0304-0160 (MISC)44555 Adams St
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04
W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
Ir- ' LILI O Lin133196 AB _ 0'313,1/2(
o Z /Date " s'" ' O ySignature of Contractor -
CD 0
J U co OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 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).
C'')() I am exempt under Section
LO B&P.C. for this reason
N Date Signature of Owner
ON
CA
2<
WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
Lo F- Q () 1 have and will maintain a certificate of consent to self -insure for workarg'
X Lu = compensation, as provided for by Section 3700 of the Labor Code, for the
m Q performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
OLID U Q Section 3700 of the Labor Code, for the performance of the work for which this
H permit is issued. My workers' compensation insurance carrier & policy no. are:
? z Carver I'AT ? RIM Policy No. 000m8-2Att3
w
C)
Q (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
3subject to the workers' compensation provisions of Section 3700"of the Labor
/Code, I shall forthwith comply with those provisions.`
Date: - I q^ C Applicant r J .
Warning: Failure to secure Workers' Compensation coverage his unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. A
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I ceriity that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize represents -hives of this City to enter upon
! the above-mentioned property for inspection urposes.,
t Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE % VALUATION LOT34 ) TRACT
Z/ / / //o C, i
JOB SITEt` le
APN
ADDRESS 44_:S-% AD.AM.1i S'g-".P-
ff
OWNER
CONTRACTOR / DESIGNER / EN (NEER
=Y OF L,A QUWrA
T.?Y.,17 CONTRACTING & MiisMr'Af ING
73495 CA= TAMPICO
9321 3RVLNSt-BLVD
L.A Q31INTA CA 92253
LCt`+IME CA, 92618
(949)305-8080 C:'i 14 6844
USE OF PERMIT
3.&SCE LKNEO S
"6'RUPC)RARY Ct.7NSTf UC..°ION ,r AR -5 Poo tin n 7'ATIO14 PEIT . MUP _
30ti3 6f►3
VALUATION 1.000,00 tS
ESrL`i1 M11" COST OF COMC!1!UCT ON
L,4 *.00
PL+'RAM, FEE Siihi11 ARY
Q
APR 14 2003
CITY OF LA QUINTA
i FINANCE DEPT.:
ate$ -IOTA PLAN C'LiE(±K:
91U.Ofi
` LEB:S PIRE-PAW F WIS
$0100
TOIAL 7P3[ 21 T 7d'i? AS ]DUE 14O W
t
I IIIIIIIIIIIIIIIIIIIIIIIII
08
IE
RECEIPT
DATE /r
I'll (")
BY ' 1 f- "
.::/"
DATE F ALD
INSPECTO
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
OX 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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final6G-ualb�/?/p7
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)
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
April 14, 2003
D.K.S. Contracting & Engineering
9321 Irvine Blvd.
Irvine, California 92618
SUBJECT: MINOR USE PERMIT 2003-403
Dear Applicant:
(7 60) 777-7000
FAX (760) 777-7101
This is.to report that the Community Development:Department has approved your
;reque'st..rto have a temporary construction trailer at 44-555 Adams Street during
construction of City Fire Station #3 based on the following findings:
1 . Adequate parking exists for guests and employees; and
2. Adherence to the conditions will ensure that adverse impacts to surrounding
properties will be minimized. .
Project conditions are:
1 : The trailer can remain on-site until April 14, 2004, unless an extension of time
is granted by this Department. A request for a time extension shall be made in
writing by March 20, 2004: The Community Development Director may, after
reviewing the facts, extend the use of the office trailer for another six-month
period.
2...:.:..:Use of the office trailer shall be limited to the hours of construction as listed in
`the La Quinta Municipal Code (Chapter 6.08, Nuisances). A copy of this time
schedule can be obtained at the Building and Safety Department.
3. A building permit is required for this application. Please apply to the Building
and Safety Department fora permit (760-777-7012).
4. Install one 2A10BC fire extinguisher inside the building by the exit door, and
provide a "Door to remain open during business hours" sign above the exit door.
5. No signs are permitted unless separately approved by this Department.
G:MUP folder/MUP403 dks Trailer."d
. �0 .
6. Mounted close to the front door shall be a written notice informing emergency
personnel of your 24-hour emergency phone number that they can call in case
problems arise that need your prompt attention (i.e:, minimum 1' high letters).
7. All requirements addressed in Section 9.60.210 (Construction .and Guard
Offices) of the Municipal Code shall be met where applicable. The Municipal
Code can be accessed online at la-quinta.org.
8. The applicant and/or property owner agree to indemnify, defend and hold
harmless the City of La Quinta in the event of any legal claim or litigation arising
out of the City's approval of this application. The City of La Quinta shall have
the right to select its defense counsel in its sole discretion. The City shall
promptly notify the applicant/developer of any claim, action or proceeding and
shall cooperate fully in the defense.
9. The City may elect to add Conditions to this application request to mitigate any
problems that arise not previously addressed herein.
This decision may be appealed to the Planning Commission provided the written appeal
and filing fee of $175..00 are submitted to this Department within 15 calendar days.
Please contact our office if you wish to file an appeal and we will assist you.
Should you have questions regarding this letter, please contact the. undersigned at
760-777-7067(Fax 760-777-1233) or gtrousde@la-quinta.org.
Sincerely,
JE HERIy AN
CO UNITY DEVELOPMENT DIRECTOR
T USDELL
Asso ' Planner
Enc.
c: Community Development Director
Ed Randall, Building. and Safety Department
Fire Marshal
Betty Sawyer, Executive Secretary
G:MUP folder/MUP403 dks Trailermpd
APR -08-2603 02:58 PM D.K.S. CONTRACTING & ENG 949 3058081
APR-86,Zp03 02:32 r� •
.t
•
•
00 of La Quanta
Community Development Department
78-495 We Tampico
La Quinta, California& 92253
(760)'777-7123 FAX: (760) 777-1233
OMcz Vii COLY
Cap No. aUD3-403
P.01 j
P.01 Al//
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LMW ab):_
APPLICATION FOR MINOR USE PERMIT APPROVAL
MINOR USE ppRMT applications are reviewed and wpproved'bY the CDn=umnity De"'OPMeat Director
rnum to Section 9.210.020, of the Zoning Code, The p*o6e of the review is to ensure tbst laced uses requiring
aw permit do not have an gdveme impact on surrounding properties, reaidartt, or budp uu-
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&w3f rrAMT D. k. S• c
19iH
MAILING ADDRESS `l3 % –Z . ve3l P-" hone No.
CnT, STA'I'D, ZIP: -L-v 1 e 1 el A 9 a eo /-P Pax No.
PROPERTY OWNER (ifdiftmut):—/
o` I-4 40ki17L&,
(Print)
MAHINO ADDRESS: 7? -45 5 0-24/lc / u-.,., i c pbot+e No.%� 7 T 7 7 o
crry, STATE, ZiP' La Qu 'I'–Cly I � --3 Pax No. 7� %777'
PROJMCT LOCATION:' �'S� �R�•-" `� 'c`-�
pRopOSED USE AND/OR CONSTRUCTION (Including operatiOARI information):
q je r L S Sn"a s-�2- 0#1 o-
( -dub show maw"
LEGAL DESCRIPTION (LOT dt TRACT OR A,P.N.):,-,_,
A16W0ft Llw P9Udt
APR -08-2003 02:58 PM D.K.S. CONTRACTING & ENG 949 3058081 P.02
'APR -06=2503 02:32 Ppe
P.02
O Plot Plow, floor plans and elevation pleas (as determined by Community Devalopmaat Dr pptment ftm.
Five (5) wts of plans on- SW x 11" sheat or folded down Io 8!'S" x 11".
d Filing the for Minor Use Permit, If filing multiple applications, the moat oVm1ve goUoa&n wiU be
obarged full fee, with mnaining related applications discounted 50% for oach. Thin disawat 6= not apply
to �nvitonmentat Inlbrmetioa forin.
+ b t t 4 i 4 + i /♦
NAME OF APPLICANT . �` �' fl1 �-�c r< n ivl e rrn I K c -
(Please Print)
SIGNATURE OP APPLICANT
4
NJAMB OF PROPERTY OwNI?R � c � � O wcl�-'
(Plelfie print) ;--hl
—� SIGNATURE OF.PROPBRTY OWN .BR(S) DATE -G3
IF NOT SAIF AS APPLICANT. _C Ll �r
(Slgroature provide; corient for applies t to use site for proposed activity).
DATB '
(Separate written author* by owner to submit apptleadon may be pravtd4
NOTE: FAL89 OR MISLEADING INFORMATION GIVEN IN THIS APPLICA'T'ION SRALL BE
GROUNDS POA DENYING APPLICATION.
Alr4d rUn Paadv