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0211-069 (DEMO)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 py 314196 Date i� , ' " -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). (' ) 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. 4-41 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 STATE FUND Policy No. S576.r +-92 (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,provlslons' Date: Ii Applicants '- :• "`" f 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. 12. 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 I above-mentioned property forinspection purposes. Signature (Owner/Agen4) - =�--� Date/,X _ t4ERMI7,' ., n BUILDING PERMIT . DATE VALUATION, LOT TRACTJOB SITE ADDRESS AIN J OWNER CONTRACTOR/ DESIQNER/EN (NEER ' T,7:24 #AN, CTE Ris IT 11TAW2 PO BOX 2589 PO BOX 2589 PfaN IlJ'.s%EJCr CA .'91;140 MIN& IYf?„MT CA 9V60 Qt(760)345-2030 CPU MD USE OF PERMIT TtUKI ENTIRE 1iO0SFJAffAXD(n 9 S -r- C, S e.°S'1"f::3'.VASDES`d CIS lZ.t�.,PPR Y said FILE, VJUXATION 113 RvWrf MATED COST CIF t dDIWIRT}�L'°T1011 L�t DEMOL.I' IOW FEE M". ` Y DLr d U SI j i NOV ?o0i CITY OF LA QUINTA FINANCE DEPT. 0B-111`t'.Yl'AL COW-1RUMON A11M P1,` 4 CH -Ras. - a;4100 J.E,9, PRF.-PAU3 ,f"1 's-0, 00 I'MAL PnMKr MS DILIX NOW $4 N' RECEIPT DATE, /' /,r BY —N,_ DATE INALED INSPE O INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I 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 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final 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 O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole >nderground Conduit Lough Wiring Voltage Wiring F ,xtures sin Service pub Panels [ cxterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power i Final Utility Notice (Perm) City,o .LaQu into., Developers PM -10 Approval Form Prior to the issuance of a Demolition Permit for the project listed below, Public Works approval must be obtained. Please return this form to the Building and Safety Department only after approval. Project Address: Scope Of Work: -/`' o.7— TIWK. ©oT Fgok` -57R)lf-TS PA,ILY /AS I t)FP _ T Public WorksDmApproval is Hereby granted: �o reeland, enior Engineer I. 0 '71(o 2 - Date' Date SCS i'T MORMSON. & ASSOCIA a >ES P.O. Box 55329 31855 Date Palm Drive, STE. #3-507 Riverside, CA 92517 Cathedral City, CA 92234 (909) 624-1665 DOSH 92-0248 (800) 824-3353 ASBESTOS SURVEY,REPORT Completed On September .2002 PLM0905#0409 Client: Ben Nance P.O. Box 2589 Palm Desert, CA 92261 Project: 51-444 Calle Paloma La Quinta, CA On September 5, 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. A..#otal 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 LLusing EPA approved method 6007M4-82-020: 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 asbestosis detected "none detected" will be noted in the report. The essence of polarized;, light microscopy Js 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 1.0616 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 sampies -to confirm or denounce :the.,initial findings. The Caiifomia 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. KE.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) P.O. Box 55329 Riverside, CA 92517 (909) 624-1665 PLM0905#0409 SCO fT MORRISON & ASSOCIA.L ES 31855 Date Palm Drive, STE. #3-507 Cathedral City, CA 92234 DOSH 92-0248 (800) 824-3353 Sample #BNP -1 Type of material: drywall- white Location: interior ceiling of the kitchen Area: throughout interior ceiling Friable:no Results: none detected Sample #BNP -2 Type of material: drywall- white Location: interior ceiling of the bedroom Area: throughout interior ceilings Friable:no Results: none detected Sample #BNP -3 Type of material: roof stucco- white (1 rst layer) Location: exterior roof above builidng Area: throughout exterior roof above building Friable:no Results: none detected Sample #BNP -4 Type of material: asphalt roofing (2nd layer) Location: under sample #BNP -3 on roof Area: throughout exterior roof above building 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 Com - Scott C. Morrison Certified Asbestos. Consultant DOSH#92-0248 (2) Se -P-10-02 09:3tam From -CAROLINA ENY- ONUENTAL 1y' I'M• « 1• CJIROL ENVIRONMENTAL, INC. h, 14 b -4W Edition Court, Cary, NC 27511 Phdna (919) §1 .1413 Fax (910 481.1442 ,fir. � �J'ryl' l;�x: Ot•'• �r49.a Client: Scott Morrison & Associates 1130 Fuerte Circle Palm Springs CA 92262 Project: 51-444 Calle Paloma La Quinta, CA +4811442 T-018 P.02/04 F-338 LABORATORY REPORT ASBESTOS BULIK_ANALYST S_ CBI Lab Code: A02-5800 Received: 09-09-02 Analyzed: 09-10-02 Reported: 09-10-02 Analyst: Gary A. Swanson CEI CLIENT ID LAB ID SAMPLE VESCRIPTION ASBESTOS BNP -1 A72514 DRYWALL ND Homogeneous, White, Fibrous, Bound BIND !)5 % CELL 5% BNP -2 A72515 DRYWALL ND Homogeneous, White, Fibrous, Bound BIND 95 % CELL 5% BNP -3 A72516 STUCCO ND Homogeneous, White, Fibrous, Bound BIND 95% CELL 5% BNP -4 A72517 TAR ROOFING ND Homogeneous, Black, Fibrous, Bound TAR 75% FBGL 25% Page 1 Sep -10-02 09:39am From -CAROLINA ENV -4 . ORENTAL, +4811442 T-618 P-03/04 F-338 Thee fq1lowing. definitions *,apply to the ablireviations used In the '.ASBESTOS BULK ANALYSIS Rt0'0'R'T-:. CHRY = Chrysotile CELL Cellulose DEB.h = Debris AMOS = Amosite FBGL = Fibrous Glass BIND =13inder C . ROC = Croddolite ORGN = Organics SILI = Silicates TREM = Tremolite SYNT = Synthetics G RAV = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTH = Actinolite CERWL = Ceramic Wool PLA$ =Plaster N D = None Detediled NTREM =Non-Asbdstif6rrn PERL = Perlite NANTH = Non-Asbes.tiform Tr6ftlite RUBR =Rubber Anthoohyllite CLIENT; Scoff: Morrison & Associates - PROJECT: 51-444 Calle Paloma La.Quirlta, CA CF1 LAb CODE: A02 -58001 - Stereoscopic microscopy and polarii4d. light mloroscopyJcoupled. with - i I th-di , spers.ion staining is the analytical lechnique used "I ..' -, 4 . for sample identification. The percentage of each-,component ,:is`visuallye'''�timated by volume. These results pertain only to the $arnplat.ana . lyzed. The sami5les'.vVe4 analyzed 'assub y thecc le q client may . not*;repres'ntalive of the larger material in question. Unless notified "'in 'writing to,retum'Sair6oles, Caroliria, Ehviro0hental, Inc. Will discard 1,11 bulk samples after 30 days. Many vinyl floor tiles have been manufactured using greater than 1 %. asbestos. Often the asbestos was mined to a fiber size below the detection 11 . Mit of polarized light microscopy. Th.6refore, a 'None Detected" (ND) reading on vinyl floor the y exclbd0he presence of asbestos. n microscopy provides a more conclusive does not necessarily P sto Transmission electro form of analysis for Vinyl floor tiles. It is certified by. the signaturebelow that Carolina Environmental, Inc. is acbeedited by. the National Volunt-my Accreditation Program .(14VLAP)' for the- analysis of asbestos in. bulk"mia-iteriali., Th -6 aWr6dited test.'method-,,.is, IEPA / 600.i M4-82,1 020 for the analysis of asbestos*'Pro in materials., P iedur6s.d6ktiW,in EPA,/1600/R-93/.116, have been incorporated ( where applicable. The detection, . , I , imit for the . method.is 01 - .%4*6 66'Ariiount), Wolihatftronmontal, Inc.'s NVLAP accreditation" number is #10176&0 This report is not; to,bi§. died',­'io claim product endo"r'sement by, NVLAP or any agency d' its are only,_valid reproduced 6 and sail analyses for of the U.S. Governifi eint, This report an Go .v lid when pr up d in f6ll. Dust asbestos using PLM are not.cover6d under NVLAP a6crediikti6n'. ANALYST REVIEWED BY Tianbao Sal, P Laboratory Director End Of Report .i, %9-111 \-VVim— ' — --� v v v a�25�u From: Scott IN-Iorrisoa &Associates LJ 1130 Fuerte Circle LL Palm Sprinev, CA 92262 (760) 323-7743 lz 0 m Client: kn &Kte IL Job No. W - O-1Z50CHA,IN OF CUSTODY To: Carolina Environmental, Inc. 102-P Commonwealth Court C:irv. !YC ?'.111 (919) 481-1413 NVLAP Code 101768-0 CA ELAP #2483 Person Taking Samp[es:_ Scott iyiorrison. CAC#92-0248 Site Address: -Tally j0 4 CA Sample # Sample 'Date Material &,Description . , . • ./ AA -Pb. Other information Nip --r .dIN"(1 �!�lP-L. �l�jl'b'. .(�!' L��tII kt a�•a N p� L6e A'j I qC(o NP- y BaaF.t;�► (Pw r ax En Kesu its :Yes into N Relinquished By: G�'lL� DatetTime:�OS f 02 Received By: Date/Time: Cl/1 /W, N•^ ' W 'viaill ax To:, Scott Morrison & Asociates, 1130 Fuerte Circle, Pa[m.Springs, CA 92262, (760) 323-7 43 VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER' (AUTO) (DISH) APPLIANCETRANS- _ FORMER K.W. GARBAGE DISPOSAL DEPARTMENT OF BUILDING &SAFETY FIELD OFFICE CFM FIXTURE OR -SOCKET KITCHEN SINK GAS PIPE ❑ NATURAL ❑.L.P.G. ❑ OIL CONST SERV. ENTRANCE WATER CLOSET COMPRESSOR 0 HP POLE LAVATORY APPLIANCE VENT . AMPERES SERV. ENT. SHOWER ABSORPTION SYSTEM O:B.T.U. SQ. FT. @ BATH TUB •: COUNTY OF' RIVERSIOE • HEATING SYSTEM ❑ FORCED ❑ GRAVITY SQ. FT. RESID. @ 1 Q SEWAGE DISPOSAL i% CONSTRUCTION ESTIMATE ELECTRICAL FEES 'PLUMBING FEES •F PERMIT FEE BALANCE OF MIN. FEE GAS PIPING SQ. -FT.' FT. @ NO. NO. 1 ST FL SQ. FT. @ PL. CK. FEE• CONST., FEE, 2ND FL. ELEC. FEE SQ. FT. n MOTOR I OR LESS H.P. DBL. ' POR. - - SQ.FT. l: @ MOTOR 5 OR LESS H.P. GAR. CAR P. SQ.,FT. @ MOTOR 20 OR LESS H.P. DRAINAGE PIPING WALL SQ.FT. M�J.::a.+.--•--•�. i J-�>^�'+r!'.A.w. �s - 5,, s �+w+�,.. D:'3+S `. -. N ..5'! D_=- X .....:.... .. ..F• -f DRINKING FOUNTAIN SQ. FL @ URINAL LOT SIZE �.. -USE # - JOB ADDRESS l- ( �/� -- OWN ffJ� / •f /rti'�P� •,... r� lK W. UNIiS WATER PIPING r ESTIMATED VALUATION $ ' .FLOOR DRAIN MFCHANICAL FEES ,�/,k�t%�J/4'. WATER SOFTENER 71 VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER' (AUTO) (DISH) APPLIANCETRANS- _ FORMER K.W. GARBAGE DISPOSAL FURNACE O UNIT ❑ WALL Cl FLOORT] SUSPENDED OUTLETS LAUNDRY TRAY AIR HANDLING UNIT CFM FIXTURE OR -SOCKET KITCHEN SINK GAS PIPE ❑ NATURAL ❑.L.P.G. ❑ OIL CONST SERV. ENTRANCE WATER CLOSET COMPRESSOR 0 HP POLE LAVATORY APPLIANCE VENT . AMPERES SERV. ENT. SHOWER ABSORPTION SYSTEM O:B.T.U. SQ. FT. @ BATH TUB INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM. SQ. FT. @ < d WATER HEATER HEATING SYSTEM ❑ FORCED ❑ GRAVITY SQ. FT. RESID. @ 1 Q SEWAGE DISPOSAL i% BOILER B.T.U. SQ. FT. GARAGE @1�2¢ HOUSE SEWER PERMIT FEE BALANCE OF MIN. FEE GAS PIPING TRAILER ISSUANCE FEE-- PERMIT FEE PERMIT FEE PERMIT FEE PER TOJTALES' REN. TRAILER fEE HEAT B VENT. FEE PL. CK. FEE• CONST., FEE, oeL. ELEC. FEE oeL. SPEC. INSP. FEE PLU/M BI FEE DBL. ' _J±.w-•a .....•C&- w..w:., T_. 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CESSATION TOTAL FEES �, _ OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME X8 Lam' -1 HEREBY AGREE THAT- ALL WORK IN CONNECTION WITH -T ;E ERMIT WILL BE DONE. IN ACCbR- N.C. CASH CHECK, M.O. ❑ ❑ ❑" DANCE WITH THE LAWS OF RIVERSIDE COUNTY AND TH,E TE OF CALIFORNIA. I A AGREE TO. CARRY. COMPENSATION INSURANCE UPON MY E�M 9aOYssCCS OMPLIANCE WITH THE LA OF,'HE STATE OK CALIFORNIA COVERING CONTRACTORS B_ TEED.' RECEIVEo BY' SEWAGE SYSTEM a JI,�, rGUA I HEREBY CERTIFY THATTHE INDIVIDUAOCNHOP�i PLANS AN�PS FIC IOi t•z SNE LL P SO IN ACCORDANCE WITH SECTION55�1OFTTiE US OF CA IFORNI L ✓ INFORMATION OWNER �N. �lvyJ��l �. �'��6✓/v � ,C/�?� . - ADDRESS ADDIS£JSS j�3l� :t..•'1,,., ` - . TEL. NO. TEL. NO.J p LIC ENS1_,arr+�'••' ^, - I L4'4YiY y - FORM 284-208. (REV. I-70) OP i` '� „, .„r . , sX,. I x t ....:. X k :w..,. b - 1 , ... k�__ - k.^. Ya �.. _I w . a. a I dr ~dr �Y _ � N i � , I _ I .�^ a ,. L. I wN I Ib N % I � � � I , . __ . a . I I _ _3�s wl,. _ I �% P I I % f I m Y. 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