0306-165 (TT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing, 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
f
e'er, 4{%�i`�ckt83 B M!"
rDate/_,•"• ?•`+"� ? Signature of Contractor %!-
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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.
( ) 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 NT's' R Vis' RMO ` Policy No. -06-:($3:9-�2 - .
(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'parmit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California,tand agre?,, at if I�should become
subjerct1to the workers' compensation provisions of�Section 3700 of the Labor
�Cod'e, I shall forthwith comply with those%prgvlsions.r
Date: i ... "/,n'gpplicant i r 3,/ JAn
�, � ,
Warning: Failure to secure Workers' Cbmpensafion 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 atm
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 representafives of, this City to enter upon
the above-mentioned property for inspection p poses.- !J
Signature (Owner/Agent) <' �/iUi Date�V c x:•
PERMIT #
`BUILDING PERMIT
DATE -VALUATION LOTTRACT
q13oc za1.V
JOB SITE -
'ADDRESS 7..`� �.�"�
APN �n
Liv-Kr�r{S 1�.��•
OWNER
CONTRACTOR / DESIGNER / ENGINEER
3e>Lti';A13C' N Onli:rEs
1"Muril VOlire' C'0.1RaUi"9s'UMITC3N
>A110f LIVISH CA..21 F0
%;A, Quwrp, c4 92253
7�Taf��.`.s1 �'11;3at
USE OF PERMIT
CL'DFS`I RU o'P 0141'RAJa ,'t:4'.IRER bUQUP 2003,4117
C PoiwT A�wpy,
VALVIATI011 1.p,
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TFUN:"ICONT'RUCTION TFAf3 ) 1.0i -0004M-000 $200,00
gof00
ii�:3
T., i)14X NOW3,��fa13.,e3t3
JUN 12 2003.
CITY OF 1 A QUINTA
FINANCE DEPT • ✓ .
RECEIPT
DATE' !
BY
D E FINAL /� /
INSIDE
`3
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
U.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 APPROVALS
Steel
POOLS - SPAS
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 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:
,
-
-
n
4
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUI.NTA, CALIFORNIA 92.253
(7 60.) .777-7000
FAX (760) 777-7101
June 2, 2003
Madison Estates, LLC
74-020 Alessandro
Palm Desert, CA 92253
SUBJECT:MINOR USE PERMIT 2003-417
(TEMPORARY TRAILER)
Dear Madison Estates:
The Community Development Department has reviewed your request to
establish an temporary construction trailer and equipment storage area at the
northeast corner of on Old Ranch Trail South and Old Ranch Trail, of Tract
3083.4 in La Quinta, and has approved your request subject to the attached
plan and the following conditions:
1. Obtain a building permit including an electrical permit for temporary
power, if necessary.
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 2A1013C fire extinguisher inside the trailer by the front exit
door.
5.. No temporary signs are permitted unless separately approved by this
Department.
6. Removal of the trailer is required and shall be done by June 2, 2004,
unless a time extension is applied for and granted by -this Department.
P\Martin\MUP 03-417.wpd
The Community Development Director may extend the permit for a set
time period if needed. No fee is charged to extend this permit.
7. The equipment storage may have a chain link fence installed around
the site. Said fence shall not be more. than 6 feet in height and shall
have a wind screen attached to the fence.
8. Dust control measures shall be employed if construction parking is
allowed adjacent to the trailer including a layer of gravel for the
parking area.
9. 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.
10. 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 please contact me at (760) 777-7068.
Sincerely,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
AA
MARTIN MAGANA
Associate Planner
C: Betty Sawyer, Executive Secretary
John Hardcastle, Code Compliance
Tom Hartung, Building .& Safety
P\Martin\MUP 03-417.wpd
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