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0209-050 (DSF)LICENSED CONTRACTOR 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 the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date .1 2,13 I 'l ., Date Signature of Contractor 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 Section 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: Carrier Policy No. S'or"t�f.e�q (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, those.provisions. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and 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 result 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) Date " BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT JOB SITE ADDRESS '"9-4-50 M ��?'4�i�<�. AMU, ..' APN OWNER CONTRACTOR / DESIGNER / ENGINEER +..t..�.4x <ir��:✓,na1.5f C , i. ;" ..x0�1'y6'�.tikA�0!dd63sp..yE; y.F,i s.LJ-%*.0 Puo},p t 111"MAL C% Q2274 i'TUAO Z309 USE OF PERMIT ,D'j0AQ4.,rV ON DfMC.1'} O FAr4{ C`,°rRt':t{2NO 4,'>F StNOIX MACL a" MIPAIH UWAN RM P113% 94,09 0�,M011111014 VEN, f 9 i t Lru I� SEP 121002 CITY OF LAQUINTA ?_;'[!":.Irk .t��", s 'AM FE2~k�? 14),I N I It CIE NIM RECEIPT DATE BY DATE FINALED INSPECTOR INSPECT �c/tio �c/>r+.fT Qac I��n G,3 ION €�RECORD T��TOR .� i APPROVALSS Set Sacks , Underground ducts Forms & Fooiings Ducts Slab Grade return fir Steel _ Combustion Air Roof neck F aust Fans m_ O.K. to Wrap � F_Ai Ut Framing Compressor InsulationVents _ Fireplace P.L. Fireplace T,C. Fans & Controls Fart} wall insulatio=n Condensate Lines 15aq irim ell Fireli Eyterior Lath-- Drywall - Int. Lath. Final Final POOLS-SFAS LOC WALL PF'Steel _ _Set Saks 71ectric Sona Frotings _ _ Mair brain a t3and Qea€n Approval to _Covet Equi rmcnt Location Underground El tris Underground Mg Test FinalPLUMBiNG APPROVALS � .. tare "rest �..._._._._._._. _.�,...�.. _ Iatric Final Waste Lines_ Heater Wirral VV ren i sha _ dumbing Final € lumb'Yig Tots Out Equipment Enclosure X 'or Finish Plaster r Pool Cover Seder Corineectionrapsttiaiican pinF Gas Tesr _ � � Final ,ELECTRICAL APPROVALS Temp, Paver Pole Undergr nn Cond sii l�oiai,'J�irirr€� _ irir Fi Main Service Sub �'anel � t Exterior Receptacles Smoke De ectors °er=.gyp. Use of Romer Utilsty. bio°;^.e (Perm) SOUTH COAST` Alit QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCACMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 900174-5641 ACRD USE ONLY SCREEN BY RECEIVED POSTMARK ENTEREU BY �� ^•^, ^^� �` 760 BY� �v COMPANY / vu et� ,' PHONE COMPLETED G Q k DATE `b ' �- `/ ' f'� CHECK # FEE $ 2 0 5 , 07 PROJECT # NOTIFICATION TYPE REVISION DATES REVISION OTHER (highlight) CANCELLATION --faINA PROJECT TYPE Z EMOLITION ORDERED DEMOLITION RENOVATION (removal) EMERGENCY REMOVAL PLANNED RENO (annual) SITE INFORMATION SITE NAME ,,f7 ,rd,'S -,7 q M SITE ADDRESS s S -Soo �. a- of r` 5 • 7 �-e%%� CROSS STREET CITY 7 /i -ter 4 -u STATE ZIP 17A X-7 y COUNTY DESCRIBE WORK AND LOCATION g 1 '�''"'Y IVo w -4-.e O dr5�C7? F r' -e lel BUILDING SIZE (SQ FT) $ cs a 0 NUMBER OF FLOORS BUILDING AGE (YEARS) d U NUMBER OF DWELLING UNITS BLDG PRIOR I PRESENT USE TCOMMERCIAL HOSPITAL INDUSTRIAL Other OFFICE .PUBLIC BLDG. NOUS SCHOOL SHIP UNNICOLLEGE SITE OWNER 7, 04 r -e r /- 0.e Y e /,W, -,,,,e ADDRESS ' 5 c'' e' %�'% ,xe(�` 5 0'+ 574, CITY 7 `/ -t / m w STATE C ZIP 9� Z CONTACT �Y h e °� % PHONE 4 15 _ `714 REQUIRED BUILDING ASBESTOS ES NO ASBESTOS CES NO ASBESTOS ES NO BUILDING TO BE 40 NO INFORMATION PRESENT? SURVEY? * REMOVED? DEMOLISHED? PROJECT DATES START g— - Z• ENO /G a Y WORK SHIFT (day, swing, night) 7- S` ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL. AMOUNT (add row) REMOVED (in square feet) ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS AMOUNT OF EACH TYPE OF ACOUSTIC CEILING 1, LINOLEUM INSULATION FIREPROOFING DUCTING STUCCO MASTIC ASBESTOS (in square feet) FLOOR TILES (VAT) DRYWALL PLASTER TRANSITS I ROOFING OTHER (describe) CONTRACTOR INFORMATION CSLB LICENSE # 6 Z ( 16 OSHA REG # AQMD ID # NAME Ya et A 's 4 h G% C 1-e a r n ADDRESS It %- ' 911 ,43 v- e, ko::pt a h11 7d el CITY r� ( STATE ��j ZIP g�t�.7 y SITE SUPVR o c ��/ ,�GGc.K PHONE -3 , S ^ w$ 5Y WASTE TRANSPORTER 01 LANDFILL Td y _ ADDRESS ADDRESS CITY STATE 7 ZIP CITY 0 4 S+a � STATE ZIPga.:)L 7cjl * Asbestos surveys are required prior to Demolition and Renovation Forms, instructions, and the Rule 1403 can be obtained from AQMD web site http:i vawiw.agmd.gov Page 1 of 2 Form REV 20020607 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL ORIGINAL TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 WASTE TRANSPORTER 02 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 #11, 2, 3, 4, 5 or Other. For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey, Bulk Sampling, Inspection, PLM, PCM, TEM, Assumed as Asbestos-PACM, Describe Other: FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL:47-4— 9--6— FOR FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME S PHONE # AUTHORIZING PERSON: TITLE DATE OF ORDER: DATE ORDERED TO BEGIN: FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT: EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASO,"i BLE FINANCIAL BURDEN: CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. iti $ f 60a e4' h 5 >` IL e_ C .5c. -e r m iLi 7cE S C In GO e4' -e /' '0 st '. C° n TRAINING CERTIFICATION:1 certify that an individual trained in the provisions of regulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. Company Name Print name of owner/operator Signature of ownerloperator Tittle of owner/operator Date INFORMATION CERTIFICATION: I certify that the above information is correct and I have enclosed any required attachments. 'Ali Ltw 1 y_ c� f' u-ip -e i' q' " N C � re'ar' i +t f B�D i � � '044 � ���i ��i�i Company Name Print name of own�rloperafor Si nat r f owner perator Tittle of owner/operator Date tf 'ro Notifications can not be accepted without the required fee (AQMD Rule 301), Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks payable to'SCAQMD'. Fees are per notification, not refundable, and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $ 321.56 FROM 100 TO 1,000 SQUARE FEET $ 28.56 SPECIAL HANDLING FEE $ 27.35 FROM 1,001 TO 5,000 SQUARE FEET $ 87.61 REVISION OF NOTIFICATION $ 11,59 FROM 5,001 TO 10,000 SQUARE FEET $205.07 RETURNED CHECK CHARGE $ 28.43 MORE THAN 10,000 SQUARE FEET $321.56 CANCELLATION OF NOTIFICATION $ 0.0 DEMOLITION OF LESS THAN 100 SQ FT $ 28.66 I ASBESTOS REMOVAL AT owner- $ 28,66 I occupied singie-unit dwelling_ ATTENTION. Keep a copy of your notHlcadon. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a demolition permit. For questions call 909-396-2336. For your convenience please mail the form and fee and do not hand carry to AQMD. MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90084.5641 Page 2 of 2 TELEPHONE: (909) 396-2336 FAX: (909) 3963342 Form REV 06072002 FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP:/(WWW.PeOMD GOV SCAOMD is located at 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 09/06/2002 15:15 FAX Q002 09/0$/2002 10:45 FA3,_ 9092774194 49/05/2a,9azFAX :S7 SetrrEmasR 5, 2002 TRILOGY AT GLEN IVY CORAL OPTION 1, LLC 7.9-R95 RAANcHo L^ QUANTA ORIME LA Qu i wrA, CA 92Q53 (760) 777-77A7 -SHEA t-&. QUINTA. LLC 6800 NOFM4 GAINEY =LATER DRIVE SUITE 350 Sc m -r a V AI -K. AZ 85258 ATTENTION ,J1=F9 A. HINXLtWRJCHARD KNOWLAlVD RE: OFR-MiTri. GRAarNa PEFEMMSION LA QUINTA, CA GIS NTLI~ M EN; 240ox M002 P,22 A5 YNE Owr MR OF CERTAIN PAAGELS OF L.^NCI IN TKF- 0MY OF LA QuINTA I'rKE "CITY") LOCATED EAST OF THE CURRENT MAMMON STRF6T ALIGPIMENT, SOUTH 4F 58' STREE'C AND KCRT" OF CNOY'" ZyREeT, forwriFiSD As Rivansimm COUNTY Amsxmcz�wa s PARrsL NQS. 764-200.00 3, 754-200-002, 764-200-003, 764-- t 0-00 1 , 754-210-000 AND 759-070- 005, BEING PART" OF OR AOJACIZHT TO -r"g ARBA INCi-U0Ed IN TME CORAL MOUNTAIN 5PiL=FLC PL -aunt #2 f 6 CTriR "Pl7taPER'TY"), CORAL OPTION I, LLC ("CCRAI-m) maite v IRRANTS PERMISSION YO 514EA L-A Qt lm'rA, I -L -C (-rma '-0m v -L.0PER"-). THE t71:V61.GPER OP THAT PQRVAON OF TFTs CORAL MOUNTAIN SP=91VIC P&.AN #210 6l'TLJATED sipuThi or OWN STRIMST (ALSO IDBN7'IFrr.= A5 Olrw[LOCr AT LA 4u1NTA') TO ACCESS TpF_ pROPER71r SOLELY FOR THE PURPOSZ QF CONSTRUCTINCs IMPROVEMENT8 TO THS fw)KcP!_RTY IN A=012DANcF. wr7H STREET IMF'RCVl�mF-rl'r FLANS ImRRpA6wRa pY WATCONl Lit WATSON 1"NGIm990tNQ AND APPROYEo 6.Y V14M CITY ANO TIdT WATER IMPROV9MENT PLANS IMPLI.:PARSD 9Y WAYsON a WATSON ENr1NAFRSN6 AND APPROVED By TIME COACHKs-LA VALI..RY WATER DISTRICT (THE RWORK"). SUCH %V0PZK.VHA1„I- AMZ31TIO74ALLY iN C-LIJOR AlU=H CLEPARINQ. aptusefNr., D1=MOLITION. DworUB REINOVAL. ANIS RCUam CgRamrimss AS MAY BS mr-C&SSAI:LY TO COMPLW`r9 "I'"m WORK, THIS INCRMLSSION SiiAL.1 IMCKAIN 1114 FULL. R019cr. AND apr EGT UNTIL. THIS 6ARL,IER T0 OCCUR aas (A) THE CAMP r.TIvN or THE PI oPioaco vl 0311K. apt (aa) F'segUARY 28. 2003, juwvs a 1IVHICH TNts Lu-rmcv 7.&*rIcN is r tjL_w- AND VOID EXCSIPT FOR THE IN0EMNIFIC:ATION rROVISIONS BELOW WHICH SHALT- SURVIVE. IV I$ UM0RRST4t7L1 ANO ^0REEa THAT ALL OF THE WORK UPON -i"HE P"OPENTY WILL 136 DOME IrI JICCOIi1aalVc>` wlrli rHE J0414T D%V rML0ImM t'N'r AoR6EMaamr'(s0 CALLED) 93AVIZO %OVE:M8ER . 2000. CORAL AGRE5S To NOL = THE Cl" OF'L^ QUINTA FR£fi Ak mw CLEAR OF AKY a7AMAGEB TO THE PftckpER-rY AF -S ILTINis FROM rHE YV4R1c. TmIS AUTHORIZATION is GRANTED 414r -Y ON THE CONDITION2 'rY4aY THIO DEVELOPER SHALL. INOEa►IIKTFT AND HOLD HAFCML.s55, AND DEFEND CORAL. ITs rIMPLOYEss, V.QNTRACrOka,-VRCONTRACTORS ^NO Amr-xTS FROM ALL COSTS JWa LI^lalUITtES (INCLUIDIN0 I%TTaRNRV FEES) RESULTING FAROM rifle i0tac3poGE0 WapK ANN DEVELOPEPIs Am-rgvl7-e ON TMR PROPERTY. 51149 AKI.-Y, CORAL PTION 1. LLC Ti -rut: IT'S � y I� •y• ACCEPioWp AJv= A4WNRX& 70. SHEA QUI NTA, I•.I-C TIT E: tsl� r.7 TCITgL P.a2 City of La Quinta Developers PM -10 Approval Form Prior to the issuance of a Demolition Permit for the project listed below, Public Works approval must be obtained. Please return this form to the Building and Safety Department only after approval. Project Address: �3- 9 - j /-�? /9- D ( -S On/ S 1— Scope Of Work: J�= /h o C i o �"� C D D F S F. Public Works Department Approval is Hereby granted: Senior Engineer 9/1(/07- Date (DZDa e C00rTIPA4L APP90A L : (,0kn( dT0k -m ►JS6 MOM AS A �S( 5uiItI/Z -5A-t > SPgA'-/ PUP-IN01 T>EM0L,Tit>J 4,01) L.oa"-) ©L)T ii�410 A ?P WVE-0 LA Q D -1= I L L, S(7167. ENVIRONMENTAL rNo CERTIFICATE OF COMPLETION THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT ]PROJECT HAS BEEN COMPLETED W ACCORDANCE TO STATE & FEDERAL REGULATIONS AT Single Family Residence Four Building Units 59-650 Madison Street Thermal, CA 92274 EKU JOB 4 202-147 Removal of non -f able asbestos containing materials (ACM), approx. 300 sq/ft black wall mastic (pool house wall), approx. 62 sq/ft roof mastic penetrations, approx. 300 In/ft window putty (exterior Windows) in accordance with survey provided by Enviro-test dated August 96, 2002, DATE September 5th, 2002 BOB NAME Young's Land Clearing Roclq 'Young _WITNES ' D Beverle Gann RO. fox 285 Mira Logia, CA 91752 Phone (909) 685-5314 Fax (909) 681-5559 n013 6995-L69-606 OE:ZZ Z00L/0Z/60