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Home My WebLink About2569 ROOSEVELT ST; ; CBR2018-3432; Permit(: eity of Carlsbad Print Date: 02/28/2019. Job Address: 2569 Roosevelt St Permit Type: BLDG-Residential Parcel No: 2031013500 Valuation: $9,240.00 Occupancy Group: U Dwelling Units: Bedrooms: Residential Permit Work Class: Demo Lot U: Reference if: DEV2017-0213 Construction Type: Bathrooms: Orig. Plan Check if: Plan Check if: Permit No: CBR2018-3432 Status: Closed - Finaled Applied: 12/13/2018 Issued: 02/01/2019 Permit Finaled: Inspector: PBurn Final Inspection: . '2/28/2019 2:44:51PM Project Title: ROOSEVELT TOWNHOMES Description: DEMOLISH ENTIRE HOUSE iN PREPARATION FOR FUTURE CONSTRUCTION Applicant: Owner: ACE HAULING SERVICES INC 2569 ROOSEVELT LLC 2220 David P1 P0 Box 448 Carlsbad, CA 92008-6884 CORONA DEL MAR, CA 92625 760-434-5740 BUILDING PERMIT FEE ($2000+) $114.96 . BUILDING PLAN CHECK FEE (BLDG) $80.47 S81473 GREEN BUILDING STATE STANDARDS FEE $1.00 STRONG MOTION-RESIDENTIAL $1.20 SWPPP INSPECTION FEE TIER 2- HIGH BLDG $1,358.00 SWPPP PLAN REVIEW TIER 2- High $383.00 Total Fees: $1,938.63 Total Payments To Date: $1,938.63 Balance Due: $0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. - You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning,, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. 1635 Faraday Avenue, Carlsbad, CA 92008-7314 1 760-602-2700 1 760602-8560 f I www.carlsbadca.gov WWA- 011- RESIDENTIAL z Plan Check (City of BUILDING PERMIT Est. Value Carlsbad APPLICATION PC Deposit B'i Date 21t 2/( JobAd2$O oosE V'L+ St Suite: APN: 3 10I 35 CT/Project Lot#_____ FireSprinklere: yes/no AlrCondltlonlng yes/no BRIEF DESCRIPTION OF wo _Pemoh ex*'i'tt- kt Addition/New: Living SF, Deck SF, Patio SF, Garage SF Is this to create an Accessoty Dwelling Unit? Yes/No New Fireplace? Yes/No, if yes how many? 0 Remodel: _________SF of affected area Is the area a conversion or change of use? Yes! No 0 Pool/Spa: _______SF Additional Gas or Electrical Features? (3 War. KW, ____Modules Mounted: Roof/Ground Tift Yes /No, RMA: Yes / No, Battery. Yes/ No Panel Upgrade: Yes! No ORerooI Med JJElectjicaI Only: 13 other.. APP1JCANT(PRIMARY) PROPERTY OWNER Name: _2569 Roosevelt LLC Name:26 - Address. P0 Box 448 Address: ID City: Corona Del Mar State: CA ZIp: 92625 city: COVOfl& DL Phone:_949 887 3795 Phone:_s4 Email:accountingtabodev.com Email: CtCUiu' DESIGN PROFESSIONAL CONTRJ Name: Frontis Studio Named Addrese: 830 Misnuri St 2 Addies City: San Diego State: CA Ztp:oiflo CltyCA Phone: 619-446-8067 Phone: Email:_torrey(frontisarchitecture.com Emalk( Architect State Ucense: State L ISK.7seL5 lusn,etsorequ!restheap4nzfouuth (OuVT9,Mmend?ngwfth5en7OOOctcMIcn3 ofthe Bunessagd Pcfe Code) orthethebexempt dwftnwddt&bwbfbrdwa1ftW empIlsn.MyvalatlansfSec*lan7D3L5WaitysppftcsnUa porn ubjeostheapptrnntt..dvll penaltyStnotrnornthansi.ltdrnddedant$scofl. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760.602.8558 Email: add B-I Page lof2 Rev. 0W18 (OPTION A): WORKERS'COMPENSATION DECLARATION: Ihearby affirm under penally ofperjury one .ofthe following declarations: Cii have and wit maintain a certificate of consent to self.Insure far workerS' compensation provided by Section 3700 of the Labor Code, for the performance of the wont which this permits issued. Dl have and will maintain warker'scompensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Insurance Company Name: Policy No. Expiration Date:__________________ Ci Certificate of Exemption; I certify that in the performance of the work for which this permit Is issued, I shall no: employ any person In any manner so as to be come subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage Is uniawf4 and shall subject an employer to criminal penalties and civil fines up to $100,000.00, In addition the to the cost of compensation, damages as provided for in Section 3706 at the Labor Code, Interest and assorney's fees. CONTRACTOR SIGNATURE: DAGENT DATE:___________ (OPTION B ): OWNER-BUILDER DECLARATION: thereby affirm that lam exempt from Contractor's License Low for the following reason: Di. as owner ofthe property or my employees with wages as their sole compensation, will do the work and the structure Is no: Intended or offered for sale (Sec. 7044, Btrsiness and Professions Coder The Ccnvactofs license Law does not apply to an owner of propettywho builds or improves thereon and who does such work himself orthrough his own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner-builder will have the burden of proving that he did no: build or Improve for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Co tractor's license law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). Ci lam exempt under Section Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. Dyes ON* 2. l (have /have not) signed an application bra building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (Include name address / phone/contractors' license number): 4.1 plan to provide portions of the work, but I have hl red the following person to coordinate, supervise and provide the major work (include name /address/ phone/ contractors' license number): S. Iwlil provide some ofthework, but I have contracted ( ad) the lowing persons to provide the work indicated (include name/ address/ phone/ type of work): OWNER SIGNATURE: DAGENT DATE: I hereby affirm that these Isa construction for the performance of the work this permit Is issued (Sec. 3037 (I) CIA Code). Lender's Name: Lender's Address: ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505,25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? DYes Ci No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYes Ci No Is the facility to be constructed within 1,000 feet of the outer boundary of a school sate? CI Yes CI No MANY OFThEANSWSRSAREYES,A FJNALERTlEICATEOF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR ISMEETINGThE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES ANDThE AIR POLLUTION CONTROL DISTRICT. APPUCANtCERTIRCATION: I certify that have read the application and state that the above information is correct and that the information on the plans Is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TOSAVE,INDEMNIFV AND KEEP HABJJUESSTRE CITY OF CARISEADAGAINSrALL umiunM JUDGMENTS. COSTS*ND EXPENSES WW04 MAY INANY wAYACCRuE AGMuSrSAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMff CSHAAnOSHApemdtIsrequlredforexzavaticnsovarS'O deep and demolition or construction of structures aver 3stories In height. CCPlRAilON: Every permit Issued by the Building cfflciai under the provisions of this Code shall expire byilmltauon and become null and void If the building or work authorized permit rot at anytime after the work is commenced for a period of 180 days (Ølon4C644 Ur15i4IdingCode). APPUCANT SIGNATURE; DATE:_IIjPI1 ' 1635 Faraday Ave Carlsbad, CA 92008 : 760-602-2719 Fax: 760-602-8558 Email: Bulldlngt!lcarlsbadca.Eov B-i V Page 2 of 2 Rev. 08118 Permit Type: BLDG-Residential - Application Date: .12/13/2018 Owner: 2569 ROOSEVELT LLC Work Class: Demo Issue Date: . 02/01/2919 Subdivision: SEASIDE LANDS Status: Closed - Finaled Expiration Date: 08/13/2019 Address: 2569 Roosevelt St Carlsbad, CA 92008-1612 IVR Number: 16012 Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reunspection Complete 0211212019 0211212019 BLDG-SW-Pre-Con 083727-2019 Failed. Paul Burnette Reinspection Complete Checklist Item COMMENTS Passed BLDG-Building Deficiency No 0211412019 0211412019 BLDG-SW-Pre-Con 083896.2019 Passed Paul Burnette' Complete Checklist Item COMMENTS Passed BLDG-Building Deficiency . No 0212812019 0212812019 BLDG-Final 084890.2019 Passed Paul Burnette Complete Inspection Checklist Item COMMENTS . Passed BLDG-Building Deficiency . No BLDG-Plumbing Final No BLDG-Mechanical Final No BLDG-Structural Final " . No BLDG-Electrical Final No February 28, 2019 . Page 1 of 1 RECEI\' ) NOV13 2018 CITY OFCARI.r, )'LDING ECEIVED DEC 132018 CITY OF CARLSBAD BUILDING DIVISION AC: SON 0 COMPREHENSIVE ASBESTOS SURVEY REPORT FOR 2569 Roosevelt Street Carlsbad, CA Prepared for Julien Tooma DATE 9/25/2016 Report # 1609-251-631373 CONDUCTED BY Jackson Environmental 7545 Irvine Center Drive Suite 200 Irvine, CA 92618 949-230-9779 TABLE OF CONTENTS INTRODUCTION SECTION I ASBESTOS SURVEY SUMMARY Executive Summary Facility Description Survey Findings SECTION II BUILDING INSPECTION FOR ASBESTOS Bulk Sampling Bulk Sample Analysis Quality Assurance Limitation of Sampling Suspect Asbestos Containing Materials SECTION Ill LABORATORY REPORTS Asbestos Laboratory Reports INTRODUCTION Jackson Environmental was retained by; JulienTooma to conduct a COMPREHENSIVE Asbestos Survey for the property located at, 2569 Roosevelt Street, Carlsbad, CA PURPOSE The purpose of this survey was to identify Asbestos Containing Material (ACBM) in all areas of the building. Work consisted of collecting bulk samples of all materials suspect of containing asbestos. THE REPORT The survey report is divided into three major sections, which provide identification of all suspected ACBM. Section I presents a summary of the Asbestos Survey and a general description of the area inspected. Survey findings are also provided in this section. Section II describes the methodology used to perform the survey and includes Jackson Environmental, and our Analytical's quality control procedures. Section III of this report summarizes the locations and materials which were identified as containing asbestos. Results of the bulk samples are included in this section. SECTION I ASBESTOS SURVEY SUMMARY EXECUTIVE SUMMARY Jackson Environmental was retained by Julien Tooma to conduct a COMPREHENSIVE Asbestos Survey for the property located at 2569 Roosevelt Street, Carlsbad, CA The sampling was conducted by Michael Jackson an Osha certified asbestos consultant # 04-3635 FACILITY DESCRIPTION The subject property is a single family, one story, wood frame building set on a foundation. While on-site the Certified Personnel noted the condition of the materials. This is noted in the survey findings below. SURVEY FINDINGS The following building materials were identified and assumed as containing asbestos: Building Material Location Condition SQ' Approximate None Detected **please note square footages are approximate estimates only and should not be used as a basis for bidding purposes** RECOMMENDATIONS: All Significantly Damaged and Damaged areas should be repaired or removed as soon as possible to avoid any potential hazards that may result from further disturbance of ACM. SECTION II COMPREHENSIVE ASBESTOS INSPECTION BULK SAMPLING Bulk samples of areas containing suspect ACBM were collected. A homogeneous area is defined as surfacing material, thermal insulation, or miscellaneous material that is uniform in color, texture, or date of application. Samples were collected using wet methods; where they are deemed appropriate, to minimize fiber release. Prior to sampling, the location is misted with water from a spray bottle. A sample of the suspect material is then collected using a chisel, core borer, knife, or other appropriate tool. After the sample was collected, the bulk material was placed in a sample bag which was sealed to prevent fiber release or contamination by outside sources. Samples are documented by entering the sample data on a bulk log, including a description of the material, a unique sample number is assigned to each sample and the sample bag was labeled with that number. During the survey, the technician also notes the condition of the material being sampled, its location, condition, and friability. Note: The amended National Emission Standard for Hazardous Air Pollutants (NESHAP), November 20, 1990, included a requirement that when the asbestos content of a bulk sample material is determined using procedures outlined in the Interim Method and the asbestos content is estimated to be less than 10% by method other than Point Counting, the parties legally responsible for a building (owner/operator) may elect to assume the amount to be greater than 1% and treat the material as a regulated asbestos containing material. If the owner or operator does not want to assume the material is asbestos containing, verification of the amount of asbestos by the Point Counting method may be required. The purpose of this procedure is to minimize false negative analysis, and false positive. Point Counting was included in NESHAP in response to an HEPA study that found unacceptable amounts of false positive and false negative analyses by methods outlined in the Interim Method. Unless otherwise directed, American Analytical will assume that PLM analysis is acceptable for this survey. CLASSIFICATION OF BULK BUILDING MATERIALS "S" Significantly Damaged Material with one or more of the following characteristics: The surface is crumbling or blistered over at least one tenth of the surface if the damage is evenly distributed :( one quarter or more if the damage is localized). One tenth (one quarter or more, if localized) of material hanging from the surface, deteriorated, or showing adhesive failure. Water stains, gouges, or mars over at least one tenth of the surface if the damaged is evenly distributed (one quarter or more if the damage is localized). Accumulation of powder, dust, or debris similar in appearance to the suspect material on surfaces beneath the material can be used as confirmatory evidence. We recommend immediate removal of Significantly Damaged material and clean up of the area by a Licensed Asbestos Abatement Contractor. "D" Damaged Material with the following characteristics: The surface is crumbling, blistered, water-stained, gouged, marred or otherwise abraded over less than one tenth of the surface if the damage is evenly distributed (less than one quarter if the damage is localized). Accumulation of powder, dust, or debris similar in appearance to the suspect material on surfaces beneath the material can be used as confirmatory evidence. We recommended removal of damaged material and clean up of the area by a Licensed Asbestos Abatement Contractor. "G" GOOD Material with no visible damage or deterioration, or showing only very dama-ge or deterioration. We recommended materials identified as in good condition be placed on an Operations and Maintenance Program (0 & M). BULK SAMPLE ANALYSIS All bulk samples were analyzed by Patriot Laboratory an NVLAP accredited laboratory. The laboratory accreditations are as follows: NVLAP #200642-0 National Voluntary Laboratory Accreditation Program (Federal) Approximately 10% of the bulk samples were split for quality control purpose. All bulk samples were analyzed by Polarized Light Microscopy (PLM) with dispersion staining in accordance with the EPA Method #600/R-93/116. 40 CFR 783.87. The reliable limit of detection for PLM is 1.0%. Where "None Detected" or ND appears in the report, it should be interpreted as meaning that no asbestos was actually observed in the sample. Samples containing, "Trace" level of asbestos indicates a possible contamination and is considered ACBM. NOTE: If a sample contains greater than 1.0% asbestos, it is considered to be a regulated material by Federal Government Standards. Under the California State Education Code, materials containing greater than 0.1% in asbestos content are considered regulated. QUALITY ASSURANCE Statement of Quality Assurance At Jackson Environmental Quality Assurance is priceless! Jackson Environmental is committed to providing analytical services and data to its clients that are of the highest quality and legally defensible. Quality Assurance (QA) procedures were employed to ensure reliable results for analysis of bulk samples as follows: The laboratory is currently participating in the NVLAP Quality Assurance Program. Quality control is processed on at least 10% of all bulk samples on a daily basis. Laboratory results of samples submitted to the laboratory were within 3% of the original side by side sample. LIMITATION OF SAMPLING OF SUSPECT ASBESTOS CONTAINING MATERIAL Reasonable effort is made by Jackson Environmental 's staff to locate and sample suspect materials. However, for any facility the existence of unique or concealed asbestos containing material and debris is a possibility. In addition, sampling and laboratory analysis constraints typically hinder the investigation. American Analytical does not warrant, guarantee or profess to have the ability to locate or identify all asbestos containing materials in any given facility. This report is intended to be used in planning for construction or demolition. This report is not intended to be a construction document. V Jackson Environmental is not, and has no responsibility as, a generator, operator, treater, storer, transporter or disposer of hazardous materials or waste found or identified as a result of Jackson Environmental's work. STATE REQUIREMENTS In accordance with State of California Regulation, all surveys are conducted by personnel holding a minimum of a Site Surveillance Technician certificate. This certificate is awarded to individuals who have fulfilled specific educational and experience requirements, as well as having completed extensive training in asbestos specific courses. Additionally, the State also mandates these individuals pass a rigorous examination. This examination is prepared, proctored, and graded by State officials. The Certified Asbestos Consultant must fulfill all the education and experience requirements as the Site Surveillance Technician, but must have additional and more extensive asbestos related training. Candidates for Certified Asbestos Consultant must also pass a more rigorous examination before being approved by the State of California. In compliance with State of California Requirements surveys and reports prepared by a Certified Site Surveillance Technician are reviewed, approved and signed by a Certified Asbestos Consultant. Certified Asbestos Consultant ' Michael Jackson Project Manager CAC # 04-3635 949-230-9779 Report # 1609-251-631373 S SECTION III BULK SAMPLE ANALYSIS SAN DIEGO REGIONAL OFFICE USE ONLY 1P HAZARDOUS MATERIALS RECORD IDS PLAN CHECK S______________________________ QUESTIONNAIRE BP DATE I— 'tMN'r8RwSWeL +-L. Telephone Inv rWWff-L+ C *I V6 7 t 10)- !S Aes( '14 ffSt _____ Code 'izc1 4 IQ I Plan FileS pNcantE.malI T&sp4 7 3715' I.' inC TOUOWtfl9 quesltons up esess'uro facility's SCUVIUGI, NOT lie spasms project descrIptIon. Agency with jurtsdlcilan Occupancy Rating: Facility's Square Footage (Including proposed project): Explosive orBlaatlngAgents 5. Organic Peroxides 9. WaterReactwes 13. Compressed Gases 6. Oxidizers 10. Cryogenics 14. FlammablelCombustlbte Uqulds 7. Pyrophorics 11. Highly Tcudc orTo3dc Materials Flammable ScUds 8. UnatabloReactivee 12. Radloactives Cal (858) 50541700 Prior to the [nuance ofa building permit. -- FEES ARE REQUIRED Project Completion Date: if. f)O. 1 Expected Date of Occupancy: YES 1. D NO 11 (for new construction or remodeling projects) layout business fisted on the reverse sIde of this form? (check all that apply). 0 0 Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will j your business store or handle Hazardous Substances In quantities greater than or equal to 55 gallons. 500 0 pounds an War 200 cubic feet? Will your business store or handle caidncganslreproducllve towns In any quantity? 0 Will your business use an existing or Install an underground storage tank? 0 J Will your business store or handle Regulated Substances (CatARP)? I] M Will your business use or Install a Hazardous Waste Tank System (Title 22. Article 10)? 0 go Will your business store petroleum In tanks or containers at your fadilty with a total facIlity storage capacity equal to —IVIL D13218 018 lithe snausr toany'Ofthe Diego. CA 02 O CalAfiP Exempt Data leWsis E3 CalARP Required Date idtida o CalARP Complete Date Initials PART' III- SM 019 LJ;Auft= 11P;0N CONTROL DISTRICT (APCt), My YES answer requires a stamp from APCD 10124 Old Grove Road. San Diego. CA 92131 W n1wm. [*No stamp requved 1101 Yes 50g 03 Yes 04.06 No]. The following questions are intended of air pollution in atmmjannlng stage. Prejecte may require addlhlonal measures not Identified by these questions. Far comprehensive to Identify the majority requirements contact APCD. Residences are typically exempt, except - those with mote than one bullding on the property single buildings with more than four dwelling units; townhamas; condos; mlxed.commerclai use; deliberate burns; residences NO forming part of a larger project. rExoludes garages & email outbuildings.) 1. 1] Will the project disturb 180 square feet or more of existing building materials? Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition. S H (ANSWER ONLY IF QUESTION I cr2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance Technician? 4. 0 , (ANSWER ONLY IF QUESTION 31$ YES) Based on the survey result. will the project disturb any asbestos containing material? Notification may be required 10 working days prior to commencing asbestos removal. 0 Will the project or associated construction equipment omit air contaminants? See the reverse side of this form or APCD factshoet 6 D (yAArw sbncd.offl0ninflactaloannfta,pdf) *,rtyplcal equipment requiring an APCD permit. (ANSWER ONLY IF QUESTION 51$ YES) Will the project or associated construction equipment be located within 1.000 feet of a school boundary to 044toy, Briefly describe proposed project Briefly describe New iW4LI the best of my knowledge and belief tile responses made herein are true and correct. Name of Owner or Authorized Agent S '" of Owner or Authorized Anent Data FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: FOR OFFICAI. USE ONLY: BY: DATE., I I erl'cRuorolnci*o oaaatiospacjrmss Rm,roronaua.asispuarersut xarroaoccupmcy RD.EAUD FOR OCCUPANCY cCUNTY-HMD COUNTY.HMD APCD c0UNtY4lMD APCD weal VC ' San Oleo, -- . . iuuwui ouwuv rinn. uuwr pwmirung requrremom, may suit apply. HM.9171 (08118) County of San DIego— DEH — Hazardous Materials Division CCity 0f Carlsbad DEMOLITION REQUIREMENTS B-9 DeveloDment Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov A permit for demolition of a structure can be issued after approval and issuance of a grading permit. Please contact the building division with questions on the demolition process. The following items must be completed prior to issuance of a demolition permit: "_1I Completed Building Permit Application (Form B-I): A demolition permit may only be issued to the owner of the property or the State Licensed Contractor that is doing the work. Four (4) sets of plans: 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. '9 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. San Diego Regional Hazardous Materials Questionnaire: For commercial demolition or demolition of more than a single residential structure, proof of application to the County of San Diego Air Pollution Control District 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. Waste Management Plan (Form B-59): Comply with Green Code waste disposal and recycling management program (65%). Sec. 5.408.1 / 4.408. Complete page 1 of 2 which estimates the waste to be recycled. Public Property: If applicable provide plans and details demonstrating measures to - protect public property and walkways. Additional items that may be required: Water Agency: Arrange for appropriate Water Agency to remove water meter unless construction of replacement structure is to begin shortly. The Planning Division will determine if the structure is in the Village Review area, the South Carlsbad Review area, the Coastal Zone or if discretionary mitigation conditions apply: (760) 602-4610. The Land Development & Engineering Division will determine if a Haul Route, Right-of-Way Permit or Storm Water Permit is required: (760) 602- 2750. Fire Department may request the use of the building for training purposes: (760) 602-4665. B-9 Rev. 07/2018 RECEIVED DEC 132018 DEMOLITION ASBESTOS CERTIFICATION CITY OF CARLSBAD ADDRESS50'1 QC RUILDING DIVISION USE OF BUILDING TO BE DEMOLISHED: SQUARE FEET Li It. X NUMBER OF STORIES I PROPERTY OWNERi2CiO5€ ,-4 LL C. - JUt,t £lt, -Me rn gA. ADDRESS: PO e oi 4'-(-g, £oi,pia.. tU HG NE i7. 3? APPLICANT: 2569 Roosevelt LLC .1 ,] ij ;4 I I;!;PA1 Section 19827.5 of California Health and Safety Code states: 1A demolition permit shall not be issued by any city, county, city and county, or state or local agency which is authorized to issue demolition permits as to any building or other structure except upon the 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 Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project The permitting agency may require the applicant to make the declaration in writing, or it may incorporate the applicant's response on the demolition permit application. Compliance with this section shall not be deemed to supersede any requirement of federal law.' As applicant for a demolition permit in the City of Carlsbad, I certify that; I have read the excerpt from Section 19827.5 of the Health and Safety Code provided above; the information I have provided on this form is true and correct; and I further certify the following: ( ) On the attached pages are copies of all written asbestos notifications regarding the above referenced building that are required to be submitted to the United States Environmental Protection Agency or to Part 61 of Title 40 of the Code of Federal Regulations, or successor to that part. I declare that the written asbestos notification is not applicable to the scheduled demolition project. 'if I 3/?'olcc) Date Rev. 0712018 Crtificate of Analysis PLMAsbestos Identification tel - 714-899-8900 free - 888-743-0998 fax - 714-899-7098 www.l)atriotlab.corn 1041 S. Placentia Avenue, Fullerton, CA 92831 p EnWi Jackson Environmental Report Number: 631373 7545 Irvine Center Dr Suite 200 Irvine, CA 92618 Project Number: Project Name: Roosevelt St IRIfVE D Project Location: 2569 Roosevelt St Carlsbad CA Dj Date Collected: Collected By: Date Received: 10/19/2016 Claim Number: Date Analyzed: 10/21/2016 P0 Number: Date Reported: 10/21/2016 Number of Samples: 10 Lab/Client ID/Layer Location Material Description Color Composition (%) 631373-001 Kitchen Flooring Fin hite 100% Non- ibrous Material I Total Asbestos None Detected 11 171? Ii A flc11fl I7 /3/11 631373-002 Kitchen 45% Non- 2 Fibrous Material 40% Cellulose Total Asbestos None Detected S_ In 15% -Tar Red 45% Non-, 3 40% Cellulose 631373-003 Kitchen / Fibrous Material CE] Total Asbestos None Detected EO 631373-004 Living Room/ Drywall White /1 85% Sulfate / 156/o Cellulose Total Asbestos None Detected 11 631373-005 Bedroom U "DiwaIl L"-,h'itf Th-85%'Sulfate 15% Cellulose- lo _ 1 / \ •\ c Total Asbestos None Detected 7 Page l of3 Certificate of Analysis PLM Asbestos Identification tel - 714-899-8900 free - 888-743-0998 fax - 714-899-7098 www.patriotlal).corn 1041 S. Placentia Avenue, Fullerton, CA 92831 Jackson Environmental 7545 Irvine Center Dr Suite 200 Irvine, CA 92618 Date Collected: Date Received: 10/19/2016 Date Analyzed: 10/21/2016 Date Reported: 10/21/2016 Report Number: Project Number: Project Name: Project Location: Collected By: Claim Number: P0 Number: Number of Samples: 631373 Roosevelt St 2569 Roosevelt St Carlsbad CA 10 Lab/Client ID/Layer Location Material Description . ...._Color - Composition (%) _\\ Tar 631373-006 Roof Roofing r'—Black 60%Glass Fibers 6 '10% Minerals UIJQ3 1,5%, Cellulose fl/I Total Asbestos None Detected 0 DL] 0 )\ UU 1 fi Iii 631373-007 Roof Roofing Black / / 60% Tar \ ; 60% Tar Fibers [ 10% Minerals 15% CIlulose / L— Total Asbestos None Detected 631373-008 Rear Unit (ccS \\b.rlwalI \ White 185%Su1fate 8 6% Carbonate 56/6 Celllose _______ I Total Asbestos None Detected 631373-009 Side Windo( Windw Putty White J 1/ U 100% Non- Fi6ious Material )~'~ 9 II N\ \ 1 _ TT 1 Total Asbestos None Detected 17 631373-010 Roof 'Vent /1 Ven't Tan 80% Mh ___ 10 -15% Carbonate 47 Paint_ u Total Asbestos None Detected 0 P r. V __/age 2 of 3 Ce,rtificate of Analysis PLM Asbestos Identification tel - 714-899-8900 free - 888-743-0998 fax - 714-899-7098 www.patriotlab.com 1041 S. Placentia Avenue, Fullerton, CA 92831 Jackson Environmental 7545 Irvine Center Dr Suite 200 Irvine, CA 92618 Date Collected: Date Received: 10/19/2016 Date Analyzed: 10/21/2016 Date Reported: 10/21/2016 Report Number: Project Number: Project Name: Project Location: Collected By: Claim Number: P0 Number: Number of Samples: 631373 Roosevelt St 2569 Roosevelt St Carlsbad CA 10 Lab/Client ID/Layer Location Material Description Color Composition (%) 631373-008 Sample contained joint compound. - ------ ---/ Raul Lanuza - Analyst 0 LiD [I Ian Reyes - Approved By 00 /"-1 fin ñ7 11 Bulk sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US Federal Register 40 CFR 763, Subpart F, Appendix A; EPA-600/R-93/I16 (Method for Determination of Asbestos in Building Materials), and EPA-600/M4-82-020 (US EPA Interim Method for the Determination of Asbestos in Bulk Insulation Samples). Samples were analy'zed using Calibiated Visual Estimatioiis (CVES); therefore, results may not be reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individiâl layers. .This report applies only to the items tested. Results are representative of the samples submitted and may not 'represent the entire'material frbii which the 'samples were collected."None Detected" means that no asbestos was observed in the sample. "<%" (liss tha'n one percent) means that asbestos 'as observed in the sample but the concentration is below the quantifiable level of 1%. This report was issued by a NIST/NVLAP (Lab Code 2003580) and CADOHS- ELAP (Cert. No. 2540) accredited laboratory and may not be reproduced, except iiffull .vithout the ixpressed written cnsent of Patriot Environmental Laboratory Services, Inc. This report may not be used to claim product certification!approval or endorsement by NIST, NVLAP, ELAP or any government agency.— I I /\\\\ \ / Page 3 of 3 Lob Use Only Report Number. 714-89g•8900 free - 888-743-04998 faX - 714-8994098 wwwpatriottab.com 1041$. Placentia Avenue, Fullerton, CA 9931 PAi1?I - Environmental Laboratory Services. Inc. CHAIN OF CUSTODY -. I Client: Jackson Environmental I Project No.: Contact Person: MIChSGI Jon Project Name: 1+ J Client Address: Project Location: ZT6q j oseue/- SI' 7545 Irvine Center Drive Suite 200, Irvine CA 92618 - oi Es-I5i.CJp 4 Contact Phone: -zxo-gns Sample(s) Collected By: Contact Fax: . Authorized by: Claim #: P0 #: How do you want your report? (Circle) Mail Fax Web Email: iecreportaegmail.com Special Instructions: . : ... . .. ... . Analysis Requested Turnaround Time (business hoursldays) . ... RUSH (4 hours) D I RUSH (8hours)D I 24Hr0. -48, Hr . 72Hr.D J Other (specify)[] Was: 4M TATae*bt. WI'JIj gg vb* 5.7dae thm matmh,m,wp.aac,eriajcuuwesr.óutr, mbenipn Mw TAT. 5T1 (4L.WT and lVlPmlnimwn TAr w. l2lwr. Asbestos PCM (fiber count) NIOSH 7400A El PLM (bulk asbestos) EPA 6001R-93/116 Point Count 400 0 CARS 435 = Point Count 1000 D - . Gravimetric Reduction:.. (01ev rReicIan Requkes P.InlnIum 101w TAT) D Mlcrobioloav . .. ..: . Fungi ... ... Non-Viable Air Spore Trap, SOP IV.4.1 m12m . ... ...... ... 0 ..: Viable (Colony. 1p & Enumeration) Air 0 Swab/Bulk 0 Non-Viable Surface Tape Lift/Swab/Bulk SOP IV 4 3m!4m D Rdi.tuii16 (Sanps rust Be received by tim laboleloly wtflth 241i1s of couecrlcn orresim may be Invalid) Total Colliorm and E. coil - Surfaces, Swabs, and Sulk Sollds,Uqulds::(flo ,potable, non-wastewater)— Presence ./Absence 0 Chemistry . ... . .. . Lead bv Flame AA - EPA 305OBi7420mod MaSH 7082mod Paint 0 Air 0 DustWipe 0 Water (non-potable) fl Soils/Solids 0 Lead Waste Profile (by Flame AA) - •..: . . .• .. 1: TFLC Total Thmsholdby EPA 3050Bmod D: ZSTI.C/CALWETTitJe•22 CCRCh11 Article 5 App 2 0 3TCLPEPA 13110 Note Please pray/do atappsuz 200 grams (aprnz4 (b) oeamplolbrcomploreprnflle. awa. seretopehbrm all lost necessaiyforthsposet 0 Rotometer Calibration 0 pH testing (soils misc sohds,&l,qwds) EPA client 90450 Sample Sample Type Data Sampled .LacatIon aahI:led . p . Description of Sample (Material typo; dimensions, etc) Mait Tim Skip Tbee Ave. (LPM) Total Mlii. IbtOl Vol 10 . Tol. Wni k 4c Aipri r10.Je:.A.1> b4 che4 p .... . &4 / ..: .. iyI/ Relinquished By (Print) MICIIael JackSon Stg Date:Time Received By: :. (Print) . ign: . . . Date: iDI44 ii Time:: 4-36 Relinquished B (Print) Sign Date Time Received By (Print) Sign Date Time Method of Shipment! Pro etvatlon Durtng:Shlpment .. . Condition of Sasfltés.Acceptabre: YESl NO -. ------------------------------------------------ - _._ Cen'ments .1. . rn. wuwIauu,flIuJ iv ou uap. IW vuilo vainpius, I urys WI 04905(5, one rnmeaiare Tor iem in air arter analytical results are reported. Unless customer provides Written ins mctionsto extend holding time, sample Will be disposed of in accordance with local, state and federal laws. Page 1 of ' . . . . . . . . v.816.2014 1-Drive/Patriot CoC 4,, C let 114-993-8900 Lab We OnlY 574/K fax - flko.joii ' I 'Report Number. 1041S.pAvOnv:; CHant Sample • Sample Type. S Locationcatlon Sampled 10 ampled P. Description of Sample I start I stop I Avg I total I Total Vol I (Ftowx (Material type, dimensions. etc) "s I I TeL Mm) MEEM - MONSOON I I ife'4 - . • .•::•. - : I - . Relinquished By (Print) sIgrt J Date - Time Received By (Print) Sn Date Time 9' 3c) Relingurshed By (Print) Sgn Date Time RecelvedlBy (Print) Sign Date Time Note: PatriDVs holding Ume for oil les.sut sampnItted is for solid samPles, Tdoys fOr digests, and Iàdd1O irafier wiälytkal results are reported. Unless customer provides written instructions to extendholtllng U me. samples will be disposed of em accordance with local state andladarat laws Page Of . n I b • •:. RECF!m SD1 DEC 13 2018 CITY OF CMkL.. FtL) ASempra Energy uIiIny BUILDING DIViSIC Notice of Service Discontinuance PERMIT DEPARTMENT, CITY OR COUNTY OF: Carlsbad RCRrr SERVICE WILL BE DISCONTINUED TO: NOV 132018 ADDRESS: 2569 Roosevelt Street, Carlsbad CITY OF CAh D BY: (Date) October 13, 2018 u1LDIN DIVISiON ELECTRIC METER NO. 05236501 IGAS METER NO. 00203997 ALL SERVICE LINES WILL BE REMOVED. THIS BUILDING CAN BE MOVED OR RAISED AFTER THE ABOVE DATE. SAN DIEGO GAS & ELECTRIC BY: Mike Sciortmo/LM PHONE: 760-480-7616 DATE: October 30, 2018 PM Forms: NoticeofServiceDiscontinuance (1) Revised: 8/8/17 0 <0 iii co co Cfl_ -I> LU - C-) L) U- j —- I' M LI- I >-= UMESNSI pR*J!CTIWOEtCTflhjOS.UP2OlMOI3 Inoire1mJ1aEtcr!a.;JoI_s1oj cn - —u -v U '5 lz i 11 - 03.5 AS1.2 EXISTUI6 SITE PLAN LEGEND: PROJECT SUMMARY: — - - - tpJ!uotAInno,n1ywesA,aopR,nRwwJnafto,go PRSCTFZSt 2JUR003SLT31 TOT&LO#VJAEflOPCSZD ,J43gATGRJ,IDLE,a - - — — PAThWAflANPDEOflmSUAItONVI*t — WMf1 01*2tECIPtUtTGIEREMWD W.2VOtA1flp$TVl%RIT.3OGWnu. NTYcFS&.l.Lco.C*Wcmn.,w,Iz, mx.flA WAhIRlSBtT NDlflflmflhtl CMLZiIOMWttJPALWATtAhI3ItICl1YOF Exln.,oNGnUcC,,ETtpmflzWAhJU@ThtWAy WflSEA 2UISa-tl,fl?IU. CAflZIIOWMTEWATtR@lSIW( e,nx,Lamsc.n.nAcntn.,sc,nnnhs GLHWLNANLNmwt 101L fl.VI1AGtIU.O Y4.flAGtSU.WO1uAOEGZNtRMmSTRmT fltBlt1l EOSIDIIEASWOR IMDZWLMES. PlRW101ncll: 4%LRUIIP. IlREOMlflhlOOVPOSEO ICYJEUNSI: 10303 OlUMF BWLOlT0LE torn is is rn rn so a. ?Tn — so' is ii, rn N - ABBREVIATIONS: 305_00505rOlel 030 3' iS 33 Si 5 Si 0 3033003551035 055330515503 - IS op-i AS1.2 lmi&i FOJtCTlt.MSEtCl2llLitit.lCPitttIi "I'll ul EXISTING SITE PLAN 1/8 • 1'O Ina.o LEGEND: PROJECT SUMMARY: — - — w.EIxoIcArnpnn,yLr.e.Ano..npgonBlyt..nn.o,tt PROJECTttIt WtR3EYELIST. CAt.ziacantl, IOT.LOIOIGPaMOPOSZD 2M3GF&lG3SDIEVfl un,.c,aopoaoowlcpAnanxoT mavttaoApapJacatr — — — t.-Jv-JalavflAclt IflQ1DtME3DflIWCK*D1IJtXUJ1.ZTOSERZOVtD A3U55PAD.Ima.ZR it34OI4Sit pAThwAflAtOtEClOpAlWSIAt1VW_tS. WEt.DC&TESDJSWC%RIIA24VIGWML citmlYtPa,.EC.WanlLwp in I7IUBEPA&!PSEN liOTtDPtt4Il2 wflhik,W&tt C,aS3*MUI.ALWMIR.a1tCY.aWO, II IITOISLqSiCAPItA!APERLN1tSCRM3 no naca.wlaoa WRMit3lRtT 10000UflT: liii i 'hot.to,onr. noanoc,,.tnpno snt,.i SO(noEFOOTAEERENOnl.UliITONE ABBREVIATIONS: 01 tittiitt.t0t.0llt. IIO0,tt,..Oit0it.t.. mw. iowouww.Ns t City of Carlsbad DETERMINATION OF PROJECT'S SWPPP TIER LEVEL AND CONSTRUCTION THREAT LEVEL E-32 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov I'm applying for: 0 Grading Permit 0 Building Permit 0 Right-of-way permit Oth Project Name: ROOSEVELT TOWNHOMES Project ID: CT 2017-000E DWG #ICB#1509% IR2.1 __________ Address: 2569 ROOSEVELT STREET APN 203-101-35 Disturbed Area: 0.221 Ac Section 1: Determination of Project's SWPPP Tier Level SWPPP Tier (Check applicable criteria and check the corresponding SWPPP Tier Level, then go to section 2) Level Exempt -No Threat Project Assessment Criteria My project is in a category of permit types exempt from City Construction SWPPP requirements. Provided no significant grading proposed, pursuant to Tablel, section 3.2.2 of Storm Water Standards, the following permits are exempt from SWPPP requirements: 0 Exempt Electrical 0 Patio 0 Mobile Home 0 Plumbing 0 Spa (Factory-Made) Fire Sprinkler0 Mechanical 0_ Re-Roofing 0_Sign 0 Roof-Mounted Solar Array Tier 3— Significant Threat Assessment Criteria - (See Construction General Permit (CGP) Section l.B)* My project includes construction or demolition activity that results in a land disturbance of equal to or greater than one acre including but not limited to clearing, grading, grubbing or excavation; or, My project includes construction activity that results in land disturbance of less than one acre but the construction activity is part of a larger common plan of development or the sale of one or more acres of disturbed land surface; or, My Project is associated with construction activity related to residential, commercial, or industrial 0 Tier 3 development on lands currently used for agriculture; or My project is associated with construction activity associated with Linear Underground/Overhead Projects (LUP) including but not limited to those activities necessary for installation of underground and overhead linear facilities (e.g. conduits, substructures, pipelines, towers, poles, cables, wire, towers, poles, cables, wires, connectors, switching, regulating and transforming equipment and associated ancillary facilities) and include but not limited to underground utility mark out, potholing, concrete and asphalt cutting and removal, trenching, excavation, boring and drilling, access road, tower footings/foundation, pavement repair or replacement, stockpile/borrow locations. Other per CGP___________________________________________________ Tier 2 - 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: l 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 sq. ft. 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: 0 Tier 2 located within 200 ft. 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 I vertical; and/or disturbed area is located along or within 30 ft. of a storm drain inlet, an open drainage channel or watercourse; and/or construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 -Apr. 30) Tier I - Low Threat Assessment Criteria My project does not meet any of the Significant or Moderate Threat criteria above, is not an exempt permit type per above and the project meets one or more of the following criteria: results in some soil disturbance; and/or T 0 Tier includes outdoor construction activities (such as roof framing, sav%cIttig qyprpent,washing, material stockpiling, vehicle fueling, _waste _stockpiling) I tt..,_I_V_Eli - items iistea are excerpt horn CGv. UGP governs criteria for triggers for Tier 3 SWPPP. Developer/owner shall confirm coverage under the current cGP and any amendments, revisions and reissuance thereof. FEB 0 1 2019 CITY OF CARLSBAD E-32 Page 1 of 2 UILDING DIVISION REV. 02/16 2 SWPPP Section 2: Determination of Project's Construction Threat Level Construction Tier (Check applicable criteria under the Tier Level as determined in section 1, check the Threat Level corresponding Construction Threat Level, then complete the emergency contact and Level signature block below) Exempt - Not Applicable - Exempt Tier 3 - High Construction Threat Assessment Criteria: My Proiect meets one or more of the following: Project site is 50 acres or more and grading will occur during the rainy season Project site is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA High g Soil at site is moderately to highly erosive (defined as having a predominance of soils with Tier 3 USDA-NRCS Erosion factors kf 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 -April 30) Owner/contractor received a Storm Water Notice of Violation within past two years Tier 3— Medium Construction Threat Assessment Criteria 0 Medium All projects not meeting Tier 3 High Construction Threat Assessment Criteria Tier 2— High Construction Threat Assessment Criteria: My Proiect meets one or more of the following: Project is located within the Buena Vista 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 High g USDA-NRCS Erosion factors k, greater than or equal to 0.4) Tier 2 0 Site slope is 5 to I or steeper J Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 -Apr. 30) Owner/contractor received a Storm Water Notice of Violation within past two years o_ Site sq. more soil disturbance _results _in_10,000_ _ft. _or_ _of Tier 2— Medium Construction Threat Assessment Criteria Medium 0 e My project does not meet Tier 2 High Threat Assessment Criteria listed above Tier I - Medium Construction Threat Assessment Criteria: My Proiect meets one or more of the following: Owner/contractor received a Storm Water Notice of Violation within past two years e Medium Tier 1 Site results in 500 sq. ft. or more of soil disturbance Construction will be initiated during the rainy season or will extend into the rainy season (Oct.1 —April 30) Tier I - Low Construction Threat Assessment Criteria Low My project does not meet Tier I Medium Threat Assessment Criteria listed above certify to the best of my knowledge that the above statements are true and correct. I will prepare and submit an appropriate tier level SWPPP as determined above prepared in accordance with the City SWPPP Manual. I understand and acknowledge that I must adhere to and comply with the storm water best management practices pursuant to Title 15 of the Carlsbad Municipal Code and to City Standards at all times during construction activities for the permit type(s) checked above. The City Engineer/Building Official may authorize minor variances from the Construction Threat Assessment Criteria in special circumstances where it can be shown that a lesser or higher SWPPP Tier Level is warranted. Emergency Contact Name: Julian Tooma Telephone No: 949 887 3795 Owner/Owner's Authorized Agent Name: Title: Julian Tooma Managing Parner Owner/Ownho ed gent Signature: Date: 01/28/2019 ~y - 1%.1-f FOR CITY USE ONLY Citrrence: 77 Yes No te: E-32 Page 2 of 2 REV. 02/16 STORM WATER STANDARDS Development Services (City of 'Carlsbad QUESTIONNAIRE Land Development Engineering 1635 Faraday Avenue E-34 (760) 602-2750 www.carlsbadca.gov I INSTRUCTIONS:. I 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 Storm Water Best Management Practices (BMPs) into the project design per Carlsbad BMP Design Manual (BMP Manual). To view the BMP Manual, refer to the Engineering Standards (Volume 5). This questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary permits and/or construction permits). The results of the questionnaire determine the level of storm water standards that must be applied to a proposed development or redevelopment project. Depending on the outcome, your project will either be subject to 'STANDARD PROJECT' requirements or be subject to PRIORITY DEVELOPMENT PROJECT' (PDP) requirements. Your 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 incorrectly filled out and is subject to more stringent storm water standards than initially assessed by you, 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 you are unsure about the meaning of a question or need help in determining how to respond to one or more of the questions, please seek assistance from Land Development Engineering staff. A completed and signed questionnaire must be submitted with each development project application. Only one completed and signed questionnaire is required when multiple development applications for the same project are submitted concurrently. PROJECT INFORMATION PROJECT NAME: Roosevelt Townhomes PROJECT ID: ADDRESS: 2569 Roosevelt Street APN: 203-101-35 The project is (check one): IZ New Development 0 Redevelopment The total proposed disturbed area is: 9613.82 ft2 (0.2207 ) acres The total proposed newly created and/or replaced impervious area is: 3250 ft2 (0.0746 acres If your project is covered by an approved SWQMP as part of a larger development project, provide the project ID and the SWQMP # of the larger development project: Project ID SWQMP #: Then, go to Step I and follow the instructions. When completed, sign the form at the end and submit this with your application to the city. E-34 Page 1 of 4 REV 02/16 STEP TO BE COMPLETED FOR ALL PROJECTS To determine if your project is a "development project", please answer the following question: YES NO Is your project LIMITED TO routine maintenance activity and/or repair/improvements to an existing building o or structure that do not alter the size (See Section 1.3 of the BMP Design Manual for guidance)? If you answered "yes" to the above question, provide justification below then go to Step 5, mark the third box stating "my project is not a 'development project' and not subject to the requirements of the BMP manual" and complete applicant information. Justification/discussion: (e.g. the project includes only interior remodels within an existing building): If you answered "no" to the above question, the project is a 'development project', go to Step 2. STEP 2 TO BE COMPLETED FOR ALL DEVELOPMENT PROJECTS To determine if your project is exempt from POP requirements pursuant to MS4 Permit Provision E.3.b.(3), please answer the following questions: Is your project LIMITED to one or more of the following: YES NO 1. Constructing new or retrofitting paved sidewalks, bicycle lanes or trails that meet the following criteria: Designed and constructed to direct storm water runoff to adjacent vegetated areas, or other non- erodible permeable areas; Designed and constructed to be hydraulically disconnected from paved streets or roads; Designed and constructed with permeable pavements or surfaces in accordance with USEPA Green Streets guidance? 2. Retrofitting or redeveloping existing paved alleys, streets, or roads that are designed and constructed in o ii accordance with the USEPA Green Streets guidance? 3. Ground Mounted Solar Array that meets the criteria provided in section 1.4.2 of the BMP manual? 0 II If you answered "yes" to one or more of the above questions, provide discussion/justification below, then go to Step 5, mark the second box stating "my project is EXEMPT from PDP ..." and complete applicant information. Discussion to justify exemption ( e.g. the project redeveloping existing road designed and constructed in accordance with the USEPA Green Street guidance): If you answered "no" to the above questions, your project is not exempt from PDP, go to Step 3. E-34 Page 2of4 REV 02/16 STEP 3 TO BE COMPLETED FOR ALL NEW OR REDEVELOPMENT PROJECTS To determine if your project is a POP, please answer the following questions (MS4 Permit Provision E.3.b.(1)): YES NO Is your project a new development that creates 10,000 square feet or more of impervious surfaces collectively over the entire project site? This includes commercial, industrial, residential, mixed-use, 0 0 and public development projects on public or private land. Is your project a redevelopment project creating and/or replacing 5,000 square feet or more of impervious surface collectively over the entire project site on an existing site of 10,000 square feet or more of impervious surface? This includes commercial, industrial, residential, mixed-use, and public development projects on public or private land. Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface collectively over the entire project site and supports a restaurant? A restaurant is a facility that sells prepared foods and drinks for consumption, including stationary lunch counters and 0 IZ refreshment stands selling prepared foods and drinks for immediate consumption (Standard Industrial Classification (SIC) code 5812). Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious surface collectively over the entire project site and supports a hillside development project? A hillside 0 11 development project includes development on any natural slope that is twenty-five percent or greater. Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface collectively over the entire project site and supports a parking lot? A parking lot is El 0 a land area or facility for the temporary parking or storage of motor vehicles used personally for business or for commerce. Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface collectively over the entire project site and supports a street, road, highway El 0 freeway or driveway? A street, road, highway, freeway or driveway is any paved impervious surface used for thetransportationof automobiles, motorcycles, other vehicles. _trucks,_ _and Is your project a new or redevelopment project that creates and/or replaces 2,500 square feet or more of impervious surface collectively over the entire site, and discharges directly to an Environmentally Sensitive Area (ESA)? "Discharging Directly to" includes flow that is conveyed overland a distance of 0 Z 200 feet or less from the project to the ESA, or conveyed in a pipe or open channel any distance as an isolated flow from the project to the ESA (i.e. not commingled with flows from adjacent lands). * Is your project a new development or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface that supports an automotive repair shop? An automotive repair shop is a facility that is categorized in any one of the following Standard Industrial Classification (SIC) codes: 5013, 5014, 5541, 7532-7534, or 7536-7539. Is your project a new development or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious area that supports a retail gasoline outlet (RGO)? This category includes RGO's that meet the following criteria: (a) 5,000 square feet or more or (b) a project Average Daily Traffic (ADT) of 100 or more vehicles per day. Is your project a new or redevelopment project that results in the disturbance of one or more acres of land and are expected to generate pollutants post construction? Is your project located within 200 feet of the Pacific Ocean and (1) creates 2,500 square feet or more of impervious surface or (2) increases impervious surface on the property by more than 10%? (CMC 0 I1 21.203.040) If you answered "yes" to one or more of the above questions, your project is a PDP. If your project is a redevelopment project, go to step 4. If your project is a new project, go to step 5, check the first box stating "My project is a PDP . and complete applicant information. If you answered "no" to all of the above questions, your project is a 'STANDARD PROJECT.' Go to step 5, check the second box stating "My project is a 'STANDARD PROJECT'..." and complete applicant information. E-34 Page 3 of 4 REV 02/16 S STEP 4 TO BE COMPLETED FOR REDEVELOPMENT PROJECTS THAT ARE PRIORITY DEVELOPMENT PROJECTS (PDP) ONLY Complete the questions below regarding your redevelopment project (MS4 Permit Provision E.3.b.(2)): YES NO Does the redevelopment project result in the creation or replacement of impervious surface in an amount of less than 50% of the surface area of the previously existing development? Complete the percent impervious calculation below: Existing impervious area (A) = 2504 sq. ft. IZI 0 Total proposed newly created or replaced impervious area (B) = 3600 sq. ft. Percent impervious area created or replaced (B/A)*100 = 144 If you answered "yes", the structural BMPs required for PDP apply only to the creation or replacement of impervious surface and not the entire development. Go to step 5, check the first box stating "My project is a PDP ..." and complete applicant information. If you answered "no," the structural BMP's required for PDP apply to the entire development. Go to step 5, check the check the first box stating "My project is a POP ..." and complete applicant information. STEP 5 CHECK THE APPROPRIATE BOX AND COMPLETE APPLICANT INFORMATION 0 My project is a PDP and must comply with PDP stormwater requirements of the BMP Manual. I understand I must prepare a Storm Water Quality Management Plan (SWQMP) for submittal at time of application. I1 My project is a 'STANDARD PROJECT' OR EXEMPT from PDP and must only comply with 'STANDARD PROJECT' stormwater requirements of the BMP Manual. As part of these requirements, I will submit a "Standard Project Requirement Checklist Form E-36" and incorporate low impact development strategies throughout my project. Note: For projects that are close to meeting the PDP threshold, staff may require detailed impervious area calculations and exhibits to verify if 'STANDARD PROJECT' stormwater requirements apply. 0 My Project is NOT a 'development project' and is not subject to the requirements of the BMP Manual. Applicant Information and Signature Box Applicant Name: Applicant Title: Applicant Signature: Date: Environmentally Sensitive Areas include but are not limited to all Clean Water Act Section 303(d) impaired water bodies; areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); water bodies designated with the RARE beneficial use by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); areas designated as preserves or their equivalent under the Multi Species Conservation Program within the Cities and County of San Diego; Habitat Management Plan; and any other equivalent environmentally sensitive areas which have been identified by the City. This Box for City Use Only nce: YES NO El El EDate: E-34 Page 4of4 REV 02/16 (City of Carlsbad STANDARD PROJECT REQUIREMENT CHECKLIST E-36 Development Services Land Development Engineering 1635 Faraday Avenue (760) 602-2750 www.carlsbadca.gov Project Information Project Name: Roosevelt Townhomes Project ID: CT 2017-0006 RP 2017-0012 DWG No. or Building Permit No.: Source Control BMPs All development projects must implement source control BMPs SC-i through SC-6 where applicable and feasible. See Chapter 4 and Appendix E.1 of the BMP Design Manual (Volume 5 of City Engineering Standards) for information to implement source control BMPs shown in this checklist. Answer each category below pursuant to the following. "Yes" means the project will implement the source control BMP as described in Chapter 4 and/or Appendix EA of the Model BMP Design Manual. Discussion/justification is not required. "No" means the BMP is applicable to the project but it is not feasible to implement. Discussion/justification must be provided. Please add attachments if more space is needed. "N/A" means the BMP is not applicable at the project site because the project does not include the feature that is addressed by the BMP (e.g., the project has no outdoor materials storage areas). Discussion/justification may be provided. Source Control Requirement Applied? SC-11 Prevention of Illicit Discharges into the M54 lI Yes F0 No T O N/A Discussionljustification if SC-i not implemented: SC-2 Storm Drain Stenciling or Signage 0 Yes 0 No lJ N/A Discussion/justification if SC-2 not implemented: No Drainage Structures SC-3 Protect Outdoor Materials Storage Areas from Rainfall, Run-On, Runoff, and Wind 0 Yes 0 No El N/A Dispersal Discussion/justification if SC-3 not implemented: None E-36 Page 1 of 4 Revised 09/16 SoureCöhtibl lReiiiremenV(iitiflUd) Aliid? SC-4 Protect Materials Stored in Outdoor Work Areas from Rainfall, Run-On, Runoff, and Wind Dispersal 0 es N o . N/A Discussion/justification if SC-4 not implemented: None SC-5 Protect Trash Storage Areas from Rainfall, Run-On, Runoff, and Wind Dispersal 9 Yes 0 No 0 N/A Discussion/justification if SC-5 not implemented: Trash Containers SC-6 Additional BMPs based on Potential Sources of Runoff Pollutants must answer for each source listed below and identify additional BMPs. (See Table in Appendix E.1 of BMP Manual for guidance). On-site storm drain inlets 0 Yes 0 No lJ N/A Interior floor drains and elevator shaft sump pumps 0 Yes 0 No lJ N/A Interior parking garages 0 Yes 0 No I!1 N/A Need for future indoor & structural pest control 0 Yes 0 No l!J N/A Landscape/Outdoor Pesticide Use lI Yes 0 No 0 N/A - 0 Pools, spas, ponds, decorative fountains, and other water features 0 Yes 0 No lJ N/A Food service 0 Yes 0 No !l N/A Refuse areas 0 Yes 0 No ll N/A C] Industrial processes 0 Yes 0 No lI N/A Outdoor storage of equipment or materials 0 Yes 0 No 0 N/A Vehicle and Equipment Cleaning 0 Yes 0 No II N/A Vehicle/Equipment Repair and Maintenance 0 Yes 0 No 0 N/A Fuel Dispensing Areas 0 Yes 0 No 9 N/A Loading Docks 0 Yes 0 No M N/A Fire Sprinkler Test Water lJ Yes 0 No 0 N/A Miscellaneous Drain or Wash Water lJ Yes 0 No 0 N/A Plazas, sidewalks, and parking lots lii Yes 0 No 0 N/A For "Yes" answers, identify the additional BMP per Appendix E.1. Provide justification for "No" answers. STORM WATER TREATMENT WITH BICK PAVERS DOES NOT REQUIRE PESTICIDE USE. FIRE SPRINKLER TEST WATER DIVERTED TO THE SEWER SYSTEM. MISCELLANEOUS WASH WATER WILL BE INTERCEPTED BY THE BRICK PAVERS. SIDEWALKS SHALL BE SWEPT REGULARLY TO PREVENT THE ACCUMULATION OF LITTER AND DEBRIS. E-36 Page 2 of 4 Revised 09/16 Site Design BMPs All development projects must implement site design BMPs SD-1 through SD-8 where applicable and feasible. See Chapter 4 and Appendix E.2 thru E.6 of the BMP Design Manual (Volume 5 of City Engineering Standards) for information to implement site design BMPs shown in this checklist. Answer each category below pursuant to the following. "Yes" means the project will implement the site design BMPs as described in Chapter 4 and/or Appendix E.2 thru E.6 of the Model BMP Design Manual. Discussion /justification is not required. "No" means the BMPs is applicable to the project but it is not feasible to implement. Discussion/justification must be provided. Please add attachments if more space is needed. "N/A" means the BMPs is not applicable at the project site because the project does not include the feature that is addressed by the BMPs (e.g., the project site has no existing natural areas to conserve). Discussion/justification may be provided. Site Design Requirement Applied? SD-1 Maintain Natural Drainage Pathways and Hydrologic Features III Yes I 0 No I 0 N/A Discussion/justification if SD-i not implemented: SD-2 Conserve Natural Areas, Soils, and Vegetation I 0 Yes I iii No I 0 N/A Discussion/justification if SD-2 not implemented: Existing site developed with single family home, no natural areas remain. SD-3 Minimize Impervious Area I ii Yes I 0 No I 0 N/A Discussion/justification if SD-3 not implemented: Pervious Paving SD-4 Minimize Soil Compaction I ti Yes I 0 No I 0 N/A Discussion/justification if SD-4 not implemented: In Landscaped Areas SD-5 Impervious Area Dispersion I iJ Yes I 0 No I 0 N/A Discussion/justification if SD-5 not implemented: Impervious Areas drain to pervious paving E-36 Page 3 of 4 Revised 09/16 Site Design Requirement (continued) Applied? SD-6 Runoff Collection 11 Yes 0 No 10 N/A Discussion/justification if SD-6 not implemented: Collected in Pervious Payers Area SD-7 Landscaping with Native or Drought Tolerant Species I lii Yes I 0 No I 0 N/A Discussion/justification if SD-7 not implemented: Landscape with drought tolerant species. SD-8 Harvesting and Using Precipitation I 0 Yes I lii No I O VA Discussion/justification if SD-8 not implemented: Insufficient demand, minimal landscape area. E-36 Page 4 of 4 Revised 09/16 JIM DETERMINATION OF PROJECT'S Development Services ".0% 4L City of SWPPP TIER LEVEL AND Land Development Engineering Carlsbad CONSTRUCTION THREAT LEVEL 1635 Faraday Avenue 760-602-2750 E 32 www.carlsbadca.gov I'm applying for: 0 Grading Permit 0 Building Permit 0 Right-of-way permit Zi Other Project Name: ROOSEVELT TOWNHOMES Project ID: CT 2017-000E DWG #ICB#__________ 2569 ROOSEVELT STREET APN 203-101-35 Disturbed Area: 0.221 Ac Section 1: Determination of Project's SWPPP Tier Level SWPPP Tier (Check applicable criteria and check the corresponding SWPPP Tier Level, then go to section 2) Level Exempt - No Threat Proiect Assessment Criteria My project is in a category of permit types exempt from City Construction SWPPP requirements. Provided no significant grading proposed, pursuant to Tablel, section 3.2.2 of Storm Water Standards, the following permits are exempt from SWPPP requirements: 0 Exempt Electrical 0 Patio 0 Mobile Home 0 Plumbing 0 Spa (Factory-Made) Fire Sprinkler 0 Mechanical 0 Re-Roofing 0 Sign 0 Roof-Mounted Solar Array Tier 3— Significant Threat Assessment Criteria - (See Construction General Permit (CGP) Section l.B)* My project includes construction or demolition activity that results in a land disturbance of equal to or greater than one acre including but not limited to clearing, grading, grubbing or excavation; or, My project includes construction activity that results in land disturbance of less than one acre but the construction activity is part of a larger common plan of development or the sale of one or more acres of disturbed land surface; or, My Project is associated with construction activity related to residential, commercial, or industrial 0 Tier 3 development on lands currently used for agriculture; or My project is associated with construction activity associated with Linear Underground/Overhead Projects (LUP) including but not limited to those activities necessary for installation of underground and overhead linear facilities (e.g. conduits, substructures, pipelines, towers, poles, cables, wire, towers, poles, cables, wires, connectors, switching, regulating and transforming equipment and associated ancillary facilities) and include but not limited to underground utility mark out, potholing, concrete and asphalt cutting and removal, trenching, excavation, boring and drilling, access road, tower footings/foundation, pavement repair or replacement, stockpile/borrow locations. C] Other per CGP___________________________________________________ Tier 2 - 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: j 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 sq. ft. 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: 0 Tier 2 located within 200 ft. 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 I vertical; and/or disturbed area is located along or within 30 ft. of a storm drain inlet, an open drainage channel or watercourse; and/or construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 -Apr. 30) Tier I - Low Threat Assessment Criteria My project does not meet any of the Significant or Moderate Threat criteria above, is not an exempt permit type per above and the project meets one or more of the following criteria: results in some soil disturbance; and/or 0 Tier I includes outdoor construction activities (such as roof framing, saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling) I - items listed are excerpt from CGP. CGP governs criteria for triggers for Tier 3 SWPPP. Developer/owner shall confirm coverage under the current CGP and any amendments, revisions and reissuance thereof. E-32 Page 1 of 2 REV. 02/16 Th SWPPP Section 2: Determination of Project's Construction Threat Level Construction Tier (Check applicable criteria under the Tier Level as determined in section 1, check the Threat Level corresponding Construction Threat Level, then complete the emergency contact and Level signature block below) Exempt - Not Applicable - Exempt Tier 3 - High Construction Threat Assessment Criteria: My Proiect meets one or more of the following: Project site is 50 acres or more and grading will occur during the rainy season Project site is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA High g Soil at site is moderately to highly erosive (defined as having a predominance of soils with Tier 3 USDA-NRCS Erosion factors kf greater than or equal to 0.4) Site slope is 5 to I or steeper Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 —April 30) Owner/contractor received a Storm Water Notice of Violation within past two years Tier 3— Medium Construction Threat Assessment Criteria Medium e All projects not meeting Tier 3 High Construction Threat Assessment Criteria Tier 2— High Construction Threat Assessment Criteria: My Prolect meets one or more of the following: Project is located within the Buena Vista 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 kt greater than or equal to 0.4) gh ( Tier 2 0 Site slope is 5 steeper Construction is initiated du?ing the rainy season or will extend into the rainy season (Oct. Apr. 30) Owner/contractor received a Storm Water Notice of Violation within past two years Site rsults'ini0000 sq. ft. or more of soil disturbance Tier 2— Medium Construction Threat Assessment Criteria Medium l My project does not meet Tier 2 High Threat Assessment Criteria listed above Tier I - Medium Construction Threat Assessment Criteria: My Prolect meets one or more of the following: Owner/contractor received a Storm Water Notice of Violation within past two years Medium 0 e Tier 1 Site results in 500 sq. ft. or more of soil disturbance Construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 -April 30) Tier 1 - Low Construction Threat Assessment Criteria 0 Low My project does not meet Tier I Medium Threat Assessment Criteria listed above i certify to the best of my knowledge that the above statements are true and correct. I will prepare and submit an appropriate tier level SWPPP as determined above prepared in accordance with the City SWPPP Manual. I understand and acknowledge that I must adhere to and comply with the storm water best management practices pursuant to Title 15 of the Carisbad Municipal Code and to City Standards at all times during construction activities for the permit type(s) checked above. The City Engineer/Building Official may authorize minor variances from the Construction Threat Assessment Criteria in special circumstances where it can be shown that a lesser or higher SWPPP Tier Level is warranted. Emergency Contact Name: Julian Tooma Telephone No: 949 887 3795 Owner/Owner's Authorized Agent Name: Title: Julian Tooma Managing Partner Owner/Owner's Authon g nt Signature: Date: 11/15/2018 FOR CITY USE ONLY City Concurrence: Yes No By: Date: E-32 Page 2 of 2 REV. 02/16