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09-0935 (DSF)$07t 1504 78495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000935 Property Address: 46,130 DUNE PALMS RD APN: 649-040-002- -000000- Application description: DEMO - SINGLE FAMILY Property Zoning: MEDIUM DENSITY RES Application valuation: 0 Applicant: Architect or Engineer: PIP C 15 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I fierebyaffirm under penaltyof'perjury that I a licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business end rofessional nd my License is in full force and effect. Licens ass: C21 nse N :: - 600283 Dec mracta: / WNER-BUILDER DECLARATI I. hereby affirm under penahyofperjury 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 countythat'requires a pemiitto constrict, 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 Sectlon 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 violationof'Se8on 1031.5 by any applicant for a permit subjects the applicant+to a civil penalty of not.more than five.hundred dollars (8500).: (_ 1 I, as owner of the property, or my employees with wages es their'sole compensation, will do the work, and the structure is not intended or offered for sale fSec. 7044, Business'and Professions Code:: The Contractors' State License Lew, 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 sale.). (_ 1 i, as ownerof,the property, am exclusively contracting with licensed contractors to constructahe project(See. 7044, Business and Professions Code: The -Contractors' State license Law does. not apply to an owner of property who builds or improves thereon, andlwho contracts for the projects with a�contractor(sj 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: kir LQPERMIT Owner' LA QUINTA REDEVELOPMENT 7849.5 CALLE TA1PICO / LA QUINTA, CA 92253 Contractor: EMERY LANDCLEARING/.GRADNG P.O. BOX 1009 THERMAL, CA 92274 (760)3'91-5840 Lie. No.: 600283 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 M \ Date: 9,/02/09. INC r ------------------- WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate at consent to self-insure.forworkers' 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 ere: Carrier GRANITE STATS Policy Number WC005144691 _ I certify that, in performan of'.thak,,ich permit is issued, I shall not employ any person manymanner so as becoorkers' compensation laws of California; and agree that; tt I should mea' compensation provisions of Section 3FTO bor Co e; I all forhose provisions. /bate: _ WARNING: FAILRE WORKERS' COMPENSATION COVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES TO ONE HUNDRED' THOUSAND DOLLARS ($100,000). IN ADDITION TO THEZOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE:LABORCODE,.INTEREST, AND ATTORNEY'S' FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of. Building and Safety fora permit subject to the conditions and restrictlons sat forth on this application. f. 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,agraes to, and shell defend, Indemnify and hold harmless the City of La Quints, its officers, agents and employees for'any act or omission related to the work being ' performed.under or following'imence of this permit. 2. Any permitIssued 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 abov Information is toff I'agrse to.complywith all city and county ordinances end state laws relating to building truation, and h eby thorlie,representatives of this county to./e)n/tte�r upon tlxf bovo-rriardtoned`property"for. i peCtion pu �� `� SI re (Applicant or Agent): Application Number . . ... . 09-00000935 PermitDEMO PERMIT Additional*desc . . Permit Fee . . . . 45.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 0 Expiration Date 3/01./10 Qty Unit Charge Per Extension BASE FEB 45..00 -------- --------------------- Notes and Comments DEMO TO BARE GROUND 1 SINGLE FAMILY DWELLING & ANY SEPTIC SYSTEMS Fee summary Charged Paid Credited Due Permit Fee Total 45.00 .0:0 .00 45.0.0 Plan Check Total .00 .00 .00 .00 Grand Total 45.00 .00 .00 45.00 LQPERMIT OW To -IrrSJE qI4� City of La Quanta Btdfding & Safety Duron Permit.# .� P.O. Box 1504, 78-495 ca11e Tampico �l fi�n/I Qufi - 9225' - (760) 777-7012 Bu►tan Application and Tracking Sheet 'Project Address:.– D _440Pi') - � , 5 : Uwnec's Name: � Q L401 �/I 1 110- A. P. Number:Add"; Legal Description: City, ST, Zip: Contractormo �d `tiCephone: Aaaress:. 6O�Projeof Description: �� City,:� ST, Zip: �f..t q 9-ae) 4 xr let Telephone: 8 t, i0 State Lic. #: 6 Q 4City Lic. tR [ Arch.,.Engr., Designer: Address: City,, ST, Zip: Telephone Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair o Name of Contact Person: UCL Sq. FL: # Stories: # Units. Telephone # of Contact Person: Estimated ValuaofProjecx: -a 0 0. 2_!� C-1, APPLICANT: DO NOT WRITE: BELOW THIS LINE # Submittal Req'd Recd TRACING PERMIT FEES Plan Seb . Pian Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Calca. Called. ContactPerson Plan Cheek Balance Title 24 Calcs Plana picked up Coustruetion j Flood plain plan Plana resubmitted Mechanical Grading plan 2'! Review, ready for correctioaOuve Electrical Subcontattor List Called Contact Person Pla Grant Deed Plata picke&up, I, ILOA. Approval Plans resubmitted Grading INHOUSE:- 3" Review,.ready for correctionallnue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date: of permit bone School Fees Total Permit.Fees OW To -IrrSJE qI4� RECORDING REQUESTED BY AND WHEN RECORDED RETURN TO: LA QUINTA REDEVELOPMENT AGENCY 78 495 Calle Tampico La Quinta, CA 92253 Attn: Executive Director DOC # 20.09 OW 807 06/12/2009 08:WA Fee:NC Page i of 5 Recorded in Official Records County of Riverside Larry U. Nard Assessor. County Clerk & Recorder I I{II{ IIAI{l {i1 {NII {lHN �{ ll{{ S R U PAPE SIZE DA MISC LONG RFD COPY 4 A L 485 426 PCORE-OJ—MF CHG EXAM Ta C 'UN I (Exempt from Recordation Fee per Gov. Code § 6103) GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Susan E. Slater, a married woman, as her sole and separate property and not :as community property, hereby grants to the LA QUINTA REDEVELOPMENT AGENCY, a public body corporate and politic, that certain real property located in the City of La Quinta, County of Riverside, State of California, legally described on Attachment No. 1, which is attached hereto, and incorporated herein by -this reference, subject to al of record. Dated Y 92009 USAN E. SLATER, a married woman, as her sole and separate property and not as community property 206MISHOM47 1005143.02AN109 N CERTIFICATE OF ACCEPTANCE THIS IS TO CERTIFY that the interest in real property conveyed by a Grant Deed dated Su ne oZO09 , from Susan E, Slater, a married woman, as her sole and separate property, to the La Quinta Redevelopment Agency, a public body corporate and politic ("Agency'), is hereby accepted by the Agency by the signature of the undersigned, agent on behalf of the Agency pursuant to the authority conferred upon him by Resolutionof the Agency, adopted on AL 2009, and that the Agency, as the Grantee, by its said duly authorized agent, hereby consents to the recordation thereof. DATED 9 LA QUINTA REDEVELOPMENT AGENCY, public body corporate and politic Name: Thomas P. Genovese Executive Director, La Quinta Redevelopment Agency I HEREBY ATTEST to the authenticity. of the foregoing signature and to the said adoption of the said Resolution JA . of his general authority to so act and certify that said - authority has not been revoked by any subsequent .Resolution or order of the Agency. DATED: �Gt7 Veronica J. tecino, CMC, Agency Secretary, La Quinta,Redevelopment Agency 2 M3.01°-0� aMM 047 touse+�.oAttachment 1 to Grant Deed o9. ATTACHMENT NO. 1. LEGAL DESCRIPTION OF PROPERTY APN: 600-030-002 That portion of the Northeast Quarter of Section 29, township 5 South, Range 7 East, in the County of Riverside, State of California, according .to official' plat thereof, described as follows; Parcel 1: Beginning at the Northwest corner of the said Northeast quarter; Thence Southerly, along the Westerly line of the said Northeast quarter, '125 feet for a point of beginning; Thence continuing Southerly., along the Westerly line of said Northeast quarter, 60 feet; Thence Easterly, parallel with the said North line, 150 feet; Thence Northerly and parallel with the Westerly line of said Northeast quarter, 60 feet; Thence- Westerly and parallel .with the Northerly line of said Northeast quarter, .150 feet, more or less, to the point of beginning; Excepting therefrom a right of way for public'highway .and public utility purposes over the Westerly rectangular 30 feet of said property,.as conveyed to the County of Riverside, by Deed recorded May 24, 1933 in Book 122 Page 374 of Official Records of. Riverside County, California; Said property is also shown by Map of Record of Survey on file in Book 8 Page 14 of Records of Survey., Records of Riverside County,, California; Together with a one -sixteenth interest in well and a one-ninthinterest in pump and to the use of water from the well located on Northwest comer of the Northeast quarter of Section 29; Township 5 South, Range 7 East,,San Bernardino Base and Meridian. Parcel 2: An easement for pipe lines together with other incidental purposes as conveyed by Deed recorded August 30, 1,965 as. Instrument No. 99570 of Official Records of Riverside County, California, over the East t 0 feet. of the West 40 feet of that portion of the Northwest quarter of the Northeast quarter of.'Section 29, Township'5 South, Range 7 East, San Bernardino Base and Meridian, described as follows: Beginning at the Northwest comer of the said'Northeast quarter; Thence Southerly, along the Westerly line of the said Northeast quarter, 185 feet for a point of beginning; Thence continuing Southerly,..along the Westerly line of said Northeast quarter, 60 feet, Thence Easterly, parallel with. the said North.line, 150 feet; Thence Northerly and parallel with - .the ith.the. Westerly line of said Northeast quarter, 60 feet; Thence Westerly and parallel with the Northerly line of said Northeast quarter, 150 feet, more or less, to the point of beginning; Excepting therefrom the West 30 feet conveyed to the County of Riverside, by Deed recorded May '24, 1933 in Book '122 Page 374 of Official Records of 'Riverside County, California. 215"15610-0047 5843.0AA09 Attachment'1 'to Grant Deed 100563.02 MUDS 'Parcel 3: An easement for pipe lines together with other incidental purposes as conveyed by Deed recorded August 30, 1965 as Instrument No. 99571 of Official Records of Riverside County, California, the Fast 10 feet of the West 40 feet thereof and the South 1.0 feet thereof commencing 40 feet from the Southwest corner of the above described property, running Easterly, 55 feet to the present well and pump location of that portion of the Northwest quarter of the Northeast quarter of Section 29, Township 5 South, Range 7 East, San Bernardino Base and Meridian, described as follows:. Beginning at a point on the, Westerly line of said Northeast quarter; 245 feet, South of the Northwest corner of said Northeast quarter; Thence South on -the West line of said Northeast quarter, 85 feet; Thence East, parallel with the North line of said Section, 396 feet to the Southwest corner of that certain parcel conveyed to Arnold Eddy, a married man, by Deed` filed for record September'23, 1:960 as 'instrument No. 83003 of Official Records of Riverside County, California; Thence North, parallel with the. West line of the Northeast quarter, 330: feet to the North line, of the Northeast quarter; Thence West on the North line of the Northeast quarter, 161 feet; Thence South, parallel with the West line of said Northeast quarter, 185 feet; Thence West, parallel, with the North line of said Northeast quarter, 85 feet; Thence South, parallel with the West line of said Northeast quarter; 60 'feet; Thence West, parallel with the North line: of'said. Northeast quarter, 1,50 feet to the point of beginning; Excepting therefrom the West 30 feet conveyed to the.County of Riverside, by Deed recorded 'May 24, 1933 in Hook. 122 Page 374 of Official Records :of Riverside County, California. 21$43.oz 6 AA ioosea3.M Attachment t to Grant Deed State of California County of ) + tMLQ On, Lf � before m4;:' (insert name and tate of the o icer) personally appeared o&4�"` '1� • Vf�- 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/shetthey executed the same in his/her/their authorized.capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. IQ" awwaft COU* :15"15617 ioose.s.oi AW .3' - LARRY W. WARD COUNTY OF RIVERSIDE ASSESSOR -COUNTY CLERK -RECORDER NOTARY CLARITY Recorder P.O. Boz 751 Riverside, CA.92502.0751 (951) 486-7000 www.rivemideecrcom Under the provisions of Government Code 27361.7, 1 certify under the penalty of perjury that the notary seal on the document to which this statement is attached reads as follows: Name of Notary: Linda Martinez Commission M 1768268 Place of Execution: La Qnta.-California Date Commission Expires: 09/1.6/2011 Date: 06/04/2009 Signature: Print Name: Linda Martinez ACR 186RAS4R1D (Rev. 09)2006) Avmlabk W Ahmu to Formab 15 Oil CITY OFIA QUINTA - PUB CWORDEPARTMENT GREEN SHEET / PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT Form updated & effective 11117/2006 'P Imo,► 00 '` Green Sheet approvals are forwarded to the Building & Safety Department directly by Public Works. Please DO,NOT submit the Green Sheet (Public Works Clearance)'Packet to the, Public Works Department until ALL requirements listed below are. complete.. Incomplete applications or applications which cannot be processed will be returned to aDDlicant. Dater Tract No.: Address(s); owirn'— Thefg are requireetsf5'ublic Works Clearance to authorize issuance of a building permit from the Building & Safety Department: •� CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4 AND #5 BELOW ❖ TRACT HOMES:. PROVIDE ITEMS #1, #2, #3,, #4 (AS APPLICABLE) AND #6 BELOW ❖ WALLS: PROVIDE ITEMS #7 BELOW •:# SIGNS:. 'PROVIDE ITEMS #8 BELOW Development Services 1.. Attach Pad. Elevation Certificates in compliance with the approved design elevation for building pad (maximum allowable deviation of . + /- 0.1 foot)_ Pad Elevation Certificates must be current (within 6 months of .current date). If a precise grading plan creates the pad for approval, please withhold green sheet submittal until a Pad Elevation Certificate can be provided. 2. Attach°geotechnical certification of grading plan compliance. 3. Attach recorded final map -showing proposed building locations are legal lots. 4. Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan & agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy plan. PM10 plans for commercial & residential developments (beyond 1 lot) are submitted separately with grading plans & are subject to additional requirements. 5. .Attach. an approved precise grading plan for the building location(s). AO flood zone developments will require an approved flood plain development plan. 6. Attach an approved rough grading plan for the building- location(s). 7. Attach wall plan & related_ approved grading. plan. 8. Attach sign layout/plan & related precise grading/landscape plan. 1 have reviewed and confirmed the requirements listed above as presented and find the improvements to be sufficiently complete for construction of tpf proposed buildings/structures/walls/signs on the subject lot(s).. Pursuant to myMrrdmgs, the Zboye p96jAct may be released for building permit issuance. Recommended by: Dated: '03, oq Public Works Distribution: (1/j Green Sheet to Building & Safety counter (_) Green Sheet to Community Development Declined for approval for reason(s) as follow(s), please correct and resubmit: V, City of La Quinta - PM 10 Project Information (< 1 acre per Lot or Infill Project) Page 1 of 3 Form updated & effective 812512005 Project Information Project Phase Pr ject Contractor: I ,er(n � nPI ►Kra - I Project Phase Project Name: (Check One):' ❑ Construction Project Tract Number: Demolition Lot Number(s): Anti ' ated Start Date: ,0 Project Street Address: Anticipated Completion: y Total acres id active construction (< 1 acre per Lot): Project -Contact Please Note: Dust control is required 24 hours a day, 7 days a week, Information regardless of construction status. Person listed below is responsible for dust control during business and non- business hours. Name: totew Title: V Company Name: �t( (pr; • mac,. Mailing Address: ad City: env � State: Zip Code: I L Primary Telephone Number: �° 3 �,�- y VA Fax: -76&Z 3 -If - S�3 24 Hour ergency Access/Emergency Phone: -7d 3 �� 7 y Cell Phone,: 6 b I -7-7q- 9M J40-7-tS PM 10 Certificate Number: —13,/ CJ (i t" ❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by the City of La Quinta. PM 10 (< 1 acre per Lot or Infill .Project) Fugitive Dust Control Plan Page 2 of 3 Plan updated & effective 8/25/2005 This plan shall take into account applicable SCAQMD Rule 403 regulations. Training may be obtained by contacting SCAQMD (Sharon Zamora - Phone: (909) 396-2183). This plan shall consist of the following action items: ❖ WATERING: Continuous watering is required to prevent dust and must occur a minimum of 4 times daily. Water shall be applied to dry soils to stop: • Visible dust emissions over 20% opacity • Visible dust emissions that travel over 100 feet. • Water'source % hch water meter at front (south) side of pad. ❖ EDUCATION: Responsible Dust Control Individual and key personnel shall attend SCAQMD PM10 class and obtain PM 10 certificate number prior to construction activity. ❖ WEATHER MONITORING: Wind predictions shall be monitored. ❖ SIGNAGE: Use Coachella Valley Fugitive Dust Control Plan Handbook Construction Site Signage Guidelines. ❖ TRAFFIC: Construction traffic shall not be allowed on the pad, unless absolutely necessary. If vehicles operate on pad, pad shall be kept firm and moist through hose watering or sprinklers. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on pad. (15 mph maximum traffic speed). ❖ PARKING: Parking is not allowed on the pad. All vehicles must park on street (at designated areas only). ❖ TRACK OUT: Provide 24 hour street cleaning and track out. system as approved -by City Public Works Inspector. (No dirt on public or private roads). 'Track out shall be; cleaned up within one hour of incident. ❖ DIRT PILES: Dirt piles shall- be limited to 50 cubic yards and built- per California Building Code grading requirements. • Piles shall be kept moist.or covered with tarp material. Larger -dirt piles will require stockpile.or grading permit. :• FENCING: Provide PM 10 fencing at perimeter of public roads and where applicable. Wood slat fencing can be installed at rear of property and return 20 feet on either side if HOA restrictions apply. Block walls can replace,PM10 fencing during the construction phase. ❖ EQUIPMENT: Extra hoses and sprinklers shall be maintained on site. ❖ EXCAVATION MEASURESAII areas to be excavatedor graded shall be pre -watered. Water shall be applied during excavation or grading operations also. ❖ DUMP TRUCKS: Open top dump trucks to be wet down, moist and tarped prior to leaving site. •3 INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required.. City of La C2uinta - Site Specific Construction .Phase PM 10 Agreement Page 3 of 3 Agreement updated & effective 812512005 The signature of the property owner for authorized representative): *:• Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to AQMD Rules -403 and 403.1; ❖ Shall constitute and agreement to comply with all project conditions as identified in the approved dust control plan; The property owner for authorized representative): v Acknowledges that dust control is required 24 hours a day,.7 days a week, throughout the period of project performance, regardless of project size or status; ❖ Shall ensure that each and every contractor/subcontractor and all other persons associated with the project shall be in continuous compliance with all requirements of the approved dust control plan; Shall take all necessary precautions to minimize dust, even if additional measures beyond those listed in the dust.,control plan are necessary;. Shall authorize representative of the City/County to enter upon the above mentioned property for - inspection and/or abatement purposes; and ❖ Shall hold harmle s the Cityounty and its representatives from liability for any actions related to this dust co.ntro 'Ian or y ty/County initiated abatement activities. Signature of PropW. Ownetbr Authori Representative Printed Name /// �a It TitleD to ori I �I C606 4 A�rra Company 08/10/2009 05:19 7603237743 PAGE 02 SCOTT MORRISON & ASSOCIATES P.O. am 55329 31855 Date Palm Dfn,% Ste. 3 0507 Riverside, CA 92517 Cathedral City, CA 92234 (409) 624-]665 (760) 323-7743 EBi'Ol� 8t"tM RUM GOlhpleled On 616 Client city at La Quints Ccmmurdty DeVeiopmerht DapL 713.495 Cade TBmpico LA Quints, CA 9225.3 Protea 40-130 Duneftlme Road' Le Quints, CA (single farnily home) On August 04, 2009 an psbesms 1 MID 0 CM 0 n and bats was =-M 11 11 at the Owe project addremi. Butt sen�ples were Moan of all suspect 8811=108 oontaining building materiels (ACBM) at the request of the client named, obave. Bulls samples were subrmiftad to Carolina Environme W. Inc. locrhted at 107 New Edf6on Court In Cary, NC (NVLAP Code 101788-0 and Cal. Environ. Lab. Cert. #2483) to estlmabe the percenbage of:asbeatos by volume and determine ihe.tyWs) present. Carolina Envlronnherhtal, ,Inch dstentwines percentages and type of asbestos by using EPA approved method 8GNM4.82-020: Interim Medved for the Determination of Afted s in Bulk Samples. Bulk samples are analyzed by PLM (Polerl2ed Light Mloroeoopy). Asbestos Is quwtftd using tre visual arena esiliva n We hnlque and con,only determine the app paw of a1eaio$ presat Atter a thorough 8earCh is conducWd and no asbedw Is debxftd Mona delacted' will be noted In the report: The essence of polarised Ilght microscopy is not to a nowficaily detemMne OW no asbestos Is present, merely that none was detected or, ff itwas, it was IAoely to be lees than 1.0% of ft sample. When findings reveal Mae than or dose to 1.0% asbestos ounwined In a ,sernple, further analysis may be caned for on additional samples to confimr or denounce thht initial findings. The Collfornia Code of RegulaVons (CCR 1529) requires buk nmp&V to be conducted according Io the AH.E.R.A, protocol provisions of 40 CFR Part M05. The A.H.E.11A prob" wxrnrnends three (3) or mat friable surfacing sampies from a Aanogeriow area be collected and analyzed before any building material Is determined to be wmwbeetos Mono ta(rhing. Scott Morison 3 Associates conducts asbeWDS, WOOMM Surveys ftilw ling G* A.H.E.RA protocol. ASBESTOS INSPECTION 8Y: Soca C. fiAo rWm DOW 9 92-0248 BULK SAMPLES ANALYZED Or. Carob* Envfrorhmuental, Inc., NVLAP by 1017138-0 The results on the ft owing pages) Indica to sobeelos (greater than 1.0%) was detected In (02) of the (15) Samples anwyzed. (1) 08/10/2009 05:19 7603237743 PAGE 03 SCOTTMOMSON & ASSOCIATES P.O. Box 55329 31855 111tc Psim Detre, SW. 3 #507 Rhwdde, CA, 92517 Catbedral,Cil), CA 92234. (909}624-1665 (760),323-7743 PLM0728d01301 9ampie MDP -1 'Type of Madel: boleurn/,red Locaidon: kltCtw fW S hallway/ SE gage Area: apptox 150 loll sq. ft: Friable: no' Results: 25% ChrysatNe asbeebo: Sample SM -2 Type of material: masW yellow Lowilan: under SDP -1 Area: approx. 160 total sq. R Friable: no. Results: rano debmM 9arrtple SOP -3 Type. of nuderw linolsuunY Bald hiber LCcWM' kttChewt 0* (Z- teyaO Area: appy ux. 100 sq. R Frlabie no Resuft 26% thryac tila asbssloe ODP -4 Friable: no Type of mated: ma6W Location: tinder sw nple # Mea: approx.100 sq. ft. Results: we detected Sample SDP -S Typa at material: fwd cow'whbs Loceftm interior N. vM, NE bedicai Ar ex . interior vralis-111 layer .Friable: no Rsaults: rme detected Sample Type of trrrd: drywall 0* Ux:o m: interior N. wag, NE bedroom Aram Interiorwallwe Friable: no Resuft none detected sample ODK7- Typo of mfit tial: ceiling drywall L.ocaUon: irderlor C"Ing, NW bedroom Area: interior wails & catling, N. bedrooms Friable: no Resuft trona detected Sample ODP -8 Type of rttatnlak tamed roc trg (with blk rnaBft) l.acedo t SE sloped red Ara& SE stoped rout -I'd Sayer Friable: no Resuft: none doiscied (2) 08/10(2009 05:19 7603237743 PAGE 04 SCO'T'T MOMSON & ASSOCIATES P.O. Box 55329 31855 Date Pdm Drive, Ste. 3 0307 Riverside, CA 92537 COW", City, CA.92234 (909) 624-1665 (760).373-7743 PLM0728#0801 Sample #DP -B Type of nmte w: MORO.few black Ux*M n: SE sloped roof Ares: SE sloped nmf-',?" °'layer Friable: no Results: none detec.W Sample MP -10 Type of material: far & gravel mng/ qmy-black Location: -kw fiat roof area Area: throughout flat ra& 1" layer Friable: no Results: none detected Semple *DP -11 Type of material: roofing.klb bW* Locadon: NW flat roof am Area:: throughout. flat roof"° layer Friable: no Results: none detected Sample #0P-12 Type of maier: exteft wan WOW while Locetlon: exWw SE (add-on area) Arm: naw exterior wall areae Friable: no Results` none detec.M Sample MDP -13 Type of tnatermr mderior veal 8tuooW white Locagon: savlor SSM (entrance area) Aro& oMm W eoctesiior'wwell areas Friable: no Results:, none detected Sample SOP -14 Type of ffw"r wag feW brawn Win: WNW wdertar wall stu000 Area: thmughout exterior walla Friable: no Results: none detected Swnple *DP -15 Type of material: roof mei W black Location: around foot pence, peerime w '11 a . BPPMX 100+ 11M mar ft Fable: no Results: none detected 08/10/2009 05:19 7603237743 - PAGE 05 SCOTT MORRISON &. ASSOCIATES P.O. Box 55329 31655 Acta Palm Drive, Ste. 3 #507 Itiv"de, CA 92517 Cat w&d City CA.92234 (909) 624-1665 (760) 323-7743 PLMONW516 NoW AO effibEMn containing buNft nwft l(s) conU&ft greetw than 1.0% a9be0as by volume or weight, must be mwied by a slat® =dMW asbestos abment oont see prlor°to any demoibm or -"ngvdbn of tlK properly. (, m #*�-- Ihspedat Scott C.Mwdson CertW Asbestos Consultant DOSHO92-0248 08/10/2009 05:19 7603237743 f11��OMM� W1a0A� C - $OM X011 31855 Dale PWm Dr. Sulb 3407 Cado" City. CA 92234 stioMob PLMOBOW51S PAGE 06 CB Lab ftft A00 8M pmm*na 004M anotmoa: 0"T -W pipe ied: OW -0 Anmbft cllg "Wnw cumrs LABS n1M101 rl war•11011 AIMEM= OP -1 A934W ! CMRY mill lie irMau. fed.MOMM.GoWd cNity mat vwn 70m sm 5% OP -2 AW4000 MfiM� Ekarnaeiniiui. Yolbw. NOWNWW LMOU ld U1"r =S COLL lei % a" AWMI L Ctlw JUs Marn•As�idu•, 1M�. Qold. Pbio�n. aaa+�d ca�nr 701i1A+M. eneb eao �x OP -4 A934M l�A"& Lf� 110 i MMOoeein•. Yabw. l BWAW mm wort C" 4"s, DP -S A934983 ENKSM MoneoOrme" v"ftNon4h'ft•,Bm" PMV 6% PIm 92% V" sir. o" A23ON 9MMI" � l�pmo�iiMe�. Wl�i, PArarl.9oond ar to sox cat 19% 09/10/2009 05:19 7603237743 PACE 07 Projk* PLMOODMIJIG 1wlMN►O�ftiuR � � �OII . Aart:9A�1+Mq RrerlIO+RI�111� Lob Deft A004M enswe � AMOMPM OPL7 A034M L ND 'IN -111 polls, VVW Flhtompound QVPKw as Cau. 6% liome�o��. �. Fbroua.eau�rd TAR 41% COLL 1091 filAM/ 3!0, Y OP4 A934M W ND TAR So% PML 10% .OP6j o ND TAR as% Am W% amuv •:'R Mil A034000 Mi ND lomop mom OW6- ft" TAR 00% F@K 10% OP -13 AROM 0 .1 110 -mono" WW"awmamoomw X13 A9840" lRQ.�KI i�'t �+amo�o�a� rvhae, a� M loos Cam 4",i POPS 08/10/2009 05:19 7603237743 CMRasICM" pwM 904MM ft; 90d"40 PI PLUDEK"olf Gob pars AMMI PAGE 08 CLI�M[® LA8 11OWGINI 1Y0 ASSIOWS DP -14 A934972 WALL FELT -T u�D Homogeneous, Brown, MOCK Fibrous, Bound TAR <f % CELL i00% DP -15 A934973 ROOT= MASTIC ND Homogeneous, Black, Fibrous, Bound TAR 90% CELL 10% Pass 09/02/2009 1,3:54 9093813433 UNIFORMHAZARDOUS 1. Generator ID.Number qtzTvOr LA QT.MwAl ' . �es ;.VTZm.y 95 MTZ POST 3,28 PAMM, ALS 853" iff—im—s— — �_ --- 8RICKLEY ENV PAGE 01/01 CW J14 rQ5. Import: to Us Eportnml.13; mo wrm CL man ww 3. W. *Mh Day 9, Ob. U.S. DOT Dftcd*n OftdWIM9 PMW8110ft Nam, Hazard On% M NLgnbwl carminers HM arid PaCWrQGrM(6any)) ASSEMS. M2212, PGTTl (ERG 0171) CW J14 rQ5. Import: to Us Eportnml.13; mo wrm CL man ww 3. W. *Mh Day •r;_: 5�<:: SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR.ASBESTOS REMOVAL 9091396.2336 -"• FAX6 9091396.3,342 MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE'# 55641, LOS ANGELES CA 90074641 AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION # COMPLETED BY COMPANY EMERY LANDCLEARING PHONE: 761391.5640 LORI EMERY V.P. AND GRADING, INC. DATE 8/1/92009 CHECK# 'UJ(�a, FEE$159.15 PROJECT# NOTIFICATION TYPE ORIGINAL. REVISION DATES REVISION OTHER (highlight) CANCELLATION PROJECT TYPE DEMOLITION ORDERED DEMOLITION RENOVAT10N (reR owpl) EMERGENCY REMOVAL PLANNED RENO (annual) SITE INFORMATION SITE NAME SITE ADDRESS 46-130 DUNE PALMS ROAD CROSS STREET WESTWORD HO DRIVE CITY LA QUINTA STATE CA ZIP 92253 COUNTY RIVERSIDE DESCRIBE WORK AND LOCATION ` HOUSE. BUILDING SIZE.(SQ Fr) 1,100 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 52 NUMBER.OF DWELLING UNITS 1 BLDG�PRIOR 1 PRESENT USE COMMERCIAL- HOSPITAL INDUSTRIAL Other OFFICE PUBLIC BLDG. HOUSE SCHOOL SHIP UNIVICOLLEGE SITE OWNER CITY OF LA QUINTA ADDRESS 78-495 CALLE TAMPICO CITY LA QUINTA STATE CA ZIP 92253 CONTACT JON MCMILLAN PHONE 760/212-2322. REQUIRED BUILDING INFORMATION ASBESTOS YES NO PRESENT? ASBESTOS YES NO SURVEY? ' 11 ASBESTOS YES NO REMOVED? BUILDING TO BE YES NO DEMOLISHED? PROJECT DATES START 9309 END 9-18-09 WORK SHIFT (day,.swing, night) ASBESTOS AMOUNT TO BE REMOVED (in square feet) FRIABLE CLASS I CLASS II TOTAL AMOUNT (add row) ASBESTOS REMOVAL.FROM SURFACES PIPES COMPONENTS AMOUNT OF EACH TYPE OF ASBESTOS (in square feet) ACOUSTIC CEILING LINOLEUMINSULATION FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER (describe) CONTRACTOR INFORMATION CSLB LICENSE# 600283 OSHA REG # AQMD ID # 100435 NAME EMERY LANDCLEARING AND GRADING, INC. ADDRESS P:Q. BOX 1009 CITY THERMAL STATE CA ZIP 92274 SITE SUPVR JAMES C. EMERY PHONE 7601774-9493 WASTETRANSPORTER #1 LANDFILL BURRTEC WASTE ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP Asbestos surveys are required prior to Demolition and Renovation Forms, instructions, and the Rule 1403 can be obtained from AQMD web site httpilhvww.agmd.gov Page 1 of 2 Form REV 20030627 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE:# 55641,.LOS,ANGELES CA 900745641 WASTE TRANSPORTER #2 WASTE STORAGE SITE ADDRESS' ADDRESS CITY STATE ZIP CITY STATE ZIP CONTROLS: DESCRIBE WORK PRACTICES:AND CONTROLS TO: BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure # 1,,, 2, 3, 4, 5 or Other. For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for.AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE: BUILDING: Survey, Bulk Samoting, 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: BRICKLEY ENVIRONMENTAL 9-1-09 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/AUTHORRINGTHE EMERGENCY, DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN, UNEXPECTED EVENT: EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS. EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN: CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS,IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED, CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. STOP PROJECT HAVE CERTIFIED ASBESTOS REMOVAL CONTRACTOR REMOVE AND DISPOSE OF. TRAINING CERTIFICATION: I.certify that an individual'trained in the provisions ohregulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence thatIthe required training has been.accomplished by this person ill'be available for.inspection during normal,business hours. Company Name EMERY Print name of owner/operat Sign W re owner rator Tittle of owner/operator Date 8-19-09 LANDCLEARING AND LORI EMERY GRADING, INC:. - 1V` VICE PRESIDENT INFORMATION CERTIFICATION: I certify that'the above Information is cor and. I have encloAd any required attachments. Company Name EMERY Print name of owner/operator ignat of, n or Tittle of owner/operator Date 8-19-09 LANDCLEARING AND LORI EMERY VICE PRESIDENT GRADING, INC. Notifications can not be accepted without the required fee (AQMD Rule 301). Asbestos removals 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 SERVICE CHARGE 1,000orless $ 52.06 SPECIAL HANDLING FEE $ 52.06- 1,001 to 5,000 $ 159:15 REVISION OF NOTIFICATION $ 52.06 5,001 to 10,000 $ 372.51 RETURNED CHECK CHARGE $ 25.00 10,001 to 50;000 $ 584.11 PLANNED RENOVATION $ 584.11 50,001 to 100,000 $ 846.52 PROCEDURE 4 OR 5 PLAN $584:11 100,001 or more $1,410:86 MAIL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074.5641 Page 2 of 2 TELEPHONE: (909).396-2336 FAX: (909) 3964342 Form REV 20030627 FORMS, INSTRUCTIONS, AND THE RULE 1403 CAN BE OBTAINED FROM AQMD WEB SITE AT HTTP:/IW WW.AQMD.GOV SCAQMD is located at 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000