10-1083 (DEMO)C-1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&ht 4:aQ"
Application Number: 10-00001083
Property Address: 79225 HIGHWAY 111
APN: 649-030-055-3 -28525 -
Application description: DEMO - COMML/OTHER
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 0
Applicant: Architect or Engineer:
6®r-F7rZA-f—T04 44
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: B Lice No.: 949005
x Date: 10 L p Contractor.
OWNER -BUILDER DECLARATION
T",
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).:
(_) 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 fSec. 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—) 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
Owner:
GARFF PROPERTIES - LQ
405 SOUTH MAIN STREET
SUITE 1200
SALT LAKE CITY, UT 84111
Contractor:
UNITED CONTR DEV & CONSTR
3170 S 1940 E
SALT LAKE CITY, UT 84106
(801)792-7417
Lic. No.: 949005
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/20/10
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 EXEMPT Policy Number EXEMPT
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 1 should bec a subject to the w rkers' compensation provisions of Section
3700 of the Labor Code, I I. forthwith co pi ith those provisions.
XDate: (Q [4 Applicant:
WARNING: FAILURE TO SECURE W RKERS' 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.
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. I agree to comply with all
city and county ordinances and state laws relating to building cons uction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for i ection purposes.
00,
)(Date:/�0 L1 /O Signature (Applicant or Agent): ��•
Application Number 10-00001083
------ Structure Information INTERIOR DEMO ONLY
----------------------------------------------------------------------------
-----
Permit . . . DEMO PERMIT
Additional desc . .
Permit Fee . . . . 45.00
Plan Check
Fee
:00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 4/18/11
Qty Unit Charge Per
Extension
BASE FEE
45.00
----------------------------------------------------------------------------
Special Notes and Comments
INTERIOR DEMO ONLY - THIS PERMIT DOES
NOT INCLUDE RELOCATION, PATCHING OR
REPAIR OF MATERIALS OR FIXTURES.
***SEPARATE PERMIT REQUIRED FOR THE
REMOVAL OF EXTERIOR WALLS*** 2007
CALIFORNIA BUILDING CODES.
October 20, 2010 4:56:15 PM AORTEGA
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 -
'
City of La Quinta - PM10 Fugitive Dust Control Plan (<1 acre per Lot or Infill Project)
This Fugitive Dust Control Plan shall take into account applicable SCAQMD Regulations Rule 403, 403.1, 401, 402, 201,
203 and Portable Equipment Registration Program (PERP).
WATERING: Continuous watering is required to prevent dust and must occur a minimum of four (4) times daily.
Water shall be applied from an adequate sized metered water source to dry soils to prevent:
■ Visible dust emissions >20% opacity
• Visible dust emissions that travel >100 feet from the source (within site)
• Visible dust emissions that cross any property line
❖ EDUCATION: The responsible dust control Individual and key personnel shall attend SCAQMD PM10 class and
obtain PM10 certificate number prior to construction activity (training information may be obtained by contacting
SCAQMD at (909) 396-2183).
❖ CONSTRUCTION 8r. DEMOLITION ACTIVITIES: A copy of this approved Fugitive Dust Plan must be kept
on site. At least one short-term stabilization method must be used during off hours. At least one long-term
stabilization measure must be used within toen (10) days of ceasing activity.
❖ WEATHER MONITORING: Wind predictions shall be monitored.
❖ SIGNAGE: Approved signs shall be installed at a highly visible location. Please refer to the Coachella Valley
Fugitive Dust Control Plan Handbook for Construction Signage Guidelines.
❖ TRAFFIC: Construction traffic shall not be allowed on the pad, unless absolutely necessary. If vehicles operate
on pad, pad shall be kept firm and moist through hose watering and sprinklers; and a maximum traffic speed of
15mph will be enforced. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on
pad.
❖ PARKING: Parking is not allowed on pad. All vehicles must park on street at designated areas only.
❖ TRACK OUT: Provide 24 hour street cleaning and track out system as approved by City Public Works
inspectors. No dirt on public or private roads. Track out shall be cleaned up within one (1) hour of incident and at
the conclusion of each workday.
❖ DIRT PILES: Dirt piles shall be limited to 50 cubic yards and built per California Building Code grading
requirements. Piles shall be kept moist or covered with tarp material. Larger dirt piles will require stockpile or
grading permit.
FENCING: Provide PM10 fencing at perimeter of public roads and where applicable. Wood slat fencing can be
installed at rear of property and return 20 feet on either side if HOA restrictions apply. Block walls can replace
PM10 fencing during the construction phase.
❖ EQUIPMENT: Extra hoses and sprinklers shall be maintained on site.
S EXCAVATION MEASURES: All areas to be excavated or graded shall be pre -watered. Water shall also be
applied during excavation or grading operations.
❖ DUMP TRUCKS: Open top dump trucks shall be wet down, moist and covered with a tarp prior to leaving site.
INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required.
RECORD KEEPING: Fugitive Dust Control Plan records (i.e. self inspection records, records of use of chemical
suppressants, tc.) shall be maintained for 3 years by the Property Owner (or Authorized Representative).
Property Owl r shall notify the City and SCAQMD within 10 days of completion of project.
AZO %D
TAChecktists - Forms & Applications\Fonns & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc
10/14/2010
To Whom It May Concern:
i"Z as Owner/Representative of the property located at
I `ToN� K2
79-225 La Quinta Drive, La Quinta City, Ca 92253 do hereby authorize the demolition
and scope of work at the above named property as outlined in the attached set of plans.
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Bin #
City Of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
10• l0$3
Project Address: '77 4
Owner's Name: 4 .¢ /Es
A. P. Number:
Address: fa 6'v
Legal Description:
Contractor: 41/1«Q 1p 40 tae; Zhr—
City, ST, Zip:�;tLT 1fjW `l u i7Y
Telephone: Y
Address: J176) ,jvvT r 19VO e41gr
Project Description:
City, ST, Zip5,W 1,16fCry !,I j.4/f Sy/d6
- /� c�A'p itliZ°�/02 O F E Iii /,y
Telephone: $61- 7f2- W/
:x }�lK. + r:;`,y:a. ,: • ' '.
State Lic. #
City Lic. #;
Arch., Engr., Designer.
Address: vie C Ewe -0"r- lucA lot
City., ST, Zip:-6ee,*VliQE C*. 26 SY
Telephone: �
P 71x0 — 7711 - oC3
; {.� ;: , }•+ ::
�••Y•xf ��.•. �{.: ;?'"•;:•�'
Construction Type: Occupancy:
State Lic. #:`r"" %' : ✓ °c"' `{
f.;•Q S f
Name of Contact Person: M EA1,V V ESq.
project type circle one New Add'n Alter Repair Demo
Ft.:
# Stories:
#Units:
Telephone # of Contact Person: �p - 7cj - %q/l
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2s. Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
7nd Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
01-1
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