9708-131 (TT)LICENSED CONTRACTOR DECLARATION i
I I hereby affirm under penalty of perjury that I am licensed under provisioris of
,� :Cid-� zr.9.(commencing with Section 7000) of Division 3 of tie Business and
C14 W ' Professionals Code, and my License is in full force•and effect. F a.
O th License # 1 Lic. Class Exp. Date .
r` d LO
t�Wr-
t r
Z r --Date Signature of Contractor
o O' r -
U
CO OWNER -BUILDER DECLARATION },
W W r` I hereby affirm under penalty of perjury that' I am exempt from tale Contracto 's '
F-(aLicense Law for the following reason: }
Z ( ) I, as owner of the property, or my employees with wages as their s' le
compensation, will do the work, and the structure is not intended or offered r
sale (Sec. 7044, Business & Professionals Code). `
(k) 1, 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
O N Date };d • S Y7Signature of Owner
Q WORKER'S COMPENSATION DECLARATION
C:) :E Cr I hereby affirm under, penalty of perjury one of the following declarations:
U-) O () 1have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U (. )" 1 have and will maintain workers' compensation insurance, as required by
O QSection 3700 of the Labor Code, for the performance of the work for which this
11 0 Z permit, is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
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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
subject to the workers' compensation provisions of Section 3700 of the Labor
/Code, I shall forthwith comply with those provisions.
f Date: 9 ' '% Applicant - .412
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 Lhave 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.
,/Signature (Owner/Agent)*, -.4
Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE ".-4/Z."7 . VALUATION 5200.00 LOT S "'"' - - TRACT
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JOB SITE •~^
APN T%.3•-A.G4.1):t.Ji
ADDREss-SHi.'fAS'i1,D�?►C:A#i:I;i.Ai�'�iE%.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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45701 �lONROz Si' Si'- u
1NbIO.r CA 92201
INDIO CA 92201
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('7001147-3157 N
USE OF PERMIT
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3rxi9fi.C9Ei
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RECEIPT
DATE
By C ""'"
DATE FINALED
INSPECTOR
K
INSPECTION RECORD
C
f
t: OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
! BUILDING APPROVALS (MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Stab Grade Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K to Wrap F.A.U.
t
Framing Compressor
1
Insulation Vents
t
Fireplace P.L. Grills
i
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
i
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS
steep,
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 OX 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
Fixtures
Main Service
Sub Panels
-'?'•;
u' Exterior Receptacles
%G:F.I.
t. Smoke Detectors
':
.,,
J•
:,limp. Use of Power
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_Final
0Utility Notice (Perm)
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78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
August 25, 1997
Mr. Ted Neal, Construction Manager
Coachella Valley Housing Coalition
45701-G Monroe Street
Indio, California 92201
SUBJECT: MINOR USE PERMIT 97-021
Dear Mr. Neal:
This is to report that the Community -Development Department has approved your request to have
a temporary construction trailer for the Coachella Valley Housing Coalition's ten residences to be
constructed in the Cove, subject to the following Conditions:
1. The temporary construction trailer shall not be installed until the Public Works Department
has issued a grading permit for the project. Once the trailer is installed, it can remain on-site
for a six-month period. However, an extension of the six-month period may be made in
writing to the Community Development Department before expiration. The Community
Development Director may, after reviewing the.facts, extend the use of the trailer for another
six-month period.
2. Use of the trailer shall be limited to the hours of construction as listed in the La Quinta
Municipal Code (Chapter 6.08, Nuisances). A copy of this time schedule can be obtained
at the Building and Safety Department.
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 construction
trailer shall be self-contained and include bathroom and lavatory facilities for workers. or
employees unless otherwise determined by the Building and Safety Director (i.e., freestanding
portable toilets, etc.).
4. 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). The building address .shall
be visible from the adjacent public street.
5. Install one 2A I OBC fire extinguisher inside the construction trailer by the exit door, and
provide a "Door to remain open during business hours" sign above the exit door. If you have
any questions, please contact.Mr. Tom Hutchison, City Fire Safety Specialist at 863-8886.
6. No temporary signs are permitted unless separately approved by this Department.
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253®(J
11
7. If construction equipment or materials are stored on the property, temporary fencing shall be
constructed. Temporary chain link fencing is allowed provided wood slates (or other
material) are woven into the diagonals.
r
8. 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 fight glare from being cast onto adjacent properties or affecting the vision of passing
motorists. Tamper resistant light fixture covers are required to reduce vandalism.
9. Mounted close to 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., minimum l" high letters),
10. The site shall be left free of debris at completion of the project improvements.
11. The City may elect to add Conditions to this application request to mitigate any problems that
arise not addressed herein.
If you have any questions, please contact me at 777-7071.
Sincerely,
�2LJ
9
CHRISTINE DI IORI
PLANNING MANAGER
cdi:cw
Enclosures
c: ✓Building and Safety Director
Public Works Director
Sheriff's Department
Code Enforcement Department
Community Development Director
P:\CAROLYN\CV Housuig Coalition Ltr8-22-97.wpd
CITY OF LA QUINTA
• Community Development Department
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
619-777-7125 C'.���c,r
Case Number: /�
IX u `I -z
7 - c.�
(0j,�T� Date Accepted: a �/ ;?:4/,i `7
OFee: `7 c C >
MINOR USE PERMIT APPLICATION
Minor Use Permit (MUP) applications are governed by Section 9.210.020 of the Zoning Code (A copy is attached).' Uses
requiring a MUP have a low or moderate potential for adverse impacts on surrounding properties, residents, or businesses.
Review and approval by the Community Development Director for this application is required.
APPLICATION PURPOSE
Purpose of Request:
Assessor's Parcel No.:
General Location: .5— Co
Acreage:
Existing Zoning: ��I)Kk 6�"7 -Z L -
Additional Information:
(Additional written material can be submitted separately)
ARCHITECTURAL PLANS - Three copies of the architectural and landscape/irrigation plans shall be submitted with this
application unless otherwise determined by Department staff. Colored renderings may be required depending. upon the
application being submitted.
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Applicant: �//f1%,f�yl� �9'`�L �7'2J Usii.is ) it.G'.y i d •�%
(Print Name) (Phone)
Address: �" Sr�l�/ G /s "/!'��c�l� L� S%� //��i��� �Z Z
Owner(s):
(Print Name)
Signature of
Authority for this application is hereb given:
Signature of Property Owner(s): i Date:
Any false or misleading information given in this application shall be grounds to deny this application. Signatures and addresses
of all property owners affected by this application shall be included in this submittal. Separate letters of authorization can be
submitted.
FMMUP-P