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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 oil
09 iillu
Signature of Contractor iIin ti• .cam „�;,,n
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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 they
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 Policy No.
poxeMWr
(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,; l hall forthwith comply with those provision ~• +• ;;_
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 Buildinq 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 urYder 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
q ins�pection purposes.
Signature (Owner/Agent)-w�---' `ft
�_ atees a _to
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE -
APN
ADDRESS
:52-90 T.XXXOR. �,' LAT
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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CAT.-b'7�,CHD�4�1MC?k' 11Wd CORP ORAMON
WDIANWELIZ Com. 92,210
bC3�773^S1�% CS.7 41 3 919
USE OF PERMIT q'
CONSTRUCTION TRt.111BIR PJM
MUP 2001-1294
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CITY OF LA QUINTA
FINANCE DEP
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RECEIPTDATE
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BY
DATE FINALED /
INSPECTOR
/ ! ' - -
w y7 ii, ,•
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
0. 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
Underground Pibg. 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 (Perm)
COMMENTS:
-'
r••
P.O. Box 1504
78'-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
May 24, 2001
Ms. Lori Hatzopaulos
Cal -Tech Development Co.
75-352 Palm Shadow
Indian Wells, California 92210
3
(760) 777-7000
FAX (760) 777-7101
SUBJECT: MINOR USE PERMIT 2001-289_(52-905 LATROBE-LANE)`'`"-
Dear Ms. Hatzopaulos:
The Community .Development Department has approved your request to establish a
temporary construction trailer measuring 8' by 20' on Lot 6 of Tract 28867, pursuant
to Section 9.60.210 of the Municipal Code, subject to the following conditions:
1 . Obtain a building permit.
2. Dust control measures shall be employed during any on-site activities.
3. Install one 2A10BC fire extinguisher inside the trailer by the exit door..
4. The trailer, if elevated off the ground, shall be skirted with metal or wood siding
material (to hide wheels, axles, etc.). The skirting material shall be painted to
match the exterior color of the construction trailer.
5. No temporary signs are permitted unless separately approved by this
Department.
6. Mounted close to the front door shall be a written notice informing emergency
personnel of your 24-hour emergency phone number that they can call in case
problems arise that need your prompt attention (i.e., minimum 1 " high letters).
7. The trailer shall be removed by May 24, 2002, unless an extension is granted
by the Community Development Director.
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.
MUP 289 Trailer;- 50 greg;R5/22 (ss/cii)
t
If you have any questions, please contact 'me at 760-777-7067.
Sincerely,
JERRY HE A
COMI�nUN Y D VELOPMENT DIRECTOR
►'U�D E LL
PI ner
Enc.
c: Community Development Director
Building and Safety Director
Code Compliance Department
Fire Department
Betty Sawyer, Executive Secretary
MUP 289 Trailer - 50 greg;R5/22 (ss/cii)
City of La Quinta
Community Development Department
78-495 Calle Tampico
La Quinta, California 92253
(760) 777-7125 FAX: (760) 777-1233
OFFICE USE ONLY
Case No. d/ — �� Y
Date Recvd. S—
Fee: -7 C
Related Apps.:
Logged in by:
APPLICATION FOR MINOR USE PERMIT APPROVAL
MINOR USE PERMIT applications are reviewed and approved by the Community Development Director
pursuant to Section 9.210.020, of the Zoning Code. The purpose of the review is to ensure that land uses requiring
the permit do not have an adverse impact on surrounding properties, residents, or businesses.
APPLICANT
(Print) t�4oi 3.
MAILING ADDRESS 1I52 1 S I QaI 1M (4V41W Phone No. 1'1; •C% �j y
CITY, STATE, ZIP: l!�%,��5. �iM1 a1L'Ll0 Fax No. 113 -141 ZS
PROPERTY OWNER (If different► 9 mocw y KL%y-^
(Print)
MAILING ADDRESS:
Phone No.
CITY, STATE, ZIP: Fax No.
PROJECT LOCATION: Z -q OS hk r OhR, lan • L•Q ' C12,7 -C3
PROPOSED USE AND/OR CONSTRUCTION (Including operational information):
Cx�n t ^ joyw y AIA
I (attach sheets if needed)
LEGAL DESCRIPTION (LOT & TRACT OR A.P.N.): L �1ra(s! _ Z 8Q (A71
• (DATE)
ASSIGNED TOz4�
A18Vvlinor Use Permit O(INITIALS)
ii 1 AY 17 200
CITY OF LA OUINTA
SUB 41M) EQ-UIEEMENTS •
❑ Plot Plan, floor plans and elevation plans (as determined by Community Development Department staff).
Five (5) sets of plans on 2" x 11" sheet or folded down to 8'/Z" x 11".
❑ Filing fee for Minor Use Permit. If filing multiple applications, the most expensive application will be
charged full fee, with remaining related applications discounted 50% for each. This discount does not apply
to Environmental Information form.
NAME OF APPLICANT l,�Y�"'t� 1A5
(Please Print)
SIGNATURE OF APPLICANT
DATE S � I i, D I
NAME OF PROPERTY OWNER
(Please Print)
SIGNATURE OF. PROPERTY OWNER(S)
DATE
IF NOT SAME AS APPLICANT:
(Signature provides consent for applicant to'use site for proposed activity).
DATE
(Separate written authority by owner to submit application may be provided)
NOTE: FALSE OR MISLEADING INFORMATION GIVEN IN THIS APPLICATION SHALL BE
GROUNDS FOR DENYING APPLICATION.
AIMinor Use Permit