Loading...
RER (06-0790)I may. P.O. BOX 1504O VOICE 760 777-7012 .4 787495 CALLE"TAMPICO FAX (760) 777-7011 .LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT" Date: 5/0.1/06 Application Number: f'06-00000790 �? Owner: Property Address: i 77350 CALLE MONTEREY JOHN & JUNE CORRIGAN APN: i 774-072-012-1 -000000- 77-350 CALLE.MONTEREY Application description: REMODEL - RESIDENTIAL ^ A QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL Application valuation: 15000 111, Applicant: Architect or Engineer: - ------------------------------------------------- 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: B License No.: 867207 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 toits 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 Contractor's 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).: 1 _ 1 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 through hisor her ow%.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.).. - 7V. j, 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.) I—) }I am exempt under Sec. , B.&P.C. for this eas Date: 1 rOwner. 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: t tractor: TI GARY 55 0 DESERT GOLD A VALLEY, -CA 92284 0)228-0102 Lic.'No:: 867207 WORKER'S 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. 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 MEMPT Policy Number EXEMPT r certify that, in the performance of the work for which this permit is issued, I shall not employ any Cperson in any manner so as to b come subject to the workers' compensation laws of California, and agree that, if I should beco sub' ct to the workers' compensation provisions of Section 3700 f the Labor Code, shall rth th comply with those provisions. Date:; pplica t: J t . _. . WARNING: FAILURE TO SECURE WORKERS' COMP SATION 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. 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 inform tion is correct. I agree to comply with all city and county ordinances and state laws relating to buildgco tructi n, and hereby authorize representatives of this county to e2t'r upon the above-mentioned property or m ectio purposes. Date: �_ ignature (Applicant or Agent i .. LQPERMIT - - - Application Number . . . . . 06-00000790 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 162:00 Plan Check Fee 105.30 Issue Date -Valuation . . . . 15000 Expiration Date 10/28/06 Qty Unit Charge Per. Extension BASE'FEE 45.00 13.00 9.0000 ----------------------------------------------------------------------------- THOU BLDG 2,001-25,000 117.00, Permit ELECT - ADD/ALT/REM Additional desc . Permit Fee 37.06 'Plan -Check Fee 9.27 v _ Issue Date Valuation 0 Expiration Date 10/28/06 Qty Unit Charge .Per Extension BASE FEE 15.00 _68.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 1.36 . 46.00. .4500 EA ELEC DEVICE/FIXTURE >20 20.70 Permit MECHANICAL Additional desc . Permit Fee 52.50 Plan Check Fee 13.13 Issue Date . . . . Valuation 0 ` Expiration Date 10/28/06 _ Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 '9.0000 EA MECH,B/C <=3HP/100K BTU -9.-00 2.00 6.5000 EA MECH-VENT'FAN 13.00 1.00 .6.5000 EA :MECH EXHAUST HOOD 6.50 ` Permit .. . . PLUMBING Additional desc . Permit Fee 88.50 Plan.Check Fee 22.13 Issue Date Valuation . . . . 0 . Expiration Date'. 10/28/06 Qty Unit Charge Per Extension BASE FEE15.00 9.00. 6.0000 EA PLB FIXTURE 54.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 LQPERMIT Application Number 06-00000790 Permit PLUMBING Qty Unit Charge Per Extension 1.00 3.0000 EA' PLB'WATER INST/ALT/REP. 3.00. -' 3.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 9.00 --------------------------------------------- Special Notes and Comments ----------=--------------- .REMODEL/ADDITION TO GARAGE.May 1, 2006 11:30:53 AM. ]Johnson - ----------------------------7------------------------- Other Fees . . . . . . . . ._ ENERGY REVIEW FEE 10.53 STRONG MOTION (SMI) - RES 1.50 Fee summary Charged Paid. Credited Due ------------------- ---------- Permit Fee Total 340.06 =---=----- ------- .00 .00 340.06 Plan Check Total 149.83 .00 .00 149.83 Other Fee Total 12.03 .00 .00 12.03 - Grand Total 501.92 .00 .00 501.92 LQPERMIT. Bia / City of La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 7 -7 3 so c,(,L(,,, mp& t agy Owner's Name: Jom $,JoAg C0M 1 &,e -,,,A A. P. Number: �01 Address: 17 750 CA LLe, VO4Te9-c, Legal Description,: n Contractor: ( %��)A M City, ST, Zip: LA, ('�V' (�� Telephone: d r3 4 S—(_t 11 5 I Address: S� V Des ��� f P _ Project Description: City, ST, ZiP: ��iu.rel Y� c�LqS i 5a F,6U09GL, Telephone: 1_ (J L -02 5? SC 6 1 f C)p L ( V Irl State Lic. # : 1(j 2© .�. City Lic. #: Arch., Engr., Designer: (6' 6AY— M TE /q C o Address: l` City, ST, Zip: Telephone: F' y State Lic. #: Name of Contact Person:.2, Construction Type: R^,, Occu anc E- P Y Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: Q 57o # Stor' s: # Units: Telephone # of Contact Person: —C-75/ Estimated Value of Project: &1r( APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready focorrections (314&Plan Check Deposit Truss Calcs. Called Contact Person �p p (j Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted 71 Mechanical Grading.plan 2" Review, rea y for correction 'ssue Electrical Subcontactor List Called Contact Person 111(2. Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3rdReview, ready for correct'ons/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Tot I Permit Fees C 0-, � `�' ;3:+0. �'� �€•,a�aa:�;,�RR:� r : ' . , a r DOC V 2005-0028225 `�.• , RECORDING REQUESTED BY ; ,01/12/2006 08:00A Fee : 33.00 r° Page 1 of 3 Doc T -Tax Paid ,.;.� Recorded in`Official Records AND "wiIEN RECORDED MAIL TO:County of Riverside f` . Larry W. "Ward John Corrigan Assessor, County Clerk & Recorder �" + - e�Corrigan 41646 Mon que Road Bermuda Dunes, CA 92203. _ A.P.N. '774-072-012 TRA #: 0= 0,2, order No.. , GRANT i UNDERSIGNED THAT DOCUMENTARY TRANSFER TAX IS: COUNTY 234.30 TIS GRANTOR(s) DECLARE(s) OEM , n® Cc FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, i JA_ Dee Williams and Robert A. Williams, successor. trustees of the Janice A, ' Williams Family Trust dated September 2, 2003 hereby GRANT(S) to John Corrigan and June Corrigan, Husband and Wife as Joint Tenants the following described property in the City of La Quinta, County of Riverside State of California; "See Exhibit "A" attached hereto and made a part hereof. The Janice A. Williams Family Trusi Dated September 2,200 3 By: l UNDERSIGNED THAT DOCUMENTARY TRANSFER TAX IS: COUNTY 234.30 TIS GRANTOR(s) DECLARE(s) [• ] computed on full value of property conveyed, or at time of sale, ];computed on full value less value of Gens or encumbrances remaining , [ [ ] unincorporated area: [ / ` ] City of La uinta ,and y , Cc FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, i JA_ Dee Williams and Robert A. Williams, successor. trustees of the Janice A, ' Williams Family Trust dated September 2, 2003 hereby GRANT(S) to John Corrigan and June Corrigan, Husband and Wife as Joint Tenants the following described property in the City of La Quinta, County of Riverside State of California; "See Exhibit "A" attached hereto and made a part hereof. The Janice A. Williams Family Trusi Dated September 2,200 3 By: l r A. Dee Willi Trustee By Willimas Robert A•Itee Successor ' Document Date: December 20 2005 - Y STATE OF CALIFO )SS COUNTY t`%^�`�' "`'�Q" -(.1✓fj l� y before me; On - personally appeared / ( proved to me on the basis of sat ry evidence) to be the person(s) whose name(s) ' are subscribed the within instrument / e/they executed the same in /their authorized capacity(ies) and that by h r/thea si�ature(s) on the inslntment 4 and acknowledged to me that the person(s) or the entity upobf of which the person(s) acted, executed the instrument • WITNESS my hand and official seal. r This area for official notarial seal. 't Y WASHA I"IP OON&MM 199 M', ' 9 wBon4a 20VI7 ' . s?a F. i l {�1W"`V[ b? .' •O� �� l•D •. , y, e;.�-.�,ii a ... sr`+ "4.�i.'T l +T yi1i - x •:^t •1.. '� 7 � �y yy try 1 �k�e �S• yj� 7 `�it'Y� �G . STALI,ATION CERTIFICATE (Page 4 of 12) CF -6R Address Permit Number STALLER COMPLIANCE STA MENT FOR DUCT LEAKAGE : !'ALLER COMPLIANCE STATEMENT. :wilding was: ✓ OTested at Final ✓ O Tested at Rough -in :TALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS: remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing vall are properly sealed. :,the house rough -in duct leakage test was conducted without an air handler installed; inspect the connection points between the r handler and the supply and return plenums to verify that the connection points are properly sealed. .spect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts. ] DUCT LEAKAGE REDUCTION F ,e duces or a vert cation and diagnostic testingo air distribution s stems are available in RACM A endix RC4.3 I i i i V CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ O Measured If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating Capacity in Thousands of Btu/hr enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentage < 6% for Final or < 4% at Rough -in without air handle: 100 x Line # 1 / Line # 2)11 ❑pass ❑Fail' :'ERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Chana-Out. Enter Reduction in Leakage for Altered Duct System Line # 4 Minus Line # 5 —(Only if Applicable) Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ " ✓ . Entire New Duct System - Pass if Leakage Percentage < 6% for Final. 100 x Line # 5 / Line # 2)11 ❑ Pass O Fail ['OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- Use one of the following four Test or Verification Standards for compliance: ✓ Pass if Leakage Percentage < 15% (100 x [ f I (Line # 5) / `rbU (Line* 2)]] �bW,4s ❑ Fail Pass if Leakage to Outside Percentage < 10% [100 x f (Line # 7) / (Line # 2)]] O Pass ❑ Fail Pass if Leakage Reduction Percentage > 60% [100 x [ _(Line # 6) / (Line # 4)]] rind Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines # 9 through # 12 pass ❑ Pass ❑ Fail 1, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance :. 1, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with atory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. .:ling Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner IY�` l • Uure: Date: i -:s to: BUILDING DEPARTMgNT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY !' ,�,ntiai Compliance Forms December 2005 02/2/2006 11:01 9099806828 PAGE 03 General Envioronmentai Man_agg�P'D'l end' SerVjCe. . -Environmental Testing. ana; Consulting t INSPECTION REPORT FOR ASBESTOS CONT IIWNG MATERIALS Prepared for; John Corrigan Project Locali ; 77350 Calle Monterey 41646 Moneaque Rd. La Quinta, CA Bermuda Dunes, C,A, 92203 ,Prepared by; Joseph Johnson, Certified Asbestos Consultant, 92-0698 GEM Services G.+EMServices Job IA, 102635 TABLE of CONTTs SECTION I INSPECTION REPORT , SECTION 2 .ZA.BORATORYSAMPLE RESULTS SECTION 3, NOTICE FOR MATERIALS CONTA)7VRVG LESS THAN I% ASBESTOS SECTION 4 FIELD DL4GRAM SECTION 5 CREDENTIALS OF INSPECTOR r 11010 Arrow Route, Suite 105, Rancho Cucamonga, CA 91730 (800) 886-2589 • Fax (909) 980-6828 02/23/2006 11:01 9099806828 PAGE 04 General Environmental Management Services- Environmental Testing and Consulting February 23, 2006 John Corrigan, 41646 Moneaque Rd. Bem. uda Dunes, CA 92203 Re: Inspection for asbestos containing materials (ACM) at; 1. 77350 Calle Monterey, La Quinta, CA On February 14, 2006, Joseph Jobnson (Certified Asbestos Consultant 92-069.9 of General Environmental Management Services (GEM Services), 11010 Arrow Route #).05, Rancho Cucamonga, CA 91730, 909-980-7020) conducted an inspection to confirm or deny the presence of ACM in the structure at the location referenced above. The structure can be described as follows; a one story -single family residence approximately 1300 :3gft. in size. The inspection was requested due to a planned renovation of the structure. Our inspection revealed that several suspect ACM were located in various areas within the. apartment unit. The following TABLE 1 represents those materials that were suspected of containing asbestos as well as the area(s) its which they were located. :[ABLE 1 • Drywall and joint compound — various walls, ceilings and debris throughout • Plaster — various walls, ceilings and debris at living room, entry, hallway, kitchen, bedroom 1, bedroom 2, bathroom 1 and associated closets ® Acoustic spray — various ceiling and debris throughout • 1' x `1 floortile and mastic — kitchen, bathroom 1, garage addition under 1' x 16" floor tiles • 1' x 1' floor tile — bedroom 2 closet (top layer) a 9' x 9' floor tile and mastic — bedroom 2 closet (bottom layer) • 1' x 16" floor tile — garage addition (top layer) • Floor tile mastic living room, bedroom 1, hallway, bedroom 2 • 2' x 4' ceding panels — garage addition • Stucco — exterior wail throughout, patio walls • Roofmg felt —.roof under foam e Asbestos cement vent pipe — roof (assumed to contain asbestos, no samples) Samples were collected of each of these materials and subsequently submitted -to EMS Laboratory, (117 W. Bellevue Dr., Pasadena, CA 91105-2503, 626-568-4065, IWLAP No. 10 1218) for analysis by Polarized Light Microscopy (PLM) to determine if asbestos was present and if so, to determine the percent composition in which it was present. 110.10 Arrow Route, Suite 105, Rancho Cucamonga, CA 91730 (800) 886-2589 4 Fax (909) 980-6828 02/23/2006 11:01 9099806828 PAGE 05 Asbestos inspection report, 77350 Calle Monterey, La Quinta, CA February 23, 2006 Page two of three Those materials containing greater than one tenth of one percent asbestos (0.1'%) are considered asbestos containing construction materials (ACCM) as defined by the State of California. If materials containing greater than 0.1% asbestos are to be disturbed, the work must be performed in compliance with the California Code of Regulations, Title 8, Section 1529, (Cal/OSHA Asbestos Standard for the Construction Industry). Those materials containing greater than one percent (1 %) asbestos are considered to be ACM by the Environmental Protection Agency (EPA) and the South Coast Air Quality Management District (SCAQMD). If ,ACM is to be damaged or disturbed during construction or demolition activities, they become subject to the requirements of the EPA's National Emission Standard for Hazardous Air Pollutants (NESHAP's) and/or SCAQMD Rule 1403, Asbestos Emissions from Renovation and Demolition Activities. The materials found to contain asbestos in amounts of greater than 0.1 % and/or 1% are listed.in TABLE 2 (see Section 2 of this report for details on the sample analysis and asbestos percentage composition). TAR L.E 2 • Plaster — various walls, ceilings and debris at living room, entry, hallway, kiteben, bedroom 1, bedroom 2, bathroom 1 and associated closets — 2700 sqft. • 1' x `1 floor tile and mastic — kitchen, bathroom 1, garage addition under 1' x 16" floor tiles -150 sgft. • 9' x 9' floor tile and mastic — bedroom 2 closet (bottom layer) — 55 sgft. • FIoor file mastic — living room, bedrooth 1, hallway, bedroom 2 — 835 :;qfL • Asbestos cement vent pipe — roof —10 if. Our findings on this project were obtained using the generally accepted practices and procedures followed by the asbestos inspection industry. The number of samples collected may not have been in accordance with the guidelines found in the AHERA regulations. The inspection was conducted in substantial compliance with the provisions of the SCAQM D's Rule 1403. GEM Services cannot be responsible for sub -surface or inaccessible materials that may not have been identified during the survey although a reasonable effort will be made to ascertain their presence. Contractors bidding'on the removal of acm or acem should use their own measurements. We recommend that any asbestos removal be performed by a contractor tminad.and experienced in asbestos removal operations and who is registered with the State of CaliforaWs Division of Occupational Safety and Health as well as being licensed with the Contractors State Licensing Board for asbestos removal. 11010 Arrow Route, Suite 105, Rancho Cucamonga, CA. 91730 (800) 886-2589 4 Fax (909) 980-6828 02/23/2006 11:01 9099806828 PAGE 06 ,Asbestos -inspection report, 77350 Calle Monterey, La Quinta, CA February 23, 2006 Page three of three This, concludes our report. Please call if we can be of further assistance. We have included a copy of the laboratory sample results and the credentials of the individual that conducted the inspection. dJos h J hnson. C sbestos Con ultant, #92-0698 GEM. Services 02/23/2006 11:01 02/22/2006 10:44 FAX 9099806828 REPORT NO: 1015506 CLIENT; Cult SERvICE3 tt010 ARROW HOUTC SUITE 105 DATE: Pet) 22, 2005 AANCMO CUCAMON01k," CA 81730 Da,TF WPCfRIV6Dt Fhb 1R, 2606 ATTENTION;, -IQk JQNN$QN DATE ANALYZED: rob 21, 2000 RfiFIEAENCE: PROJECT: 102635 AATC P TIIIAC e.^$ 0 CPTCr%- SUPJFqCT: LIMAIAe AT 47 -AA OV 1 Inu Ne ARI Polarixod Light Micrvbevpy AVAIy.YS 10r Asbestos; 23 Samples MGTHODOLOQV: "Mothotl for Determination of AFbaxtoa In Sulk Dulldlnll (Materials.' EPA 60018.93/116 AGCMEDITED: National Institute of 8tandsraa and Yachnology (NVLAp) 0101210 CERTII■IED; Csliferaia Vapartmont of Health Svrvfces Environmeirtel Testing Laboratory FLAP 1119, County Sanitation ObtrlCte of Los Angeles County, Labaratary Identiflcatton No. 10120 QUALITY CONTROL SAMPLE (with 1666 QLASS FIRERS AS THE BLANK): NONE DETECTED SAMPLE ID SAMPLE LOCATION 8 � VISUAL AMBES PICIFi t OTNF-R FIBROUS NUMBER 063CRIPTION [,'0N-FRrWLE DESCRIPTION MINERALS MATERIAL.; WHITE GRANULAR NONEDETECT ED CELLULOSE JA nW NON -FRIABLE WHITE GRAN UL.AFl N OhEDETEC"1'� NONE Ct@C:T1� 1A JC Nati-FRIABLE WHITEGRANULAR NCKDMWE0 CELLULOSE 3% is ow I NON-FAIAILE .. WHITEGRANLILAR NQN60ET.GMW CELLtAOSE- 18 JC LESS THAN 1% NON -FRIABLE WHITEGRANULAR NONEDETECTED CELULOSETY 1C DW l I I I MON-FRIABLE WHITE GRANULAR NONE DETECTED 10 JO I NON -FRIABLE vvI it1E GpMIUl11R CI IRIYSCTiLc LES THM11% ?A 05TEME0 RM;i OETECTED PAGE 07 Q002 NON-FRIASLE WHITE GRANULAR CHAYSOTItF. LESS THAN 1% CIELLULbaE- t:B LESSTHAN 196 Optical MF aeapiat. P.M. Koik, Laboratory Plrector BMKIvai ,IV., 610A me0*0 is a semi quantttative preaadurs. The detection limit is balWAAn 1110 to 1 percent by area and In dApandenl Upon the .het et tam osbeelwo. Ilya, ihr: mi.1{11y Of ydtMplirig and the matrix of Ihn sampled material The test results raparted aro for the sample o- sempleo dallvorna 10 vs dnd may not reprm2em PtPe entire renvurlyl from wheat% the SaMPIC w&S t7aliM Tile EPA ra0ommends three samploe or more he taken of a-hamagoneous srlmplfng area'( before friable material Is considered man-eBuestas-conttrining. These anulysar. were perfomted as a'aeraanlmg' which Is allowed by NVLAP, but omltsome of inn raeommanded OC of the method, --Negative floor the samples may contain gignl1103AI 6m0untr (p1%) of very thin 00008101; fibmrs which cannot be dateetoo I)y PLM, CanBrmetcn by X -Ray diflrsell or TBA i; reeommendad by EPA (Federal Register Vel. SB, No. 106), This report, tram a NIST cacemclled 19L101340ry througli NvI.AP, must not bre uses by IhP client to nlalm proauci ondcrsoment by NVLAF or any r gency of the U.S. Gavemment. NOTE: TI11t r000A tlhaa not bo roproducco, extspt In full. r4thoub The veriaen approval of EMS Laborataria6, Inc. PG 1 �! EMS LABORATORIES 117 West Bellevue Drive / Pasadena CA. 9110.5-2503 /626-568-40()5 02/23/2006 11:01 9099806828 PAGE 08 . 0`2/22/2006 10:44 FAX 11003 REPORT NO: 105505 CONTINUED PG. 2 $AMPLE ID SnMPLO LOCATION iL VISUA4 ASSESTIFORM OTHER FIRROUS - NUMBER DESCRIPTION DESCRIPTION I TmNERALs MATERIALS NON -FRIABLE "ITE GRANULAR . CHRvsOTILt! LESS TH41 11% N17NE0ETECTM i3G - i ! NCN•FRIABL-E BEIGEGRANULAR CHRYS(MLE- NONEDETEGTED 3 PT GREATER THAN 1% Ndr+FRIABLE BLACK TAR LIKE CMRYSOTILPi 1.2% CELLULOSE a rpt LAC16 THAN 1% NON•FRIABI. E TAN GgANUTAP, NONE DETM71M r VOIVE De IECTFp 4 - NaN•F RLR GREENGRAWIAq CHR'YSOTTLE- NONEOST90TED 5 FT - GREATER THAN 11% - NON�FRIABLE ' BLACK TAR LIKE ONRYFOTIE.G 91A NONE DETECT'm SM NON-FRtAsLB BROWNRUMERY INOW- OEIECTID NONE10FTl9TED 6 ` r-Flut2LE1MIiITE r GPM ULATI ; NOW DET13%TEP NONE DETE-= 7A Optical `1TAioroscoplet 8,11A. KOM, Gaberatory biganfor The EPA method is a semi qupnIhRtive procodums. Tnle aAtAcllar, droit is betwear• 7110 to T percent by area and in depohdilm Upon me ofse of thv asbestos fibers, the mune of sampling and the matrix of the srtmpfed material. The test results reported ere for the Semple or aampl-s dwlivcred fo Us era fnoy not reCressnf Me orlbro mbleriat from which ilia sample was taken. The EPA racammends Ihrrru Sdmpw#L or more be taken of a •horrla$eneous sampling area° bafara friable material is considered non•as4ctltn0.ranl llnlnp. 1 hese artetybec tv m portoemea sa a'acrooning' adtloh Is alloomd by NvLAP, Lti,f ortdt some eI Ino recommended OC of the melhOd. '-Nagativq (Icor his Samplaa may o?nt&in 91grlficant smountc (a1'rj at very chin aeboamp fiber; which Cannot be detbctod by PLM. Contlrmtillon by x•Finy diffraction or TEhT is rocommandelf by EPA (Fadarai Register Vol, fag. No. 169). ThIr raport, Irom a NIST acamellind teogratery throltPh NVLAP, must not be used by the client to claim product erldOrsemerl by NVLAP or any agency of the U.S. Oovommem. NOTE: This report moll "I be reproduced, atappt In fuli, without me written approval of EPA& Laboratories, Inc. EMS LAIBORATO RI ES 117 West Bellevue Drive J Pasadena CA 91105-2503 /626-569-4065 02/23/2006 11:01 9099806828, 02./2212006 10:45 FAX REPORT NO: t 0,5 so a CONTINUED SAMPLE ID SAMPLE LOCATION 8 VISUAL NME DETECIED Nummert AR3CRIPTION DESCRIPTION FRIABLE went= GRANULAR 7S N0,90free, NOACIFTEGTE0 NONS DETECTED FRIABLE I WPTrr. taRANVLAR NONEPETECT50 70 CELLULp.*EW/; I NCNFKiInrdL@ WWITE PAINT 8 i GRAY RSFICUS Ifs I NON-FR.tABLE BBaEOFANILAR 901 NON -FRIABLE 8EldEGRANULAR i qs 3RAYGRANIAAR NON-FRIA13LE BEIGEGWWULAR +CRAY BC GRANULAR - NON•FRIA13hE' . BLACK TAP UKE t t1 SLACK FIBROUS ASDBSTIFORIV I OTHER FIBROUS MINERALS MAT6arAL3 NONE D-=T8nr :b MINE DETECTED NONE 08190M NME DETECIED WJ4E0STWTW CELWIA3E 25% GLASMOM 0101A NON900=0 NONE oEfia M N0,90free, NOACIFTEGTE0 NONS DETECTED NCWIkMVM NONEPETECT50 CELLULp.*EW/; I Optlge Mioroobopiat PAGE 09 0004.' 13A, KOIN, Laboratory olrxtor Thr. FPA method m a y,rml quentltalivp procedure. Tho dptsetion limit Is between WIG to 1 percenl by area and 13 d0pondIPM .pan fila rl;e of the asbesms f1beta, tho means of aampflrtg and 7ro »..lrix of the "mptec malarial. The teat reaults reported ars for the sample or somples delN9red to ue and may not represent the entero motarinl from whloh the sample vm taken. The EP{t recommends three samptea or more be tern of a "hemogpnevus 50mpling maw bore friable mmenef is considered non-astieetoa.aon;asnlnq. These analyeae warp psiftrinod as Wafeaningr whkt. Is allowed tfy NVLAP, but omlt some of the recommended (2c of the method. —Negative fluor ill. samples may romai. algnlllcant amount+ fo i%. of very thin eatiestes 11aor. wMah cannot be detaotoa by PLM. Ccoflrmahon by X -Ray diffraction or TEM r, rocomtrKmeteo"EPA (fMapml Replsteir Vol. SI), No. 140), Thle sport, from a N13T aeereditod IntoMtory dlrougn NVLAP, must not be Lined by the client to claim prolluel ondorsamont by NVLAp or Any ttg.:nry of me LIZ. Government. NOTE' This report chall not be reprodaeed, oxoRpt In full, without the wrltlen approval of EMS Labcramrlea, Inc. - DzMO lENAS LABORATORIES 117 West Bellevue Drive ! Pasadena CA 91105-2503 /626-568-4065 m 0 0 ISP V C# #V1 ap L;11 fig 1 �iBI1J1Cl rr u � 11010 ArroW Route, Stlrte 1(15, Hanogo Cucamonga, CA. 91730 Mara emenf Services Ud Twine and Consuli e-_ 1800) 886-2584 , Far ~01 oRn_tiD-jo SAMPLE DATA SHEET PAGE or . L PROJECT: E� �rYl� �PsiG�+� CrP CONTACT: 1704pwoh TtlRNAROUNO. Same day �� �YJ SAMPLED BY. _.�_ .76banrM^ -7-735-c) +tr9zM t !-fv PROJECT 113—L0a63_.5 24 Hr. dg ii r. SAMPLING TIME: !a , i e SAMPLING DATE: -D-y-ac 3� Day 1--l"Weekertd SAMPLE ID LOCATIONlDESCRIlynoN START: FLOW RATE VOLUME! SAMPLETYPE ANALYSIS STOP: MINUTES AREA_ ismbdmwl REQUESTED{seebeiowl 1,4 d ALM ;�o�o!VLA � a Ila � ff • ,Cr I I ,<lbrn a Os a � Corr. �C I4nM a i 001 'Aaf Iv 1 0� - f7 b I% ,6et how jw, t 7 it /`a �J ` ei m r V A = air. WC - walI cavity. T- tape liR. S = Swab, S = bulk, AN D = Anderson. M V - microvae. W = wipe, O - other Analysis codes: — TFS = (0111 fungal spores, TFCFU = total fungal cfu's. TUCFU = toial bactesis cfu's. TECJ1 F =10(31 E. Coli. elm's. DE =mold growth spores by direct exam. TEM =Transmission electrum microscopy, PCM -phased contrast microscopy. PLM = polarized light microscopy, AA =Atomic Absorptioa. 0 = olher Relinquished by: Uate:-IC'o� _Receive Dale: 30 Vt CD N m m 0 i L�ltt�l Cif A-llYro LOAjdllICIALas . 1101U AMOW Haute, sulre sus, Harlcrry LUC17MOn-W, Col. 91738 m�ntai Tessin acrd Consrd�i t800l 886-,2SRQ o. rray sono, non �.._., SAMME DATA SHEETPAc>V �0 � PROJECT: Orrr sicYrr- COOVTAC1; TURNAROUND: Same day SAMPLED BY: PROJECT ID: /0�3 _ _ Z4 Hr. 48 Hr. SAMPLJ14C TIME: SAMPLING DA'C'E: J 5 flee ,/ Wao4ona A = a'r, WC -wall caysy, F=1apc lilt, S =Swab. 8 = bulk, AND= Anderson, MV = m(cmyac, W =wipe. O = a16er Anal a cedes- _ TFS - total fungal spores, TFCFU = total fungal cfu's, TOCK = total bacletiacfu's. T.ECUF - tat8l E Cali du's, DE = Mold groW1hfsporesby direct exam, TEM=Transmissionelecuonnticroscopy, PCM =phasedcontrasl nticroscepy. PLM =polarized fight micro Q = other- A=Alorrtic Abaorytion_ Rc linquishcd by:C I S `OG y O Rate:—Received Dale: ✓ N W N m cri m Lo CS) Lo Lo m CS) ao N M D G) M N N 02/23/2006 11:01 9099806828 PAGE 12 02/22/2006 10:46 FAX 0 007 SLTBIVII"1 AL FORM Lab. t y Serptcsa REL D • ►TIME / DATE - 0 CLIENT ► DATE OF SHIPMENT _► CARRIER f 0 ADORESS 0 CLIENT P.O. NO. �. 0 CLIENT JOB/PROJECT ID NOp . ► TELEPHONE 0 CONTACT ► PACKAGE SHIPPED F OM,, 0 RESULTS REQUESTED VIA VEREALE7 FAX ► CLIENT FAX NO. (NOTE: Carom wow reports vAM fokw an anaryoeo, In o w&rl to arty prior Nwsmlw venal of rax fwpp-; 0 DATE/TIME OF SAMPLE COLLECTION _ 1 SAMPLE PRESERVATIVE5 HOLDING TIMES ► NO. OF SAMPLES SENT SAMPLER'S NAME -- / I) TYPE: 0 WATER 0 WASTE WATER [3 SOIL El FILTER 0 SORSENT TUBE O IMPINI'ER 0 OTHFR rr r r r CLIENT jlaf,J'pL[ NO. C —4l (i :f' 1 (� _ �F oI" c ATS r I G ,I-�.A ,5 �F'WIN- ► timbmvtwT NIL 0 mea ► ►c'.maf mm ofPabge on pweipt ►c. ", of4m� Mffrr If ft package has tuMbi cd subsuatial d"c oe the mmo gest IS htOlGeft, step atla Contact them mup WflJ a8a wA the aMipPQ.l p Nm t f Samples C2 t ck"b-d-cmgoay s1 Dam of Acoeptaace into sample Bank — -- c- 1 Mise. fafw M ► IDIRmitic„ of Samples 3AW EMS LAsoRATORIES 117 West Bellevue Drive / Pasadena. CA 91105-2503 / 02/23/2006 11:01 9099806828 PAGE 13 General Environmental " Mann ement Services- Environmental Testing an Consulting Important notice for materials Containing less than one percent (1%) astlestos. Asbestos containing construction materials (ACCM) which are those manufactured construction materials containing more than 1/I& of l% asbestos by weight x;0.1%), are required to be removed by a contractor that is registered with Cal/OSHA, to conduct asbestos related work. Although these materials must be removed by a registered contractor, many of the burdensome requirements normally associated with asbestos abatement, such as conducting the work within a containment, disposal of the acem as hazardous waste, etc., may not apply. Although the requirements for removal of ACCM are less burdensome than for the removal of asbestos containing materials (ACM), those materials containing greater than one percent asbestos, many provisions of the Cal/OSHA, construction standard for asbestos still apply. Some of the requirements that still apply include but are n.ot limited to; monitoring of employees exposures during removal of ACCM; use of wet :methods to control airborne dust generation; prompt disposal of ACCM debris; notification to Cal/OSH,A, concerning -temporary job site for asbestos related work. Due to the requirements listed above as well as additional requirements not listed in this notice, we suggest that our customers always select a contractor registered by Cal/OSHA for asbestos related work when removing materials containing more than 0.1 °o asbestos. In cases where bulk sample results show asbestos is detected in amounts of less than 1% or trace, alternative analytical methods and techniques may be used to determine if the actual. amount of asbestos is greater or less than 0.1 %. These methods and techniques may be employed at the customer's request for an additional charge. '. Contact our office if we can be of further assistance. GEM Services 11010 Arrow Route, Suite 105, Rancho Cucamonga, CA 9.1,"730 (800) 886-2589 4 Fax (909) 980-6828 02/23/2006 11:01 9099806828 PAGE 15 DtPARTMENT OF INDUSTRIAL RELATIONS . DIVISION OF OCCUPATIONAL SAFETY AND HEALTH ASBESTOS CONSULTANT and TRAINER APPROVAL UNIT 2211 Parti Towne Circle, Suite 1 � Sacramento, CA 96825 _..,..,. Tel: (916) 574-2993 Fax: (916) 483-0572 209090698C 18 General Environmental Management Services October 17, 2005 Joseph Edward Johnson ' 11010 Arrow Route, 105 Rancho Cucamonga CA 91730 Dear Certified Asbestos Consultant or Technician: Enclosed is your certification card. To maintain your certification, please abide by the rules printed on the back of the certification card. Your certification is valid for a period of one year. If .you wish to renew your certification, you -must apply for renewal at least 60 days before the expiration date shown on your card. [8 CCR 341.15(h)(1)j. Please hold and do not send copies of your required AHERA refresher renewal certificates to the Division until you apply for renewal of your certification. Please inform the our office at the above address or fax number of any changes in your mailing address or work address within 15 days of the change. Sincerely, Steve Smith Supervising Industrial Hygienist SS/ms Attachment: Certification Card cc: File taenia - QM nftd,ed Ruses I0/13MS) J State of Caalti inia Division of,bccupatjen�l. Saipty and Health o-erAaeoA.Asbestos Consultant ON f CERTIFICATE NUMBER W - g certificate oAttendance46469,f , '� ` TRAINIKG lNBTITiTT2 Y • • GO- �LD m LO ID co 0 00 This is to Certify that JOSEPH JOHNSON SS # 567-31-9113 • Has ComPleted the Course of ASA ASBESTOS ABATEMENT BUILDING INSPECTOR 4 HR. RERESHER _06 COURSE CA -014 ° ! n u section 2m o oxlc SubstaRm C43RIMI Act (TSCA) and oomplianoe with AMAP in accordance with 59 FR 5236 effective April 1994 ARMANDO DUCOING August 1Z, Zoos LAREMEt - E081205BLR 081205 August 12, 2006 COPomPLETm ATE . SS umBER / TARTING ATE CmwicATE ExPiP.Es T D Ecologics Training Institute 550 N. Parlkcenter Drive, Suite 102. Santa Ana, CA 92705. Ph. (714) 480-0111. Fax (714) 480-0222 Building Address 77-350 Calle Mon Mr/Mrs Arthur Willkim 44 P.O. BOX 1504 te,rey 7&105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253> , r Mailing Address same City Zip Te . La Quinta 92233 Contractor " L. W7.�aOit Construction Address City -Zip; Tel.: Indio 92203 342-2322 State Lic. City & Classif. 529319 Lic. # Arch., Engr.; " Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION " I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ' 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. }} Yf1i�x� _SIGNATURE "� - - r DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any "city, or county which requires a permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also . requires the applicant for such permit - to rile a signed statement that he is licensed pursuant to * the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of 'Division 3 of the Business and Professions Code, or that. he 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). ❑ 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who• • builds or improves thereon andwho does such work himself or through his own employees, . provided that such improvements. are not intended or offered , for sale. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving that he did not build or fmprove,for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P:C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that l have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. .Company ' ❑ Copy is filed with the city. ❑.Certified copy is hereby furnished: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars (8100) valuation or less.) I certify that in the performance of thq 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 Date Owner ' NOTICE TO APPLICANT: h, after making this Certificate' of Exemption you should become subject to the' Workers' Compensation provisions of'the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name _ Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above informationAs correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above•. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 10792 f BUILDING: TYPE CONST. OCC: GRP: A.P. Number 774-072-012 Legal Description Project Description Sewer Hook Up' Sq. Ft. No. No. Dw. -Size Stories Units New ❑ Add ❑ . Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1,760 PERMIT AMOUNT Plan Chk. Dep. Plan Chk..Bal. t; Const. a Mech. " 'Electrical' Plumbing 30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 30.00 REMARKS,., . `r"SL!•S.m � uia:.t.tfitti �}-r ,i.=`Si"y+'6.i f4l:L� �. f` r ,:: �?l: s a Yr";} ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by:" Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SQ. FT. ® SQ FT @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENTSYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11% c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER Dppl k rROU WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION- l✓ CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 4- 0 ja� - - _�-- jer/ t^4 G f � Building Address Owner 4 4 Qgb& P.O. BOX 1504 78-105 CALLE ESTADO -350 Monterey LA QUINTA, CALIFORNIA 92253 Art Williams Mailing Address 77-350 Monterey City Zip Tel. n. % Quinta 1 9225 .$64..-;332 Contractor Address jZip State Lic. City & Classif. - I Lic. # Arch., Engr., Designer Address Tel CityI Zip I State # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division.3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the .Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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). O 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B.,&.P.C. for this reason Date � ' f %�:7 ;i Owner tms N WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for whish 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. . 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 city to enter the above- mentioned property for inspection purposes. Signature of applicant Dale Mailing Address City, State, Zip BUILDING: TYPE CONST. OCC. GRP. A.P.-Number 774-043"012 04. 1t Legal Description Project Description' Chang' 100 amp to 200 amp. Sq. Ft. No. No. Dw. Size Stories Units New O Add O Alter ❑ Repair ❑ Demolition 0 Estimated Valuation 0*00 PERMIT AMOUNT Plan Chk. Dep. BY: Plan Chk. Bal. Distances: Const. Front Setback from Center Line Mech. . Rear Setback from Rear Prop. Line Electrical $20.00 Plumbing Side Setback from Property Line S.M.I. FINAL DATE Grading Driveway Enc. Issued by: Infrastructure Validated by: TOTALi�' #^� REMARKS 2C or Validation: 1 WHITE -FINANCE, PINK -APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: 1 WHITE -FINANCE, PINK -APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl y S UNITS SLAB GRADE ROUGH PLUMB BONDING Y YARD SPKLR SYSTEM 2ND FL SO FT. lit FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT. a GAS (ROUGH) METER LOOP GAR SO. FT. a POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO FT. g GROUT WATER HEATER WALL SO. FT. rd FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SO. FT. d =S LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN -EVAP.COOL HOOD SIGN WASH ER(AUTOKDISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID C 1Y. c SEWAGE DISPOSAL SO.FT.GAR g 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE CBL TOTAL FEES MICRO FEE MECH.FEE aL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. S plus xS =S LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 71 44 P.O. BOX 1504 NO.. 002.'€.6. Building78-105 CALLE ESTADO Address 77-350 Wle blmterw LA QUINTA, CALIFORNIA 9225.3 Owner Mailing BUILDING:- TYPE CONST. OCC: GRP. -- Address A. P_. Number City Zip Tel. Legal Description .. F. Contractor Project Description . Address .. 74-47A TUv 111_. �i1a *1 City . Zip . Tel. ralm Bill 92260 568-9369 State Lic. City & Classif.- 31,5 4.6 Lic. # Sq. Ft.- No. No. Dw. Arch., Engr.,. . _. Size •• Stories Units' Designer New.R Add ❑ Alter ❑. Repair ❑ Demolition ❑ Address Tel. Cjty Zip ' State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under provisions°of Chapter 9'(commencing with Section .7000) of Division 3 off the Business and Professions Code, -and my license is in full force and effect. - it .e�^+YS . �2a— Z .'la. 441 DATE- - - OWNER -BUILDER DECLARATION EStlmated Valuation hereby affirm that I am exempt from the Contractor's License Law for the following. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires•a �- pemiif to construct, alter, improve, demolish, or repair any structure,' prior -to its issuance also- requires lso requires the applicant /or such permit to file a signed statement that he. is 'licensed pursuant 'to .. _. PERMIT - - AMOUNT " the provisions o/ the Contractor's License Law, Chapter 9 .(commencing with Section .7000) of Division 3 of the Business 'and Professions Code, or that. he is exempt therefrom, and the 'basis ' for the alleged exemption. Any violation of Section 7031.5. by 'any applicantfor a permit Plan Chk. Dep., - subjects the applicant to a civil penalty of not more than five hundred dollars ($500). " . ' - ' O I, as owner of the property, or my employees with wages as their sole compensation; will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and ConS'C 44. Professions Code: The Contractor's license Law does not, apply to an owner. o/ property who 5 builds of improves thereon and who does such work himself or through his own employees, Mech:* - provided that such 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. ElectrlCdl, .., , of proving that he did not build or improve for the purpose of sale.)., - - ❑ •I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law _ does not apply to an owner of property who builds or. improves thereon, and who contracts for S. M. 1. .. - such projects with econtractor(s) licensed pursuant to the Contractor's License Law.) - O I am exempt under Sec. -.. .. B. & P.C. for this reason Grading Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION hereby affirm that 1 -'have a certificate of consent to 'self -insure, or a certificate of ; Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor.Code.) - Policy No. Company O Copy is filed with the city. , ❑ Certified copy is hereby furnished. . TOTAL 45-.00 CERTIFICATE OF EXEMPTION FROM REMARKS. WORKERS'- COMPENSATION INSURANCE _ (This section need not be completed i/ the permit is for one hundred dollars ($100) valuation - - - or less.) —.. ... .. 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. Date `Owner . _ NOTICE: TO APPLICANT: If, after making., this Certificate of Exemption you 'should become • ZONE: BY: subject to the Workers' Compensation.provisions' of the- Labor Code,' you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center.Line Rear Setback from Rear Prop.,Line CONSTRUCTION LENDING AGENCY . Side Street Setback from Center Line I hereby affirm that there is'a construction lending agency for the performance of the. . work for which this permit is issued. (Sec. 3097; Civil code.). Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to' expiration it work thereunder is suspended for 180 days.' 3'^i - I certify that I have read this application and state that the above information is correct. : Issued by: Date • J i Permit - , agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representativesof this city to enter the above-,.- - - ' mentioned property for inspection purposes. �} �pf' Validated by: Signature of applicant v D te` Mailing Address ' F % a < ' t Validation: City, State, Zip ` A4682 3 10 4500 S1 HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST F.L. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SQ. FT. p CARP. SQ. FT. WALL SQ. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE TLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING ttVINAL INSPECTION 3 �� CERT. OCC. FENCE FINAL imor t:I VM", wumA I VMCwmi I IALb. GARDEN WALL FINAL