DSF (05-0894)BUILDING & SAFETY DEPARTMENT
)x 1504 J (760).777-7012
CALLE TAMPICO FAX (760) 777-7011
NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
1r 8 'lUU3 BUILDING PERMIT
u MAR 1
Of f LlllaTA
App �ic'a''on Number 05-00000894 Date 3/16/05
roperty 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 05/31/05
CCC: A -C21
Other struct info . . . . . NUMBER OF UNITS 2.00
----------------------------------------------------------------------------
Permit . . . . DEMO PERMIT
Additional desc
Permit Fee . . 45:00 t 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. G
Fee summary Charged Paid Credited Due
Permit Fee Total 45.00 .00 .00 45:00
Plan Check Total .00 .0'0 .00 .00
Grand Total 45.00 .00 .00 45.00
a
P.O. B O x 1504
��/�G�
78-495 CALLS TAMPICO Y VOICE (760) 777-7012
LA4 FAX (760) 777-7011
QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: c4- Sgq
Applicant:
Applicant's Mailing Address:
Date: 3 -
Architect or Engineer:
Arcnitect or Engineer's Address:
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).):
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
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.).
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. B.& P.C. for this reason
15 -ate -3" %L'c 5,r��
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
ertify 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.
/ "ae plicant
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
ACKNOWLEDGEMENTAPPLICANT
IMPORTANT Application is hereby made to the Director of Building and Sa etty,fo apemit
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 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 property for inspection purposes.
Date F. -O.5 Sure (Applicant or Agent��
ENVIRONMENTAL
KLEAN-UP
Contraerors smtj Ucense #684979 • bOSH #595
NOTICE OF COMPLETION
THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT
PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO
SCAQMD,. CAL -OSHA & EPA REGULATIONS AT:
Single Familyes" nee
Buildi «G»
81-470 Av e 53
Indio; CA.
JOB #
E" -204-107-G
Asbestos abatement and disposal of asbestos containing materials (ACM)
Per survey report number PLM 0629#0807 provided by Scott Morrison & Associates
dated July 8h, 2004.
DATE
October 21, 2004
JOB NAME
The Hideaway
Demo Unlimited, Inc. .
Mel.Curci .
PROJECT COMPLETION 'WITNESSED BY
Beverley J. Gann
P.O. Box 285 Mira Loma, CA 91752
Phone (909) 685-5314 Fax (909) 681-5559
Contractors License #684979 DOSH #595
$q�
n1471 699ST89606 0T:6T b00Z/5Z/0T
N. SCOTT MORRISON & 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#0807
Client: Lori Emery
Emery Land Clearing
P.O. Box 1009
Thermal, CA 92274
Project: Building °G"
81-470 Avenue 53)
' Vndio, CA
(light blue stucco single family home)
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 (8) 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
' SCOTT MORRISON & 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
The results on the following page(s) indicate that asbestos (greater than 1 %) was detected in 0Z of the
'08 samples analyzed.
PLM0629#0807
Sample #HI -79 Type of material: stucco- light blue (1 rst layer)
Location: exterior north wall
Area: throughout exterior walls
Friable:no Results: none detected
Sample #HI -80 Type of material: exterior plaster- grey (2nd layer)
Location: behind sample #HI -79
Area: throughout exterior walls
Friable:no '. Results: none detected
i
Sample #HI -81
Type of material: 9" floor tile- tan (1 rst layer)
Location: floor of kitchen and bath
Area: approx. 100 total sq. ft.
Friable:no
Results: 10% Chrysotile asbestos
Sample #111-85
Type of material: tar and gravel roof (1 rst layer)
Sample #HI -82
Type of material: floor tile mastic- black (2nd layer)
Location: under sample #HI -81
Friable:no
Area: approxi 100 total sq. ft.
Friable:no
Results: 10% Chrysotile asbestos
Location: under sample #HI -85
Sample #111-83
Type of material: drywall
Friable:no
Location: interior north wall of bathroom
Area: throughout interior walls :
Friable:no
Results: none detected
Sample #HI -84
Type of material: drywall
Location: interior ceiling of livingroom
Area: throughout interior walls
Friable:no
Results: less than 1% Chrysotile asbestos
Sample #111-85
Type of material: tar and gravel roof (1 rst layer)
Location: exterior roof
Area: throughout exterior roof
Friable:no
Results: none detected
Sample #HI -86
Type of material: asphalt roof- black (2nd layer)
Location: under sample #HI -85
Area: throughout exterior roof
Friable:no
Results: none detected -
(2)
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329 1 31855 Date Palm Drive, Ste. #3-507
Riverside, CA 92517 Cathedral City, CA 92234
(909)624-1665 (760)323-7743
PLM0629#0807
Note: The transite pipe located above the southeast roof is presumed asbestos containing material
(PACM).
Note: The penetration mastic around the roof penetrations is presumed asbestos containing material
(PACIVI). `
Note: All asbestos containing building materials) 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 G. �•
Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
(3)
J.u1=08-04 12:44pm from -CAROLINA ENVIRONMENTAL- +4811442 T-488 P.02/05 .F-201
GAROLNA ENVIRONMWrAI, INC. "
LABORATORY REPORT
107 Ne4v Eddon CaA Ovy,NC27511
ASBESTOS BULK ANALYSIS
Phone: (818) 481-1413 Fax- (818) 4811442
Client: Scott Mlorrisori & Associates
CEI Lab Code: A04-4864
31855 Date Palm Dr, Suite 3-507
Received: 07-02-04
Cathedral City, CA 92234
Analyzed: 07-06-04
CELL
Reported: 07-06-04
Project: PLM0629#0807
Analyst: Gregory J. Hanes
CLIENT ID LABID HOMOGENEITY DESCRIPTION
ASBESTOS
HI -79 A276367 STUCCO
NO
Heterogeneous, Off-white, Green, Non-fibrous, Bound
BIND 97%
CELL
HI -80
A276368
PLASTER
ND
Heterogeneous,
Grey, Non-fibrous, Bound
BIND 98%
CELL
2%
HI -81
CHRY 10%
A276369
FLOOR TILE
Heterogeneous,
Tan, Non-fibrous, Tightly Bound
CHRY 10% BIND 90%
CELL
<1 %,
HI -82
CHRY 10%
A276370
MASTIC
Heterogeneous,
Black, Non-fibrous, Bound
CHRY 10% BIND 85%
CELL
5%
HI -83
A276371
NO
DRYWALL
Heterogeneous,
White, Tan, Fibrous, Bound
BIND 85%
CELL
15%
HI -84
CHRY C1 %
A276372
DRYWALUJOINT COMPOUND
Heterogeneous,
White, Tan, Fibrous, Bound
CHRY <1% BIND 85%
CELL
15%
Joint compound contains 3% Chry;
Sample is <1 % Chrys overall
Page 1
.Jul -06-04 12:44pm From -CAROLINA ENVIRONMENTAL +4811442 T-488 P.03/05 F-201
CAROLINA ENVIRONMENTAL, INC Project: PLM062W807
107 New Edition Couit Cary. NC 27511
Phone, 519481-1413 Fox: 919481-1442
Lab Code: A04-4864
CLIENT ID CEI HOMOGENEITY DESCRIPTION %
LAE; 10 ASBESTOS
Hi -85 A276373 ROOFING ND
Heterogeneous, Black, Grey, Fibrous, Bound
BIND 55% CELL" 5%
GRAV 40%
HI -86 A276374 ROOFING ND
Heterogeneous,; Black, Fibrous, Bound
BIND 55% CELt 5%'
FBGL 40%
4ul-06-04 12:44Pm From -CAROLINA ENVIRONMENTAL +4811442 T-488 P.04/05 .F-201
The following definitions apply to the abbreviations used In the ASBESTOS BULK
ANALYSIS REPORT:
CHRY
= Chrysotlle
CELL
= Cellulose
DEBR =.Debris
AMOS
= Amosite
FBGL
= Fibrous Glass
BIND -Binder
CROC
= Crocidolite
ORGN
= Organics
SILT = Silicates
TREM
= Tremolite
SYNT
= Synthetics
GRAV = Gravel.
ANTH
= Anthophyllite
WOLL
= Wollastonite
MAST = Mastic
ACTN
= Actinolite
CERW L = Ceramic Wool
PLAS = Plaster
N 0
= None Detected
NTREM = Non-Asbestiform
PERL = Perlite
NANTH = Non-Asbestiform
{
Tremolite
RUBR =Rubber
Anthophyllite
CLIENT: Scott Morrison $ Associates
PROJECT: PLM0629#0807
CEI LAB CODE. A04-4864
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 Environ mental, 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
Tionbno GOi, r'h.D.
Laboratory Director End of Report
70
71
CHAIN OF. Uff Off
From: Scott Morrison & Associates
P.O. Boz 55329
River id4 CA 92517
(760) 323-774;
- fcv� iii r
AZ) -76 -7-A27617 Y
To: Carolina Environmental, be.
107 New Edman Court
Cary, NC 27511
(919) 451-1413
1NVLAP Code 10176" CA CLAP #2483
Client:
'-rk}c-A1A/Ay Paxson Taldng Samples.-EceyT A4o(Lki%oUj �O$ 213 1 ��
pL1f 1� X25
Sob No. D - Site Address: g i -q� -6 5 «u kj e +U V F 1 .A--NIbk o
D
Sande #
Sample Date
N2sterW do Descaiption
P AA Pb
Other Informadon
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` Datafiime: � � / 'b0 liecei�,ed By: `� f2 �y X01.?0/� o
Reliugaished BY: A f DatvJTime:
Mail ,az To: Scott Morrison & Asociates, 31955 Date Palm Dr., Ste. 03-507, Cathedral City, CA 92234, (760) 323-7743