08-1653 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08,`.,0.0.0.01653
Property Address:
53962 GRAY AVE
APN:
767-200-998-S -330762-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3950
Applicant:
T4tyl
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
N4 -
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 thss and Professionals Code, and my License is in full force and effect.
License Class: B C10 e ineA.ense N .. 746198
atin.l.aC.r� . 1 C
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 ISec. 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).:
1 _ 1 1, 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 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 _ I 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:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/08
Contractor:
A & M CONSTRUCTION
P.O. BOX 366
LA QUINTA, CA 92247
(760)564-4832
Lic. No.: 746198
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.
1 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 STATE FUND Policy Number 044-0028137-07
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,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the LaboyeIIdEy shall IS' h co ply with those provisions.
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. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize re resenI tives
of this county to enterer uponthe-above-mention �-e ection urposes.
Datelo-q-U�Sionature (Aoolicant-or Ace I
Application Number . . . . . 08-00001653
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3950
Expiration Date . . 4/06/09
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG,
2,001-25,000
18.00
G----------------------------------------------------------------------------
Special Notes and Comments
158 LN FT X 6 FT HT GARDEN BLOCK
WALL
TO
CITY STANDARDS AND APPROVED PLANS.
Fee summary Charged
Paid
Credited
Due
-------------------------------------
Permit Fee Total 63.00
----------
.00
-------•---
.00
63.00
Plan Check Total .00
.00
.00
.00
Grand Total 63.00
.00
.00
63.0.0
a
LQPERMIT
_ 'n #
Y04
City of La Quinta`t
Building 8Z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
g
Project Address5y?�z ,` v
Owner's Name:
Te"1-CK- lk 3 v%
A. P. Number: �
Address: 56 - qss AV ei\U c SZ—
Legal Description:
City, ST, Zip: L, nutxaVc,t
Contractor: 1� Cp�,` �y��tp�
Telephone:
Address:
Project Description:
`
City, ST, Zip: LCA l ad �
®GCA -1-0 C1 S�
Telephone:-�-
LJ Z
11
State Lie. # :
City Lic. #:
SC Co`c�eC Er� C p n
Arch n)gr�>eesigner: e2L ,
Address: ` I(l-1 AL ��.�
) �
1 S �T
City, ST, Zip: p Co,, 917/0
Telephon L153 -OL( lConstruction
State Lic. #: CO 4-7(b3project
Type: I cock ��ccupancy:
type (circle ew Add'n Alter Repair Demo
Name of Contact Person: p���
Ln '
Sq. Ft.: # Stories:
#; Units:
Telephone # of Contact Person:
Estimated Value of Prqject'Y�61 C66
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Rec'd
TRACKING PERMIT FEES
Plan Check submitted [ Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for correctionsfiissue
Electrical,
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP,P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
(� t7C>-1
t't-�'oW'�A tt7-
Talf 4 4 a"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
To: Greg Butler, Building & Safety Manager
From: Les Johnson, Director -PDD
Permit #: 08-1653
BUILDING & SAFETY DEPARTMENT
(7 60) 777-7012
FAX (760) 777-7011
To PD: 10-01-08
Due Date: 10-09-08
Status: 1 ST REVIEW
Building Plans Approval
(This is an approval to issue a Building Permit)
The Planning Department has reviewed the Building Plans for the following
project:
Description: BLOCK WALL/ SECONDARY ENTRY AT GRAY AVENUE
Address or General Location: 53-962 GRAY AVENUE
Applicant Contact: RON LANE (760)-3912563
The Planning Development Department finds that:
❑ ...these Building Plans do not require Planning Department approval.
...these Building Plans are approved by the Planning Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Planning Department for review.
10h <
Les Johnson, Director -PD ate
RECEIVED
OCT 01 2008 . 4
"tbpment Servi, TW�p 4
P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
To: Greg Butler, Building & Safety Manager
From: PAUL GOBLE; SENIOR ENGINEER
Permit #: 08-1653
To PW: 10-01-08
Due Date: 10-09-08
Status: 1 ST REVIEW
Building Plans Approval
(This is an approval to issue a Building Permit)
The Public Works Department has reviewed the Building Plans for the following
project:
Description: BLOCK WALL SECONDARY ENTRANCE ON GRAY AVENUE
Address or General Location: 53962 GRAY AVENUE
Applicant Contact: RON LANE (760)-391-2563
The PUBLIC WORKS DEPARTMENT finds that:
❑ ...these Building Plans do not require PUBLIC WORKS Department
approval.
these Building Plans are approved by the PUBLIC WORKS Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the apRlicant. When the corrections are made
please return t em to the PU I WORKS Department for review.
PAUL GOBLE SENIOR ENGO&ER ( Date
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 6/26/2008
Green Sheet _approvals are forwarded to the Buildinq & 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 a pli a/nt.
Date: Developer: Z41 -L, 4y"
Tract No.:�! O-1 Tract Name ` Lot No.(s):
Address(s)` Phone Number:
�jf p p �� ��� ar a ati
The fOlIi ing"are h� �qui�ments fo�Public Works CI a artce to authori4e'ne o in g ermit f m the
Building & Safety Department: A !�
❖ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4 AND #5 BELOW
❖ TRACT HOMES: PROVIDE ITEMS #1, #2, #3, #4 (AS APPLICABLE) AND #6 BELOW
❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1, #2, #3 AND #5 BELOW
WALLS: PROVIDE ITEMS #7 BELOW
❖ SIGNS: PROVIDE ITEMS #8. BELOW
❖ OTHER: PROVIDE ITEM #9 BELOW
1. Attach Pad 'Elevation 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.
Final maps may be viewed at the following website:
http://www.la-guinta.org/PlanCheck/m search.aspx
4. Attach a completed <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 precise grading plan to the Public Works Department showing building location(s). AO
flood zone developments will require an approved flood plain development plan.
6. Attach an approved rough or precise grading plan for the building locations) for pad elevation verification or
City plan set number if available. Plans may be viewed at the following website:
http://www.la-guinta.org/PlanCheck/m search.as x
7 tach wall plan & related approved grading plan. o8cn Z 4,P�El>
8. Attach sign layout/plan & related precise grading/lanaTscape plan.
9. Attach supporting documentation for grease trap or special facility installations.
I have reviewed and confirmed the requirements listed above as presented and find the improvements to be
sufficiently complete for construction of the oposed buildings/structures/walls/signs on the subject lot(s).
Pursuant tom 7projects the a m e released for building permit issuance.
Recommended by: Dated: AR
Public Works Distribution: ( L,) Green Sheet to Building & Safety
(_) Green Sheet to Planning Department
Declined for approval for reason(s) as follow(s), please correct and resubmit:
Page 1 of 4
City of La Quinta, California
PM 10 Fugitive Dust Control Project Information (< 1 acre/lot or Infill Project)
(Form Updated & Effective 6-26-08)
❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by the City of La
'Quinta.
Page 2 of 4
Project Information
Project Contractor:
Project Phase
(check one)
❑ Construction
❑ Demolition
Project Name:
Project Tract Number:
Lot Numbers:
Project Street Address:
Anticipated Start Date:
Anticipated Completion
Date:
Total Acres in Active
Construction (< 1 acre
per Lot):
Project 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:
Title:
Company Name:
Mailing Address:
Cit
State:
Zip Code:
Primary Phone #:
Fax #:
24. Hour
Access/Emergency
Phone#: -
Cell Phone #:
Email address:
PM 10 Certificate #:
❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by the City of La
'Quinta.
Page 2 of 4
I
All 0...
Fugitive Dust Control PM10 Plan (< 1 acre per Lot or Infill Project)
Plan Updated 6-26-08
This Fugitive Dust Control Plan shall take into account applicable SCAQMD Regulations Rule 403, 403.1,
4011 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. Water shall be applied from an adequate sized metered water source to dry soils to prevent:
• Visible dust emissions > 20% opacity
a Visible dust emissions that travel > 100 feet from the source (within site)
■ Visible dust emissions that cross any property line
❖ 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. Control
•:• WEATHER MONITORING: Wind predictions shall be monitored.
❖ 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.
❖' 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.
❖ 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.
❖ 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 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.
EXCAVATION MEASURES: All areas to be excavated or graded shall be pre -watered. Water shall also
be applied during excavation or grading operations.
Page 3 of 4
Fugitive Dust Control PM 10 Plan (< 1 acre per Lot or Infill Project)
Plan Updated 6-26-08
❖ 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.
City of La Quinta — Site Specific Construction Phase PM 10 Agreement
Agreement Updated 6-26-08
The signature of the property owner (or authorized representative):
❖ 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.
The property owner (or authorized representative):
❖ 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;
❖ 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 upon the property for inspection and/or abatement
purposes; and
❖ Shall hold harmless the City/County and its representatives from liability for any actions related to this dust
control plan or any City/County initiated abatement activities.
Signature of Property Owner or Authorized Representative
Printed Name of Property Owner or Authorized Representative
Company Name
Date
Title of Property Owner. or Representative
Phone Number
Page 4 of 4