MISC (0403-042)50672 Mandarina
0403-042
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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 #n{y { }Lic. Class
/ Exp. Date
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75
Date Signature of Contracto""
OWNER -BUILDER DECLARATION
W LU
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) 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).
( ) 1, as owner of the property, am exclusively contracting with. licensed
contractors to construct the project (Sec. 7044, Business & Professionals:
Code).
LO ,. ,() I am exempt under Section , B&P.C. for this reason
N , Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
`O Q: b hereby affirm under penalty of perjury one of the following declarations:
Lo • 0, () 1 have and will maintain a certificate of consent to self -insure for workers'
X W. compensation, as provided for by Section 3700 of the Labor Code, for the
m_ Q performance of the work for which this permit is issued.
Q. U ( ) I have and will maintain workers' compensation insurance, as required by
Q 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
d Cn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Fi ,18T,0'41Ajp I3r" I Policy No. 130102202
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J (This. section need not be completed if the permit valuation is for $100.00 or less).
O 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' compensati sin provisions of S ction 3700 of the Labor
Code„I.,shall forthwith comply with hoprovisions
/'Date: `I'” f CI ApPliCant i -•',ems• ^4`• %v//// ''.'i`'.i'
Warning: Failure to secure WorkersCompensation 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 application 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. f agree to comply with all City, and State laws relating to the building
construction, and hereby authorize fepresentatives of this City to enter upon
the bove-mentioned property for inspection purposes.
to
,"Signature (Owner/Agent' -' ^Date
BUILDING PERMIT
DATE - / VALUATION $ LOT
JOB SIT2,. k
ADDRESS:. 1 f . I. A
OWNER
4) 00MACAR17HUR RLVD 4200
NEW. ORT BFAC-11 O.A 92660
USE OF PERMIT
PERMIT #
W03-042 TRACT
a ,.
APN _
CONTRACTOR/DESIGNER/
CAP!'I'.P L PACIFIC }.TC, WM T90
4100 MAC MTHM BLVD 0200
W"OS`TBEACH CA 92660
(9.49)622-8400 CBI',. ; 1503
TEMP C';ONSTRUCTION TRAILER PER A!ft: P 2004.466.
"JA W& T ICN
1,200.00 Le
=ZYMUD COST or, CONSTRUCIMON 1.200=
RPM= F FX SUWMARY
7`T5," F C!aNSTRUCTION TRAIt.M 101.000.423.000 1$200.00
FM4R
1:1200471
OF LA
Sly -TOTAL Ctq?bSURTYMON .AN PILAN C 7rTEC K' $200.00
IYU-1119 PRE, PPM FELS $0, Go
RECEIPT DATE BY :i 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 & 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
K
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbet .•es
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
QUMrC4V
P.O. Box 1504
78-495 CALLS TAMPICO (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101
March 2, 2004
Capital Pacific Homes
200 S. Main Street
Corona, CA, 92882
RE: Minor Use Permit 2004-466; Construction trailer at; The Citrus
50670 Mandarina Tract 24890-1
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 "2A1OBC-fire extinguisher inside the trailer by the front exit door.
1
2. Any temporary lighting shall be directed away from surrounding residential J
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 any 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..
Etumiwizis
8. Approval of Minor Use Permit 2004-466 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.
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
c: Building and' Safety
Fire Marshal
Code Compliance
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