04-5108 (DSF)U
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
OF ,94`' ^ r7,8,,4�95 CALLE TAMPICO , FAX (760) 777-7011
p LA�QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
� I
D �} BUILDING PERMIT -
ION 25
�....---, ..., ter.
App1% c:at'i"on Number <04-00.00510 Date' 6/23/04
Pro- - t -y'-- d7dr se s . . . . . . 46450 JEFFERSON ST
APN: 649-090-008-32 -2190 -
Application description DEMO - SINGLE FAMILY
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 0
Owner Contractor
CITY OF LA QUINTA TRESIERRAS CONSTRUCTION, INC.
78495 CALLE TAMPICO 2235 N. LAKE AVENUE, #107
LA QUINTA CA 92253 ALTADENA CA 91001
(626) 794-3333
WCC: STATE FUND
WC: 1454302 07/01/05
CSLB: 725996 02/28/05
CCC: B -C21
-------------------------- Structure Information -------------------------
Construction Type . . . . . TYPE V - NON RATED
.Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10
Flood Zone . . . . NON -AO FLOOD ZONE
Other struct info . . . . . NUMBER OF UNITS 1.00
----------------------------------------------------------------------------
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 HOUSE
AND ALL IMPROVEMENTS
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
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Q4
Applicant: I Architect or Engineer: Date: 60a S^ ''O 4
Applicant's Mailing Address:
Architect 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
C e, and my License is in full fort and effect.
icense Class icense Nq� Z r c/ c/ Se
,OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the ntractors' 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 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.).
L) I 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.
I have and will maintain workers' compensa . n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ed My workers' compensation rance carrier and policy number are:
mer `=� t�j//!N� —�, �w Policy Number / S --&f :3 Q -2 — U
I certify that, A 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 shall
forthwith comply with those prgvWan37)
G"Z 1
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV GE 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.
CONSTRUCTION LENDING AGENCY
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.).
Lenders Name
Lender's Address
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 ho'd 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 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 and state laws relating to building
construction, and hereby authorize representatives of this y toen r upon the tioned property for inspection purposes.
,,�ate Liignature (Applicant or Agent):
SCOTT MORRISON & ASSOCIATES
P.O. Box 55329
Riverside, CA 92517 s
(909) 624-1665 DOSH 92-0248
ASBESTOS SURVEY REPORT
Completed On
March 8th, 2004
PLM0226#4025d
Client: c/o Tom Hartung's Office
City of La Quinta Redevelopment
P.O. Box 1504
La Quinta, CA 92253
Project: 46450 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 (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 MOMSON & 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 00 of the 09 samples
analyzed.
PLM0226#4025d
Sample #QN-27
Type of material: acoustic ceiling- white
Location: interior ceiling of southwest livingroom
Area: approx. 200 sq. ft.
Friable:yes
Results: none detected
Sample #QN-28
Type of material: final coat (1rst layer)
Location: interior east wall of southwest livingroom
Area: throughout interior walls of room
Friable:no
Results: none detected
Sample #QN-29
Type of material: drywall (2nd layer)
Location: behind sample #QN-28
Area: throughout interior walls of room
Friable:no
Results: none detected
Sample #QN-30
Type of material: acoustic ceiling- white
Location: interior ceiling of garage
Area: approx. 300 sq. ft.
Friable:yes
Results: none detected
Sample #QN-31
Type of material: acoustic spray- white
Location: interior walls of water closet in garage and
exterior south HVAC closet
Area: approx. 160 total sq. ft.
Friable:yes
Results: none detected
Sample #QN-32
Type of material: stucco- light tan (1rst layer)
Location: exterior east wall
Area: throughout exterior walls
Friable:no
Results: none detected
Sample #QN-33
Type of material: plaster- grey (2nd layer)
Location: behind sample #QN-32
Area: throughout exterior walls
Friable:no
Results: none detected
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#4025d
Sample #QN-34
Type of material: duct tape- white
Location: exterior south HVAC closet
Area: approx. 15 linear ft.
Friable:no
Results: none detected
Sample #QN-35
Type of material: roof felt- black
Location: exterior roof under wood shingle
Area: throughout exterior roof
Friable:no
Results: none detected
9
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
r
(3)
Mar-04-04 II:10am FrokAROLINA ENVIRONMENTAL +4811442 T-417 P.02/05 F-543
CAR UNAENVIRONMENTAL,INC. LABORATORY REPORT
Ph0w:(E9)41l- url;Cary,NC27511 ASBESTOS BULK ANALYSIS
Phone: �'t9) 481.1413 Fa:c {S19I481-1442
Client: Scott Morrison & Associates CEI Lab Code: A04-1470
31855 Date Palm Dr. Suite 3-507 Received: 03-03.04
Cathedral City, CA 92234 Analyzed: 03-04-04
Reported: 03-04-04
Project: PLM0226#4025d Analyst: Gary A. Swenson
CLIENT ID CEI HOMOGENEITY DESCRIPTION
LAB ID ASBESTOS
ON-27 A234281 ACOUSTIC CEILING NO
Homogeneous, White, Non-fibrous, Bound
BIND ' 100 %
ON -28 A234282 FINAL COAT ND
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QN-29 A234283 DRYWALL ND
Homogeneous, White, Fibrous, Bound
BIND 93% CELL 7%
QN-30 A234284 ACOUSTIC CEILING
Homogeneous, - White, Non-fibrous, Bound
BIND 100%
QN-31 A234285 ACOUSTIC SPRAYED ON
Homogeneous, White, Non-fibrous, Bound
BIND 100%
QN-32
A234286 STUCCO
Homogeneous, L,Tan, Non-fibrous, Bound
BIND 100%
ND
i:l7
ND
Page 1
filar -04-04 11:10am From -CAROLINA ENVIRONMENTAL +4811442 7-417 P.03/05 F-543
CAROUNAENMNMENTAI„INC. Project: PLM0226#4025d
107 New Eftw Court, Cary, NC 2/511
Phone' 919181-1413 Fax: 919.481-1442
Lab Code: A04-1470
CLIENT ID CEI HOMOGENEITY DESCRIPTION %
LAS.ID- ASBESTOS
QN-33 A234287 PLASTER ND
Homogeneous, Grey, Non-fibrous; Bound
BIND 100%
QN-34 A234288 LICT TAPE
Homogeneous, White, Fibrous, Bound
BIND 25% CELL 75%
ND
QN-35 A234289 ROOF FELT Np
Homogeneous,. Black, Fibrous, Bound
TAR 25% CELL 75%
Page 2
'Mar -04-04 11:10am From -CAROLINA ENVIRONMENTAL +4811442 T -C T P.04/05 F-543
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
REM = Tremolite SYNT = Synthetics GRAV = Gravel
ANTH = Anthophyllite WOLL = Wollastonite- MAST = Mastic
ACTIN = Actinolite CERWIL = Ceramic Wool PLAS =Plaster
N D = None Detected NTREM = Non-Asbestiform PERI = Perlite
NANTH = Non-Asbestiform Tremolite RUBR =Rubber
Anthophyllite
CLIENT: Scott Morrison & Associates '
PROJECT: PUN0226#4025d
CEI LAS Conk: A04-1470'
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 anelysls of asbestos in bulk materials. The accredited test method is EPA 1600 / M4-82 / 020 for
the analysis of asbestos in building materials. Procedures described in EPA / 600 / R-931 116 have been incorporated
where applicable. The detection limit for the method is 0.1 % (trace amount). Carolina Environmental, Inc: s NVI.AP
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
41A~ t
rifanboo Bai, Ph.D,
Laboratory Director End of Report
From: Scott Morrison & Associates
P.O. Box 55329
Riverside, CA 92517
(760) 323-7743
CHAIN OF CUSTODY
To: Carolina ]Environmental, Inc. o
107 New Edition Court o
Client: I
(I--, LA Qytfs�
Job No. -?LAA 0I -4c, Site Addres
Cary, NC 27511
(919) 481-1413
NVLAP Code 101768-0 CA ELAP #2483
Person Tatting Samples: tw.o ' oaP- (so J�%OS4 *oz, -31
4 ESDtJ�'
Sample #
Sample Date
Material & Description
LM) AA -Pb
Other Information
*Z
Q
m-16 -zcb
�.0 7
Fax in Results ? ✓ s No
ReGngnis6ed By: Date/Time: 0-42s3 O - 1poO Received By: ��-{ DatelTime:O� 03 y
Mail/Fax To: Scott Morrison & Asociates, 31855 Date Palm Dr., Ste. #3-507, Cathedral City, CA 92234, (760) 323-7743
P.O.. Box 55329
Riverside, CA 92517
(909) 624-1665
INVOICE
SCOTT MO.RRISON & ASSOCIATES
31855 Date Palm Drive, Ste. #3-507
Cathedral City, CA 92234
(760)323-7743
•Client: Tom Hartung's Office
City of La Quinta Redevelopmemt
P.O. Box 1504.
La Quinta, CA 92253 "
...Project: 46115,, 46280, 463-05, 46395;
and 46450 Jefferson St. '
La Quinta, CA
(5 single-family homes)
Inspection date: February'26, 200
Date: March 16, 2004
Project/ P.O#
File name: PLM0226#4025a-e
asbestos inspection/ bulk sampling: 5 single-family homes @ $125.00 ea. ,= $625.00
40 total bulk samples for analysis (PLM) @ $20.00 each = $800.00
# hours of travel time @ $ each = included
Total amount due =:$1,425.00
Please send paymerit to: 31855 Date Palm Drive; Ste. #3-507
Cathedral City, CA. 92234.
Terms: Net 15 days
Thank you.
APPR VE FOR PAYMENT
BY
BY O r
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ACCOUNT N to�J
DESCRIPTION e, oG
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AMT. TO PAY