HomeMy WebLinkAbout1026 GRAND AVE; ; CB011321; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Q4/09/2001 Demolition Permit Permit No:CB011321
Building Inspection Request Line (760) 602-2725
Job Address: 1026 GRAND AV CBAD
DEMO
6103 04/09/01 ~~F~l
Permit Type:
Parcel No: 2031303400
Full Demo: Y
Lot#:
Reference #:
Status:
0 Applied:
Entered By:
Plan Approved: Occupancy Group:
# Dwelling Units: 0 Structure Type: Issued:
Bedrooms: 0 Bathrooms: 0 Inspect Area:
Project Title: DEMO-FUTURE EXTENDED STAY AM
Applicant:
E S A SERVICES INC
SUITE 310
2525 CHERRY AV
SIGNAL HILL CA 90806
562-981-5885
Owner:
SHAPERY SANDOR W
C/0 SHAPERY ENTERPRISES
1133 COLUMBIA ST #105
SAN DIEGO CA 92101
ISSUED
04/09/2001
CB
04/09/2001
04/09/2001
Total Fees: $30.00 Total Payments To Date: $0.00 Balance Due: $30.00
Building Permit
Plumbing Fee
Other Fee
Additional Fees
TOTAL PERMIT FEES
$20.00
$10.00
$0.00
$0.00
$30.00
Clearance:
NOTICE: Please take NOTICE th t 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 Car1sbad 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 capactiy
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any
fees/exactions of which ou have reviousl been iven a NOTICE similar to this, or as to which the statute of limitations has reviousl otherwise ex ired.
02 30.00
PERMIT APPLICATION
,CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
FOR OFFICE USE ONLY
PLAN CHECK NO(;eQ l/3.:).)
EST.VAL.~~~~~~~~~~
Plan Ck. Deposit----------
ValidatAJ Cf??
Date -=fl-9/ Q /
Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units
Proposed Use
3
# of Bedrooms # of Bathrooms
City S.tate/Zip Telep~one #
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement 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 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 ($5001).
Name Address City State/Zip Telephone#
State License # ----------License Class----------City Business License # --------
Address City State/Zip Telephone
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a 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.
O I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My worker's compensation insurance carrier and policy number are:
Insurance Company Policy No. Expiration Date _______ _
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS)
0 CERTIFICATE OF EXEMPTION: 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: FaUure to 1ecure work.,.' compenaatlon coverage Is unlawful, and ahaU aubject an employer to criminal penalties and civU fines up to one hundr.ad
thousand dollar• ($100,000), in addition to the cost of compensation, damage••• provided for in Section 3706 of the Labor code. interest and attorney'• feea.
SIGNATURE DATE
OWNEA;.auilDliL._~=·=lARA===n=ON..._~~~~~~~~~~~~~-
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).
lil I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
io~tractor'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 Section ------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 ~O
2. e, have not) signed an application for a building permit for the proposed work.
3. I have contracted with the follow__!ll.Person (firm) to provide the proposed construction (include name I address I phone number I contractors license number):
· +fl. be. d47~£.m ;~i!&.
4. I plan to provide portions o~ the work, but I have hired t~ followin perso o coordin,te, super ·• e and provide the major work (include name I address I phone
number I contractors license number): tT? bL-e ,v L
5. g ~ to provi~e the wo~indicated (include name I address I phone number I type
t.e-tC.. ;Y1 ' ~ e_ ct--..
DATE
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, 26533 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 boundary of a school site? 0 YES O NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIACATE 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.
C O ING
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(il Civil Code).
LENDER'S ADDRESS ~:;;;;;:;;;;;:;;;:;=:=:=:=:=:==-::...:.. :..:..:.:==;;;;::::;;::========;;::--:::;::::::::;::;;;:;;;;;::::;;:;;::;;;;;:::;;;::;:=:::;;:::;,
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 Citt 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 limitation and become null and void If the building or work
authorized by such permit is not commenced within 180 days from the date 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 180 s (Section 106.4.4 Uniform Building Code). r
APPLICANT'S SIGNATURE
WHITE: File YELLOW: Applicant PINK: Finance
DATE _..Y:_..(2_,_,__/......,_tJ_I ---/ I .
Rece ived Feb-09-01 02:20pm from 562 997 0165 ~ KRAZAN CORONA page 3
P.003/003 F-724 FE~-~Q-2001 03:24PU FROU-EXTENOEO STAY AI.IERICA !SM OT-0185 T-125
-· City of Carlsbad
I ill II Gii•G I-SD 161 Yi h ID ii I
DEMOLITION ASBESTOS CERTIFICATION
ADDRESS: 1026 Gr and Avenue, carlsbad, CA 92008
USE OF BUILDINO TO BE DEMOUSHl:D: Singl e-family Residential
SQUARE FEET 1 ,000 X NUMBER OF STORl6 _ _.__ __ _
PROPERTY OWNER: _s_an_d-'o=r_w;.;_;.::.......;;;s=ha=pery="'---------------
ADDRESS: 1133 Col umbia St, #105, San Di ego, CA921 D1PHONE 619/293-4700
APPLICANT: Mr Matt o' Shea
ADDR'fSS: 2525 Cherry Ave . #31 o. Sjgnal Hi J J, ra908°'9HONE 562/981-5880
•---••-••••••••-•---•-•••••~~--------••••••••••••••••••••••••~~·•w••-•••••~--~•~••
Sadlon 19827.S of California Health and Safety Code states in part:
NA demolition permit shall not be Issued by any city ... as to any building or other
structure except upon receipt from the permit applicant of a copy of each written
asbestos notification regarding the building that has been required to be submitted to the
United Statti Environmental Protection ~ency ot to a designated stata esency, or both,
pursuant to Part 61 af Title 40 of the Code of Federal Re,ulation,, or the succasior ta
that part. The permit may be issued wftoout the applicant submitting a copy of the
written notificatfon if the applicant declares that the notification Is not applicable to the
scheduled demolltlon project."
•----••••••••••••r~•~•-~~--•-•••••••••••~•••••••-••we•P•••---------•••••••••••••••
As applicant for a demolition permit ' in the City of Carlsbad, I certify that, I have read
the exc~rpt from Section 19827 .5 of the Health and Saf.ty Code provlded above) the
inform1tion I have provided on thii form is true and correct; and I further certify the
followini:
(x) On the attached J pages are copies of all written asbestos notifications
regarding the above referenced building that are required to be submitted to the
United State, Environmental Protection Aeenc:y or to Part 61 of Title 40 of the
Code of Federal Regulation,, or succeHor to that part.
C ) I declare that the written asbestos notification Is not appllcable to the scheduled
demolmon project.
Applicant' Ii Signature
r:\wortfl/orm~lldlns\demolltlon P'fmf1 requiremen~.doc REV August 9, 2000
ASBESTOS NOTIFICATION OF DEMOLITION AND RENOVATION
Operator Project #
I
Postmark
II
Date Received
I
Notification #
114-01013
I. Type of notification (O=Original R=Revised C=Cancelled): 0
2. Facility information (Identify owner, removal contractor, and other operator)
Owner name: Sandor W. Shapery
Address: 1133 Columbia Street, Suite 105
City: ~;:in ni i:::,.nr, State: l"''A I Zip: 92101 -
Contact: Sandor W. Shapery Telephone #: ( 619) 293-4700
Removal contractor: N/A
Address:
City: State: I Zip:
Contact: Telephone #:
Other operator: ESA Services. Inc.
Address: 2525 Cherry Avenue, Suite 310
City: Signal Hill State: CA I Zip: 90806
Contact: Ma.tt o• Shea Telephone #:
3. Type of Operation (D=Demo O=Ordered Demo R=Renovation E=Emer. Renovation): D
4. Is asbestos present? (yes/no) Yes
5. Facility Description (Include building name, number and fl oor or room number)
Bldg. Name: Sinqle Family Residential Structure
Address: 1026/1050 Grand Avenue and 1085/1091 I..aquna Drive
City: carlsbad State: CA I Zip: 92008
Site Location: Grand Avenue & Laguna Drive west of the San Diego Freeway
. . ap~~ox. Building S1ze: 1 1n c:n ft-a=-I # of Floors: one I Age in Years: aoorox. SO years -I Prior Use: Present Use: sinole familv residence undeveloN'rl
6. Procedure, including analytical method, if appropriate, used to detect the presence of asbestos material:
Conprehensive ACl1 Survey, PIM analytical method
7. Approximate amount of asbestos Nonfriable Asbestos Indicate Unit of
material: RACM Material not to be removed Measurement Below
a. Regulated ACM to be removed to be
@ Category I ACM not removed removed Cat I Cat II Unit c. Category II ACM not removed
Pipes LnFt: Ln m:
Surface Area Roofing &
l<'l mri ... ,.. Sq Ft: 3,000 Sq m: -
Vol RACM off Facility Component Cu Ft: Cum:
8. Scheduled dates asbestos removal (mm/dd/yy) Start: Complete:
9. Scheduled dates demo/renovation (mm/dd/yy) Start: 3/16/01 Complete: 3/23/01
SDAPCD -SUBPART M -Rule 361.145 Page I of2
ASBESTOS NOTIFICATION OF DEMOLITION AND RENOVATION (continued)
10. Description of planned demolition or renovation work, and method(s) to be used: conventional demolition
I'l . Description of work practices & engineering controls to be used to prevent emissions of asbestos at the demolition
and renovation site: Material will be kept wet durinq demolition.
12. Waste Transporter #1
Name:
Address:
City: State: I Zio:
Contact Person: Telephone#:
Waste Transporter #2:
Name:
Address:
City: State: I Zio:
Contact Person Teleohone #:
13. Waste Disposal Site
Name:
Location:
City: State: I Zip:
Contact Telephone #:
14. If demolition ordered by a government a2:encv, please identify the a2:encv below:
Name I Title:
Authority:
Date of Order (mm/dd/vv): I Date Ordered to Begin (mm/dd/vv):
15. For Emergency Renovations
Date and Hour of Emergency (mm/dd/yy):
Description of the Sudden, Unexpected Event:
Explanation of how the event caused unsafe conditions, or would cause equipment damage or an unreasonable financial
burden:
16. Description of procedures to be followed in the event that unexpected asbestos is found or previously nonfriable
asbestos material becomes crumbled, pulverized, or reduced to powder. See attachment
17. I certify that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be onsite
during the demolition or renovation & evidence that the required training has been accomplished by this person
will be available for inspection during no.,business hours.
~,,,u-A -, -1,,f-o/ -(Signature of &'wn'er/Ooerator) (Date)
18. I certify that the above information is correct:
/_J, /~ ~ .,_ -7-f-0) -.... (Signatufe of ~O<!r/Ooerator) (Date)
SDAPCD -SUBPART M -Rule 361 .145 Page 2 of2
.
-. -··' ··-···------· .., __ ·----------··-·"'--.. ----··-------------·-··-··· -· ···-···· ·······---------
1/!5£ NOTICE OF SERVICE DISCONTINUANCE
Aalfnol'II~
~DEPARTMENT
(~RCOUN:,vOF CA~~==~~~~~~~~~~~~~~~~
ElECTRl<?g-~ GAS SERVICE WILL BE DISCONTINUED
TO ro2u +-U}8{1' .. (oaeA,LL0 _ l\V -?~
AODMS8
BY 0 f 2~ f C) J ALL SERVICE LINES Will BE REMOVED.
DAU
THIS BUILDING CAN BE MOVED OR RAZED AFTl:R THE ABOVE DAU.
SAN DIEGO GAS & ELECTRIC
BY l!ACU:l(_{; f.:U)~ ·-----·--·------·-·-----------------
DATE .DI l-b ltJ I PttoNE 1u o -~B. ~mtJ ---
1v•...atu m•11
,-··
··-i
I
I
t
I
I-I I I I ! . ~
I '· . i t i
i
ii rr1
~ ~ ;:; ~ "' .g? .!..
<" .> "1
...l
\
0
er c,,
~ 6 ~ ,,I ,,I (")
* ::, ~
*'
~~
CJ 2
Cl\ 0
~ m
'I°\\ ~I -.J Ol ::1
...
,,
:;u
l D 3: .
m en D .... z () I ...
I
V ;:,
I
" -
,0 ...
b• I ~ 1
·~ I ; !
" " • QI
"' J -
" .. ,,
J D
C X
;o I z D
co (.J1 co CTI ..... <.,J ..... ::. U)
(.J1
·J
. . ... a,
~I 3: ~, Ill
"'I -; ... ... : I\) -I I -,J
I I\) I IS) t IS) .....
I IS)
n I U)
~ I ::. (,J
D 3:
-0 .....
FAX NO. : 8586131495 Mar. 15 2001 11:55AM P2
-{J: l!i/01 011: J ,l
-• , t ._, t , L-I, t I\ .1 ._J L J blU ~~7 0101 p.3
Match lS, 2001
1133 Columbia St. S,ute lOS
Sall i::>ieao ea. 92101
1'o Wboai It May~=
CARLSBAD OD
Per your request. we have amoved t!Jt wacer mews from dw lite a 1br SE ead of
l.a&uaaDr, / 'W I•.S UC, NE end ofGl'IDd A:ve !WI-!, Pucel 20J-lJ. lobi· lS,18JO. &m1
J.4. The correq,andina accau1,1 nurnbcrs 1!111 addreSlel forlhes, nmen arc u followl.
A<;COUNINQ
S,03100-04
Sl0l20o.o4
110130~3
1101400.03
ll01!i00-01 •
.ADDUSS ·i
10~0 Grand Ave.
1026 Oraad Ave.
I 085 Lapa I>r.
1091 Lqaab.r.
lOOOLlpuDr.
Ill can be of 4J1Y ftartbcr mim.nce concmi:lJ wa:er m=ten. pleas, feel fi'ee to ~I me at •
431-lnl t 71S l . .
smcaely,
liJOOli00.1
511S0 Bf Cemfna A.al• Carlabad, CA l:iaD8-Ul3 • (HO) 4311-a?ZZ • FAX (760) 431•1801 e