9704-097 (SOTB)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,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.
()C) 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 Policy No.
FUND
1'.* 1 <7 11-%
(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,73700 of the Labor
bode, I shall forthwith comply with - those -provisions. %
, Date: 'i�/ C/ Applicant %I'Ilr,/tfx'1r.
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
jr�te above-mentioned property, for inspection purposes.
ignature (Owner/AL T�` _ � 1 ! ( I r`�, Dated -*O'// %
PERMIT #
BUILDING PERMIT
CONTROL #
97(14-097
5022
VALUATION ��11'll LOT TRACT
DATE 02197
JOB SITE
ADDRESS 81I-345AVEI!VE54
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
%,9t'sRV GRIFFIN
t:!\!:; r "VAl.l.EY C ON 11RI 11C. N
81345 AVENUE 54
54MO AVE AL^VA[dADO
[.A Q1,1[NTA CA 92251
i,A QIAN •A CA 92243
f 611W_
Ci3[A
1961
USE OF PERMIT
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSP9CTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS=
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings — v
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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)
COMMENTS:
(,
�! ,' i IIIIIIIIIIIIIIIIIIIIIIIII 73
P.O. Box 1504 - — -- - --
78-495 CALLS TAMPICO (760) 777-7000
LA QUINTA, CALIFORNIA 92253 (TDD) (760) 777-1227
February 17, 2000
La Quinta Arts Foundation
P.O. Box 777
La Quinta, California 92253
SUBJECT: MINOR USE PERMIT 2000-192
Dear Applicant:
The Community Development Department approves your request to hold a private 15
minute fireworks show at 8x1-345 Aven�- ue�54�on February 20 (Sunday), pursuant to Section
n
9.60.170 of the Zoning Ordinance, subject to the following conditions being completed by
February 18, 2000:
1. A notice shall be given to the existing residential property owners within 500 feet of
the site informing them of the fireworks show. A copy of'the written notice shall be
given to the Community Development Department.
2. The firework's contractor shall obtain a City Business License
3. Obtain a Public Fireworks Display Permit from the Riverside County Fire
Department.
Additional conditions are:
4. Any trucks used to transport fireworks to the site. shall be parked a minimum
distance of 500 -feet from any residential house until the live mortars are unloaded.
The firework's contractor shall comply with the regulations contained in Chapter
11.20 (Explosives) of the La Quinta Municipal Code and Charter.
5. The Riverside County Fire Department shall be on-site during the fireworks show,
unless other contractual arrangements have been made with their Department.
Please contact their office at 760-863-8886.
6. The site shall be left clean of any litter or fireworks canisters by February 21, 2000.
7. By holding the fireworks show, the applicant and property owner agree to indemnify,
defend and hold harmless the City of La Quinta in the event of any legal claim or
MUP192 Fireworks - 39 _OD,
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.
The City may elect to add Conditions to this application request to mitigate any problems
that arise not previously addressed herein.
If you have any questions, please contact meat 760-777-7067.
Sincerely;
JET Y 7RMAN
COIWMUI�YITY DEVELOPMENT DIRECTOR
af4 -Assoclanner
Enclosures
c: City Manager
Community Development Director
uBuilding and Safety Director
Public Works Director
Community Services Director
Code Compliance Department
Fire Department
Sheriffs Department
FEE -15-00 05:29 PM LQAF
®2-11-60 12:30 pity of LaQulnta Comm.Dev-DSP{
760 564 6884 P.02-1
ID- 769 777 1233 P•02
Cite of La Quinta
Community Development Department
78.495 Calle Tampico
Le Quinta, California 92253
(760) 777-7125 FAX (760) 777-1233
�` IIIIIIIIIIIIIIIIIIIIIIIII 74
1E _
OfrCE USE ONLY
9�-
Datc
Fee: ��-
Relaced Apps.:—.
APPLICATION FOR MINOR USE PERMIT APPROVAL
NUNOR USE pMMIT applications are reviewed and approved by the Corn nlmity Development Director
pursuant to Se, tion 9.210-020, of the Zoning Code. The purpose of the review is to ensure that land uses requiring
the permit do not have an adverse impact on surrounding properties, residents, or businesses'
APPLICANT u
t r
�,
MAILING ADDRESS Phone N�—� r
CIT1, STA'T'E, ZIP; � c9. � 9 2 FaxNo.
PROPERTY OWNER (If different :
(Print)
�( Phone
MAILING ADY?RP.S5•���,��_ ,..•ri ��la.
CITY. STATE, ZIP: - Qom. - 2 - Fax No._
PROJECT LOCATION:���'-
pAopOS'ED USE AND/OR CONSTRUCTION (Inciudkg operational�information): ' __� r
-
LEGAL DESCRIPTION ('LOT & TRACT OR A.P.NJ: -.
Al 9%1&01Use PmWt
02-15-00 18:22 RECEIVED FROM:760 564 6884 P-02
FEE-15-00 03:44 PM LQAF 760 564 6334 P_03'
._ IDS 766 777 1233 P•03
182-11-66 12:36 City of '1.e6Uinto Comm.Dev-Dept
��3ISSID ent slafy)
L-1 Plot Plan, floor plans. .
and elevation plans (as detemined by Community Devolopment DepaAM
Five (5) sets of plans on Sy:" x 11' sheet or folded &Wfti
togy3"x11
fee for Minor Use Permit. If filing multiple applications, the most expensive application will be
C3 Fiimg related applications discounted 50% for each. This discount does not apply
in
charged full fee, with cemain
3 to Environmental In OMatiofl forrr,.
4 ++ + !'
NAME OF APPLICANT (Please Print),
SIGNATURE OF APPLICANT
i NAME )F PROPERTY OWNER _--r
(Please Print) .
j SIGNATURE OF, PROPERTY OWNF'R(
IF NOT SAME AS APPLICANT:10,
to proposed activity).
( (Signature provides consertfur applicant
(Separate written authoWy by owner tv submit application may ba provided)
NOTE: FALSE OR MISLEADING INFORMATION GIVEN Il` THIS APP=1CATiON SHALL BE
GROUNDS FOR DRNYII\G APPLICATION'
AIKAia0s Uce Permit
02-15-00 16:37 RECEIVED FROM:760 5.64 6884 P•03
FEB -15-00 03:45 PM LOAF 760 564 6884
�62-11-00 12:31 City of LaAuinta Camm.Dev.DNPZ ID- 760 777 1233
1
02-15-00 16:38
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RECEIVED FROM:760 564 6884
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