06-3752 (DSF)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06--00003752
Property Address: 46160 DUNE PALMS RD
APN: 649-040-004- -000000-
Application description: DEMO - SINGLE FAMILY
Property Zoning: 'MEDIUM DENSITY RES
Application valuation: 0
T-edf 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY .DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjurythat I am. fioensed,underprovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pa ionals Code, and my License is -in full force and effect.
License Class: C21 Licerq@N 600283
Date: 0� _Z`I` OContractor:
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. 7031.6, 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 orshe 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 penefty�of not more than five hundred dollars (86001.:
(_) 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 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 oroffered 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, as.owner of the property, am exclusively contracting with licensed contractors to construmthe project (Sec.
7044, Business and Professions.Code: The Contractors' State License Lawdoes not apply town owner of
property who; builds or improves thereon, and who contracts for the projects with a coritractorls) 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 penaltyof.periury 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 Addre:
LQPEItMIIT
VOICE (760) 777-7012
FAX (760) 777-701.1
INSPECTIONS (760) 777-7153
Owner:
CITY OF LA QUINTA REDEV.AGENCY
UNKNOWN,, CA 99999
Contractor:
EMERY LAND CLEARING & GRAD
P.O. BOX 1009
THERMAL, CA 92274
(,760)391-5840
Lie. No.: 600283
Date: 10/23/06
PNI OrT 2 iti 2006
CITY OF IjA GUNTA
FINANCE DEPT.
------------------
WORKER7S1 COMPENSATION DECLARATION
(',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 oCthe Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation. insurance, as required try 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 046116532005
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 beco bject;to the workers' compensation provisions of Section
3700 of the Labor Code, I all rthwith'comp ith those provisions.
L. c
Dete•110-24-0 Applicant:
WARNING: FAILURE TO'SECURE WORKERS' COMPENSATION r0VFRAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES -AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100,000). IN ADDITION TO THE COST OF'COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, JNTEREST, 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 pers9n upon whose behalf this application is made, each person at whose request and for
whose benefitwork'is performed under or pursuant; to any permit issued as�a result of this application,
the owner, and the,applicam, 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 followingissuance of this permit.
2. Any permit issued as a.resun 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 andetate that the above information is correct. Cagree;to comply with all
city and county ordinances and state laws relating to building ?"ruction, and hereby authorize representatives
of this county to:enter.ypon the. above-mentioned: property fo ' pectioy�ur s.
. / b
Date: to ZN ignsture (Applicant or Agent,:
Application Number . . . 06-00003752
Permit. . . . DEMO PERMIT
Additional desc .
Permit Fee . . . . 45.00
Plan Check
Fee
.00
Issue -Date . . .
Valuation
. . .
. 0
Expiration.Date.. 4/21/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
- ---- -----------------------------------------
Special Notes and Comments
DEMO TO BARE GROUND OF EXISTING SFD,
INCLUDING SEPTIC ABANDONEMENT. PRE -SITE
INSPECTION REQUIRED PRIOR TO START OF
DEMO.
Fee summary Charged Paid
Credited
Due
----- -----
Permit Fee Total 45.00
--------
:00
-- ----------
.00
45.00
Plan Check Total .00
.00
.00
.00
Grand Total 45.0'0
.00
.00
45.00
LQP6RMff
Biu tit
City of La. Quinta
,Building a Safety Division
P.O. Box 1'504, 78-495 Calle Tampico
La Quinta, CA 92253- (760)'777-7012
Building Permit Application and Tracking Sheet
Permit ff ��
ProjectAddress: - 6 0 � hV_C MS
Owner's Name: Q '
1
A. P. Number:
Address:
Legal Description:
Contractor: lri)t ( l�
Address 6� O
City, ST, Zip:
Telephoner
Project Description:
City, ST, Zip:
Telephone: U6 ?)qf _S {o
01
State Lic. # : Tit,Lic. #
Arch, Eng., Designer.
Z
Address:
City, -ST, Zip:
Telephone:
State Lie,
Constrgction'�pe.. Occupancy:
PwiedtYpe(circlegne): New Add'n Alter Repair Demo .
Name of Contact Person: �Q
Sq.
# Stories• C
# Units• '
Telephone# of.contactPerson,
FstinWW Value of Project:
APPLICANT:
DO'NOT WRITE BELOW THIS LINE
#
Submittal
Req'd . ;
Recd
IMACIMG .
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item
Amount
Structural calm
Reviewed,.ready for corrections
Plan Cheek beposit
Trus Cales.
Called Contact Person
Plan Check Balance
Energy Coles.
Plans,bicked ap
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2- Review, ready for correctionstinue
Electrical
Sabcontactor List
Called,Coutact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
HAA. Approval
Plans resubmitted .
Grading
IN HOUSE:-
°r' Review, ready for corrteii s/issae
Developer Impact I<eb
Planning Approval
Called Contact Person
A;Lp.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees,-.:.:
V . i
_ SOUTH COAST AIR QUALJTY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLMON Olt " ESTM FMOVAL 909 9.2;136 -
FAX"..` WPM=
WQ FORM AND FEE TO ASBESTOS NGTMAIMK ME # 55641; IAS A OEM CA S M44W
AQII®Y SCliiEBi:B1f -
COMPLETED BY COMPANY EMERY LANDa0aW PHONE: 76MI-0 0
LORI EMERY V.P. AND :GRADING, INC
DATE ;10,3-06 CHECK# , 3 el3 , FEE513 M PROJECT#
NOTFICATION TYPE OAGWL Remm DAm ReMM Onffa (Iithl&Q CAMMMIM
PROJECT TYPE DEMMMON Orme*D DexxffppoN . POWA aN,(MMOV4 Emaw= REWWAL PLAMw Rero (anntw4
SITE UIgIATloN SITE NAME
SITE ADDRESS 46460 DUNE PALMS ROAD CROSS STREET WESTWORD HO DRIVE
CITY LA fA INTA STATE CA ZIP 92253 COUNTY RIVERSIDE
DESCRIBE WORK AND LOCATION DBIOLISH ONE HOUSE
BUWNG`SM (W FO I= NUMBER OF R.00RS-1 BUILDING AGE.MARS) 40 NUMBER OF DWELLINGUNITS 2
OMPRMIPRESMTIBE HDWffAL Omiirsnm Offer 0WIM POWUM t t SMM SW uwdcouBm
SITE OWNER CITY OF LA QUINTA OOMMUNIT,Y'OEVBAPlI Jiff DEPT. ADDRESS 78485 CALLE TAMPW
CITY LA QUINTA STATE CA - ZIP 9?253 CONTACT JOHN MCMILLEN PHONE ' 76D1212-2322
REQUIRED BU8.W. ASBESTOS YES W ASBESTOS ) NO ASBESTOS IES NO BUILDING TO BE YES NO .
@IFOTiMAT10lI PRESENT? SiHtVE1f? s. REMOVED? DEMOLISHED?
PRO= DATES START. OCT. 23, 2006 END OCT. 31, 2006 WORK SHIFT (dam,, swing, n04
ABBE -19-40AEMW TO BE FRIABLE _ CLASS I CLASS N TOTAL AMOUNT (add row)
ASB fOSREMOVAL'FRIOM SURFACES PIPES COMPONENTS
ANDD OF EACH TYPE of ACOUSTIC CEILING LINOLEUM um"MON FIRE PROORM. DUCTING STUCCO MASTIC
FLO. ORTILES(VAT) DRYWALL' mm TRANSITS mom OTHER
(ymu
Commmuffai1IATIWI CSLB.LICENSE#'60= OSHAREG# AWDID# 100435'
NAME EMERY.LANDCLEARMG AND.GI ADMG, MIC. ADDRESS P.O,-BOX 1009.,
CITY THERMAL STATE CA ZIP 9W4 SITE SUPVR JAMES.C: EMERY PHONE 760ffT4=9493
WAS'1'ETRANSPORTER#'L LANDFLl
ADDRESS °Ai>I)RESs
CITY STATE ZIP CITY STATE 21P
*
Asbestos swveys am 1@ p&W pdartmDardWan and RwlaimMon
Forms. kwhc&m and the Rule 1403 can be obtained tom AQMD Web sbe hBpJhvwwmpd4lov Page 1 oI 2 Farm REV 20030627
SCALD NOTMATION OF DEMOLMON OR ASBESTOS REMOVAL
WUL FOM AND FEE 70 SCAM14 ASBEWIOB 110111FICAXIOWFILE 00M. LOS ANGELES CA90074W
WASTE TRANSPORTER 0
WAiTESTOMSEME
ADDRESS,
ADDRESS
rm = STATE zip.
CRY STATE 23P
CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE LMED AT THE RENOVATION AND DEMOLITION WE PMc8&m#l,Z3,45orOIiw.-
Farasb.esooe`mwv*dRM@w co on of" 1403 wed. RooMn4and 5.sft**mforACMpdorappoveL
ASSESTOBBETEC"PROCEIMM, CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TODET EFD"ASBES='INTMBUILDING:
Stmm &ft Swvft kqmft. PM,PM TM Ammet! as Aftd**AM Dewft Oft W SURVEY GUIDELINES CHEO(LIM
FOR DBUMONS GIVE THE COMPANY NAM AM DATES OF THE ASBESTOS RBMAL OCT.ff–ifi BRICIMENIAMMMAI.
RR-ORDEM =1=1011 SEND A OOPY OF THE ORDMAND GIVE THE AGENCY NAME & PHONE # -
AUTHORIZING PERSON: TITLE
DATE OF ORDER: OATE'ORDERED TO BEG
FOR EUMMENMASBESTOS REMOVAL (INE THE NAME AND PHONE NIMMOMEPERSON THE BOMMDATE AND HOUR IF
AM' 'r EStAXWUNEWEMWEVEW.
OWL&AHOW MEVENT WOULD Q4U1MUN&%%=0n0KE"MENT DAMAMORUNREASONOLEFINAICALBUFUR
-CONTINGENCY PLAN:70MMMIONRYOSEFaUNED FMOVEMMAMMMISFOW0 MOM OMM" CRAMMOS MUERIAL
OWURBM.aRRGMRLM9i1�.C)FtRMM70PONML
STOP PROJECT' HAVE CERTFM ASBESM.REMOVAL CONTRACTOR Rl3KM AND O18K)SE*OF
TRAINING CEltl CA11M.1 cw*,#W an kdddud fratrred MAN Pmddaw of AC MD Rede 1403 ard NESHAP will be an afte dft the removal and
-dkdRmhmm
Cop" Nom 84ERY P*d name of TiffleafomwdowsW Da 1o13106
GPAMIGi1k. VIC9PRESIDENT
Campy Nam EM Pft.rm1neQf&m=*qm-&r qI mTwftm& DO low
UMM—FARINGAND VICE.PRESIDEM
N*t*mcan ndtie moupWwMWftmp*Wfee (ASD Rule 3M. Admftsmvi&of than l00s*mfeet are ewn0*=fwmcdmand fees.
Pillolinett r'nr'rmpays* IDO,Q,CAQka. Fees ampwmiffimer, not jdun&b%and wyawwftIoftprqjWsb& Fees meas ioftw
DEMOUTIONORASEN11OS'REMOM JUM MARGE
..'arim $ 4M $ 4102
"Im qPBNAIf0NX=FEE
I.M1.4D.5.WD $ 131.9 REVISION OF NOTIFICATION $ 4=
wimlom $ WA RETtIRNED'CI-FECKCHARGE $ 31.97
.10AM 105M $ 48274 PLANNED RENOVATION $46'1.74
5000110100.000 $ agm PROCEMIRE 4 OR 5 PLAN $482.74
100AM armors $ila&OD
MAB. IFORMANO FEE TMISCAOMASPES nR'NO' m7mKFRESM4lLAS ANGMCKOW441M, Page.2d2
TELEMONE' (9W3*= FAX Foran REV 20MO627
FORMSONSTMMONS, ANDTHEMILE 1403 CAN BEOSTAINED FROM Am WEB SITE AT -'H=-1fWW-W.A0MD-G0V
SCN=b'm 1, 'at21865 E Copley Dft Dbaux! Bar, CA 91766-4182 (" 39f •2000
i
10!20/2006 08:30 90938.13433 BRICKLEY ENV
NON -HAZARDOUS mwdntom ft L PON +
WASTE MANIFEST ' N 0 T R R a U.1 R$ 27, O 1
F.
ITY DMLORPIM DEPT.
78-495 CALLS tAMPICO
LA QUIKTA; CA 92253
2 21-2332
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26999 iilC3iMY 95 XlLJ.t POST 126 A Z C 9 5 0 6 2 3 1 1 1`
PARKER, A8 85344
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PAGE 82102
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$4-7424
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(928)169-2559
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EMERGINCY CONTACT: INFOTRAC (900) 535-5053
EPA RRGIOV IX 75 HAWTHORNE ST., SAN ?RANCTSCO, CA 94105 (425); 744-1089
SOUTH COAST AGM 21865 E. OOPLEY DR., DIAKOND BAR, CA 91765 (909) 3.96-2336
SITS ADDRESS: SFR -DEMO, 46-160, DUNE PALM WOAD, LA W11IMLA, CA 92253
TA OIC Inom lip L
ORIGINAL -RETURN TO GENERATOR
t7 c
d
Owner CITY OF LQ REDEV AGENCY
Contractor EMERY
Permit Number 06-3752
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALLAPPLICA6LE SPACES
JOB ADDRESS 46-160 DUNE PALMS RD
DEMO TO BARE GROUND OF EXISTING SFD, INCLUDING
SEPTIC ABANDONEMENT. PRE -SITE INSPECTION REQUIRED
PRIOR TO START OF DEMO.
TYPE OF INSPECTION I DATE I INSP.
TEMPORARY POWER
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. (DRYWALL)
EXTERIOR LATH
SEPTIC ABANDONMENT
SEWER CONNECTION y v -
SEPTIC / GREASE INTERCEPTOR T
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER (ALARMS/ BARRIERS)
TEMP. USE OF PERMANENT POWER I I
PLUMBING
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE. RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING