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DSF (05-0891)�y°f �R'Qu�ta BUILDING $ SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO _ FAX (760) 777-7011. LA QUINTA, CALIFORNIA 92253 L$E—UES TS (760) 777-7153 BUILDING PERMI MAR I A )nnr -00000 9►ate 3/16/05 C'=1C-1WVfin Tffn-z+ CTV ®FLA ®IJ1NTA I Application Number . . . . . Property Address . APN: Application description . Property Zoning Application valuation 7 6 7- 210 - DEMO - SINGLE FAMILY LOW DENSITY RESIDENTIAL 0 Owner Contractor ------------------------ NRI CCP I. ------------------------ DEMO UNLIMITED, INC. C/O NRI CCPI 81750 AVENUE 50 81100 AVENUE 53 INDIO CA 92201 LA QUINTA CA 92253 (760) 775-5884 WCC: HRH INS WC: 009421-2005 01/01/06 CSLB: 473328 05/31/05 CCC: A -C21 Other struct info NUMBER OF UNITS 2.00 Permit . . . . . DEMO PERMIT Additional desc . Permit Fee. 4.5.00 Plan Check Fee .00 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 45.00 ---------------------------------------------------------------------------- Special Notes and Comments. DEMO TO BARE GROUND SINGLE FAMILY RESIDENCE, ABANDON SEPTIC - BLDG. I Fee summary. Charged Paid Credited Due Permit Fee Total 45.00 .00, .00 45.00 Plan Check Total .00 .00. .00 .00 Grand Total 45.00 .00 .00 45.00 P.O. BOX 1504 T4,!t ��f',�� 78-495 CALLS TAMPIco folj� VOICE (760) 777-7012 LA4 FAX (760) 777-7011 QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: n4 -,6q I Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: tj A Lic. No.: t$UILUI U 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 properly 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 A ate 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. ate_ ,..�-6'r�s pIA/ icant 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 N lik 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 -me tioned property for inspection purposes. a/fj CSignature (Applicant or Agent): ENVIRONMENTAL KLEAN-UP Contmetors Srste fleense #684979 - DOSH #595 NOTICE OF COMPLETION THIS IS TO CERTIFY THAT AN ASBESTOS AB AIVAEN PROJECT HAS BEEN COMPLETED IN ACCORDANCE SCAQMD, CAL -OSHA & EPA REGULATIONS AT: .Single Family Residence Building T7 81-65.0. Avenue 53 Indio,. CA JOB # EKU-204-107-1 Asbestos abatement and disposal of asbestos containing materials (ACM) Per survey report�numbcr PLM 0629#1405 provided by Scott Morrison & Associates dated July 8"h, 2004. DATE October 22, 2004 JOB NAME The Hideaway, Demo Unlimited, Inc. Mel Curci PROJECT COMPLE'T'ION WITNESSED -BY Beverley J. Gann P.O. Box 285 Mira Loma, CA 91752 Phone (909) 685-5314 9 (909) ROSH #59559 Contractors License 468497 6999189606 Jc k 0T:6T b00Z/9Z/0T SCOTT MMORRISON & 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 08th, 2004 PLM0629#1405 Client: Lori Emery Emery Land Clearing P.O. Box 1009 Thermal, CA 92274 Project: The Hideaway Building "LID 81-650 Avenue 53 Indio, CA (2700 sq. ft. stucco building with attached garage) 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 (14) 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. I 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 T 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 07 of the 14 samples analyzed. PLM0629#1405 . Sample #HI -47 Type of material: 9" floor tile- mauve (1 rst layer) Location: floor of east rooms and bathroom Area: approx. 435 total sq. ft. Friable:no Results: 5% Chrysotile asbestos Sample #HI -48 Type of material: floor tile mastic- black (2nd layer) Location: under sample #H 1-47 Area: approx. 435 total sq. ft. Friable:no Results: 10% Chrysotile asbestos Sample #H149 Type of material: 12" ceiling tile- white Location: interior ceiling of east rooms, Area: approx. 435 total sq. ft. Friable:no Results: none detected Sample #HI -50 Type of material: 12" floor tile- grey/blue (1 rst layer) Location: floor of south-central hallway bathroom Area: approx. 60 sq. ft. , Friable:no Results: 5% Chrysotile asbestos Sample #HI -51 Type of material: floor tile mastic- yellw/brwn(2nd layer) Location: under sample #HI -50 Area: approx. 60 sq. ft. Friable:no Results: none detected Sample #HI -52 Type of material: 9" floor tile- dark red (1 rst layer) Location: floor of west hallway and livingrooms (2) Area: approx. 510 total'sq. ft. Friable:no Results: 10% Chrysotile asbestos Sample #HI -53 Type of material: floor the mastic- black (2nd layer) Location: under sample #HI -52 Area: approx. 510 total sq. ft. Friable:no Results: none detected Sample #HI -54 Type of material:rolled linoleum floor-gm/yllw(1 rst layer) Location: floor of north -central kitchen Area: approx. 110 sq. ft. Friable:no Results: 25% Chrysotile asbestos (2) P.O. Box 55329 Riverside, CA 92517 (909)624-1665 PLM0629#1405 SCOTT MORRISON &'ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 Sample #HI -55 Type of material: floor mastic- black (2nd layer) Location: under sample #HI -54 Area: approx. 110 sq. ft. Friable:no Results: none detected Sample #H1-56 Type of material: texture coat Location: interior south wall of northwest room Area: appr6x.'95 sq. ft. throughout interior wall Friable:no Results: none detected Sample #HI -57 Type of material: stucco- off white (1rst layer) Location: exterior north wall Area: throughout exterior walls Friable:no Results: 5% Chrysotile asbestos Sample #HI -58 Type of material: plaster- grey (2nd layer) Location: behind sample #HI -57 - Area: throughout exterior walls " Friable:no Results: none detected Sample #HI -59 Type of material: tarred felt Location: exterior roof of home Area: throughout exterior roof Friable:no ' Results: none detected Sample #HI -60 Type of material: stucco- off white Location: exterior south-central wall . Area: throughout exterior walls Friable:no Results: 5% -Chrysotile asbestos 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. Morris n Certified Asbestos Consultant DOSH#92-0248 (3) . r 0 Jul -06-04 10:58am From -CAROLINA ENVIRONMENTAL +4811442 T-483 P.02/06 F-196 C040UNA&MRQNME Q,INc. LABORATORY REPORT E CaA144113 ry,Nczrell PhOW.WNw )'A ' Phone: (919j: 481-1413 fax: (919)481-1442 ASBESTOS EUL.K ANALYSIS Client: Scott Morrison & Associates 31855 Date Palm Dr. Suite 3-507 CEI Lab Cod®: A04-4862 Cathedral City, CA 92234 Received: 07-02-04 Analyzed: 07-06-04 Reported: 07-06-04 Project: PLM0629#1405 Analyst: Gary A. Swanson CLIENT ID CEl LAB ID HOMOGENEITY DESCRIPTION % r ASBESTOS HI -47 A276335 FLOOR TILE CHRY. 5% Homogeneous; Mauve, Fibrous, Bound CHRY 5% VINYL 95% CHRY 10% HI -48 A276336 MASTIC Homogeneous, Black, Fibrous, Bound CHRY 10% MAST 90% HI -49 A276337 CEILING TILE ND Heterogeneous, White, Brown, Fibrous, Loosely Bound PAINT 5% CELL .95% HI -50 A276338 FLOOR TILE CHRY 5% Homogeneous, Grey, slue, Non-fibrouS, Bound CHRY 5% VINYL 95 % HI -51 A276:339 ND MASTIC Homogeneous, Yellow, Brown, Fibrous, Bound MAST 95% CELL 5% HI -52 A276340 FLOOR TILE CHRY 10% Homogeneous, Brown, Fibrous, Tightly Bound CHRY 106/4 VINYL no v Page 1 Jul -06-04 10:58am From -CAROLINA ENVIRONMENTAL +4811442 T-483 P.03/06 F-196 CAROUNAENVIRONMENTAL,INQ Project: PLM0629#1405 107 New Eam Court, Ouy, NC 27511 Prtane: 91941-1413 Fax: 919481-1442 Lab Code: A04-4862 CLIENT ID LEI LAB in HOMOGENEITY• DESCRIPTION °10 ASBESTOS HI -53 A2743341 ' MASTIC Homogeneous, Black, Fibrous, Bound ND MAST 98% CELL 2% HI -54 A276342 LINOLEUM CHRY 25% ' Heterogeneous,, Green, Yellow, Fibrous, Bound - CHRY 25% VINYL 50% CELL 5% -BIND 20% HI -55 A276343 MASTIC Homogeneous, Black, Fibrous, Bound ND MAST 98% CELL 2 HI -56 A276344 TEXTURE COAT ND Homogeneous, White, Non-fibrous, Bound SIND 100% S HI -57 A276345 STUCCO CHRY s°io Homo4leneous, Off-white, Non-fibrous, Bound , CHRY 5% BIND 95% HI -58 A216346 PLASTER Homogeneous, Grey, Non-fibrous, Bound ND BIND 100% HI -59 TARRED FELT ND A276,347 Homogeneous, Black, Fibrous, Bound TAR 50% CELL 40% Page 2 Jul -06-04 10:59am From -CAROLINA ENVIRONMENTAL +4811442 T-483 P.04/06 F-196 CAROUNAEWRONMENPTAL,M Project: PLM0629#1405 107 Now EdNm Court Cary, NIC 27511 Phone: 9194231-1413 Fax : 919481-1442 Lab Code: A04-4862 CLIENT Ip I HOMOGENEITY DESCRIPTION % • LAB13ID _ ASBESTOS HI -60 A276348 TEXTVREED STUCCO CHRY 5% Hornogenecus, Off -White, Fibrous, Bound CHRY 5°/u BIND 95 Jul -06-04 10:59am From -CAROLINA EN'VIRONMENTA! +4811442 T-483 P-05/06 F-196 The following definitions apply to the abbreviations used in the ASBESTOS BULK ANALYSIS REPORT: CHRY = Chrysotile CELL = Cellulose DEER = Debris AMOS = Amosite F8GL = Fibrous Glass BIND = Binder CROC = Crocidolite ORGN = Organics SILI = Silicates TREM = Tremalite SYNT = Synthetics GRAY = Gravel ANTH = Anthophyllite WOLL = Wolfastonite MAST = Mastic ACTN = Actinolite CERWL _ Ceramic Wool PLAS = Plaster N D = None Detected NTREM = Non-Asbestiform PERIL = Perlite NANTH = Non-Asbestiform Tremolite Anthophyllite RUBR =Rubber CLIENT: Scott Morrison $ Associates PROJECT: PLM062W405 CE(LAS CODE: A04-1862 Stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical technique used �or sample identification. The percentage of each component is visually estimated by volume. These results pertain only 'o the samples analyzed. The samples were analyzed as submitted by the client and may not be representative of the larger naterial in question. Unless notified in writing to return samples, Carolina Environmental, Inc, will discard all bulk samples after 30 days. vlany vinyl floor tiles have been manufactured using greater than 1% asbestos, Often the asbestos was milled to a fiber iize below the detection limit of polarized light microscopy. Therefore, a "None Detected" (ND) reading on vinyl floor tile foes not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive orm of analysis for vinyl floor tiles, t is certified by the signature below that Carolina Environmental, Inc_ is accredited by the National Voluntary Accreditation 'rogram (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA / 600 / M4-82 / 020 for ie analysis of asbestos in building materials, Procedures described in EPA / 600 / R-93 / 116 have been incorporated There applicable, The detection limit for the method is 0.1% (trace amount), Carolina Environmental, Inc.'s NVLAP .ccreditation number is #101768-0. This report is not to be used to claim product endorsement by NVLAP or any agency f 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 Tianhlo Rwi, Ph.IS. Laboratory Director End ®f Rep®rt ill - CHAIN OF CUSTODY From: Scott Morrison & Associates To: Carolina Environmeatal, Inc. P.O. Hoa 36329 107 New Edition Court Riverside, CA 92517 Cary, NC 27511 (760) 323-7743 (919) 481-1413 NVLAP Code 10176" CA FLAP #M3 �'� o'iT No221 Soot)�bc6�t+-k1-31qZ- Client: � ibF-AWAY Person Taking Samplesj. Job No. 'Z.� � S Site Adair+ess - 53 t-- /UU ? N fl Sample # Sample Date Material & Description Ali Pb Other Informion 71 F — /k4d VE- 7T7-- Fede 7 t� AOS rtc l � rZ. u eS L 4 cri bA) -- 7WE' E' —&* /?E Ftoa12 1L C>ca TILS' nvSTiC �— 91" FCW4 7-r c IR - j -'1 CE /h4sric- —AzA ffT - 55— 2 ,J,4sr-r C - 8 WC -4 -� X7u2C ed, --r S'n-LCC' V - er-7' � I E eo u7 O Ii'aX 16l Re8ult8i es 1110 0 m' Relinquished By: DaWrime: 06 -30-0y Received By: �`�A1 DatelTime~% .l oY MaiUFaa To: Scott Morrison & Asociates, 31855 Date Palm Dr., Ste. #3-50.7, Cathedral City, CA 12234, (7610) 323-7743