BELC2018-0127D 4Qu,�t& VOICE (760) 777-7125
78-495 CALLE TAMPICO ce4ht LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL/ Owner:
Application Number: BELC2018-0127 CITY OF LA QUINTA
Property Address: 54005 MADISON ST P O BOX 1504
APN: 775100004 LA QUINTA, CA 0
Application Description: CRUZ / CELL TOWER MODIFICATION
Property Zoning:
Application Valuation: $18,500.00
Applicant: Contractor:
DERRA DESIGN - STEVE CRUZ P
INSITE TELECOM INC
495 E. RINCON ST. STE # 204 521 W BRIARDALE AVE
CORONA, CA 92879 OCT
10 20,9 ORANGE, CA 92865
CITY OF LAQUINTA (714)282-0663
DESIGN& DEVELOPMENT DEPARTMENT Llc. No.:835985
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: B. C10 License No.: 835985 ,7
Date: a- /a ( Contractor:
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.).
(_) 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
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
Lender's
Date: 10/10/2019
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 k for which this permit is issued.
Z�ave 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9080105
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.
1
Date: fU ��G—/ % Applicant:
WARNING: FAILURE TO SECURE WORKERS' 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 Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalfthis 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 upon the above -
mentioned property for inspection purposes.
Date: 1P ISlgnature (Applicant or Agent):
Dace.'---10/10/2019
Application Number:
BELC2018-0127
Property Address:
54005 MADISON ST
APN:
775100004
Application Description.
CRUZ / CELL TOWER MODIFICATION
Property Zoning:
Application Valuation:
$18,500.00
Applicant:
DERRA DESIGN - STEVE CRUZ
495 E. RINCON ST. STE #
204
CORONA, CA 92879
Owner:
CITY OF LA QUINTA
P 0 BOX 1504
LA QUINTA, CA 0
Contractor:
INSITE TELECOM INC
521 W BRIARDALE AVE
ORANGE, CA 92865
(714)282-0663
Llc. No.: 835985
Detail: REPLACEMENT OF VERIZON COMMUNICATIONS EQUIPMENT - (6) - 6' NEW PANEL ANTENNAS, (3) NEW B13 RRU'S, (3) NEW B66 RRU'S, NEW RAY
CAP BOX AT ANTENNA LOCATION, NEW RAY CAP AT EQUIPMENT SHELTER, WITH 1 NEW HYBRIFLEX CABLE FROM SHELTER TO TOWER [GARRETT
ENGINEERING]. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL
DESCRIPTION
• •
ACCOUNT CITY AMOUNT
HOURLY CHARGE - ESGIL CIVIL ENGINEER
101-0000-42600 2 $210.00
Total Paid for BLDG CITY STAFF - PER HOUR: $210.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.68
Total Paid for ELECTRICAL: $53.36
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS::0
GEM efdx DESERT
PERMIT # D� L,C, 2 W 8 "— C) i Z"l
PLAN LOCATION:
Project Address:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #: .5—Do t
3 /
y
0
Applicant Name: /
,V► I
Address:
City, ST, Zip: H f
Telephone:!f
Email
Valuation of Project $� 7
Contractor Name: /
New SFD Construction:
Address:
Conditioned Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
Arch/Eng Name: t 1,
Construction Type: Occupancy:
Address: _ {
Grading:
City, St, Zip
Telephone: !� , g e—
r7 0
Bedrooms:
Stories: # Units:
Email:
State Lic: C 3z19j City Bus Lic: 76 7 2�
Property Owner's Name: C / �•
New Commercial / Tenant Improvements:
Address: —
Total Building SF
City, ST, Zip /'
Construction Type: VIP Occupancy:S•„
Telephone: 74 d •7 7
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
Rec'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License