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- - LICENSED 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 force and effect.
License # Lic. Class Exp. Date
650,189 J A /� � 07/31/,7.(
ate 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.
(X)' 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 ,OTATE'U`,e D Policy No. 1576661-01
(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.
Date: ' 4,. !a >=- Applicant ./ / e �` I l �
If Y f /P.r 7FF , f =W_ 7
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. f
Signature (Owner/Agent'� >*J Date
� , r • , r'
• .BUIL WN PERMIT PERMI tw •�
,
DATE—VALUATION LOT TRACT 6
• .�-r �; -
�
JOB SITE wee
ADDRESS %t�»_S� ri/"� ,ED �. E uI�TJ E:�Ia
APN
OWNER
CONTRACTOR
j NPA{PWN+CO.
SIDA20
.i�/�iDyJLES�IGNrNdEJ�R0.`EC(�NIIFN7�ElyJ,ER
220:5-pOLNIYM y:A
-41-625 JiwhS -6Sw:.Sy<��G!
Z"XRA fAW'8V,,hiCff CA 902"
PAi:.IMDF...:xi:RT C.A. 92255..0
1;760)340.0194. (MIAM, 3026
USE OF PERMIT
`1'F.t P0FZt-,,1 .'Y C01-1T.1oT}':?JC 1`100 •i`R_A1t:.lA'. PER MUP 201,1.3 fa AT .t,A QUI 'A
"if'11.L,iAT10-N Sfl0,4p i.
tai '
Xt,rITMAIM) COST OF C0.N9rX-UC;1'10X
TEMP (.XA48TR U(_g16N T 3b.AILE] 10`1 -000423.0rJO S290.00
STJP� TCM I, Chi u1�'�'1MUMICSN MID PLAM CIS:
$200.00
1XISS PRE -PAM Fmi
$0,00
TOTAL 11MUT IE S D'MaNNW_
$2,00100
RECEIPT
DATEh�A !�.
.By
DATE7 &
I INSPE R
INSPECTION kECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
3�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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final
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 APP OVAL
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Shining Brighter Than
August 9, 2.002
P.U. Box 1504:
75-4:95 CALLE TAMPICO
LA QUIN'TA, CALIFORNIA 92253
Mr. Bob Neubauer
Jacobsson Engineering Construction, Inc.
PO Box 14430
Palm Desert, CA 92255-4430
ii i aIr i :1
JACWSQ% M CONTR., Me.
BE: Temporary Use Permit 2002-348
Construction trailer at La Quinta Auto Centre and La Quinta Drive
Dear Mr. Neubauer:
(760) 777-7000
FAX (760) 777-7101
The Community Development Department has reviewed your application for the above
referenced Use Permit. Your request for a 576 s.f., temporary constructiontrailer is approved
provided the following conditions are met:
Genera! Conditions
1:. The applicaht/developer agrees, to indemnify, 'deferid, and'hold harmless the City- of La
Quinta' from any legal claim or- litigation. arising out of 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.
Site Trailer:
2. Install one 2A1 OBC fire extinguisher inside the trailer by the front exit door. .
3. Any temporary lighting shall not be directed toward surrounding properties.
4. No trailer setup shall be permitted until a grading or building_ permit is issued. Obtain
a building permit including an electrical permit for temporary power.
5. This approval is for location of the construction office trailer only. It does not allow
establishment of any storage/staging areas. Trailer shall not be located so as to block
approved travel ways or required fire access during construction activities. The site
shall be kept clean and free of construction debris.
6. The on-site parking area must he established - compacted base,' aggregate or similar,
or parking shall be restricted to existing street parking. areas around the site. Any
access into the site shall be developed as set forth in the approved Fugitive Dust
Control Plan 2000-81 for the La Quinta Auto Centre project.
P:\Wally\tup 2002348.wpd
E
7.' One 2' x 3' trailer -mounted sign shall be placed close to the front door, providing
emergency personnel a 24-hour .emergency phone number to contact in case problems
arise that need prompt attention (minimum 1 " high letters). The sign shall include any
temporary address, and may include the company name for the purpose of
identification.
8. Provide restroom facilities to accommodate on-site construction workers.
The City may impose additional conditions to this application to mitigate any problems that
arise not previously addressed herein. 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 of the date of approval.
If you have any questions, please contact me at 760-777-7069.
Very truly yours;
JERRY HERMAN.
COMMUNITY DEVELOPMENT DIRECTOR
Wallace H. Nesbit
Associate Planner
Enclosure
c: Code Compliance
Fire Marshal
Counter Technician, Building/Safety
File; TUP 2002-348
P:\Wally\tup2002348.wpd
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O City Council
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• - -'. • �. � � ��, , � - . •! Community Dev. Dept.
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CURVE. LATA' <N89.51 43'W 1932.24 LINE DATA -'-'
NO.RAL1/US DELTA ' ARC. NO. BEAR/NC DISTANCE
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