0106-156 (MISC) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
U) 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 DATE VALUATION LOT TRACT
04 W Professionals Code,and my License is in full force and effect.
O :) ch License# Lic.Class `Exp.Date
� LU i'
r JOB SITE APN
� W � S ��'C! � f 0������.�� ADDRESS ��—�'II�XI,��.�1.4.�b.T,�S:�.�J
Z t- Date 11-1 l Signature of Contractor, ���`^;`�� � OWNER CONTRACTOR/DESIGNER/ENGINEER
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J U OWNER-BUILDER DECLARATION WUM21Y CLUB PARTNERS CSO G'J+,PMIQL144 I9kN31,01 ;NT
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's d 10 0 xAMME S3 796 7 COM RY CUB)BIZ 4201
~ W License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole '� 13 1�? C 25 33IQ60)343-71155
0)343-711)�fJl +e � ZSlI
compensation,will do the work,and the structure is not intended or offered forGn34'S•P P�� �` 1��
sale(Sec.7044,Business&Professionals Code). USE of PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals MKS K LANE-10j�
Code). IIIIIIIIIIIIIIIIIIIIIIIII 70
c () I am exempt under Section , B&P.C.for this reason '.YMPORARY'COM'S t'2?UCTION T�LfB.TLER AS F�LrFP,..A�UP 2000.293 IE
N Date Signature of Owner --
O N
rn
Z WORKER'S COMPENSATION DECLARATION
CL
C) Q Z I hereby affirm under penalty of perjury one of the following declarations:
O O 1 have and will maintain a certificate of consent to self-insure for workers' VALUATION )'S
X W tL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers'compensation insurance,as required by
O CJ Q Section 3700 of the Labor Code, for the performance of the work for which this
IlLOZ permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
w O '01AT FUND 229.99- 4 229-994037116 �:�,'W#4W(ED c(�SM OrC�Q�.�T URTY:�'�'&t�.�i 21 ,
Q (This section need not be completed if the permit valuation is for$100.00 or less). PRIR #3F' E Wq MAUR 1
J ( ) I certify that in the performance of the work for which this permit is issued, TOM-1 CONST ROOTION TRMLE)101-000.423,NO 52�4.�t1
1 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 ofSection 3700 of the Labor
Code,I shall forthNith comply with those provisio6"c '
Dafe: Applicant
Warning: Failure to secure Workers'Compensation coverage is unlawful and DF
nl
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 N I 3 2nn1
for a permit subject to the,ponditions and restrictions set forth on his
application.
1.Each person upon whose behalf this application is made&each person at CITY OF I A Of INTA `
whose request and for whose benefit work is performed under or pursuant to ;��}f3 "t1`T Asi '37 r * Cl��F �,fQ�sf� t ,L';1 , �a)fJ•CC,
any permit issued as a result of this applicaton agrees to, &shall, indemnity USM PRE-PAR)1101 f $0100
w & hold harmless the City of La Quinta, its officers, agents and employees.
2.Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such TOTAL M"Iff FEEN:1$UE NOW &2MAM
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>'rispection purposes. /
, { RECEIPT DATE ! BY f DATE FINALED INSPECTOR
Date
,Signature (Owner/Agent) -���j u �, '• n �'` u t �` -°
w^r
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
O.K.to Wrap F.A.U.
Framing Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans 8 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 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 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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�{ P.O. Box 1504
^f �? 78-495 CALLE TAMPICO (760) 777-7000.
P
�1g� r LA QUINTA, CALIFORNIA, 92253 FAX (760) '777-7101
June 12, 2001
Ms. Kristie Porter
Country Club of the Desert
P.O. Box 980
La Quinta, CA 92253
Subject: Minor Use Permit 2001-293 (Temporary Management Office Trailer)
Dear Ms. Porter,
The Community Development Department has approved your request for a temporary
management office trailer just north of 81-1051/ 53RD Avenue, subject to the
enclosed plan and the following conditions:
1 . Obtain a building permit including an electrical permit for temporary power and
fencing.
2: Trailer shall have restroom facilities to accommodate personnel.
3. Mounted on the exterior of the trailer close to the front 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).
4. Install one 2A10BC fire extinguisher inside the trailer by the front exit door.
5. No temporary signs. are approved unless separately approved . by this
Department.
6. Removal of the temporary construction trailer is required by June 12, 2002, or
upon completion of a permanent management facility, whichever occurs first.
An extension of time may be requested prior to expiration.
7. Trailer skirting shall be installed within 30 days if the trailer is mounted above
finished grade level.
J V�
A
A!
8. Any permits required by.the Public. Works Department shall be obtained prior
to any work proceeding.
9. Developer 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 project. The City of La Quinta shall have the right to select its defense
counsel in its sole discretion.
10. 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 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 760-777-7064.
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
STAN B. SAWA
Principal Planner
Attachment
c: Building and Safety Director
Public Works Director
Code Enforcement Department
Fire Department
Sheriff's Department
P:\STAN\Itr app mup 2001-293.wpd
• Coachella Valle Unified School District i 71
y. This Box For District Use Only IE
83-733 Avenue 55, Thermal, CA 92274 DEVELOPER FEES PAID
(760) 398-5909 — Fax (760) 398-1224 AREA. AMOUNT
LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMM/MD.AMOUNT:
DATE: RECEIPT: CHECK N: INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Easf`oflVMadisoii1 C =The°1VI;adlson Club) Date: March 10,2006
Owner's Name: East of Madison LLC Phone No. (760)391-5072
Project Address:_ 81-650 Avenue 53,La Quintal CA-
Project
A-Project Description: Temporary Club Dinning/Temporary Sales Office/Temporary Pro Shop (Tents w/con. slab)
APN: 767-210-009 Tract #: Lot#'s:
Type of Development: Residential Commercial XX Industrial
Total Square Feet of Building Area: 3,325 sq.Ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: 03/10/06 Signature: C�
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAV EN OR WILL B ATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov.Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 3,325 sq.ft.
Amount per Sq.Ft. $ 2.88
Amount Collected 1 1,396.50
Building Permit Application Completed: Yes/No
By: Carey M. Carlson,Asst. Supt.,Business Services
Certificate issued by: Leticia C.Torres,Facilities Clerk Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEME F FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081,effective January 1,1997,requires that this District provide(1)a written notice to the
project appellant,at the time of payment of school fees,mitigation payment or other exactions("Fees"),of the 90-day period to protest the imposition of these
Fees and(2)the amount of the fees. Therefore,in accordance with section 66020 of the Government code and other applicable law,this Notice shall serve to
advise you that the 90-day protest period in regard to such Fees or the validity thereof,commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally,the amount of the fees imposed is as herein set forth,whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty(30)days from the date of issuance. Extension will be granted only for good cause,as determined by the School District,and up
to three(3)such extensions may be granted. At such time as this Certificate expires,if a building permit has not been issued for the project that is the subject
of this Certificate,the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
i.f,c'mydiu+s,'dcvfi�sicortiticat�+�fcompiian c form tables i to USF:.dac 1/16/03 T
I .� Building & Safety Department.
78-495 Calle Tampico
OF T PO Box 92247-1504
La Quinta, CA 92253
(760)777-7012 voice—(760)777-7011 fax
CERTIFICATION OF BUILDING AREA
STREET ADDRESS OF JOB: 81-650 AVENUE 53 (Madison Club)
APN: 767-210-009
DESCRIPTION OF WORK: Temporary Club Dining (tent w/ conc. Slab)
Temporary Sales Office (tent w/ conc. Slab) Q`
AI.
Temporary Pro Shop (tent w/ conc. Slab
SQUARE FOOTAGE: Club Dining = 1,500 Sq.Ft. Conditioned Area
Sales Office = 625 Sq.Ft. Conditioned Ar
4� Q
Pro Shop = 1,200 Sq. Ft Conditioned IWIR .
OWNER'S NAME: EAST OF MADISON LLC.
P.O. BOX 1482
LA QUINTA, CA 92253 OP ,
PH: 760-391-5072,
Coachella Valley Unified School District
83-733 Avenue 55
P O Box 847
Thermal, CA 92274
(760) 398 5909
SCHOOL FACILITY FEES COLLECTION HOURS:
8.00 A.M. - 4.00 P.M. Monday- Friday
PLEASE NOTE:
FEES MUST BE PAID IN CHECK OR CASHIERS CHECK. NO CASH.
For questions regarding this letter, please call.
Ed Randall, Counter Technician
(760) 777-7012