0009-182 (DEMO) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT 9482 TRACT
04 W Pry fessionals Code,and my License is in full force and effect. 09/25(2(C Mmm
=) M License'o_ Lic.Class Exp.Date
CY JOB SITE APN
W 632630 C2� 12131/2L ADDRESS £ifl tSm Rei :NU ;59 7451416,0 01,
r-
/'rf- 1� GN' 'i%i. OWNER CONTRACTOR/DESIGNER/ENGINEER
Z t,/bate Signature of Contractor,f
r- O C:) OWNER-BUILDER DECLARATION FRANK Ba:ivft RGA�?E` PERRY YO N&S LJWD t'I,,�".�t WNG
—' PPLI M`MOODS 52.91 U Lj1rC�, DA,
11.1 W � I hereby affirm under penalty of perjury that I am exempt from the Contractor's 390 R
~ U) License Law for the following reason: VIti 17OR Mx 59875 T.HkRMAL CA 9'2274
Z_ ( ) I, as owner of the property, or my employees.with wages as their sole (760)398.0854 CBLff 2809
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044, Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals D' 01MC
Code). DEMOLITION 0$EXISTING HOUSE AS PER REQUEST OF OWNER
U0 () I am exempt under Section , B&P.C.for this reason
N Date Signature of Owner
ON
rn
Nt d z
WORKER'S COMPENSATION DECLARATION
o :EI hereby affirm under penalty of perjury one of the following declarations:
Lo F2 p ( ) 1 have and will maintain a certificate of consent to self-insure for workers' VAI�LIAI`FON .�(Igp,40 1,5
X w �L- compensation, as provided for by Section 3700 of the Labor Code, for the '
O J Q performance of the work for which this permit is issued.
m Q U (�)�I have and will maintain workers'compensation insurance,as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
CL � Z permit is issued. My workers' compensation insurance carrier & policy no. are:
CarrierSTATE 1+"172•ID Policy No.
ao � 1242819.99 :Gb'l d!iATED COST OF CONmuC')i' os 510W.00
O PKRhlrr PIX913A04ARY
J (This section need not be completed if the permit valuation is for$100.00 or less). 1�1;moi I1s'
u oI 103-000.423.000 c $45.00 "
( ) I certify that in the performance of the work for which this permit is issued, <P o
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 q,1
Code,I„shall forthwith comply with those pr_ouislo s. 9 } t 3
/Date: !':� +`�< Applicant-4. ash � �':� :.
Warning: Failure to secure Workers' ompe ationpoverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to$100,000,in C'� 16
addition to the cost of compensation,damages as provided for in Section 3706
of the Labor Code,interest and attorney's fees. r a • _y
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 t
application. a
1.Each person upon whose behalf this application is made&each person at r- ON 1 ,,
whose request and for whose benefit work is performed under or pursuant to
any
� 'C ” 7XLfC`11C1N AND 1?f �'GO )
any permit issued as a result of this applicaton agrees to,&shall, indemnify U.93 lf.&PID EMS $0.00
& 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 •oTAL nawr mm mw iiow �
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 I IIII II I I I III VIII IIII 61
• 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 IE 11
the above-mentioned property for in ection purposes. ' - ---
�r' RECEIPT DATE!". J BY� r DATE FINALED INSPECTOR
Signature (Owner/Agent)r� ' Date '`
r � 1
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Becks 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&Controls
Party Wall Insulation Condensate Lines
Party Wall 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 PI .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
COMMENTS:
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)
09/22/2000 10:03 909-784-0844 STEVEN WALKER HOMES PAGE 02
STEVEN WALKER HOME'S
J U L "''7;2000
j
BY,
June 30.2000
Frank&Margaret Perry
380 Rippling Woods
Victor, MT 59875
Dear Frank&Margaret Perry,
RE:Agreement for Services
This letter is to confirm our agreement concerning th®terms and conditions under which this company
will perform the agreement pursuant to our telephone conversations.
Whereas,Steven Walker Homes(SWH)are owners of Tract 28603-1 within the PGA West commu fifty.
Whereas, Frank&Margaret Perry(Perry)are owners of parcel number APN#761-090.011,in the City
of Quinta, CA,which property is contiguous to SWH property.
Whereas, the Perry property has an older home in poor condition and is affecting the sales of SWH
production homes,and SWH contacted Perry to discuss the removal of said home.
Therefore we have agreed to the following tends and conditions.
1. Upon acquiring a demolition permit from the City of La Quints and furnishing the required
Certificates of Insurance,Steven Walker Homes shall perform the following tasks with the sole
intent of improving the visual appearance of said lot.
2. Perry agrees to allow SWH access to Perry property to perform described work only.
3. SWH will contract with and schedule a California licensed Demolition Sub-Contractor.
4. Supervise all work while Sub-Contractor is on your property.
5. Work included:
• Raise structure and foundation,including foundation footings to the depth of 24"
• Load and haul off property all demolition debris, including any hazardous materials
found within said building.
• Rough grade building site to approximate grade of surrounding surface.
■ Perform all safety procedures required by code and law.
■ Protection from damage by this operation of existing walls,landscape,fences and drive
approaches.
■ Dust Control during work progress and cleanup of site after work completion.
6. Work excluded-.
• Excavation of any below ground level structures, pipes, valves etc, outside of existing
building"footprint"or any items below 24"within the existing building footprint.
• Search, Certification and/or removal'of any hazardous material on said lot outside of
building stricture,except asbestos were found within building.
• Watering, dust control and cleanup other than that needed while SWH performs
demolition work on jobsite.
SWH agrees that the above scope of work will be performed at no cost to Perry.
If this describes your understanding of our te:ephone conversation, please sign as"accepted try" and
return to me in the enclosed envelop.
WWW.STEVENWALKERHOMES.COM
7161 Indiana Avenue, Rlverslde, CA 92504 909.784.0840 fax 909.784,0844
09/22/2000 10:93 909-784-0844 STEVEN WALKER HOMES PAGE 03
Frank&Margaret Perry Page-2 June 30,2000
Thank you for your cooperation in this matter. Next time you are in Califomia please give me a call I.
would like very much to meet you in person,
Sincerely— Accepted By:
Daniel R.Beal
Director of Land Development Frank or Margaret Perry Date
Steven Walker Homes Owners of APN#761-090-011
Enclosure Retum FedEx shipper
' -AQMD SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
21865 E.Copley Drive,Diamond Bar,CA 91765-4182(909)396-2000 ,
MAIL ORIGINAL TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES,CA 90074-5641
AQMD USE ONLY TSCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION#
COMPLETED BY SILVIA COMPANY BRICKLEY ENVIRONMENTAL PHONE 909-888-2010
DATE 09-05-00 CHECK# f&().5 FEE$ 26.96 PROJECT# 3333
NOTIFICATION TYPEOrigin Revision Dates Revision Other(highlight) Cancellation
PROJECT TYPE Demolition Ordered Demolition Renov�(removal) Emergency Removal Planned Reno(annual)
SITE INFORMATION SITE NAME SFR
SITE ADDRESS 58'&MADISON CROSS STREET MADISON ST.
CITY LA QUINTA STATE CA ZIP COUNTY RIVERSIDE
DESCRIBE WORK LOCATION THROUGHOUT THE HOUSE
BUILDING SIZE(SQ.FT.)1,000 NUMBER OF FLOORS 1 BUILDING AGE(YEARS)30 NO. OF DWELLING UNITS 1
BLGS PRIOR I PRESENT USE Commercial Hospital Industrial Other Office Public Bldg Residence School Ship Unv/College
SITE OWNER COCOPAH NURSERY ADDRESS 81910 ARDS ST.
CITY INDIO STATE CA ZIP 92201 CONTACT ROCKY YOUNG PHONE 760-347-7906
REQUIRED BUILDING ASBESTO YE NO ASBESTOS YE NO ASBESTOS YES BLDG TO BE YES NO
INFORMATION PRESENT SURVEY? REMOVED? DEMOLISHED?
PROJECT DATES START 09-19-00 END 09-20-00 WORK SHI (aMpm)
ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS IITOTAL REMOVED(ADD ROW)
REMOVED (in square feet) 1,000 1,000
ASBESTOS REMOVED FROM FACES PIPES COMPONENTS
DESCRIBE TYPE 8,AMOUNT OF ACOUSTICAL CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC
ASBESTOS (in square feet)
FLOOR TILE(VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER(DESCRIBE)
1,000
CONTRACTOR INFORMATION CSLB LICENSE#610414 OSHA REG#49 AQMD ID#76397
NAME BRICKLEY ENVIRONMENTAL ADDRESS 957 WEST REECE STREET
CITY SAN BERNARDINO STATE CA ZIP 92411 SITE SUPVR BRICKLEY/DARST I GOMEZ PHONE 909-888.2010
LARGENTICLONINGER/CRUZ
WASTE TRANSPORTER#1 BRICKLEY ENVIRONMENTAL LANDFILL AZUSA LAND RECLAMATION CO.
ADDRESS 957 WEST REECE STREET ADDRESS 201 GLADSTONE AVE
CITY SAN BERNARDINO STATE CA ZIP 92411 CITY AZUSA STATE CA ZIP 91702
Asbestos demolition/Renovation Notification Form REV 990601
Forms,instructions and the Rule 1403 can be obtained from AQMD web site http://www.agmd.gov Page 1 of 2
----------------------------• MetroScan / Riverside (CA) ----------------*
Owner :Perry Frank M/Margaret M Parcel :761 090 011
Site :80650 Avenue 58 Thermal 92274 Xfered :10/29/1999
Mail :390 Rippling Woods Victor Mt 59875 Price :$281,500 Full
. Use :A16 Agr,Miscellaneous Structures Phone
Bedrm: Bath: TotRm: YB: Pool:No B1dgSF: Ac:9.78
i
The Information Provided is Deemed Reliable, But Is Not Guaranteed.