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0111-125 (RER)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjay 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 ez- Date Signature, of Contractor/ OWN ER-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). ( ) 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 Section B&P.C. for this reason Date Signature of Owner 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 pe,,Armance 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��, Policy No. (This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become ,subject to the workers' compensation -provisions of�Section 37100 of he.Labor ,0 Code,�l i6ll ` hfiw6h comply wifi�t' ho'�(?ro;jsjons'. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful 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, indemnify,, & 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'kfrom date of ,issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that.l 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 propeftyafor inspection pu�otes.?4 ,,,J f/ j Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# (/ / �.x- rE/1/1,.f,.( VALUATION LOT TRACT JO ITE APN ADDRESS , filo cm nww OWNER CONTRACTOR / DESIGNER / EN (NEER WE 11 d, AQCld'NT..0, CA, 92253 VOtitiB2'aUl:Qi.tA CA TJV8,86 USE OF PERMIT R:C' ±E Dr"L K1T+( HgN !tRMOD WITH STRUCTURAL Cr'li,t4hfGEN 221500.00 fes' P3in�YSA.l1V,.gY.'b11k��.,q2,.AYY'lG�7AaN iGARY . � aD�EAWt1!000t♦1 $+52 /i 101-000-439.316 VONSTiaUC,Ti aN FEER', IM -d3004.18-004 $2x" STRONG MC227'�%T RE RUID 1'01A000-241-000 $ .5 t RM -TOTAL CONSMUCTLON ANDD ..JJAW Cr~�Ii}�/ IC�ryy���./ij/Se RECEIPT DATIE-, �} f J�F BY DAOALED/ -Z INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs_ Forms &Footings 7-/ -a.� Slab Grade MECHANICAL Underground Ducts Ducts Return Air Combustion Air APPROVALS _ Steel _ _ _ _ Roof Deck Exhaust Fans / O.K. to Wrap_ Framing Insulation 2=�©� F.A.U. Compressor Vents g7 Fireplace P.L. Grills f Fireplace T.O. %� Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath v Final Finales 3 POOLS - SPAS BLOCKWALL APPROVALS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans Sewer Lateral _ _ O.K. for Finish Plaster Pool Cover Sewer Connection _ _ Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) = z ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring=. v o 2— Low Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) — ?: , Z LAM � .N 6-01 12:42 DECO 1 RECEIVED 2001 P _ of Asbestos Bulk Sample Analysis P Y 11040 Rose Avenue, Suite 101 • Fontana, CA • (909) 4281-3099 Lab #: 2447 Client: General Environmental Management Services Job ID: 9433A Sample# Serial# Material Type Description Analysis Date Total Asbestos Content Asbestos Percent. Type Nonasbestos Fibers ' Nonfibrous Material " Sample Location 1 Acoustic Spray White nonfibrous material 11126101 2% 2 % Chrysotile 0 % Arnosite - 0 % Crocidolite % . % % % GM 56722 2 D wall White nonfibrous material i ?!2F/01 N. D. 0 % Chrysotile 0 % Amosite 0 % Crocidolite % % % % GM, Paint 56723 a r i Analyst: James Jacks Report Date: 11/26/01 Date Received: 11/26/01 N.D. = None Detected ' GW = Glass wool SY = Synt etic fiber " GM Granular material V = Vermiculite R = Resin A = Asphalt F = Foarn CE =Cellulose fiber P = edile, P e FG = Fiberglass B =Bider D=Di M -is N =None NOTE: Sample Result alon • do not constitute an asbestos inspection of any kind. Lab results must be accompanied by a S to Ce tified Asbestos Consultants report. to constitute an inspection. Aa:y.<1a by P.aariad-Light Mienscopy will, Okper•imt seining in occurd-n a with the EPA Meth.nl 1n 40 CPR Pan 76}, Suhparl R Appcndia A. Suhsamplcx of unn-hnmugcta-utu tantNcs arc .,n Ay -d .a.pnr:ucly amt 111:1 usuh< arc c.0 hined in the rvp . d result. Thc limit if .kmetinn t:x ih.s mepht:tl is app ­ match• line percent ashestns. Quantilieali..n it, by ciaual csttmale Thi.. rrp;.n appi ,.nly 1r the item, ta.tu.l. Sampling dat. and sahq>IB idataific:niun are suhmiuud by client. The lahor:mtry is atxreJIMI by the NIST Nalinnal Voluntary l.ahormrny AccrcJirnian Pmg, rmj Ylns tep..rt y h n,.t hl• used a. Blair.: pn.11nn ::nJ..r.•.•:n,•n1 t.y NVI.AP .0 any apatuy .n the t:.S. (in�crnmcnt. lltis rep..n moy only Ie mpr. �luWit a lid! uni wish Ill,: wnitcn eredi al nl trig lar S:nuplaa may he Jisp.rsed of thirty dnys ulicr rq I J:ec. RECEIVED DEC 0 1 2001 General Environmental 10970 Arrow Route, Suite 212, Rancho Cucamonga, CA. 91730 ana-gement SerV Ces Environmental Testing and Consulting (800) 886-2589 • Fax (909) 980-6828 SAMPLE DATA SHEET PAGE ( OF� PROJECT: �t/ �� / r��� CONTACT: �% �dA v l� TURNAROUND: Same da j � y Z—a 11&/�4 PROJECT ID: 3314- 24 Hr. --,---48 Hr. SAMPLING DATE: 3-5 Day Weekend SAMPLE ID LOCATION DESCRIPTION SAMPLE. TYPE (see below) FLOW RATE/ MINUTES VOLUME/ AREA ANALYSIS REQUESTED see below ` Q9mn1P fvnnc• A = air,. WC = wall cavity, T= tape lift, S = Swab, B = bulk, AND = Anderson, MV = microvac, W = wipe, O = other S�. Analysis codes; TFS = total fungal spores, TFCFU total fungal cf i's,. TBCFU = total bacteria cfu's, TECUF = total E. Coli cfu's, DE = mold growth by direct exam, TEM = Transmission electron microscopy, PCM =phased contrast microscopy, PLM = polarized light, microscopy, AA = Atomic Absorption, O other Relinquished by: Date: Received hv- VL St}ate I f forn�lEsfionmenfal Protection Agency SFR • LAW DR' / LA `CU19TA Form Approved OMB No. 2050-0039 (Expires 9.30.99) See Instructions on back of page 6. Department of Toxic Substances Control Please print or, type. Forrq designed for use on elite (12 -pitch) typewriter. Sacramento, California DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) EPA 8700-22 Yellow: GENERATOR RETAINS UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas WASTE MANIFEST CIAID19181114101015111810 14 13 5 17 1 of I is not required by Federal law. ' 3. Generator's Name and Mailing Address RICK MW PWGY 191MON SPR. A. State Manifest Document Number A 2 `,j 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID [Reserved.] BRICKLEY EN'VIKONMENTAL 1 11 i ) P P, P P 1 7 3 D. Transporter's Phone (9C9) 88$_2010 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID [Reserved.] ECTI, 953 W. REECE ST. F. Transporters Phone SAN BERN RD NO. C 2 C IA R In 10 0 0 b 0 f A 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID AZUSA LAND RECLAMATION 1211 W. GLADSTONE H. Facility's Phone AZUSA, CA 91702 In Ic 1A, In In IQ In In 17 IA 1-7 aar.._n , o 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total 14. Unit No. Type Quantity Wt/Vol I. Waste Number a. State G R.Q. ASBESTOS, 9, NA2212, PG III (NAERG011111) nA EPA/OtVer'� Nb. State E EPA/Other R A T `' State O EPA/Other R ' d. State EPA/Other J. Additional Descriptions for Materials Listed Above +� r K. Handling Codes for Wastes Listed Above a. b. NON RCRA WASTE ASBESTOS CONTAINING CONSTRUCTION MATERIALS � C. d. 15. Special Handling Instructions and Additional Information BRICKLEY ENVIRONMENTAL PHONE 800-530-3366 EMERGENCY PHONE 800-535-5053 957 W. REECE ST. SAN BERNARDINO, CA 92411 SCAQMD PHONE (909) 396-2336 EPA REGION Ili PHONE 415-744-1089 2186 E. COPLEY DR. 75 HAWTHORNE ST., SAN FRANCISCO, CA 94105 DI&MONI) BAR, CA 91756--4182 16. GENERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by propershipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am a small I have faith to quantity generator, made a good effort minimize my available to me and that I can afford. waste generation and select the best waste management method that is Prrintted/Typed%%Name ��nn� �t��' >'� �^ `:roE ttA�> �r.1 ' Signature Month DayYear J4,01 T R 17. Transporter 1 Acknowledgement of Receipt of Materials I p Printed/Typed �y zad C 6v J /)W L"'G� Signature %Mon, fjDay. Year j C P C✓ f 0 18. Transporter 2 Acknowled emenf of Receipt of Materials RPrinted/T E YP ed Name Si-9noture g Month Day Year R 19. Discrepancy Indication Space F A C I L 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Printed/Typed Name Signature . Month Day Year Y DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) EPA 8700-22 Yellow: GENERATOR RETAINS J CAL/OSHA ASBESTOS NOTIFICATION BRICKLEY ENVIRONMENTAL 957 WEST REECE STREET SAN BERNARDINO, CA 92411 TEL: (909) 888-2010 FAX: (909) 381-3433 CAL/OSHA LICENSE NO. 610414 DEPT. OF INDUSTRIAL RELATIONS ASBESTOS CERT. A-6005 ADDRESS: SAN BERNARDINO DIST. OFFICE DOSH REGISTRATION #49 464 WEST 4TH ST., # 332 SAN BERNARDINO, CA 92401 DATE: 'l 1/28/01 - JOB # 4357 NAME / ADDRESS OF EMPLOYER: RUTTMAN CONSTRUCTION '36660 BANKSIDE DRIVE, SUITE D CATHEDRAL CITY, CA 92234 ADDRESS OF JOB SITE: EIDSON RESIDENCE JOB LOCATION: THROUGHOUT 78026 LAGO DRIVE LA QUINTA, CA 92253 NEAREST CROSS STREET: AVENUE 50 NAME OF CERTIFIED SUPERVISOR: CLONINGER/BRICKLFf/GO-MEZ/L4RGENT/CRUZ/BOYT/GORDON NAME OF QUALIFIED PERSON IN -CHARGE OF AIR MONITORING, LAB WORK AND RESPIRATORS: AS ABOVE AND GEM SERVICES OR CONTRACTED C.A.C. / I.H. JOB START DATE: X1.2-3-0! JOB COMPLETION DATE: 512-3-01 DESCRIBE SCOPE OF JOB AND WORK PRACTICES (Inc. sq. ft.): SCRAPE AND REMOVE WET IN SECTIONS AND DISPOSE OF APPROXIMATELY 1,700 SQ. FT. OF ACOUSTICAL CEILING ESTIMATED NUMBER OF EMPLOYEES ON JOB: 6-8 EVALUATION OF POTENTIAL FOR EXPOSURE: MINIMAL EXPOSURE - RESPIRATORS AND PROTECTIVE CLOTHING WORN THROUGHOUT PROJECT. TRANSPORTED BY: BRICKLEY ENVIRONMENTAL U.S.E.P.A. # CAR 000053173 STATE HAULER #2599 AND/OR ECTI P.O. BOX 7318 SAN BERNARDINO, CA 92411 STATE HAULER # 3731 DUMP SITE: AZUSA LAND RECLAMATION CO 1201 W. GLADSTONE STREET AZUSA, CA 91702 CAD009007626 CAL OSHA 031201 AQMD SOUTH CO ST AIR Qt. MANAGEMENT DISTRICT NOTIFICATION OF DEN, `;ON OR ASBESTOS REMOVAL 21865 E. Copley Drive, Diamonu i:r, CA 91765-4182 (909) 396-2000 MAIL ORIGINAL TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE #55641, LOS ANGELES, CA 90074-5641 AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION # COMPLETED BY KERI COMPANY BRICKLEY ENVIRONMENTAL PHONE 909-888-2010 t DATE 11-28-01 / CHECK # Iq q,o FEE $ 2; 5 PROJECT # 4357 NOTIFICATION TYPE Original _--/ J Revision Dates Revision Other (highlight) Cancellation PROJECTTYPE Emergency Removal SITE INFORMATION I SITE NAME EIDSON RESIDENCE SITE ADDRESS 78026 LAGO DRIVE CROSS STREET AVE 50 CITY LA QUINTA STATE CA ZIP 92253 COUNTY RIVERSIDE DESCRIBE WORK LOCATION THROUGHOUT BUILDING SIZE (SQ. FT.) 2,500 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 30 NO. OF DWELLING UNITS 0 ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL REMOVED (ADD ROW) REMOVED (in square feet) 1,700 1,700 ASBESTOS REMOVED FROM SURFACES DESCRIBE TYPE & AMOUNT OF ACOUSTICAL CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC ASBESTOS (in square feet) 1,700 FLOOR TILE (VAT) I DRY WALL PLASTER I TRANSITE ROOFING OTHER (DESCRIBE) CONTRACTOR INFORMATION CSLB LICENSE # 610414 OSHA REG # 49 AQMD ID # 76397 NAME BRICKLEY ENVIRONMENTAL ADDRESS 957 WEST REECE STREET CITY SAN BERNARDINO STATE CA ZIP 92411 SITE SUPVR BRICKLEY I DARST/ICRUZ PHONE 909-888-2010 LARGENT/CLONINGE WASTE TRANSPORTER #1 BRICKLEY ENVIRONMENTAL LANDFILL'AZUSA LAND RECLAMATION CO. ADDRESS 957 WEST REECE STREET ADDRESS 201 GLADSTONE AVE CITY SAN BERNARDINO STATE CA ZIP 92411 CITY AZUSA STATE CA ZIP 91702 Asbestos demolition/Renovation Notification Form REV 990601 Forms, instructions and the Rule 1403 can be obtained f.�C .J-agMd.gOV Page 1 of 2 BLGS PRIOR / PRESENT USE Residence SITE OWNER RICH & PEGGY EIDSON ADDRESS CITY STATE ZIP CONTACT SAME PHONE REQUIRED BUILDING INFORMATION ASBESTOS YES PRESENT? ASBESTOS SURVEY? NO ASBESTOS REMOVED? No) TO BE NO DEMOLISHED? PROJECT DATES START 12-3-01 END 12-3-01 WORK SHIFT (am/pm) 0800-1500 ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL REMOVED (ADD ROW) REMOVED (in square feet) 1,700 1,700 ASBESTOS REMOVED FROM SURFACES DESCRIBE TYPE & AMOUNT OF ACOUSTICAL CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC ASBESTOS (in square feet) 1,700 FLOOR TILE (VAT) I DRY WALL PLASTER I TRANSITE ROOFING OTHER (DESCRIBE) CONTRACTOR INFORMATION CSLB LICENSE # 610414 OSHA REG # 49 AQMD ID # 76397 NAME BRICKLEY ENVIRONMENTAL ADDRESS 957 WEST REECE STREET CITY SAN BERNARDINO STATE CA ZIP 92411 SITE SUPVR BRICKLEY I DARST/ICRUZ PHONE 909-888-2010 LARGENT/CLONINGE WASTE TRANSPORTER #1 BRICKLEY ENVIRONMENTAL LANDFILL'AZUSA LAND RECLAMATION CO. ADDRESS 957 WEST REECE STREET ADDRESS 201 GLADSTONE AVE CITY SAN BERNARDINO STATE CA ZIP 92411 CITY AZUSA STATE CA ZIP 91702 Asbestos demolition/Renovation Notification Form REV 990601 Forms, instructions and the Rule 1403 can be obtained f.�C .J-agMd.gOV Page 1 of 2 SCAQMD NOTIFICATION OF DEMOLITION OR ASBES4 REMOVAL MAIL ORIGINAL TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE #55641, LOS ANGELES CA 90074-5641 WASTE TRANSPORTER #2 E.C.T.I. WASTE STORAGE SITE BRICKLEY ENVIRONMENTAL ADDRESS PO BOX 7318 ADDRESS 957 WEST REECE STREET CITY SAN BERNARDINO STATE CA ZIP 92411 CITY SAN BERNARDINO STATE CA ZIP 92411 CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure #1 , 3, 4, 5 or other. For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. 1 ASBESTOPROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING. Bulk sampling Inspection, Survey, PLM, PCM, TEM, Assumed as Asbestos, Describe Other. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME: AUTHORIZING PERSON: TITLE: DATE OF ORDER: DATE'ORDERED TO BEGIN: FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT: EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN: PLEASE SEE EMERGENCY LETTER CONTINGENCY PLAN: DESCRIBE ACTIONS AND PROCEDURES TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR NON -FRIABLE ASBESTOS MATERIAL BECOME CRUMBLED, PULVERIZED, OR REDUCED TO POWER. REVISED NOTIFICATION LETTERS WILL BE SENT IF / WHEN APPROPRIATE. REMOVAL WILL BE DONE WITHIN STATE, FEDERAL, CALIOSHA, EPA RULES & REGULATIONS. TRAINING CERTIFICATE: I Certify that an individual trained in the provisions of the regulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required training has been accomplished by this person will be available for inspection during normal businl'es hours. N _?4 0 J � BRICKLEY ENVIRONMENTAL KERIANNE HEIL i PROJECT ADMINISTRATOR Company Name Print name of operator Signature of operator Title of operator Date INFORMATION CERTIFICATION: I Certify that the above informal: n is correct and that I have enclosed any required attachments. 1113010 ) BRICKLEY ENVIRONMENTAL KERIANNE HEIL PROJECT ADMINISTRATOR Company Name Print name of operator Signature of operator Title of operator Date Notifications are not accepted without the required asbestos fee (AQMD Rule 301). Removal of less than 100 square feet are exempt from notification anC fees. Please make checks payable to "SCAQMD". Fees are per notification, not refundable, and vary according to the asbestos amount to be removed. Fees are as follows: FROM 100 TO 1,000 SQUARE FEET $ 27.96 DEMOLITIONS UNDER 100 $ 27.96 FROM 1,001 TO 5,000 SQUARE FEET $ 85.47 REVISIONS $ 11.31 FROM 5,001 TO 10,000 SQUARE FEET $200.07 CANCELLATIONS $ 00.00 MORE THAN 10,000 SQUARE FEET $313.72 PROCEDURES 4 OR 5 PLANS $313.72 RESIDENTIAL REMOVALS $ 27.96 RETURNED CHECK CHARGE $ 27.74 EMERGENCY NOTIFICATION FEE $ 26.68 SPECIAL HANDLING FEE $ 26.68 ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a demolition permit. For questions call 909-396-2336. For your convenience please mail and do not hand carry. MAIL ORIGINAL TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE #55641, LOS ANGELES CA 90074-5641 TELEPHONE: (909) 396-2336 FAX: (909) 396-3342 FAX BACK FORMS: (909) 396-2550 WEB SITE: HTTP://VWIIW.AQMD.GOV Asbestos Demolition /'Renovation Notification Form REV 980610 Page 2 of 2 LAGO LA QUINTA Homeowners Association Post Office Box 1188 La Quinta CA 92253 760/564-2177 FAX 760/564-4882 November 9, 2001 Planning Department CITY OF LA QUINTA P. 0. Box 1504 La Quinta CA 92253 RE: Changes to Existing Residence 78-026 Lago Drive Ladies and Gentlemen: The Architectural. Comm it tee/Board of Directors of Lago La Quinta has reviewed the plans prepared by Ruttman Construction and submitted by owner, Rich and Peggy Eidson. The remodel is involves interior changes and does not alter the exterior .. structure or roof line.of the residence. Since there is no conflict with our governing documents, we hereby approve the plan as submitted. If you have any questions, please contact the office at the number above. Yours truly, LAWRENCE S. KRUEGER President LSK/at C:\WS2000\D0CUMENT\L3\CITY.EID = M E T R O S C A N PROPERTY PROFILE= Riverside (CA) *************************************************************************************** * * <<< OWNERSHIP INFORMATION >>> * * * Parcel Number :658 270 036 S: T: R• Q: * Ref Parcel # :000 000 000 Pos Interest: * Owner Name :Eidson Richard C/Peggy J * -CoOwner * Site Address :780.26 Lago Dr La Quinta 92253 * Mail Address : * Telephone :Owner: Tenant: * * * <<< SALES AND LOAN INFORMATION >>> ------------ * * * Transferred :03/30/2001 Loan Amount :$200,000 * Document # :133044 Lender :Chase Manhattan Mo * Sale Price :$340,000 Full Loan Type :Conventional * Deed Type :Grant Deed Interest Rate :Fixed * % Owned :100 Vesting Type :Married Persons * * * <<< ASSESSMENT AND TAX INFORMATION >>> * * Land :$80,000 Exempt Type * Structure :$220,000 Exempt Amount * Other Tax Rate Area :20-002 * Total :$300,000 Taxes :$4,166.30 * % Improved :73 * * * <<< PROPERTY DESCRIPTION >>> * Map Grid :849 F6 * Census :Tract:451.04 Block:4 * Land Use :R1 Res,Single Family Residences * Legal :LOT 11 MB 073/038 TR 4418 & INT * :COMMON AREA * * Sub/Plat :Tr 4418 * Book :73 Page:38 * * * <<< PROPERTY CHARACTERISTICS >>> * * * Bedrooms :3 Stories :1 YearBuilt:1974 AgPreserve * BathFull :2 Units .1 MiscImprv:No * Bath3Qtr :1 Bldg SgFt:2,332 Street :Paved ADDITIONAL * BathHalf : Ga': SgFt :506 Waterfrnt: * Fireplce :No Gar Type :Detached Elect Svc! RmAddtns :Yes c * Cntrl Ht :Yes Lot Acres:.10 Gas Svc RmAddSF * Cntr1A/C :Yes Lot:SgFt :4,356 WaterSrce: AddGarType * Pool :No Roof Type:Tile SewerType: OthrPkng * * Information compiled from various sources. Real Estate Solutions makes no representations or warranties as to the accuracy or completeness of information contained in this report. i JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 ,SPECIAL I' • Fax (760) 772-7193 REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑POST TENSIONED CONCRETE ❑ REINFORCED MASONRY ❑ STRUCT. STEEL ASSEMBLY ❑ ASPHALT ❑ FIRE PROOFING ❑��// ❑ OTHER N JOB LOCATION 4 0 LA --o �` J A �v ` REPORT SEQUENCE NO. TVP pF ST URE S ��� � PE i}w11T O`-_^/�.1 /'+1 �✓ ,v_J_��J D T � � DAV OF WEEK MATERIAL DESCRIPTION ARCCHHITEC.`jT 1141PECTO HRS. CHARGED ENGIyE�R�� n ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL V CONTRACTOR SUB CONTRACTOR 00a� + T�A S div J % -uXq / / (V1 f19 I InrN(H-7 COPY SENT TO CLIENT O I COFkTI1NED ON NEXT PAGE O I PAGE OF I CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF M1 SIGN TUBE OF REGISTERED INS CTOR KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE I` GOVERNING BUILDING LAWS DATE Ot REPORT REGISTER NUMRFR