0211-107 (RER)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
364270 B 10C 0913012(
Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury. that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
�(X\ ) I, as owner of the property, am exclusively contracting with licensed
contractors,to construct the project (Sec. 7044, Business & Professionals
Code).
I am exempt under S ction B&P.C:;for this reason ?
Dated rel �� ` Signature of Owner s , 'dle' �� /� A11 1"
WORKER'S COMPENSATION DECLARATION t
I hereby affif;mu der penalty of perjury one of the following declarations:
() I have and— -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 & policy no. are:
Carrier 1?Xd1'7" Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
J7 ) 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 3790 of the Labor
Code, I shall forthwith comply wit thoee'provisions; .i
:
1
Date. =11" A,7*1e .Z_ .t / . tx
Warning: Failure to secure Workers' Co
mpensation coverage isounlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes)
Signature (Owner/Agent) 4 'f/77 l , Date 2/1/,"7—
BUILDING
/1/, 7r
BUILDING PERMIT PERMIT#
DATE � VALUATION LOT TRACT
5 S391999.50 3/4 : II r. 2136 7,126
JOB SITE- f,, ; i;i; �- py� y�c�6
ADDRESS .4.065 . �.1"t.INWA CARRAN
7�`' APN
4-2.+4'-5 01,14
OWNER
CONTRACTOR /DESIGNER /EN NEER
MIR SgYMS
MMw4.tARTUS
54.065 A DAIt)-1 CARYMMA,
43-71MA`!"IGOD)
LA QUD.,Trk CA 92253
PALMDT,a €"A 97.260
(760)346.4051 MIA- 1946
USE OF PERMIT
RtMMEN'1IA% REMODDL
315 SIP Ar )ITIONi'UMOrMA, PER. Al'PVM''F.0 LA43.'ROY CABS P1 113.
RES, REMODEL 22,895.00 UR
.d XH)IT:ION 315.0 Si+
EgUMAUX, COST OF 4iONU3447'Sv.8d0,!'Stl
M.W. M
1mwr FIT. SUMI'ARY
PLAN 41•inK YEE 101.000-439.318 38;3':.19
C 0 WV r R L I � T7 n. N F" 1041-000-4.18-000 SM9.50
009
NlEt;HAic�yIC A�lr R'l 1(01-��➢y15?�0-421.00�,l0u
Q$20,
'�� ;'(�,1l...lyy���.�iyL� FEE. 101-��Lriq�7{{4��"44�y��OpyOO y3rr -qq00
yyP_J,
i'LUMB11"'�fO RM 101-000-419!,000 0 S30A.)
S°1'RON0 MOTION Teft ; ,RESI a 101.000-241-000 8st.0at
S(566.68
e TOTAL, "M. U f' �`a�s"EN D'11'NOW
swm
DEC 0 9 2002
t
CITY OF LA DUINT
CEIP CE DEE /
B %' `___
DAT FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— 0-7
Underground Ducts
Forms & FootingsDucts
Slab Grade
C
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
6
Compressor
Insulation
_
_G
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final �-3 0 _
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Plumbing Top Out
_ �Ot/ S�
12, 3�
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
Gas Test
Appliances
Final
Final
Utility Noticz (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors.
Temp. Use of Power
Final
Utility Notice (Perm) — - - -
COMMENTS:
r
Je
Din # �� )
City of La -Quin ta
Building 8r Safety Division
P.O. Box 1504, 78.495 Calle Tampico
Quinta, CA 92253 - (760) 777-7012
Building
Building Permit Application and Tracking Sheet
Permit #
10%
Project Address: -.5*4165Atwner's Name:
A. P. Number: *77V -2 — ZWXAddress: 671-0,615- Iq k11101ox
Legal Description: 4 ,P L) Cin-. ST. Zip:9 01111-)414- t CjQ, i T3
-z-9—M &�
Contractor: Kelepbone:
Address: #Project Description:
City. ST. Zip:
Tel
.... ... .. . .....
...... .........
. .. ......
............ ....
.............
................
.......... .....
State Lic. # -3 q 2?0
Citv Lic.'":
Arch- Ener.. Designer:
Address:
City. ST, Zip:
. ........... ..
..... .. . Construction Type: Occupanc%-
Tele phone:
State Lic. Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ec* Sq. Ft.: -3L5, # Stories: 7_4U. nits:
Telephone # of Contact Person: J�IrEstimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'!_
Rec'd
TRUCKING PER.FUIT FEES
2-
Plan Sets
Plan Check submitted 10 Item
Amount
Structural Calcs.
Reviewed, ready for corrections IXIZ-� Plan Check Deposit
Truss Calcs.
Called Contact Person 1111 y ay Plan Check Balance
41
Title 24 Calcs.
Plans picked up OZ Construction
Flood plain plan
Plans resubmitted II Mechanical
2,-)
Grading plan
2"d Review, readv for corr,,tian�.,su, Electrical
Subcontactor List
Called Contact Pers('/VMA3h60L" 4lumbing
Grant Deed
Plans picked up S.M.I.
I-I.O.A. Approval
*Plans resubmitted Grading
IN HOUSE:-
Review, ready for correction -Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
A•ersy T6 ISSU'e-
Pro
Total Permit Fees
RAS ff*D swoz- pAG4 9 f-- rae-scoa4 pr -w -e- nxumss_ vo7- 2
V 7X
Lr -i2 - NP1,V;dF 4- Cl*i S 14A tA+Oew AVron'A4- Ap"' )'.cAA
Date
12/9/02
No.
23940
Owner
Bettie Meyers
Address
54065 Avenida Carranza
City
La Quinta Zip 92253
Tract #
Type
Residential Addition
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
Lot # No. Street S.F. Lot # No.
Unit 1 54065 Avenida Carranza 315 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
13,
o
Q BERMUDA DUNES r
C00 RANCHO MIRAGE d
INDIAN WELLS
�. PALM DESERT ,y
t}i LAQUINTA
IN0O
'Q yh
O J
774-204-014
La Quinta
1
Street
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 315 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage 'in this proposed project may now be issued.
Fees Paid By EXEMPT - Bettie Meyers Check No. -
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen 0.00
11 Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
;CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -1R
Project Title Date
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement
them. This certificate has been signed by the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS
rater.
Designer or Owner (per Business and Professions Code)
Name:
Documentation Author
Title/Firm: Title/Firm: }� v� �/
Address: Address: -7 -2 - Cp•L D F R E0 � � 401A)C-
1
�90 q 'PC-
Telephone: Telephone:
Lic. #:
(signature) (date) (signature) (date)
Enforcement Agency
Name:
Title:
Agency:
Telephone:
(signature / stamp)
(date)
CIN �F ILA QUANTA
BUIL®INC & SAFETY
DEpT�
VED
�'P rRuCTION
FOR
DATE L
Compliance Forms August 2001 A-4
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page I of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (•) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Building Envelope Measures:
§150(a): Minimum R-19 ceiling insulation.
§150(b): Loose fill insulation manufacturer's labeled R-Valuc.
i
` § 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -Factor in metal frame walls
does not apply to exterior mass walls).
' §I50(d): Minimum R-13 raised floor insulation in framed floors.
§ 150(1) : Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no
greater than 2.0 perm/inch.
, V
NIA
§ 118: Insulation specified or installed meets insulation quality standards. Indicate type and form.
$116-17: Fenestration Products. Exterior Doors, and Infiltration/Erfiltration Controls
1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
2. Fenestration products (except field -fabricated) have label with certified U -Factor, certified Solar Heat
Gain Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed.
J.
§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§150(0: Special infiltration barrier installed to comply with § 151 meets Commission quality standards.
§150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas pilot lights allowed.
Space Conditioning, Water Heating and Plumbing System Measures:
:Xl- �nN G
§110-§113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.t—
§150(h): Heating and/or cooling loads calculated in accordance with ASH I2AE. SMACNA or ACCA.
§ 150(i): Setback thermostat on all applicable heating and/or cooling systems.
§1500): Pipe and tank insulation
I. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with
insulation having an installed thermal resistance of R-12 or greater.
2. First 5 feet of pipes closest to water heater tank, non -recirculating systems. insulated (R-4 or greater)
3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R-12
external insulation or R-16 combined internal/external insulation.
4. All buried or exposed piping insulated in recirculating sections of hot water systems.
5. Cooling system piping below 55° F insulated.
6. Piping insulated between heating source and indirect hot water tank.
Compliance Forms August 2001 A-5
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 2 of 2) MF -1R
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of .
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Space Conditioning, Water Heating and Plumbing System Measures: (continued)
§ 150(m): Ducts and Fans
I. All ducts and plenums installed, sealed and insulated to meet the requirement of the 1998 UAC Sections 601,
603, 604, and Standard 6-3; ducts insulated to a minimum installed Ie% el of R-4.2 or enclosed entirely in -
conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant. or other duct -closure system
,
that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B. If mastic or tape is used to seal
openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. Building
cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their
components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in
combination with mastic and drawbands.
2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials
other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned
air. building cavities and support platforms may contain ducts. Ducts installed in cavities and support
platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
3. Joints and seams of duct systems and their components shall not be scaled with cloth back rubber
adhesive duct tapes unless such tape is used in combination with mastic and drawbands.
4. Exhaust fan systems have back draft or automatic dampers.
5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
6. Protection of Insulation. Insulation shall be protected from damage. including that due to sunlight,
moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to
weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas,
or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material..
§114: Pool and Spa Heating Systems and Equipment.
1. System is certified with 78% thermal efficiency, on-off switch. weatherproof operatine instructions, no
electric resistance heating and no pilot light.
2. System is installed with:
a. At least 36" of pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets and a circulation pump time switch.
§ 115: Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no
continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr
§ 118 (f): Cool Roof material meet specified criteria
Lighting Measures:
§I50(k)l.: Luminaires for general lighting in kitchens shall have lamps with an efficacy of40 lumens/watt '
or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily
accessible lighting control panel at an entrance to the kitchen.
§ I50(k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an -
efficacy of 40 lumens/watt or greater switched at the entrance to the room or one of the alternatives to this
requirement allowed in § 150(k)2.; and incandescent recessed ceiling fixtures are IC (insulation cover)
approved.
Compliance Forms August 2001 A-6
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 3) CF -1R
Project Title
��'-?��<.',�`Jt=LY/f7i4- C'�RRA/�"7R •ZA- (�L)it�rl PC i�
Project Address
<51LL�1 M C.Z.Cfi�
Documentation Author Telephone
Compliance Method (Package or Computer) Climate Zone
Building Permit #
Plan Check / Date
Field Check / Date
GENERAL INFORMATION
Total Conditioned Floor Area 17�ek ftZ Average Ceiling Height: ft
Conditioned Slab Floor Area 17Y ftp - >
Building Type: Single Family V Addition
(check one or more) Multi -Family Existing -Plus -Addition
Front Orientation: North/ South ast ' West/ All Orientations
(input front orientation in degrees from True North and circle one)
Number of Stories 1
Number of Dwelling Units:
Floor Construction Type:la /Raised Floor (circle one or both)
RADIANT BARRIER (required in climate zones 2, 4. 8-15) Required for this submittal_ yes Ino
BUILDING ENVELOPE INSULATION
Component
Type
Frame Type
wd = wood
stl = steel
Cavity
Insulation
R -Value
Sheathing Total R- Assembly Location/Comments
Insulation Value' U -Factor' (attic, garage, typical, etc.)
R -Value
Wall
trU V
2 n
N — —
Wall
laJD
Roof
Roof
Floor
Floor
fo' f 2415
-716-o.-1'6
--
Slab Edge
uc ° z .,
m -7 C
0 o -7?
' For prescriptive compliance, Total R -Value and Assembly U -Factor are not required for a wood -framed wall that meets cavity R -value
insulation requirements for the Prescriptive Package.
FENESTRATION
Shading Devices
Fenestration
#/T e/Pos.
Orien- Area
tation(ft')
Fenestration
U -Factor
Fenestration Exterior Overhangs/
SHGC Shading Att. Fins
Front
Front.
Left
Left
Rear
Rear
fo' f 2415
-716-o.-1'6
--
Right
uc ° z .,
m -7 C
0 o -7?
Right
Skylight
Skylight
Compliance Forms August 2001 . A-2
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -1R
Project Title
Date
HVAC SYSTEMS
Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load.
Distribution
Heating Equipment Minimum Type and Duct or Heat Pump
Type (furnace, heat Efficiency Location Piping Thermostat Configuration
pump, etc.) (AFUE or HSPF) (ducts, attic. etc.) R -Value Type (split or package)
Cooling Equipment Minimum Duct Heat Pump
Type (air conditioner, Efficiency Location Duct Thermostat Configuration
heat pump, evap. cooling) (SEER) (attic, etc.) R -Value Type (split or package)
SEALED DUCTS and TXVs (or Alternative Measures)
�r� ❑ Sealed Ducts (all climate zones)
(Installer testing and certification and HERS rater field verification required)
C1TXVs, readily accessible (climate zones 2 and 8-15 only)
Iva
va (Installer testing and certification and HERS Rater or field verification required)
❑ Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only)
// (Installer testing and certification and HERS Rater or field verification required)
r�
❑ Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone)
Climate Zone Window SHGC Window U -Factor SEER Heating
WATER HEATING SYSTEMS
Energy' External
Rated' Tank Factor or Tank
Water Heater Distribution Number Input (kw Capacity Recovery Standby' Insulation
Type Type in System or Btu/hr) (gallons) Efficiency Loss (%) R -Value
I . For small gas storage water heaters (rated inputs of less than or egtuil to 75,000 But/hr), electric resistance, and heat pump water heaters, list Energy
Factor. For large gas storage water heaters (rated input.ofgreater than 75.000 Btu/hr), list Rated Input, Recovery Efficiency and Standby'Loss.
For instantaneous gas water heaters, list rated input and recovery efficiencies.
SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant
Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001Residential Manual).
Package C: thermal mass (thermal mass type, covering, thickness, and description).
Compliance Forms August 2001 A-3
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329
Riverside, CA 92517
(909)624-1665
ASBESTOS SURVEY REPORT
Completed On
October 15, 2002
PLM1009#0401
Client: Bette Meyers
P.O. Box 1518
Palm Desert, CA 92211
Project: 54065 Avenida Carranza
La Quinta, CA
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(800) 824-3353
On October 09, 2002 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) from
the areas to be remodeled only at the request of the client named above. A total of (4) bulk samples
were submitted to Carolina Environmental, Inc. 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. 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 then 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.
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 00 of the 04 samples
analyzed.
(1)
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329 3.1855 Date Palm Drive, Ste. #1=507
Riverside, CA 92517 Cathedral City, CA 92234
(909)624-1665 (800)824-3353
PLM1009#0401
Sample #BM -1 Type of material: exterior stucco/ white -grey
Location: exterior W. wall
Area:throughout exterior walls
Friable:no Results: none detected
Sample #BM -2 Type of material: 12" vinyl tile/ white
Location: kitchen floor
Area:approx. 70 sq. ft.
Friable:no . Results: none detected
Sample #13M-3 Type of material:tile mastic/ yeloow-tan
Location:under sample #13M-2
Area:approx. 70 sq. ft.
Friable:no Results: none detected
Sample #BM -4 Type of material: asphalt roofing felt/ black
Location:SW roof
Area: roof above kitchen
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 �) a (m� —
Scott C. Morrison
Certified Asbestos Consultant
DOSH#92-0248
(2)
Oct -15-02 05:01 Pm Frcm-CAROLINA ENVIRONMENTAL +4811442 T -23d P.03/04 F-794
i
The following definitions apply to the abbreviations used in the ASBESTOS
BULK ANALYSIS REPORT:
CHRY
= Chrysotile
CELL
. = Cellulose
DEBR = Debris
AMOS
= Amosite
FBGL
= Fibrous Glass
BIND = Binder
CROC
= Crocidolite
ORGN
=Organics .
SILI = Silicates
TRE:M
= Tremolite
SYNT
= Synthetics
GRAV =Gravel
ANTH
= Anthophyllite
WDLL
= Wollastonite
MAST = Mastic
ACTN
= Actinolite
CERWL = Ceramic Wool
PLAS =Plaster
N D
= None Detected
NTREM = Non•Asbestiform
PERL = Perlite
NANTH = Non-Asbestiform
Tremolite
RUBR =Rubber
Anthophyllite
CLIENT: Scott Morrison & Associates
PROJECT: 54065 Avenida Carvanza, La Quinta
CEI LAB CODE: A02-6732
Stereoscopic microscopy and polarized light microscopy coupled with dispersion staining is the analytical lechnique used
for sample identification. The percentage of each component is visually estimated by volume. These resorts pertain only
to the samples analyzc-d. 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 I1 bulk samples
after 30 days.
Many vinyl floor tiles have been manufactured using greater than 1 % asbtastos. Often the asbestos was mi;led to a fiber
size below the detection limit of polarized light microscopy. Therefore, a "None Detected" (ND) reading on vinyl floor tile
does not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a mare 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 Accreditatior.
Program (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA / 600 / r%R4-82 / 020 for
the analysis of asbestos ir building materials. Procedures described in EPA 1600 / 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 4101758-0. This report is not to be used to claim product endorsement by NVL.AF or any agency
of the U. S. Government, This report and its contents are only valid when reproduced in full. Dust and sail analyses for
asbestos using PLM are not covered under NVLAP accreditation.
ANALYST � �-
REVIEWED BY
Tianbao Sai, Ph.D.
Laboratory Director End of Report
Oct -15-02 05:01pm From -CAROLINA ENVIRONMENTAL
,CqA OLlNf1 ''ENVIRONMENTAL, INC.
a0;ll'Nevr Editidn Court, Cary, NC 27511
Ph0n9:.(919)- ! 1-1413 Fax: (919) 481.1442
Client: SCott Morrison & Associates
1130 Fuerte Circle
Palm Springs C A 92262
Project: 54065 Avenida Carvanza, La Quinta
+4811442 T-239 P.02/04 F-794
LABORATORY REPORT
ASBESTOS BULK_�ALYSIS
CEI Lab Code:
Received:
Analyzed:
Reported:
Analyst:
A02-673'
10-14-02
10-15-02
10-15-02
Gregory J Hanes
CLIENT 11ctl
17- SAMPLE, DES'CRIP..T.I.ON
LAB:'lA
BM -1 A84159 STUr- ND
Heterogeneous, White,Grey, Non-fibrous, Tightly Bound
BIND 98 t% CELL 2 %
BM -2 A84160
FLOOR TILE
Heterogeneous,
White, Non-fibrous,Tightly Bound
BIND l o0 ,%
CELL <1 %
BM -3 A84161
UASJIQ
Heterogeneous,
Yellow,Tan, Fibrous,Sound
B ND 97 '%
CELL 3 0/6
BM -4 A84152
ROOFING
Heterogeneous,
Black, Fibrous, Bound
BIND 80'%
CELL 5 °/f:
FBGL 15
BM -4 A84163 ELAUER
Heterogeneous, White, Non-fibrous,Bound
2 Samples labeled BM -4 were BIND 100% CELL <1 %
submitted -
ND
ND
ND
ry u
Page 1
II k--4 V-4
(3 sLu E)q - dSLI lQ3
From: Scott Morrison & Associates Gb 1130 Fuerte Circle
Palen Springs, CA 92262
(760) 323-7743
C1"N OF CUSTODY
To: Carolina Environmental, Inc.
102-1H Commonwealth Court
Cary, NC 27511
(919) 481-1413
NVLAP Code 101768-0 CA ELAP #2483
Client: &Q 4 ijtr-3 Person Taking Samples: Scott Morrison, CAC#92-024$
jos uA WA60LAU,A1 I-d1AI-.r A J. /... - . � . fl r
Job `i V,
Sire Address: iLV7 I1-vVii0L (I"VUJIut61 L41i41-44
Sample i!
Sample Date
Material & Description
/ AA -Pb
I Other Information
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Fax in Results ? v es/ ,,nn No
Relinquished By: �( �`�4�y� iDate/Tinje: (011'0[0Z— Received Byc_ �--Date/Time:�/1/e,
llait/Far To: Scott Morrison & Asociates, 1130 .Fuerte Circle, Palm Springs, CA 92262, (760) 33-7743 � �t