HomeMy WebLinkAbout2647 STATE ST; ; CB983672; PermitB U I L D I N G
10/26/98 10:35
P E R M I T Permit No: CB983672
P1oiect No: A9804798
Development No : Page 1 of 1
Job Address : 2647 STATE ST
Permit Type: DEMOLITION PERMIT
Parcel No: 203-054-13-00
Valuation: 0
Suite:
Lot#:
Construction Type:
Occupancy Group: Reference#: Status:
NEW
ISSUED
10/26/98
10/26/98
RMA
Descripti on: COMPLETE DEMO OF RESIDENCE & Applied:
: GARAGE-W/ASBESTOS ,UTILITY&HOUSING APPROV Apr/Issue:
Appl/Ownr : VIKING EQUIPMFNT CORP
P .O. BOX 251257
GLENDALE CA
F'ees Required ***
Fees:
Adjustments:
Total Fees:
Entered By:
818 500-9447
Pee Collected & Credits
.00
.00
30.00
"* *
Fee description e ~lt'/26/98EG001f01e 00ata
Enter "Y" for
Enter
Total
-------------lrffi~'f.-------~~-00
;--· ----,--FINAL APPJ:?ovAL. ___
1
_
INSP, _____ DATE ------r,LEARANCE --------=--~-------... -------
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
20 .00 Y
10.00 Y
30.00
FOR OFFICE USE ONLY
PLAN CHECK NO. 98 3b 7 2.. PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
EST. VAL. _________ _
1. PROJECT INFORMATION
-i. b':i J ':5Jl?rIE sr. Cf:·
Address hnclude Bldg/Suite I )
r/\:ffI -# I] l. '2...
e .. ,,_. Name lat tho• eddteul
Legal Descrop~
q
Lot No. Unit No. Phaae No. Total I of units
Assessor's P■rcel I Existing u ..
CA"'> P l.e:-TE Dt::"r-'\ D 2oCO
Descnptoon of Work SO. FT. lot St-• of Bedrooms • of Bathrooms
2. CONTACT PERSON llf dlft..itt trvm ~J .... ---,-------··-.. ------··-·-----··· -·
7"(2.E: D c...\~ 6 o
Name Address City
3. APPLICANT O Contractor O Agent fo, Comnctor . 0 Owner -[3'Agent ior 0wner
Name Address City State/Zip Telephone•
4. PROPERTY OWNER
t-,,\<>i,:fr\ LovNT"I
Name Addrns City State/Zip Telephone •
5. CONTRACTOR· COMPANY NAME .. \J \~I~ b -f;di.0 i~fi--T~co~:----:-~----~"."""--··-·~ --····· ..
1sec. 7031.5 Business and Profna,ons Code: Any City or County which requirN a permit to c:onltrUct, alter, improve, demoliah or repair any structure, pnor to Its
issuance, also reouores the applicant tor such permit to file a signed statement that he ia lic-■11 pursuant to the provlaiona of the Contractor's License Law
(Chapter 9, commending with Section 7000 of Division 3 of the 81111ineu end Prof ... iona Codel or thet he Is exempt therefrom, and the b■sis for the elleged
exemption. Any violation of Section 7031.5 by eny applicant for a permit subjects the applieent to a civil penalty of not mo,e then five h dred dollars lt500)).
~ c.otf. .6. \1.15 Co\.. \.E -1 I O -
Name Address
State License I 3 \ 0 'B 52,.. License Cius __ A-..._S"-=B'--<:._'2. ....... ) __
Designer Name Address City State/Zip T■lept,one
State License I _________ _
6. WORKERS" COMPENSATION
Workers' Compensation Declaration: I here~y affirm under penalty of perjury one of the following decler■tiona:
D I have end will maintain a certificate of consent to aelf•insure for work■n' compeneation H provided by Section 3700 of the Labor Code, for the pertorm•nc•
of the work for which this permit 1s issued.
~ave and will m11nta1n workers' compensation, es r■Quir■d by Section 3700 of the Labor Code, for the pertormance of the work for which this permit Is
,ssued. My worker's compensation insurance c■mer ■nd policy number ere: / l
Insurance Company G.C\..OstJ 6¼\t.. 1tJ.S2Mt:?fEe LJ!>. Policy No. N\..U C.47 Y So'7-03 Exs,iretion Date G _ 01 _ q <} I (THIS SECTION NEED NOT IE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOUARS lt100J OR LESS)
0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which thi■ permit ia Issued, I ahelt not employ eny person in any manner so••
to become sub1ect to the Workers' Compensation Laws of California.
WARNING: Failure to ■-cur• wortt■n' companeatlon coverage la unlawful, ■nd ■hall eull;act ■n amployar to atfflktal panalt6a■ ■nd dvll fine• up to -hundred
thou,end dollar• 1'100,0001, In~ to the cost of co~.~::-tor In Sact1on 3706 of IN ~:1:-lnt-t ■nd llttmNY'• .....
SIGNATURE -'.?:;;&.V----A...... -t,;:t:__~ DATE !JdlillB
7. OWNER-BUILDER DECLARATION . . . .. ·' .. . . . . . ·•·., ., .-.-1~ -• · "' • " . • .,,. ,.. ..
I hereby efform that I am exempt from the Contractor's License Law for the following re■eon:
D 1. es owner of the property or my emplovees with wages as their sole compensation, will do the work ■nd the structure 19 not intended or offerad tor a■le
(Sec. 7044, Bu11nesa ■nd Profass,ons Code: The Contractor's Lie-• Law don not apply to an o-of property who bullde or impl'ovn thereon, and who don
such work himself or through his own emplovees. provided that such improvemanu ■re not lntendacl or offered for Nia. If. ho-, the building or lmpfo-i la
sold within one ye■r of completion, the owner-builder will have the bufdan of prOYing tn■t he did not build or lmoroW for the ~ of Nia!.
D I, es owner of the property, em excl1111ively contracting with licensed contractors to construct the project !Sac. 7044, Biai,-s and Profu■~ Code: The
Contractor's Licenae Law does not apply to en owner of Pfoperty who builds or imPfOVfl thereon. ■nd contrecte for IIUCh pr0f9CD wtth contractorlel licanead
pursuant to the Contractor's License Law).
D I em exempt under Section ______ BiaineH ■nd Protaseions Code for thi1 rHson:
1. I personally plan to provide the major labor end materials for construction of the propoaed property Improvement. 0 YES ONO
2. I (have / have not) signed an application tor• building permit for the propoHd work.
3. I have contracted w ith the following person lfirml to provide the prapoaed conatruction linclude name / addrau /~number/ comractors Ii-■ number):
4. I plan to provide portions of the work, but I heve hired the following person to coordinate. ■upan,iH ■nd provide the major -k !include name/ addrNI / ~
number/ contractors license number!: _______________________________________________ _
5. I will provide aome of the work, but I heve contracted !hired) the following.,.,._ to provide the~ Indicated !Include name/ addrns /~number/ type of workl: _________________________________________________________ _
PROPERTY OWNER SIGNATURE _______________________ _ DATE _________ _
·COMPLETI:THIS SECTION FOR NON-lfff/DENTIAL IUILDINO PEJIMITS ONLY-.;·---•,.....,..,...., .. ·,...----,--"':'"". '"L~,_._ -•••.-:-.., ..... ··-..
ls the applicant or futu,e building occupent ,.quired to aubmit e bu■Nss plen, acutely henrdoue fflllteriele ragie1,■tion form or riek management and p,ev.ltion
program under Sections 25505, 25533 or 25534 of the PrHlay.T■nner Hazardoue Subate,-Account Act? 0 YES O NO
Is the 1pphcent or future building occupant required to obtain• permit from the 1ir pollution control district or air quality maneoement district? 0 YES O NO
Is the facility to be constructed within 1,000 feet of the outer boundary of • school ■ite7 0 YES O NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT IE ISSUED UNLESS THE Al"PLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
~-CONSTRUCTION LENDING AGENCY -• • -• -·•-• ••,-~•••...--·•·•-..r~•1•~•-,..~•,,,,.~,n-•1 •••••• ,• ••-... • .... ,... •-•,
I hereby affirm that there is a construction lending agency for the pertormence of the work tor which this permit Is issued !Sec. 3097(11 Civil Code).
LENDER'S NAME ______________ _ LENDER"S ADDRESS ________________________ _
:9 , APPLICANT CERTIFICATION -.••• -·---· ... ---------•. -• -. -• ,--,,. ----,. -----~'1•'t', ........... ,,. ..
I certify that I h111e rHd the application ■nd state that the above information is correct end that the Information on the plans is accurate. I 19111 to comply with all
Coty ordinances end State laws relating to building construction. I hereby authorize reprnentativn of the Citt of Carlsbad to enter upon the above mentioned
property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES,
JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit 1s requored for excavations over 5'0" dNP ■nd demolition or construction of structures over 3 storoes in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code 1hllll expire by limitation end become null end void ii the building or
work authonzed by such permit is not commenced within 365 days from the date of such pe,mit or if the building or work euthonzed by such permit ,s suspended
or abandoned It eny tome after the work is commenced for • period of 1 80 days (Section 106.4 .4 Uniform Building Code). (
APPLl~ANT'S SIGNATURE P ... i:::-. µ A-, DATE /0 I 2-lo 98
WHITE: File YELLOW: Applicant PINK: Finance
'
City of Carlsbad
■~1 1 11 NI I el· I •24·614 i ■ ,14 ,I I
DEMOLITION PERMIT REQUIREMENTS
B' A demolition permit may only be issued to the owner of the property or
the State Licensed Contractor that is doing the work. The contractor
must provide use with a letter, signed and dated by the property owner,
giving permission for the building to be demolished.
B" The fee for a demolition permit is $30.00. The attached Demolition
Asbestos Certification application must be completed, signed and have
the correct square footage of the structure being demolished, as well as
it's use.
□
Applicant must provide a letter from San Diego Gas and Electric stating
that the utilities have been disconnected.
Arrange for appropriate Water Authority to remove water meter unless
construction of replacement structure is to begin shortly.
Contact the Planning Depa~tment at (760) 438-1161 ext 4325 or ext
4328 to determine if the structure is in the Redevelopment area, if it is
in the Coastal Zone, and if it is on the list of Carlsbad Historic Sites.
Contact the Engineering Department at (760) 438-1161 ext 4315 or ext
4374 to determmine if a Haul Route or Right-of-Way Permit is required.
Notify the Fire Department at (760) 931-2121 to see if they need the use
of the building for training purposes.
h:\word\forms\building\demolition permit requirements.doc REV May 7, 1998
2075 Las Palmas Dr.• Carlsbad, CA 92009-1576 • (760) 438-1161 • FAX (760) 438-0894
•
..
City of Carlsbad
■ =1 1 II t#I •• ,. 1 ·24-61 I;, ,I§,; I
DEMOLITION ASBESTOS CERTIFICATION
ADDRESS:
USE OF BUILDING TO BE DEMOLISHED:
SQUARE FEET ___ 2-=o-=a~D~-----X NUMBER OF STORIES -~~s~-r<>_"'-_Y~-
PROPERTY OWNER: f(g..m Co..i»n \O-fo:JS1,
ADDRESS: \310 V'\1',$10..i ~l-G. Oc..g,t'tN::, rpE
APPLICANT:
ADD RESS: ____:_P.:....o...c.._Q,:,:_o.;..)(."----Z.'-'6'-"1'-''2..=",._7.,__ __ C.=..,\."'G>J=l)"-'~'-=-'-=---=C.e...P._
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 applicant submitting a copy of the
written notification if the applicant declares that the notification is not applicable to the
scheduled demolition project."
As applicant for a demolition permit in the City of Carlsbad, I certify that; I have read
the excerpt from Section 19827.5 of the Health and Safety Code provided above; the
information I have provided on this form is true and correct; and I further certify the
following:
( ✓ On the attached ___ pages are copies of all written asbestos notifications
regarding the above referenced building that are required to be submitted to the
United States Environmental Protection Agency or to Part 61 of Title 40 of the
Code of Federal Regulations, or successor to that part.
( ) I declare that the written asbestos notification is not applicable to the scheduled
demolition project.
Applicant's Signature Date
h:\word\forms\building\demo1ition permit requirements.doc REV May 7, 1998
2075 Las Palmas Dr.• Carlsbad, CA 92009-1576 • (760) 438-1161 • FAX (760) 438-0894
ff'~
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB983672 FOR 10/28/98
DESCRIPTION: COMPLETE DEMO OF RESIDENCE &
GARAGE-W/ASBESTOS,UTILITY&HOUSING APPROV
TYPE: DEMO
STE:
INSPECTOR AREA
PLANCK# CB983672
OCC GRP
CONSTR. TYPE NEW
LOT: JOB ADDRESS: 2647 STATE ST
APPLICANT: VIKING EQUIPMENT CORP
CONTRACTOR:
PHONE: 818 500-9447
OWNER:
REMARKS: C/818/500-9447 PM PLEASE
SPECIAL INSTRUCT:
TOTAL TIME:
CD
22
LVL DESCRIPTION
PL Sewer/Water Service
------------------
------------------
------------------
PHONE:
PHONE:
INSPECTOR
ACT COMMENTS
1tf
***** INSPECTION HISTORY*****
DATE DESCRIPTION ACT INSP COMMENTS
Raenette Abbey -2647 State Street
From:
To:
Date:
Subject:
Craig Ruiz
Mike Peterson
10/14/98 3:09PM
2
NCTD has hired Viking Construction to dema-a..hau•a~ Slila' They should be applying with
your Dept. for a demo permit in the next wee (ofso . ey were tora over the phone that they would need
an approval letter from this department prior to permit issuance. Hopefully this e-mail will suffice. They do
not need a permit from our department. It is sue the permit.
CC: Lori Rosenstein
Page 1 I
•
-1 0 -1 l) r
'ti
(S)
I\)
---~~--·------·-. --·--···-----··· --· -······ -··-··-----·-··--·-·. -·--·--·-------·---·-·---------·-------·-·-----. ··------. ·--· ·------·-·------. -
ei•·· SD f
San Diego Gas & El~lric
NUTICE OF .SERVICE" 01s·coNTINUANCE
6~T~M~1 ~~~~~g~T ~A,U l7P7/t 0 ---------------------------
El E CTR IC ANOlaftGAS SERVICE WILL BE 4 11SCONTINUEO
TO L--lL-' L-J 7 7 fA 1 6 S T -· C.-Alll, 0 ~A-0
AOORE.SS
BY I v-J ti -q f, _______ All SERVICE LINES Will BE REMOVED.
DATE
THIS BUILDING CAN BE MOVED OR RAZED AFTER THE ABOVE DATE.
San Diego Gas & Electric
sv c: Rbo <r ell
0 ()
• -1 ·:_.·. r0
(S)
-I ... p
·,·•
o,O
<fl
(S)
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____________________ __J)AI.£.. I D -1 .D --<1 f., --ri -PHONE 7 1.;D · Lf t'..U -17 ·?_~{_) ··-----------
FORM 116-21~2 (Or◄!11TJ Ol9'l
'ti
CS)
fl.)
i .. I
I
\ OCT-20-1998 05:33 P .01 '-
SDG,.. ff Slln Olego Gas & Ele<;tric
: An /!nova Com;,.ny
PROJECT MANAGEMENT NORTHERN
FAX:# (760.) 746-06:51
1
I
i
FACSIMILE COV~R SHEET
TIME--+---;.'-----DATE_I_C_·'_l_0_-_'1_P __
FRQM __ l_. -_K_t_~~_J_~_tt_1'f..J _____ t----+----
PHONE/EXTENSION "7lil O -tf Q) · -I?~}
TO_~P._t'.\-_,.:...----:;~=L:~1 ~~l...1..-111T·7_.,,~·----+--+----
COMPANY/DEPARTMENT I I
l .
FAX NUMBER I -'i5 I ,,_ sou-'l l "~O I
PHONE/EXTENSION ---------t~-+-----------..1 ___ _
MESSAGE 't-\~.f,-· l c.) L-f f)Ul.-h1 Di '1 C....-1:.: 0 F 0b {(_\LI C . t.:.-1
Dt'1 CDNTl ~UA-k!Lt r-orc
i
THIS FACSIMILE CONSISTS OF 7..J PAGE$, INCLUDING THIS COVER~ HEET. IF
YOl,J DO NOT RECEIVE ALL THE PAGES. PLEA~E CALL THE NUMBER INOICi~TED
ABOVE BY THE SENDER'S NAME. 1
I i
TMIS,COMMUNICATION IS INTENOEO roR TME US! OF HE INOl~OUAL OR ENTITY TO W!'11CH rT 1$ AOO ESSEO ANO
MAY CONTAIN INFORMATION THAT IS PRIVILEG!C. C:O~IFIO!NTI LANO ex!:,.,.PT FROM OISCLOSUAE u~ oe~
APPLICA9L! i.,,\W. IF THi AEAO!" oi: TMIS COMMUN1C ~TION IS OT THE INiENCEO ~ECtP1ENT OR EM~LOYH/AGENT
RESPONSlll;E ,-OR 0£LIVERY r·o Tf.lE INTENOEO RECIPIENT. YO ARE HE"!BY NOTIFtEO THAT ANY Oil SEMINATION,
OISTRl&UTION OR C:OPYING 01' n,us COMMUNICATION S ST"IC: LY PROHISITEO.
II' YQU H.4VE Pl!CEIVEO T..flS COMMIJNICATION IN ERR 1,t, .. LE.A' E NOTIFY SENOER lt.AMEO,ATEL V BY T ~E THEPMONE
ANO RETURN TME ORIGINAL COMMUNICATION TO SEN ER AT T,~E ABOVE AOORESS VIA V, S, MAIL.
• • • • PLEASE DELIVEF AS SC ON AS POSSIBLE • • • •
I . I i I I I
.• ·--··· ···-~· ··--·-· ;-•_,_•...;.,;· ·.:...:..-·,.........:..:..···l::.::1v ==·=· =.::i•:r::i:••;;;:;,.:.::;:<:=.• ~:::.:.i, -
NOTIFICATION OF DEMOLITION AND RENOVATION
upcmor ProJcc:t # PostnW'k Date Rcc:c1 vCCl Notific:aaon #
1. Tvne of notiffcatlon (o-0ri1tinal R•Revised C-Cancelled):
2. Facilitv information lldentifv owner. removal contractor and other o,v,rator)
Owner name: NO~~ Ci)UNTY 11--A IJ S I -,-
Address: SID m1 SS1ou AVG.
Citv: OC,81-J~, o~ State: CA f Zio: quysL{
Contaet C.,H IP W-H I t,LE-r-f' Teleohone #: · 1 l,o... q (o 1-)..g I L,
~emo V/K..llJ/..-i:;nu1r'(Y)~k.ff' C,[)U Re 111cn-n contractor: .
Address: ll>,~Oi. ?,f.,IU°"?
Citv: ~OAut State: CA-I Zin: 0, I 2,2, '5
Contael SI' r>-'(1 --( IZ~ ICAl-Teleohone#:. j/f-500-q'-{l.{7
Other nnerator: tJ/Jr
Address:
Citv: State: f Zio:
Contaet Teleohone #:
3. Tvna of a-ration m-Demo 0-0rdered Demo R•Renovation E-Emer. Renovat1on): ])
4. Is asbestos nresent? lve.1/no) N 0
( FacUln Descrintlon llnclude hnildin1t name number and floor or room numberl
Bld1r. Name: V PrvAtJ~ H-OV.S~
Addless: ,2_ (() YI S 1 A-re s-r.
6A us 6 ()(1) ·
. ..._
CA I Zin: Cltv: State:
Site Location: ,2((,1../1 S1p.-n; s-r.
Buildin1r Size: :J. 000 f/f I # of Floors: I I ArMin Y~: 50
Present Use: VA t,,A IJ-f' J.-rOU .s E:' Prior Use: HOIJS~
6. Procedure. lDdudiDI ualJtkal ••dlod. if appropriate. ued to detect &be pwce ot uba&OI ma&erial:
.tJA
7. Approximate alDOUII& ol Nonfriablc Asbe1101
uba&OI ma&erial: RACM Material not 10 be removed
L Rcpla&at ACM 10 be nwovcd• IObo
b. Cale&ory I ACM not remcwed n:moved Call Cl&ll c. Ca&cllotY II ACM not removed
Pi""'• LnFt:
Surface Area SoFt:
Vol RACM off Facilitv Com~n, CuFt
Nk Comnlere: ,J A 8. Scheduled dates asbestOI removal lm-,... ... '--y) Swc
9. Scheduled dates demo/renovation fmmldd/vv) Start: Io/, !5' / q Y Comnlete: 10/2,y/q/
FIGURE 3
M-X-12
·,
.
lndicaao Unit of
Meumemenl Below
Unit
Lnm:
Sam:
Cum:
;.
10. Dllcripdoll ot pluatd demolldoa or rtDOv,~a work, ud me&bod(s) to bt used:
LOl-\-'P@L Wt.~N&-' .
11. Dacripdoa ot work practices & en1i.Deerin1 controls to be used to prevent emilliou ot asbatol at tbe demolitioa
ud renovation si&e:
..... -,. . . .; . . ... . . -. . ...
12. Waste Transoorter #l
Name: .. Address:
Citv: State: I Zio:
Contaet Person: Teleohone #:
Waste Transnoner #2:
Name: .
' Address:
Citv: State: I Zio:
Contaet Person Teleohone #:
13. Waste Dlsnoul Site
Name:
Location:
Citv: ' State: I Zio:
Contaet • Telenhone #:
14. If demolition ordered by a 1ov1rnmeat aaeney, olease ldendfy the 11eney below:
Name I Title:
Authoritv: ., I Date Ordered to Belin (mm/dd/vv): Date of Order <m-, .... '-.-.~:
IS. For Emerirenev Renovations
Date and Hourof Ementencv <m_,..,. ... ,.""I):
Oescriotion of the Sudden. Unexnec&ed Evenc
Explanation ol how &ho evcm cauaed uauCo condi&ions. or would causo eqwpmem damap or an IWIUOGlblo financial
burden:
16. DtscrlptioD ol procld""' to N followtcl la tu eYIDt &bat unexpected ubeltal ii fouad or pnvioully ~ia~ uffltol material becoaa• muDblecl, ~«reduced=•· 1'A~ 6~ SPrm f~ .f-HP. ,
A-v'/UP. $F R$m5'(0.s ~UtJ~j NO r:-y A()... ues I o61'AIIJ V€'1-6~1.,, ~ FD~ W 1 -r11 11JL r-n::,-V O♦r I hr An ~
17. I certify &bat aa 1Dd1Yldual tramed 1a tlN proviaiou of tbia rt1uladoll (40 CFR Part 61, Subpart M) wW N ODSi&e
dur1D1 the dtmolidoll or naovadoD & nideDct &bat &bt required traiD1D1 baa betll accompU.INcl by tla1a person will
be available for luptetlaa duriDI Wlllal buaiNM ~oun. I
(Simature of Owner/Ooerator)
18. I cenif)' 11w tbubove 1111 ..... 11o11 ii cwna: 8 _
. -'rJl~
(Si1mature of Owner/Ooerator)
FIGURE 3
M-X-13
<Oare)
1°(L2l'
<Date)
.
m1· N.ON-HAZARDOUS SPECIAL WASTE & AS~EST,OS MANIFEST
If waste is asbestos waste, complete Sections I, 11, lll and IV.
If waste is NQI asbestos waste, complete only Sections I, II and III. No. 3344 6
Section I. GENERATOR (Generator completes all of Section I.
a. GeneratorName: Nert.h Co1tftt!,y 'i'raR•iti. Dist,rl-~nerating Location: Vacant. Uouae
c. Address: 810 ldi11aion 1've. 0. d. Address: l647 State Street
Ooeaa~i4a, CA glOS4 aai:1,};)ad, CA
e.PhoneNo.: ~~&~~ ~ ~sq4 u owner of the gene a~ngaility ~;rs 7cm he generator, provide:
f. Phone No.: ______________________ _
g. Owner's Name: ------------,...---...,-----... -_-_-r---...,-,....-:...-:,.-::._,h. Owner's Phone No.: ru @ill I ~ ij q ~ q ~ I d q Nt q tj 41 Containers i. BFI WASTE CODE
j. Description of Waste:__________________ _ Uncontaminated friable k Quantitt Units No. TYPE
and/or non-fnable asbestos (ACM) -~) P I)~ I Gt[I}[E[J
GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or
any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to
applicable regulations; AND, if the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal
Restrictions, I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 266 and is no longer a
hazardous waste as defined by 4 CFR Part 261. \ ,f-.
• . \ l'.1 .~ 0 r1 \ o-~ . , . -.. I) •·• , I,.~ • t J.'"'II!"'·•·.
,I • • L... ", ..J.+-.::;~"-'-""'-""'''""<F'a.::: .. :,<-t..,....,...:..' --------. Generato Authorize .~ •'Signature '
Section II TRANSPORTER Generator com
TRANSPORTER I
D'.f.E
OM · METAL DRUM
DP · PLASTIC DRUM
B -BAG
BA • 6 MIL. PLASTIC BAG
or WRAP
T · TRUCK
0 • OTHER
.!J1:illS.
P • POUNDS
Y • YARDS
M3 -CUBIC METERS
Y3 • CUBIC YARDS
0 · OTHER
a. Name: ___ E.....,.OuYLi....,r...,o...,c ..... 0u.n.._ ... r .... n,IJc ....... _________ _
I RAN$PORTl;R II S & R ~erv1ces, Inc
h. Name: ---.-.,....,.._..,......,,...,.-----,-...,...-r---,----------19 172 Stewart Stroot b. Address: __ .... 1 ... 1...,o ... 2 ... 2_-"w .... 1 .... o ....... o ... e,..r._.s.._...,c""i ... r...,c ...... 1..,e'--"#IL2 .... 0~0'---
T.ns Alamitos, CA 90720
i. Address: --...-..---.---.-----.-----.---------........-...... ..,.,.----Hunflngfon Beach, CA 92663
c. Driver Name/ Title: _________________ _
PAINT /TYPE
d. Phone No.: ___________ e. Truck No.: ____ _
j. Driver Name / T.iJlil: rr~.,,.-.,...,rTlP't""""-::-=:77.:-:-::=:---------( {·J 4) 37S:: n48 PAINT/TYPE k. Phone No.: ___________ I. Truck No.: _____ _
f. Vehicle License No./ State: _______________ _ m. Vehicle License No. I State: _______________ _
Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials.
I I I I I I I
Shipment Date
e. Discrepancy Indication Space:------------------------------------------
1 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate.
f. I I I I I I I
Name of Authorized Agent Signature Receipt Date
Section N ASBESTOS (Generator complete a-d, I, g, Operator• completes e.)
a. Operator's• Name: __________________ _ b. Operator's• Phone No.: ________________ _
c. Operator's• Address:---------------------------------------------
d. Special Handling Instructions and additional information:
OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed,
marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations.
.
u; ______ E;;;.._;;_NVi.;;....;;;..;IR;_;;;__;O::;.._;;;_N.;;.;;_;;;_M~E.;;.._;;;_NT..;;_:;_'1=L
(-:l lf SPECIALIZING IN ASBESTOS INSPECTIONS
CLIENT:
ATTENTION:
E.P.A. ACCREDITATION# I-000-110-CA
VIKING DEMOLITION
P.O.BOX 251257
GLENDALE,CALIF.
BERGER/MIKE
# I-01675-CA
91225
Following your request for an inspection for asbestos containing
building materials at 2647 STATE STREET,CARLSBAD,CALIF.
T & T ENVIRONMENTAL SERVICES completed the following inspection
on July 29, 1998. Our on site representative was
R.D.STRONG
Our asbestos inspection produced a total of 16 samples from the
buildings. Our inspection was based on sampling of homogeneous
areas within a building. The bulk samples were taken from
different strategic locations within the homogeneous areas to
determine whether those areas were comprised of asbestos
containing building materials (ACBMS). The approximate locations
and material descriptions of the sampled areas are found in the
attached survey sheets.
TEST METHOD
DESIGNATION:
40 Code of Federal Regulations Chapter I
(1-1-87 edition) part 763, Subpart F,
Appendix A, pages 293-299 or the current
U.S. EPA method for the analysis of
asbestos in building materials by
polarized light microscopy. NVLAP Test
Method Code 18/A01. All percentages are
based on visual area estimates. This test
report relates only to the items tested.
RESULTS OF ANALYSIS: See attached sheets for detailed results.
BUS (562) 420-3036 (800) 400-4828 FAX (562) 420-3742
P O BOX 3433, LAKEWOOD, CA 90711-3433
-------____ " _________________ _
,--,-----~r-------------
u; ______ E_NVi_lR;....;;.._;O;;;....;;_N.c....;;..;;.M.c...=E.;;;...;;;..NT.;;;...c;._:A=L
('2 lf SPECIALIZING W ASBESTOS INSPECTIONS
CONCLUSIONS:
Based on our survey and accredited laboratory analysis of the
bulk samples taken during the survey, it is our opinion that
asbestos containing materials (ACBMS) are present in some
locations of the buildings.
1 All linoleum found in the front house,is nonfriable ACBM in
good condition.
Extent is estimated at 253 sq.ft.
2 The layered 12x12 floor tile found in the front house
kitchen,is nonfriable ACBM in good condition.
Extent is estimated at 117 sq.ft.
3 The roof mastic found around the front house roof vents,is
nonfriable ACBM in good condition.
Extent is estimated at 5 sq.ft.
BUS (562) 420-3036 (800) 400-4828 FAX (562) 420-3742
P O BOX 3433, LAKEWOOD, CA 90711-3433
----------------------------·-·····-·----··--. ------·-···-·-•·
u; ______ E_NVi_lR_Oe,__N_M_E_NT_)l_L (~ if SPECIALIZING IN ASBESTOS INSPECTIONS
EPA LABORATORY ACCREDITATION #I-2204
NVLAP ID #200080-0
LAB. NO. C-664
REPORTED 7/31/98
CLIENT:
INVESTIGATION:
TEST METHOD
DESIGNATION:
SAMPLE LOCATION:
RESULTS OF ANALYSIS:
VIKING DEMOLITION
P.O.BOX 251257
GLENDALE,CALIF.
91225
Determine presence and amount of
asbestos in 16 Bulk samples submitted on
7/29/98 .
40 Code of Federal Regulations Chapter I
(1-1-87 edition) part 763, Subpart F,
Appendix A, pages 293-299 or the current
U.S. EPA method for the analysis of
asbestos in building materials by
polarized light microscopy. NVLAP Test
Method Code 18/A01. All percentages are
based on visual area estimates. This test
report relates only to the items tested.
2647 STATE STREET,CARLSBAD,CALIF.
See attached sheets.
Respectively Submitted,
T & T Environmental
BUS (562) 420-3036 (800) 400-4828 FAX (562) 420-3742
P O BOX 3433, LAKEWOOD, CA 90711-3433
-------------------------"
u; ______ E_N'li_lR_O'--N_M_E_NT_)l~L
~ V SPECIALIZING IN ASBESTOS INSPECTIONS u SURVEY SHEET
LOCATION: 2647 SfATE STREET,CARLSIIAD,CALIF.
KEY FOR ClJNDITION: G=GOOD F=FRIABLE
D=DAMAGED NFI=NONFRIABLE CLASS I
SD=SIGNIFICANTLY DAMAGED NFII=NONFRIABLE CLASS II
L=LOW POTENTIAL FOR DAMAGE
M=MODERATE POTENTIAL FOR DAMAGE
H=HIGH POTENTIAL FOR DAMAGE
SAMPLE MATERIAL DESCRIPTION LOCATION ClJNDITION EXTENT SAMPLE
LOCATION
6100 12Xl2 FLOOR TILE REAR GARAGE G/NFI/L 130 SQ.FT. FLOOR
6101 12Xl2 CEILING TILE REAR GARAGE G/F/H 130 SQ. FT. CEILING
6102 12Xl2 FLOOR TILE REAR APT./KITCHEN G/NFI/L 84 SQ. FT. FLOOR
6103 LINOLEUM REAR APT. /BATH G/NFI/L 24 SQ.FT. FLOOR
6104 LINOLEUM REAR APT./LIVING RM. G/NFI/L 117 SQ.FT. UNDER CARPET
6105 LINOLEUM FRONT HOUSE/BEDRM. G/NFI/L 108SQ.FT. FLOOR
6106 LINOLEUM FRONT HOUSE/BATH G/NFI/L 15 SQ.FT. FLOOR
6107 12Xl2 FLOOR TILE/LAYER FRONT HOUSE/KITCHEN G/NFI/L 117 SQ. FT. FLOOR
6108 INTERIOR PLASTER FRONT HOUSE/LIV.RM. G/NFI/L N/A WALL
6109 LINOLEUM FRONT HOUSE/PORCH G/NFI/L 130 SQ. FT. REAR PORCH FLOOR
ND=NONDETECT
ACBM=ASBESTOS
CONTAIN IN
RESULT
ND
ND
ND
ND
ND
ACBM
ACBM
ACBM
ND
ACBM
6110 LINOLEUM FRONT HOUSE/PORCH G/NFI/L 4 SQ. FT. REAR PORCH PATCH ND
6111
6112
6113
ROOFING PAPER/LAYER
ROOF MASTIC
ROOFING PAPER
FRONT HOUSE G/NFI/L 804 SQ. FT.
FRONT HOUSE G/NFI/L 5 SQ.FT.
PATIO ROOF G/NFI/L 288 SQ.FT.
BUS (562) 420-3036 (800) 400-4828 FAX (562) 420-3742
PO BOX 3433, LAKEWOOD, CA 90711-3433
-----------------------------
ROOF ND
ROOF VENTS/CHIMNEY ACBM
PATIO ROOF ND
¼"7-------=E=-=-N'li.::....::..;lR:....=....:O:::.....:....N-=-=-=-M=E-=-=--N-=-=--T A=L ~ Q SPECIALIZING IN ASBESTOS INSPECTIONS u SURVEY SHEET
LOCATION: 2647 STATE STREET,CARLS8AD,CALIF.
KEY FOR CXlNDITION: G=GOOD F=FRIABLE L=LOW POTENTIAL FOR DAMAGE ND=NONDETECT
SAMPLE
6114
6115
D=DAMAGED NFI=NONFRIABLE CLASS I M=MODERATE POTENTIAL FOR DAMAGE ACBM=ASBESTOS
SD=SIGNIFICANTLY DAMAGED NFII=NONFRIABLE CLASS II H=HIGH POTENTIAL FOR DAMAGE CONTAININ
MATERIAL DESCRIPTION
ROOFING PAPER/GRN.
ROOFING PAPER/GRAY
LOCATION CXlNDITION EXTENI
REAR APT.ROOF G/NFI/L 216 SQ.FT.
REAR APT.ROOF G/NFI/L 732 SQ.FT.
BUS (562) 420-3036 (800) 400-4828 FAX (562) 420-3742
PO BOX 3433, LAKEWOOD, CA 90711-3433
SAMPLE
LOCATION
ROOF
ROOF
RESULT
ND
ND
Ju 1. 31 98 ·04: 04p 602-844-1752 p. 1
-----------'= CONTINENTAl ENVIROTECH, INC. -
ADHS #AZ0916
f'llHA PAT#1B106
CA ELAP #2204
Moss # AA 000 I 55
NVlAP· 200080-0
TX DOH: 30-0208
----rm ----BULK ASBESTOS Ai~ALYSIS SUM"MARY REPORT --
CLIENT NAME: T & T Environmental
P.O. Box 3433
Lake1M>Od, CA. 90711-3433
CEl LABORATORY #: 98-C664
CEILAB CLIENT SAMPLE
SAMPLE SA.MP£E DESCRTPTION
ID # ID#
C664-1A 6100 A 12x 12 Floor Tile Ton
C664-1B 61 00 B l 2x 12 Floor Tile Back
C664-1C 6100 C 12x12 Floor Tile Mastic
C664-2 6101 12x:12 Ceiling Tile
C664-3A 6102 A 12x 12 Floor Tile Too
C664-3B 6102 B 12xl2 Floor Tile Back
C664-3C 6102 C 12x 12 Floor Tile Mastic
C664-4A 6103 A Linoleum Too
C664-4B 6103 B Linoleum Back
C664-5A 6104 A Linolewu Ton
C664-5B 6104 B Linoleum Back
C664-5C 6104 C Linoleum Vapor Barrier
C664-6 6105 LJnol,um
C664-1A 6106 A Linoleum
C664-7B 6106 B Linoleum Tile
C664-7C 6106 C Linoleum Mastic
C664-8A 6107 A 12xl 2 Floor Tile Laver 1
C661...SB 6101 B 11.xl 2 Floor Tile Laver 2
C664-8C 6107 C l 2x 12 Floor Tile Layer 3
C664-8D 6107 D 12x 12 Floor Tile Layer 4
Attention: .Bob Strong
PROJECT: 2647 State St.
Carlsbad
TEST RESULTS OTHER
MATERIALS
Pos. / NCf?. % & Troe
Ne2ative --------------100% Non-Fibrous
NeJtative -----·---------100°/o Non-Fibrous
Negative _______ 4 ______ 3% ('.,ell ulose,
97% Non-Fibrous
Negative ----------------·-85% CelJulose,
15% Non-Fibrous
NelUlbve ............................ -. 1000/o Non-Fibrous
Neaative ·---·------... ·----100% Non-FibrotU
Negative .. -... ----------·---·-100/o C-ellulose,
90% Non-Fibrous
Nell.atlve ____ .,_ .. _____ ,.. __ 100% Non-Fibrous
Negative ----------·--200/o c.euulose,
15% Fiberglass,
15% Synthetic,
50% Non-Fibrous
Nej!,ative -------100% Non-Fibrous
Negative --· .,_ ....................... _ SS% Cellulose,
5% Synthetic,
400/o Non-Fibrous
Negative ---------.. --..... ---55% Cellulose,
5% Synthetic,
40% Non-Fibrous
Positfre 20% Chrys()li/e 20% Cellulose,
60" Non-Fibrous
Positive 20% ChrysotJ/e 20% Cellulose.
60% No11-Fibrous
Poslti,1e I 0% Chrvsotiltt 90¾ Non-Fibrous
Negative ............... ---··-··-2% Cellulooe,
98% Non-Fibrous
Ne2.ative -------------·--100% Noa-Fibrous
Posltfre 10'¼ Chrw1ctl/e 90¾ Non-F7brous
Negative -·---.. ------·---2% Cellulose,
1 % Synthetic.
97% Non-Fibrous
Negative ........ ____ ,. ___ ,.. ____ l % (',ellulose,
99% Non-Fibrou&
Jul 31 98 04:04p
Laboratory Number: 98-C664
Client: T & T Environmental
Paec: 2
CEILAB CLIENT SAMPLE
SAMPLE SAMPLE DESCRlPTION
ID# ID#
C664-9A 6108 A Interior Plaster Pamt
C664-9B 6108 B T nterior Plaster Paper
C664-9C 6108 C Interior Plaster
C664-J0A 6109 A Linoleum
C664-l0B 6109 B Linoleum Vapor Banier
C664-11A 61 10 A Linoleum Too
C664-11B 6110 B Linoleum Backing
C664-11C 6110 C Linolewn Vapor Barrier
C664-12A 6111 A Roofing Paper Gray Layer 1
C664-12B 611 1 B Roofing Paper Gray Layer 2
C664-12C 6111 C Roofing Paper Gray Layer 3
C664-13A 6112 A Roof Mastic 1
C664-13B 6112 B Roof Mastic Shingle
C664-13C 6112 C Boof Masiic 2
C664-14 6113 Roof Paper Green
C664-15A 6114 A Roofing Paper Layer l
C664-15B 6114 B Roofing Paper Layer 2
C664-I6A 6115 A Roofing Paper Layer 1
C664-16B 6115 B RoofinJt Pat>cr Laver 2
602 -844 -1752 p.2
TEST RESULTS OTHER
MATERIALS
Pos. / Ne11. 0/o & Type
Ne2ative ----------·-------100% Non-Fibrous
Negative ------------------95% Cellulose,
5% Non-Fibrous
Negative -----------------5% Cellulose,
95% Non-Fibrous
Positfre 10¾ Chrysotlle 28¾ Cellulose,
60% Non-Fibrous
Negative -·---------·----55% Cellulose,
5% Synthetic,
400/4 Non-Fibrous
Ne~IVC ------------------100% Non-Fibrous
Negative --------------............ 55% Cellulose,
5% Synthetic,
40% Non-Fibrous
Neg,1tive ----------------55% Cellulose,
5% Synthetic,
40% Non-Fibrous
Negative --·-------------35% Cellulose,
65% Non-Fibrous
Negative -------------35% Fiberglass,
65% Non-Fibrous
Negative ·----·--... ----35% Cellulose,
65% Non-Fibrous
Negative ---------------I 0% Cellulose,
90% Non-Fibrous
Negative ................. __________ 35% Fiberglass,
65% Non-Fibrous
Po!i;itive 1 O¾ Chrvsotile 90¾ Non-Fibrous
Negative --·-------------35% Cellulose.
65% Non-Fibrous
Negative ......................... ___ 35% Fiberglass,
65% Non-FibroU!
Negative ·--------------30% Cellulose,
70% Non-Fibrous
Negative ---------35% Fiberglass,
65% Non-Fibrous
Nejl,3tive ---------------lOOo/o Non-Fibrous
Laboratory Number: 98-C664
Client: T & T Environmental
Pas:e:3
602-8 44-1752
Method: Polarized Light Microscopy, EPA Method 600/R-93/116
'The rewll quaotitaticm ~<rt&!d are an atimatiCll based an lhe methods cl viSUAI mi~ic esunatian vo.h.icb is oal&ldt:red c:cly a temt•
quantitatiw tedmique. Alto. thiJ NpOrt is indicaiw coly <£the sample maurial Cmtina:iUII f!nvirotec:h, fnc. received. R-.iha do Del
n~y rtilect the makeup ct'the mtire iipan c:.{the material from which the samples were d«ived. Sampling tedmiquet1 md/or sample
h111dlina may affect the imearlly d'the umplc/a Wore mhmillliCll to Caxtinmtal Envira.edl, Inc. and hence the OU1ocme c:.{ the laboratocy
resulu. Samplasnc( destroyed bytatina are rltained a minimum of thirty days
Ccmtincmal E.nwcuch, ~di re-aoalyai.a by poilll. oount or Trlll8miasioo Electrm Mia Ol!COpy (TEM) fa mataialJ thllf i,re found
to 00lltain lesS\hm ta\ pwoatt (<1~~) ui-ta. by l'LM
Analyst: Date Analy7.ed:
Steve Hutton
July 31, 1998
-_.,_...,
p.3