05-2093 (DSF)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00002093,
Property Address:
APN: 54975 AVENIDA OBREGON .
Application description: 774-294.-025-12 -000000-
Property Zoning: DEMO - SINGLE FAMILY
Application valuation: COVE RESID
Applicant:
r0�
V
Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/31/05
Owner:
GRIMES MARK
22021 NEWPORT CIRCLE
HUNTINGTON BEACH, CA 92646
RV---------------------------------
AY. BALANDRA, ALFREDO
3 1 ZO05 4292 N 7TH STREET
C1 Opp DEVORE, CA 92407
�CF ei//I�T� Lic. No.: 1786578
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 Class: 781942 ��ybb License No.: 1786578
a(Cont.rSci�di
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to .
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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).:
1—) 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 and Professions Code: The
Contractors' State License Law does not apply'to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( _.) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I 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
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.
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 and policy number are:
Carrier 1510 Policy Number STATE FLTND
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— �J� Applicant: n (fes/s
Ir �'
WARNING: FAILURE TO SECURE WO�1 RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMIfgAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for insp ction purposes.
Date°S3 ( Suture Applicant or-Agentl:
In
Application Number . . . . . 05-00002093
Permit .
. DEMO PERMIT
Additional desc .
- Permit Fee
45.00
Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date
11/27/05
Qty Unit Charge Per
Extension
BASE
FEE
45.00
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Special Notes and
Comments
DEMO TO BARE GROUND & SEPTIC
ABANDONEMENT.
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
45.00
.00
.00
45.00
Plan Check Total
.00
.00
.00
.00
Grand Total
45.00
.00
.00
45.00
LQPERMIT
1321 N. Aetna'St.
Anaheim, CA 9'2$p1
;'S-670 Highway 11.1, #�Z11
Office: 17147 778-3160
�'
La Quints, CA'9ZZ53
Fax: (7i 4) 778-3135
Office: (760) Z00-8531 .
L-JAIL
ILIO NY10"
Fax: (760) 772-8691
CA-LIC.472
313 Dosh.#613
May 10, 2005
Mr. Mark H. Chimes
22021 Newport Circle
Huntington Beach, CA 92646
Re: Asbestos Abatement Completion
Site: Grimes Residence
Obregon, La Quints; CA
5el-Q7
Dear Mr. Crimes:
On April 18, 19 and 20, 2005, Fust Quali Service removed the following. asbestos containing ;items
from the above referenced Iocation:
o Lntire roof and penetrations fro the m;iin house.
o Floor tile, and inas#ic ih the fivir g room, bedroom #1 and bedroom 42.
Enclosed are the Hazardous Waste Manic t from Consolidated Taste Industries, In �„ and a paid
invoice.
If You have any questions or need additio information, please -call us at (760) 200...8531.
Sincerely,
Jason Williams
Enclosures
4:1.500 Washington f.reet.
lei
8-105, #201
Indio, CA 92203 y�(jrjAorn j �`�
HI
Fax of 77z-6254 ENVIRONMENTAL, INC. ��ca
May 10, 2005
Mr. Mark H. Grimes
22021 Newport Circle
HuntizWon Beach, CA 92646
Re: Proposal for Demolition
Site: Grimes Residence
54-97f0bregon, La Quinita, CA
Dear ifr. Grimes:
J&H Environmental, Inc. is pleased to submit o,ir contrast fhT demol. HQA of the above -referenced
residence. The purpose of this document is to define the scope, of work and pricing structure, and to
identify- any conditions that would require coordimition in orderto complete your project in a safe and
timely manner.
All work is to be performed by a licensed dewoliti,= contractor. The pricing schedule and work terms
included in this contract are effiective for thirty (30) days from today.
Scope of Work �.
This contract includes supplying all labor, material, disposall and ecpripment: associated with the
dBM01ition of the followixkg:
Remove and dispose of one single family re sidence and dt;taahed :garage. .
• Pump the septic tank„ crush and back fill..
TOTAL COS'1,
Tbc following items will be saivaged by others prixr to the demolition:
o HVAC system
o Kitchen cabinets
o Kitchen applitances.
Condition of the Ilpt=d
This contract is based on private wage rates.
If you have any questions or need addition inforn cation, please d,all meat (760) '77,1-) 263.
Sincerely,
Thomas F. Sullivan
President
This proposal and terms are accepted.
to be scheduled at 54--976 Obregon, La
Authorized by:
Signature:
Date:
F.nvir(mmental, Inc. is authorized to .proceed with the work
ta, CA.
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