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05-0012 (MISC)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 89 A U5/1/2C Date ''' ` 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 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. ( ) 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 workers' compensation insurance carrier & policy no. are: Carrier CONTMENTAI, CAST Policy No. WC 10419 0M (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. Date: " .' Appllcant - 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. 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. i Signature (Owner/Agent) Date PERMIT PERMIT# iBUILDING DATE j' /J VALUATION LOT 00IM012 TRACT JOB SITE f APN ADDRESS 80411,AVI'2RW, 52 - - OWNER CONTRACTOR/DESIGNER/EN (NEER #0' TAY BADAW GRA I. =. COX M1 UC IYON' CO1&A1;Y ` 78-6741II(3IiVi1'AY 111 38004 MONROE Ft. LA QUOMA CA 92253 INDIO CA 92203 (;760)7757500 CBI.# 2341 USE OF PERMIT MIE3CT _AMOU8 (I)TEIdIPOr,ARY CONSTi2.LiC.Y7 ON 't RAILER FOR THE DURATIOTi OF THE JEFFERSON STREET IhIPROVEdd)ENT PROJECT PIER TX.R2000.450 VALUATION I, ,00, 00 I,S TgYM& E D COST OF COINS'r UC'1T0K 115I1i M PKRW,r FEE A TA04AR9t' TEMP CONSTRUCTION TRAILY)101-040-423•,;344 $2MOO k � Y 9UB-170TAI, CONT1' tTC110W AND PLAY C T CIS. $200.00 S3 P12.&PAM FIM $0.00 I'MA36 PRIM ' FEES DUE NOW r 11111111 VIII III VIII IIII 45 IE RECEIPT DATE BY DATE FINALED INSPECTOR 11—Z INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS S ` 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 I I 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 APPROVAL Temp. Power Pole g 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) n March 28. 2000 Jay Haden 73-670I:istiway 111 #f1.78 La Quinta, California 92253 RC: Jafferson Street Improvements Project No. 99-05 Subject: Construction Field Office Agreement Dear Mr. Baden: GRRMTE consTnuunan COMPRI19 S19 2E Z -'7-900- z5-0 SCE E IAI 1 2000 CITY OF LAQUINTA - PLANNING DEPARTMENT This letter serves as our agreement to occupy a portion of your property, located at the southeast corner of "r;ff ;n,qn Street and Avenue 52 in �a Quii�ta, for purposes of a construction field office and storage yard. The terms of this agreement are as follows:. Granite shall set up their comtruction trailer and storage yard, at the location indicated on the attached Exhibit A,* and shall remain in place for the•duration of the Jefferson Street Improvement project being performed for the City of La Quinta. 2. C ranite shall secure the necessary utility services needed for the office trailer and shall pay for diose services based on metering systems that are separate from those that serve your house at 80-111 Avenue 52. 3. Granite shall be responsible for dust control measures within the limits of their construction, yard, access road to their yard, and anv errant tracks made by construction equipment for the duration of occupancy-. =1. Granite shall remove all temporary facilities associated with their construction field office and restore the construction yard space to its existing condition upon completion of the Jefferson Street Improvement project. Tenn not to exceed 13 months from start of construction with acts of God excepted. 5. In consideration for the above use of your property, Granite agrees to remove certain items of debris from your property as indicated on the attached Exhibit A. Theitems are designated as number 1 through number 9 and are referenced as to approximate location throughout your Parcel 1 and Parcel 2 properties. Page 1 of 2 . Southern California Region 38000 Monroe St. Indio, CA 92203 Phone 7601775-7500 FAX 7601775-8227 J FA page 2 of 2 >f Jay Baden IM -arch 28, 2000 6. Granite shall provide dust contra.1 measures during the course of the removal of the items numbered 1 through 9 within Parcel 1 and Parcel 2. 7. Mr. Baden shail be responsible for permanent soil stabilization measures, as may be required by city ordinance, after. Granite has vacated the property and completed the removal of the debris listed on Exhibit A-. .i 8. Granite shall provide a final dust control watering of any and all disturbed soil areas on the property upon final exit from the property. 4 9. Granite shall hold Mr. Baden harmless for actions arising due to the activities involved with the construction operations on -Ir. Baden's property. This agreement shall become effective upon both parties` signature and dating below and the submittal of a certificate of liability insurance to Mr. Haden naming him as an additional insured. Very truly yours. CJ t; CUA STR CTION Co\.T.� Y 'otz J halB aden Date Senior Project Manager Cc: J. McQuillen G. Moschopoulos M Hont E.vhibit'A attached �I2E�+v 15e-2 C--tilr A/G (Z I k)S-7-,-,ze c]> /+ ,;AP P. Mar 24 00 09:06a JAY BADEN MAR -22-00 WED 02:46 Pr GRANITE CONSTRUCTION CO, FAX N0, �• low X"rl ltt ,CSC TlVi 14',R a€ � sa� � l`s r1oR Scc rF cram �� JE F'r o;,s `► t F:rok ,e,��><.ss To EZ: _. 7607715824 760 115 8353 .,i .,- ' P.3 P. 04/04 i ON AV 6 Z we fritlotc.` N G� s,, \ ouA ria) Wy FplAGE b1 r To'e� MIMtNt� o �}C ts'r t UOt1 ` `t PARCEL I >. ' *IT4EM S To UE F—emoyED / i'AZT A l.t.y s Ver EM ?XLJ- J- of C RA r N L r AJW- t "7-;-1CF 1� LRM as I-rzv lK$ MkSotJ Y P LA -5 3 . O 1 of 'AT ATMCA r (eIi'N'1J'Id ii'itI'� AI r ` � • J.�.s •11 . EXHIBIT L.1 ,7 P.O. Box 1504 78-495 CALLE TAM.PICO LA QUINTA, CALIFORNIA 92253 May 1, 2000 Mr. Jay Baden Granite Construction Company 38-000 Monroe Street Indio, CA 92203-9500 SUBJECT: TEMPORARY USE PERMIT 2000-250 Dear Mr. Baden: ,7t (7 60) 777-7000 (TDD) (760) 777-1227 The Community Development Department hereby approves your request to establish a construction trailer at 80-111 Avenue 52 pursuant to Section 9.60.250 of the Municipal Code, subject to the following conditions:. 1. Mounted on the exterior of the construction trailer door shall be a written notice providing emergency personnel your 24-hour emergency phone number they can call in case problems arise that need your prompt attention (i.e., minimum 1 " high letters). 2. - Green screening material shall be installed on the chain link fence immediately. 3. Install one 2A1 OBC fire extinguisher inside the front exit door of the trailer. 4. The City may elect to add conditions to this application request to mitigate any problems that arise not previously addressed herein. in addition to those stated herein and in the attached letter. 5. The applicant agrees 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 permit. The City of La Quinta shall have'the right to select its defense counsel in its sole discretion. C:\My Documents\WPDOCS\ItrApprvl TUP 250.wpd s� ow «: V. S 6. The trailer shall be removed within eights months or January 1, 2001, unless the Community Development Director grants an extension. This decision: may be appealed to the Planning Commission provided the necessary paperwork and filing fee of $175.00 are filed with this office within 15 days. If you have any questions, please contact me at 760-777-7125. Sincerely, JERRY HERMAN COMMUNITY DEVELOPMENT DIRECTOR CHRISTINE DI 101310 Planning Manager CDI:bjs Attachments c: t,�Kuilding and Safety Director, Code .Compliance Department, & Counter Technician Public Works Director Fire Department CAMy Documents\WPDOCS\ItrApprvl TUP 250.wpd P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 December 21, 2000 Mr. Joe Richardson Granite Construction Company 38-000 Monroe Street Indio, CA 92203-9500 fn t. (760) 777-7000 FAX (760) 777-7101 SUBJECT: TEMPORARY USE PERMIT 2000-250 Dear Mr. Richardson: The Community Development Department hereby approves your request for. a six month extension of the above -noted permit for the construction trailer at 80-V1`1 . =Avrue 52 subject to the conditions of approval previously sent to you. Your new expiration d is July 1, 2001. If you have any questions; please contact me at 760-777-7125. Sincerely, JERRY HERMAN COMMUNITY DEVE OPMENT DIRECTOR CHRISTINE DI TORI Planning Manager CDI:bjs Attachments c: Building and Safety Director Code Compliance Department Counter Technician Public Works Director Fire Department G:\WPDOCS\ItrApprvl TUP 250.wpd I't, r I IIIIIII ILII III VIII IIII 44 IE RIVERSIDE COUNTY FIRE DEPARTMENT FIRE PROTECTION JOB CARD THIS INSPECTION -RECORD MUST BE AT JOB SITE WITH AN APPROVED SET OF PLANS Owner _f,,Z rj�a � u.��� f • Date / U Location'yo 3_2 , -q 0f1Z -44 Case No. 0%2 Sprinkler Company Underground Static Date in (200. PSI For 2 Hrs. Prior to Inspection Time (Center Load Pipe Only, Joints and ThrysKBlocks Must Be Exposed). Underground Flush Date Inspector Overhead tatic Date Inspector (200 PSI For rs. Prior to Inspection Time) Overhead Final Date Inspector - Fire Main Installer � uliutirgrouna staticDate Inspector (200 PSI For 2 Hrs. Prior to, nspection Time) (Center Load Pipe I , Jo Oints and Thrust Blocks Must Be Exposed). L derground Flush Date Inspector Extinguishing System Installer Fina Date Inspector Fire Alarm Installer Final Date Inspector Tank Installer Final Date Inspector. FINAL for OCCUPANCY Inspector - Date DO NOT OCCUPY THIS STRUCTURE UNTIL AFTER FINAL INSPECT"ION. 264.159 (Rev 10/97)