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04-4535 (DSF)P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number . . . Property Address . . . . APN: Application description Property Zoning . . . . . Application valuation.. . BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760).777-7153 047--"00004"535 --I Date 5/24/04 46335 JEFFERSON ST 649-071-017-26 -2190 - DEMO - COMML/OTHER LOW DENSITY RESIDENTIAL 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/CONG <=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 -------------------------------------------------------------------------=-- Special Notes and Comments COMPLETE DEMOLITION OF EXISTING HOME AND IMPROVEMENTS Fee summary Charged ----------------- ---------- Permit Fee Total 45.00 Plan Check Total .00 Grand Total 45.00 Paid Credited . Due ---------- ---------- ---------- .00 .00 45.00 .00 .00 .00 .00. 0,0, 45.00 D GJ � MAY 2 5 2004 01 CITY OF LA QUINTA P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: 5 VOICE (760) 777-7012 FAX (760) 777-701 1 INSPECTIONS (760) 777-7153 Date: Jf- .74- Architect 4 Architect or Engineer: Architect or Engineer's Address: A) /44 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 in fu foice and effect. License Class] (' L' nse No. Date OWNER43UILDER LARATION 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 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 I am exempt under Sec. B.& 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. I have and will maintain workers' compensatio , surance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is 'ssue My w qrkers'combensati�o��irance carrier and policy number are: y16 5—� 3ZX2l�C wrier r)A— Policy Number _ 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 agre that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date I v I nt ` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS LAWFUL, 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.). Lender's 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 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, 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 dayt 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 informaf6n is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ent upon the ve-mentioned property for C. P PertY inspection purposes. Date 1 V ignature (Applicant or Agent): (� r, . 0 Project/Case (o `Y% v 71- 0117 and VACANCY WALKTHROUGH Any and all personal property left on the project premises located at 4%ro 3 ,lgoln A , o�' Pii -- , is to be considered abandoned as of AS EVIDENCE BY SIGNATURE AND DELIVERY OF KEYS I HEREBY AGREE THAT OCCUPANCY OF THE LISTED ADDRESS HAS BEENABANDONED AND THATNO FURTHER ENTRANCE TO THE ABOVEADDRESS WILL BE MADE. X �� t�imant�(s)Nar��' X X / oL/CClaAant(s)'Signature ate � T REPLACEMENT ADDRESS: . % r / NEW PHONE ON THIS DATE I PERSONALLY INSPECTED THE DISPLACEMENT AT THE ABOVE ADDRESS AFTER THE OCCUPANT HAD MOVED AND FOUND THE PREMISES TO BE IN SATISFACTORY CONDITION AND THAT ALL PERSONAL PROPERTY, EXCEPT FOR TRASH OR DEBRIS PLACED FOR REMOVAL, HAD BEEN REMOVED FROM THE ACQUISITION AREA EXCEPT.FOR THE FOLLOWING: 7-1 .,� . elocution tpresentative ate Od J3/a-9/oy N0'7' ee4d y ❑ There are tenants remaining on this property. This property is now vacant ❑ Abandoned property remains \ on site PROPERTY MANAGEMENT Keys given to:_ /; J fipa 5 & Date: Received by: OvalanOaac & Cutler, Inc. 07/03 notes: �Q,O 0 RECEIVED. APR 2 00 2004 ®l � PUBLIC WORKS. May 12 04 12:47p P.O. Box 55329 Riverside; Caliromia 92517 Timothy S. Morrison 7608634919 p.4 SCOTT MORRISON & ASSOCIATES (909) 624-1665 (800) 824-3353 ROSH 92-0248 1 ASBESTOS SURVEY REPORT Completed On ' May 10th, 2004 PLM0428#0928 Client: Tom of LauQuinta 's Office Redevelopment City P.O. Box 1504 La Quinta, CA 92253 Project: 46335 Jefferson Avenue La Quinta, CA (single family home with attached garage) ro ect bulk ACBM at the ad April B27th, 2004 an asbestos inspection of all uspect asbestos ole tain ng building materiaing was conducted at ls ( above )p address. Bulk samples were taken bull: samples were submitted to Carolina request of the client named above. A total Court (9) and Cal. Environmental, Inc. located at: 107 New Editioe aeof a bestos by volume and determ ne 0the type(s) Environ. Lab. Cert. #2483) to estimate the perc 9 present. t,!pe of asbestos by using EPA approved Carolina Environmental, Inc. determines percentages and ,.p Samples. Bulk atho d Light Microscopy) Asbestos is quantified by using the visual method 6001M4-82-020: interimMethod for the Determina•:ion of Asbestos in Bulk amp samples are analyzed by PLM ( ro:imate percentage of asbestos present. arena estimation technique and can only determine the app is not to j:mphatically determine that no asbestos is 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 present, merely that none was detected or, if it was, it was likely to be less than 1.0% of the sample. asbestos ned in a er analysis may be When findings reveal less than or close f moor denounce thea'initiiial findings. e The hCalifornia Code of called for on additional samples to confer be conducted according to the A H orR.A. protocol Regulations (CCR 1529) requires bulk sampling provisions of 40 CFR Part 7 o3•eneous area behe c lieped (,Ol recommends End analyzed beforerany(building.material is surfacing samples from a hom g determined. to be non -asbestos containiiog. Scott Morrison &Associates conducts asbestos inspection surveys following the A_H.E.R.A. inspect protocol. SH 142 ASBESTOSINSP ANALOYZED BY: Carolina mothy oEnvironmental, Inc-3NVLAP #101768-0 BULK SAMPLES (1) SCOTT MORRISON & ASSOCIATES P.O. Box 55329 (909) 624-1665 Riverside, California 92517 DOSH 92-0248 (800) 824-3353 The results on the following page(s) indicate that asbestos was detected in 00 of the 09 samples analyzed. PLM0428#0928 Sample #QT -71 Type of material: smooth coat- white (1 rst layer) Location: interior north wall of northeast bedroom Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -72 Type of material: drywall (2nd layer) Location: behind sample #QT -71 Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -73 Type of material: ceiling drywall Location: interior ceiling of northwest diningroom Area: throughout interior ceilings Friable:no Results: none detected Sample #QT -74 Type of material: smooth coat- white (1 rst layer) Location: interior west wall of southwest bedroom Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -75 Type of material: drywall (2nd layer) Location: behind sample #QT -74 Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -76 Type of material: final coat- white (1 rst layer) Location: exterior north wall Area: throughout exterior walls Friable:no Results: none detected Sample #QT -77 Type of material: plaster- grey (2nd layer) Location: behind sample #QT -76 Area: throughout exterior walls Friable:no Results: none detected Sample #QT -78 Type of material: final coat- white (1 rst layer) Location: exterior east wall Area: throughout exterior walls Friable:no Results: none detected (2) SCOTT MORRISON & ASSOCIATES P.O. Box 55329 Riverside, California 92517 DOSH 92-0248 PLM0428#0928 Sample#QT-79 Type of material: roof felt- black Location: exterior roof under clay tiles Area: approx. 1500 total sq. ft. Friable:no Results: none detected (909)624-1665 (800) 824-3353 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 '- Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 i (3) •May -06-04 01:15pm From -CAROLINA ENVIRONMENTAL CAROUNA eMONNENTA1q INC . 107 New Edition Court Cary, NC 27511 ph"-, (919) 481.1413 FaX (919) 481-1442 Client: Scott Morrison & Associates 31855 Date Palm Dr. Suite 3-507 Cathedral City, CA 92234 +4811442 T-114 P.02/05 F-549 LABORATORY REPORT ASBESTOS BULK ANALYSIS . CEI Lab Code: A04-3151 Received: 04-30-04 Analyzed: 05-03-04 Reported: 05-03.04 Analyst: Gary A. Swanson Project: PLM0428#0928 CLIENT ID CEI% LA13 ID HOMOGENEITY DESCRIPTION ASBESTOS QT -71 A257262 SMOOTH COAT ND Homogeneous, White, Non-fibrous, Bound BINC 100% QT -72 A257263 DRYWALL ND Heterogeneous, Brown, White, Fibrous, Bound BIND 85% CELL 15% QT -73 A257264 DRYWALL ND Heterogeneous, Brown, White, Fibrous; Bound BIND 85 % CELL '15% QT -74 A257265 SMOOTH COAT ND Homogeneous, White, Non-fibrous, Bound BIND 100% ND QT -75 A257266 DRYWALL Heterogeneous, Brown, White, Fibrous, Bound BIND 85% CELL 15% QT -76 A257267 FINAL COAT ND Homogeneous, White, Non-fibrous, Bound BIND i 100% r Paso 1 ' May -06-04 01:16pm From -CAROLINA ENVIRONMENTAL +4811442 7-114 P.03/05 F-549 CAROUNAEN1 RONMENTAL,INC: Project: PLM0428#0928 101 New Edition Court Cary, NC 21511 Phone: 919.481-1413 Fax: 9191 1-1442 Lab Code: A04-3151 CE1 HOMOGENEITY DESCRIPTION ASBESTOS CLIENT ID LAR ID ND QT -77 A257258 PLASTER Homogeneous, Grey, Non-fibrous, Bound SIND; 100% ND QT -78 A257269 FINAL COAT • Homogeneous, White, Non-fibrous, Bound BIND 100 0/9 ,QT -79 A257270 ROOF FELT i ND Homogeneous, Black, Fibrous, Bound � TAR 35% CELL i 65% i i Page 2 May -06-04 01:16pm From -CAROLINA ENVIRONMENTAL +4811442 T-114 P.04/05 F-549 t I The following definitions apply to the abbreviations used in the ASBESTOS BULK ANALYSIS REPORT; a CHRY = Chrysotile - CELL = Cellulose DEER = Debris AMOS = Amosite FBGL = Fibrous Glass BIND a Binder, CROC = Crocidolite ORGN = Organics SILT = Silicates TREM = Tremolite SYNT = Synthetics GRAY = Gravel. ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastici ACTN = Actinolite CERWL = Ceramic Wool PLAS = Plaster N D = None Detected NTREM = Non-Aspestiform PERL = Perlite' NANTH = Non-Asbestiform Tremolite RUBR =Rubber Anthophyllite CLIENT: Scott Morrison & Associates PROJECT: PLM0428#0928 CEI LAB COOE: A04-3151 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 to the samples analyzed. The samples were analyzed as submitted by the client and may not be representative of the larger material in question. Unless notified in writing to return samples, Carolina Environmental, Inc, will discard all bulk samples 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 Voluntary Accreditation Program (NVLAP) for the analysis of asbestos in bulk materials. The accredited test method is EPA / 600 / M4-82 / 020 for the analysis of asbestos In building materials. Procedures described in EPA 1600 / R-93 / 116 have been incorporated where applicable. The detection limit for the method is 0.1% (trace amount). Carolina Environmental, fnc,'s NVLAP accreditation number 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 soil analyses for asbestos using PLM are not covered under NVLAP accreditation, ANALYST REVIEWED BY Tianbao Sai, Ph.D. _ Laboratory Director End of R®port i. I , Irma: Scott 1V enixoa & Assodates LO P.O. Boz 56329 Riverside; CA 92517 (760)323-7743 a Wit: .- Job No.t �`� -LB-42-`6 Site Addres by 4, v z 2t CO, 7� W Q Z O ac Q U 1 E 0 /Ivy- 4�-90"7,W-4�,�7.27o To: Carslbu Eaviroamental, Inc. 107 New Mdoa Cosr4 Csry, NC 27511 (919)481.1413 NVLAP Cela 190"-* G ZLAP #UW :try O QOc:(Z' io Person Tsl�B Ssmpfes�, 3-765- Sample # Sample Date mataW a Description P. AA -Pb other Information _J^ �— /� l� �--� 04- - Si 'y l�/�[/ lam' 1 � W � � �� 1 • iY N&WXTi�- a. .. �. J. o Fox Is ROW" S PO m - ime' 2 5011 Bw&w By: ti Datenrime: fo M Re4inquisl�ed By: Dawn . ` ' 1KaiPFaa To: Scott 1k6enine & Asaciates, 31855 Date Pefat Dr -9 Ste. 03-507, Cathedral Clty, CA 92234, 060j 323-7743 P.O. Box 55329 Riverside, California 92517 SCOTT MORRISON & ASSOCIATES DOSH 92-0248 ASBESTOS SURVEY REPORT Completed On May 10th, 2004 PLM0428#0928 Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 33s' Project*5 Jefferson Avenue La Quinta, CA (single family home with attached garage) (909)624-1665 (800) 824-3353 On April 27th, 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 (9) 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) 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 Y E AQIND USE ONLY ""' SCREEN BY =`Y RECENED t POSTMARK= F ; " ENTERED BY. - NOTIFICATION # ' „.w�#l'i,.Gk .. q,eti .+ns.�y`.,Yi-t4 '"". .T`."`w :",aWM"^".,�5•-Si.�, ?7_41 ..•'3'.,«4' t^:H v..G •r+m, � -f 'y(y �• '"7 P"". . " n, COMPLETED BY COMPANY EMERY L_ANDC_LEARING PHONE 760/391-5840 LORI EMERY V.P. AND GRADING, INC. DATE 5126/04 CHECK # ' �?J' ." FEE $118.41 PROJECT # NOTIFICATION TYPE ORIGINAL REVISION DATES REwsION OTHER (highlight) CANCELLATION PROJECT TYPE DEMOLrrION ORDERED DEMOLRION RENOVATION (removaq EMERGENCY REMOVAL PLANNED RENO (annuaq SITE INFORMATION SITE NAME CITY OF LA QUINTA ROAD EXPANSION PROJECT SITE ADDRESS 4635 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) 2,149 -NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 15 NUMBER OF DWELLING UNITS 1 COMMERCIAL HOSPITAL INDUSTRIAL Other OFFICE PUBLIC BLDG. -HOUSE SCHOOL SHIP UNNICOLLEGE SITE OWNER CITY OF LA QUINTA ADDRESS 78.495 CALLE TAMPICO CITY LA QUINTA STATE CA ZIP 92253 CONTACT MR TOM HARTUNG PHONE 760!177-7019 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 6122/04 WORK SHIFT (kL 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 I FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) DRYWALL PLASTER TRANSITS ROOFING OTHER (describe) CONTRACTOR INFORMATION TCSLBUCENSE#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 ZIP Asbestos survevs are required prior to Demolition and Renovation SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL k1L FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074.5641 WASTE TRANSPORTER #2 WASTE STORAGE SITE ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure # 1, 2, 3, 4, 5 or Other. For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING Survey, Bulk Sampling, Inspection, PLM, PCM, TEM, Assumed as Asbestos-PACM, Describe Other: FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE # AUTHORIZING PERSON: MR. TOM HARTUNG TITLE BUILDING AND SAFETY DIRECTOR DATE OF ORDER 5/17104 DATE ORDERED TO BEGIN: 611/04 FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT: EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN: CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. STOP PROJECT HAVE CERTIFIED ASBESTOS REMOVAL CONTRACTOR REMOVE AND DISPOSE OF. TRAINING CERTIFICATION: I certify that an individual trained in the provisions of regulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required training has been accomplished by this person 'll be available for inspection during normal business hours. ComName EMERY Print name of owner/operat Si lure o own / for Tittle of owner/operator Date 5/26/04 pany LANDCLEARING AND LORI EMERY .. GRADING, INC. VICE PRESIDENT INFORMATION CERTIFICATION: I certify that the above information is correct and I have enclosed arty required attachments. Company Name EMERY Print name of owner/operator Signa of owned for Tittle ofowner/operator Date 5/26104 LANDCLEARING AND LORI EMERY VICE PRESIDENT GRADING, INC. Notifications can not be accepted without the required fee (AQMD Rul 1). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks payable to 'SCAQMD*. Fees are per notification, not refundable, and vary according to the project size. Fees are as follows: DEMOLITION 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 DEMOLITION OF LESS THAN 100 SQ FT $ 29.52 ASBESTOS REMOVAL AT owner- $ 29.52 occupied, single -unit dwelling MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 900745&41 Page 2 of 2 TELEPHONE: (909) 396-2336 FAX: (909) 396.3342 Form REV 20030627 FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP://WWW. AQNM.GOV WPAAYn i.. 1-*.d,a 74QRr, C nlhm niem^nA 1.1or PA 047R9Z A407 ronol Boa )nnn P.O. Box 55329 Riverside, California 92517 SCOTT MORRISON & ASSOCIATES DOSH 92-0248 ASBESTOS SURVEY REPORT Completed On May 10th, 2004 PLM0428#0928 Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 46335 Jefferson Avenue ' La Quinta, CA (single family home with attached garage) (909)624-1665 (800) 824-3353 On April 27th, 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 (9) 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' (909) 624=1665 Cathedral City, CA 92234 (760)323-7743 INVOICE Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 76-055 Jefferson St. 76=235 Jefferson St. q(0 335 Jefferson St. 76-480 Jefferson St. Inspection dates: April 27 and April 28, 2004 Date: May 10, 2004 Project/ P.O# File name: PLM0427#1226 PLM0427#0927 PLM0428#0928 PLM0428#1529 asbestos inspection/ bulk sampling: 4.single-family homes @ $125.00 ea. = $500.00 45 total bulk samples for analysis (PLM) @ $20.00 each =4900.-00 # hours of travel time @ $ each = included Total amount due = $1,400.00 Please send payment to: 31855 Date Palm Drive; Ste. #3-507 Cathedral City, CA 92234 Terms: Net 15 days Thank you. APPROVED FOR PAYMENT 8 8Y A(XXX T No. - �' J DESCRIPTION--..;. AMT T AY as bes-Eos �. M O _`