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DSF (05-0837).O. Box 1504 8-495" CALLE TAMPICO iA QUINTA, CALIFORNIA 92253 MAR 18.2005 N7l► AF � �e BUILDING PERMIT !Application Number . . . . Property Address . . . . . APN: Application description Property Zoning Application valuation . Owner NRI CCP I C/O NRI CCPI 81100 AVENUE 53 LA QUINTA CA 92253 BUILDING & SAFETY DEPARTMENT ` (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-71153 05-00000837 Date 3/16/05 53555 MONROE ST 767-210-043- -000000- DEMO - SINGLE FAMILY LOW DENSITY RESIDENTIAL 0 Contractor DEMO UNLIMITED, INC. 81750 AVENUE 50 INDIO CA 92201 (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 ---------------------------------------------------------------------------- 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 RANCH HOUSE & BARN; ABANDON SEPTIC - BLDG. A 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 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date Architect or Engineer: Architect or Engineer's Address: 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.). 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.). U I am exempt under Sec. , BA P.C. for this reason WORKERS' COMPENSATION DECLARATION 1 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 cerfify 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. r 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 1 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 /� Lender's Address `+ APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety 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 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-mentioned roperty for inspection purposes. OSgn9( ature (Applicant or Agent): Mar y ZM b 3PM UEN UNLIMIItU No 5001 P 2 ENVIRONMENTAL' KLEA.N-UP coawwots state Lkense 11681979 D&M N-595 NOTICE OF COMPLETION THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO SCAQNID, CAL -OSHA & EPA REGULATIONS AT: THE RANCH HOUSE 81-100 Avenue 53 Indio, CA 92203 14D 4 A JOB # EKU-204-107-N Asbestos abatement and disposal of friable asbestos containing materials (ACM) per survey report number PM0628#1501 provided by Scott Morrison & Associates dated July 9th 2004. DATE March 4; 2005 JOB NAME The Hideaway Project/ Demo Unlimited PROJECT COMPLETION WITNESSED BY �%p+. P,U�iX�•� �Gli�?il2 Beverley J. Gann P.O. Box 285 • Mira Loma, CA 91752 Phone (909) 685-S314 • Fax (909) 681-5559 10 39Vd n>i3 6SSST89ZS6 vv=9T 500L/60/E0 MAN . . .... .... in . . . . . . . . . . . . . . . . . . . . . . . Iwo X.tAi A" "'T wa ME ................ lamb ............... P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORRISON & ASSOCIATES $ ASBESTOS SURVEY REPORT Completed On July 09th, 2004 r ; PLM0628#1501 Client: Lori Emery Emery Land Clearing P.O. Box 1009 Thermal, CA 92274 Project: The Hideaway (Building "A" on diagraml 81-100 Ave. 53 J Indio, CA ("The Ranch House") 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 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 (15) bulk samples were submitted to Carolina Environmental, Inc. located at: 107 New Edition Court in Cary, NC (NVLAPCode 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 pfesent. 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 r P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORMON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 PLM0628#1501 - The results on the following page(s) indicate that asbestos (greater than 1.0%) was detected in 07 of,the 15 samples analyzed. Sample #HI -01 F Type of material: acoustic ceiling spray Location: ceiling, NW.lobby area Area:approx. 5,000 total sq. ft. throughout interior Friable:yes Results: 5% Chrysotile asbestos. Sample #HI -02 Type of material: acoustic ceiling spray Location: ceiling, N. -central room Area:approx. 5,000 total sq. ft. throughout interior Friable:yes Results: 5% Chrysotile asbestos Sample #HI -03 Type of material: acoustic ceiling spray Location: ceiling, SE office area Area:approx. 5,000 total sq. ft. throughout interior Friable:yes Results: 5% Chrysotile asbestos Sample #HI -04 Type of material:final coat/ white ' Location: interior S. wall, SE office Area: interior walls -1 st layer Friable:no Results: none detected Sample #HI -05 Type of material: drywall Location: interior S. wall, SE office Area: interior walls -2nd layer Friable= Results:none detected Sample #HI -06" Type of material:vinyl flooring/ beige -grey Location:floor, S -central (copy) room Area:approx. 55 sq. ft. Friable:no Results: 25% Chrysotile asbestos Sample #HI -07 Type of material: mastic/ beige f Location:under sample #HI -06 Area:approx. 55 sq. ft. Friable:no Results: 5% Chrysotile asbestos Sample #HI -08 Type of material: exterior wall stucco/ It. brown Location: exterior E. -central wall Area:throughout exterior -1 st layer Friable:no Results: less than 1% Chrysotile asbestos . N (2) E R P.O. Box 55329 Riverside, CA 92517 (909)624-1665 PLM0628#1501 SCOTT MORMON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 Sample #HI -09 Type of material: exterior wall plaster/. grey Location: exterior E.central wall Area:throughout exterior -2nd layer Friable:no Results: none detected Sample #HI -10 Type of material: exterior wall stucco/ tan Location: exterior N. -central wall Area:throughout exterior walls Friable:no Results: none detected Sample #HI -11 Type of material: acoustica I spray Location: exterior W. roof overhang Area:exterior W. roof overhang Friable:yes Results: 8% Chrysotile asbestos Sample #H 1-12 Type of material:joint compound (mudded drywall tape) Location: exterior W. roof overhang Area: exterior W. roof overhang Friable:no Results: 3% Chrysotile asbestos Sample #H 1-13 Type of material: roofing felt/ black Location -under clay roof tiles ' Area:throughout roof Friable:no Results.- none detected Sample #H 1-14 Type ofmaterial:rolled roofing/ grey Location: E. flat roof area -1st layer Ar.ea:approx. 230 sq. ft. , Friable:no Results: none detected Sample #H 1-15 Type of material: roofing felt/ black Location: E. flat roof area -2nd layer Area:approx. 230 sq. ft. Friable:no Results: none detected (vote: 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 (2) Ju1-06-04 09:15am From-CAROLINVENVIRONMENTAL +4811442 T-474 P.02/06 F-187 LABORATORY REPORT couNaE;,MRONrg,wc BULK ANALYSIS 107,Wj4 WomCouft,QV, NCNMI -ASBESTOS phone: (919) 4811413 Fax: (919) 48.1=1.442 Client: Scott Morrison & Associates CEI Lab Code: A04-4858. 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: PLM0628#1501 t % CEIr CLIENT -11) LAB ID HOMOGENEITY DESCRIPTION ASBESTOS HI -01 A276289 ACOUSTIC CEILING CHRY 5% Heterogeneous, Off-white, Ton,- Fibrous, Bound CHRY 5% BIND 45% CELL 0 % rOAM 35% ' PAINT 15% HI --02 A276290 ACOUSTIC CEILING CHRY 5% Heterogeneous, Off-white, Tan, Fibrous, Bound CHRY 5% BIND 45% CELL <1 % FOAM 35% PAINT 15% HI -03 A276291 ACOUSTIC CEILING CHRY 5% Heterogeneous, Off-white, Fibrous, Bound CHRY 5% BIND 45% CELL <1 % FOAM 35% ~ PAINT 15% HI -04 A276292 FINAL COAT ND Heterogeneous, Off-white, Fibrous, Bound BIND 75% CELL 15% MICA 10 HI -05 A276293 DRYWALL ND Heterogeneous, Off-white, Tan, Fibrous, Sound - GYPSUM 75% CELL 15% BIND 10% HI -06 A276294 VINYL FLOORING CHRY 25% Heterogeneous, Beige, Grey, Fibrous, Bound CHRY 250/0 VINYL 50% CELL 5% BIND 20% i Page 1 Jul-06-04 09:15am From-CAROLINA ENVIRONMENTAL +4811442 T-474 P.03/06 F-187 r CAROUNAEWRONMENTAL,INC• Project: PLM0628#1501 107 New Edon Court, Cary, NC 27511 ., l pt a-w, 919.481-1413 Fax : 919.481-1442 Lab Code: A04-4858 1 CEI CLIENT ID HOMOGENEITY DESCRIPTION HOMOGENEITY ASBESTOS . LAB ID HI-07, A276295 MASTIC CHRY 5% Heterogeneous, Beige, Fibrous, Bound CHRY 5% MAST 90% CELL 5% Mastic contaminated from fibrous backing layer of vinyl flooring. ` HI-08 A276296 STUCCO CHRY <1% Heterogeneous, Tan, Non-fibrous, Bound CHRY -1% PLAS 95% CELL PAINT 5% HI-09 A276297 PLASTER ND. Heterogeneous, Grey, Non-fibrous, Bound PLAS 100% CELL <1 % HI-10 A276298 STUCCO ND Heterogeneous, Beige, Non-fibrous, Bound PLAS 95% CELL % PAINT 5% HI-11 A276299 ACOUSTIC SPRAY CHRY 8% Heterogeneous, . Off-white, Tan, Fibrous, Bound CHRY 8% BIND 45% CELL �1 FOAM 32% PAINT 15% HI-12 A276300 JOINT COMPOUND CHRY 3%- Heterogeneous, Off-white, Fibrous, Bound CHRY 3% BIND 75% CELL S MICA 12 PAINT 5% a HI-13 A276301 ROOF FELT ND Heterogeneous, Black, Grey, Fibrous, Bound TAR 40% CELL 45 % MICA 10% ' BIND 5% Page 2 Jul -06-04 09:15am From -CAROLINA ENVIRONMENTAL +4811442 T.-474 P.04/06 F-187 CAROUNAUMRONMENTAL,INC. Project: PLM0628,41501 107 New Edition Court Cary, NC 27511 Phone: 919481-1413 Fax' 919481-1442 Lab Code: A04-4858 CEI% CLIENT ID HOMOGENEITY DESCRIPTION ASBESTOS LAB ID HI -14 A276:302 ROLLED ROOFING ND Heterogeneous, Black, Grey, Fibrous, Bound TAR 30% CELL 20% GRAY* 30% SYNT 15% ` MICA 5 H1-15 A276303 ROOF FELT ND Heterogeneous, Black, Brown, Fibrous, Bound TAR 45% CELL 55% Xul-06-04 09:15am From -CAROLINA ENVIRONMENTAL +4811442 T-474 P.05/06 F-187 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 SIND = Binder GROG = Crocidolite ORGN = Organics MI = Silicates TREM = Tremolite SYNT = Synthetics GRAY = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTN = Actinolite CERWL = Ceramic Wool PLAS =Plaster N D = None Detected NTREM = Non-Asbestiform PERIL = Perlite NANTH = Non-Asbestiform: Tremolite RUBR =Rubber Anthophyllite CLIENT: Scott Morrison & Associates PROJECT: PLM0628#1501 CEI LAR'CODE: A04-4858 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" (NO) 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 #101168-0. This report is not to be used to claim product endorsement by NVLAP or any agency of the U. S. Govemment_ 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 Tianbao Qai, Ph.D. Laboratory Director End of Report CHAINOF CUSTODYr-!r -7vie U To: Carolina Environmental, Inc. From: Scott Morrison & Associ$tes 107 New Edition Court W P.O. Box 55329 Cary, NC 27511 LL Riverside, CA 92517 (919) 481-1413 o (760) 323.7743 NVLAP Code 10176" CA RLAP #ZW ac o-cr �E So+� ,'S it 9Z 3lyz Client: �' � WyDF AwAy Person Taking Samples• IL t �(-T A site Address 01_ ioo Job No. © Pti Material & Description PLM AA -Pb Other Information Sample # Sample Date `� N P. C -C- SYrc Fc LI NG- "'`tin► N 2 u2S —O-�) l� \471: - o E tj-L cjDAT- .– 0 -t:zf w# i I E �y _p� o z 97 p - 5 GaA WS'tucc� - bc,* �fzowr-� V9 i C 0-5 1 iL cJ �� -'Poe, R r iYY` " ���-�, 2u,�All of CU '02 o 03 `1-5 o 'ooReceived`�•c�9 Fax in Results T No ��,�Date1T`ime: � �'Oy %•'�oPr Relinquished By: a-- Datell`ime: . By: Ma8/Fax To: Scott Morrison & Asociates, 31855 Date Palm Dr., Ste. #3-507, Cathedral City, CA 92234, (769) 323-7743