FPYR2020-0005ADDITIONAL SITES
CHRONOLOGY
CONTACTS
NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL
APPLICANT Marco Montenegro 3196 N. Locust Ave.Rialto CA 92377 (909)355-8120 mmontenegro@pyrosp
ec.com
BILL TO Marco Montenegro 3196 N. Locust Ave.Rialto CA 92377 (909)355-8120 mmontenegro@pyrosp
ec.com
CONDITION
TYPE CONTACT DATE
ADDED
DATE
REQUIRED
DATE
SATISFIED STATUS REMARKS NOTES
READY TO ISSUE
CHECKLIST FIRE BUCKET 11/4/2020 11/5/2020 COMPLETE FEES DUE
CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES
E-MAIL AARON HICKSON 11/2/2020 11/2/2020 EMAIL TO APPLCANT FOR PAYMENT
CONDITIONS
Description: HIDEAWAY GOLF CLUB FIREWORKS DISPLAY 11/14/2020
Type: FIRE PYROTECHNICS (WEB)Subtype: Status: FINALED Applied: 10/30/2020 EPRS
Parcel No: 777070043 Site Address: 80440 HIDEAWAY CLUB CT LA QUINTA,CA 92553 Approved: 11/2/2020 AHI
Subdivision: TR 32453 Block: Lot: 30 Issued: 11/5/2020 ONLINE
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: 11/14/2020 KHET
Valuation: $0.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: Fireworks Display On November 14, 2020
Printed: Thursday, February 16, 2023 3:16:20 PM 1 of 3
Permit Details
City of La Quinta
PERMIT NUMBER
FPYR2020-0005
CONTACTS
NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL
CONTRACTOR Marco Montenegro 3196 N. Locust Ave.Rialto CA 92377 (909)355-8120 mmontenegro@pyrosp
ec.com
OWNER ND LA QUINTA PARTNERS 80440 Hideaway Club
Court
La Quinta CA 92253 (909)355-8120
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED
DATE
COMPLETED
DATE
RESULT REMARKS NOTES
FIRE FINAL**KHET 11/14/2020 11/14/2020 APPROVED FSO STANDBY
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED
DATE STATUS REMARKS NOTES
PARENT PROJECTS
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT #CHECK #METHOD PAID BY CLTD
BY
FIRE PYROTECHNICS 101-0000-42421 0 $322.00 $322.00 11/5/20 WEB6694 415050 CREDIT Marco Montenegro EPRS
FIRE PYROTECHNICS PC 101-0000-42420 0 $403.00 $403.00 11/5/20 WEB6694 415050 CREDIT Marco Montenegro EPRS
Total Paid for FIRE FEES: $725.00 $725.00
RECORDS
MANAGEMENT FEE 101-0000-42416 0 $10.00 $10.00 11/5/20 WEB6694 415050 CREDIT Marco Montenegro EPRS
Total Paid for RECORDS MANAGEMENT FEE: $10.00 $10.00
TECHNOLOGY
ENHANCEMENT FEE 502-0000-43611 0 $5.00 $5.00 11/5/20 WEB6694 415050 CREDIT Marco Montenegro EPRS
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 $5.00
TOTALS:$740.00 $740.00
Printed: Thursday, February 16, 2023 3:16:20 PM 2 of 3
Permit Details
City of La Quinta
PERMIT NUMBER
FPYR2020-0005
ATTACHMENTS
Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED
DOC 10/30/2020 EtrakitPublicReg Permit Application
Documents
Hideaway Golf Club
Permit App 11-14-
2020.pdf
1
DOC 11/4/2020 KOHL HETRICK
FPYR2020-0005 - PUB
DISPLAY PERMIT -
APPROVED.pdf
FPYR2020-0005 - PUB
DISPLAY PERMIT -
APPROVED.pdf
1
DOC 11/16/2020 KOHL HETRICK FPYR2020-0005 - FW
CHECKLIST.pdf
FPYR2020-0005 - FW
CHECKLIST.pdf 1
BOND INFORMATION
1ST PERMIT TECH (1
DAY)
AARON
HICKSON 10/30/2020 11/2/2020 11/4/2020 COMPLETE
1ST FIRE - ETRAKIT
(1 WK)
KOHL
HETRICK 10/30/2020 11/6/2020 11/4/2020 APPROVED SEE ATTACHMENTS
Printed: Thursday, February 16, 2023 3:16:20 PM 3 of 3
Permit Details
City of La Quinta
PERMIT NUMBER
FPYR2020-0005
Draft 5/1/2019
RIVERSIDE COUNTY FIRE DEPARTMENT
FIREWORKS INSPECTION CHECKLIST
Per State Fire Marshal Laws and Regulations for Transportation,
Use and Storage of Fireworks in California
Title 19 California Code of Regulations, Chapter 6 State Fireworks Regulations
Location -
Address
Date
Time
Inspector Name
Permit#
Operator to initial items with area for initial once task has been completed.
PAPERWORK
Contact Pyro Operator before date of display to verify:
o Arrival/Inspection Time
o Set Safety Briefing/Staff Present
o Determine Security or Site Contact (Cell Phone)
o Discuss Weather Forecast
o Discuss Possible Wind Triggers
o Discuss Possible Test Shot (If Applicable)
o Discuss Inspections of Mortars (Preloaded If Applicable and Requested by FS0)
o Discuss for Approval to Fire Show
Verify Approved Permit – attached [HSC, §12640]
Approved Site Plan - attached
Security Plan – attached
Verify the local weather on the date of display
PERSONNEL
Verify and record pyrotechnic operator identification – Class & Number _____________________[Title 19, §997]
Verify pyrotechnic operator possesses valid driver license of proper type - DL# _____________________
Verify and record pyrotechnic information on the identity and age of all assistants on application
Safety Briefing & Staff Sign-in sheet (see last page of this form)
SECURITY [Title 19, §992.6, §997]
Verify site security of storage area, discharge area, display area and fallout area as indicated on approved plan.
Verify arrangement for traffic and crowd control before, during and after display
FIRE PROTECTION AND SAFETY EQUIPMENT
Fire extinguishers (proper type and size) are available and accessible [Title 19, §1004(a)]
Shovel and container available for retrieving duds [Title 19, §1004(a)]
Verify with Pyrotechnic Operator appropriate protection gear, minimum a hard hat, eye protection, long sleeve
shirt, gloves, long pants, and shoes or boots are available for persons discharging fireworks manually [Title 19,
§1004(b)]
MORTAR INSPECTION
Draft 5/1/2019
Compare list of mortar racks, etc. with actual equipment
Mortars are approved for use with type of shells to be fired [Title 19, §999]
Mortars are inspected prior to use for defects, debris, etc. [Title 19, §999]
Base plugs are securely attached to bottom of mortars [Title 19, §999]
Mortars are proper length for size of shells to be fired [Title 19, §999]
RACK INSPECTION [Title 19, §1002(a) See Figure A]
Racks have no more than 10 tubes per unit
Base and ends of racks are nominal 2 inches thick lumber
Racks have blocks (nominal 2”X4”) separating individual mortars
Racks for mortars 3” or larger have side braces of 1” X 6” nominal lumber or ½”X4” p lywood
All racks with more than 5 tubes have diagonal side braces
Racks are secured to prevent falling over
TROUGH INSPECTION [Title 19, §1002(b) See Figure B]
No trough is more than 8 feet in length
Bottom surface of trough is provided with ¾” plywood if not sufficiently stable to support firing of the mortar
Troughs are constructed of minimum 3/4 “plywood and secured with 3/8” through-bolt, rods or angle iron “U”
brackets at each end and center.
Sand or soft dirt, free of racks or debris, is on-hand to fill trough
Minimum separation distance between mortar is provided
Trough is of adequate height to securely bury mortar 2/3 of their minimum legal length
DRUM INSPECTION [Title 19, §1002(c) See Figure C]
Drums are in good condition
Sand or soft dirt, free of rocks or debris, is on-hand to fill drum
Drums are of adequate size to provide minimum separation distance between mortars
Drums are of adequate height to securely bury mortars 2/3 of their minimum legal length
TRENCHES, ETC TO BURY MORTARS IN GROUND [Title 19, §1001]
Planking below mortars is provided for unstable or unleveled surfaces
Trenches are of sufficient depth to securely bury mortars 2/3 of their minimum legal length
Minimum separation distance between mortars is provided
Sand or soft dirt, free of rocks or debris, is on-hand to fill trench
AERIAL SHELL INSPECTION [Title 19, §997, §1003]
Number of shells matches quantity listed on permit – ask for Bill of Transportation
Shells properly labeled for use in California
___ Operator examines shells for damage [req. operator initials once completed]
___ Operator verify size shell for proper fit in mortars [req. operator initials once completed]
GROUND DEVICES INSPECTION [Title 19, §1003(e)]
Ground devices match items listed on permit
Location and spacing of devices is per approved permit
Equipment available to secure & brace ground devices
Draft 5/1/2019
DISCHARGE FALLOUT AREA INSEPECTION
Location is as per approved permit
Minimum required fallout area is provided
Arrangement provided to secure fall out area when shell loading begins
ELECTRICALLY FIRED DISPLAY INSPECTION [Title 19, §992.1 – §992.4]
Power source is restricted to batteries or individually isolated generators.
Firing system Is protected against accidental firing
Method for circuit testing is available
Firing panel is located with continuously unobstructed full view of operator
MANUALLY FIRED DISPLAY INSPECTION [Title 19, §1003(a)(3)]
o Safety caps protecting fuses remain in place until immediately before firing
RELOADING MORTARS DISPLAY INSPECTION
o No HDPE mortars shall not be reloaded for a period of at least one (1) hour after use [Title 19, §999(d)]
o Ready box(es) are located more than 25 feet upwind of the closest mortar
o Ready box(es) are divided into separate compartments for each shell size
o Ready box(es) are covered with a flame-resistive canvas cover
OPERATION OF DISPLAY
Discharge, display and fallout area are cleared of all unauthorized personnel prior to loading shells [Title 19,
§997]
No one under the age of 18 is in discharge, display and fallout area once loading of shells begins [Title 19, §997]
Mortar are aimed to be within the fallout area and away from spectators [Title 19, §997]
On electrically fired shows, discharge area is cleared of all people prior to electrical circuit testing [Title 19,
§992.2 – 992.4]
All devices are ONLY fired upon or signal from licensed operator [Title 19, §1003(d)]
___ During discharge of shells, operator observes activities to ensure wind and trajectory are adequate and makes
adjustment if necessary [req. operator initials once completed]
___ If a misfire occurs, pyrotechnic shall handle in an appropriate manner [Title 19, §997, §1003(g)] [req. operator
initials once completed]
POST DISPLAY ACTIVITES
NO ONE permitted to enter display, discharge or fall out area until pyrotechnic operator has determined the
area to be safe and secure [Title 19, §1003(d)(3)]
Entire firing area is inspected by pyrotechnic operator and crew to locate any unexploded shells. Shells located
are properly disposed of [Title 19, §1003(f)(2)]
Unfired shells: re-loaded and re-fire; removed and returned directly to supplier or stored in manner approved
[Title 19, §1003(h)]
Inspect surrounding area to verify that no fire(s) were started from debris
Draft 5/1/2019
NOTIFICATION [Title 19, §1005]
➢ PYROTECHNIC OPERATOR will provide verbal report to State Fire Marshal for any incident involving injury or
death to public or crew, or for any fire requiring emergency action or response resulting from the firing of the
show
➢ PYROTECHNIC OPERATOR will provide a copy of all reports sent to the State Fire Marshal to Riverside County
Fire Department – Office of the County Fire Marshal
Draft 5/1/2019
Return this completed form to the office and place in file with original application and transportation permit.
SAFETY BRIEFING AGENDA
1. Introduction of All Present
2. Review Required Safety Equipment/PPE
3. Communication Plan – Radio/Cell Phones
4. Plan for Securing Fallout Area
5. Review/Verify Weather Conditions
6. Emergency Response Procedure
7. Review Process for Approval to Fire Show
Pyrotechnician Assistants Sign-In
Print Name Signature ID/Driver’s License Pyro License
Signature