HomeMy WebLinkAbout245 ACACIA AVE; ; CBRA2023-0051; PermitBuilding Permit Finaled
( City of
Carlsbad
Residential Associated Permit
Print Date: 08/21/2023
Job Address: 245 ACACIA AVE, CARLSBAD, CA 92008-3206
Permit Type: BLDG-Associated Permit Residential Work Class:
Parcel#: 2042400800 Track#:
Valuation: $90,000.00 Lot#:
Occupancy Group: Project#:
#of Dwelling Units: Plan#:
Bedrooms: Construction Type:
Bathrooms: Orig. Plan Check#:
Occupant Load: Plan Check#:
Code Edition:
Sprinkled:
Project Title:
Description: DEMOLITION OF (2) EXISTING SMALL HOMES (11,250 SF)
FEE
DEMOLITION OF BUILDING: RESIDENTIAL
SB1473-GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION -RESIDENTIAL (SMIP)
Demo
Total Fees: $607.70 Total Payments To Date: $607.70
Building Division
Permit No:
Status:
CBRA2023-0051
Closed -Finaled
Applied: 04/26/2023
Issued: 04/26/2023
Finaled Close Out: 08/21/2023
Final Inspection: 06/05/2023
INSPECTOR: Renfro, Chris
Balance Due:
AMOUNT
$592.00
$4.00
$11.70
$0.00
Pagelofl
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov
( Cicyof
Carlsbad
RESIDENTIAL
BUILDING PERMIT
APPLICATION
B-1
Plan Check
Est. Value
PC Deposit
C BA-tr ·2 o.2.? -CIV 5 I
Date
Job Address,___;2_'-/..:....:;_7....:.,/4-...::.f....:./J..;.C_/,4.;___,4-_V_£_. _____ Unit:. ____ APN:. ________ _
CT/Project #: __________________ ,Lot #: ____ Year Built: _________ _
BRIEF DESCRIPTION OF WORK: 17,er,t,Pu -r,o,-.1 OF c'.?> ,f lYtJll'U. l,Hw~f>
1/1 '2fo {"-~~.
0 New SF: Living SF, ____ Deck SF, ___ Patio SF, ____ Garage SF __ _
Is this to create an Accessory Dwelling Unit? O Y O N New Fireplace? O YON, if yes how many? ___ _
D Remodel: SF of affected area Is the area a conversion or change of use? O YON -----
□ Pool/Spa:. _____ SF Additional Gas or Electrical Features? ____________ _
0Solar:. ___ KW,, ___ Modules, Mounted:QRoofQGround, Tilt: 0Y0 N, RMA:OY ON,
Battery:OYO N, Panel Upgrade: OYON Electric Meter number: ___________ _
Other:
APPLICANT (PRIMARY CONTACT) PROPERTY OWNER
Name:f?,,.-trJr-1 /f,fK-fi Name: _________________ _
Address: 'rJI~ J/p,y/q,,l .et'(t:1tv/lt ~ddress:. _______________ _
City: C:':akl> State: C./1-Zip: q,zp~ City:. _________ State: ___ .Zip: ____ _
Phone:~91 ~ 7ft,-u,;zo ~ Phone:. _______________ _
Email: ;f;f;tt,cll a ,Kr!Y'~/'r~.CJ.P/11 Email: _______________ _
DESIGN PROFESSIONAL CONTRACTOR OF RECORD
Name:, __________________ Business Name:. ________________ _
Address: Address:, _________________ _
City: ________ .State: ___ Zip: ____ _ City: _______ State: ___ ,Zip: ______ _
Phone: _________________ _ Phone: __________________ _
Email: _________________ _ Email: __________________ _
Architect State License: ___________ _ CSLB License #: _______ Class:. ______ _
Carlsbad Business License# (Required): _______ _
APPLICANT CERTIFICATION I certify that I have read the app/Jcat1on and state that the above 1nformat1on 1s correct and that the mformatron of the plans 1s accurate I
a::::m;;:;::1)~,tya,d,;:;;la;l:;;wldmgcoa,::::, ~ r DATE: 2 t '3
1635 Fa,aday Ave Caclsbad, CA 92008 Ph 442-339 2719 f
REV. 04122
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.
(OPTION A): LICENSED CONTRACTOR DECLARATION:
I herebyaff irm under penalty of perjury that I am I icensed under provisions of Chapter 9 ( commencing with Section 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect. I a/so affirm under penalty of perjury one of the
following declarations (CHOOSE ONE}:
~ have and will maintain a certificate of consent to sel
~rk which this permit is issued. PolicyNo. ___ --;~~---J.'--t-4'---,f.---c;>.~,._,--_ ____________________________ _
-OR-
DI 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: lnsuranceCompany Name:-------------------------•
Policy No. ____________________________ Expiration Date: _________________ 1 -OR-
D 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 CERTIFICATION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and
utilities/utility easements. All proposed modifications and/or additions are clearly labeled on the site plan. Any potentially existing 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 appl'1cat'1on is based on the premise that the submitted documents and plans show
the correct dimensions of; the property, buildings, structures and their setbacks from property lines and from one anotl1er; access roads/easements, and utilities. The existing and proposed
use of each building as stated is true and correct; all easements and other encumbrances to development have been accurately shown and labeled as well as all on-site grading/site preparation. All::::,;::;;:~;: the pcopecty wm;;_;ted ic cocdacce wit~;'~'::~::~':"'"'' at t timrtcoctioc "°'"' 0
::~::oted'(,/ ,< &, /z
2
Note: If the person signing above is an authorized agent for the contra 'd er of authorization on contractor letterhead. f ' ,
-OR-
(OPTION B): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
D I, 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).
-OR-
DI, 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).
-OR-
DI am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason:
AND,
D FORM B-61 "Owner Builder Acknowledgement and Verification Form" is required for any permit issued to a property owner.
By my signature below I acknowledge that, except for my personal residence in which I rriust 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 bl.Jilt 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 foflowing Web site: http://www./eginfo.ca.gov/calaw. html.
OWNER CERT/FICA TION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and utilit1es/ut1lity
easements. All proposed modifications and/or additions are clearly labeled on the site plan. Any potentially existing 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, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities. The existing and proposed use of each
building as stated is true and correct; all easements and other encumbrances to development have been accurately shown and labeled as well as all on-site grading/site preparation. All
improvements existing on the property were completed in accordance with all regulations in existence at the time of their construction, unless otherwise noted.
NAME (PRINT): SIGN: __________ DATE: ______ _
Note: If the erson si nin above is an authorized a ent for the ro ert owner include form B-62 si ned b ro ert owner.
1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339~2719 Email: Building@carlsbadca.gov
2
REV. 04/22
Building Permit Inspection History Finaled
(city of
Carlsbad
PERMIT INSPECTION HISTORY for (CBRA2023-0051)
Permit Type: BLDG-Associated Permit Residenti,
Work Class: Demo
Status: Closed -Finaled
Application Date: 04/26/2023 Owner:
Issue Date: 04/26/2023 Subdivision: PALISADES #2
Expiration Date: 12/04/2023
IVR Number: 48620
Address: 245 ACACIA AVE
CARLSBAD, CA 92008-3206
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Date Status
06/05/2023 06/05/2023 BLDG-11 213130-2023 Passed Chris Renfro
Monday,August21,2023
Foundation/Ftg/Piers
(Rebar)
Checklist Item
BLDG-Building Deficiency
NOTES Created By
Angie Teanio
COMMENTS
Demo
TEXT
949-910-3510 Chad
BLDG-Final Inspection 213252-2023 Passed
Checklist Item
BLDG-Building Deficiency
BLDG-Plumbing Final
BLDG-Structural Final
BLDG-Electrical Final
COMMENTS
Demo completed
Chris Renfro
Passed
Yes
Created Date
06/02/2023
Passed
Yes
Yes
Yes
Yes
Complete
Complete
Page 1 of 1
NOISl/1I0 8NI07In8
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€202 9 g ~dV
COMPREHENSIVE AS~lffi93~
SURVEY REPORT
FOR
245 Acacia
Carlsbad, CA
Prepared for
Rincon
DATE
12/09/2022
Report# 2212-091-942222
CONDUCTED BY
Jackson Environmental
120 Tustin Ave C-1121
Newport Beach, CA 92663
949-230-9779
Mjacksonenvironmental@gmail.com
TABLE OF CONTENTS
INTRODUCTION
SECTION I ASBESTOS SURVEY SUMMARY
Executive Summary
Facility Description
Survey Findings
SECTION II BUILDING INSPECTION FOR ASBESTOS
Bulk Sampling
Bulk Sample Analysis
Quality Assurance
Limitation of Sampling Suspect Asbestos Containing Materials
SECTION Ill LABORATORY REPORTS
Asbestos Laboratory Reports
INTRODUCTION
Jackson Environmental was retained by Rincon to conduct a COMPREHENSIVE
Asbestos survey for the property located at 245 Acacia, Carlsbad, CA, on November
14th, 2022. The purpose of this survey was to identify Asbestos Containing Material
(ACBM) in all areas of the building. Work consisted of collecting bulk samples of All
materials suspect of containing asbestos.
THE REPORT
The survey report is divided into three major sections, which provide identification of all
suspected ACBM.
Section I presents a summary of the Asbestos Survey and a general description of the
area inspected. Survey findings are also provided in this section.
Section II describes the methodology used to perform the survey and includes Jackson
Environmental, and our Analytical quality control procedures.
Section Ill of this report summarizes the locations and materials which were identified
as containing asbestos. Results of the bulk samples are included in this section.
SECTION I
ASBESTOS SURVEY SUMMARY
EXECUTIVE SUMMARY
Jackson Environmental was retained by Rincon, to conduct a COMPREHENSIVE
Asbestos Survey for the property located 245 Acacia, Carlsbad, CA. The sampling was
conducted by Michael Jackson an Osha certified asbestos consultant # 04-3635
FACILITY DESCRIPTION
The subject property is a single family, one story, wood frame building, set on a
foundation. While on-site the Certified Personnel noted the condition of the materials.
This is noted in the survey findings below.
SURVEY FINDINGS
The following building materials were identified and or assumed as containing
asbestos:
Building Material Location Friable/NonFriable/ Condition SQ' A~~roximate
ect.
Mastic Kitchen Non Friable G 200
Interior Plaster <1 % Throughout Non Friable G 2000
Exterior Plaster <1 % Stucco Non Friable G 2000
**Please note square footages are approximate estimates only and should not be used
as a basis for bidding purposes**
RECOMMENDATIONS:
All Significantly Damaged and Damaged areas should be repaired or removed as soon
as possible to avoid any potential hazards that may result from further disturbance of
ACM. SCAQMD's Rule 1403 requires a Procedure 5 Work Plan for any unscheduled
asbestos fiber release episode involving ACM or Class II non-friable ACM.
SECTION II
COMPREHENSIVE ASBESTOS INSPECTION
BULK SAMPLING
Bulk samples of areas containing suspect ACBM were collected. A homogeneous area
is defined as surfacing material, thermal insulation, or miscellaneous material that is
uniform in color, texture, or date of application.
Samples were collected using wet methods; where they are deemed appropriate, to
minimize fiber release. Prior to sampling, the location is misted with water from a spray
bottle. A sample of the suspect material is then collected using a chisel, core borer,
knife, or other appropriate tool. After the sample was collected, the bulk material was
placed in a sample bag which was sealed to prevent fiber release or contamination by
outside sources. Samples are documented by entering the sample data on a bulk log,
including a description of the material, a unique sample number is assigned to each
sample and the sample bag was labeled with that number. During the survey, the
technician also notes the condition of the material being sampled, its location, condition,
and friability.
Note: The amended National Emission Standard for Hazardous Air Pollutants
(NESHAP), November 20, 1990, included a requirement that when the asbestos content
of a bulk sample material is determined using procedures outlined in the Interim Method
and the asbestos content is estimated to be less than 10% by method other than Point
Counting, the parties legally responsible for a building (owner/operator) may elect to
assume the amount to be greater than 1 % and treat the material as a regulated
asbestos containing material. If the owner or operator does not want to assume the
material is asbestos containing, verification of the amount of asbestos by the Point
Counting method may be required. The purpose of this procedure is to minimize false
negative analysis, and false positive. Point Counting was included in NESHAP in
response to an HEPA study that found unacceptable amounts of false positive and false
negative analyses by methods outlined in the Interim Method. Unless otherwise
directed, American Analytical will assume that PLM analysis is acceptable for this
survey.
CLASSIFICATION OF BULK BUILDING MATERIALS
"S" Significantly Damaged Material with one or more of the following characteristics:
The surface is crumbling or blistered over at least one tenth of the surface if the
damage is evenly distributed :( one quarter or more if the damage is localized).
One tenth (one quarter or more, if localized) of material hanging from the surface,
deteriorated, or showing adhesive failure.
Water stains, gouges, or mars over at least one tenth of the surface if the
damaged is evenly distributed (one quarter or more if the damage is localized).
Accumulation of powder, dust, or debris similar in appearance to the suspect
material on surfaces beneath the material can be used as confirmatory
evidence.
We recommend immediate removal of Significantly Damaged material and clean
up of the area by a Licensed Asbestos Abatement Contractor.
"D" Damaged Material with the following characteristics:
The surface is crumbling, blistered, water-stained, gouged, marred or otherwise
abraded over less than one tenth of the surface ii the damage is evenly
distributed (less than one quarter if the damage is localized).
Accumulation of powder, dust, or debris similar in appearance to the suspect
material on surfaces beneath the material can be used as confirmatory
evidence.
We recommended removal of damaged material and clean up of the area by a
Licensed Asbestos Abatement Contractor.
"G" GOOD Material with no visible damage or deterioration. or showing only very
damage or deterioration.
We recommended materials identified as in good condition be placed on an
Operations and Maintenance Program (0 & M).
BULK SAMPLE ANALYSIS
All bulk samples were analyzed by Patriot Laboratory 1041 S. Placentia Ave, Fullerton,
CA, 92831. Phone# 714-607-5227, an NVLAP accredited laboratory. The laboratory
accreditations are as follows:
NVLAP #200642-0 National Voluntary Laboratory Accreditation Program (Federal)
Approximately 10% of the bulk samples were split for quality control purpose.
All bulk samples were analyzed by Polarized Light Microscopy (PLM) with dispersion
staining in accordance with the EPA Method #600/R-93/116. 40 CFR 783.87. The
reliable limit of detection for PLM is 1.0%. Where "None Detected" or ND appears in the
report, it should be interpreted as meaning that no asbestos was observed in the
sample. Samples containing, "Trace" level of asbestos indicates a possible
contamination and is considered ACBM.
NOTE: If a sample contains greater than 1.0% asbestos, it is a regulated material by
Federal Government Standards. Under the California State Education Code, materials
containing greater than 0.1 % in asbestos content are considered regulated.
QUALITY ASSURANCE
Statement of Quality Assurance
At Jackson Environmental Quality Assurance is priceless! Jackson Environmental is
committed to providing analytical services and data to its clients that are of the highest
quality and legally defensible.
Quality Assurance (QA) procedures were employed to ensure reliable results for
analysis of bulk samples as follows:
The laboratory is currently participating in the NVLAP Quality Assurance
Program.
Quality control is processed on at least 10% of all bulk samples on a daily basis.
Laboratory results of samples submitted to the laboratory were within 3% of the original
side by side sample.
LIMITATION OF SAMPLING OF SUSPECT ASBESTOS CONTAINING MATERIAL
Reasonable effort is made by Jackson Environmental 's staff to locate and sample
suspect materials. However, for any facility the existence of unique or concealed
asbestos containing material and debris is a possibility. In addition, sampling and
laboratory analysis constraints typically hinder the investigation. American Analytical
does not warrant, guarantee, or profess to have the ability to locate or identify all
asbestos containing materials in any given facility. This report is intended to be used in
planning for construction or demolition. This report is not intended to be a construction
document.
Jackson Environmental is not, and has no responsibility as, a generator, operator,
treater, storer, transporter or disposer of hazardous materials or waste found or
identified as a result of Jackson Environmental's work.
STATE REQUIREMENTS
In accordance with State of California Regulation, all surveys are conducted by
personnel holding a minimum of a Site Surveillance Technician certificate. This
certificate is awarded to individuals who have fulfilled specific educational and
experience requirements, as well as having completed extensive training in asbestos
specific courses. Additionally, the State also mandates these individuals pass a
rigorous examination. This examination is prepared, proctored, and graded by State
officials. The Certified Asbestos Consultant must fulfill all the education and experience
requirements as the Site Surveillance Technician but must have additional and more
extensive asbestos related training. Candidates for Certified Asbestos Consultant must
also pass a more rigorous examination before being approved by the State of California.
In compliance with State of California Requirements surveys and reports prepared by a
Certified Site Surveillance Technician are reviewed, approved, and signed by a Certified
Asbestos Consultant.
Certified Asbestos Consultant
Michael Jackson
Project Manager
CAC # 04-3635
949-230-9779
Report # 2212-092-942222
Certificate of Analysis
PLM Asbestos Identification
Jackson Environmental
120 Tustin Ave C-1121
Newport Beach, CA 92663
Date Collected:
Date Received: 11/15/2022
Date Analyzed: 11/17/2022
Date Reported: I I/ 18/2022
Lab/Client ID/Layer Location
942222-001 Kitchen
Total Asbestos None Detected
942222-002 Kitchen
2
Total Asbestos None Detected
942222-003A Kitchen
3
Total Asbestos None Detected
942222-0038 Kitchen
3
Chrysotile 2 %
Total Asbestos 2
942222-004 Living Room
4
Chrysotile <I %
Total Asbestos <1
%
%
tel -114-601-1117
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~[lab•!l'!Ji-Otlab.com DATnl~T LAB 1041 I. Plii!enliaA,eou,,firlJ,rto,, [A 91831 1--" I ■,1 ~
Report Number:
Project Number:
Prl~ject Name:
Project Location:
Collected By:
Claim Number:
PO Number:
942222
245 Acacia
245 Acacia
Carlsbad, CA
Number of Samples: 16
Material Description Color
Flooring Brown
Flooring Brown
Flooring Brown
Mastic Brown Black
Interior Plaster White Green
Composition ( % )
90% Non-
Fibrous Material
10% Glass
Fibers
9WY'c Non-
Fibrous Material
10% Glass
Fibers
90% Non-
Fibrous Material
10% Glass
Fibers
98% Non-
Fibrous Material
!00% Non-
Fibrous Material
P<1ge I of4
Certificate of Analysis
PLM Asbestos Identification
Jackson Environmental
120 Tustin Ave C-1121
Newport Beach, CA 92663
Date Collected:
Date Received: I 1/15/2022
Date Analyzed: I 1/17/2022
Date Reported: I I /I 8/2022
Lab/Client ID/Layer Location
942222-005 Bedroom I
5
Chrysotile <I %
Total Asbestos <1
942222-006 Bedroom 2
6
Chrysotile <I %
Total Asbestos <I
942222-007 Living Room
7
Total Asbestos None Detected
942222-008 Bedroom 1
8
Total Asbestos None Detected
942222-()()9 Bedroom 2
9
Total Asbestos None Detected
942222-010 Side
10
Chrysotile <l %
Total Asbestos <I
%
%
%
tel -114-&0Mlll
Ire! -815-91,lHill
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104lS.!'la,,nl.iAv.mi,.f•l~rtoo,{A911lll I.-,... I'-. ~
Report Number: 942222
Project Number:
Project Name: 245 Acacia
Project Location: 245 Acacia
Carlsbad, CA
Collected By:
Claim Number:
PO Number:
Number of Samples: 16
Material Description Color Composition ( % )
Interior Plaster White Green 100% Non-
Fibrous Material
Interior Plaster White Green 100% Non-
Fibrous Material
Acoustic White Beige 100% Non-
Fibrous Material
Acoustic White Beige 100% Non-
Fibrous Material
Acoustic White Beige 100% Non-
Fibrous Material
Ext Plaster Tan Grey 100% Non-
Fibrous Material
Page 2 of 4
Certificate of Analysis
PLM Asbestos Identification
Jackson Environmental
120 Tustin Ave C-1121
Newport Beach, CA 92663
Date Collected:
Date Received: 11/15/2022
Date Analyzed: 11/17/2022
Date Reported: 11/18/2022
Lab/Client ID/Layer Location
942222-01 I Rear
I I
Chrysotile <I %
Total Asbestos
942222-012 Front
12
Chrysotile <I %
Total Asbestos
942222-013 Roof
13
<1
<1
Total Asbestos None Detected
942222-014 Roof
14
Total Asbestos None Detected
942222-015 Roof
15
Total Asbestos None Detected
%
%
t'1l -114-60)-1111
tree -85l-%1H512
O(tab:,:f>'!li~ll•bxom n A "l"'r.9:l~T LAB
1041 S. 1'1arnnlii! im,11, foll,rtoa, (A 91ill 1--". I 1,1 ~
Report Number:
Project Number:
Project Name:
Project Location:
Collected By:
Claim Number:
PO Number:
942222
245 Acacia
245 Acacia
Carlsbad, CA
Number of Samples: 16
Material Description Color
Ext Plaster Tan Grey
Ext Plaster Tan Grey
Roofing Black
Roofing Black
Roofing Black
Composition ( % )
1 00o/r) Non-
Fibrous Material
100% Non-
Fibrous Material
80% Non-
Fibrous Material
20% Glass
Fibers
80% Non-
Fibrous Material
20% Glass
Fibers
80% Non-
Fibrous Material
20% Glass
Fibers
Page 3 of 4
Certificate of Analysis
PLM Asbestos Identification
Jackson Environmental
120 Tustin Ave C-1121
Newport Beach, CA 92663
Date Collected:
Date Received: 11/15/2022
Date Analyzed: 11/17/2022
Date Reported: 11/18/2022
Lab/Client ID/Layer Location
Carla Ruiz -Analyst
Report Number:
Project Number:
Project Name:
Project Location:
Collected By:
Claim Number:
PO Number:
942222
245 Acacia
245 Acacia
Carlsbad, CA
Number of Samples: 16
Material Description Color Composition ( % )
Kwin Sheena Legaspi -Lab Manager-Approved By
Bulk sampk(s) submiHcd was (were) analy7cd in accordance with the procedure outlined in the US Federal Register 40 CFR 763. Subpart f, Appendix
A: EPA-600/R"93/l 16 {Method for Determination of Asbestos in Building Materials). and EPA-600/M4-82-020 (US EPA Interim Method for the
Determination of Asbestos in Bulk Insulation Samples). Samples were analyzed using Calibrated Visua] Estimations (CVES); therefore, results may not he
reliable for samples of low asbestos rnncentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and
reported as composite unless ~pccifically rc4uested by the customer to report analytical results for individual layers. This report applies only to the items
tested. Results are representative of the samples ;.ubmitted and may not represent the entire material from which the samples were collected. "None
Detected" means that no asbestos was observed in the sample. "< 1 %"" (less than one percent) or Trace means that asbestos was observed in the ~ample hut
the concentration is below the quantifiable level of 1 % . This report was i;.sue<l by a NIST/NVLAP (Lab Code 200358-0) and CADOHS-ELAP (Cert. No.
2540) accredited laboratory and may not be reprodwxd, except in full without the expressed written consent of Patriol Environmental Laboratory
Services. Inc. This report may not be used to claim product certification. approval or endorsement by NIST, NVLAP, ELAP or any govemmenl agency
ASB_Rcp_8. l 4
Page 4 of 4
REPORT NUMBER (Lab Use Only)
q Ll 1.:z..:1----L I
CHAIN OF CUSTODY
COMPANY INFORMATION
Company Name: Jackson Environmental Project No.:
Contact Person: Michael Jackson Project Name:
Company Address: Project Location:
1
PATRIOT LAB
FULLERTON I LOS ANGELES I SAN DIEGO I SAN JOSE
Tel: (888)743-0998 • Email: laboratory@patriotlab.com
PROJECT INFORMATION
. POii: ' -7u.~ Ar-°",,.!°' .
:l,.'f .5 -1c. le.-r-'\
f'_,-..r I<.{,~ ·----
Contact Phone: Sample(s) Collected By: l Date: ..
Email(s) For Special Instructions: T.est to fi~ positive Report:
Turnaround Time D1HR 0 3HR O6HR Dz4HR 0 48 Hir' nul!R: OsoAv (Busir1ess Hours/Days)
ANALYSIS REQUESTED
► FUNGI BACTERIA ---~ ~~I.M'IBiJH;,/llllestos) 0 PLM POINT COUNT 400 ~ Viable (Colony ID & Enum~ration) □ PRESENCE/ABSENCE ---.,, 9 0 D SWAB/BULK ' sa Iii EPA 600/M4-82-020 □ PLM POINT COUNT 1000 0 Tot.14 Coliform & E.coli -
"' EPA 600 / R-93 / 116 m Non-Viable surface Surfuces, SWllbs, and Bidk J m 0 PCM (Fiber Count) 0 GRAVIMETRIC REDUCTION 0 Sollds. Uqulm Coon-
~ a: □ TAPE LIFT/SWAB/BULK potable, fflNl-.waslewatllr) u
N\OSH 7400 i □ AIR SPORE TRAP
~ LEAD BY RAME AA -EPA 3050B/7420mod, NIOSH 7082mod
0 PAINT □ DUSTWIPE 0 SOILS/SOLIDS □AIR □ WATER (non-potable) Iii
i LEAD WASTE PRDALE (by Flame AA) D Check here to perform ALL THREE tests necessary for disposal (S-7 Days TAT) ... :c • 0 TTLC ONLY (Total Threshold by EPA 30508 mod) 0 STLC/CAL WET ONLY (CCR Ch11, A,t;cle 5, App II) □ TCLP ONI.Y (EPA 1331)· u
NOTE: Pleose proVlcle approx. 200 gr~imS{appl'OX:½ lb.) of Sample for complete profile.
0 ROTOMETER CALIBRATION Total Rotometers: □ pH TESTING (Soils, solids, liqulds, misc.) EPA 9045
• • IFOR AIR SAMPLES ONLY!)
le 'ii I!. Description of Sample ~ ,": LDcadon Sampled (Material Type, Dimensions, start Stop Total A'I. Total .I! ~ etc.) Time Tlme Min. R-Vol. .. , .
fl L,. : J_,.. {, (.) ) . y /('(-,,,) A L,
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Rellnqu/shed By: {Prir1t) imo Relinquished By: (Print) (Sign)
Michael Jackson
(Date) (Time}~ (Date) (Time)
' r I
Received By: ~~!\ ~\L'~\ RecellJed By: (Print) (Sign)
(D'1\. \ f:;, ?Jo (TI"to (Date) (Time}
Method of Shipment l Preservation During Shipment: Condition of Samples: Acceptabte -u,u
Comments: "'•·
v.G.22.2022
1
REPORT NUMBER (Lab Use Only/
~~ 1, =r::-ci,,
.J
PROJECT NAME: _______ _
PROJECT NUMBER: _______ _
' PA1Rl0TLAB
FULLERTON I LOS ANGELES I SAN DIEGO I SAN JOSE
Tel: {888)743-0998' Email: laboratory@patrlotJab.com
~ -~., (FOR AIR SAMPLES ONLYI) -;A,·,·'
....
• • ... 15.c J! Description ofSample
To.I.I
-
E-LDcation Sampled (Material Type, Dlmensions, Start .... Total '• .ii Stop Flow etc.) Time Time Min. .. .. Vol. •
a I°' .; ,~Ao s::-~ {)l,,,.c;h /
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Relinqulshlld By: (Print) <~n Relinquidled By: (Print) (Sign)
Michael Jackson
(Date) (Time) (/ tDate} (Time) . . ' '
Recelv.d By: .. \'H~v~VWI (Sit JVL, Received By: jPrtnt) {Sign)
16a -l:y) r {Time) ;>;---(Date)· (Time)
v.15 . .U.ztl22
Notes: Patriot's holding time for all samples submitted 30 days for solid samples, 7 days for digests, and immediate for lead in air after analytical results are reported.
Unless customer provides written instructions to extend holding time, samples will be disposed of in accordance with local, state, and federal law.
*3 Hour Turnaround Time available until 2pm PST. Gravimetric Reduction requires minimum 10 HR Turnaround Time. Viable fungi samples require minimum S-7 days
Turnaround Time. Bacterial cultures require minimum 30 HR Turnaround Time. STLC/CAL-WETand TCLP require mlnlmum 72 HR Turnaround Time.
2
'
•
-----------------. -------SAN DIEGO REGIONAL OFFICE USE ONLY
0 HAZARDOUS MATERIALS RECORD ID#
PLAN CHECK#
~-. ,. QUESTIONNAIRE I I
~""oc BP DATE
Business Name
,, -------------81.lsiness Contact -·----Tele~one#
Vick Construction Company L')'le Vick 9 9-501-2555
Project AddreSs (include suite) c~ State Zip Code APN#
245 Acacia Ave ' arlsbad Ca 92008
t-.Aailing Address (inctude suite) City State Zip Code Plan Ftle#
12942 Leith Way Yucaipa Ca 92399
Project Contact Applicant E-mail Telephone#
Lyle Vick Lvle@vick.construction 909-501-2555
The following questions represent the facility's acttvltln, NOT the speclflc project descr1ption.
PART I: ARE DEPARTMENT~ HAZARDOUS MATI;RIALS DIVISION: OCCUPANCY CLASSIFICATION: !not regulred for projeets within the City 'lf San Qinstl: lnc:ltcate by orcl,ng _the item, ~ether your business wdl use, process, or store any of the following hamrdous materials. If any of the items are arcled.
applicant must contad the Fire Protection Agency with jurisdiction prior to plan submittal.
Oeeupancy Rating: Facility's Square Footage (including proposed project):
1. Expk)s!ve or Blasting Agents 5. Organic Peroxides 9. Water Reaclives
2. Compressed Gases 6. Oxidizers 10. Cryogenics
3. Flammable/Combustible Liquids 7. Pyrophorics 11, Highly Toxic or Toxic Materials
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
13,
14,
15,
Corrosives
Other Health Hazards
None of These.
Questions ts yes, applicant must contact the County o San Diego Hazardous Materials Division, 550 Over1and Avenue, urte 1 an Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building permit
FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy:
1.
2.
3.
4.
5.
6.
7.
8.
YES NO (for new construction or remodeling projects)
§ ~ Is your business listed on the reverse side of this form? {check all that apply),
□
§
D
" WiO your business dispose of Hazardous Substances or Medical Waste in any amount?
..., Will your business store or handle Hazardous Substances in quantiUes greater than or equal to 55 gallons, 500
pounds and/or 200 cubic reet? 0 Win your business store or handle carcinogens/reproductive toxins in any quantity? 0 Win your business use an existing or install an underground storage tank?
~ WiO your business store or handle Regulated Substances (CalARP)?
[ZJ WiD your business use or install a Hazardous Waste Tank System (Title 22, Article 10}? 0 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),
0 CalARP Exempt
I
Date Initials
0 GalARP Required
I
Date Initials
0 CalARP Complete
I
Date Initials
PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT APCD: The following questions are intended to identify the majority of
air ution tsSues at e p nning stage. our project may require a itiona measures not identified by these questions. Residences are typically
exempt, except~ single building with more than four dwelling units and those with more than one detached residential buildings
on the property-e.g. granny flats [+Exdudes garages & small outbuildings nol used as dwelling units]. If yes is answered for the questions below
please see link for further instructions: here or for more comprehensive requirements, please contact apcdcomp@sdapcd.org or call (858) 586--2650.
YES NO
10 □
2,0 □
3.□
4.0
Will the project disturb 100 square feet or more of existing building materials? If yes, submit an asbestos survey to apcxlcomp@sdapcd.org.
Wdl any load supporting structural members be removed? . If yes, submit an asbestos survey and demolition notification to
apcdall'np@sdapc:d.org at least 10 WOfking days priOf' to starting lhe demo~tion of a load bearing structure. A notification Is required even if no asbestos is present
in the structure.
{ANSWER ONLY IF QUESTION 1 IS YES) Will 100 square feet Of' more of friable asbestos material be disturbed? If yes, submit a notification of asbestos
removal to apcdcomp@sdapcd.org at least 10 working days prior to starting asbestos removal.
Wdl any equipment or operations be installed that may require an APCD Permit to Operate? Please see the reverse side of this tom, for typical equipment
requiring an APCO permit. If yes, contact APCD prl°' to the issuance of a building pennit.
Briefly describe business activities: Briefly describe proposed project:
3 new single fam· y residents Demolition and grading
S:: / / 7 / ?o23
Date
FOROFFI
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION
BY: DATE: I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RElEASfD FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMO• APCD COUNTY-HMO APCD COUNTY-HMO APCD
-.)'-'on Cor,t. §' 'o, q
~ Reviewed ~ -~~{!6/~~23 __ MF
O<'ltt->/(l'Hll.tls
-.S::J"
,, .~ Diego co . A stamp In thtS box ~ exempts busmesses from completing Of updating a Hazardous Matenals Business Plan. Other pennitting reqwremenlS may still apply
HM-9171 (01/22) County of San Diego -DEH -Hazardous Materials DMslon
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[I EXISJ'JNG STRUCMIE TO 8E RHrlOVED
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I EX/STll/G TREE TO BE REMOVED
:I EX/STl/lG FENCE TO BE RE.lf.'.JVED
I f!(/SJ'JNGWAil TOBE REMOVED
]J EXISJ'JNGWALL TOREWJN
II] EXISTINGIIARDSCAFf TOBE FIEM'.WEO
[I) EXISTINGOVERHEADIJIJUTYTOBEREMOVED
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SITE NOTES
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EXCEPTIOO OF SE\tER IJIJLJTlES CONTRACTOR TO F/Ell) \IERJFY smrn IJlJ/JTIES
2 A.LL EXISTI/l, ONSITF. STROCTI.RES TO BE DfMOUSHED U/'l.ESS OJHERl'l!SE NOTED
3 Ail EX/STlM; ON!SiTF. /REES TO BE REMO\IED I.KESS OTIEffWISE NOTED
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FOR IOFEET.AND~ FORA II/JIIMUMOF5o,t,/NACCORDAIK:f. WTH THE 2016
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PASCO LARET SUITER "'---'"----
-----&ASSOCIATES San Diego I Soh~~ Q~,-'-' ~-----r----• REVIEWED BY
Phone 858 259 ~
CBRA2023-0051
245 ACACIA AVE
I
DATE
DEMOLITION OF (2) EXISTING SMALL HOMES (11,250 SF)
DAtt J N'nAL
ENGINEEI 0f wtlflC REVISION DESCRIPTION "~ ,,,., . 2042400800
4/26/2023
CBRA2023-0051