BDEM2019-002578-495 CALLETAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
NICK NIETO
78155 CALLE ESTADO #105
LA QUINTA, CA 92253
c%4�PQw4trw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
DEMOLITION/COMMERCIAL/OTHER
BDEM2019-0025
78080 AVENIDA LA FONDA
770121005
KELSEY / INTERIOR DEMOLITION ONLY
$31,200.00 0
L�
OCT 0 / 2019
G YOF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class:,,, License No,:
Date:
Contractor:
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. 7031.5, 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 sines, and Professions Code) or that he or she is exempt therefrom and the'l
basis the alleged exemption. Any violation of Section 7031.5 by any applicant for a
pe subjects the applicant to a civil penalty of not more than five hundred dollars
as owner of the property, or my employees with wages as their sole
ensation, 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' ended or offered for sale. If, however, the building or improvement is sold
wit 6as
one yearofcompletion, the owner -builder will have the burden of proving that
hdid not build or improve for the purpose of sale.).
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
ther . 6' and who contracts for the projects with a contractor icensed pursuant to
ontractors' State License Law.).
I am exempt under Sec. B.&P.C. for eason
CONSTRUCT19N LENDING AGENCY
I hereby affirm under penalty of perjur that there is a construction lending agency for
r the performance of the work fowhi this permit is issued (Sec. 3097, Civ. C.).
Lender's N
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/7/2019
Owner:
AARON KELSEY
78080 AVENIDA LA FONDA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER - AUTHORIZED SIGNEE JIMMY
ABSMEIGR
Llc. No.:
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.
have and will maintain workers' compensation insurance, as required by
Sect ltin 37 f the Labor Code, for the performance of the work for which this permit
IS issued, workers' compensation insurance Carrier and policy number are:
Carri Policy Number:
l certify that in the performance of the work for which this permlt is issued, I
play any person In any manner so as to become subject workers'
co pensation laws of California, and agree that, if I should beco Ubject to the
workers' compensation provisions of Section 3700 of the Cade, I shall forthwith
comply with those provisions.
App
WARNING: FAILURE TO SECURE WORKERS'C PENSATI0N COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRI AL 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 Building 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 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 thZinformatlon orrect.
I agree to comply with all city and countyordinances anuilding
construction, and hereby authorize representatives of th
above-mentione pr erty for inspection purposes.
0 �• 5lgnaturi's(Applicant or Age
Application Number:
BDEM2019-0025
Property Address:
78080 AVE NIDA LA FONDA
APN:
770121005
Application Description:
KELSEY / INTERIOR DEMOLITION ONLY
Property Zoning:
Application Valuation:
$31,200.00
Applicant:
NICK NIETO
78155 CALLE ESTADO #105
LA QUINTA, CA 92253
Date: 10/7/2019
Owner:
AARON KELSEY
78080 AVENIDA LA FONDA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER - AUTHORIZED SIGNEE JIMMY
ABSMEIGR
Llc. No.:
Detail: DEMOLITION OF EXISTING NON -LOAD BEARING PARTITION WALLS AND MISCELLANEOUS INTERIOR FIXTURES FOR PREPARATION OF FUTURE TI.
SEPARATE PERMIT IS REQUIRED FOR FUTURE IMPROVEMENTS AND BUILDING OCCUPANCY. 2016 CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEMOLITION, INTERIOR
101-0000-42404
0
$40.25
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEMOLITION, INTERIOR PC
101-0000-42600
0
$107.87
Total Paid for DEMOLITION 2019: $148.12
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION ACCOUNT CITY AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
F3
r
AI try_; NIA —
Project Addre��ss: 7 ?Oro U G
APN #: 7.7}- 17, J - 0
Applicant Name: I ,' L [ +ek
Address: 7 9 jr�SuC u
City, ST, Zip: V
Telephone: 74 0 �-(' t
Email/V fC ",1c,0/1 \
� ., cam,
PLAN LOCATION:
Project Description:
Project Valuat�on $ 22)60
Architect/Engineer Name:&J1`[-\ Vvec,ot. ❑nstruction
Address: 0 /- A F Grading:
City, St, Zip
Telephone: C _ �J Bedrooms:
Email: :�f,u Cov-1
r
State Lic: City Bus Lic:
Property Owner's Name:
Address: 7 o At°
City, ST, Zip L,,, /)
Telephone: -�
Email:
Stories:
o/d,)vn
71�14 tl�
Occupancy:
# Units:
e New Commercial / Tenant Improvements:
n Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
U0-:
OFFICE USE ONLY
#
Submittal
ride i JCLJ
Pia
Required Received
1
Structural Calcs
Truss Calcs
i
Title 24 Calcs
CVWD Fire Flow Letter
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
about:blank
P.O. Box 1504 ^
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 7 77-7 012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a buildin permit has ben submitted in our listing yourself as the builder of the property
improvements specified at a i5 n �SL•,srnlQ yvl•!DA
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
Read and initial each statement below to signify you understand or verify this information.
_t.. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property, My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
A my pr9perry.
I understand building permits are not required to be signed by property owners unless, they are responsible for the
:tion and are not hiring a licensed Contractor to assume this responsibility.
I understand as,an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
�i4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
puts and contracts.
f understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
state and federal law.
U�1 understand if I am considered an "employer" raider statc and federal law, I must register with the state and federal
overnment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
mpensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
ttruct7.
I understand under California Contractors' State License Law, an Owncr-Builder who builds single-family residential
ures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
1 of 2 9/30/2019, 12:33 PM
about:blank
I understand as an Owner -Builder if 1 sell the property for which this permit is issued, I may be held liable for any
i • cial or ersonat injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
wo ip or materials.
_9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I -
-321-C (2752) or www.csib.ca.gov for more information about licensed contractors.
0. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
pa legal and financially r�ponsib)c for oposccl�, gvtistruCtiott activity at the following address:
`111. IUagre'Ce]that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
icable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediatcly of any additions., deletions, or Changes to any of the infortttation I
have provided on this torm. Licensed contractors are regulated by laws dexigned to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be rouble to assist you with any financial loss
you may sustain as a result of a complaint, Your only retnedy against unlicensed Contractors may be in civil court. It is also
important for you to understund that if an unlicensed Contractor or employee of that individual or firm is injurcd while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issu Nis form must be completed and signed by the property owner and returned to
the agency responsible for issuing t pe mil. te..! copy of the property owner's driver's license, form notarization, or
other verification acceptable to th agen is equi d e presented when the permilvj]'N'e-sl to verb the property
owner's signature.Signature of property owner Date: r
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACTON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work)A 6—V/ 110
Project Location or Address
Name of Authorized Agent:
Address of Authorized Agei
9
1,9 PAL�s
I declare under penalty of perjury that I am the pm wncr for the address listed about and I personally filled out the above
information and certify its accuracy, Note• �l o , of the wner's drivers license, form noturiza 'on, or other verification
acceptable to the agency is required to pre F.
d whet r; it is issued to verify the pro �rl_y`.ow er', signature.
Property Owner's Signature: Date: L ,N
2 of 2 9/30/2019, 12:33 PM
Aaron Xehey, DDS
79W Avi?. Mida La Fond t
Li Quinca. CA 922 53
949.:Fs 44h4
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INSPECTION REPORT
ASBESTOS
Conducted at
78080 Ave. La Fonda
La Quinta, CA
Prepared for
Steve Nieto
Prepared by
MASTERS ENVIRONMENTAL INC.
44719 ALEXANDRIA VALE
I N DI O, CA 92201
ASBESTOS CONSULTANT
# 03-3366 — GREGORY MASTERS
CALIFORNIA LEAD INSPECTOR/ASSESSOR #18638
MASTERS
ENYIRONMENTAI
September 25, 2019
CITY QUINTA
BUILDING DIVISION
REVIEWED FOR
CODE
COMPLIANCE
DATE 4 10
t0fk4Ujej . uflLY
RECEIVED
SEP 2 7 2019
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
DATE OF SURVEY:
LOCATION:
MAMRS
ENVIRONMEN7AL
ASBESTOS SURVEY
September 20, 2019
78080 Ave. La Fonda
La Quinta, CA
BY:
Gregory Masters
California Certified Asbestos Consultant # 03-3365
Masters Environmental Inc.
44719 Alexandria Vale
Indio, CA 92201
760-200-2900
Survey authorized by: Steve Nieto
Methods:
Selected materials in the structure that were suspected of containing asbestos
were sampled according to specified protocols. Samples were sent to a
NAVLAP accredited laboratory, Patriot Environmental Laboratory Services,
Fullerton, CA — Lab code 200358-0. They were analyzed by Polarized Light
Microscopy according to Bulk Analysis Protocol EPA 600/R-93/116. The
laboratory report is attached to this message for your inspection. Collection of
suspect ACM's followed the National Emissions Standards of Hazardous Air
Pollutants (NESHAPS) protocol for sample collection for a demolition/renovation
survey.
Bulk Sampling of Asbestos
Bulk samples of all homogeneous materials from identified areas containing
suspect JM were collected. A homogeneous material is defined as a
surfacing material, thermal system insulation (TSI), asbestos -containing
construction material or miscellaneous material that is uniform in use; color,
texture and age of construction. As materials were identified, bulk samples
were placed into individual sampling bags. Each sample was given a discreet
identification number and recorded on chain -of -custody forms.
Sampling Table:
Sample Location Description Friable Quantity Condition Asbestos
01 Reception Drywall
F TBD
Good
ND
02
F
Good
ND
03
F
Good
ND
04 Reception Taping
F TBD
Good
ND
05
F
Good
ND
06
V
V
F
Good
ND
In lieu of a diagram where samples were taken, the locations were marked on
each wall with a marker.
Results:
All ceiling materials that were suspected of containing asbestos were sampled
for analysis of asbestos content by Patriot Environmental Laboratory Services,
Fullerton, CA.
All samples tested negative for asbestos.
Masters Environmental can find no asbestos in any of these building mateerials.
Therefore REMOVAL of these ceiling materials can be done by UNLICENSED
workers.
p. 3
This survey was visual. Investigation requiring demolition or special testing
equipment was beyond the scope of this survey. It should be understood that
our findings reflect these limitations and that no warranty or guarantee is implied
or expressed.
We appreciate the opportunity to serve your asbestos needs, and look
forward to working with you again.
a Y W.
No OM365
74
�9{1PgpgAA
Masters Environmental Inc. 760-200-2900
44719 Alexandria Vale
Indio, CA 92201 mastcrsraisonic.nct
Certificate of Analysis
PLM Asbestos Identification
Masters Environmental
44719 Alexandria Vale
Indio, CA 92201
tel - 714-899-8900
free - 888443-0998
fax - 714-899-1188
Pattlallabsom
1041 S. Placentia Avenue, Fullerton, {A 9I831
Report Number:
Project Number:
Project Name:
Project Location:
784721
2018
PATRI&
Environmental Laboratory Services, Inc.
7080 Ave La Fonda
La Quinta, CA
Date Collected:
9/20/2019
Collected By:
Date Received:
9/23/2019
Claim Number:
Date Analyzed:
9/23/2019
PO Number:
Date Reported:
9/23/2019
Number of Samples: 6
Lab/Client ID/Layer Location
Material Description Color
Composition (%)
784721-001
Reception
Drywall White
88% Non-
LQ-01
Fibrous Material
10% Cellulose
2% Glass Fibers
Total Asbestos None Detected
784721-002
Reception
Drywall White
88% Non-
LQ-02
Fibrous Material
10% Cellulose
2% Glass Fibers
Total Asbestos
None Detected
784721-003
Reception
Drywall White
88% Non-
LQ03
Fibrous Material
10% Cellulose
RECEIVED
2% Glass Fibers
Total Asbestos
None Detected
SFP 2 7 ?D19
784721-004
Reception
Tapjlpg, Beige
100% Non-
LQ04
UU�r�Y �
OF INTA
Fibrous Material
DESIGN AND DEVELOPMENT DEPARTMENT
Total Asbestos
None Detected
784721-005
Reception
Taping Beige
100% Non-
LQ05
Fibrous Material
Total Asbestos
None Detected
Page 1 of 2
I"
Certificate of Analysis
PLM Asbestos Identification
Masters Environmental
44719 Alexandria Vale
Indio, CA 92201
Report Number:
Project Number:
Project Name:
Project Location:
td - 714-899-8900
free - 888-743-0990
fax - 714.899.1188
Patriollab.com
10415. Placentia Avenue, Fullerton, CA 92831
784721
2018
7080 Ave La Fonda
La Quinta, CA
Date Collected: 9/20/2019 Collected By:
Date Received: 9/23/2019 Claim Number:
Date Analyzed: 9/23/2019 PO Number:
Date Reported: 9/23/2019 Number of Samples: 6
Lab/Client ID/Layer Location Material Description Color Composition (%)
784721-006 Reception Taping Grey 100% Non-
LQ06 Fibrous Material
Total Asbestos None Detected
Lyn Terry - Analyst -
Ian Reyes - Approved By
Bulk sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US Federal Register 40 CFR 763, Subpart F, Appendix
A; EPA-600/R-93/116 (Method for Determination of Asbestos in Building Materials), and EPA-600/M4-82-020 (US EPA Interim Method for the
Determination of Asbestos in Bulk Insulation Samples).Samples were analyzed using Calibrated Visual Estimations (CVES); therefore, results may not be
reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and
reported as composite unless specifically requested by the customer to report analytical results for individual layers. This report applies only to the items
tested. Results are representative of the samples submitted and may not represent the entire material from which the samples were collected. "None
Detected" means that no asbestos was observed in the sample. "<I%" (less than one percent) means that asbestos was observed in the sample but the
concentration is below the quantifiable level of 1%. This report was issued by a NIST/NVLAP (lab Code 200358-0) and CADOHS- FLAP (Cert. No.
2540) accredited laboratory and may not be reproduced, except in full without the expressed written consent of Patriot Environmental Laboratory Services,
Inc. This report may not be used to claim product certification, approval or endorsement by NIST, NVLAP, ELAP or any government agency.
Page 2 of 2
!fir
CHAIN OF CUSTODY
Page of tip'Only,
MASTERS ENVIRONMENTAL
44719 ALEXANDRIA VALE Moot Name-
Maio, CA 92201 Location: 70'30 L c,
760-2110-2900 CA
Contact Phone: i�seserva �� qr� �y � D333GS
-- --- --- .• ...., rc Claim #:
Special Instructions:
Time
u
(fMarcounQ NIOSH 7400A. —
72HR
HR
CARE 435 Ej
Point Count 400 ❑ Note., -STLC. C L. WET requires a minimram of 52 hrs turnaround
Point Count 1000 ❑ -TCLP requires a minimum of22 hrs tumaround
Gravimetric Reductionri I -Cultma mgwrs 5-7 days fummund
by Flame AA Paint, Air Cassette, Duet Wipe, Waste Water, Soils, Misc. Solids EPA 3050Bl7420mad, NIOSH 7082mod
Waste Profile As neess"ry for dloposal Lj 'Note: Pleese pmvWe at least 200-5p0 grams (approx. ill -11b)
wed by Flame AA of sample fornecassary analyses.
-or individual tests by request-
1: TfLC Total Threshold by EPA 3050B mod 13
2: STLC/CAL WET Title 22 CCR Ch11 Article 5 App 2 [D
3: TCLP EPA 1311
SAMPLE # I LOCATION DESCRIPTION CiIANTRY CONDITfON
(Print) t .7 f "l Q S
ff)
By: (Print) (Sion)
MASTERS ENVIRONMENTAL
44719 ALEXANDRIA VALE
iNDiO, CA 92201
760-200-2900
Contact Phone:
760.399-676910EL
760.200-2901 (FAX)
Special Instructions:
CHAIN OF CUSTODY
Page of Lab use only
Report Number:
Project #: -z- U
Proiect Name:
Location:7 D ��I Q�c� �c� K�i..�^
Authorized By:
PO#: Claim #:
Time
Rosh Same Day) �� Othar ❑
Mtos 24HR (specify):
{/dbercouny NIOSH 7400A ❑ 48HR ❑
(bulk asbestos) EPA 600/R-93/116 Ga 7:2HR
CARE 435 ❑
Point Count 400 ❑ ftta : 47LCICAL WETrequims a minimum of 52 hrs tumaround
Point Count 1000 ® -TCLP requires a minimum of 22 hrs turnaround
Gravimetric, Reductionn-Cullums require 5-7 days turnaround
I by Flame AA Paint, Air Cassette, Dust Wipe, Waste Water, Sails, Misc. Solids EPA 3050BR420mnd, NIOSH 7082mod
I Waste Profile As necessary for disposal * Note. Please provide at least 200-500 grams (appwx.112 -11b)
wed by Flame AA of sample fornecessary analyses.
-or lndlvidual Nests by r+equest-
1: TTLC Total Threshold by EPA 3050B mod ❑
2: STLC/CAL WET Title 22 CCR Ch11 Article 5 App 2 ❑
3: TCLP EPA 1311 �]
SAMPLE 0 LOCATION •� DESCRIPTION I QUANTtTy CONDITION
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78-115 Calle Estado, Ste.105
La Quinta, CA 92253
P: (760) 564-4707 P (760) 564-4955
www.swconcepts.com
TENANT IMPROVEMENTS
DR. AARON KELSEY, D.D.S.
78-080 AVENIDA LA FONDA
LA QU I N TA, CA 92253
APN: 770-121-005
Date / Description
Number
Stephen R. Nieto Date
Date: 9/25/2019