06-3295 (DSF)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
06-00003295
46178 DUNE PALMS RD
649 -040 -612 -
DEMO - SINGLE FAMILY
MEDIUM DENSITY RES
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
S
Architect or Engineer:
P P(
LIC ED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that l licensed under provisions of C1apter9 (commencing with
Section 7000) of Division 3 of the Business aril Professionals and my License is in full force and effect.
Licerms'CI 21 nse.No.: 600283
Data: k Contractor•
f OWNER-01111DER DEC TION
I"hereoy affirm ,under penalty of perjury that am exam Jr 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, after, 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 8 (commencing with Section 7000) of Division 3 of the Buslness'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
anyappliaent•for a permit subjects the,applicertt to a-civil.penalty of not nlowthan five hundred dollars (8500).:
(_) 1, as owner of the property, or my employees with wages as their sole compens itioni 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 town owner of property who builds or improves thereon,
and who does the work himseWor 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:).
(_! I, as owner of the property, am exclusively, contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions'Codc The Contractors' State.Ucense Law does notapply to an owner of
property who builds or improves thereon, and who contracts for the projects'with a oontractor(s).licensed
pursuant to the Contractors' State License .Law;).
(_) I am:exempt under Sec. B.&P:C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that ther6 is a construction lending agency for the performance of the.
work for which this permitis issued (Sec. 3097, Civ. C:).
Lender's Name:
Lender's Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: SI/11/0,05
Y OF LA QUINTA .
95 CALLE TAMPICO
QUINTA, CA 92253
EERY LAND CLEARING & GRAD INC
P.O. BOX 10.09
THERMAL, CA 92274
(760)39.1-5840
LiC.. No.: 600283
------------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have ".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 046116532005
_ I.certifythati in the performance of the work for which this, permiWis issued, I shall notemploy any .
Person in any manner so as to come subject to the workers' compensation laws of California,
and agree that, rf I should oeco subject to the workers' compensation provisions of Section
9700 of the Labor Code hal hwith mp1 ' h those provisions.
Date Applicant: -
WARNING: FAILURE TO SECURE WORKERSIVERAGE ISIN LAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS:(11100,000). IN ADDITION TO THE. COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND.ATTORNEY'S FEES.
APPLICANTACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and, Safety'.for a permit subject to the
conditions•end, restrictions set forth an 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 Quints, its officers, agents and employees for any actor omissionseiated 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,.orcessation of work for 180'days will subject
permit to cancellation.
I certify that I have read this application and state that the. above I rmation incorrect. I agree to comply with all
city and county ordinances and state laws relating to building cc ction, and.her Y authorize representatives
of this;cou ty enter upon the above-mentioned property for ins tion r
Date: Signature (Applicant or Agent):
ty—
11.
Application Number . . . . . 06-00003295
Permit: . . . . . . DEMO PERMIT
Additional desc
Permit Fee . . . . 45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. . 0
Expiration Date . . 3/10/07
Qty Unit.Charge Per
Extension
BASE FEE
45.00
---- -------------------------------------------------------
Special.Notes and Comments
DEMO TO BARE GROUND OF SFD/POOL/SEPTIC
SYSTEM. PRE -SITE INSPECTION REQUIRED
PRIOR TO COMMENCEMENT OF WORK.
Fee summary Charged Paid
Credited-
Due
--------------------- ---------- -----------
Permit Fee Total 45.00
----------
.00
-----------
.00
45.00
Plan Check Total .00
.00
.00
Grand Total 45.00
.60
.66
-.00
45-00
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL 9091396-2336
FAX: .:9091396=3342
MAIL FORM AND FEE TO SCAQMD. ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 900745641
AQMD USE ONLY SCREt N`BY .. RElltEm POSTMARK . ENTERED BY NOTIFICATION #
COMPLETED BY COMPANY EMERY LANDCLEARING PHONE: 761391-5840 t
LORI EMERY V.P. AND GRADING; INC.
DATE 8129108 CHECK # �� FEES 131:53 PROJECT #
NOTIFICATM TYPE
OR=M REMON DATES REvaw Qm WW CANCEunTM
PR )JECT TYPE
DBoamm ORDMw DE IMMON RENOVATION (nNraval) EmucerCY REYWAL PLAmm RENO (annual►
SITE INFORMATION
SITE NAME HOUSE
SITE ADDRESS 46478 DUNE:PAUMS ROAD CROSS STREET WESTWARD HO DRIVE
CITY LA QUINTA STATE CA ZIPS= COUNTY RIVERSIDE
DESCRIBE WORK AND LOCATION DEMOLISH REMOVE AND DISPOSE OF ONE STUCCO HOUSE
BUILDING SIZE (SQ Fr) M. NUMBER OF FLOORS 1 BUILDING AGE (YEARS), 49 NUMBER OF DWELLING UNITS 2
BLJDG.PRIORIPRESENTUSE
CaNmm HOSMAL hNotlS ML 011W Ori Pd8wam HOUSE scwm sw uWr.0lEM
SITE OWNER CITY OF LA QUINTA ADDRESS '78495 CALLE TAMPICO
CITY LA QUINTA STATE CA INP 92253 CONTACT JOHN MCM811AN PHONE 760212
REQUIRED BUILDING
INFORMATION
ASBESTOS YES NO
PRESENT?
ASBESTOS YES NO
SURVEY? '
ASBESTOS YES NO
REMOVED?
BUILDING TO BE YES NO
DEMOLISHED?
PROJECT DATES
START SEPTEMBER 12.2006 END SEPTEMBER 26.2005 WORK SHIFT (d" swing, night:
ASBESTOS AMOUNT TO BE
(In sqmm
FRIABLE
CLASS I
CLASS -11
TOTAL AMOUNT (add row)
ASBESTOS REMOVAL FROM
SURFACES PIPES COMPONENTS
AMOUNT OF EACH TYPE OF
ASBE8TOS (in sWmfeeQ
ACOUSTIC CEILING
I LINOLEUM
INSULATION
FIRE PROOFING
DUCTING
STUCCO
MASTIC
FLOOR TILES (VAT)
DRY WALL
WASTER
TRANSITE
ROOFING
OTHER
(d=ft)
CONTRACTOR INFORMATION
CSLB LICENSE # 600283 OSHA REG # AQMD ID # 100435
NAME EMERY LANDCLtkRING AND G1'NADING,'INC. ADDRESS P.O: BOX 1000
CITY THERMAL STATE CA ZIP 92274 SITESUPVR JAMES IC EMERY PHONE 760x174-9493
WASTE TRANSPORTER #1
LANDFILL
ADDRESS
ADDRESS
CITY
STATE
ZIP
CITY
STATE
DP
* Asbestos surveys are required prior to DemoGfjon and Renovation
Forms, inStruciions, and the Rule 1403 can be obtained from AQMD web stbe httpJ/wwW.agmd.gov Page 1 of 2 Form REV 20030627
SCAQMD'NOTIFICATION OF DEMOUMN OR ASBESTOS REMOVAL
MAIL FORM MD FEE TO SCAQMD, ASBESTOS NOTIFICATIONS. FILE lig 5541, LOS ANGELES'CA900744641
WASTE TRANSPORTER #2.
WASTE STORAGE SITE
ADDRESS
ADDRESS
CITY STATE ZIP
CITY STATE ZIP
CONTROLS DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE Procedure# 1,2,,3.4; 5 or-Ot1w.
Far asbestos renhohrats drde the combination of Rule 1403' p used. P=edure'4 and 5 abnit plans for-AQMD prior approval.
AS'BESTOS'DE7ECTM PROCEDURE:. CIRCLE THE' PROCEDURES AND ANALYTICAL METHODS11SED TO.DETERMINE ASBESTOS IN THE BUILDING:,
Surrey, B* SamoBsha..hsoedon. PLM, PCM„ TEM. A mmmd as Asbe�ACM, Describe 011m (SEE SURVEY GUIDELINES CHECt(LJST):
FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL
FOR ORDERED DENOUTION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME S PHONE hT
AUTHORIZING PERSON: TITLE
DATE OFORDER: DATEORDERED,TO,BEGiN:
FOR lEMBOBICY ASBESTOS REWVAL GIVE THE. NAME AND MW NUMBER OF TWRER90N DECLARINGAMMIOROW THE OAMENCY, DATE AND HOUR OF
EIYBt( C1f AND DESCRIBETHE SUDDEN, UNEXPECTED EVENTi
EPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS. EQUFME NTDAMAGEOft UNREASONABLE FINANCIAL tea.
COKrMGENCYRAltDESCROEAMMTODEFaLOMMFLOOPECTEDASSMISFOWWRMOEmoLrnON OR ASBESTOS MATERIAL BECOME
DISTURBED. CRUMBLED. PULVEt®. OR REDUCED TO POWDER.
STOP PROJECT HAVE CERTIFIED ASBESTOS'REMOVAL CONTRACTOR REMOVE AND DISPOSEOF.
TRABN W CERi1ICAT1011k I certify0W an hhdivi" trained. In the of regulation AQMD Rhe 1403 and,NESHAP will' be on site during the moral and
wWencm1 W the required training has been a000rrgag'Ied. br this person will . mdable for kgmd m during normal busirim hours:
ConpW Name EMERY Print name of ownerlaperat of Tittle of owner/aposim Date iVAM
LANDCLEARING AND LORI EMERY
GRADING, INC. VICEPRESIDENT
WFORMATION CERTIFICATION:1 cerdly'that the alxm infomhabm is and I have endosed any regained agadwmts.
Cly Nam EMERY PdW name d-owrsrkperalor oF Time of omatoperator Date 019/06
LANDCLEARING AND LORI EMERY VICE PRESIDENT
GRADING, INC.
Notifications ' cannot be aooepted wWW the required fee (AQMD Rule 301). Asbestos removals of _ _ than 100 square feet are ermo irate notification and fees.
'PAM makdhecks,payabie t0SCAQMD'. Fees are pernotiricationj not refundable, and vary a000rtGng io the projed size. Fees me as idlorrs:
DEMOLITION OR ASBESTOS REMOVAL SERVICE CHARGE
1.000 or less $ 43:02 SPECIAL HANDLING FEE $ 43.02
1,001 to 5,000 $ 13153 REVISION OF'NOTIFICAMON $ 43.02
5,001 to 10AW $ 307.86 RETURNED CHECK CHARGE $ 31.97
10,001 to 5OA00 $ 482.74 PLANNED RENOVATION $ 482.74
50.001 to 100,OOD $699.60 PROCEDURE 4 OR 5 PLAN $ 48274
100 0011 or more $1,166.00
MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTF"TIONS, FILE * 4"41,,LOSANGELES:CA 900744641 Page 2 ot.2
TELEPHONE -(909).3965-2336 FAX (909) 396 3342 Fonn.REV 2003OW
FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEBSITE AT HTTP://WWW.AOMD.GOV
SCAWID Is'Da-1 at 21865 E. Copley Drive,.Diemond Bar, CA 91.765.4182 (909),396-2000
.A-1 Cesspool Service, Inc.
P.O. BOX 5901AN&Ith !Palm Springs, CA. 92258 JOB INVOICE
- 'Since 19591
760) 329-"75 Fax (760) 251-3405 ate Ordered 7Cw-� Order No. D
State L ic. #265214
www.alcesspool.com T By
BILL TO 11II PWNE 1,141 L
ADDRESS C--,' !I T"l9A3*it
-
;7e. D C -11V 6` 2!2�Z- ArS. D
amfollSEPTICTANK HAS SSMC TANK BEEN DUG UP? os -1314o ' OWTONSITE
REQUESTED �91:uuwmp y SEEPAGE PIT plOFFICE BILLING
QUANT. DESCRIPTION PRICE AMOUNT
J
Pumping Fee per J000 Gallons (or fiaction).Z
Wage Discharge Fee per 1000 Gallons
Locating.wa0*ing Fee (1hr. Min;)
Out of Area Ne
f t
Q. ALM. LtACW!46'SYSTEM HAS FAILED.
Q I'ftEIS-ANOBSMUCTION4WnMAM-OPTHFIMICTANY-
q WE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY
13YEAR C]OTHEILYEAR (32-3YEARS
To mnmbuilt W sobb. Mds will kmw the life ofyoow1wbir4S systow
E3 THIS PUMPINC -WILL PROVIDE ONLYTEkPORARY- RELIEF AND NOT
SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OFJHE ABOVE.
CUSTOMER HAS IBEEN'GIVEN AN "LXPLAINATIOW PACKET.
A S9RVIlC9 CHARGE OF SU WILL BE DUE
ON ALL RETRUNED CHECKS.
AFRqANCECHARGE Olrlt*%PZRMONTH, lt%PERYL%V.WILL.Bg
CHARGED ON PAST DUE ACCOUNTS OVER 30DANS.
IF PAYMENT IS BY CHECK
DRIVERS LIC0 STATE_
SIGNATURE W22
Total
[ D
;go
i
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