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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
286936 C",.0 Cgo HIC 04, 30112(
D eSignature 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.
1-(,�)'•' 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 S TATE FUND Policy No. €46.0200 4779
(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: 11- / c 2 Applicant-
Warning:
pplicant Warning: Failure to secure Workers' Compensation cove ge 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, indemnity
& 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.
Signature (Owner/Agent) t�td.?�lr%j�x�Date'%'-
BUILDING PERMIT PERMIT#
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VALUATION LOT-� TRACT
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ADDRESS i'jj,_&Pj AV F,_qi1iA8,��
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
LA QX3s' TA CA 922,13
Dli3I0 CA r1201
(7,6C)3&7•,3605 C 8110 32
USE OFF�PERMIT
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TOM Pl?.:RAgr MAS 13 OF, NOW
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RECEIPT
DATEBY
DAT FIN ED
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 8 Controls
Party Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
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) �7
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P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
October 1.4, 2002
Ms. Lori Abdelnour
Allstate Insurance
_51650 Avenida Bermudas
La Quinta, California 92253
(760) 777-7000
FAX (760) 777-7101
CITY OF I_A 011IP,ITA
,QCT 14 RECD
BUILDING AND bier ETy
SUBJECT: PLANNING COMMISSION ACTION ON VUP 2002-014
Dear Ms. Abdelnour:
The Planning Commission at its meeting of October 8, 2002, adopted Resolution
2002-096, approving your request for the above noted application for a office use,
subject to conditions of approval. Attached is a copy of the applicable Resolution and
conditions of approval. Please comply with them as required. Failure to do so may
result in this permit being revoked. This action is final unless appealed to the City
Council within 15 days of the action. Please contact us should you wish to appeal.
You are required to obtain.a City business license in order to conduct your business
if not already obtained.
If you have any questions, please contact me at (760) 777-7064.
Sincerely,
JERRY. HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
STAN B. SAWA
Principal Planner
enclosures
c: Building and Safety Department
p:\stan\Itr app sdp 2002-741.wpd
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PLANNING COMMISSION RESOLUTION 2002-096
A RESOLUTION OF THE PLANNING COMMISSION OF THE
CITY OF LA. QUINTA, CALIFORNIA; . APPROVING_
CONVERSION OF A RESIDENCE TO AN OFFICE
CASE NO.: VILLAGE USE PERMIT 2002=014
LORI ABDELNOUR (ALLSTATE INSURANCE)
WHEREAS, the Planning Commission of the City. of La Quinta, California,
did on the 80' day 'of, October, 2002, hold a duly noticed Public Hearing to consider
the request of Lori Abdelnour (Allstate Insurance), for approval of a Village Use Permit
to allow conversion of a residence to an office located at 51650 Avenida Bermudas,
more particularly described as:
APN 770-182-003
WHEREAS, said Village Use Permit has complied with. the requirements
of "The Rules to Implement the California Environmental Quality Act of 1970 as
amended (Resolution 83-63) in that the Community Development Department has
determined this Village Use Permit request is categorically exempt from further
environmental review pursuant to Section 15301, Class 1 of the Guidelines for
Implementation of the California Environmental Quality Act, as amended (Resolution
83-63), and;
WHEREAS, at said Public Hearing, upon hearing and considering all
testimony and arguments, if any, of all interested persons wanting to be heard, said
Planning Commission did make the following Mandatory Findings justify approval of
said Village Use Permit:
A. The project is consistent with the General Plan and Zoning Code in that the use
is permitted in the VC District and has been designed to comply with the
applicable VC District development standards, guidelines, and provisions,
except for providing the required on-site parking. In this case, parking need
will be adequately satisfied with the limited on-site parking and adjacent street
parking.
B. This project has been determined.to be categorically exempted from California
Environmental Quality Act requirements under Section. 15301, Class 1 of the
Guidelines for Implementation.
C. The project will not create conditions materially detrimental to the public-
health, safety, and general welfare in that. the use is contained in an existing
structure.
p:\stan\vup 2002--014.wpd
Planning Commission Resolution 2002-096
Village Use Permit 2002-014
Lori Abdelnour (Allstate Insurance)
October 8, 2002
D. The architectural design of the building with the restoration completed, is
compatible with the surrounding uses and quality of design illustrated in the
Village at La Quinta Design Guidelines.
E. The site design of the project including entries, circulation, screening, is
compatible with the surrounding project.
F. The landscaping provides an attractive appearance surrounding the existing
building.
NOW, THEREFORE, BE IT RESOLVED, by the Planning Commission of
the City of La Quinta, California, as follows:
1. That the above recitations are true and constitute the Findings of the Planning
Commission in this case;
2. That it does hereby approve Village Use Permit 2002-014 for the reasons set
forth in this Resolution and subject to the attached conditions.
PASSED, APPROVED, and ADOPTED at a regular meeting of the La
Quinta Planning Commission held on this 81 day of October, 2002,. by the following
vote, to wit:
AYES: Commissioners Robbins, Tyler, and Chairman Butler
NOES: None
.ABSENT: Commissioners Abels and Kirk
ABSTAIN: None
RICH BUTLER, Chairman
City of La Quinta,California
ATTEST:
JERRY HERMAN, Community. Development Director
City of La Quinta, California
p:\stan\vup 2002-014 pc res.wpd
Planning Commission Resolution 2002-096
Conditions of Approval - Final
Village Use Permit 2002-014
Lori Abdelnour (Allstate Insurance)
Adopted: October 8, 2002
GENERAL
1.. The applicant agrees to defend, indemnify, and hold. harmless the City of La
Quinta (the "City"), its agents, officers and employees from any claim, .action
or proceeding to attack, set aside, void, or annul the approval of this Village Use
Permit thereunder. The City shall have sole discretion in selecting its. defense
counsel.
The City shall promptly notify the applicant of any claim, action or proceeding
and shall cooperate fully in the defense.
2. The second story shall not be used by health care providers or for retail use
unless an elevator is provided.
3. Install portable fire extinguishers as required by the California Fire Code (Fire
Department - 863-8886).
4. Install a KNOX key box on each . commercial suite as required by the . Fire
Department. Small buildings may use a common box (Contact the Fire
Department for an application).
5. Use shall not be expanded or changed without approval of the Community
Development Department.
6. The freestanding business identification sign is hereby approved..
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