06-1531 (DSF)P.O. BOX 1504-
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&ty/ 4 4 Q"
Application Number: .06.-00001531 D
Property Address: 48751 SAN DIMAS ST
APN: 646-130-002- - -
�� Application description: DEMO - SINGLE FAMILY
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 0
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
q Owner:
JEAN T STEPHENSON
APR 13 LA Q SAN DIAAS
LA UINTA, CA 92253
006
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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 icens No 5�2�18�9/0
Date: Jq_1'G4r Contract.
OWNER -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 _ 1 1, 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 contractorls) 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: _
LQPERMIT
Contractor:
KIRK CONSTRUCTION INC, MIKE
72677 BEAVERTAIL STREET
PALM DESERT, CA 92260
(760)346-1820
Lic. No.: 521890
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/13/06
-----------------------------------------------
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 1090480-2006
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 I should become subject to the workers' compensation provisions of Section
t 3700 of the Labor Code, forthwit ply witefhoseiV,sions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSA ION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE. HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 agr to comply with all
city and county ordinances and state laws relating to building c uction, and reby au rize r esentatives
of this county to enter upon the above-mentioned propert r i s n sea.
Date: 1� Signature (Applicant or Age
dr
Application Number . . . 06--00001531
Permit DEMO PERMIT
Additional desc .
Permit Fee 45.00
Plan Check -Fee
.00
Issue Date
Valuation
0
Expiration Date .- 10/10/0.6
Qty Unit Charge Per
Extension
BASE
FEE,
45.00
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Special Notes and Comments
DEMO OF SFD INCLUDING ABANDONMENT
OE
EXISTING SEPTIC SYSTEM PRIOR TO REBUILD
OF SFD WITH NEW SEPTIC SYSTEM.
`
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 -
PROPERTY LINE.
----FACE OF CURB
C.L. 5AN DIMA5 —
• 1
NOTE! DRIVEWAY APPROACH
AND INSPECTION FROM RES A SEPARATE PE
RMI
WORKS DEPARTMENT.
CIN OF LA QUINTA PU13LIC T
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Residential Plan Check Correction List (os) —
Page 1 of 4
1 /8" = I '-(
April 14, 2006
To Whom It May Concern:
I hereby give permission to Mike Kirk Construction, Inc., or to any subcontracator
employed by Mike Kirk Construction, to demolish my residence at 48751 San Dimas
Street, La'Puinta, California 92253.
l /
l k
Jea T. Stephenson
RECORDING REQUESTED BY:
MME Cw= TME vii.
AND WHEN RECORDED, MAIL TO:
Jean Stephenson
25 Edgewood Lane
Bronxville, NY 10708
DOC a 2003-213700
03/27/2803 08:800 Fee:27.00
Paps 1 of I Doe T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
Assessor, County Clark t Recorder
I 111 1111 111111111111111111
ose
mMe0SEEMMMMMMp
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MENIMMOMM000
e..IMMeMeeM
ASSESSOR'S PARCEL NO.: 646-130-002-4 The u1n.=a V,wu wainu,ka) utsunitips/ t11 tt t11e UU%PUMtN 1
TiTLEORDERNO.: R-222488-1 $ 665.50 County $
011
t mmizi 6R
City
ESCROW NO.: 21914-001 = computed on the full value of the interest of property conveyed, or
— computed on the full value less the value of liens or encumbrances
GRANT DEED remaining thereon at the time of sale
— OR transfer is EXEMPT from tax for the following reason: FT
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged,
Karen D. Price, Trustee of The Karen D. Price Revocable Living Trust dated March 9,.1996
hereby GRANT(S) to
Jean T. Stephenson, a married.woman as her sole and separate property
all that real property situated M the City of La Quinta
County of Riverside , State of Califomia, described as:
Lot 33 of La Quinta Golf Estates No.l as per map recorded in Book 37, Pages 96 of Maps in
the office of the County Recorder of Riverside County, State of California
Dated February 28, 2003
STATE O rSSdic/ll}
COUNTY OF ss.
0n before me
tncJ�aQlr,ne G"r"` 91'C_%<_> Public, personally appeared
r� D
ren D. Price, Trustee
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
Is/are subscribed to the within Instrument and acknowledged
to me that he/she/they executed the same in his/her/thelr
authorized capacity(ies), and that by his/her/their signature(s) . 'WiypK, ,, MICHAELINE CARIJTHERS
on the Instrument the person(s), or the entity upon behalf of �� Notary ;? St. Chades Cowry
which the person(s) acted, executed the instrument
� Seal: � = My Camrrdssion Expires
WITNESS my hand and official seat. le..
,, October 18.2006
Signature
MAIL TAX STAT MENTS TO: (Th` `n` 1m `no
"r v"r'
Jean Stephenson -25 Edgewood Lane, Bronxville,NY 10708
NAME ADDRESS CITY, STATE & ZP
211111111
a -i
ENV/RONMENlAL P.O. Box 7318
GCAffmAcrCum San Bernardino, CA 92411
T PD�A��Ni Phone (909) 8847424
iNr— Fax (909) 884-3744
NON -HAZARDOUS
1. Generator's US EPA ID No.
Doc. No.
2. Page 1
WASTE MANIFEST
°M�an'rfest
14.0 T R E OU'
I R F .D
" "•`
of 1
Q
3. Generator's Name and Mailing Address
O'F.AN STE.PH;ENSON v
48751 SAIVDIMAS STREET
,.
LA 2UI14TA., CA 92553
4. Generator's Phone ( 760 ) 777-9821..
5. Transporter 1 Company Name 6.
US EPA ID Number
A. Transporter's Phone
BRIC.KLEY •ENVIRONMENTAL� �, : c� � C A R
�_
0 8 0,.0 5 3 1. 7 3
009)[880-2010
7. Transporter 2 Company Name i G 8.
US EPA ID Number
-0
B. Transporter's Phone
E C T I C A R
0 0 0 0, 49 E 4
(909)BB4-79^4
9. Designated Facility Name and Site Address/ 10. -
US EPA ID Number
C. Facility s Phone '
LA,PAZ COUNTY LANDFILL
-26999 IIIGH14AY 95 MILE POST 12(3 ,
r
PARYER, AZ 05344 A Z •C
9 5 0 8 2 3 1 1 1
(928)6c,9-2559
11. Waste Shipping Name and Description
12. Cont
s
lKgmf.IFMI
FRIABLE ASBESTOS WASTE
b•
D. Additional Description for Materials Listed Above. `
E. Handling Codes for Wastes Listed Above
15. Special Handling Instructions and Additional Information i
04ERGENC` - CONTAC"I':. INFCTRAC {.600) 535-5053
:EPA REE37TON IX 75 HAWTHORNE ST., SAID FRANCISCO,
CA 94105 !415) ,744-1069
SOUTH, COAST AQMD 21@65 E. �COPUY DR., DIAMOND BAR, CA 91765 ' (93!x) ?nsi—r33Fi
SITE. ADDRESS: SVP — DEMO ./ 46751 SAN DIMAS
ST. { LA QUI14TA '
16. GENERATOR'S CERTIFICATION: I certify I he materials described above on this manifest
�Printedfryped Name, J %
are not subject to federal regulations for reporting proper disposal of Hazardous Was te
Signatures ` tironm Der year.
17. Transporter 1 Acknowledgment
of Receipt of Materials
ntedlTyped Name `
Signature F i ' Der
18. Transporter 2 Acknowledgment Receipt
of of Materials
Printed/Typad Name
Signat`ulre Mmm Der Y11r
19. Discrepancy Indication Space
t
20. Facility Owner or Operator:
Printed/Typed NameSignature
Nonei Der Y111
GENERATOR'S COPY
7
J
• �lG�f�W
DEMOLITION PERMIT REQUIREMENTS
The. following items are required prior to the issuance of a Demolition permit.
• Two sets of plans showing the complete scope of work.
• Proof of property ownership (e.g., Grant Deed).
• Letter from property owner authoring demolition with scope of work.
Asbestos Report for all pre -1979 Properties, If asbestos is present, proof of
removal by a licensed. Asbestos Abatement Contractor.
• HOA Approval, if. applicable.
• Public Works PM -10 Approval.
• Building Department Management Approval