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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...,
,'692234 BMC.` mz(. .
Date"' vSignature 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.
( ) 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:
Cartier .A�`p.1tl�t D Policy No. 044
-02,0014314
(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 ection 3700 of the Labor
Code, I shall fort, with comply with those provisions/
Date: x Applicant -
4F -
Warnin : Failure 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
t`e'above-mentioned property for inspection purposes.
Signature (Owner/Agent) �, A Date °f
V
PERMIT #
BUILDING PERMIT �)
DATE `:� VALUATION LOT 0302-107 TRACT
JOB SITE
ADDRESS 7S^(KM. CjUjX)3 AR(ws��Q 1A
APN
OWNER
CONTRACTOR / DESIGNER/ENGINEER
TT Y7ftt,5 //,
GRaL SZ
C & G CQVS'AM CTION -
8-034 CA'):LE RARC`-U)NA
965 MG?R"J`H MIXONDAWINUR,
Lik Q019rA fes. 92253
i5i 3�i3� .:- �,. • .. . . 'CA, P1786
(909)982-9%. 5 CII -4 3539
USE OF PERMIT
CWT MAf .
780 L. V Sg,LirMP,3=49 WALL PER, CITY STANDARD AND CCDD APPF2OVE0
PLAN&
0 rr. WALL 200d)10 L
Xlslnullixo COSU oil, CG?NUMUC IG NIT
510M.00
]PERMWIME SUMMARY
' CONSTRUCTION FEE 101.000.41,8-000
T�I'.��t`.�7C1°l:i'C�1�
I'M PME-PAWFUIVIS
$0,00
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FEB 1 2 2003 :. �� � C)w
CITY OF LA QUINTA
S71M
FINANCE DEPT.
RECEIPT
DATEA j r
BY C: ��
D7FINAL,.D_ /�
INSPEC
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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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
Final /Z -�� r� ��
• PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
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:
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Anproved by: R e o jk
Planning Commission
N O ity Council �._..
I' '�Comm i�� Dev. Dept.
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Exhibit
0 With Conditions _
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Architectural and Landscape Review Committee Recommendations
The Architectural and Landscape Review Committee reviewed the initial request, and
their recommended conditions of approval. have been incorporated into the attached .
conditions.
STATEMENT OF MANDATORY FINDINGS:
The findings necessary to approve Village Use Permit amendment can be made, as
noted in the attached Resolution with the following exceptions:
1. No master sign program has yet been submitted for the project site. A
condition has been included that requires the approval of both a master sign
program, and a conforming sign permit for the businesses before they occupy
the site.
2. Although the parking lot improvements have been previously reviewed and
approved by the City, a potential conflict in use exists between the parking lot
activity (e.g. noise., lights, alarms ... etc.) and the future use of the vacant
properties east of the site. A condition has been placed that requires a slump
stone block wall to match the existing wall in accordance with Section
9.100.030 (C).
3. A sidewalk will be located along Avenida Bermudas in the right of way and into
the project site. Due to the mature trees that exists along the right of way the
sidewalk ends half way along Avenida Bermudas. The applicant has agreed to
work with the City to extend the sidewalk at some point in the future. A
condition has been included to reflect this agreement with the applicant.
RECOMMENDATION:
Adopt Planning Commission Resolution 2003-_, approving an Amendment to Village
Use Permit 2001-013, subject to the findings and conditions.
Prepared and Submitted by:
y c�
Oscar W. Orci, Planning Manager
Attachments:
1. Resolution 2001-145
2. Previously approved plans (separate, Planning Commission only)
3. Proposed improvement plans (separate, Planning Commission only)
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