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0311-026 (TT)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 763595 B CS1 .r 0,9rSGf2t 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). O I am exempt under Section B&P.C. for this reason'" Date �%`/{ '"��z p 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 p .TATL,LIND Policy No. 1603626,02 (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 provisiops� Date: d!Z- 6'k "e", '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.M-- Signature (Owner/Agent) Datet4l/z �`a'. L- BUIDING- PERMIT PERMIT# DATE VALUATION, — LOTr TRACT 1 V050,01: $200.00 " JOB SITE i ADDRESS 79_%2 MCI APN OWNER CONTRACTOR/DESIGNER/ENGINEER 091M.LEV"Aw.LA6ICRePr�A, LWI DC7..9" DEV., WC dh&DRSEU UMS DFV- 71-111" TAMARI 1%LP;t*- 78-600 WON WAY.1).i RANCHO 1a�G E Ck 92270 LA QTJUfA CA 92153 0160)771-5345 C91.4 215; USE OF PERMIT 1vt..iSC E 'i�t�}?t; US 9`Lrlflll d3WtY COldS'Pt2iJt"TION11T.AM.ER PER TL8P142003.426 VALUAT10)q 200.00 LS 1f>t('a'L9.�.A`.C�a) COST OF CCANsIR 1111 ?0 2WJ30 TEMP 0.CXN0ThUCT1I011 RAJIM 1.51.-000.433.000 MUD D E�La�TMAL ,V .t ... �X©1� � 1�1.�521' �'t rid $200.00 t LF.03 PRE -PAID MW W 0o NOV Q ti CITY OF LA QUINTA FINANCE DEPT. .� RECEIPT n P DATE /pp BY 4: DATE FINALED INSPECTOR 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 O.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 (Penn) COMMENTS: ; <k 1. . TUT 4 4 a" P.O. Box 1504 78-495 CALLS TAMPICO (760) 777-7000 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101 November 5, 2003 Mr. Michael Shovlin Desert Cities Development Company 71-084 Tamarisk Lane Rancho Mirage, CA 92270 Subject: Temporary Use Permit 20037426 (Temporary Construction Trailer for SDP 03-770) Dear Mr. S!hovlin: The Community Development Department has approved your request for a temporary construction trailer in the One -Eleven La Quinta Shopping Center for the construction of a retail building, pursuant to the enclosed plan and subject to the following conditions: 1. Obtain a building permit including an electrical permit for temporary power prior to setting trailers on site.. 2. The trailer shall have restroom facilities to accommodate personnel unless off- site facilities shall be easily available. 3. Moupted on the exterior of the trailer close to the front door shall be a written Notice providing emergency personnel your 24-hour emergency hone 9 Y p number they can call in case problems: arise that need your prompt attention (i.e., minimum 1 " high letters). 4. . Install one 2A1OBC fire extinguisher inside the trailer by the front exit door. 5. No temporary signs are approved unless separately approved by this Department. 6. Removal of the temporary construction trailer is required upon completion of this project. ffW "l 7. The Public Works Department shall approve the temporary aisle relocation prior to any work proceeding. 8. 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 provided the necessary paperwork and filing fee of $175.00 are filed with this office within 15 days.. If you have any questions, please contact me at 760-777-7064. Very truly yours, JERRY HERMAN COMMUNITY .DEVELOPMENT DIRECTOR STAN B. SAWA Principal Planner c: Building and Safety Director Public Works Director Code! Enforcement Department Fire Department P:\STAN\mup tup\tup 2003-426 Itr app.wpd i 11,;;; v-1i iiiwc?� N `HX3 31110 01 h LN3W1H d30. 3WdOl3A30 ALI f1WW 8 03 ddb G" '610 s .\ ZZ z . ev 1 � � � '�-• .'tip •.,r'•--,��.. . ^ A.�.�--�...,'�.��"�?,:.�rAC.(� ,.,� - 4an-30-02 04:14pm From -MOBILE k'.011wAR - +19083606622 T-458 P.002/001 F-968 ollta Mobile Modular Management Corporation Quote. Reference # of8049LY -_,� 11450 Mission Blvd, Mira Loma, CA 91752 Date of Quote: 1/30/02 www.MobileModularRents.com 112 x 35 sn-7459 Gi4382e .� I ��►I1 Floorplan # 123500032,6 Customer DesertiCitles Development Attn Caroline Sales Representative Lori Young Phone (760) 771-3345[young (�imobtlemodularrertts.com Fax . (760) 771-4431 Email Ph 909-360.6600 Fax 909-360-6622 - Term 12 Months* Deliver to iLA QUINTA Building $283.00 Fumiture $0.00 Ramp $0.00 Insurance Waiver $0.00 ONWOUNNIM&. � 32i . " 0 12 24 o = N— 36 48 60 72 80 illlllllir�ltttillllitllilillllllr�llllilill at Notes: NAL ITEMS: Plan Desk $18.00 + tax per month, ffsomowl Matched perimeter 9 $8.00 + tax per linear foot, Foundation plans and oaloulabons $3S0.00 + taX Metal steps (30" high) are included. This does not include any additional requirements by the city or building department Mobile Modular accepts no isibilbtyfor electrical connections done on site by others. V T1-1 i premium Oougtas Fir wood manor painted a CamelMiesa Brown color kited 91M wflh bronze tinted frames (number a location as shown on dmh-ha) -grid swpended oe4in9 It preflnlshed wood Mani gi throughout I Ov duplex eteddcat ouilets located appmx 17 O.C. !eating 8 air condifianir g ducted thru the ce1'mg wlret m air at the end wan Aaamonai intermation Quota is valid rar 3o days. A minimum cleaning charge of $75.00 per floor vnll appy i7 the umiit ISM mWmed denied. Customees aft must be dry, compacted, level and accessible by normal truck delivery. Costs to Bony. cM.e, Totkift. ft colli be paid by cusbomor. linlesa noted prices do not 1ncode permits, ramps, ramp rerrrowal, staffs, sdanie foundation sysoaft t d0HY, a foundation sidr8ng, skirting removal, w9neering, taxes or u5my hookups N! drawings and spedllcatfons are nomtnaL This t on Ic wbject prior approval and all terms,conditions and attachmerts of MV1MCs standard contract. security Depost may be required. • Rent VA be billed in advance Avery 30 calendar days. •• Prices do not Include applicable tax Thank you for contacting Mobile Modular. Please call me with any questions or comments. Page 1 of 1 Deliver to iLA QUINTA Delivery $368.00 Skirting Optional Block/Level $90.00 Optional Return Delivery $366.00 Install/Dismantle Ramps) Optional Dismantle $80.00 Other Optional Modifications Optional Furniture Optional 36 48 60 72 80 illlllllir�ltttillllitllilillllllr�llllilill at Notes: NAL ITEMS: Plan Desk $18.00 + tax per month, ffsomowl Matched perimeter 9 $8.00 + tax per linear foot, Foundation plans and oaloulabons $3S0.00 + taX Metal steps (30" high) are included. This does not include any additional requirements by the city or building department Mobile Modular accepts no isibilbtyfor electrical connections done on site by others. V T1-1 i premium Oougtas Fir wood manor painted a CamelMiesa Brown color kited 91M wflh bronze tinted frames (number a location as shown on dmh-ha) -grid swpended oe4in9 It preflnlshed wood Mani gi throughout I Ov duplex eteddcat ouilets located appmx 17 O.C. !eating 8 air condifianir g ducted thru the ce1'mg wlret m air at the end wan Aaamonai intermation Quota is valid rar 3o days. A minimum cleaning charge of $75.00 per floor vnll appy i7 the umiit ISM mWmed denied. Customees aft must be dry, compacted, level and accessible by normal truck delivery. Costs to Bony. cM.e, Totkift. ft colli be paid by cusbomor. linlesa noted prices do not 1ncode permits, ramps, ramp rerrrowal, staffs, sdanie foundation sysoaft t d0HY, a foundation sidr8ng, skirting removal, w9neering, taxes or u5my hookups N! drawings and spedllcatfons are nomtnaL This t on Ic wbject prior approval and all terms,conditions and attachmerts of MV1MCs standard contract. security Depost may be required. • Rent VA be billed in advance Avery 30 calendar days. •• Prices do not Include applicable tax Thank you for contacting Mobile Modular. Please call me with any questions or comments. Page 1 of 1