08-1747 (DEMO)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001747
Property Address: 53251 AVENIDA VELASCO
APN: 774-084-.024-3 000000 -
Application description: DEMO - COMML/OTHER
Property Zoning: COVE RESIDENTIAL
Application valuation: 0
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Applicant: Architect or Engineer:
--------------------------7-----------------------
LICENSED CONTRACTOR'S 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 Class: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
() 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and whocontracts for the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
/te: 1 fl-) i O 11 wner:
CONSTRUCTION LENDING AG CV
I hereby affirm under penalty of perjury that there, is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
1
LQPER1t1TT
Owner:
BOB HULL
53251 AVENIDA VELAS
LA QUINTA, CA 92253.
-------------------
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/21/08
WORKER'S COMPENSATION DECLARATION
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 and policy number are:
Carrier Policy Number
1 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
700 of the Labor Code, I shall forth ith comply with those provisions.
ate`0'UQ Applicant:
�llw�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL -FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT"
IMPORTANT Application, is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances ano state laws relating to building construction, and hereby authorize representatives .
of this unty t enter upo he above-mentioned property or inspection purposes. ^
ate: b hA gnature (Applicant or Agent):
Application Number•
. . . . . 08-00001747
Permit
DEMO PERMIT
Additional desc .
Permit•Fee
45.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
0
Expiration Date
4/19/09
Qty Unit Charge
Per
Extension
BASE FEE
45.00
--------------------------
Special Notes and
--------------------------------------------------
Comments'
INTERIOR DEMO ONLY
PER GREG BUTLER
APPROVAL
Fee summary
-----------------
Charged Paid
--------------------
Credited
--------------------
Due
Permit Fee Total
45.00
.00
.00
45.00
Plan Check Total
.00
.00
.00.
.00
Grand Total
45.00
.00
.00
45.00
LQPERMIT
DATE OF SURVEY: October 10, 2008
LOCATION: 53251 Ave. Velasco
La Quinta, California
BY:
Gregory Masters
California Certified Asbestos Consultant # 03-3365
Masters Environmental
44719 Alexandria Vale
Indio, CA 92201
760-200-2900
Survey authorized by: Doug Bogren
Methods: All materials inside the structure that were suspected of containing
5
asbestos were sampled according to specified protocols. Samples were sent to
a NAVLAP accredited laboratory, Patriot Environmental Laboratory Services of
Garden Grove, CA — Lab code 200358-0.. They were analyzed by Polarized
Light Microscopy according to Bulk Analysis Protocol EPA.600/R-93/116. The
laboratory report is attached to this message for your inspection.
Site: This structure is a single family residence, built in the 1940's. The
interior is being remodeled, and requires an asbestos survey. Materials
inspected and surveyed were linoleum, tile and mastic, plaster and skim coat,
wallboard joint compound, and'stucco.
Results:
The only materials that tested positive for asbestos were two small areas of
linoleum in the living room:.
1. 5 sq. ft. of linoleum, backing', and mastic that tested positive for Chrysotile
` asbestos at 40%, 20%, and 4%.
2. 8 sq. ft. of linoleum and mastic that tested positive for Chrysotile asbestos
at 20% and 3%.
p. 2
The South Coast Air Quality Management District regulations specifically permit
the owner of the property to (personally) abate any asbestos containing building
materials in his own property, using the appropriate safety precautions to protect
his own safety and that of others.
No guarantees are offered or implied. ,
We appreciate the.opportunity to serve your asbestos needs, and look
forward to working with you again.
7
Q'@g
pQ'V W. A4,9 tis
0 No. 03-3365
CALFO
Masters Environmental 760-200-2900
44719 Alexandria Vale 760-200-2901 FAX `
Indio, CA 92201 gmasters@mastersearch.com
•
- P.O. Boz 73
n 18
EnnaanrMavnaL San Bernardino, CA 92411
C0ArrF74CMM9
rixaros R—ra- ` Phone (909) 884-7424
/1r6. Fax (909) 884.3744
NON -HAZARDOUS
MaRnifest Doc. No.
2. Page1
WASTE MANIFEST,,
7I.Genoator'sUSEPAIDNo.
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3. Generator's Name and Mailing Address r
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BOB HULL
532-51 VVEN:IDA JALASCG
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5. Transporter 1 Company Name' C- y r `r
' 6. US EPA ID Number
A. Transporter's Phone ,
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7. TranspCompany Name - orter 2 ?
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8. US EPA ID Number
B. TransporteYs'Phone
9. Designated Facility Name and Site Address
10. US EPA ID Number ^
C. Facility's Phone
E RECLAMATION
LAND RECLAMATIO
N 1211 W. GLADSTONE
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626-•334�0719
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NON FRIABLE'ASBESTOS-WASTE
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'D.r Additional Description for A«Aaterials Listed Above- ' � � �
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" ' E. Handling Cades far Wastes Listed Above
15. Special Handling Instructions and Additional Information
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a) CLIENT: BOB HULL#1054.1 VSITE
ADDRESS: SFR -HULL 532-51 A1JL°"NIDA VALASCO, LA4QUITA,,'
CA 92253
,
EMERGENCY CONTACT: .INFOTRAC
(800)5.'35-5053 EPA REGION IX 75
HAWTHOR.NE ST -SAN'"
FRANCISCO CR 94105 (415)'744-1089
S_CAQMD 21865.•E. COPLEY ;Pk_. DIAMOND BAR CA 91`76.5
(949)396-2336. 'TRANSPORTERS:
957-& 953 W,,R.EECE ST: SAN BERNARDINO CA.,92411
Printeddrryped.Name f J
1111111111111111111111111111 lip III
Signature /
Month
Day '`' Year
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17. Transporter 1 Acknowledgment of Receipt of Materials
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Printed/Ty�pleld� Name
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Month
Year
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18. Transporter 2 Acknowledgment of Receipt of Materials
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19. Discrepancy Indication Space
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20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 19.
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Printed/Typed Name
Signature
- Month
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GENERATOR'S DOPY
PATRIOT ENVIRONMENTAL LABORATORY SERVICES, INC.
Polarized Light Microscopy Analysis
Masters Environmental Report Number: 335417
44719 Alexandria Vale Project Number: 1415
Indio, CA 92201 Project Name: Bogren
Project Location: 53251 Ave. Velasco
La Quinta, CA
Claim Number: NA
Date Received: 10/13/2008 Number of Samples: 12
Date Analyzed: 10/13/2008: PO Number: NA.
Date Reported: 10/14/2008
Lab/Client ID/Layer Location Material Description Color Composition {%)
335417-001 Walls Plaster and Skim Coat Light Green White 75% Carbqnate
001-001 15% Minerals
8% Perlite
2% Paint
Total Asbestos None Detected
335417-002 Walls Plaster and Skim Coat Light Green White 75% Carbonate
001-002 -15% Minerals
8% Perlite
2% Paint
Total Asbestos None Detected - -
335417-003 Sun Room 12x12 Floor Square Beige 80% Carbonate
002-003 20% Vinyl
t
Binder
Total Asbestos None Detected r
335417-004 Sun Room Mastic Clear 100% Binder
002-004
Total Asbestos None Detected
t '
.335417-005A Living Room Backing Beige 52% Cellulose
003-005 8% Glass Fibers
Chrysotile 40 % .
Total Asbestos 40 %
created with
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download the Gee trial online at pjl@{I�j,Cgib(ptpfQ
7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: i t4/0
il-0Vvv - rax: I I-*Iovv-.v>8
www. pa trio tla b. com
Polarized Light Microscopy Analysis
Masters Environmental
Report Number:
335417
44719 Alexandria Vale
Project Number:
1415
Indio, CA 92201
►
• Project Name:
Bogren
Project Location:
53251 Ave. Velasco
La Quinta, CA
Claim Number:
NA
Date Received: 10/13/2008
Number of Samples:
12
Date Analyzed: 10/13/2008
PO Number:
NA
Date Reported: 10/14/2008
Lab/Client ID/Layer
Location
Material Description Color
Composition (%)
335417-005B
Living Room
Linoleum Tan
20% Linoleum
003-005
50% Vinyl
Binder
r
10% Cellulose
Chrysotile
20 %
Total Asbestos
20 %
335417-005M
96% Tar
Living Room
Mastic Black
003-005
Chrysotile
4 %
Total Asbestos
A %
335417-006,
20% Linoleum
Living Room
Linoleum Beige Tan
003-006
50% Vinyl,
Binder
10% Cellulose
Chrysotile
20 %
Total Asbestos 20 %
'335417-006M Living Room Mastic Black 97% Tar
003-006
Chrysotile 3 % ,
Total Asbestos 3 %
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-' eo.,wee a• r„• u�i or• •oirmadLwmlammawn � g
7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel:
www.patriotiab.com
Polarized Light Microscopy Analysis
Masters Environmental.
Report Number:
335417
44719 Alexandria Vale
Project Number:
1415
Indio, CA 92201
Project Name:
Bogren -
Project Location:
53251 Ave. Velasco
La Quinta, CA t
Claim Number:
NA
Date Received: 10/13/2008
Number of Samples:
12
Date Analyzed: 10/13/2008
PO Number:
NA
Date Reported: 10/14/2008
Lab/Client ID/Layer Location
Material Dcscription Color,
Composition (%)
335417-007 Office
12x12 Flooring White
80% Carbonate
004-007
20% Vinyl
Binder
Total Asbestos None Detected
335417-008 NA
Stucco Light Green Grey 85% Minerals
005-008
12% Carbonate
3% Paint
Total Asbestos None Detected
335417-009 Bathroom
75% Carbonate
Joint Compound White
006-009
15% Minerals
8% Perlite '
2% Paint
Total Asbestos None Detected
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Page 3 of 4'
7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: 7 _ _, _- _ a���e .f��,lo•r•e•, ,m,ffim,, 3
www.patrlotlab.com
Polarized Light Microscopy Analysis
Masters Environmental Report Number: 335417
44719 Alexandria Vale Project Number: 1415
Indio, CA 92201 Project Name: Bogren
Project Location: 53251 Ave. Velasco
La Quinta, CA
Claim Number: NA
Date Received: 10/13/2008 Number of Samples: 12
Date Analyzed: 10/13/2008 PO Number: NA '
Date Reported: 10/14/2008
Lab/Client 1D/La et Location Material Description Color Com osition (%)
Rosa Mendoza Cristina E. Tabatt
Analyst Approved Signatory
Bulk samples analyzed per 40 CFR 763, Subpart F, Appendix A; EPA-600/R-93/116 and for friable materials, EPA-600/M4-82.020. Samples are analyzed
by calibrated visual estimation; therefore, results may not be reliable for samples of low concentration levels. This report applies only to the items tested.
The results are representative of the samples submitted and may not represent the entire material from Which samples were collected. This report was issued
by a NIST/NVLAP (Lab Code 200358-0) accredited laboratory and may not be reproduced without the expressed written consent of Patriot Environmental.
This report must not be used to claim product certification, approval or endorsement by NIST, NVLAP or any agency of the federal government.
Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite. Samples such as floor tiles and ceiling
tiles with mastic layers are analyzed and reported separately.
335417-005A Sample Is Backing
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Contact Phone:
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Contact Fax:
#: Claim #:
Special Instructions:
Analysis Requested
Turnaround Time
Rush (Same Da) Other
Asbestos
24NR (speaty):
PCM (kbercounq
NIOSH 7400A ®
48HR
PLM (bulk asbestos)
EPA 600/R•93/116
72HR
CARE 435
Point Count 400 ®
Note: -STLGCAI. WET requires a minimum o/ 52 hrs turnaround
Point Count 1000 []
•TCLP requires a minimum o/ 22 his turnaround
Gravimetric Reduction n
•Cultures require 5-7 days turnaround
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TELEPHONE (760) 777-7012 FAX (760) 777-7011
OVVNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
,If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit -will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
OWNER'S SI NATURE ATE
53'.251 ✓ -L��C�
PROPERTY ADDRESS
06- 174
PERMIT NUMBER(S)
SL s
k.V- YNO V^
Bin #
City of La Qui'ntaa
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 611\
l
Project Address: S�,Z 1 P/h ec�ft
Owner's Name: a D 77 1(
A. P. Number: 77 —.O!Ftf -01-11_ 3
Address: �
�-
Legal Description:
City, ST, Zip:YZZ,S
C�
Contractor:
Telephone: 7e.,0 71L11p8y
Address:
Project Description:
City, ST, Zip:
w.% room allq-/ 14� 0�,r
Telephone:
a
State Lic. # : City Lic. #:
Arch., Engr., Designer:
` ;Aay
VL'K ti D'rr.l. e
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter RepairIsemo
Name of Contact Person: p o rC
--
Sq. Ft.:
T# Stories:
#Units:
Telephone # of Contact Person: 760 7 01- 5) %S
Estimated Value of. Project: 0.7,pap
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d Review, ready for correctionsfissue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees