11950 (DEMO)♦ 1 _ i. •A
fl 1
P.O. BOX 1504
No. 11954
Building 78--330 Calle Tampico 78-105 CALLE ESTADO
Address s LA OUINTA, CALIFORNIA 92253
Owner a
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 78-330 Calle Tampico A.P. Number
City Zip Tel.
i a Quintdt ! # 92253 564-3340 Legal Description
Contractor _ Project Description Demolition ,
Address
80--644 Ave 49
City lZip Tel.
State Lia City
& Classif. C21 600283 Lic. # lg
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
J hereby affirm that I am licensed underoovisions of Chapter 9 (commencing with Section
`7,000) of Division �F{o�f the Business an -Professions Code, and my license 's inn full force and
effect. .�T(i: .�.+ 4 /-5
SIGNATURE X ( `��`'^^�••••• IT DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, 'prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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 (8500).
O 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not Intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder wiF have the burden
or proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Coda The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. E P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy �6� Company
LYCopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE'OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it OW permit is for one hundred dolla,-s (8100) valuation
or less.)
I certify that in the performance of thg 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. L
Date Owner k
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation.fprovisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
�Lf}y
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 re:ating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant -Dale-
Mailing
aleMailing Address
City, State, Zip
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
' Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
I
FINAL DATE INSPECTOR
r
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ ,, Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
N-6sceil.aneous
.TOTAL
REMARKS lei
y#'t�yyir+(x°�
1 tJ
1y4¢E(! yr
5f}�'i
L%��V ti F• i U, 11441- 1 U# ILIV
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
' Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
I
FINAL DATE INSPECTOR
r
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
ROUGH PLUMB. BONDING
r
STORAGE TANK
FORMS
SE UGH WIRING
YAAD SPKLR SYSTEM
2ND FL. ) SO. FT. @
FOUND. REINF.
S (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
MOBILEHOME SVC.
GAS (FINAL) TEMP. POLE
BAR SINK
FOR. SQ. FT. ®
GROUT
WATER HEATER SERVICE
FINAL INSP.
POWER OUTLET
WATER SYSTEM
ROOF DRAINS
GAR. SQ. FT. @
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
VENTILATION
(t
V
DRAINAGE PIPING
CARP. SQ. FT. @
WALL SQ. FT.
FIRE ZONE ROOFING
DRINKING FOUNTAIN.
FIREPLACE
URINAL
SQ. FT. @
GAR. FIREWALL
ESTIMATED CONSTRUCTION VALUATION $
LATHING
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSPECTION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
INSPECTOR'S SIGNATURES/INITIALS
I KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
'
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
'
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
J
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SE UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
S (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
VENTILATION
(t
V
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
INSU IONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
P 02
AlfYID( (RAST ASHESI US DEMOL i T I UN / RENOVAT I ON NOT I F I CA'l- I ON
4H
mff1fJVT DIS1R1l.T
RUJECT JOS #93A -IU t I
Cancellation( I Revision (Project dates)t 1 Rovisiun (Other)
r f recellation or Revision, fill out sections 1003(d)(1)(AlID 0 III IIVI,II%I and others that apply
...._
pmpleted By: David W. Vu
_.....:.... ..:...
el Date: U3 -U1-97 Notif #:
—
Date Rec:
)mpany: C.S.S. IN(;.•„
Nus•rMAaK :..... ..:
1`etephone: 909-794•-119`7Status Codi:
01. L TO t
uartpr:
..d ...B
South Coast Ali, Qua)it),
n ere .,..--'
Management District'' SC t-USE-GNLY-------
Air Toxic Team
21865 Copley Drive
Diamond Bar, CA 51785-4102
W31d)(1)(A) 'TYPEWF(ITTEN
ONLY' Incompleto.Noti'ficatior► wlll result in LnfUL'Cement Action.
E03(d►(i)(Alll) Operator/Contractor.
-Name:
Contractors Specialty•Service,.Inc.
' Address:
316%U Uuter Hwy. 10 South, Suite D
City, State, Zip -trade:
Redlands, CA 92373
Cite* Supervising Parson:
Cesar Hidalgo
Telephone:
(909) 794-1197
04(d)(1)(A)(I) Property URnerts).
Name:
La Uuinta Hotel
Address:.
78-330 Calle .Tampico
City, State, Zip -Code:
La Quinta, `CA 92253
Contact, Person:
Mike Tallier
Telephone:
(619) 564-3340
03(d)(1)(A)III) Facility
Location.
5it+1.Na- me:
Vacant Structures - A,B,C,"D
Street Address:
78--330 Calle 'Campico
City, State, Zip -Code:
La Quanta, CA 92202
County:
ltiverside
eemul i tiun / Renovation:
R D-Deuot ition R -Removal _ O-Urdered Demolition E -Emergency Renovation
U3 (d) (A) (1 I I) Facility Descr-apt ion.. (Please Use Codes Where Indicated)
size (Sq. Ft.):
i,506
Aga 1Years):
30 -
Number o -f Fluurb:
1
Building Type:
R Fl-Huspital S -School 11 -Office I -Industrial P -Public Building R -Residence
Prior.Use:
H H -Hospital S -School U -Office I -Industrial P -Public Building R -Residence
mber of Dwelling Units:
4 (For Residents Unly)
rk Location '(Describe):
Interior of each unit and roof of unit B :
03(d)(1)(A)(IV) Project Dates.
Start Date:
03-10--93
Completion bate:
03-20-93.
AAQMD Rule 1403 Notification Form (1403.FRM) Page i of 2
Ifs
P 03
2141(i)IA110 Indicate York Practices and Engineering Controls, Reference 14031d1(11(DIIt1 through W
Procedure 1. IXX]
Procedure 2. I ]
Procedure 3. I XX]
Procedure 4. I ] (Attachsents Required)
Procedure 5. I ] (Attaehsente Required)
103(d1(11(AI(vil Amount of Friable, Class 1, and.Class It nonfriabie Asbestos Gontaining Material. IAGMI
Friable Linear Feet;
Sq"are Feet;
Class l Linear Feet:
Square Fwet:
;urface Area Equivalent:
n = 3. Ili d = (Diameter of Pipe and ACM j Feet1
Linear Ft. Fquivalt-111t (Sq. Ft.) _
Def.ertbe Class 1:
(Total of Linear Feet Equivalent and Square Foet (Friable and Class 111)
t:l ams:. t 1 L i near 'Vee t
Square.Feet 840
Cla6s 11: Linoleum, Floor Zile, Rauf Mastic
;urface Area Equivalent:040 Ilotal of Linear Feet Equlvaloni and Squaro Feet (Class 1111 —
4031d1IIffilmil ;'sale Di6posal Site,
Landfill Name: Southwest Disposal / Gucopah Indian Reserva.tiull
Address: •Ave" 0 County 17 1/2
',ity, State 'Lip Code. Yuma, Arizona 05365
Permit : iKC957100091
1403(d)(iI(Al(viiil Procedures to t>e foliesed if unexpected asbestos is found or naniriabie ACO l�ecoees friable.
Immediately apply amended water and contain.
HD3ldil111AI11x1 Proof of Glitoraia State Contractor Certification and ratluSlfA Etegietralion.
Contractus -ss License 4-. 572346
Cal/OSHA Registration #: 229
IAWIdif111AI(xl Location of off-site storage area for asbestos crontalning ea6te ualerial:
N/A
1`ti3(dl(11l'AI(xi) I(Le of ttnsperterlsl used. to lraesport *ante to disposal site.
Specialty Wycte. — -
1�Q3(dlltl(8!(11 F�argeacy Poeaovatlon. -
Authur i zed Parsos►:
Telephonw:
rim, U t81(l11 Essrgenc7 torderedl FMii ;tion. (1Ro orderWd tho do+wl ition?)
Agency:
Na■d:
Title:
Tnlephonw:
Authority',
•t �, ��r t r d � �
' ®/''6� � .CONSTRUCTIQN � CO•� �I��.t, , `''a �t'� � �,�'� r �� r < ` �; .
2219 NORTH LEE AVENUE
P.O. BOX 3925
SOUTH EL MONTE, CALIF.; 91733
SAN GABRIEL VALLEY 1 ORANGE COUNTY.
LOS ANGELES (714) 994.5310
(213) 283-0361 (818) 443 0151
December.21, 1984
Mr. Mike Butler
G.W.B. INC. COMPANY: Peninsular Fire
400,S. Farrell Dr. #8204
Palm Springs, CA 92262
OWNER, Mrs. Loyes� Scott,..-. ADJUSTER. Mike .Butler
LOCATION: CHECKED BY: Jeff Krug
78330 Calle Tampico
La Quinta, California 92253
19-564-3764 JOB NUMBER:84-5468
TELEPHONE,
R 21A n fi ..�`
/ROpOSE♦' WORK TO BE ACCOMPLISHED ;
FIRE DAMAGE REPAIRS
!
1. Permiot
2. Demolition
a ��
'
_
Cartage
.4. Carpentry labor - materials itemized below ,
5. Electrical wiring - includes repairs to damaged ,..
circuits, outlets, and switches
M
6. Electrical fixtures - allowance.
7. Final clean-up•
av .
!BIEDROOM - 10'6 x 9�eoar
' ep ace masons and moldings on ceiling and l
walls
2. Replace 216 x 216_casement window•
3. Recase openings
,
4. Replace wall -mounted light fixture
5. Paint ceiling and walls
6. Paint openings !.
7. Replace carpet and pad ,
9-
DIVING ROOM - 15 x 9 x 6 av 5
y K : i; .,
)*.
t F pia
1. Replace tall—agF.masonite and moldings on ceiling.
and walls
2.. Replace door frame to bedroom..
-
3. Recase 1 opening
,
4. Reglaze broken window liter I
5. Recondition wall mounted air, conditioner
.'
6. Recondition wall furnace
7. Heavy prep
.8. Paint ceiling and .walls
9. Paint openings
10. Paint closet
11. Replace carpet and pad
12. Replace light fixture
''.,,;a�Js,H ,
are n wired by low to be licensed and regulated by the Contractor's
Contractor q
contractor may be nhrred to t •
State license Board. Any questions concerning a
the board whose address is: Contractor's State license. Board 1020 N
registrar of
Street, Sacramento, California 94614.
FIRE AND RICLAMATION NE;W