09-0803 (DSF)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,"CALIFORNIA 92253
T,itit 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 7/28/09
Application Number: 09-00000803 Owner:
Property Address: 53277 AVENIDA DIAZ AHMSI
APN: 774-071-014-2 -000000- 53277 AVENIDA DIAZ
Application description: DEMO - COMML/OTHER LA QUINTA, CA 92253 fo�
Property Zoning: COVE RESIDENTIAL
Application valuation: 0 / �S
Contractor: /`� `'=• _
Applicant: Architect or Engineer: GRISA ENTERPRISES IN,
44695 SAN BENITO CIRCL
PALM DESERT, CA 92 3yCNc
(760)341-0555
Lic. No.: 921518
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 License No.: 921518
Zltate: tractor: -
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).:
(_) 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 ISec. 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, 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
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 SPARTA INS Policy Number 03WK02881
1 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
37090 of the Labor Code, I shall rthwith comply with those provisions.
a0 te: ��/ plicant
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 above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this unty to enter upon the above-mentioned property f r inspec ion purposes.
ate:/ Si ture (Applicant or Agent
Application Number . . . . . 09-00000803
------ Structure Information GARAGE
----------------------------------------------------------------------------
-----
Permit . . . DEMO PERMIT
Additional desc . .
Permit Fee 45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 1/24/10
Qty Unit Charge Per
Extension
BASE
FEE
45'.00
----------------------------------------------------------------------------
Special Notes and Comments
RETURN ILLEGAL GARAGE CONVERSION
TO
ORIGINAL STATE
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
M
LQPERMIT
07/27/2009 11:17 FAX
Micron .Environmental lbs
3557 Lexirryt m Are - Et Monte, Catrjvrnia 91731 (625) 454.1,782 Fax (626) 454-.9$49
Q0001/0002
Idy 28, 2009
Grisha Enterprise
53277 Avenida Dona
La Quetta, CA 42253
Subject: PWAna{ysis of Buck Sam*2
Micron Job No.: 33709200
aTientRep Crrisha Enterprise-5327TAvendda Dia& La "ta, iA 92253
Dear
nis report includes an attached summary of the samples eoIIerted for the anaj}rses of the 2
bulk samples remh*d by this taborobw on Ju$r 28, 2004 The analyses were completed using
polarized light murascbpy (PLM) irr accordance with the EPA Wdtad 600IN-93/116, July .1993. The
quant>)tc Von is bond on the percentage of visual area estimation and is expressed as pereent area
Samples that are matltliayer are anr4zed by layer unless it has been regmm ted as a composite analysis. 7hm resuld
visual area estimate results are band on using reference standards malerieZs that are routinely used in the
laboraftq.
For all the organic matrix samples that were n& asbestos clued by (PLAT), Xicran Environmental recommends
the use of Vansrrduton Electron MierascoW (Wo due to the srze are the masking of the filters.
Micron Pmdronmentaal Labs is ocaedbd by the Hatfonal Voluntary Laboratory Accreditation Program (JVVZAP)
Lab (ode 2002W for asbestosjRw analysis (PLAT).
A icran Environmental Labs :.s respow-ble for the atxwrary in tlds rgort, but wiz are not Liable for orry wrong dao given
to us by the client regodirrg these samples or for any misuse or intarpretation of in, farmation supplied by us.
Liability shat! extend to providr'ng replicate analyses only. This report must not be used by the client to claim
product endorsement by NPLAP or arty agency of the U.S. Government, We wrZl retain these sompEas fiat a
pfd of ninety tlRys unless otherwise specified. Phis report pertains only to- the samples submitted
and anabyaed,
Micron lisv6=nwtal will not grant reproduction of this report unless an approval is obtained from this laboratory.
Please feet free to contact the laboratory for questions regarding results or the anakdcol methods used at
(626)45a -d782.
rttal Labs
Daioiet `
.Oiredor .
Attachments ,
KG
07/27/2009 11:17 FAX
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Q0002/0002
Aeaktiml lfet?rod EPA 6O0IR 93/116 ,
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Mitran Enviranmentat Labs Mrmn.Ref. No.
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Sample &wm4aResults
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Bin
city f
0 dinta
Building a Safety Division
P.O. Box 1564, 78-495-Calip arnpico
La Quinta, CA 92253 -(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 5 A
?),
14
Owner's Name: A 4
A. P. Number:
Address—
Legal Description:
City, ST, Zip:
-Contractor: r -()C
Address: .6"
Project Description:
City, St, zip:
Telephone:
K
City Lie.
State Lie. # 01 �VS I O
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
•
. -
State Lie. #: .......... . ... .-f
Construction Te:WV4 "A VMCUACY: V0_6&_t�
Project type (circle one): New Add'n Alter Repair1?�emo
Name of Contact Person:
Sq. FL: U3
Stories:
Units:
Telephone # of Contact. Person: Estimated Value of Project: 9 Cb
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req1d
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Cates.
Called Contact Person Plan Check Balance..
Title 24.Cales.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2d 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--
Reyiew,ready for torrectionstissue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr.
Date of peimit issue
School Fees
Total Permit Fees