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04-4855 (DEMO)A ,:&4 4 4 a" BUILDING & SAFETY DEPARTMENT. P.O. Box 1504 (760)'.777-7012 78-495 CAULS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760),777-7.153 BUILDING PERMIT Application Number . . . . . Property Address . . . . APN: Application description Property Zoning . . . . . . . Application valuation . . . . Owner ------------------------ ND LA QUINTA PARTNERS 375 N FRONT ST STE 200 COLUMBUS OH 43215 04-00'0048-55, 52500 HIDEAWAY CLUB 772 -410 -033 - DEMO - COMML/OTHER LOW DENSITY RESIDEN 200000 Contractor Dat "--&/-27/04 SEP 2 g 1004 LINTHICUM CONSTRUCTION, INC. 17700 N. PACESETTER WAY SCOTTSDALE AZ 85255 (480) 515-1700 WCC: EATON & ASSOC WC: MXI98383545 03/01/05 CSLB: 764528 03/31/06 CCC: A -B ------ Structure Information DEMO ---------------------------------------------------------------------------- Permit DEMO PERMIT Additional desc . . Permit Fee 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 200000 Qty Unit Charge Per Extension BASE , FEE 45.00 ----------------------------------=----,------------------------------------- Special Notes and Comments DEMO @ SECOND FLOOR AND STAIRWAYS Fee summary Charged .Paid- Credited Due ------------------------------------------=-------------- Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total .00 .00 .00 .00 Grand Total 45.00 ..00 .00 45.00 P.O. BOX 1504 • ��IIG Y'1 � 78-495 CALLS TAMPICO VOICE (760) 777-7012 '� FAX (760)w777-7011 LA Qu►NTA, CALIFORNIA 92253 .INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT i Application Number.. Applicant: Applicant's Mailing Address: Architect or Engineer: : Architect or Engineer' Ad r s: i Date: - - I Lic. No.: BUILDING PERMIT DECLARATIONS. ->. LICENSED CONTRACTOR'S DECLARATION w 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 fo a and,sffect. j- -- — _ License Class, -76-f.4 % License No. Date /- ��=—t�`�'ContractorA4�A Cys,.� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following re,3son (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 Contractors' 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 ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec: BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. —1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issuecj<;[\Ay orkers' compensation insurance caner a d of 9 e re:- 3 r- Carrier/,l�On/ �Tjj fS�OG Policy Number �yjl� ���� 3 • c$!ls I certify that; in the performance of the work for which th t ss 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 ' hould become subj to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those posins,'Date — —© Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL -AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND It 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. 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. C.). Lender's Name Lender's Address 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 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, indemnity 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 the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter nth above -menti property for inspection purposes. Date L �2TJ _Q T Signature (Applicant or Agent): L •, M.xS ?O rW� c33 City of La Quinta Building at Safety Division . P.O. Box 1 SO4, 78-495 Cape Tampico 6.4 t Quinta, CA 922S3 - (760) 777.7012 gr PF-PLt-uilding Permit Application and Tracking Sheet Owrcr's Name: �► �►P 7? Z- 4&L OV Addr=:. Tic. 29 !(9 city. ST. Zip: FTcicphonc: is l ject Description:. 0 PA' L.ic. #: IN NZ C PTOjW type (circle one): New Add'n : Alta . Rcpair' Demo Permit If 1f -7 Project Address: A. P. Number: Leeal Description: Z'7- A/ X Contractor. x Addr=: X City, ST, Zip: L- Telephone: _ X PERMIT FEES- State Lic. I arch., Engr., Desip,a: Item Address: 779-S City, ST.:Zip: Telephone: State Lae. *: Reviewed, ready for corrections X Name of Contact Persoa: . X Caned Contact Person Telephone d of Contact person: M Submittal Ro Plans D»cked up. a. Plan Sets Structural Gla, Plans resubmitted techanieal Truss Cala. . ' Energy Cala. issue etrical Hood plain plan Called Contact Person Plumbing Grading plan Pians picked up S.[►I.1. Subcootactor List Plans resubmitted Grading Grant Deed . Review, ready for corrections/asue Developer Impact Fee N.O.A. Approval Called Contact Person IN HOUSE;- A.1.P.P.. •' Planning Approval Date of permit issue Pub. Wks. Appr N. School Fees City of La Quinta Building at Safety Division . P.O. Box 1 SO4, 78-495 Cape Tampico 6.4 t Quinta, CA 922S3 - (760) 777.7012 gr PF-PLt-uilding Permit Application and Tracking Sheet Owrcr's Name: �► �►P 7? Z- 4&L OV Addr=:. Tic. 29 !(9 city. ST. Zip: FTcicphonc: is l ject Description:. 0 PA' L.ic. #: IN NZ �n struction Type: Occupancy: PTOjW type (circle one): New Add'n : Alta . Rcpair' Demo v dZ Sq. FL: d Stories: d Units: -7 .S- -7-7a 1 Value of Project: t 40-0 APPLICANT: DO NOT WRITE! BELOW THIS UNE Recd TRACKING PERMIT FEES- Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Caned Contact Person Plao Check Balauct Plans D»cked up. Construction Plans resubmitted techanieal 2-� Review. ready for eorrtctio issue etrical Called Contact Person Plumbing Pians picked up S.[►I.1. Plans resubmitted Grading Review, ready for corrections/asue Developer Impact Fee Called Contact Person A.1.P.P.. •' Date of permit issue N. Total Permit Fees S wo SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL: MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION # COMPLETED BYU4� 4 IV COMPAt1�l (2 WIC) d n) i p � T PHONE 160 l .7 �,S9 q i ri�� r DATE _ CHECK # FEE $ PROJECT # (-ie J� . NOTIFICATION TYPE ORIGINAL REVISION DATES REVISION OTHER (highlight) CANCELLATION PROJECT TYPE 1, DEMOLITION ORDERED DEMOLITION RENOVATION (removal) EMERGENCY REMOVAL PLANNED RENO (annual) SITE INFORMATION _ 1 , SITE NAME de, SITE ADDRESS,. l��� — CROSS STREET i V © e, CITY Ih- ( uSTATE ZIP�� COUNTY ��� r S I e DESCRIBE WORK AND LOCATION BUILDING SIZE(SQ FT) 5)1 6 (� NUMBER OF FLOORS BUILDING AGE (YEARS) �' NUMBER OF DWELLING UNITS BLDG PRIOR 1 PRESENT USE OMMERCIAL HOSPITAL INDUSTRIAL Other OFFICE PUBLIC BLDG. HOUSE SCHOOL SHIP UNIVICOLLEGE - 11 h A fa"2L> i n as 'u ;J�y-Tv'a Zti S, SITE OWNER �. ADDRESS CITY J � - STATE CAZIP C� � 3 CONTACT Reo 6e—Tl- PHONE REQUIRED BUILDING INFORMATION ASBESTOS YES . NO PRESENT? ASBESTOSYES NO SURVEY? * ASBESTOS YESBUILDING REMOVED? TO BE YES NO DEMOLISHED? PROJECT DATES START 02 z END WORK SHIFT day swing, night) �� ASBESTOS AMOUNT TO BE REMOVED (in square feet) FRIABLE CLASS i CLASS 11 TOTAL AMOUNT. (add row) ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS AMOUNT OF EACH TYPE OF ASBESTOS (in square feet) ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER (describe) CONTRACTOR INFORMATION CSLB LICENSE #OSHA REG # AQMD ID # 1� G & NAMEV►fl 17 C 1'K ADDRESS l� ' U CITY �.� y STAT ZIP t SITE SUPVR jo e co 12G �' PHONE WASTE TRANSPORTER #1 LANDFILL /41 A) ADDRESS ADDRESS ati-3 Q 6 I . CITY STATE ZIP CITYSTATE I-i-3PA-L-11 s ZIP as 70 * Asbestos surveys are required prior to Demolition and Renovation Forms, instructions, and the Rule 1403 can be obtained from AQMD web site http://Www.agmd.gov Page 1 of 2 Form REV 20020607 N. l . SCAQMD NOTIFICATION OF DEMOLITION OR .ASBESTOS REMOVAL MAIL ORIGINAL TO SCAQMD, ASBESTOS NOTIFICATIONS `FILE # 55641, LOS ANGELES CA 90074-5641 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 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, P.M, PCM, TEM, Assumed as Asbestos-PACM, Describe Other: FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE # AUTHORIZING PERSON: TITLE DATE OF ORDER: DATE ORDERED TO BEGIN: FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND.PHONE NUMBER OF THE.PERSON DECLARING/AUTHORIZING THE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUCDEN, UNEXPECTED EVENT: EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE 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. TRAINING CERTIFICA ION: I certify that an ilidividual 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 owner/operator Tittle of owner/operator Date INFORMATION CERTIFICATION: I..certify that the above information is correct and I have enclose . ny required attachments. e m un l d N t N t.- C.•a ro t_`� h.� cva,L i ' t �)Y.t Company Name Print name of owner/operator Signature of owner/operator Tittle of owner/operator Date 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 $ 28.66 SPECIAL HANDLING FEE $ 27.35 FROM 1,001 TO 5,000 SQUARE FEET $37.61 REVISION OF NOTIFICATION $11.59 FROM 5,001 TO 10,000 SQUARE FEET t- 2� 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 ASBESTOS REMOVAL AT owner- $ 28.66 occupied, single -unit dwelling ATTENTION. Keep a copy of. your notification. 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.90074-5641 Page 2 of 2 TELEPHONE: (909) 396-2336 FAX: (909) 396.3342 Form REV 06072002 FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP://WWW.AQMD.GOV SCAQMD is located at 21865 E. Copley Drive, Diamond Bar, CA 91765.4182 (909) 396-2000 HIDEAWAY April 30, 2004 Greg Butler CITY OF LA QUINTA P.O. Box 1504 La Quinta, CA 92253 RE: Hideaway/PM-10 Dust Control Plan/Linthicum Construction Dear Mr. Butler: The Hideaway has requested that Linthicum Constructors, Inc. obtain a permit from the city to demolish part of the main clubhouse structure in preparation for re -initializing construction. The Hideaway has provided a copy of the Dust Control Plan approved by Mr. Jonasson dated July 31, 2003 to Linthicum. They have been made aware of the requirements of the Plan, including Paragraph 3 of the Application Consent. Sincerely, ND LA QU PARTNERS, LLC o n P. Ga lin VP - Development PO BOX 1540 - 81-100 AVENUE 53 - LA QUINTA . CALIFORNIA . 92253 PH: 760.391.5072 - FX: 760.398.5788 - www.hideawaygolfclub.com DISCOVERY LAND COMPANY HIDEAWAY April 30, 2004 Greg Butler CITY OF LA QUINTA P.O. Box 1504 La Quinta, CA 92253 RE: Hideaway/Minor Demolition of Main Clubhouse Dear Mr. Butler: The Hideaway team has been working diligently over the last year on plans for the permanent golf clubhouse. The existing foundation and first floor has been largely integrated into the redesigned building to take advantage of economies in place. However, there is some rework necessary to implement the new design. We would like to begin construction on the clubhouse again as soon as plans are approved by the city, so in preparation for this we are requesting a demolition permit. The clubhouse parcel is Lot W of Tract 29894-2. Title to the property and improvements is vested in ND La Quinta Partners, LLC per the attached grant deed. Also, ND La Quinta Partners is currently the Declarant of the Hideaway Association and retains control of the board of directors at this time. I serve as the President of the Association. Therefore, on behalf of the Association I support the request for a permit to perform demolition in accordance with plans approved by the city. If there are any questions, please call me. Sincerely, ND LA QUINTA PARTNERS, LLC Jo n . amlin VP — DevelODMdHt Enclosures; PO BOX 1540 • 81-100 AVENUE 53 . LA QUINTA . CALIFORNIA . 92253 PH: 760.391.5072 . FX: 760.398.5788 • www.hideawaygolfclub.com DISCOVERY LAND COMPANY