DEMO (05-0900)i
Ox 1504
bOF 78- ' CALLE TAMPICO
LA U NTA, CALIFORNIA 92253
MAR 1$ 2x05 BUILDING PERMIT
aw OF LA QultfrA g
FINANCE DEPT•
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
�--A•p Tcation' Number . . .
. X05=0 -0_0-0_09-0_0a-- � Date
3/16/05
Property Address . . . .
. 53555 MONROE ST
APN:
,767-210-043- -000000-
Application description .
. . DEMO - COMML/OTHER
Property Zoning
LOW DENSITY RESIDENTIAL
Application valuation . .
. 0
Owner
Contractor
NRI CCP I
DEMO UNLIMITED, INC.
C/O NRI CCPI81750
AVENUE 50
81100 AVENUE�53
INDIO
CA 92201
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 Phan Check Fee
.00
Issue Date
Valuation-
0
Qty Unit Charge Per
Extension
------------------------------------------------------
BASE FEE.
45.00
Special Notes and Comments
DEMO TO BARE GROUND 2 STORY
BARN
?(' - BLDG. B.
Fee summary Charged
Paid Credited
Due
PermitFee Total 45.00
-----------
--Permit
.00 .00
45.00
Plan Check Total
.00 .00 .00
.00
Grand Total 45.00
.00 .00
45.00
P.O. BOX 1504T-Vf Ot
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: OS-Q�0
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
Lic. No.:
CSUIL UINU 1'LKMIT DECLARATIONS
/%-
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectibn 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 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 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
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.
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 arm under penalty of perjury that there is a construction lending agency orJthe peAGENCY
performance
ce of he work for which this permit is issued (Sec. 3097, Civ. C
Lender's Name
Lenders Address N
IMPORTANT Application is hereby made to the Director of Building and Safety APPLICANT NOWor a p ACKNOWLEDGEMENT
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. 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.
��4'— Signature (Applicant or Agent
lvull(��; ur' LVMYLL�'llUP!
THIS IS TO CERTIFY THAT AN ASBESTOS ABATEWN'T
PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO
SCAQMD, CAL -OSHA & EPA REGULATIONS AT:
2 -Story Barn
91.-500 Avenue 53 (Building "B" on Diagram)
Indio, CA 92203
tDC7
JOB #
EKU-204-107-B
.Ohms
Asbestos abatement and disposal of friable asbestos containing materials (A:CK.
per survey report number PLM0628# 1102 provided by Scott Morrison & Associates
dated July 7, 2004.
DATE
January 17, 2005
JOB NAME
The Hideaway Project/
Demo Unlimited
PROJECT COMPLETION WITNESSED BY
Beverley J. Gann
P.O. Box 285 • Mira Loma, CA 91752
Phone (909) 685-5314 • Fax (909) 681-5559
170 39Cd nA3 6999T89T96
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9960 900Z/T0/E0