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12-0246 (DSF)P.O. AX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:12-0000.024.6 Property Address: 51556 AVENIDA HE] APN: 773-133-003-22 Application description: I DEMO - COMML/OTH Property Zoning: COVE RESIDENTIAL/ Application valuation: 0 ii Applicant: T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 000000-141 I% IeA hitect or,Engi .ee� ,- a�P, -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provi ' ns of Chapter 9 ommencing with Section 70001 of ivision 3 of the Bu ' ss and Profession s Co 4..9 cense is full force and effect. Licease Class: ice454 Date: traaor. OWNER -B DER DECLARATION, I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).: 1 _ 1 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 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 sate.). (_) 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.). ( ) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: 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: LQPERMIT Owner: ZUNIGA D HUGO ARTURO 51556 AVENIDA HERRERA LA QUINTA, CA 92253 Contractor: RFM GENERAL CONSTRUCTION 1327 MCDONALD AVENUE WILMINGTON, CA 90744 (310)629-1645 Lic. No.: 692454 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/19/12 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION 1. hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EEMPT Policy Number EXEMPT 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 w kers' compepsation laws of California, and agree that, if 14ould become subi to ttj)�j vor ' compensa¢'on provisions of Section 0700 of the Labo, ode, I shall forthW, co 1 those Drov ns. WARNING: FAILME TO SECURE WORKERS' COMPENVATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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. 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. I . 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 hold harmless the City of La Quinta, 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 correc I re o comply ith all city and county ordinances and state laws relating to buil ' construction, and hereb ( o represe tives �oe: his un[y t ,enter upon the ove-mentioned grope y or inspection purpo es. re (Applicant or Agent): C LQPERMIT Application Number . . . . . 12-00000246. Permit. . DEMO PERMIT Additional desc . Permit Fee 45.00 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 0 Expiration Date 9/15/12 Qty Unit Charge Per Extension BASE FEE 45.00 ------------------------------------------------------- Notes and Comments --------------------- .Special DEMO REAR CASITA -650 S.F. (UNPERMITTED), DEMO CARPORTS AT FRONT (UNPERMITTED), ENTIRE STRUCTURE @ NORTH & HALF (SOUTH). TO RESOLVE CODE CASE # 11-1335, (MR) 2010 CODES. 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 Bin.# City Of .a.A �utn a Buikring 8L. Safety Division . . P.O. Box 1504, *76-49S Calle 'Tampico,. la.Quinta, CA 92253 - (760) 777-7012 U Building Permit Application• and Tracking Sheet Permit # Project Address:. 5 �� Owner's Name:. l A. P. Number: Address: . e e_-4 V P"(' Legal Description:. S Con -4- - City, ST, Zip: C 2-2-632LQ Contractor.` Telephone: ,.;,• .�Y .,::�~ ; Address: AA LIP iatI Project Description: Ci ST, Zi :/4 L70%40 Telephone: D 6 a ��. P State Lie. # : City Lie. #; N Tn �' (A -l; 10* STrhbWWdm* OALA: Sk.1 ". Arch., Engr., Designer. C..11N` (466: it • I?35 N' IL Address: City., ST, Zip: Telephone: �. P State Lie. #: - ' - Name of Contact Person: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. FL: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: ® C14- �6 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACEING PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit. . Truss C21cs. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2`! Review, ready for correctionsrissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review; ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A:LP.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees r CERTIFiCATE of COMPLETION.. st ...... ........ .....—. 61668AVEN�A ... _ . SA CNINTA, CA 92M3 #MOVE A86E fLAOR TLE. VjNn, AN[)CERA# IC TILE FROM FiA�.. 2 KiTtW NS- 2 UV WG ROC" 3 BATHROOW AND 8 mss• Dow .bb Numbs: l� p, W. s CJ, . IFnwnoA CA . a�s.��o-rrss PATRIOT � rJvu�i iiarw� NINI PROJECT NAME: ZV ►1� vi ck- FIELD SERVICES COC RQUESTED LAB .TAT PROJECT CITY: Z111 ADDRESS: fferiprat �a- OW Y)4 --c7 PROJECT S . I — Sample Location Material Type -jj�Condition !7-- WWQAWM�O§971�� S NNW. h- AN? AIA WINWEEIIIIIIIN SRI - 0 W, MIN ONIMIN �In MINION IR d'IOMENS Samples relinquished by: Date/Time: 1 O J 0 g' Samples received by: Date/Time: 7271 Garden Grove Blvd. Suite A, Garden Grove, CA 92841 Tel: 888/743-0998 Tel: 714/899/8900 Fax: 714/899-7098 • PATRIOT FIELD SERVICES COC r rrvu<<irJ M:lJ I,I - PROJECT PROJECT NAME: ADDRESS: PROJECT (� NUMBER: %, Z;vl _ ----- a (o4i G RQUESTED LAB TAT CITY: Z1P P5 Samples relinquished by: Samples received by: Date/Time: l Ag �a Date/Time: 7271 Garden Grove Blvd. Suite A, Garden Grove, 'CA 92841 Tel: 888/743-0998 Tel: 714/899/8900 Fax: 714/899-7098 H Sample Location Material Type s ILA mom= oil �,F■ =�A INE �,l Samples relinquished by: Samples received by: Date/Time: l Ag �a Date/Time: 7271 Garden Grove Blvd. Suite A, Garden Grove, 'CA 92841 Tel: 888/743-0998 Tel: 714/899/8900 Fax: 714/899-7098 H P.W. STEPHENS, INC. ASBESTOS- LLAD• \101.1) IiEME'DIATION IWSIDE.NTI,1 J.I COAMERCIAL INVOICE #: 15201 I'ipulinc Lam:. Suiia B y ' Iduntingum Beach. CA 42649 (.714) 892-20''S .Imstephensim:.c:nm JOB #: ' Fcd'ras I.I). 122-:462-501.4 a .• JOB NAME: Hernandez/zuniga SALESMAN: 51556 Avenida Herrera La Quinta', Ca 92253 CUSTOMER: McClarens Young Insurance Cc 100 W. Broadway Ste 750 Glendale, Ca 91210 CLAIM #: 0106656333 JOB SCOPE: INVOICE DATE: 8/18/08 44-61251 .44-53622 GS TYPE: A ORIGINAL CONTRACT AMOUNT 2-, 650 . 00 TOTAL: 2,650.00 Interest at the rate of 1 1/2% per month will be charged on all past due accounts. In the event of failure to pay any of the amount due on this invoice, all collection cost and/or attorney's fees in the collection of any such amount will be paid by the customer. P.W. STEPHENS, INC: JOB'NAME: INVOICE # 44-61251 JOB # 44-53622 . DATE 8/18/08 TOTAL $ 2,650.00 BALANCE DUE $ 2,650.00 PLEASE PAY THIS AMOUNT: F $ 2,650.00 PAYMENT OPTIONS VISA CARD # M/C NAME AS SHOWN ON CREDIT CARD AUTHORIZED SIGNATU EXP DATE DETACH AND RETURN THIS STUB WITH YOUR REMITTANCE MAIL PAYMENT TO: P.W. STEPHENS, INC. 15201 PIPELINE LANE, SUITE B HUNTINGTON BEACH, CA 92649 PATRIOT ENVIRONMENTAL LABORATORY SERVICES, INC. Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 16416 Attn: Patsy Project Number: 2598 4076 Alai -no St. Project Name: Zuni Riverside, CA 92501 Project Location: 5 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (%) 316416-001 Exterior Wall NE Stucco Grey 85% Minerals 1 13% Carbonate 2% Paint Total Asbestos None Detected 316416-002 Exterior Wall NW Stucco Grey 85% Minerals 2 13% Carbonate 2% Paint Total Asbestos None Detected 316416-003 Exterior Wall S Stucco Grey 85% Minerals 3 13% Carbonate 2% Paint Total Asbestos None Detected 316416-004 Wall Cavity At Rear Vapor Barrier Paper Brown 95% Cellulose 4 Bedroom 5% Tar Total Asbestos None Detected 316416-005 Wall Cavity At Rear Vapor Barrier Paper Brown 95% Cellulose 5 Bathroom 5% Tar Total Asbestos None Detected Page I of 10 7271 Garden.C6rbve Blvd., Suite A • Garden Grove, CA 92841 • Tel:, 714/899-8900 Fax: 714/899-7098 www.patriotlab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076.Alamo St. Project Name: Zuniga Riverside, CA 92501 " - Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (%) 316416-006 Wall Cavity At Living Room Vapor Barrier Paper Brown 95% Cellulose 6 5% Tar Total Asbestos None Detected 316416-007 Roof 1st Layer N Rolled Roofing Black 65% Tar 7 15% Glass Fibers 20% Minerals Total Asbestos None Detected 316416-008 Roof 1st Layer S Rolled Roofing Black 65% Tar g 15% Glass Fibers 20% Minerals Total Asbestos None Detected 316416-009 Roof 1st Layer E Rolled Roofing Black 60% Tar 9 12% Glass Fibers 16% Minerals 12% Cellulose Total Asbestos None Detected Page 2 of 10 7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: 7'14/899-8900 • Fax: 714/899-7098 www.patrijotlab.com G Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076 Alamo St. Riverside, CA 92501 Project Name: Zuniga Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (%) 316416-010 Roof 2nd Layer N Roof Shingle Black White 60% Tar 10 15% Cellulose 20% Minerals 3% Carbonate 2% Paint Total Asbestos None Detected 316416-011 Roof 2nd Layer S Roof Shingle Black White 60% Tar 11 15% Cellulose 20% Minerals 3% Carbonate 2% Paint Total Asbestos None Detected 31.6416-012 Roof 2nd Layer E Roof Shingle Black White 60% Tar 12 15% Cellulose 20% Minerals 3% Carbonate 2% Paint Total Asbestos None Detected 316416-013 Penetration At Roof N Penetration Mastic Black 85% Tar 13 15% Cellulose Total Asbestos None Detected Page 3 of i0 7271 Garden Grove Blvd., Suite A • Garden Grove, CA.92841 • Tel: 714/899-8900 • Fax: 714/899-7098 www.patriotlab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076 Alamo St. Project.Name: Zuniga Riverside, CA 92501 Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (%) 316416-014 Penetration At Roof S Penetration Mastic Black 85% Tar 14 15% Cellulose Total Asbestos - None Detected 316416-015 Penetration At Roof E Penetration Mastic Black 85% Tar 15 15% Cellulose Total Asbestos None Detected 316416-016 Living Room Wall NE Drywall and Joint White 80% Sulfate 16 Compound 12% Carbonate 6% Cellulose 2% Paint Total Asbestos None Detected 316416-017 Kitchen Wall SE -Drywall and Joint White 80% Sulfate 17 Compound 12% Carbonate 6% Cellulose 2% Paint Total Asbestos None Detected 316416-018 Rear Bedroom Wall SW Drywall and Joint White 80% Sulfate 18 Compound .12% Carbonate 6% Cellulose 2% Paint "r Total Asbestos None Detected Page 4 of 10 7271 Garden. - Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: 7 14/899-8900 • Fax: 714/899-7098 www.patriotlab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076 Alamo St. Riverside, CA 92501 Project Name: Zuniga Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ED/Layer Location Material Description Color Composition (%) 316416-019 Living Room"Ceiling Center 1x1 Ceiling Tile Brown Beige 96% Cellulose 19 4% Carbonate Total Asbestos None Detected 316416-020 Kitchen Ceiling Center 1x1 Ceiling Tile Brown 100% Cellulose 20 . Total Asbestos None Detected 316416-021 Bedroom Ceiling Center 1x1 Ceiling Tile Brown Beige 97% Cellulose 21 3% Paint Total Asbestos None Detected 316416-022 At Roof 3rd Layer N Felt . Brown 75% Cellulose 22 25% Tar Total Asbestos None Detected 316416-023 At Roof 3rd Layer S. Felt Brown 75% Cellulose 23 25% Tar Total Asbestos None Detected 316416-024 At Roof 3rd Layer E Felt Brown 75% Cellulose 24 25% Tar Total Asbestos None Detected Page 5 of 10 7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: 714/899-8900 Fax: 714/899-7098 www.patriotlab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076 Alamo St. Project Name: Zuniga Riverside, CA 92501 Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date.Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (%) 316416-025A Rear Bedroom N Floor 12x12 Vinyl Floor Beige 75% Carbonate 25 Under Carpet Tile 25% Vinyl Binder Total Asbestos None Detected 316416-025B Rear Bedroom N Floor Floor Tile Brown 75% Carbonate 25 Under Carpet 20% Vinyl Binder Cluysotile 5 % Total Asbestos 5 % 316416-026A Rear Bedroom S Floor 12x12 Vinyl Floor Beige 75% Carbonate 26 Under Carpet- Tile 25% Vinyl Binder Total Asbestos None Detected 316416-026B Rear Bedroom S Floor Floor Tile Brown. 75% Carbonate 26 Under Carpet 20% Vinyl Binder Cluysotile 5 % Total Asbestos 5 % Page 6 of 10 7271 Garden Grove Blvd., Suite A Garden Grove, CA 92841 • Tel: 714/899-8900 • fax: 714/899-7098 www.patriotiab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 -Attn: Patsy. Project Number: 25982 4076 Alamo St. Project Name: Zuniga Riverside, CA 92501 Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (°/q) 316416-027A Bedroom Center 12x12 Vinyl Floor Beige 75% Carbonate 27 Tile 25% Vinyl Binder Total Asbestos None Detected 316416-027B Bedroom Center Floor Tile Brown 75% Carbonate 27 20% Vinyl Binder . Chrysotile .. 5 % Total Asbestos 5 % 316416-028 Living Room Floor Under 12x12 Vinyl Floor Beige 70% Carbonate 28 Carpet N Tile 23% Vinyl Binder . Chrysotile 7 % Total Asbestos 7 % 316416-029 Living Room Floor Under 12x12 Vinyl Floor Beige 70% Carbonate 29 Carpet Center Tile 23% Vinyl Binder Chrysotile 7 % Total Asbestos 7 % Page 7 of 10 7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • _Tel: 714/899-8900 Fax: 714/899-7098 www.patriotiab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076 Alamo St. Project Name: Zuniga Riverside, CA 92501 Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ED/Layer Location Material Description Color Composition 316416-030 Living Room Floor Under 12x12 Vinyl Floor Beige 70% Carbonate 30 Carpet S Tile 23% Vinyl Binder Chrysotile 7 % Total Asbestos 7 % 316416-031 2nd Layer Floor At Living 12x12 Vinyl Floor Brown 75% Carbonate 31 Room Tile 20% Vinyl Binder Chrysotile 5 % Total Asbestos 5 % 316416-032 2nd Layer Floor At Living Mastic Black 100% Tar 32 Room Total Asbestos None Detected 316416-033 2nd Layer Floor At Bedroom 12x12 Vinyl Floor Brown 75% Carbonate 33 Tile 20% Vinyl Binder Chrysotile 5 % Total Asbestos 5 % 316416-034 2nd Layer Floor At Bedroom Mastic Black 100% Tar 34 Total Asbestos None Detected Page 8of10 7271 Garden Grove Blvd., Suite A Garden Grove, CA 92841 • Tel: 714/899-8900 • Fax: 714/899-7098 www.patriotiab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Report Number: 316416 Attn: Patsy Project Number: 25982 4076 Alamo St. Project Name: Zuniga Riverside, CA 92501 Project Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: • NA Date Received: 1/28/2008 Number of Samples: 42 Date Analyzed: 1/29/2008 PO Number: NA Date Reported: 1/29/2008 Lab/Client ID/Layer Location Material Description Color Composition (%) 316416-035 2nd Layer at Rear Bedroom 12x12 Vinyl Floor Brown 75% Carbonate 35 Tile 20% Vinyl Binder Chrysotile 5 % Total Asbestos 5 % 316416-036 2nd Layer at Rear Bedroom Mastic Black 100% Tar . 36 . Total Asbestos - None Detected 316416-037 Attic Space At Living Room Blown In Insulation Beige 100% Glass 37 Fibers . Total Asbestos None Detected 316416-038 Attic Space At Hallway Blown In Insulation Beige 100% Glass 38 Fibers Total Asbestos None Detected 316416-039 Attic Space At Rear Blown In Insulation Beige 100% Glass 39 Bedroom Fibers Total Asbestos None Detected Page 9 of 10 7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: 714/899-8900 • Fax: 714/899-7098 www.patriotiab.com Polarized Light Microscopy Analysis Frontier Construction & Interiors Attn: Patsy 4076 Alamo St. Riverside, CA 92501 Date Received: Date Analyzed: Date Reported: Lab/Client 1/28/2008 1/29/2008 1/29/2008 Location Material Report Number: 316416 Project Number: _ 25982 Project Name: Zuniga Project. Location: 51556 Avenida Herrera La Quinta, CA 92253 Claim Number: NA Number of Samples: 42 PO Number: NA Color 77 Ian Reyes c Cristina E. Tabatt Analyst Approved Signatory Bulk samples analyzed per 40 CFR 763, Subpart F, Appendix A; EPA -600/R-93/116 and for friable materials, EPA -600/M4-82-020. Samples are analyzed by calibrated visual estimation; therefore, results may not -be reliable for samples of low concentration levels. This report applies only to the items tested. The results are representative of the samples submitted and may not represent the entire material from which samples were collected. This report was issued by a NIST/NVLAP (Lab Code 200358-0) accredited laboratory and may not be reproduced without the expressed written consent of Patriot Environmental. This report must not be used to claim product certification, approval or endorsement by NIST, NVL A.P or any agency of the federal government. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite. Samples such as floor tiles and ceiling tiles with mastic layers are analyzed and reported separately. Page 10 of 10 7271 Garden Grove Blvd., Suite A • Garden Grove, CA 92841 • Tel: 714/899-8900 • Fax: 714/899-7098 www.pitridti.ab.com CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California CML CODE § 1189 County of v �/ On I �Ibefore me, Pill/lot' nvuo-) (� Date /�j Xav Here Insert Nam and itllnof the Oifcer personally appeared W O t t Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by rA CHLOE OARCIA his/her/their signature(s) on the instrument the Commission #E 1954694 person(s), or the entity upon behalf of which the .-a� .. Notary Public - California person(s) acted, executed the instrument. Los Angeles County MY Comm. Expires Oct 2, 2015+ I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and cwect. Signature: Place Notary Seal Above Si atur�roA�ory Public— ` 1 OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached DocumenNtpoll,bmfi,on-, Title or Type of Document:, �rw--- Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer.— Title(s):_ ❑ Individual ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is of thumb here of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Individual ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is © 2010 National Notary Association • NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) of thumb here Item #5907 )b 3/14/2012 To whom it may concern: I, Mr. Carlos Zuniga. hereby give authorization to Mr. Rosendo Miramontes to submit application, plans, permits and to performed the demolition of the back house and front porch of my property address located in the City of La Quinta, at 51556 Avenida Herrera St La Quinta, CA 92247. Carlos uniga Carlos Zuniga 1215 W. 23' St. San Pedro, CA 90731 310 832-4661 k ( 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 AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION # f COMPLETED BYCnf \ !COMPANYPHON�)JC)) b5 0 -Z1` 11 DATE-�- CHECK # FEE $-t�G� PROJECT # --- NOTIFICATION TYPE 0 L REVISION ATE REVISION OTHER (highlight) CANCELLATION PROJECT TYPE DEMOLITION `QRDERED RENOVATION EMERGENCY PLANNED RENO Procedure 4 Plan Procedure 5 Plan DEMOLITION (removal) REMOVAL (annual) SITE INFORMATION SITE NAMEV SITE ADDRESS CROSS STREET v� CfTY `,f a 1 I STATE ZI 2 2. S' COUNTY ' (` DESCRIBE WORK AND LOCATION ; Imo BUILDING SIZE (SO FT) 3e% G NUMBER OF FLOORS BUILDING AGE (YEARS) NUMBER OF DWELLING UNITS BLDG PRIOR 1 PRESENT USE COMMERCIAL HOSPITAL INDUSTRIAL Other OFFICE PUBLIC BLDG. HOUSE SCHOOL SHIP UNNICOLLEGE SITE OWNER C'G1/ 1 S _t ,1. (1` I ADDRESS'S C� (E)V. CITYVAC� U\M STAT511C ZIh92293 CONTACT PHONE REQUIRED BUILDING ASBEdOS YES NO 'ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRES SURVEY? REMOVED? DEMOLISHED? ,IT? PROJECT DATES START,_/ —12 END°.. --' WORK SHIF((day, swing, night) I t *ASBESTOS AMOUNT TO BE REMOVk I - FRIABLE CLASS I CLASS II TOTAL AMOUNT (add row) (in square feet) *ASBESTOS REMOVAL FROM SURFACES PIPES COMPONENTS *AMOUNT OF EACH TYPE OF ASBESVS ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO t MASTIC (in square feet) �( FLOOR TILES (VAT) DRY WALL I IT I STER TRANSITE ROOFING OTHER (describe) CONTRACTOR INFORMATION CSLB LICENSE # OSHA REG # ^- AQMD ID # NAME C(� to t A.�`i.# ADDRESSC�� c v\ �JSTATE�+ b CITY ZIP q22� 3 SITE SUPVR PHON WASTE TRANSPORTER #1 S � _ �-� �v LANDFILL ADDRESS ' ADDRESS la 4 . �� - CITY I STATE ZIP CITY �? STATE ZIP " Not required for demolition notifcatpns ' asbestos surveys are required prior to Demolition and Renovation. Forms, instructions, and the Rule 1493 can be obtained from AQMD web site http:lhvww.agmd.gov Page 1 of 2 J II U.S.-POStA Service,. Ln :(Domestic m ,Provided) � Ln cr, u7 Postage $ --, Certified Fee O O Return Receipt Fee (Endorsement Required) r Postrnark�.„ ST• ; .; Here , O Restricted Delivery Fee, .: (EndorsementFlAulred) 9 ", • . , "7 �•� Ln Total Postage & Fees $ $5.75:. rl rl Sent To � — -- city,state-,'Z--IR--lo PS Form :rr August 2006 ...�..y.�.-'_� ........ �7-- ..._ i SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 0++074.5641 WASTE TRANSPORTER #2 " WASTE STORAGE SITE ADDRESS \J ADDRESS CITY STATE ZIP CITY STAT ZIP ` CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITIO!SITE. PtooedUre # 1, 2, 3, 4, 5 or Other. For asbestos removals circle the combination of Rule 1403 proceduFes used. Procedure 4 and 5 submit plans for AQMD pri !fpproval (See procedure 4/5 guidelines) ASBESTOS DETECTION PROCEDURE: Circle the procedures and analytical methods used to determine the presence of a in the building. Survey, Bulk Sampling, Inspection, PLM, PCM, TEM, Assumed as Asbestos-PACM, Describe Other (See survey guidelines checklist): FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: i FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE # R AUTHORIZING PERSON: TITLE DATE OF ORDER: DATE ORDERED TO BEGIN: ' FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZ G THE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT (Disturbed /damaged asbestos requires a procedure 5 plan apx oval prior to clean-up): EXPLAIN W H THE EVENT WOULD CAUSE UNSAFE CONDITIONS EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDE' 0 i, CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION ��SBESTOS MATERIAL BECOME DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. (Disturbed /damaged asbestos requires a procedure Sptan aroval prior to clean-up): K on ci co `TRAINING CERTIFICATION: I certify that an individual trained in the provisions of regulation AQMD Rule 1403 and NESFWU will be on site during the removal and evidence that the required training has been accomplished by this person will be available for inspection during normal busin " hours. Company Name Print name of owner/operator Signature of owner/operator Tittle of Tr/operator Date INFORMATION CERTIFICATION: I certify that them above infor I have enclosed any required aftachmen �isand CC1Y10S Z�I�q� 3--•z.- 2fl l 2 r r Company Name Print name of owner/ rator7'77or Tittle of r/operator Date II Notifications can not be accepted without the required fee (Rule 3}j). Asbest removals of less than 100 square feet a .'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: PROJECT SIZE in square feet DE N OR REMOVAL fDITIONAL SERVICE CHARGES 1,000 or less --- $ 53.899 <C7Ei pecial Handling Fee — $ 53.89 1,001 to 5,000 --- $ -- R` vision to Notification- - $ 53.89 5,001 to 10,000 --- $ 385,65 E med Check Fee — - $ 25.00 10,001 to 50,000 - $ 604.731 nned Renovation — - $ 604.73 50,001 to 100,000 --- $ 876.40 xedure 4 or 5 Plan--$ 604.73 100,001 or more -- $1,460.66 pedited 4 or 5 Plan ...... $ 302.36 ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition notification t uilding and Safety before issuance of a demolition permit. For questions call 909-396-2336. Please mail the form and fee to AQMD. Mailing saves time, money an reduces traffic and air pollution MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641Pg 2 of 2 FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP://W V, 1vH1.GOV SCAQMD is located at 21865 Copley Drive, Diamond Bar, CA 91765-4182 PHONE: (909) 396.2336 F (909) 3 d';3342 , REV20110615