0103-190 (TT)"LICENSED CONTRACTOR DECLARATION
Thereby affirm under penalty of,perjury that I am licensed under provisions of
Chapter 9 (commencing with'Sectioii 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
B CiW:� T d,2i
'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 exempt under Section , B&P.C. for this reason
Date z.,• .�f �_.l�! ,` Signature of Owner'";iF.f 4..
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 foIF, 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 work: rs' compensation insurance carrier & policy no. are:
Carrier Policy No:
STATE WND
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 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.
Dater �., _, , Applicant.>r rw""
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
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
y 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 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
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 property for inspection purposes.
Signature (Owner/Agent)• / f _ • 'yam.- Date's > +"f d,
PERMIT#
BUILDING PERMIT
r
DATE VALUATION LOT kR`�,•p�itf�i TRACT
(yun a .. VWXX)
JOB SITE - ''
APN
ADDRESS
78•• (.:1..8 11-2 CORPORAW, CIrF T0.Z' VR
_
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WMIAN `VdA1:f EN tisllRMIP
1•19119CO.RP03 t.Ni"�.;D
'445 �?f 912U.17 7
4921 EIRC-I ) M -E a
,0.�.[a3W1f•4TA01.,11CA CA 96401
X.(tNVP0R*fB.EA(,wH CA 92660
CIM. A 4834
USE OF PERMIT
CONI S °ii f CT14Ost `T RA11<>, .. M T(!P3 2 1,TTI
VALUATION T ION 2itG. Da ins
`€'BMP CXMPTRUCY ION 'I"RAn,91101 AW -423-(30€) 4� fit
p A
r MAR
D
1 9 2001
CITY OF
LA QUINTA
FINI
NCE DEPT
U.33 Y'RE-PAM M4�'J
S0100
i
RECEIPT
DATE /r !
BY
DATE FINALED
INSPECTOR
/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
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 Wall 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)
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
4.
Indio
Lake Elsinore
4.
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Tim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of *Torestry and Tire Protection
210 West San Jacinto Avenue • Perris, California 92570• 909 9 Fax 909 96910
May 14, 2001 -
To: . United Fire Protection, Inc.
2625-A So. Orange Ave
Santa Ana, CA 92707
Re: Fire Sprinkler Plan Review
SDP 2000-673 / USA Storage — Phase II
The sprinkler plans you submitted for the above referenced project have been reviewed by Riverside
County Fire Department Planning & Engineering personnel and are approved with the following
conditions:
1) Provide a 10" alarm bell at each riser.
2) Install tamper alarm on riser supply valve (butterfly) for each sprinkler system.
3) Permanently marked identification signs shall be attached to all control valves.
4) Provide a means to secure each cabinet for spare sprinkler heads & wrenches from theft and
vandalism.
5) A sign shall be located adjacent to the alarm bell worded as follows:
SPRINKLER FIRE ALARM - WHEN BELL RINGS CALL 911
6) Provide for 24 hour monitoring of the sprinkler alarm system.
7) The following inspections/tests are required to be witnessed by the Fire Department Planning
Division staff:
a) Underground: All joints must be exposed. Piping may be center loaded. 200 psi hydrostatic for
2 hours before inspection. After pressure is released, underground will be flushed. The
underground flush shall be done through a pipe or hose equal in size to the sprinkler
underground supply pipe. A diffuser shall be used for all underground flushes.
b) Overhead: All piping must be visible and 200 psi hydrostatic for 2 hours and flushed. Ceiling
panels must not be in place.
c) Final inspection.
The Fire Department job card, approved plans and conditions letter must be at the job site or NO
inspection will be performed.
Applicantfinstaller shall be responsible to contact the Fire Department to schedule inspection.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
RIVERSIDE COUNTY FIRE DEPARTMENT
FIRE PROTECTION
JOB CARD'
THIS INSPECTION RECORD MUST BE
AT JOB SITE WITH AN APPROVED
SET OF PLANS
Location
Case No. ,��2zQQv -6y
Sprinkler Company UL 4 -, d E, r,z
a 4S i t'
Under round Static Dae Inspector
(200 PSI For 2 Hrs. Prior to Inspecti n Time)
(Center Load Pipe Only, Joints and Thrust Blocks Must B E sed).
Undergroun Flush�D—e — �slr5pector
oL SS �7 ! 0 C t y u C
Overhead Static Date Inspector.
(200 PSI For 2 Hrs. Prior to Inspection Time) S y
Fire. Main Installer
Underground Static Date Inspector
(200 PSI For 2 Hrs. Prior to Inspection Time)
(Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed).
Underground Flush wate inspectnI,-
Extinguishing
System Installer
Final Date Inspector
Fire Alarm Installer
Fin Date Inspector
Tank Installer
Fire Main Installer
Underground Static Date Inspector
(200 PSI For 2 Hrs. Prior to Inspection Time)
(Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed).
Underground Flush / pate Inspector:-'\
�J
Extinguishing System Installer.
Final Date Inspector
Fire Alarm Installer
Fin Date Inspector
Tank Installer
Fi ' Date Inspector
FINAL for OCCUPANCY cco,2�/
SS $ of
Inspectof Date
DO NOT OCCUPY THIS STRUCTURE UNTIL
AFTER FINAL. INSPECTION.
264-159 (Rev 10/97)
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
4.
Cahmesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
4.
Lake Elsinore
La Quinta
Moreno Valley
4.
Palm Desert
Perris
Rancho Mirage
4 -
San Jacinto
4.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Tun Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • 909 940-6900 •' ax ( 940-6910
August 14, 2001
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance for the group
S-1 occupancy known as Storage USA, Phase II located at 46-600 Adams St.
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By �
Walter Brandes
Fire Safety Specialist
H:XPEAWPDATAUAQUIMAIPROJECTS INALS%SDP2004873.doe
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2.d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072