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DSF (05-0890)U S BUILDING &. SAFETY DEPARTMENT P.O. Box 1504 (766).777-7012 C��!9 LLE TAMPICO a oFTt�• 49S , FAX (760) 777-7011 p kA Q , CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 a Qa5 BUILDING PERMIT MAR 1 � Ap lica9 ; On Thu .e=r . . . . 05�00000�890. Date 3/16/05 Pr•per Address . . . . . . ST AP 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 NR -I 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 z. 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 • 4 ------------------------------------- 7 -------------------------------------- Special Notes and Comments DEMO TO BARE GROUND SINGLE FAMILY RESIDENCE, ABANDON SEPTIC- BLDG. E 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. BO:: 1504 ,�� VOICE (760) 777-7012 7S -49S CALLS TAMPIG FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0.5-890 Date: 3 -/%au - Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: OUIL UINU rtKM1 t DEGLARATIONS 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).): L) 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 CVsold 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.). A, 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.). L) I am exempt under Sec. , BA P.C. for this reason Date 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 forthwith comply with those provisions. n ��C5_ 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 I hereby affirm under penalty of perjury that there is a construction lending agency orJthe performance of he work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name �hn Lenders Address fit APPLICANT NOW IMPORTANT Application is hereby made to the Director of Building and Safety for p ACKNOWLEDGEMENT 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-mentio d property for inspection purposes. ate /�� ign`�s acure (Applicant or Agent): ENVIRONMEN'T'AL KLEAN-UP. coarractors State Ucease #684979 - D.OSH #595 NOTICE OF COMPLETION THIS IS TO. CERTIFY TRAT. AN ASBESTOS ABATEMENT PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO SCAQMD, CAL -OSHA & EPA REGULATIONS AT: Single Family. Residence Building " E" 81-380 Avenue 53 Indio, CA JOB -9 EKU-204-1.0 -E) Asbestos. abatement and disposal of asbestos containing materials (ACM) Per survey report number PLM 0628# 1004 provided by Scott Morrison & Associates dated July 70, 2004. DATE October 20, 2004 JOB NAME The Hideaway Demo Unlimited, Inc. Mel Curci PROJECT COMPLETION WITNESSED BY. a�j. N Beverley 1. Gann P.O. Box 285 Mira Loma, CA 91752 Phone (909) 685-5314 Fax (909)681-5559 Contractors License 4684979 DOSH 4595 n,rz 6S5gi39606 0t:6Z b00Z/5Z/0Z P.O. Box 55329 Riverside, CA 92517 (909)624-1665 SCOTT MORRISON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 ASBESTOS SURVEY REPORT Completed On July 07th, 2004 PLM0628#1004 Client: Lori Emery Emery Land Clearing P.O. Box 1009 Thermal, CA 92274 Project: The Hideaway (Building "E" 1 81-380 Avenue 53 / Indio, CA (white wood house with detached garage) 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, 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) i 1 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 The results on the following page(s) indicate that asbestos was detected in 03 of the 10 samples' analyzed. PLM0628#1004 Samples #HI -37 thru #HI -46 were taken from the white wood house labeled "bldg. V. See diagram Sample #HI -37 Type of material: drywall Location: interior west wall of southwest room Area: throughout interior walls Friable:no Results: none detected Sample #HI -38 Type of material: 12" ceiling tile- type 1 Location: interior ceiling of south-central room Area: throughout interior ceiling of room Friable:no Results: none detected Sample #HI -39 Type of material: 12" floor tile- red (1rst layer) - Location: floor of southeast room Area: approx. 335 sq. ft. Friable:no Results: 3% Chrysotile asbestos Sample #HI -40 Type of materiaLfloor tile mastic-yellw/brown(2nd layer) Location: under sample #HI -39 Area: approx. 335 sq. ft. Friable:no Results: none detected Sample #HI -41 Type of material: 12" ceiling tile- type 2 Location: interior ceiling of southeast room Area: throughout interior ceiling of room Friable:no Results: none detected Sample #HI -42 Type of material: 12" floor tile- white (1 rst layer) Location: floor of kitchen Area: approx. 180 sq. ft. Friable:no Results: 3% Chrysotile asbestos Sample #HI -43 Type of material: floor tile mastic- brown (2nd layer) Location: under sample #H 1-42 Area: approx. 180 sq. ft. Friable:no Results: none detected (2) , r SCOTT MORRISON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, Ste. 0-507 Riverside, CA 92517 Cathedral City, CA 92234 (909)624-1665 (760)323-7743 PLM0628#1004 Sample #HI-44 Type of material: rolled vinyl floor (1 rst layer) Location: floor of closet north of kitchen Area: approx. 80 sq. f. Friable:no Results: 25% Chrysotile asbestos' Sample #HI-45 Type of material: floor mastic-yellow (2nd layer) Location: under sample #HI-44 Area: approx. 80 sq. ft. Friable:no Results: none detected Sample #HI-46 Type of material: rolled roofing- white/black Location: exterior roof Area: throughout exterior 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 H---- Scott'C. Morrison Certified Asbestos Consultant DOSH#92-0248 i (3) Jul -06-04 11:49am From -CAROLINA ENVIRONMENTAL +4811442 T-486 P.02/05 . F-199 LABORATORY RE PORT CAROUNAENVIRONMENTAL,ING 107.NewEditanCcACary,NC27511 ASBESTOS BULK ANALYSIS - Moir. (919),481-14.13 Fax: (919)481.1442 Client: Scott Morrison & Associates . CEI Lab Code: A04-4851 31855 Date Palm Dr. Suite 3-507 Received: 07-02.04 Cathedral City, CA 92234 Analyzed: 07-06-04 Reported: 07-06-04 Project: PLM0628#1004 y Analyst: Gary A. Swanson = ' CEI CLIENT ID LA8 ID HOMOGENEITY DESCRIPTION % ASBESTOS HI -37 A276325 -.' DRYWALL ND Homogeneous, brown, White, Fibrous, Bound 'BIND SO % CELL 20% HI -38 A276326 ND CEILING TILE Homogeneous, White, Brown, Fibrous, Loosely Bound PAINT 6% CELL 95% H1-39 A276327 FLOOR TILF CHRY 3% Homogeneous, Red, Fibrous, Tightly Bound CHRY 3% VINYL 97% MASTIC ND HI -40 A276328 Homogeneous, Yellow, Brown, Fibrous, Bound MAST 95% , CELL 5% ND HI -41 A276329 CEILING TILL" Homogeneous, Beige, Fibrous, Loosely Bound ' PERL 30% CELL 36% FBGL 35% HI -42 A276330 FLOOR TILE CHRY 3% Homogeneous, White, Non-fibrous, Tightly Bound CHRY 3.1/0 VINYL. 97 Page 1 Jul -06-04 11:49am From -CAROLINA ENVIRONMENTAL +4811442 T-486 P.03/05 . F-199 CAROLWAe11flMNNIENTAL,INC Project: PLM0628#1004 1a7 Now Edition Cctat Cary, NC 27511 Pty 916481-1413 Fax: 919.481-1442 Lab Code: A04-4861 CLIENT ID % ASBESTOS r CEI LAf1ID HOMOGENEITY DESCRIPTION HI -43 A276331 MASTIC ND Homogeneous, Brown, f=ibrous, Bound MAST 95% CELL 5% HI -44 A276332 CHRY 25% .ROLLED VINYL FLOOR Homogeneous, Beige, Grey, Fibrous, Bound CHRY 25% VINYL 50% CELL 5% BIND 20 % H1-45 A276333 MASTIC ND Homogeneous, Yellow, Fibrous, Bound MAST 95% CELL 5% HI -46 ND A276334 ROLLED ROOFING Heterogeneous, White, Black, Fibrous, Bound GRAY 20% CELL 40% TAR 40% Page 2 Ju1-06-04 .11:49am From -CAROLINA ENVIRONMENTAL +4811442 The following definitions apply to the abbreviations used In the ASBESTOS BULK ANALYSIS REPORT: T-486 P.04/05 , F-199 CHRY = Chrysotile CELL = Cellulose DEBR = Debris AMOS = Amosite FBGL = Fibrous Glass BIND = Binder CROC = Crocidolite ORGN = Organics SILI = Silicates TREM = Tremolite SYNT = Synthetics GRAV = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTN = Actinolite CERWL = Ceramic Wool PLAS =Plaster N 0 None Detected NTREM = Non-Asbestiform PERIL = Perlite NANTH = Non-Asbestiform Tremolite RUBR =Rubber Anthophyllite CLIENT: Scott. Morrison & Associates PROJECT: PLMo628#1004 CEI LAB CODE: A04-4861 - t Stereoscopic microscopy ano 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" (NIS) 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 / 6001 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, Ine.'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. Z-0 s REVIEWED BY Tianboo Bai, Ph.D. Laboratory Director ;3a I 3f E CHAI OF CUSTODY From: Scott Morrison & Associates P.O. Boa 55329 ' Riverside, CA 92517 (760) 323-7743 Client: Job No. SiteAddees 401/- To: Carotins Environmental, Inc. 107 New Edition Court Cary, NC 21511 (919)481-1413 NVLAP Code 10176" CA FJ" #2483 t l:ersonTa&ingSamples: Sco'� r�a2t�nN��d$iy2-3!j/Z T--- I - 3SO 9�3 44 ,4FAj tJie- } 7/Vo 10 SwkLhi&vl- u r7 " Sample 4 Sample Date Matwia l & Description P119 AA -Pb Otiser Information T -3 0,6 -2-0 -- Z001-5(bi w.4LL 38 117- cFtL,NG- -Tic- --ryp zq jjJzS PLFAsF- e- l I L� #-T —�D P oe2 °T1 LIE As4ST' C t"19 P,.ojvAl "-" CFtGtj& iL —iU t 7 — yz 2L4 — 7 It F- r r� y Yaz W Results i i llo Relinquished IV:Dateffime: 66-30-0 11-7,30 Received By: Datemme/-.1.0 U A+lail FAx To: Scott Morrison & Asociates, 31855 Date F" Dr., Ste. 03.5507, Cathedral City, CA 92234, (760) 323-7743