B&P. r,this rea /
Date �' Signature of Owner i 9
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 & policy no. are:
Carrier
Policy No.
STATE FUND . 1.$1f97�St
(This section need not be completed if the permit valuation is for $100.00 or less).
4v�(o�) I certify that in the performance of the work for which this permit is issued,
all 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 Ifo hwith comply with those rovisions.
Date: Applicant—
Warning:
pplicant ,
r
Warning: Failure to secure Workers' Compensation coverage is unla
shall subject an employer to criminal penalties and civil fines up to $10Phi;
n
addition to the cost of compensation, damages as provided for in Seoti
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building an
for a permit subject to the. conditions and restrictions set forth
application.
1. Each person upon whose behalf this application is made & each p -rson
whose request and for whose benefit work is performed under or.pu uant to
any permit issued as a result of this applicaton agrees to, & shall, i
& 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
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope� inspection purposes.
'
Signature (Owner/Age z% Date O
BUILDING PERMIT PERMIT#
DATE VALUATION LOT W12 "W9 TRACT
Q
JOB SITE
APN
ADDRESS 79-120 C"ORP01WFE C - M DMAK
••� �-��i�9
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TiBIINOORPORATM
32:;5 W M tal L14
4921 MRCH M' EM I
+�re"iC�'ItJI� CA 95219
NEWPORTBRACIR CA 92660
(!14)851-2211 (MLO, 4834
USE OF PERMIT
t. OMMM1 a41.
39LP STORA.01F, FAC] 1'TY (RUILOTNO C)
CONTRACT AMOUNT W"
.�.7t.R,R"�iA�'4.4 S i. W' C`Ld',i`JNs.Gi'hU4.A4.JO
'��,,,yy�..�� .yyyy�,•;vpyy,,
� �.F.�.6pr�,�t`}0-00
yq y��,�y�ggr�yl5�F.Y
CX)N 1TRUC' ION IT -1 101.000-41a-000 31,001-00-
1,001. 0.T?IAN
PIAN101-00"J9_318
MECTR1C , FER 101 AQ0,420.000 MUD
STIZONO T► OVOW EF . 100-000-241 -000 448.02
'COMM
(ium't a nx, 101460K)423-000 32ADO
D,P'�TELOPIM IMPACT PEE $11,595,10
.a ._ PIN."' ..�y • :r0'4Jf 701ui10(lu�.`>Sur}(}0
APR 3 2001
CITY OF LA OUINTA .T.Bi-TCaYf,
FINANCE DEPT TAM" PRY, P.A1D'Fn7ut
$0,00
Wr PEi YWIVn" IN DUE 1q0W
$14,01.►31
RECEIPT
DATE {
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs OY
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return 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 Wali insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
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:
_
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)
-Awqi''^`.+'.'�W�:T�„':Myy',rf`'"{'�++.,y.#$1'C1Tt.�...+�; r1+c::�'�,s1'.+tit`'-i-st';`''+i9.'�%�C5/17r'-i+Y�^
(wSladden Engineering
6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax -(760) 772-3895
Date LI -6-6/
Job No. !?7-00 `
FIELD MEMO '
Project Name Q &1Y174 � � � > ,I)rg(2 e Client:
c. -
Site Address
/9
Job Phone
Work Done
Test Summarii / Footings Inspected
Test
No.
Location
Elev.
Dry
Density
Moist
%
% Relative
Compaction
Ref. Max
pcf
Moist
%
rnmmantc
M/field-fekkf
Super. or Agent
24 hour notice requested to schedule Field Technician." Thank you for:the opportunity to be of service.
Y A QUINTA
BUIL{ & DEPARTMENT
nSPCLLC
2
INSPECQUEST LINE
A 001 N53
CITY OF � pEP�
F N
Contractor HBI INCORPORATED
Permit Number 0012-009
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRES%9-120 CORPORATE CENTRE DRIVE
SELF STORAGE FACILITY (BUILDING C)
TYPE OF INSPECTION
DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
. 2 --ol
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING 8 VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
Q ,G
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST /
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED I
TEMP POWER
D F_-+)7 P01 X131 r l
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
7 C)
Certificate.of Occupancy
City. of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building. construction or use. For the following:
BUILDING ADDRESS: 79-120 CORPORATE CENTER DRIVE
Use Classification: SELF STORAGE FACILITY (BLDG A,B,C & D) Bldg. Permit No.: 0012-007,008,009 &
010
Occupancy Group: S-1 Type of Construction:
Owner of Building: LA QUINTA SPC LLC
TEMPORARY CERTIFICATE OF OCCUPANCY
Building -Official
II N Land Use Zone: CR
Address:
3255 W MARCH LN
City:
STOCKTON, CA., 95219
By:
DANIEL P. CRAWFORD JR.
Date:
30 DAY TEMPORARY - EXPIRES 9/8/01
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-120 CORPORATE CENTER DR
Use Classification: STORAGE FACILITY Bldg. Permit No.: 0012-
007,008,009,010
Occupancy Group: S-1 Type of Construction: II N Land Use Zone: CR
Owner of Building: LA QUINTA SPC LLC
l
Building Official
Address: 3255 W MARCH LN
City: STOCKTON CA 95219
By: KIRK KIRKLAND
Date: 8-14-01