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0209-194 (DSF)##-) LCCENSED CONTRACTO(i EGLARATION 1 -hereby affirm under penalty of perjury that 'yam licensed under provisions of Chapter 9 (commencing with Section 7009] of Division 3 of the Business and Professionals Code, and my License is in full force and effect/ ) . , , License # Lic. Class Exp. Date 1211; 1112 C Date ! ,;Y X� 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). ( ) 1, 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 performance of the work for which this permit is issued. (++ 1 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: CarrierC1:,p,1,Aa3t~,g x''1gD `:.� Policy No. InVSfi9949a (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 l�o) as to become subject to the Califor workers' compensation laws of nia, a d,agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wit tho's'e previsions. /Date: a> P) t, d.^. C•Applicant f L- Warning: Failure to secure Work' 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-'t,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 from date of issuance of such. permit, or cessation of work for 180 days i subject permit to cancellation. I certify that I have read this applicatio andjsstate that the above information is correct. I agree to comply with all Citya d�State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for,l spe tion purposes. rSIgnature (Owner/Agent) i Date BUILDING PERMIT PERMIT DATE VALUATION' LOT TRACT ,n JOB SITE APN ADDMESS '10-3,74. SAS IRVIaMO OWNER CONTRACTOR / DESIGNER / EN (NEER UffA DAVE; MILE W RUM C014STR1T r1 1T 7€-17.1OAN'i°� O- T°'UST 5R•159PU.Z<[0'KAA1!, LAf>UTw.3`1°A CA 92253 YUC."t..A'UA.f.,TZ";!.` , CA 92294 (760)365-7838 (MD4 2817 USE OF PERMIT a�ciL�'ridA7 r X10M-S l`fil,`UCTTtR.P L MIMIC) 0M.Y PER APP'ki,I ED Ft..P,K 'NO WORK ' MMOf::1° ION f Er,. 101 "C 00.423-OUO 1 .Q _ - .�3-•rug•, K b>v ROC7109 Alo'� :LIMIT MECK b TM3 PIM -PAX FM S0100 2 b 2002 . SES KNOW 11M KNOW $ 45".00 U�UINTA C�F � ANCEpE�• - RECEIPT DATE / 4 BY .. DATE FINAL D INSPECTORIf • INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation 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 �D"'� BLOCKWALL APPROVALS POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Fi al Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (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: CZ Ind'1 Com'1 PropI Fax:310-715-2339 Sep 16 2002 14:59 P.02 LEWIS C. BISHOP AIA ARCHITECT 44645 SAN ONOFRE AVE., PALM DESERT, CA 92260 VOICE 760-340-0604 FAX 760-837-0214 EMAIL lewbishop.architect®gte.net 24. September 2002 TO: Mr Greg Butler Building Department City of La Quinta FROM: Lew Bishop SUBJECT: Mileski Residence 78-171 San Timoteo It is'the intent of the owners to renovate and remodel the residence noted above. As a part'of the work we have engaged Scott Morrison Associates to propare an asbestos report as required to obtain a demo permit. As a result of the report, we will -be required to remove some maferials in the various mechanical closets. We need to do some work on the house prior to working on the areas that have the asbestos which requires opening up some areas to determine the structure of the roof and to remove some of the walls and plumbing in the bedroom wing of the house. We respectfully request that we be allowed to proceed with preliminary demo work until we will need to work in the areas of the mechanical closets, at which time we will pull off the job and have the asbestos work done, then resume the w, ork on the remodel. SCOTT MORRISON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, STE. #3-507 Riverside, CA 92517 '1, a Cathedral City, CA 92234.1 (909) 624-1665 DOSH 92-0248 `" (800) 824-3353 ASBESTOS SURVEY REPORT - Completed On September 23, 2002 PLM0918#1301 r- Client: Dave Mileski ; Go Lewis Bishop AIA Architect 44-465 San Onofre Ave. R - Palm Desert, CA 92260 _ • :t Project:76-171 San Timoteo La Quinta, CA At, - (single -family home, attached garage and guest home) r On September 18, 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) at the request of the client named above. 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 than or close to 1.0% asbestos contained in a sample, further analysis may be called for on additional samples to confirm or denounce the initial findings. The California Code of Regulations (CCR 1529) requires bulk sampling be conducted according, to the A.H.E.R.A. protocol provisions of 40 CFR Part 763.86. The A.H.E.R.A. protocol recommends three (3) or more friable surfacing samples from a homogeneous area be collected and analyzed before any building material is determined to be non -asbestos containing. 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 03 of the 13 samples analyzed. J �, P.O. Box 55329 Riverside, CA 92517 (909) 624-1665 SCOTT MORRISON & ASSOCIATESi •` ,' , 31855 Date Pal'D riveSTE...#3-507 f Cathedral City, CA 92234 DOSH 92-0248' ' .. , (800) 824-3353 , PLM0918#1301 Sample #LB -01 Type of material:wallboard Location: interior W. wall, E. room . `{ Area:throughout interior walls, guest home Friable:no Results: none detected Sample #LB -02 Type of material: acoustic ceiling spray Location:top of sinks (debris), guest home Area:approx. 150 sq. ft. area Friable:yes Results: 7% Chrysotile asbestos Sample #LB -03 Type of material: ceiling drywall r Location: bathroom ceiling, guest home Area:bathroom ceiling, guets room Friable:no Results:. : none detected , Sample #LB -04 t Type of material: leveling compound_ .. Location:SE floor area, living room Area: under wood floor tile, living roomy Friable:no Results: none detected Sample #LB -05 Type of material: interior wall plaster, final coat/ white Location: interior NE wall, living room -1st layer Area: load bearing walls Friable:no Results:none detected Sample #LB -06 Type of material: interior wall plaster, It. grey coat - �_ Location: interior NE wall, living room -2nd layer Area:load bearing walls Friable:no Results: none detected Sample #LB -07 Type of material:drywall Location: interior W. wall, living room Area:throughout most interior walls , Friable:no Results: none detected ' Sample #LB -08 Type of material:acoustic ceiling spray Location:SE HVAC closet, interior walls & ceiling - Area:3'X5' room, ceiling & walls t ` Friable:yes Results: 8% Chrysotile asbestos rte•. �• .}a e 1 _ t', .+.y S. ' � r.•.. i=,�- ,,_ P.O. Box 55329 Riverside, CA 92517 (909) 624-1665 PLM0918#1301 SCOTT MORRISON & ASSOCIATES 31855 Date Palm Drive, STE. #3-507 Cathedral City, CA 92234 DOSH 92-0248 (800) 824-3353 Sample #LB -09 Type of material: acoustic ceiling spray Location: W. water heater closet* . Area: 3'X5' room, interior ceiling & walls Friable:yes Results: 5°% Chrysotile asbestos *Note: There is also a central water heater closet in guest home (approx. 5'X5', ceiling & walls) that is assumed to be asbestos containing. Sample #1-13-10 Type of material: exterior wall stucco Location: exterior S. wall, main house Area:throughout exterior walls Friablemo Results: none detected. Sample #LB -11 Type of material:tar & gravel roofing/ black -grey Location: roof -1st layer Area:throughout roof Friable:no Results: none detected Sample #LB -12 Type of material: roofing felt/ black Location: roof -2nd layer Area: throughout roof Friable:no Results: none detected Sample #1-13-13 Type of material: exterior wall stucco Location: exterior N. wall, guest home Area:throughout exterior walls - Friable:no Results: none detected Note: All asbestos containing building material(s) containing greater than 1.0% asbestos by volume or weight, must be removed by a state certified asbestos abatement contractor prior to any demolition or renovation of the property. Inspector Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 (3) Oct 25 02 08:23a Oct -23-02 08:05 Brickley Environmental 909.381-3433 p.2 PROTOCOL owulting & Management 6570 Muruecarlo Place • Alta Loma, CA 91701 (909) 355-74001 FAX (909) 428-3098 P.Oi Air Sample Results Lab Number BEIM to CLIENT: Brickley Environmental JOB#Y: 5255 957 West Reece Street SITE NAME: Pam Const San Bernardino, CA 92411 LOCATION: 78171 San Tirnoteo (909) 888-2010 ) Fax (909) 381-3433 SAMPLED BY: Daniel Wallis SAMPLE_ DATA samob 0 Sample location 1n Area? Worker's Name ap.E_ Pump Run Time Volume Date F/cc 9eriel Y Aa11vI - Tv00 tMe- 10.23-02 ,-..... -- ._....... 0 t 10D Blank 0 Blank 10raw - aQ 10-23.02 _ - Blank 1 Blank 1Ur22102 OIIOD a0 [104 Outside Fan Civet Yes Wood. Wtchael Suits PAPR 21 09-0 - 1005 25 - 2S 163 21100 10-23-02 25 .006 2 Remove Acoustics Persor� 102= 2055 7 Outdoor Fan Closet Yes Ramos, Javter Suits 73 0935 - 1115 250 PAPR 13 Remove Acoustics Personal 1tY2202 1045 7 25 - 25 41100 W23-02:008 5 Outdoor t=an Closet 1 Yes 77 10-5 112b 1245 104984 Remove Acoustics Clearance 102202 2 15D - 150 0l 100 b Outdoor Fan Closet 2 Yes D 1130 - 12:5S 1275 10-23-02 104986 Remove A=Sbcs Clearonoe 1022A7L 2 ISO - 15D 111100 1.3 7 Outdoor Fan Closet Yes 6 10-5 - 11:41 1440 10-23.02 • 0 104886 RemOYe pcpust;ce Ctearance 1022102 2 15.0 - 150 11100 1.3 CLENL Sample anatysls performed using phase contrast microscopy in acoordance with NIOSH Method 7400 counting rules (A). Samples analyzed by AIHA Prefcclency Analytical Testing (PAT) pprrogram panccipatlny 1aDJanafyst. Statistical fw1k at quaMiftation is l00 to 1300 libers per square millimeter by phase contrast microscopy. any reading below 1Ms leve! is corts�dered below detection level. Sample Volume Is in Liters of Air. Results are reported in fibers per cubic centimeter and fibers poo square millimeter. All sample data provided by person eoaectig samples and anaMical reults by analyst. P.P.E. - Personal Prolective E(OP—N. Report Date: 10.23-02 Analyst: j'P Ned M. Heber 7 'Y' Page 1 _ r