HomeMy WebLinkAbout2690 ROOSEVELT ST; ; CBR2022-1151; PermitBuilding Permit Finaled
Residential Permit
Print Date: 05/02/2023
Job Address: 2690 ROOSEVELT ST, CARLSBAD, CA 92008-1613
Permit Type:
Parcel#:
Valuation:
Occupancy Group:
#of Dwelling Units:
Bedrooms:
Bathrooms:
Occupant Load:
Code Edition:
Sprinkled:
BLDG-Residential
2031021500
$0.00
Project Title: 2690 ROOSEVELT
Work Class:
Track#:
Lot#:
Project#:
Plan#:
Construction Type:
Orig. Plan Check#:
Plan Check#:
Demo
DEV2018-0183
Description: 2690 ROOSEVELT: DEMO VACANT HOME AND EXISTING SITE IMPROVEMENTS
Applicant:
RANDOLF CHEREWICK
2033 SAN ELIJO AVE
CARDIFF BY THE SEA, CA 92007-1726
(760) 598-7374
FEE
Property Owner:
ROOSEVELT NINE LLC
2690 ROOSEVELT ST
CARLSBAD, CA 92008-1613
(425) 345-2773
BUILDING PLAN REVIEW-MINOR PROJECTS (LDE)
BUILDING PLAN REVIEW-MINOR PROJECTS (PLN)
DEMOLITION OF BUILDING: RESIDENTIAL
SB1473 -GREEN BUILDING STATE STANDARDS FEE
SWPPP INSPECTION FEE TIER 2 -High BLDG
SWPPP PLAN REVIEW FEE TIER 2 -HIGH
Total Fees: $2,676.00 Total Payments To Date: $2,676.00
Permit No:
Status:
{ City of
Carlsbad
CBR2022-1151
Closed -Finaled
Applied: 04/04/2022
Issued: 08/08/2022
Fina led Close Out: 05/02/2023
Final Inspection: 04/27/2023
INSPECTOR: Renfro, Chris
Balance Due:
AMOUNT
$194.00
$98.00
$550.00
$1.00
$1,494.00
$339.00
$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.
Building Division Pagelofl
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov
{
RESIDENTIAL
Cicy of 1:1u~1NG PERMIT
Carlst..::""'A:. (:::,~-\\J 't;l(PPLICA TION
,U~, l i~'l.'l ,,1;3-1
Plan Check~~2o'2.'Z -II SI
Est. Value
PC Deposit
i ~~ :·.
\).'? ·,',· .. ,.:,'
Date ""( -~ zo-z-Z--.
Fire Sprinklers: QvES0NO Air Conditioning:O YESO NO Electrical Panel Upgrade:0YES0No
BRIEF DESCRIPTION OF WORK: v' c\-C.•••-.:\ :1-k J'NZ. -+.., •I'
.1,1(.."'-> l ,1~,...
0 New SF : _____ Living SF, ____ Deck SF, ____ Patio SF, ____ Garage SF __ _
Is this to create an Accessory Dwelling Unit? Ov ON New Fireplace? Ov ON, if yes how many? __ _
□Remodel: SF of affected area -----Is the area a conversion or change of use? Ov ON
□ Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _
OSolar: ___ KW, ___ Modules, Mounted:ORoof OGround, Tilt: 0 vO N, RMA: Ov ON,
Battery:OY ON, Panel Upgrade: 0v ON
D Re roof: __________________________________ _
D Plumbing/Mechanical/Electrical
0 Only: Other:
DESIGN PROFESSIONAL
µ;...,__ LL(..
CONTRACTOR OF RECORD
Name: _________________ Business Name=-------,,4_,>.L=--:,,.,....~-----
Address: ________________ Address: _____ __,,.,-,,.;.......---,.-,::;--------
City: _______ State: ___ Zip: ____ City: ____ -.:::tif-"-
Phone: Phone: ___ _,,7 ,c;;.. ____________ _
Email: Email: __ ~.,c----------------
Architect State License: CSLB Licens _______ Class: ______ _
Carlsbad Business License# (R_equired): _______ _
APPLICANT CERT/FICA TION: /certify that I have read the application and state that the above information is correct and that the
information on the plans is accurate. /agree to comply with a/177.Jity · nces and State laws relating to building
construction. r .... p ) /
NAME (PRINT~ftC~'l\'-r~O'-SIG : l -• DATE: .;> /t,f ;].
1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-27~_F.£: 760-002-8558 Email: Buildiqg@carlsbadca.gov
REV 07121
THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: _____ _
A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. IF THE PERSON SIGNING
THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE.
( 0 PTION A) :._,Le>IC,_,,E!!N.,,,SE,.eD'--"'~~"-'-'"':',_,___,.""
I herebyaffirm under penal tyof p ·ury that I am I icensed under provislonsof Chapter 9 ( commencing with Sect ion 7000) of Division 3
of the Business and Professions Code, my license is in full force and effect. I also affirm under P, yof perjury one of the
following declarations /CHOOSE ONE/:
01 have and will maintain a certificate of consent to self-insure fo n 3700 of the Labor Code, for the performance of the
work which this permit is issued. PolieyNo .. __________ __:"-~--------7"'"-----------------------
·0R-
E] 1 have and will maintain worker's compensation, as required by Section 3700 of Labo ode, for the performance of the work for which this permit is issued.
My workers' compensation insurance carrier and policy number are: lnsuranceComP, ame: Zurich American Insurance Company
Policy No. WC 0384064-04
-OR-
Expiration Date:,'~'~"~'~"~°'=':.... _____________ _
D Certificate of Exemption: I certify that in the performance of the work r which this permit ls issued, all not employ any person in any manner so as to become
subject to the workers' compensation Laws of California. WARNING· ilure to secure workers compensatio verage Is unlawful and shall subject an employer to
crlmlnal penaltles and civil fines up to $100,000.00, In addltlo e to the cost of compensation, damages as pr ed for in Section 3706 of the Labor Code,
Interest and attorney's fees.
CONSTRUCTION LENDING AGENCY IF
I hereby affirm that there is a construction lendi 3097 (i) Civl de),
Lender's Name: _________ -.,,,L ____________ ,Lender's Address:
CONTRACTOR CERT/FICA TION: plkant certifies that all documents and plans clearly and accurately show all e~isting and proposed buildings, str ures, access roads, and
Jtlllties/utlllty easements. All proposed fflcations and/or additions are clearly labeled on the site plan. Any potentially @)(!Sting detail within these plans inconsisten ith the site plan are
not approved for construction and m e required to be altered or removed. The clty's approval of the application is based on the premise that the submitted docume and plans show
the correct dimensions of; the pro rty, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities. The e)(istln d proposed
use of each bu!ld!ng as stated is e and correct; all easements and other encumbrances 10 development have been accurately shown and labeled as well as all on.site grading/site p
All Improvements @)(isling o e property were rnmpleted in accordance with all regulations In ewlstence at the time of their construction, unless otherwise noted,
,~
ATE:03/m/~
tterhead,
-OR-
(OPTION B): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
D 1, as owner of the property or my employees with waaes as their sole compensation, wilt do the work and the structure is not Intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such
work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold
within one year of completion, the owner•builder will have the burden of proving that he did not build or improve for the purpose of sale).
-OR-
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project )Sec. 7044, Business and Professions Code: The
ntractor'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).
-OR-D l am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason:
AND1
,FORM 8-61 "Owner Builder Acknowledgement and Ve,lfication Fo,m" is ,equi,ed fo, aay pecmit Issued to, prnpe,ty ow""
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 cl structure that I ti ave built as an own~r·builder if it hc1s not been constructed in its entirety by licensed
contractors. J 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 following Web site: http:Ilwww.lejlnfo.ca,jovlcalaw.html.
OWNER CERTIFICATION: The applicant certifies that all documents and plans clearly and accurately show all e)(lsting and proposed buildings, structures, access roads, and utilities/utility
easements. AU proposed modifications and/or additions are clearly labeled on the site plan. Any potentially e)(lsting detail within these plans Inconsistent with the site plan are not approved
for construction and may be required to be altered or removed. The city's approval of the application is based on the premise that the submitted documents and plans show the correct
dimensions of; the property, buildin11s, structures and their setbacks from property lines and from one another; cess roads/easements, and utilities. The e)(lstlng and proposed use of each
building as stated Is true and correct; a/1 easements and other encumbrances to development have b e c ratelv shown and labeled as well as all on•site grading/site preparation. All l:::;";•;:::~;;1hPr,;~£tii?flil ,,g,1~,;: m ~,1,t,"' 1h 11m, of1ho,, ,,os1rnc11o", ""'''' ,::~•~:ot? d/2: L
Note:lfthe rsonsl nlnbovefsanauthorlzeda entforthe ro ert o owner. /
1635 Faraday Ave Carlsbad, CA 92008 Emall: Bulldjng@carlsbadca.gov
2
REV. 10/2
{city of
Carlsbad
OWNER-BUILDER
ACKNOWLEDGEMENT
FORM
8-61 -'-"
Development Services
Building Division
1635 Faraday Avenue
442-339-2719
www.carlsbadca.gov
OWNER-BUILDER ACKNOWU:iDGMENT FORM
Pursuant to State of California Health and ~~f~i~~~d; ~~ction 19825-19829
To: Property Owner
An application for construction permit(s) has been submitted in your name listing you as the owner---builder of the
property located at: /4' 7 _ /f J7
rJ/ /_ vi C, /,.., <} J-<"J€,, C /J JY • Site Address __ D_b _ _,/.___ ______________________________ _
The City of Carlsbad ("City") is providing you with this Owner--Builder Acknowledgment and Verification form
to inform you of the responsibilities and the possible risks associated with typical construction activities issued
in your name as the Owner-Builder.
The City will not issue a construction permit until you have read and initialed your understanding of each
provision in the Property Owner Acknowledgment section below and sign the form. An agent of the owner
cannot execute this notice unless you, the property owner, complete the Owner's Authorized Agent form and
it is accepted by the City of Carlsbad.
INSTRUCTIONS: Please read and initial each statement below to acknowledge your understanding and
verification of this information by signature at the bottom of the form. These are very important construction
related acknowledgments designed to inform the property owner of his/her obligations related to the requested
permit activities.
I. M I understand a frequent practice of unlicensed contractors is to have the property owner obtain an "Owner·
l/~er" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries
sustained by an unlicensed contractor and his or her employees while working on my property. My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of
th l'mits of my insurance coverage for injuries to workers on my property.
II. I understand building permits are not required to be signed by property owners unless they are responsible
e construction and are not hiring a licensed contractor to assume this responsibility.
Ill. 4-_1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I U~_a,~ -~rotect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his
or her name instead of my own.
IV. N' I understand contractors are required by law to be licensed and bonded in California and to list their license
~ers on permits and contracts.
V. 1 I understand if I employ or otherwise engage any persons, other than California licensed contractors, and
{) foe total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
1 REV. 08/20
Owner-Builder Acknowledgement Continued
~
I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
I ay subject me to serious financial risk.
V I understand under California Contractors' State License Law, an Owner--Builder who builds single--family
tial structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
th ark is performed under contract with a licensed general building contractor.
VI I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
y financial or personal injuries sustained by any subsequent owner(s) which result from any latent
uction defects in the workmanship or materials.
IX. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
ue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at l-800-321-CSLB (2752) or www.cslb.ca.gov for more information
t licensed contractors.
X. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
XI. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
II applicable laws and requirements that govern Owner-Builders as well as employers.
X l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
mation I have provided on this form.
Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who
does not have a license, the Contractor's State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court.
It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm
is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-·
Builder and wish to hire contractors, you will be responsible for verifying whether or not those contractors are
properly licensed and the status of their workers' compensation coverage.
Before a building permit can be issuedJ this form must be completedJ signed by the property owner and returned
to the City of Carlsbad Building Division.
I declare under penalty of perjury that I have read and understand all of the information provided on this form and that my responses, including my
authority to sign this form, is true and correct. I am aware that I have the option to consult with legal counsel prior to signing this form, and I have
either (1) consulted with legal counsel prior to signing this form or (2) have waived this signing this form without the advice of legal counsel.
Property Owner Name ("._Rl~T) ~ f-f /J_ av-"-~ r
/fl.of~ l tff
2 REV. 08/20
Building Permit Inspection History Finaled
( City of
Carlsbad
PERMIT INSPECTION HISTORY for (CBR2022-1151)
Permit Type: BLDG-Residential Application Date: 04/04/2022 Owner: ROOSEVELT NINE LLC
Work Class: Demo Issue Date: 08/08/2022 Subdivision: SEASIDE LANDS
Status: Closed -Finaled Expiration Date: 02/06/2023 Address: 2690 ROOSEVELT ST
IVR Number: 39779 CARLSBAD, CA 92008-1613
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Dale
08/09/2022 08/09/2022 BLDG-SW-Pre-Con 188789-2022
COMMENTS Checklist Item
BLOG-Building Deficiency
04/27/2023 04/27/2023 BLDG-Final Inspection 209482-2023
Tuesday, May 2, 2023
Checklist Item
BLDG-Building Deficiency
BLDG-Plumbing Final
BLDG-Structural Final
BLDG-Electrical Final
COMMENTS
Stat,us
Passed Chris Renfro
Passed Chris Renfro
Passed
Yes
Passed
Yes
Yes
Yes
Yes
Complete
Complete
Page 1 of 1
-REPORT-
ASBESTOS AND LEAD
INSPECTION, ASSESSMENT, SAMPLING
Property:
Converted Single Family Residence
2690 Roosevelt Street
Carlsbad, California 92008
Report date: January 25, 2018
Asbeslos & Lead Testing • Hazardous Malerisls Mansgemenl • Enviroomenral Engineering • Site Assessments & R11mediatioo
6035 Fremont Street • Riverside, CA 92504 • Phone 951 .352.65 10 • Fax 951.352.6514
> 1--, ·o
ON ON l.()O
r-N N-o:'.:t
T""" "'-1"
C")
0 N
Phase I ESA & Pre-Demo HazMat Survey-Kitchell Development Company
Proposed Residential Development -2690 Roosevelt Street, Carlsbad, California
January 30, 2018
EEi Project KIT-72710.1
On January 16, 2018, EEi personnel conducted a site reconnaissance to visually observe the subject
property and adjoining properties for conditions indicating a potential environmental concern.
Environmental concerns would include any evidence of contamination, distressed vegetation,
petroleum-hydrocarbon staining, waste drums, illegal dumping, or improper waste storage and/or
handling. At the time of EEi's site visit, the subject property, consisting of a one-story commercial
office/medical clinic building, was vacant and unoccupied. No evidence of contamination, distressed
vegetation, petroleum-hydrocarbon surface staining, waste drums, USTs, ASTs, or improper waste
storage/handling was noted during our site reconnaissance.
• At the request of the Client, on January 16, 2018, Altec Testing and Engineering (Altec) conducted
Asbestos and Lead Inspection, Assessment, Sampling at the subject property. According to Altec's
report (attached to this ESA), ACM was found throughout building materials within the property
building, including: tan resilient sheet flooring; gray/black penetration tar; white window
glazing/putty; pink (and gray) exterior stucco; and transite pipes. Furthermore, green exterior facia
yielded lead concentrations above the 1.0 milligrams per square centimeter (mg/cm2) United States
Department of Housing and Urban Development (HUD) action level. In addition, bulk samples
collected from the green exterior eaves/fascia were identified with lead concentrations exceeding
the Cal/OSHA action level of 600 parts per million (ppm). Altec stated that any planned renovation
activities that will impact lead components will need to be performed by qualified representatives in
compliance with USEPA and Division of Occupational Safety and Health (DOSH) rules and
regulations.
• EEi performed a Vapor Encroachment Screen (VES) for the subject property, in accordance with
ASTM E2600-15. The purpose was to evaluate whether sites (e.g., gas stations, dry cleaners, or
other listings of environmental concern) that store or dispose of potential chemicals of concern or
have documented releases, may migrate as vapors onto the property, as a result of contaminated
soil and/or groundwater which may be present on or near the property (i.e., a potential Vapor
Encroachment Condition or pVEC). Based on EEi's Tier 1 Screening evaluation, four (4) sites were
identified within the AOC that were considered to pose a potential VEC (pVEC) at the subject
property. The presence of the identified pVECs, necessitated a Tier 2 Screening in accordance with
ASTM E2600-15, to assess whether or not documented soil and groundwater contamination is
located within the critical distance to the subject property, which could result in a VEC. Based on the
results of the VES, EEi concluded that a VEC can be ruled out based on: 1) each site's cross-gradient
location as it relates to groundwater flow direction; and 2) the distance from the contaminated soil
and/or groundwater to the subject property is greater than the critical distance (for chemicals of
concern) of 100 feet.
Findings and Opinions
Based on the information obtained in this ESA, EEi has the following findings and opinions:
• Known or suspected RECs-are defined by the ASTM E1527-13 as the presence or likely presence of
any hazardous substances or petroleum products in, on, or at a property: (1) due to any release to
the environment; (2) under conditions indicative of a release to the environment; or (3) under
conditions that pose a material threat of a future release to the environment.
This assessment has revealed no evidence of known or suspected RECs in connection with the
subject property.
iii
Scope of work:
Property location:
Date(s) of sampling:
Altec Project No.
Requested by:
Inspection, assessment and
sampling by:
Allee Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Inspection, Assessment and Sampling for
Asbestos-Containing Materials (ACMs) and Lead Paint
Converted Single Family Residence
2690 Roosevelt Street
Carlsbad, California 92008
January 16, 2018
419-2018110
Ryan Merkey
Environmental, Inc.
24445 Faraway Park Drive, Suite F
Carlsbad, California 92008
(760) 434-3755 Telephone
Allee Testing & Engineering, Inc.
6035 Fremont Street
Riverside, California 92504
(951) 352-6510 Telephone
Mason S. Adams
Certified Asbestos Consultant #15-5479
Lead Sampling Technician #21996
Jay A. Yowell
Certified Asbestos Consultant #97-2295
Lead Sampling Technician #7202
lo,µ it, !.tb
Lynn A. Laborde
Certified Asbestos Consultant #92-0495
Lead Inspector, Risk Assessor, Project Monitor #7203
Page2
Allee Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page3
TABLE OF CONTENTS
1.0 INTRODUCTION ............................................................................................................................. 4
2.0 RESULTS SUMMARY ..................................................................................................................... 5
3.0 SPECIAL NOTATIONS & QUALIFICATIONS ............................................................................... 6
4.0 ASBESTOS ....................................................................................................................................... 7
5.0 LEAD PAINT .................................................................................................................................. I I
Appendices
Appendix A -Common Acronyms/Definitions
Appendix B -Supplemental Information (Sampling Overview, Strategy, Protocol, Limitations)
Appendix C -Inspector Certificates
Appendix D -Laboratory Certifications, XRF PCS
Appendix E -Analytical Results, Lead XRF Data Sheets, and Chain of Custody Forms
Appendix F -CDPH Form 8552 and Lead Location Maps
Appendix G -Universal Waste Supplement
1.0 INTRODUCTION
Allee Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page4
Altec Testing & Engineering, Inc. (Altec) performed a visual inspection and testing/sampling to
identify asbestos-containing materials (AC Ms) and lead in paint which could present an
exposure/release risk during renovation/demolition activities at the following property:
. \ddn•ss: 2690 Roosevelt Street, Carlsbad, California
Typt' of stnu::1un.•s: Converted Residential
Surn'y Date January 16, 2018
I nh'lllkd nork: Demolition
The specific asbestos scope of work included:
• Asbestos -Inspect the scope of work areas and collect bulk samples of suspect asbestos-
containing materials and obtain laboratory analysis for asbestos by Polarized Light
Microscopy (PLM).
The specific lead paint scope of work included:
• Lead XRF -Inspect the scope of work areas and perform testing to identify LBP on
structural components using an x-ray fluorescence (XRF) analyzer
• Lead Bulk -Collect representative samples of interior/exterior paint where possible and
obtain laboratory results for lead in percent dry weight or parts per million by EPA Method
7000, 7420 or equivalent.
This work was performed exclusively within the scope of work areas to identify the types and
approximate quantities of ACMs and lead paint that will require special handling, removal and
disposal procedures prior to construction efforts .
'
2.0 RESULTS SUMMARY
Altec Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page 5
\slwslns Results Summar~
The following asbestos-containing materials were identified 1:
► Tan Resilient Sheet Flooring
► Grey/Black Penetration Tar
► White Window Glazing/Putty
► Pink (and gray) Exterior Stucco
► Transite Pi es
Asbestos removal by California certified asbestos workers is necessary prior to disturbance of these materials.
Exercise caution during construction and notify a certified asbestos consultant (CAC) for sampling if additional
sus ect ACMs are found and will be disturbed.
Removal or stabilization of LBP components should be performed by CDPH certified lead workers.
Cal/OSHA requires that renovation or demolition work performed on components containing lead concentrations
above 600 parts per million (ppm) must be performed with appropriate personal protective measures until
employee exposure assessments establish that air concentrations are below the lead permissible exposure limit
PEL . Removal or stabilization of LBP com onents should be erformed b CDPH certified lead workers.
Cal/OSHA requires that renovation or demolition work performed on components containing lead concentrations
above 600 ppm must be performed with appropriate personal protective measures until employee exposure
assessments establish that air concentrations are below the lead PEL.
Waste characterization sampling and analysis will be necessary for any construction waste/debris containing lead
in_concentrations above 50 parts per million (ppm) prior to disposal. ---·--~ -·-.~.
1 ACM = Asbestos concentrations of greater than 1 %, ACCM = Asbestos concentrations 0.1 % by weight or greater.
3.0 SPECIAL NOTATIONS & QUALIFICATIONS
3.1 Special Notations
Altec Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page6
The former single-family dwelling had been previously converted to a dental office. The shed at the
rear of the building was locked and inaccessible during sampling. The roofing materials on the shed
appeared homogeneous with the materials observed and sampled on the dwelling structure. Two
transite pipes were identified on the roof of the dwelling structure and were assumed positive. They
are approximately 6' long with a 4" diameter.
3.2 Inspectors Qualifications
Ailee's asbestos inspectors hold State of California Department of Occupational Safety and Health
(DOSH) Certified Asbestos Consultant (CAC) licenses and maintain current AHERA certifications
in Asbestos Building Inspection, Management Planning, Project Design, and Abatement
Supervision. Altec's lead sampling technicians have completed an EPA and State of California
Department of Public Health (CDPH) approved curriculum in Lead in Construction Inspector/Risk
Assessor and/or Sampling Technician Training. They are certified by the State of California
Department of Public Health (CDPH) as a Lead in Construction Sampling Technician. Altec's
Sampling Techs work under the direct supervision of a CDPH Lead Inspector/Risk Assessor. Altec
defines direct supervision as follows: (1) following clear and concise instruction for the testing of
paint/coatings, collection of samples, and the assessment of sampled media, (2) establishing
forms/maps used to document the assessment information, (3) being physically present at the
testing/sampling location during testing, or being available at all times during the inspection and
available to respond to the location if needed, (4) daily monitoring of project progress, and (5)
reviewing and approving all collected data. Personnel certifications are provided in Appendix C.
Allee Testing & Eng. Inc.
Asbestos~Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page?
4.0 ASBESTOS
4.1 Laboratory Analysis
The bulk samples collected were analyzed for asbestos by Polarized Light Microscopy (PLM) using
the Environmental Protection Agency (EPA) Methods EP A/600/R-93/116 and EP A/600/M4-82-020
by the following National Institute of Standards and Technology's (NIST) National Voluntary
Laboratory Accreditation Program (NVLAP) accredited laboratory:
■i@@jjjj& ,)uanTEM Laboratories, 2033 Heritage Park Drive, Oklahoma City, OK
4.2 PLM Results (Visual Estimation)
Polarized Light Microscopy (PLM) is the method most often used for the analysis of
construction/building materials for the presence of asbestos fibers. The method utilizes the unique
features of polarized light to observe mineral specific optical properties in prepared samples. In this
manner, PLM can differentiate asbestos from non-asbestos fibers and further classify the various
types of asbestos. The PLM procedure is an economical technique for screening a large number of
samples; however, there are limitations due to the magnification (!00-400X) employed and due to
other interferences present in the building material matrices. PLM results are reported as a
percentage of the total sample. The method utilizes two protocols for the quantification process,
which include visual estimation and point counting. Depending on the sample matrix, PLM
analytical sensitivity can be a fraction of a percent. Gravimetric reduction protocols further enhance
this technique's ability to accurately quantify and qualify asbestos.
The collected samples were grouped into homogeneous categories, assigned individual sample
numbers, sealed in plastic bags, and transported under proper chain-of-custody documentation to
the selected laboratory.
The following is a summary of the materials that were determined to be asbestos-containing. A list
of the materials that were determined to not contain asbestos fibers are listed in Table 3. Most
asbestos-containing materials must be removed prior to any renovation or demolition. Abatement
contractors shall verify ACM quantities prior to providing bids for removal work.
Table 1 -Positive Asbestos Materials (Asbestos)
lfr,ult
Sam pk \lafl'rial \ppt O'\. ( \slH•sto-,:
~(I. lh·scription Sampll· I o<.·alion I· ri.1hilil) ( ondilion Quan tit) I ) Ill')
-.
' ' 0
resilient sheet WhiteRSF Chrysotile
20 23 26 2 Layer Tan Office/Kitchen Beneath Fnable Good 80 20¼
floorin<> /RSFl
37-39 Grey/Black Roof Category I Good 10 ft' 15%
Penetration Tar non-friable Chrvsotile
40,41 Window Putty Exterior Windows Category II Good 30 ft2 2-3%
non-friable Chrvsotile
43-45 Stucco Exterior Walls Category II Good 2,500 ft' 2-3%
non-friable Chrvsotile
Allee Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page 8
4.3 PLM by 1000-Point Count Analysis with Gravimetric Reduction
In PLM point counting analysis, a graticule containing a crosshair is placed in the ocular ( eye piece)
of the microscope. The place at which the crosshairs meet is known as the "point". The analyst
moves the slide around under the microscope until the "point" lands on a particle. If it is visually
identified as an asbestos fiber the point is counted as an asbestos point. lfit is visually identified as
a non-asbestos particle, the point is counted as a non-asbestos point. If the point falls on an empty
area of the slide nothing is counted and the slide is moved to a new field of view. The process is
repeated until 400 to I 000 asbestos and non-asbestos points are counted. The total number of
asbestos points is found and is divided by the total number of points counted (both asbestos and
non-asbestos). The result is multiplied by 100 to obtain the percent of asbestos in the sample.
Gravimetry is a technique that enhances PLM in the quantitation of asbestos in bulk building
materials by eliminating or significantly reducing the organic matter in the sample (the asbestos
fibers remain). It improves the ability to detect asbestos fibers in the sample and also improves the
quantification. Prior to slide preparation, the sample is dried, weighed and placed in a high
temperature (up to 500 C0) furnace for a 6-hour period. It is then cooled and weighed. Further
treatment with dilute hydrochloric acid may be used to remove carbonates and other acid soluble
substances in the sample. The remaining material is then washed with water, dried and weighed.
The residue is now examined by PLM or other techniques for the presence of asbestos fibers.
Using PLM point counting is performed to determine the concentration of asbestos fibers in the
residue. Once the point count result is obtained, the weight of the residue is used to calculate the
concentration of asbestos in the original sample.
The following table lists the samples that were additionally analyzed by the 1000-point count
method.
Table 2 -I 000-Point Count Results (Asbestos)
Exterior Stucco Exterior
Exterior Stucco Exterior 3%
Exterior Stucco
2.807%
Additional analysis using the 1,000-point count method with gravimetric reduction confirmed the
initial PLM results of 2-3% asbestos content. The estimated amount present is 2,500 square feet.
4.4 Types of Asbestos-Containing Materials
Altec Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page9
All ACMs must be removed prior to any renovation or demolition activities that could result in
damage or disturbance. Regardless of the quantity estimates provided above or in the narratives
below, the abatement contractor must verify the quantities of all ACMs prior to bid submission.
Regulated Asbestos-Containing Material (RACM) is(!) a friable asbestos-containing material,
(2) a Category I non-friable ACM that has become friable, (3) a Category I non-friable ACM that
will be or has been subjected to sanding, grinding, cutting or abrading or ( 4) a Category II non-
friable ACM that has a high probability of becoming or has become crumbled, pulverized, or
reduced to powder by the forces expected to act on the material in the course of demolition or
renovation operations. An initial exposure assessment should be conducted in accordance with Title
8 CCR section 1529 during any disturbance of these materials.
Friable refers to any material containing more than 1 % asbestos as determined by Polarized Light
Microscopy (PLM), that, when dry, can be crumbled, pulverized or reduced to powder by hand
pressure.
Category I ACM (Non-Friable) refers to asbestos containing packing, gaskets, resilient floor
covering, Galbestos™ siding and roofing, and asphalt roofing products containing more than I%
asbestos. Asphalt roofing products, which may contain asbestos, include built-up roofing; asphalt-
containing single ply membrane systems; asphalt shingles; asphalt-containing underlayment felts;
asphalt-containing roof coatings and mastics; and asphalt-containing base flashings. ACM roofing
products that use other bituminous or resinous binders ( such as coal tars or pitches) are also
considered to be Category I ACM.
Category II ACM (Non-Friable) refers to any material that contains greater than l % asbestos and
is not friable and is not a Category I ACM. Category II includes asbestos-cement shingles, tiles, and
transite boards or panels containing more than I% asbestos. In general, Category II ACM is more
likely to become friable when damaged than is Category I ACM.
4.4.1 Friable (RACM)
Resilient Sheet Flooring (RSF) with Friable Paper/Fibrous Backing (2•d Layer)
Asbestos-containing tan RSF is located beneath the top layer of white RSF in the office/kitchen
area of the building. The material contains 20% chrysotile asbestos and is presently in good
condition. This material contains a friable fibrous paper backing, and if it is inseparable from the
two other layers of flooring, they must all be disposed of as asbestos-containing. The estimated
amount present is 80 square feet.
4.4.2 Category I Non-Friable ACM
Roof Patching/Penetration Tar
Asbestos-containing grey/black penetration tar is located on the roof of the dwelling structure and
shed. The material contains 15% chrysotile asbestos and is presently in good condition. The
estimated amount present is IO square feet.
Allee Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page 10
4.4.3 Category II Non-Friable ACM
Transite Pipe
Two asbestos-containing transite pipes are located on the roof of the building and extend into the
attic. The materials were assumed positive and are presently in good condition. The estimated
amount present is 12 linear feet.
Exterior Stucco
Asbestos-containing pink stucco is located on the exterior of the dwelling structure. Point counting
by the I, 000-point count method was performed and confirmed that the material contains 2 to 3 %
chrysotile asbestos. The material is co-located/layered with gray stucco that was analyzed and did
not contain asbestos fibers. However, because these materials are layered and considered to be an
integral system, it is not possible to remove the pink stucco material without also impacting the
gray stucco material. Therefore, the materials should both be considered asbestos-containing and
should be removed/disposed of together. The materials are presently in good condition. The
estimated amount present is 2,500 square feet.
Window Putty
Asbestos-containing window glazing/putty is located on the exterior windows of the building. The
material contains between 2% and 3% chrysotile asbestos and is presently in good condition. The
estimated amount present is 30 square feet.
4.5 Non-ACMs
The following is a list of the sampled materials that did not contain asbestos in concentrations
above the analytical detection limits.
Table 3 -Non-ACM Results
Sampk
'.\os. \lakrial lkscf'iption I or,1fion
1-3 White texture, tan/blue skim coat, plaster Throu!!hout Building
4-12 Wall Texture,Drvwall/Joint Compound Throul!hout NW Addition
13-15 Yellow Cove Base Adhesive Throu!!hout NW Addition
16-18 Yellow Carnet Adhesive Throu<>hout Bui!dinl!
19,22,25 Top Laver flooring, White RSF Office/Kitchen
21 24,27 3 ,d Laver Floorilll!, tan linoleum Office/Kitchen
28-30 White 2' bv 4' Ceilinl! Tile Throughout NW Addition
31-36 ShimdefT ar Paper Roof
42 White window glazing/putty (all of the glazing/putty should Exterior windows
be assumed to contain asbestos because 2 of the 3 collected
samv/es were asbestos-containimz,)
43a-45a Gray stucco (must be remaved along with the asbestos-Exterior
containim! pink stucco /aver)
4.6 Previous ACM Survey Reports
No previous asbestos survey reports or data were provided.
5,0 LEAD PAINT
5.1 XRF Testing Results
Altec Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page I I
Lead XRF testing was performed in the scope of work areas to identify components containing lead
above the established action level or threshold of 1.0 milligram per square centimeter (mg/cm2). In
addition, the current condition of the tested paint/coating was noted. Ceramic tile was also tested to
identify the presence oflead in the glazing.
Prior to the start of testing and at the end of the test period (or 4 hours, whichever is less), Altec
recorded pre-and post-calibration readings on a calibration form. Altec recorded the XRF readings
on data sheets which are presented in Appendix E. Please note that many additional confirmatory
and/or quality assurance readings were taken during the inspection, but listing each of the additional
tests/readings along with the locations, material assessment, etc. would require an exhaustive effort
that was not part of the scope of work.
The components identified in the following table were tested and found to be above 1.0 mg/cm2 by
the XRF analyzer and are lead-based paint. CDPH2, EPA and HUD defines LBP as paint or other
surface coating that contains any amount of lead equal to or in excess of 1.0 mg/cm2 or more than
0.5% by weight. It must be understood that painted/coated materials that contain lead at
concentrations ofless than 1.0 mg/cm2 still contain lead, but these lesser amounts have been
determined to be "safe" by CDPH, EPA and HUD. Cal/OSHA, however, does not consider
concentrations above 600 ppm "safe", and requires bulk sampling and/or air sampling for exposure
assessment purposes to determine regulatory compliance for general industry or construction work.
Table 4 -Positive XRF Results (Lead)
A complete list of all test locations can be found within the XRF data sheet which is provided in
AppendixE.
5.2 Paint Chip Sample Collection and Laboratory Analysis
Altec collected bulk samples from selected tested paint/coatings to assist in future construction
planning. The samples were collected in order to assist the contractors with Cal/OSHA compliance.
It should be noted that this sampling effort did not cover I 00% of the surface coatings or materials
associated with the evaluated structure(s) but does provide an indication as to whether the surface
coatings or materials contain lead in concentrations that will require employee exposure assessment
prior to demolition or renovation.
2 CDPH (Title 17 CCR Division I, Chapter 8, Section 35033).
Allee Testing & Eng. Inc.
Asbestos-Containing Materials & Lead Paint
Inspection, Assessment, Sampling Report
Page 12
The samples were submitted to a National Lead Laboratory Accreditation Program (NLLAP)
accredited laboratory for analysis by EPA 600/R-93/200 Preparation Modified, EPA Method 7000B
Analysis Modified (which is equivalent to ASTM E 1729 -Standard Practice for Field Collection
of Dried Paint Samples for Subsequent Lead Determination).
■ijjjj@jjjjN <luanTEM Laboratories, 2033 Heritage Park Drive, Oklahoma City, OK
A total of 4 samples were collected and submitted for laboratory analysis. The bulk sample results
are presented in the following table:
Table 5 -Bulk Sample Results (Lead)
Bulk \ i,ihh• I l':td lfr,ulis
Samplt' Building Paint '~;. h~ mg,I'":,?. or
\o. { ·ompo1u·nt I ocation Substrate ( 'olor "{'ight ppm'
I
2
3
4
Door Jambsfrrim Throuuhout Interior Wood White <0.005% <50nnm
Walls Throughout Interior Plaster/Drywall Ligbt <0.00495% <49.5 ppm Blue
Doors Throughout Interior Wood Blue <0.00488% <48.8nnm
Eaves/Fascia Exterior Roof Wood Green 1.13% 11,300 ppm
Cal/OSHA Employee Exposure Determination
CCR Title 8 Section 1532.1 (d)(5)(B) indicates that surface coatings or materials that contain lead
at concentrations below 0.06% dry weight (or 600 ppm) do not constitute a health hazard to
employees engaged in typical lead-related construction work. This means that construction work
( demolition of structures, manual scraping, and manual sanding and a few additional tasks)
involving materials below 0.06% or 600 ppm oflead can be performed without the customary
employee protection measures (respiratory protection, protective clothing, clothing change areas,
hand washing facilities, biological monitoring, and training), which are otherwise necessary until
employee exposure monitoring shows that airborne lead concentrations are shown to be below the
lead PEL of 50 mg/m3•
When construction work (involving the tasks described above) involves materials containing lead in
concentration at or above 0.06% or 600 ppm, Cal/OSHA requires that employers must first perform
a negative exposure determination to prove that employee exposures are below the lead PEL before
employees can perform such work without the customary protection measures. In these situations,
employee protection measures must be used until the exposure assessment results are obtained and
confirm exposures are below the lead PEL.
The collected paint chip samples contain lead in concentrations greater than 50 mg/kg; STLC and
TCLP analysis will be required for waste characterization purposes. In addition, any paint chip
waste generated by stabilization efforts (loose and flaking paint scraping) must be contained and
profiled properly for transportation and disposal.
3 milligrams per kilogram (mg/kg)~ parts per million (ppm)
. .
Analytical Flow Chart
Testing Process for Lead Based
Paint/Coated Components for Disposal
in California Landfills
5elrephl
components
andolrtaln ,.,,....,_
sampl" of each
(Samp!H llhoilld
lnducle at lout 200.,..,,....,
matarlal)
,trform
m.c
Analylllby
£PA 7420
Lead Removal
ffiCResultls
BelowSO~
TTLC Result Is
between
S0-349mc/kl
TTLC Result Is
Between
350-999 mg/kl
me Result Is
Abovo 1000 mg/q
P9rform
STLC
Analysis
Perform
"RV
Analysis
me Result ls
Below 5.0 mg/land me
Rosult Is Below 349 mg/kg)
mcResultls
Below 5.0 mg/land TTLC
Rosult Is 350-999 m&/kl
mCResultls
AboveS.Oma/1.
TCLP Result Is
Below S.O mg/l
TCLP Result Is
Abovo 5.0 ma/l.
Demolition activities that will impact lead-based components must be performed by certified/qualified
representatives in compliance with EPA and DOSH rules and regulations. All lead-based paint
components that are deteriorated or peeling must be stabilized in accordance with all applicable
regulations prior to demolition work. A contractor who is trained and holds licenses and insurance in this
field of hazardous materials remediation should conduct any lead related removal work. Exposure
assessments and air monitoring should be conducted in the initial phases of any lead abatement to
determine the amount of personal protection required by workers. Lead components will need to be
properly packaged and characterized utilizing TILC, STLC and TCLP laboratory analysis as necessary to
determine disposal requirements.
Lead Limitations
This inspection was planned and performed in accordance with Altec training and experience in
performing lead inspections. The inspection was performed to support renovation or demolition of the
building(s). It was NOT performed in accordance with Chapter 7 of the HUD Guidelines for the
Evaluation and Control of Lead-Based Paint Hazards in Housing. Altec's evaluation of the relative risk of
exposure to lead identified in this survey is based solely on the conditions observed at the time of the site
visit. This project included limited lead testing and not lead risk assessment. Altec cannot be held
responsible for changing conditions that may alter the condition of the lead component surfaces after the
time of the testing or in changes in accepted protocol, methodology or action levels.
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MATERIALS
QUESTIONNAIRE
RECORD ID # __________________ I
PLAN CHECK # _________________ I
Business Name
Roosevelt Nine, LLC
Project Address (include suite)
2690 Roosevelt Street
Ma1hng Address (include suite)
2033 San Elijo Ave, Ste.
Business Contact Randolf Cherewick
Cily
Carlsbad
City
423, Cardiff,
Slate CA
State
CA
BP DATE
Telephone#
425-345-2773
Zip Code
92008
Zip Code
92007
APN#
Plan File#
Project Contact Applicant E-mail Telephone#
Randolf Cherewick stmichel@msn.com 425-345-2773
The following questions represent tho facility's activities, NOT the specific project doscrlptlon.
PART I: FIRE DEPART -H ARDOUS M TERIALS DIV SI N: CCUPANCY CLASSIFICATION: n r uired for
Diego): Indicate by circling the item, whet er your business will use, process, or slore any of the following hazardous materials.
applicant musl contact the Fire Protection Agency 'Nith Jurisdiction prior to plan submittal.
Occupancy Rating: Facility's Square Footage (including proposed proiect):
5. Organic Peroxides 9. Water Reactives 13. Corrosives 1. Exploslve or Blasting Agents
2. Compressed Gases
3. Flammable/Combuslible Liquids
6. Oxidizers 10. Cryogenics
7. Pyrophorics 11 Highly Toxic or Toxic Materials
14. Other Health Hazards
1 5 None of These
4. Flammable Solids a. Unstable Reaclives 12 Radioaclives
PART II; SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMO): 11 lhe answer to any ot the
quesllons Is yes, appHcanl musl contact the County of San Diego Hazardous Materials Division. 5500 Overland Avenue, Suite 170. San Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building perrrut.
Expected Date or Occupancy: FEES ARE REQUIRED Project Completion Date: (for new construction or remodeling projects)
Is your business listed on the reverse side of this fom1? (check all thal apply).
0 CatARP Exempt
I
1.
2.
3.
4.
5.
6.
7.
8.
YES NO
D IZI WI» your business dispose of Hazardous Subslances or Medical Waste in any amount? D Ill! Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
pounds and/or 200 cubic feel? D Ill!
D D D D D
~ Will your business store or handle carcinogensfreproduclive toxins in any quantity? j Will your business use an exlsUng or lnslall an underground storage lank?
w Will your business store or handle Regulated Substances (CalARP)? Kl Will your business use or inslall a Hazardous Waste Tank System (Title 22. Article 10)?
@ wm your business store petroleum in tanks or contamers at your facility with a total facility storage capacity equal to
or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act).
Date lnilials
0 CalARP Required
I
Date tnibals
0 CalARP Complele
I
Date
PART Ill: SAN DIE COUNTY AIR POLLUTION CON OL DISTRICT APCD: The following quesllOns are intended lo idenlify the maIority of air polluhon
issues at t e planning stage. Your project may require a itional measures not identified by these questions. Some residential projects may be exempt from APCD
requirements. tf yes is answered for either quesllons 1. 2 or 5 or for more comprehensive requiremenls, please contact APCD at apcc!con1p@sdcoun1y_0:!..:.l.' •.-
(858) 586-2650: or 10124 Old Grove Road, San Diego, CA 92131.
1.
2.
3
YES NO
IZI D 0 D
0 □
Will the project disturb 100 square feel or more of existing building materials?
Will any load supporting structural members be removed?
(ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbeslos survey been performed by an individual lhal has passed an EPA-approved
building Inspector course?
4. l1'iJ D (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Based on the survey results. will the project dislurb any asbestos containing material? Ir yes. a
notification may be required at least 10 working days prior to commencing asbestos removal. Add1t1onally. a notification may be required prior 10
5.
6.
D
D
the removal of a road supporting structural member(s) regardless of the presence of asbestos. 181 Will the project or associated construction equipment emit air contaminants? See the reverse side of this fonn for typical equipment requiring an
APCD permit. If yes, contact APCD prior to the issuance of a buildmg permit.
(ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associaled construction equipment be located within 1.000 feet of a school
bounds ? D
Briefly describe business activities: C t t · ons rue ion Briefly describe proposed project: Demolition SFR
I declare under penally of perjury thal to the best of my knowledge and be · Juana Bailey 1Y-/ I I;;; ! Sid:<
Name of Owner or Authorized A enl lri Date
FOR OFFICAL USE ONLY: FIRE DEPARTMENTDCCUPANCY CLASSIFICATION: _____________________________ _
BY· DATE· I I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY •HMO• APCD COUNTY-HMO APCO COUNTY-HMO APCD
~'-'°" Co,,t ,if ,..o.,.
.. Reviewed 9
C 04/14/2022-MF ~
Oate/(nitlals
.t I' 6,, c,o~ D1e90
A stamp m this box gruy: exempts businesses from comp!etmg or updating a Hazardous Malerlals Busmess Plan. Other penmltmg requirements may shll apply
HM-9171 (9/18) County of San Diego -DEH -Hazardous Materials Division
STORM WATER POLLUTION PREVENTION NOTES
1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE
AVAILABLE ON SITE TO FACILITATE RAPID INSTALLATION
OF EROSION AND SEDIMENT CONTROL BMPs WHEN RAIN
IS EMINENT.
2. THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSION
CONTROL DEVICES TO WORKING ORDER TO THE SATISFACTION
OF THE CITY INSPECTOR AFTER EACH RUN-OFF PRODUCING
RAINFALL.
3. THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION
CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY
INSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS OR
UNFORESEEN CIRCUMSTANCES WHICH MAY ARISE.
4. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE
AT THE END OF EACH WORKING DAY WHEN THE FIVE (5)
DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT
( 40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER
EACH RAINFALL.
5. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM
AGGREGATE.
6. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER
PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST
BE INSTALLED AND MAINTAINED.
7. THE CITY INSPECTOR SHALL HAVE THE AUTHORITY TO ALTER
THIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDED
TO ENSURE COMPLIANCE WITH CITY STORM WATER QUALITY
REGULATIONS.
OWNER'S CERTIFICATE:
I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT
BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTION
ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO AVOID
THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO
AVOID THE EXPOSURE OF STORM WATER TO CONSTRUCTION
RELATED POLLUTANTS; AND (2) ADHERE TO, AND AT ALL TIMES,
COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP
THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES
UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED
BY THE CITY OF CARLSBAD.
l <...c, iJ..""" tf UI k'>1 ~<
:Rs-~GENT NAME PRINT
,-.-.:,-,c-~ac/
O~fOWblER'S AGENT NAME (SIGNATURE) ~4/42-DATE
E-29
STORM WATER COMPLIANCE FORM (!,8;;_1..,oz2 -11.s-/
TIER 1 CONSTRUCTION SWPPP
BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE
Erosion Control
BMPs Sediment Control BMPs I Tracking I Non-Storm Water I Waste Management and Materials
Best Management Practice*
(BMP) Description ➔
CASQA Designation ➔
Construction Activity
Grading/Soil Disturbance
Trenching/Excavation
Stockpiling
Drillinq/Borina
Concrete/Asphalt Sowcutting
Concrete Flatwork
Paving
Conduit/Pipe Installation
Stuce<y'Mortar Work
Waste Disposal
Sta_g_inq/Loy Down Area
Equipment Maintenance and Fuelina
Hazardous Substance Use/Storage
De watering
Site Access Across Dirt
Other (list):
w -0 "' 'Ow
"' cc "' Ii cc 0,5 :c w "' " "'"' ,; ;:!!: Ql "' 0 "' X 0 "' -'O .c cc
0 0 t·o "' 0 OL "' ,. WO
"1 00 10, I I I u u u w w w
w cc ·e
0
"' g.
"'
'T u w
"' " cc "' "--V)
'T w "'
X
),
c_
0 L f-E -0 cc 0 "' E -"' " 'o " "' .c
"' u
"' ..,.
I I w w "' "'
Control BMPs
cc cc :8 0
'O -cc " " 0 -C, C,
E "' L L
"' L --L cc "' c w w w "' ·c: -cc w cc 'a. CD L 0"' 0 "' 0 cc UL u w o> "' o> CD ·o c: o> 0 "' cc "fil~ 'O >, 0 L 0 CD "'·-o> O:..:; i!:l 0 Ct'. E 0 NW
" -C, .c E al = UJ =~ L "' C, 'O :c e ·--o
"' > " " 00 .c 0 0 cc 0 o> .c L .:Oo 0 -L ii, cc .s 0 G: "' v,> "' v, CL "' Ct'.
U') "' r--00 0 N
I I I I 'T 'T I w w w w w ~ ~ "' "' "' "' "'
Management BMPs Pollution Control BMPs
--
cc -0 --cc "' 'O cc
"' 0 E cc "' 'O cc -" "' 0 E cc 0 ·c: c_
"" 'O L ':, "' 0 "' cc ' >, "' -~ ·c: <T L 0 cc w L "' 0 L "' w cc 0
"' "' > "" ,._ -., 0 -w 'O w ~ 'O " w "' cc "' cc cc cc cc cc cc 0 ::::, ~ _., w"' 0 w 0 "' [3 E " E u"' 0 0 "' "' " en:;:::; "' "' cc o"' :g c._ L-,. "' 0"' L•-:0 u·c ·-o> CL O "' 1:' o> .,-cc 0 LO "' -"' L 'O 0 O 0 -" ·1; ~ .s ·-0 0, L " -~ 00 i:5~ -o -0 = c:: ·-cc N CC
0 o_ 0 -c_ 0 oo 0 0 ,. 0:: CLO CL >u ::,; "' "' "' "' u "'::,; :c::,;
"' r--00 N "' ..,. U') "' 'T I I I 'T I I I I I
"' U1 "' "' "' :::, ~ :::, ::,; "' :z z :z z ,. ,. ,. ,. ,.
./4
)l
Instructions: 1. Check the box to the left of all applicable construction activity (first column) expected to occur during construction.
2. Located along the top of the BMP Table is a list of BMP's with it's corresponding California Stormwater Quality Association (CASQA) designation number. Choose one
or more BMPs you intend to use during constnuction from the list. Check the box where the chosen activity row intersects with the BMP column.
3. Refer to the CASQA construction handbook for information and details of the chosen BMPs and how to apply them to the project.
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PROJECT INFORMATION
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Construction Threat to Storm Water Quality
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