MISC (9712-022)57141 Medinah
9712-022
r LICENSED CONTRACTOR DECLARATION!
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals' Code, and my License is in full force and effect.
License # Lic. Class Exp Date15,
LO
W T
Z ;/DateSignature of Contractor J 4
O O
V co`
o .' " ' OWNER -BUILDER. DECLARATION, ` .
W W 1•herel5y affirm under penalty of perjury that, am exempt from the Contractor's
a ` License Law for the following reason:
Z" p (°)•a'1, as owner of the property, or my employees.with'wages as`the'ir sole
compensation, will do the work, and the structure is not intended or offered for
site (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" '
-
coO LO I am'exempt under Section ; B&P.C. for this reason
Date Signature of Owner
a rn:
f..
U Q WORKER'S COMPENSATION DECLARATION
Q° . Thereby affirm: under penalty of perjury one of, the, following. declaratioris:'
r l. p, () 1 have and will maintain a certificate.of consent to self -insure for workers'
'X Ld .- 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.'
.r Q U ( ). 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
r.tl •F_; permit'is issued. My.workers'.compensation insurance carrier & policy no. are:
Z Carrier Policy "No.
*"Cb r a"TU
N011, to - - ... rt t R red
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(This section -need not be completed if the permit valuation is for $10000 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' compensation provision's of Section 3700 of the Labor
3 Code, I shall forthwith comply with those provisions.
,. Date :'` Applicant t C Y
.•,.
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,.se't 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 prsuant 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.
Fr 2. Any. permit issued as a result of this application becomes nulland-void if
F 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 'aipplication and state that the above information is
• Correct'.J 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 purposes'.
Signature (Owner/Agent)
Date t
PERMIT# CONTROL# y jQQ
BUILDING PERMIT ILI
. DATE . >f'%. VALUATION LOT TRACT ;
JOB SITE y
ADDRESS) I F ,.lii Tiii
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
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Ila 01r. Waiwive i i it
USE OF PERMIT
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DEC 041997
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RECEIPT
DATE
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 & 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
F'rdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
November 26; 1997
Trans West Housing ;
78-401(F) Highway 111
La Quinta, California 92253
SUBJECT: MINOR USE PERMIT 97-022 (AMENDMENT #1) FOR TENTtkTTVE TRACT
MAP 28410 AND SITE DEVELOPMENT PERMIT 97-602 (MC COMIC
CONSOLIDATED) `
Dear Applicant
The Community Development Department has approved your request to establish a 8'. wide by 16'
long construction trailer on Lot 5 subject to issuance of a building permit including an electrical
permit for temporary power during construction of your model home complex:.: -The following
Conditions shall also be met:
1. 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 V high letters).
2. Install one 2A10BC fire extinguisher inside the trailer by the exit door.
3. No temporary signs are permitted unless separately approved by this Department.
4. Wood or metal trailer skirting is required if the trailer is elevated off the ground. The skirting
material shall be solid with no openings and painted to match the color of the trailer.
5. The requirements of Tentative Tract Map 28410, Site Development Permit 97-602 and Minor
Use Permit 97-022 shall be met where applicable.
6. The City may elect to add Conditions to this application request to mitigate any problems that
arise not previously addressed herein.
7. Contact this Department when all on-site model complex improvements have been installed,
and we will conduct a final inspection to determine compliance with all Conditions of
Approval.
8. Obtain applicable PGA West HOA approval.
MUP97-022McComic-20
MAILING ADDRESS — P.O. BOX 1504 — LA QUINTA, 'CALIFORNIA 92253
9. The construction trailer is allowed to remain until the model home complex is built and
occupancy has been permitted. Removal of the trailer is required on May 26, 1998, unless'-
a time extension is applied for and granted by this Department.
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,
JE Y 4EIRMAN
C NITY DEVELOPMENT DIRECTOR
i
O SDELL
Associa a er
GT.
Enclosure
c: Mc Comic Consolidated
Community Development Director
Building and Safety Director . 4+
Public Works Director
Sheriffs Department
Code Compliance Department
Fire Department
ljl 25:97 10:15 $909 ' 9615 L1:ND DEQ' Coo
APPRL7VEp FOR PE-RM/T7/NG.' - FLq.NN.ING AND ZONIA/G CWPLIANCE
DA TE ERPY DA 7F
6UILD!NC EA%-rY D1RCCTOR CQ'IMUN;Tv CL QP.s1EhT OIP.£CTJP.
pTY OF LA QUwTA CITY OF LA FL,*
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