BDEM2017-000278-495 CALLE TAMPICO D �i�tILICl/ VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 "� FAX (760) 777-7011
DESIGN &DEVELOPMENT DEPARTMENT FAX
(760) 777-7153
BUILDING PERMIT
Date: 3/14/2017
Application Number: BDEM2017-0002 Owner: .
Property Address: 77050 AVENIDA FERNANDO ROBERT EDWARDS
APN: 658240008 1739 FOREST VIEW AVE
Application Description: PANOS / DEMO EXTERIOR CONCRETE HARD SCACPE AND POOL SHELL HILLSBOROUGH, CA 92253
Property Zoning:
Application Valuation:
Applicant: 4 a Contractor:
JUAN RODRIGUEZ JUAN RODRIGUEZ
80614 TANGELO CT ® 80614 TANGELO CT
INDIO, CA 92201 MAR 14 2017 INDIO, CA 92201
CITY OF IAQUINTA (760)578-7100
OESIGN AND DEVELOPMENT DEPARTMENT Llc. No.: 904127
---------------------------------------------------------------------------------------------
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 the Business and Professions Code,
and my License is in full force and effect.
License
RClas : C- license No.: 904127
Date: V ?i 4 Contractor:
OWNER -BUILD R DECLAON
I hereby affirm under penalty of perjury tha am exp pt from 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, 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).:
( ) 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 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 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 contractorjs) 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 there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. Q.
Lender's Na
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificateof consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor. Code, for the performance
of the ork or which this permit is issued.
,�-Dave 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 COMPENSATION INSURANCE FUJD Polity Number: 9166760
I certify that in the performance of ne 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,;of th abor Code, I shall forthwith
comply with th se pr visions.
Date: O Applicant: —
WARNING: FAILUR TO SECURE WORKERS'NSATIO OVE GE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIPENALTI CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000h. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOM LEDGEMENT
IMPORTANT: Application is hereby made to the4Building Official 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 C-ty 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 resultof this applica'ion 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 stale that the above information is correct.
I agree to'comply with all city and county ordinances and state laws rela ing to building
construction, and hfreby authorize representati+es of thi i to enter Xhon the
above-mentibned p operty for inspection purposes. /T
Date: �� ,� f Signature (Applicant o• Agent
A
Date: 3/14/2017:
Application Number:
BDEM2017-0002
Owner:
Property Address:
77050 AVENIDA FERNANDO
.,
ROBERT EDWARDS
APN:
658240008
1739 FOREST VIEW AVE
Application Description:
PANOS / DEMO EXTERIOR CONCRETE HARD SCACPE AND POOL SHELL
HILLSBOROUGH, CA 92253
-
Property Zoning:
Application Valuation:
Applicant:
Contractor:
JUAN RODRIGUEZ
JUAN RODRIGUEZ
80614 TANGELO CT
80614 TANGELO CT
INDIO, CA 92201
INDIO, CA 92201
°(760)578-7100
Lic. No.: 904127
--------------------------------
-- - - --- ---- s--------------------------------
Detail:
A
FINANCIAL
DESCRIPTION
INFORMATION
ACCOUNT 'QTY
AMOUNT
DEMOLITION, FULL
101-0000-42404 0'
$25.84
DESCRIPTION
ACCOUNT QTY
AMOUNT
DEMOLITION, FULL PC
101-0000-42600 0
$91.20
Total Paid for DEMOLITION:
$117.04
Iain tt
Permit tt
Project Address: 77_ 0 v
City of La Qu«n to
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Name: flr/oC
A. P. Number:
Address: Q
Legal Description:
City, ST, Zip: &A 211Y 7,
r
ont act
Contractor:.
o r .G
T N
,� l
n
Telephone:
Po e
Address:
L
Project Description:
City_ ST, Zip:-nJfi
n
✓ 0
Telephone:
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J
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J D
State Lic. # : -fa Z
City Lie. #
Arch.,*Engr., Designer:
Address:
City; ST, Zip:
Telephone:
fraction Type: Occup 3ncY
:Con
i _#
State Lc
Project type (circle one): New Add'n Alter r Re ai r Demo
0
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Depcsit
Truss Cafes.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
Plan Submittal
Building Permit Number.
Project Description: QpL
. I Exempt: ❑
(Materials may contain hazardous wastes and
are not subject to recycling provisions)
Construction Debris Management Plan
3//14/17
Job Site Addressl 77050 Avd Fernando
Owner's Name
Number, Street, or PO Box
City, State, Postal Code
Owner's Phone Number
Owner's E -Mail Address
Project Manager's Name
Project Managers Phone Number
Project Managers E-mail Address
Panos, Jack
77050 Ave Fernando
La Quinta, CA 9253
Juan Rodriguez
760-578-7100
imrod760®aol.com
Builder/ Contractor JRC Construction
Number, Street or PO Boxi 80614 Tangelo Ct.
City, State, Postal Codel Indio, CA 92201
Project Square
City Approval By
Date of City Approval
Materials To Be Discarded:
Product
Tons
Trash
0.00 Not recyclable
Product
Asphalt
0.00 Recyclable
Masonry (broken)
Brick/Block
0.00 Recyclable
Plaster
Cardboard
0.00 Recyclable
Scrap Metal
Commingled
0.00 Recyclable
Tile (floor)
Concrete0.00
Recyclable
Tile (roof)
Drywall
0.00 Recyclable
Wood
Donated /Reuse'
0.00 Recyclable
Landscape Debris
'Describe Items
Totals: Recycle Trash
60.011 0.0
Tons
Projected Diversion:
100.0%
I understand it is the property owner's responsibility to submit copies of weight tickets or receipts to the District
Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the
Debris Management Plan (DMP) for the above named project shall guarantee that at least 50% of the jobsite waste is diverted
from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining materials
generated from the first day of the project through the completion of the project in accordance with this pian. This DMP is
issued in the name of the property owner(s) and shalt remain their property throughout the construction and/or demolition
project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still issued in the
name of the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the DMP are
adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through bi-monthly
reports. If self -hauling, all refuse material from this project site must be taken to an approved recycler or transfer station.
Owner / Developer / Project Manager / Superintendant Date
Construction Debris Management Plan
Summary of Requirements
As of January 1.,•2011, The Green Building Standards Code (CALGreen) requires that the construction of
most new structures in the State of California comply with sections 4.408 and 5.408 of the code in
^' accordance with. Assembly Bill 939 requiring that no more than 50% of jobsite waste be disposed of as
trash at local land fill sites and transfer stations. Exceptions may be made for certain projects under
certain conditions.
The City of La Ouinta is committed to the highest level of environmental respect, to conserving our
precious natural resources and setting an example to provide for a better world for generations to come.
Recycling helps keep reusable resources out of landfills and will also reduce disposal costs.
IMPORTANT: Burrtec Waste & Recycling Services is the City's franchise
haulers. If you choose to self -haul any recyclables or trash, you must
provide copies of all weight tickets and/or receipts from the transfer
station, landfill, or recycler as the job progresses. Clean-up companies
and other haulers are not permitted to haul waste or recyclables from the
City of La Quinta. Self -haul weight tickets should be submitted to: Kenn
Stevens, District Environmental Coordinator -
kstevens@burrtecdesert.com, or faxed to (760) 340-0417, or mailed to:
41575 Eclectic Street, Palm Desert, Ca 92260.
Recording Requested By
North American Title Company, Inc.
File No. 55913-1391334-15
i" AND WHEN RECORDED MAIL_TO:
Name: The Panos Family Trust
Street Address 615 West Santa Inez Avenue
City &State Hillsborough, CA 94010
SPACE 'ABOVE THIS LINE FOR RECORDER'S USE
A.P. No. 658-240-608-7 i ',GRANT DEED
4 1 1 `' J ' 0 "q O o''••'Q' �` C ,5,.
Srd7
The Undersigned Grantor(s) Dedare(s): DOCUMENTARY TRANSFER TAX $1,100.00;,0 .TRANSFER TA $NONE; c x
x computed on the consideration or full value of property conveyed, OR, r
computed on the consideration or full value less value of liens and/or enambrances remaining at time of sale,
unincorporated area;, [ x) City of La Quinta, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Robert F. )Edwards, Jr. and
Andrea Allen Edwards, Trustees of the Edwards Family Trust under agreement dated October 7,
1999'
i
'hereby, GRANTS to John Joseph Panos and Susan Pauline Panos, Trustees of the 1998' Panos Family
. ''
Trust dated September 14, 1998 ,
the following described, property in the City of La Quinta, County of Riverside, State of California:
I
LEGAL DESCRIPTION ATTACHED HERETO AS EXHIBIT "A" AND MADE A PART HEREOF
Dated: April 08, 2016
4 i id '
a f
Robert F. Edwards, Jr. and Andrea Allen 't..
Edwards, Trustees of the Edwards Family '
° Trust under agreement dated October 7, try
1999
Robert F. Edwards, Jr. ,(Trustee'
Andrea Allen Edwards, Trustee
■
f '}
r
i Mail Tax Statements To: SAME AS ABOVE aty '
Armando Magallon
From: JRC Concrete Construction <jmrod760@aol.com>
Sent: Tuesday, March 14, 2017 2:38 PM'
To: Armando Magallon
Subject: Fwd: Demo Permission
Juan Rodriguez JRC Concrete Construction www.JRC-Concrete.com' Phone # (760) 578-7100 Fax # (760) 342-7238 On
Tuesday, March 14, 2017, Jack Panos <jackpanos@comcast.net> wrote:
To Whom it may concern,
I John Panos gave permission to JRC Construction to perform demo work at my home locatec at 77050 Avenida
Fernando in La Quinta.
John Panos
Sent from my iPhone
0
I