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0007-020 (DSF)LICENSED CONTRACTOR DECLARATION Cl) _1 hereby affirm under penalty of perjury that I am licensed under provisions of h.- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N_ Prbfe`ssi6n&'Is Code, and my License is in full force and effect. P • ,) ' License # ' Lic. Class Exp. Date ti LO W 506667 B 03/3112( � 1 ! OZ /Date ( Signature of ContractorIr A� J U � OWNER -BUILDER DECLARATION WW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z ( ) 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). c� ( ) I am exempt under Section B&P.C. for this reason LO N Date Signature of Owner ON am Q WORKER'S COMPENSATION DECLARATION o Cl I hereby affirm under penalty of perjury one of the following declarations: Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers' X W LL compensation, as provided for by Section 3700 of the Labor Code, for the m� Q performance of the work for which this permit is issued. Q 0 ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this rn f- permit iS -Kg' jd?'Wily'j,Wi )(e",rsl'yco"_mpensation insurance carrier & policy no. are: ,It Z Carrier Policy No. CIS 5 r` C) J (This section need not be completed if the permit valuation is for $100.00 or less). (y� 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 s all.forthwith comply with those Provisi Date: 6 Applicant W.,t.1 Z � ons. A , /e~ 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 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 • r 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) � `�' (- L. (r ' `/1"` Date J BUILDING PERMIT PERMIT# 0007-020 DATE )VALUATION $$OMW LOT TRACT JOB SITE APN ADDRESS 49-2" AatRIMA)M MMO « OWNER CONTRACTOR-/ DESIGNER/ EN (NEER DOUG x3la&a2AM JACK CI. AM CIE14001 COgrRACTOR 49-201 AVF.NWA KWUNIM0 51.22€) A -M DA CARRANZ A LA QVINTA CA 92253 L QUWrA CA, 92253 (760)564.3511 +CB 1115 USE Pgi9U l.r10)q EST I'D COST OF CONJMMMO T DEM(7UTION WE l01-000.423-000 $45,00 WA -TOTAL CO1ti1MU tON AND PLAN ;OX LE.S3 PRF -PAID FEW RECEIPT I DATE `-T"O'M PTAWEI IMS DUE NOW .. DATE FINALED I INSPECTOR 3�,�CdJ r>. S4WX) INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Ser 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 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 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 ,17 am 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.0;) Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Final COMMENTS: 41-800 Washington Street 5405 Alton Parkway B-105, PMB 201 PMB 5A-623 Bermuda Dunes, CA 92201 ml, H -Irvine, CA 92604 Tel. (760) 772-1263 Tel. (949) 654-0979 fax (760) 772-6254 ENVIRONMENTAL, INC. Fax (949) 654-1049 July 12, 2000 Mr. Jack Clark Clark Construction 51220 Ave. Carranza La Quinta, CA 92253 Re: Asbestos Inspection and Survey Report Site: 49220 Ave. El Nindo La Quinta, CA Dear Jack: �- l5- D67 14 X830 On July 8, 2000, 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 and certified by the State of California. The inspector extracted six bulk samples (report attached) from areas made accessible by yourself for this inspection. The samples were tested for asbestos -content. The following is a recap of this inspection and our findings: I. Executive Summa 1.01 The asbestos inspection and survey covered a single family residence located in the La Quinta Golf Estates. 1.02 The conclusions are built on the assumption that the obtained samples of general building components (i.e. insulation, flooring and wall materials, etc.) represent the materials used throughout the inspected area. II. Bulk Survey Limits 2.01 The inspection covered all suspect materials. The presence or absence of any asbestos - containing materials encased or underground could not be determined due to lack of access. At the time of the survey, neither the construction drawings nor the "as -built" drawings were 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 house at the time of the survey. 2000 J&H Environmental, Inc. All Fights Reserved it III. Bulk Samples 3.01 Six samples of suspected asbestos -containing materials were extracted and submitted to the laboratory for analysis. The analyses were performed using the polarized -high microscopy technique described in the EPA Interim Method of the Determination of Asbestos in Bulk Insulation Samples (40 CFR - Part 763, 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 II), 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 Mr. Jack Clark of Clark Construction. 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 party 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 performed and completed on behalf of and exclusively for the use of Clark Construction. 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 implied is included. 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. © 2000 J&H Environmental, Inc. -All .Rights Reserved V 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: None were found in this category. 6.03 Asbestos -Containing Non -Friable Building Materials: None were found in this category. 6.04 Non -Asbestos Containing Friable Building Materials: Number Type Location Sample #1 Tan Stucco Exterior of House Sample 42 Drywall Mud Living Room Sample #3 Gray Stucco Garage Sample #4 Drywall Mud Kitchen 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 abraided. If this occurs, the SCAQMD Board Rule 1403 requires that asbestos -containing (Class I) non -friable materials be treated as friable. 7.02 Non -Asbestos -Containing Non -Friable Building Materials: The following non -friable materials were sampled and found not to contain asbestos based on laboratory analysis: Number Type Location Sample #5 Insulation Furnace Pipes Sample #6 Roofing Material Roof VIII. Laws & Regulations 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 (760) 772-1263. Sincerely, Navid Salari, Civil Engineer DOSH Certification # 94-1557 © 2000 J&H Environmental, Inc.,All Rights Reserved .J= - km LABORATORI@S 2033 Heritage Park Drive Oklahoma City, OK 73120 Ph. (405) 755-7272 Fax (405) 755.2058 QuanTEM Set ID: 0007P484045 Received By: Casey Barnett Date Received: July 10, 2000 Analyzed By: Brandy Pelts Date Analyzed: July 11, 2000 Methodology: EPA 600/M4-82-020 Polarized Light Microscopy Asbestos Analysis Report Client: J&H Environmental, Inc. Account Number: A484 Project: Clark Construction Location: 49220 Ave. EI.Nindo La Quinta. Golf Estates Project No: N/A QuanTEM Sample ID Client Sample ID Composition Color/Descriptlon Asbestos Non-Asbaslos Fiber Other 1 1 Homogeneous Tan Asbestos Not Present Cellulose <t% Stucco 2 2 Homogeneous, White Asbestos Not Present, NIA Drywall Mud 3 3 Homogeneous Gray Asbestos Not Present Cellulose 0% Stucco 4 4 Homogeneous. While Asbestos Not Present Cellulose <1% Drywall Mud 5 5 Homogeneous Yellow Asbestos Not Present Glass Fiber 99% Insulation 6 6 Homogeneous Black Asbestos Not Present Cellulose 20% Shingle Glass Fiber 25% July 11, 2000 Project Manager Date Note: Structures denoted as being'<5p refer to the structures whose length is from 0.50m to 4.9µm. DuanTEM Is a NVLAP•accredlted TEM and PLM laboratory (Lab Code 101959). This report relates only to the specific Items tested. NVLAP accreditation applies only to AHERA analysis 140 CFR Ch. 1(1.1-87 ad.) Part 763. Appendix A to Subparts E and F). This report may not be used to claim product endorsement by NVLAP or any other agency of the U.S. Government. EXCAVATING &• GRADING, INC. POST OFFICE BOX 1036 / LA QUINTA, CALIFORNIA 92253 PHONE (760) 360-0255 / FAX (760) 771-9695 Lic. 610005 November 7, 2000 City of La Quinta Building & Safety Department P.O. Box 1504 La Quinta, California 92253 To Whom It May Concern: Gentlemen: 0 This letter is to confirm that the work for Jack Clark Construction, on 127 Avenida El Nido, La Quinta Estates, was completed. The septic tank at this property had minimum water, approximately one foot. The tops were broken off and backfilled with dirt. If there are any questions, please call my office. g es CITY OF LA OUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTI5____ i I -ATE �� % BY