DEMO (05-0896)Tldf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
>x- 1504 (760).777-7012
CALLE TAMPICO FAX (760) 777-7011
NTA; CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
P1NAn`'� "--
App ication Number
Property Address . .
APN:
Application description
Property Zoning . . . .
Application valuation
05-00000896 Date 3/16/05
53555 MONROE ST
767-210-043- -000000-
DEMO COMML/OTHER
LOW DENSITY RESIDENTIAL
0
Owner
Contractor
NRI CCP I
DEMO UNLIMITED, INC.
C/O NRI CCPI
.81750 AVENUE 50
81100 AVENUE 53
INDIO
CA 9.2201
LA QUINTA
CA 92253
(760) 775-5884
WCC: HRH INS
WC: 009421-2005
01/01/06
CSLB: 473328
05/-31/05
CCC: A -C21
Other struct info
NUMBER OF UNITS
2.00
Permit . . . .
DEMO PERMIT
----------------------------
Additional desc
Permit Fee
45.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
0
Qty Unit Charge. Per
Extension
BASE
FEE
45.00
Special No.tes and
Comments
-.---------------------------------
DEMO TO BARE GROUND GRAY METAL TRAILER
- BLDG. I.
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
P.O. Box 1504 �/� ,
78-495 CALLE TAMPICO (N VOFAX ICE (760) 777-7012760) 777-7011
LA QUINTA, CALIFORNIA 92253 4 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: _ 0.7 - $9 (p
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
ouit-UINU rtGIKm1I utVLAMATIONS
LICENSED CONTRACTOR'S 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 Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 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 or 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.).
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.).
L) I am exempt under Sec. , BA P.C. for this reason
ate �0 n9t'er
WORKERS' 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 and policy number are:
Carrier Policy Number
_"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.
p icant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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.
CONSTRUCTION
I hereby affirm under penalty of perjury that there is a construction lending agency orJthe performance AGENCY
of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address — s0 /A
IMPORTANT Application is hereby made to the Director of Building and Safety Jfor a permit OGE
ACKNOWLEDGEMENT
he 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 Ouinta, 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. I 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 inspection purposes.
.,"e �8ranature (Applicant or Agent):
m
ENVIRONMENTAL
KLEAN-UP
CoettactorS State Y.,6cease "U979 DOSH 4595
NOTICE OF COMPLETION
THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT
PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO
SCAQMD, CAL -OSHA & EPA REGULATIONS AT:
Gray Metal Trailer
53-555 Monroe Avenue
r .7. o, CA_92203 :
JOB #
EKU-204-10'-M
Asbestos abatement and disposal of non -friable asbestos containing materials (ACM)
Approx. 10 Sq/ft roof mastic penetrations per survey report provided by
Enviro-Test dated February 22, 2005.
DATE
January 18, 2005"
JOB NAME
The Hideaway Project/
Demo Unlimited
PROTECT COMPLETION WITNESSED BY
Beverley J. Gann
P.O. Box 285 • Mira Loma, CA 91752
Phone. (909) 685-5314 • Fax (909) 681-5559
SOY
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