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HomeMy WebLinkAboutFPYR2019-0003Description: MADISON CLUB / PYRO / MARCH 20 / 8:30PM Type: FIRE PYROTECHNICS Subtype: Status: APPROVED Applied: 3/19/2019 AMA Approved: 3/20/2019 EGO Parcel No: 767871006 Site Address: 53035 MERIWETHER WY LA QUINTA,CA 92253 Subdivision: TR 34969 Block: Lot: 1 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: ADDITIONAL NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT PYRO SPECTACULARS, INC PO BOX 23297 329 RIALTO CA 92377 BILL TO THE MADISON CLUB - CARRIE CLARK 53035 MERIWETHER WAY LA QUINTA CA 92253 CCLARK@MADISONCL UBCA.COM OWNER EAST OF MADISON P O BOX 1482 LA QUINTA I CA 92253 Printed: Tuesday, February 14, 2023 9:54:16 AM 1 of 3 WsYsrEMS ■ CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY FIRE PYROTECHNICS PC 101-0000-42420 0 $400.00 $400.00 3/20/19 R46732 079505 CHECK PYRO SPEINC CTACULARS, AMA Total Paid for FIRE FEES: $720.00 $720.00 RECORDS 101-0000-42416 0 $10.00 $10.00 3/20/19 R46732 079505 CHECK PYRO SPECTACULARS, AMA MANAGEMENT FEE INC Total Paid for RECORDS MANAGEMENT FEE: $10.00 $10.00 TECHNOLOGY 502-0000-43611 0 $5.00 $5.00 3/20/19 R46732 079505 CHECK PYRO SPECTACULARS, AMA ENHANCEMENT FEE INC Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 $5.00 TOTALS:00 $735.00 INSPECTIONS RETURNED REVIEWS STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE 1ST PERMIT TECH (1 ARMANDO 3/19/2019 3/20/2019 3/19/2019 COMPLETE DAY) MAGALLON THIS IS A DIGITAL REVIEW. (SEE ATTACHED) FIRE SAFETY OFFICER STANDBY AND INSPECTION 1ST FIRE (2 WK) EDGAR 3/19/2019 4/2/2019 3/20/2019 APPROVED- GONZALEZ CONDITIONS TO TAKE PLACE BEFORE AND DURING FIRE WORKS SHOOT. Printed: Tuesday, February 14, 2023 9:54:16 AM 2 of 3 WsYsrEMS Printed: Tuesday, February 14, 2023 9:54:16 AM 3 of 3 WsYsrEMS March 18, 2019 City of La Quinta Fire Prevention Bureau Attn: Edgar Gonzlaez 78495 Calle Tampico La Quinta, CA 92253 edga r. go nzalez 0fi re. ca.gov Dear Fire Prevention, Please find enclosed our Application for Permit to conduct a fireworks display for The Madison Club on March 20, 2oi9. The Certificate of Insurance covering the display, our check in the amount of $735.00 to cover the permit/standby fees and a diagram of the firing site are also enclosed. �? If additional standby firemen fees apply, please bill them directly to: The Madison Club Attn: Carrie Clark 53-035 Meriwether Way La Quinta, CA 92253 If you have any questions or need further information please call our office at (909) 355-812o ext 231. We would appreciate a copy of the permit after it has been approved. Thank you. Sincerely, Pyrro Spectaculars, Inc. Maria Barajas Customer Service Represe tive mbarjas@pyrospec.com /mb cc: Armando Magallon amagallon@lacuintaca.go� Enclosures PYRO SPECTACULARS, INC. P.O. Box 2329 - Rialto, CA 92377 • Phone: (909) 355-8120 or (888) 477-PYRO • Fax: (909) 355-9813 taQaiatav CALIFORNIA DESIGN & DEVELOPMENT DEPARTMENT 78-495 Calle Tampico La Quinta, California 92253 (760) 777-7125 FAX (760) 777-7011 FIRE REVIEW APPLICATION 0 NEW 0 TENANT IMPROVEMENT PROJECT INFORMATION Project Name: The Madison Club Site Address: 53-035 Meriwether Way City & Zip La Quinta, 92253 PERMIT NO. `Please Print) Sign: - • t. Print: Maria Barajas • Pursuant to a Cooperative Agreement to Provide Fire Services, the Riverside County Fire Department serves as the City's fire department, and the County designee serves as the City's fire chief. Applicant recognizes this contracted arrangement and shall comply with County Fire Dr, porlmont directions. APPLICANT/CON1 Applicant Name: Pyro Spectaculars, Inc. Contractor #: The Madison Club Contact Person: Maria Barajas Contact Person. Carrie Clark Mailing Address: P.O. BOX 2329 Mailing Address: 53-035 Meriwether Way City & Zip: Rialto, 92377 City & Zip: La Quinta, 92253 Phone Number: (909) 355-8120 ext. 231 Fax: Phone Number: (760) 391 -4500 Fax: Email: mbarajas@pyrospec.com Email:CClark@madisonclubca.com A. APPLICATION TYPE , -FIRE SPRINKLEIR SYSTEM SUPRESSION SYSTEM ❑ NEW COMMERCIALIINDUSTRIAL ._ © HOOD & DUCT $415 * 0-35,000 SQ FT $655 ❑ SPRAY BOOTH i $816 ❑ 35,001-75,000 SQ FT $775 ❑ CELL SITE $816 $816 l7 75,001-120,000 SQ FT $976 ❑ OTHER SUPRESSION SYSTEM ❑ 120,001 AND UP $1216 MISC ❑ TI COMMERCIAL/INDUSTRIAL $415 ❑ HAZMAT $335 O RESIDENTIAL- 1S7 DWELLING UNIT $415 ❑ HIGH PILE RACK STORAGE $335 ❑ RESIDENTIAL - (EA) ADDITIONAL x $175 ❑ NEW COMMERCIAL - U/G WATER $495 ❑ MULTI -FAMILY (3 OR MORE) $575 ❑ FIRE FLOW REPORT $335 FIRE ALARM SYSTEM ❑ TECHNICAL REPORT RESEARCH HOURLY @ $160/HR ❑ COMMERCIAL - SPRINKLER MONITORING $415 ❑ SPECIAL INSPECTION $165 ❑ COMMERCIAL - FIRE ALARM SYSTEM $1056 ❑ FIRE PUMPS E3 STANDPIPE SYSTEMS $655 $575 FIRE ALARM SYSTEM ❑ COMMERCIAL - SPRINKLER MONITORING $415 ❑ WATER TANKS $415 ❑ COMMERCIAL - FIRE ALARM SYSTEM $1056 ❑ MASTER PLAN HOURLY @ $160/HR STORAGE TANKS ❑ MASTER PLAN REVISION HOURLY @ $160/HR ❑ DISPENSERS ONLY HOURLY @ $160/HR ❑ ABOVEGROUND HOURLY @ $160/HR Each application type includes a Technology Enhancement FeeSS & Records Management Fee $10 REVISED 9/27/2018 RIVERSIDE COUNTY FIRE DEPARTMENT FIRE PREVENTION PUBLIC FIREWORKS DISPLAY PERMIT APPLICATION PLEASE PRINT OR TYPE, INCOMPLETE APPLICATIONS WILL BE RETURNED. Choose: ❑ FIREWORKS PROGRAM ❑ FIRE PROTECTION PLANNING — EAST either: PO BOX 2047 77933 LAS MONTANAS RD. STE #201 PERRIS CA 92572-2047 PALM DESERT CA 92211-4131 APPLICATIONS SHALL BE SUBMITTED 14 DAYS PRIOR TO THE DISPLAY. Itwe hereby make application for a permit to conduct a public fireworks display as defined by the California State Health and Safety Code, and agree to comply in every particular with the law pertaining thereto as set forth in Part 2 of division II of the Health and Safety Code, and the rules and Regulations adopted by the State Fire Marshal. SPONSORING ORGANIZATION INFORMATION 1. Sponsoring Organization Name: The Madison Club Sponsoring Organization Representative: Carrie Clark 2. Address: 53-035 Meriwether Way, La Quinta, CA 92253 PUBLIC DISPLAY INFORMATION 3. Company Name/Address: Pyro Spectaculars, Inc. P.O. Box 2329, Rialto, CA 92376 Phone Number/Fax: 909-355-8120 Fax: 909-355-9813 4. Public Display License No.: GPD-0672 EVENT INFORMATION 5. Date of Display: March 20, 2019 6. Times: From: 8:30 PM To: 8:35 P M 7. Exact location of display: (see note 1) The Madison Club, Golf Course, 53-035 Meriwether Way, La Quinta, CA PYROTECHNIC OPERATOR INFORMATION 8. Pyrotechnic Operator supervising discharge of fireworks: Name: Jeff Martin 9. State License Number: 1195-02 Phone Number 909) 831-9985 10. Pyrotechnic Operator Assistants: Name: TBD 11. Name: TBD 12. Name: TBD 13. Name: TBD PRODUCT INFORMATION 14. Class of fireworks to be displayed: (see Note 2) 1.3G 15. Number of items (specify if single or multiple break) 15-3" Single Break Aerial Shells 16. Number of set pieces 0 17. Other items to be displayed (describe) 1-.75", 5-1.2", 2-2.5", Multi -Shot Devices 18. Name of wholesaler supplying all items used in display: Pyro Spectaculars, Inc 19. Wholesaler's state license number: W-0144 20. Name of Importer/Exporter supplying all items used in display: Pyro Spectaculars, Inc 21. Importer/Exporter's state license number: I/E-0153 he MadisoU Club 3-20-19 STORAGE INFORMATION 22. Location of fireworks storage PRIOR to display: 23. City and State: Street address: 3196 North Locust Avenue Rialto, CA 24. Departure date and time from storage location: 25. Route(s) used: Between 8 am & 6 pm date of display Safest most direct route 26. Location of fireworks storage DURING display: 27. City: Street address: See #7 Above La Quinta, CA 28. Describe provisions for return of unused/unfired product after 29. Location of storage of unused/unfired product if applicable display Returned in DOT approved cartons 3196 North Locust Avenue, Rialto, CA PUBLIC FIREWORKS DISPLAY PERMIT APPLICATION INSURANCE INFORMATION 30. Policy number of Employees Compensation Insurance (see Note 31. Policy number of Public Liability Insurance attach copy to Permit 0803749-18 1 (attach copy) CA000002771-33 In affirming my signature hereon, I realize that as the permittee, I am responsible for compliance with all provisions under which this permit may be granted, including the filing of reports required by Title 19, California Code of Regulations. I further affirm that I am an authorized wmil for the public flkpla. license listed hereon, as required by California Health and Safes Code, Section 12583. APPLICANT'S SIGNATURE _ Amy `� I March 18. 2019 Use space below for additional information (attach additi tv, eet(s) if necessary) NOTES I. Provide dimensioned plot plan diagramming the area, which the display is to be held. Plot plan shall include the placement of devices, location from where operator will discharge fireworks, location of any performers, location of the audience and the lines behind which the audience will be restrained. Additionally, show the location of highways, overhead obstructions, nearby trees, telephone lines and other lines of communication. When necessary, a sectional drawing shall be provided. 2. Include complete description of all fireworks to be displayed, specifying if single or multiple break shells. If set pieces are used, they shall be described in detail. Provide complete description of additional items to be displayed. 3. Insurance Required: An original Certificate of Insurance must be filed with this application, which complies with the following requirements (refer to Section 993, Title 19 and 12611, California Health & Safety Code): • The deductible (if any) may not exceed fifteen thousand dollars ($15,000.00). Limits of bodily injury and property damage may be not less than one million dollars ($1,000,000.00) combined single limits for each occurrence annually. • A statement must be included that the insurer will not cancel the insured's coverage without 15 days prior written notice to the State Fire Marshal and the Riverside County Fire Department. • The County of Riverside / Fire Department shall not be responsible for any premiums or assessments involving the policy. • The licensed pyrotechnic operator supervising/discharging the display and the State of California, its officers, agents, employees, and servants must be included as additional insured's OFFICE USE ONLY BELOW LINE Permit for Transportation of Fireworks for Display to be held: is Hereby: (DATE) Granted Denied Name: Title: Signature: Date: Permit for Public Display of Fireworks to be held: is Hereby: (PATE) Granted Denied Name: Title: Signature: Date: CONDITIONS and/or RESTRICTIONS *A UTHORITY HA VING JURISDICTION RESERVES A UTHORITY TO MAKE CHANGES TO THIS PERMIT UPON ANY CONDITION(S) Application for Permit -- Public Fireworks Display We, Pyro Spectaculars , hereby make application for permit to conduct a display of fireworks by the California State Health and Safety Code, and agree to comply in every particular with the law pertaining thereto as set forth in Part 2 of Division 11, Division 12, and other applicable sections of the Health Safety Code, and the Rules and Regulations adopted by the State Fire Marshal. Sponsoring Organization: Madison Club, The Address: 53-035 Meriwether Way, La Quinta, ca 92253- Person in charge of display: Jeff Martin Lic#: 1195-02 (909) 831-9985 Location of display: The Madison Club - Golf Course 53-035 Meriwether Way La Quinta, ca Ave 52 Dates of display: Wednesday, March 20, 2019 Time of display: Approximately 8:30 PM Pyrotechnic Operator in charge (license number): Jeff Martin Lic#: 1195-02 (909) 831-9985 Type of Display: 0 Aerial ❑ Low Level ❑ Set Pieces ❑ Devices ❑ Manual 0 Electric Description of Product to be Fired Low Level 11 (Approximately 100 -150 feet) 6 - Multi -Shot Device(s) High Level Aerial (Approximately 200 - 1,000 feet) 15 - 3" Peanut Aerial Shell(s) 2 - 2.5" Multi -Shot Device(s) Description of storage facilities and location on grounds: Delivered to site on date of display Insurance/License Workers Compensation: State Compensation Insurance Fund Date: 10/14/2018 - 10/14/2019 Public Liability Insurance: $ 5,000,000.00 (Certificate attached) General Public Display License No. 672 issued by State Fire Marshal Wholesale License No. W-144 issued by State Fire Marshal Pyyro Spectaculars Applicant's Signature Applicant's Address PO Box 2329, Rialto, C 92 7 AL FOR PERMIT PERMIT FOR PUBLIC DISPLAY OF FIREWORKS to be held (date) is hereby Granted Denied Signature Title DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE NO. 900112 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO. CA000002771-33 NAMED INSURED Pyro Spectaculars, Inc. Pyro Spectaculars by Souza Pyro Events, Inc. Pyro Spectacular Industries, Inc. Pyro Spectaculars Productions, Inc. North American Fireworks Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fireworks Rialto, California 92377 POLICY TERM January 13, 2019 to January 13, 2020; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $1,000,000 each occurrence, $2,000,000 general aggregate, $2,000,000 products/completed operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tenant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jurisdiction, issuing licenses/permits for insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insured(s) for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS PROPERTY OWNERS, LICENSORS The Madison Club 53-035 Meriwether Way La Quinta, CA 92253 ADDITIONAL INSURED(S): The Madison Club, City of La Quinta, County of Riverside, Riverside County Fire Department, the State of California and their officers, agents and employees when acting in their official capacity as such. It is agreed and understood that the State of California shall not be held liable for any premiums or assessments on this policy. DISPLAY LOCATION The Madison Club La Quinta, CA DISPLAY DATE(S) March 20, 2019 It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and address is shown hereon, but failure to snail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. March 18 2019 DATE OF ISSUE STRINGER, PRESID CALIFORNIA LICENSE NOOWA18664 1IL t • -\ L LLJ 7 W Q 0 0 v O am qv Lu an Z L m JA s 1 S Z � z � u .0 x m w