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2501 EL CAMINO REAL; ; CB131572; Permit
08-15-2013 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: Building Inspection Request Line (760) 602-2725 CB131572 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: 2501 EL CAMINO REAL CBAD Tl Sub Type: COMM Status: ISSUED 1563020800 Lot#: 0 Applied: 06/28/2013 $0.00 Construction Type: 5B Entered By: JMA Reference # Plan Approved: 08/15/2013 Issued: 08/15/2013 Inspect Area Plan Check #: 130045 ROBINSON MAY: DEMOLITION OF STRUCTURE INCL. REMOVAL OF PENTHOUSE AND SECOND LEVEL. SHORING AND RELOCATION OF SOME COLUMNS AND FOOTINGS Applicant: MICHAEL SHELLER 41 ST FLOOR 2049 CENTURY PARK EAST CENTURY CITY CA 90067 319-575-5909 Ow^ner: CMF PCR LLC C/o WESTFIELD PROPERTY TAX DEPT PO BOX 130940 DEPT WFLD CARLSBAD, CA 92013 Building Permit $0.00 Meter Size Add'l Building Permit Fee $0.00 Add'l Red. Water Con. Fee $0.00 Plan Check $0.00 Meter Fee $0.00 Add'l Building Permit Fee $2,492.70 SDCWA Fee $0.00 Plan Check Discount $0.00 CFD Payoff Fee $0.00 Strong Motion Fee $0.00 PFF (3105540) $0.00 Park Fee $0.00 PFF (4305540) $0.00 LFM Fee $0.00 License Tax (3104193) $0.00 Bridge Fee $0.00 License Tax (4304193) $0.00 BTD #2 Fee $0.00 Traffic Impact Fee (3105541) $0.00 BTD #3 Fee $0.00 Traffic Impact Fee (4305541) $0.00 Renewal Fee $0.00 PLUMBING TOTAL $0.00 Add'l Renewal Fee ($1.00) ELECTRICAL TOTAL $0.00 other Building Fee $0.00 MECHANICAL TOTAL $0.00 Pot. Water Con. Fee $0.00 Master Drainage Fee $0.00 Meter Size Sewer Fee $0.00 Add'l Pot. Water Con. Fee $0.00 Redev Parking Fee $0.00 Red. Water Con. Fee $0.00 Additional Fees $0.00 Green Bldg Stands (SBl473) Fee $1.00 HMP Fee ?? Fire Expedidted Plan Review $0.00 Green Bldg Standards Plan Chk ?? TOTAL PERMIT FEES $2,492.70 Total Fees: $2,492.70 Total Payments To Date: $2,492.70 Balance Due: $0.00 Inspector: FINAL APPyROVAL Date: Jlkd^^ 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 infomiation with the City Manager for processing in accordance with Cartsbad 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 fees/exactions of which vou have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously othenwise expired. ^ # 09-26-2013 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Storm Water Pollution Prevention Plan (SWPPP) Permit Permit No:SW130236 Job Address: 2501 EL CAMINO REAL CBAD Permit Type: SWPPP Parcel No: 1563020800 Reference*: RW 13-140 CB#: CBI 31572 Project Title: ROBINSON MAY: DEMOLITION Applicant: MICHAEL SHELLER 41 ST FLOOR 2049 CENTURY CITY CENTURY CITY CA 90067 319-575-5909 Lot #: Status Applied Entered By Issued Inspect Area Tier Priority: ISSUED 06/28/2013 JMA 07/25/2013 PY 1 M Owner: CMF PCR LLC C/O WESTFIELD PROPERTY TAX DEPT PO BOX 130940 DEPT WFLD CARLSBAD, CA 92013 Emergency Contact: BILL HEITMAN 314-565-2584 SWPPP Plan Check SWPPP Inspections Additional Fees $51.00 $216.00 $0.00 TOTAL PERMIT FEES $267.00 Total Fees: $267.00 Total Payments To Date: $267.00 Balance Due: $0.00 FINAL APPROVAL DATE SIGNATURE CLEARANCE (VHE!H)ILOW»« APPROVE fiEQlHiaD PTO? TO PEIUirriSSUAhffi DPtAHtJING [IjENGHeSaire •BUR.BHG IUFRE OHEALTH •HAZBAT/APCD CfTY OF CARLSBAD Building Pennit Application 1635 Faraday Ave., Carisbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: buildtr)g@car1sbadca.gov www.cartebadca.gov PlanCheckNo. ^CT3 15 ' (3'7Z Est Value Plan Ck. Deposit Pate 06 2^2013 [SWPPP l=S-^3i,| JOB/tDDKESS 2501 El Camino Real xt/vmt < BATHROOMS TYPT OCC. GROUP Merc CT/PROJBCT# The Rob May box sits at the east end of the Plaza Camino Real Mall. We will be affecting all 150,000 square feet of the building. We intend to remove the penthouse and the second level of the building leaving only the footings, coluims and second floor slab. There will be some shoring involved to relocate some colurans and footings. PATIOS (Sf) N/A EXISTING USE vacant Mercantile PROPOSEDUSE Lifestyle QARAQE (SF) N/A Da;KS(SF) N/A FIREPLACE AIRCOMOmONIKIG YES ONO [3 FIRESPRINKLERS VESQNO|3 APPLICAHT NAME (Primtrf Otmiaet) Michael Sheller APPUCANTIOAME (Secenilar)r Contact; ADDRESS 2049Century Park East 41st floor AODRESS entury City STATE CA ZIP 90067 CITY STATE ZIP PHONE 319 575 5909 FAX PHONE FAX EMAIL msheller®westfield.com EMAIL PROPEHTY.OWNEH NAME See Attached NAME. ermined ADDRESS ADDBESS CTY STATE ZIP CITY STATE ZIP PHONE FAX PHONE EMAIL ARCH/DESieNER NAME & ADORESS (Sec. 7031.5 Busines and Pfofesskins Code: Any Clly or Counly whicfi requires a parmit to construcL alter, ImpiDve, dennotish or rojtir any stnicture, prior to its Issuinoe. also requires the applicantfor such pennit to flea signed statement that he Is licensed puisuant to the provisionsof tna Contractor's UcenseLaw (Chapter 9, conunendkiewlth SecHon 7000 of Division 3 oftiie Businsss and Prolessions Code] or that he is exempt theielhim, end the tiasis for the sieged exemption. Aiv violatian of Section 7031.5 by any apptcanvnir a pemilt suUscts the applteant to a dvil penalty of not more than five hundred dollars ($500)). w o r? ir E If s c o M p E N s A T i o ti YVorken'Coiapeiitatoii Dtctaallon: / Asisly ato WPifBr peiBllr of peifvy'0^ BI)iiviindwRraaliitiia>caitilieriicfcon««httostHnwf*to«ioitels'ooi^^ 3?tia of tin Labor Coda, fix Sie pertomanisal lhe wottcfbrwhldi thk psn^ I feiva and wn imiiiiatt woftori' compaBsttioR, at isquM l>r SecM 37X)0 of SIS L niiiiit»ra»: Insuiance Ca PofcyNa. ExpkaSanDab p^secion nasd riM lis compislad f the pemilt Is br ona hundred ddlais ^lOq or less. {_J CertllicitB of Enmpllan: I laiflfy ftat h te pafamiaius of tie woit for Cdbnla. WARNMO: Mn to secure •nrinrs' campBinBan cavertga It unlmrful, and tliill ttibject so enqilayar to ciMnal psndte and dvH Rnes up lo one hundnd lhavsand dollan ^lOSfiOOl In sdiWan to the cM of campematlan, damagsi ss prcvliisd for in Section 3706 of Dit Latior code, latctast and aitomey^ ItM. JBS COmRACTOR SIQNATURE •AfiENT DATE O.W W JE R • J/ieretyalftiiHiiatJaiiieiBnpffaiii Corteiiof's lfcense U» fiy ffie fafewfegmaaw: I I I, as omisrolthepniiei^Dr iny ernpfoirees will wagesas talrsolecompansaGaii Ucanse Law does not apply to an owner praperty lite buikis or impniyes theieon, and ^A/sds. H, howeyer, Ihs buiUng or hipnivenisnt Is sold withh ona y^^ DH l.asDiwierollheptoiiei^.anieiicluslya^contiactlnBirift nit apply to an owner ol piopgity nAo Mds or improves thereon, and contracts fv such prajeds wDh conlraclor(s) Hcensed puisuant to the Connacbrs t^aise Iwi}. I I I aw etempt under Seclion ^austoass ard PraessionE Coda for t* reason: 1.1 personally plan iopmvUe he mitjor labor and maleiialtliN'constmcion of Sapr^ QYes r~lNo ZI (havaf ham noQ signed an spptcstianfDra buKUng pentiKforlhe proposad work. 3.1 have contacied wIBi fn foSowing paisan (Ihn) lo poiMe Ihe pioposed CDRS&ucton ^ 4.1 |ian to piovide portions of 9ie woiK but I have hi'ed ths fcMng peison b coorclnale, sifiennsa an^ 5,1 will provide some of An smx, bit I have contiactsd (filled) fe fiMng psiaont lo pro^ .^fpROPERTY OWNER SIGNATURE QAOENT DATE S/,V>. ail , 2JOI3 C OTV1 P L E T e TH IS SEC T 1 O ffl f O f? N O IM I? £ S I f? E N Tl A t B U 1 «-Q 1 N G PEK M ITS O UJ L ¥ Is tha applicant or future buHIng oocupant required ID sdnttabusinesB pbn, soaely hazantous malerialt tegktratlon bmi or iM management and pmnnlkin ingiim under Sedbia 255CS^ 2S533 or25534 olthe Piesley-Tannar Hazatdous Substance AccounI Actr 'Yes • "No ltth>!(ipicantiTfutiretijUlno<x»4>an(iBqaliadtacl]lainap«imtfiii^ );-Yes i.No Is Ihe fKiNy to be constracted wllliih 1,000 fed of the outer bounds " 'Yes '^.No FANY0FTHEM4SME)ffiAREYES,ARNALCBniFX>TEQF0CCUPAIOMAYH0TK EMERGBta SBMCES AND TKE AR POLLUTiOK COHTROL DISTRICT. to NSTflUCTIQfii lEf^D ING AGENCV I heretiy affinn that there'» a constmcSon ierx&ig egency for Uie perfbnnance of the work this pennit Is issued (Sec 3097 (i) Chi Cods). Lender^ Nsme Landers Address fi. I' PLICA hi T C E If T » f t C A T t O N liart^rtiitlhauereadteaivlicgBonandMlhBttheBbaisMbiTaBllDnbccaedlntfM Iheieby auihorize rapreserMieoFlheCily Of Caifebadbeitot^lie^ AGAWSTAaUABLmES,JUDGMBflS,CC3SreA^©E)«NSESWHICH OSHA:/«i OSHA pimit Is leqM br M»aeo(» over SO'deep and d^ D<PIR^TI0N:B«iypgmAlssijedbyl«Blddli9CHHd 160 d^ linn Ihe ifaie of siil pernitv ItnbLUH^ .jCfAPPLICANT'SSIONATURE DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the follovring ONLY ff a Certificate of Occupancy wfll be requested at finai inspection. Fax (760} 602-{560, Emill buildBTOI^C^sbadca.gov or Mall the ccrnpleted fiimi to CIV of Carisbad, Building DMsion Faraday Aveniie. Carisbad, Callbmia 92008. C0#: (Offlee Uas Only) CONTACTNAME OCOUPANTNAME ADORESS BUILDING ADDRESS cmr STATE ZIP crry STATE ZIP Carlsbad CA PWNE FAX EMAI. OCCUPANTS BUS. uc. No. DBJVERV OPTIONS nCKUP: CONTACT fisted above) OCOJPANT (Usted above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (Usted above! OCCUPANT (Listed above) CONTRACTOR (On Pg.!) MAIL/FAX TO OTHER: ASSOCIATED C8# NO CHANGE IH USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION ASSOCIATED C8# NO CHANGE IH USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION ^efAPPUCANrS SGKATURE DATE Attachment to Buildmg Permit Application CityofCarlsbad Owner's Signature Page Dated: June 27,2013 PL/^ZA CAMINO REAL, a Califomia limited partnership By: PCRGP, L.P., a Delaware limited partnership its general partner By: Plaza Camino Real LLC, a Delaware limited liability company, its general partner By: Westfield America Limited Partnership, a Delaware limited partnership, its sole member By: Westfield U.S. Hp4diBgs, ^Delaware limited Uability company, its^^iKal pa Inspection List Permit*: CB131572 Type: Tl COMM ROBINSON MAY: DEMOUTION OF STRUCTURE INCL. REMOVAL OF PENTH Date Inspection Item Inspector Act Comments 10/23/2013 19 Final Structural PY AP Thursday, September 10, 2015 Page 1 of 1 EsGil Corporation • AF In (PartnersHip witH government for (BuiCding Safety DATE: AUG. 05, 2013 JURISDICTION: CARLSBAD PLANCHECKNO.: 13-1572 SET: II PROJECTADDRESS: 2501 EL CAMINO REAL PROJECT NAME: ROBINSON - MAY 2ND STORY & PARTIAL 1ST LEVEL DEMOLITION & SHORING PPLICANT JURIS. • PLAN REVIEWER • FILE Xl The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. • The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. I I The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. I I The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. I I The applicant's copy of the check list has been sent to: Michael Sheller 2049 Century Park East 41^' floor, Century City, CA 90067 IXI EsGil Corporation staff did not advise the applicant that the plan check has been completed. I I EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Mike Telephone #: 310-575-5909 Date contacted: (by: ) Email: msheller@westfield.com Fax #: Mail Telephone Fax In Person • REMARKS: By: ALI SADRE, S.E. EsGil Corporation • GA • EJ • PG 6/28 Enclosures: 9320 Chesapeake Drive, Suite 208 • San Diego, Califomia 92123 • (858) 560-1468 • Fax (858) 560-1576 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: CARLSBAD PLANCHECKNO.: 13-1572 PREPARED BY: ALI SADRE, S.E. DATE: AUG. 05, 2013 BUILDING ADDRESS: 2501 EL CAMINO REAL BUILDING OCCUPANCY: M TYPE OF CONSTRUCTION: II-A BUILDING PORTION AREA ( Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE ($) DEMOLITION/ SHORING Air Conditioning Fire Sprinklers TOTAL VALUE 568,040 Jurisdiction Code CB By Ordinance Bldg. Permit Fee by Ordinance Plan Check Fee by Ordinance Type of Review: 0 • Repetitive Fee I Repeats J Complete Review • Other |-| Hourly EsGil Fee • Structural Only Hr. @ * $2,492.70 $1,620.26 $1,395.91 Comments: As per Contractor's Estimate. Sheet 1 of 1 macvalue.doc + EsGil Corporation In (Partnersliip witR government for (BuiUing Safety DATE: JULY 08, 2013 • AEajCANT •''JURISX JURISDICTION: CARLSBAD CTPtAN-f^ViEWER • FILE PLANCHECKNO.: 13-1572 SET: I PROJECT ADDRESS: 2501 EL CAMINO REAL PROJECT NAME: ROBINSON - MAY 2ND STORY & PARTIAL 1ST LEVEL DEMOLITION & SHORING I I The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. I 1 The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. r~| The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. PLEASE SEE BELOW I I The applicant's copy of the check list is enclosed for the jurisdiction to fonward to the applicant contact person. The applicant's copy of the check list has been sent to: Michael Sheller 2049 Century Park East 4f' floor, Century City, CA 90067 I I EsGil Corporation staff did not advise the applicant that the plan check has been completed. EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Mike (-^^ M) Telephone #: 310-575-5909 Date contacted: 7l/ol ;3(by: ^ ) Email: msheller(a)westfield.com Fax #: 6; Mail Telephone Fax In Person CORRECTIONS: #1j: On Sheet SD1.1, grid point G-9, clarify if the existing pad & column are being removed (typical), if so, provide a section through this area indicating how it is being shored (this applies to gridlines 2,9,10,11 & 12) as well as the areas bounded by lines 4,6, A & E, as well as 7,9, G.5 & K; #2): Show how the structure is laterally supported while columns, footing elements are being removed; #3): Submit calc's. forthe demolition/ shoring; #4): Submit a contractor's written estimate for this project; #5): Submit (3) sets of revised/ stamped & signed plans & calc's. to the city for review & approval. By: ALI SADRE, S.E. Enclosures: EsGil Corporation • GA • EJ • PC 6/28 9320 Chesapeake Drive, Suite 208 • San Diego, Califomia 92123 • (858)560-1468 • Fax (858) 560-1576 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: CARLSBAD PLANCHECKNO.: 13-1572 PREPARED BY: ALI SADRE, S.E. DATE: JULY 08, 2013 BUILDING ADDRESS: 2501 EL CAMINO REAL BUILDING OCCUPANCY: M TYPE OF CONSTRUCTION: II-A BUILDING PORTION AREA ( Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE ($) DEMOLITION/ SHORING Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code CB By Ordinance Bidg. Permit Fee by Ordinance ""•] Pian Check Fee by Ordinance Type of Review: [Zl Complete Review • Structural Only • Repetitive Fee Repeats • Other Q Hourly EsGil Fee Hr. @ * Comments: Sheet 1 of 1 macvalue.doc + ^ CITY OF PLAN CHECK Community & Economic ^ CITY OF REVIEW Development Department 1635 Faraday Avenue CARLSBAD TRANSMITTAL Carlsbad CA 92008 www.carlsbadca.gov DATE: 7/16/13 PROJECT NAME: 2501 El Camino Real PROJECT ID: SDP 09-04 PLAN CHECK NO:CB 131572 SET#:I ADDRESS: 2501 El Camino Real APN: 156-302-08 VALUATION: APPLICANT CONTACT: msheller@westfield.eom X This plan check review transmittal is to notify you of clearance by: LAND DEVELOPMENT ENGINEERING DIVISION - SEE NOTE BELOW - Final /nspect/on by the Construction & Inspection Division is required: Yes No X 0\ For status from a division not marked below, please call 760-602-2719 This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. PLANNING 760-602-4610 LAND DEVELOPMENT ENG. 760-602-2750 FIRE PREVENTION 760-602^665 Kathleen Lawrence 760-602-2741 Kathleen.Lawrence@carlsbadca.gov 760-602-46153 3 Gregory. Hyart;6/ca rlsiiadca, eov J \/ Linda Ontiveros /\ 760-602-2773 Linda.Ontiveros@carlsbadca.gov Cindy Wong ; 7G0-602-4662 ; CvfUhir Woiny*c,i>isb;idca,;-ov j Dominic Fieri ; Ttili-tiCtt'4664 i NOTE: APPROVAL IS CONTINGENT UPON MEETING ALL REQUIREMENTS FOR ISSUANCE OF RIGHT OF WAY PERMIT, RVV^i30i40, CONCURRENTLY WITH THE TIER 1 SWPPP, SWi30236. ^ CITY CARLSBAD O F STORM WATER COMPLIANCE ASSESSMENT B-24 Develooment Services Building Division 1635 Faraday Avenue 760-«O2-2719 www.carlsbadca .gov I am applying to the City of Carlsbad for the following type(s) of construction permit: • Buildingpermit • Right-of-Way Permit • My project is categorically EXEMPT from the requirement to prepere a stomi water pollution prevention plan (SWPPP) because it only requires issuance of one or more of the followir^ permit types: Electrical Rre Additional Rre Alarm Rxed Systems Mechanical Mobile Home Plumbing Patio/Deck Photo Voltaic Re-Roofing Sign Spa-Factory Sprinlder Water Discharge Project Storm Water Threat Assessment Criteria* No Tf}reatAssessment Criteria • My pro|ect qualifies as NO THREAT and Is exempt from the requlTement to prepare a storm water pdlufidn preventipn plan (SWPPP) because t meeis the 'no threaT assessment criteria on the City's Project Threat Assessment Woiteheet for Determination of Construction SWPPP Ter Level. My project cfoes not meet any of the High, Motlerate or Low Threat crtere descrbed tielow. /er t Lot Tier l Low Tfireat Assessment Crftsria Uf project does not meet any of the Significant or Moderate Threat cnteria, is not an exempt permit type (See list above) and the project meets or» or more til the ioilowing criteria: ' Results in some soil disturbance; and/or > • Includes outdoor construcfon activities (such as saw cuttiig, equipment washing, material stocltpiling, vehicie fuerng, waste stockpiling). Tiler 2 - Moderate Threat/Cessment Criteria • My project does not meet any of the Significant Threat assessment Criteria described below and meets one or more of ihe following critsria: • Prajed requires a grading plan pursuant to the Carisbad Grading Ordnance (Chapter 1^.16 of the Carisbad fi4unicipal Code); or, • Project wll result In 2,500 square feet or'more of soils disturbance including any associated consinidicn staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and prpject meets one or more of the additional following criteria: • Located wiihin 200 feet of an ei)virpnn»nially sensitive araa or the Paafic Ocean, and/or • Disturbed area Is located on a skipe wtth a grade at or exceeding 5 horizontal to l vertical, and/or • Disturbed area Is located abng or wilhki 30 feet of a stonn drain inlet, an open drarnage channel or watercourse, and/or • Construction wit be initiated during the rainy season or will extend into the rmny season (Oct. 1 through April 30). Tier 3 • SignlflcantTlireat/Assessment Criteria • My pmject includes clearir^, grading or other disturbances to the ground resulting in soil disturtiance totaling one or more acres Including any associated constnidion staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas: and/or • My project Is part of a phased development plan ttiat will cumulatively result in soil distuibance totaling one or more acres Induding any associated constmctkm staging, equipment storage, rehje&ng and mdntenance areas; or, • Mf project is kicated inside or wthin 200 feet of an envirenmentaDy sensitive area (see City ESA Proximity map) and has a significant potentied tor contribufing pi^lutants to neariiy receiving waters by way of storm water runoff or non-stomi water dischaiige(s). / cartHy to Hit best of my knowlatlge that tfie aliove chadsad stttaments are tnm and correct / undarattnd and aeknowladge that even though th/s project does notretiuirepreparaffon ofa constructfon SWPP, I must sHIl adhere to, and et all times durtng eonstruetion activitiea for the permit type(s) cftedt tbotre comply tW(A tfie storm rater best manajiement practices pursuant to Titie 15 of ttie Carlstad municipal Code and to CItjf SiMndaids, 'Ths City Engineer may auihorize minor variances trom the Storm Waler Threat Assessment Criteria In specisl drcumstances where H can Iw shown that a lesser or higher Constniction SWPPP Tier t.evet is warranled Prolecl Address: » Assessor Parcel No. Owner/Owners AiiBwiUedAsent Nam; . Title: Owner/Owner's Authorized Agent Signature: ^ tSle: V city Concumnct: By: DM: • YE£ DNO Project D: B-24 Page 1 of 1 Rev.03/09 STORM WATER Development Services Engineering Department ^ CITY OF STANDARDS Development Services Engineering Department ^ CITY OF QUESTIONNAIRE 1635 Faraday Avenue CARLSBAD E-34 760-602-2750 www.carlsbadca.gov INSTRUCTIONS: To address post-development pollutants that may be generated from development projects, the City requires that new development and significant redevelopment priority projects incorporate Permanent Stomn Water Best Management Practices (BMP's) into the project design per the City's Standard Urban Stormwater Management Plan (SUSMP). Initially this questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary permits and/or constructkin permits). The results of the questionnaire determine the level of storm water standards that must be applted to a proposed development or redevelopment prqject. Depending on the outcome, your project will either be subject to 'Standard Stormwater RequH'ements' or be subject addittonal criteria called 'Priority Development Project Requirements'. Many aspects of project site design are dependent upon the storm water standards applied to a prpject. Applicant responses to the questionnaire represent an initial assessment of the proposed project conditions and impacts. City staff has responsibility for making the final assessment after submission of the development application. If staff determines that the questionnaire was incorrectiy filled out and Is subject to more stringent stomi water standards than initially assessed by the applicant, this will result in the return of the development application as incomplete. In this case, please make the changes to the questionnaire and resubmit to the City. If applicants are unsure about the meaning of a question or need heip in determining how to respond to one or more of tlie questions, tiiey are advised to seek assistance from Land Development Engineering staff. A separate completed and signed questionnaire must be submitted for each new development application submission. Only one completed and signed questionnaire is required virhen multiple development applications for the same project are submitted concurrently. In addition to this questionnaire, applicants for construction permits must also complete, sign and submit a Project Threat Assessment Form to address construction aspects of the project. Rease answer ttte questions fce/ov/, follow tt)e instructior)s and sign itie form at the end. 1. Is your project a significant redevelopment? DEFINITION: Signfficant redevelopment is defined as the creation, addition or replacement of af least 5,000 square feet of impervious surface on an already existing devetoped site. Significant redevelopment includes, but is not limited to: the expansion of a building footprint; addition to or replacement of a structure; structural development including an increase in gross floor area end/or exterior construction remodeling; replacement of an impervious surface that is not part of a routine maintenance activity; and land disturbing activities related with strucmral or impen/ious surfaces. Replacement of impen/ious surfaces includes any activity that is not part of a routine maintenance activity wfiere imfyervious material(s) are removed, exposing underiying soil during constmction. If your project IS considered significant redevelopment, then please skip Section 1 and proceed with Section 2. If your pn>ject IS NOT considered significant redevelopment, then please proceed to Section 1. E-34 Paget of3 REV3/23/10 STORM WATER Development Services Engineering Depaitment STANDARDS Development Services Engineering Depaitment ^ CITY OF QUESTIONNAIRE 1635 Faraday Avenue CARLSBAD E-34 750-602-2750 www.carlsbadca.gov ISECTION 1 NEW DEVELOPMEhnr PRIORPIT PROJECT TYPE Does you project meet one or more Of the following crtteria: YES NO 1. Nous/na subdivisions of 10 or more dwellina units. Examples: single familv homes, multi-family homes, condominium and apartments X 2. Commerciai - areater tfian l-acre. Anv develooment other than heaw Industry or residential. Examples: hospitals; laboratories and other medical facilities; educational institutions; recreational facilities; municipal facilities; commercial nurseries; multi-apartment buildings: car wash facilities; mini-malls and other business complexes; shopping malls; hotels; ofFlce buildings; pubfic warehouses; automotive dealerships; airfieMs; and other light industrial facilities. Y 3. Heavv Industrial / Industrv- areater than 1 acre. Examples: manufacturlna plants, fbod processinq plants, metal working facilities, printing plants, and fleet storage areas (bus, truck, etc.). X 4. Automotfve reoa/r shoo. A facilitv cateoorized in anv one of Standard Industrial Classification (SIC) codes 5013, 5014, 5541, 7532-7534, and 7536-7539 y 5. /Restaurants. Anv facilitv that sells prepared foods and drinks for consumption, including stationary lunch counters and refreshment stands selling prepared foods and drinks for Immediate consumption (SIC code 5812), where the land area for development is greater than 5,000 square feet. Restaurants where land development is less than 5,000 square feet shall meet all SUSMP requirements except for structural treatment BMP and numeric sizing criteria requirements and hydromodification requirements. X 6. Hillside develooment. Anv develooment that creates 5.0CK} sauare feet of impervious surface and Is located in an area with known erosive soil conditnns, where the development wOl grade on any natural slope that Is twenty-five percent (25%) or greater. X 7. Environmentallv Sensitive Area (BSAi'. All develoDment located within or directiv adjacent^ to or discharqing directty* to an ESA (where discharges from the development or redevelopment wlll enter receiving waters within the ESA), which either aeates 2,500 square feet of impervious sur^K» on a proposed project site or increases the area of impervnusness of a proposed project site to 10% or more of its naturally occurring corKlition. X 8. Parldna lot firea of 5.000 sauare feet or more, or with 15 or more oarking spaces, and potentiallv exposed to urban runoff X 9. Sfreets. roads, hiahwavs. and freewavs. Anv paved sur&ce that is 5.000 sauare feet or greater used for the transportatkm of automobiles, trucks, motorcycles, and other vehicles X 10. Retail Gasoline Outlets. Servina more than 100 vehicles oer dav and areater than 5.000 sauare feet X 11. Coasta/ Develooment Zone. Anv oroiect located viHthin 200 feet of the Pacific Ocean and (1) creates more than 2500 square feet of impermeable surface or (2) inaeases impenneable surface on property by more than 10%. X 12. More ihan 1-acre of disturbance. Proiect results in the disturbance of more than 1-acre or more of land and is consklered a Pollutant-generating Development Project*. y 1 Environmentally Sensitive Arems include bui are not Imiited to all Clean Water Act Section 303(d) impaired water tiodieB; areas designalad as Ar«as of Spacial Bbloglcal Signilicance by the State Water Rssouroes Control Board (Water QualKy Control Plan for the San Diego Basin (1994) and amendments): water bodies designated with Uie RARE beneficial use tiy Ihe State Water Resouices Control Board (Water Quality Control Plan for the San Dlego Buin (1994) and amendments): areas designated as preserves or thalr equivalent under the IMultl Speotes Conservation Program within the Cilies and County of San Oiegs: and any other equhmiem anvironmsntaliy ssnsHh/e areas which have been identified by the Copermittees. 3 'Dlradly adjacent' means situated wKhin 200 feet of the Environmentally Sensitive Area. 3 '^DischarginB directly to'means outilow from a drainage conveyance system that is composed entiraiyof flows fnom he subject developmenl or redeveiopmenl sKe. and not commingled with flow fmm adjacent lands. 4 Pollutant-generating Development Prajects are those projects that generate pollutants st levels greater than background levals. in general, these tnchida al projects that contribute to an exceedance to an impaired water body or whioh create new impervious surfaces greater than 5000 square feet and/Or Introduce new landscaping areas that require routine use of ferfHlzerB and peslicides. In most cases linear pathvny prpjects that are for infrequent vehide use, such as emergency or maintenance access, or for pedestrian or bicyde use, are not considered PoUutanl-generatlng Development Projects if lhey are built with pennous surfeces or r they sheet tiow to surrounding pervious surfaces. Section 1 Results; .If you answered YES to ANY of the questions above your project is subject to Pilortty Development Project requirements. Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box In Section 3. A Sform Water Management Plan, prepared In accordance with City Stomi Water Standards, must be submitted at time of application. If you answered NO to ALL of ttn questions above, then your project is subject to Standard Stormwater Requirements. Please check the "does nol meel PDP requlrBments' box In Sedton 3. ^ E-34 Page 2 of 3 REV 3/23/10 STORM WATER Develooment Services Engineering Department ^ CITY OF STANDARDS Develooment Services Engineering Department ^ CITY OF QUESTIONNAIRE 1635 FaradayAvenue CARLSBAD E-34 760-602-2750 www.carlsbadca.gov SECTION 2 StGNIRCANT REDEVELOPMENT Complete the questions below regarding your redeveloiMnent project: YES NO 1. Prqject results in the disturbance of more than 1-acre or more of land and is conskiered a Pollutant-generating Development Project (see definition in Section 1). X If you answered NO, please proceed to question 2. If you answered YES, then you ARE a significant redevelopment and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirements. Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 below. 2. Is the project redevetoping an existing priority project type? (Priority projects are defined In Section 1) X If you answered YES, please proceed to question 3. Ifyou answered NO, then you ARE NOT a significant redevetopment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check the "does not meet PDP requirements" box in Section 3 below. 3. Is the project solelv limited to just one of the fbltowing: a. Trenching and resurfacing associated with utility wori(7 b. Resurfacing and reconfigunng existing surface paridng lots? c. New sidewalk constructton, pedestnan ramps, or bike lane on publto and/or private existing roads? d. Replacement of existing damaged pavement? If you answered NO to ALL of the quesUons, titen proceed to question 4. If you answered YES to ANY of tiie questions tiien you ARE NOT a significant redevelopment and your project Is subject to Standard Stormwater Requirements. Please check the "does not meet PDP requirements" box in Section 3 betow. 4. Will your redevelopment project create, replace, or add at least 5,000 square feet of impen/ious surfaces on an existing devetopment or, be located within 200 feet of Uie Pacific Ocean and (1)create more than 2500 square feet of Impermeable surface or (2) increases impermeabto sur^ca on the property by more than 10%? X If you answered YES, you ARE a significant redevelopment, and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirements. Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Sectton 3 below. If you answered NO, then you ARE NOT a significant redevekipment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check tiie 'does not meet PDP requirements' Ixix in Section 3 below. SECTION 3 Questionnaire Results • My project meets PRIORITY DEVELOPMENT PROJECT (PDP) requirements and must comply with additional stormwater criteria per the SUSMP and must prepare a Storm Water Management Plan for submittal at time of applicatton. My project does not meet PDP requirements and must only comply with STANDARD STORMWATER REQUIREMENTS per the SUSMP. Applicant Information and Signature Box This Box lor City use Only Address: . Assessor's Parcel Number(s): Applicant Name: Applicant Titie: Applicant Signature: . . . Iv^Tj-cNMarv y—L_a. Da/e: .', V '7- City Concurrence; By: YES Pra;sct 10: E-34 Page 3 of 3 REV 3ffi3/10 CARLSBAD CITY OF PROJECT THREAT ASSESSMENT WORKSHEET FOR DETERMINATION OF CONSTRUCTION SWPPP TIER LEVEL E-32 Developmertt Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov Project Storm Water Threat Assessment Criteria* Construction SWPPP Tier Level Significant Threat Assessment Criteria • My project includes clearing, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas; or, • My project is part of a phased development plan that wili cumulatively result in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, refueling and maintenance areas; or, • My project is located inside or within 200 feet of an environmentally sensitive area (see city ESA proximity map) and has a significant potential for contributing pollutants to nearby receiving waters by way of storm water runoff or non-storm water discharge(s). Tier 3 Moderate Threat Assessment Criteria My project does not meet any of the significant threat assessment criteria described above and meets one or more of the following criteria: • Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 of the Carlsbad Municipal Code); or, • Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria: a located within 200 feet of an environmentally sensitive area or the Pacific Ocean; and/or, • disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical; and/or • disturbed area is located along or within 30 feet of a storm drain inlet, an open drainage channel or watercourse; and/or a construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). Tier 2 Threat Assessment Criteria My project does not meet any of the significant or moderate threat criteria, is not an exempt permit type (see city's list of permit types exempt from construction SWPPP requirements) and project meets one or more ofthe following criteria: results in some soil disturbance; and/or includes outdoor construction activities (such as roofing, saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling) Tien No Threat Proiect Assessment Criteria • My project is in a category of permit types exempt from city construction SWPPP requirements (see city's list of permit types exempt from construction SWPPP requirements) and/or does not meet any of the high, moderate or low threat criteria described above. Exempt *The city engineer may authorize minor variances from the storm water threat assessment criteria in special circumstances where it can be shown that a lesser or higher construction SWPPP tier level is warranted in the opinion of the city engineer E-32 Page 1 of 1 REV 4/30/10 ^ CITY OF CARLSBAD CONSTRUCTION THREAT ASSESSMENT WORKSHEET FOR DETERMINATION OF PROJECT'S PERCEIVED THREAT TO STORM WATER QUALITY E-33 Development Services Land Development Ertgineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov Construction SWPPP Tier Level Construction Threat Assessment Criteria* Perceived Threat to Storm Water Quality Tier 3 Tier 3 - Hioh Construction Threat Assessment Criteria High Tier 3 • Project site Is 50 acres or more and grading will occur during the rainy season • Project sHe Is 1 acre or more In size and Is located within the Buena Vlsta or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA • Soil at Site Is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kr greater than or equal to 0.4) • site slope is 5 to 1 or steeper • Construction Is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). • Owner/contractor received a Storm Water Notice of Violation wtthin past two years High Tier 3 Tier 3 - Medium Construction Threat Assessment Criteria Medium Tier 3 • All projects not meeting Tier 3 High Construction Threat Assessment Crileria Medium Tier 2 Tier 2 Hiah Construction Threat Assessmenl Criteria • Projecl Is located wtthki the Buena Vlsta or Agua l-ledlonda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA • Soil at sKe Is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kr greater than or equal to 0.4) • Site slope is 5 to 1 or steeper • Constructton Is Initiated during the rainy season or wlll extend into the rainy season (Oct. 1 through April 30). • Owner/contractor received a Storm Water Notice of Violation wtthin past two years • Stte results In one half acre or more of soli disturbance High Tier 2 Tier 2 - Medium Construction Threat Assessment Criteria Medium Tier 2 • All projects not m eeting Tier 2 High Construction Threat Assessment Crtteria Medium Tier 1 Tlarl - Medum InsDection Threat Assessment Crtterfa Medium Tier 1 MJ Project Is located wtthin the Buena Vlsta or Agua Hedionda Lagoon watershed, within or ' direcfly adjacent to an environmentally sensftive area (ESA) or discharges directly to an ESA • SoH at stte Is moderately lo highly erosive (defined as having a predominance of sols wtth USDA-NRCS Erosion factors kr greater than or equal to 0.4) • Stte siope Is 5 to 1 or steeper • Construction Is Inttiated during the rainy season or will extend Into the rainy season (Oct. 1 through April 30). • Owner/contractor received a Storm Water Notice of Violation wtthin past two years • Stte rssuKs In one half acre or more of soil disturbance Medium Tier 1 Tier 1 - Low Inspection Threat Assessment Crtteria Low Tier 1 • All projects not meeflng Tier 1 Medium Construction Threat Assessment Crtteria Low Exempt - Not Applicable • Exempt 'The ctty engineer may authoiize minor variances from the construction threat assessment crtteria In special circumstances where tt can be shown that a lesser or higher amount of storm water compliance Inspection Is warranted in the opinion of the ctty engineer E-33 Page 1 of 1 REV 4/30/10 CITY OF CARLSBAD STANDARD FORM - TIER 1 STORM WATER POLLUTION PREVENTION PLAN STORM WATER COMPLIANCE CERTIFICATE My project Is not in a category of permrt types exempt Irom the Construction SWPPP requirements My projecl is not located inside or wilhin 200 feel of an environmentally sensitive area with a significant potential for contributing pollutanis to nearby receiving waters by way of storm water runoff or non-storm water discharge(s) ^ My project does not requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 ofthe Caiisbad Municipal Code) My project will not result In 2,500 square feel or more of soils disturbance Including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas that meets one or more of the additional following cnteria: • located wrthin 200 feet of an environmentally sensitive area or the Pacific Ocean; and/or, . disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical; and/or • disturbed area is located along or within 30 feet of a storm drain inlet, an open drainage channel or watercourse; and/or • constnjction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT ALL OF THE ABOVE CHECKED STATEIVIENTS ARE TRUE AND CORRECT. I AIVI SUBMITTING FOR CITY APPROVAL A TIER 1 CONSTRUCTION SWPPP PREPARED IN ACCORDANCE WITH THE REQUIREMENTS OF CITY STANDARDS. I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IIVIPLEIVIENT BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTION ACTIVITIES TO THE IVIAXIMUM EXTENT PRACTICABLE TO MINIMIZE THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO MINIMIZE THE EXPOSURE QF STORM WATER TO CONSTRUCTION RELATED POLLUTANTS; AND, (2) ADHERE TO. AND AT ALL TIMES, COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP THROUGHTOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED BY THE CITY OF CARLSBAD. Haixin Li, Hofman Planning & Engineering OWNtR(S)/0WNFR'S AQ1;N r NAMti (PRrNT) (iXVNI^RrSj/OWNI^R-S A<ir N|:R(S)/0WNI^R-S M\^H\ NAI^t (SrGNATURR) 6/13/13 DAn; STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE IO FACILITATE RAPID INSTALLATION OF EROSION AND SEDIMENT CONTROL BMPS WHEN RAIN IS EMINENT. 2. THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSION CONTROL DEVICES TO WORKING ORDER TO THE SATISFACTION OF THE CITY ENGINEER AFTER EACH RUN- OFF PRODUCING RAINFALL. 3. THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY ENGINEERING OR BUILDING INSPECTOR DUE TO UNCOMPLETED GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES WHICH MAY ARISE. 4. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE AT THE END OF EACH WORKING DAY WHEN THE FIVE (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PERCEN r (40%). SILT AND OTHER DEBRIS SHALL BE REMOVED Al-TER EACH RAINFALL. 5. ALL GRAVEL BAGS SHALL BE BURLAP TYPE WITH 3/4 INCH MINIMUM AGGREGATE. 6. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. SPECIAL NOTES PROJECT INFORMAUON Sile Address: 2501 EI Camlno Real Assessor's Parcel Number: 156-302-08 156-302-24 Project ID: Construction PermitNo.: Estimated Construction Start Date June. 2013 Project Duration 6 Months Emergency Contacl: Name: Bill Heitman 24 hour Phone: 314-565-2584 Perceived Threat to Storm Water Quality ^Medium i Low If medium box is checked, must attach a site plan sheet showing proposed work area and location of proposed structural BMPs 1. See attached site plan for construction activity areas, existing drainage facilities and location of proposed BMP controls. 2. Total soil disturbance shall not exceed 2,500 sf 3. All trenching for temporary utility connections shall be backfilled and paved. For City Use Only CITY OF CARLSBAD STANDARD TIER I SWPPP Approved By: Date; Page I or 3 Erosion Control BMPs Sediment Control BMPs Best Management Praclice (BMP) Description -> Geotextiles & Mats Wood Mulching Earth Dikes and Drainage Swales Stope Drains Silt Fence Sediment Trap Check Dam Fiber Rolls Gravel Bag Bemi Street Sweeping and Vacuuming Sandbag Barrier Storm Drain Inlet Protection Stabilized Construction Ingress/Egress Stabilized Construcion Roadway Water Conservation Practices Paving and Grinding Operations Potable Water/ln-igation Vehicle and Equipment Cleaning Material Delivery and Storage Material Use Stockpile Management Spill Prevention and Control Solid Waste Management Hazardous Waste Management Concrete Waste Managemem CASQA Designation Construction Activity EC-7 "? O UJ EC-9 EC-11 SE-1 SE-3 T UJ to SE-5 "9 tu w SE-7 SE-8 SE-10 TR-1 TR-2 NS-1 NS-3 NS-7 NS-8 WM-1 WM-2 WM-3 WM-4 WM-5 WM-6 WM-8 Grading/Soil Distuftance X Trenching/Excavation X X X X X X X Stockpiling X X X X X X X Dnlltng/Boring X ConcTBte/Asphalt Sawcutting X X X X Concrete flatwork X Paving X X X Conduit/Pipe Installatton X X X Stucco/Mortar Vi/ork X Waste Disposal X X X X X X X X Staging/Lay Down Area X X X X X X X Equipment Maintenance and Fueling Hazardous Substance Use/Storage Dewatering Site Access Across Dirt X Other (list): Spoils lo be hauled X X off-slte. Tracking Control BMPs Non-Storm ater Management BMPs Waste Management and Materials Pollution Control BMPs Instructions: Begin by reviewing the list of construction activities and checking the box to the teft ofany activity that will occur during the proposed construction, Add any other activity descriptions in the blank aciivity description boxes provided for lhat purpose and place a check in the box immediateiy to the left of the added activity description. For each activity descrribed, pick one or more best management practices (BMPs) from the list located alon the top of the form. Then place an X in the box at the place where the activity row intersects with the BMP column. Do this for each activity lhat was checked off and for each of thc selected BMPs selected from the iist. For Example - If the project includes site access across dirt, then check the box to the lef^ of "Site Access Across Dirt". Then review the list for something that applies such as "Stabilized Constmcion Ingress/Egress" under Tracking Control. Follow along the "Site Access Across Dirt" row until you get to thc "Stabilized Construction Ingress/Egress" cohimn and piace an X In the box where the two meet. As another example say the project inciuded a stockpile that you intend to cover with a plastic sheet. Since plastic sheeting is not on the list of BMPs, then write in "Cover with Plastic" in the blank column under the heading Erosion Control BMPs. Then place an X in the box where "Stockpiling" row intersects the new "Cover with Plastic" column. I o learn more about what each BMP description means, you may wish to review the BMP Reference Handout prepared lo assist applicants in the selection of appropriate Best Management Practice measures. The reference also explains thc Catifornia Stormwater Quality Association (CASQA) designation and how to apply the various selected BMPs to a project. Page 2 of 3 PLANNING DIVISION Development Services Planning Division BUILDING PLAN CHECK Development Services Planning Division ^ CITY OF REVIEW CHECKLIST 1635 Faraciay Avenue CARLSBAD P-28 (760) 602-4610 w/ww.carlsbadca.BOV DATE: 8/1/2013 PROJECT NAME: Westfield Carlsbad PROJECT ID: EIR 09-02/SDP 09-04 PLAN CHECK NO: CB131572 SET#: 2 ADDRESS: 2501 El Camlno Real APN: 156-302-08 ^ This plan check review is complete and has been APPROVED by the Planning Division. By: Jason Goff ©/'/2*>3 A Final Inspection by the Planning Division is required • Yes ^ No Vou may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance ofa building permit Resubmitted plans should Include corrections from all divisions. [] This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check Comments have been sent to: For questions or clarifications on the attached checklist please contact the following reviewer as marked: PLANNING 760-602-4610 ENGINEERING 760-602-2750 FIRE PREVENTION 760-602-4665 1 1 Chris Sexton 760-602-4624 Chrls.SextonOcarlsbadca.eov 1 Kathleen Lawrence 760-602-2741 Kathieen.Lawrence@carlsbadca.gov 1 Greg Ryan 760-602-4663 GregorY.Rvan@carisbadca.fiov 1 Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov 1 Linda Ontiveros 760-602-2773 Linda.Ontlveros@carisbadca.gov Q Cindy Wong 760-602-4662 Cynthia.Wong@carlsbadca.fiov X Jason Goff yVj^ 760-602-4643 fr jason.goff@carisbadca.gov • Dominic Fieri 760-602-4664 Dominic.Fieri@carlsbadca.gov REVIEW #: Plan Check No. CB131572 Address 2501 El Camino Real Date 8/1/13 Review # 2 Planner Jason Goff, Associate Planner Phone (760) 602- 4643 Type of Project & Use: Demolition (Rob-May Box) Net Project Density: NA Zoning: £^2 General Plan: R Facilities Management Zone: 1 CFD (in/out) #NA Date of participation: NA Remaining net dev acres: NA (For non-residential development: Type of land use created by this permit: Demolition of Rob-May Box) 12 3 Legend: ^ Item Complete • Item Incomplete - Needs your action • IEI • Environmental Review Required: YES |EI NO • TYPE EIR 09-02 DATE OF COMPLETION: Certified Julv 9. 2013 (CC Resolution #2013-176) Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval: Condition No. 9 of PC Resolution #6983 • Kl • Discretionary Action Required: YES 1^ NO Fl TYPE EIR/SDP APPROVAL/RESO. NO. 2013-176 DATE Julv 9. 2013 PROJECT NO. EIR 09-02/SDP 09-04 OTHER RELATED CASES: SP 09-01 Compliance with conditions or approval? If not, state conditions which require action. Conditions of Approval: Condition No. 9 of PC Resolution #6983 • • Coastal Zone Assessment/Compliance Project site located in Coastal Zone? YES • NO El CA Coastal Commission Authority? YES • NO El If California Coastal Commission Authority: Contact them at - 7575 Metropolitan Drive, Suite 103, San Diego, CA 92108-4402; (619) 767-2370 Determine status (Coastal Permit Required or Exempt): EDD Habitat Management Plan Data Entry Completed? YES • NO • N/A |E1 If property has Habitat Type identified in Table 11 of HMP, complete HMP Permit application and assess fees in Permits Plus (A/P/Ds, Activity Maintenance, enter CB#, toolbar. Screens, HMP Fees, Enter Acres of Habitat Type impacted/taken, UPDATE!) IEI • • Inclusionary Housing Fee required: YES • NO • N/A M (Effective date of Inclusionary Housing Ordinance - May 21, 1993.) Data Entry Completed? YES • NO • (A/P/Ds, Activity Maintenance, enter CB#, toolbar. Screens, Housing Fees, Construct Housing Y/N, Enter Fee, UPDATE!) IEI • • Housing Tracking Form (form p-20) completed: YES • NO • N/A El p-28 Page 2 of 3 07/11 Site Plan: K • • Provide a fully dimensional site plan drawn to scale. Show: North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements, right-of- way width, dimensional setbacks and existing topographical lines (including ali side and rear yard slopes). Provide legal description of property and assessor's parcel number. City Council Policy 44 - Neighborhood Architectural Design Guidelines • • 1. Applicability: YES • NO • N/A E • • 2. Project complies: YES • NOQ N/A E Zoning: • • • • 1. Setbacks: Front: Interior Side: Street Side: Rear: Top of slope: Required Required Required Required Required 2. Accessory structure setbacks: Front: Required Interior Side: Required Street Side: Required Rear: Required Structure separation: Required Shown Shown Shown Shown Shown Shown Shown Shown Shown Shown • • 3. Lot Coverage: Required Shown • • 4. Height: Required Shown • • • ED Spaces Required. Shown 5. Parking: (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required Shown Additional Comments (see below) 4.—Please add Hazards and Hazardous Materials Mitigation Measure No. Haz-1 to the plans in the form of a note (see EIR 09 02 Mitigation Monitoring and Reporting Program, Haz 1). 2r.—Future approval of this permit (CBI31572) is contingent upon meeting all requirements involved with issuing right of way permit (RW 13-140). OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER: Jason Goff DATE 8/1/2013 p-28 Page 3 of 3 07/11 PLAN CHECK PLAN CHECK Community & Economic ^ CITY OF REVIEW Development Department ^ CITY OF REVIEW 1635 Faraday Avenue CARLSBAD TRANSMITTAL Carlsbad CA 92008 www.carlsbadca.gov DATE: 8/14/13 PROJECT NAME: westfield plaza-demo permit PLAN CHECK NO: cbl31572 SET#: I ADDRESS: 2S0t ecr PROJECT ID: APN: • This plan check review is complete and has been^PROVED by the fire Division. By: cwong ^ A Final Inspection by the Division is required 1^^ • This plan check review is NOT COMPLETE. Items missingw incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check Comments have been sent to: Ybu may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance ofa building permit. Resubmitted plans should include corrections from all divisions. For questions or clarifications on the attached checklist please contact the following reviewer as marked: '•• " • .. ™..„-,..,-..,.,_^.™ , , -riiiiiiiiiiiiiiiw-' 1 1 Chris Sexton 760-602-4624 Chris.Sexton@carisbadca.gov 1 1 Kathleen Lawrence 760-602-2741 Kathleen.Lawrence@carisbadca.gov Q Greg Ryan 760-602-4663 Grefiorv.Rvan@carlsbadca.gov 1 Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov Linda Ontiveros 760-602-2773 Linda.Ontiveros@carlsbadca.gov Cindy Wong 760-602-4662 Cvnthia.Wong@carisbadca.gov • • 1 1 Dominic Fieri 760-602-4664 Dominlc.Fieri@carisbadca.gov Remarks: **APPROVED: THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUEANCE OF A BUILDING PERMIT. Page 1 of 2 THIS APPROVAL IS SUBJECT TO FIELD INSPECTIONS, ANY REQUIRED TESTS, FIRE DEPARTMENT NOTATIONS, CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND REGULATIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW. Page 2 of2 Carlsbad Fire Department Plan Review Requirements Category: TI, COMM Date of Report: 08-14-2013 Reviewed by: (^ Name: Address: MICHAEL SHELLER 41ST FLOOR 2049 CENTURY PARK EAST CENTURY CITY CA 90067 'I Permit #: CB131572 Job Name: ROBINSON MAY: DEMOLITION OF Job Address: 2501 EL CAMINO REAL CBAD TLUMFLETE ThU Item yiya'1iave-<»wbmittgd,,fe*ggy'iUW IS incomplete. At this timeTOflSTDttiGe cannot adequately conduct a review to '^p'fgj[p»i»'*^^rr^Yyy^ryc^\ liii TI mniiea}^)^ ocAcz and/or standards. Please review carefully all commentsaJtafrffe3!Please resubmit the necessary plans and/or speCTfieetiQUgjjvith changes "clouded", to this office forrg*<ewandapproval. Conditio^^; Cond: CON0006491 [NOT MET] *** Bubble all changes *** L Sheet TS: Structural drawings listed do not match what is submitted in plans. Example: SD-5 listed. No SD-5 supplied. SD 2.1 supplied, not listed. 2. Sheet TS: Appendix listed but not provided in submittal - provide. 3. Sheet TS: Building data not provided. Please do so. Include construction type, year built, etc. 4. Applicable codes this project conforms to is not listed. Please do so. Cite code and edition. 5. Sheet AD2.1: On notes to "Remove EX. STAIRS COMPLETE". Add that this shall not be done prior to second floor demo completion. This is designed so all occupants on 2nd floor have sufficient path of egress. 6. Note 10: Add that removal of existing fire protection system shall be done in phases as demolition progresses. Entry: 07/19/2013 By: cwong Action: CO Cond: CON0006556 [MET] ** APPRO VED: THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUEANCE OF A BUILDING PERMIT. THIS APPROVAL IS SUBJECT TO FIELD INSPECTIONS, ANY REQUIRED TESTS, FIRE DEPARTMENT NOTATIONS, CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND REGULATIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW. Entry: 08/14/2013 By: cwong Action: AP KCJ Engineering Inc. sheet | / |of fH 25431 Cabot, Suite 109 Client: C.A.S. Laguna Hills, Ca. 92653 Project: Westfield Carlsbad Tel (949) 380-8186 Date: 07/26/13 Fax (949) 588-1664 "i^tAl ^ s' ^s' s'-y o&e (-2) v©x\o -rteAp^ RECEIVED UoAD JUL 3 0 2013 2^ ^ CITY OF CARLSBAD BUILDING DIVISION - \\\e. > lo W KCJ Engineering Inc. 25431 Cabot, Suite 109 Laguna Hills, Ca. 92653 Tel (949) 380-8186 Fax (949) 588-1664 sheet [T|of Q Ciient: C.A.S. Project: Westfield Carlsbad Date: 07/26/13 - 1-2 ^ f ^—^ .i- K 2/ "'4°^" 1 see & ^ ^ —HT—^ ^ ^ Out o 4 a WinBeam By CAST TIME : 07/26/13 12:15:13 Page: I I * SUMMARY OF' THE INPUT INFORMATION * TYPE OF THE PROBLEM : CONTINUOUS BEAM CALCULATION * Types and the locations of the supports in Inch Hinged support at X= 24.000 Hinged support at X= 216.000 * Total number of different inaterials : 1 From X= 0.000 to X= 240.000 E= 29000.000 ksi * Total number of different sections : 1 From X= 0.000 to X= 240.000 IX= 2370.000 Inch**4 * Total number of distributed loads : 1 Unit kip/ft At X= 0.000 Wl= -4.000 At X= 240.000 W2= -4.000 * SUMMARY OF THE RESULTS * * LENGTH UNIT Inch ; FORCE UNIT : Kip * MAXIMUM VALUES * Max. displacement is 0.03091 at X= 240.000 * Min. displacement is -0.07938 at X= 120.000 * Max. shear force is 32.00000 at X= 216.000 * Min. shear force is -32.00000 at X= 24.000 * Max. moment is 1439.99991 at X= 120.000 * Min. moment is -95.99999 at X= 24.000 I WinBeam By CAST TIME : 07/26/13 12:15:13 Page: * TOTAL APPLIED LOADS * Total applied concentrated load: * Total applied concentrated moment: * Total applied distributed load: * SUPPORT REACTIONS * Reaction at X= 24.000 : Force= 0. 000 0. 000 * Reaction at X= 216.000 : Force= 0.000 Kip 0.000 Kip Inch -80.000 Kip 40.000 Moment= 4 0.000 Moment= * DETAILS OF THE .ANALYSIS * * DISPLACEMENT AT OUTPUT POINTS : At X= 0 000 Displacement= 0 03091 At X= 6 000 Displacement= 0 02320 At x= 12 000 Displacement= 0 01548 At x= 18 000 Displacement= 0 00776 At x= 24 000 Displacement= 0 OOOOO At x= 60 000 Displacement= -0 04429 At x= 72 000 Displacement= -0 05632 At x= 120 000 Displacement= -0 07938 At x= 168 000 Displacement= -0 05632 At x= 180 000 Displacement= -0 04429 At x= 216 000 Displacement= 0 OOOOO At x= 222 000 Displacement= 0 00776 At x= 228 000 Displacement= 0 01548 At x= 234 000 Displacement= 0 02320 At x= 240 000 Displacement= 0 03091 * SHEAR FORCES Coordinate X= X= x= x= x= x= x= 0.0000 6.0000 12.0000 18.0000 24.0000 60.0000 72.0000 Shear (LT side) Shear (RT side) 2.0000 4.0000 6.0000 8.0000 -20.0000 -16.0000 0.0000 OOOO OOOO OOOO -32.0000 -20.0000 -16.OOOO I WinBeam By CAST TIME : 07/26/13 12:15:13 Page: X= X= X= X= X= X= 120.0000 168.0000 180.0000 216.0000 222.0000 228.0000 0.0000 16.0000 20.0000 32.0000 -6.0000 -4.0000 0.0000 16.0000 20.OOOO -8.0000 -6.0000 -4.0000 Web Yielding W24x84 Web Yielding W10x54 tw = N = k = tf = d = Max end reaction Max interior reaction 36 0.47 4 1.27 0.77 24.1 80.12466 kips 115.5805 kips tw = N = k = tf = d = Max end reaction Max interior reaction 36 0.37 4 1.12 0.615 10.1 59.78016 84.39552 Web Crippling Web Crippling Load < d/2 Load > d/2 141.7018 kips 71.37572 kips Load < d/2 Load > d/2 111.1137 55.96836 Unbraced length L b, 216 9.02 Unbraced iength L bf 48 10 Compression flexural Web Yielding 16.0106 W8x10 Compression flexural = 21 Ksi Fy = tw = N = k = tf = d = Max end reaction Max interior reaction 36 0.17 4 0.505 0.205 7.89 21.25629 kips 26.35578 kips Web Crippling Load < d/2 Load > d/2 27.61526 kips 13.90991 kips Unbraced length L b, 48 3.94 Compression flexural 21 Ksi <A> DEMOLITION ""'""'"ZS^ ^ CITY or REQUIREMENTS 1635 FaradayAvenue r^ADI QRAr\ B-9 760-602-2719 V-/\l\L.OD/\L/ " www.carlsbadca.gov The following items must be completed prior to Issuance of a demolition permit 0 ^ Completed Application and Plans: A demolition permit may only be issued to the owner of the property or the State Licensed Contractor that is doing the work. An application and four (4) sets of plans should be submitted. Building, Planning, Engineering and Fire divisions will review and comment/approve the submittal. • Letter from Property Owner: The contractor must provide a letter, signed and dated by the property owner, giving permission for the building to be demolished. Demolition Asbestos Certification: This certification must be completed, signed and have the correct square footage of the structure being demolished, as well as its use. If asbestos remediation is required, proof of application to the APCD must also be provided. Asbestos or lead paint remediation must occur prior to issuance of a demolition permit by the City. San Diego Gas and Electric: Applicant must provide a letter from San Diego Gas and Electric stating that the utilities have been disconnected. <^c^^c/( 1,(20 Qm,^ Additional items that will be required or discussed in review are: 1. Green Building Code: Comply with waste disposal and recycling management program (50%). Sec. 5.408.1 74,408 2. Water Agency: Arrange for appropriate Water Agency to remove water meter unless construction of replacement structure is to begin shortly. 3. The Pianning Division will determine if the stmcture is in the Village Review area, the South Carlsbad Review area, the Coastal Zone or if discretionary mittgation conditions apply. (760) 602-4610 4. The Land Development & Engineering Division will detemiine if a Haul Route, Right-of-Way Pennit or Storm Water Permit Is required. (760) 602-2773,602-2775 or 602-2741. 5. Fire Department may need the use ofthe building for training purposes. (760) 602-4665. B-9 Page lof 2 Rev. O6/2013 DEMOLITION ASBESTOS CERTIFICATION ADDRESS: ^^Ol f.L r.^A[V^O ^U/^ USE OF BUILDING TO BE DEMOLISHED: ^^1^ /^ei/^ SQUARE FEET 150^t)CO X NUMBER OF STORIES _ PROPERTYOWNER: lU^T^^ ADDRESS: Zof 1 (Tf/jTH/^ fftlv^ B/^^ PHONE (^lo\ HIS'^"^Sio APPLICANT: ^:Lct^ HP:S1>AJ^ ADDRESS: ^^2^ <56 C/1*M3^ 1^6^ <~(%t /ooj PHONE 76o '"IJ^f' 4»/^S Section 19827.5 of California Heaith and Safety Code states in part: "A demolition permit shatl not be Issued by any city ...as to any buiiding 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 Environmental Protection Agency or to a designated state agency, or botii, pursuant to Part 61 of Title 40 of the Code of Federai Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the appiicant declares that the notification is not applicable to the scheduled demolition project." As applicant for a demolition permit in the City of Carisbad, 1 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 fonm is true and correct; and I further certify ttie foiiowing: 0() On the attached pages are copies of ail 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 Titie 40 of the Code of Federal Regulations, or successor to that part. ( ) I declare that the written asbestos notification is not applicabie to the scheduled demolition project. Date WESTFIELD CARLSBAD DEMOUnON OF EXISHNG BUILDING FIRST l£Vail^RIOR AND SECOND LEVEL EXTERIOR BMP LEGEND INLET PROTECnON WFTH GRAVEL BAG BERM, PER BMP SE-6, SE-10 UnLRY TRENCHING, BACKFILL AND PAVING, PER BMP SE-7, NS-3 LAYDOWN AND STAGING AREA PER WASTE MANAGEMENT BMP WM-1, 2, 3, 4, 5, 6, 8 HAUL ROUTE, PER BMP SE-7 GENERAL NON-STORM WATER MANAGEMENT BMPs AND WASTE MANAGEMENT BMPs SHALL BE IMPLEMENTED AT THE STTE WHERE APPUES, PER BMP NS-1, NS-3, WM-1, 2, 3, 4, 5, 6, 8 LEGEND. f FT. FlYIWOOO BARRICAOE r FT. FENCE WISCREEN OPERABLE CONSTRUCTION GATES CONSTRUCTION WORK AREA CONSTRUCTION TRAILERS HAUL ROUTE TRAFFIC ROUTE CONSTRUCTION FLAGMAN Uo<J*»d by Pioi»a ControU Group (PSO) Hndtton I 0 Oalad: JUOB 7. 2013 Page 3 Of 3 SDGF A Sempra Energy utility" RECEIVED JUN2 8?013 PROJ# 352504-010 May 16, 2013 CITYOFCARLSBAD BUILDING DiVISiON Bill Heitman C/O Westerfield Construction Dear Bill: Subject: Westerfield Carisbad Maii - Robinsons May Removai You requested a cost estimate to remove our electric underground facilities at the above project. SDG&E will remove the facilities for the cost of $15,397.00. These charges are for removal of the electric facilities located at 2525 El Camino Real, Carisbad as described on the attached sketch. The cost quoted above is a net contract price, not subject to any additional billing or refunds. The above cost does not inciude any work by the telephone company or cable T.V. company. Please call them for any charges they may have to relocate their facilities. Whenever differences between the preliminary and final street improvement plans or actual construction and final plans require a revision of the work order or additional relocation work, the applicant agrees to pay all engineering fees and associated construction costs incurred by SDG&E due to such differences. Such differences may also require rescheduling of SDG&E design and construction work provided for in this agreement Before excavating in the vicinity of gas or underground electric facilities, please call Underground Servioe Alert System (USA) at 1-800-227-2600. Within 48 hours, we can indicate the location of SDG&E facilities on the job site. All costs and offers quoted in this letter shall expire at the end of the business day on August 16, 2013. If business negotiations are not completed, or if you request revised costs after that date, an engineering fee may be required. Also, please understand that SDG&E is subject to California Public Utilities Commission decisions - any changes directed by the Commission can affect the quotes. The costs quoted in this letter include a cost component to cover the Utility's estimated liability for State and Federal Income Tax. If you cancel your request after the payment has been made, we will retain a portion of the original payment which represents SDG&E's expense of processing your request. The remaining amount, if any, will be refunded to you. Please send your check payable to SDG&E for $15,397.00 and the Customer Payment Remittance form in the enclosed envelope. Project Management Offices can not accept payments. All payments must be mailed to: Customer Payment Services - CP61C San Diego Gas & Electric PO Box 129831 San Diego, CA 92112-9831 Once your check is received, the work orders can be issued to construction. If I may be of further assistance or if you have any questions, please call me at the number listed below. Our hours are 7:00 AM - 4:00 PM, Monday through Friday. Mike Saldana Senior Customer Project Planner Telephone: (760) 480-7655 Enclosures n UL AUG 1 6 2013 i BUILDING DEPARTIVIENT ADDRESS: ^^Ol £Z. r^-^jvyO^D RU^ USE OF BUILDING TO BE DEMOLISHED: SQUARE FEET 150^V>i^ X NUMBER OF STORIES PROPERTYOWNER: tuB^T^^ ^/^ ADDRESS: ZoV-j Cttit^^ fftlV^ BA^ APPLICANT: 9.:tL(^ HFZSTWUJ PHONE (^/o) Hie-^'^Sig ADDRESS: ^^2^ £d C/1«M3^ I<&^ t-(St IOO^ PHONE 74o "t^?" Section 19827.5 of California Heaith 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 Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Titie 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 ara required to be submitted to the United States Environmental Protection Agency or to Part 61 of Titie 40 of the Code of Federal Regulations, or successor to that part. ) i declare that the written asbestos notification is not applicable to tiie scheduled d^oiition project. Date SAN DIEGO AIR POLLUTZON CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 PHONE (858) 586-2650 FAX (858) 586-2651 FOR APCD USE OWLY NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Postmark Received Fee/ Receipt Notification # Entered Sector Inspector Assigned/Date Completed by: USA POWELL Company: MATRIX ENVIRPNMENTAL NOTIFICATION • Original • Cancdlation • Courtesy • Other(speclfy): • Revision M Chsnge In asbestos amount • Change In start/end date (indicate typa of revision) (greater than 20%) PROJECT TYPE FACILITY INFORIWATION • Demolition • Emergency Removal • Ordered Demolition • Emergency Demolition 13 Renovation (removal) • Planned Renovation (annual) Facility Name: WESTFIELD PLAZA CAMINO REAL Address: 2501 EL CAMINO REAL Cross Street: HAYMAR City; Carlsbad ZipCode: 92008 Facility Owner: WESTFIELD LLC Address: 11601 Wilshire Blvd City: LosAngeles State: CA zip Code: 90025 Contact: CONTRACTS Title: Phone No: 310.575J901 Buildtng Size (sq. ft): 150,000 Bulldlng Age (years): 50 Number of Floors: 2 Number of Units; 0 Building prior/present use: H Commercial • Hospital • Industrial • Office • K-12 School • Public BIdq • House/Condo • Ship • Unlv/College • Other PROJECT INFORMATION Asbestos Survey Performed?* K! Yes • No Is Asbestos Present? 12 Yes • No Will the asbestos be removed? El Yes n No Is the building to be demolished? EYes DNO Asbestos Amount to be removed (sq/ln ft): Friable Wpes: 50 Category I Pioes: Category n Ploes: Total Asbestos Amount to be removed (sq/ln ft): Surface Area: 19000 Surface Area: Surface Area: Asbestos Amount to be removed (sq/ln ft): Facility Component: Facilitv Comoonent: FadlHv Component! Asbestos Amount to be removed (sq/ln ft): Revised Amounts (If a revision) 31000sf mastic | {^(JV-kU Asbestos Removai Start Date; 4/15/13 Asbestos Removal End Date: 5/30/13 Demolition Operation Start Date: Demolition Operation End Date; For revisions only Revised start Date:. Revised End Date: _ For revisions only Revised Start Date:. Revised End Date: _ Removal Contractor: Name: MATRIX ENVIRONMENTAL Phone No: 562.236.2704 CSLB License*; 697132 Address; 2330 CHERRY INDUSTRIAL CIRCLE City/State/Zlp; LONG BEACH, CA 90805 Site Supervisor: JORGE MARQUEZ Demoiition Contractor: Name: US DEMOUTION Phone No: 714.695.9026 CSLB Ucense*: 778598 Address; 4510 E. EISENHOWER CIRCLE Clty/State/Zlp: ANAHEIM, CA 92807 Site Supervisor: DUANE PATE •Asbestos Surveys are required prior to Renovation and Demolition, howevei the actual survey is not required to be submitted with the notification. SD/VPCD-SUBPART M - Rule 361.145 Page 1 of 2 04/2010 STATE OF CALIFORNIA DEPARTIVIENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH Asbestos Contractors Registration Unit (619)767-2280 |^ (818)901-5578 (626)359-4291 (310)516-4253 Temporary Worksite Notification for Asbestos-Related Work Company/Employer Name: MATRIX ENVIRONMENTAL Headquarters Acidress: 2330 Cherry Industrial Circle., Long Beach, CA 90805 Contractors State License Board #; 860131 DOSH Asbestos Registration Number: 869 Address of Temporary Worlisite and Precise Location: Westfield Plaza 2501 El Camino Real, Carlsbad, CA 92008 Remove and dispose of ACCM drywall and joint compound Type of Business: Commercial Name of Certified Supervisor (Competent Person): Jorge Marquez Natne of the Qualified Person in charge of air momtoring, laboratory work and respirators: Patriot Name of Certified Consultant (ifany): TBD Project Job Start Date: 6/3/13 Project Completion Date: 6/30/13 Describe type, scope and work practices of job: Demarcate work area(s) using dropcloths & tenting where feasible. 1/2 face or full face respirator with HEPA Cartridge. Evaluation of Potential Exposure: 1. Low, Non-friable, ACCM. Low Content ACM. Estimated number of employees on this job: 2 to 10 Prior to the start of each job or phase of asbestos-related worli requiring the employer or contractor to be registered, Section 341.9 ofthe California Code of Regulations (8 CCR 341.9) requires notifications to the nearest DOSH District Office. Do not send this notification to DOSH Headquarters or DOSH Consultation. This will not satisiy the notification requirement and could result in citation Note: Any change in the infonnation provided to the district office by the written notice shall be reported to the district office within 24 hours of such change NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Waste TrBnsparter#l: Waste Transporter#2; Name; MATRIX ENVIRONMENTAL, INC Name: BDC (NON FRI/HBLE) Address; 2330 CHERRY INDUSTRIAL QRCLE Address: 1211 W. GIADSTONE Clty/State/Zlp: LONG BEACH, CA 90805 Cit^/State/ZIp: AZUSA, CA 91702 Contact Person: LISA POWELL Phone: 562.236.2704 Contact Person: SEAN KELLY Phone: 626.334.0719 Waste Disposal Site (Landfill): Name: fiZUS/^ LAND RECUi^MATION Address; 1211 W. GUDSTONE Clty/State/Zlp; KZOSk, CA 91702 Contact Person; SEAN KELLEY Phone: 626.334.0719 Asbestos Detection Procedures: Check the appropriate procedures and analytical methods used to detect the presence of asbestos containing materials. S Survey IS Bulk Sampling El Inspection EJ PLM • TEM • PCM E Other: Attachment A (flreprooflnql Describe wori< practices and engineering controis to be used. Check appiicable methods belowi IS Water • Demolition w/rooflng materials In place • Skid Loaders/bobcats/Top Loaders • Amended Water • using sledge hammers. • Terminator™ • Roofing Cutting Saws • Axes • Shovels • Implosion • High Pressure Water Blast • Demolition w/Cat I Floor tiles In place • Explosion • Infrared Machines • Ice Chlppers • Pry Bars Negative Air Machines • Cranes (wrecking ball, • Bulldozer IEI Fuil Containment clamshell, bucket) • Intentional Burning ISl 3 Stage Decon • Zamboni • Backhoes M Glove Bag • Bead Blast • Other: • Critical Baniers • Floor Buffer For Ordered Demolition provide a copy of the order and complete the Information below: Agency Name: Authorizing Person; Title; Date of Order: Date Ordered to Begin: Phone: Contingency Plan Describe actions to be followed If unexpected asbestos Is found during demolition or removal or asbestos material becomes disturbed, crumbled, pulverized or reduced to powder. EVACUATE AREA, WET ACM, DEMARCATE WORK AREA, STABIUZE AND HAVE C.A.C INSPECTION Training Certification I cerdfy that an Individual trained in the provisions of this regulation (CFR. Part 61, Subpart M) will be on site during the removal and evidence that the required training has been accomplished by this person will be available for Inspection during normal business hours. Date: 05/16/13 Print Name; LISA POWELL (Owner/Operstor) Signature; (Owner/Operotor) Information Certification: I ceridfy that the above Information Is comect. Dste: 05/16/13 Print Name: USA POWELL (Ownar/Operator) Signature: (Owner/Open Original notifications are to be submHted to the District at least 10 working dsys prtor to removal or demolition. Revised notices are to be submitted as soon as possible but DO laterthan the orlgihal start date. Original notifications cannot be accepted vinthout the required fee(s) (Rule 40(f)(2)), however revised notlfteatlons will be accepted without the required fee provkled the lee Is paid prior to ths start date of the original notWcaUon. SDAPCD -SUBPART M - Rule 361.145 Page 2 of 2 Removal Procedures (I) Procedure I - HEPA Flitration Remove AOA wthin an isolated woik arta. The • followmg techniques shall bc used during Procedure I ACM removal activities: (1) All stationary objects and surfaces not intended for removal or stripping of ACM shall be covered with plastic sheeting; . (2) AU air passageways, such as doors, windows, vents and registers in the work area, shall bc covered and rendered air tight with plastic sheeting or hard wooden barriers with studded support. Air passageways used to provide maketip air for the isolated work spaoe need not be covered; (3) All sources of air moveinent, including the air-handling system, shall be shut off or temporarily modified to restrict air movement into the work zone; (4) Thc barriers used for the construction of the isolated work area shall bc equipped vrith transparent viewing ports which allow' outside observation of all stripping and removal of ACM; (5) Thc isolated work area shall be vented, wjth negative air pressure to a HEPA filtration system, which shall bc operated continuously from the commencement of removal activities through thc final clean-up ofthe work area; (6) Thc HEPA filter shall be firee of tears, "firactures, holes or other types of damage aad shall be securely latched and properly situated in the holding frame to prevent air leakage from the filtration system; and (7) ACM shall be adequately wet during the removal process. 'rocedure 2 - Gbvcbag p^raovX by the s|gn^'^nd opiratii ;), Abpen^ Jim de ml r6quirMn6nts> Procedure 3 - Adequate Wetting ProccdBje 3 shall only be usedfto remove nonfriable asbestos-c^tijaining material^ using the following techniques: (1) All expos^ACM jShall be adequately wet during cuttijagbcdiBmantling procBdures. (2) ACM shall be adbquately wet while it is being removed feom swility components and priorto its ramoval fitin^cfacility. (3) Drop cloths anp tenting sha!ll!\be used to contain thc worK area to thc extent feasible.. (4) Only non-power tools shall be used. APCD 116 (Rev. 04/07) SAN DIEGO AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD. SAN DEGO CA 92I3I-J649 PHONE (858) 586-2600 • FAX (858) 586-2601 PERMTF / REGISTRATION APPLICATION SlBMrrTAL OF THIS APPLICATION DOES NOT GRANT PERMISSION TO CONSTRUCT OR TO OPERATE EQUIPMENT EXCEPT AS SPECtFIED IN RULE 24(d) IMPORTANT REMINDERS: Read instructions on tbe reverse side of this foim prior to completing this application. Please ensure that all ofthe following are included before you submit flie ^plication: • Appropriate Permit Fee D Completed Supplemental Fonn(8) Q Signature on Application REASON FORSUBMrTTAL OF APPLICATION; (check the appropriate item and enter AppllcaBoB (AP) or Permit to Operate (PO) somber if required) 1. • Newlnstallatwn 2. • Existing Unpennitted Equipinent or Rule 11 Change 3. Q Modification of Existing Permitted Equipmait 4. C] Amenilment to Existing Aufliraity to Construct or AP 5. C] Change of Equipment Loeation 6. C] Change of Equipment Ownership 7. • Change of Pennit Conditions 8. Q Change Pamit to Operate Status to Inactive 9. D Banking Emissions 10. • Registration of Portable Equipment 11. g?l Other fSoeclfy^ Sentinel 909 Soybean based mastic remover 12. List affected AP/POIII(s): APPUCANT INFORMATION 13. Name of Business (DBA) Matrix Environmental. Inc 14. 15. Nature of Business Abatement 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. Does ttiis organization own or operate any other APCD permitted equipment at this or any other adjacent locatiwis in San Diego Coumy? QVes KlNo Ifyes, list assigned location ID's listed on your PO's Type of Ownership E! Coipotatron D Partnership • Individual Owner • Govemment Agency • Other Name of Legal Owner (if different from DBA),2iiA A-,. Sqffipniwl; Offntr B. Authority to Construct Of different fk-om A) Name Mailing Addiess Chy State Phone Name Mailing Address City State Phone 11601 Wilshire Blvd Los Aneeles CA Zip 90025 Zip am 575-5901 FAXf ) r "1 FAX( ) C Permit to Ooerate (if difTerent from A) Mairix Environmental. Inc D. Bllltne Information flf different fVom A) 2330 Cherrv Industrial Cirlce Lone Beach CA Zip 90805 Zip (562) »$-3704 FAX (562) 23$-J7?5 f ) FAXI 1 EQUIPMENT/PROCESS INFOR^U•^ON: Type of Equipment: glstjtlonary • Portable. U portable, wtU operation exceed 12 consecutive months at the same locadon • Ves • No 28. Rquipment Location Address 2501 El Camino Real Citv Carlsbad State £(4 Zipi2QQS Hione ( 1 29, 30 31, Parcel No. _ PAX( L Site Cwtact E^gai Algaptara Title Supervisor Phone OZ}) 7U-172S General Description of Equipment/Process Tbe mastic remover will be applied to the mastic once the tile is removed, This will allow Matrix to clean up fte mastic easier 32. Application Submitted by D Owner • Operator S Contractor D Consultant Affiliation EXPEDITED APPLICATION PROCESSING: • I hereby request Expedited AppKcatiou Processing and underttand that: 33. a) Expedited processing wHl incur additional ftes and permits will not be issued until the additional fees are paid io flill (see Rule 40(d)(6)(iv) for details), b) B;q)edit«d processing is contingent on the availability of qualified staif. c) Once engineering review has b^un this request cannot be cancelled, d) Expedited processing does not guarantee action by any specific date nor does it guarantee permit a^jjoval. I berel>3> certiiy tbat all informadon j^revidedjob this application is true and correct t \^ „ 34. .rr^ATTmP. ^Date ^\\\\^ 35. Print Name Lj^a Powell Title Vipp jPrCSidffit 36. Companv Matrk Environmental. Inc Phone (5621 587-8163 E-mail Address lpoyyeIligim8tTijda.net AP# Receipt* Engineering Contact. Refiind Claim* ID# _Cust. No. Dale _Sector_ .UTM'sX. SIC Anrt Rec'd $. Fee Code. Fee Code, Date APFee$_ Application Oeneialed By NV^, NC# _Odier„ J)Bte_ T&MR«)ewalFee$_ Amt$ _In5pector 4.07-TW/flm •1- APCD County of San Diego '"'S) 586-2600 FAX (858) 586-2601 AIR POLLUTION CONTROL DISTRICT Smoking Vehicie Hotlina AIRPDLUmDHICDNTBOLDRTBICT 10124 Old Grove Road, San Dlego, CA 92131 COORTV or HH DIECI 1-B0D-2B-SMOKE vyww.sdapcd.org May 13, 2013 Lisa Powell IVIatrix Environmental, Inc. 2330 Cherry Industrial Circle Long Beach, GA 90805 After examination of your Application APCD2013-APP-002778 for an Air Pollution Control District (District) Autiiority to Construct and Permit to Operate for equipment to be located at various locations In San Dlego County, the District has decided on the followring actions: Authority to Constnjct is granted pursuant to Rule 20 of the Air Pollution Control District Rules and Regulations for equipment to consist of: Portable asbestos mastic removal operation (Type 1) consisting of: squeegees, brushes, brooms, mops, coarse stripping pads, buffers, and rags. Solvent; SENTINEL 909 SOYBEAN BASED DEGREASER & MASTIC REMOVER only. Usage Volume: Total usage of mastic removal solvent shall not exceed 40 gallons per day. This Authority to Construct Is issued with the following conditions: 1 Permittee shall only use the mastic removal solvent(s) and the specified amounts under the equipment description ofthis permit, (Rule 21) 2 This portable mastic removal operation shall be operated only at stationary sources which have aggregate actual emissions of less than 25 tons per year of volatile organic compounds (VOC) or have aggregate potential to emit of less than 50 tons per year of VOCs. (Rule 20.4) 3 Prior to applying the solvent, the portable equipment permittee shall verify with the stationary source that emissions from all materials containing volatile organic compounds (VOC) to be appiied by the permittee will not cause the stationary source to exceed the permitted daily emission threshold. 4 Mastic removal operations shall not be conducted simultaneously at different stationary sources unless a separate permit to operate is obtained from the District. 5 Pemnittee shall maintain records for the portable mastic removal operation in accordance with Rule 66,1. The records shall Include the following information: a, dally solvent usage; b, date solvent is applied; c, the starting and ending times for each mastic removal operation; d, current material safety data sheets (MSDS), manufacturer's specifications or analytical data regarding volatile organic compounds (VOC) and toxic air contaminant (TAC) ,D, #APCD2013-SITE-01366 Sector # 01 Page 1 of 3 Matrix Environmental, Inc. May 13, 2013 Application #: APCD2013-APP-002778 content. MSDS, manufacturer's specifications, analytical data or a combination thereof shall, at a minimum, contain the following information: VOC content weight or weight percentage, TAC content weight or weight percentage, material density (weight per volume) or material specific gravity (material density relative to the density of water) and vapor pressure; and e. address of the sites undergoing asbestos abatement. A copy of these records shall be provided to the stationary source at the end of the work day for facility-wide emission calculations. In addition, these records shall be maintained at a central location and shall be readily available to the District upon request for a minimum ofthree (3) years. (Rule 21 and 66.1) 6 Prior to operation of this equipment at any location within San Diego County, the Air Poiiution Control District Compilance Division shall be in fomned in writing within two days ofthe specific location (including the address) of operation. 7 The Compliance Division shall be supplied with the name and phone number of the person responsible for supervising operation ofthis equipment located at the processing site. 8 Permittee shall comply with 40 CFR Part 61 Subpart M, as applicable. 9 All materials containing volatile organic compounds shall be stored in closed containers In accordance with Rule 67.17 requirements. (Rule 67.17) 10 Access, facilities, utilities and any necessary safety equipment for source testing and inspection shall be provided upon request of the Air Pollution Control District. 11 This Air Pollution Control District Permit does not relieve the holder from obtaining permits or authorizations required by other governmental agencies. 12 The permittee shall, upon detennination of applicability and written notification by the District, comply with all applicable requirements ofthe Air Toxics "HotSpots" Information and Assessment Act (California Health and Safety Code Section 44300 et seq.) This Authority to Construct authorizes temporary operation of the above-specified equipment. This temporary Pennit to Operate shall take effect upon written notification to the District that construction (or modification) has been completed in accordance with this Authority to Construct. This temporary Permit to Operate wil! remain in effect, uniess withdrawn or modified by the District, and a revised temporary permit (Startup Authorization) is issued or a Permit to Operate is granted or denied. Upon completion of construction (or modification) in accordance with this Authority to Construct, and prior to commencing operation, the applicant must complete and mail, deliver or fax the enclosed Construction Completion Notice to the District. After mailing, delivering or faxing the notice, the applicant may commence operation ofthe equipment. Operation must be in compilance with all the conditions of this Authority to Construct and applicable District Rules. This Authority to Construct shall be posted on or within 25 feet of the above described equipment or maintained readily available at all times on the operating premises. This Air Pollution Control District Authority to Construct does not relieve the holder from obtaining permits or authorizations, which may be required by other governmental agencies. This Authority to Construct Is not authority to exceed any applicable emission standard established by this District or I.D.#APCD2013-S1TE-01366 Sector#01 Page2of3 Matrix Environmental, Inc. May 13, 2013 Application #; APCD2013-APP-002778 any other govemmental agency. This authorization Is subject to cancellation if any emission standard or condition Is violated, Within 30 days after receipt of this Authority to Construct, the applicant may petition the Hearing Board for a hearing on any conditions imposed herein in accordance with Rule 25. This Authority to Construct wiil expire on 05/13/2014 unless an extension is granted in writing. This is not a Permit to Operate. Please be advised that installation or operation ofthis process or equipment without written authorization may be a misdemeanor subject to fines and penalties, if you have any questions regarding this action, please contact me at 858 586 2735 or via email at Kevin,Sung@sdcounty,pa.gov. Kevin Sung Junior Engineer CC: Compliance Division l,D.#APCD2013-S!TE-01366 Sector#01 Page 3 of 3 APCD KHinuininicnimniHSTm OgHNTV tF SUM DIEIS COUNTY OF SAN DIEGO, AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 (858) 586-2600 FAX (858) 586-2601 wwv/.sdapcd.org Sectors: , ID#: APCD2013.SITE.01366 APP: APCD2013-APP.002778 ATC EXPIRES 05/13/2014 CONSTRUCTION COMPLETION NOTICE Please complete the APPLICANT ONLY section of this Nolice and fax/mail to APCD upon completion of constructton. The following information is based on submitted Application APCD2013-APP-002778. Please note any changes to this infonnation, marking amendments clearly. ATC MAILING Matrix Environmental, Inc. Lisa Powell 2330 Cherry Industrial Circle Long Beach CA 90805 EQUIPMENT ADDRESS Matrix Environmental, inc. Lisa Powell 2330 Cherry Industrial Circle Long Beach CA 90805 EQUIPMENT DESCRIPTION Portable asbestos mastic removal operation <40 gallons/day of Sentinel 909 only. APCD Assigned Staff: Kevin Sung Telephone: 858 586 2735 Email: Kevin.Sung@sdcountv.ca.qov APPLICANT ONLY Date Construction was Completed: Equipment Seriai Number: Date of this Notification: Person providing Notification: Contact Telephone Number: Signature: \ \ ,(MM\DD\YYYY) , (MM\DD\YYYY) APCD ONLY Notification Received Oate: BCMS Entry Date: \ \ TOR APCD USE OWLY SAN DIEGO AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 PHONE (858) 586-2650 FAX (858) 586-2651 Postmark Received Fee/ Receipt Notification # Entered Sector Inspector Assigned/Date NOTIFICATION OF ASBESTOS RENOVATION OR DEMOUTION OPERATIONS Completed by: USA POWELL Company: MATRIX ENVIRONMENTAL ISl Original • Revision (indicate type of revision) • Cancellation • Courtesy • Other(specif/): • Change In asbestos annount • Change In start/end date NOTIFICATION _ , . (greater than 20%) • Demolition • Ordered Demolition • Emergency Renxival • Emergency Demolition FACILITY INFORMATION PROJECT TYPE ISI Renovation (removal) • Planned Renovation (annual) Facility Name: WESTRELD PLAZA CAMINO REAL Address: 2501 EL CAMINO REAL Cross Street: HAYMAR aty: SANDIEGO Zip Code; 92008 Facflity Ownen WESTRELD LLC ;AddFess:-:=3241410R.T0W:£lAZA:; Contact: CONTRACTS Title: Phone No: 619-239-8180 Building Size (sq. ft): 150,000 Building prior/present use: Building Age (years); 50 Number of Floors: 2 Number of Units: 0 H Commercial • Hospital • Industrial • Office • K-12 School • Publlc Bldg • House/Condo • Ship • Unlv/Colleqe • Other PROJECT INFORMATION Asbestos Removai start Date: 4/3/13 Asbestos Removal End Date: 5/30/13 For revisions only Revised Start Date:. Revised End Date: _ Removal Contractor Name: MATRIX ENVIRONMENTAL Address: 2330 CHERRV INDUSTRIAL CIRCLE Demolition Contractor: Name; US DEMOUTION Demolition Operation Start Date: Demolition Operation End Date: For revisions only Revised Start Date;. Revised End Date: _ Phone No: 562.236.2704 City/State/Zip: LONG BEACH, CA 90805 Address: 4510 E. EISENHOWER CIRCLE CSLBUcense#: 697132 Site Supervisor: JORGE MARQUEZ Phone No: 714.695,9026 City/State/Zlp: ANAHEIM, CA 92807 CSLB License*: 778598 Site Supervisor: DUANE PATE Asbestos Survey Performed?* la Yes • No Is Asbestos Present? Kl Yes • No Will the asbestos be removed? g] Yes • No Is the building to be demolished? IEI Yes • No Asi>esto5 Amount to be removed (sq/ln ft); Friable Ploes: SO Category I Pipes: Category II Ploes: Total Asi>esto5 Amount to be removed (sq/ln ft); Surface Area: 8000 Surface Area: Surface Area: Asi>esto5 Amount to be removed (sq/ln ft); Facility Component: Facility Component: Facility Component! Asi>esto5 Amount to be removed (sq/ln ft); Revised Amounts (If a revision) •Asbestos Sunreys are required priorto Renovation and Demolition, however the actual sun/ey Is not required to be submitted with the noBficatlon. SDAPCD -SUBPART M - Rule 361.145 Page 1 of 2 04/2010 NOTIFICATION OF ASBESTOS RENOVATION OR DEMOUTION OPERATIONS Waste Transporter#l: Waste Transporter#2; Name: MATRIX ENVIRONMENTAL, INC Name: BDC (NON FRIABLE) Address: 2330 CHERRY INDUSTRIAL CIRCLE Address: 1211 W. GLADSTONE City/State/Zlp: LONG BEACH, CA 90805 Clty/State/Zlp: ALZUSA, CA 91702 Contact Person: LISA POWELL Phone: 552.236.2704 Contact Person: SEAN KELLY Phone: 626.334.0719 Waste Disposal Site (Landfill): Name: AZUSA LAND RECLAMATION Address: 1211 W. GLADSTONE City/State/Zip: AZUSA, CA 91702 Contact Person: SEAN KELLEY Phone: 626.334.0719 Asbestos Detection Procedures; Check the appropriate procedures and analytical methods used to detect the presence of asbestos containing materials. Kl Survey Kl Bulk Sampling • Inspectton S PLM • TEM • other: • PCM Describe work practices and engineering controls to be used. Check appiicable methods betow: ISI Water • Amended Water O Roofing Cutting Saws • High Pressure Water Blast • Infrared Machines • Cranes (wrecking ball, clamshell, bucket) • Zamboni • Bead Blast • Floor Buffer • Demolition w/rooflng materials In place • Skid Loaders/bobcats/Top Loaders using sledge hammers. • Terminator^" • Axes • Shovels • Implosion • Demolition w/Cat I Floor tiles In place • • Explosion • Ice Chlppers • Pry Bars Negative Air Machines • Bulldozer Full Containment • Intentional Buming Kl 3 Stage Decon • Backhoes f. i , i IS • Glove Bag Cntical Barriens For Ordered Demoiition provide a copy of the order and complete the information below; Agency Name: Authorizing Person: Title: Date of Order: Date Ordered to Begin: Phone: Contingency Pian Describe actions to be foltowed If unexpected asbestos Is found during demolition or removal or asbestos material becomes disturbed, crumbled, pulverized or reduced to powder. . EVACUATE AREA, WET ACM, DEMARCATE WORK AREA, STABILIZE AND HAVE C.A.C INSPECHON Training Certifkratfon I certify that an Individual trained In the provisions of this regulation (CFR Part 61, Subpart M) will be on site during the removal and evidence that the required training has been accomplished by this person will be available for Inspection during normal business hours. Date: 3/20/13 Print Name: USA POWELL (Owner/opeifltor) Signature: (Owner/Operator) Information Certification; I certify that the above Information Is correcL Date: 3/20/13 Print Name: USA POWELL (Owner/Operator) Signature: {0wner/op«r8tor) mm Original notifications are to be submitted to the District at least 10 woridng days prior to removal or denrrolltion. Revised notk«s are to be submitted as soon as possibte but no later than the original start date. Original notiffcatlons cannoi be accepted without the required fee($) (Rule 40(f)(2)), however revised notifications will be accepted virtthout the required fee provided the fee is paid prior to the start data of the original notificatton. SDAPCD -SUBPART M - Rule 361.145 Page 2 of 2 state of California Department of Indnstrlal Retetions DIVISION OF OCCUPATIONAL SAFETY AND HEALTH Certificate of Registration for Asbestos-related Work Certificate No. ExpiraUon Date 1.3-QcfTl3 IVIATRIX ENVIRONMENTAL, INC. (Name ofEmploifff) is duly ri^istered by the Diviston of Occupational Safety and Health in aixordance with the Cslifornis Administrative Code, Title 8, Article 2,5 for asbestos-related woric. 2p^Sep-12 Dale of Issuance ElTectlve Date .. 14-pct; 12 afety and 1-Iealth Contractor's License No. $60131 This r^istration is valid only when tie followingrequlranents and conditions are met: 1. The registered employer shall safely perform asbestos-related work in compliance witli relevant occi^ational safety and healtfi regdations. 2. The registered empbyer diall notify theDivisioti of dianges in wotk locations or conditions as specified by Sect'on 341.9 of Title 8 of ttie California Administrative Code. 3. The regstered employer shall post a sigi readable at 20 feet at the location of any asbestos-related work stating; Danger-Asbestos Cancer and Lang l^azard Authorized Personnei Only 4. Acopy of the registration shall be posted atthe jobate beside the Cal-OSHA poster. 5. The registered employer shal! provide s copy of fliis regislraion cettificate to the prime contractor and any otha* enployers at the site before the aimmencemait ofany asbestos-related work. 6. The registered emptoyer shall conduct a safety conferaice prior to the commaicemait of any asbestos-related woik as specified by Section 341.11 of Title 8 of the Califomia Adminstrative Code. 7. The registered emptoyer acknowled gps the Division's right to revoke or suspend this registration as provided by Section 341.14 of title 8 of the California Administrative Code. ® A (^Sempra Energy utility" PROJ# 352504-010 May 16, 2013 Bill Heitman C/O Westerfield Construction Dear Bill: Subject: Westerfield Carlsbad Mall ~ Robinsons May Removal You requested a cost estimate to remove our electric underground facilities at the above project. SDG&E will remove the facilities for the cost of $15,397.00. These charges are for removal of the electric facilities located at 2525 El Camino Real, Carlsbad as described on the attached sketch. The cost quoted above is a net contract price, not subject to any additional billing or refunds. The above cost does not include any work by the telephone company or cable T.V. company. Please call them for any charges they may have to relocate their facilities. Whenever differences between the preliminary and final street improvement plans or actual construction and final plans require a revision ofthe work order or additional relocation work, the applicant agrees to pay all engineering fees and associated construction costs incurred by SDG&E due to such differences. Such differences may also require rescheduling of SDG&E design and construction work provided for in this agreement Before excavating in the vicinity of gas or underground electric facilities, please call Underground Service Alert System (USA) at 1-800-227-2600. Within 48 hours, we can indicate the location of SDG&E facilities on the job site. All costs and offers quoted in this letter shall expire at the end ofthe business day on August 16, 2013. If business negotiations are not completed, or if you request revised costs after that date, an engineering fee may be required. Also, please understand that SDG&E is subject to California Public Utilities Commission decisions - any changes directed by the Commission can affect the quotes. The costs quoted in this letter include a cost component to cover the Utility's estimated liability for State and Federal Income Tax. If you cancel your request after the payment has been made, we will retain a portion of the original payment which represents SDG&E's expense of processing your request. The remainmg amount, if any, will be refunded to you. Please send your check payable to SDG&E for $15,397.00 and the Customer Payment Remittance form in the enclosed envelope. Project Management Offices can not accept payments. All payments must be mailed to: Customer Payment Services - CP61C San Diego Gas & Electric PO Box 129831 San Diego, CA 92112-9831 Once your check is received, the work orders can be issued to construction. If I may be of further assistance or if you have any questions, please call me at the number listed below. Our hours are 7:00 AM - 4:00 PM, Monday through Friday. Mike Saldana Senior Customer Project Planner Telephone: (760) 480-7655 Enclosures ! '• 12274 Plaza Camino Real 696458 SAN DIEGO GAS & ELECTRIC REORPER SOIB. US- PATENT ND. 5538290, 5575500, 5541103, 570538^5904364, 603DDOD CHECK# 8000806 DATE 05/28/2013 PAGE 1 of 1 Date Invoice Description 05/16/2013 263761 Project #352504 Total $15,397.00 iTHIS CHECK IS VOID WITHOUT A BLUE & BURDUNpY BORDER AHDBACKGROUND PLUS A KHtOKT & FIMOEBPRINT WATERMARK OW THE BACK . HOLD AT AWSLE TO VIEW Westfield' May 28 2013 PLAZA CAMINO REAL 2049 Century Park East 42nd Floor Los Angeles, CA 90067 08000806 70/2328/719 $****! 5,397.00 Pay tothe order of: *****FIFTEEN THOUSAND THREE HUNDRED NINETY SEVEN AND 00/100"*"*"******"""*"**""** Bank of America Controlled Disbursement Bank of America, N.A. Northbrook, Illinois SAN DIEGO GAS & ELECTRIC POBOX 129831 SAN DIEGO CA 92112-9831 .y.alid.for.I8.CLDay.s.iroj]iIssue.Date„„ 3 ii«nflnnnflnp,ii' i:n ? ? i PAUI: R TP, qnnp,fl PUH- SAN DIEGO AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 PHONE (858) 586-2650 FAX (858) 586-2651 (5) FOR APCD use ONLY Postmark Received Fee/ Receipt Notification # Entered Sector Inspector Assigned/Date NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Completed by: USA POWELL NOTIFICATION Company: MATRIX ENVIRONMENTAL • Original • Revision (indicate type of revision) • Cancellation • Courtesy • Other(specify): DECEIVED PROJECT TYPE FACILITY INFORMATION • Demolition • Emergency Removal 13 Change In asbestos amount (greater than 20%) • Ordered Demolition • Emergency Demolition • Change in start/end date 'JUN 2 8 2013 H Renovation (removzCITY OF CARLSBAD • Planned Renovation ^UALOKM(3 DIVISION Faciiity Name: WESTRELO PLAZA CAMINO REAL Address: 2501 EL CAMINO REAL Cross Street: HAYMAR City: Carisbad Zip Code: 92008 Faciiity Owner: WESTRELD LLC Address: 11601 Wilshire Blvd City: LosAngeles State: CA ZipCode: 90025 Contact: CONTRACTS Title: Phone No: 310.575.5901 Building Size (sq. ft): 150,000 Bulldlng Age (years): 50 Number of Floors: 2 Number of Units: 0 Building prior/present use: H Commercial • Hospital • Industrial • Office • K-12 School • Public BIdq • House/Condo • Ship • Unlv/College • Other PROJECT INFORMATION Asbestos Survey Performed?* 13 Yes • No Is Asbestos Present? S Yes • No Will the asbestos be removed? S Yes • No Is the buiiding to be demolished? H Yes • No Asbestos Amount to be removed (sq/in ft): Friable Ploes: 50 Category I Pipes: Category II Pipes: Total Asbestos Amount to be removed (sq/in ft): Surface Area: 19000 Surface Area: Surface Area: Asbestos Amount to be removed (sq/in ft): Faciiity Component: Facilitv Comoonent: Facilitv Component! Asbestos Amount to be removed (sq/in ft): Revised Amounts (If a revision) 3l000sf mastic Asbestos Removal Start Date: 4/15/13 Asbestos Removal End Date: 5/30/13 Demolition Operation Start Date: Demolition Operation End Date: For revisions only Revised Start Date:. Revised End Date: _ For revisions only Revised Start Date:. Revised End Date: _ Removai Contractor: Name: MATRIX ENVIRONMENTAL Phone No: 562.236.2704 CSLB License*: 697132 Address: 2330 CHERRY INDUSTRIAL QRCLE City/State/Zip: LONG BEACH, CA 90805 Site Supervisor: JORGE MARQUEZ Demolition Contractor: Name: US DEMOLITION Phone No: 714.695,9026 CSLB Ucense#: 778598 Address: 4510 E. EISENHOWER CIRCLE City/State/Zlp: ANAHEIM, CA 92807 Site Supervisor: DUANE PATE 'Asbestos Surveys are required priorto Renovation and Demoiition, hovraver the actual sun/ey is not required to be submitted with the notification. SDAPCD -SUBPART M - Rule 361.145 Page 1 of 2 04J7010 STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH Asbestos Contractors Registration Unit X (619)767-2280 (818)901-5578 (626)359-4291 (310)516-4253 Temporary Worksite Notification for Asbestos-Related Work Company/Employer Name: MATRIX ENVIRONMENTAL Headquarters Address: 2330 Cherry Industrial Circle., Long Beach, CA 90805 Contractors State License Board #: 860131 DOSH Asbestos Registration Number: 869 Address of Tempomry Worlisite and Precise Location: Westfield Plaza 2501 El Camino Real, Carlsbad, CA 92008 Remove and dispose of ACCM drywall and joint compound Type of Business: Commercial Name of Certified Supervisor (Competent Person): Jorge Marquez Natne of the Qualified Person in charge of air monitoring, laboratory work and respirators: Patriot Name of Certified Consultant (ifany): TBD Project Job Start Date: 6/3/13 Project Completion Date: 6/30/13 Describe type, scope and work practices of job: Demarcate woric area(s) using dropcloths & tenting where feasible. 1/2 face or full face respirator with HEPA Cartridge. Evaluation of Potential Exposure: I. Low, Non-friable, ACCM, Low Content ACM. Estimated number of employees on this job: 2 to 10 Prior to the start of each job or phase of asbestos-related work requiring the employer or contractor to be registered, Section 341.9 of the California Code of Regulations (8 CCR 341.9) requires notifications to the nearest DOSH District Office. Do not send this notification to DOSH Headquarters or DOSH Consultation. This will not satisfy the notification requirement and could result in citation Note: Any change in the information provided to the district office by the written notice shall be reported to the district office within 24 hours of such change NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Waste Transporter#l: Waste Transporter#2: Name: MATRIX ENVIRONMENTAL, INC Name: BDC (NON FRIABLE) Address: 2330 CHERRY INDUSTRIAL QRCLE Address: 1211 W. GLADSTONE City/State/Zip: LONG BEACH, CA 90805 City/State/Zip: AZUSA, CA 91702 Contact Person: LISA POWELL Phone: 562.236.2704 Contact Person: SEAN KELLY Phone: 626.334.0719 Waste Disposal Site (Landfill): Name: AZUSA LAND RECLAMATION Address: 1211 W. GUDSTONE City/State/Zip: AZUSA, CA 91702 Contact Person; SEAN KELLEY Phone: 626.334.0719 Asbestos Detection Procedures: Check the appropriate procedures and analytical methods used to detect the presence of asbestos containing materials. Survey Bulk Sampling IS Inspection El PLM • TEM • PCM S Other: Attachment A fflreproofmq) Describe worit practices and engineering controls to be used. Check applicable methods beiow: Water • Demolition v^/roofing materials In place • Skid Loaders/bobcats/Top Loaders • Amended Water using sledge hammers. • Terminator™ • Roofing Cutting Saws • Axes • Shovels • Implosion • High Pressure Water Blast • Demolition w/Cat I Floor tiles In place • Explosion • Infrared Machines • Ice Chlppers • Pry Bars Negative Air Machines • Cranes (wrrecklng ball, • Bulldozer IEI Full Containment clamshell, bucket) • Intentional Burning ISI 3 Stage Decon • Zamboni • Backhoes Glove Bag • Bead Blast • Other: • Critical Barriers • Floor Buffer For Ordered Demolition provide a copy of the order and complete the Information below: Agency Name: Authorizing Person: Tide: Date of Order: Date Ordered to Begin: Phone: Contingency Plan Describe actions to be followed If unexpected asbestos is found during demolition or removal or asbestos materlai becomes disturbed, crumbled, pulverized or reduced to powder. EVACUATE AREA, WET ACM, DEMARCATE WORK AREA, STABILIZE AND HAVE C.A.C INSPECTION Training Certification I certify that an individual trained In the provisions of this regulation (CFR Part 61, Subpart M) wlll be on site during the removal and evidence that the required training has been accomplished by this person will be available for Inspection during normal business hours. Date: 05/16/13 Print Name: USA POWELL [Owner/Operator) Signature; (Owner/Operator) mi Information Certification: I certify that the above Information is correct. Date: 05/16/13 Print Name: LISA POWELL (Owner/Operator) Signature: (Owner/Operator) I Original notlficattons are to be submitted to the District at least 10 working days prior to removal or demolition. Revised notices are to be submitted as soon as possible but no later than the original start date. Originai notifk»tions cannot be accepted without the required fee(B) (Rule 40(f)(2)), hovraver revised notifications wlli be accepted without the required fee provided the fee is paid prior to the start date of the original notification. SDAPCD-SUBPART M-Rule 361.145 Page 2 of 2 Removal Procedures (I) Proc(sdurc 1 - HEPA Filtration Remove ACM within an isolated work area. The • following techniques shall bc used duriag Procedure I ACM removal activities: (1) AU stationary objects and surfaces not intended for removal or stripping of ACM shall be covered with plastic sheeting; . (2) All air passageways, such as doors, windows, vents and registers in fhe work area, shall bc covered and rendered air tight with plastic sheeting or hard wooden barriers with studded support Air passageways used to provide makeup air for the isolated work spaoe need not be covered; (3) All sources of air movement, including the air-handling system, shall be shut off or temporarily modified to restrict air movement into lhe work zone; (4) Thc barriers used for the construction ofthe isolated work area shall be equipped with transparent viewing ports which allow' outside observation of all stripping and removai of ACM; (5) Thc isolated work area shall be vented, with negative air pressure to a HEPA filtration system, which shall bc operated continuously from the conunencement of removal activities through the final clean-up ofthe work area; 192' (6) The HEPA filter shali be fiee of tears, "fractures, holes or other types of damage and ^all be securely latched and properly situated in the holding frame to prevent air leakage from the filtration system; and (7) ACM shall be adequately wet during the removal process. (II) Procedure 2 - Glovebag " bythe md opdrat!^ ;), Ajjpen^ requu-fc (HI) Procedure 3 - Adequate Wettini Procedtija 3 shall only be usedfto remove nonfriable asbestos-coRjaining materia!^ using the following techniques: (1) All expos^ACM Shall be adequately wet during cuttingWdismantling procedures. ACM shall be aobquately wet while it is being removed from swility components and prior to its ramoval froiit^e facility. Drop clolhs anA tenting shalis.be used to contain the wonc area to the extent feasible. • Only non-power tools shall be used. (2) (3) (4) J APCD 116 (Rev. 04/07) SAN DIEGO AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD. SAN DIEGO CA 92131-1649 PHONE (858) 586-2600 • FAX (858) 586-2601 PERMIT / REGISTOATION APPLICATION SUBMITTAL OF THIS APPLICATION DOES NOT GRANT PERMISSION TO CONSTRUCT OR TO OPERATE EQUIPMENT EXCEPT AS SPECIFIED IN RULE 24(il) IMPORTANT REMINDERS: Read instructions on the reverse side of tiiis fbrm prior to completing this application. Please ensure that all oflhe followii^ are included before you submit tfie appiication: O Appropriale Pennit Fee • Completed Supplemental Fonn(s) • Signature on AppUcation REASON FOR SUBMITTAL OF APPLICATION: (check the appropriate item and eflter ApplicatioD (AP) or Permit to Operate (PO) number if required) 1. n New Installation 2. d Existing Unpennitted Equipment or Rule 11 Change 3. • Modification of Existing Permitted Equipment 4. • Amendment to Existing Authority to Construct or AP 5. [H Change of Equipment Location 6. [Zl Change of Equipment Ownership 7. d Chan^ of Pennit Conditions 8. O Change Permit to Operate Status to Inactive 9. O Banking Emissions 10. • Registration of Portable Equipraent 11. |3 Other (Specify) Sentinel 909 Sovtiean based mastic remover 12. List affected AP/PO#(s): APPLICANT INFORMATION 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. Nameof Business (DBA) Matrix EnvironmentaL Inc Nature of Business Abatement Does this organization oym oc operate any other APCD pennitted equipment at this or any other adjacent locations in San Diego County? QVes I3NO Ifyes, list assigned tocation ID's listed on your PO's Type of Ownership El Corporation • Partnership • Individual Owner • Govemment Agency • Other Name of Legal Owner (if diffitrent from DBA)_N/A A. Eanipmect Owner B. Aiithorirv to COM tract (if differeot ITom A) Name Mailing Address Ciiy State Phone Name Mailing Address City State Phone 11601 Wilshire Blvd Los Aneeles CA Zip 90025 Zip (3101 575-5901 FAXf ) f ) FAXf ) C. Permit to Onerate (if difTerent from A) Mairix Environmental. Inc D. Billine Infonnation ftf different from Al Same as C. 2330 Chenv Industrial Cirlce Lone Beach CA Zip 90805 Zip f562> 236-2704 FAX f562) 236-2725 f 1 FAXf 1 EQUIPMENT/PROCESS INFORMATION: Type of Equipment: Kl Stationary •Portable. If portable,'will operation exceed 12 consecutive months at the same location O Yes O No 28. 29. 30. 31, Equipment Location Address 2501 El Camino Real State CA Zip 92008 She Contact Edpar Alcantara General Description of Equipment/Process Citv Carlsbad Phons (_ Title Supervisor Parcel No. _ FAX( L Phone f323l 712-1728 The mastic remover will be applied to the mastic once thc tile is removed. This vrill allow Matrix to clean up the mastic easier 32. Appiication Submitted by [H Owner • Operator S Contractor • Consuhant AfBliation EXPEDITED APPLICATION PROCESSING: • I hereby request Expedited Application Processing and understand that: 33. a) Expedited processing will incur additional fees and permits will not be issued until the additional fees are paid in fiill (see Rule 40(d)(8)(iv) for details), b) Exptiited processing is contingent on thc availability of qualified staff. c) Once engineering review has begun this request cannot be cancelled, d) Expedited processing does not guartmtee action by any specific date nor does it guarantee pennit approval. I hereby certify tbat all infonnation previdedtoV j^is apnl^tion is true and correct 34. SIGNATURE '^O'J^^vW^O^J^ Q'-^-' 35. Print Name Lisa Powell 36. Companv Matrix Environmental. Inc Phone r5621 587-8163 E-mail Address lpovyetl(ataatriyla.net TMe Vice Presideait AP# Receipt*. ID#_ _Cust. No., Date_ Sector: _UTM'sX. SIC. AmtRec'dS. Fee Code. Engineering Contaet. Refiind Qaiin* Fee Code. Dale_ APFee$_ Applieation Generated By NV#_ _NC# Other_ Date_ T&M Renewal Fee $_ Amt$ _Inspector 4.07-TW/flm -I- ARCD County of San Diego ^se-zeoo FAX (B58) SB6-2601 AIR POLLUTION CONTROL DISTRICT smoking Vehicle Hotline AIR PDUimON CDNTBOL DBTRICT 10124 Old Grove Road, San Diego, CA 92131 COUNTV OF SDN DIEGI 1-800-28-SMOKE www.sdapcd.org May 13, 2013 Lisa Powell IVIatrix Environmental, Inc. 2330 Cherry Industrial Circie Long Beach, CA 90805 After examination of your Application APCD2013-APP-002778 for an Air Pollution Control District (District) Authority to Construct and Permit to Operate for equipment to be located at various locations in San Diego County, the District has decided on the following actions: Authority to Construct is granted pursuant to Rule 20 of the Air Poiiution Control District Rules and Regulations for equipment to consist of; Portable asbestos mastic removal operation (Type 1) consisting of: squeegees, brushes, brooms, mops, coarse stripping pads, buffers, and rags. Solvent: SENTINEL 909 SOYBEAN BASED DEGREASER & MASTIC REMOVER only. Usage Volume: Total usage of mastic removal solvent shall not exceed 40 gallons per day. This Authority to Construct is issued with the following conditions: 1 Permittee shall only use the mastic removal solvent(s) and the specified amounts under the equipment description ofthis permit. (Rule 21) 2 This portable mastic removal operation shali be operated only at stationary sources which have aggregate actual emissions of less than 25 tons per year of volatile organic compounds (VOC) or have aggregate potential to emit of less than 50 tons per year of VOCs. (Rule 20.4) 3 Prior to applying the solvent, the portable equipment permittee shall verify with the stationary source that emissions from all materials containing volatile organic compounds (VOC) to be applied by the permittee will not cause the stationary source to exceed the permitted daily emission threshold. 4 Mastic removal operations shall not be conducted simultaneously at different stationary sources unless a separate permit to operate is obtained from the District. 5 Permittee shall maintain records for the portable mastic removal operation in accordance with Rule 66.1. The records shall include the following information: a. daily solvent usage; b. date solvent is applied; c. the starting and ending times for each mastic removal operation; d. current material safety data sheets (MSDS), manufacturer's specifications or analytical data regarding volatile organic compounds (VOC) and toxic air contaminant (TAC) LD, #APCD2013-SITE-01366 Sector # 01 Page 1 of 3 Matrix Environmental, Inc, May 13, 2013 Application #: APCD2013-APP-002778 content. MSDS, manufacturer's specifications, analytical data or a combination thereof shall, at a minimum, contain the following information: VOC content weight or weight percentage, TAC content weight or weight percentage, material density (weight per volume) or material specific gravity (material density relative to the density of water) and vapor pressure; and e. address ofthe sites undergoing asbestos abatement. A copy of these records shall be provided to the stationary source at the end of the worl< day for facility-wide emission calculations. In addition, these records shall be maintained at a central location and shall be readily available to the District upon request for a minimum ofthree (3) years. (Rule 21 and 66.1) 6 Prior to operation of this equipment at any location within San Diego County, the Air Pollution Control District Compliance Division shall be in formed in writing within two days ofthe specific location (inciuding the address) of operation. 7 The Compliance Division shall be supplied with the name and phone number of the person responsible for supervising operation ofthis equipment located at the processing site. 8 Permittee shall comply with 40 CFR Part 61 Subpart M, as applicable. 9 All materials containing volatile organic compounds shall be stored in closed containers In accordance with Rule 67.17 requirements. (Rule 67.17) 10 Access, facilities, utilities and any necessary safety equipment for source testing and inspection shall be provided upon request of the Air Pollution Control District. 11 This Air Pollution Control District Permit does not relieve the holder from obtaining permits or authorizations required by other governmental agencies. 12 The permittee shall, upon determination of applicabiiity and written notification by the District, comply with all applicable requirements of the Air Toxics "Hot Spots" Information and Assessment Act (California Health and Safety Code Section 44300 et seq.) This Authority to Construct authorizes temporary operation of the above-specified equipment. This temporary Permit to Operate shall take effect upon written notification to tlie District that construction (or modification) has been completed in accordance with this Authority to Construct. This temporary Permit to Operate will remain In effect, unless withdrawn or modified by the District, and a revised temporary permit (Startup Authorization) is Issued or a Permit to Operate is granted or denied. Upon completion of construction (or modification) in accordance with this Authority to Construct, and prior to commencing operation, the applicant must complete and mail, deliver or fax the enclosed Construction Completion Notice to the District. After mailing, delivering or faxing the notice, the appiicant may commence operation of the equipment. Operation must be in compliance with all the conditions ofthis Authority to Construct and applicable District Rules. This Authority to Construct shall be posted on or within 25 feet of the above described equipment or maintained readily available at all times on the operating premises. This Air Pollution Control District Authority to Construct does not relieve the holder from obtaining permits or authorizations, which may be required by other governmental agencies. This Authority to Construct is not authority to exceed any applicable emission standard established by this District or l.D, #APCD2013-SITE-01366 Sector # 01 Page 2 of 3 Matrix Environmental, Inc, May 13, 2013 Application #: APCD2013-APP-002778 any other governmental agency. This authorization is subject to cancellation if any emission standard or condition Is violated. Within 30 days after receipt of this Authority to Construct, the applicant may petition the Hearing Board for a hearing on any conditions imposed herein in accorciance with Rule 25. This Authority to Construct will expire on 05/13/2014 unless an extension is granted In writing. This is not a Permit to Operate. Please be advised that installation or operation of this process or equipment without written authorization may be a misdemeanor subject to fines and penalties. Ifyou have any questions regarding this action, please contact me at 858 586 2735 or via email at Kevin.Sung@sdcounty.ca.gov. Kevin Sung Junior Engineer CC: Compliance Division l.D. #APCD2013-SITE-01366 Sector#01 Page 3 of 3 APCD AKPOUVrinCDIIITniMSTRICT COUHTT CF mil OIECI COUNTY OF SAN DIEGO, AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 (858) 586-2600 FAX (858) 586-2601 www.sdapcd.org Sectors: , ID#: APCD2013-SITE-01366 APP: APCD2013-APP-002778 ATC EXPIRES 05/13/2014 CONSTRUCTION COMPLETION NOTICE Please complete the APPLICANT ONLY section of this Notice and fax/mail to APCD upon completion of construction. The foilowing information is based on submitted Application APCD2013-APP-002778. Please note any changes to this information, marking amendments clearly. ATC MAILING Matrix Environmental, Inc. Lisa Powell 2330 Cherry Industrial Circle Long Beach CA 90805 EQUIPMENT ADDRESS Matrix Environmental, Inc. Lisa Powell 2330 Cherry Industrial Circle Long Beach CA90805 EQUIPMENT DESCRIPTION Portable asbestos mastic removal operation <40 gallons/day of Sentinel 909 only. APCD Assigned Staff: Kevin Sung Telephone: 858 586 2735 Email: Kevin.Sung@sdcounty.ca.gov APPLICANT ONLY Date Construction was Completed: Equipment Seriai Number: Oate of this Notification: Person providing Notification: Contact Telephone Number: Signature: \ \ . (MM\DD\YYYY) . (MM\DD\YYYY) APCD ONLY Notification Received Date: BCMS Entry Date: SAN DIEGO AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD, SAN DIEGO, CA 92131 PHONE (858) 586-2650 FAX (858) 586-2651 FORAF>CP USEONLY Postmar1< Received Fee/ Receipt Notification # Entered Sector Inspector Assigned/Date NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Completed by: USA POWELL Company: MATRIX ENVIRONMENTAL NOTIFICATION El Original • Cancellation • Courtesy • Other(specify): • Revision • Change In asbestos amount • Change in start/end date (indicate type of revision) (gteater than 20%) PROJECT TYPE FACILITY INFORMATION • Demolition • Emergency Removal • Ordered Demolition • Emergency Demolition 13 Renovation (removal) • Planned Renovation (annual) Facility Name: WESTHELD PLAZA CAMINO REAL Address: 2501 EL CAMINO REAL Cross Street: HAYMAR City: SAN DIEGO Zip Code; 92008 iracility Owner: WESTFIELD LLC Address:_3241JHORI01t«LAZA_ Contact: CONTRACTS Title: Phone No: 619-239-8180 Building Size (sq. ft): 150,000 Building Age (years): 50 Number of Floors: 2 Number of Units: 0 Building prior/present use: S Commercial • Hospital • Industrial • Office • K-12 Sciiool • Public Bldg • House/Condo • Ship • Unlv/College • Other PROJ ECT IN FORMATION Asbestos Survey Performed?* ^ Yes • No Is Asbestos Present? la Yes • No Will tlie asbestos be removed? ^ Yes • No Is the building to be demolished? la Yes • No Asbestos Amount to be removed (sq/in ft): Friabie Pipes: 50 Category I Pipes: Category II Pipes: Surface Area: 8000 Surface Area: Surface Area:. Facility Component: Facility Component: Facility Component: Total Revised Amounts (if a revision) Asbestos Removal Start Date: 4/3/13 Asbestos Removal End Date: 5/30/13 Demolition Operation Start Date: Demolition Operation End Date: Por revisions only Revised Start Date:. Revised End Date:, For revisions oniy Revised Start Date:. Revised End Date: _ kemoval Contractor; Name: MATRIX ENVIRONMENTAL Phone No: 562.236.2704 CSLBUcense#: 697132 Address: 2330 CHERRY INDUSTRIAL CIRCLE City/State/Zip: LONG BEACH, CA 90805 Site Supervisor: JORGE MARQUEZ Demolition Contractor: Name: US DEMOUTION Phone No: 714.695.9026 CSLB Llcense#: 778598 Address: 4510 E. EISENHOWER CIRCLE aty/State/ZIp: ANAHEIM, CA 92807 Site Supervisor: DUANE PATE */\sbestos Suweys are required prior to Renovation and (Demolition, fiovrever the actual survey is not required fo be submittecl vtrfth the nofification. SDAPCD-SUBPART M-Rule 361.145 Pagel of2 04/2010 NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS Waste Transporter#l: Waste Transporter#2: Name: MATRIX ENVIRONMENTAL, INC Name: BDC (NON FRIABLE) Address: 2330 CHERRY INDUSTRIAL CIRCLE Address: 1211 W. GLADSTONE City/State/Zip: LONG BEACH, CA 90805 City/State/Zip: AZUSA, CA 91702 Contact Person: USA POWELL Phone: 562.236.2704 Contact Person: SEAN KELLY Phone: 626.334.0719 Waste Disposal Site (Landfill): Name: AZUSA LAND RECLAMATION Address: 1211 W. GLADSTONE aty/State/Zip: AZUSA, CA 91702 Contact Person: SEAN KELLEY Phone: 626.334.0719 Asbestos Detection Procedures: Ched< the appropriate procedures and analytical methods used to detect the presence of asbestos containing materials. 13 Survey 13 Bull< Sampling • Inspection S PLM • TEM • other: • PCM Describe work practices and engineering controls to be used. Check applicabie methods below: El Water • Amended Water • Roofing Cutting Saws • High Pressure Water Blast • Infrared Machines • Cranes (wrecking ball, clamshell, bucket) • Zamboni • Bead Blast • Floor Buffer • Demolition v*f/roofing materials in place • Skid Loaders/bobcats/Top Loaders using sledge hammers. • Terminator™ • Axes • Shovels • Implosion • Demolition w/Cat I Floor tiles In place • Explosion • Ice Chippers • Pry Bars Negative Air Machines • Bulldozer Full Containment Intentional Buming 13 3 Stage Decon • oSn°^'kmikM, ^\ Mmx^ • Glove Bag Critical Barriers For Ordered Demoiition provide a copy of the order and complete the information below: Agency Name: Authorizing Person: Tide: Date of Order: Date Ordered to Begin: Phone: Contingency Pian Describe actions to be foWowed If unexpected asbestos Is found during demolition or removal or asbestos material becomes disturbed, crumbled, pulverized or reduced to powder. . EVACUATE AREA, WET ACM, DEMARCATE WORK AREA, STABILIZE AND HAVE C.A.C INSPECTION Training Certification I certify thst an individual trained in the provisions of this regulation (CFR Part 61, Subpart M) wlll be on site during tt)e removal and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. Date: 3/20/13 Print Name: USA POWELL (Owner/Operator) Signature: (Owner/Operator) Information Certification: I certify that the at»ve information is correct. Date: 3/20/13 Print Name: USA POWELL (Owner/Operator) Signature: (Owner/Operator) Original notifications are to be submitted to the District at least 10 working days prior to removal or demolition. Revised notnes are to be submitted as soon as possible but no later than the original start date. Original notIfk:ations cannot be accepted without the required fee(s) (Rule 40(f)(2)), hovi/ever revised notifications vinll be acce|:ited without the required fee provided the fee is paid prior to the start date of the original notification. SDAPCD -SUBPART M - Rule 361.145 Page 2 of 2 State ofCalifomia Department of Indastrial Relations DIVISION OF OCCUPATIONAL SAFETY AND HEALTH Certificate of Registration for Asbestos-related Work Certificate No. 869 Expiration Date I J-ftctrlS MATRIX ENVIRONMEMTAL, INC. (XaTO of Empl over) is duly registered by the Divtsion of Occupational Safety and Health in accordance with the Califomia Administrative Code, Title 8, Article 2.5 for asbestos-related work. 20-Sep-12 Date Of Issuance Effective Date . ^^OQ.t-\2 Il4eartii afety and Health Contractor's License No. 860131 This registration is vafid only when fte following requirHnents and conditions are mrt: 1. The registered employer shall safely perform asbestos-related work in compliance with relevant occupational safety and healtfi regulations. 2. The registered anptoyer diall notify the D ivision of dianges in wotk locations or conditions as specified by Sectfon 341,9 of Title 8 of the California Administrative Code. 3. The registered emptoyer shall post a sigi readable at 20 feet at the location of any asbestos-related woilc stating: Danger-Asbestos Cancer and Lung Hazard AuthorEced Personnel Only 4. A copy of the registration shall be posted at the jobate beside the Cal-OSHA poster. 5. The registered onployer shall provide a copy of this registration cotificate to the prime contractor and any other employers at the site before the commencement of any asbestos-related work. 6. The regstered emptoyer shall conduct a safety conference prtor to the commencanent of any asbestos-related woilc as specified isy Section 341.11 ofTitleS of flie Califomia Adminstrative Code. 7. The regista-ed enpfoyer acknowledges the Division's right to revoke or suspend this r^istration as provided by Section 341.14 of title 8 of the Califbrnia Administrative Code. NOTE: CONTRACTOR TO PROTECT SHORING FROM ALL ACTIVITIES IN THE AREA SHORING DESIGNED FOR 4KLF TOTAL LOAD BY OTHERS EOR TO VERIFY THE CAPACITY OF (E) SLAB TO SUPPORT SHORING LOADING AS SHOWN .4' WIDE SHORE X FRAME W/ 5" CROSSBRACE U.NO. N hl>l h-j N N N NN hhN-P-l.!:^ i-l N h-l N N h-J h'l h-l U h-l f'i H4 12' W8X10 BEAM -<Sc (2)W8X10 HEADER TYP. 40' r4 N N hT R h j 30' N N N<\ i t RECEIVED JUL 3 0 2013 CITY OF CARLSBAD BUILDING DIVISION f4 K ENGINEERING inc. 25431 CABOT ROAD, SUITE 109 LAGUNA HILLS. CA 92653-5526 TEL: (949) 380-8186 FAX: (949) 588-1664 CALIFORNIA ACCESS WESTFIELD " CARLSBAD ^ SH ORI N G DRAWN J Q jAPP1«>VED R Q.M. DATE REMARKS 7/25/13 -— J SHORING LAYOUT BE REPRC THIS DRAWING IS THE PROPERTY OF KCI ENGINFFRIMR INO. AND MAY NOT REPRODUCED NOR ITS CONTENTS ANY FORM WITHOUT EXPRESS WRITTEN PE NOTE: CONTRACTOR TO PROTECT SHORING FROM ALL ACTIVITIES IN THE AREA SHORING DESIGNED FOR 4KLF TOTAL LOAD OTHERS EOR TO VERIFY THE CAPACITY OF (E) SLAB TO SUPPORT SHORING LOADING AS SHOWN 4' WIDE SHORE X FRAME W/ 7' CROSSBRACE TYP W8X10 SLEEPER TYP W8X10 BEAM TYP. (2)mx^0 HEADER TYP. MIN. DISTANCE AS REQD'. 1OK/LEG TYP. TYP. SHORING SECTION K ENGINEERING Inc. 25431 CABOT ROAD, SUITE 109 LAGUNA HILLS, CA 92653-5526 TEL: (949) 380-8186 FAX: (949) 588-1664 CALIFORNIA ACCESS WESTFIELD CARLSBAD SH ORI N G M««N J 0_ |APP«>VB) R G DATE REMARKS 7/25/13 -— THIS DRAWING IS THE PROPERTY OF KCI ENGIMFFBIMR IMn AND MAY NOT BE REPRODUCED NOR ITS CONTENTS USED IN ANY FORM WITHOUT EXPRESS WRITTEN PERMISSION 1.02 NOTE: CONTRACTOR TO PROTECT SHORING FROM ALL ACTIVITIES IN THE AREA SHORING DESIGNED FOR 4KLF TOTAL LOAD BY OTHERS EOR TO VERIFY THE CAPACITY OF (E) SLAB TO SUPPORT SHORING LOADING AS SHOWN 19' W8X10 IT W24X84 W8X10 -W10X54 BEAM TT •(2)W8X10 HEADERS 4' WIDE SHORE X FRAME W/ 4' CROSSBRACE TYP. 12' W8X10 SLEEPER, TYP. IOK/LEG TYP. SHORING SECTION A K ENGINEERING inc. 25431 CABOT ROAD, SUITE 109 LAGUNA HILLS, CA 92653-5526 TEL: (949) 380-8186 FAX: (949) 588-1664 CALIFORNIA ACCESS IW n ^ ^rv^ WJKiL 1 ^Ti 11 ^cg^^ r ^ WESTFIELD CARLSBAD SH ORI N G DRAW J Q jAPPROVED R Q.M. DATE REMARKS 7/25/13 -— V THIS DRAWING IS THE PROPERTY OF ^ KPJ FNRIMFFBIMO IMH AND MAY NOT \ BE REPRODUCED NOR ITS CONTENTS ) USED IN ANY FORM WITHOUT EXPRESS / , WRITTEN PERMISSION / 1.03 Westfield Corporation Westfield Carlsbad (Plaza Camino Real) Construction Costs for Shell Demolition of Existing Robinson-May Building Shell Demolition/Abatement Structural Shoring $ 523,400 $ 44,640 Total Shell Demolition Cost $ 568,040 RECEfVED JUL 3 0 2013 CITY OF CARLSBAD BUILDING DIVISION CB131572 2501 ELCAMINOREAL ROBINSON MAY: DEMOLITION OF .STRI ICTI IRF IMn RFMnvai np pcMTur-ii ICC AMn PC130045 2501 ELCAMINOREAL ROBINSON MAY: BUILDING RENOVATION f T^ ^ gf/NtJ' til SW [SSUED if Approved ENGINEERING FIRE Expedite? Y^ AFS Checked by: lleaTth Forms/Fees HazHealthAPCD Stormwater Special Inspection CFD: Y N LandUse; Densfty: /mpArea. PFF: Y N Comments Date - D Building Planning Engineering Fire Mb-