TUP 0112-093LICENSED 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 forceland effect.
License # Lic. Class Exp. Date
123596 D32 C)0061 t7)13 1 /Z if
Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the -following reason:
( ) ; 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).
( ) I am exempt under Section B&P.C. for this reason
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.
AI have and will maintain workers' compensation insurance, as required by
on 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 OTATRMOD Policy No. 1335110-99 _
(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.
6 Date: Applicant
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.
d,Signature (Owner/Agent)`+ n} S� fi f1. a Date3-�'At
"BUILDING PERMIT PERM
DATE VALUATION S1,Q :00 _-a LOT TRACT
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APN _
OWNER
CONTRACTOR / DESIGNER / EN (NEER
rib 140.
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USE OF PERMIT
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TRAIPORARY CO'NO'i!tCJf'.'1'103! TWNHAY.R AS PER TUP 2091.303
VAJAiAT1ON LZ
IFIMO= COST Off?° CONS TRUCUOR
`7 RIMP TRAI1 j 3 01';.000411 2'3 -000 $200,100
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C117Y OF LAQUiNTA
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67M.00
rFR10EIPT
DA11TE/
BY,
DATE FINALED
INSPECTOR
p
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
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D II - 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 I
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
Law Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific informationabout your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A- frequent -practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
i
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
• 760) 777- 11
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
o 112 - o7-3
PERMIT NUMBER(s)
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
September 27, 2001
Mr. Edward Alderson
Madison/PTM, L.L.C.
45-987'/2 Washington Street
La Quinta, CA 92253
I
(7 60) 777-7000
FAX (760) 777-7101
FILE COPY
SUBJECT: TEMPORARY USE PERMIT 2001- 308 (CONSTRUCTION TRAILER)
Dear Mr. Alderson:
The Community Development Department hereby approves your .application request
to install a new temporary construction trailer on site. as shown the attached graphic
subject to the following Conditions:
1.. Once the trailer is installed, it can remain on-site for a Six -Month period.
Removal of the temporary construction trailer is required on March 29, 2002.
However, an extension of the six-month period may be applied for, with 'no
additional fee, 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 from 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 (760- `
777-7012). '
4. The trailer shall be located as shown on the attached graphic.
5. Temporary parking will be provided for 4 employees as shown on the attached
graphic; the lot will constructed with 'AC paving.
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).
C:\!WPDdocs\TUP 2001-308 new construction trailer.wpd �(�
t
7. Provide one 2A10BC fire extinguisher inside the construction trailer and sign
over the exit door which states "Door to remain open during business hours."
The Fire Marshall can be reached at 863-8886.
8. Mounted close to the front door on the outside of the building shall be a
written notice informing emergency personnel of your 24-hour emergency
phone number in case problems arise that need your prompt attention (i.e.,
minimum one -inch high letters).
9. The trailer, if elevated off the ground, shall be skirted with metal or wood
siding material. The skirting material shall be painted to match the exterior
color of the construction trailer. The exterior surfaces of the trailer shall be
painted (or may be stuccoed) and in overall good condition.
10. No temporary signs are permitted unless separately approved by this
Department.
10. No exterior lighting for the trailer is allowed unless approved by the Building
and Safety Department. All security light fixtures shall be hooded to prevent
light glare from being cast onto adjacent properties..
11. Provide restroom facilities to accommodate on-site construction workers.
12. The Fugitive Dust Control Plan (FDCP) shall be re -submitted to the Public
Works Department as required by Chapter 6.16 of the Municipal Code..'The
Plan shall provide methods to control dust problems at the site during grading
or construction activities. Tracked out mud and dirt from vehicles of
equipment onto City streets shall be removed daily or kept damp until removal
can occur. The Plan is required for the entire site and is to be re -submitted for
approval within 5 working days from the date of this letter.
Specifically, the following conditions will apply to the Temporary Use Permit:
• Adequately stabilize parking area. All temporary office facilities
(sales, construction, etc.) Shall be provided with paved,
compacted, or other wise stabilized parking and access during
their operation, with those improvements to be constructed as
required by Public Works Department standards. This
requirement shall be in effect whether or not included in any
approval for such facilities under a minor use or other permit
process.
• Stockpiled dirt to be kept damp at all times, or covered at night.
• Vehicles hauling dirt are to be kept covered (or by other means)
to keep dirt from creating dust. Sweep trucks out daily or flush
with water. All unpaved access shall be prepared for traffic:
C:\!WPDdocs\TUP 2001-308 new construction trailer.wpd
3
watered down or paved. Entry areas into construction site shall
be stabilized to prevent dust.
13. No lighting is allowed unless approved by the Building 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 on yo adjacent
properties or affecting the vision of passing motorist. Tamper resistant light
fixture covers are required to reduce vandalism.
-14'. Developer agrees to indemnify, defend and hold harmless the City of La Quinta
in the event of any legal claim or litigation arising out 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.
15. The City may elect to add conditions to this application request to mitigate any
problems that may arise and are not addressed herein.
If you have any questions, please contact me at 760-777-7065.
Sincerely,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
l�
W��
FRED M. BAKER. AICP
Principal Planner
c: Building and Safety Director.
Public Works Director
Code Compliance Department
Sheriff's Department
Wally Nesbit, Associate Planner'
C:\!WPDdocs\TUP 2001-308 new construction trailer.wpd
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