MISC (0403-092)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
r W Professionals Code, and my License is in full force and effect.
5 ch License # Lic. Class Exp. Date
r- CY Ln
% r.• a}�'�
oZ ti� . Date Signature of Contractor t' �t
Or
rU C) OWNER -BUILDER DECLARATION
W Wd I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
M() I am exempt under Section B&P.C. for this reason
t[)
C\; 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 STATE FWW Policy No. 0464M,48 -2(t(1;
(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°the Labor
Code, I shall forthwith comply with those provisions." j
Date: � %r Applicant I. I
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 purposes. tt
Signature (Owner/Agent) (- jY Date
BUIL DIN05 PERMIT PERMIT# l -,
DATE ,. VALUATION I LOT (;:_^i TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CORAL Ox-en-cros 1', uc
IPA!7XS -C ONi rtWC411ON
P.O. BOX 17) 6
79.295 R A.ACH0 .t.,111ITT A DPS,
LA 01MITA. CA 92253
LAQUNTA CA 92253
(160) 7"71 ^1941 091111 ;:19961
USE O•,F� PERMIT
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t`EMPORAM'Sa CUMT UCIA`10W TkAll,RR PF ;. MUP 0:4004.46s.
500.0. LS
COST OF CONTrRUCTIOV11
5%4*
Pai:UM(.7.T 'R RE N,t�.Rl.(,lfiRY
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TEMP C N3TRTJCT10;'_ 7 ',MIX) 101.000-123.000 MIN
MAR 12 2004
CITY OF LA QUINTA
FINANCE DEPT-
0113-'i'OTIN-.17,C` �1M[iMONAND PiL,.t+N CMM
;200.00
I -V - IL 1' %-PAXf) .,VER!;
Tam)
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
Fina! L
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
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
"Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
eGas 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;
March 2, 2004
Mr. Patrick O'Dowd
Rancho La Quinta
79-285 Rancho La Quinta Drive
La Quinta, Ca 92253
SUBJECT: MINOR USE PERMIT 2004-463 (TEMPORARY CONSTRUCTION
TRAILER)
Dear Mr. O'Dowd:
The Community Development Department has reviewed your request to establish a
construction trailer on the southwest corner of Monroe Street and Avenue 59 within
Tract 31681 and has approved it, subject to the following conditions:
Obtain an electrical permit from the Building Department for temporary power.
2. Provide restroom facilities to accommodate personnel.
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 case 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. Removal of the construction trailer is required within 30 days of completion of
the project 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.
6. Dust control measures shall be employed if construction parking is allowed
adjacent to the trailer. Such measures may include watering the site regularly
or laying gravel in the area for parking.
7. Trailer skirting shall be installed within 30 days if the trailer is mounted above
finished grade level. Temporary landscaping is not required to screen the trailer
if skirts are installed and the immediate area around the trailer is kept clean and
free of construction debris.
Mr. Patrick O'Dowd
MUP 04-463
Page2
8. The City may elect to add Conditions to this application request to mitigate any
problems that arise not previously addressed herein.
This decision may be appealed to the Planning Commission by anyone provided they
submit the necessary paperwork and filing fee of $175.00 with this office within 15
days of approval of this permit.
Should you have any questions or need additional information please do not hesitate
to contact me directly at (760) 777-7068.
Sincerely,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
MARTIN MAGAI A
Associate Planner
C: Building & Safety Department
Chron file
MUP 04-463 TempConstTrail