BOTH2014-001178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Qum&
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BOTH2014-0011
Property Address:
45190 SEELEY DR
APN:
604630057
Application Description:
(25) LIGHT POLES AND (1) FLAG POLE
Property Zoning:
Application Valuation:
$10,400.00
Applicant:
LA QUINTA RETIREMENT
RESIDEN
2264 MCGILCHRIST SE 210
SALEM, OR 0
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 Busi ss and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 678862
I-- I I I ti I I 1 -12 �,
Date: Contractor:
OWNER-BUILDERDECLARATI&QJ X
I hereby affirm under penalty of perjury that I am exempt from 1he 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).:
(_) 1, 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, 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 rea;on
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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/4/2014
Owner:
LA QUINTA RETIREMENT RESIDEN
11CA hArt--ii rUDICT CC )in
SALEM, OR 0
Contractor:
COLSON & COLSON GENERAL CO
2260 MCGILCHRIST STREET SE
SALEM, OR 97302
(503)586-7401
LIc. No.: 678862
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'
com nsation, as provided for by Section 3700 of the Labor Code, for the performance
of t ork for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sectio 3700 of the Labor Code, for the performance of the work for which this permit
�ct
is issue . My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number: _
_ 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 becon)t subject to the workers'
compensation laws of California, and agree that, if I shou eco^ subject to the
workers' compensation provisions of Section 3700 of th t 11 forthwith
comply With h e provisions.
Applica
D nt. 4.u4
WARNING: FAILURE TO SECURE WORKERS'COMPEN TI N COVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL Ph T�13 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 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 inform on is correct.
2,t,
e li
a.s rel�f
I agree to comply with all city and county ordinances and st� __ to bu'ding
construction, and hereby authorize representatives of this city to ente f pon th a ove-
mentionedfrojerty for inspection purposes.
E Signature (Applicant or
A I
FINANCIAL INFORMATION
DESCRIPTION 'ACCOUNT CITY AMOUNT PAID
PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
PAID BY METHOD RECEIPT # CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
FLAG/LIGHTING POLE, EA ADDITIONAL
101-0000-42404
0
$362.50
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FLAG/LIGHTING POLE, EA ADDITIONAL PC
101-0000-42600
0
$108.75
$0.00
PAID BY
e.
METHOD
RECEIPT #
CHECK#
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
FLAG/LIGTHING POLE, FIRST
101-0000-42404
0
$36.26
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
FLAG/LIGTHING POLE, FIRST PC
101-0000-42600
0
$97.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forFLAG/LIGHTING POLE: $604.68 $0.00
TOTALS: $605.68 $0.00
Description: (25) LIGHT POLES AND (1) FLAG POLE
Type: STRUCTURE OTHER THAN Subtype: Status: APPROVED
Applied: 10/14/2014 SKH
BUILDING
Approved: 11/4/2014 AOR
Parcel No: 604630057 Site Address: 45190 SEELEY DR LA QUINTACA 92253
Subdivision: Block: Lot:
Issued:
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $10,400.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: (25) LIGHT POLES AND (1) FLAGPOLE NOT TO EXCEED (35) FEET [ENGINEERED] THIS PERMIT DOES NOT INCLUDE LIGHT BOLLARDS OR
OTHER PHASE TWO INSTALLATIONS. 2013 CALIFORNIA BUILDING CODES.
Printed: Tuesday, November 04, 2014 2:16:48 PM I of 3 CRLafYSTEMS
ADDITIONAL
SITES
CHRONOLOGY
CHRONOLOGY TYPE, STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
PLAN CHECK
COMPLETE/READY FOR PICK
UP
AJ ORTEGA
11/4/2014
11/4/2014
PHONED TERRY JOHNSON FOR PICK UP.
PUBLIC COUNTER VISIT
STEPHANIE KHATAMI
10/16/2014
10/20/2014
SUBMITTAL WAS NOT COMPLETE. SK
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESS1
CITY STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
LA QUINTA RETIREMENT RESIDEN
2264 MCGILCHRIST SE
210
SALEM OR
0
CONTRACTOR
COLSON & COLSON GENERAL
CONTRA
2260 MCGILCHRIST
STREET SE
SALEM OR
97302
Printed: Tuesday, November 04, 2014 2:16:48 PM I of 3 CRLafYSTEMS
CONTACTS
NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX: EMAIL
OWNER LA QUINTA RETIREMENT RESIDEN 2264 MCGILCHRIST SE SALEM OR 0
1 210
INSPECTIONS
SE I QID-' INSPE - CTION'*YPE INSPECTOR ,SCHEDULED COMPLETED RESULT REMARKS '46TES",�"
DATE DATE
FINAL"
I' PARENT PROJECTS I
Printed: Tuesday, November 04, 2014 2:16:48 PM 2 of 3 CRWYSTEMS
FINANCIAL
INFORMATION
CLTD
DESCRIPTION
ACCOUNT QTY
AMOUNT
PAID
PAID DATE RECEIPT# CHECK # METHOD PAID BY
BY
BSAS SB1473 FEE
101-0000-20306 0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00
$0.00
BSA:
FLAG/LIGHTING POLE,
101-0000-42404
0
$362.50
$0.00
EA ADDITIONAL
FLAG/LIGHTING POLE,
101-0000-42600
0
$108.75
$0.00
EA ADDITIONAL PC
FLAG/LIGTHING POLE,
101-0000-42404
0
$36.26
$0.00
FIRST
FLAG/LIGTHING POLE,
101-0000-42600
0
$97.17
$0.00
FIRST PC
I
Total Paid forFLAG/LIGHTING POLE:
$604.68
$0.00
TOTALS:
$605.68
$0.00
INSPECTIONS
SE I QID-' INSPE - CTION'*YPE INSPECTOR ,SCHEDULED COMPLETED RESULT REMARKS '46TES",�"
DATE DATE
FINAL"
I' PARENT PROJECTS I
Printed: Tuesday, November 04, 2014 2:16:48 PM 2 of 3 CRWYSTEMS
I BUILDING I AJ ORTEGA 1 11/4/2014 1 11/4/2014 1 11/4/2014 1 APPROVED I I I
Printed: Tuesday, November 04, 2014 2:16:48 PM 3 of 3 CN?WYSTEMS
ATTACHMENTS
Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR
ETRAKIT ENABLED
APPLICATION BOTH2014
APPLICATION BOTH2014
DOC
10/28/2014
STEPHANIE KHATAMI
-0011.pdf
-0011.pdf
0
1ST PLAN CHECK
1ST PLAN CHECK
DOC
10/28/2014
STEPHANIE KHATAMI
STRUCTURAL - LIGHT
STRUCTURAL - LIGHT
0
POLES AND FLAG
POLES AND FLAG
POLE.pdf
POLE.pdf
DOC
10/28/2014
STEPHANIE KHATAMI
1ST PLAN CHECK Al
1ST PLAN CHECK Al
0
1B.pdf
1B.pdf
DOC
I
10/28/2014
STEPHANIE KHATAMI
I
1ST PLAN CHECKA1 la
1ST PLAN CHECKA1 la
I
0
I (2).pdf
(2).pdf
Printed: Tuesday, November 04, 2014 2:16:48 PM 3 of 3 CN?WYSTEMS
Bin #
Permit #
Project Address: LAS I CA 13
A. P. Number:
Legal Description:
Contractor:
Address: 40 4 -4 -
City, ST, Zip:
Telcphonc:SQ:�-UA-M-
State Lic. 4:
Arch., Engr., Designer:
Address:
City., ST, Zip:
relephone:
3tatc Lic. it:
'4ame of Contact Pers
Fcicphone 4,of Contact Person: C
City of La Quinta
BuMing &r Safety Division
P ' 0. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
A 12 LC)
ddress:
City, ST, Zip:S&l t -M 0 fi,
Telephone:
:z a6
Project Description:
PF
Lie.
P
Olt=
ancy:
--ruction Type:
O&P
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . ....... .
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: If Units:
660n ) I # Stories: .
9A, A -'1141 C, Estimated Value of Project: '419r 4 14,n�#
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Rcqld
Rcc'd
TRACMG PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural C21cs.
loe
Revivived,'rcady for corrections Plan Check Deposit
Truss C21cs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Mood plain plan
Plans resubmitted Mechanical
Grading plan
2" Review, ready for correctionstissue Electrical
Subcont.qctor List
Called Contact Person Plumbing
Grant Deed
Plans picked up -ft
�ittcd Gradin
1Y.O.A. Approval
IN HOUSE:-
31d Review, ready for.corrcctio srissu cvclop Impact Fee
lled Contact Person A.I.
Date o rmit issue
Planning Approval
Pub. Wks. Appr
School Fees
DMcisir.
Total Permit Fc rpL6�lrla V
OCT 14 2014
10 1 'Li UM� Ot
MY OF. LA QUINTt�
0 COMMUNI7Y DEVELOPMENT