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07-2288 (DEMO)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ,,,.Application Number: 07-00002288 Property Address: 79651 HIGHWAY 111 APN: 600-020-004- - Application description: DEMO - SINGLE FAMILY Property Zoning: COMMERCIAL PARK Application valuation: 33000 Applicant: Architect or Engineer: 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTO CLARATION I hereby affirm under penalty of perjury that I licensed unde rovisio sof Chapter 9 (commencing with Section 7000) of Division 3 of the Business an rofe�de,.anmyLicense is infull force and effect. LicenseClass: C21 600283 -Dat Contractor: NER-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.). 1 _ 1 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: LQPLRM IT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 )Date: 8/10/07 Owner: CITY OF LA QUINTA 78-495 CALLE TAMPICO LA QUINTA, CA 92253 Contractor: EMERY LAND CLEARING/GRADNG INC P.O. BOX 1009 THERMAL, CA 92274 (760)391-5840 Lic. No.: 600283 ----------------------------------------------- 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. 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 STATE FUND Policy Number 0011653-2007 1 certify that, in the performanc the work for which this permit is issued, I shall not employ any person in any manner so as o ecome subj to a workers' compensation laws of California, and agree that, if I should b e s jec o the orkers' compensation provisions of Section 33377//00 of the Labor Co e I II forth ply with those provisions. - Date:Applicant:- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE GE 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 1 have read this application and state that the above i ormation is correct. I agree to comply with all city a4cninancesy ordand state laws relating to building cos uctio nd y authorize representatives of thienter upon the above-mentioned grope y for i s ectionuses. Date: a Signaature (Applicant -or Agent): LQPERN11T Application Number . . . 07-00002288 Permit . . . . . . DEMO PERMIT Additional desc . Permit Fee . . . . 45.00 Plan Check Fee .00 Issue .Date Valuation . . . . 33000 Expiration Date 2/06/08 Qty Unit Charge Per Extension . BASE FEE 45.00 ------------------------------------------- Special Notes and Comments -------------------------------- _ DEMOLISH TO BARE GROUND SFD 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 r SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL 9091396.2336 FAX: 9091396.3342 . e n • MAIL FORM A D FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, Los ANGELES CA 90074-5641 7AQMD ONLY SCREE�BY RECEIVED POSTMARK ENTERED BY NOTIFICATION # COMPLETED BY COMPANY EMERY LANDCLEARING PHONE: 761391-0840 LORI EMERY V.P. AND GRADING, INC. DATE JULY 2, 2007 CHECK # FEE $47.32 PROJECT # NOTIFICATION TYPE ORIGINAL REmsioN DATEs REVISION OTHER (highlight) CANCELLATION PROJECT TYPE DEMOLTION ORDERED DEMOLTION RENOVATION (removal) EMERGENCY REMOVAL PLANNED RENO (annual) SITE INFORMATION SITE NAME CITY OF LA QUINTA SITE ADDRESS WEST OF 79-795 HWY 111 CROSS STREET JEFFERSON STREET CITY LA QUINTA I STATE CA ZIP 92253 COUNTY RIVERSIDE DESCRIBE WORK AND LOCATION DEMOLISH REMOVE AND DISPOSE OF ONE STRUCTURE -BUILDING SIZE (SQ FT) 1,000 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 50 NUMBER OF DWELLING UNITS 1 ` BLDG PRIOR f PRESENT USE C. HOSPRAL INDUSTRIALS ONCE Puauc BLDG HOUSE SCHOOL SHIP UNNICOLLEGE SITE OWNER CITY OF LA QUINTA REDEVELOPMENT AGENCY ADDRESS P.O. BOX 1504 CITY LA QUINTA STATEICA ZIP 92253. CONTACT JON MCMILLEN PHONE 760/212-2322 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? PROJECT DATES START 8-14-07 END 8-18-07 WORK SHIFT (day. swing, night) ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL AMOUNT (add row) REMOVED (in square feet) ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC ASBESTOS (in square feet) FLOOR TILES (VAT) DRYWALL PLASTER TRANSrrE ROOFING (de HER hal CONTRACTOR INFORMATION CSLB�LICENSE # 600283 OSHA REG # NAME EMERY LANDCLEARING AND GRADING, INC. ADDRESS P.O. BOX 1009 CITY THERMAL STA TE CA ZIP 92274 SITE SUPVR JAMES C. EMERY WASTE TRANSPORTER #1 LANDFILL ADDRESS ADDRESS CITY STATE ZIP CITY AQMD ID # 100435 PHONE 7601774-9493 STATE I ZIP * Asbestos surreys are required prior to Demolition and Renovation Forms, instructions, and the Rule 1403 can be obtained from AQMD web site http:llwww.agmd.gov Page 1 of 2 Form REV 20030627 r SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 WASTE TRANSPORTER #2 WASTE STORAGE SITE ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP CONTROLS: DESCRIBE WORK PRACTICESAND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure # 1, 2, 3, 4, 5 or Other. For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Surve Bulk Sampling, Inspection, PLM, PCM,JTEM, Assumed as Asbestos-PACM, Describe Other (SEE SURVEY GUIDELINES CHECKLIST): FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL WA FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE # AUTHORIZING PERSON: TITLE DATE OF ORDER I I DATE ORDERED TO BEGIN: FOR EMERGENCY ASBESTOS REMOVAL (SIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT: EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN: CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER- STOP OWDERSTOP PROJECT HAVE CERTIFIED ASBESTOS REMOVAL CONTRACTOR REMOVE AND DISPOSE OF. TRAINING CERTIFICATION: I certify that an Individual trained in the provisions of regulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required training has been accomplished by this person will be, available for inspection during normal business hours. rator Date 7-2-07 Company Name EMERY Print name of owner/operat tignature of owneV/ope�atorTrltie of owner/o_ Pe LANDCLEARINGAND LORI EMERY VICEPRESIDENT GRADING, INC. INFORMATION CERTIFICATION: I oertify that the above inforrnation'is correct and 1 have en an' Vequired attachments. Company Name EMERY Print name of owner/operato ' Signage ofowner/oo�'� Tittle of owner/operator Date 7-2-07 LANDCLEARING AND LORI EMERY rte . / -VICE PRESIDENT GRADING, INC. Notifications can not be accepted without the required fee (AQMD Rule 301). Asbestos removals of than 100 square feet are exempt from notification and fees. Please make checks payable to'SCAQMD'. Fees are per notification, not refundable, and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL SERVICE CHARGE 1,000 or less - $ 47.32 SPECIAL HANDLING FEE $ 47.32 1,001 to 5,000 $ 144.68 REVISION OF NOTIFICATION $ 47.32 5,001 to 10,000 $ 338.64 RETURNED CHECK CHARGE $ 25.00 10,001 to 50,000 $ 531.01 PLANNED RENOVATION $ 531.01 50,001 to 100,000 $. 769.56 PROCEDURE 4 OR 5 PLAN $ 531.01 Page 2 MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 Form REV 20 0627f 2 TELEPHONE: (909) 396-2336 FAX: (969) 396-3342 FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP://WWWWHTTP:/ .AQMD.GOV SCAQMD is located at 21865 E. Copley$Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 Bin # City -of La Quinta. Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit.# Project Address:'. Tw if Owner's Name: r �,Ck f Address: City', ST, Zip: A. P. Number: Legal Description: t Contractor: Address: - Telephone: Project Description: City, ST, Zip: Telephone: 8 State tic. # : V� City Lic. #: l .. Arch., Engr., Designer: Address: City, ST, Zip: ^^ Telephone: Construction Type:Occu an Ii1,U P cY: State Lic. #:== MIMI Project type (circle one): New Add'n Alter Repair Demo. Name of Contact Person: tQ^ Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: 0 Estimated Value of Project: ] 0-00 � _V APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact•Person Plan Check Balance Plans picked up'. Construction Plans resubmitted Mechanical -7 2"Review, ready for corrections issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Structural Calcs. Truss Cafes. Energy Calcs.. Flood plain plan Grading plan' Subcontactor List Grant Deed H.O.A. Approval Plans resubmitted Grading INHOUSE: Review, ready for correctionsfissueDo acfee Called Contact Person Q • Planning Approval Pub. Wks. Appr Date of permit issue School Fees ..._ ...... �_* � CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT Form updated & effective 11/17/2006 ureen meet approvals. are forwarded to the Building. & Safety Department directlyb Public Works. Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the'Public Works Department until ALL requirements listed below are. complete. Incomplete applications or applications which cannot be processed will be returned to applicant. E#!Vr ` Date: �I Developer: LM W: wb' /ff (� Tract No.: ' `,C Tra,t. Name: Lot No. (s): Address(s): y� n ca i /) A �1 i LA P1►1 The following are the requirements for Public Works Clearance to authorize iss �ce f a� Ey from the Building & Safety Department: building permit CUSTOM HOMES: PROVIDE ITEMS #2 #3 #4 AND # �L • 5 BELOW ❖ TRACT HOMES:. PROVIDE ITEMS #1 #2 #3 #4 AS APPLICABLE AND #6 BELOW COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS.#1 #2 #3 AND #5 BELOW ` WALLS: PROVIDE ITEMS #7 BELOW ❖ SIGNS: PROVIDE ITEMS #8 BELOW 1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad (maximum allowable deviation of . +/- 0.1 foot). Pad Elevation Certificates must be current (Within'6 months of current date). If a precise grading plan creates thepad for a withhold green sheet submittal until a Pad Elevation Certificate can be provided. approval, please. 3}Attach geotechnical certification of grading. plan compliance. Attach recorded final map.showing proposed building locations are legal lots. l4. Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form, PM 10 plan & agreement or provide alternative & valid City approved PM 10 plan set reference number or hard Copy plan. PM 10 plans for commercial & residential developments (beyond 1 lot) are submitted separately with grading plans & are subject to additional requirements. 5. .Attach an approved precise. grading plan for the building location(s). AO flood zone developments will require an approved flood plain development plan. 6. Attach an approved rough grading plan for the building location(s). 7. Attach wall plan & related approved grading.plan. 8. Attach sign layout/plan & related precise grading/landscape plan. have reviewed and confirmed the requirements listed above as presented and find the improvements to be sufficiently complete for construction of the roposed buildings/structures/walls/signs on the subject lot(s). Pursuant to finding thea ove pro may be released for building permit issuance. Recommended by: Dated: Public Works Distribution: {_ Green Sheet'to Building & Safety counter (_) Green Sheet to Community Development Declined for approval for reason(s) as follow(s), please correct and resubmit: City of La Quinta - PM 10 Project Information ( < 1 acre per Lot or Infill Project) Page 1 of 3 Form updated & effective 8/25/2005 Project Information 'Project Contractor: Project Phase �� AiqA Project Phase Project Name: (Check One): b f C ` '— &�' - � Project Tract lac/ ❑ Construction Number: Demolition Lot Number(s)- Anticipated Start Date: Anticipated Project Street Address: of Completion: G Total acres in active construction (<1 acre per Lot): i Project Contact Information Please Note: Dust control is required 24 hours a day, 7 days a week, regardless of construction status. Person listed below is responsible for dust control during business and non- business hours. Name: 0 f * �M Title: Company Name: Mailing Address:an 0�© av C City: State: Zip Code: 63 7 Primary Telephone Number: Vo q'T �o h6db l —zffZ Fax: 24 Hour Access/Emergency Phone: Cell Phone: 6 d y PM 10 Certificate Number: o ❖ .Expanded PM 10 plans for commercial and residential developments > 1 acre are required by the City of La Quinta. ' 1 ' PM 10 ( < 1 acre per Lot or' Infill Project) Fugitive Dust Control Plan Page 2 of 3 Plan updated & effective 8/25/2005 l� This plan shall take into account applicable SCAQMD Rule 403 regulations. Training may be obtained by contacting SCAQMD (Sharon Zamora - Phone: (909) 396-2183). This plan shall consist of the following action items: • i ❖ WATERING: Continuous watering is required to prevent dust and must occur a minimum of4 times daily. Water shall be applied to .dry soils to stop: • . Visible dust emissions over 20% opacity • Visible dust emissions that travel over -100 feet. • Water source % hch water meter at front (south) side of pad. it ❖ EDUCATION: Responsible. Dust Control Individual and key personnel shall attend SCAQMD PM10 class and obtain PM10 certificate number prior to construction activity., WEATHER MONITORING: Wind predictions shall be monitored. ❖ SIGNAGE: Use Coachella, Valley Fugitive Dust Control Plan Handbook Construction Site Signa� e Guidelines. � _ . 9 I 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 or sprinklers. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on pad. (15 mph maximum traffic speed). PARKING: Parking is not allowed on the pad. All vehicles must park on streetat designated areas only). ( gnat j�d �j ❖ TRACK OUT: Provide 24 hour street cleaning and track out system as approved -by City Public Works Inspector.. (No dirt on public or private roads). Track out shall be cleaned up within one hour of .incident. DIRT PILES: Dirt piles shall be limited to 50 cubic r •'� ya ds 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 PM 10 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. �i �i •:• EXCAVATION MEASURES:t All areas to be excavated or graded shall be pre -watered. Water shall be applied during excavation or.grading operations also. I� s• DUMP TRUCKS: Open top dump trucks to be wet down, moist and tarped prior to leaving site. INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required. City of La Quinta - Site Specific Construction Phase PM 10 Agreement Page 3 of 3 Agreement updated & effective 8/25/2005 g The signature of the property owner (or authorized representative) ❖ Shall act as his/her acknowledgement of dust control requirements and their enforceability, .pursuant to AQMD Rules 4p3 and 403.1; ❖ Shall constitute and agreement to comply with all project conditions as identified in the approved dust control plan; The property owner (or authorized representative): ❖ Acknowledges that dust control is required 24 hours a day,.7 days a week, throughout the period of project performance, regardless of project size or status; ❖ Shall ensure that each and every contractor/subcontractor and all other persons associated with the project shall be in continuous compliance with all requirements of the approved dust control plan, ❖ Shall take all necessary. precautions to minimize dust, even if additional measures beyond those listed in the dust control plan are necessary; Shall authorize representative of the City/County to enter upon the above mentioned property for inspection and/or abatement purposes; and Shall hold Varmless th ity/County and its representatives from liability for any actions related to this dust ¢ntrol plan or any City/County initiated abatement activities. Signaturee ofWroberty Owner or A�orized Representative Zx Printed Nre Via PAo4' Title Date Chu[ A-4 W Company