HomeMy WebLinkAbout148 TAMARACK AVE; ; CBR2019-0757; PermitPERMIT REPORT
Residential Permit
Print Date: 08/03/2021
Job Address: 148 TAMARACK AVE,
Permit Type: BLDG-Residential
Parcel#: 2042530700
Valuation: $5,482.40
Occupancy Group:
#of Dwelling Units:
Bedrooms:
Bathrooms:
Project Title: 148 TAMARACK AVENUE
CARLSBAD, CA 92008-4059
Work Class:
Track#:
Lot#:
Project#:
Plan#:
Construction Type:
Orig. Plan Check#:
Plan Check#:
Description: PINPOKINTR: DEMO 650 SF SFD AND 240 SF GARAGE
Applicant:
JEFF PARSHALLE ARCHITECT
JEFF PARSHALLE
PO BOX 230132
ENCINITAS, 92023
(619) 985-4099
FEE
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
SB1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-RESIDENTIAL
Demo
DEV2016-0047
Total Fees: $136.83 Total Payments To Date: $136.83
(city of
Carlsbad
Permit No: CBR2019-0757
Status:
Applied:
Issued:
Fina led Close Out:
Inspector:
Final Inspection:
Balance Due:
Closed -Expired
04/02/2019
02/12/2020
AMOUNT
$79.48
$55.64
$1.00
$0.71
$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 Page 1 of 1
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
Ccityof
Carlsbad
RESIDENTIAL
BUILDING PERMIT
APPLICATION
B-1
Plan Check
Est. Value
PC Deposit ---------
Date ----'L/,_,_J=-.i+-t1~'1 __
Suite: _____ APN: __________ _
CT/Project#:. __________ Lot#: ____ Fire Sprinklers: yes/ no Air Conditioning: yes/ no
□ Addition/New: ______ ,Living SF, ____ Deck SF, ____ Patio SF, ____ Garage SF
Is this to create an Accessory Dwelling Unit? Yes/ No New Fireplace? Yes/ No, if yes how many? __
D Remodel: SF of affected area -----Is the area a conversion or change of use ? Yes/ No
0 Pool/Spa: ____ SF Additional Gas or Electrical Features? ____________ _
□ Solar: ___ KW, ___ Modules, Mounted: Roof/ Ground , Tilt: Yes/ No, RMA: Yes/ No, Battery: Yes/ No
Panel Upgrade: Yes/ No
D Reroof: _____________________________________ _
D Plumbing/Mechanical/Electrical Only: ________________________ _
D Other: ____________________________________ _
APPLICANT (PRIMARY CONTACT} ,
Name: fA{:51trl ?1r)PCJNN 1"'
Address: 201:2 t1l)lt?' At i/L VVl'r t
City: UL (B gp State: vA Zip: 9 ')-O~ 1
Phone: ~c r '.2o~3S'~~
Email: Y'-'.JiA;-,h lm4 t'J:m'lL/2 COh1
DESIGN PROFESSIONAL
Name: ✓ft/7" e;/tl-.f'.-o/# (,, 4S
Address: /• • ~« 2-3<> /!,4-
City: ptVCf/V /7}/£ State:<:# Zip:
Phone: v/9. '11':£ · lh9!l
Email: "ic#, .,¢&eh. '1-f'/-
Architect State License: _ _.(!.,__,.(i,_1..:.1-..,~'-"-2------
PROPERTY OWNER
Name: tlJ if;,r&--/P'l,VC
Address: ___________________ _
City: __________ .State: __ ~Zip: ____ _
Phone: ___________________ _
Email: ____________________ _
CONTRACTOR BUSINESS
Name: ___________________ _
Address: __________________ _
City: _______ State: ___ .Zip: ______ _
Phone: ___________________ _
Email: ___________________ _
State License: ______ Bus. License: ______ _
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License law
{Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he/she is exempt therefrom, and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}).
1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov
8-1 Page 1 of 2 Rev. 06/18
( OPTION A): WORKERS'COMPENSATION DECLARATION:
I hearby affirm under penalty of perjury one of the following declarations:
□ I have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the
work which this permit is issued.
□ I have and will m~intain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation insurance carrier and policy number are: Insurance Company Name: ______________________ _
Policy No. ______________ Expiration Date: _________ _
0 Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to be come
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 cl vii 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.
CONTRACTOR SIGNATURE: __________________ □AGENT DATE: _____ _
( OPTION B ): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
□ 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).
p(.1, 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).
□ I am exempt under Section ________ ,Business and Professions Code for this reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. □ Yes □ No
2. I (have/ have not) signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction (include name address/ phone/ contractors' license number):
4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name/ address/ phone/
contractors' license number):
5. I wlll provide some of the work, but I have contracted (hired) the followl persons to provide the work indicated (include name/ address/ phone/ type of work):
DATE: ___,,l-7-pL,t'4/,C£'J'-•..::.U'--
CONSTRU
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: _____________________ _
ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ Yes □ No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No
ts the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ Yes □ No
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES ANO THE AIR POLLUTION CONTROL DISTRICT.
APPLICANT CERTIFICATION:
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction.
I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP
HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF
THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized
by such permit is not commenced within 180 days from ate of s ermit or if the building or work authorized by such permit is suspended or abandoned at anytime
after the work is commenced for a period of 180 (Sectio Uniform Building Code).
1635 Faraday Ave Carlsbad, C
B-1
2008 Ph: 760-602-2719 Fax: 760-602-8558
Page 2 of2
Email: Building@carlsbadca.gov
Rev. 06/18
·--------···-·····-'"-·---··---
December 30, 2020
JEFF PARSHALLE ARCHITECT
ATTN: JEFF PARSHALLE
PO BOX 230132
ENCINITAS, 92023
RE: BUILDING PERMIT EXPIRATION
PERMIT TYPE: BLDG-Residential, Demo
{city of
Carlsbad
PERMIT#: CBR2019-0757
ISSUED: 02/12/2020
ADDRESS: 148 Tamarack Ave
Carlsbad, Ca 92008-4059
Our records indicate that your building permit will expire by limitation of time on 02/16/2021.
18.04.030 Section 105.5 amended -Expiration:
Every permit issued by the Building Official under the provisions of this code shall expire by limitation
and become null and void if the building or work authorized by such permit is not commenced within
180 calendar days from the date of such permit, or if the building or work authorized by such permit is
stopped at any time after the work is commenced for a period of 180 calendar days, or if the building or
work authorized by such permit exceeds three calendar years from the issuance date of the permit.
Work shall be presumed to have commenced if the permittee has obtained a required inspection
approval of work authorized by the permit by the Building Official within 180 calendar days of the date
of permit issuance. Work shall be presumed to be stopped if the permittee has not obtained a required
inspection approval of work by the Building Official within each 180 day period upon the initial
commencement of work authorized by such permit.
Before such work can be recommenced, a new permit shall be obtained to do so, and the fee therefore
shall be one half the amount required for a new permit for such work, and provided that no changes
have been made or will be made in the original plans and specifications for such work, and provided
further that such suspension or abandonment has not exceeded one year. In order to renew action on a
permit after expiration, the permittee shall pay a new permit fee.
Any permittee holding an unexpired permit may apply for an extension of time within which work may
commence under that permit when the permittee is unable to commence work within the time period
required by this section for good and satisfactory reasons.
Please check below indicating your intentions and return this letter to us.
D Project abandoned. A new permit will be obtained prior to commencing work.
D No fee extension requested for 180 days. (Must attach a letter of explanation)
D Renewal permit requested.
If the project has been completed and only a final inspection is needed, please call the
inspection request line at (760) 602-2725.
If you have any questions, please contact the Building Inspection Division at 760-602-2700.
Community & Economic Development
Building Division I 1635 Faraday Avenue Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
/
APR o
C17 'r 2 20/g
BL u
DEMOLITION ASBESTOS CERTIFICATION A')
'ro . v
ADDRESS: / r g r/4")7~/Z~ cK-Z:,/PT!f-Ct'/tE..!:-
USE OF BUILDING TO BE DEMOLISHED: J1,u G-t.£ &.mrc. 7 (Zi!E~/t?£~ctf;. i 6,'r~
SQUARE FEET CJ}.. 1f~u X NUMBER OF STORIES __ / ___ _
PROPERTY OWNER: flri Strr-/ <pi'N poK :rv-r1e. '
ADD RESS: _1-o....;;.....:.-:;,,_1_...:...fr\41\.___;__;1 ;__:..-47..::..../J~L ....;..W.:..:.A...:...1,1---&).:....2-__,;();;...;:;(};....11---PHONE 760--&0 f 5 .s-sz;
APPLICANT: J t:re fr>~5/#lt-c,~
PHONE ~ 19, 98-5' · 1tJ'1J
------------------------------,--------------------------------------------------------------------------------------------------------------------------------------
Section 19827.5 of California Health and Safety Code states in part:
"A demolition permit shall not be issued by any city ... as to any building or other
structure except upon receipt from the permit applicant of a copy of each written
asbestos notification regarding the building that has been required to be submitted
to the United States Environmental Protection Agency or to a designated state
agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations,
or the successor to that part. The permit may be issued without the applicant
submitting a copy of the written notification if the applicant declares that the
notification is not applicable to the scheduled demolition project."
As applicant for a demolition permit in the City of Carlsbad, I certify that; I have
read the excerpt from Section 19827 .5 of the Health and Safety Code provided
above; the information I have provided on this form is true and correct; and I further
certify the following:
(· ) On the attached ___ pages are copies of all written asbestos notifications
regarding the above referenced building that are required to be submitted to
the United States Environmental Protection Agency or to Part 61 of Title 40
of the Code of Federal Regulations, or successor to that part.
( 0 I declare that the written asbestos notification is not applicable to the
sche uled demolition project.
Date
Rev. 11112118
-~
April 11, 2019
tel -ass-m-e,oo
fret · 855-781-4522
fu • 858-677.goog
Patrlotlab.com
~ tusk Blvd .. Suite A-JOO, San Oifgo, CA 92121
Paisan Pinpokitr
2072 Mar Azul Way
Carlsbad, CA 92009
. RECt/\lF')
FEB ~ 2 2020
CiTY0
fJ '
Re: Limited Asbestos Inspection
Paisan Pinpokitr
148 Tamarack Avenue
Carlsbad, CA 92008
Claim No: NIA
Project No: SD126961
Dear Mr. Pinpokitr,
'-3 J
ulON
On April 9, 2019, California DOSH Certified Site Surveillance Technician, Mr. Francisco
Barney (CSST 14-5283) of Patriot Environmental Laboratory Services, Inc. (Patriot) performed
a limited asbestos inspection at the above subject property located in Carlsbad, California. The
purpose of the inspection was to determine if asbestos is present in any of the building
materials soon to be disturbed by an upcoming demolition at the subject property.
Summary o(Findings
No asbestos was detected in the building materials sampled.
Property Description
The subject property is a single-family residential structure. The subject building is a single-story
wood frame building set on a raised foundation.
Scope of Work
On April 9, 2019, Mr. Francisco Barney, (CSST 14-5283) of Patriot conducted a limited asbestos
inspection at the subject property. The interior of the building was visually inspected for the
purpose of inventorying any suspect asbestos containing materials soon to be disturbed by an
upcoming demolition at the subject property. Once the inventory of suspect materials was
created, physical bulk samples were collected of the materials from representative locations.
Samples were collected in airtight containers. Upon collection, sample numbers, descriptions,
and collection locations were entered on to a chain of custody for transportation to Patriot's
NVLAP accredited laboratory.
Sampled Suspect Materials
Samples of the following suspect materials were collected:
Drywall & Joint Compound Pink Fiber Glass Insulation Grev Mastic
Grey Roof Shingles ----
Sample Protocol/Analvsis
Samples were collected in accordance with the Asbestos School Hazard Emergency Response
Act ( 40 CFR 763 Subpart E) as mandated by Cal/OSHA (Title 8 Section 1529).
Physical bulk samples were analyzed by Patriot. Patriot is accredited by the National Voluntary
Laboratory Accreditation Program (200358-0). The method of analysis was Polarized Light
Microscopy (EPA 600/M4-82-020).
Recommendations
No asbestos was detected in the building materials sampled. Therefore, no recommendations are
warranted at this time.
Disclaimer
Limited destructive sampling was conducted at the subject property. If additional suspect
materials are discovered during renovation, all work should cease until a Certified Asbestos
Consultant is contracted to ascertain the possibility of asbestos content. This inspection was
performed in accordance with current regulations and state of the art practices. The inventory of
asbestos containing materials and determination of their condition are based upon conditions
observed at the time of inspection. Patriot does not assume responsibility for future regulatory
changes or changes in the condition of the building.
Enclosed is the laboratory analysis report. Please contact our office if there are any questions
regarding this inspection.
Sincerely,
Cristopher J. Meile
Certified Asbestos Consultant 08-4340
Enclosure: Laboratory Results
,.
Certificate of Analysis
PLM Asbestos Identification tel • 858 ·671-8900
free • 855-787-4521
fax -858·67MO09
Patriotlab.com
6640 Lusk Bfvd., Suite A-100, San Diego, CA 91121
Paisan Pinpokitr Report Number: 760411
Paisan Pinpok.itr Project Number: SD126961
2072 Mar Azul Way Project Name: Paisan Pinpokitr Carlsbad, CA 92009 Project Location: 148 Tamarack A venue·
Carlsbad, 92008
Date Collected: 4/9/2019 Collected By: Francisco Barney
Date Received: 4/10/2019 Claim Number:
Date Analyzed: 4/10/2019 PO Number:
Date Reported: 4/10/2019 Number of Samples: 34
Lab/Client ID/Layer Location Material Description Color
760411-001 Living Room Wall Drywall and Joint White
Compound
Total Asbestos None Detected
760411 -00IA Living Room Wall Drywall White
Total Asbestos None Detected
760411 -001B Living Room Wall Joint Compound White
Total Asbestos None Detected
760411-002 Kitchen Wall · Drywall and Joint White
2 Compound
Total Asbestos None Detected
760411-003 Hall Wall Drywall and Joint White
3 Compound
Total Asbestos None Detected
Composition (%)
80% Sulfate
10% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
84% Sulfate
12% Cellulose
4% Glass Fibers
95% Carbonate
5% Paint
95% Carbonate
5% Paint
80% Sulfate
10% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
Page l of7
Certificate of Analysis
PLM Asbestos Identification
Paisan Pinpokitr
Paisan Pinpokitr
2072 Mar Azul Way
Carlsbad, CA 92009
Date Collected: 4/9/2019
Date Received: 4/10/2019
Date Analyzed: 4/10/2019
Date Reported: 4/10/2019
Lab/Client ID/Layer Location
7604 I 1-003A Hall Wall
3
Total Asbestos None Detected
76041 l-003B Hall Wall
3
Total Asbestos None Detected
760411-004 Bath Wall
4
Total Asbestos None Detected
76041 l-004A Bath Wall
4
Total Asbestos None Detected
76041 l -004B Bath Wall
4
Total Asbestos None Detected
tel -858-677-8900
free -S.55-787-4522
fax ~ 858·671-9009
Patriotlab,com
6640 Lusk Blvd .. Suite A-100, San Diego, CA 92121
Report Number: 760411
Project Number: SD126961
Project Name: Paisan Pinpokitr
Project Location: 148 Tamarack A venue
Carlsbad, 92008
Collected By: Francisco Barney
Claim Number:
PO Number:
Number of Samples: 34
Material Description Color Composition(%)
Drywall White 84% Sulfate
12% Cellulose
4% Glass Fibers
Joint Compound White 95% Carbonate
5% Paint
Drywall and Joint White 80% Sulfate
Compound l 0% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
Drywall White 84% Sulfate
12% Cellulose
4% Glass Fibers
Joint Compound White 95% Carbonate
5% Paint
Page 2 of7
Certificate of Analysis
PLM Asbestos Identification
Paisan Pinpokitr
Paisan Pinpokitr
2072 Mar Azul Way
Carlsbad, CA 92009
Date Collected: 4/9/2019
Date Received: 4/10/2019
Date Analyzed: 4/10/2019
Date Reported: 4/10/2019
Lab/Client ID/Layer Location
760411-005 Bedroom Wall
5
Total Asbestos None Detected
760411-00SA Bedroom Wall
5
Total Asbestos None Detected
760411-00SB Bedroom Wall
5
Total Asbestos None Detected
760411-006 Attic Surface
6
Total Asbestos None Detected
76041 1-007 Attic Surface
7
Total Asbestos None Detected
760411 -008 Attic Surface
8
Total Asbestos None Detected
tel-858·677-8900
free~ 8SS• 787-4S22
fax -853·671-9009
Patriotlab.com
6640 Lusk Blvd., Suite A· 100, San Diego, CA 92121
Report Number: 76041 I
Project Number: SDl26961
Project Name: Paisan Pinpokitr
Project Location: 148 Tamarack Avenue
Carlsbad, 92008
Collected By: Francisco Barney
Claim Number:
PO Number:
Number of Samples: 34
Material Description Color Composition ( % )
Drywall and Joint White 80% Sulfate
Compound 10% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
Drywall White 84% Sulfate
12% Cellulose
4% Glass Fibers
Joint Compound White 95% Carbonate
5% Paint
Fiberglass Insulation Pink 100% Fiberglass
Fiberglass Insulation Pink 100% Fiberglass
Fiberglass Insulation Pink 100% Fiberglass
Page 3 of7
Certificate of Analysis
PLM Asbestos Identification
Paisan Pinpokitr
Paisan Pinpok.itr
2072 Mar Azul Way
Carlsbad, CA 92009
Report Number:
Project Number:
Project Name:
Project Location:
Collected By:
Claim Number:
PO Number:
tel -858·677-8900
free-85,-781-4522
fax -858·671-9009
Patriotlab.com
6640 Lusk Bl~d., Suite A-100, San Diego, CA 92121
760411
SD126961
Paisan Pinpokitr
148 Tamarack A venue
Carlsbad, 92008
Francisco Barney Date Collected: 4/9/2019
Date Received: 4/10/2019
Date Analyzed: 4/10/2019
Date Reported: 4/10/2019 Number of Samples: 34
Lab/Client ID/Layer Location Material Description Color Composition ( % )
760411-009 House At Roof Penetration Mastic Black Grey 98% Non-
9 Fibrous Material
2% Polyethaline
Total Asbestos None Detected
760411-010 House At Roof Penetration Mastic Black Grey 98% Non-
10 Fibrous Material
2% Polyethaline
Total Asbestos None Detected
760411-011 House At Roof Penetration Mastic Black Grey 98%Non-
11 Fibrous Material
2% Polyethaline
Total Asbestos None Detected
760411-012 House At Roof Surface Roof Shingles Grey 70% Non-
12 Fibrous Material
30% Cellulose
Total Asbestos None Detected
760411 -013 House At Roof Surface Roof Shingles Grey 70%Non-
13 Fibrous Material
30% Cellulose
Total Asbestos None Detected
Page 4 of7
Certificate of Analysis
PLM Asbestos Identification
Paisan Pinpokitr
Paisan Pinpok.itr
2072 Mar Azul Way
Carlsbad, CA 92009
Report Number:
Project Number:
Project Name:
Project Location:
Collected By:
Claim Number:
PO Number:
tel· 858·677-8900
free -855-787-4522
fax -858·677-9009
l'atriotlab.com
6640 Lusk Blvd •• Suite A-100, San Diego, CA 92121
760411
SD126961
Paisan Pinpok.itr
148 Tamarack Avenue
Carlsbad, 92008
Francisco Barney Date Collected: 4/9/2019
Date Received: 4/10/2019
Date Analyzed: 4/10/2019
Date Reported: 4/1 0/20 I 9 Number of Samples: 34
Lab/Client ID/Layer
760411 -014
14
Total Asbestos
760411-015
15
Total Asbestos
760411-015A
15
Total Asbestos
760411-0l 5B
15
Total Asbestos
76041 1-016
16
Total Asbestos
Location
House At Roof Surface
None Detected
Detached Garage At Wall
None Detected
Detached Garage At Wall
None Detected
Detached Garage At Wall
None Detected
Detached Garage At Wall
None Detected
Material Description
Roof Shingles
Drywall and Joint
Compound
Drywall
Joint Compound
Drywall and Joint
Compound
Color
Grey
White
White
White
White
Composition(%)
70% Non-
Fibrous Material
30% Cellulose
80% Sulfate
10% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
84% Sulfate
12% Cellulose
4% Glass Fibers
95% Carbonate
5% Paint
80% Sulfate
10% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
Page 5 of7
Certificate of Analysis
PLM Asbestos Identification
Paisan Pinpokitr
Paisan Pinpokitr
2072 Mar Azul Way
Carlsbad, CA 92009
Date Collected: 4/9/2019
Date Received: 4/10/2019
Date Analyzed: 4/10/2019
Date Reported: 4/10/2019
Report Number:
Project Number:
Project Name:
Project Location:
Collected By:
Claim Number:
PO Number:
Number of Samples:
tel • 858·671 ·8900
free -85S-787-4m
fa:< -658-677-9009
Patriotlab.wm
6640 Lus:k Blwd., Suite A-100, San Diego, CA 92121
760411
SDl26961
Paisan Pinpokitr
148 Tamarack A venue
Carlsbad, 92008
Francisco Barney
34
Lab/Client ID/Layer Location Material Description Color Composition ( % )
76041 l -016A Detached Garage At Wall Drywall White 84% Sulfate
16 12% Cellulose
4% Glass Fibers
Total Asbestos None Detected
76041 l -016B Detached Garage At Wall Joint Compound White 95%. Carbonate
16 5% Paint
Total Asbestos None Detected
760411-017 Detached Garage At Wall Drywall and Joint White 80% Sulfate
17 Compound J 0% Cellulose
6% Carbonate
2% Glass Fibers
2% Paint
Total Asbestos None Detected
760411 -017 A Detached Garage At Wall Drywall White 84% Sulfate
17 12% Cellulose
4% Glass Fibers
Total Asbestos None Detected
76041 l-017B Detached Garage At Wall Joint Compound White 95% Carbonate
17 5% Paint
Total Asbestos None Detected
Page 6 of7
Certificate of Analysis
PLM Asbestos Identification
Paisan Pinpokitr
Paisan Pinpokitr
2072 Mar Azul Way
Carlsbad, CA 92009
Report Number:
Project Number:
Project Name:
Project Location:
Collected By:
Claim Number:
PO Number:
tel -858·677-8900
free -855· 787-4522
fax -858·671-9009
Patriotlab.com
6640 LU$k Blvd .. Suite A-100, San Diego, CA 92121
760411
SD126961
Paisan Pinpokitr
148 Tamarack A venue
Carlsbad, 92008
Francisco Barney Date Collected: 4/9/20 I 9
Date Received: 4/10/2019
Date Analyzed: 4/1 0/2019
Date Reported: 4/10/2019 Number of Samples: 34
Lab/Client ID/Layer
760411-018
18
Total Asbestos
760411-019
19
Total Asbestos
760411-020
20
Location
Detached Garage At Roof
Surface
None Detected
Detached Garage At Roof
Surface
None Detected
Detached Garage At Roof
Surface
Total Asbestos None Detected
Material Description Color
Roof Shingles Grey
Roof Shingles Grey
Roof Shingles Grey
Composition ( % )
70% Non-
Fibrous Material
30% Cellulose
70% Non-
Fibrous Material
30% Cellulose
70%Non-
Fibrous Material
30% Cellulose
7604 l 1-002 No drywall present; joint compound only.
Krystal Prodigalidad -Analyst Krystal Prodigalidad -Approved By
Bulk sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US Federal Register 40 CFR 763, Subpart P, Appendix
A; EPA-600/R-93/1 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 Visual Estimations (CVES); therefore, results may not be
reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and
reported as composite unless specifically requested by the customer to report analytical results for individual layers. This report applies only to the items
tested. Results are representative of the samples submitled and may not represent the entire material from which the samples were collected. "None
Detected" means that no asbestos was observed in the sample. "<I%" (less than one percent) means that asbestos was observed in the sample but the
concentration is below the quantifiable level of I%. This report was issued by a N[ST/NVLAP (Lab Code 200982-0) and CADOHS-ELAP (Cert. No.
2805) accredited laboratory and may not be reproduced, except in full without the expressed written consent of Patriot Environmental Laboratory Services,
lnc. This report may not be used to claim product certification, approval or endorsement by NIST, NVLAP, ELAP or any government agency.
Page 7 of 7
Lab· Use Only: :=tl,OLJJ) tel -858-677-89D0
free -855-787-4522
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Bulk $ample COC Rev 12.27.2017
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MA TE RIALS
QUESTIONNAIRE
RECORD ID# _________________ _
PLAN CHECK# __________________ I
BP DATE
Business Name Business Contact Telephone#
APN# Project Address l/8 St~ Zip Code 'f'JO~t, '2 d </ -Z, S3 -0? • Oo
Mailing Address C!!;' , State Zip Code ~ O. ~4'1( 'J,Jo !Jv p,tVu,-/1 -p/J q; ,f'J,,() i, 3 Plan File#
Project Contact
The following questions represent the facility's activities, NOT the specific project description. I 'f
PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects withio the City of San
Diego): Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any p f the items, are,cir.cled,
applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. ~Pf? O '
Occupancy Rating: Facility's Square Footage (including proposed project): C; r 2 <O
1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. CorreJives U · /9
2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards
3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These.J
4. Flammable Solids 8. Unstable Reactives 12. Radioactives .., ' I
PART 11: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMO): If the answer to any of the
questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San 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:
YES N()-(for new construction or remodeling projects)
1. D ~ Is your business listed on the reverse side of this form? (check all that apply).
2. D Gr: Will your business dispose of Hazardous Substances or Medical Waste in any amount?
3. D 0'" Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
4.
5.
6.
7.
8.
pounds and/or 200 cubic feet? O ll1f Will your business store or handle carcinogens/reproductive toxins in any quantity?
0 G2f Will your business use an existing or install an underground storage tank? D g' Will your business store or handle Regulated Substances (CalARP)? D li2f Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
D EJ"' Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to
or realer than 1,320 allons? (California's Above round Petroleum Stora e Act).
0 CalARP Exempt
I
Date Initials
0 CalARP Required
I
Date Initials
0 CalARP Complete
I
Date Initials
PART 111: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): Any YES* answer requires a stamp from APCD 10124 Old Grove Road, San
Diego, CA 92131 apcdcomp@sdcounty.ca.gov (858) 586-2650). [*No stamp required if Q1 Yes and 03 Yes and Q4-Q6 No]. The following questions are intended
to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive
requirements contact APCD. Residences are typically exempt, except -those with more than one building• on the property; single buildings with more than four
dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. [•Excludes garages & small outbuildings.]
YE9" NO
1. ~ -D Will the project disturb 160 square feet or more of existing building materials?
2. g": D Will any load supporting structural members be removed? Notification may be required 1 O working days prior to commencing demolition.
3. §" D (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance
......./ Technician?
4. El b1 (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification
may be required 1 O working days prior to commencing asbestos removal.
5. D ig/ Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.sdapcd.org/info/facts/permits.pdf) for typical equipment requiring an APCD permit.
6. D D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
bounda
Briefly describe business activities:
'7/~6U ~tt, #~~l:!/VC.c
Briefly describe propo ed project: £-
r/ I fl=
f I z. I 19'
Date
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. _____ -,,,L---------------------------
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 APCD COUNTY-HMO APCD
.. *A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEAL TH -HAZARDOUS MATERIALS DIVISION
Check all that apply:
AUTOMOTIVE
D Battery Manufacturing/Recycling
D Boat Yard
D CarWash
D Dealership Maintenance/Painting
D Machine Shop
D Painting
D Radiator Shop
D Rental Yard Equipment
D Repair/Preventive Maintenance
D Spray Booth
D Transportation Services
D Wrecking/Recycling
CHEMICAL HANDLING
D Agricultural supplier/distributor
D Chemical Manufacturer
D Chemical Supplier/Distributor
0 Coatings/Adhesive
0 Compressed Gas Supplier/Distributor
0 Dry Cleaning
D Fiberglass/Resin Application
D Gas Station
0 Industrial Laundry
D Laboratory
D Laboratory Supplier/Distributor
0 Oil and Fuel Bulk Supply
D Pesticide Operator/Distributor
CHEMICAL HANDLING
D Photographic Processing
D Pool Supplies/Maintenance
D Printing/Blue Printing
D Road Coatings
D Swimming Pool
D Toxic Gas Handler
D Toxic Gas Manufacturer
METAL WORKING
D Anodizing
0 Chemical Milling/Etching
D Finish-Coating/Painting
D Flame Spraying
D Foundry
D Machine Shop-Drilling/Lathes/Mills
0 Metal Plating
D Metal Prepping/Chemical Coaling
D Precious Metal Recovery
D Sand Blasting/Grinding
D Steel Fabricator
D Wrought Iron Manufacturing
AEROSPACE
0 Aerospace Industry
0 Aircraft Maintenance
D Aircraft Manufacturing
OTHERS AND MISCELLANEOUS
0 Asphalt Plant
D Biotechnology/Research
D Chiropractic Office
D Co-Generation Plant
D Dental Clinic/Office
D Dialysis Center
D Emergency Generator
D Frozen Food Processing Facility
D Hazardous Waste Hauler
D Hospital/Convalescent Home
D Laboratory/Biological Lab
0 Medical Clinic/Office
D Nitrous Oxide (NOx) Control System
D Pharmaceuticals
0 Public Utility
D Refrigeration System
D Rock Quarry
D Ship Repair/Construction
D Telecommunications Cell Site
D Veterinary Clinic/Hospital
D Wood/Furniture Manufacturing/Refinishing
ELECTRONICS
D Electronic Assembly/Sub-Assembly
D Electronic Components Manufacturing
D Printed Circuit Board Manufacturing
NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES.
ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE
HAZARDOUS MATERIALS DIVISION (HMO) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (858) 505-6880.
LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES
Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District.
CHEMICAL
47 -Organic Gas Sterilizers
32 -Acid Chemical Milling
33 -Can & Coil Manufacturing
44 -Evaporators, Dryers & Stills Processing
Organic Materials
24 -Dry Chemical Mixing & Detergent Spray
Towers
35 -Bulk Dry Chemicals Storage
55 -Chrome Electroplating Tanks
COATINGS & ORGANIC SOLVENTS
27 -Coating & Painting
37 -Plasma Arc & Ceramic Deposition Spray
Booths
38 -Paint, Stain & Ink Mfg
27 -Printing
27 -Polyester Resin/Fiberglass Operations
METALS
18 -Metal Melting Devices
19 -Oil Quenching & Salt Baths
32 -Hot Dip Galvanizing
39 -Precious Metals Refining
ORGANIC COMPOUND MARKETING
(GASOLI NE, ETC)
25 -Gasoline & Alcohol Bulk Plants & Terminals
25 -Intermediate Refuelers
26 -Gasoline & Alcohol Fuel Dispensing
COMBUSTION
34 -Piston Internal -Combustion Engines
13 -Boilers & Heaters (1 million BTU/hr or larger)
14 -Incinerators & Crematories
15 -Burn Out Ovens
16 -Core Ovens
20 -Gas Turbines, and Turbine Test Cells & Stands
48 -Landfill and/or Digester Gas Flares
ELECTRONICS
29 -Automated Soldering
42 -Electronic Component Mfg
FOOD
12 -Fish Canneries
12 -Smoke Houses
50 -Coffee Roasters
35 -Bulk Flour & Powered Sugar Storage
SOLVENT USE
28 -Vapor & Cold Degreasing
30 -Solvent & Extract Driers
31 -Dry Cleaning
ROCK AND MINERAL
04 -Hot Asphalt Batch Plants
05 -Rock Drills
06 -Screening Operations
07 -Sand Rock & Aggregate Plants
08 -Concrete Balch, CTB, Concrete Mixers, Mixers
&Silos
1 O -Brick Manufacturing
OTHER
01 -Abrasive Blasting Equipment
03 -Asphalt Roofing Kettles & Tankers
46 -Reverse Osmosis Membrane Mfg
51 -Aqueous Waste Neutralization
11 -Tire Buffers
17 -Brake Debonders
23 -Bulk Grain & Dry Chemical Transfer & Storage
45 -Rubber Mixers
21 -Waste Disposal & Reclamation Units
36 -Grinding Booths & Rooms
40 -Asphalt Pavement Heaters
43 -Ceramic Slip Casting
41 -Perlite Processing
40 -Cooling Towers -Registration Only
91 -Fumigation Operations
56 -WWTP (1 million gal/day or larger) & Pump
Station
NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION
CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division