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0107-226 (DSF)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 31 48306 it �� Date �`` Signature of Contractor �.'" i `�'�,,,. 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 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 Policy No. a iBDCt7t.'�ai�-KI,A��,`f; ' ,AF )POS3Z.2W5 (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 3700 of the Labor Code, I shall forthwith comply with those pfovisions. Date: �� `.� t I Applicant— Warning: Failure to secure Workers' Com pensatibnecoverage 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 Labol 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 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. Date 7 BUILDING PERMIT PERMIT# DATE VALUATION } LOT Q)1'�'a?t TRACT JOB SITE . APN ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER LAWCI HUG F&E AR.fTfIUABPYLFE .'d0501 VIEWLTRADLVD1122f 33 rU:{,AMli?a RANE::k O NIMAQW, 92 2. 10 WC,A'.Y.OY.J ND MIS CA 91364 PAM. DlF. kt.'i<; CIA 92260 C'760)324.3525 t,I BL6 5010 USE OF PERMIT OFMO PEk, "PROM) ial:-r9NS rJNLN ti MATED C 090 OF COrMIRR[7;T."•:&? ON PER, rTEXE 9(.TMAMARY DEMC•fI,1T1014 FER 10)-VIO-423-000 y k� JUL 2 3 2001 CL HK VGB-'iU1`AL (701M.;MUC°i".iC).a3 ffD PLAN C�E�i.�_ ` - � $45.00 UO3 PRE-TiND MED, X 00 RECEIPT DATE BY DATE INALED INSPECTOR '/)16 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 �D V- y BLOCKWAL PROVALS Final POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location ' Underground Electric Underground Plbg. Test Final I 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: Bin # City of La Quin W Building 8i Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ( -L Project Address: Z Owner's Name::, �. A. P. Number: Address: — Legal Description: Contractor: Address: 01Project City, ST, Zip: Tel Tel Pone: e h Description: J City, ST, Zip: a Y Telephone: Y� l Y' s? State Lic. # az 4L City Lic. #: Arch., Engr., Designer: Address:. S S(�� Z 6 City, ST, Zip: Tel e h . n Statei Lc.#: V� Name of Contact Person: '• Construction n Type: e: ane Occupancy: Y• Project ect hPe (circle rcle n e). New Ad ' o Alter Repair air Dem 0 Sq. Ft.: # Stories: #Units: Telephone # of Contact Person:Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal 71Y41f Rec'd TRACKING PERMIT FEES Plan Sets 2s Plan Check submitted <5;1Q Item Amount Structural Calcs. Reviewed, ready for corrections 61614 Plan Check Deposit Truss Calcs. Called Contact Person C �j pr Plan Check Balance Title 24 Calcs. Plans picked up QZ /`; Cf I Construction Flood plain plan Plans resubmitted % 1.Mechanical Grading plan 2nd Review, ready for correction /issu ? t p Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- d'd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue G*fir , oe School Fees V Total Permit Fees 41-800 Washington Street 5405 Alton Parkway B-105, PMB 201 PMB 5A-623 Bermuda Dunes'; CA 92201 Irvine, CA 92604 - Tel. (760) 772-1263 Tel. (949) 654-0979 Fax (760) 772-6254 ENVIRONMENTAL, INC. Fax (949) 654-1049 May 18, 2001 ri Mr. Arthur B. Pyle ; Pyle Contractors 44-489 Town Center Way, Suite D Palm Desert, CA 92260-2723 Re: Asbestos Inspection and Survey Report Site: 78-224 San Timoteo, La Quinta, CA • W Dear Art. ; On May 16, 2001, a Certified Asbestos Consultant from J&H Environmental, Inc. inspected the above - referenced location for asbestos -containing building materials. The inspector is certified by the California Department ,of Health Services. The inspector extracted 13 bulk samples from assumed. asbestos -containing materials in selected areas of the residence. The samples were tested for asbestos - content. The following is a recap of this inspection and our findings: I_. _--Executive Sumrnary . 1.01 The collected samples were found to contain asbestos. The following building areas were inspected and sampled: Sam�ale Number Description Asbestos Inspection Report © 2001 J&H Environmental, enc. All Rights -Reserved Location 1 Drywall Mud Bedroom '#2 2 Drywall Mud Bedroom #I 3A _ — Ceiling Plaster Joint Compound Bedroom #1 Closet Bedroom #1 Closet 4 Ceiling Plaster ' Living Room 4A Joint Compound Living Room 5 Acoustic Material Maid's Quarters 6 Wall Plaster Maid's Quarters Wall 6A White Texture Maid's Quarters Wall _ 7 Exterior Stucco Near Entrance 8 Exterior Stucco Patio Area 9 Roof Penetration Mastic House Roof 10 _ Roofing Material Garage 11 Roofing Material House Roof 12 _ Roofing Material House Roof 13 Acoustic Material Garage/Maid's Quarters Asbestos Inspection Report © 2001 J&H Environmental, enc. All Rights -Reserved PLEASE NOTE: At the time of inspection, the HVAC system was not accessible, as its location is in the slab. Two asbestos containing transite pipes are located on the main roof of the house. 1.02 J&H Environmental, Inc. recommends that prior to disturbing any areas that were not sampled, these areas should be sampled to ascertain the presence of any and all asbestos -containing materials of suspected asbestos -containing materials, and that all samples obtained be sent to an accredited laboratory f6r analysis. . II. Bulk Survev Limits " '2.01 The inspection covered all areas of the above referenced residence. At the time of the survey, the "as -built" drawings were not 'available. This report is not intended to identify all hazards or unsafe conditions or imply that others do not exist, but is merely an indication of the condition of the suspect asbestos -containing materials in the residence at the time of the survey. III. Bulk Samples 3.01 Thirteen samples of suspected asbestos -containing materials were taken and submitted to QuanTem Laboratories for analysis. The analyses were performed using the polarized -light microscopy technique described in the EPA Interim Method of the Determination of Asbestos in Bulk Insulation Samples (40 CFR - Part 76.3, Appendix *A). The results of'the analyses are enclosed. IV. Definition of Asbestos -Containing Building Materials 4.01 Asbestos -containing building materials are those who contain 'more than one percent (1%) asbestos by weight. They are classified as follows: 1) Friable materials that may be crumbled, pulverized or reduced to powder by hand pressure; 2) Non -friable materials (Class I), that may potentially be broken, crumbled, pulverized or reduced to powder in the course of demolition or renovation activities; and 3) Non -friable materials (Class I1), that cannot be crumbled to powder by hand pressure. V. Work Authorization 5.01 This report, alone, is not intended for asbestos abatement purposes.' The survey and sample analyses were performed and the report was prepared under authorization of Mr. Arthur Pyle of Pyle Contractors. Neither J&H Environmental; Inc. nor any of its employees, nor any contractors; subcontractors, or any of their employees make any warranty, expressed or implied, or assume any legal liability or responsibility for any third parry use of or the result of such use of any information, apparatus, product or process disclosed in this report, or represent that its use by such third party would not infringe on private held rights. 5.02 The work completed has been performed on behalf of and exclusively for the use of the client. w J&H Environmental, Inc. warrants that our services are performed within the limits prescribed by the client, with the usual thoroughness and competence of the Environmental Consulting and Testing profession. No other warranty or representation, 'either expressed or implies is included. Asbestos Inspection Report Page 2 © 2001 JSH Environmental, Inc. All Rights Reserved 5.03 The judgmental considerations necessary for the performance of this work have been made by trained. professionals, in accordance with generally accepted practices of Engineers and Scientists undertaking similar duties and performing similar projects. 5.04 Although comprehensive in nature, results of this survey should not be extrapolated to include areas not specifically mentioned. VI. Friable Building Materials 6.01 Friable building materials are those which can be crumbled to powder by hand pressure. Fiber release is, therefore, more likely under these circumstances. The EPA indicates that the following factors should be considered when assessing the potential for fiber release: a) Condition of Material, evidence of physical and water damage, debris or deteriorating connection to the substrate. b) Potential for Future Disturbance, erosion or damage -proximity to air stream, visibility and accessibility, type and intensity of activity in the area, sources of vibration, air movement and building users. 6.02 Asbestos Containing Friable Building Materials Sample #2 Sample #3A Sample #5 Sample #7 Sample #8 Sample #13 6.03 Non -Asbestos Containing Friable Building Materials Sample #1 Sample #3 Sample #4 Sample #4A Sample #6 Sample #6A VII. Non -Friable Building Materials 7.01 Non -friable materials cannot be crumbled to powder by hand pressure. If these materials are intact and in good condition, fiber release is unlikely. Significant fiber release and asbestos exposure can occur, however, if the surfaces of these materials are broken, drilled, sanded, scraped, cut or otherwise abraded. If this occurs, the SCAQMD Board Rule 1403 requires that asbestos containing (Class I) non -friable materials be treated as friable. 7.02 Asbestos -Containing Non -Friable Building Materials; Sample #9 Sample #10 Sample #11 Sample #12 Asbestos Inspection Report Page 3 © 2001 J&H Environmental, Inc. All Rights Reserved Two transite pipes were visually identified on the roof of the residence. 7.03 Non -Asbestos -Containing Non -Friable Building Materials; None were found in this category. VIII. Laws & Regulations 8.01 Federal, state and local laws require that building owner(s) and/or their representative(s), prior to any demolition and/or renovation operation that may disturb any asbestos -containing material(s) in the residence, to meet the following requirements: a) Notification; b) Removal techniques, plans and specifications for asbestos -containing material(s); c) Clean-up procedures; and d) Waste storage and disposal requirements. 8.02 Federal and state rules and regulations required that asbestos removal be carried out only by licensed and certified asbestos abatement contractors by the State Contractors License Board and currently registered by the State of California Division of Occupation Safety and Health. If you have any questions or need additional information, please call us at (800) 303-0661. Sincerely, Brad Sullivan PVO ,a STOS,O Certified Asbestos Consultant �60 Po sutt/` �`rG DOSH Certification # 90-2845 �P qy lz c> D.O.S.H.# —� t�r 90-2845 N� OFAL�FO�= C Asbestos Inspection Report Page 4 © 2001 J&H Environmental, Inc. All Rights Reserved a ■ ow Mir r. ® Page 1 of 3' '5 — �. r7VONEWN LABORATORIES 2033 Heritage Park Drive / Oklahoma City, OK 73120 1 (405) 755-7272 1 Fax (405) 755-2058 Polariud Light Microscopy Asbestus Analysis Report QuanTEM Lab No. 01.05PA48434U Client: 1 Sc I! Fnvirontnt ntal, Inc. Date hocoi—d: u5/1712001 Account Number: A484 Received, By: Amy Gill Date Analyzed: 05/17/2001• Project: Plyle Contractors , Analyzed 13y: S. Baker Project Location: NIA Methodology: EPA 600. Project Number: N/A • Qu;ui I'I'.M Client Color / Non-A �I+c:+tos Sample 11) Sample 1.0 Compositioal Description Asbestos (%j f=iber (.6) 001 Whitc AsbcStuw Not Pres:.nt l :a Iht1n:C <1 Mud 002 2 Hurnogencous Whitt Asbestos Pruscnt Cc1101Osa ••t Mud Chrysotile 2 001 3 I_aycrtd White Asbistu5 Not Present NA 1'1•astcr 003a 3 White Asbestos Present NA Joint Compound Citrysotile 2 004 4 Layered White A:best usNot Present NA Plaster 4 WtulC ASliesws Nut. Pcosari NA 004a• Joint Compound 005 5 llomogcntous White Asbcst09 Present NA Ceiling Texture (.:hrysohle 10 006 6 Loye ml White Asbestos Not Present NA (�iaStt:r t juwillM is a NVLAP accredited •I'L•M and PLM laboratory (Lab Code: 10)959). This rt:pOrt relates only to the sNcittc dents tested. NVLAP accn dit ttiat applies only to r11itRA atalysi (40CFR f ;h. 1 (1.1-87 cd.) Can 763, Appendix A to Subpats L aid 171. This report may not be reproduced except in lull, wallour the written approval ol'the laboratory. ■ NM ok M ' ® Page.2 of 3 v7 am��� LABORATORIES 2033 Heritage Park 06ve / Owahoma CIV, OK 73120 ! (405)1755-7272 Fax (405) 755-2058 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 0105PA484340 Client: J & H Environmental, Inc. . Datc Received: 05/17/2001 AccountNtimber: .. A484 Received By: Amy Gill Date Analyzed: 05/17/2001 Project: P1yle.Contractors - • Analyzed Liy: S. Baker 1�roject t.ocadoti: Methodology: EPA 600 Protect Number: NIA 00101' / Nuu-AsLcaat Quanif:Nl Sample 11) Client Asbestos % Sample 1D Composition Dcscrip[irnt ) Fiber .......... ........ Wltilc A UU6a ti . Twure 007 7 Homugeneous White Asbestos Present NA Ceiling •1'zxturc Chryso(ile l0 . UUR R Homogeneous White ' Asbestos I" scllt NA ' Ceiling Texture Chrysotile 10 �. 9 1•101nogeneous Block . Asbestos Present Cellulose 2 009 Chrysolile 2 Glass Fibcr 2 Tar IU Homogeneous Black Asbe<tosNot Present (:cllulo, 5 UlO [;lass liber 10 lar Oil it l lomogcneous Black i\Sbestws t'rvxul NA Tar Paper Chrysotile 4 Rlitck Asbestos Not Pre cnt NA . 012 12 'l•Igmugenaous ". 'Pante 013 White Asbestos Present 13 1 IomttgdneowS , NA Ceiling,rexturo Chrysotile W QuanTL-•M is a NVLAP aecrc&W TEM and PLh1 I.borutory (Lab Cadc: 10' 959). This f, d Al`s � btluts rile spf ific i ais Lestoil ndi. Nv+ h t' art H3, AI P p accreditation applies wily to AHERA analysis (4OCFR Ch. 1 (1.1.87 ed.)1 in Poll, wilhour the written approval ortbc laboratory, mproduccd —sept • t ■ 1•�O ®. Page 3 of 3 1"OWLABORATTORIEs 2033 Heritage Park Drive / Oklahoma city, OK 73120 / (405) 755-7272! Fax (405)'755-2058 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 0105PA484340 Client: J & H Environmental, Inc. DateRcccived: 05i17i2001- Account Number: A484 Received By: Amy Gill Date Analyzed: 05/17/2001 Project: Plyle Contractors - Analyzed By: S_ Baker project Location: WA ; Methodology: .. EPA 600 Project Number: N/A QuanTEM Client Color./ Null-AJbcium Sample ID Sample 1D Composition Description . Asbestos (°`o) 1=ibcp 05/17/01 Rcvicwed and Approved -pate of Repot Quan'YCM is a NVLAP accredited TEM and PLM Iuburatury (1..ab Code: 101959).• This renurl rclalcs only to ttic spcCiliC item. bated. NVI.AP- accn:ditatioriapplies only to AHIMA an:ilysis 140CI-ACh. 1 0-1-87 ed.) Pan 7ti3, Appendix A to Subpurt> E and P). This mpcut may not be reproduced except in +LU, tvithnut the written unnroval oldie laboratory. CLIENT NAME: Brickley Environmental, Inc. JOB NAME: Hughes Residence JOB ADDRESS: 78-224 Ave. San Timoteo La Qunita, CA J&H Environmental, Inc. Air Samples' Results LABORATORY REF. #: N/A CLIENT JOB NUMBER: N/A CLIENT P.O. NUMBER: N/A ANALYTICAL DATA d DATE: 13 -Jul -01 r PAGE:1. LABORATORY "PAT" ID # : 11067 ANALYTICAL MFTT40D NTOR14 7400 "A" Sample I.D. Pump No. Flow (1/min.) Cassette Type Sample Date Running Time Start Stop Duration (Min.) Volume (Liters) Pump Calibration Before After Field / Fiber F/Sq.mm Det. Lim Fiber/cc Results Fiber/cc 1 J&H 1 10.0 25 7/13/01 15:30 17:30 120 1200 10.0 10.01 100 4.0 5.10 0.0022 B.D.L. 2 J&H 2 10.0 25 7/13/01 15:30 17:30 120 1200 10.0 10.0 100 3.0 - 3.82 0.0022 B.D.L. 3 J&H 3 0.0 25 7/13/01 0:00 0:00 0. 0 0.0 0.0 100 0.0 0 - N.D. DESCRIPTIVE INFORMATION Sample Sample I.D. Type Sample Location Resp, Type Remarks U.C.L. 1 Area Inside Work Area - Maid's Quarters HM Post Asbestos Abatement Activities (Finals) 2 Area Outside Work Area - Maid's Quarters HM Post Asbestos Abatement Activifies (Finals) 3 Blank Field Blank Field Quality Control Blank COMMENTS: KEY TO ABBREVIATIONS SAMPLE TYPE: PRS: Personal, PRM: Perimeter, ENV: Environmental, BGD: Background, FC: Final Clearance, HEX: HEPA Exhaust, AR: Area. RESPIRATOR TYPE: HM: Half Face Negative Pressure, FF: Full Face Negative Pressure, , PAPR: Power Air Purified Respirator, SAC: Supplied Air Continuous, SAPD: Supplied Air Pressure Demand, SCBA: Self Contained Breathing Apparatus. SUCCSC2 ,1, Analyze Mason Sulliv D.O.S Ri Z N� 90-284; SOF CAOf