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DSF (05-0889)5r BUILDING & SAFETY DEPARTMENT x 1504 (760).777-7012 Cb�OO CALLE TAMPICO FAX (760) 777-7011 QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153 BUILDING PERMIT' App cat'on Number . . . . . �05-00000.8,89 Date 3/16/05 PropeN4 Address . . . . 53555 MONROE ST APN: 767-210-043-' --000000-. Application description DEMO - SINGLE FAMILY 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/;:3:1/05 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 SINGLE FAMILY RESIDENCE, ABANDON SEPTIC - BLDG. D 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 78-495 CALLE TAMPICO VOICE (760) 77 FAX 760) 777-7011 7-7012 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: _ G7 5 - �� Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: tj /A Lic. No.: FSUILUINU 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 1, 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 bate i 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 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. �nt 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 Lender's Address ft ACKNOWLEDGEMENTAPPLICANT IMPORTANT Application is hereby made to the Director of Building and Safetyfor permit ubo 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 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 county to enter upon the above-mentioned property for inspection purposes. ate 3 —�� re (Applicant or Agent): f ENVIRONMENTAL KLEAN-UP CoatMCWra State Uetwe #684979 • DOSH #595 NOTICE OF COMPLETION f THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT PROJECT. HAS BEEN COMPLETED IN ACCORDANCE SCAQMD, CAL -OSHA & EPA REGULATIONS AT: Single Family Residence Building "D" 81-350 Avenue 53 Indio, CA JOB # EKU-204-107-D - Asbestos abatement and disposal of asbestos containing materials (ACM) Per survey report number PLM 0628# 1003 p hovided by Scott Morrison & Associates dated July 7", 2004. DATE October 21, 200.4 q JOB NAME The Hideaway Demo Unlimited, Inc. Mel Curci PROJECT COMPLETION WITNESSED By �. (am Beverley J. Gann ' P.O. Box 285 Mira Loma, CA 91752 Phone (909) 685-5314 Fax (909) 681-5559 Contractors License 4684979 DOW #595 nv� 6S5SZ8960.6 0Z�6I b00Z/5Z/0Z � P.O. Box 55329 Riverside, CA 92517 (909) 624-1665 SCOTT MOMSON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 ASBESTOS SURVEY REPORT Completed On July 07th, 2004 PLM0628#1003 Client: Lori Emery Emery Land Clearing P.O. Box 1009 Thermal, CA 92274 Project: The Hideaway (Building "D° 81-350 Avenue 53, Indio, CA (tan & brown wood house with east attached carport) 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 (10) bulk samples were submitted to Carolina Environmental, 1nc. located at: 107 New Edition Court in Cary, NC (NVLAP Code 1.01768-0 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) P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORRISON & ASSOCIATES. 31855 Date Palm Drive, Ste. #37507 Cathedral City, CA 92234 (760)323-7743 The results on the following page(s) indicate that asbestos was detected in 01 of the 10 samples analyzed. „ PLM0628#1003 r Sample #HI -27 Type of material.- roof felt- black Location: exterior southeast ground debris Area: distributed around perimeter of home Friable:no Results: none detected Sample #HI.28 Type of material: drywall Location: interior east wall of central livingroom Area: throughout interior wall Friable:no Results.- none detected Sample #HI -29 Type of material: wall plaster- gray Location: interior west wall of livingroom Area: throughout interior wall Friable:no Results: none detected Sample #HI -30 Type of material: 9" floor tile- beige (1 rst layer) Location: floor of southwest add-on room under carpet Area: approx. 250 sq. ft. Friable:no Results: 5% Chrysotile asbestos Sample #HI -31 Type of material: floor tile mastic- black (2nd layer) Location: under sample #HI -30 , Area: approx. 250 sq: ft. Friable:no Results: none detected Sample #HI -32 - Type of material: final coat- orange (1 rst layer) Location: interior north wall of southwest room Area: throughout interior wall Friable:no Results: none detected Sample #HI -33 Type of material.- plaster- light gray (2nd layer) Location: behind sample #HI -32 Area: throughout interior wall, Friable:no Results: none detected P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORRISON & ASSOCIATES '31855 Date?alm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 PLM0628#1003 Sample #HI-34 Type of material: stucco- tan Location: interior east wall of west-central add-on room Area: throughout interior wall Friable:no Results: none detected Sample #HI-35 -Type of material: plaster- grey Location: interior ceiling of east hallway Area: throughout interior ceiling Friable:no Results: none detected Sample #HI-36 Type of material: asphalt roof- black. Location: exterior northwest roof Area: throughout exterior roof Friable:no Results: none detected Note: Unable to sample all potential flooring material due to excessive floor debris throughout home. 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 Ju1-06-04 02:56pm From -CAROLINA ENVIRONMENTAL +4611442 7-405 P.02/05 . F-211 CAROUNAIEWRONMWAL,11C LABORATORY REPORT 1 ftw.(M9)d4W441kC2uFmc(9 Phoale: 481-9413 ASBESTOS BULK ANALYSIS (919) Fax {919)481.1442 9)4 - Client: Scott Morrison & Associates CEI Lab Code: A04-4860 31855 Date Palm Dr. Suite 3-507 Cathedral City', CA 92234 Received: 07-02-04 Analyzed: 07-06-04 Reported:. 07-06-04 Project: PLM0628#1003 Analyst: Gary A. Swanson CLIENT ID CEI LAB ID % HOMOGENEITY DESCRIPTION ,ASBESTOS HI -27 A276315 ROOF FELT ND Homogeneous, Black, Fibrous, Bound BIND 60% CELL 50% HI -28 A276316 ND _R_YWALL Heterogeneous, Brown, White, Fibrous, Bound BIND 80% CELL 20% ND HI -29 A276317 PLASTER Homogeneous, Grey, Non-fibrous, Bound BIND 100% CHRY 5%u HI -30 A276318 FLOOR TILE Heterogeneous, Beige, Fibrous, Tightly Bound CHRY 5% VINYL 95% HI -31 A276319 ND MASTIC Heterogeneous, Black, Fibrous, Bound MAST 98% CELL 2% HI -32 A276320 ND FINAL COAT Homogeneous, Orange, Non-fibrous, Bound BIND 100% Page 1 Jul -06-04 02:56am From -CAROLINA ENVIRONMENTAL +4811442 T-495 P.03/05 F-211 CAROUNAENVIRONMEN%AI,INC. Project: PLM0628#1003 107 New Edition Cour, Cary, NC 27511 Phone: 919.481-1413 Fax: 915481-:1442 Lab Code. A04-4860 CLIENT ID CEI LAB 10 HOMOGENEITY DESCRIPTION % ASBESTOS HI -33 A276321 PLASTER ND Homogeneous, L.Orey, Non-fibrous, Bound BIND 100% HI -34 A276322 STUCCO ND Homogeneous; Tan, Non-fibrous, Bound BIND 100% ND HI -35 A276323 PLASTER Homogeneous, Grey, Non-fibrous, Bound SIND 100% HI -•36 A276324 'ASPHALT ROOF ND Homogeneous, Black, Fibrous, Bound TAR 35% CELL 65 c Jul -06-04 02:56pm From -CAROLINA ENVIRONMENTAL +4811442 T-495 P.04/05 F-211 The following definitions apply to the abbreviations used in the ASBESTOS BULK ANALYSIS REPORT: CHRY = Chrysotile AMOS = Amos ite CROC = Crocidolite _ TREM = Tremolite ANTH = Anthophyllite ACTN = Actinolite N D = None Detected NANTH = Non-Asbestiform Anthophyllile CELL = Cellulose FBGL = Fibrous Glass ORGN = Organics SYNT = Synthetics WOLL = Wollastonite CERWL = Ceramic Wool NTREM = Non-Asbestiform Tremolite CLIENT: Scott Morrison & Associates PROJECT: PLM0628#1003 CEI LAB CODE: A04-4860 DEER = Debris BIND = Binder BILI = Silicates GRAV = Gravel MAST = Mastic PLAS = Plaster PERIL = Perlite RUBR =Rubber 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 file 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 / M4-821020 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 01% (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, REVIEWED BY ret� Tianbac Doi, Ph.D. Laboratory Director From: Scott Morrison & Associates P.O. Boa 55329 Riverside, CA 92517 (760) 323-7743 A -WA Job No, PLt4A o 2$ # 1,41-4 OF CUSTODY To: Carolina EnWrsamentat, Inc. ..o 107 New Edition Court o Cary, NC 27511 A 0 (919) 482-1413 ^' NVLAP Code 101=4 CA LLAP #US3 Person TaWg Sam es: 3c i`T Site Address: s t -3 su S -15R D 1-:,,-N D 6 �u.Ld�+vCr� r Sade # Sample Date NUterial & Description AA -Pb Other Information -2 2 wA lL RvXS . LGAS't—__ 4Ai --3-0 �� 7 LF7 f4l: 3 Z LjlvA6 Ce>A7- R L - ,��- -� -Ae a -D Fax in Results ? 4/ No . N ReingBisbedBy: g' IDatwTime:06 30 !3!W Received BY: I AAA L-0 Datetnme: -Z-ol U'Af Mai W To: Scott Morrison & Asociates, 31855 Date Pahn Dr., Ste, 0.547, Cathedral City, CA 92234, (760) 323.7743