MISC (0307-018)57325 Madison St
0307-018
LICENSED CONTRACTOR DECLARATION ,
I hereby affirm under penalty of perjury that I am licensed under provisions ofr .
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,
88 122480
tate % Signature of Contraccttorr, +'
OWN ER -BU I LDER'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 nat 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 ZURIi .I1 A15+IEg1CA-0 Policy No. yy ; egg RDS
(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 anyrmanner so as to become subject to the
workers' compensation laws ofralifornia, and,agree that if I should become
subject to the workers' compensation p Vislons of Sectioil,.370b3 df`the,Labor
r ,,; ,_
Code, I shall forthwith comply with th`gse p rovisions „
Date! 7 -g Applicant-
/
pplicant
,C-- r
Warning: Failure to secure V orkers' 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,.represental'IVe (this City to enter upon
the above-mentione "d property o lnsp p y rposes.
SSignature (Owner/Agent)/ '%'`' + - Date"`/ `
, PERMIT ^
BUILDING PERMIT O,x s
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 517.325 MAD.IS0.114 STREET
OWNER
CONTRACTOR / DESIGNER / EN (NEER
vy .
yAND
1:!•`71}0 3,1 l uppme0Oi2 Jmm2 .Y 1D
169 MXONY R0AT?, 3TI?. 105
PORTLAWD OR 97224
RMCMATI S CA, 92024
(7§;0)634-2350 CLIL 420
USE OF PERMIT
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'I'I?IM;4 OR AJtX' CLiNS 'RLiC'I'IO T xRRiII ]Z 1' I ,E: It L+Plf +J '3 lZ3.i31 'T V' 2'
LOTS 36M Iy TICTA AM,
V'AI.1.1ATIUIr 1, Afl.i70 w
T."sauu7m) COST OF CC>aS71rm'CTAon
1.,R51i 7.1 I3 '
PEMM, Sr;DMUJL Y
TEMP CONSTRUCTION T RAILEi i OI -000-423.000 MOM
WJB-TMAL d :OJtJ9'1:-R0"x . 0141 AND PLAN CHEM
$200,00
LE M FRT?-1"AID ITMS
$0.00
DVE
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JUL o 2 2003 /
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RECEIPT
DATE =' I I BY (
DATE FINALED
INSPECTOR
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
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
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
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:
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
rl
July 1, 2003
Davis Reed Construction
169 Saxony Road, Ste. 105
Encinitas, CA 92024
RE: Minor Use Permit 2003-423; Construction trailer for Puerta Azul
Lots 36 & 37 of TR 30096-1
(760) 777-7000
FAX (760) 777-7101
Gentlemen:
The Community Development Department has reviewed your. application for the above
referenced Minor Use Permit. The request for a construction trailer at the referenced location
is approved in accordance with the following conditions:
GENERAL CONDITIONS:
1 . Install one 2A 10BC fire extinguisher inside the trailer by the front exit door.
2. Any temporary lighting shall be directed away from surrounding residential properties
and properly shielded,, in accordance with the City Outdoor Lighting requirements.
3. No set-up of the trailer shall be permitted until a grading or building permit is issued.
Obtain a building permit including an electrical permit for temporary power.
4. This approval is for location of a construction office trailer only; it does not allow
establishment of any fencing, equipment storage/staging areas, etc.
5. One 2' x 3' trailer -mounted sign shall be placed close to the front door, displaying a
24-hour emergency phone number (minimum 1 " high letters) which emergency
personnel may call in case problems arise that need prompt attention. The sign shall
include any temporary address, *and may include the company name for the purpose
of identification.
6. Restroom facilities shall be provided as may be required.
7. The applicant/developer agrees to indemnify, defend, and hold harmless the City of La
Quinta from 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. at its
sole discretion.
C:\Wrkgrp\Letters\MUP\mup03423ct:wpd
8. Approval of Minor Use Permit 2003-423 shall be in effect 15 days from the date of
this letter, unless appealed pursuant to Section 9.200.120. It will expire one year from
the date of this letter. An extension may be. applied for by filing a written request to
the Community Development Director, pursuant to Section 9.200.080.D. of the La
Quinta Zoning Code. ,
e' The City may impose additional conditions to this application 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 of the date -of this approval letter.
If you have any questions, please contact me at 760-777-7069.
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
Wallace H. Nesbit
Associate Planner.
13
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