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BDEM2019-002478-495 CALLE TAMPICO LA Q;UINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: DEMOLITION/COMMERCIAL/OTHER Application Number: BDEM2019-0024 Property Address: 51945 AVENIDA VELASCO APN: 773173030 Application Description: ADDAL GONZALES / 800SF CASITA DEMOLITION Property Zoning: Application Valuation: $7,000.00 Applicant: LORI EMERY -EMERY LANDCLEARING AND GRADING I F P 0 BOX 1009 THERMAL, CA 92274 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/23/2019 Owner: ADDAL GONZALES 51945 AVENIDA VELASCO LA QUINTA, CA 92253 Contractor: EMERY LANDCLEARING AND GRADING INC SEP 2 3 2019 P 0 BOX 1009 THERMAL, CA 92274 DESIGN & DEVE OPMENT DEPARTMENT Lic. N .: 600 0 Llc. No.: 600283 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division iness and Professions Code, and my License is in full force and effect. License Class: License No.. Date: } Contractor: OWNER -BUILDER 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).: (_) 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 sale.). (_) 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 N Lender's Address: WORKER'S 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 th work or which this permit is issued. 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: Ca r ri e r: 516R NE I INSURANCE COMPANY Policy Number: BNUWC0147057 I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner me subject to the workers' compensation laws of California, and a ee that, if I shou ecame subject to the workers' compensation provisions of tt= 3700 of the Lab Code, I shall forthwith comply with hose p OVISIO S. Date: 1� Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and 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 that0;e above informis correct. I agree to comply with all city and county ordinancesajld state laws relating t building construction, and hereby authorize representatives o on he above - mentioned rope ty for inspection purposes. Date: 3 { 1 Signature (Applicant or Agent Date: 9/23/2019 Application Number: BDEM2019-0024 Property Address: 51945 AVENIDA VELASCO APN: 773173030 Application Descriptions ADDAL GONZALES / 800SF CASITA DEMOLITION Property Zoning: Application Valuation: $7,000.00 Applicant: LORI EMERY - EMERY LANDCLEARING AND GRADING INC P 0 BOX 1009 THERMAL, CA 92274 Owner: ADDAL GONZALES 51945 AVENIDA VELASCO LA QUINTA, CA 92253 Contractor: EMERY LANDCLEARING AND GRADING INC P 0 BOX 1009 THERMAL, CA 92274 (760)391-5840 Llc. No.: 600283 Detail: DEMOLITION OF ENTIRE 800SF UNPERMITTED CASITA INCLUDING SLAB WITH ABANDONMENT OF UNDERGROUND PLUMBING/SEPTIC SYSTEM. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT CITY AMOUNT DEMOLITION, FULL 101-0000-42404 0 $27.37 DESCRIPTION ACCOUNT CITY AMOUNT DEMOLITION, FULL PC 101-0000-42600 0 $96.60 Total Paid for DEMOLITION: $123.97 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $138.97 eca Q�dgra C %I-IFO RNIA ----- Project Address: APN #: Applicant ame: Address: 16 & City, ST, Zip: `' 4 Telephone: 1&0 Email: J. A -0 A . Contractor Name: Address: V6 City, St, Zip Telephone: Email: �Mkf(, State Lic:[AM-%C- M — o �c l; City Bus Lic: Architect/Engineer Name: Address: City, St, Zip Telephone: Email: State Lic: City Bus Lic: Property Owner's Name: Address: 1" City, ST, Zip 0, R AAII^ Telephone: Email: A PERMIT # k pCMz01 cl — OOZq PLAN LOCATION: Project Description: ccst' Project Valuation $_ -T-, -1, &M- - New Construction: Conditioned Space Garage Patio/Porch Fire Sprinklers Construction Grading: Bedrooms: Stories: SF SF SF .SF Occupancy: # Units: New Commercial / Tenant Improvements: Total Building SF Construction Type: Occupancy: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Required Received Pian Sets Structural Calcs Truss Calcs Title 24 Calcs CVWD Fire Flow Letter Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan y Planning approval Public Works approval Fire approval City Business License 4 -60 Lith a 0.90 The South Coast Air Quality Management District acknowledges by this 4 I of Completion that Lori Emery successfully completed 06/20/2019 Date Issued: (expires two years from issue date) Certificate no. CV1906-008118-8160 Instructor Engineering & Compliance 21865,Copley Drive, Diamond Bar, CA 91765-4182 Ph e. (909) 396-2336 w.agmd.gov We 1403 Notification of Routine Demolition maintain a copy of this Notification at the job site, either electronic or paper. Project Type Project Type Demolition Project Urgency Routine Completed By Lori Emery Phone Number (760) 391-5840 Contractor Information Company Name EMERY LANDCLEARING address P 0 BOX 1009 City THERMAL State CA Zip 92274 CSLB License # 600283 OSHA REO .# Supervisor #1 James Emery Phone (760) 774-94193 Supervisor #2 Jonathan Stiles Phone (760) 343-6688 Site Information Site Name Structure Project # Site Street # 51945 Street Name Avenida Velasco Cross Street Calle Durango Site County Riverside i" La quinta State CA Zip 92253 Contact Name Addal Gonzalez Contact Phone (760)399-63835 Site Owner Addal Gonzales Owner Address 52525 Eisenhower Dr City La Quinta State CA Zip 92253 Project Start Date 9/24/2019 Project End Date 9/27/2019 Project Work Shift(s) Day Building Size in Sq.ft B00 Number of Floors 1 Building Age (years) 50 Number of Building/Dwelling Units i Building Prior Use Other Casita Asbestos Survey Yes Asbestos Found No Asbestos Removed NA Building to be Demolished Yes Describe Work Demolish structure Describe Work Location Neighborhood Project Information )emofltion Bnforrrration 01 "sbestos containing materials must be removed prior to any demolition activity brce of Demolition Project in sq. ft 800 Notification Numt Work Practices at Demolition Site Spray Water, Exit Grates, Tarp Trucks/Bins Contingency Demolition plan Stop Work, Isolate Work Area, Notify 1 "PROPOSAL" EMERY LANDCLEARING AND GRADING, INC. (� P.O. BOX 1009 THERMAL, CA 92274-1009 V 760/345-4746 FAX: 760/391-5839 nz�lyEGrer�_i lit3aol.rnli>< LIC. #600283 C-12 & C-21 AUGUST 6, 2019 ATTN: ADDAL GONZALES PHONE: ( SUBJ: DEMO GUEST HOUSE �' 1 955 DURANGO, LA QUINTA 61 q`j EMERY LANDCLEARING AND GRADING, INC., PROPOSES TO REMOVE AND DISPOSE OF AN APPROX. 40 X 20 GUEST HOUSE; WORK TO BE PROVIDED AS SPECIFIED BELOW: 1. CONCRETE SLAB ON WOOD STUCCO DRYWALL GUEST HOUSE TO BE REMOVED 2. EMERY LANDCLEARING AND GRADING TO PAY CITY OF LA QUINTA PERMIT (UP TO $200) AND AQMD PERMIT (UP TO $150) 3. AFTER CONCRETE SLAB REMOVAL, EMERY LANDCLEARING AND GRADING TO BACKFILL SLAB WITH EXISITING;DIRT USED ON -SITE AND TO SEMI GRADE OUT 4. OWNER TO SUPPLY EMERY LANDCLEARING AND GRADING WITH THE CONTACT NAME OF THE PERSON FROM THE THE CITY OF LA QUINTA SO WE CAN INFORM THEM WE HAVE THE JOB UNDER CONTRACT NOTES: 1. ASBESTOS AND LEAD INSPECTION AND REMOVAL TO BE PROVIDED BY OWNER AT OWNERS EXPENSE, IF LOCATED. 2. OWNER TO SUPPLY ALL PERMITS, INSPECTION FEES, AND TESTING, ALSO TO SUPPLY ANY ADDITIONAL REQUIREMENTS FROM THE CITY, COUNTY AND STATE. 3. WATER METER AND WATER TO BE SUPPLIED BY OWNER. 4. PERFORMANCE AND PAYMENT BONDS TO BE SUPPLIED BY OWNER, IF REQUIRED. 5. CONSTRUCTION SURVEYING, SOILS ENGINEERING AND TESTING TO BE SUPPLIED BY OWNER, IF REQUIRED. 6. OWNER TO SUPPLY COMPLETE IMPLEMENTATION OF TRAFFIC CONTROL AND PEDESTRIAN CONTROL THROUGH OUT PROJECT, ALSO TO SUPPLY STREET CLEANING IF REQUIRED 7. WORK TO PROCEED WITH EMERY LANDCLEARING AND GRADING, INC.'S APPROVED SCHEDULE. 8. OWNER TO SUPPLY PLANS, IMPLEMENTATION, MAINTENANCE AND REPORTING FOR SWPPP/WPCP AND PM-10 DUST CONTROL IF REQUIRED. 9. COSTS ABOVE IS FOR SPECIFIED THICKNESS OF CONCRETE, IF FOUND TO BE THICKER AND OR WITH METAL, ADDITIONAL COSTS WILL BE DETERMINED ON -SITE. 10, ALL UTILITIES TO BE DISCONNECTED AND MARKED BY OTHERS PRIOR TO CLEARING (DIG ALERT). 11. SPRINKLER AND IRRIGATION LINES, IF LOCATED TO BE LEFT INTACT, EMERY LANDCLEARING AND GRADING, INC., NOT TO BE HELD LIABLE FOR REMOVAL OR RESPONSIBLE FOR DAMAGE, UNLESS OTHERWISE NOTED. 12. COSTS DOES NOT INCLUDE ANY ITEMS OF WORK NOT SPECIFICALLY LISTED IN PROPOSAL, OR ANY BURIED DEBRIS (COSTS TO BE DETERMINED ON -SITE BETWEEN OWNER AND EMERY LANDCLEARING AND GRADING, INC. 13. DEBRIS TO BE DISPOSED OF AT A LEGAL RECYCLING DUMP SITE FACILITY, TO SUPPLY DUMP RECEIPTS FOR CITY CREDITS. 14. NO IMPORTING OF MATERIAL (UNLESS OTHERWISE STATED ABOVE). 15. IF ANY HAZARDOUS DEBRIS CONSISTING OF OIL, PAINT, BATTERIES, HOUSEHOLD CLEANING SOLVANTS, T.V.'S, COMPUTERS, LIGHTBULBS, AND MISC. TO BE DISPOSED OF BY OWNER OR LICENSED HAZARDOUS WASTE COMPANY, PAID BY OWNER. 16. IF ANY BEES, WASPS OR RODENTS LOCATED, OWNER TO HAVE PROFESSIONALLY REMOVED. 17. EMERY LANDCLEARING AND GRADING, INC., IS A LICENSED AND INSURED COMPANY. 18. INSURANCE CERTIFICATES TO BE SUBMITTED AS REQUESTED. 19. OUR TERMS ARE NET 30, ACCOUNTS WILL ACCRUE INTEREST AT 1-1/2% PER MONTH FROM 30 DAYS AFTER DATE OF INVOICE. IF WE COMMENCE COLLECTION, INCLUDING RECORDING OF MECHANICS LIEN AND OR SUIT, WE WILL BE ENTITLED TO REASONABLE (NOT COURT RULE FORMULA) ATTORNEY'S FEES AND EXPENSES OF COLLECTION. 1 .,AL" .f LANDCLEARING AND GRADING, INC. ilAL GONZALES dEMO GUEST HOUSE 51495 DURANGO, LA QUINTA AUGUST 6, 2019 PAGE #2 CONTINUED FROM PAGE #1: TOTAL PROPOSAL: $7,050.00 DOLLARS ACCEPTED BY: EMERY LANDCLEARING AND GRADING, INC. BY; lames EmerV JAMES EMERY TITLE: PRESIDENT DATED:_ AUGUST 6.1019 BID GOOD FOR 20 DAYS. PAYMENT TO BE MADE AS INVOICED. BY: s TITLE: N BP? 12d 19-0o2Y CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT Form updated & effective 9/25/2009 Green Shc,�et 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 applicant. Date: 9 / 6 / 19 Developer: Emery Landclearing And Grading, Inc. Tract No.: Tract Name: Address(s): 51945 Avenida Velasco Lot No.(s): Phone Number: ( 760 1 391-5840 The following are the requirements for Public Works Clearance to authorize issuance of a building permit from the Building & Safety Department: ❖ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4, #5 & #7 BELOW ❖ TRACT HOMES: PROVIDE ITEMS #1, #2, #3_& #5 BELOW ❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1, #2, #3, #5 & #7 BELOW ❖ WALLS, SIGNS, OTHER: PROVIDE ITEM #6 BELOW 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 including compaction reports from a licensed Soils Engineer. Recently rough graded residential developments which have a previously approved geotechnical certification are exempt from this requirement. 3. Attach recorded final map or title information/grant deed showing proposed building locations are legal lots. 4. Complete the attached <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. A current PM10 certification number is required. 5. Attach a copy of the rough or precise grading plan to the Public Works Department showing building location(s) for pad elevation verification. AO flood zone developments will require an approved flood plain development plan. 6. Attach supporting documentation for wall plan, monument sign, grease trap or special facility installations. 7. Complete and sign the attached water quality management plan (WQMP) exemption form, if applicable. PW approved building construction projects require either a WQMP or a completed WQMP exemption form. Approved maps/plans may be viewed at the following link: http://www.la-_quinta.org/PlanChecklm search.aspx I have reviewed and confirmed the requirements listed above as presented and find the improvements to be sufficiently complete for construction of the proposed buildings/structures/walls/signs on the subject lot(s). Pursuant to my findings, the above project may be released for building permit issuance. This section completed by City staff. Recommended by: Aa Date: � /�I "1 / Public Works Distribution green Sheet to Building & Safety ( ) Green Sheet to Planning Department Declined for approval for reason(s) as follow(s), please correct and resubmit: T:\Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09 doc City of La Quinta - PM10 Fugitive Dust Control Project Information Construction Phase PM10 Agreement (<1 acre/lot or Infill Project) Information Project Phase (check one) Construction El Demolition Total Acres in Active Construction (<1 acre per Lot): Project Contractor: Emery Landclearing And Grading, Inc Project Name: Structure Removal Project Tract/Lot Numbers: Project Street Address: 51945 Avenida Velasco Anticipated Start Date: 9 !`�1 19 Anticipated Completion Date: 9 /4� 7/ 199 PM10 Contact Please note: Dust Information construction status. non -business hours. Name: I Lori Emery Title: -Irw control is required 24 hours a day, 7 days a week, regardless of Person listed below is responsible for dust control during business and Company_Name: I Emery Landclearing And Grading, Inc. Mailing Address: I P.O. Box 1009 , State, ZIP Code: Primary Phone #: Thermal, CA 92274 760/345-4746 Fax #: 760/391-5839 24 Hour Emergency 760/345-4746 Phone#: Cell Phone #:1 760/774-9493 Email Address: I emerylcrecycling@aol.com PM10 Certificate #: I CV1906-008118-8160 The above stated Property owner or authorized representative): ❖ Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD Rules 403, 403.1, 401, 402, 201, 203 and PERP; ❖ Shall constitute an Agreement to comply with all project conditions as identified in the approved dust control plan. ❖ Acknowledges that dust control is required twenty-four (24) hours a day, seven (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 representatives of City/County to enter the property for inspection and/or abatement purposes; ❖ Shall hold harmless the City/County and its representatives from liability for any actions related to this dust control plan or any City/County initiated abatement activities. Signature of Property Owner Representative T1Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09 doc 1q, a0 I q Date City of La Quinta - PM10 Fugitive Dust Control Plan (<1 acre per Lot or Infill Project) This Fugitive Dust Control Plan shall take into account applicable SCAQMD Regulations Rule 403, 403.1, 401, 402, 201, 203 and Portable Equipment Registration Program (PERP). ❖ WATERING: Continuous watering is required to prevent dust and must occur a minimum of four (4) times daily. Water shall be applied from an adequate sized metered water source to dry soils to prevent: Visible dust emissions >20% opacity • Visible dust emissions that travel >100 feet from the source (within site) • Visible dust emissions that cross any property line ❖ EDUCATION: The responsible dust control Individual and key personnel shall attend SCAQMD PM10 class and obtain PM10 certificate number prior to construction activity (training information may be obtained by contacting SCAQMD at (909) 396-2183). ❖ CONSTRUCTION & DEMOLITION ACTIVITIES: A copy of this approved Fugitive Dust Plan must be kept on site. At least one short-term stabilization method must be used during off hours. At least one long-term stabilization measure must be used within ten (10) days of ceasing activity. ❖ WEATHER MONITORING: Wind predictions shall be monitored. ❖ SIGNAGE: Approved signs shall be installed at a highly visible location. Please refer to the Coachella Valley Fugitive Dust Control Plan Handbook for Construction 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 and sprinklers; and a maximum traffic speed of 15mph will be enforced. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on pad. ❖ PARKING: Parking is not allowed on 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 inspectors. No dirt on public or private roads. Track out shall be cleaned up within one (1) hour of incident and at the conclusion of each workday. ❖ 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 PM10 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 MEASURES: All areas to be excavated or graded shall be pre -watered. Water shall also be applied during excavation or grading operations. ❖ DUMP TRUCKS: Open top dump trucks shall be wet down, moist and covered with a tarp prior to leaving site. ❖ INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required. ❖ RECORD KEEPING: Fugitive Dust Control Plan records (i.e. self inspection records, records of use of chemical suppressants, etc.) shall be maintained for 3 years by the Property Owner (or Authorized Representative). Property Owner shall notify the City and SCAQMD within 10 days of completion of project. TAChecklists - Forms & ApplicationsWonns & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09 doc Water Quality Management Plan (WQMP) Exemption Form - Whitewater River Region Documentation of Pro-ect Not Requiring a WQMP but Requiring Site Design BMPs and Source Control BMPs by Entitlement Conditions of Approval or Permit Conditions — WQMP Required for the Listed Change of Land Uses or for Changes of Pollutant Stream (All Questions Below Must be Answered "No" To Exempt Project) Entitlement or construction of new single-family hillside residence(s) that create 10,000 square feet, or more, of impervious area where the pre -development natural slope is 25% or greater? Yes No ❑ Entitlement or construction of new single-family hillside residence(s) that create 10,000 square feet, or more, of impervious area where the pre -development natural slope is 10% or greater where erosive soil conditions are known? Entitlement or construction of new commercial and industrial development(s) of 100,000 square feet or more? ❑ ❑ Entitlement or construction of new automotive repair shop(s) including body, upholstery, paint, exhaust, tire, transmission, engine or other automotive specialty repair. [Standard Industrial Classification (SIC) codes 5013, 7532, 7533, 7534, 7537, 7538, and 75391? ❑ Entitlement or construction of new retail gasoline outlet(s) disturbing greater than 5,000 square feet? ❑ Entitlement or construction of new restaurant(s) (or potential restaurant shell space) disturbing greater than 5,000 square feet? Entitlement or construction of new home subdivision(s) with 10 or more housing units? ❑ RI ❑ ❑� Entitlement or construction of new parking lot(s) of 5,000 square feet or more, or with 25 or more parking spaces, and 2otentially exposed to Urban Runoff? ❑ Applicant Information Name and Title Lori Emery President Company Emery Landclearing And Grading, Inc. Phone 760/345-4746 Email emerylcrecycling@aol.com Project Information Project Name Type (SFH, Multi -Family, Commercial, Etc.) Structure Removal Location or Street Address 51945 Avenida Velasco Nearest Cross Streets Durango Municipality/County/Zip Code La Quinta Tract Number(s) and/or Assessor Parcel Number(s) Other Location Information Watershed Whitewater River Source Control BMP Information Size of Project Area (nearest 0.1 acre) 800 sf Project Area managed with Site Design or Low Impact Development (LID) BMPs (nearest 0.1 acre) Is the project subject to onsite retention by City ordinance or policy? Name of the Entity that will implement, operate, and maintain the Source Control BMPs G r{ Contact Name Street or Mailing Address City OP[ (ryl.q fi Zip Code L f Phone 760/345-4746 TAChecklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09 doc Check Item To be Performed Source Control BMP Requirements - All Projects Require Non -Structural BMP Source Control Non -Structural BMP (See Appendix H, Section 4.5.2.1) Ongoing Irrigation System and Landscape Maintenance Ongoing Litter Control Ongoing Drainage System Inspection & Maintenance Education/Training for Property Owner, Operators, Occupants, or Employees Activity Restrictions — Prohibition of Debris Blowing/Sweeping/Washing into Street/Storm Drain, Closed Trash Lids, Restriction of Vehicle Washing Ongoing Street Sweeping at Private Streets and Private Parking Lots Check Item To be Provided Source Control BMP Requirements — Small Sloped Lots, Small Commercial, <10 Unit Subdivisions, <5,000 Square Ft. Parking Lots, Etc. Structural BMP (See Appendix H, Section 4.5.2.2) Storm Drain Inlet Stenciling and Signage Landscape and Irrigation System Design to Minimize Erosion & Nuisance Runoff Protection of Slopes and Channels to Minimize Erosion Multi -Family Project Use of Community Car Wash Racks Wash Water Controls for Food Preparation Areas to Use Sanitary Sewer Fueling Area (Design & Maintenance) Including PCC Surface, Canopy & Spill Prevention Air/Water Supply Area Drainage (Design & Maintenance) Including Spill Area Containment Trash Storage Areas (Design & Maintenance) Including Attached Lids, Storm Water Controls ❑ Loading Docks (Design & Maintenance) Including Storm Water Controls, Dry & Frequent Cleaning Procedures Maintenance Bays (Design & Maintenance) Including Indoor Location & Storm Water Containment Vehicle and Equipment Wash Areas (Design & Maintenance) Including Canopy & Containment Outdoor Material Storage Areas (Design & Maintenance) Including Canopy & Containment Outdoor Work Areas or Processing Areas (Design & Maintenance) Including Canopy & Containment CC&R's, Maintenance Agreements or Other mechanisms will be used to ensure the ongoing operation, maintenance, funding, transfer and implementation of the project -specific WQMP requirements. Legal description and plat stamped by Registered Surveyor to be attached to the applicable CC&R or Maintenance Agreement for recordation at Riverside County. (Optional Requirement to be reviewed on a Project by Project basis) _ C Z=, BMP The applicant shall comply with listed BMPs and applicable provisions of the City's NPDES stormwater discharge permit, LQMC Sections 8.70.010 et seq. (Stormwater Management and Discharge Controls), and 13.24.170 (Clean Air/Clean Water); Riverside County Ordinance No. 457; the California Regional Water Quality Control Board — Colorado River Basin Region Board Order No. R7-2008-0001 and the State Water Resources Control Board's Order No. 99-08-DWQ. went Signature: Print Name. C► Title: Date: 9 /L! 19 Phone: ( 760 ) 391-5840 T:\Checklists - Forms & Applicalions\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09 doc (;heck Item To be Source Control BMP Requirements - All Projects Require Non -Structural BMP Source Control Performed Non -Structural BMP (See Appendix H, Section 4.5.2.1) fOngoing Irrigation System and Landscape Maintenance Ongoing Litter Control Ongoing Drainage System Inspection & Maintenance Education/Training for Property Owner, Operators, Occupants, or Employees Activity Restrictions — Prohibition of Debris Blowing/Sweeping/Washing into Street/Storm Drain, Closed Trash Lids, Restriction of Vehicle Washing Ongoing Street Sweeping at Private Streets and Private Parking Lots Source Control BMP Requirements — Small Sloped Lots, Small Commercial, < 10 Unit Check Item To be Subdivisions, < 5,000 Square Ft. Parking Lots, Etc. Provided Structural BMP (See Appendix H, Section 4.5.2.2) Storm Drain Inlet Stenciling and Signage Landscape and Irrigation System Design to Minimize Erosion & Nuisance Runoff Protection of Slopes and Channels to Minimize Erosion Multi -Family Project Use of Community Car Wash Racks Wash Water Controls for Food Preparation Areas to Use Sanitary Sewer Fueling Area (Design & Maintenance) Including PCC Surface, Canopy & Spill Prevention Air/Water Supply Area Drainage (Design & Maintenance) Including Spill Area Containment Trash Storage Areas (Design & Maintenance) Including Attached Lids, Storm Water Controls Loading Docks (Design & Maintenance) Including Storm Water Controls, Dry & Frequent Cleaning Procedures Maintenance Bays (Design & Maintenance) Including Indoor Location & Storm Water Containment Vehicle and Equipment Wash Areas (Design & Maintenance) Including Canopy & Containment Outdoor Material Storage Areas (Design & Maintenance) Including Canopy & Containment Outdoor Work Areas or Processing Areas (Design & Maintenance) Including Canopy & Containment CC&R's, Maintenance Agreements or Other mechanisms will be used to ensure the ongoing operation, maintenance, funding. transfer and implementation of the project -specific WQMP requirements. Legal description and plat stamped by Registered Surveyor to be attached to the applicable CC&R or Maintenance Agreement for recordation at Riverside County. (Optional Requirement to be reviewed on a Project by Project basis) BMP Acknowledgement The applicant shall comply with listed BMPs and applicable provisions of the City's NPDES stormwater discharge permit, LQMC Sections 8.70.010 et seq. (Stormwater Management and Discharge Controls), and 13.24.170 (Clean Air/Clean Water); Riverside County Ordinance No. 457; the California Regional Water Quality Control Board — Colorado River Basin Region Board Order No. R7-2008-0001 and the State Water Resources Control Board's Order No. 99-08-DWQ. Signature: _ Print Name: Title: Date: 1 Phone: Certification certify that I have read this form in its entirety and understand the City's submittal and review process and the requirements for this form. I understand and agree that if during the processing of the form, it is determined the information contains errors or omissions, clarification and/or supplemental information may be required and the preparation of such information may be considered, in the Community Development Director's judgment, an unreasonable delay and will result in a suspension of processing time limits in accordance with the California Code of Regulations, Title 14, Section 15109. Signature: Print dame: r _ �r�f/� G jc,-� Title: �•�' r�/� Date: y Phone: Owner Certification I certify under the penalty of the laws of the State of California that I am the property owner of the property that is the subject matter of this application and I am authorizing and hereby do consent to the filling of this application and acknowledge that the final approval by the City of La Quinta, if any, may result in restriction, limitations and construction obligations being imposed on this real property. Signature ��•._ _J� e �+ Print Name U. U • G-c�- &oJ e� Title: �2)UA %PA Date.,bq Phone: 1 �O y L.AQUINTA 5 BiJILDING DIVISION REVIEWED FOR I CODE COMPLIANCE ;,nrEq U f BY sF — ��q5 d-.c;- ^37 F' kz a°t -- 007-V S l 9* S- AMEN tD A VELASC-0 RECEIVED SEP 0 9 2019 Cm OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT �1 I � — � �'r� I.' l.' i a I•. Sii r. • _ i � Ili.... ,III i �■ �i '� �"v '' 0. *I. sial _71ES�'aatlllr�ki._"_ , n - aw.r.*rrh41Pwy. .• . �.... ilFt� ..: C: i.. ..i ~nrf I a .. �r ■ K Gaogl 4, 4- iiiii U+ii� it� W.'[^•Y� •!0�' . .. � iA•Y' J INSPECTION REPORT ASBESTOS Conducted at 51945 Ave. Velasco La Quinta, CA Prepared for Addal Gonzalez Prepared by MASTERS ENVIRONMENTAL INC. 44719 ALEXANDRIA VALE INDIO, CA 92201 ASBESTOS CONSULTANT # 03-3365 — GREGORY MASTERS CALIFORNIA LEAD INSPECTOR/ASSESSOR #18638 IAAM�R:is LN"Ll:�'�,-�l",!Ii,l:�il'lil��1j�i�� I l�:ii� �: -i 1111, lhi! September 3, 2019 CITY OIrLA OUINTA BUILDING DIVISION REVIEWED FOR CODE COMPLIANCE DATE ?►{ BY RECEIVED SEP 0 9 2019 CITY OF LA QLIINTA DESIGN AND DEVELOPMENT DEPARTMENT 1� DATE OF SURVEY: LOCATION: ASBESTOS SURVEY August 22, 2019 51945 Ave. Velasco La Quinta, CA BY: Gregory Masters California Certified Asbestos Consultant # 03-3365 Masters Environmental Inc. 44719 Alexandria Vale Indio, CA 92201 760-200-2900 Survey authorized by: Addal Goonzalez Methods: Selected materials in the structure that were suspected of containing asbestos were sampled according to specified protocols. Samples were sent to a NAVLAP accredited laboratory, Patriot Environmental Laboratory Services, Fullerton, CA — Lab code 200358-0. They were analyzed by Polarized Light Microscopy according to Bulk Analysis Protocol EPA 600/R-93/116. The laboratory report is attached to this message for your inspection. Collection of suspect ACM's followed the National Emissions Standards of Hazardous Air Pollutants (NESHAPS) protocol for sample collection for a demolition/renovation survey. Bulk Sampling of Asbestos Bulk samples of all homogeneous materials from identified areas containing suspect ACM were collected. A homogeneous material is defined as a surfacing material, thermal system insulation (TSI), asbestos -containing construction material or miscellaneous material that is uniform in use, color, texture and age of construction. As materials were identified, bulk samples were placed into individual sampling bags. Each sample was given a discreet identification number and recorded on chain -of -custody forms. Sampling Table: Sample Location Description 01 Wall Drywall 02 Wall 2 03 Wall 3 F 04 Wall 1 Tap ng 05 Wall 2 06 Wall 3 07 Stucco Stucco 08 Stucco 09 Stucco IF 10 Roof Black roll rfg 11 Roof 12 Roof IF 13 SLAB Concrete 14 SLAB 15 SLAB Friable Quantity Condition Asbestos F 2400 sq.ft Good ND F Good ND F Good ND F TBD Good ND F Good ND F Good ND NF 1200 sqq.ft Good ND NF Good ND NF Good ND NF 800 sq.ft Good ND NF Good ND NF Good ND NF 800 sq.ft Good ND NF Good ND NF Good ND M p. 3 Results: All materials that were suspected of containing asbestos were sampled for analysis of asbestos content by Patriot Environmental Laboratory Services, Fullerton, CA. All samples tested negative for asbestos. Masters Environmental can find no asbestos in any of these building materials. This survey was visual. Investigation requiring demolition or special testing equipment was beyond the scope of this survey. It should be understood that our findings reflect these limitations and that no warranty or guarantee is implied or expressed. We appreciate the opportunity to serve your asbestos needs, and look forward to working with you again. BEST Q FSY W M yny .1 '�Clrap�r►� Masters Environmental Inc. 44719 Alexandria Vale 760-200-2900 Indio, CA 92201 gmasters ason ic.net "ertificate of Analysis 0 PLM Asbestos Identification tE~I 714 Z799-6�60 free � �88-i'93-g598 PATR fax -1'14-M-1113E I�atriutt&tbm 10415. Plar ntia Avenue, Fallertoit, �A 928I1 Environmental Laboratory Services, lne. Masters Environmental Report Number: 781250 44719 Alexandria Vale Project Number: 2999 Indio, CA 92201 Project Name: Project Location: 51945 Ave Date Collected: 8/24/2019 Collected By: Date Received: 8/27/2019 Claim Number: Date Analyzed: 8/27/2019 PO Number: Date Reported: 8/28/2019 Number of Samples: 15 Lab/Client ID/Layer Location Material Description Color Composition (%) 781250-001 Wall 1 Drywall White 88% Non- 01 Fibrous Material 10% Cellulose 2% Glass Fibers Total Asbestos None Detected 781250-002 Wall 2 Drywall White 88% Non- 02 Fibrous Material 10% Cellulose 2% Glass Fibers Total Asbestos None Detected 781250-003 Wall Drywall white 88%Non- 03 Fibrous Material I0%6 Cellulose 2% Glass Fibers Total Asbestos None Detected 781250-004 NA Taping White 8V°Te Non- 04 fibrous Material 10% Celliilosc 2%.Glus,. Fibers Total Asbestos None Detected 781250-005 NA Taping Purple 100% Non- 05 Fibrous Material Total Asbestos None Detected 411 Page 1 of 3 Certificate of Analysis PLM Asbestos Identification Masters Environmental 44719 Alexandria Vale Indio, CA 92201 Report Number: 781250 Project Number: 2999 Project Name: Project Location: 51945 Ave w-114-84 -4900 free ° 888•hiI OW fax - 714-8"-1198 htdotla am lgml S. PI'dt`rfthla svr�lt�, t�tleitan�'Cf� 9��i Date Collected: 8/24/2019 Collected By: Date Received: 8/27/2019 Claim Number: Date Analyzed: 8/27/2019 PO Number: Date Reported: 8/28/2019 Number of Samples: 15 Lab/Client ID/Layer Location Material Description Color Composition (%) 781250-006 NA Taping Yellow 100.% Non- 06 Fibrous Material Total Asbestos None Detected 781250-007 Stucco Stucco Beige 100% Non- 07 Fibrous Material Total Asbestos None Detected 781250-008 Stucco Stucco Beige 100% Non- 08 Fibrous Material Total Asbestos None Detected 781250-009 Stucco Stucco Beige 100% Non- 09 Fibrous Material Total Asbestos None Detected 781250-010 Roof Roll Roofing Black 60% Tar 10 40% Cellulose Total Asbestos None Detected 781250-011 Roof Roll Roofing Black 50% Tar 11 30°(o Non - Fibrous Material 20% Cellulose Total Asbestos None Detected i, Page 2 of 3 Certificate of Analysis PLM Asbestos Identification tel-114-49Ci0 free Y w-743.008 tax-1,i4.819.1188 Paholtaa,com 10415. Platentia A*%t , Fdotan, (A 92831 Masters Environmental Report Number: 781250 44719 Alexandria Vale Project Number: 2999 Indio, CA 92201 Project Name: Project Location: 51945 Ave Date Collected: 8/24/2019 Collected By: Date Received: 8/27/2019 Claim Number: Date Analyzed: 8/27/2019 PO Number: Date Reported: 8/28/2019 Number of Samples: 15 Lab/Client ID/Layer Location Material Description Color Composition (%) 781250-012 Roof Roll Roofing Black 60% Tar 12 4A Cellulose Total Asbestos None Detected 781250-013 13 Total Asbestos Slab None Detected Concrete Green 100%n Non - Fibrous Material 781250-014 Slab Concrete Green 100% Non- 14 Fibrous Material Total Asbestos None Detected 781250-015 Slab Concrete Green 100% Non- 15 Fibrous Material Total Asbestos None Detected 781250-004 Sample contained drywall only. Lyn Terry - Analyst Kwin Legaspi - Approved By Bulk sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US Federal Register 40 CPR 763, Subpart F, Appendix A; EPA-600/R-93/1 16 (Method for Determination of Asbestos in Building Materials), and EPA-64(WN14-82-020 (US EPA Intv011i Method I'vr the 17etemlinati( Asbestos in Bulk Insulation Samples).Samples were analyzed using Calibrated Visual Estimations (CVES); therefore, results may not be reliable for sampler low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individual layers. This report applies only to the items tested. Results are representative the samples submitted and may not represent the entire material from which the samples were collected, "None Detected" means that no asbestos was obser in the sample. "<I %" (less than one percent) means that asbestos was observed in the sample but the concentration is below the quantifiable level of I %. Tl report was issued by a N1STINVLAP (tab Code 2011358-U) and CADOHS= ELAP(Cert. No. 2540) accredited laboratory and may not be reproduced, except full without the expressed writlon consent of Patriot Envirortrnental I.abmitory SetYices, Inc. This report may not be used to claim product Certification, app or endorsement by NIST, NVLAP, ELAP or any govemment agency. Page 3 of 3 MASTERS ENVIRONMENTAL 44719 ALEXANDRIA VALE INDIO, CA 92201 760-200-2900 Contact Phone: CHAIN OF CUSTODY Page of Lab Use Only ~� Report Number: >'rdect #: Project IVarne: Location: 51 ct 4 5 -1- & h C '? _ _ T_! � x. '�'1-0s r b3 33655 r vu-tuv-caul P-AA) i'O#: Claim #: Special instructions: Analysis -Requested Turnaround Time Flush (Same Da) Other Asbestos 24HR (specify): PCM (fiber count) NIOSH 7400A ® 48HR El PLM (bulk asbestos) EPA 600IR-93/116 72HR CARB 435 Point Count 400 Nute :-STLC/CAL WET requires a minimum of 52 hrs turnaround Point Count 1000 -TCLP requires a minimum of 22 hrs turnaround Gravimetric Reduction -Cultures require 5-7deys turnaround Lead by Flame AA Paint. Air Cassette, Dust Wipe, Waste Water, Soils, Misc. Solids EPA .3()50B17420m0d, NIOSH 7082mod Lean Waste Profile As necessary for disposal Note: Please provide at least 200-500 grams (approx.112 - i lb) followed by Flame AA of sample for necessary analyses. -nor Individual tests by reguest- 1: TTLC Total Threshold by EPA 3050B mod 2: STLC/CAL WET Title 22 CCR Ch11 Article 5 App 2 13 . 3: TCLP EPA 1311 SAMPLE # LOCATION AESCRIPTI N QUANTITY CONDITION a. (I P- W Q 7 0 Fin 'et Received By: (Print) Relinquished By: (Print) Received By: (Print) Relinquished By: (Print) o C 2 o rs 41 Przft r-fxn `4L e T-on I -.e I 7500 S (Sign) inarei z14- •s TERS ENVIRONMENTAL 9 ALE XANDRIA VALE J, CA 92201 Phone: Instructions: CHAIN OF CUSTODY Page J__ of _L Lab Use Daly Report Number: Project #: 2 Project Name: Location: 5'i g 4 5 PO#: Turnaround Time Rush (Same Dav) Claim #: Other 13 (specify): 4;3330&5 PCM (fbercouno NIOSH 7400A ® 48HR P L M (bulk asbestos) EPA 600111-931116 72HR CARB 435 Point Count 400 ® Note: -STLCICAL WET requires a minimum of 52 hrs tumaround Point Count 1000 -TCLP requires a minimum of 22 hrs tumaround Gravimetric Reduction -Cultures require 5-7 days tumaround Lead by Flame AA Paint, Air Cassette, bust Kj)e, Waste Water, Soils, Mism Solids EPA 3050817420mod, NIOSH 7082mod Lead Waste Profile followed by Flame AA As necessary for disposal Lj Note: Please provide at least 200-500 grams (approx.112 - 1 ib) of sample for necessary analyses. -or individual tests by request- 1: TTLC Total Threshold by EPA 3050B mod 2: STLC/CAL WET Title 22 CCR Chill Article 5 App 2 3: TCLP EPA 1311