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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 %!- " y,/ 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, c:t�''-.;;e�aei`;.c°y:a ;�r�.►n) T, ��;1y` i�i�';.Y.n't: G: f:+.fW 11D3L• JV9Va., Ll!ommur 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 nv --/��/v 150 d �h N4L w. w %./z�;-IvL kh orb- g� r 77P�i �pldTHi .D 7 m Ln F+ C F W O n T r� rt O 17 W �d ,�` I n'asm..rx ori -37Nl6i3O $II.aM1tl1$NI ^+' mA33M3 NYId MIS VINa0jnV3'VLNIn0 Vl L3UIS NOLDNIHSIM M AWHJIH JO OMN d31N30 N0111AYd J,dddH 1VIOd Op,M.O•<•.ti •.r<I w.• •r.cw w...• :..a .s •wl •r.n,ww r,. •u •uru �. � uu ssnsr -.v.w.,•.0 S-,—. x —'TA 5lv: pNw OR O i Lr Y Od tl 07N,1 SiO3ilHO2J omm 1S32ld nv --/��/v 150 d �h N4L w. w %./z�;-IvL kh orb- g� r 77P�i �pldTHi .D 7 m Ln F+ C F W O n T r� rt O 17 W