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DEMO (05-0898)o�� !• 2, BUILDING & SAFETY DEPARTMENT c t� is 150442 .... . f (760).777-7012 �M9 78- -C �ALLE TAM-PICO • S FAX (760) 777-701 1 D LA QU N,A, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT CIS ofNC�D�', Ap lic =`ro Number .5-00000.898 Date 3/16/05 Property Address 53555 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:" A7C21 Other struct info NUMBER OF UNITS 2.00 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 MOBILE HOME STRUCTURE SOUTH OF "RANCH HOUSE" - BLDG. 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. B O a 1504 ��r�G� 78-495 CALLS TAMPICO Y VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 44FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: 3 -17 - Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: t3UiLUINU 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.). >� as owner of the properly, 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.). L) I am exempt under Sec. , BA P.C. for this reason ,,�ate 6r 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. 1 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, t shall )forthwith comply with those provisions. oe ,-O-ate 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. 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 Name Lenders Address l" IMPORTANT Application is hereby made to the Director of Building APPLICANT and Safetyfor . permitf ACKNOWLEDGEMENT subject 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. 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 county to enter upon the above -m ntion d property for inspection purposes. uat9-fi Cis S lure (Applicant or Agent): KLEAN-UP Connectors State License #68W9 • DOSI1 #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:, Mobil Home (South of Ranch14 use 91-500 Avenue 53 (Buildin ' on Diagram) Indio, CA 92 JOB # EKU-204-107-L Asbestos abatement and disposal of friable asbestos containing materials (ACM) per survey report number PLM0629#0610 provided by Scott Morrison & Associates dated July 10, 2004. DATE January 18, 2005 JOB NAME The Hideaway Project/ Demo Unlimited PROJECT COMPLETION WITNESSED BY Beverley J. Gann P.O. Box 285 • Mira Loma; CA 91752 Phone (909) 685-5314 • Fax (909) 681-5559 ZO 39dd nA3 6999THT96 55:60 5007/T8/E0 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 10th, 2004 PLM0629#0610 Client: Lori Emery Emery Land Clearing P.O. Box 1009 Thermal, CA 92274 Project:The Hideaway (Building °L" on diagram - Indio, CA (Mobile home structure south of "ranch house") On June 29th, 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 (06) bulk samples were .submitted to Carolina Environmental, Inc. located at: 107 NeEdition 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's telephone number is (919)481-1413: 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., NVLAR#101768-0 The results on the following page(s) indicate that asbestos was detected in 02 of the 06 samples analyzed. aA P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORRISON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 s Cathedral City, CA 92234 (760)323-7743 PLM0629#0610 Sample #H 1-122 Type of material: linoleum/ yellow-brown Location: kitchen, bathroom floors Area:approx. 200 total sq. ft. Friable:no ," Results: 25% Chrysotile asbestos Sample #H 1-123 Type of material: linoleum mastic/ tan Location: under sample #H 1-122 Area:approx. 200 total sq. ft. Friable:no Results: 5% Chrysotile asbestos Sample #HI -124 Type of materialsoof shingle/ red -black , Locationsoof-1st layer Area:throughout roof Friable:no Results: none detected Sample #H 1-125 Type of material:roof shingle/ brown Location: roof -2nd layer Area: throughout'roof Friable:no Results: none detected Sample #H 1-126 Type of material: roofing felt/ brown Location: roof -3rd layer Area:throughout roof Friable:no Results:none detected Sample #H 1-127 Type of material: roofing felt/ black Location:roof-4th layer, Area:throughout roof 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 A04, Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 (2) e ; Jvl-06-04 10:02am From -CAROLINA ENVIRONMENTAL, ., +4811442 T-478 P.02/04 F-191 J LABORATORY REPORT ' CAROUNAENVIRONIVIR4TAI, INIC. 10yN6wEdbx1CoultCary,NC27511 ASBESTOS BULK ANALYSIS Phone; (919) 4811413 Fac (919) 4811442 Client: Scott Morrison & Associates CEI Lab Code: A04-4868 31855 Date Palm Dr. Suite 3-507 Received: 07-02-04 Cathedral City, CA 92234 Analyzed: 07-06-04 Reported: 07-06-04 Analyst: Scott Minyard Project; PLM0629#061 0. CLIENT ID LAS ID r HOMOGENEITY DESCRIPTION % ASBESTOS HI -122 A276410 LINOLEUM CHRY 25% Heterogeneous, Beige, Grey, Fibrous, Bound CHRY , 25% VINYL 50% CELL 5% ' BIND 20% HI -123 A276411 MASTIC CHRY 5% Heterogeneous, Tan, Fibrous, Bound - CHRY 5% MAST 65% CELL • 30% Mastic contaminated from fibrous backing layer of vinyl flooring. HI -124 A276412 ROOF SHINGLE ND Heterogeneous, Black, Pink, Fibrous, Bound TAR 30% CELL 35% GRAV 30 $ILI 5%. HI -125 A276413 ROOF SHINGLE ND Heterogeneous, Black, Grey, Fibrous, Bound TAR 30 % CELL 35% GRAY' 30% SILI 5 HI -126 A276414 ROOF FELT ND Heterogeneous, Black, Brown, Fibrous, Bound TAR 40% CELL 55% BIND 5% HI -127 A276415 ROOF FELT ND Heterogeneous, Black, Brown, Fibrous, Bound TAR 40% CELL 55% BIND 5 % Page 1 J0-06-04 10:02am From -CAROLINA ENVIRONMENTAL +4811442 T-478 P.03/04 F-191 The following definitions apply to the abbreviations used In the ASBESTOS BULK ANALYSIS REPORT: CHRY = Chrysotile CELL = Cellulose DEER = Debris AMOS = Amosite FBGL = Fibrous Glass BIND = Binder CROC = Crocidolite ORGN = Organics SILT = Silicates TREM = Tremolite SYNT = Synthetics GRAV = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTN = Actinolite . CERWL = Ceramic Wool PL -AS = Plaster N D = None [)elected* NTREM = Non-Asbestiform PERL = Periite NANTH = Non-Asbestiform Tremolite RUBR =Rubber Anthophyllite CLIENT: Scott Morrison & Associates PROJECT: PLM0629#0610 CEI LAB CODE: A04-4868 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 1 % 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 tile 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 / 600 / M4-82 / 020 for the analysis of asbestos in building materials. Procedures described in EPA / 600 / R-93 / 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. ANALYST REVIEWED BY Tianbfao Doi, Ph.D. Laboratory Director End of Report . CHAIN OF CUSTODY From: Scott Morrison & Associates • To: Carolina Environmental, Inc. P.O. Box 55329 107 New Edition Court Riverside, CA 92517 Cary, NC 27511 (760) 323-7743 (919) 481-1413 NVLAP Code 1017684 CA FLAP #2483 a f ' Client: _T- C L AA)j AN Person Taking Samples: (9,5 ' h [ �W-DJob No. Site Address ► - W R 0 0 Sample # Sample Date Material & Description PLM AA -Pb Other Information — l2 'LOQ- AIV STC C- F -3 tf 1mr,CE •_ (2* -b I F , . -' ( J t. i Fax in Results ? No o o Relinquished By: ®--� DateMme: CC / ' �� Received By: Al 4 • �' ,> Mail/Fax To: Scott Morrison & Asociates, 31955 Date Palm Dr., Ste. 0-507, Cathedral City, CA. R7