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0006-048 (DEMO).� �C SED CONTRACTOR DECLARATION I he,`reby 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 # ; t Lic. Class Exp. Date 63 2453 0 C21 IV31 Date Signature of Contractor°��% '-- t r OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner 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 Se•tion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carer STATE YUND • Policy No. 1242019.09 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) 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 3700 of the Labor Code, I shall forthwith comply with thos pro; )Bions. Date: 2 aos Applicant101, UG Warning: Failure to secure Workers' Compensation coverage is unlawful and. r" shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 rresult of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent);/ '---,_ h, Date 06 BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT N. JOB SITE APN ADDRESS 43-5.76 WASTUNGT N N RZT .W.9-070-029 OWNER. I CONTRACTOR/DESIGNER/EN (NEER SADHYA GANDI YMM&S M&S LARD C JA'RWI3 2424 a0-1 $ YR1 $2-91 O W—CKMA1s DR, 1,TT: 1 Q `'(X.. 79412 1'MRMAL CA 92271 CLkidi 2809 I USE OF PERMIT D OLT11013. DEGtic'7I.i:I'I011I ONi.X (M,F.A MFIXCAL CLININC) Esl.[.wam cos op cip.L7t+mVcrto YORAM r, KE KrAomply DEMOLITION FEE 101n000-423-000 $45,00 SUB -TOTAL !:'OMTRLTMTONT AND PUS OTlECK, ECEIPT DATE DATE FINALED 0.00 VIM. $0.00 $411MY INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final a-- BLOCKWALL APPkOVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ac.. oy. mCU :UA unour'c�_•Uwul�..b :^.ALN11%Uii14 l!lv�:eee' May•GJ•UU b:Y1; , i ,Med Tox, Inc. Ade •tos Laboratory Services .l N c:titicate of Analysis age z!3 JA N Equipment, Ref tel REPORT DATE.: 05:221"0 28115 Gerald Lahe AMPLE(S) RECEIVED: 05129!00 Merenc valley, GA 9555 SAMPLE (5) TAKEN. 0511&30 ! ECCLO3 CS LABORATORY NO: 005022 ATTfv: Jerry CLIENT PROJECT NO: Youngs Land NO. OF AMPLE(S) ANALYZED- 22 ANALYSIS. I ASBESTOS IN BULK SA WLE METHOD- PLWPOLARIZFD LIGMT MIQROSGOPY/DISPERS•ON STAINING) AMPHIBOLE ASBESTOS PERCENT ND(1) MO(1) e NW 1) NDt1) rapt 1 Of 2 1 • t'ax (714) 480-0222 i EPA 6001M4-82-020 SAMPLE IDENTIkICATION, CHRYSOTILE BRIEF PHYSICAL ASBESTOS ;°I.IFNT LAB NO. 'DESCRIPTION PERCENT Sam t ! 005022-01A Off-white acoustic material ND(1) ihomageneous) hiablo Sam 2 005022-02A Off•wilite consolldeted material , NO(1) • wl paper backing. non -friable (non-Nmogenaous) Sam 3 005022-03A Beige floor tib material ND(1) i (homogeneous) non -friable' Sam 4 005022=04A Off•wNle consolidated material ND(I) i (homogeneous) non -friable Sam S' 005022-05A OA -white corsolktated material NOi 1) [I05022,38A (homogartgus) non -friable Sane 6 OH -white acoustic material ND(l) Sam 7 06022=07A Grey consolidated material (homogeneousi) non -friable Sam 8 i C5u22-0BA Greylloor We material NO(t) (homogeneous) non-mabl• Sam 9 �105022-09A Off-white floor We material VO{1) (homogeneous) non -friable Sam 10 I 022.1OA ON -white consolaawd material NO(?' (homogeneoui) non -friable Sam 1 1 05022.11A Oft -white con"kfttad material - ND(t) -/,paper backing, nofi-6hsble (non4!0mogenecu3) - ' Sam '2 j 5022.12" Off-white ooneolideted material ND(J) (f•ornogeneous) non -triable 55A &-enler fir,, Aiitc 102 • Sarva Al ia, CA 92705 Tele}1llnne (714) tA(1 AMPHIBOLE ASBESTOS PERCENT ND(1) MO(1) e NW 1) NDt1) rapt 1 Of 2 1 • t'ax (714) 480-0222 i Sett LAY: DIED T X' OROUPIECOLJGIw 7riA1NI\G;714 480.222; atny 23.00 8:23; =age 3Q i - FCOLOC ICS LABOP.AT.ORY NO. 0:502' CL1EyT PROJECT NO Youngs Land SACt1� LE 10ENTIFIC�, i ICN CHRYSOTILE A.,.IPHISOLE 3RIEF PHYS CAL A.SSESTOS F,S8cSTC5 C LiENT LAS NO.. UESC.RIPTION PERCENT 3 ERC_E ItiT Sam 13 03802203A Brown tonsolidatedmaterial NGi1, NO(1) (homogeneous) non-trnebls Sem 14 I008022.14A Off-white consotldated materiel` NO(11 ND(t) (homogeneous) ncn-treble Sam 15 005022-18A Gray cosoideted material NU(i) (homogeneous) non;friable Sam 16 005022.16A Brown, beige floortile '"ateriat ha(t) tv0{1> i(homogeneous) non-triabie Sam 17 1005022•17 Tar and roofing materiel ND(t)' ND } �5022-18A ('tomogenea,$) nor-hNiaoSpin 18 Tar andfooririgmsleriel NO(1) Np(1) (homageheous) non-friable Sart 19 005022-19A Tar and roofing material N.0(1) ypt� (homogeneous) non-frlebte Sec+ 20', 05022-200 Tar anc roofing materiel ND(1) M1p(1, ' (hompgehe0U1) n0►(riabia Sam 21 05022-21A Tar and felt roofing material NO(1) J Np(1) (hdmopereouts) non-triable Sam 22 5022.22A Tar and to" foofing Inateris' NJ!t} I ND(1) (hornugeneotrs) non-friable Armand. DJCoing; Sojean Peou .DATE -- LABORATORY MANAGER LABORATORY ANALYST, N00.) Asbestos )s n-deteckd Regulatory Nmit. one percent. TRACE, Asbeslo} id tilled in sample, concentration less than method detection lir+tit of dna percent. N: Soils and slurry ba ied materials ie.g soreyosd-on and trswlad-on) can be non-homoge�reous due to t?eir menufsclure, applicator o: formation ; Th s C rifftate pe"i s only to the samptes iiwestligeted ano does not neressa:ity apply to other app Wily denU :al or. sintiler mdt4nais cnotell h Tile, b foam, PL deteCte' nc, tar, masFor s and flee powder samples may contain asbestos fibers. of sucth S all d:amete: that ?haae fibers anby PQM For suen semplqs more ser.sltive.anayticel ittethods (e.g. ?(RD, T'EM. EM) are reoommendetl if greate1 t:artnsity a out asbestos content is ,eautrao. Amphibole asbestpa i _vides: arnuyde. crociaollte. anthopryAhe, tremotite and actinolite. greater than, -0 • sa than ��•':�TMI;�11U.W tq1 ,�Ofr�Yl Li�,N.bYf 4/MM•1pp1•Yi'W1GIA7:0/l. Page i at 2 • l "/1-Q—\�-< � ens a� 07 BOX y� BOX 1504 APPLICATION ONLY Building i 78-495 CALLE TAMPICO Address . 3 5 ��, w 1 �; Fit NG "'fi�tJ' , LA OUINTA, CALIFORNIA 92253 Owner Mailing /,��A LJr Address Z 7 VJA 5f 11 N 6T, -,t,) City Zip_ Tel. Contractor Address p State Lic. I City & Classif. Lic. # Arch., Engr., Designer ` , F W t\ 9 —f 'V -0b b AP .D . Address�� i_ ? 7 {j A+ c N i h %i Tel. 964 City Zip State L.! UiN-1 A I q LZ Lic. III C42.T7 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE 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 rile a signed statement that he is licensed .pursuant'to ' the provisions of the Contractor's License Lew,..Chapter.9"(commericingwith'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 ($500). LJ 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 orimprovement is sold within one year of completion, the owner-buildei will have the burden of proving that he did not build or improve for the purpose of sale.) I l 1, as owner of the property, am exclusively contracting with licensed contractors to con. struct the project. (Sec. 7044, Business and Professions Code: 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.) i 7 I am exempt under Sec. B. & 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 No. Company f7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 it 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 relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip WHITE = FINANCE h JILDING: TYPE'CONST. Y= 0 OCC. GRP. e) P. Number (' () Ci —O"70 —hl? f�, Y, 02A Legal Descripti Project Descrir T X 7,�", 2 - Sq. Sq. Ft. G U U Stories Size New Add ❑ Alter ❑ PERMIT r Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. IInnffrastructure TOTAL REMARKS M£ �>K A O z o N.o. Dw. I inifc Repair ❑ Demolition ❑ 49, Ioy 3, S� � /8og9oa AMOUNT :-1 3 43.50 2.55' 2 -OF. ao 37 o/ /./?9.94 ��n- Y ZONE: BY: 1 Minimum Setback Distances: Front Setbackfrom Center Line ,r Rear Setback from Rear Prop. Line Side Street Setback from Center Line—1 Side Setback fro Tl Property Line j FINAL DATE 4VSPECTOR Issued by: Date Validated by: FEB ra 1999 Validation: JITY OF CNJINTA i YELLOW = APPLICANT PINK = BUILDING D VISION Building AddressName of Applicant Plan Check No. Date 43576 Washington SL. _(shell) The Woodard Group • t �- 43576 Washington 08 Jul -99, Use of Permit ; C :; Occupancy Type of Construction ° APN . Healtli Care women B V N zr m. MECFIANICAL .. , ki _ . P>>.prniltglssunnce. _y .316?00 . Fmce<=100 (1) 22 Boiler or Comp >3<15 HP (8) Vent Fans, to dud (I S) Fmce>100 (2) "s' ; Boiler or Comp>15<30 HP (9) Vent not part of HVAC (lE) + µ Fmce-Floor (3) - Cmprsr or Comp>30<50 HP (10) , Hood .Incl Dd (17) ~' Space Heater (4) . Boiler>50 HP (11) Incinerator domestic (18) Vent Appliance (5) '.. 1' . Air Handir<=10k cfm (12) Incinerator com (19) ' 1 Cooling Unit (6) ,"` `t. Air Handlr>10k cfm (13) Other (20) 1: . Boiler or Comp<=3 HP (7) Evap Cooler (14) " Miscellaneous Desc . ,' @'. Total Fee - �,„ EL'EG'I'RICr1>�• .' � �...' �' �' PermitIssuance� -`�; '' b SF15A0''' 40 Recep, outlets •: Motor, gen < lhp or Kw 1000 Sernce1 (Amps) r-, 59-, Light fixtures ;x Motor, gen >1<11 hp or Kw Service2 (Amps) f =' 18 Pole or platform light 2 Motor, gen >10<SOhp or'Kw Service3 (Amps) "; �. A: 'i • - Theatrical -type light Motor, gen >50<100hp or Kw. Service >600Volts t <5 . ` 1 , Res Appliances: Motor, gen >100hp or Kw + 11 Subpanels ea.(<200amp) _ �� ' r, Non -Res Appliances' , ' Busways each 100 feet Residential Other Items - Signs Multi -family. - Other Items; 1 .. Add circuits to same sign ^ Commercial } Miscellaneous Desc ? ® Total Feej ;S342.551 No Plan -Estimate Only ''P,ermltTssuarice Plumbing fixture or trap (1) i Kitchen Sink - Bidet_' 2 Water Heater (6) k ^ Bar Sink'Garbage Displ Waste Intercpt (7)'' f ` Floor Drain(& Drip Dry) "t, Laundry Tray ' 1 Water Piping (8) 0 Lavatory - F - Water Closet'', ' 1 Drainage (9) e. Washer k Building, trailer park sewer (2) Lawn Sprinkler (10)' Urinal Rainwater system (3) - Vacuum Brk/Bf (11) Drinking Fntn_ r; Cesspool (4) 1 ' Backflow<2" (12) =• Bath Tub,yshower Private Sewage disposal (5) $ Backflow >2 (12) a` 19 Roof Drains)t "+. 26 Gas Outlet (13) Miscellaneous Desc - ® t , Total Fee $209.00 ' :;, , . _. ". -� . _._C .mss.. • .. _ . 1PerniltIssuance °.w 5:00 Description Group Rate Square Feet Valuation, , . Irving Area R3(Ind. A/C) `. 87.00 , Patio/Porch/Canopy r�._ 4 R3 ' „25.40 ` - - , • Private Garage " Ul •:22.10 - • � " � _ is � 1 Hrs Additional P/C a% P/C FreeMILO1?AL�aYALL7ATiON�o ".? 9 k' " 131a s r, Plan Check Fee = $0.00 % SMI= _Tf' 10 h1echanical Fee = $393.50 r _ Electrical Fee = $342.55 _ ti" t' r Total Fee -�$945.05 Plumbing Fee. = $209.00 ^`SMI = $0.00' Additional P/C . r ` a '' CITY OF, LA QUINTA ` FEE WORKSHEET Structural Plan Check_Only Building Address Name ofApplicant.PlanCheck No. Date - 43576 Washington Street -Shell Only.. The Woodard Group 43576Washington 23 -Apr -99 Use of Permit Occupancy Type of Construction APN Health Care-Womens' Health Source B VN' o -.- .. �- ,MECHAIVIC'AL, Permi_tIssuance. � $�1�5€Op � ._ . I Frnce < =100 (1) Boiler or Comp > 3 < 15 HP (8) Vent Fans to duct (15) .• _ = Frnce> 100 (2) . Boiler or Comp> 15 <30 HP (9) Vent not part of HVAC (16) - Frnce=Floor (3) '. y Cmprsr or`Comp>30<50 HP (10) Hood, Incl Dct (17) Space Heater (4) Boiler>SO HP (11) , a Incinerator domestic (18) Vent Appliance (5) .'-j Air Handlr<=lOkcfm (12)-, " Incinerator coin (19) -• Cooling Unit (6) . Air Handlr> 10k cfm,(13) Other (20) Boiler or Comp < 3 HP (7) Evap Cooler(14) r.. , Miscellaneous Desc Q �. '- Total Fee ELEC�TRICrAL PermitIssuance $�1`5I00 t Recep; outlets.:.. Motor, gen < lhp or Kw ... ,. Servicel (Ames) ,..::. ; ' Light fixtures Motor, gen >1 <11 hp or Kw >; Service2 {Amps) ' " � ` Pole or.platform fight � : Motor, gen >10450hp or Kw Service3 (Amps) ` - _ � Theatrical type light � -, �� Mofor, gen>50<IOOhp.or Kw ' j Service>600Volts ' � ct :; � 1tesApphances,`'- Motor, gen>100hp;oiKw ;Subpanelsea.(<200amp) � � r S,Non=Res Appliances Busways each 100 feet . Residential 'Other Items r Signs ­.Multi -family Other Items } ; t' Add circuits to same sign ; k Commercial y Miscellaneous` Desc @._ Total Fee 4777 a ' No Plan Estimate Only PLUMBING Permit Issuance k,. �$1'S 0 -owl or trap Plumbing fi7nk KiSmk Bidet z' 1. Water Heater (6) 'l ' ;BaGarbage Displ Waste. Intercpt (7) - Floor Dram & Drip Dry ( p) Laundry Tray ' , Water•Piping (8) Lavatory Water Closet.` ... ., • Drainage (9) Washer:, Building, trailer parksewer,(2) y Lawn Sprinkler (10) Urinal ''• *r Q `. Rainwater system (3) a Vacuum Brk/Bf (I'l ) Drinking Fntn, '; Cesspool (4). j Backflow<2" (12) Bath`Tuli, shower Private Sewage disposal (5) Backflow >2 (12) l Roof Drain(s) r .'' � - .•. Gas Outlet (13),' :' Mscellaneous Desc _ @ Total Fee BU!ILD`ING PetviitISsuance.�, , .fir ,$1500 Description „ 'Group , Rate Square Feet Valuation Floor Area B(Incl. A/C) 73.50 24,000 " 3 $1,764,000.00 7 - i . Hrs Additional P/C (oP/CFe, T®TAI,�IALiJATION = . $3764,00000 $I°d FEE _ �$SQ67i50 ; Plan Check Fee = 3,293.88 %SMI= 10 Mechanical Fee _ - Electrical Fee p .;: ; . Total Fee _ $8,552:78 Plumbing Fee = SMI — $176.40 k Additional -P/C