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HomeMy WebLinkAbout2407 LA COSTA AVE; MULTI-PERMIT FILE; CB062030; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 07-17-2006 Demolition Permit Permit No: CB062030 Building Inspection Request Line (760) 602-2725 Job Address: 2407 LA COSTA AV CBAD Permit Type: DEMO Full Demo: Y Status: Parcel No: 2162405544 Lot#: 0 Applied: Entered By: Occupancy Group: # Dwelling Units: Reference #: Plan Approved: Bedrooms: Project Title: Applicant: 0 Structure Type: 0 Bathrooms: O MARSELLA CONDO-DEMO 4 UNITS & GARAGES-UNITS A,B,C & D Owner: Issued: Inspect Area: AMG DEMOLITION & ENVIRONMENTAL ROBINSON MICHAEL A STE 523 1220 ROSECRANS ST 92106 619 501-7427 Building Permit Plumbing Fee Other Fee Additional Fees TOTAL PERMIT FEES $0.00 $0.00 $240.00 $0.00 $240.00 PO BOX 130902 CARLSBAD CA 92013 ISSUED 07/17/2006 RMA 07/17/2006 07117/2006 Total Fees: $240.00 Total Payments To Date: $240. 00 Balance Due: Inspector. Clearance: $0.00 approval of your project includes the "Imposition· of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions.· ou 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 seivice fees in connection with this project. NOR DOES IT APPLY to any fees/ex i ns f h"ch ou h v r vi I n i en a N Tl E imil hi r whi h t f limi FOR OFFICE USE ONL V PERMIT APPLICATION PLAN CHECK No. c,&ol, ·J.D.3 o CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Plan Ck. Deposit ________ _ Validated By __________ _ Date, _____________ _ L..<\.Co Lot No. Subdivision Name/Number Total # of units B:0,·Jm+.-9 I Assessor's Parcel II Existing Use SQ. FT. #of Stories State/Zip Telephone# Fax# .. •G, 1q~ SO I ~74 d-J • Telephone # Nam a l\!ll!!J• 6~'fi7,,eGll1,MOl'irbCOMMN¥i~¥;:tt_~JG?ki'iti'.!'f'.g1~~/;t;f,r4;- (Sec. 7031.6 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 qt Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($6001). . . . ·SO Address City State/Zip Telephone # City Business License, la219as8: License Class A I f3 1 C ~ \ Designer Name Address City State/Zip Telephone State License # _________ _ •• ,, ,,,illl!IIIIICliRll~IA11Q!tb ,.,,, · Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D f ~ave 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. issued. My worker's compensation insurance carrier and policy number are: J( /~ f'r( _ I}__ ~ I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for_wfiqh thi. p;mit is Insurance Companv5b+.-Ct,r.,p.....,,'t,;,.,~wc &rd Pol;cy No. / ui'x'.45 7 7 Exp;rafon oa[./l_';Sj!:ijHbtf~~'J....- (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) D 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: Failure to secure workera' compensation coverage la unlawful, and shall aubject en employer to criminal panaltlea and civil finea up to one hundred thouaand dollara ($100, 00) In a to the coat of companaatlon, damage• u provided for In Section 3708 of the Lr::::.r··c• Interest and attorney's feea. ;:~:=:a~ .... ~~~lbri ~fij~t~s=:~~;:1~:::--;::::-::-;::::;::-::-:-;:::-:--:-=== DATE_..,_,_/_,,"""""'--- I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, wilt 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 buitd or improve for the purpose of sale). D 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). D 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, D 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 I 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 I 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):, ______________________________________________________ _ 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, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act7 D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D 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 ANO THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30970) Civil Code). LENDER'S NAME _____________ _ 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 s•o• 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 uspended or abandoned at any time after the work is com en for a p 180 days Section 106.4.4 Uniform Building Code). v· APPLICANT'S SIGNATURE WHITE: File YELLOW: Applicant PINK: Finance • City of Carlsbad Bldg Inspection Request For: 09/06/2006 Permit# CB062030 Title: MARBELLA CONDO-DEMO 4 UNITS & Description: GARAGES-UNITS A,B,C & D Type: DEMO Sub Type: Job Address: Suite: Location: 2407 LACOSTAAV Lot 0 APPLICANT AMG DEMOLITION & ENVIRONMENTAL Owner: Remarks: SEWER CAP INSP Total Time: CD Description 22 29 Sewer/Water Service Final Plumbing Act Comment Comments/Notices/Hold Associated PCRs/CVs Original PC# Inspection History Date Description Act lnsp Comments Phone: 6195190450 Inspector: ---- Requested By: SHANNON Entered By: CHRISTINE DEMOLITION ASBESTOS CERTIFICATION ADDRESS: .QljD$ J::l,B, G, D -e.;J'f{D A, R,C.,.D LaG,c,k, Ave; La&k,cA '1~'1 usE OF BUILDING TO BE DEMOLISHED: ___,_R.,,.es.....,_,..,.·J ... e_..n ..... l-..1..,-.,,,a......,_l _____ _ SQUARE FEET 7, noo x NUMBER OF STORIES __,,a...,_ __ PROPERTY OWNER:rrkl~-!=:/_~a,~~~~1.J,.1-'li..L:lf.1..(g__ _____ _ C./0 ~~r 01\'\MUI\. ADDRESS: ·I PHONE ]fa0943-q53"3 APPLICANT: fl:00 {2 J>,mgl, ·t; i,., ~ G, viCOn ruc:n±Q I Ss,n1(cc .Tv< . ADDRESS: k¥,ao f¼«:@n:s.:St.st< ,c;a& .S.nD~C--4 PHONE (ptg-So/ •7':t'J,7 ·---------------------------------------------------~d.c..----------------------· Section 19827.5 of California Health and Safety Code states in part: "A 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 States E.nvironmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project." ----------------------------------------------------------------------------------· As applicant for a demolition permit in the City of Carlsbad, I certify that; I have read the excerpt from Section 19827.5 of the Health and Safety Code provided above; the information I have provided on this form is true and correct; and I further certify the following: ( ) On the attached __ pages are copies of all written asbestos notifications regarding the above referenced building that are required to be submitted to the United States Environmental Protection Agency or to Part 61 of Title 40 of the Code of Federal Regulations, or successor to that part. I declare that the written asbestos notification is not applicable to the scheduled demolition project. ~;h '4~A.diu+o~ A lica'itt's81gure Date 1 ' h:\word\front counter handouts\demolition permit requirements.doc REV April 19, 2004 IA CQSJA DE NMBELlA HOMEOWNERS mDOATIQN C/0 Premier Community Services, LLC 325 Carlsbad Village Drive Suite D-1 Carlsbad, CA 92008 June 12, 2006 To Whom It May Concern: 7 60-730-7888 760-730-7883 Fax La Costa de Marbella Homeowners Association is the entity statutorily charged with and created for the purpose of managing the condominium project commonly referred to as "La Costa de Marbella." The undersigned, pursuant to the direction of the Association's Board of Directors, hereby authorizes AMG Demolition and Environmental Service, a licensed building, demolition and engineering contractor (hereinafter "AMG"), Cal. License No. 813313, to proceed with demolition of the buildings comprising the 8 units 2405 #A, #B, #C & #0 & 2407 #A, #B, #C & #0 which were damaged in 2005. AMG is also authorized to apply for all permits necessary to effectuate such demolition. Dated: La Costa de Marbella Homeowners Ass'n. A California nonprofit corporation By:~ ,=------- Jeff FOOOy, Po,s;dern P?i3 ·' I. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT re '";.,;..,"" I _ . VICKI COLLO <l! NOTARY PUBLIC·CALIFORNIA~ II!• • COMM. NO. 1598588 -I . . SAN DIEGO COUNTY I . MY COMM. EXP. JULY 31, 2009 souae ■a c us sad a □ personally known to me Ji( proved to me on the basis of satisfactory evidence to be the perso~ whose name@ isl© subscribed to the within inst~ent and acknowledged to me that he/she/~xecuted the s~m in his/her/@ aulhor~ capacit 1e , and that by his/her~ signature s n the instrument the person(Q, or the entity upon behalf of which the person@ acted, executed the instrument. WITNESS my hand and official seal. yd;~.•·~ Signature of Notary Pubhc ------------OPTIONAL------------ Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document ntle or Type of Document: ~~-JI; ,//Jr~ Document Date: tG / ;J. · ti b Number of Pages: _/ __ _ Signer(s) Other Than Named Above: _______________________ _ Capacity(ies) Claimed by Signer Signer's Name: ________________________ _ [] Individual □ Corporate Officer-Title(s): __________________ _ □ Partner -□ Limited □ General □ Attorney-in-Fact □ Trustee □ Guardian or Conservator □ Other: ________________________ _ ,J I Signer Is Representing: _____________________ _ I ·I ·~~I © 1999 National No1ary Association• 9350 De Soto Ave., P.O. Bo~ 2402 • Chatsworth, CA 91313-2402 • www.nationalnota,y.org Prod. No. 5907 Reorder· Call Toll-Free 1-800-876-6827 June 12, 2006 Sheri Behar 2415 La Costa Ave. #8 Carlsbad, CA 92009 e-mail: info@alliance-enviro.com , web address: www.alliance-enviro.com Lie. #716538 • D.O.S.H. #630 Re: Asbestos Remediation: 2407 La Costa Ave., Carlsbad, CA 92008 Dear Mrs. Behar: We appreciate the opportunity to service your asbestos abatement needs. The enclosed package provides documentation for the removal and disposal of the hazardous waste that was taken out of the above stated property. Please keep these papers along with other pertinent papers regarding this property. You will be receiving the following items: Certificate of Completion stating that your job has been completed in accordance with Federal, State and local regulations. Area After Reports as analyzed by an independent laboratory confirming that ambient air sample was at an acceptable limit. EPA dictates this level as less than or equal to 0.01 fibers per cubic centimeter. (When available) Uniform Hazardous or Non-Hazardous Waste Manifest showing that the hazardous waste was transported from the job site to an EPA approved landfill. (When required) We appreciate the opinions and ideas of our customers and we would like to hear from you if you have any questions or comments regarding our work. If we can be of service to you in the future please give us a call at (619) 229-6135. Sincerely \ ~ Cameron Kincade, Alliance Environmental Corporate Office: Simi Valley Office San Diego Office: 990 W. Tenth Street, Azusa, CA 91702 , pl1. 626.633.3500 • fax 626 633.3599 680 Flinn Avenue, Unit 32, Moorpark, CA 93021 • ph. 805.378.6590 • fax 805 378.6594 4667 Mission Gorge Pl., Suite B, San Diego, CA 92120 • ph. 619.229.6135 • fax 619.229.6143 Certificate of Completion This is to certify that an asbestos abatement project Scope of Work: Abatement of asbestos acoustic and flooring in units 2405-A, 2405-C,2405-D,2407-B,2407-C,2407- D has been completed at: 2407 La Costa Ave., Carlsbad, CA 92008 La Costa De Marbella Job Name 6-12-2006 Date D-05-005254 Job# ( ~~ State of Cc.iifornio-Environmentol Protection Agency · Form Approved O_MB No. 2050-0039 (Expires 9-30-99) Please print or ~,pe~ · Form designed for use on elite I 12·pi ~'t . ~~ !~~tructions on bt•l. . :·,: · :It .-Department of Toxic Substances C, ''---,-:-----.~~---,--,--,-.,----S-a_c,_a~m-e_nt~o~,~C~al~if~o~•n~.ia:_ ' 1. Gen•~~\j('..s US iPA<!C'~~o . .;ij,. . , ;;:~l' Manifesl · ument N_o. 2. Page 1 lnfor(Tlalion.in the shaded oreas G c=-.i E o N ~ E -~ R ~ A 6 T ~. " 0:: ~-0 1( ·w ~ ~- .u w ,V> z . 0 0. ti) w 0:: -' ' ' <( z 0 ~ z w ,I ~ -' -' <( u _.- -' 0: ... t ti) 0:: 0 UNIFORM HAZA~DOUS WASTE MANfFEST l of 1 is not r<\quired by Federal law. CA COO 2 5-9 5 8 2 6 S 3 2 3. Generator's Name ond Moiling Address 1 a losta de Marbe'lla HOA Site:la Cost-1 -do Marbelia 240 La Costa Ave 2407 Li!. Costa Av.e. 11 4~~!.rJP.,~a-'ne ~A 9~008 ',1 Carlsbad, CA 92008 5"Z,,'J "I Group 7. Transporter 2 Company Nome 8DC Spe~Jal Waste S-etYiCt~~()" 766 s. l\)'OA. Azusa. CA 9)./ ~ 9. Designa.ted facilitY, 1:-lffie al)II Site A\ldless Aiusa Land ec iamat on 1201. W. &la JtQne B'vd. Azusa. CA 91702 c._ 6. US EPA ID Number CA RO O O O 1. 7 6 5 7 l 0. US EPA ID Number C A D O O 9 0 0 7 6 2 6 11 .. US, DOT _Descriptio; (in~luding f/oier Shipping Nome, Hazard Class, a~d ID Numbe;) R:Q~ Asbes.to$/9, NA l2i2, PGIII . I , . ., ,• . . ~ ...... _ .. b. c .. y j.;_.------'----'-------------"------,--------+--'---L-1--'--+--'--'---l..--'-i-:----=- d. 15. Special Handli,ng Instructions .and Additional Information 24 Hour . Emev-g'ency,~· 800) 4Sl-8346 Wh~n handeHng waste use _.proper safiety/Fers011a prote~t1ve clothfog .. & _equipment. · EPA Regi.0'\· lX 75 Hawthornit St. Sl)n Fra.nc.1sco. A 94015 {415J 744-1305 an ie -Air Pollution Control 01str1ct 9150 Chesapeake Or. San Diego, CA 92123 16. GENERATOR'S CERTIFICATION: I hereby declare thot the contents of this con,ignment ore fully and accurately described above by proper ,hipring name and are classified, pocked, marked, and lobeled, a1'd ore in all respects in proper condifion for transport by highway according to applicable internationa! and notiono government regulations. If I am a Iorgo qu~mtity generator, I cf'lrtify that I hove a program in place to reduce the volume and toxicity of wos~e generated to the degree I have determined to be economically procticoble ·ond thot•I hov~~ selected the proctico.ble method of treatment, slorog.e, or ?isposol curre~t!y ~voiloble to me whic~ minimizes the present ond future threat to humon health and the enVironmel)I; ORt if I om a small quantity generator, I hove mode a g~od faith effort to m1n1m1ze my waste generation and select the best waste monpgement method that is available to "rtie and thqt I con afford. ~ · · ~-•-··•·.. .-,. · Month Doy Yoor U Pr~~'.•fTyp;_d Nam~<;:, _;.,-11·, '"·.:,."~· l.J •• >'\!..c-l • l Signalure /" ··:/.,., ~~-T4 •.,,.:c.•;-~-~--~-r~-:-;-=.'.,oc..·'r-t~-";f:...l..;~::.:~.,.;n-~:-w"'C;e"'.,.,d.,-e-m'":n~.'-,::..~:.,.;.,.~~-c-'-:•-i~_tt·•-~f::-1_M-'o_l_e:"-;-:--'"-·-•~·-: __ _.__ ___ ..f;_.:_·,.,_ .. _·_ • ..,f,,-,:-·'_,_' r_._•·--_·_·· ______________ _,__:__--'-'::_-'--"'--'--,'--'-..CC...J...,o<_--, e5 ; P_ri~!~</,/Typed Name / / Sig:~~:".r •, .-/' I t) l ? ,o Month Day Year ~ $ .. ··/ • ..... ,f1r,_';,ft /l, ;,_,.1.J .I (1'" 'j ,le ./' ' ... ~ !'"., .• ...,.,r". I I,) 1: .., \';.',> r ~ 18. Trans orter 2 AcknowfecJ ement of Recei t of Materials ~,'-: ,,., .•. ,: ,-· Ou. R·· ~~~==!....!:..====='-"'--=='-"'-.:::::::=::.:.:.. ___ -'-,--:-:---~~-~ /"'--;,..C...-----:r-7'------------,---,----:----::--------j 1 Printed/Typed Name Signotur!( (' ,,/4 _. :':' :-:,< w E ./ .;./. · ·; / t, · •" ·:;,••7'·~•.? .. ; __ · / /.·· .. 1/ /, , Month Day Year ~ ~R-/-__:fl~·--~···· • ~.££.."'=:~4.,· ·::,,,--.,..-J....J!k•':C.· :.:.· .::..'I".:..""_'''_"_·'·..,__. _' --------'----r-'-r--"''--'(""--.•_:'7'---"-'---'"------------'---'-----'--,___-'-::.:;__j"'---j U 19. DiscreponCY Indication Space 0 , 0 \- ~ F A C I L I T y 20. Foci Ii Owner or O erator Certification of recei t of hozardous materials coverod b this manifest exec I as noted i Item 19. _Printed/Typed Name Signolure :_, .. ,, 1 .. \ -~., ,..1,_ r'i .. -i ·,.,: l •• --, '', •. i .. i \ ', t" I .. DO NOT WRITE BELOW THIS LINE. DTSC 8022A { l /99) EPA 8700-22 Month Day Year / ·. 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' - I ~'--v= 'j~o ~ TbTAc fXPDS~.M t-!iNUTi:S Lab: _________ ====- '":\ --,,. r:: __ s= -. --~(/1 c. ... ,,!;:,, ;:.ESPiRi\-C=-··, .. ,-.c (,t: _:.~-re-,i1 ~:.::.., cor·J,-_r 1::.:.: ~ h · = [ I a# ; I I,,.;:;:~~"" :-;;:' / 01r --~,~)': !, S'.uc::""J H1tJh 8r1ron,-1 :nc ,-Jres!:_:;E:--------- :...~"·'.v f?2:·on-··~·1'":C ·-':·e~:-.,. h:t}l ter(':pt:; '.~G,"L.: __________ _ J, D T y:.ie ::,nde:: -::5:·· ~ ' ! D -Demo!iue,,, GM -,ross Reli70,ci 'vAC -iacuum o~crn1 c -Enc:osu•a:e c;s -Glo, e 82,, Samele Type Codes: c-.-.. cf .. ~ ..i ";r;;u11;tt2. f~i". .. ":'-~ r"....;L~:.~;.;··..:1~::::;.n~·-p:;.;;.E;.;"..;·,;;~~:·,~·=---------------------U,..;;:,t D .. ~br;s ~=.tr _____________________ _ L-.f,,''' :-·ec:. ,~.,1 •.:: -: '. '~".,- --::uic.;-,.--i -:01e· P -P.;;sona: Ao -A, ~a 8t:!0re AD -F-ita Ourwg AA -PPa After I=\' . i:-.,, .. 11(<"1"., T\/? \,,ai Qt; ier ;:.-.t1v;: -:;$ Li !:..rf,Z: __________________ _ Fi'.J.s~,·:.: L..ea1..1 Cc1,: s -------------------------- Respira\.Q.__l_Sooe_s_ AP -Air Purifying . =--,~·-. r-·~ P -PAPR :-:; · ;;;:;;;:-o-t,-i:_o~ C · Typt C •-· ,-" .... · "\ C i -•· --• • .!) °\I :.J • \Jraa~ u , o .te,,.d t,,-~ O:.,y Alliance Environmental Group, Inc. Tim Tilley 4667 Mission Gorge Pl., Suite B San Diego, CA 92120 Project Location: Mirabella 2407 Costa A venue Carlsbad, CA 92008 Report of Test JobNo: 1-17 Date: 10/10/05 Client Job No: 5254 Client PO No: ReportNo: 1-17-101005-A PHASE CONTRAST MICROSCOPY -ANALYSIS Procedures: Air (cassette) samples submitted by Alliance Environmental Group, Inc. were analyzed in accordance with NIOSH (National Institute for Occupational Safety and Health) #7400 Method requirements. After the samples were delivered to the laboratory at JMR Environmental Services, Inc., the Ii lters were rendered transparent and fibers were counted using a Phase Contrast Microscope. Results are calculated to determine the fiber concentration per cubic centimeter of air (flee). Sample ID Sample Date Location/Sample Type Volume(Liters) Results ( fl cc) 10857-l 10/06/05 2407 Bedroom/ Area After 960 10857-2 10/06/05 240C Bdr Closet/ Area After 960 10857-3 10/07/05 2407 A Living Room/ Area After 960 l 0857-4 10/07/05 2405D Living Room/ Area After 960 10857-5 10/08/05 2405A Kitchen/ Area After 960 10857-6 10/08/05 2405A Bdr Closet/ Area After 960 * Fibers / Fields = Blank Check JMR Environmental Services, Inc., appreciates the opportunity to be of service. Analyzed By:_+-------------1- ill Brodwolf · Laboratory Anal st Rick De Nisco Laboratory Manager ' <0.005 <0.005 <0.005 <0.005 <0.005 <0.005 Page I of 4560 Alvarado Canyon Rd., Suite 20, San Diego, CA 92120 Tel: [619) 858-7260 Fm< [619JBm7264 ( _r .~----( ' State of California-Environmental PrQtection Agency i F01m Appoved OM8 No. 2Q5o--0039 (Expires 9-30-9y) Pleose p~int br type. Form de,igned for u,e on elite ( I 2-pitc~ Jee Instructions on back of nqge 6. t Department of Toxic Substances Control Sacramento, California 0 ~ ~ " N ~ 00 6 0 t.n~ (0= N< ('4')u a,~- ('4')~ ..::t2 N ~ u z :i: I-~ N 0 00 00 ..:r N "'f 6 0 ~ °' w 1-z w u w V') z 0 0.. V') w °' < z 0 ~ z w :x: I- -' -' < u _,- -' a: V') °' 0 >-v z w ~ w ~ w 0 w V') < u ?; j ~ G E N E R A T 0 R '~ T R A N s p 0 R T E R F A C I L I T y ·rifer. . 1, 6enerotor's US EPA ID No. Manifest Document N.,. 2. Page I Information in the shaded areas UNtfORM HAZARDOUS is not required by Federal law. WASTE MANIFEST CIAICIOl0 12 1519 1518 12 16 l 91 3 I 2 ~ 6 I ,5 1 of 1 3. Generator's Name and Mailing Address A. State Manifest Document Number ~a losta de Marbella HOA Site:~a ~osta de Marbella ... 43 93265 40 La Co~ia A~8 40 ka Colta A~8s 8. State Generator's ID ar sba 9 ar sad A 92 4, Generator', ~8ne 619~ 4i8-8248 • I I I I I I I I I I I I I 5i1liin~~R,v{ro"nmental Group 6. US EPA ID Number C. State Transporter's ID [Reserved.] 3472 .~8~~: ~ t il 1~, le IA IL 10 10 10 11 16 10 11 11 11 D. Tran,porter's Phone (626) 633-3500 7 9Rrpf~e~gf:wi¥~ta !eEX 1 §t 102 8. US EPA ID Number E. State T ron,parter' s ID [Reserved ] jC 1A 1R 10 10 10 10 11 17 16 15 17 F. Tran,partor's Phone \ ()t'.b J !:lb!:l•l;,H4 9 A°esiyrta~~ N[eci i ~.td~o 10. US EPA ID Number G. State Facility's ID 1~8 w. i a stone B v~. 1C 1A ID 10 10 19 1010 17 16 jt. 16 I Azusa, C 91702 Ic IA Io Io Io 19 Io Io 17 6 12 16 H. Facility's Phone (626) 334-0719 I I. US DOT Description (including Proper Shipping Name, Hazard Closs, and ID Number) 12. Containers 13. Total 14. Unit No. Tvpe Quantity Wt/Vol I. Waste Number a, State 151 R.Q. Asbestos, 9, NA 2212• PGIII y ("--jaI, A i t--"") lu l 'I . 11 EPA/Other b. State ,I EPA/Other I I I I I I I C. State I I I I I I I EPA/Other d. State I I I I I I I EPA/Other J. f~1iiG 1 fecrAttbsefai tct01c~'; ttfn 1 ng Wast e K. Handling Codes far Wostes Listed Above o. OJ b. C. d. i s~~i c;I h;d~d:lr12;s i ~~dt;on~ ~~rmC;§~ r HoUJ iy /~~~;~ta ~ 8~~lt!§t ~f 4; 1 jlh 1 n~ I equ 1 pment • P Region 7 Hawthorn • San ranc scot CA 9 01 5 4-1 0 lB~A~1~ff8-~tt9Po1 1ut1on Control 01str1ct 9150 Chesapeake Or, San Diego, CA 92123 I 6. GENERATOR'S CERTIFICATION: I hereby declare thot the contents of this constnment ore fully and occuratelf; described obave by proper shiptng nome and ore classified, packed, marked, and labeled, and ore in all respects in proper condition for transport y highway according to opp icoble international and notiono government regulations. If I am a large quantt generator, I certify that I hove a prc:,rom in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economical!~ practicable and that I ave selected the r;rocticable method o treatment, storage, or dispasol currently ovoilable to me which minimizes the present and furure threat to humon heah and the environment; OR, if I am a smo I quantity generator, I hove mode a good faith effort to minimize my waste generation and select the best waste management method that is availoblo to mo and that I can afford. . -Printed/Typed Nome I", j'" I l\ .,,. '-' ! (. I• l.-I Signature ~ I ;01; I 1 °1~ I ;•lrs / ' /(..__..... / /' '? ,_,,,,.. G, • C r Q • 17. T ransoorter 1 Acknowledaement of Receipt of Moterials ' . Printed/Typed Nome/' la I Signature \,L:J I Month Day -Year ')I I t lo I , I 71 _.,1 r ,,.,,,~~ . ( .. 18, T ronsparter 2 AcknowledRement of Receipt of Material, -Printed/Typed Nome I Signature I Month Day Year I I I I I I 9. Discrepancy Indication Space ' 20. Focilitv Owner or Ooerator Certification of receiot of hazardous materials covered bv this manifest exceot as noted in Item 19. Printed/Typed Name I Signature I Month Doy Year I I I I I DO NOT WRITE BELOW THIS LINE. DTSC 8022A ( I /99) EPA 8700-22 Yellow: GENERATOR RETAINS Sherri Behar La Costa De Marbella 2415 La Costa Avenue, Suite B Carlsbad, CA 92009 Report of Point Count Test 1-1056-083105-A September 2, 2005 Tl>Iee sample( s) were collected by JMR Environmental Services, Inc. on August 16, 2005 from La Costa De Marbella: 2407 Building for bulk point count sample analysis. Project: The purpose of this bulk sample analysis is to determine if asbestos is present in the material sampled. Bulk samples were collected by a trained representative of JMR Environmental Services, Inc. in accordance with EPA recommendations and techniques. Care is taken during the sampling to avoid fiber release and cros, contamination. Sample analysis of bulk materials was performed in accordance with EPA/600/R-93/116 Test Method: Method for the determination of Asbestos in Bulk Building Materials. This procedure involves examination of the samples with a petrographic microscope utilizing polarized light, a procedure commonly known as Polarized Light Microscopy (PLM). JMR Environmental Services. Inc. appreciates the opportunity to provide this service. flvs report shc!ll not be reproduced, except in fu!L without prior authorization by JMR and shall not be used by the client to claim NVLAP or U.S. Government product endorsement. Laboratory Analyst Revised I 0/tltl Page I ot .' Reviewed by, • Rick De Nisco Laboratory Manager 4560 Alvarado Canyon Rd., Suite 20, San Diego, CA 92120 Tel: (619) 858-7260 ,~, [619[ 8587264 f Project: Sample Number 81219 La Costa De Marbella 2407 Building Sample ID 58; Exterior Stucco 2407 Building Exterior Point Count Analytical Result= None Detected Type of Fibers Asbestos lde11tified Present In 400 Points No11e Detected 0 Previous Polarized Light Microscopy Analysis Detennined = <!% Chrysotile 81220 59; Extrrior Stucco 2407 Building Exterior Point Count Analytical Result= 0.5% Chrysotile C'hrysotile 2 Previous Polarized Light Microscopy Analysis Detecmined = 2% Chrysotile 81221 60; Exterior Stucco 2407 Building Exterior Point Count Anal}1ical Result = None Detected None Detected 0 Previous Polarized Light Microscopy Analysis Detennined = <I% Chrysotile ---~ Envlronmontal Sorvlcoa, Inc. Page 2 of2 JMR Job Number Date Analyzed Total Percentage 0% 0.5% 0% 1-1162--083105-A 08/31/05, 09/01/05, & 09/02/05 Shem Behar from: Sent: To: Subject: Sherri, Mal1o Remlllartl (MReml@cl.ca11sbad.ca.us) Tuesday, March 07, 2006 11 :30 AM Sherri Behar RE: Water Meters @ Marbella All meEers nave· been removed. If you nave anYfuote quesEions please give me a call. Mario Remillard 1 Sti•m Setiar rrom: Sent: To: Greg Fisher (Gf1sh@cl.car1sbad.ca.usJ Thursday, March 02, 20061:18 PM Sherri Behar Subject: Re: 240S & 2407 La Costa Ave -La Costa de MartJella demolition The aoove mentioned project is not located Within the City's coastal zone nor is it located within a Redevelopment zone. Please call me if you need further infotfi\ation. Greg Fisher Assistant Planner city of carlsoad C760l 602-4629 phone (760) 602-1052 fax gfish@ci.carlsoad.ca.us >>> "Sherri Behar" <sherri.15el'li!ir@fedex.com> Mr. G. Fish Planning Department Gity of GaEisbad Mr Fish: Thanks for speaking with me today regarding the planned demolition of the 8 units in La Costa de Marbelia, As peE ouE eonve£sation, these buildings (2 buildings with 4 units in eaeh building and eight garagesi are scheduled to be demolished some time in late March I April or May of 2006, Ail part of the requirements to ol5tain the Defflolitioh Permits from the city of carlsl5ad, we ate teqUired to confirm with your department that the said property is NOT in the Redevelopment atea or in the Coastal Zone. The addresses are: 2405 # A, 2405 # B, 2405 #C, & 2405 #0 and 2407# A, 2407 # B, 2407# C & 2407 #0 La Costa Ave. Carlsbad, CA 92009. Please confim 15aek to me via email that the al5ove is true. ThanR you for your support on this teqUest. RegaEds, Sherri. Behar HOA 8ea£d Member La Costa de Marbelia 760-943-9533 2415 #B La Costa Ave. Carlsbad, Ca 92009 1 "' ' "' • 0 ro "' ro ro • 11!9{ NOTICE OF SERVICE DISCONTINUANCE ~~Sempra Energy"utllRY • ~ i ~ PERMIT DEPARTMENT CITY OR COUNTY OF: CARLSBAD 0 ro ' )-~ cr w z w < cr ~ ~ w ~ ~ ro N ' ~ 0 ' "' ' ro GAS □ ELECTRIC O GAS AND ELECTRIC l8J SERVICE WILL BE DISCONTINUED TO: 2407LACOSTAAVE (ADDRESS) BY: 09/02/05 ALL SERVICE LINES WILL BE REMOVED (DATE) THIS BUILDING CAN BE MOVED OR RAZED AFTER THE ABOVE DATE SAN DIEGO GAS & ELECTRIC BY: TERRY L. ZEPEDA (EMPLOYEE NAME) TODAY'S DATE: 09/02/2005 :3./.:t{. \·ft,.£~ .. ; PHONE 7609317309 ' License Detail Page I of2 Cahforn,a Home fv1ondc1y J License Detail Contractor License# 813313 DISCLAIMER A license status check provides information taken from th_e CSLB license data base. Before on this information, you should be aware of the following limitations: • CSLB complaint disclosure is restricted by law {B&P 7124.6). If this entity is subject tc complaint disclosure, a link for complaint disclosure will appear below. Click on the lin button to obtain complaint and/or legal action information . • Per B&P 7071.17, only construction related c;iviljudgments reported to the CSLB are disclosed · . . · · .,,;., ;,i/,, · .> •-. · . . _. <, .. ,.,L ... _;\t•. :.,,,1•\:·_. i'• .. ,\,-.. '··,·1.-:. ·_ .,_. • Arbitrations are not listed unless the contracto(fglil§ to ~C)(r.Jply v¢[tp the terms of the arbitration. · . ,·);_, ::":" .... ,;.\~/ . o Due to workload, there may be relevant infomiation thafhas 11d(~etbeen entered ont Board's license data base. ·· · -· :c,;: : :}_;; / , /J: , : -•.. -.. -,,; > -'t-.: ,, :, '~ff,{" ;·, ._:;-,:_,,. (.':·'_;...;/;._',) Extract Date: 07/17/2006 · · :., * * * Business Information * * * AM G DEMOLITION & ENVIRO!llMENTAL SERVICE 1220 ROSECRANS STREET - SUITE#523 SAN DIEGO, CA.92106 . Business Phone Numt,er: (619) 501-7427 Entity: Corporation . . .. . - Issue Date: 10/03/2002 Expfr!2,Oate:·10I31{2006 ',"i ' , '· ;· ' ·1 ¥• * * * License Stiltus * * f. This license is current and active. All information belQw sh<>~lcl, be. rev.iewed. 'ti-;·(1g(.". * * * Classific'atio'ris\f;i, ~ ·. ··-·-· · ------·· 1-··--·· · · · ·----. ··-·-····-----· ----· ·---· --·-----' --· ... I Class I Description iB ,G~ERAL BUILDING.CONT.RAC"(QB . · -.... -•• I --.... ' . ----···--· __ __, ___ ·-.. ·----.• -I C21 ;BUILDING MOVING, DEMOLITION ; ;A 1GENERAL ENGINEERING CONTRACTOR j . . . ' * * * Bonding Information * * * ,; '' http://www2.cslb.ca.gov/CSLB _ LIBRARY /License+Detail.asp.. -------....... ·--", 07/17/2006 License Detail Page 2 of2 CONTRACTOR'S BOND: This license filed Contractor's Bond number 9060028 in the arr $10,000 with the bonding company AMERICAN CONTRACTORS INDEMNITY COMPANY. Effective Date: 01/01/2004 Contractor's Bonding History BOND OF QUALIFYING INDIVIDUAL(1): The Responsible Managing Officer (RMO) MIC ANTHONY GAFA certified that he/she owns 10 percent or more oOhe voting stock/equit) corporation. A bond of qualifying individuaHs not required. Effective Date: 10/03/2002 BOND OF QUALIFYING INDIVIDUAL(2): This license filed Bond of Qualifying Individual 1 10039512 for GLENN WENDELL MONTAGUE in the amount of $7,500 with the bonding c ACCREDITED SURETY AND CASUAL TY COMPANY INC. Effective Date: 09/07/2005 ·. * * * Workers Compensaijo~~l"formation * * * This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND Policy Number: 1684577 Effective Date: 05/01/2002 Cancellation Date: 08/14/200E ;;·>r:.,, ,[~·-1:·· Personnel listed on this license (current or disil~.sociate,d) a.re listed on other lice, Personnel List Other Licenses I ■·=sa=le=s=pe=•=•o=n=R=ea=u=e•=t _ ____Jj __ ~alesperson, ~ame· Request : , ' © 2006 State of California. Condition.~-¢ U~e ~rivacy·Policy ,.·,.:, . I'.'. ; <. l ,' .' • http://www2.cslb.ca.gov/CSLB _ LIBRARY /License+Detail.asp 07 /l 7 /2006 A E-R WA WI 1 : A N7, R ~ R 4 l A ,A AR~ ,BAD, jUl Cl M t #: #. CITY OF CARLSBAD 4 3692 08/30/Q3 0001 0~ -PRMT A I• h xt C Fl~PPROVAL INSP. ~ DATE 9:1•tr CLEARA C c?-73 ~ • '8' .' <('' 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION PLAN CHECK NO. City of carlsbad Building Departaent 2075 Las Pal-Or., Carlsbad, CA 92009 (619) 438-1161 EST.VAL. __________ _ ' PLAN CK DEPOSIT. _______ _ VAIID.BY __________ _ I. PkkMI I IYPE DATE A -U COmmerc1al O New Building O I enanc Improvement B -□ Industrial □ New Building D Tenant Improvement C -□ Residential □Apartment)( Condo D Single Family Dwelling □ Addition/Alteration □ Duplex D Demolition □ Relocation O Mobile Home O Electrical )i{ Plumbing □ Mechanical □ Pool □ Spa D Retaining Wall □ Solar □ Other FOR OFFICE USE ONLY mt o. ase o. CHECK BEWW IF SOBMl 11 ED: □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PARCEJ: EXISTING USE PBOPQSED USE DEscR1PTioN0FwoRK Run Gfl.S L,,-1-<. +-o ~"""'5 ... SQ. IT. # OF STORIES 3. WNIACI PERSON (I[ dnlerenl from apphcani) NAME ADDRESS CITY STA TE ZIP CODE DAY TELEPHONE NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE NAME CITY STATE STATE UC.# ADDRESS ZIP CODE UCENSE CLASS DAY TELEPHONE CITY BUSINESS UC. # CITY STATE ZIP OODE DAY TELEPHONE STATE UC.# 7. WORkERS' WMPENSAIION Workers' Compensation Declarat1on: I hereby ailtrm that I have a cert1hcate of consent to self-msure issued by the D1rectorof lndustnal Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE OOMPANY POUCYNO. EXPIRATION DATE Cert1llcate of Exemption: I certify that JO the performance of the work for which this pemut 1s issued, I shall not employ any person JO any manner so as to subject to the Workers' Compensation Laws of c.alifomia. SIGNATIJR DATE □ □ I hereby afllrm that I am exempt from the COntracto?s License Law for the followJOg reason: 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 Llcense 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.). 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 Llcense Law). I am exempt under Section ________ Business and Professions Code for this reason: (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 Llcense Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and t e basis for the alleged exemption. Any violation of Section 70 1.5 by any applicant for a permit subjects the applicant to civil pen of not more than five hundred dollars [$500]). SIGNATIJRE DATE ~(A Is the applicant or future building occupant required to submit a business plan, acutely hazardous material registraf n form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □YES □NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □YES □NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □YES □NO IF ANY OF nm ANSWERS ARE YES, A FINAL CERTIFICATE OF OOCUPANCY MAY NOT BE ISSUED AFI"ER JULY ], 1989 UNI.ESS THE APPLICANT HAS MET OR IS MEIITING nm RF.QUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND THE AIR POI1.lJTION mNTROL DISllUCT. 9. WNSJROCIION LHNDJNG AGENCY I hereby aihrm that there as a construcuon lending agency for the performance of the work for which this permit 1s issued (Sec :3097 (I} CIVIi Ccxle). LENDER'S NAME LENDER'S ADDRESS 10. APPilCANI CFJtlMCAl1dN I certify that I have read the apphcauon and state that the above mformauon 1s correct. I agree to comply with all City ordinances and State laws relating co building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP IIARMIJ'.SS THE CITY OF CARISBAD AGAINST AIL IJABIIJTIES, JUDGMENTS, CDSTS AND EXPENSES WIIlCH MAY IN ANY WAY A£DUIE AGAINST SAID CITY IN mNSEQIIENCE OF TIii! GRANTING OF nns 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 365 days from the date of such permit or if the building or work authorized by such permit is suspended or a ndoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Buildi g Code . DATE: fl/A () C/ _3 YELLOW: Applicant PINK: Fmance PERMIT# C~~30899 DESCRIPTION: GAS LINE TYPE: PLUM CITY OF CARLSBAD INSPECTION REQUEST FOR 09/08/93 FOR WATER HEATER INSPECTOR AREA PY PLANCK# CB930899 OCC GRP JOB ADDRESS: 2407 LA APPLICANT: SAENZ, ROGER CONTRACTOR: COSTA AV CONSTR. TYPE NEW LOT: STE: A PHONE: 619 944-8854 OWNER: PHONE: ~ PHONE: REMARKS: MH/ROGER/944-8854 INSPECTOR-""---------- SPECIAL INSTRUCT: ROGER SAYS HE IS READY FOR YOU TOTAL TIME: LVL DESCRIPTION ACT COMMENTS CD 23 PL Gas/Test/Repairs L _____ _ ------------------------------------------------------ ***** INSPECTION HISTORY***** DATE DESCRIPTION 090393 Gas/Test/Repairs ACT INSP CO TP COMMENTS SEE JOB CARO B U I L D I N G P E R M I T F ._ .c '-...,J01981J 1 2 / 31 / 9 O; •1 3 : 3 4 Page ,1 of 1 Job Address: 2407 LA COSTA Permit Type: PLUMBING Parcel No: 216-240-55-44 Valuation: o Construction Type: NEW Occupancy Group: Description: GAS LINE AV Appl/Ownr : LE FEVERS, ANNA 2407 C LA COSTA AV CARLSBAD, CA 92009 OWNER LE FEVERS, ANNA *** Fees Required * * Fees: Adjustments: Total Fees: Fee description Ent.er "Y" for Plum 1. Gas Piping System * PLUMBING TOTAL Class Code: * le Str: * * Project No: A90022q3 Development No: Fl: **** Ste: C ~ 01 12/~l 90 oon r.1 PR~ Status: Applied: Apr/Issue: Validated By: 619-552-0770 ISSUED 12/31/90 12/31/90 KZH Credits .00 .oo 10.00 *** Ext fee Data 7.50 Y 2.50 10.00 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 --·----~-·----------------------- PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Pal_;4s Dr., Carlsbad, CA 92009 (619) 438-1161 & .. EST. VAL. ______________ _ PLAN CK DEPOSIT ___________ _ VALID. BY ____________ _ 1. PERMIT TYPE DATE ______________ _ A B C COMMERCIAL TENANT IMPROVEMENT 0 INDUSTRIAL □NEW □TENANT IMPROVEMENT □RESIDENTIAL □APARTMENT )(CONDO □SINGLE FAMILY DWELLING 0ADDITION/ALTERATI □DUPLE)( 0DEMOLITIOH ~OCATION □MOBILE HOME □ELECTRICAL )(PLUMBING □MECHANICAL □POOL □sPA □RETAINING WALL □SOLAR Do ER 2. PROJECT INFORMATION '""'"''PltJ7 C t.,fUJST"1 Nearest Cross Streets (!,,1/lf,IA}(J LEGAL DESCRIPTIOI Lot No. CNECK BELOW IF SUBMITTED: Q2 Energy Cales q2 Structural Cales ASSESSOR IS PARCEL Q2 Soils Report 0 1 Addressed Envelope EICISTING USE Unit No. Phase No. PROPOSED USE ~~.du:br.Xni~ ;LDG. SO. FTG.tl /~¢ # OF STORIES ? u 3. CONTACT PERSON NAME CITY SIGNATURE STATE ADDRESS ZIP CODE DAY TELEPHONE 4. AP.11,LICANT , ___ o.co,;,mOR NAMEh.1?/'Ji!J. ~e,.::, 0 AGENT FOR CONTRACTOR 1!(0\./NER O AGENT FOR OlolNER ADDRESSz,,//j7CLt!/ C4$;r/7 ,4//,5 CITY CA~MZ> STATECA ZIP CODE 9~ DAY TELEPHONE ~Z,-ttJ77ZJ 5. PROPERTY OWNER OWNER □LESSEE □TENANT NAME CITY STATE ADDRESS Z!P CODE DAY TELEPHONE 6. CONTRACTOR 7. 8. NAME CITY SIGNATURE DESIGNER NAME CITY STATE STATE LIC. #, ____ _ STATE WORKERS' COMPENSATION ADDRESS ZIP COOE LICENSE CLASS _____ _ TITLE ADDRESS ZIP CODE DAY TELEPHONE CITY BUSINESS l!C, # DATE DAY TELEPHONE STATE LIC. # Workers• Corrperisat,on Declaration: hereby affirm that have a certificate of consent to self·insure issued by the Director of Industrial Relations, or a certificate of l,lorkers' Corrpensat ion Insurance by an actni t ted insurer, or an exact copy or ckJpl i cate thereof certified by the Di rector of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY POLICY NO. EICPlll:ATION DATE Certificate of Ex~tion: I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in any manner so as to become subject to the Workers' C~nsation Laws of California. SIGNATURE DATE OWNER-BUILDER DECLARATION Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D I as owner of the property or my employees with wages as their sole c~nsation, 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 ifff)roves thereon,, and who does such work himself or through his own employees, provided that such irJllrovements are not intended or offered for sale. !f, however, the building or irJllrOvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or irJllrove for the purpose of sale.). D 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). D I am exempt under section ___________ _ Business and Professions Code for this reason: (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, conmencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exeffl)tion. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant t a civil penalty of not more than five h dollars [$500] /?, .2 j SIGNATURE DATE ,r, COMPLETE THIS SECTION Js the applicant or future building occupant required to subnit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tamer llazardous Substance Account Act? QYES 0NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □YES 0NO ls the 'facility to be constructed within 1,000 feet of the outer boundary of a school site? QYES 0,0 If ANT OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCaJPAMCY MAY NOT BE ISSU:0 AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIRB£11TS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 9. CONSTRUCTION LENDING AGENCY hereby affirm that there is a construct i Ofl I ending agency for the performance of the work for which this permit is issued (Sec 3097( i ) Ci vi I Code). LENDER'S NAME LENDER'S ADDRESS 10. APPLICANT'S SIGNATURE I certify that I have read the application and state that the above mformation is correct. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE INDENNIFT AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES, Jll>Q4ENTS, COSTS AND EXPENSES loll!ICII MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. Expiration. Every permit issued by the Building Official under the provisions of this Code shall e11.pire by limitation and become null and void if the building or work authorized by such permit is not COlllllenced 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 coomenced for a period of 180 days (Section 303Cd) uniform Building Code) . .-0\./NER □ CONTRACTOR □BY PHONE APPRO\iED. BY: ______ _ DATE: WHITE: File YELLOW: Applicant PINK: Finance PERMIT# CB901980 DESCRIP'l'ION: GAS LINE TYPE: PLUM CITY OF CARLSBAD INSPECTION REQUEST FOR 04/11/91 JOB ADDRESS: 2407 LA COSTA AV APPLICANT: LE FEVERS, ANNA CONTRACTOR: PHONE: PHONE: OWNER: LE FEVERS, ANNA PHONE: REMARKS: MH SPECIAL INSTRUCT: TOTAL TIME: INSPECTOR AREA PY PLANCK# CB901980 OCC GRP CONSTR. TYPE NEW STR:** FL:**** STE: C 619-552-0770 CD 23 LVL DESCRIPTION ACT COMMENTS PL _G_a_s_f_T_e_s_t_f_R_e_p_a_i_r_s _______ M:--------------- -------------------- -------------------- ***** INSPECTION HISTORY***** DATE DESCRIPTION 040891 Gas/Test/Repairs ACT INSP NR PY COMMENTS NOT HOME/NO GAS PRES TEST