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09-1050 (DEMO)C, P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00001050 Property Address: 57453 SEMINOLE DR APN: 762-350-025- - - Application description: DEMO - COMML/OTHER Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 0 Applicant: Tt-t!t 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT r 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 CI ss: B C53 C10 License No.: 836088 ate: 0 ontractor: 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) ofDivision3 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 ofproperty 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 buildingor 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.)- (_ 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 Owner: MICHAEL.STOJKOVICH 57453 SEMINOLE DR LA QUINTA, CA 9225 Contractor: 1ST ATRIUM INC P.O. BOX 3882 PALM DESERT, CA (760)880-6606 Lic,. No.: 836088 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/02/09 92261 ------------------ 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 �o issued: t( I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor T' 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 0028277008 I certify that, in the performance tt)f the work for which this permit is issued, I shall not employ any person in any manner so as t me subject to the workers' compensation laws of California, and agree that, if I should o e .s bject to the workers' compensation provisions of Section yry�Jt 3700 of the Labor Cog e, I ort i h comply with those provisions. te: ' V p licant: 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. _ 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 a ve infor ' n is correct. I agree to comply with all city and county ordinances and st to laws relating to buildin ons uction, nd hereby authorize representatives of t '1 county to enter upon th bove-mentioned�pe y f nsp tion p poses. DateLI tig . ure (Applicant or Agent): Application Number, . . . . . 09-00001050 -Permit" DEMO PERMIT Additional desc . Permit Fee . . . 45.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 3/31/10 ..Qty Unit -Charge, Per Extension - BASE FEE 45.00 ----- --------------------------------------------------------------------.--- Special Notes and Comments DEMO PORTIONS OF INTERIOR AND EXTERIOR, PER APPROVED PLANS & P/W APPROVAL. 2007 CODES. Fee.summary .=Charged - Paid Credited ---------- Due R 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 v ti CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT Form updated & effective 9/2512009 Green Sheet approvals are forwarded to the Building & Safety Department directly by 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. l.Sf r j_ G Date: /0-/ ©// Developer: h l w�ti► , �1 Tract No.:� tract Name: !'✓�s� Lot No.(s): (!/ Address(s):. � 53 ��� Phone Number: &o ) 6?0 6606 The following are the requirem nts for Public Works Clearance t authorize issuance of a building permit from the Building &Safety Department:,,,,. " -� �--� CUSTOM HOMES:IDE ITEMS#2 #3 #4 #5 & #7 BE OW •3 TRACT HOMES: PROVIDE ITEMS #1, #2, #3-& #5 BELOW COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1 #2 #3 #5 & #7 BELOW ❖ WALLS, SIGNS, OTHER: PROVIDE ITEM #6 BELOW 1. Attach PadElevation 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 the pad for approval, please withhold green sheet submittal until a Pad Elevation Certificate can be provided. 2. Attach geotechnical certification of grading plan compliance including compaction reports from a licensed Soils Engineer. Recently rough graded residential developments which have a previously approved geotechnical certification are exempt from this requirement. 3. Attach recorded final map or title information/grant deed showing proposed building locations are legal lots. 4. Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan & agreement or provide alternative & valid,City approved PM10 plan set reference number or hard copy plan. PM10 plans for commercial & residential developments (beyond 1. lot) are submitted separately with grading plans & are subject to additional requirements. A current PM10 certification number is required. 5. Attach a copy of the rough or precise grading plan to the Public Works Department showing building location(s) .for pad elevation verification. AO flood zone developments will require an approved flood plain development plan. 6: Attach supporting documentation for wall plan, monument sign, grease trap or special facility installations. 7.. Complete and sign the attached water quality management plan (WQMP) exemption form, if applicable.. PW .approved building construction projects require either a WQMP or a completed WQMP exemption form. Approved maps/plans may be viewed at the following link: http:l/www.la-guinta.org/PlanCheck/m search.aspx I have reviewed and "confirmed the requirements listed above as -presented and find the improvements to be sufficiently complete for construction of the proposed buildings/structures/walls/signs on the subject lot(s). Pursuant to my findings, the above project may be released for building permit issuance. This section completn Recommended by: Date:lV' Public Works Distribution: ( Green Sheet to Building & Safety ( ) Green Sheet to Planning Department Declined for approval for reason(s) as follow(s), please correct and resubmit: I ! TACheddists - Forms & ApplicationsTorms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc } d a City of La Quinta - PM10 Fugitive Dust Control Project Information Construction Phase PM10 Aareement (<1 acreilot or Infill Proiect) Project Information Project Contractor: Sr7T'r'n %L444 K.! 6 - Project Phase (check one) onstruction B-fDemolition Project Name: ��t© f GCD (/t rC%�2. APs r, Project Tract/Lot Numbers: Project Street Address: Total Acres in Active Construction (<1 acre per Lot): Anticipated Start Date: OT/ O / Anticip ated Comp letion Date: � PM10 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: /r AvH e- �i/ T Lam.S Title: ?1 es z` (N ei,�,( Company Name: Si -Ake tI 114 C. - Mailing Mailin Address: 3 ,S>J>2 City, State, ZIP Code: ( l a jwc (,-,-T �2�� Prima Phone #: / 6 o GU a� © 64106 Fax M —260 2c9'3 S �7 24 Hour Emergency Phone#: 7�o io Cell Phone #: /' 760 ��� 6 lD ©(O Email Address: S G 7i Y$ ? Ql7 r t ,�� Age- C 0 PM10 Certificate #: -- 0 — -3 The above stated property owner (or authorized representative): s• Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD Rules 403, 403.1, 401, 402, 201, 203 and PERP; ❖ Shall constitute an Agreement to comply with all project conditions as identified in the approved dust control plan. ❖ Acknowledges that dust control is required twenty-four (24) hours a day, seven (7) days a week, throughout the period of project performance, regardless of project size or status; �o 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 representatives of City/County to enter the property for inspection and/or abatement purposes; Shall hold harm ss County and its representatives from liability for any actions related to this dust control plan or any Ci Cotnty in' ted abatement activities. / /0101 D Signature VrVrtyNvner o uthorized Representative Date TAChecklists - Forms & Applicalions\Fofms & Applications\GREEN SHEET cover & PM10less than t Acre Revised 9-25-09.doc i I R _ 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. i 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 ¢ 4 -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 & 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 ten (10) days of ceasing activity. i WEATHER MONITORING: Wind predictions shall be monitored. j ❖ 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. s 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. i ❖ 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. j 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 f } 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. i ❖ 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, etc.) shall be maintained for 3 years by the Property Owner (or Authorized Representative). Property Owner shall notify the City and SCAQMD within '10 days of completion of project. I i TAChecklists - Forms 8 Applicalions\Forms 6 Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc i .. V4- vv� \`V p i eC,l� dVl S V U GA- \ nn \ Bin # Citl Quintaof La Building &r 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: J ...J e%/J7 i O1�/ Owner's Name: 1 AQ v ", (� A. P. Number: Address: G� Legal Description: City, ST, Zip: Contractor:f t d Telephone: P hone• Address: • d ®x Project Description: City, ST, Zip: Ta L1 2 "lic blit Q c, Gl^Q °t Telephone: le P d W aGC.CS S State Lie. # City Lie. II Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lie. #• Construction TY Occu Type: Occupancy: P Y• Project (circle one): New Add'n n A]ter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd 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 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- M Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 041, Ta ISSJs -D'C?�t.D f 11- `"101.�oQ `�'-Q-D?K