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BDEM2014-0002
78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4'y4 4Qdrrw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BDEM2014-0002 Property Address: 77985 AVENIDA MONTEZUMA APN: 773104036 Application Description: DEMO OF 1,666SF MARKET AND 1,092SF RESTAURANT BUILDINGS Property Zoning: w o LU Application Valuation: $2,000,000.00 Applicant: Q U CS U MCI CONSTRUCTION COMPANY 82-746 KYLE DRIVE � INDIO, CA 92203 D LICENSED CONTRACTOR'S DECLARATION 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 Professions Code, and my License is in full force and effect. License Class: B License No.: 377905 Date: Contractor: OWNER -BUIL DECLARATION I hereby affirm under penalty of perjuryat 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 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).: (_) 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 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.). (_) 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.). (_) I am exempt under Sec. . B.&P.C. for this reason Date Owner: 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 Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: TOWER ENERGY GROUP 1983 W 190TH ST TORRANCE, CA 92253 Contractor: MCI CONSTRUCTION COMPANY 82-746 KYLE DRIVE INDIO, CA 92203 (760)498-7053 LIc. No.: 377905 Date: 7/21/2014 1� 0 0 N j �—+ w o LU U- —� Q U CS U � z D $ 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 rk for which this permit is issued. have and will maintain workers' compensation insurance, as required by Se ion 700 of the Labor Code, for the performance of the work for which this permit issued. My workers' compensation insurance carrier and policy number are: Carrier: _ Policy Number: _ _ I certify that in the performance of 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 that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: — f- Applicant: WARNING: FAILURE TO SECURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 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 city to enter upon the above- mentioned property for inspection purposes. Date: �< Signature (Applicant or Agent): i DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE DEMOLITION, EXTERIOR 101-0000-42404 0 $35.75 $0.00 PAID BY " METHOD _ - _ .-RECEIPT # • CHECK # CLTD BY.', DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEMOLITION, EXTERIOR PC 101-0000-42600 0 $107.25 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for DEMOLITION: $143.00 $0.00 TOTALS:00 $0.00 �"' O'1. 1 ,.her • • ' • 0 'DAME CP`�OP•'fNvb�. -¢rKWF� h h� r y4-T�' �t3 x a x �.y,�.. M ; �"•a ,,4 a PermitTRAK $143.00. BDEM2014-0002 Address: 77985 AVENIDA MONTEZUMA Apn: 773104036 $143.00 DEMOLITION $143.00 DEMOLITION, EXTERIOR 101-0000-42404 0 $35.75 DEMOLITION, EXTERIOR PC 101-0000-42600 0 $107.25 Date Paid: Tuesday, July 22, 2014 Paid By: MCI CONSTRUCTION COMPANY Cashier: SKH Pay Method: DEBIT Printed: Monday, July 21, 2014 3:26 PM 1 of 1 Cil Ll &7CYCTF AAC Permit Details PERMIT N.U.MBER City of La Quinta BDEMg20�14-0002 Description: DEMO OF 1,666SF MARKET AND 1,092SF RESTAURANT BUILDINGS Type: DEMOLITION Subtype: COMMERCIAL/OTHER Status: PENDING DOCUMENTS Applied: 7/17/2014 AOR Approved: Parcel No: 773104036 Site Address: 77985 AVENIDA MONTEZUMA LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 134 Lot: 24 Issued: NO 14 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,000,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: DEMO OF 1,666SF MARKET AND 1,092SF RESTAURANT BUILDINGS (RESTAURANT BUILDING LOCATED AT 77-965 AVENIDA MONTEZUMA) INCLUDING MISCELLANEOUS STRUCTURES AND FLAT WORK PER THE APPROVED NEW CONSTRUCTION PLAN - PERMIT 13-1641.2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES CHRONOLOGY CONDITIONS DESCRIPTION ACCOUNT QTY• `- AMOUNT PAID ;-PAID,,DAT E' :RECEIPT # CHECK #,,, ' METHOD PAID BY ; CLTD• . "BY'- DEMOLITION, EXTERIOR 101-0000-42404 0 $35.75 $0.00 Printed: Thursday, July 17, 2014 10:41:43 AM 1 of 2 . cowYSTf. AAS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY DEMOLITION, EXTERIOR 101-0000-42600 0 $107.25 $0.00 PC Total Paid for DEMOLITION: $143.00 $0.00 TOTALS:00 $0.00 INSPECTIONS SEDID INSPECTION TYPE INSPECTOR SCHEDULED. COMPLETED BATE 'DAIt- RESULT REMARKS NOTES _ -- FINAL" PRE -SITE BOND INFORMATION Printed: Thursday, July 17, 2014 10:41:43 AM 2 of 2 MYSTEMS Bin # Permit # .Project Address: 0LGe-72 -1 11-1 Qty of La Quinta Building 8i Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet m J Owner's Name: A. P. Number: I A .tIV& Vk4HT , -Address: tffW �l�07r7 re da Legal Description: City, ST, Zip: e �$U Contractor:c -' e �Telc hone•v- 7 001i Address: -9;7_249 :Project Description: City, ST, Zip: O G/t} 2G� D`/J L--eyeokie� Telephone: a_ c State Lic. # : 0-2 US' City Lie. Arch., Engr., Designer ��i�u1G1J /V(0((,(% 76?0 Q� Address: tZe /,,Wago � 9 1C City., ST, Zip: o— Telehone P r Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: --75-0— Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: — —S/ rJ ( E '=Estimated Value of Project: , APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrcctionsrssue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Jrd Reyiew, ready for correct' s/issue Developer Impact Fee Planning Approval Called Contact Person 1�1 A.I.P.P. Pub. Wks. Appr Date of permit issue Scho61 Fees ees Total Permit Fees- -111, J11,,4 — Offt,4 --W %ttI&E w I AA^%D . Nn t S41U04 bm* (3RAK1(31 to TOM ta`D7tiA0Y OUP, A CALIPORNIA CORPORATION the f dtt=iW rW property im the City of LA QUINTA Coltntyof RIVERSIDE ,SleteofCoWmnia. LEGAL DESCRIPTION ATTACHED HERSTG AND MADE A PART HEMP BY REFERENCE Dated July 21, 2008 RECORDING REQUESTED BY DOC # 2006-0419743 07/31/2008 08t00A Feet32.00 CHICAGO TITLE COMPANY Page t of 2 Doo I Tax Paid Recorded In OfflcJal Records AND WHEN RECORDED MAIL TO County of Riverside I—TOWBR ENERGY GROUP Larry W. Ward Assessor, County Clark 6 Recorder 8RRANCE 19IA CALIPORN T0M04 I IIIIII IIIIIII II IIIIII IIID VIII IIIIIII III VIII III) IIII S R U I VAvr I WZL I UA MIS(: LUNGI RFD COPY M A l 465 424 PCOR CO SMP HCHG L mate o/she ttatatovAndyrd m rttr tltet hr/oM/9tey eRtxnrb0 the urns U hb/1wr/thdr he " hb/hu/ft" ¢arsetr Ne. ceoot4rn F117T: QLder itt,. 87oo7��J] Bb] e= p�n{e), of wh u twad, uuoubtd IM litahumrnt. �K61�BWGTM8IftFOR nFDerG6t'81786 �. GRANT DEED Aeaessor's Parcel No. n. 773104036-3 YHHUMIBRSION� ORAMORtS)DF.C]/1 DOCUMANfARVTRANSP}1R?AJf 18 0.00 AMADOR ZUAZUA ❑ uohteotpontederea ® atyw LA QVINTA NOTARY PUBLIC ® emeputedoethe fellvelueofthe tnoemnorptoperiyomaepa4urts �r ur. mm,tanrup.a ❑ o mPutesanthe(UllvNoeI=thevalueof11morm®mhmnm amde6tgLtime aftmle aw FOR A VALUABLE CONSII)ERATION, n=iptt of which is hareby admowledpd, 039 MELL INVESTMENT SERVICES, INC., A NEVADA CORPOUTION pry, 8trte 9 239 bm* (3RAK1(31 to TOM ta`D7tiA0Y OUP, A CALIPORNIA CORPORATION the f dtt=iW rW property im the City of LA QUINTA Coltntyof RIVERSIDE ,SleteofCoWmnia. LEGAL DESCRIPTION ATTACHED HERSTG AND MADE A PART HEMP BY REFERENCE Dated July 21, 2008 STATE OF NB>i?i1' WOM INVEBTMSERVICSS, INC., A OOUNTYOF Cat, }NSVAVA CORPORATION On _ Oeton mr, PeAlonaRyame-ed THEODORE C. NMIAL who provrd m rnr on tM haste of wtlofaetory evtdenee m b t tln perwnG) whose nered t} bee to qtr Intt 4vtd mate o/she ttatatovAndyrd m rttr tltet hr/oM/9tey eRtxnrb0 the urns U hb/1wr/thdr he " hb/hu/ft" SY �. uuthtzlI capadty{taa, old that by hN/her/emir aalI�prmhee{■}�enn� tnabunu of Me entity upon behell t THE ODORS C. t4EA16I+I., R IA&NT e= p�n{e), of wh u twad, uuoubtd IM litahumrnt. theof theSbft of captotrusuthattltrtoroeoln¢��rag�hf.w� Mm ancnat AMADOR ZUAZUA tMfNE6S An to "-WLLL NOTARY PUBLIC S-0-201 STATE OF IDAHO �r ur. mm,tanrup.a MAL TAX STATEN TO PARTY &40VM ON F=OWN0 UNE IF ND PARTY SO yNOM, MAR AS UREOTEO AliOVf Nemo Stna Addr6m pry, 8trte 9 239 dol - Irj*aMAA I Order: 23840 Doc: RV:2008 00419743 Page 1 of 2 Created By: bacastillo Printed: 5/15/201410:48:47 AM PST Page I Escrow No. 870014272 -P77 LIG" DUCRIPTION MMXBIT LOTS 1, 2, 23 AND 24 IN BLACK 134 OF SANTA CARMELI7% AT VALE, LA OUINTA UNIT NO. 14, IN THE CITY OP LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILM IN BOOK 18 PAGE 82 OF KAPS, RECORDS OF RIVERSI06 COUNTY, CALIFORNIA. EXCEPT THE SOUTlH 16.00 PFZr OF SAID LATS 2 AND 23. ALSO EXCEPT THS WEST 70.00 PEST OF SAID LATS 23 AND 24, tdPMMED AT RIGHT ANGLES TO THE WEST LIES OF RAID LOTS 23 AND 24. Order: 23840 Doc: RV:2008 00419743 Page 2 of 2 Created By: bacasdllo Printed: 5;15/2014 10:48:47 AM PST . .4, I RECORUING REQUE87ED BY: Equity Title Company AND WHEN RECORDED MAIL T0: Tower Energy Group, a California Corporation C/O Steven J. Cramer 1111 Broadway, Ste_ 2400 Oakland, CA 04607 Order No.: OR 1050276 Escrow No.: 10044 GRANT DEED DOC # 2010-0096660 03/03/2010 08:00A Fee:28.00 Paco I of 2 Ooo T Ta. paid Recorded In official Records County of Riverside Larry W. Word Assessor, County Clerk b Recorder 11111111111111111111111111 in IIIIIII III IN IT IN UNI THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $385.00 [ X J computed on full value of property conveyed, or [ ] 06 T - computed on full value less value of liens or encumbrances remaining at time of sale. 061 [ ] unincorporated area j X ] City of La Qulnta FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, The Yessayfan Family Limited Partnership, a California Limited Partnership hereby GRANT(S) to Tower Energy Group, a California Corporation the following described real property in the County of Riverside, State of California See legal description EXHIBIT "A" attached hereto and made a part hereof Dated: February 12, 2010 STATE OF CALIFORNIA COUNTY OF RIVERSIDE } SS. Qn F -a (0 li a Aj g 0. , aQ ItD before me, I nS,-1yIaP4,6iP,A Notary Public personate appeared RaPe��- Y— sl a gs ,1L o + tausi t" who proved to proved to m6on th besls of of satisfactory evidence to be the person l6l whose name J01M subscribed to the within instrument and acknowledged to me that hes-steel thU executed the same In his/ heft ,Weir; authorized capacity les , and by h4sf-herftheir signature .(s) on the Instrument the person, or the entity uppn ehalf of which the person (aacted, executed the Instrument, I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. " Signature Ld The a Ian Family Limited Partnership By. Rupert 13, Yessayyl�an�Ge/neral Partner I % By: Meron B. Yessa Aan, Gen ral Partner 'Lia ay+ LINDA MARTINEZ Commission p 1760260 4,0 Notory Public • Cglltornlo `t�� • Rlvoraltl0 County CorcmF� Mees 142011 (This area for official notary seal) MAIL TAX STATEMENTS AS DIRECTED ABOVE Order: 23840 Doc: RV:2010 00096660 Page 1 of 2 Created By: bacastillo Printed: 5/15/2014 10:48:47 AM PST i AA'Nll1I>W6 LOTS 23 AND 24, EXCEPT THE EAST 30 FEET OF LOTS 23 AND 24 AND THE SOUTH 16 FEET OF LOT 23, IN BLOCK 134, OF SANTA CARMELITA AT VALE LA QUINTA UNIT NO. 14, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 18, PAGE 83, OF MAPS, IN THE OFFICE OF THF. COUNTY RECORDER OF SAID COUNTY. `END OF LEGAL DESCRIPTION" Order: 23840 Doc: RV:2010 00096660 Page 2 of 2 Created By: bacasdllo Printed: 5/15/2014 10:48:48 AM PST i 77-985 Avenida Montezuma Permit: 13-1641 APN: 773-104-035 and 773-104-036 Owner: Tower Energy Group TUMF Category Gross Floor Area (1000s) TUMF per unit TUMF Existing (Less) Restaurant 1.092 $9,409.10. $10,274.74 Convenience Market 1.666 $54,611.26 $90,982.36 New Convenience Market 4.728 $54,611.26 $2581202.04 TOTAL $156,944.93 The existing market (1,666 square feet) and existing adjacent building (1,092 square feet) to be demolished equate to a total of 2,758 square feet of existing building floor area. TOWER ENERGY GROUP lighting& Electric Inc. Jon Olson 73-804 Dinah Shore Drive Palm Desert, CA. 92211 RE: Scope of Work authorization at site #912 1 authorize the listed SOW to be conducted at TM #912 located at 77985 Avenida Montezuma, La Quinta, CA. 92253. Project: Tower Market Existing Building Demo July 7, 2014 • Call Dig Alert to identify all Existing Utilities. Install Construction Fencing. • Properly cap off all existing Utilities. • Pump all grease in Existing grease trap. Remove existing grease trap. Remove Existing Asbestos. • Import dirt to backfill grease trap hole. • Dispose Qty(2) existing Ficus trees and Qty(2) olive trees. • Dispose of existing 20 foot existing palm tree. • Demo & Remove existing restaurant building As per Phase 1. • Demo & Remove existing restaurant buildings foundation including all footings. Demo & Remove all Existing Flat Work Concrete as per Phase 1. Dirt Work Compaction Soils Report Testing. Over excavate 4 feet, Re -Compact Pad and Glue Down pad. Demo & Remove South Stucco wall and its foundation. Level all Dirt and water down lot as per phase 1. John T: 60r*_, Presiden Tower Energy Group 0 1983 W. 190" Street, Suite 100 + Torrance, CA. 90504 ss n it SanAir Technologies Laboratory, Inc. SanAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: iaq@sanair.com FINAL, REPORT Name: H2 Env..Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 .. I U uornpo�ls SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 01 / 14016945-001 Off-white 2* Cellulose 98% Other None Detected Drywall North Wall Order Area Non -Fibrous < 18 Glass Homogeneous StereoscopicComponents Asbestos Description Appearance % Fibrous % Non -Fibrous Fibers 02 / 14016945-002 Off -White 2% Cellulose 98* Other None Detected Drywall East Wall Order Area Non -Fibrous < 1% Glass Homogeneous Stereoscopic Components Asbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 03 / 14016945-003 Off -White 2% Cellulose 98% Other None Detected Drywall West Wall Kitchen Non -Fibrous < 1% Glass Homogeneous Stereoscopic Compqnents Asbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 04 / 14016945-004 White 100% Other None Detected Joint Compound North Wall Order Non -Fibrous Wall Homogeneous Stereoscopic ComponentsAsbestosSanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 05 / 14016945-005 White 100% Other None Detected Joint Compound East Wall Order Non -Fibrous Wall Homogeneous Stereoscopic• ••nents Asbestos SanAir ID I Description Appearance % Fibrous % Non -Fibrous Fibers 06 •• - 06 / 14016945-006 White 100% Other None Detected Joint Compound West Wall Kitchen Non -Fibrous Homogeneous Stereoscopic Components Asbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 07 / 14016945-007 White 100% Other None Detected Skim Coat North Wall Order Area Non -Fibrous Homogeneous Certification Signature:Reviewed: Date: 7/1/2014 Date: 7/1/2014 Page 1 of 8 s it SanAir Technologies Laboratory, Inc. SanAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: laq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 Ucereuscopic•. Description Appearance % Fibrous % Non -Fibrous. - 08 / 14016945-008 White 100% Other None Detected Skim Coat East Wall Order Area Non -Fibrous Homogeneous Stereoscopic ComponentsAsbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 09 / 14016945-009 White 100% Other None Detected Skim Coat West Wall Kitchen Non -Fibrous Homogeneous Stereoscopic Components Asbestos Description Appearance 10 / 14016945-010 Black 100% Other None Detected Grout Southwest Side of Order Non -Fibrous Area Homogeneous Stereoscopic Cornoonents SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 11 / 14016945-011 Black 100* Other None Detected Grout South Side of Order Area Non -Fibrous Homogeneous Stereoscopic ComponentsAsbestosSanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 12 / 14016945-012 Black 1008 Other None Detected Grout Southeast Side of Order Non -Fibrous Area Homogeneous Stereoscopic ComponentsAsbestos!SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 13 / 14016945-013 Black 100% Other None Detected Door Sealant West Side of ,forth Non -Fibrous Doors Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 14 / 14016945-014 Black 100% Other None Detected Door Sealant East Side of North Non -Fibrous Doors Homogeneous Certification Signature:-P_A'Z�e. s 2r.'t. Reviewed: Date: 7/1/2014 Date: 7/1/2014 Page 2 of 8 s nit SanAir Technologies Laboratory, Inc. SanAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: iaq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 �reabuoplc.- •. SanAir ID / Description Appearance •rous % Non -Fibrous Fibers 15 / 14016945-015 Black 100% Other None Detected Door Sealant South Side of West Non -Fibrous Windows Homogeneous Stereoscopic• .. SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 16 / 14016945-016 Black 1008 Other None Detected Window Sealant Center of Non -Fibrous Northwest Window Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 17 / 14016945-017 Black 1008 Other None Detected Window Sealant North Side of Non -Fibrous West Window Homogeneous Stereoscopic Compgnents SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 18 / 14016945-018 Black 1008 Other None Detected Window Sealent South Side of Non -Fibrous West Window Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 19 / 14016945-019 Black 1008 Other None Detected Cove Base Northeast Side of Non -Fibrous Order Area Homogeneous Stereoscopic ComponentsAsbestos• •Appearance20 / 14016945-020 Black 1008 Other None Detected Cove Base East Side of Order Non -Fibrous Area Homogeneous Stereoscopic• •. SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 21 / 14016945-021 Black 1008 Other None Detected Cove Base West Side of Order Non -Fibrous Area Homogeneous Certification Signature: -� 1. i '25_� Reviewed: Date: 7/1/2014 Date: 7/1/2014 Page 3 of 8 ss n it SanAir Technologies Laboratory, Inc. BaaAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http:/Avww.sanair.com E-mail: iaq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 otereuscupic tomponenis Description Appearance 22 / 14016945-022 Brown 100% Other None Detected Cove Base Mastic Northeast Side Non -Fibrous of Order Area Homogeneous 23 / 14016945-023 Brown 100% Other None Detected Cove Base Mastic East Side of Non -Fibrous Order Area Homogeneous Stereoscopic ComponentsAsbestos• • • 24 / 14016945-024 Brown 100$ Other None Detected Cove Base Mastic West Side of Non -Fibrous Order Area Homogeneous Stereoscopic Components• • ,SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers ----- 25 / 14016945-025 Beige 100% Other None Detected Mirror Mastic Northwest Side of Non -Fibrous Restroom Homogeneous Stereoscopic Components !SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 26 / 14016945-026 Various 98% Other 2% Chrysotile Mirror Mastic North Side of Non -Fibrous Restroom Homogeneous 27 / 14016945-027 Beige Mirror Mastic Northeast Side of Non -Fibrous Restroom Homogeneous 28 / 14016945-028 Black Vapor Barrier Northwest Side of Fibrous Building Homogeneous Signature: Date: 7/1/2014 100% Other None Detected 80% Cellulose 20% Other None Detected Reviewed: Date: 7/1/2014 Page 4 of 8 sa it SanAir Technologies Laboratory, Inc. SanAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: iaq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-931116 oEereuscapicASDesios ,SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 29 / 14016945-029 Black 808 Cellulose 208 Other None Detected Vapor Barrier North Side of Fibrous Building Homogeneous 30 / 14016945-030 Black 808 Cellulose 208 Other None Detected Vapor Barrier Southwest Side of Fibrous Building Homogeneous Stereoscopic Components• - �SanAir ID / Description Appearance % Fibrous % Non -Fibrous ____ Fi-bers 31 / 14016945-031 Grey 1008 Other None Detected Exterior Stucco Northwest Side Non -Fibrous of Building Homogeneous Stereoscopic Components SanAir ID I Description Appearance % Fibrous % Non -Fibrous Fibers 32 / 14016945-032 Grey 1008 Other None Detected Exterior Stucco North Side of Non -Fibrous Building Homogeneous Stereoscopic Components• - SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 33 / 14016945-033 Grey 1008 Other None Detected Exterior Stucco Southwest of Non -Fibrous Building Homogeneous Stereoscopic ComponentsAsbestos!SanAir ID / • • •Appearance % Fibrous % Non -Fibrous Fibers 34 / 14016945-034 Black 808 Cellulose 208 Other None Detected Roof Felt Northeast Side of Roof Fibrous Homogeneous 35 / 14016945-035 Black Roof Felt Northwest of Roof Fibrous Homogeneous Signature: Date: 7/1/2014 808 Cellulose 208 Other None Detected Reviewed: Date: 7/1/2014 Page 5 of 8 sa �r SanAir Technologies Laboratory, Inc. SanAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: iaq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 .. .• SanAir ID / Description ••. •us % Non -Fibrous Fibers 36 / 14016945-036 Black 80% Cellulose 20% Other' None Detected Roof Felt Tile West Side of Roof Fibrous Homogeneous Stereoscopic Components Asbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 37 / 14016945-037 Various 100% Other None Detected Duct Wrap North Side of A/C Unit Non -Fibrous Homogeneous Stereoscopic ComponentsAsbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 38 / 14016945-038 Various 100% Other None Detected Duct Wrap North Side of A/C Duct Non -Fibrous Homogeneous Stereoscopic• ••AsbestosSanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 39 / 14016945-039 Various 100% Other None Detected Duct Wrap South Side of A/C Duct Non -Fibrous Homogeneous Stereoscopic ComponentsAsbestosSanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 40 / 14016945-040 White 100& Other None Detected Roof Coating North Side of Flat Non -Fibrous Roof Homogeneous Stereoscopic ComponentsAsbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 41 / 14016945-041 White 100% Other None Detected Roof Coating West Side of Flat Non -Fibrous Roof Homogeneous Stereoscopic ComponentsAsbestosSanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 42 / 14016945-042 White 100% Other None Detected Roof Coating South East Side of Non -Fibrous Flat Roof Homogeneous Certification Signature: � �. -. s 2r-,t� Reviewed: Date: 7/1/2014 Date: 7/1/2014 Page 6 of 8 s it SanAir Technologies Laboratory, Inc. san►ir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Fres: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: iaq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 9171)-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 .• •. SanAir • Description Appearance 43 / 14016945-043 Black 5% Cellulose 93% Other None Detected Rolled Roofing North Side cf Non -Fibrous 2% Glass Flat Roof Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 44 / 14016945-044 Black 5% Cellulose 93% Other None Detected Rolled Roofing Center of Flat Non -Fibrous 2% Glass Roof Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 45 / 14016945-045 Black 5% Cellulose 93% Other None Detected Rolled Roofing South Side of Non -Fibrous 2% Glass Flat Roof Homogeneous Stereoscopic • ••ngats Asbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 46 / 14016945-046 Black 10% Glass 87% Other 3% Chrysotile Roof Felt North Side of Flat Non -Fibrous Roof Homogeneous Stereoscopic ComponentsAsbestos• Description 47 / 14016945-047 Black 10% Glass 90% Other None Detected Roof Felt Center of Flat Roof Non -Fibrous Homogeneous Stereoscopic• •.nents Asbestos SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 48 . - 48 / 14016945-048 Black 516 Glass 95% Other < 1% Chrysotile Roof Felt South SIde of Fla: Non -Fibrous Roof Homogeneous Stereoscopic Components SanAir • I Description Appearance % Fi• •us % Non -Fibrous Fi• - rs 49 / 14016945-049 Black 5% Cellulose 95% Other None Detected Roof Mastic East Side of A/C Non -Fibrous Unit Homogeneous Certification Signature: -1�?. Reviewed: Date: 7/1/2014 Date: 7/1/2014 Page 7 of 8 s it SbnAir Technologies Laboratory, Inc. sanAir ID Number 1551 Oakbridge Drive, Suite B, Powhatan, VA 23139 14016945 804.897.1177 Toll Free: 888.895.1177 Fax: 804.897.0070 Web: http://www.sanair.com E-mail: iaq@sanair.com FINAL REPORT Name: H2 Env. Consulting Services, Inc. Project Number: 1713614AS Address: 13122 6th Street P.O. Number: 77965 Ave Montruma CA Quinta CA Chino, CA 91710-9008 Project Name: Miguel Gonzalez Collected Date: 6/27/2014 Received Date: 6/30/2014 10:40:00 AM Report Date: 7/1/2014 1:27:41 PM Analyst: Szabo, Philip M. Asbestos Bulk PLM EPA 600/R-93/116 Stereoscopic.. SanAir ID / Description •..•Fibers 50 / 14016945-050 Black 58 Cellulose 958 Other None Detected Roof Mastic west Side Flat Unit Non -Fibrous Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 51 / 14016945-051 Black 58 Cellulose 958 Other None Detected Roof Mastic East Side of Non -Fibrous Exhaust Fan Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 52 / 14016945-052 Grey 1008 Other None Detected Metal Caulking North East Side Non -Fibrous of Flat Roof Homogeneous Stereoscopic. •. Description Appearance 53 / 14016945-053 Grey 1008 Other None Detected Metal Caulking East Side of Non -Fibrous Flat Roof Homogeneous Stereoscopic Components SanAir ID / Description Appearance % Fibrous % Non -Fibrous Fibers 54 / 14016945-054 Grey 1008 Other None Detected Metal Caulking South East Side Non -Fibrous of Flat Roof Homogeneous Certification Signature:-P_A'1..J" -'s Reviewed: Date: 7/1/2014 Date: 7/1/2014 Page 8 of 8 SanAir Technologies Laboratory, Inc. 1551 Oakb*c Drive, Suite B - Powhatan, VA 23139 Asbestos 804-897-1177 / 888.895.1177 /Fax 804.897.0070 Chain of Custody H2 Environmental Consulting Services, Inc. �•� a: 3 �, I M1 " 13122 6th Street Pm.acx Num: I .ti z h- k L Chino, CA 91710 Dau cene�. enod B : S. Whitacre P.O. Nmnber7 % 4 to l/ A &,.7A (A.ftZ,1v 909-628-0369 909-613-5845.— d: labresults@h2env.com ..uru w1m ataadard turn aroaad Nme seat Priori Ove ~_ 6— .u1F FEW COM amend time. ty might and Bleed To Recipient will be charged a $10 shlppiag fee. Page _ of, UMV11"NA&U T Bulk Sampling Form RCtMiSUl1L11 N6 INC. ❑ Stop at First Positive 24 Hour tum around ❑ Rush turn around (4 Hours) �X Do Not Layer Samples CLIENT PROJECT NO. PROJECTIDDATE PAGE / OF i .,c L i3 �, . [ i „/6 /..fir /) Y T Z 7. / 3 PROJECT LOCATION INSPECTOR 77965 /1 v...":• ✓,F At.,.-Lt,,•t:t c.clq U t ` j i'{ GRP. SA NO. NOO MATERIAL DESCRIPTION LOCATION OF SAMPLE QTY O POS J a. ,�• P' i ,r •rl c t `..� � % c� a'et - der 9 F,f .i,Cr ,1 /l r'v rl L . c r7 c'/1 �✓ rc s. G- 3 c? L 4 J „///7 �7J // • •T'r` i/I�v,�Lc - C/?IJr/,' d�r�,•! ', L LP t r'� .T. f' 7if c .'r7lf J G i. /• i i , (I .. ,t7/f.= /.S7 �• (� � - et f' !C 3 ," /) r A* .4,f, -,i �. 7 : / .. 'r d V -)o- .lR0 rC Notes: m w 3 0 9na ViuMm 13122 6th Street • Chino, CA 91710 (909) 628-0369 • Fax(909)613-5845 • MEnvironmental.com �NYI�D'jv Bulk Sampling Form CONSU111W SEVVIUVINC. ❑ Stop at First Positive )(24 Hour tum around ❑ Rush turn around (4 Hours) X Do Not Layer Samples CLIENT /� / PROJECT NO. v / 7 / • C �� S PROJECT ID �u/=�:/•E .,—f.u�Y.S DATEF; TFPAZE a OF l�iyi/�=r� :: R� _ 7. , 3 PROJECT LOCATION INSPECTOR ✓1"141 ,-Z✓hd L•! ✓,• ��(. i^ f/�•t.i/.�� S .S'%rte �- d GRP. SAMP. % NO. NO MATERIAL DESCRIPTION LOCATION OF SAMPLE QTY POS ; S'iati r �o� I ��jPl S i C. O Jt' 0 elf d 4 <` K /k/ o /t 7 i'/ r H •I7 -7 .4 /C' i %' v/ c 0 r. G / V /ii •;.1:'/i✓.ter !' `t jr j_ Ur/• L 't t /�' R ., r' E 7- •. ,c / Lc' P S r r 7- / L a� a X- '1 7 <vr'.cj��'/rr S� �T,H P.,r 43 "4j r- T/dF 4F Notes: 02,0 u*' 11 3 0 2014 ,A, ,/.'i,n 13122 6th Street • Chino, CA 91710 (909) 628-0369 • Fax(909)613-5945 • 142Environmental.com UNVI"N AfNTAj- Bulk Sampling Form CUNSUMN6 SUNKM INC. o Stop at First Positive X 24 Hour tum around o Rush tum around (4 Hours) X Do Not Layer Samples CLIENT 7. PROJECT NO. 7i 361 S PROJECTID /- DATE PAGE OF 3 a PROJECT LOCATION INSPECTOR i r � "1 !s 6 v ; ::, i[ u r %�r : vN AlN L -.-f i„ / .af,l •.(. '� // � :. +1•.+/ .1 : ti'i C> GRP. SAMATERIAL DESCRIPTION LOCATION OF SAMPLE QTY NO. NOO POS •�-� /` occ s /J cF',� 7 J i j{7 lQ L c: �.. r it J'.,��' r ; ..,.;= 17 .v 7 oi r Notes: i Qf% a 4A 9MA Awn nn 13122 6th Street - Chino, CA 91710 (909) 628-0369 9 Fax(909)613-5945 • MEnvironmental.com . South Coast Air Quality Management District (www.apmd.poy) Mail Form and Fee To: 21865 Copley Drive, Diamond Bar, CA 91765-4182 Phone: (909)396-2336 SCAQMD Rule 1403 Form Asbestos Notification File # 55641 Notification of Demolition or Asbestos Removal Los Angeles, CA 90074-5641 1 Fax these type of Notification Forms to (909)396-3342 and mail the orioinals within 48 hrs ProjecType DEMOLITION DEMOLITION ASBESTOS REMOVAL PLANNED RENO r PROCEDURE 4 PLAN r PROCEDURE 5 PLAN P� EMERGENCY ORDERED (Are ) (R ) ( 11 Urgency Type ORIGINAL 'CANCELLATION 'REVISION AMOUNT 'REVISION DATES r REVISION OTHER ❑✓ ❑ ❑ ❑ ❑ Contractor Information: Notifications should be submitted by the contractor performing the project csLelf—e 610414 cd0s1IAREG 00049 AQMD D 076397 c1¢CK 6151 FEE $ 57.18 'DATE 07/16/2014 PRO' Ec" 14139 Company Name ShcMey Construction Co., Inc. dba Bricldey Environmental List Site Supervisor(s) Phone Address 957 Reece street Rafael Aguayo / Martin Cruz (909) 888-2010 City San Bernardino State CA Zip 92411 Alfonso Rios / Christian Ibarra (909) 888-2010 Completed by Kathleen Herrera/Jessica Johns Phone (909) 888-2010 Dane Brickley / Allen Fields / Mike Moon (909) 888-2010 Site Information: Copies of this notification and the CAC asbestos survey report must be kept at the worksite during this project Site Nara Commercial Building SiteAddress 77965 Avenida Montezuma Cross Sheet Avenida Navarro Site City La Quinta State CA Zlp 92253 County Los Angeles Site Owner JTN Land Company Contact Angel Garcia Phone (310) 538-8000 OHmerAddress 1983 W.190th Street, Suite 100 City Torrance State CA Zip 90504 Describe Work Asbestos Removal DesaibeworkLocation(s) Throughout building Removal Project Start Date 07/30/2014 Removal Project End Date 07/30/2014 Project Work Shift Day E) Swing Q Night Q 2BUILDING SIZE In sq It 1200.00 Number of Floors 1 Building Age (rears) Number of Buildings or Dwelling Units BUllding Priori SCHOOL HOSPITAL CONDO/APT PUBLIC BLDG. INDUSTRIAL COMMERCIAL OFFICE UNUCOLLEGE HOUSE SHIP OTHER Present Use ❑ ❑ ❑ ❑ ❑ a ❑ ❑ ❑ ❑ Required Building Monnation ASBESTOS SURVEY? ASBESTOS FOUND? ASBESTOS REMOVED? BUILDING TO BE DEMOLISHED? YES Q NO Q YES C) NO 4 YES O NO (D YES © NO Q Asbestos Information: Do not provide this information in demolition notifications, see pg 2 Asbestos Amount to be Removed FRIABLE CLASS I CLASS II 2 TOTAL in sq ft 452.00 AMOUNT 452.00 I4nountofEach ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) Type of Asbestos gq ft DRYWALL PLASTER TRANSITE ROOFING OTHERPLEASE DESCRIBE OTHER TYPE OF ASBESTOS: 432.00 Mirror Mastic - 20 Asbestos Removal From SURFACES PIPES ❑ COMPONENTS ❑ Asbestos Detection Procedures: Check the procedures and analytical methods used to determine the presence of asbestos in the building. See SurmyCriedc st SURVEY [Z] BULK SAMPLING ❑ INSPECTION ❑ CAC ASSUMED AS ASBESTOS•PACM ❑ PLM ❑ PCM ❑ TEM ❑ Controls: Check the combination of Rule 1403 procedures used to control asbestos emissions. (Procedure 4 and 5 submit plans for AQMD prior approval) PROCEDURE NUMBER 1 ❑� 2 ❑ 3 it 4 ❑ 5 ❑ Emergency Asbestos Removal: Check the sudden unexpected event and attach a letter from the person affected by the emergency explaining how this event caused unsafe conditions, equipment damage or unreasonable financial burden. For disturbed/damaged asbestos materials see Procedure 5 Guidelines. FIRE FLOOD WATER DAMAGE EARTHQUAKE NUISANCE VANDALISM HEALTH/SAFETY FINANCIAL BURDEN EQUIPMENT DAMAGE OTHER ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Name of Person Declaring/ Date of Hour of Authoriang the Emergency Phone Emergency Emergency AQMD USE ONLY: SCREENED BY RECEIVED POSTMARKED ENTERED BY NOTIFICATION # 2 Fees are per Notification and vary according to the 2TOTAL AMOUNT of asbestos removed or the demolition 2BUILDING SIZE 0 South Coast Air Quality Management District, Notification of Demolition or Asbestos Removal Form (2014.07) Page 1 of 2 sa F1ipp,T.F?F�'. MCI CONSTRUCTION COMPANY 82-746 KYLE DRIVE Invoice Date: 11/6/2014 Ire City of La Quinta 13- 1&41 INVOICE # INV -107 Date Due: 12/6/2014 Record # Record Type Fee Group Fee Description Quantity Amount CSCS-13-1641 BUILDING, COMMERCIAL BLDG CITY STAFF - PER HOUR HOURLY CHARGE - BLDG CITY 0.5 $72.50 STAFF HOURLY PLAN CHECK - YES 1 $70.00 $142.50 Invoice.Total: $142.50 CITY OF LA QUINTA BUILDING & SAFETY DEPT. ,gin;' FOR CONSTRUCT[ON DATE 111. Please send your payment to this address: I Printed: Thursday; November 06, 2014 10:17 AM 1 of 1 " SYS7EM5