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04-4534 (DSF)a C&tye 4 4 Q" BUILDING & SAFETY DEPARTMENT P..O. Box 1504 . (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04.7-000045341-7 Date 5/24/04 Property Address . . . . . . 46305 JEFFERSON ST APN: 649-071-016-25 -2190 - Application description . . . DEMO - COMML/OTHER Property Zoning . . . LOW DENSITY RESIDENTIAL Application valuation . . . . . 0 Owner Contractor ------------------------ ------------------------ CITY OF LA QUINTA EMERY LAND CLEARING & GRAD INC 78495 CALLE TAMPICO P.O. BOX 1009 LA QUINTA CA 92253 THERMAL CA 92274 (760) 391-5840 WCC: STATE FUND WC: 116532004 04/12/05 CSLB: 600283 11/30/05 CCC: C21 -------------------------- Structure Information ------------------------- Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . . .. NON -AO FLOOD ZONE --------------- ------------------------------------------------------------ Permit . . . . . . DEMO PERMIT Additional desc Permit Fee 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 45.00 ---------------------------------- 7 ----------------------------------- Special Notes and Comments COMPLETE DEMOLITION OF EXISTING HOME AND IMPROVEMENTS 0 Fee summary Charged ----------------- ---------- Permit Fee Total 45.00 Plan Check Total .00 Grand Total 45.00 r Paid .00 .00 .00 Credited- - Due P.O. BOX 1504 ��r�� 78-495 CALLE TAMPICO Y � VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 44FAX (760) 777-701 1 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 Application Number: - L.,�rJ�� Date: jr. Applicant: Architect or Engineer: Applicant's Mailing Address: /!2 Hrcnitect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS 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 ull forceand effect. / �� ,,,-License Class — ense No. & Date C�ctor OWNER -BUILDER CICLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 1, 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 or 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.). U 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 who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U 1 am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' 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. 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 issu d. toy wo�r*e�rs' comp nsation insy�nce carrier and policy nu r a farrier ! .� FViicy Number _ %%r� 3 _ I certify that, in the performance of the work for which this permit is issued, I shall not emp oy any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I fibuld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall (orthwit � mply with those provisions. /1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. I herebyaffirm under CONSTRUCTION LENDING AGENCY 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.). Lenders Name Lenders Address IMPORTANT APPLICANT ACKNOWLEDGEMENT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictionsset 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, indemnity and hold harmless the City of La Ouinta, 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 suor cessation of work for 180 days will subject permit to cancellation. ch permit I certify that I have read this application and state that the above informatiopy is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize reolesentatives of this count to enter n the abo ntioned property for inspection purposes. at � � � Signature (Applicant or Agent): P.O. Box 55329 Riverside, CA 92517 (909).624-1665 SCOTT MORRISON & ASSOCIATES 2' . DOSH 92-0248 ASBESTOS SURVEY REPORT Completed On March 8th, 2004 PLM0226#4025b Client: c/o Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 46305 Jefferson Street La Quinta, CA (single family home) 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 On February 26th, 2004 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 total of (10) bulk samples were submitted to Carolina Environmental, Inc. located at: 107 New Edition Court 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 using EPA approved method 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Samples. Bulk samples are analyzed by PLM (Polarized Light Microscopy). 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 asbestos is detected "none detected" will be noted in the report. The essence of polarized light microscopy is 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 1.0% 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 samples to confirm or denounce the initial findings. The California 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.H.E.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. Scott Morrison & Associates conducts asbestos inspection surveys following the A.H.E.R.A. inspection protocol. ASBESTOS INSPECTION BY: Timothy Morrison, DOSH #02-3142 BULK SAMPLES ANALYZED BY: Carolina Environmental, Inc., NVLAP #101768-0 (1) SCOTT MORRISON & -ASSOCIATES P.O. Box+55329 31855 Date Palm Drive, Ste. #3-507 Riverside, CA 92517 Cathedral City, CA 92234 (909) 624-1665 DOSH 92-0248 (760) 323-7743 The results on the following page(s) indicate that asbestos was detected in 01 of the 10 samples analyzed. PLM0226#4025b Sample #QN-09 Type of material: acoustic ceiling- white Location: interior ceiling of livingroom Area: approx. total 1700 sq. ft. Friable:no Results: none detected Sample #QN-10 Type of material: texture coat- white Location: interior south wall of livingroom Area: interior walls of entrance area Friable:no Results: none detected Sample #QN-11 Type of material: acoustic ceiling- white Location: interior ceiling of garage Area: approx. 1700 total sq. ft. Friable:no Results: none detected Sample #QN-12 Type of material: 12° vinyl tile- white (1 rst layer) Location: floor of kitchen Area: approx. 110 sq. ft. Friable:no Results: none detected Sample #QN-13 Type of material: floor the mastic- clear (2nd layer) Location: under sample #QN-12 Area: approx. 110 sq. ft. Friable:no Results: none detected Sample #QN-14 Type of material: rolled linoleum floor- white/gold Location: floor of north hallway bathroom Area: approx. 40 sq. ft. Friable:no Results: 25% Chrysotile asbestos Sample #QN-15 Type of material: acoustic ceiling- white Location: interior ceiling of southeast bedroom Area: approx. 1700 total sq. ft. Friable:no Results: none detected a (2) s SCOTT MORRISON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, Ste. #3-507 Riverside, CA 92517 Cathedral City, CA 92234 (909) 624-1665 DOSH 92-0248 (760) 323-7743 PLM0226#4025b Sample #QN-16 Type of material: smooth coat- white Location: interior south wall of southeast bedroom Area: throughout interior walls of room Friable:no Results: none detected Sample #QN-17 Type of material: exterior stucco- cream color Location: exterior east wall Area: throughout exterior walls Friable:no Results: none detected Sample #QN-18 Type of material: roof felt- brown Location: exterior roof under wood shingles Area: approx. 2000 sq. ft. throughout roof area 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 asbesto abatement contractor prior to any demolition or renovation of the property. Inspector Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 Mar -04-04 11:24am From -CAROLINA ENVIRONMENTAL CAROUNAENVgMMENT LILAC. 107-Nv,wEd6w cwrt,,CT)h NC 27511 phone: (919) 481.1413 F=(9`19)481-1442 Client: Scott Morrison & Associates 31855 Date Palm Dr. Suite 3-507 Cathedral City , CA 92234 project: PLM0226#4025b +4811442 T-419 P.02/05 F-546 LABORATORYSPO ST ASBESTOS SULK CEI Lab Code: A04-1472 Received: 03-03-04 Analyzed: 03-04-04 Reported; 03-04-04 Analyst: Gary A. Swanson 9/9 CEI HOMOGENEITY DESCRIPTION ASBESTOS CLIENT ID LAB•ID ND QN-09 A234298 ACOUSTIC CEILING - Homogeneous, White, Non-fibrous, Sound BIND 100% NID QN-10 A234299 TEXTURE COAT Homogeneous, White, Fibrous, Bound BIND 97% CELL 3 % - — —� ----- —.—.—. ND ON -11 A234300 ACOUSTIC CEILING Homogeneous, White, Non-fibrous, Bound BIND - 100 % —. —� ND QN-12 A234301 VINYL TILE Homogeneous, White, Non-fibrous, Tightly Bound VINYL 1000/0 ND QN-13 A234302 MASTIC Homogeneous, Yellow, Fibrous, Bound MAST 98% CELL 2% CHRY 25% ON -14 A234303 LINOLEUM Homogeneous, White, Gold, Fibrous, Bound CHRY 25% VINYL 50% CELL 5 `yo BIND 20% Page 1 Mar -04-04 11:25am From -CAROLINA ENVIRONMENTAL +4611442 7-419 P.03/05 F-546 Page 2 Project: PLM0226#4025b caRouNAENwtoNMEnfrAL, INC. i07 New Ed -+tion C4MK Cary, NC 27511 PhOM: 918481.1413 Fax 1919481-1442 Lab Code: A04-1472 v�v CFI HOMOGENEITY DESCRIPTION ASBESTOS CLIENT ID LAS ID ' QN-15 . 8234304 ACOUSTIC CEILING NO Homogeneous, White, Non-fibrous, Bound BIND 100% QN-16 A234305 SMOOTH COAT NO Homogeneous, White, Non-fibrous, Bound SIND 100% NO QN-17 A234306 STUCC Homogeneous, Cream, Non-fibrous, Bound BIND 1100% ON -18 A234307 ROOF FELT ND Homogeneous, Black, Fibrous, Bound TAR 25% CELL 70% - SYNT 5% Page 2 ' Mar -04-04 11:25am From -CAROLINA ENVIRONMENTAL +4811442 T-419 P. 04/05 F-546 The following definitions apply to the abbreviations used in the ASBESTOS BULK ANALYSIS REPORT: CHRY =Chrysotile CELL = Cellulose DEBR =Debris AMOS = Amosite FBGL = Fibrous Glass BIND = Binder CROC = Crocidolite ORGN = Organics SILT = Silicates TREM . = Trem SYNT Synthetics ° yolite GRAY = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTN =Actinolite CERWL = Ceramic WOOI PLAS =Plaster N D =None Detected NTREM = Non-Asbestiform PERI = Perlite Tremolite _ bb r NANTH = Non-Asbestiform RUBR -Ru e Anthophyllite CLIENT: Scott Morrison & Associates PROJECT: PLM0226#4025b cF1 LAB CODE: A04-1472 Stereoscopic microscopy. and polarized light microscopy coupled with dispersion staining is the analytical technique used for sample identification. The percentage of each component is visually estimated by volume. These results pertain only as the client and rger m the al in les analyzed - question. Unless enotfisamples d Sn wrung analyzed were rturnsubmitted samples, Ca Carolina Environmental, tbe Inc.rwill discardve of the all bulk samples material In q after 30 days. Many vinyl floor tiles have been manufactured using greater than 1 % asbestos. Often the asbestos was milled to a fiber size below the detection limit of polarized light microscopy. Therefore, a "None Detected" (ND) reading on vinyl floor tile does not necessarily exclude the presence of asbestos. Transmission electron microscopy provides a more conclusive form of analysis for vinyl floor tiles, it is certified by the signature below that Carolina Environmental, Inc, is accredited by the National Voluntaiy Accreditation Program (NVLAP) for the anaiysis of asbestos in bulk materials. The accredited test method is EPA 1600 f M4-821020 for the analysis of asbestos in building materials. Procedures described in EPA / 6001 R-931116 have been incorporated where applicable. The detection limit for the method is 0.1% (trace amount). Carolina Environmental, Inc.'s NVLAP accreditationnumber is #101768-0. This report is not to be used to claim product endorsement by NVLAP or any agency of the U. S. Government. This report and its contents are only valid when reproduced in full. Dust and sail analyses for asbestos using PLM are not covered under NVLAP accreditation. -ANALYST REVIEWED BY TianbOo BaI, Ph.D. Laboratory Director End of Report U, a CHAIN OF CUSTODY Prom: Scott Morrison & Associates P.O. Box 55329 Riverside, CA 92517 (760)323-7743 Client:�f—lk"1• of LA O U j– Job No. WAA0 z 90 -ZS Site Addres. Fag in Results 7 Relinquished By: A[U17—/ It / d (! � A?3 V,2 sk To: Carolina Environmental, Inc. 107 New Edition Court Cary, NC 27511 (919) 481.1413 KV LAP Code 101768-0 CA ELAP #2483 Person TaldngSamples: 1 1 0Rm►sod.��'3�2 & JVJ JE (A t N -TA �c•.� D CJs fog /,?•'?o�/i 0 YY eccived By: P` DatelTime: Mail/Fax To: Scott Morrison & Asociates, 31855 Date Palm Dr., Ste. 63-507, Cathedral City, CA 92234, (760) 323-7 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 �111a{i. R .fe i . !•`' IYLs -aR G .;'+� RAQMD USE ONLY�"x�': xSCREEN BY %RECENEDrF! {POSTMARK; a �wENTERED BY=� Y ` NOTIFICATION # ro.: ^- :St:``:,...:.i'i."a.�id..3'in<:..,s_s'..w'+`-'w�•>,C.=:..:ne'�'Fi.w:. �, ...nae..?.»..-s.4ria..'?''..,.,fks'•`-?�kw'.3:.,.::.iJI.N'%Y:r4't-.:sw>S.s"u'.4.-.��.As-rY'n,.%_»`:{.sdF{ay.e'yv,w.e:•xe'c,+vx+e:i COMPLETED BY COMPANY EMERY LAND_ CLEARING PHONE 760/391-5840 LORI EMERY V.P. AND*GRADING, INC. Y DATE 526/04 CHECK # FEE $118.41 PROJECT # NOTIFICATION TYPE ORIGINAL REVISION DATES REVISION OTHER (highlight) CANCELLATION PROJECT TYPE DEMOLITION ORDERED DEMOLITioN RENOVATION (rerno* EMERGENCY REMOVAL PLANNED RENO (annualI SITE INFORMATION SITE NAME CITY OF LA QUINTA ROAD EXPANSION PROJECT SITE ADDRESS 46-305 JEFFERSON STREET CROSS STREET WESTWARD HO CITY LA QUINTA STATE CA ZIP 92253 COUNTY RIVERSIDE DESCRIBE WORK AND LOCATION DEMOLISH AND REMOVE AND DISPOSE OF HOUSE FOR PROPOSED ROAD EXPANSION BUILDING SIZE (SQ FT) 1,583 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 26 NUMBER OF DWELLING UNITS 1 COMMERCIAL HOSPITAL INDUSTRIAL Other OFFICE PUBLIC BLDG. -HOUSE SCHOOL SHIP UNIVICOLLEGE SITE OWNER CITY OF LA QUINTA ADDRESS 78495 CALLE TAMPICO CITY LA QUINTA STATE CA ZIP 92253 CONTACT MR TOM HARTUNG PHONE 760!777-7019 REQUIRED BUILDING INFORMATION ASBESTOS YES NO PRESENT? ASBESTOS YES NO SURVEY? * ASBESTOS YES NO REMOVED? BUILDING TO BE YES NO DEMOLISHED? PROJECT DATES START 6/1/04 END 622/04 WORK SHIFT (M swing, night) ASBESTOS AMOUNT TO BE REMOVED (n square feet) FRIABLE' CLASS I CLASS II TOTAL AMOUNT (add row) ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS AMOUNT OF EACH TYPE OF ASBESTOS (in square feet) ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING . STUCCO MASTIC FLOOR TILES (VAT) DRYWALL PLASTER ' TRANSITE ROOFING OTHER (describe) CONTRACTOR INFORMATION CSLB LICENSE# 600283 OSHA REG# AQMD ID# 100435 NAME EMERY LANDCLEARING AND GRADING," INC. ADDRESS P.O. BOX 1009 CITY THERMAL STATE CA ZIP 92274. SITE SUPVR JAMES C. EMERY PHONE 7601774-9493 WASTE TRANSPORTER #1 LANDFILL ADDRESS ADDRESS CITY STATE ZIP CITY STATE FZIP * Asbestos surveys are required prior to Demolition and Renovation SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074.5641 ASTE TRANSPORTER #2 WASTE STORAGE SITE )DRESS ADDRESS TY STATE ZIP CITY STATE ZIP ONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure # 1, 2, 3, 4, 5 or Other. x asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit place; for AQMD prior approval. SBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: urvey, Bulk Sampling. Inspection, PLM, PCM, TEM, Assumed as Asbestos-PACM, Describe Other: OR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: TRESIERRAS CONSTRUCTION 4/21/04 OR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME 8 PHONE # UTHORIZING PERSON: MR. TOM HARTUNG TITLE BUILDING AND SAFETY DIRECTOR ATE OF ORDER 5/17/04 DATE ORDERED TO BEGIN: 6/1/04 OR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY, DATE AND HOUR OF NERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT: KPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN: ONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME ISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. TOP PROJECT HAVE CERTIFIED ASBESTOS REMOVAL CONTRACTOR REMOVE AND DISPOSE OF. RAINING CERTIFICATION: I certify that an individual trained in the provisions ofTegulation AQMD Rule 1403 and NESHAP will be on site during the removal and uidence that the required training has been accomplished by this person will beilable for inspection during normal business hours. ompany Name EMERY Print name of owner/operat atur o / t i Tittle of owner/operator Date 5/26/04 ANDCLEARING AND LORI EMERY RADING, INC. VICE PRESIDENT (FORMATION CERTIFICATION: I certify that the above information is correct and I have enclosed arty QWired attachments. ompany Name EMERY Print name of owner/operator Signatur f owner/ for Tittle of owner/operator Date 5/26/04 ANDCLEARING AND LORI EMERY VICE PRESIDENT GRADING, INC. btifications cannot be accepted vAhout the required fee (AQMD Rule .Asbestos removals of lei than 100 square feet are exempt from notification and fees. lease make checks payable to'SCAQMD'. Fees are per notification, not refundable, and vary according to the project size. Fees areas follows: EMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $ 331.21 FROM 100 TO 1,000 SQUARE FEET $ 29.52 SPECIAL HANDLING FEE $ 28.17 FROM 1,001 TO'5,000 SQUARE FEET $ 90.24 REVISION OF NOTIFICATION $11.94 FROM 5,001 TO 10,000 SQUARE FEET $211.22 RETURNED CHECK CHARGE $ 29.28 MORE THAN 10,000 SQUARE FEET $331.21 CANCELLATION OF NOTIFICATION $ 0.0 EMOLITION OF LESS THAN 100 SQ FT $ 29.52 ASBESTOS REMOVAL AT owner- $ 29.52 occupied, singe -unit dwellin MAIL FORM AND FEE TO-.SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)V& FAX: (M)1963342 Form REV 20030627 =ORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP://WWW. AQMD. GOV 2NAnur%C.. 1.,,,...,..+..a )4=A G fl --J—, na.,e N m—A Der PA 04712r A401 10n0l'" 7Mr1 P.O.. Box 55329 Riverside, CA 92517 (909) 624-1665 SCOTT MORRISON & ASSOCIATES 31855 Date Palm Drive, Ste. #3-507 Cathedral City, CA 92234 (760)323-7743 INVOICE. Date: March 16, 2004 Client: Tom Hartung's Office Project/ P.O# City of La Quinta Redevelopmemt P.O. Box 1504, La Quinta, CA 92253 Project: 46115, 46280; 46:305, 46395; File name: PLM0226#4025a-e and 46450 Jefferson St. La Quinta, CA (5 single-family homes) Inspection date: February 26, 200 asbestos inspection/ bulk sampling: 5 single-family homes @ $125.00 ea. _ $625.00 40 total bulk samples for analysis (PLM) @$20.60 each = $800.00 # hours of travel time @ $ each = included Total amount due =.$1,425.00 Please send pay' erit to: 31855 Date Palm .Drive, Ste. #i3-507 Cathedral City, CA -92234 Terms: Net 15 days APPR VE FOR PAYMENT -Thank you. BY BY �S5 ACCOUNT NO oG�t01 JDESCRIPTIONe. t AMT. TO PAY V#