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HomeMy WebLinkAbout2701 LOKER AVE W; 235; CBC2020-0461; PermitBuilding Permit Finaled {city of Carlsbad Commercial Permit Print Date: 01/22/2021 Permit No: CBCZ0Z0-0461 Job Address: Permit Type: Parcel#: Valuation: Occupancy Group: #of Dwelling Units: Bedrooms: Bathrooms: Project Title: 2701 LOKER AVE W, # 235, CARLSBAD, CA 92010·6641 BLDG-Commercial Work Class: 2090812200 Track#: $102,859.68 Lot#: Project#: Plan#: Construction Type: Orig. Plan Check#: Plan Check#: Status: Demo Applied: Issued: Fina led Close Out: Inspector: Final Inspection: Closed· Fina led 11/19/2020 12/11/2020 TKers 01/22/2021 Description: PALOMAR CREST: 16,698 SF INTERIOR DEMO TO SHELL (NO OCCUPANCY UNDER THIS PERMIT) FOR SUITES 235, 250, 270 FEE BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) Property Owner: REEF PALOMAR LLC 2701 LOKER AVE CARLSBAD, CA 92008 581473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $1,116.11 Total Payments To Date: $1,116.11 Contractor: SP WHITE CONSTRUCTION INC -INACTIVE 2524 GATEWAY RD CARLSBAD, CA 92009-1742 (760) 931-1130 Balance Due: AMOUNT $636.65 $445.66 $5.00 $28.80 $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.11 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. Building Division Page 1 of 1 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov {city of Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check C&.202P -o4{,J Est. Value q/.Qz.1 '&'<:\J. b~- PC Deposit Date I/-n-2.o2o Job Address 2701 Loker Avenue Carlsbad, CA 92010 Tenant Name: No tenant, demolition only. Suite:. _____ .APN: 209-081-22-00 Lot #: TR 10372 Lot 22 Year Built: _1_99_9 ___ Occupancy:_s_o_mce __ _ IA C:JD C:JD Construction Type;..;• a....;.. ____ ,Fire Sprinklers: yes no 'A/C: yes no BRIEF DESCRIPTION OF WORK: Interior Demolition Only l~G1i SF De,,,.0 , Svt /+es 235"; · , 1-S-O, ,,2 -=/-o D Addition/New: ___________ New SF and Use, ___________ ,New SF and Use, ____ Deck SF, Patio Cover SF (not including flatwork) D Tenant lmprovement:. _____ SF, _____ SF, Existing Use. ______ Proposed Use ______ _ Existing Use Proposed Use ______ _ D Pool/Spa: _____ .SF Additional Gas or Electrical Features? ___________ _ DD DD DD D Solar: ___ KW, ___ Modules,. ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No D Plumbing/Mechanical/Electrical Only: -------------------------- ~ Other: Interior Demolition Only IC.,b'tB sF I This permit is to be issued in the name of the Property Owner as Owner-Builder, licensed contractor or Authorized Agent of the owner or contractor. The person listed as the Applicant be/aw will be the main point of contact throughout the permit process. PROPERTY OWNER APPLICANT O PROPERTY OWNERS AUTHORIZED AGENT APPLICANT 0 Name: Reef Palomar LLC Name: Unire Real Estate Group Address: 1200 6th Ave. S. #700 Address: 1800 East Imperial Highway, Suite 205 City: Seattle State:._W_A __ .Zip: 98134 City: Brea State: CA Zip:._9_2a_2_1 __ _ Phone: _________________ Phone: (714) 990-2100 Email: harryman@uniregroup.com Email: harryman@uniregroup.com DESIGN PROFESSIONAL APPLICANT Ill CONTRACTOR BUSINESS APPLICANT 0 Name: Hurkes Harris Design Associate Name: White Construction Address: 3838 Camino Del Rio North, Suite 252 Address: 2524 Gateway Road City: San Diego State: CA Zip: 92108 City: Carlsbad State:_C_A __ Zip: 92009 Phone: (619) 702-0380 X119 Phone: (760) 931-1130 Email: ejustinscott@hhdainc.com Email: darrin@whiteconstructioninc.com Architect State License: CCIDC #0807 State License: 1023856 Bus. License: BLNR000431-□2-2011 ----------- 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph: 760-602-2719 Fax: 760-602-8558 Page 1 of 2 Email: Building@carlsbadca.gov Rev. 08/20 ' IDENTIFY WHO WILL PERFORM THE WORK BY COMPLETING (OPTION A) OR (OPTION B) BELOW: (OPTION A): LICENSED CONTRACTOR DECLARATION: I hereby affirm under penalty af perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 af the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. Policy No. ________________________ _ Ii I have and will maintain worker's compensation, 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: _,,_,._,_,m_~-•-"-"00_'•-~-•-"'-' '-""-'------------ Policy No. 924J0Js-21 Expiration Date: -'-""-"-"------------------- 0 Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage Is unlawful 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 of the Labor Code, Interest and attorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name: _____________________ ,Lender's Address: ____________________ _ CONTRACTOR PRINT:_S_te_v_e_W_h_it_e _____ _ SIGN: Ste,eWhile-CE~~F,;E,.;,,:._ DATE: 11/16/20 -------- (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I om exempt from Contractor's License Law for the following reason: DI, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: 0 "Owner Builder acknowledgement and verification form" has been filled out, signed and attached to this application. Proof of identification attached. 0 Owners "Authorized Agent Form" has been filled out, signed and attached to this application giving the agent authority to obtain the permit on the owner behalf. Proof of identification attached. By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the fallowing Web site: http://www.Jeginfo.ca.gov/calaw.html. OWNER PRINT: ____________ SIGN: _________ DATE: ______ _ APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL By my signature below, I certify that: f am the property owner or State of California Licensed Contractor or authorized to act on the property owner or contractor's behalf. f certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SA VE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT, OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures aver 3 stories in height. APPLICANT PRINT: Erin Ju 5lin-Scott SIGN: z;. ~ 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602- 8-2 Page 2 of 2 DATE: Email: Building@carlsbadca.gov Rev. 08/20 Building Permit Inspection History Finaled (city of Carlsbad Permit Type: BLDG-Commercial Work Class Demo Status· Closed -Finaled Scheduled Actual Inspection Type Date Start Date Checklist ltem Applkat1on Date: Issue Date: Expiration Date: IVR Number: Inspection No. 148494-2021 COMMENTS 11/19/2020 Owner: REEF PALOMAR LLC 12/11/2020 Subdivision; CARLSBAD TCT#74-21 12/13/2021 Address: 2701 LOKER AVE W, # 235 30060 CARLSBAD, CA 92010-6641 Inspection Primary Inspector Reinspection Inspection Status Complete PassC;d BLOG-Building Deficiency Pre con with Paul. Yes -·---··----·---------·----------,--,..,-,c-c~-----c--,-.,.-,c---cc-c--,,,-,c-----------.,.----,---01/22/2021 BLDG-11 148971-2021 Scheduled Chris Renfro Incomplete Friday, January 22, 2021 F ou n datlon/Ftg/Ple rs (Rebar) Checklist Item COMMENTS BLDG-Building Deficiency BLDG-Final Inspection 148970-2021 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final COMMENTS Demo only Passed Chris Renfro Passed N{, Passed Yes Yes Ye:, Yes Complete Page 1 of 1 {city of Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN 8-59 Development.Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov Section 4.408.1 and Section 5.408.1 of the 2016 California Green Building Standards requires at least 65% of non-hazardous construction debris is recycled and/or salvaged for reuse. With the submitting of your application for a Building Permit or permit issuance, you must have completed a Construction Waste Management Plan (CWMP) demonstrating how you will recycle a minimum of 65% of the construction waste generated from your project. NOTICE: Applicant (contractor and subcontractors) shall comply with the project's CWMP. It is the Applicant's responsibility to collect all receipts from the facilities that recycle their materials AND all project waste/landfill disposal receipts. When working with the City's franchised hauler, Waste Management, one cumulative project receipt is acceptable. However, it is the Applicant's responsibility to confirm that the bins are collected for C&D Recycling. 1. This project shall generate the least amount of waste possible by planning and ordering carefully, following all proper storage and handling procedures to reduce broken and damaged materials, and reusing materials whenever possible. 2. Waste Management Services can provide 2 roll-off bins, one for commingled construction debris and one for trash. The commingled construction roll-off bin will be taken to a Certified Mixed C&D Processing Facility to sort the material and create receipt(s), to demonstrate the project has met a 65% diversion rate or greater. 3. Applicants with a goal of recycling greater than 65% of the project's total waste should work with, the City's exclusive franchised waste hauler, to develop a more specific CWMP. This plan may include using additional roll-off bins for particular phases of construction (e.g., concrete and wood waste) to ensure the highest waste diversion rate possible. 4. Contractors/subcontractors hauling their own waste as part of their scope of work (e.g., construction clean up companies, etc.) SHALL NOT be excluded from complying with the CWMP and shall provide weight and waste diversion receipts from a Certified Source Separated Recycling Facility. For a current list of Certified Recycling Facilities go to http://www.sandiego.gov/environmental-services/recycling/cd/index.shtml. 5. If contractors/subcontractors furnish their own debris boxes as part of their scope of work, they SHALL NOT be excluded from complying with the CWMP and shall provide weight and waste diversion receipts from a Certified Source Separated Recycling Facility. Part 1 -Before the Project Begins Prior to issuance of a Building Permit, Applicant must submit PART 1 of the Construction Waste Management Plan (CWMP) Table. a. Submit completed and signed form to City with Building Permit application. Part 2 -During and After the Project Prior to receiving inspection for final sign off of the Building Permit or Certificate of Occupancy, Applicant must submit the fully completed and approved PART 2 of the Construction Waste Management Plan (CWMP) Table. a. Save all receipts and/or documents from reuse facilities, recycling centers, processing facilities, and landfills where materials were taken. b. Complete the Debris Recycling Report (DRR) as your project progresses. Recycling/diversion goals are (at a minimum) 65% of the waste generated by your project. c. Return completed form to: City of Carlsbad Building Division -1635 Faraday Ave, Carlsbad, CA 92008 or your inspector prior to requesting final inspection. Rev. 11112118 Ccityof Carlsbad DEMOLITION REQUIREMENTS 8-9 D~yJ!lopment 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. ✓ Completed Building Permit Application (Form B-1): A demolition permit may only be issued to the owner of the property or the State Licensed Contractor that is doing the work. □ B Four (4) sets of plans: Building, Planning, Engineering and Fire division will review and comment/approve the submittal. letter tram Prop2Rr1 8.urrir: 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. San Diego Regional Hazardous Materials Questionnaire: For ALL demolition projects, proof of application to 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 6a:: II go Gas and Electric: Applicant must provide a letter from San Diego Gas and Electric stating that the utilities have bee,:;-aisconnected. Waste Management Plan (Form B-59): Comply with California Green Code waste disposal and recycling management program (65%). Section 4.408.1 and Section 5.408.1. Complete the attached B-59, Waste Management Plan which estimates the waste to be recycled. Public PropaFly: If applicable provide plans and details demonstrating measures to protect public property and walkways. Additional items that may be required: 1. Water Agency: Arrange for appropriate Water Agency to remove water meter unless construction of replacement structure is to begin shortly. 2. 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 3. The Land Development & Engineering Division will determine if a Haul Route, Right-of-Way Permit or Storm Water Permit is required. (760) 602-2750. 4. Fire Department may need the use of the building for training purposes. (760) 602-4665. Rev. 11112/18 Ccityof Carlsbad CONSTRUCTION WASTE MANAGEMENT PLAN B-59 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov Many of the materials generated from your project can be recycled. You are required to list materials that will be reused, recycled or disposed from your project. If you have questions about the recycling requirement or completing this form, please contact Waste Management at (760) 929-9400, a certified C&D recycler, or the Carlsbad Building Division at (760) 602-2700. Please note: Unless you are self-hauling. Waste Management or approved haulers must be used for all construction projects within the City of Carlsbad. PART l Complete and submit this form when applying for a Building Permit. Note: Permits will not be issued without a completed Construction Waste Management Plan. Applicant MalllngAddress (If differtnt than project address) Project Type Residential (check all that apply/: Brief Description Project Size \4 ,':\$"~ {square footage) □ Please check the appropriate box: Applicant Information Commercial gJ "Perrc>!,...no~ a~'-'i Estimated Cost of Project$._~::,....;:5::+ea::t::>=::;.;::_~-'-------- DI plan on using WASTE MANAGEMENT roll-off bln(s) for all materials and will provide all receipts after construction. ~ I plan on self-hauling to a certified recycling facility and will provide all receipts after construction. D This is a proposed LEED certified project and I plan on separating materials on site In conjunction with WASTE MANAGEMENT. Acknowledgement: I certify under penalty of perjury under the laws of the State of California that the information provided In and with this form pertains to construction and demolition debris generated only from the project listed in PART 1, that I have reviewed the accuracy of the information, and that the information Is true and correct to the best of my knowledge and belief. Slgnature,_-ie~-·~4\c4=~:,,-,__ ___ 0ate > 1--0 Page 1 of4 Rev. 11112/18 PART 1 Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Permits will (cont'd) not be issued without a completed Construction Waste Manaiement Plan. DEBRIS RECYCLING ESTIMATE: Permit No. Project Title M---r.---•--~f'l..'\l LI I • . . Project Address ~O\ ~& ~'lllii.·~ ~1:B>i~70 CAAL~!A01 CA APN ----::>.":>-co Applicant Name ~,i~-~'Oil k£1N Ph~ 10 (f d&,c I '10;1.. •~80 Last First • Complete the following table with estimated waste tonnage to be generated by your project . This Is your plan for construction waste management. Changes can be made on the final recycle report. Goal: the diversion rate shall be 65% by weights of debris. A B C Material Type Estimated Place a (0) check Place a (0) check next Place a (0) check next Waste Quantity next to items to be to Items to be to items to be (tons) reused or salvaged recycled disposed at landfill Complete th~ line of the table only if 011/y using WASTE MANAGEMENT roll-off bins. 6 TbtJ,S S' 7/Jf'IJ r.tJ Mixed C&D Debris I . Asphalt & Concrete Brick / Masonrv / TIie Mixed Inert Debris It> 11),-li ' " Tr,·'✓ Cabinets, Doors, Fixtures, Windows (circle all that apply) Carpet carpet Padding/ Foam Cardboard Ceiling Tile (acoustic) Drywall (used, new, scrap) t/ to,Jr ·'-I 1" 0.Y ( Landscape Debris (brush, trees, stumps, etc.} No dirt. fl Unpainted Wood & P;1llets ~ t-', Roofing Materials '!( tt ~ I Scrap Metal 'i T~NS Cf T'J••J Stucco Other: TOTAL = J~·'T'vlr -Z.< r-Jr II r,,.,~ Sf cr1ori c To meet 65% Diversion Requirement {estimate) Ji.J r'!!,,Jr x 0.65 = L'1 tons Tot~td Waste from above Mlnrmum Required Diversion Contractor/Owner Signature \ ,,l-z31~ ~--t1 Date • ' Page 2 of 4 Rev. 11/12118 OFFICE USE ONLY SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE RECORDID# _________________ I PLAN CHECK# __________________ , Vacant Suite Business Contact Erin Justin-Scott Telephone# (619) 702-0380 BP DATE Project Address (include suite) 2701 Loker Ave. Suites 240, 250, 270 City Carlsbad State CA Zip Code 92011 APN# 209-081-22-00 Mailing Address (include suite) 3838 Camino Del Rio N. Suits 252 City State Zip Code San Diego CA 92108 Applicant E-mail Telephone# Plan FIie# Project Contact Erin Justin-Scott ejustinscott@hhdainc.com (619) 702-0380 The following questions represent the facllttya activities, NOT the specific project description. app icant must contact the ire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Faclllty's Square Footage (Including proposed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorlcs 11. Highly Toxic or Toxic Materials 15. None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radloactives PART 11: SAN DIEG : If the answer to any of the ques ons s yes, ap n Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED Project Completion Date: VI/ I v,~u~v Expected Date of Occupancy: vc::n.;c:1I II i:IUILt:: 1. 2. 3. 4. 5. 6. 7. 8. YES NO (for new construction or remodeling projects) ~ I Is your business listed on the reverse side of this form? (check all that apply). • WIH your business dispose of Hazardous Substances or Medical Waste In any amount? • Win your business store or handle Hazardous Substances In quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet7 I I V\liH your business store or handle carcinogens/reproductive toxins in any quantity? • wn your business use an existing or install an underground storage tank? · • WIii your business store or handle Regulated Substances (CalARP)? • Will your business use or install a Hazardous Waste Tank System (Trtle 22, Article 10)? • Will your business store petroleum In tanks or containers at your facility with a total facility storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). □ CalARP Exempt Dale Initials □ CalARP Required I Date Initials □ CalARP Complete Date Initials PA I • · The following questions are Intended to Identify the majority of air pollutlon ssues at t p ann ng stage. our pro ect may req re ona measures not ent tied by these questions. Some residential projects may be exempt from APCD requirements. If yes is answered for either questions 1, 2 or 5 or for more comprehensive requirements, please contact APCD at apcdcomp@sdcounty.ca.gov; (858) 586-2650; or 10124 Old Grove Road, San Diego, CA 92131. YES NO 1./11111 the project disturb 100 square feet or more of existing building materials? WIii any load supporting structural members be removed? 1. 2. 3. ~ ~ (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by an individual that has passed an EPA-approved building Inspector course? 4. □ l!I (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Based on the survey results, will the project disturb any asbestos containing material? W yes, a notification may be required at least 1 O woridng days prior to commencing asbestos removal. Addltlonally, a notification may be required prior to the removal of a IOad supporting structural member(s) regardless of the presence of asbestos. 5. □ l!I WIH the project or associated construction equipment emit air contaminants? See the reverse side of this form for typical equipment requiring an APCD permit. If yes, contact APCD prior to the issuance of a building permit. 6. □ □ (ANSWER ONLY IF QUESTION 515 YES) WIii the project or associated construction equipment be located within 1,000 feet of a school bounds ? Briefly describe business actlVltles: Briefly describe proposed project: Office Buiding Interior Demolition Only I declare under penalty of perjury that to the best of my knowtedge and belief e responses made herein are true and correct. Erin Justin-Scott " I " Name of Owner or Authorized Agent Signature ofOwner or Authorized Agent Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION-------------------------------- ~ ~~ I I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO• APCD COUNTY-HMO APCD COUNTY-HMO APCD * A stamp In this box 2!!b: exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other permitting requirements may still apply HM-9171 (9/18) Counly of San Diego -DEH -Hazardous Materials Division DEMOLITION ASBESTOS CERTIFICATION ADDREss: :,no1 1..-QY,Ee., Aire~ 2up,-z.s-o,-:no Ce&.:>Mo. c-A "-010 USE OF BUILDING TO BE DEMOLISHED: )fil:P©st ~mt;> Ot-:>U1 -croc..t J!,4o. SQUARE FEET \l..\,'jil;>?,-X NUMBER OF STORIES ____ ,..._ __ _ PROPERTY owNER: RE'Ef Y9\,,QyY\AA u,..c.. o/o lMste %;.A.1., 31:m? ADDRESS: \f'o()O "re&, \t'\W,\Plt1-..\'"f'l"-2)5?$J:A.iAPHONE LJl':9C\lp-2tm APPLICANT: ...;Hu~;a.uoO.,/)..~-------------------- ADDRESS: 3E?,~ (Am1tJO J?e+-.~,o °N, :t.z~ $A..;,t;).f mu.PHONE ( j0CtJ:k)~0 Section 19827.5 of California Health and Safety Code states in part: "A demolition permit shall not be issued by any city ... as to any building or other structure except upon receipt from the permit applicant of a copy of each written asbestos notification regarding the building that has been required to be submitted to the United States 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 appllcant submitting a copy of the written notification if the applicant declares that the notification is not appllcable to the scheduled demolition project." As applicant for a demolition permit in the City of Carlsbad, I certify that; I have read the excerpt from Section 19827.5 of the Health and Safety Code provided above; the Information I have provided on this form Is true and correct; and I further certify the following: ( ) On the attached __ pages are copies of all written asbestos notifications regarding the above referenced building that are required to be submitted to the United States Environmental Protection Agency or to Part 61 of Title 40 of the Code of Federal Regulations, or successor to that part. ~) I declare that the written asbestos scheduled demolition project. & notification is not applicable to the Date Rev. 11112/18