MISC (9708-090)LICENSED CONTRACTOR DECLARATION
CD 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
N W Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
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te /<''" &gnature of Contractor
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C:) OWNER -BUILDER DECLARATION
LU W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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
LO
N Date Signature of Owner
ON
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a Q WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
'X W L—L compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
Go Q U j�(f 1 have and will maintain workers' compensation insurance, as required by
O (-) Q Section 3700 of the Labor Code, for the performance of the work for which this
li v Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier1., 1 7 1 Policy No.
5 .131V1..4l. �1V1.9, 1��.tp+i d�fie YJllta�i
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J (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
Tbject
to the workers' compensation provisions of Section 3700 of the Labor
de, I shall forthwith comply with th se provisior ste: Applicant /K. {
f
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.
isignature (Owner/Agent)p0-_ r.�`�. Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE ..,�I Li�f:�I� VALUATION .S1i13 ).00 LOT TRACT
A -A E-lcil
JOB SIT 191135 A%.Iil.EN A��i:1'�UE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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SAN BT;ftNARDINO CA 5124("18
SAN i,}iRNARDINO CA 92409.
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USE OF PERMIT
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RECEIPT E
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 APPROV LS
POOLS - SPAS
steer.-
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P1bg. Test
Final I
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
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
FILE
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78-495 CALLE TAMPICO '— LA OUINTA, CALIFORNIA 92253 - (619) 777-7000
i FAX (619) 777-7101
May 29, 1997 L SSv�
Mr. Dennis Cunningham, Project Manager
Century -Crowell Communities
1535 South "D" Street, Suite #200'
San Bernardino; California 92408 '
SUBJECT: MINOR USE PERMIT 97-010 �� l2 1-7
REF: - TENTATIVE TRACT MAP 27899 '
Dear W. Cunningham: '
This is to report that the Community Development Department has approved your request to have
a temporary sales trailer on the south side of Miles Avenue for Tehtative Tract Map 27899, subject
to the following provisions. "
Prior to building permit issuance, the following Conditions shall be met: '
1. A Certificate of Deposit,' in the amount of $2,500.00, shall be posted with the City to insure
the trailer and accessory improvements are removed when the permanent model complex is
completed. The City shall be named as the controlling party to insure removal of the
temporary improvements.
2. A temporary landscape and irrigation plan shall be submitted for review and approval by this
Department.
General Conditions '
3. A building permit is required for the temporary trailer and temporary electric power. Please
apply to the Building, and Safety Department for a permit (777-7012). , The trailer facilities
shall be accessible to the physically challenged; .
4. Once the trailer is installed, it can remain on-site for a six-month permit unless the model
complex is completed prior to this time period. Prior to expiration of the permit, a six-month
time extension request may be made in writing to the Community Development Department.
The Community Development Director may, after reviewing the facts, extend the use of the
trailer for another six-month period. ,
5. Fringe -toed Lizard mitigation fees shall be paid prior to the site being disturbed (i.e., $600.00
per acre).
MUP97-010/ 14 "
C.
MAILING ADDRESS P.O. BOX 1504 - .LA QUINTA, CALIFORNIA 92253 ���
11
6. A qualified archaeologist shall be on-site during grading and/or installation Of the trailer
7. Use of the trailer shall be limited to the hours of 8:00 A.M.'to 5:00 P.M.
8. ,A building address shall be installed on the trailer to help identify the temporary business
location (e.g., minimum 3 -inch high letters in a contrasting color).
9. `Install one 2AIOBC fire extinguisher inside the trailer by the front (entry/exit) door; and
provide a "Door to remain open during business hours" sign above the doorway., If you have
any questions, please contact Mr..Tom Hutchison, Fire Safety Specialist (Riverside County)
at 863-8886.
l'O. The exterior surfaces of the, trailer shall be painted (or may be stuccoed) and be in overall
good condition since it faces an image corridor street.
11. No temporary signs are permitted unless separately approved by this Department:
12. Temporary landscaping shall be installed around "the perimeter of�the trailer, parking lot and
along Miles,Avenue. Alllaadscapirg and irrigation improvements shall be install ed_prior to
use of the .railer by sales personnel:
13. No lighting is allowed unless approved by this Department ,prior to on-site installation.
Should security lighting .be required for the project, all light fixtures shall be hooded to
prevent light glare from being cast onto adjacent properties or affecting the vision of passing'
,motorists. Tamper resistant.light fixture covers.are required to reduce vandalism.
14 Mounted close to the outside of the front door shall be a written notice informing emergency
personnel of your 24-hour emergency phone number that they can call in case problems arise,
that need your prompt attention (i.e., rninimnum l," high letters).
15. Allrequirements addressed in Section 9.60.250 (Model Home Complexes)'of the Municipal
Code shall be met where applicable.
16. The trailer; ifelevated off the ground, shall be skirted with metal or wood siding material (to
hide wheels, axles, etc.). The skirting material shall, be painted to match or complement the.
exterior color of the construction trailer.
17. The physically challenged parking space shall comply with the Americans with Disabilities Act
provisions which require hard surfacing with striping and signs.
18. A dust control plan shall be Submitted for review and approval by this Department prior to
issuance of a grading perm::. Please submit the PM10 Plan to M:. Wally Nesbit, Associate
Planner for his review.
19. The City may elect to add Conditions to this application request to mitigate any problems that
arise not previously addressed herein.
20. Contact this Department when all on-site improvements have been installed, and we will
conduct a final inspection to determine compliance with all Conditions of Approval.
The proposed flags in front of the trailer shall not be installed because under the provisions of the
Zoning Code this type of advertising is only permissible at the -permanent on-site model home
complex. If you have any questions, please contact me at 760-777-7067.'
Sincerely,
Y E N `
C MU I Y DEVELOPMENT DIRECTOR
RE USDELL
cl anner
GT. '
Enclosures -
c: Community Development ;director
Building and Safety Director
Public Works Director
Sheriffs Department
Code Compliance Departn_ent
MUP97-010/ 14
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I Building Size. For. kenl•al, Lease or Sale..
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12'0" _
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4' Wood Bi -Fold
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:t:.,►,o;:�.x �c,��ipr�tc�yl The Designer Eutras _ Branch Offices
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Fully Insulated Commercial Carpeting Over 80 Locations to Serve You
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FCeiling Heights Recessed fluorescent Lights Call 800-523-7918
30,000 BTUH of Air Conditioning Wood Exterior Siding - All the space that fits your needs.
10KW Ducted Heat Coffee Bar with Sink
�+ Bath and Closet Mansard Type Roof Trim
- Concealed Tie Down Straps Detachable Hauling Hitch - O
Office Partition with Swinging Door Trim On Door and Windows
Recessed French Doors Bronze Glass Windows Space
1 36" Steel Rear Exit Door Bronze Glass Entrance Door
60 CFM Bathroom Fan Two Bala Plaza, Bala Cynwyd, PA 19004
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Copyright 1987 Rev GS -1248D Specihcahons may vary.
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