DEMO (05-0897)z
U
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760) .777-7012
C
IF = 78 -fl -A,
TAMPICO FAX (760) 77.7-7011
LA A, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
MAR 18 20051 BUILING PERMIT
CITY OF LA QUINTA
FINANCE DEPT.
Application Number •. . . .05-00000897 Date 3/16/05
Property Address . . . 3555 MONROE:ST
APN: 767-210-043- -000000-
Application description . . DEMO - COMML/OTHER
Property Zoning . . . . LOW DENSITY RESIDENTIAL
Application valuation 0
Owner Contractor
NRI CCP I DEMO UNLIMITED, INC.
C/O NRI.CCPI 81750 AVENUE 50
81100 AVENUE 53 INDIO CA 92201
LA QUINTA CA 92253 (760) 775-5884
WCC': HRH INS
WC: 009421-2005 01/01/06
CSLB: 473328 05/31/05
CCC: A -C21
Other struct info . . NUMBER OF UNITS 2.00
y
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -•- - - - - - - - - - -
Permit DEMO PERMIT
Additional desc
Permit Fee 45.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 45.00
----- - ---------
Special Notes and Comments
DEMO TO BARE GROUND DOUBLE WIDE MOBILE
HOME - BLDG. C.
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 � VOICE (760) 777-7012
78-495 CALLS CALIFORNIAO FAX (760) 777-7011
LA QUINTA, IFOR9225344 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:y Z� - 2:� If /
Applicant:
Applicant's Mailing Address:
Date: 3 (�—
Architect or Engineer:
Architect or Engineer's Address:
13/A
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 Professionals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 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.).
1, 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
-/;�'O-
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.
_ I 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
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
p !forthwith comply with those provisions.
ate_ 7yg<.05 ,plicant
WARNING: FAILURE TO SECURE WORKERS' 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.
I hereby affirm under penalty of perjury that there is a construction lending lg age cyorJthe peAGENCYING
performance of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address �� /A,
-
r
APPLIC
NT
IMPORTANT Application is hereby made to the Director of Building and Safety for ACKNOWLEDGEMENT
subDGEoM he 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 Ouinta, 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.
1 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 upon the above-mentioned property for inspection purposes.
Xte �`Signature (Applicant or Agent)
ENVIRONMENTAL
I LEAN -UP
Contractors Stec License #684979 DOSH #595
NOTICE OF COMPLETION
THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT
PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO
SCAQMD, CAL -OSHA & EPA REGULATIONS AT:
Double Wide Mobil Home
9.17500 Avenue 53 (Building "C" onDiagram)
Indio, CA 92203
JOB #
EKU-204-107-C
Asbestos abatement and disposal of friable asbestos containing materials (ACM)
per survey report number PLM062891102 provided by Scott Morrison & Associates
dated July 7, 2004.
DATE
January 1$,,2005
JOB NAME
The Hideaway. Project/
Demo Unlimited
PROJECT COMPLETION WITNESSED BY
Beverley J. Gann
P.0. Box 285 • Mira Loma, CA 9.1752
Phone (909) 685-5314 • Fax (909) 681-5559
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90 39dd n>13 6SSSZ89ZS6 SS:6A 5AA7TA/PA
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329 31855 Date Palm Drive, Ste. #3-507
Riverside, CA 92517 Cathedral City, CA 92234
(909)624-1665 (760)323-7743
ASBESTOS SURVEY REPORT
Completed On
July 07th, 2004
PLM0628#1102
Client: Lori Emery
Emery Land Clearing
P.O. Box 1009
Thermal, CA 92274
Project: The Hideaway
CBuilding "B° and "C"
Via Pessaro
Indio, CA
(2 -story barn and mobile home)
On June 28th, 2004 an asbestos inspection and bulk sampling was conducted at the above project
address. Bulk samples were taken of all suspect asbestos containing building materials (ACBM) at the
request of the client named above. A total of (11) bulk samples were submitted to Carolina j
Environmental, Inc. located at: 107 New Edition Court in Cary, NC (NVLAP Code 101768-0 and Cal.
Environ. Lab. Cert..#2483) to estimate the percentage of asbestos by volume and determine the type(s)
present .
Carolina Environmental, Inc. determines percentages and type of asbestos by using EPA approved
method 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Samples. Bulk
samples are analyzed by PLM (Polarized Light Microscopy). Asbestos is quantified by using the visual
arena estimation technique'and can only determine the approximate percentage of asbestos present.
After a thorough search is conducted and no asbestos is detected "none detected" will be noted in the
report. The essence of polarized light microscopy is not to emphatically determine that no asbestos is
present, merely that none was detected or, if it was, it was likely to be less than 1.0% of the sample.
When findings reveal less than or close to 1.0% asbestos contained in a sample, further analysis may be
called for on additional samples to confirm or denounce the initial findings. The California Code of
Regulations (CCR 1529) requires bulk sampling be conducted according to the A.H.E.R.A. protocol
provisions of 40 CFR Part 763.86. The A.H.E.R.A. protocol recommends three (3) or more friable
surfacing samples from a homogeneous area be collected and analyzed before any building material is
determined to be non -asbestos containing. Scott Morrison & Associates conducts asbestos, inspection
surveys following the A.H.E.R.A. inspection protocol.
ASBESTOS INSPECTION BY: Scott Morrison, DOSH #92-0248
BULK SAMPLES ANALYZED BY: Carolina Environmental, Inc., NVLAP #101768-0
(1)
Sample #HI -19
Type of material: drywall tape- white/beige
(2)
Location: interior east wall of central bathroom
SCOTT MORMON & ASSOCIATES
P.O. Box 55329 -
31855 Date Palm Drive, Ste. #3-507
Riverside, CA 92517
Cathedral City, CA 92234
(909)624-1665
(760)323-7743
Location: floor of kitchen, southeast room, baths (2)
Area: approx. 1100 total sq. ft.
The results -on the following page(s) indicate that asbestos (greater than 1%) was detected in 03 of the
11 samples analyzed.
Sample #HI -21
PLM0628#1102
Samples #HI -16 thru #HI -19 were taken from the 2 -story barn labeled "bldg. B"..See diagram.
Sample #H 1-16
Type of material: rolled linoleum floor- brown(1 rst layer)
Friable:no
Location: floor of northwest room
Sample #HI -22
Area: approx. 140 sq. ft.
Friable:no
Results: 25% Chrysotile asbestos
Sample #H 1-17
Type of material: floor mastic- gray (2nd layer) „
Friable:no
Location: under sample #H 1-16
Area: approx. 140 sq. ft.
Friable:no
Results: 10% Chrysotile asbestos
Sample #H1=18
Type of material: drywall only
Location:'interior east wall of central bathroom
Area: throughout interior walls of bathroom
Friable:no
Results: none detected
Sample #HI -19
Type of material: drywall tape- white/beige
(2)
Location: interior east wall of central bathroom
Area: interior drywall seams
Friable:no
Results: none detected
Samples #HI -20 thru #HI -26 were taken from the double wide home labeled "bldg. C". See diagram
Sample #HI -20
Type of material: rolled vinyl floor -brown (1 rst layer)
Location: floor of kitchen, southeast room, baths (2)
Area: approx. 1100 total sq. ft.
Friable:no
Results: 25% Chrysotile asbestos
Sample #HI -21
Type of material: floor mastic- tan (2nd layer)
Location: under sample #HI -20
Area: approx. 1100 total sq. ft.
Friable:no
Results: less than 1% Chrysotile asbestos
Sample #HI -22
Type of material: ceiling panel- white ,
Location: interior ceiling of kitchen
Area: throughout interior ceilings
Friable:no
Results: none detected
(2)
SCOTT MORRISON_ & ASSOCIATES'
P.O. Box 55329 31855 Date Palm Drive, Ste. #3-507
Riverside, CA 92517 Cathedral City, CA 92234
(909)624-1665 (760)323-7743
PLM0628#1102
Sample #HI -23
Type of material: drywall
Location: interior wall of HVAC closet
Area: throughout interior walls
Friable:no
Results: none detected
Sample #HI -24
Type of material: roof shingle- red painted (1rst layer)
Location: exterior roof of mobile home
Area: approx. 1370 total sq. ft.
Friable:no
Results: none detected
Sample #HI -25
Type of material: roof shingle- brown (2nd layer)
Location: under sample #HI -24
Area: approx. 1370 total sq. ft. ,
Friable:no
Results: none detected
Sample #HI -26
Type of material: roof felt- black (3rd layer)
Location: under sample #HI -25
Area:
Friable:no
Results: none detected
Note: All asbestos containing building material(s) containing greater than 1.0% asbestos by volume or
weight, must be removed by a state certified asbestos abatement contractor prior to any demolition or
renovation of the property.
Inspector
Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
(3)
Jul-06-04 03:39pm Frcm-CAROLINA ENVIRONMENTAL +4811442 T-498 P.02/05 . F-214
LABORATORY REPORT
Q WUNAEPMRONMENTA4IWI
1&.Ni k-EdilioncowtCmy,NC27611
ASBESTOS BULK ANALYSIS
phorie: (918). 4811413 Fax: (919) 4814442
Client: Scott Morrison & ASS®CIaatOS CEI Lab Code: A04-4859
31855 Date Palm Dr. Suite
3-507 Received: 07-02-04
Cathedral City, CA 92234 _ Analyzed: 07-06-04
Reported: 07-06-04
Analyst: Gary A. Swanson
Project: PLM0628#1102
CEI%
CLIENT ID LAB ID
HOMOGENEITY DESCRIPTION ASBESTUS
HI-16 A276304
LINOLEUM CHRY 25%
Heterogeneous,
Brown, Grey, Fibrous, Bound
CHRY 25% VINYL 50% CELL 5%
BIND 20%
HI-17 A276305
MASTIC CHRY 10%
Heterogeneous,
Grey, Fibrous, Bound
CHRY 10% BIND 90%
HI-18 A276306
DRYWALL ND
Heterogeneous,
Brown, White, Fibrous, Bound
BIND 80% CELL 20%
HI-19 A276307
DRYWALL TAPE ND
Homogeneous,
White, Beige, Fibrous, Bound
BIND 50%, CELL 50%
HI-20 A276308
ROLLED VINYL FLOORING CHRY 25%
Homogeneous,
Brown, Grey, Fibrous, Bound
CHRY 25% VINYL 50% CELL 6%
BIND ' 20%
HI-21 A276309
MASTIC CHRY <1 %
Homogeneous,
Yellow, Fibrous, Bound
CHRY eARK MAST 95% CELL 5%
Page 1
Jul -06-04
03:40pm From -CAROLINA ENVIRONMENTAL +4811442
T-408
P.03/05 F-214
CAROLINIE.NIARONMENTALINC•
Project: PLM0628#1102
107 New mon Court, Cary, NC 21511
Phone: 919AW-1413 Fax: 919.481-1442
Lab Code: A04-4859
CLIENT ID
CEI
HOMOGENEITY DESCRIPTION
ASBESTOS
LAB ID
HI -22
A276310
CEILING PANE,
NO
Heterogeneous,
White, Brown, Fibrous, Loosely Bound
PAINT 5% CELL -
95%
HI -23
A276311 ;
ND
'DRYWALL
Heterogeneous,
White, Brown, Fibrous, Bound
SIND 80% CELL
20%
HI -24
A276312
ROOF SHINGLE
NO
Heterogeneous,
Red, Black, Fibrous, Bound
GRAV 20% FBGL
20%
TAR 60%
HI -25
ND
A276313
ROOF SHINGLE
Heterogeneous,
Brown, Black, Fibrous, Bound
GRAV 20% CELL
40%
TAR 40%
HI -26
A276314
ROOF FELT
ND
Homtqeneous,
Black, Fibrous, Bound
TAR 30% CELL
70%
i
Jul -06-04 03:40pm From -CAROLINA ENVIRONMENTAL
+4811442 T-498 P.04/05 . F-214
The following definitions apply to the abbreviations used in the ASBESTOS BULK
ANALYSIS REPORT:
CHRY
= Chrysotile
CELL
= Cellulose
DEBR = Debris
AMOS
= Amosite
FBGL
= Fibrous Glass
BIND = Binder
CROC
= Crocidolite
ORGN
= Organics
SILT = Silicates
TREM
= Tremolite
SYNT
= Synthetics
GRAV = Gravel
ANTH
= Anthophyllite
WOLL
= Wollestonite
MAST = Mastic
ACTN
= Actinolite
CERWL = Ceramic Wool
PLAS =Plaster
N D
= None Detected
NTREM = Non-Asbestiform
PERL = Perlite
NANTH = Non-Asbestiform
Tremolite
RUBR =Rubber
Anthophyllite
CLIENT: Scott Morrison & Associates
PROJECT: PLM0628#1102
CEI LAS CODE: A04-4859
Stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical technique used
for sample identification. The percentage of each component is visually estimated by volume. These results pertain only
to the samples analyzed. The samples were analyzed as submitted by the client and may not be representative of the larger
material in question. Unless notified in writing to return samples, Carolina Environmental, Inc. will discard all bulk samples
after 30 days.
Many vinyl floor tiles have been manufactured using greater than 11% asbestos. Often the asbestos was milled to a fiber
size below the detection limit of polarized light microscopy. Therefore, a "None Detected" (ND) reading on vinyl floor the
does not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive
form of analysis for vinyl floor tiles.
It is certified by the signature below that Carolina Environmental, Inc. is accredited by the National Voluntary Accreditation
Program (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA 1600 / M4-82 / 020 for
the analysis of asbestos in building materials. Procedures described in EPA / 6001 R-931 116 have been Incorporated
where applicable, The detection limit for the method is 0.1 % (trace amount). Carolina Environmental, Inc.'s NVLAP
accreditation number is #101768-0. This report is not to be used to claim product endorsement by NVLAP or any agency
of the U. S. Government, This report and its contents are only valid when reproduced in full. Dust and soil analyses for
asbestos using PLM are not covered under NVLAP accreditation.
ANALYs'r
REVIEWE=D BY
7ianboo Doi, Ph.D.
Laboratory Director
End of Report
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107 New Edition Court
P.O. Bax 55329 Cary, NC 27511
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Riverside, CA 92517 (919) 481-1413
(760) 323-7743 r1V,nr Ceft ia176" CA $i.AP #2483
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Sample #
Sample Date Material & Description
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Maiffgm To: Soon Momison & Asociates, 31855 Date Palm Dr., Ste. #3-507, Cathedral City, CA 92234, (764) 323-7743