HomeMy WebLinkAbout2747 WASHINGTON ST; ; CB021589; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
~ rl.()
1})\9'0\Y .•
05-31-2002 Demolition Permit Permit No: CB021589
Job Address:
Permit Type:
Parcel No:
Occupancy Group:
it Dwelling Units:
aedrooms:
?roject Title:
Building Inspection Request Line (760) 602-2725
2747 WASHINGTON ST CBAD
DEMO Full Demo: Y Status:
2031720600 Lot#: 0 Applied:
Entered By:
Reference #: Plan Approved:
0 Structure Type: Issued:
0 Bathrooms: 0 Inspect Area:
DEMO:4500SF UNITS A,B,C,D &
1800 SF HOUSE, FUTURE VILL.BY SEA
ISSUED
05/24/2002
CB
05/31/2002
05/31/2002
Owner: 8304 05/31/02 0002 01
Applicant:
ANASTASI CONSTRUCTION CO
1200 AVIATION BL VD
REDONDO BEACH CA
902278
310-376-8077
Total Fees:
Building Permit
Plumbing Fee
Other Fee
Additional Fees
$60.00
TOT AL PERMIT FEES
Inspector:
ANASTASI DEVELOPMENT COL L C
C/O BRIAN SAMUELS
1200 AVIATION BLVD #100
REDONDO BEACH CA 90278
Total Payments To Date: $0.00 Balance Due:
$0.00
$0.00
$60.00
$0.00
$60.00
CGP
$60.00
Fl NAL APPROVAL
Date: \ \ /;:J l,, J~ Clearance: ______ _
NOTICE: Please take NOTICE that approval of your project includes the 'Imposition' of fees, dedications, reservations, or other exactions hereafter collectively
referred to as 'fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any . . . hi hi f •• i h • I • •
02
60.00
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1-635 Faraday Ave., Carlsbad, CA 92008
de •
Address (include Bldg/Suite #)
Subdivision Name/Number
Assessor's Parcel # Existing Use
Description of Work bv~ ~ jA,_n:""l,·n,l;..,., vJv(+> 4rOl1.,
~CJ..ff.!\iPN (It dlffer..f.!!,U!!lm.tPetlSJ!Ui--:::::;;:......,, ..... __ ..._
;ll-,:a/h>n h /A.-tal e;f: lfa,v .ffe:,,,;-f-.,,;,,...
Name Address
SQ. ~T. #of Stories
~
.,,?...,Jc, /? e,£
City
'-""'-"'"""'-'--□ r Owner
f?/.lz ~ lfc,/...
City
RT:YOWNER
/JhAJmt i l?ld7~ Name
Hpo Ai ,&:fUb Clw
Address
FOR OFFICE USE ONLY
PLAN CHECK NoCJ[i!)Z !SB?
EST. VAL. _________ _
Plan Ck. Deposit ________ _
Validated By_.._C,_......b=--------
Oate 5:--2-?f:=(J?_
Unit No. Phase No. Total # of units
Proposed Use
a # of Bedrooms I # of Batrroams -y 'I
(/f-'k~?J' ~-~~~31.f-t9'>o/
State/Zip Telephone # Fax #
vt 'µ,),).J f/D -£?tr fq7)
State/Zip Telephone #
h qo<7)JJ 51v :n" . .,An 2
State/Zip Telephone#
6 CONTRACT,QR • COMPA~1~AmMu.-....,; _______ _
(Sec. 7031 .5 Business and Professions Code: Any City or County which requir.i,{aZ t to construct, alter, improve, demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed state""nt that he is licensed pursuant to the provisions of the Contractor's License Law
[Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the aileged
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 ($5001).
/}o4S171:fJ C:>ry~~ 4, ),¼~/h.l,~Jg),1-r,I M.../4 /4'...t; t'4-f.•c>-).1 5JP -:J7 t -./J07")
Name Address City State/Zip ~e~ephone #
St ate License # cQCj 1 0 q 5 License Class /] City Business License # s~\
Address City State/Zip Telephone
8,
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain e certificate of consent to self-insure for workers' compensation as provided 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, as required by Section 3700 of the Labor Code, for the performance of the w ork for which this permit is
issued. My worker's compensation insurance carrier and policy number are:
Insurance Company S'rtJ:r]q i;:YAI D Policy No. '?'/,,--//Jd 2 -Jt:i, Expiration Date 0 /Ip I /ot? :s
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS)
0 CERTIFICATE OF EX~MPTION: 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 Workers' Compensation Laws of California.
WARNING: Failure to H cure work '
thousand d
verege 11 unlawful, end shell 1ubject en employer to criminal penalties and civil fines up to one hundred
naetion, damages ea provided for In Section 3706 of the. LabJ' ~od,. interest and attorney's fees.
~~~~~~~~~~~=-======;;:::::=::--:;;-:;::::;:::;-DATE S:/~.?fa.et
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
0 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does
such work himself or through his own employees, provided that such 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 did not build or improve for the purpose of sale).
0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License Law).
0 I am exempt under Sectlon ______ Business and Professions Code for this reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO
2. I (have / have not) signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number):
4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number): ______________________________________________ _
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (Include name / address / phone number / type
of work):. ________________ ~----------------------------------------
PROPERTY OWNER SIGNA T DATE __________ _
COJi,PLETI! HIS SE.c.JION F IDEN17AUY1
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25605, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO
Is the facility to be constructed within 1,000 feet of the outer bo~ndary of a school site? 0 YES O NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
8 QlillfilJCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
I certify that I have read the application and state that the above information is correct and that the information on the plans Is accurate. I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit\' of Carlsbad to enter upon the above mentioned
property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES,
JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit is required for excavations over 5•0-deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the building Official under the provisions of this Code shall expire by llmitation and become null and void if the building or work
authorized by such permit Is not commenced within 180 days from the da of such permit or if the building or work authorized by such permit is suspended or abandoned
at any time after the work Is commenced for a period of ys (Se .4.4 Uniform Building Code). _ L _ L
~APPLICANT'S SIGNATURE XJ~~~~~--=f:t.2t:t:&J.~~:____________ DATE -.) 0J:/P2
WHITE: File YELLOW: Applicant PINK: Finance
l l-O< -1897 JS:44
NOTIFICATION OF DE MOLITION AND RE NOV ATlON
oscmar • oti 1canon 1r
I. TV t of no tl ncatlon O-Ori inal R•Revised C-Cancelled •
2. Facllit Information
Other o trator:
i :
6. p
7. Approxlmatt amouJlt ot
ubfft09 material:
11. RejU.la.t.ed ACM to be removed
b. Ca~10tY I ACM noc removed
c. Cat.e o II ACM not removed
?i s
Vol RACM off 'F ant
8. Schtdultd datH ubutos removal
9. Schtdultd dates dtm~renovatlon
ZI :
lpproprllt.e, UNd to MtKt th• pl"Ntftct ol ~ JMWla.l:
RACM
to 'be
removed
Non!rla.ble Albe.UC. -
MatuW nO( IO ti.a iwnoYfld
--0 0-Com lete:
s Wt:
FIG URE 3
M•X-12
Com loi.o:
lndl ca.10 U l\il O (
~tB~low
Unit
c.'-3
NOTIFICA, IO N OF DEMOLITION AND RE~vV AT ION (continued)
tO:-DescnptJoa or planntd demolldoo or renovatloa work, and metbod(.s) to b• 1.1.Wd:
l I. Des,crlprlon of work practlcu & tnil.nHrina coolrol, to be wad to pr,vei:>f ,mwloa.1 of ub~tot at tb, d,moli tloo 1 and renovation site; /
c(!J vt 1 ~ 1 '2=> ,
12.
~ame:
Waste Tra
Name:
Address:
Cil : St.at.e: Zi:
Tele hone #:
13. Watte
Nam t:
Cit :
ontac,
14 , Ir molltlo" 01'
Nam
AuthOrit :
Descri
Exp on o how e event e cond.itJons, or would caw, t1qijjprMnt {WTl.lst Of''-" ~le financi.a.J
burdtn:
16. D•~rlpUon ol proodurtt to be ollowed In Utt tvtot ttllt unup«ted 1Jbfttoe I.I ound or prtv!.o1.Uly onfl'U'bl"'
ubuto. material Me<>n11• crumbled, p-.lYerlud. or reductd to po-wd•"·
18. I ctrtlfy 1b11 tbe above lnlorrutJoa ~~~ ~-/ cf'-C (.__
SI nal re of Owne r O rater) (De.te)
FIGURE 3
M·X• l 3
CUtNT:
€~¥!6P~E~fr:rw.~,~~i.~Jg~i-:~:i.:c~
~75~TH FAX &04-•21~7'
Fedo ::..LC
427 E.ut 17th 8tnet~2t 7
Co.;tll MH.t., CA ~2627
DAT£ OF ~c«l~: 26 MA.112002
OATE OF A"'I\LY81S: 28 MAR 2002
DAT!: 01' ~IPO~: 28 MA.It 2002
CU!WT HUMBIIUt
f':HS "lltOJECT #:
wue A
o~.02.300.-4
PROJl!CT:
eH.S
SAMPLE.
o,
O?.
03
04
()5
06
07
09
l l)
1lA
Anastasi; 2141 A, B. C. D: Wuhington St., CA rl9bn rl
CLl~NT S.AA1PLE !II
LABO,V.TORY GBO§I D,£_5
01/
Wb1t11 Powder; f'1b.
02/
\1/hite 'Powd,w, Fih.
03/
White Powd>tr: fib.
0 4/
W'hit~ Powder; Fib.
051
W'h1t. Powder; Ftb.
06/
White Powder
07/
W}ute f'awder: Btown Fib,
08/
White Powd~r; Brown Fib.
Q<'!/
V/hitl'I ?o...,.der
lOi
Whu Powd er; Bto~ri Fib.
l l<a),Li11.oleum/
v~lto\.\' LiMl<tll'C'I'\; Croy f'ib.
3¾ Chrysotile
3% Tot.al Ashea·
3% Chrysot.ile
a•-i Total Asbealo:;i
3% Chry9ou1e
3% Tota! A~b()ntoi:,
3% Chryantile
3% Total A~be:ito:i
3°.<, Chry30tllt
3a{, Tot~I Asbu ros
Ttace. <I¾ ChrysoLdt
<l½ Total A:,.beJlc:i
Trace, <l¾ Cb rylK>tilt! * 1.0•~ C~ilul,...1,...,
<l~i Total A.hetto• 00% l'Jon-F'il.:rou,;
* 2% chrysotilc JlTP.9<'nt tn joint compounr.! like
mlltuia!.
'T'l-,icc. <l'½ Chr:;ootil~ +
<1'4 Total Asbe.itct
'rrMe, <1% Chryso~1lc
<1•1, Tot.Iii J\i;butoi;
i O~ Cf'lluJ..,y
9O•4..'on F'ih,,u<
Tur.I':, -<l½ Chryaotile -. 10% c ~11ulo~~
<1% 'Tor &! A~bMtoS 90% \':,:,.f1\n:,u,;
1r Trnce. chry11otil<> pr~sent in 101nt ~:.,mpound,l1\i.i,
t'n~tet:til.
NAO
.,PAOE 01af03·-
20% Ccll:;b•~
1C% f b r-,u\ G•(\~
'10% i..:o-.. r ·:,r,'u,
ENVIRONMENTAL. HAZARDS SERVICES! L.L.C.
CUENT NUM8f!R· '-Uh A
EHS PROJECT #: 03-0i•~
PROJECT: Anat1!14loi; 2747 A, :S, C. I'.>: Wu hlng1,0n. St.: Cul,b~d
t!._.S CLl!HT IAMPLI fl %ASIUTO$ OTI-fEj\l! MATE-..i~.S
MMe~-• ~QUIAIX illQH Quall'IIQN
t l B t l(b)•Mutio/ .1" Cbryaot.ile 9'N Non •Fibro,~
Black Adl,,ci. S% TotaJ A8~to,
12 121 S'AD 100-% Ncn-?1b:m1~
GrayGu.x,..
I 3 13/ J-,;A.D 100•~ Non-F,brou~
Grsy Oru1.
l -t L4/ NAD 100"0 1'-"on-r'i"i:-r•"a~
Grny Gran.
15 l 5/ NAD 10'½ f ,broul Gl.iss
Bbelc Tar-Lile• M% ;\",:,n-Fibrou.➔
16 16/ NAO 10~ Fibro,,~ G\~~s
Slack 1'Ar-1Jk.t 90% ~-)n-F·.bro·J~
17 l 7/ _:\;AI) 10~-~ Pibroll~ f. lasl;
Black 'l'tr-Lilte 90¾ ~:)1-..F•\-~c,•J~
]8 18/ N.-\D I 00% t,on-f;c-rou~
OrayGNlr'I.
19 19/ NA.D 100% :--ion r ,bro-is
Cray G,al\.
QC BLMIK:
RE~TING Ullti: 1½ At;br.stoe
MF.THOD: Polarit.ed Li«ht Mitro~opy, EPA '.\frthod WOIR-9311 16 ~
~AL. YST: F'eni: Jian~, M.S.
~<1 .t/2C lt,i~w-d l!y Authofbtt!td 6i;r,1tory: --
' Houxml. v'cv1w , l4l>Mt11.0f)' D1rfc:o,
r --r·•
Jrma Faa.twtlt/, Q11al,ry ,t crnrcin.l'T. Cmrd 1,iator
J)auid Xu, MS. ~"i4r Che/t\i8t
F,"I J14"¥, MS. ~11ior OH>IQi<itt
Mkho,il A Mu;l/er. Qvraht:, t\•JIITOl"I-<' ,JJ,,,~er
,,-le '
l=AX: 80427S71,JS
ENVIRONMENTAL HAZARDS SERVICES, l..L.C.
Cl.lEMT NUMB£R:
fSH3 ,-."().,IECT t :
PROJIIC"t;
&-61~ A
oa.02.3064
Anuua&I; 2H7 A, 8. C, O; Wu11rn,.rton S~.: C1.1r lsbad
Rv.5ul!.s ~, ~~ enal~ of~ ait>n'!tflbd br IN! client. s11n1pie ll>Ca~I". oMClfptio,"\, att-a, \'Ol•.,me. me .. wu pre"'6,(; ':ly
11'),$ '1ient. Thlt (rtpoft ~nriot be YMd by ... ~ tr, elalm pro<illd ~t by N',11.AP Of ¥1'( "9MC)' of t:'» \.I.S GC\,,orrroeN
Thi& Ntp'.)11 tha/I fl(lt b4I ~ix:ied IW'..e()t 11'1 ti.Ill, ~~ ~ ~ ~!'It or f~"""11tMI H~ ~ I...LC. ~
C..~n #2319 NY l!W :rnn,. IJ ~ ~~ Mffl~ ~. ti~M, 11/'ld titM °'n t>!l b.lr'ld O'l ~In-Ct·
Cunxiy. El'Hil'On~I He.tard!s ~-LL. C. tic," not perfom\ any ~ ~.
Envlmnl"MM!II HQarda s.Molll L.L.C. leOOm!'Nrl~ ~"81')1$.it t;y po~t oour,t (/er mor• ~.uN!tO quii~n) or ·~,.,t m,uJOn
Etttetron Mi<:ro.~i,y (TE~). for ittll'tencta di!,~, ctpilbilltW)g) fot ~1$ "'QUIA\nd by ~ EPA NESHAP (l',l.!lbCll!~I E'!'I•~"
Standlll'dt for Haurtous AJr Pobutanta) sod found to 00t1tll~ lttAG ll'\an tMI ~<!If!!. (<10¾) ~a ey OOlt,/1..ttod llq'll ,,.cro~pv
(PLM). 8oth flCNicM ere 11vefl111:M for~,, addition•' 1".
• All C11Ufomia ~m~I .. •na!yzttd by Pot,ritod L,Oht M1CtO$¢Opy, t;PA Mttthoo ~OtM+IIZ...020. Dec, 1~1.
1-!Gf:MO NAO " no aa'"'G.ato~ ~lld
------S_C~F-•-§IJJW~WDi~fi~tLL---~-------------------plrr, ~ rioL'07 JAN2002.i dpb
-PAGE 03 c,f 03 -ENO OF Rl!!PORT -
JJ-04-1997 JS :44 c.02
NOTIFICATION OF DEMOLITION AND RENOVATION
JCCt #
I. Tv tor not lncalfon O-Ori inal R•Revi,ed C-Cance lled :
Other o erator:
i :
5.
?rese
6. p
I?)
,. Appl't)Xlmate lfflOllllt ot
ubtstot mattrlal:
11. RejUJaud ACM to be removed
b. Cattaory I ACM l'IO( remOY'ed
c, Cm o Ir ACM no< removed
Pi s
RACM
to be
l'ffllOved
8. Sch.dul~ datM ubutos removal mm
9. Schedultd dares dtmolrenovatlon
Non/ruble A&be.slot .
Mat.erW l\0t tO bt removed
s wt:
FIGURE 3
M-X-1 2
CllU
Com lete:
Zi:
I.ndl C!UCI U n.1 l O [
~tB~IOW
~OTIFIC ...... ION OF DEM OLIT ION AND R£r,hJV ATION (continued)
10. Des.criptJon or planned dtmolf tjoo or r.enovatloo work, and mttbod(1) to b• Ubltd:
11. 0ts(rlptloo of work practices & enalJ1eerlna control& to be u.ud to puveiH •m~oas or .ubestO\I it uu d•molitloo
and reoovatlon tlte:
Name:
Cont.act ?er.;on:
Was te Trans orttr '2:
Name:
Address:
Cit : Zi
Tele hone Ir.
13 . Wute 0
Name :
Nam
Authorit :
Exp o ow o tvent unsa!e condition&, or would cause eq~l:prM,nt (IAmaJt or M ur.muon.a.ble financUI.I
burden:
16. D«J(rlption ol proctdurtt to be ollowtd In th• neot llut unupf(t.td ub4tlOl.1J ou.nd or pNvl.ot.llly aoofr\.Qb lc
ubtsto. mat.rial bffom .. crumbled, p1alvwlud. or reduc.td to powder.
FIGURE 3
M·X· t 3
lO
t;-/8-<J 2_
Date
Cllf.NT;
ENVlf!ONMENTAL HAZARDS SERVICES, L.L.C. -1• WAI, I Pl'IU Nbib . ilieRMbWb, VJ !!bSt
80447S◄7U ,AX 10f.2'TI....Of
IULK MICIIQI 161P~ MAl.YI& FNMW
t•doU,C
427 4Ut 17th Streclt #217
C~ta Mesa, CA 92S27
O.ATI Of RECEIP'T: 26 MAR 2002
DATE OF AMA.l.'f81S: 28 MAR i oo2
r>Aft OF REPORT· 2S MM 2002
CLIENT NUMIIER:
~HS PROJECT J:
S.~lSi A
03--02-3068
PflOJl!C'T:
EHS
$,WPl.iL
01
0~
0:)
0'!
05
06
07
08
09A
09B
09(;
A.nar.&.111i Dev ; a747 Wuhin,u>n; Carlabad, CA
CLIENT 5AM~LE tM -r. A~BESTOS
LASORATQf!:! OPJPH QElCf!f PTIQN
01/
Mute Brit,le; 8eif t Gun.
O'lJ
Whitt Briti:le: &ire Gun
03/
vY'hir.. Btit1,le, B♦i&• Gran.
04/
Black Tar-Uk&
0!!11
Black Tar•l.ike
06/
Bl•c'k Tu,Lilct
07/
Gray ~me-otitious
oa.,
WMte Cnal'11ty
09(a}•Llool•um ti
Bei,:e LiMltum: Tan Fib
09(b)•Muhc I/
Wh.lte Adhe.s.
09(c),I.Jnole~m 11/
Bei,e Linole-t1111; Tan Fib.
K._D
NAD
NAO
NAO
NAD
NAD
20~ Chryaottle
20¾ Total A.be,toe
2% Chry90tlle
2% Tot.al A11'be&to~
NAD
10'¼ Ch:-y.,:oti}g
20% 'fotal A1bettos
-PAGE 01 of 02 -
OTH~R MATERIALS
100¾ :--:or.-F ibrrJ11s
100% Nun-f 1brou1
40% Cellu \o,e
l 0°1o Fibrous GI.us
SO¼ Scn-Fibrow
•O¼ Cell ufose
10% Fibrous Glu e
~0'¼ Non FibrolJ!\
4Q•4 Coliu lose
10¾ 'fibrous Glu~
50% Non•P1brou:\
25% Ct lll .. lc~
I 5% F1b rou& Ola.u
60¾ '-'on-P\bro1H
5~\ C4llulo,~
75% :-:on -F'trtr('11s
FILE No .1:,8 03128 '02 1~ :46 fD ;EHS
ENVIRONMENTAL HAZARDS SERVICES, L.L.C.
CL.la.IT NUM81Eft: 5-5.l!t A
£HI PROJECT f ; 03,02•3068
P~OJECT: Anutui Dev.; 2747 Washin,ton: Carla~ad, CA
CLIENT SMf Pl.E II .,,. A.6tleaTDa OTH!R MATE!t~S
J.MQM(OftY QPIQH..Q~CBleJIQN
09D 09(d)-Mutie Tl/ 2% Chryaotile * 98¾ Non-Fibro11~
Yellow A4het.. 2% To~I Asbutt>t
• Pouibla l!ont.am1nation from flbro\.1$ back.in~
09E
09f'
09(a)-Lin4ltum Ill/
Crun Linoleumi Bladt Fib
09(O-Manic lll/
Brown Adhes.
QC S~PlE.
REPOlltftNC LtNIT:
NA.D
Ml 1992·2
SRM l868 Fiberi:lass
251~ Cellul~e
10~ SynthQtlC
Mo/e t\'on,Fibrcu.1
100% ~on-Ftbrous
METHO0:
AH.Al. VST:
Polarh.od Lirht M.itro~opy. EPA Method 600/R-93.'l 16 •
M,liua Beus
R•vltw•d ly AuthorlHd Sigl'lator;: ~ '~
Houxud VcrMr, J.abotatory Director
Irmo Po,mwlki, QiuaJuy .41tl4t an« O:>crd.1r.aJor
Dauid Xu.. MS, S.nio, c~,,,,.,
F#"I Jiofl#, },,($, S,nibf-<Aolo/i,11
Ml,c~/ A M~l~r. Quality A.m mv.ct M~,
Ao$1Jlb r•preMnt ttle 1n1ry111, o, M!r"p!M wbm~ by tht ollent. Sampif ~-delet11f.'On, ,,..a, volum.. Qllc .. ..wi. orovidPC tlv
IM dient. Thlt f9PQl1 cenno1 t>t UMd by tho client IO Claiffl prOduct tnoors.rnent by NVI...AP or any age~y of tM u S Goi,emr,e~
Th,s ~port shill no\ be rep~ ..xoepl In ruu, without tr-.. wn1ltn 001\$.,,I or El'lyj~"'"l'IIIII Hau~ 9trnott, L L.C. CaHorr1a
Certlfatic:ln t2319 NY El.AP #1171-4. All lnlofm1tjgn conc.mlr,o ~mpllng IOC.l!llori, oat.e. and time can bP. found o'\ Chalf'H)I
Cust,;idy. Er,vironmental Hazards 5en,ice.,, u .. C. doe, rot o.mirrn an~ !..lmpt• colledlon.
El'l11ironm6"1tal 1-ianroa ~""""· L.L.C nK;Omffljtn<fs fM1'18lytlt by pc,int count (for mort 9CCV?t• qu.-ntfficabo'1) or Tra1'srr,s,;,ol'I
El~n Mief<aco())' (TEM). for entlan<»CS det~11 capllbUiliN) lor rn1terlala regulattd by the EPA NESHA~ (N:itJcf'al Et111M•M
SU1nd11n1s for Hau,doua .Air ~014Ulal'lta} 1t1d to1,1nd to contain less than 18"1 pe~nt (<10%) 1itlKtos by pol111iz.a IIQ~t micros :opy
(l'LM). &th .. rvicaa are avail•* rnr •n addi110l'l1I f••·
• All California ,amptH anal)Ud 'by Potarttftd Light t,A1CJ'MCOpy, EPA Me!Nld &()0~4-82-020, Cec. 1962.
U:0iM0 NAO ,. no ati.toa d~•<Ud
_____ _.s .. C ... f-•_,.,.,1l~&ed c:tetall\i.ell..JftQt.._...,!,1.__ ___________________ ~----
plfTl1.doVO?' JAN2002/ MR
-PAOI 02 of 02 .. ENO OF PIEPOftT -
. .
. PIN.&ti p~nt or~~ ' . •. • . _ (Form de•lgned ~ tiM on 111119 (12,,pftth)iypeW1119r)
NON-HAZARDOUS 1~2°1,t · I
----
11. Generator's US EPA ID No. 2. Page 1
WASTE MANIFEST ~~ lllgUtt6d. . t of l
J 3. Generator'!Na~and Mailing Af dress ., SITE: Anast.as ~--'1.747 washingtcn Street 1200 Aviation Blvd. Redondo Beach, CA -Unite a,b,c,d.
4. Generator's Phone ( 310 ) 386-8077 car1abad, CA
5. Transporter 1 Company Name 6. US EPA ID Number A. Transporter's Phone
/ s & R Services, lnc. CC A L O O O I 1 s 6 l 2 (7 14)375-774~
7. Transporter 2 Company Name 8. US EPA ID Number B. Transporter's Phone
I
: 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone
I La Paz County Landfill
26999 HiefrMy 9S, Mile Pallt 128
A ZC 9 n ~ AZ 85344 5 0 8 2 3-l l 1-( 52fJ~'i. 45 .58 .
11. Waste Shipping Name and Description 12. Containers 13. 14. Total Uni!
I No. Type Quantity WWol ~ a.
\ _ _) \ .f, r' \ r··x•··' • 1J. /· I(:;' . ' Non Frinblc Asbestos --~ •. l :· .. J I ·. G b.
E
: N
E
t R
A C. T
1·
0 R
d. ·, ~ rt D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above .,.
~!' N
~1.,
l~t 15. Special Handling Instructions and Additional Information
Non Hazardous Ii'. Profile No. NF O O t 6 Awit1Hmittringdu1ct. i
Emel~Cfflbct: EIDC!lamcyno:
DOT P 5800.5 GDido 171 ' ' Region lX/SCAQMD -2186SE. Copley Dr.,D:iamond Bar, CA 91763/ADEQ
,. ~-r,, .. 1'-1 '2n 'l'2 l..l ~--..1 .A.•--. A 7 R.c.ts 1 ? -A Trhl • T,..l...,. ~A:arti nu
. 16. GENERl'rO R'S°tERTif:ICATION: I ccrtiJy the materials described above on this manife!il-er,e Ji.subject to federal regulations for reporting proper disposal of Hazardous Waste
'/I' Pri~~d/Ty~!l(I Nj,r, IVS r,'/',·1 +, r { ;,: .,r r,,; ( r ,:. I Signt;!Ji ~~'--
Month Day Yesr ,; ,. /.·./.....} ·(' I// l· J, ln7 ....... 1 ' . 1. : I.I;
' T 17. Transporter _1 Acknowledgement of Receipt of Materials / R Printed/Ty~ Name I I
I Signature \ -. 1 / A \ , Month Day Year N ,: ' I f ·,. ' I I ,, ·-; , , . ·",.. s ·, p
18. Transport~r :1' Acknowledgement of Receipt of Materials '----· -0 R I Signature T Printed/Typed Name Month I Day Year E I I R
19. Discrepancy Indication Space
F A
C f
L 20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19. I
T y Printed/Typed Name I Signature Month Day Year
I I I
Printed by J. J. KELLER & ASSOCIATES, INC.
Neenah, WI s.495'7--0368 GENERATOR'S COPY
12-BLS-C5 Rev. 12/98
..
• PleanpnhlO(~· • , -
' (Form d(:afgned .or use ori e)lit (fa-pRoh) lypeM!ter)
NON-HAZARDOUS
l M?~2:~ I
--
1
1. Generator's US I PA ID No. 2, Page 1
WASTE MANIFEST Not Requ red . 0. . . . . . . . . .
I 3. Generator's Name and Malling Address SITE: ~ Anastasi Const.ruction Onit~s a b,c,d. . i\~~~~ B~ggJql 380 stiansen Way
4. Generator's Phone ( 110 ) 376-8077 Carlsba , CA
5. Transporter 1 Company Name 6. US EPA ID Number A, Transporter's Phone
S & R ServiceN .. Inc. C IA.L . 0 . 0 . 0 . l . 1 . 5 . 6 . l 2 (7 14)37:5-7748
7. Transporter 2 Company Name 8, US EPA ID Number B, Transporter's Phone
I
9. Designated Facility Name and Site Address 10. US EPA 10 Number C. Facility's Phone
La Paz County Landfill
26999 Highway9', Mtle Potlt 121'
A Y,C -. A.7 OC:'lAA 95 0 8 2 3 .} -1 -1 t5W)6(,9-4 5~ W .
11, Waste Shipping Name and Description 12, Containers 13. 14,
Total Unit No. Type Quantity WWol
a,
,:, . ·/ <J / ; ,,.. ',. ;1··, . .'/ •~./ Non Fri,able A~bestos :' ' • ., \ • I . -/
G b,
E
N
E
R
A C,
T
0
R . d.
D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above
.
15. Special Handling Instructions and Additional Information
Non Hazardous
Profile No. NF O O l 6 Avoid Ilre.lthN:tg W-'ll.
. F.meramc,~ ~DO:
DOT P 5800.5 Guide 171
Rogion lX.ISCAQMD -2 1865 E. Copley Dr., Diamond Bur. CA 91763/ADEQ
.. • .--••-~h-• -:21\'l~ -,.,y , .1 A -·--• A7 R~)l? _ AT'rl'J• Jnhn '" -·,.~
16.~GENE~ATOR'S CEITTfFiCATfON:-I ;,rtiry the materials described ebove on this maJ>i/.est-.,J ~ not subjecUo led!lral regulations for reporting proper disposal or Hazardous Waste.
Printedfr'Jiped Name,lf:") /1 ·,,..,_' 1< ,,. (·'::,,-.1'1/& 't ,;:
I Stn,tli'ur ~/2~~ Monti> Day Year
'
• , . . /. I {r : ~ )(, lrrl , )1 ,\ i I ! ...... , f1/ ,/; · (__,.-, I II ' /" '
T r'1 Acknowledgement of Receipt of Materials
,_, • ' / 17. Transport, R I Signature l , A Printedrry ~ltl Name . \_ Month Day Year N \ --·\. ! -ll ; I. I . I . __ ,,,,. ..... s .. •. '-.,( p -.. 0 18. Transporter 2 Acknowledgement of Receipt of Materials R
I Signature T Printed/Typed Name Month Day Year E I · I . I R
19. Discrepancy Indication Space
F
A
C
f
L 20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19. I
T y
Printed/Typed Name I Signature Month Day Year
I I I
Prlntod by J. J. KELLER & ASSOCIATES, INC.
Neenah, WI 54957·0368 GENERATOR'S COPY
12-BLS-CS Rev. 12/98
~
rHl\•OV'-ICfO(J.LJO
ENVIRONMENTAL HAZARDS SERVICES, L.L.C.
tai WAffE PINI NbXb -NiekidNb, vi mst
I04-21M7U FAX 804-27Mt01
BULK ASBESTOS SAMPLE ANALYSIS §YMMMY
Fedo U.C
427 Eaet 17th Street #217
Co•ta Meaa, CA 92627
DATI OF RECEIPT: 12 APR 2002
DATE OF ANALYSIS; 15 APR 2002
DATe OF REPORT: 15 APR 2002
c::; UN-Y-UMBER: S..5139 A
~ti$ PR(ECT #: 04-02-1680
p~~t:Cl Anutasi; 4120 Harri&0n St.: Carlsbad, CA
£:!I-IS CLIENT SAMPLE #I •.4 ASBESTOS OTHER MATERIALS
SAMPLE! LABORATORY GROSS DESCRIPTION -
otA 01 {a)-White Linoleum/ NAD 20¾ Cellulose
White Linoleum; White Fib. 80% Non-FihTous
01B 01 (b)-Tan Linoleum/ NAO 20% Cel!ulose
Tan Linoleum; Black Fib. 80% Non-Fibrous
0 2 021 NAD 30% Cellulose
White _Powder; Brown Fib. 70% Non-Fibrous
03 03/ NAD 30% Cellulose
White Powder; Brown Fib. 70% Non-Fibrous
04 04/ NAD 30% Cellulose
White Powder; Brown Fib. 70% Non-Fibrous
05 05/ NAD 100% Non-Fibrous
White Powder
06 06/
White Powdel'
NAD 100% Non-Fibrous
0 1 07/ NAD 100% Non-Fibrous
Whi~Powder
OB 08/ NAD 30% Cellulose
Brown/Red Linoleum; Black Fib. 70% Non-Fibrous
09 09/ NAD 40% Celluio$e
Beige Linoleum: Black Fib. 60¾ Non-Fibrous
10 10/ NAD 100¾ Non-Fibrous
White Powder
11 11/ NAD 95% Fibrous Gla:3s Brown Fib. 5% Non. Fibrous
12 12/ NAD 90% Cellulose
BIAek Fib,; Black Rubbery 10% Noo-Fibrous
•• PAGE 01 of 02 -
****LESS THA N 100 SQUARE FEET OF ASBE STOS CO NTAINING BUILDING MATERIALS .****
NO SCAQMD FILING REQUIRED.
I l \-,1.... l 'tV •VVV v .... , L .J V C. J..V •VV JU "'-1 IV I H /, •<...•\.'"-+C...f ...)1 ..L"-+v
ENVIRONMENTAL HAZARDS SERVICES, L.L.C.
CL1ENT NUMBER: S-.Sl39 A
04-02,1680 EHS PROJECT #:
PROJ~CT: Anaatasi; 4120 Harrison St.; Carlsbad, CA
CLIENT SAMPLE #I % A.59!:STOS EHS
SAMPLE# LABORATORY GROSS DESCRIPTION
13
14
15
16
17
13/
Black Tar-Like
14/
Black Tar-Like
15/
Black 'far-Like
16/
Black Tar-Like
17/
Black Tar-Like
QCSAMPLf;
QC BLANK:
Rl!PO~TING LIMrT :
NAD
NAD
NAD
NAD
NAD
M2-1994-2
SRM 1866 Fiberrlass
1% Asbe6tos
OTHER MATERIALS
400,(, Cellulosa
20% Fibroua Glass
40% Non-Fibrous
40% Cellulose
20% Fibrous Glas,
40% Non -Fibrous
30% Cellulose
70% Non-FibrQus
30% Cellulo9e
70% Non-Fibrous
20% Cellulo~c
80% Non-Fibrous
METHOD: Polarized Light Microacopy, EPA Method 600/R-93/116 •
ANALYST: Feng Jiang, M.S.
Reviewed By Authorized Signatory: ~ ~Y.->
Howard Varn.tr, LaborGU,ry Direct.or
Irmo Fo.r.u1.1.11lti, Quality AuuratJU CoordiNllor
David Xu, MS. Senior Clwmi.et
Fef\g Jiang, MS, Senior G,o/ogi.at
Mie~l A. Muell,r, Quality At&ur41\Ce Ma.nager
...:,
Resutt.s represent tile aMlysis of sampK's submitled by the client sample location, description. art'&. volume, etc •. was provid~ by
the client. This report eaMot be used by IN client to claim product endorsement by NVW or any agency of the U.S. Govemment,
This report shall not be reproduced except In f\111, witho11t lhe written consent of Environmental Hazards S.Nices. L.L.C. Califomi,
Certification #231Q NY E~P #11714. All information cone.ming sampling location. date, and Uma can be found on Chain-of-
Cu&lody. Environmental Hazards S.Nicas. L.L.C. does not perform any sample collectiOn.
Environmental Hazards Services. LL.C. recommends reanalysis by poir,I count (for more aceurate quonlfflcation) or Transrnlss1on
Electron Microscopy (TEM), for enhanced detec:1Jon capabilities) for matanala regulated by 1t)e EPA NESHAP (National Emission
Standard& for Hazardous Air PoUwnt.s) end found to contain le~ thl!ln ten percent (<10%,) asbestos by polari?ed light microscocy
(PLM). Both services are available for en additional tee.
* All California nmples analyzed by Pol~rized Light Micro1copy. EPA Melhod 600/M4-82-020, Dec. 1982.
LEGiND NAD .. no asbestos detected
SCF = •uspected ceramjc f}bef§
plm1 .dot/07J"N2002/ pd
.. PAGE 02 of 02 -ENO OF REPORT -
From:
To:
Date:
Debbie Fountain
Mike Peterson
5/16/02 11 :55AM
Subject: Demolition Permit for buildings on Christiansen and Washington
Hi Mike. I received a call from Aaron Galaudet with Anastassi Development. He will be submitting a permit
for demolition of several buildings on Christiansen and Washington. This e-mail is forwarded to you to
confirm that the Housing and Redevelopment Department has determined that the subject demolition
activity is exempt from the redevelopment/coastal development permit requirements in the Village
Redevelopment Area. Therefore, Mr. Galaudet may be permitted to obtain his demolition permit from the
Building Department.
The building addresses for the subject demolition permit include the following: 380 Christiansen, 370 A, B,
C ChristiansenL?747_Washington, and 2247 A, B, C, D Washington.
If you have any questions, give me a call at X2935. Thanks.
CC: Lori Rosenstein
-§C. BC! '2 1 J 8 3 -":67e> C-hrz~l(di:!U:y-
c e,crc .. 1 5' '7 I -3 E3CJ C?t v6 ~td. i 1Sf n 7 _
C ~c___.. t s-Ber 2-. 7 q 7 tJ a.sh,""J lo, J /!o-,/SL 5 (I VI' tf s
5-30-02; 10 :22AM;SEMPAA E NEAOY ;7130 438 6280 # 2 / 2
. . ,..
·SDffE
A~SempraEMrgy·comp.ny NOTICE OF SERVICE DISCONTJNUANCE
PERMITDEPARTM'ENT ~ rl/Ab·~ CITY OR .corn~ OP ·-__,;,,Ul."'""""-'-~-~....r:..a.-~'Ul&.-...:..= ______ ---:-_--.:... __ _ . . ~e .
. ELECTRIC ANDl6R.GAS SERVIC WILL 8:E DISCONflNlJED
TO 67D ·+ <!> -·n5ti
!;M· El~-. t:/2, /oJ • 6a5.
DATE
TIUS BUILDING CAN BE MOVED OR RAZED AFfER THE ABOVE DATE
BY--+,:~~~~~~~~~~~~~--,----::--~~-r---=---r-~....------
.L...!..:..,l"-4~i,;::--~:a,...£...l--_l,£,.~=_;__---· PHONE q(d) -••
FORM lll6-0l1S2 (0221121 MlO
11~S~mp~aEnergy·-NOTICE OF SERVICE DISCONTINUANCE
PERMIT DEPARTM'ENT C a.rl &.b{UL .
CITY 0R .C01:JU1'Y OF • ~ ·"U . . · .. VJe)'l
ELE
·DATE
THIS BUil,DJNG CAN BE MOVED _9R RAZED AFTER THE ABOVE.DATE
.,
BUILDING PERMIT APPLICATION
Permit No. ~2 . 1 City of CARLSBAD, CALIFORNIA 92008
Applicant to complete nJrnbered spaces only. Phone 7 29-1181
JOB A00fll lE.SS 0 '-
~ 0
2747 Was.:u.ngton Street z !II
"' > LOT NO. Im I TUC~Ol-172-06
]l 0
LCGAL I Qscc ATTACHED SHCCT> 0 1 DUC~. ]l "' OWNCfll ~AIL AODfllCSS ZIP PHONC "' "' 2 Wayne Wright.
'""'.) CONTtltACTOfll MAIL AOOflllE.95 PHONC LICENSE NO. ~ 3 lton • • co. 729-2034
Afll:CHITECT Ofll DCSIC.:NCIIII MAIL ADDRESS PHON [ LICCNSC NO.
4 r,
ENGINEtfll MAIL AOOflllCSS PHONE LICCNSC NO. I~' 5 ,,, .
LENDCIII MAIL ADOfll:£55 IUIANCH r 6
USE 0,. 8UIL01NG !,
7
:~
8 Class of work: ~NEW 0 ADDITION 0 ALTERATION 0 REP.Ali □MOVE 0 REMOVE -I:'
~
IJ 9 Describe work:
'·· 4-hi t apart.men t. .
10 Change of use from
Change of use to
11 Valuation of work : $ 39,332.80 PLAN CHECK FEE ~ I PERMIT FEE s201.oo
SPECIAL CONDITIONS: Type of Occupancy
Const. F Group Division
Size of Bldg. 3224 N o. of 2 Max.
(Total) Sq. Ft. Stories 0cc. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Zone Zone R-3 Required OYes □No . I OFFSTREET PARKING SPACES:
i,,~ I ,c -, N o. of I U ncovered Dwelling Units ' Covered
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB· ZONING
ING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF FIRE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T HIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISION S OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE G RANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFOf'tMANCE OF CONSTRUCTION . • .. 1 , ,y
SIGNATV"l 0~ COf,ITIIIACTOIII Oflt AUTHONIZlD AGENT (DA.TEI
.... :
51GNATUfU: o, OWNtft: 1, OWN[.111 BUI LOtlll) DATE)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERM IT VALIDATION CK. M.O. CASH
INSPECTOR
-0 ct>
3
::z
0
INSPECTION RECORD
DATE REMARKS INSPECTOR
FOUNDATIONS:
SET BACK
TRENCH
REINFORCING
FOUNDATION WALL &
WEATHER PROOFING
CONCRETE SLAB
FRAMING
INT. LATHING OR DRYWALL
EXT. LATHING
MASONRY
FINAL
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
3-z JUµ::(, ,._,,__ 'd?-4?df c.,d ~ ~
CITY OF CARLSBAD SEWER
BUILDING DEPARTMENT PERMIT -APPLICATION
FOR APPLICANT TO FILL IN
LEGAL BUILDING DESCf?IPTION Lo·r NO. ADDRESS ; -
BLOCK TRACT NEAREST
CROSS ST.
USE OF
BUILDINGS OWNER
MAIL
CONTRACTOR ADDRESS
ADDRESS CITY TEL. NO.
CITY TEL. NO. CONNECTION DATA
CONTRACTOR'S STATE CARLSBAD BUSINESS Lateral Chargo Computation
LICENSE NO. LICENSE NO.
30' H., 10' V. @ 4" = ___ 6" -----
Add. Horiz. @ 4" = ___ 6" -NO. DESCRIPTION OF WORK FEE ----
HOUSE SEWER CONNECTING TO Add. Vert. @ 4" = ___ 6" -PUBLIC SEWER @ $3.00 ----
SEPTIC TANK. SEEPAGE PIT OR
PITS @ $5.00 Totol Construction Cost
OVERFLOW SEEPAGE PIT, ORAINFIELD EXTN.,
CESSPOOL. DRYWELL, MANHOLE @ ss.oo 10% Service Charge
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ SI.SO Toto! Loterol Chorge
CONNECT ADDITIONAL BLDG. OR Lot.
WORK TO HOUSE SEWER @ St.SO No.: Logged in Plot:
ALTER. REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.00 LINE COST DATA
@ $ A. D. & Assmt. No.
LINE COST: -
OWNER'S I PERMIT $ 2 00 C. C. @ __ / dwelling
AUTHORIZATION TOTAL FEE P.S. @ __ / dwelling
OTHER I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONN ECT THE ABOVE DESCRIBED BUILD· TOTAL ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF Grond Toto!, Loterol, etc.
OWNER OR
OWNER'S AGENT FOR SEWER LOCATION
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT ...: vi AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND V)
STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED St. AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-NORTH
BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP· ENGINEERING SEWER DEPT. ERTY.
SIGNATURE Signed -I Signed OF PERMITTEE
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By ____________________ _
PERMIT VALIDATION