HomeMy WebLinkAbout07-2179 (DSF)t
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Wqrpw
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
voICE (760) 777-70r2
FAX (760) 777-70rr
TNSPECTTONS (760) 777 -7 rs3
Date: 7 /25 /07
07-00002L79
46L76 DUNE PALMS RD
500-030-008-
DEMO - SINGLE FAMILY
MEDIUM DENSITY RES
0
Owner:
CITY OF LA QUINTA
78495 CALLE TAMPICO
LA QUINTA, CA 92253
(7'77)000-7000
Contractor:
EMERY LAIID cLEARTNG/cnaosc rNC
P.O. BOX 1009
THERMAL, CA 92274
(750 ) 391-s840
Lic. No.: 600283
4}art""Architect or Engineer:
$:t-"n tJ {"
I hereby affirm under penalty of perjury that I am
Section TOOO) of Division 3 of the Business and I
TICENSED CONTRACTOR'S DECLARATION
under of Chapter 9 (commencing with
License is in full {orce and effect
600283
License Law for the
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 37OO of the Labor Code, lor the p€rformance of the work for which this permit is
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 37OO 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 SJATE FUND Policy Number 045L15532005
_ I certify thar, in the performancgof the 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 rhat, if I workers' compensation provisions of Section
Date:Owner:
CONSTRUCTION LENDING AGENCY
I hereby aflirm 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:
nals
License Class 2t
Date:0 Contractor
OWNER.BUILDER
I hereby affirm under penalty of perjury that I am exempt from the
DEC
of the Labor wilh those provisions.
Date:Applicant
WARNING: FAILURE TO SECURE .COMPEN IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL UP TO ONE HUNDRED THOUSAND
DOLLARS ($1OO,OOO}. 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 Director of Building and Safety for a permit sub,ect 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 rhis application,
the owner, and th€ 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 subiect
permit to cancellation.
I cenify that I have read this application and state that the is I agree to comply with all
city and county ordinances and stale laws relating to building and representatives
/ 3700thit
of this coulrty tolenter u
o*.,"1 lzlfsl ,,n
pon the above-mentioned property for on
nature (Applacant or Agent)
LQPER]\{IT
I
following reason (Sec. 7O31 .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 stalement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7OO0) of Division 3 of the Business and Professions Codel or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7O31.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5OO).:
( _ ) l, 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. lf, 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.l.
( _ ) l, as owner of the propeny, am sxclusively contracting with licensed contractors to construct the proiect (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 proiects with a contractor(s) licensed
pursuant to the Contractors' State License Law.l.
(-}lamexemptunderSec.B.&P.c.forthisreason
t
StructureOther struct Information
info
Application Nunrlcer 07-00002L79
NUMBER OF UNITS
1
1.00
PermitAdditional- descPermit FeeIssue DateExpiration Date
DEMO PERMTT
45.00
1,/ 2L/ 08
Per
BASE FEE
Pl-an Check Fee
Va l-uat i on
.00
0
Extension
45.00
Qty Unit Charge
Special Notes and Comments
DEMOLISH TO BARE GROUND SFD
Fee summary Charged Paid Credited Due
Permit Fee Total-PIan Check Total-Grand Tota1
45.00
.00
45.00
.00
.00
.00
.00
.00
.00
45.00
.00
45.00
LQPER-]\{IT
l
Bin #
Permit #
,-nq
Building e Safety Division
P.O. Box I 504, 78-4gS Calle Tampico
La Quinta, G,92253 - (7601 7TT-TOI2
Building Permit Application and Trackin
City of La Quinta
,Y
g Sheet
Project Address:1 'r1'z-5i Owner's Name:(i (o lr"l-a-
A. P. Number:Address:
City, Sl Zip:
Contractor:
Address:00c0 Project Description:4 ,lCity, ST, Zip:
UTelephone:7 t-44a
State Lic. # :o0 )City Lic. #:p
Address:
city, sT, zip:
Telephone:Constnrction Type:Occupanry
State Lic. #:hojecttype (circleone): New Add'n Alter Repair Demo
Name of Contact Person:Sq. Ft:# Stdries:# Units:
# of Contact Person:Estimated Value of ect:
APPLICANT: DO NOT WRTTE BELOW THIS LINE
#Submittal Rectd FEES
Plan Sets Plen Check submitted Item Amount
Structural Calcs.Reviewed, rcedy for corrections Plan Check Deposit
Truss Calcs.Celled Contact Person PIan Check Balance
Encrgy Calcs.Plans iricked up Construction
Flood plain plan Plans resubmitted Mechanical
Grading plan 2il Review, ready for correctionMssue Electrical
Subcontactor List Called Contact Person
Grant Deed Plans picked up s.M.I.
H.O.A. Approvrl Grrding
IN HOUSE:-td Review, ready for correctionVissue Developcr Impact Fee
Planning Approval Called Contect Person A.I.P.P.
Pub. \Yks. Appr Date of permit issue
School Fees
Total Permit Fees
E
PIans resubmitted
I
Arch., Engr., Designer:
Req'd TRACKING
Plumbing
CITY OF LA OUINTA . PUBLIC WORKS DEPARTMENT GREEN SHEETPUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT. Form updated & effective 11117t2OO6
Sh ta OV forw ded oth ut De rtm di ctlPlease DO NOT subrnit the G reen Sheet (Public Works Ctearance) p acket to the pubtic Works De partment
C
until ALL requirements listed below are complete. lncomptete a pplications or applications whi ch cannotbe processed wilt be returned to applicant.
Darc: 7-zLl -o1
Tract No.:
Devetoper: e tl d Cl/\J;?^LTract Name:
Address (s):Lot No. (s):
The foilowing are the requirements for pubti" wkt,HHftfrom the Building & Safety Department:* CUSTOM HOM P VID ITEM s #2.#4A ND #5 BELOW
CTH OMES:PRO VIDE MS#1. #2.
"1ffi[6ai2e issua n"" #US/!(.
building bermit
#3. #,4 (AS AND WBLEI
COMMER ctA L BUILDIN GS/OT HER: P RO VIDE ITEMS #1,#2, #3 A ND #5 BEL OW
WALLS: P R OVIDE ITEM S #7 BELOW
IG VIDE TE #8 OW
1 ' Attach Pad Elevation certificates in compliance with the approved design elevation for buildingpad (maximum allowable deviation of + /- o.1 foot). pad Elevation certificates must be current(within 6 months of current date), rf a precise grading pran creates the pad for approvar, preasewithhold green sheet submittar untir a pad Erevation certiiicate
"un u" p-ria"a.2. Attach geotechnical certification of grading plan compliance,3' Attach recorded finar map showing p.opo*a buirding rocations are regar rots.4' Attach a completed < 1 acre per lot or infill project iugitive or., c.*i"i prriect information form,PMl o plan & agreement or provide alternative & vatid city approved prurj o plun set referencenumber or hard copy plan. PM'lo plans for commercial & residential developments (beyond 1 lot)
- are submitted separatery with grading prans & are subject to additionar ,"qrii",n"n,..5. Attach an approved precise griding ftin tor the building location(s]. nO iUoJ zlne,developments_ will require an approved flood plain development plan.6. Attach an approved rough grading plan foitne Ouilair7. Attach wall'ptan a r"LtEa approved grading plan. tg location(s)' lgl'e*, Soatlttao/
8. Attach sign layout/plan & related pr""i"u giding/landscape plan. @*at eA
I have reviewed and confirmed the re qutrements listed above as presented and find the improvements tobesufficiently complete for construction of the proposed buildings/structureslwalls/signs on the su bject
aoaa
olro
aaa
a
o
lot(s). Pursuant to
Recommended by:
indi ng S ea VC may be released for building permit issuance.
Dated:,/,
Public Works Distribution: (Green Sheet to Buitding & Safety counter(_l Green Sheet to Community DevelopmentDeclined for approval for reason(s) as follow(s), please correct and resubmit:
10 lnfo n ( 1 acre or 1 3
L
Form updated & effective B/25/2OO|
Project lnformation
Proiect Phase
Proiect Contractor:
Project Name:
J.,D a
Project Tract
Number:
Lot Number(s):
Project Phase
(Check One):
fJ Construction
Anticipated Start Date:
Total acres in active
construction (< 1 acre
per Lot):
Demolitionr
Anticipated
Completion:
Project Street
Address:W-(7L Lu*
Lo Qcpi^,f^
poJ^s Cr
Project Contact
lnformation
aPle S DeoNet U tS cont o S r lrU 2ed h4 o urs da aeq d7 a kweeYays
re ra edt S S to cog NS cttru o statun s Pers o n stti e d below S res n sib lepo
ort Ud S t oc ntr ol und bu s en andSS on n bu S en sS h ours
Name:I
Title:\CL \O\At $l-
Company Name:
Maili Address:
City:
State:
Zip Code:1
Primary Telephone
Number:4tD t-gtr+o'3
Fax:3q t-1
24 Hour
Access/Emergency
Phone:1tx 1 1((?
Cell Phone:-"zL"l
PM 1O Certificate
Number:-04-lj$
*Expanded PM 1 o plans for commerciat and residential developments ) 1 acre are required bythe City of La Ouinta.
I ,
f PM 1O (<1 a qre per Lot or lnfill }F itive Dust Qontrol Plan Paqe 2 of 3Plan updated & effective 8/25/2OOs
This plan shall take into account applicable scAoMD Rule-403 regulations. Training may be obtained by
:il:X"H#,*oMD
(Sharon zamora - Phone: (9091 sgo-zlasl. this pran shari consist or the ro[owins
* SIGNAGE:
Guidelines.
Use Coachella Valley Fugitive Dust Control Plan Handbook Construction Site Signage
*TRAFFIC: construction traffic shall not be allowed on the pad, unless absolutely necessary. lfvehicles operate on pad, pad shall be kept firm and moist through hose watering or sprinklers.Fugitive Dust shall be prevented by fencing ofl site to prevent unauthorized traffic on pad. fl5mph maximum traffic speedl.
* PAR ING:Parking is not allowed on the pad. All vehicles must park on street {at designatedareas only).
*TRAGK OUT: Provide 24 hour street cleaning and track out system as approved by City public
Works lnspector, (No din on public or private roads). Track out shall be cleaned up within onehour of incident,
{' DIRT PILES: Dirt piles shall be limited to 50 cubic yards and built per California Building Codegrading requirements. Piles shall be kept moist or covered with tarp material. Larger. dirt piles will
require stockpile or grading permit.
'3' FENCING: Provide PMlO fencing at perimeter of public roads and where applicable. Wood slatfencing can be installed at rear of property and return 2O feet on either sije it HOA restrictions
apply. Block walls can replace PMlO fencing during the construction phase.
* EOUIPMENT: Extra hoses and sprinklers shalt be maintained on site.
* EXCAVATTOI\I MEASURES: All areas to be excavated or graded shall be pre-watered. Water shall
be applied during excavation or grading operations also.
* DUMP TRUCKS: Opeo top dump trucks to be wet down, moist and tarped prior to leaving site.
* INACTIVE SITE:Within 1O days of ceasing of activities, re-vegetate or permanentty stabitize as
required.
* wATERING: continuous watering is required to prevent dust and must occur a minimum of 4times daily. Water shall be applied to dry soils to stop:o Visible dust emissions over 2O06 opacityo Visible dust emissions that travel over 1OO feet.. Water source % hch water meter at front (south) side of pad.
* EDUCATION: Responsible Dust Control lndividual and key personnel shall attend SCAqMD pMlo
class and obtain pMlO certificate number prior to construction activity.
* WEATHER MONITORTNG: Wind predictions shall be monitored.
vofQuic1Ament3of3Agreement updated & effective 8/25/2OOS
The siqnatur e of the prope rtv ow ner (or au thorized represe nt e):
*shall act as his/her acknowledgement of dust control requirements and their enforceability,pursuant to AOMD Rules 4e3 and 4O3.1;
*shall constitute and agreement to comply with all prorect conditions as identified in the approveddust control plan;
o ora nz r VE
* Acknowledges that dust control is .required 24 hours a day , 7 days a week, throughout the periodoI project performance, regardless oI proiect size or status;
'!' Shall ensure that each and every contractor/subcontractor and all other persons associated withthe proiect shall be in continuous compliance with all requirements of the approved dust controlplan;
* Shall take all necessary precautions to minimize dust, even if additional measures beyond thoselisted in the dust control plan are necessary;
{' Shall authorize representative of the city/county to enter upon the above mentioned property forinspection and/or abatement purposes; and
* Shall hold
this dust c
Signature
Printed Name
Title
(
Compa ny
h less the
ol plan
o or
Y
/County and its representatives from liability for any actions related toCity/County initiated abatement activities-
ed Representative
t
I
&4S r
^J-iL
AcLh{:
Date
J k^&hc
\
D
{FrFrn&r
SOUTH COAST AIR QUALITY TANAGETTENT DISTRICT
ilOTIFICATION OF DETUIOLITION OR ASBESTOS REUOVAL 909'396.2336
FN(: 9091396-3342
IAIL FORT AIID FEE TO SCAQilD, ASBESTOS NOIFICATrcilS, FILE # 55641, LOS AIIGELES CA 9007+5641
' Asbeshs suneysale rcquimd giorb Domdtbnad R€nota[bn
Forms, insfrudims, ad he Rule 1400 can be ottahed fiom AOMD lrteb ttib ltup/funv,agd.gd P*1d2 Fom REV 20Gx)62/
AQTD USE O}ILY SCREEil BY RECETVED POSTHARK ENTERED BY NOTtFtCATtOil #
COMPANY EMERY LANDCLEARING
AND GRADING, INC.
PHONE: 76891-5840
DATE JULY 2,m7 CHECK#
'{qbq
FEE $144.68 PROJECT#
NOTIFICATIO}I WPE Oruerual Ransor Dares Rruspn OrHEn (highlight)Cercru.eror
PRO.'ECTTYPE DEuounox Onoeneo Demormox Flenorrenon (rennvdl Euencercv Rerovnt- PtilttnEo ReNo(annuall
SITE INFORTATIO}I SITE NAME CITY OF 1A QUINTA
SITE ADDRESS 4S176 DUNE PAT"i'S ROAD CROSS STREET WESTWARD HO
CITY LA QUIT.ITA STATE CA aPgn53 COUNTY RIVERSIDE
DESCRIBE WORK AND LOCATION DEMOLISH REMOVE AND DISPOSE OF ONE HOUSE STRUCTURE
BUII"DINGSIZE(soFD 1,400 NUMBEROF FLOORS 1 BUILDING AGE (YEARS) 40 NUMBER OF DWELLING UNIrS 1
BLDG PRIOR' PRESEilt USE Comnncru-l'hsprru- lrousrRrAl Oher OFHcE PT.sLrcBtDG. HOT SE So{oor SHp UuvCIou-eee
SITE OWNER CIW OF I.A QUINTA REDEIELOPMENT AGENCY ADDRESS P.O. BOX 1504
CITY I.A QTJINTA STATE CA ztP 9n53 CONTACT JON MCMILIEN PHONE 7ffim2-2322
REQUIRED BUILDIilG
IIIFORTATION
ASBESTOS YES NO
PRESENT?
ASBESTOS YES NO
SURVEY? '
ASBESTOS YES NO
REi,to!ED?
BUII.DING TO BE YES NO
DEIIOLISHED?
PRO.'EGT DATES START 8{607 END &24{7 WORK SHIFT ({gy, swing, nrghQ
ASBESTOS AT(X']{T TO BE
REXIOVED (in square ftet)
FRIABLE CLASS I ct-ASS il TOTAL Atqrffi (add row)
ASBESTOS RETOVAL FROT SURFACES PIPES COMPONENTS
ATOT'1{T OF EACH TY?E OF
ASBESTOS (in sryare feet)
ACOUSTIC CEILING LINOLEUM INSUI.ATION FIRE PROOFING DUCTING STUCCO MASTIC
FLOOR Til.ES (VAT)DRY WALL PI.ASTER TRANSITE ROOFING OTHER
(desclibe)
col{tRAcToR t}lFoRtATtoN CSLB LICENSE # 600283 OSHA REG #AQMD tD # 100435
NAME EMERY LANDCLEARING AND GRADING, INC.ADDRESS P.O. BOX 1OO9
CITY THERMAL STATE CA AP 92274 SITE SUPVR JAMES C. EMERY PHONE 760n7+W93
WASTE TRANSPORTER #1 1.AT{DFILL
ADDRESS ADDRESS
CITY STATE alP CITY STATE ztP
COMPIETED BY
LORI EMERY V.P.
t
?
MAIL FORM AND FEE TO: SCAQMD, ASBESTOS ilOTIFICATIONS, FILE il 55641, LOS ANGELES CA 9007+5641
TELEPHOI{E: (909) 396-2336 FOC (90e) 396-3342
SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
TAIL FORTI AT{D FEE TO SCAQ}ID, ASBESTOS iIOTIFICATIOilS, FILE # 55641, LOS ANGELES CA 9007+5641
Page2ol2
Form REV 20030627
FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT
SCAQMD is located at 21865 E. Copley Drive, Diamond Bar, CA 917654182 (909) 396-2000
WASTE TRAilSPORTER #2 WASTE STORAGE SITE
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE zlP
CO TROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USEO AT THE RENOVATION AND DEMOLITION SITE, PTCEdUTE # I, 2, 3, {, 5 OT OIhET.
For asb€stoe rernovds cirde lhe combination of Rule 14fi1 pocedures used. Prucedu€ 4 and 5 subrnit plans for AQMD pdff approval.
ASBESTOS DETECIP PROCEII RE: CIRCIE THE PROCEDT RES AND ANALYIICAL METHODS USED TO DETERMINE ASBESTOS lN THE BUILDING;
Survev. Bulk Sdnpling, lnspec{ion, Ptfi, rcM, TEM, Assumed I AsbestcPACM, Desqibe Otler (SEE SURVEY GUIDELINES CHECKLIST):
FOR DEilOLITOilS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: BRICKLEY ENVIRONMENTAL 7117 -ln$n7
FOR ORDERED DETOLTflOil SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE #
AUTHORIZING PERSON
DATE OF ORDER:
TITLE
DATE ORDERED TO BEGIN:
FOR EIERGEI{CY ASBESTOS RET(n'AL GIVE IHE NAIG AND PHCII,IE iIUIAER OF IHE PERSON DECI.ARII{GIAUI}IORtrING IHE Ei'ERGEiICY, DAIE AND HOUR OF
ENERGENCY AND D€SCRISE IHE SUDDEN, UNEXFEC1ED EVET{T:
EXPI.AIN HOWTHE EVENTWOI.JLD CAUSE UNSAFE CONDITIOT.IS, EQUIPMENT DAMAGE OR UNREASOT.IABLE FINANCIAL BURDEN:
COI{flI{GEIICY PI-AI{: DESCRIEE ACTIONS TO BE FOI.IOIVED IF UI{EXFECIED ASBESTOS IS FOUND DIJRING DEMqJIOI,I OR ASBESTOS i'AIERIAL BECOftE
DISIURBED. CRUIA]N'.ED. PULVERIzEO. OR REDUCED TO POVDER.
STOP PROIECT HAVE CERTIFIED ASBESTOS REMOVAL CONTRACTOR REMOVE AND DISPOSE OF.
IRAlXll{c CERTlFlCAltOll: I oeft'fy fiat ar individual trainod in the plovisions of rcguldim AQMD Rule 1403 and NESHAP will be on site dudng the r€moval and
euirence that fie rcquired f?ining has been acorndished by thh persm will bs avdla e b. inspeclidt dudng nqmd busine€s hotils.
Company Name EMERY
T.ANDCLEARING AND
GRADING, INC.
Print name of owner/operat
LORI EMERY
Signature of owner/operator Tittle of owner/operator
VICE PRESIDENT
Date 7-247
ll{FORtATlOil CERTIFICATOil: I certify that the above information is conect and I have enclosed any required attadtments.
Company Name EMERY
LANDCI.EARING AND
GRADING, INC.
Print name of owner/operator Signature of owner/operator
LORI EMERY
Tittle of owner/operator
VICE PRES!DENT
Date 7-247
Notifications can not be reded sithout the required lee (AQMD Rule 301). Asb€sbs r€movals of less than 1m square feet de ocmpt from notl'fication and fees.
Ple6e md(e checks payable to 'SCAQMD'. Fe€s are per notficatioo, not refundaue, and vary according to the prcje61 size. Fees are 6 follofls:
DEMOLITION OR ASBESTOS REMOVAL
1,000 or less
1,001 to 5,000
5,001 to 10,000
10,001 to 50,000
50,001 to 100,000
100,001 or more
$ 47.32
$ 144.68
$ 338.64
$ 531.01
$ 769.56
$1,282.60
SERVICE CHARGE
SPEC]AL HANDLING FEE
REVISION OF NOTI FICATION
RETURNED CHECK CHARGE
PIJ\NNED RENOVATION
PROCEDURE4OR5PLAN
$ 47.32
$ 47.32
$ 25,00
$ 531.01
$ 531.01
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