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