MISC (9903-061)55016 Madison St
9903-061
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
g3filCS A 10,'31!99
r' <
. '
vDateate M 2 `+ 4f Signature -of Contractor
OWNER -BUILDER DECLARATION
Thereby 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.
(a) 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.
VORIM—MI'j.SURAT WX16=64338
(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 th ,L-abor
Code, I shall forthwith comply with those provisions. ✓ P
vl5ate: `a ' ]°I Applicant
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'pu/rposes.
/Signature (Owner/Agent) _" =" -^ ✓ Date 9
' ' f
PERMIT#
BUILDING PERMIT
"03-061
DATE 313199 VALUATION S28.1i.fJo LOT TRACT
JOB ADDRIT S P4116 tAiAlUI,S014 STRE11"T
APN ... _
55-01 ca
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'KS:i.:D S RT.RIaSC Y.` S 111,11C
LAYS DSC PTH'S'(111LINTITED INC;
49-499 El SEI HOWER M
1601 OLD CI` ENEY RD
LA QUIN rA (:;A 92253
LINCOLN N1 68512
(402)423-6653 CBL 4
USE OF PERMIT
MISCELLANEOUS
INSTALL TEMPORARY Ci3NST12i iC ':ii3N R ATTi.I t PFA A091 -i21
.
j
MAR 0,3 1999
V'ALaTei tc N 295,00x.,1
"i :
ITY OF LA QUI.
ES'i'IMT D COST OF C+DI+t;;.i'.RUMOAN
kap f.ui
PERMIT KE SUMMARY
x`isMP C t0;TWJCT1'0N RXILE110.I-000-423-000
r
SK►MICfI'AL C-C)NMEic,:°rON AND Pf AN r HFCK.
MM
.EPSS PR,E-PAID PT, ES
$0.00)
` k fAI.. leEAMIT FUS DidF iN0W
5200.00
RECEIPT
DATE
BY
FINALED
INSPECTOR
NT
INSPECTION RECORD
OPERATION
DATE
I 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 & 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 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
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:
ILE COPY
T4 4 Q"
78-495 CALLE TAMPICO —, LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
TDD (760) 777-1227
March' 2, 1999
Mr. Detrick Brock
Landscape Unlimited
1601 Old Cherry Road
Lincoln, NE 68512 -
SUBJECT: MINOR USE PERMIT 99 -121 -
Dear Mr. Brock:.
The Community Development Department has approved your request to establish a temporary
construction trailer (8' by 24') for grading of the Greg Norman Golf Course on the east side of
Madison Street approximately -2,400' north of Airport Boulevard, subject to the following conditions:
1. Obtain a building permit.
2. Provide restroom. facilities to accommodate on-site construction workers.
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
problems arise that need your prompt attention (i.e., minimum 1" high letters).
4. Install one 2A1 OBC fire extinguisher inside the trailer by the front exit door.
5. No temporary signs are permitted unless separately approved by this Department.
6. Removal of the temporary construction trailer is required on October 31, 1999, unless a time
extension is applied for and granted by this Department. The Community Development
Director may extend the permit for another six-month period if construction activities are
still occurring. No fee is charged to extend this permit.
7. All on-site temporary employee facilities (sales, construction, equipment storage/staging,
etc.) shall be provided with paved, compacted or otherwise stabilized parking'and access
during their operation, with those improvements to be constructed/installed to the applicable
Public Works Department standards, pursuant to Fugitive Dust Mitigation Plan #99-56 (i.e.,
Condition #15).
MUP99-121 -30
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
8. Trailer skirting shall be installed within 30 days if the trailer is mounted above finished, grade
level.
9. An opaque material shall be attached to the inside of the storage yard fence to reduce views
of.the grading equipment by March 24, 1999. The opaque material shall be approved by the
Community Development Department before being installed.
10. No additional construction trailers shall be installed unless first approved by this Department.
11. The City may elect to add Conditions to this, application request to mitigate any problems
that arise not previously addressed herein.
Temporary landscaping is not required to screen the trailer if the site is kept clean and free of
construction debris. .
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 760-777-7067.
Sincerely,
J Y RMAN
TY DEVELOPMENT DIRECTOR :
DELL
Associate Planner
Attachments
c: Community Development Director
Building and Safety Director:
Public Works Director
Sheriff's Department
Code Compliance Department s
Fire Department
Greg Butler, B/S Counter Technician
MUP99-121 -30
4
City of La Quints
Community. Development Department.'
78-495 ,Calle Tampico
La Quinta, California 92253
(760) 777-7125 FAX: (760) 777-1233
OFFICE USE ONLY
Case No.
Date Re vd.
Fee: 7%', 1
Related Apps{
APPLICATION FOR _ PROVAL
TEMPORARY USE PERMIT applications are reviewed and approved by the Community Development Director
pursuant to Section 9.210.050, of the Zoning Code. The purpose of the review is to regulate certain.temporary land
uses and activities and ensure minimum negative or adverse impacts on surrounding areas.
APPLICANT L V PC L nl i►a, f 'O 1 ;
w (Print) s•
Phone No(402-) l
MAILING ADDRESS
CITY, STATE, ZIP: Ubu' lv %i . 10?,5;
Fax No. ' - %?3 -4YS- 7
PROPERTY OWNER (If different): s (—
(Print) '
MAILING ADDRESS: 7i 0W 4(1,K -51 Phone,NoLI L
CITY, STATE, ZIP: 9,; SL ? Fax No '? Lam) 7 '71
LOCATION OF USE/ACTIVITY: Ives ;
LEGAL DESCRIPTION (LOT & TRACT OR A.P.N.): ick' r'T ✓ ,,',,' d
PROPOSED USE AND/OR ACTIVITY: Q A r, Ma6 ► 2r FFIt: o
.rNA-rl L7= _
5c. ;,,7;11 . k j -no -1
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` ii c `r4- (.attach sheets if needed]
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Q f>r i; ler CSS . KREA Iso, wt 11 PA Vii:. _ k i
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A l l \'onn.409 '
i
Temporary Use Permit
rr /
Length of Activity (Dates): , L3 40 Ae. T a 7e
Hours of Activity: 19 Z.462ta r',' q"d'S
Equipment Set Up Date: /Acct% 7 %9"i'Cr Equipment Removal Date: r- 31' 1 r i i
Maximum number of people workin at site during activity at any one time: C"5L, 9
Maximum number of people expected to attend the activity at any one time:
Total per Day: .—.Grand Total: 30 Vo
SUBMISSION REQUIREMENTS:
Site Plan showing layout of activities, tents, parking areas, etc. planned.
j Filing fee for Temporary Use.Permi.t. If filing multiple applications, the most expensive application will
be charged full fee, with remaining related applications discounted 50% for each.
NAME OF APPLICANT p v/ 5 i'r3 /01
(Please P ' t)
SIGNATURE OF. APPLICANT DATE
NAME OF PROPERTY OWNER 045'5F e f S61F'Sa
(Please Print)
SIGNATURE OF PROPERTY O Ej '
DATE
IF NOT SAME AS APPLICANT:
(Signature provides consent ses silo, for proposed activity).
DATE 2 2 dq
(.Separate written authority by owner to m4bniil application may be pravided)
NOTE: FALSE OR MISLEADING INFORMATION GIVEN IN THIS APPLICATION SHALL
BE GROUNDS FOR DENYING APPLICATION.
A 1 I Wonn.409
F `
FEB-24-18UU WEE U2:46Hf1 KSL DEV CUKN Fk NU. (bW'WbU3 F. U1/U1
C. TY OR LA Q UINTA
Community Development Department
78-495 CALLE TAMPICO ;
LA QUINTA•, CA 92253 ,
619-777-7125
Case Number-
Date cce ted 2 - ti ` T9
7 -
• •
MINOR USE PERMIT APPLICATION x
Minor Use permii (MUP) applications are governed by Section 9.210,020 of the Zoning Code (A mpy is attadi d). Uses
requiring a MUP have a low or. moderate potential for adverse impacts on surrounding properties, residents, or businesses.
Review and approval by the Community Development Director for this application is required.
6vF1 IC'ATTONPURPD
Purpose of Request: `kyh P C r a f 0.118
Assessor's Parcel No.:
76-7-332- O 3 5k C .
General Lo3cation: ayeo N , rP lZci SCS' E 11 i(ti.
Acreage: ``
Existing Zoning.
Additional Information:
(Additional written material can be submitted separately)
Anr•umG'r nMAT Poi.ASSS - Three copies of the architectural and landscape/irrigation plans shall be submitted with this
application unless otherwise determined by Department staff. Colored renderings may be required depending upon the
application being submitted- y
• gs ra l•Y NN►as'rsssYM y A 1 tlA
`1NU ``Ir 1 Mif i l tM t /f M• I `•Nss s
/Y►v r3 : E r 7 v - ZS v _ _ yz3 - . r• 3
Applicant: 1- j 2 Cc K 7E,c;
'(Print Name) J - -e (Phone)
AddreSs: //ri / C'/ / /, F r r` / ;cr L ,' /1 s c= ✓1 / Vfr l , S -
Owner(s):
(Print Name)
Address: SG aU %Gl
Signature of Applicant: Date:
Authority for this application is he 2
Signature of Property Owner(s): Date:
Any false or misir hng injbrmation given in taus application .shall be grounds to darty this application. Signatures and adrirssses
of all pnT"V ormem affected by this application shall be included in this submittal.. Separate letters of authorization am be
submitted. ,
FMNiUP-P 01. -
f ,
MAR 0.1.1999 '
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f x f yr , lj& RVA 7J T. A/ Tv