0402-362 (BLCK)N CD
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty bf perjury that I am licensed under provision's of
Chapter 9 (commencing with Section 7000) of Division 3 of the ECusiness `And
Professionals Code, and my License is in full force and effect. .,�• ^ }
License # Lic. Class Exp. Date
364Mi3 B 12/3111t'
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 a tKe, it 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 & Professional's
Code).
( l,I am exempt under Section , B&P.C. �for this reason -6
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Date ,) CW w
!114 Signature of Owner fw,slt
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:
CarriercMPi Policy'No'.'
EX
(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 t ose provision /P j t✓em! g:
, � I, �2, 2
Date: �.�'� -L% 14 Applicant +��� � � -P--,
)- Ott!' L/_
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions,. and restrictions set forth on his `
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby author,i!ze representatives of this City to enter upon
the above-mentioned propertyy f5r'inspec-oi�.purposes.
Signature (Owner/Agent) { �K+'•1J,r r �i'.,--$Date -.5
BUILDING PERMIT w ._ PERMIT#
DATE VALUATION LOTW2-M?.TRACT �+r /fin
7JOB
SITE
ADDRESS Lam—
''`''7i`Ei.�-3_►7t]'Y�� �
APN
- -
OWNER
CONTRACTOR/DESIGNER/EN (NEER
317 I.1 S J 5333XI '•.T
S S 15) NAIMM cav,ci '
CGS',! )MOA. Cts, 9262'
MVI?J� CA 92604
(94.9)872.7474 CUL4 TDD
USE OF PERMIT
t `iF°P A I B`tTILDI>h1G
166 L1y6' P10CK WAU ,AROUN1]'t4911.Sf t'E PE:F CITY s7'.A I)A.fRi
MD APPROVED N.>< N, 48" C1YH R_kC t OR ALSO DOING
-' OR.&MIC10MAIIIAGE A CURB/C014CREr9'4WOM. 8001 CEC:.
6 FFT. WALL jbfi (1fl 11F
rs'Z`11i nn) cost o.if' d."ommI.3n"Iom
4,110,00
CONSTRUCTION FREE a 01.000-43 VI.00 ! 972.00
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-�-� 2 5 2004
CITY OF L,A' 0`14- 'I4NTAY, C 01MIZZiTa ; l'It' W AMP .AN C%�EZK
G'3100
Ir
FINANCE DEPT. =F SS PRE PAM FESS
S0100
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q�g �s3-qua
RECEIPT
DATE
BY -\f
DATE FINALE9
INSPECTOR
INSPECTION RECOR9
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
PSet Backs
Underground Ducts
?'Forms & Footings
Ducts
cSlab 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 - IM. Lath
Final
}
Final;
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Rbotings
Main Drain
Bond Beam
Q
Approval to Cover
Equipment Location
Underground Electric
Al
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROV S
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
'Hewer Connection
Encapsulation
Gas Piping
�Gas,Test
-.Appliances
Final
COMMENTS:
le�o MW_
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole/3—Bt:
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
I tiltty Notice (Perm)
�F �wCl�rw
MEMORANDUM
TO:. Daniel Crawford, Building Inspector I
FROM: , Wally Nesbit, Associate Planneroi
DATE: 10/11/05
RE: FENCE/WALL ISSUE AT CVWD WELL SITE — SDP 2004-804
As we discussed previously, this is to verify that the existing chain link fence
and gate, along the south and east boundaries of the CVWD well site at
78180 Corporate Center Drive, may remain in'place as stipulated herein. This
is based on an approval issued for a temporary construction trailer under TUP
2005-578. The fence was originally approved as part of a wall permit related
to this site; later it was found to have .been approved in error, based on the
fact that the site zoning only allows walls and fences as accessory uses.
It is determined by the CDD, that the approval for the temporary trailer
constitutes a primary use located on the property, and therefore an
accessory use can be established. This will allow the. fencing to remain until
the permanent wall . is permitted and construction on it commences. Please
inform ORR Builders that the existing chain link fence must be green-
screened, in order to camouflage its appearance and provide a measure of
blowsand control. In addition, the fence is approved for a 6 -month term,
which coincides with the use approval for the temporary trailer. Any time
extension approved for the trailer will not be applied to this fence; therefore,.
the fencing in question must be removed on or before March 6,.2006. There
will be no.exceptions to this.
c: Anthony Moreno, Sr. Code Compliance Officer
File; SDP 2004-804
File; TUP 2005-578