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04-5109 (DSF)V ^� w` )?..0. $pox 1504 78-49�1r� ALLE TAMPICO LA QUr110 IjNTA, CALIFORNIA 92253 JUN 2 5 2004 I BUILDING PERMIT CITY OF LA Application'1Vumber . . . . Property Address . . . . . APN: Application description Property Zoning . . . ... . Application valuation . . . BUILDING & SAFETY DEPARTMENT . . •-o,.1.. , (760).777-7012 .a t" ". ,FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 s 0400005109 ;Date 46480 JEFFERSON ST 649-090-009-31 -2190 =--! DEMO - SINGLE FAMILY LOW DENSITY RESIDENTIAL 0 6/23/04 Owner 'Contractor ------------------------ CITY OF LA.QUINTA --------------- -------- TRESIERRAS CONSTRUCTION, INC. 78495 CALLE TAMPICO 2235 N. LAKE AVENUE, #107 LA QUINTA CA 92253 ALTADENA CA 91001 (62 6) 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/LONG.<=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 L Qty Unit Charge Per Extension -------------------------------------------- BASE FEE �, -----------------------------='- 45.100 Special Notes and Comments COMPLETE DEMOLITION OF EXISTING HOUSE AND ALL IMPROVEMENTS Fee summary Charged Permit Fee Total 45.00 Plan Check Total .00 Grand Total 45.00 r . Paid Credited Due ------- ----- 00-----`-.`=�:,00� 45.00 .00 .00 .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 Tf 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: (o— ZS'D(I Architect or Engineer: Architect or Engineer's Address: ZA Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under prov' ions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals / , and Li nse is i full force and effect � `i C icense Classss —L � t icense No. -172 -0y OW ISR -BUILDER DECLARATION I hereby affirm under penalty of perjury that I m 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 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. , BA P.C. for this reason Date 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' 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��ance carrier and Policy number are: Carriers 7 n= �/Dl�d�-lam . Z7/LZS "Policy Number _ / 4,/ 3Q ZZ I certify that, in th performance of the work for which 1his 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 th prov's'o ate —,?-5--,0 plicant WARNING: FAILURE TO SECURE WORK S' COMPENSAION COVEKNADDITION IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), 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.). Lender's 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, 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 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 abo MTO ation is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of t county Zen:upon 7theabo - entio ed property for inspection purposes. ate��2 5 Q Y S�re (Applicant or Agent): SCOTT MORRISON & ASSOCIATES P.O. Box 55329 Riverside, California 92517 DOSH 92-0248 ASBESTOS SURVEY REPORT Completed On May 10th, 2004 PLM0428#1529 Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 46480 Jefferson Avenue La Quinta, CA (3 bedroom single family home with attached garage) (909)624-1665 (800) 824-3353 On April 28th, 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 (15) 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) P.O. Box 55329 Riverside, California 92517 SCOTT MORRISON & ASSOCIATES DOSH 92-0248 (909) 624-1665 (800) 824-3353 The results on the following page(s) indicate that asbestos (greater than 1%) was detected in 04 of the 15 samples analyzed. PLM0428#1529 Sample #QT -80 Type of material: acoustic ceiling- white Location: interior ceiling of west -central livingroom Area: approx. 1450 total sq. ft. Friable:yes Results: 50/6 Chrysotile asbestos Sample #QT -81 Type of material: acoustic ceiling- white Location: interior ceiling of southeast bedroom Area: approx. 1450 total sq. ft. Friable:yes Results: 5% Chrysotile asbestos Sample #QT -82 Type of material: acoustic ceiling- white Location: interior ceiling of southwest bedroom & hall Area: approx. 1450 total sq. ft. Friable:yes Results: 5% Chrysotile asbestos Sample #QT -83 Type of material: smooth coat- white Location: interior north wall of east -central diningroom Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -84 Type of material: smooth coat- white (1 rst layer) Location: interior east wall of southeast bedroom Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -85 Type of material: plaster- grey (2nd layer) Location: behind sample #QT -84 Area: throughout interior walls of room Friable:no Results: none detected Sample #QT -86 Type of material: textured ceiling- white (1 rst layer) Location: interior ceiling east -central diningroom only Area: approx. 350 total sq. ft. Friable:no Results: 8% Chrysotile asbestos Sample #QT -87 Type of material: plaster- grey (2nd layer) Location: behind sample #QT -86 Area: approx. 350 total sq. ft. Friable:no Results: less than 1% Chrysotile asbestos (2) SCOTT MOMSON & ASSOCIATES P.O. Box 55329 (909) 624-1665 Riverside, California 92517 DOSH 92-0248 (800) 824-3353 PLM0428#1529 Sample #QT -88 Type of material: stucco (1rst layer) Location: exterior south wall Area: throughout exterior walls Friable:no Results: none detected Sample #QT -89 Type of material: plaster- grey (2nd layer) Location: behind sample #QT -88 Area: throughout exterior walls Friable:no Results: none detected Sample #QT -90 Type of material: rolled roofing (1rst layer) Location: exterior east flat roof Area: approx. 850 total sq. ft. Friable:no Results: none detected Sample #QT -91 Type of material: roof felt- black (2nd layer) Location: under sample #QT -90 Area: approx. 850 total sq. ft. Friable:no Results: none detected Sample #QT -92 Type of material: roof tar- black (3rd layer) Location: under sample #QT -91 Area: approx. 850 total sq. ft. Friable:no Results: none detected Sample #QT -93 Type of material: roof felt- black Location: exterior central roof under wood shingle Area: approx. 1700 sq. ft. Friable:no Results: none detected Sample #QT -94 Type of material: rolled roofing- brown (1rst layer) Location: exterior northwest flat roof Area: approx. 350 sq. ft. 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 asbestos abatement contractor prior to any demolition or renovation of the property. Inspector /41 , W�0101 Scott C. Morrison Certified Asbestos Consultant DOSH#92-0248 (3) May -06-0: 7i:1:0m From -CAROLINA ENVIRONMENTAL CAROUNAEW RDNIAENTAL, INC. 107 New Edition Court, Cary, NC 21511 Phom:(919) 481.1413 Fw(919)481-1442 +4811442 7-114 P. 02/06 F-550 LABORATORY REPORT ASBEST S BULK ANALYSIS Client: SCOtt Morrison & Associates CEi Lab Cod©: A04-3150 31855 Date Palm Dr. Suite 3-507 Received: 04-30-04 Cathedral City, CA 92234 Analyzed: 05.03-04 Reported: 05-03-04 Analyst: Sera Harrison Project: PLM0428#1529 % CEI HOMOGENEITY DESCRIPTION ASBESTOS CLIENT ID LAB ID, - ACILING CHRY OU QT -so A257248 �TICAL CE Heterogeneous, White, Fibrous, Loosely Bound - CHRY 5% BIND 75% MICA 200/6 QT -81 A257249 ACOUSTICAL CEILING Heterogeneous, White, Fibrous, Loosely Bound CHRY 5% BIND 750/4 MICA 20% QT -82 A257250 ACOUSTICAL cEIUNG Heterogeneous, White, Fibrous, Loosely Bound CHRY 5% BIND 75% MICA 20% QT -83 A257251 SMOOTH COAT Heterogeneous, White, Fibrous, Bound BIND 93% CELL 2% PAINT 5% QT -84 A257252 SMOOTH COAT Heterogeneous, White, Fibrous, Bound BIND 93% CELL 2% PAINT 5% QT -85 A257253 ELAST R Heterogeneous, Grey, Fibrous, Loosely Bound Pans 90% CCU 2% PERL 8% CHRY 5% CHRY 5% ND ND ND Page 1 May -06-04. 01.13rm From -CAROLINA ENVIRONMENTAL +4611442 7-114 P.03/06 F-550 CAROLINAENVIRONMF.NTAL,INC Project: PLM0428#1529 101 New Fcredon Court, Cary+ NC 27511 Phone: 919481.1413 Fac: 819+181-1442 Lab Code: A04-3150 °10 CEI HOMOGENEITY DESCRIPTION ASBESTOS CLIENT ID LAB ID Q7-86 4257254 TEXTURED CEILING CHRY 8% Heterogeneous, White, Fibrous, Loosely Bound CHRY 8% BIND 77 PERL 15% Q7_88 A257255 STUCCO CHRY <1 °lo ' Heterogeneous, Tan, Fibrous, Loosely Bound CHRY 0% SIND 95% PAINT 5% QT -89 4257256 WALL PLASTER NiJ Heterogeneous, Grey, Fibrous, Bound PLAS 97% CELL <1 % MICA 3% QT -90 4257257 ROCUE-D ROOFING ND Heterogeneous, Black, Fibrous, Bound TAR 57% CELL 30% GRAV 3% QT -91 A257258 ROOF FELT NO Heterogeneous, Black, Fibrous, Bound TAR 40% CELL 60% ND QT -92 A257259003- OF TAR Heterogeneous, Black, Fibrous, Bound - TAR 98% CELL 2% R00F FELT NO QT -93 A257260 Heterogeneous, Black, Fibrous, Bound TAR 90% CELL 10% Page 2 • May -06-04 01:13pm From -CAROLINA ENVIRONMENTAL +4811442 T-114 P.04/06 F-550 Project- PLM0428#1529 CAROUNAENVIROI�NMENTA�INC• 107 New Edition Court, Cary, NC 27511. phonv: 91941-1413 Fac: 919481-1442 Lab Coda: A04.3150 CEI HOMOGENEITY DESCRIPTION ASBESTOS CLIENT ID LAO ID QT -94 A257261 • R01 -LED ROOFING • ND Heterogeneous, Brown, Fibrous, Bound BIND 70% FBGI_ 25% GRAY 5% Page 3 Ma.Y-06-04 01:14pm From -CAROLINA ENVIRONMENTAL +4811442 7-114 P.05/06 F-551 The following definitions apply to the abbreviations used in the ASBESTOS BULK ANALYSIS REPORT: CHRY = Chrysotile CELL = Cellulose DEER = Debris AMOS = Amosite FBGL = Fibrous Glass BIND = Binder CROC = Crocidolite ORGN = Organics SILI = Silicates TREM = Tremolite SYNT = Synthetics GRAV = Gravel ANTH = Anthophyllite WOLL = Wollastonite MAST = Mastic ACTN = Actinolite CERWL = Ceramic Wool PLAS =Plaster N D = None Detected NTREM = Non-Asbestiform PERL = Perlite NANTH = Non-Asbestiform Tremolite RUgR =Rubber. . Anthophyllite CLIENT: Scott Morrison & ASsociateS PROJECT: PLM042841529 CEI LAB CODE: A04-3150 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 / 600 / R-93 1 116 have been incorporated where applicable. The detection limit for the method is 0.1 % (trace amount). Carolina Environmental, Inc.'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 1'ianbao Bal, P11,0 - Laboratory Director End of Report 1 Fnm-. Scott Morrison & Associates @.t3. Bas 35329 liiverside, CA 92517 (760) 32.3-7743 -4.2s 7,1 �14 Carolina EaviennmMW, Tnr- 107 New Edition CourtIn Cary, NC 27511 (919) 481-1413 NVLAP Cole i@i7M4 CA ELAP #ZW q Sa® �iw-��i y ! `%icaci� t sc aS N T Client. Pennon Taldag p�� nn � � _ tem a rQ vc �. � E i� zk 15 Z Ste Adw��� � f- F {� 12SN o r Job Ka 5i �I /6`d V! Fit in Riau is 7 T 1 til (�1 3:00 Rmived By.—:-- — Rdinquished By: I _--- M&ibVa$ To: Scott idinrrison &. Aaoelatea, 31835 Date fain Dr., Ste. #3-587, Csstb City, CA 92234, (760) 323-7743 P.O. Box 55329 Riverside, California 92517 SCOTT MORRISON & ASSOCIATES DOSH 92-0248 ASBESTOS SURVEY REPORT Completed On May 10th, 2004 PLM0428#1529 Client: Tom Hartung's Office City of La Quinta Redevelopment P.O. Box 1504 La Quinta, CA 92253 Project: 76480 Jefferson Avenue La Quinta, CA (3 bedroom single family home with attached garage) (909) 624-1665 (800) 824-3353 On April 28th, 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 (15) 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 Part763.86. 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, (A-92517 Cathedral City; CA 92234 (909)624=1665 (760)323-7743 INVOICE- Date: May 10, 2004 Client: Tom Hartung's Office Project/ P.O# City of La Quinta Redevelopment P:O. Box 1504 La Quinta, CA 92253 .Project: 76-055 Jefferson St.. File name: PLM0427#1226 76=235 Jefferson St. PLM0427#0927 76-335 Jefferson St. PLM0428#0928 480 Jefferson St. PLM0428#1529 .Inspection dates: April 27 and April 28, 2004 asbestos inspection/ bulk sampling: 4. single-family homes @ $125.00 ea. _ $500.00 45 total bulk samples for analysis (PLM) @ $20.00 each = $900:00 #'-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 8Y eY ACCOUNT NO. / DESCRIPTION 4. AMO T BRI[CKLEY ENVIRONM ENTAILC17Y o!--,9R�-q TA Environmental Remediation Contractor JUN 7 INVOICE INVOICE DATE 61112004 BILL TO CITY OF LA QUINTA P.O. BOX 1504 LA QUINTA, CA 92253 ATTN: TOM HATUNG INVOICE # BID # TERMS 6847AA 10895 DUE UPON RECEIPT JOB SITE SFR - VACANT 46480 JEFFERSON AVENUE LA QUINTA, CA 92201 P.O. NUMBER CONTRACT DUE DATE CONTRACT AMT REP 61112004 3,900.00 IFG DESCRIPTION OF WORK PROVIDED PER ATTACHED PROPOSAL AND CONTRACT: REMOVE AND DISPOSE OF ASBESTOS CEILING MATERIALS. APPROVEO FOR PAYMENT AV ACCOUNT NO. ' DESCRIPTION-�•------�'�"'"'"" AMT: TO PAY--- • the rate of 1 Y:% per month -will be char ed on Ind: a/s ❑ Proposal/Contract/Work order ❑ Purchase Order [--].Certificate of Insurance ❑ Copies of Notification Letters ❑ Supervisor's Log ❑ Dump Manifest ❑ Progress Payment/Releases BALANCE DUE 3,900.00 $3,900.00 N 957 West Reece Street, San Bernardino, CA 92411', Lic. No. 610414 CAUOSHA No. 49 _ 909-888-2010 800-530-3366 FAX 909-381-3433 FROM :BRICKLEY ENVIRONMENTAL FAX NO. :909 381 3433 May. 21 2004 03:20PM P2 BRIC"K�,��� Y VI�:�� MENTAL 'Environmental Remediation Contractor PROPOSAL & CONTF;ACT May 14, 2004 TO CLIENT: CITY OF LA QUINTA'REMMIELORMFiN PROPOSAL NUMBER: 10895 ATTN: TOM HARTUNG JOB NAME: VACANT SFR ADDRESS: P. 0. BOX 1504 SITE ADDRE:3S: 46480 JEFFERSON AVENUE CITY: LA QUINTA, CA ZIP: 92253 CITY: LA QUINTA, CA ZIP: 92201 PHONE: 760-777-7013 PROPERTY OWNER: FAX: 760-777-7011 CONTRACT �,MOUNT: $3,900.00 REMOVE" AND DISPOSE OF ASBESTOS CONTAINING MATERIALS (ACM) PER SITE INSPECTION ON 5/12/04 AND SCOTT MORRISON & ASSOCIATES SURVEY #1529, IN QUANTITIES AND LOCATIONS AS OUTLINED BELOW: • APPROX. 1,450 SQ, FT. OF ACOUSTIC CEILING SPRAY - THROUGHOUT. APPROX. 350 SQ. FT, OF TEXTURED CEILING — DINING ROOM. COST $3,800.00 SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJECT: COST $100.00 CLIENT/OWNER TO PAY ALL RE -NOTIFICATION FEES (MINIMUM $25.00 EACH) AND TO BE RESPONSIBLE FOR ALL FEES IF THE PROJECT IS CANCELLED, THIS PROPOSAL IS BASED ON PREVAILING WAGE DETERMINATON SC -102-882-1-2003-1, ISSUE DATE FEBRUARY 22, 2003 AT THE RATE OF $29.90 PER HOUR. BRICKLEY ENVIRONMENTAL WILL PROVIDE ALL OSHA REQUIRED PERSONAL AIR MONITORING AND HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIED LABORATORY. AT THE COMPLETION OF THIS PROJECT, OR AS REQUIRED, BRICKLEY ENVIRONMENTAL WILL PROVIDE, COMPLETE DOCUMENTATION i.e. NOTIFICATIOl LETTERS, WASTE MANIFEST, CERTIFICATE OF INSURANCE, SUPERVISORS DAILY LOGS, ETC. ALL REGULATED WASTE GENERATED FROM THIS PROJECT WILL BE: PROPERLY DISPOSED OF AT AN EPA, STATE OR LOCAL REGULATORY AGENCY APPROVED DISPOSAL FACILITY, UTILIZING THE APPROPRIATE~ WASTE DISPOSAL MANIFEST, OWNER TO PROVIDE WATER AND ELECTRIC AT JOB SITE. BRICKLEY ENVIRONMENTAL WILL PROVIDE NECESSARY CONNECTIONS, 957 Rooce Street, San Bernardino, CA 92411, Llc. No. 6, 0414 CALIOSHA No. 49 Pqpn f of 2 909-888-2010 800-530.3366 FAX 909.391-3433 FROM :BRICKLEY ENUIRONMENTAL FAX NO. :909 381 3433 May. 21 2004 03:20PM P3 WORK SHALL BE PERFORMED IN ACCORDANCE WITHIN OSHA, EPA, AND STATE REGULATIONS. THE ABOVE WORK TO BE COMPLETED IN A SUBSTANTIAL AND WORKMANLIKE MANNER ACCORDING TO STANDARD PRACTICES FOR THE SUM OF: THREE THOUSAND NINE HUNDRED' rxxwwx**,•x*xwxww.xww 'DOLLARS ($3,900.00 A. TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED B. THIS PROPOSAL MAY BE WITHDRAWN BY BRICKLEY ENVIRONMENTAL IF NOT ACCEPTED WITHIN 30 DAYS. C. CONTRACTOR WILL MAINTAIN INSURANCE IN THE AMOUNT OF $1,000,000.00 OR AS REQUIRED BY SPECIFICATIONS. 0, CONDITIONS: THE TERMS AND CONDITIONS AS RE EXPRESSLY INCORPORATED INTO THIS CONTRACT. _ )) ON PROJECT MANAGER / ESTIMATOR KEH ACCEPTANCE OF PROPOSAL THE ABOVE PRICES, SPECIFICATIONS, AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK SPECIFIED. PAYMENT WILL BE MAD = ASSOOUTLI ED BOVE. CLIENT.... 0/LJ/ i �acnl%(�i��`S� !_ CITY OF LA QUINTA RffVYEV7ZEt0PVENT AUTHORIZED SIGNATURE #10895 DATE_/i i TITLE ADDITIONAL TERMS a CONDITIONS OF CONTRACT TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED. INTERES T AT THE RATE OF 1'/m PER MONTH WILL BE CHARGED ON ALL PAST DUE ACCOUNTS. IN THE EVENT OF FAILURE. TO PAY ANY OF TI -IE AMOUNTS DUE ON THIS INVOICE, ALL COLLECTION COSTS, AND/OR ATTORNEY'S FEES IN THE COLLECTION OF ANY SUCH AMOUNT, WILL BE PAID BY THE CLIENT. UNLESS OTHERWISE STATED IN THIS PROPOSAL, BRICKLEY ENVIRONMENTAL WILL PROVIDE ONLY THE OSHA REQUIRED PERSONAL AIR MONITORING. THE OWNER SHALL PRCVIDE, AT THEIR COST, ALL ADDITIONAL TESTING AND ALL FINAL CLEARANCE TESTING OR RETESTING ON THIS PROJECT. THIS BID OFFER IS BASED ON REMOVAL OF CERTAIN TYPES AND QUANTITIES OF HAZARDOUS AND NOW HAZARDOUS MATERIALS AS LISTED IN THE PROPOSAL. IF ADDITIONAL OR CONCEALED HAZARDOUS MATERIALS ARE FOUND AND THE OWNER CHOOSES ABATEMENT, A CHANGE OR)FR WILL BE REQUIRED TO ALLOW THE ADDITIONAL. COSTS AND TIME TO COMPLETE THE ADDITIONAL WORK, PLEASE BE ADVISED THAT THE OWNER OF THE PROPERTY AND GENERATOR OF ANY HAZARDOUS MATERIALS MAY BE SUBJECT TO MANIFEST / EPA NUMBER FEES ISSUED BY THE DEPARTMENT OF TOXIC SUBSTANCES CONTROL (DTSC). ALL FEES ISSUED BY DTSC ARE THE RESPONSIBILITY OF THE OWNER / GENERATOR. FEES ARE BILLED DIRECTLY FROM DTSC AND ARE NOT INCLUDED IN THE CONTRACT AMOUNT. ALTHOUGH BRICKLEY ENVIRONMENTAL TAKES PRECAUTIONS TO AVOID DAMAGE TO FINISHED SURFACES, SOME DAMAGE MAY OCCUR. BRICKLEY ENVIRONMENTAL SHALL NOT BE RE.3PONSIBLE FOR ANY SUCH REASONABLE COSMETIC DAMAGES NOR SHALL PAYMENTS TO BRICKLEY ENVIRONMENTAL BE REDUCED OR WITHHELD AS A RESULT THEREOF. I.e, DAMAGES STEMMING FROM PLACEMENT OR REMOVAL OF POLYETHYLENE AND WOODIDRYWALL BARRIERS AND FASTENING MATERIALS WHICH ARE REQUIRED TO HOLD BARRICADES IN PLACE DURING ABATEMENT. ALL REPAIRS OR REFINISHING WILL BE PERFORMED ONLY UNDER SEPARATE WRITTEN AGREEMENT OR CHANGE ORDER BETWEEN BRICKLEY ENVIRONMENTA+. AND OWNER. THE OWNER, BY ACCEPTANCE OF BRICKLEY ENVIRONMENTAL BID OFFER, HEREBY AGREES TO ABSOLVE BRICKLEY ENVIRONMENTAL OF ANY AND ALL RESPONSIBILITY F0:> ITEMS OR OBJECTS WHICH MAY BE REPORTED DAMAGED, DESTROYED OR MISSING, UNLESS OWNER CAN PROVE BEYOND A REASONABLE DOUBT THAT AN EMPLOYEE OR SUB CONTRACTOR OF BRICKLEY ENVIRONMENTAL IS THE RESPONSIBLE PARTY. CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE CONTRACTORS' STATE LICENSE BOARD. ANY QUESTIONS CONCERNING A CONTRACTOR MAY BE REFERRED TO THE REGISTRAR, CONTRACTORS' STATE LICENSE BOARD, P.O. BOX 26000, SACRAMENTO, CALIFORNIA 95826. Pmp 2 of 2 01/03/1994 21:15 6267943339 TRESIERRAS INC TRESIEKKASCONST 626 239 2035 Jim amour • sletTae Construction, Inc. General Contractors 2235 No �rai�'i333ke A venue Suite 107 Altaid(�na, t;;q 91001 ;L • , V x' { : Tel: (6?6) 794•Fax: (6�b) 94 .33A9 • State I..icerse..725996 20 ury Moe Od i May l QTF,sP NAME: i ;,�= � •� �: '.1�,yi,�its�; Cale,. 9�2�3 � � - - f - '� . tia 11arO� �Perl of tequec(I,�Ttaviefli s COrBtrlt On Inc is p]ettseSl t0 submit for your rcvikw a futttp sum bid proposal ' l�'{' � '' .' 1�•". IIOWtf,9 o work. i : i..�. �. ff q li Tt mdYal nqr >�lsposaT.of asbes s maurirls des your survey peovided and identified as Suryq p• bed in '.ma 0..2004 ,M042 1549. I • i� Pre Idri ;. r '(• >a full tb> ae sta��gFFe{a�y�d�ecvn eliainboi, Negative ai� system to romain tsmniri�r tGitil firinl nic crca; ante is `'i IV� ��1�!.• •tVl••:rP•'"� 'e F ip ,3 .NOtlf�toa rP "a$exl. Q.MD and c;iiy ntm�itti�ig. �'. s n1t+<ted rtes CAGUSH.A CA -; 4'D ­ Disposal of p11 Hatat+dotiim wad inatarlals at Licensed Landfill, Azusa :l mo Itfclamation. _ t, S. IE'r`oVido CI6nt ritl Liebll�`ij Inaunfice and Workman om isation G: r 6; is iroJcct H ptrfon:n d under #'eavailing wages sc i¢duled for Red wc4ypmont Agency. Ir. titr�ctvr' 11.'Oovie a water tied power N project )pgation for Abate,ntnt oply. .,.r.r a• r r: 8. 'C`h�a pate d s not inc�tide'T} hd Party Industria# .H{ ienist services. k ; `�:.Tr►Mclv�='Thott3utid, Nin,..:;....-. r Htittdee�,.................r......r.,... ...........rr.,. 'tip � y.........r .............12pyi3�.P0 . .Dollars .Y ?' this r0 981 =r . t:e .:.s .� old you have �)' gtt�tlons f�gt rding p po. 'please do not hcsitatP to,cal�. nm a; the.Follv��•ing ;; 1i�te titibiber P r 626 25-3044 Office 626-794-1333. 7i -• 7'Ws oegl al.l Yaina 'openo� thirty (30) days from dte flrst writ f'`� � �• tc n drr.y, , at which time it s.hal l ..yJ .7 ;, a„ ►411 p void w gut a" .;futT�er.notico- t ion { i' )ipe !S, ,rpr. - '+i. :• i � r, + id tit%� 6t •+.j PAGE 02 P . it ;i. _Z_' ,,+�:.,l •.�: ;� 1, F I , 9 i F 1 r W, Project/Case ACY 1 ' �� '�" Gl�7c j = L/ ABANDONMENTCERTIFICATE OF PROPERTY and VACANCY WALKTHROUGH Any and all personal property left on the project premises located at J , is to be considered abandoned as of 3 y a AS EVIDENCE BY SIGNATURE AND DELIVERY OF KEYS I HEREBY AGREE THAT OCCUPANCY OF THE LISTED ADDRESS HAS BEEN ABANDONED AND THAT NO FURTHER ENTRANCE TO THE ABOVE ADDRESS WILL BE MADE. X,vc x x &loi�0�' Claiman (s) Name Claimant(s) Signature Date REPLACEMENT ADDRESS: 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 .: R REMOVAL, HAD BEEN REMOVED FROM THE ACQUISITION AREA EXCEPT FOR THE FC: WING: JX Re o ion Representative sol Date' A& ❑There are tenants remaining on this property. :This prope,Vy s now' cant _DAbandoned property remains on site PROPERTY MANAGEMENT..10 . Keys given to: . `r notes: Date: Received by :X / 0verland,Pacific & Cuder, Inc. 07/03 IB1RRCI 'dEY ENVIRONML .TAIL' Environmental Remediation Contractor PROPOSAL & CONTRACT May 14, 2004 CLIENT: CITY OF LA QUINTA REDEVELOPMENT PROPOSAL NUMBER: 10895 ATTN: TOM HARTUNG JOB NAME: VACANT SFR ADDRESS: P. 0. BOX 1504 SITE ADDRESS: 46480 JEFFERSON AVENUE CITY: LA QUINTA, CA ZIP: 92253 CITY: LA QUINTA,. CA. ZIP: 92201 PHONE: 760-777-7013 PROPERTY OWNER: FAX: 760-777-7011 CONTRACT AMOUNT:' $3,900.00 REMOVE AND DISPOSE OF ASBESTOS CONTAINING MATERIALS (ACM) PER SITE INSPECTION ON 5/12/04 AND SCOTT MORRISON & ASSOCIATES SURVEY #1529, IN QUANTITIES AND LOCATIONS AS OUTLINED BELOW: • APPROX. 1,450 SQ. FT. OF ACOUSTIC CEILING SPRAY - THROUGHOUT. • ' APPROX. 350 SQ. FT. OF TEXTURED CEILING — DINING ROOM. COST $3,800.00 SOUTH COAST AQMD NOTIFICATION FEE FOR THIS PROJECT: COST $100.00 CLIENT/OWNER TO PAY ALL RE -NOTIFICATION FEES (MINIMUM $25.00 EACH) AND TO BE RESPONSIBLE FOR. ALL FEES IF THE PROJECT IS CANCELLED. THIS PROPOSAL IS BASED ON PREVAILING WAGE DETERMINATION SC -102-882-1-2003-1, ISSUE DATE FEBRUARY 22, 2003 AT THE RATE OF $29.90 PER HOUR. BRICKLEY ENVIRONMENTAL WILL PROVIDE ALL OSHA REQUIRED PERSONAL AIR MONITORING AND HAVE SAMPLES ANALYZED BY AN INDEPENDENT AND CERTIFIED LABORATORY. AT THE COMPLETION OF THIS PROJECT,' OR AS REQUIRED, BRICKLEY ENVIRONMENTAL WILL PROVIDE, COMPLETE DOCUMENTATION i.e. • NOTIFICATION LETTERS, WASTE MANIFEST, 'CERTIFICATE OF INSURANCE, SUPERVISORS DAILY LOGS, ETC. ALL REGULATED WASTE GENERATED FROM THIS PROJECT WILL BE PROPERLY DISPOSED OF AT AN EPA, STATE OR LOCAL REGULATORY AGENCY APPROVED DISPOSAL FACILITY, UTILIZING THE APPROPRIATE WASTE DISPOSAL MANIFEST. OWNER TO PROVIDE WATER AND ELECTRIC AT JOB SITE. BRICKLEY ENVIRONMENTAL WILL PROVIDE NECESSARY CONNECTIONS. 957 Reece Street, San Bernardino, CA 92411, Lic. No. 610414 CAL/OSHA No. 49 Page 1 of 2 909-888-2010 800-530-3366 FAX 909-381-3433 �054/2004 09:27 7607777011. LA QUINTA PAGE 03 r 1101`'► RR I CKLEY ENU I RONMENTAL ERX N0. :909 381 3433 r1a i 9 d 2604 03:15PM P3 WORK $HALL BE PERFORMED IN ACCORDANCE WITHIN OSHA, EFA, AND STATE REGULATIONS, THE ABOVE WORK TO BE COMPLETED IN A SUBSTANTIAL AND WCF(KMANLIKE MANNER ACCORDING TO STANDARD PRACTICES FOR THE SUM OF: THREE THOUSAND NINE HUNDRED""•"" """**° ($3,900.00) A. TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED B. THIS PROPOSAL MAY BE WITHDRAWN RY BRICKLEY ENVIRONMENTAL IF NOT ACCEPTED WITHIN 30 DAYS, C. CONTRACTOR WILL MAINTAIN INSURANCE IN THE AMOUNT OF $1,000,0)0.00 OR AS REQUIRED BY SPECIFICATIONS. D. CONDITIONS: THE TERMS AND CONDITIONS AS kt@dK (ARE EXPRESSLY INCORPORATED INTO THIS CONTRACT. j BY. IAN G ON PROJECT MANAGER ! ESTIMATOR KEN ACCEPTANCE OF PROPOSAL THE ABOVE PRICES, SPECIFICATIONS, AND CONDITIONS ARE SATISFAC70RY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO 00 THE WORK SPECIFIED, PAYMENT WILL BE MADE AS OUTLINEaABOV CLIENT-z;4CITYOFLAQUINTA AUTHORIZED SIGNATURE� ` 1110895 ADDITIONAL TI~RMS & CONDITIONS OF CONTRACT TERMS: DUE UPON RECEIPT UNLESS OTHERWISE ARRANGED. INTERESr AT THE RATE OF 1%% PI=R MONTH WILL BE CHARGED ON ALL PAST DUE ACCOUNTS. IN THE EVENT OF KAILURI? TO PAY ANY OF THE AMOUNTS DUE ON THIS INVOICt, ALL COLLECTION COSTS, AND/OR ATTORNEY'S FEES IN "'HE COLLECTION OF ANY SUCH AMOUNT, WILL BE PAID BY THE CLIENT, UNLESS OTHERWISE STAYED IN THIS PROPOSAL, BRICKLEY ENVIRONMENTAL WILL PROVIDE. ONLY THE OSHA REQUIRED PERSONAL AIR MONITORING. THE OWNER SHALL PRCVIDE, AT THEIR COST, ALL ADDITIONAL TESTING AND ALL FINAL CLEARANCE TESTING OR RETESTING ON THIS F`ROJECT, THIS BID OFFER IS BASED ON REMOVAL OF CERTAIN TYPES AND QUANTITIES OF HAZARDOUS AND NOW HAZARDOUS MATERIALS AS LISTED IN THE PROPOSAL. IF ADDITIONAL OR CONCEALED HAZARDOUS MATERIALS ARE FOUND AND THE OWNER CHOOSES ABATEMENT, A CHANGE OR)ER WILL BE REQUIRED TO ALLOW THE ADDITIONAL COSTS AND TIME TO COMPLETE THE ADDITIONAL WORK. PLEASE BI= ADVISED THAT TI4E OWNER OF THE PROPERTY AND GENERATOR OF ANY HAZARDOUS MATERIALS MAY BE SUBJECT TO MANIFEST I EPA NUMBER FEES ISSUED BY THE DEPARTMENT OF TOXIC SUBSTANCES CONTROL (DTSC). ALL FEES ISSUED BY DTSC ARE THE RESPONSIBILITY Of THE OWNER I GENERATOR. FEES ARE BILLED DIRECTLY FROM DTSC AND ARE NOT INCLUDED IN THE CON TRACT AMOUNT, ALTHOUGH BRICKLEY ENVIRONMENTAL TAKES PRECAUTIONS TO AVOID DAMAGE TO FINISHED SURFACES, SOME DAMAGE MAY OCCUR. BRICKLEY ENVIRONMENTAL SHALL NOT BE RE iPONSIBLE FOR ANY SUCH REASONABLE COSMETIC DAMAGES NOR SHALL PAYMENTS TO BRICKLEY ENVIRONN ENTAL BE REDUCED OR WITHHELD A5 A F RESULT THEREOF. i.e. DAMAGES STEMMING FROM PLACEMENT OR REMOVAL OF POLYETHYLENE AND WOOD/DRYWALL BARRIERS AND FASTENING MATERIALS WHICH ARE REQUIRED TO HOLO BARRICADES IN PLACE DURING ABATEMENT. ALL REPAIRS OR REFINISHING WILL Be PERFORMED ONLY UNDER SEPARATE WRITTEN AGREEMENT OR CHANGE ORDER BETWEEN BRICKLEY ENVIRONMENTAI,AND OWNER. T14C OWNER, BY ACCEPTANCE .OF BRICKLEY ENVIRONMENTAL BID OFFER, HEREBY AGREES TO ABSOLVE BRICKLEY ENVIRONMENTAL OF ANY AND ALL RESPONSIBILITY F0:t ITEMS OR OBJECTS WIiICH MAY BE REPORTED DAMAGED, DESTROYED OR MISSING, UNLESS OWNER CAP PROVE SEYOND A REASONABLE DOUBT THAT AN EMPLOYEE OR SUB CONTRACTOR OF BRICKLEY ENVIRONMEN rAL IS THE RESPONSIBLE PARTY, CONTRACTORS ARE REQUIRED BY LAW TO SE LICENSED AND REG UILATED BY THE CONTRACTORS' STATE LICENSE BOARD, ANY QUESTIONS CONCERNING A CONTRACTOR MAY BE REFERRED TO THE REGISTRAR, CONTRACTORS' STATE LICENSE BOARD, P.O. BOX 28000, SACRAMENTO. CALIFORNIA 95826. P"oyofS me SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL w MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION # ni COMPLETED BY JASON COMPANY' BRICKLEY CONST. CO., INC. dba PHONE 909.888-2010 BRICKLEY ENVIRONMENTAL DATE 5.25.04 CHECK # 2647 FEE $ 57.69 PROJECT # 6847 NOTIFICATION TYPE ORIGINAL PROJECT TYPE EMERGENCY REMOVAL SITE INFORMATION SITE NAME SFR SITE ADDRESS 46480 JEFFERSON AVE. CROSS STREET FIESTA DR. CITY LA QUINTA . STATE CA ZIP 92201 COUNTY RIVERSIDE DESCRIBE WORK AND LOCATION ASB REMOVAL FROM CEILING & WALLS BUILDING SIZE (SQ FT) 1,300 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 30 NUMBER OF DWELLING UNITS 1 BLDG PRIOR 1 PRESENT USE HOUSE SITE OWNER CITY OF LA QUINTA REDEVELOPMENT ADDRESS P.O. BOX 1504 CITY LA QUINTA STATE CA ZIP 92253 CONTACT TOM HARTUNG PHONE 760.777-7013 REQUIRED BUILDING INFORMATION ASBESTOS YES PRESENT? ASBESTOS YES NO SURVEY?* ASBESTOS NO REMOVED? BUILDING TO BE NO DEMOLISHED? PROJECT DATES START 5-27.04 END 5-27-04 WORK SHIFT, 0800-1630 ASBESTOS AMOUNT TO BE REMOVED (in square feet) FRIABLE 1800 CLASS I CLASS II TOTAL AMOUNT (ADD ROW) 1800 ASBESTOS REMOVAL FROM SURFACES AMOUNT OF EACH TYPE OF ASBESTOS (in square feet) ACOUSTIC CEILING ` 1450 LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) DRYWALL 350 PLASTER TRANSITE ROOFING OTHER (DESCRIBE) CONTRACTOR INFORMATION CSLB LICENSE # 610414 OSHA REG # 49 AQMD ID # 76397 NAME BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL ADDRESS 957 WEST REECE STREET CITY SAN BERNARDINO STATE CA ZIP 92411 SITE SUPVR SNYDER 1 LIEDER 1 MOORE 1 GOMEZ PHONE 909-888.2010 LARGENTICRUZ IGORDON IBOYTIWOOD WASTE TRANSPORTER #1 BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL LANDFILL AZUSA LAND RECLAMATION CO. ADDRESS 957,WEST REECE STREET ADDRESS 201 GLADSTONE AVENUE CITY SAN BERNARDINO STATE CA FZIP92411 CITY AZUSA STATE CA ZIP 91702 Asbestos Demolition / Renovation Notification Form 080403 Page 1 of 2 ,# SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL ORIGINAL TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 900145641 WASTE TRANSPORTER #2 E. C. T. I. WASTE STORAGE SITE BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL ADDRESS P. 0. BOX 7318 b ADDRESS 957 WEST REECE STREET CITY SAN BERNARDINO STATE CA ZIP 92411 CITY SAN BERNARDINO STATE CA ZIP 92411 CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure &. 2,.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. 1,3 ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Inspection, PLM, Bulk Sampling, Survey, 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: TITLE DATE OF ORDER: DATE ORDERED TO BEGIN: FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZING 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: PLEASE SEE EMERGENCY LETTER 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. REVISED NOTIFICATION LETTERS WILL BE SENT IF / WHEN APPROPRIATE. REMOVAL WILL BE DONE WITHIN STATE, FEDERAL, CAUOSHA, and EPA RULES & REGULATIONS. 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 will be availabl fo inspection during normal business hours. BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 5-25.04 Company Name Print name of owner/operator Si ature of Operator Tittle of Operator Date INFORMATION CERTIFICATION: I certify that the above information is correct and I h e e closed any required attachments. BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL JASON BERGERON PROJECT ADMINISTRATOR 5.25.04 Company Name Print name of owner/operator Si ature of Operator Tittle of Operator Date Notifications cannot be accepted without the required fee (AQMD Rule 301). 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 $ 0.00 DEMOLITION OF LESS THAN 100 SQ FT $ 29.52 ASBESTOS REMOVAL AT owner- $ 29.52 occupied, single -unit dwelling ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition notification to Building and Safety before issuance of a demolition permit. For questions call 909-396-2336. For your convenience please mail the form and fee and do not hand carry to AQMD. MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 TELEPHONE: (909) 396-2336 FAX: (909) 396-3342 WEB SITE: HTTP:/NMW.AQMD.GOV Asbestos Demolition / Renovation Notification Form 080403 Page 2 of 2 05/21/2004 14:04 7607777011 L 1NTA PAGE 04 r.v. JD UX l:)u4k 78-495 CALLS TAMPICO LA QVINTA, CALIFORNIA 92253 May 21, 2004 (760) 777-7000 FAX (760) 777-7101 SOUTH COAST AIR QUALITY MANAGEMENT DIVISION 21865 East Copley Drive Diamond Bar, CA 91765-4185 'ATTN: Mr. Mohan Nagavedu BUILDING DEMOLITIONS — ASBESTOS ABATEMENT Project Address: 46-480, 46-055, 46-145 Jefferson and. 80-020 Vista. Grande La Quinta, CA . We are requesting that SCAQMD waive the usual 14 -day notification waiting. periodJor the project listed above. The subject buildings must be abated to makeroom for a road expansion. There is also concern for the unsafe condition of these buildings and the potential for unlawful trespassing and illegal activities on these sites. Please feel free'to contact me at (760) 7777019, if you have any questions or concerns. Thank you foryour attention to this matter, Sincerely, Tom Hartung Building & Safety Director w'ools CAL/OSHA ASBESTOS NOTIFICATION BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL 957 WEST REECE STREET SAN BERNARDINO, CA 92411 TEL: (909) 888-2010 FAX: (909) 381-3433 CAL/OSHA LICENSE NO. 610414 DEPT. OF INDUSTRIAL RELATIONS ASBESTOS CERT. A-6005 ADDRESS: SAN BERNARDINO DIST. OFFICE DOSH REGISTRATION #49 464 WEST 4TH ST., # 332 SAN BERNARDINO, CA 92401 DATE: 5-25-04 JOB # 6847 NAME / ADDRESS OF EMPLOYER: CITY OF LA QUINTA REDEVELOPMENT P.O. BOX 1504 LA QUINTA, CA. 92253 ADDRESS OF JOB SITE: SFR JOB LOCATION: THROUGHOUT 46480 JEFFERSON AVE. LA QUINTA, CA. 92201 NEAREST CROSS STREET: FIESTA DR. NAME OF CERTIFIED SUPERVISOR: WOOD NAME OF QUALIFIED PERSON IN CHARGE OF AIR MONITORING, LAB WORK AND RESPIRATORS: AS ABOVE AND GEM SERVICES OR CONTRACTED C.A.C. / I.H. 'JOB START DATE: 5-27-04 JOB COMPLETION DATE: 5-27-04 DESCRIBE SCOPE OF JOB AND WORK PRACTICES (Inc. sq. ft.): SCRAPE AND REMOVE WET 1N SECTIONS AND DISPOSE OF 1450 SQ. FT. OF ACOUSTIC CEILING, 350 SQ. FT. OF DRYWALL ESTIMATED NUMBER OF EMPLOYEES ON JOB: S+4 EVALUATION OF POTENTIAL FOR EXPOSURE: MINIMAL EXPOSURE - RESPIRATORS AND PROTECTIVE CLOTHING WORN THROUGHOUT PROJECT. TRANSPORTED BY: BRICKLEY CONST. CO., INC. dba BRICKLEY ENVIRONMENTAL U. S. E. P. A. # CAR 000053173 STATE HAULER #2599 AND/OR ECTI P.O. BOX 7318 SAN BERNARDINO, CA 92411 STATE HAULER # 3731 DUMP SITE: AZUSA LAND RECLAMATION CO. 1201 W. GLADSTONE STREET AZUSA, CA 91702 CAD009007626 CAL OSHA 042503 BRICKLEY ENVIRONMENTAL ' SUPERVISOR DAILY LOG SHEET 6 DATE: 5-7-7 SUPERVISOR NAME: / . Inz>4 JOB NUMBER JOB NAME: LA- _tJic- . lam JOB LOCATION: q6,ggb PRE JOB SAFETY MEETING NOTES & ATTENDANCE: SSR-l.•� S c:lmsoificelwi nwomVorms%sdls.ds ENTSTAR'>�':.U.:..G..K 1�5',::.::.::.:::::::::::::::::::::::::::::::::::::::::::::::::::::..:... ::......:::::::::.::.................. ...........................:...:....::..:::.::::.:::::::::::::.:::::::::.::::::::.::::..:...............................................' .....................................<....................................:....::.::::.:::::::::::.......::::::::::::::::.::::::::::::::::::::::::::. :...:.:....::::::... ::. 5:::::::NCX.::::.:_:.Ititk.:. 1. ENTRY/EXIT LOGS, DECONTAMINATION PROCEDURES, EMERGENCY PLAN POSTED. f 2. JOB/EMPLOYEE FILES, EMERGENCY KIT, FIRE EXTINGUISHER ON SITE. f 3. RESPIRATOR BOARD UP,.PROPER RESPIRATOR SELECTED/. USED..* ... 4. WARNING SIGNS / CRITICAL�BARRIERS POSTED. ` y 5. AIR MONITOR ON SITE•& READY. , , , ✓ ^ 6. WORK AREA PRE.CLEANED. , ,. , • _�' 7. POLLY CONTAINMENT ENCLOSUREINSTALLED. 8. DECONTAMINATION SYSTEM INSTALLED AND FUNCTIONING.. 9. WATER FILTRATION SYSTEM INSTALLED. ti y 10. NEGATIVE PRESSURE ESTABLISHED. !� :;:.;;:.:Xx ;:E :.: i ........Nf... 1. RESPIRATORS & SUITS WORN BY ALL PERSONNEL IN CONTAINMENT. 2. WET REMOVAL/ PROPERLY BAGGED ACM. 3. NO SMOKING, EATING, DRINKING IN CONTAINMENT. 4. HEPA VACUUM USED. 5. CONTAINMENT BARRIER WORKING PROPERLY. 6. NEGATIVE AIR PRESSURE OPERATIONAL. 7. PERSONAL UTILIZING DECONTAMINATION SYSTEM PROPERLY. c:lmsoificelwi nwomVorms%sdls.ds ......... . ............ ...... X ... ............ X: ....... ............. . .. ..... ..... xx X 'S.T x....: ..... . . ... X...... ..... ........ ...... /A .. .............. ACM DEFINED IN SCOPE OF WORK REMOVED 1. ALL ACM WASTE PROPERLY PACKAGED, LABELED & MANIFESTED. 2. INSPECTION FOR RESIDUAL DEBRIS: A. HORIZONTAL SURFACES - I.E. - FLOORS, PIPES, VENTILATION DUCTING, ETC. B. VERTICAL SURFACES - I.E. - WALL, REGISTERS, WINDOWS, LIGHTS, ETC;. - 3. WORK AREA ACHIEVE VISUAL CLEARANCE. 4. ENCAPSULATION OF WORK SURFACES. 5. CLEARANCE AIR SAMPLES COLLECTED. ARRIVAL TIME: o--)Iz> DEPARTURE TIME: ... ... OPE QF:::W.......... ............ ....... .... :X: .... ....... ...... ... . ......... . . ....... . .td.... 4— nil -t SUPEPMS-OR'S SIGNATURE c:\msofficelvAnword\formslsdis.ds ,r7 Of e0 State of California—Environmental Protection Agency Form Approved OMB No. 205070039 (Expires 9-30.99) See Instructions on back OF page 6. Department of Toxic Substances Control Please`print or type. Form designed for use on elite (12 -pitch( typewriter. Sacramento, California v ` DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) UNIFORM HAZARDOUSEl..enerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal law. g WASTE MANIFEST of 1A IDIQ 0 10 15 11181 0 1 6 1 R 4 17 3. Generator's Name and Mailing Address A. State Manifest Document Number CITY OF LA QUINTA REDEVELOPMENT 23535719 P.O. BOX 1504 B. State Generator's ID LA QUINTA, CA 92253 _ A. Generator's. Phone ( 760) 777-7013 5. Transporter 1 Company Nome 6. US EPA ID Number C. State Transporter's ID [Reserved.] 'BRICKLEY•'ENVIRONMENTAL — ` C A' R 0 '0 '0 11 5 3 `1'-% '3 D. Transporter's Phone {909)-888-2410 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID [Reserved.) E C T I CAR 0 0 0 0 9 9 0. 6 4 F. Transporter's Phone 9 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID V C)II AZUSA LAND REC TON le H. Facility's Phone 1211 W. GLADSTDNE U AZUSA CA, 91'702 ICIAIDIO10191010171161216 (6`26) 334--0719 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit Wt/Vol I. Waste Number No. Type --R. Q. ASBESTOS, 9, N.A2212, PG III (ERG#1 ) State _ 151✓ EPA/Other' G' /� 4 d Q 1. Y E b. t. ` State r E R EPA/Other; T C � Statee R EPA/Other d. State ' EPA/Other i J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above — $:""C`OITTALNI ISG—�ONSTRUCTIO �T�IATRIAI;S ___, _ . -; _ . _ _ a.'-03- e, Hj _ C. d. 15. Special COInstructions a EMERGENCY Handling NTACT and PHONEInformationo800) 535—•5053 EPA REGION IX (415) 7447-11089 75 HAWTHORNE•ST., SAN FRANCISCO, CA 94105 SCAQMD (909) 396-2336 21865 E. COPLEY DR., DIAMOND BAR, CA 91765 16. GENERATOR'S" CERTIFICATION: I hereby declare that the contents of this consignment are fully and occurately described above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I con afford. Printed/Typed NameSignature(rj t�,t„r-� 1�--- Month Day Year To;,- -I M o zr�--4 T 17. Trans orter I Acknowledgement of Receipt of Materials R A Printed/Typed Name Signature Month Day Year S"I �j -S 1:21-7 1 c) I7 0 18. TransK i1V2 Acknowledgement of Receipt of Materials R Printed/Typed Name Signature Month/ Day Year os L/ v r! B R. d2 oQ O 8 4d R 19. Discrepancy lndication Space F A C L 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as notedii Item 19. T Signature Year ('Printed/T�yped`Nome +�j I /-Month \Day v ` DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)