05-2930 (TT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
1
C05-00002930 411,47647 CALEO BAY
643 -200 -004 -
TEMPORARY TRAILER
COMMUNITY COMMERCIAL
15000
Tit!t 4 4 Q"
Architect or Engineer.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
a a�
JUL 2 2 2005
CITY OF 111 QUINTA
FINANCE DEPT.
Owner:
LA QUINTA MEDICAL PARTNERSHIP
5500 TRABUCO RD #100
IRVINE, CA 92620
Contractor:
DIFFENBAUGH INC, J D
6865 AIRPORT DRIVE
RIVERSIDE, CA 92504
(951)351-6865
Lic. No.: 181805
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/22/05
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business aW Professions s Cod nd my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: A B C8 C27 icens o.: 181805
_
for by Section 3700 of the Labor Code, for the performance of the work for which.this permit is
(7
issued.
/DaJte Contractor:
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
6"
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILD DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law.for the
Carrier AMER CASUALTY Policy Number WC274965862
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I sOd b ome subje t to t orkers'compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor C, I all forthw' h co with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: : i - Applicant:
(_ 1 1, 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 and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENS ION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
1 _) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuantto the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , BAP.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 tgovormation is correct. agree to comply with all
city and county ordinances and state laws relating to buuctithorize representatives
of this county to ent upon the above-mentioned propection p p ses.
Date:_ Signature (Applicant or Agent):
Application Number . . . . . 05-00002930
Permit . . . TEMP TRAILER
/ MOBILE HOME
Additional desc .
Permit Fee . . . . 200.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
15000
Expiration Date 1/18/06
Qty Unit Charge Per
Extension
BASE
FEE
200.00
----------------------------------------------------------------------------
Special Notes and Comments
TEMP CONSTUCTION TRAILER PER MUP
#2005-558
Fee summary Charged
-------------------------------------
Paid Credited
----------
Due
Permit Fee Total 200.00
.00
----------
.00
200.00
Plan Check Total .00
.00
.00
.00
Grand Total 200.00
.00
.00
200.00
LQPERMIT
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
July 21 2005
Chris DeYoung
6865 Airport Drive
Riverside, CA 92507
SUBJECT: TEMPORARY USE PERMIT 2005-558
Dear Mr. DeYoung,
. (760) 777-7000
FAX (760). 777-7101
r
The Community Development Department hereby approves your application
request to install a construction trailer on the southeast corner of Washington
Street and Lake La Quinta Drive, as shown on the attached exhibit during the
construction of the facility, subject to the following conditions:
1 . Once the trailer is installed, it can remain on-site for a six-month period.
However, an extension may be applied for, with no additional fee, in
writing to the Community Development Department prior to the expiration
of the permit. The Community Development Director may, after reviewing
the facts, extend the use of the trailer for another.six-month period.
2. Use of the trailer shall be limited to the.hours of construction as listed . in
the La Quinta Municipal Code (Chapter 6.08, Nuisances). A copy of this
time schedule can be obtained from the Building and Safety Department.
3. A building . permit is required for the temporary trailer and temporary
electric power. Please apply to the Building and Safety Department for a
permit (760-777-7012). Written' permission from the property owner is
required before a building permit can be issued.
4. The trailer shall be placed a minimum 10 -feet from the street unless
otherwise approved by the Building and Safety Director.
5. A building address shall be installed on the trailer to help identify the
temporary business location (e.g., minimum 2 -inch high letters in a
contrasting color).
6. Provide one 2A10BC fire extinguisher inside the construction trailer and
sign over the exit door which states 'Door to Remain Open During
Business Hours.'
7. The trailer, if elevated off the ground, shall be skirted with metal or wood
siding material. The skirting material shall be painted to match the exterior
color of the construction trailer. The exterior surfaces of the trailer shall
be painted (or may be stuccoed) and in overall good condition.
8. No temporary signs are permitted unless separately approved by this
Department.
9. No exterior lighting for the trailer is allowed unless approved by the
Building and Safety Department. All security light fixtures shall be hooded
to prevent light glare from being cast onto adjacent residential properties.
10. Mounted close to the front door on the outside of the building shall be a
written notice informing emergency personnel of your 24-hour emergency
phone number in case problems arise that need your prompt attention
.(i.e., minimum one -inch high letters).
11 The trailer and fence shall be removed from the site prior to the issuance
of a Certificate of Occupancy.
12. . Provide restrooms facilities to accommodate on-site construction workers.
13. Dust control measures shall be employed if construction parking is allowed
adjacent to the trailer.
14. The City may elect to add conditions to this application request to mitigate
any problems that may arise and are not address herein.
If you have any questions, please contact me at (760) 777-7067.
Very trulylyoAjrs,
JAY W1 U
Assistan P nner
c: Building and Safety Department
Public Works Director
Code Compliance Department
Sheriff's Department
r
rtl9wGi0w STkFFI
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