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0212-005 (DEMO)r,. LICENSED CONTRACTOR DECLAMATION I hereby affirm under penalty of perjury that I am'lice'rsew, under provisions of Ch9pter 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 Eiip. Date Date _ 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: (X� 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, Busin ss & Professionals Code). l () I am exept• under Section + B&P.C. Jor this re sony ,,"Date ��' ��' �C�O`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. (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, Irshall 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 prisons of Section 3700 f the Labor Code, I sha I forthwith comply with those provisions Date., Applicant 7 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. +r'N" 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 authorizeetepresentatives of this City to enter upon theabove-mentioned property for. inspectio purpo es. �- �'� �'r ,, Signature (Owner/Agent) �� /_ '1\ Date 1 \ , -' -'BUILDING PERMIT PERMIT# DATE VALUATION '� .LOT TRACT JOB SITE"^ •a ," APN* ADDRESS-„ 9 r T.T�y h �/ y4 .�ai`r'®?,.WVI?: ,& :7"•.B,i�Fi.YL'4.E' ,3 y : ' ... •• OWNER CONTRACTOR/DESIGNER/EN (NEER 54.066 AVENIDA VELASCO LA QialNTA elk 912141131 `. USE OF PERMIT DZMD OF OLASS OLOCK WINDIJE WS &5TIM W3.L P'Xft. PPRCP1hD MAN, MAMMON ON " 0D LF.:PRE-PA131-T&F-3 DLR. • DEC 13 2002 CITY OF LA QUINTA FINANCE -DEPT. , •'�� RECEIPT - -- DATE D E FINALE INSPE R \ M c ,vT AWz "H-' OA Pe44, oL, r?AW,d 8161- AKIng5 - /01/119Z 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 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 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: 4DFidelity National Title Company 72171 Highway 111 Suite 201 • Palm Desert, CA 92260 (760) 776-5770 • FAX (760) 779-0394 DATE: November 4, 2002 TIME: 10:01:42• ESCROW NO: 45214 -CB ESCROW OFFICER: Cathy Boyd CLOSING DATE: November 1, 2002 BUYER FINAL CLOSING STATEMENT SELLER(S): Daniel D. Morris BUYER(S): Richard Donnelly and Zoe Myerson PROPERTY: 54066 Avenida Velasco, La Quinta, CA 92253 $ DEBITS $ CREDITS .FINANCIAL:_ I " Total Consideration 125,000.00 j, Deposit -./ Richard Donnelly 5 000.00 ..y F �•fie! • s.{ :Deposit - Richard Donnelly. 14,786.27 ;New -1st -Trust Deed,to Daniel D. Morris 106,250.00 PRORATIONS/ADJUSTMENTS: Prepaid County Taxes at $532.20 Semi -Annual from 177.40 141 /0'1 /02 to 01 /01 /03 TITLE CHARGES: ALTA Loan Policy (10-17-92) w/Form 1 Cov. for 125.00 106,250.00 . Recording Deed 7.00 Recording Trust Deeds) 18.00 Monument Fee 10.00 :ESCROW CHARGES « Escrow Fee 400.00 y .,Draw. Deed of Trust/Note 75.00 r _� MISCELLANEOUS CHARGES: -�j-.=-Fidelity-National Home Warranty Company for Home 200.00 x F .Protection Policy s ('BUYERS REFUND g 23.87 F. q?pyrr ,TOTALS $ 126,036.27 $ 126,036.27 SAVE THIS STATEMENT FOR INCOME TAX PURPOSES 41-800 Washington Street B-105, PMB•201 Bermuda Dunes, CA 92201 ' Tel. (760) 772-1263 Fax (760) 772-625544 ENVIRONMENTAL, INC. � December 12, 2002 Mr. Rick Donnelly 54-066 Avenida Velasco La Quinta, CA 92253 Re: Asbestos Inspection and Survey Report Site: Donnelly Residence 54-0.66 Avenida Velasco, La Quinta Dear Rick: On December 11, 2002, a Certified Asbestos Consultant from J&H Environmental, Inc. conducted a limited inspection for asbestos -containing materials at the above referenced location. a , The inspector -is certified by the California Department of Health Services. The inspector extracted seven bulk samples from assumed asbestos -containing materials from the inside and outside the residence and these samples were sent to QuanTem Laboratories to be tested for asbestos -content. The following is a recap of this inspection and our findings: I. Executive Summary 1.01 There was no asbestos found in the sampled materials. 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 and that all samples obtained be sent to an accredited laboratory for analysis. II. Bulk Survey Limits 2.01 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 material's in the buildings at the time of the survey. III. Bulk Samples 3.01 Seven samples of suspected asbestos -containing materials were taken 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). ' Page 1 © 2002 J&H Environmental, Inc. All Rights Reserved 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 of Mr: Rick Donnelly. 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 completed has been performed on behalf of and exclusively for the use of Mr. Donnelly. 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 toinclude areas not specifically mentioned. VI. Friable Building Material 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. Page 2 © 2002 J&H Environmental, Inc,. All Rights Reserved 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. VIII. Sample Results Location Material Sampled Sam le # Results Entry Living Room White Drywall Mud White Drywall Mud 1 2 Trace Chrysotile Asbestos Trace Chrysotile Asbestos Hallway White Ceiling Tile 3 Asbestos Not Present Living Room White Ceiling Tile 4 Asbestos Not Present Rear Storage White Ceiling Tile 5 Asbestos Not Present Front of House Tan Stucco 6 Asbestos Not Present Rear of House Tan Stucco 7 Asbestos Not Present IX. Laws & Regulations 9.01 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 their building(s), to meet the following requirements: A. Notification; B. Removal techniques for asbestos -containing material(s); C. Clean-up procedures; and D. Waste storage and disposal requirements. 9.02 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 contact us at (760) 772-1263. Sincerely, ,,SBEMe _ S UCC D.O.S.H. it Brad Sullivan 90-2845 Certified Asbestos Consultant N DOSH Certification # 90-2845 FOS — ' Page 3 © 2002 J&H Environmental, Inc. All Rights Reserved 12 02,01:51p QuanTEM Labs [4051.755-2058 ip.1 ■ m mift ® Page 1 of 1 ��i LABORATORIES 2033 Heritage Park Orive / Oklahoma City, OK 73120 (405) 755-72721 Fax (405) 755.2058 Polarized Light Microscopy Asbestos Analysis Report QuanTEM Lab No. 0212PA4840382 Client: J & H Enviromncntal, Inc. Dale Received: 12/12/2002 Account Number: A484 .�. Received By: Katt Hedlicka Date Analyzed: 12/12/2002 Pr•glect: Rick Donnelly Analyzed By: Barbara Taylor Project Location: 54-066 Aveien(lu Vacl3o, Lo• )uintn, CA ' Methodology: EPA 600 Project Number: N/A Quan'1'1:M Client Color / Nun- \sbwatus Sample II) Sample In Composition Description, Asbestos (%) Fit r (%) 661 1 1lanngeneouS White Asbrslus Present Cc lulosc 2 Drywall Mud Chrysotile I 002 2 Homogeneous White Asbestos Present (;c lulosc 2 Drywall Mud Chrysotile :I 003 3 l tomogeneous White Asbrslus Nol Prescnt Cc lulosc 95' Ceiling'I'ile , 004 4 l lomogeneous White ' Asbestus Not Present Cc lulosc 95,1 • Ceiling file 005 5 Homogeneous While Asbestos Not Prescnt CL lulosc 95 { 1 006 6 Homogencouv Tan Asbc3tn3 Not Present Ck Iotas <l 1 Stucco { } 007 7 Homogeneous Tan Ashestos Not Present Ct lulose <1 $ Stucco 12/12/02 Reviewed imd App ed Date of Report QuanTEM is a NVLAP accredited'ITM and PLM laboratory (Lob Code. 101959). 111is report relates only to the specific items tested NVLAP aoereditntion applies only to AHERA analysis (40CFR Ch. l (1-1.37 ed.) Pari 763, Appendix A to Suhparts F and f•7. 1his report may Ir i be used to claim product endorsement by NVLAP or any other agency orthe US Govcmment. Phis report muy, not be reproduced except in full, ithout the written approvol of the ktborotory. OWNER/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. x 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 including 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 Adrriinstration). For more specific information about your obligations under Stair 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) 777702 FAX: (760777 /6"�Z7011 GG: OWNER'S SIGNATURE%DATE `�lj tJ r< �f� �/� (see ' PROPERTY ADDRESS PERMIT NUMBER(s)