DSF (05-0892)a1
o�
oz .
----�(j� BUILDING & SAFETY DEPARTMENT
.04 (760) .777-7012
5a LE TAMPICOFAX (760)-777-7011
�SUIN` a! CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Coy QU1NTA BUILDING PERMIT
FINANCE DEpT.
Application Number . . . . . 05-00000892 Date 3/16/05
Property 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.w
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 . . . 45.00 P1'an Check'Fee .00
Issue Date . . . . Valuation 0
Qty Unit Charge Per Extension
BASE FEE 45.00
------------7---------------------------------------------------------------
Special Notes and Comments
DEMO TO BARE GROUND SINGLE FAMILY
RESIDENCE, ABANDON SEPTIC - BLDG. K
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
• o
!�!'ftr6v
P.O. Box 1504 11::;ii� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA. QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D.�" —8qa- Date: 3 -
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
ID/A
Lic. No.:
rsUILUINU 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 (Seca 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
t 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.).
mfl I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
r� 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
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.
pliA� cant i A
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
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 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.
Date ��V_<ignature (Applicant or Agent
ENVIRONM.ENTAL-
KLEAN-UP.
Conusstors State TScense #684979 - POSH #5"
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 "K"
Long Driveway Off Avenue 52
Indio, CA
JOB #
EKC7-204- 07 K
Asbestos abatement and disposal.of asbes os containing
materialsAC1VpMorrison & Associates
Per survey report ntunber PLM 0629# 1209 provided y
dated July 9`h, 2004.
DATE
October 14, 2004
JOB NAME
The Hideaway
Demo Unlimited, Inc.
Mel Curci
PROJECT COMPLETION WITNESSED BY
Sawa
.Beverley J. Gann
P.O. Box 285 Mira Loma, CA 91752.
Phone (909) 685-5314 Fax (909) 681-5559
Contractors License 9684979 DOSH 9595.
n,A,:]
699ST89606
OZ:6Z 170OZ/SZ/0t
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
c
ASBESTOS SURVEY REPORT
Completed On
July 9th, 2004
PLM0629#1209
Client: Lori Emery
Emery Land Clearing
P.O. Box 1009
Thermal, CA 92274 '
Project: The Hideaway
Building "K"
(single-family home with long driveway off Ave. 52)]
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 (12) 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
The results on the following page(s) indicate that asbestos was detected in 01 of the. 12 samples
analyzed.
P.O. Box 55329
Riverside, CA 92517
(909) 624-1665
PLM0629#1209
SCOTT MORRISON &• ASSOCIATES
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(760)323-7743
,
Sample #HI -110 Type of material: 12" floor tile/ beige -grey
Location: central -room floor area
Area:approx. 450 sq. ft.
Friable:no Results: none detected
Sample #HI -111 Type of material:tile mastic/ clear
Location: under sample #H 1-110
Area:approx. 450 sq. ft.
Friable:no Results: none detected
Sample #HI -112
Type of material: interior wall plaster, smooth coat
(2)
Location: interior N. wall, central room
Area: interior walls -1 st layer
Friable:no
Results: none detected
Sample #HI -116
Type of material: interior ceiling stucco/ green -white
Sample #HI -113
Type of material:drywall
Location: interior N. wall, central room
Friable:no
Area: interior walls -2nd layer
Friable:no
Results: none detected
Location: ceiling,. W. room
Sample MIA 14
Type of material: 12" floor tile/ tan -white
Friable:no
Location:W. bathroom floor
Area:approx. 40 sq. ft.
Friable:no
Results: none detected
Sample #HI -115
Type of material:tile mastic/ black
(2)
Location: under sample #H 1-114
Area:approx. 40 sq. ft.
Friable:no
Results: none detected
Sample #HI -116
Type of material: interior ceiling stucco/ green -white
Location: cei I ing, W. room
Area:interior ceiling -1st layer
Friable:no
Results: none detected
Sample #HI -117
Type of material: interior ceiling plaster/ grey -
Location: ceiling,. W. room
Area: interior ceiling -2nd layer
Friable:no
Results: none detected
(2)
f t
SCOTT MOMSON & 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
PLM0629#1209
Sample #HI -118 Type of material: drywall
Location: interior N. wall, E. room
Area:throughout interior walls
Friable:no Results: none detected
Sample #HI -119 Type of material: exterior stucco/ pink -grey
Location: exterior E. -central wall
Area:throughout exterior walls
Friable:no Results: none detected
Sample #H 1-120 Type of material: exterior stucco/ pink -grey
Location: exterior W. -central wall
Area:throughout exterior walls
Friable:no Results: none detected
Sample #H 1-121 Type of material: asphalt roofing/ black
Location: central roof area
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
Scott C. Morrison
Certified Asbestos Consultant "
DOS H#92-0248
(3)
� r
;Ju -1-06-04 11:26am From -CAROLINA ENVIRONMENTAL +4611442T-464
P.02/05 F. -197
CAROLIkAENVIRONMENTAL, INC
LABORATORY REPORT
107New EftonCuK,Cwy,NC27511
ASBESTOS BULK ANALYSIS
Phone: (919) 4891413 Fax: (919) 4811442
Client: Scott Morrison & Associates CEI Lab Cade:
A04-4867
31855 Date Palm Dr. Suite 3-507 Received:
07-02-04
Cathedral City, CA 92234
Analyzed:
07-06-04
Reported.
07-06-04
Project: PLM0629#1200
Analyst:
Scott Minyard
CLIENT ID LAB 10
ASBESTOS
HOMOGENEITY DESCRIPTION
HI -110 A276398
FLOOR TILE
ND
Heterogeneous,
Beige, Grey, Njon-fibrous, Tightly Bound
VINYL , 97% CELL <1 %
MICA 3%
HI -111 A276399
MASTIC
ND
Heterogeneous,
Clear, Non-fibrous, Bound
MAST 100% ' CELL <1 %
ND
HI -112 A276400A
SMOOTH COAT - GRAY LAYER
Heterogeneous,
Grey, Non-fibrous, Bound
PLAS 100 % CELL <1 1/0
ND
A27640013
SMOOTH COAT - GREEN LAYER
Heterogeneous;
Green, Off-white, Non-fibrous, Bound
PLAS 85 % CELL <1 %
PAINT 15%
HI -114 A276402
FLOOR TILE
ND
Heterogeneous,
Beige, Non-fibrous, Tightly Bound
VINYL 97% CELL <1 %
MICA 3% .
HI -114 A276403A
MASTIC (TYPE 1)
CHRY 5%
Heterogeneous,
Black, Fibrous, Bound
CHRY 50l MAST 950/6, CELL <1 %
Page 1
;.Jwl-06-04
11;26am From -CAROLINA ENVIRONMENTAL - +4811442
T-484 P.03/05 F-197
CAROUNAENWZONMENTAt, INC.'
Project: PLM0629#1209
/
107 New Edition Cc A Cary, NC 27511 -
-
Phone: 919.481-1413 Fac: 919481-1442
Lab Code; A04-4867• .
CLIENT ID
CEI
LAB ID
HOMOGENEITY DESCRIPTION
%
ASBESTOS
A276403B
MASTIC (TYPE 2)
ND
Heterogeneous,
Clear, Fibrous, Bound
MAST 100% CELL
<1
HI -116
A276404 ;CEILING
STUCCO
ND
Heterogeneous,
Green, Off-white, Non-fibrous, Bound
N
PLAS 95% CELL
<1 %
PAINT 5%
HI -117
A276405
CEILING PIASTER
ND
Heterogeneous,
Grey, Non-fibrous, Bound
PLAS 100% CELL
<1 %
t
HI -118
A276406
DRYWALL
ND
Heterogeneous,
Off-white, Tan, Fibrous, Bound
'
GYPSUM 66% CELL
2.5%,
BIND 10%
;
HI -119
A276407
EXTERIOR STUCCO
ND
Heterogeneous,
Grey, Pink, Non-fibrous, Bound -
PLAS 95% CELL
<1 %
PAINT 5 %.
HI -120
A276408
EXTERIOR STUCCO
ND
Heterogeneous,
Grey, Pink, Non-fibrous, Bound
PLAS 95% CELL
<1 %
PAINT 5%
HI -121
A276409
ASPHALT ROOFING
ND
Heterogeneous,
Black, Brown, Fibrous, sound
TAR 35% CELL
35%
GRAV 25
MICA 5
Page 2 '
-Jul&06-04 11:26am From -CAROLINA ENVIRONMENTAL +4811442
The following definitions apply to the abbreviations used in the ASBESTOS BULK
ANALYSIS REPORT:
CHRY
= Chrysotile
AMOS
Amosite
CROC
= Crocidolite
TREM
= Tremolite
ANTH
= Anthophyllite
ACTN
= Actinolite
N D
=None Detected
NANTH
= Non-Asbestiform .
Anthophyllite
CELL
= Cellulose '
FBGL
= Fibrous Glass
ORGN
= Organics
SYNT
= Synthetics
WDLL
= Wollastonite
CERWL = Ceramic Wool
NTREsM = Non-Asbestiform
Tremolite
CLIENT: Scott Morrison &- Associates
PROJECT: PLM0629#1209
CEI LAB CODE: A04-4867
T-484 P.04/05 F-197
DEBR =Debris
BIND = Binder
SILI = Silicates
GRAV = Gravel
MAST = Mastic
PLAS =Plaster
PERL = Pedite
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 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 1020 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
Tianbao Bpi, Ph.D.
Laboratory Director
MUM
"/I
Y(V
GI
02
103
CHAIN OF CUSTODY C v
Af 762yg-,4,276 Yo y
From: Scott Morrison & Associates To: Carolina Environmental, Inc.
P.O. Boa 55329 107 New Edition Court
Riverside, CA 92517 Cary, NC 27511 A
(760) 323-7743 (919) 481-1413
NVLAP Code 10176" CA ELAP #2483
Client: Person Taldng Samples: 5"-tr "O •j , jp -OT2_31 V IL
Job No.
PL
-Mo Zq Site Address: 5. 4"1 A Vgiu U gF
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r
Sample #
Sample Date
Material & Description
/ AA -Pb
Other Information
�flueee?
A
A
N
A
m
A
0
fil
Fax in Results Yy Y No
' T
T
Relinquished By:
�— Dateffime: 06 -3 I S;� °� Received By: ® Date/Time.-
MaillFaa To: Scott Morrison & Asociates, 31855 Date Paha Dr., Ste. #3-607, Cathedral City, CA 92234, (760) 323-7743