0107-106 (COMM)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
IA
f�•a. f •f lI�^�i
9' ate 'l—&-bi Signature of Contractor, --�' • • ry -'- - ^
OWNER -BUILDER ECLARATION
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 Signature of Owner
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.
(,v) I have and will 'maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance (if the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
IITA.T:R IMD 044INITHIT 002O
(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 sr-*,
2ate '0 + Applit
.5 canF..-.,�; ry,m.� •_ .........•ate-..,.......,...w,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and -Jvil 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. .,
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 authorizeirepresentatives of this City to enter upon
the above -mentioned property for lnspection'`purposes.
f�
Signature (Owner/Agent) " N' - Date;' /, f�
BUILDING PERMIT PERMT#
DATE ' VALUATION LOT TRACT
JOB SITE
APN
ADDRESS •�Qf, d•� y� +�j�g•��
_
OWNER
CONTRACTOR/DESIGNER/EN INEER
A:b9lL'.I.1'.��iAl.:.i1.�,A .Y'�.E°.a1.7�ari�F..L 1'! h.4V if
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U,QMriiA CA 92253
BLOO UTaMN, CA 92316
(909)6--75-'2112 MIX.
USE OF PERMIT
COMMERCIAL FJLD0 &55° $Jft' NORA1LM)
PORC:k�d"r'A'TIO 466.0 5F
0". AGEICARPORT 341010 Say
MO -- COMMERMAL. 340A SIB
66100 EF
31}wMA'!CND >C OSIF. OF C:`Q:?MMUMON
� 7fiC�'l.83f9
RUNTKARY
PLAN i;HECK PEX' 101-000-439.318 08162
+v'{ sdla i TZiiC `"iCYOI PEP 1.01-000-419.000 Wl .54
.
W.CRANICAL YEE 101.00042 X -000 axe, say
KLXS."iPJCAL. ME 1.01-000-42Ct,000 S'd.t1+1
1'3:.1lA381140 :FEV, 101.00 19-000 $24,00
f
TRf,3M M } T 1G14 M. " COMA! 100-000-243 -000 $5.63
ALIT N 1121RLIC;" PLACa - COW701-000-255.000 $135.14
VZVEIOPER IMPACT 72
r YA " RLIC ON Atv;f3 PLAN t:'MX
L�1 MISS PIM-PAID FRO
$0,00
A'UG 16 2001
CITY OF LA QUINTA
.
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
i
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
,r
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
F
y
..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:
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1-oGGc� la 60swQ: (PRoW6 KWI j. S&B ?912"T
Ir00.6«L OI(`) - 0� Q-Ri��EQj_C tS.1,fE,
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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)
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Desert Sands Unified School District '
' 47-950 Dune Palms Road ,
Notice: La Quinta, CA 92253 '
Document Cannot Be Duplicated 760-771-8515
r CERTIFICATE OF COMPLIANCE
Date 8/9/01 APN# 658-190-011
No. 22366 Jurisdiction' La Quinta .
Owner NameKSL (AT&T) Permit #'
No. 49-499 Street Eisenhower Drive ,' Log #
.. City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage - 1100
f
Type of Development' Commercial No. of Units 1 '
Comments
bldg. is a cellular site/unmanned equipment. A
- At' the present time, the Desert Sands Unified School District does not collect fees on ,garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has beendetermined the above -named owner is exempt from paying school fees at this time due to the following reason:
Commercial Building
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
.33 X 1,100 or $ 363.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now lie issued
Fees Paid By CASH - Polly Johnson' Teleph, pne 909-506 9825
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow Payment Received $363.00
Check No.
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90-day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to
collect them on the Distdct('s)(s') behalf, whichever is earlier. -
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant ' Copy - ApplicarAeceipt . Copy - Accounting
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: AT&T un-manned cellular. site (SDP 01-701 & CUP 01-061)
La Quinta Resort .
49-499 Eisenhower Drive
Applicant Contact: Polly Johnson - (909) 506-9825
Application / Circulation Date: i p (�
Da e
Development Department ,
di Iorio, Planning Manager
Public Works Department
Steve Speer, Senior,.Engineer
Building and Safety Department
Greg Butler, Building & Safety Manager
I
Date d
J
4
d
Date
Date
AUK
TY LAQUINTA
PL N G DEPARTMENT .
'Pot Wtcs
City. o LaQuinta
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: AT&T un-manned cellular site (SDP 01-707 & CUP. 01-061)
'La Quinta Resort
49-499 Eisenhower Drive
Applicant Contact: Polly Johnson - (909) 506-9825
Application / Circulation Date: -1 pi
Date
Community Development Department
Christine di Iorio, Planning Manager
Public Works Department
Building and Safety Department
Greg Butler, Building & Safety Manager
Date
Date
Date
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