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Home My WebLink AboutGRAND AVE 15900_04-00002595 i 73 i of Lake' Elsinore 130 South Main Street s PERMIT PERMIT NO: 04-00002595 DATE: 10/06/04 JOB ADDRESS . . . . . : 15900 GRAND AVE TENANT NBR, NAME . . . UNITS A,B & D-K DESCRIPTION OF WORK DEMOLISH ALL OTHERS OWNER CONTRACTOR ELSINORE NAVAL & MILITARY SCHO ENVIRONMENTAL CONTROL 15900 GRAND AVE 3564 CENTRAL AVE LAKE ELSINORE CA 92530 RIVERSIDE, CA 92506 909-788-1483 LIC EXP 0/00/00 A.P.## . . . . . 381-050-002 1 SQUARE FOOTAGE 0 OCCUPANCY . . . - GARAGE SQ FT 0 CONSTRUCTION . . FIRE SPRNKLR . VALUATION . . . 10, 000 ZONE . . . . . . NA DEMOLITION PERMIT QTY UNIT CHG ITEM CHARGE BASE FEE 30 . 00 10.00 X 30.0000 DEMO PERMIT PER UNIT 300 . 00 1.00 X 5.0000 PROFESSIONAL DEV FEE 5 . 00 FEE SUMMARY CHARGES PAID DUE PERMIT FEES DEMOLITION PERMIT 335.00 . 00 335 . 00 OTHER FEES PLAN RETENTION -FEE 20.80 .00 20 . 80 TOTAL 355.80 . 00 355 . 80 SPECIAL NOTES & CONDITIONS DEMOLITION OF FORMER NAVAL MILITARY ACADEMY UNITS A,B,& D TO K (10 UNITS) Mte: 10/06/01 06 PSMjrt M: 1M TcW ted ed $3%.80 Tctal Pit $3%.80 City Of Lake Elsinore Building Safety Division Ftease• • 1uus . 1 am Licensed ender the� rBueirress and professional 41,Code Section 7000 et seq�' 1e in full f6ce. Post in conspicuous lace 2. 1.as owner of the pro'` my 6ep oyees w/wages as their sole P P compensation will do;' -ert x structure Is not intended or on the job offered for salt work W 3. 1.as owner of Property ncdusNdy contracting with licensed You must furnish PERMIT NUMBER and the � ��etorothe jav 4. i have a certlt'rcate aJ to adflnsure or a certificate of Workers JOB ADDRESS for each respective inspection: compammmuoninsurane�°a certified copy thereof. Approved plans must be on job 5.��oy an,, ;tnmanner to pC1q . pe ��become at all times: which this permit is issued. Note: of you should become subject to Workers Compensation after making this cerdfication.you must forthwith comply with such pro- visions or this permit shall be deemed rewked Code Approvals Date Inspector EL01 T -Elec Services PL01 Soil Pipe LkKWground EL02 Elec Condult Underground 131301 1 Footings B1302 I Steel Rsintorcernent 131503 Grout B1304 Slab Grade PLO1 Under wound Water Pipe SS01 Ro SWO1 On Site Sewer EL04 RouahElectric-Widna EL05 Rough Electric-T-Bar ME01 Rough Mechanical ME02 Ducts,Ventilating PlwTest 1131-02 Roof Drains SPIG Framing A Flashing BP13 Drvwafi Nailina BP11 Lathing&Sidiry PL99 Find plumbing EL99 Final Electrical ME99 Final Mechanical BPW Final Buildi Code Pool a spa Approvals Date hepector OTHER DEPARTMENT RELEASES Dm Inspector Department Approval rOgJh d prior b the P001 Pool steal Rein./Forms build r g being released by the city P001 Pool PlurniftAoress.Test P003 Pre-Gunite Date Inspsctor EL06 Rough Pool Electric Pianning Sub List P004 Pool FencirWAocess Finanou P005 I Pre-Plaster Enaineenng P009 I Final Poo City 01rake Elsinore 130 South Mann S "PLICATION FOR �u�u�c�- ;e`'f APP O BUILDING PERMIT DDATEC�&y'jtE VALUATION CALCULATIONS 400 Z By �` 1st FLOOR , u 1 �SF IL DI p VCN fit C L AGt LOT7PARCEL Znd FLOOR rJ/A SF -- NAM 3rd FLOOR SF o 1..W trlstAiam (/lLGR4EI LGC W GARAGE A)A SF N E STORAGE &/n. SF R I that am 6cens under prmnsions o chapter commencing DECK 3 BALCONIES SF with section 7QW)of division 3 of the business and professions code.and my C ricense is in fug force and effect OTHER: n SF O LICENSE* G ` CITY BUSINESS N AND CLASS TAX# T NJWE VALUATION: R N A MAILING C ADDRESS 356pY V FEES T C STATE/ZIP HONE% 1 o V or C7199 BUILDING PERMIT 3 R CONTRACTOWS S1GfA UR ATE PLAN CHECK NAME LICENSE# A Ii PLAN REVIEW R A9ALAVU C ADDRESS Jj SEISMIC H I STATEMIP PHONE PLAN RETENTION ❑NEW OCC GRP./ CONST. (]ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF ' p OTHER STORIES: BEDROOMS: ❑SINGLE FAMILY ZONE: ❑APARTMENTS 1 oettdy that 1 have read this application and state that the ❑CONDOMINIUMS HAZARD YES abo%e information is correct.I agree to compty with all city ❑TOWN HOMES AREA? NO and county ordirm=and state laws relating to bugdinig ❑COMMERCIAL SPRINKLERS YES cortsmxdon.and hereby authorize representatives of Mis O INDUSTRIAL REQUIRED? NO city to enter upon the abase-mentioned property for insp- ❑REPAIR PROPOSED USE OF BLDG: tion purposes. 14 OEMOUS14 PRESENT USE OF BLDG: APtnQ JOB DESCRIPTION 6DEMDUT-lb3 6r EnsT Signature of Applicant or Agent Date r Agent for ❑ contractor V9 owner Agents Name&f t'JE VA. aT Agents Address 3rli 9!7j AL A Sd,TE ZM- gra k CA e b Street City State Zip _yL 1 � 1�il.Jl�i s�AS\✓ l J A. L,L UATCUUNE-SEE SHEET 4 -- — -- - ` 1 }• f l 1 I W e mil. r+ d mr .. �_ { i 1 111i 1 �, F0�• • • -r - � iti ---- -1 r- -+- ---- lr. .. Z + ' AWZ - •' r :i : '� �� V1: I 1 •i- - - �. - \ e - - -ram-- � zmyr. , • - _ r 1 S7GIPr BIDG x i '� ` r t f ♦ \ i r------T- T ,R �• I � YI A II 1 1 i`V •1 1 I ------' \ it I 1 �gi 1 I 1 I I � .Y• t� I 'i 1 I p� _r7Fa�s_ _rs, o _ _ •• tn� — - - - — -� • GRAND AVE1�17�------- --�� --~------- ------------- \ I F apawc SLUE 20 WE ELSINORE— Ir.a a 2 Bit r%j58jQ [all 4lszlQKj PERMIT # 'SOUTH COAST AIR QUALITY MAIAGEMNT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL HAIL FORM AND FEE TO SCAQi1lD,ASBESTOS NOTIFICATIONS,FILE#55841 LOS ANGELES CA 9W4M41 AM USEONLY SCREEN-8Y RECEIVED POSTMARK ENTERED BY NOTIFICATION# COMPLETED BY G Van Houtet COMPANY Errviorrrmial Contrd Sai tm Inc. PHONE (951)78&1483 DATE Qctober 5a,2004 CHECK# 1651 FEES 33121 PROJECT #083D 4R NOTIFICATION TYPE Orsmm soot ReAsm DATES REVISON OMER(higtt6ght) CANC81AT10N PROTECT TYPE De wm Otter Demxff oN REWVATM(MMOV84 E-Am cr RwovAL PLANm RENo(annuap xxx SITE INFORMATION SITE NAME Fenner Elstnae Naval S Mffitrry Scfwol SITE ADDRESS 159M Grand Avenue CROSS STREET Riverside Drive CITY Lake Elsinare STATE Caftnia ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper De dition of Structures BUILDING SIZE(SO F) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)50.70 NUMBER OF DWEWNG UNITS 11 BLDG PRIOR I PRESENT USE CaarERM HmmAL IrmusTRIK Other OFFrcE Pwm am HOUSE SOM SHIP UMCOUEW XXXX)= SITE OWNER Lake Elsinore wage I.LLC. ADDRESS 43529 Ridge Park Drive CITY Terneotrla STATE CaSfonria ZIP 92590 CONTACT John Leway PHONE(951)506-6W REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? ' REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10105004 END 10r30104 WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRIABLE WA CLASS I NIA CLASS II NIA TOTAL AMOUNT(add row)WA REMOVED(ut sguare feet) ASBESTOS REMOVAL FROM SURFACES WA PIPES WA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEIL1AlG I UN mum I INSULATION I FIREPROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m square feet) NIA NIA WA WA WA FLOOR TILES(VAT) DRYWALL PLASTER TRANSITS I ROOFING OTHER WA WA WA NIA NIA (descft)WA CONTRACTOR INFORMATION CSLB DENSE#809807 OSHA REG# AOMD ID# NAME Ernruomnental Conytol Solu6orts,Inc. ADDRESS 3654 Central Avenue,Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER 91 LANDFILL ADDRESS NIA ADDRESS NIA CITY WA STATE NIA ZIP N/A CITY NIA STATE WA ZIP WA Asbestos surveys are mquired prior to Demolition and Renovation Page 1 of 2 4 QMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL EMAIL FORM AND FEE TO SCACMD,ASBESTOS NOTIFICATIONS,FILE 9 SS641,LOS ANGELES CA 90D74.5641 WASTE TRANSPORTER 02 NIA WASTE STORAGE SITE NIA ADDRESS NIA ADDRESS N/A CITY WA STATE NIA ZIP WA CITY ri/a STATE Na ZIP n/a CONTROLS DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedtue#1,2.3,4,5 or Other. For asbestos terrmvafs ratde the corribinabon of Ride 1403 procedtaes used Procedwe 4 and 5 submit plans for AOMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey.Bulk Sant5,Irspec§ort,PLK PCM,TEM.Assumed as AsbesfasPACM,Describe Other. FOR DEMOLITIONS GIVE THE COa1PANY NAME AND BATES OF THE ASBESTOS REMOVAL eec-2 8I0 M T01=5I04 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME&PHONE# AUTHORIZING PERSON:Card Gordon TITLE Senior Code Enforcement Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE W.ME AND M2XE MWBER OF THE PERSON DECLARMAUTHORIZING THE EMERGENCY.DATE AND HOUR OF E,Y Y AND DESCRIBE THE SUDDEN,UNL�ECTED EVENT. M &V%fiW HOW THE EVENT WOUD CAUSE UNSAFE COMDITOIS.EQLCP'AENT DAMAGE GNt UNREASONABLE FINANCIAL BURDEN: CONTINGENCY PLAN:DESCRIBE ACTIOm TO BE FOLLOWED IF UNWECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME OISTURSED.C1 LD411W PULVER®.OR REDUCED TO PGTVIDER NA TRAINING CERTIFICATION:I certify that an 6tdvidual trained in the pars of regulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence dot 0te remixed tra:rrag has beer[aworrpshed by this person will be availlabfe for inspection wing normal business hours. Company[dame NIA Print mine of e.-merloperator Signature of o:ntedoperatir Tittle of otimer/operator Date INFORMATION CERTIFICATION:I cefay that the above udanrta' aril I - enclosed arty required attach rents. Cornpany Manta ECS Print name of Gown ioperator igna 13or Tittle of owner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER Notifications can not be accepted adhmd the required Gee(AOMD We 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks papab!e to'SCAQ1.10'. Fees are per notification.not rehm&b!e,and vary according to the project size. Fees are as follows: OEl10LITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FROIIJ 100 TO I.M SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5,000 SOUARE FEET S 90.24 REVISION OF NOTIFICATION $11.94 FROM 5,001 TO 10.000 SOUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10,000 SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT $29.52 ASBESTOS REMOVAL AT owner- $29.52 si dwelfing ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of fhe demo ition notification to Bulking and Safely before issuance of a demcbm permit. For call 909,395.2336. For%rout conveniertm please mad the form and fee and do not hand carry to AOMD. MAIL FORM AND FEE TO:SCACLMD,ASBESTOS NOTIFICATIONS.FILE #55641,LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)396.2336 FAX: (909)396.3342 Form REV 200306-27 Fomis,insirucdo ns.and Rtde 1403 are available at AOMD's web site www.aqmd.gov SCAQMD is located at 21865 Cadw Drive.Di mind Bar.CA 91765-4182 (9091396-2000 . _� .ti �. t.•+y.�;_4 _ ._;+:.;t.=� :�;._..-s.�. -_ �_ w_= __.,_,_ -. .� t:_ r.• '+ yam_. SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT MMFICATION OFOEMOLITION OR ASBESTOS REMOVAL MAGI.FORM AND FEE TO SCAGMD,ASBESTOS ItO MCATIONS,F11:.E S 55641,LOS ANGELES CA 90074.5641 OQ,""L 'ay LUFS N WA6992POf f S mac-- FHO,�E�Z^ZDS-Zr QATt: 0g�0 - -c'` $�t =5 331 - Raecr — o o NOTO ICATION TYPE t?,aGtAtatRPAM Dxr::s Aaron OrHut(higWighq CMWdAn0N PROJEC TYPE DM M (�.SM OaWlIav Re /AnW iMMCIZI FJAEJRWiccr HEWWAL Rar+NEo iZha OMUM) SITE 1NFORUATM ! WE-.'&Y.E F,j 1EM tv r% c L 5 rN E N-A V A -4 NI!L I S c DC L SIr 400 sr t Do G g-,q•N11N A"J tF N U E CROSS S T RET i C(iY Loo�W—E. EL5INa26 STATE CAL tFORr'V/A M clZ53 0 CCUNTY J;QvE2s t1,E DESwilEctit WA.\DiL"'G1T10.t' ftt1F•re-4,1 (ZEMwAL OF ,dsaesps. Ciro ,'Avrsrros, c BUIDINGS22,WFT1 :dU,ASERCf P-OORS ?ULE-M AGE(YWS) y'umno.rF 7WE_' _PSG UNITS BLDG PRW I PRO LW USE Caaor cx !a COAL a Oh-sr t'ff�a =uauc aus;. ram SCRcm S-- unr c= 7; r,EG v R:a Fair.►_: CA V? I sjv "HONE t9Sl)- REQUIRci SU&MUG ;SeESTICS VD ! ASSSS-t=s' C-E3r\ .10 i .S3E-E-:Cs '!ES EUIL:iNG` 3E 45 r 91FQR11Tls7N R .=R=:ri'• ' `c ?�.l'fJ'!`. GEMCL:SiaG�? ASv�+� ?ROJECT DATES aTART _=, U T Et•!O v� _ � : v:CR-.SHi=� da sw rc,rion ASSESTCSA&U INTTOBE FRIABLE CLASS: I __=SS TOTAL AMOUNT(3W Mv r�dOVED im ss are i�t) i 466- l '0 o i SC^ ;60 f 4f05•Sy, j .WESTOS RRE3t0VAL FROM 1 SURFACES r c=_ CZM=ONENiT 1 AMOUNT OF cACtI T1Pe Of ( A:O_R3TiC C:t'_C , ' UW`UIM WSU1.aiROh1 i =tPE FR iNG I DUGTIVG i _'Tir U;S _ ASI:Esras (tsaRa=ts~a .Z C o /S 000 CONTRACTOR INFORMAPON I ZS:3 i.f:• OSE= g OSK-.FrG E (�.- .^_!r11:` /'j I r'4L!E " C G^ 7r A:aDREx� i:,O� f/J ,Jryc!y LI E yD1sD S:T=SRtcv: � I i^i^flri �t2JLZA ash WASTE TRAHSFOiT_.4#1 c G�� " LiNDFIL �Z .r S.t ,.�+ f-• L L =]J 55 '• �. Ac.x, 1 R S '.O'RE'"_ 1P C' L 5,4 f?^r'E N.R 5 E -Z r.,�.irtN t f' ''P `ili� Cf 0,,: �,4 STLrE <ZA 'JP 0117 Fsbrsios surveys are requaes onor to Own and Renovath,.n Torras.:use ck-ns,aria ihe Rule 1403 can be ob-mined tirn -GIX wet site 'nrm:;lww,v.au-md.gov =am; =onn REV 20733 r7 SCAM NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL. 41AIL FORM AND F:E TO SCAM.ASBESTOS NOTIFICATIOW FILE 8 SWI,LOS ANGELES CA 0007"41 WP=TRANSPORTER At VIAM STORAGE SITE ADDRESS / ADDRESS CITY STATE rP CITY STATE ZIP CONTROLS: D:S'..1�18E WORK PRACTICC S AND CON i ROLS TO BE USO AT T HE R340VATION AND DEMOUTION SITE Procedure#1,204,5 or Ctn! x asassz, rrat w&dnde Lis camUre fart of RL9a 1403 ommdtrres umm Pmoedm 4 and 5 as'txrdt plans for ADD prier approval. ASBESTOS DETECTIORMC CIRCLE-i tE,ROCEDWES AND AIMLYTICA `1,:i HODS USED TO DETERMINE ASBESTOS IN THE BUILUINI grey,Busk Sam.;", PCM.7E►l.Asslarted 23 Astlesto;PACU,Desabe C•L1er: FOR DEMOLITIONS GI`T THE CCMPANY NA M E AKD:;ATES OF-,HE AS9E5TOS RSAOVAL - FOR ORDERM*3EMOLUM S=P 0A COPY OF THE CRbER AND GIVE THE AGENCY'AME 3r?HONE i AUTHORIZING PM-311: TITtLE DATF-OFOfiOM' / DATE ORDERED TO EEGIN: FOR EMERGENCY ASBESTOS REMOVAL GIVE 7H:.11AW.A,10?ttQ`L:rtR E:r?CF THE F-E°Sa%,C:;URWG-AUTV0;t LNG THE EMERGENCY.aaTc ANC HOUR C URGENCY MOD GrrSMBE T?-SUXZ--N.l'NDC?-C E--D EVS-4T: �C-�1uN H01L x 'c:�i fi'OIfLC CAilw= fir:OC{ID:i,Cn`IS,�JIPI Ni,?4F+AS=O•A UURZASUW-31.E F?RANCiAI_i AE:?J: 1 i CONTINGENCY PL AX:-DESCR!Aaw TCI Smiitme)IF UL•E.r3!-M ASa STM IE t?FSIMJTION-OR ASGESTOS MA I r.RIAL 5E AS ,�W'Ti�I�C.�152-I.cs?.,rill:YY♦:R'L�.0.R?.EL�C�'.tr�_IF3:.4 , TRAINING i c13 are YE8KAP%i;l Se cn she dur'ng the rere�al ane eveerios Mat the mqured UdnbW has:-'t eccwq� Y.ae ai trds parse-wX to avalarri�a f—�-irsr7=.durir,S mina!'usinass n a u m E� 1. WILFO—ft :am�2riy Nairn Pant rac±_c wrimki rzrm S!Fa_•ra cf a max: r Tittle of ov nerwoeratcr Die INFORMATION CER i IFICAT101r I cw it We a:-."htmidw..%s rsr�cr ano I Aeve �v recrire i aftacnr^ents. C3apany Haw rasta a�urerratzraa?r S!p,:re. --- r or ?brie of owner/operator Date 3 Mth-teibm can ee acnVeo, 1=l the racuimd:ee�kW1,L•3de:-C%A3telcs wrarals Wass gran 100 ware feet are exemot from notif ca4on Erm tees. I ?lease n.ake dtrxs payara tG•SCAvIC•. Fels era-pw-»ZUgan.ant ra`nrable,am ray acoG.assc to the project size. Fees are as ioMws: I !)EMCLIT!Ci%.ZRASI:ESTCS.gE&tOVAL -1 PROCEDUFE 4OR 5 PLAN Il;- ie F-ROM'1OD T01 W0 SMIARE T g ??52 SFSC.AL I-.,NDUNG r� =nGU i(0 T O 5.aM SO''l ARE FEET b S0.22t .� R=-VIS N OF KOT-rF!C:TQP1 E 1'94 =n0lA E.CCH TO;0,!W SatJAiC'FG=T FEE URNED Q4ECK CHA;ZGE S 29.23 WRE T:-lAN 1.WI SOU RE FE-t S.i3i 1 J CANCRI.ATrON OF NOTFICATiON I mOUTION OF LESS 7HAN 10 SO F 1 S Z..5? I ASBESTOS REWVAL AT mvner- S 29.52 cap mae.srcle-cnil dwaft ATTENTION: Keep a copy ofimur net tc8don. Sfax'W requb% pr_nide;copy d EIs.1--noOm nodcation is EMUnt}aid Safei,ceime reeance der.Ioiira�aeran :ar qu .roru.a!1°09.i°6•�" =W .nreti�z. �1e�e m20 the Tarn ex'se and do not nand om ra A::Mc MAIL FORM AND FEE TO:SCAWD,AWES=NOTIFICATIONS.RLE :;'56e1.LOS ANG US CA 90074-564i Face 2 a' TELEPHONE (909)39&2336 FAX: CM)336•S:�i :orm PZV 2C^30E2 =CRUS.WSTRU---,im,.,Afi,`THS<UL 4.403 CANE`=37Ad'1 D FPCE'A:,O:B SIT=.AT �=T•TP:', Y.AQMD C_Off` SCAQMD Is beater at 21865 E.Copley Dame.Ciamond Ear.Z.13:?LE. i6� ;3.331�95•ZL�L _��..•?�.+ � - - r-. ,r^._ �r _n nr- ?.ter. i City of Lake Elsinore 130 South Main Street APPLICATION FOR gu t al nl4 "g' AP Srr NZ5 BUILDING PERMIT APPLICATION RECEIVED DATE AP S By VALUATION CALCULATIONS 381 — P _ 1st FLOOR ��00 SF BUILDING ADDRE TRACT A LOT/PARCEL Znd FLOOR tJJg_SF .� NAM 3rd FLOOR SF O L.4Kf Q51AjW (AGGA4Er LZC GARAGE �SF N ADDRESS 1 hereby affirm that I am licensed under pro%nsions of chapter commencing DECX tL BALCONIES SF with section 7000)of division 3 of the business and professions code.and my C ficense is in full force and effecL OTHER: SF O LICENSE* (086, CITY BUSINESS N AND CLASSTAX# T VALUATION: R N A MAILING !J C ADDRESS 7519Y AVi FEES T STAT P HONE Vo V 1254 BUILDING PERMIT S R 'S SIGNATURE DATE PLAN CHECK NAME - LMENSE A PLAN REVIEW R MAILING C ADDRESS SEISMIC H CITY A I PHONEA PLAN RETENTION 0 NEW OCC GRP./ CONST- ❑ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF 0 OTHER STORIES: BEDROOMS: ❑SINGLE FAMILY ZONE: ❑APARTMENTS 611 caft tad I have read this application and state that the ❑CONOOPAINIUMS HAZARD YES above information is correct.I agree to comply with all city 0 TOWN HOMES AREA 7 NO and cc"ordinances and state taws relating to buitd'mg ❑COMMERCIAL SPRINKLERS YES consauctkm.and hereby authorize representatives of this ❑INDUSTRIAL REQUIRED 7 NO city to enter upon the above-mendoned property for insp- 0 REPAIR PROPOSED USE OF BLDG: tion purposes. DEMOLISH ]PRESENT USE OF BLDG: JOB DESCRIPTION 16 X4.411)&IJ7 oii�J � xT1 Signature of Applicant or Agent Date , Agent for ❑ contractor td owner Agents Name 30 aE A,, 11►Y Agents Address Xjv4 agrMAL AVE Street City State Zip M ------------- --------------- 00 MEM orj fit �r,�..�._.: '4• �. ,.r, y,a � r •:I i 1 L_ I � 1i • �� I r. _ -.q��_ -r-f�'?_.•_y �•, �'.•..-- -_- - -_r�.�l. rye.:l.vt�.. �,,. a f - _- - _.ice_1•fs �_ • ti-. ._ -_ •_ _. ..ti.-.r. ti.:i.__ i _ •t_._ - �- -i:ham-._ • - - �.( .I�..---�� ..•T`\i—y TT �.-1� i •-_ • - .. .-_. _: _tz.- _z- - .---•' _ -__��.�_._.-- - �..�.••-..-.-try;=-' - --- �L �._ v..v-.,.-rr_-v--i:.;c..','W. SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT %WFICAMN OF OElMMON OR ASBESTOS REMOVAL • MAL FORM AND FEE TO SCA=.ASBESit}S NOTIRCAT10NG.FU II 53M,LOS ANGELES CA 808T4-5841 t 1p!!By ILLIE NN►A6p {rrr EEc.- FlraNe�Z��S-Zr ` OAT£ 0?-9*—lDt �g-rf r s:-=3331 - FRclEcr NGT1FIC Tm TVP= . OEReism Dmu ASUON OniER(highlighO Gv+CEunON PROJECTTYF_ 0--a rm Ow---;a OawTtar %WATMt IrT MCW2 C EreE.4ca_ucr REMOVAL PuNNEO RENO(arrnrai) SREINFORKATION ' WEaIA.Y.E �MEk l^StNd 6 N-A A M!L•'l :5 r_ 00L SRe iOD U E CROSS STRE=_r cRY L•!�}�c' ELSINDKfi STATE CALWOR.'V/A Z'4 925? 0o:UNTY FZ1VE2slt�c DESvi6E AARK A.VD 'C,.TiON ftJ?-04.1- P_6MOvRL Jr A-s6E•57Ds GONTr}rr4rlJs, ailb'l1trGSiL3'Li� \MrmERCF r j ORS BUILU4G AGE(`.'EARS) '+' mi!=..R of 74E_JNG UNITS BLDG PRIOR 1 PPrSENT USE F_wrmL "nousmal Our-, C F47- Ngm SLOG. Sc Hoa. S-•P i1fov'Cau E i A%3R_SS srri=cv� � ram'- tl.c ` �3saQ ,2»�r .44�t ��✓� cry Cfi.T_ CA 71F(�w Sao :3'.�i"CT .�Ga r ... rNRT FiQiJE`9SI}-SD(O_, EoU1RmRUPONNG Zszs s <an W .IS=S:03 C No AS3�:--S YES 2UI rII,C'C 3E 4 � VlFCRMATF0l1 r �S=t►i r` `trnt =�170`lr" [ENICL:SHED? ?.ROJECT DATES _ Evo v�_ �C. ,' �ORK SHIP i da ,swine,nlgnt? ASSESTCS AMOL%4T TO SE FR6ELE CLASS! ( __-Sa"II i TOTAL AMOUNT(add rOv i ?.MOVED('ln!v2uue ieetj i ASBESTOS MWNAL FROM i _Uk=ACES rr=__ COIMPONEKTS MOUNT Or EACN rm=-OF .,za_-sm.—:—I= UXVS lhSI1+�i ION l =FE FROOrt\G I DUCTING _TUC . I V�r"E AS$ASBESTOS (ets•-r- f } t I XEU�D , ��oS- I % .�--' :LG:,R Tom-,.AR ' 05—K.WAL ! PLa's,M � -R�,- ; R0r Erx— CT.f CONTRACTOR INFORMATION ZS_-t —MOS gq —L 1-.+7e.RESS I y I'.? c CA C� ST;TE iJP G r SITE Sc: ?i IONS !a N . ago SA ; 1r.�� c�1' �A �s =s e WASTE TiZAHSFOzMR si LANDFILL 5,4 Grit ;n: "'' 'O,- tv� ST.-.rE ., : Z1P a �- Asoeslos surreys are reauffed actor to G_-arl alffl n and Renoovawn Fo,-,ns.:nsm, c r.s,ano m, Rule 1403 can be obained ftw.nC10 Ymb Sits::r:,:;iww-,v.3Q;rd.gov ?ags --arm PEV i SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MIL FORTH AND FEE TO SCAM.ASSESTOS NOTIFICATIONS.FILE 8'i5641,LOS ANGELES CA 90074-6641 WASTE TRANSPORTER#2 WASTE STORAGE SITE ADDRESS / ADDRESS CRY STATE zip -CITN STATE 21P CONTROLS: ASCRIBE VMRK PRACTICES AND COWW-3 TO sE USO AT THE RENOVATION AND DEMOLITION SITE. Procedure 1,2(34,5 or CGht I :cr asae4tos refittrr&drde his aantlAmdaa d Fla 14M procedures tsea. Prooedtre 4 and 5 submit Flans for AQMD prIcr approval. ASBESTOS DETECTION PROCt : CIRCLE--4E PROLE wes AND ANALYTIuAL w,,HoD`USED TO DETERMINE ASBESTOS IN THE BUILDING-.: Survey,80 San:?6n9.trspectiort, FW.-at Az&mW as Aswws-PACM,Desaft CNt ,: FOR DEMOLRIOHS Gffc-T rrc CCMr?AW f4 uE Am OAT ES OF.r:EASSE:TOS RENOY4L � FOR ORDERED DEMOLIffmi Sm.-COPY OF TrlE CRbER AND G.'V`THE AGEERCY?*.ME&PRONE# AVrhVROM PERSON: TIP.E OATEOFMEr2 - ! aATE- RD---4E0 TO EEG'P:: FOR EMERGENCY ASBESTOS REMOVAL THE PERSON VSSLARWG.'t --ORONG THE EMEPGENCY.>kT-c Af IC HOUR C -WR68tCYAND CES=E T}r SUZZ-A i-V°sff. :YF3.A;N cg1Y:r:£°►�Ti Y.'t)ULC G,lSS�'V�.r:�Xi�D.TiG`!S,�;,R?tVF�T?AbL'.�=4R UVRz�SClNA81E FTU.NCi4L5UROQJ: . CONTINGENCY PLAN:DESCRY ACTME IF U.''Err:rT_=.WE3TG5 IE FC'.%4C L:4ING 0EMW T ION OR ASSES OS MATBR:AL 31ST4mSEC.CR1!l1t�.cs7.ARYc7t�.t3R RI•=L�G�J TG==�1'J3i. - . TRAIN64G CirRWCATION:;cwW t:a1 to I;.p:i6u&lair ed In&e r---vbAcats d reg:dadw A0.iD Rde 1 e93 and NESHAP wA;f be.r+ve dudpg the r=,ravat aria •evter�:tat tha mowed Late;sae^�•t ac�{r5;ht��+tr,ts pars::xS to ova+ia��insr:�:duties na:mai Business nags. >✓EG-1• Ir�I:.i-sZ.E� .jW�� . �1U'r� ;��'��'�`� t'iwN� e��oo-t. :ompm I&a PfAi harm afcasarfepeww! S47a.m of awrjedlr-w«a Title o:ownerrooema Dxe INFORMATION CER i I-=7tOtr-1 certaj tat we&me in&rtaa„ftan Le wsgG and I have ancizad Fey rom fired allachments. jFfC- ill IrSo �� 0 Fr- Caatyaa►yt�faloe =i t;tt a a7urerretzr3 er ak..:�e'g . 31"edopeow Tltdeof awnarhDo.,mor late Nsrftalium caa-�M De a=teo wiles.'!Ike watrrred fee(AQMD File:C* Asbr_!cs rewafs of wss amn 190 square feet are exemot from=ificason arto fees I P'°1ss make c3taas Wow tL'SCn0.1.ir'_ Fees para ..:_t raParccabfa,am ray eCCE,. iC Mes1ze. Fees are as tlo0ows: I CE-11CLITN]K R;SEESTOS REMOVAL flROCEDiIF=4 OR 5 FLAN ;111;- 2 -n01R'100 TO 1.000 scuam�F E i _ a 5 2 SPECIAL FJ%NC-UI%*r =WA 10CI TO 5.i,D0 SO-IJAR:Fe_Z S 's0.24 Rc1ASIC,H OF NOT-F G TICPN $1'S, FROM 50 1 TO W:030 SGUArR Fz 3211.E Rc-TL RNED CN=C&CHAKGE S'i9.23 MORE THAN 13.000 SQUARE FEE 5.a"31.: A.T10 1 CANCEL LAWN Or NOTIFICATION MOUTION OF LESS-,H,�IIW SO FT S�.5? ' EST05 RE!AOVAL AT owner- Boar e-sinol&enil dwelling I ATTENTION: keep a copy otrur np4ttcatlon. Sia Lan reetti c yr_•paida a copy d Gts damodor,noiftcakn;o M(fing and Safe;) --siore rsuarce u ! :.wD",pencil Far g6'_Sdwu-19Q3.396.23B. =ar 7mr;MI:Sve:K_Oaase mad the iart end fee and cc not hand carry io„CMD MAIL FORM AND FEE TO:SCAWD,AWES=NOTIFIC:.T10Ns.FiL- s'5641.LOS MIGE-aS CA 9W74-5641 ?aye 2 of 9G ; TELEPHONE: (909132336 FAX: (9t191396.3541 =oats REV 203GE27 '.VAS.WSTRJAnj ONS.AW Th_RKS 1403 CANE--3TA41SO FaCl.'.,Zvi;:1Ea Scl Ta AT :`?-'Z'P:.rWWW.AQMD GOV SCAOMD is looted a>:21865 E.Comer Orive.Diamond Ear.CA.917:,`.=167 (�9)386•2000 ill�� ' `SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTfFlCAT10N OF OEMOLlT10N OR ASBESTOS REMOVAL MAIL 1=0R>ri AND FEE TO SCM 10.ASBESTOS NOTIFICATIONS,FILE#551141.LOS ANGELES CA 9W45841 ACM USEONLY SCREEN B1r RECEMM POSTMARK ENTERED BY NOTIFICATION# COMPLETED BY G Nan Houten COMPANY E itarim nW Control Sohrtions,Irrc PHONE (951)788.1483 DATE October 5h.2004 CHECK# 1651 FEES 33121 PROJECT #083W4R NOTIFICATION TYPE Orilceal root REvmw DAB kWM OrHM(high6g l) CANCELLAMN PROJECT TYPE Denincm ORmsvD De mama ROMAMN pernovaq Eraewmy REMovAL RANNw REw(annuaq roe SITE INFORMATION SITE NAME Fww Elsinore Naval&Merry Sdtod SITE ADDRESS 15900 Grand Avenue CROSS STREET Riverside Drive CITY Lake Elsmore STATE California ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Demolition of Strur*aes BUILDING SIZE(SO Fr) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)50-70 NUMBER OF DWELLING UNITS 11 BLDG PRIOR I PRESENT USE Wamtwti HoswrAL bawsraw Other OFlicE Pusuc erns. HOUSE S0400L SH P UNNICauECE xt00000c SITE OWNER Lake Elsinore VWp 1.I.I.C. ADDRESS 43529 Ridge Park Drive CITY Temecula STATE California ZIP 92590 CONTACT John Leway PHONE(951)506-6558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10l85104 END I0/MM WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRIABLE WA CLASS I NA CLASS 11 NIA TOTAL AMOUNT(add rove)WA REMOVED(in square feeQ ASBESTOS REMOVAL FROM SURFACES WA PIPES NIA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING I LINOLEUM I INSULATION I FIREPROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m sp ne teeQ WA WA WA WA N/A FLOOR TILES(VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER WA WA NIA NIA WA (describe)WA CONTRACTOR INFORMATION CSLB LICENSE#809807 OSHA REG# AOMD ID# NAME Ewhamental Conytol Solutions,Inc. ADDRESS 3654 Central Avenue,Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER#1 LANDFILL ADDRESS WA ADDRESS NA CITY WA STATE NA ( ZIP NA CITY WA STATE WA ZIP WA Asbestos surveys are req*ed prior to Denmlition and Renovation Page 1 of 2 " y - SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES CA 90074-5641 WASTE TRANSPORTER 92 NIA WASTE STORAGE SITE NIA ADDRESS NIA ADDRESS WA CITY WA STATE WA ZIP WA CITY nla STATE Na ZIP Na CONTROLS: DESCRIBE WORT(PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1,2.3,4,5 or Other. For asbestos re navals circle the aombir atlar of Rule 1403 prooediaes used Procedure 4 and 5 submit plants for AQMD prior approval. ASBESTOS DETECTION PROCEDURE CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Stavey,Butt Sarrp".n Inspecl5ori.PI K PCM,TEM.Assumed as Asbestos-PACM,Describe Other. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eac-2 8108l04 T010/OS104 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDERAND GIVE THE AGENCY NAME 8 PHONE# AUTHORIZING PERSON:Carol Gordon TITLE Senior Code Enfo ce nent Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAh E AND PHONE W43ER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY,DATE AND HOUR OF EKI[ERGENCY AND DESCRIBE THE SUDDEN,UNEXPECTED EVENT: WA E.'�IA 4 HOW THE=_VENT WOULD CAUSE UNSAFE CONDITIONS.EGUIPNIENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN CONTINGENCY PLAN:DESCRIBE AC'TOW TO BE FOLLOWED IF UXE)CPECTED AS3ESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED.CRILISLED PULVERIZED.OR REDUCED TO POWDER ft TRAINING CERTIFICATION:I cartilly that an i ciividual trabted in the provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidence Drat the reed tra hM has been acommliished by Om person wiB be avadaMe for inspection during normal business hours. Company Name NIA Print name of otmesloperator Signature of otvnerfoperator Tittle of owner/operator Date INFORMATION CERTIFICATION:I certDy that the above mfonria' i Correct and I -e endosed any required attachments. Contparry Name ECS Print name of ownedoperator igrta for Tittle of ownedoperator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER Notifcauans can not be accepted wttha►t the required tee(AQMD Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please crake I a payab5'to'SCACW(r. Fees are per notification.riot refundable.and vary aaardrg to the project size. Fees are as follows: DEl l0UT10N OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FROM 100 TO 1.000 SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5.000 SOUAF;F-FEET S 90.24 REVISION OF NOTIFICATION S 11.94 FROM 5.001 TO 10.000 SQUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10.000 SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- S 29.52 occupiecL it duelling ATTENTION: Keep a copy of your notification. State lane refit m that you provide a copy of Dte demolition notification to Building and Safety before issuance oJa derrmlition pwn:L For questions call 909-39b-2356. For your convenience please marl the farm and fee and do not hand carry to AOMD. MAIL FORM AND FEE TO:SCAQMD,ASBESTOS NOTIFICATIONS,FILE #55641.LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)396 336 FAX: (W9)396.3342 Form REV 20030627 Forms,in inmdom and Rule 1403 are avadaDle at AOMD's web site terww.agmd.gov SCAQMD is located at 21865 Coalev Drive.Diamond Bar.CA 917654182 (9091396-2000 city of Lake Elsinore 130 South Main Street APPLICATION FOR �j� LZc�4 D` APP N . 5 BUILDING PERMIT APPLICATION RECEIVED DATE AP ax BY VALUATION CALCULATIONS 391 ! oSo` ooZ BUILDING _ EiF) OCO SF 115MMC TRACTBLOCK/PAGE LOT/PARCEL Znd FLOOR rj/A _SF — r— NAME 3rd FLOOR SF O LAKf F6StN U�GtaatE� LGC �� -�{ Z W N _ GARAGE A)/A SF N ADDRESS 4 3SZ9 RI Able ( (vE E STORAGE dZ- SF R GfJL�A L 2.5- j) that 1 am licensed under prwnsions of chapter commencing DECK 3 BALCONIES SF with section 7000)of division 3 of the business and professions cade.and my C feoense is in full force and effect- OTHER: tJIA SF O LICENSE f G CITY BUSINESS N AND CLASS TAX# T NAME VALUATION: R EM(/ A MAILING C ADDRESS 35&y eFV FEES T CI STAT IP HONE[� r o IV 7 BUILDING PERMIT S R CONTRACTOR'S I A UR A PLAN CHECK NAM . ` LICENSE A Il0 PLAN REVIEW R MAILINU C ADDRESS SEISMIC H CITY blA IPHONE/ PLAN RETENTION ❑NEW OCC GRP./ CONST. ❑ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF ❑OTHER STORIES: BEDROOMS: ❑SINGLE FAMILY ZONE: ❑APARTMENTS 141 certify Iha31 have read this application and smote that the ❑CONDOMINIUMS HAZARD YES above information is correct.I agree to comply with as city ❑TOWN HOMES AREA? NO and county ordinances and state laws relafhg to building ❑COMMERCIAL SPRINKLERS YES construction,and hereby auf iarke representatives of this ❑INDUSTRIAL REQUIRED? NO city to enter upon the abate-mentioned property for insp- ❑REPAIR PROPOSED USE OF BLDG: lion XOEMOLISH PRESENT USE OF BLDG: JOB DESCRIPTION A O r rl�la.) JCISt Signature of App (cant or Agent Date Agent for ❑ contractor Q( owner Agents Name at 146 VA&J Wr Agents Address XS,64 t2iWAL AVE MITE M- U slo6 CA l2r7,0b Street City State Zip Y, c, I "- w=c 57 t --MINN hWA I � • I �I A PP I � •I � /'�� I i J � Q I z 20 Z r - IL E ° sIZ �i I ° C6 v M j Id __ CZ 4 Q t �_ •r7 L� �a I ti It fiJ�j Ci11 07c QO. C-:C7 W1G7 rr..lcn f. =*fJ `SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAOAD,ASBESTOS NOTIFICATIONS,FILE 0 55841,LOS ANGELES CA 9W745841 AQMD USE ONLY SCREEN BY RECENED POSTMARK ENTERED BY NOTIFICATION# COMPLETED BY G Van Houton COMPANY Emmomienlal Control Solu&m Inc PHONE (951)788-1483 DATE October Sm.2004 CHECK# 1651 FEES 33121 PROJECT #083004R NOTIFICATION TYPE Om mm root Rtmort DATIES RRWN omm"moo CANCBIA11ON PROJECT TYPE Damunom OHpstED Damunom RBMATM(rerrroval) ErameicY RaavAL Perm®RENo(annual) �o0c SITE INFORMATION FSrTE NAME Farmer Elsinore Naval&Military Sdwd SITE ADDRESS 15900 Grand Avenue CROSS STREET Riverside Drive CITY Lake Eisirm STATE Cafrfania ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Dom fition of Strudtaes BUILDING SIZE(SO Fr) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)50.70 NUMBER OF DWELLING UNITS 11 BLDG PRIOR I PRESENT USE Caa490A HosPrra IoUsTim 00m Omm Rax am HOUSE SC►M SHIP UMICaL LEce x)ocxrooc SITE OWNER Lake Elsinore Volage 1.LLC. ADDRESS 43529 Ridge Park Drive CITY Temecula STATE Cakfomia ZIP 92590 CONTACT Jahn Leway PHONE(951)5064558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10105104 END 10/30104 WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRIABLE WA CLASS I NIA CLASS 11 N/A TOTAL AMOUNT(add row)WA REMOVED on Squam feet) ASBESTOS REMOVAL FROM SURFACES NIA PIPES WA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m square feet) N/A NIA WA WA WA FLOOR TILES(VAT) DRY WALL PLASTER TR 14SITE ROOFING OTHER WA NIA NIA NIA NIA (describe)NIA CONTRACTOR INFORMATION CSLB LICENSE#809807 OSHA REG# AOMD ID# NAME Environmental Canytol So>trdom Inc. ADDRESS 3654 Central Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houton PHONE 951-788-1483 WASTE TRANSPORTER 91 LANDFILL ADDRESS NIA ADDRESS WA 1 CITY WA G STATE WA ZIP NIA CITY WA STATE WA ZIP WA i Asbestos sumys are required prior to Demolition and Rww ration Page 1 of 2 r SCAGMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAGMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES CA 90074-5641 WASTE TRANSPORTER#2 NIA WASTE STORAGE SITE NIA ADDRESS WA ADDRESS WA CITY WA STATE WA ZIP NIA CITY Na STATE n/a ZIP n/a CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure Al 1,2,3,4,5 or Other. For rer w als circle the canbination of Rule 1403 proce Ares used Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey,Bulk SampBrtgr Inspection,PLM.PCM.TEM.Assumed as ASbesl os-PACId.Desarbe Other. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec-2 8►06/04 TO 10/05104 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME&PHONE# AUTHORIZING PERSON:Carol Gordon TITLE Senior Code Enforcenent Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PRONE WASTR OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY,DATE AND HOUR OF EMERGENCY AMID DESCRIBE THE SUDDEN UNEXPECTED EVENT- WA E.XJM HOW THE EVENT WOULD CAUSE,UNSAFE CONDITIONS.EQUIPMENT QMV$=—OR UNREASONABLE FINANCIAL BURDEN- CONTINGENCY PLAN:DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND OUR114G DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED.CRW.MW PULVERIZED.OR REND TO PO:YDER *,VA TRAINING CERTIFICATION:I certliSr that an etdlvidtral trained in the providons of regulation AQMD Rule 1403 and NESHAP will be on site during the removal and evidence that the regt&ed trakdM has been aooanplkhed by this person will be available for inspection during normal business hours Corrmany Name WA Print name of o:merAoperatr Signature of m-aw/operator Tittle of owner/operator Date INFORMATION CERTIFICATION:I certify Thal the above&donna' � for Tittle of owner/operator Date 10/05M4 GENE VAN HOUTEN GENERAL MANAGER Notifications can not be accepted v&Ieut the fequhO fee(AO;yD Rile 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make duels parable to WAQMD-. Fees are per rofficaft,not refundab'e,and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FROM 100 TO 1,000 SQUIRE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROMA 1.001 TO 5.000 SQUARE FEET S 90.24 REVISION OF NOTIFICATION S 11.94 FROM 5.001 TO 10.000 SOUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10.=SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- $29.52 occimi rtit dweRing ATTENTION: Keep a copy of your notification. Slate law regimes that you provide a copy of the dema6tion notification to Building and Safety before issuance of a cemofift pernat. For questions call 909-396-2336. For your convenience please marl the form and fee and do not hand carry to AQMD. MAIL FORM AND FEE TO:SCAQMD,ASBESTOS NOTIFICATIONS,FILE #55641,LOS ANGELES CA 9W74-5641 Page 2 of 2 TELEPHONE: (909)396.2336 FAX: (909)39 i-3342 Form REV 20030627 Forms,insoruu6m and Rule 1403 are available at AGMUs web site www.aqmd.gov SCA CORD is located at 218M Cc dev Drive-Difnond liar.CA 91765-4182 (9091396-2000 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NMFICA77OR OF OEMOLMON OR ASBESTOS REMOVAL , W a FORM AND FEE TO SCAOMD.ASBESTOS NOTIFICATIONS,FLE 9 55641,LOS ANGELES CA 90074.5841 Y, L•• 1 - M i' j4iLUE NWA6tSoSfw4Nr EEc.- PHONE STez.-2013-ZI GATE 0?-0(f- p=CKa g-Gu FEE S 331 1 P.RaJEcr# NOTIFICATION TT?E tOEi� REVEM DABS dal C!rEtEk;hiL�ligna Gw Unon PRQIECT TYF= Oocvaar Om-=;m Damunm ,�e+ovanm lrarr y ' E1AERmNcr REUDVAL PLANNED REND(=Ual) SITE tHFCtfM4TIOti + SITE:4At i'c l=0 RIM 611 r LS/N E N•ANI A M;L 1'r c t I-+i70 L S'm AQO,L=Sr I OQ G r,-,cr1--I n '&,V 1r N U e CROSS S T REST C(TY L E E L.5 iNvig,5c STATE CA L I FOie-,v/A `LP = S 3 C C:;UNTY FQ v 6 tLs 11 c DESCREE:Lm Pg.t??-,r--R- ,2E1'ncv4L- OF A-Sg s?Ds GI%1�'ir�rrir•�Ji, c EULDihG S:ZS SD I SIU.`G-:R CF r=_)ORS °UP b.%%AGE(rEAPS) '+U1.1=E.==F DY1 El-iNG UNITS SLOG PRIORI PRESERT USE a *Mw.- ;L 005- _Ef-a °veuc 3WG. ra sE r C `- `^'' - I 6i PA.+ Z Vie¢1✓t i REQUIP-EX6 BLIP DW -'S SaT3S (S NC. i A$=-S'CS � r:C YES it-nw-;rC S'c i 91FTF3N G ' :ROJs= 'ES ; 3 ?i:' swric,rF-mC ASSESTr$3aWNT TO EE TOTAL AMOUNT(add rev r �C AMESTOS REUOVr4L FROM SURFACES r=='e_ CZ:."•=�1NE.i S AMMOUh';13F EACH Tt'Pf:OF :=mt lM WML 1Fn7N RRE FROO INC3.1 aK,1'4G I STUC .iSB'cSTGS @rt _aa 1 ` I �� 1-1 � ! i Z C� r_a:?T;r�S.".'�-: �z::�L_ �,a "R \51it .atwmr- f C-e:-- I COMP.:CTOR INFORMATION .:S_==.r=l._E 3 f j a, & �; 03rik AEC G C-C Tr T.• CY C CI !L=N C t I t- $;Tz ''rt;N" z WASTE:!-J�NS.-"''�_ T_.R wl G x LANDFILL E- -17,C, �• cr l,t c-s T �o:f: a : -. _ �- a /-- Asam Sa^mtri are.re-cusE::.rct;'r:r 3,dlJ'.(ilfiPi aanG Rewvalkn rQ,T,15, 'S6TLf �l:5_?Ii3:.1r.^i-na f+C3 Lai,,bE OIJmmed f-,:l<.4.Q!-1L 1ie sftm-'s►:,:JWWW.aQMd.goV- =ap -,_ corm. PEV 2MOE?, i 1 SCAOMD NOTIFICATION OF DEMOLITION OR ASSESMS REMOVAL VAIL FORM AND KE TO SCAQb@.ASBESTOS NOTIFICATIONS,FRE I SS641,LOS ANGELES CA 90074.61141 WASTE TRANSPORTER#1 WASTE STORAGE SITE ADDRESS / CRESS CITY STATE _'IP CRY STAT-E. ZIP CONTROLS: iDS^.RIEE WORK PRACTICES AND C*VTRO'LS TO SEE USED AT THE RENOVATION AND DEMOUTION SITE a ocedure#1,204,5 or Cthi or as' mmav&cue Lie cornWhadan dtide t M procedures used. Prooedtre 4 and 5 submit Mans for A(lVD prtar approval. ASBESTOS DETECTION PROCENIN: CIRCLE:-I't:AOCEDWRES AND ANALYTICAL tJ.c;HODS USED TO I?'=TERMINE AS3EST-3S IN THE BUILDING: am",Bulk Sar..3 tg,Fcspec oX, PCd.:CRL A:9rmed as AsbeswwPACMI Draft Cil er: FOR DEMOLITIONS GPr THE CCMP.k aY INAME A.ND:ATES OF ir1E ASBESTOS R9AOV.41: FOR ORDERE 0- GEMOLIItO}!$ENO:,CQPY OF Tire G.•-DER Am wE TKE-A 9?NCY NA1AE S PHONE d AUTHORIZING PERSON: Tm.-: DATE.Or-ORDS:t / . DATE e7RDERED TO ESM-N: FOR EMERGENCY ASBESTOS REMOVAL War TFS nAWXNl'PKC M Y AFEER C•F THEE PERSO.Y 0SUARMAJJW-'ORONG THE SuEmGENCY.DA i E AfIC HOUR C URGENCY AND rIPbC,41EE Ttr aa:xzN.Lw00'r-r.T'c_•EVENT: ��C�LN: 1\'x �T't10ULCG ilS�A�rs�x{�i'tG`!S.Eail'?l4Elti DAMAGE 02U:�KCSCNA3LE FMNCiAIbUROEM t - - 1 TRAL a-X-GNTINGENCY PLAN: W 31aT+mSE1.`.Ct�1sEl.C??.?IPVc�t2�.OF.?.E:.��J'B==�A3'e1. TRAINING C2.4ZWtCATIOR::eW.4y t:a an i-.a'vm mined In the crovLsk m of 1e Gad Man SCIAC Rule 1433 ara NESSW witl be^n:ite durng tia ra-mavai a eviceliof3 zal The mwjed: has beem ac=p5stw 31 cjs aws .wE ba ava'iaabb fm inSET."bn during ia:tra!wsinass onus. i c C—C, :`!w#g466w :arttxny Nairn i ittle of ou mmovatcr Da:e 1NFOR14lAT1Q!!�Rirt:::.T10!!:t certdy 1•�:13rte txve in.`ame5an fs�sreci ana t h:v® dy rac:drec attachrttents. 6fc ',V?l Al4.Dt1lR+n1A{r&50 %nlkrD D MZ Ole 01!6-0 • cmpmy-maw Ash tares -: aqI•e.a6 swekperator Tlttfe of owned-,wato Date N1otttatiarm c.a c —3 armea WIC_'!the ramed;e.MW I:?,.de 3 tk Asbes cs nw,ats of less than 100 square teat are exerr m,5_m nottF;anon arm tees. IPI...ase Matte amms wrams z'SCA=* fee!3m 2 noffi afrt,oat rafmabfe,am ray ttcm*iG is the t>rclea s!ze. Fees are as f0m: ,EmCLMC,t` r.AS:EST:.'s:ZL:OVAL I PROCEDURE 4 OR 5 FL A, 3 331. t -RDU*i00 TO 1.},M SQ DAE c_Ei _ a52 SP-%'AL HANCUNG F+= -SOU I'a I TO 54-m Srtt,F—C rCFT RREVISJCii[OF NOT-F!CATI;1N 51'34 FROM-940 1 TO:0.030 SGUARE FEET 3211..E REF.TURNED CHECK CHARGE S•29.23 s70Rc Tc-aN i3.Ct►C Q1i�4i,t frc- ta3i 1 Q!.HC3LATPDN OF NOTIFICATION S G.; { 3_MOUT10N OF LESS:I•AN 1 W SO F? 5 290.52 ASBESTOS RE11OVAL AT mvner- S 29.52 t oora.-a�,srtale•a:nit dweU'ma ATTENTION: Keep a copy at.pour nafteon. ya a tah:eotdr-s mat)m pr_•v1de a eapy d Frs danobtiart nol kation to 80ding and Safety :eiore issuance u dem- bat arts t. :a•ties Oaasa mad the imm ena l!ae and ac not hand carry to A:t•^ hqPJL FORNY AND FEE TO:SCAOMD,ASBSS r`S NOTIFCCATiONS,FILE 15641.LOS ArG c.S CA 20Q744641 Page 2 Of TELEPHONE (309)39&2335 FAX: (909133o•354 =(no ram,/2003CE27 �I;1AS.LUST llCT��TTlS.;avr'TFE RULE;433 CAN k:3itdl�FROl:1k.-XV0 NEE SIT EAT HT-TP!,WWW..-kQNM.G0 V SCAOXII)is Imtec as 2186E E.Cadet Drive.Ciamoad Ear.CA 917ES-162 -309):.96.2400 z r r fin_ i.^ :n nr. gnu .05/1412384 ' 13:91 7S832377d3 9Co1T aORRISt3fi a ASS PAGE 91 SCOTT MORMSON & ASSOCIATES- P.O.Ho=33329 31853 Dae Palm Driv4 Ste.Q-507 Riverside CA 92511 Cadse*d pry,CA 92234 (909)624-1665 (760)323-7743 TOTAL LEAD In PAINT REPORT Completed On March 12.2004 Pb0303116801 Client Constriction TestirtQ&Engineering, Inc. 2414 Vineyard Avenue.Suite G Escondido.CA 92029 Pmjmt Elsinore Naval&Military Sd11oo1 ISIM Grand Ave. t.afae Elsinore, CA On March 02 and March 03.2004 a tood-paint inspecdon and bulk sampling was conducted at the above pool address. Samples were taken of random point dupe from interior and erdenor surface areas at the request of the c1lem named abova Samples were taken of flaking, chipping and/or cheulking surfaces only. The removed samples were submitted to Caroline Environmental, Inc. In Cary, NC (ELAP 02283)on March 04.2004 to determine me percentage of lead in the paint chip(s), if any. Carolina Environmental's ALMA ELPAT accredited laboratory determines percentage cf lead in paint chips by using NIOSH approved madmd 7082M. Results are indicated in 96 by weight. The federal HUD definition of lead-based paint requiring abatement and/ or hazardous waste disposal is 5,000 ppm or 0.5% Lead by weight In the city of Los Angeles. the definition of lead-based paint requiring abatement alto/cr;hazardous waste disposal is 600 com or 0.08% NO by weight. The Consumer Products Safety Standard is ,also 0.06% lead by weight It should be emphasized though that the only time removal becomes required or recommended is if the surface(s)wthicn contain lead-based oaint above the levels mentioned above are flailing, chipping and/or chaufking and the property is going to be renovated or demolished. The samples listed and cesttibea below were taken from reasonably accessible areas of the ouildings. Any materials located in areas of the oullding tnm were inaccessiole were not tested. Such areas Include.trot are not limited to,narrow crawl spaces and unstabte/dangerous roof or floor areas. LEAD PAINT INSPECTION BY: Scott 1Aorrison. Cal. Lead Insp. Cart tt 1-7596 BULK SAWFLES ANALYZED BY:Carafine EnvironmerttM'a AIHA ELPAT accredited laboratory The wits on trts dewing pages)fnd'cates that 10 of the 68 samcles were above 0.5% ;pad oy weight or 5.000 own(Faderal Lead 8lartoard). CITY OF LAKE ELSINORE BUILDING DIVISION PERMIT # Oq- 0 5q5 Earsrx�wOfc�r.�a:.r�'�--^'•••-•s=axv-._...�-.c:_�a�a-�_a ,e.-, -_z.- .z:x 85/14/2884 -19:8f 7583Z37743 SCO1T t+ORRISON $ ASS PAGE 82 Pb03oQ1 W1 NOW.Sample VS EN41 tltru ENL 14 wwrs all talasn Aom 1'tte 18t floor of the stain building. Note:See endesed drama for building layout and saetpls IOeatlofta. Sample#ENL-1 Type of mstsdatpaint chip;white Location interior ceiling, library Arewinterior osiling, library Results:0.019% lead by weight Semple#ENL-2 Type of material:paint chip/off-white, yellow, biue-grey Locailaminterior S.wail, library Araairtterior wails,library Resultf:0.24% lead by weight Sample#ENL-3 Type of maUVW:paint chip/yellow, blue-preen LocadmIrftrior window Uame AnoLintenor S.wirtdaw, library Rssulls:0.33% lead by weight Sample#ENL4 Type of material:paint chid white Locatdominrorior E.wall,&WIway . C Area:interior-wail, hallway outside library Results:0.712A lead by weight Sample XENLS Type of matenal:paint c nip/pale yellow LocBtfort:Inartor wall, E.side officers quar:ere Area:intedor walls Results:0.48% lead by weight Sample#ENL-8 Type of material:paint cmp/ten Loc:ation:interiar wall. W.side olficera Quarters Arsa:interior walls Results:0.0230A lead by weight Semple aENL-7 Type of rnaterial:whtta-grsen Locait ramund toilet, bathroom Ama:offloeYs quarters Results:0.31% lead by weight Sample dENL-8 Type of mataiiai:paint chip)white-green Location:Intarfor W.wail, sWrwell Am:stairway to oflicer•s quarters Results:0.28% lead by weight (2) - ' -65n4/2W4 -I3:E ' -7653237743 !§M bOWIstT1 & ASS PAGE 03 r• Pb030211118801 Semple IENL-9 Type o/matatietpeint chip/white Locellam-kywriar N.wall, E.-central room Ama:asflaers'e quarters Results:0.025% toad by weight Sample#ENL-10 Type of material:paint chip/tan(over wood) Location:1ramor W.wall,window sill Area:o icees quarters Results:0.036% lead by weight Sample*ENL-11 Type of matall al:paint chip/pink Lacation:inWor N.wall, ballroom Arumbove fireplace In bellrnom Re3W%: <0.010% lead by weight Semple#ML-12 Type of meteriatpaint chip/of-white Location:lnterior S.wail, dining room AreWntenor wells, dining room Results:0.38% "by weight Semple*FNL-13 Type of material:paint Chia/white Locawmimerior ceiling,dining room Ares:11iterior Ceiling, dining room Results 0.03D% lead by weight Sample#ENL-14 Type of mafenatpaint c`tip/It. gray Locatioreinieft W.wall,dasw=m 9 Area:intedor walls,classroom Results:0.67% lead by weight Sample SENL-15 Type of materlat:paint chip/green Locatiomdoor to basement Area door to basement Rowlix: IA% toui by weight Sample MENL-16 Type Cf material:paint chip/white Locatimirdwior ceiling,basement stairway landing Are&interior ceiling,basement Stairway iaftr-g Results:0.044% lead by weight (3) 05/14/2a@4 39:82 7693237743"--- - - — SGUTT KWISON & ASS- - - --- PAGE --04 - -- Pb03a WMI Sample OENL-17 Type of malerial:paint chip/reddish-brown Locaborebeemmnt stalrvnay hand railing Area:besement stairway hand railing Resuln:0.23% lead by weightt Sample SENL-18 Type of rrate":paint chip/tan �— Locatfon:lrtLerior SE wall,storage room ArmAnterior wall. basement — Results:0.16% lead by weight Sample SENL-19 Type of rtau rial:paint chip/yellow Location:interior ceiling,dining roan Area: umont dining room Results:0.66% Wed by weight Semple SENL-20 Type of materiakpaint chip/off-white LocadanIntedw E.wall, dining room Area:interior walls, basement dining room Results:0.41% head by weight Semple#ENL-21 Type of matenal:paint chic/red Locadomintefku N.well,ding room Anlainterlor N.well, basement dining room Results:0.30% Ind by weight Sample NENL-22 Type of materiat:paint cnlp/muRi-Mored LoceBon interior window tome Area:interior N.wall, basement dining room Results:0.53% land by wsightt Ssrple OENL-23 Type of meteriatpaint chip/green Locanortinterior wall.above drop Ceiling Arembssem A kitchen Results:0.14% lead by weight Sample OENL-24 Type of material:paird chip/white Locatiort hwd above stove Arembasernant kitcher: Results:0.050% lead by weight 85/ii/2883' 59:81- 7663237743 SOOTT KMISON & ASS PAGE 05 PbO31 Sample aIIENL-25 Type of materlal:peint chip/red Locaiiom.basement kitchen floor Area:throughout dining room)kitchen Results: c0.009% lead by weight Sample#ENL-26 Type of matarldpaint chip/pray L=2111 :basement kitchen floor Arwan top of sample OENL-25 Resutta: m.008% lead by weight Sample OENL-27 Type of mate ial:paint chip/white Locatiaminterior W.wall, private dining room Area:bassment Resuhs:0.25% lead by weight Sampie SENL-20 Type of material:palnt aapl white Locedominterior S.wail, shower room •.L Areatasemenl shower room(lower well) Res"2.4% lead by weight Sample SENL-29 Type of materialmaint chic/ye!kra Lacedamutmrior N.well, shower room Arae:basament shower room(upper wall) Resultx 0.18% lead by weight Sample#ENL-30 Type of materiaroaint cnip/while Locatiaminteritir coiling. E.classroom Area:tssemsnt classroom ceiling Results: i.0% lead by weight Semple OENL-31 Type of matenal:paint chip/pea-green Loc allominterior S.wall, E. classroom bathroom Area:bssement class=m bathroom toilet Results:0.081% lead by weight Sample*ENL-32 Type of material:paint clop/black Location'Intericr S.wall, maintenance roorr. Area:bssement maintenance room FResuRo:0.14% lead by weight (5) - DW14/=4 I9:at 7SOM77'43 _. SCOTT MORRISON ASS PAGE 96 Ph03021680t Now:Sample firs ENL-33 tie ENL-44 were all taken ftm flits bid floor of ntaln bulidfrtg. 3ampta SENl-33 Type of maWaEpaint chip/tan"llow Um ti mintarior S.wall, SW oRioe Araa:2nd floor office Results: tO.00M% lead by weight Sample SENL34 Type of matsdol:palnt chip/white LocationInteriot ceiling, SW office Araa:2nd floor office Results: cO.010% lead by weight Semple SENL-35 Type of matertal:paint chip/white Locadomirrterior W.well. E-cwMal room Arw-2ndfloor,intedwwall RaWfti: cO.00M lead by weight Sample SENL-36 Type of materfal:paim chip)It. bias Lo atfon:lmerior door to bathroom Arse:SW room.2nd floor Results:0.17% lead by weight Sample 6ENL-37 Type of matenal:paint chip/blue Location:interior S.wall. SW2 room Arsa:SW2 room,2nd floor Results:0.28% lead by weight Semple NENL-38 Type of materiakpaint clVix ton Locatiominterior N.well, SW3 roorr Area:SW3 room.2nd floor Results:0.40% lean by weight Semple NENL49 Type of materiatpaint chip/green Locsborttntericr W.wall, SW3 bathroor* Area SW3 battwoom,2nd floor Results:0.47% lead by weight Sande aENL-40 Type of matenatpalnt chip/white Locatitm Interior window frame, of SW kitchen Area Uttencrwindow, SW kitten-2nd floor Results:0.25% lead by weight 16) 85/14/2a84 19.01 7683237743 SCUT-r MOFMSCN ASS - PAGE V Pb03t Sample SENL-41 Type of material-paint chip/dark yellow Loeatiort:interior well, S-Gomal bathroom, Arer2nd floor bovoom 0_by y wsrp�t Sample SENL-42 Type of ffwWal:paint&-iol white Locedw.iriterW N.trail, NE roar Anas:2nd floor Interior wail Resuib: <0.00996 bed by weight _ Sample OENL- 3 Type of nttnerial:paint chip/off-white Location interior E. wail, NE1 room Arso 2nd floor. NE1 room Results:0.11% lead by weight Sample*ENL-44 Type of rneWal:palnt chip/dark brow, Locatlon:interior window sill of NO room Aroa:2nd floor, NE3 roars Results:0.37% lead by weight Sample#ENL-45 Type of mstarial:pslnt ch1W tan Locatfon:intei km window sill of NE1 room Aros:2ndfloor, NE1 room Results:0.38% lead try weight Sample SENL-46 Type of material:paint chip/tan Loasdomextei or W. wall of main bldg. Aroa:wUrlorwall&of main building Rmwft 0.030% lead by weight Sample*ENL-47 Type of materisi:paint chip/reodist}brown Loptiartexterior W.-contral window(inrwr`came) Area duoughout exterior windows(inner frames) Resuftx 11.0% !and by wWoM Sample*ENL-48 Type of materlal:pairtt chipt tan Location:eAerior W.-csnbral window(outer frame) Arwhroughout sMenor vwndows(outer framew Resufts: 17.09E lead by weight 17! 05/14/2089t ' is:ef 7SO3237743 - - SCOTT MORRISON & ASS PAGE ea Pbd302t1 W1 Sample MENL59 Type of material:paint clip/tan Locatlomexterior W.wail, next to main antranoe Aroa:exterior walls of main building Results:0.059% lead by weight Sample SENL50 Type d matsrW.paint chip/cream, tan iocation:exteriot E.wall AnnLexterior wall of main building Results:0.020% teed by weight Sample SENL-51 TYPO of mpWrial:Palnt chip/light tan Location:w4mior W.wall Araa:axtarior wall of bldg.'9' Results:0.051% lead by weight Sample 9ENL-82 Type of n%sterial:palnt chip/tan Locatldn:gym(bldg.-C-),floor Area:oenter court area Results <0.009% lead by weight Sample*ENL-53 Type of material:paint chip/yellow Locatbrt:gym(bk4 'C'), Floor Ares:'inrw circle'.court floor Results: 1.9% lead by weight Sample#ENL-54 Type of material:paint Cnlp/dark blue Locedw,gyrr.(bldg. 'C'),floor Arewouter perimeter of court floor Resuttllr <0.010% land by weight Sample IiENL-55 Type of materidpaint ctipf white LocedomatWor S.wall, of gym(blog. 'C") Area:axtarior well. -Ndg.`C' Resuft <0.007% lead by weight Semple#ENL-W Type of material:paint chip/wnra Locabortiexterior wall around pool Area:extenor wall around pool Rasuttr.0.10% lead by weight (8? - 85/14/23SC- I3:81 768323774Z SCUTT 143W2ISOV $ ASS PAGE 09 Pb03M#Mo1 Sample GENL-37 Type Of materiahpaint chip)white loasti Le>derior N.wall, bldg. .D' Areaexterior walla, bidg. 'D• Result 0.055% lead by weis�ht Sample MENL-58 Type d rra tarial:*rit chip/tan LocsWrlrtteriorwell of hallway Area:hniedorwall. bidg. 'IY Resifts:0.096% head by weight Sample#ENL-59 Type of noftial:paint chip/white LocaticMirtterior S.wall, SE room Arewlntarror wall, bid% 10' ResulW cO.010% lead by weight Sample VENL-60 Type of rmrMsl:paint Chip/yellow LOCRO n:intsrioo W.wail. SE room AreeIrderior well, bide.60' Reauhs:0.040% ISM by weight Sample*ENL-61 Type of material:paint Chip/brown LocatlanInterior N.well, S.-central room Ares:interior wall, bldg.'D. Results:0.010% lead by weight Sample*ENL-62 Type of maim ial:paint snip/off-wh to Locetion:utterior ceiling&wells. blog. 'E" Ama:interbr ceiling&walls. blog. 'E" Resuft <0.007% !sed by weight Sample*ENL-33 Type of matenakoeint chip✓tan Locsfa r exterior E.wall, bldg. 'E' Aremextenor wells, bldg. 'E' Results:0.25% load by weight Sample*ENL-64 Type of meterial:pairi chip/red LocatiorcrW perimeter.bldg.`F' Area:roof perimeter,bldg. •F. Resuft 0.19% lead by weight. (9) City Of Lake Elsinore 130 South Main Street APPLICATION FOR & c.'D IM4. E 4 APPMN 2.,gg BUILDING PERMIT APPLICATION RECEIVED DATE AP,7 BY VALUATION CALCULATIONS MI — Q�O` DD Z BUILDING _ 1st FLOOR 3 s� SF uFNNC BLOCK/PAGETRACT LOT/PARCEL Znd FLOOR _/_SF •� NAM ]rd FLOOR SF o LRKf Fi U/LU4LEI LGC -4 2 W WOW— GARAGE AJIA SF N ADDRESS 4 3S-Z9 RI A!S!. 9W N2 We STORAGE � SF R CU L A I 2.-5r Z) I hereby aMM that I am licensed under pro-Asians of chapter commencing DECK 3 BALCONIES SF with section ipoo)of division 3 of the business and professions code.and my C &cense is in full force and effect OTHER: A SF O LICENSE# to 0, CITY BUSINESS N AND CLASS TAX St T VALUATION: R v A IMAILING C ADDRESS Y e V FEES T C STAT IP HONE% I O plv 144 7 BUILDING PERMIT $ R CONTRACTOR'S SIGNATURE DATE PLAN CHECK NAME TICENSE# A M PLAN REVIEW R MAILING C ADDRESS SEISMIC H CITY Q I APHONE/ PLAN RETENTION O NEW OCC GRP./ CONST. O ADDITION DIVISION: TYPE: O ALTERATION NUMBER OF NUMBER OF O OTHER STORIES: BEDROOMS: O SINGLE FAMILY ZONE: O APARTMENTS J8 I cw*that 1 have read this applicatian and state Btat the O CONDOMINIUMS HAZARD YES above information is correct 1 agree to comply with all city O TOWN HOMES AREA? NO and county ordinances and state laws ndadng to budding O COMMERCIAL SPRINKLERS YES construction.and hereby authorize representatives of this O INDUSTRIAL REQUIRED? NO city to enter upon the above-mentioned property for kmp- O REPAIR PROPOSED USE OF BLDG: lion JqOEMOLISH PRESENT USE OF BLDG: JOB DESCRIPTION AG o ► IS1 Signature of Applicant or Agent Date , Agent for ❑ contractor W!( owner Agents Name�t��. aTaT� Agents Address��X Street City State Zip AL.l A/ A%1 61vi Z HA7CNUAVE—SEE SHEET 4 ,�• �g �- ' ------t------- .+� J, �,''¢'�_'=.Y..e - �%y :� ��• - •- °S+ LmT.l16II ,,, I I v ' ----- J J .o-----r-- �. f�Sf. ? •� tmT.Bf�t i I I •a :I 1 155YYY� � I 1 I .y I — —-- -- A R Ur-- -—-— �- — e — --------- \ �. 11 -----------T J--------------------- am----------------------------------------------------- -- - ------- i ORIPMC T= f _S Li ul v 101%79 1. BUIL"I PERMIT # oo � ED �pp� 4 Z 4 j I �- N � M lei d C o. Na o N Az et , ra Lv � rl • r ' r I I •G -� �C9 { w� = � 1 O i ' n .WE _� r. I mr 43 I '. a p Mtn r 7 r i At chi n I ZO 39Vd EOLLEZE09L E:EZ b00Z/6E/60 5� C � + ZN a c I QW 9R 1T. Q. 4► �� G Q y I M � pZ .Qv► o t� tai;zCA qr V ` tz `- ! u`a. z p t= O olol j v O� C� A 4ca ft 3 � it -jr*4-j SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAMD,ASBESTOS NOTIFICATIONS.FILE#5941,LOS ANGEL ES CA 9W745841 AM USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED 13Y NOTIFICATION# COMPLETED BY G Van Hm tNel COMPANY Emrkonrnrrlial Contrd Solutions,Inc. PHONE (951)7MI483 DATE October Sin,2004 CHECK# 1651 FEES M121 PROJECT #083004R NOTIFICATION TYPE ORlGp1AL= REvmi DATES REvmm OTHER(hWghl) CANCELLATION PROJECT TYPE oexxff 01I OaxRm DEtimmoN R MATION(MMOV q EMERGENCY REMOVAL PLANNED REND(annua4 )00t SITE INFORMATION SITE NAME Farmer Elsinore Naval&Military Sdmd SITE ADDRESS 15900 Grand Avenue CROSS STREET Riverside Drive CITY Lake E1si m STATE Cafikmia ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Dentition of Sbuctlaes BUILDING SIZE(SOFT) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)50-70 NUMBER OF DWEWNG UNITS 11 BLDG PRIOR I PRESENT USE CawEracxu HosPrut ba=TRfK Otem Omm Pum c st DG HOUSE S0400L SMP UNNOCOLLEM xxxxxxx SITE OWNER Lake Elsinore Vftp I,LLC. ADDRESS 43529 Ridge Park Drive CITY Terneada STATE Ca6lomia ZIP 92590 CONTACT John Leway PHONE(951)506-6558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? ' REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10/05004 END 10130/04 WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRIABLE NIA CLASS I NIA CLASS 11 WA TOTAL AMOUNT(add row)WA REMOVED(in square fe" ASBESTOS REMOVAL FROM SURFACES WA PIPES NIA COMPONENTS NIA AMOUNT OF EACH TYPE OF ACOUSTK;CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m sure feet) r-VA I NIA I WA I WA WA FLOOR TILES(VAT) CRY WALL PLASTER TRANSITE ROOFING OTHER WA NIA WA WA NA (descne)WA CONTRACTOR INFORMATION CSLB LICENSE#809807 OSHA REG# AOMD ID# NAME Emkwment W Conylol Sdufians,Inc. ADDRESS 3654 Central Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER#1 LANDFILL ADDRESS WA ADDRESS WA CITY NIA STATE WA ZIP WA CITY NIA STATE NIA ZIP WA Asbestos sunrays are regleled prior to Dmolition and Renovation Page 1 of 2 i SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES CA 9W745641 WASTE TRANSPORTER#2 NIA WASTE STORAGE SITE NIA ADDRESS NIA ADDRESS NIA CITY WA STATE NA ZIP WA CITY Na STATE Na ZIP n/a CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1,2.3.4,5 or Other. For asbostos removals dude the combinaiim of We 1403 procedures used Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE CIRCLE THE PROCEDURES AND ANALYTICAL.METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey.Buck Sartprtrrg,Inspection,PI K PCM.TEM.Assumed as Asbestos-PACM,Describe Other: FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec•2 8106/04 T010/05104 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME 8 PHONE# AUTHORIZING PERSON:Carol Gordan TITLE Senior Code Enforcement Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NLW3ER OF THE PERSON DECLARMAUfHORIZING THE EMERGENCY.DATE AND HOUR OF FfAERGE)CY AND DESCRIBE THE SUDO£N.MEWECTED EVW- WA EXPLAIN HOY1 THE EVENT WOULD CAUSE UNSAFE CONDITIONS.EQUUWEIR OAMAM OR UNREASONABLE FINANCIAL BURDEN: CONTINGENCY PLAN:DESCRIBE ACTUM TO BE FOLLOWED IF LNEXPECTEO ASBESTOS IS FOUND OLJRING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED,CRIMH1.ED,PULVERIZED.OR REDUCED TO PaXDER NIA TRAINING CERTIFICATION:I crrtity that an kKWkkmi trained in fhe provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required tram"has been accomplished by tim person wig be available for inspection during normal business hours Company Name WA Print name of oumerloporator Signature of ot-medbperator Tittle of owner/operator Date INFORMATION CERTIFICATION:t certify Thai the above biorrrta-' and 1 - endosed anv required artactvnents Company Name ECS Print name of ovum/acerator y of /gperator Tittle of owner/operator Date 10/05/04 _ GENE VAN HOUTEN GENERAL MANAGER Notifications can not be accepted v&tout the required fee(AOMD Rude 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please crake r4tecls payab!e to*SCAQMD. Fern are per not'dreafinn,not refturdaMe,and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS RE!AOVAL PROCEDURE 4 OR 5 PLAN S 331.21 FROM 100 TO 1.=SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5.=SQUARE FEET S 90.24 REVISION OF NOTIFICATION $11.94 FROM 5.001 TO 10.=SQUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10,000 SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- $29.52 single-unit dwelling ATTENTION: Keep a copy of your notifioatiom State law requires.that you provide a copy of the demotlitiort notification to Building and Safety before issuance of a demobon pernA For questions call 909- W2336. For your convenience please read the form and fee and do not hand carry to AQMD. MAIL FORM AND FEE TO:SCAQMD.ASBESTOS NOTIFICATIONS.FILE 4 55641,LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)396-2336 FAX: (909)3963342 =orm REV 20030627 Forms,instnm9wis,and We 1403 are avahWe at AOMUs web site www.aqmd.gov SCAQMD is Ioxated at 21865 Codev Drive.Diamond Bar.CA 91765.4182 f9091396-2000 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAC M%ASBESTOS NOTSCATIONS,FILE 155M I,LOS ANGELES CA 900745641 oo;'pLE"o8tr ILLlE NWA6902FO f 1=Fc——Ir a�esrC2z=-ZaS-Zr iJATi: v =s351!? PROJECT NOTIFICATION TYPE CAG6v4t REymm DATrs imoN Ormt(highfigh0 CANC-a AnoN PROJECT a fFS oamwmm Om---;a D mGUnom .�9�ovAnm(m EcAERGEIIC'REU VAL RANNEO kcho(annual) SITE INFORMATION ! SITE NAME r--0 r2/M 6 Fi E LS trJ _ 5 N A A Srrc'fD; S.. CROSS S TREc CrIY E1..5I^}0KE STATE CAL.1FOKr'y/A `� LSD C CJUNTY FZty�2sr�G - I DESCRF-E:FORK AND OF ,a-s8E57i>s GOl�lir3vr�r�6+ ,»f}'T�r2/�L uktria G Set=;SOrm WER CF;r_DORS :JP_r'1NG AGE(Y.SARS) 'q'Itd3='. D'NELiNG UNITS BLDG PRIORI PRESENT USE Howl& ;NxwmAL Door C-.-cE =V9L1C 3Lw. F!OLIc ScHom S-•r UNN'COU L _ o L •N' F �IT_GY f � LLG ..i'�ZE>< Cr�S a .�/DGr_'- � i✓E ;I:'r i ��vL ST.:= �. _•i �� S � ::r.�'IAC'. 10ijc�9S!}-$i�(q� I ia=-OUIP.ED =£££aT33 %Ic, ASESj.Ca DS YES 03 1 2UI_;;\G-� 3= 91FORMATEW =R="r_-\i` SL�n�'c 0`I�. ! C-EMC :S=£D?-DSO/+* ;�ROlErTD?==S i �.:r,- ice EN^ _ �, ,:;;F.:;Shi-�(ca ,Swnc,r.gm ` ASBESTCSA14OI:NT TO SCE I FRI^B.t C!ZSS: I __=.SS 1. TOTAL AMOUNT tsW rev F M MOVE4lin squam 6m) { r.o L. • -'-�7r---s , ASBESTOS REMOVAL.FROM M-0NEN i S I AffiW hT J3F EACH TYPE Of Uw.Um R'.'SS-AnoR =I_FRGOFhN3 I DUCTING I 3%C`; i V AA ASEESTOS finsm.m FLO:R TKESI ti.fl 105 AALL ?J.57ER ` -��sNE51- I �=f$'.Z F G71i£ I Ste: i tsas3e � :5 roc J �} CONTP.Ae:T0:2WFOR3LCTiOIiAEG= I Cam. �r•:?_'-? I t�4 G R NAbi£ " rTr t DDRESE , 1 c,:Y L of G A C-A o4 _7ATE LI Q ' $.T_S�+P'.= 14-!V�v,.^•'�'i �1.L.�4-'�R J�'.�.N �$��5^� 9 WASTE T'eSI+NS iT=.t gi L L aNDFs t A-z c :L A-somms surer are rewire__or tD r_t:ko:ifiOn anc Renovml_%n icims. ishc&ms,and the Rule 140:can be ob!anmA-f.-.m 140MO web sits REV 2:=E27 SCAOMO NOTIFICATION OF DEMOUTION OR ASBESTOS REMOVAL 4WL FORM AND FEE TO SCAGMD.ASBESTOS NOTIFICATIONS,FILE#SWI,LOS ANGELES CA 90074.5641 WASTE TRANSPORTER#2 WASTE STORAGE SITE ADDRESS / ADDRESS CITY STATE rP CITY STA E ZIP CONTROLS: i?-=MOUSE WM PRACTN...ES AND CONTRO-S TO SE USED AT T HE RENOVATION AND DEMOLITnN SITE Procedure or Othi *�t i'SD taster ►ais tide Lis canbC�ksn of Ru!a UT)aocc tires u t. Rtooedure 4 and 5 submit Mans for ACIM Pi appmvW. ASBESTOS DETECTIONfROC ClR:LE TriE?FQC4;Otlr�'.4 AND+;IiACYiii„iL 1 'T!r.00.S USED TG t?FTE?l�flhE AS3ESTrJS IN THE i3UIL01Nu: Smq.Bulk Sargg",Irspeduk"M ,MEAL A.-mmed as Asbenx-FAC M,0e6mbe Um: FOR DEMOLMM GPrE?FEE CCM?ANY WJJE AND ZATES of;'rlE ASSEzTCS REMOVAL FOR ORDEFED DEMOLITION SFXD ,COPY OF THE 0R6ER A40 G`E THE-AGENCY?WAE S°ItiONE 9 AUTHORING PERSON: TIP..: DATF-OPORDEk t7ATE 0DEqEA TO EEMN: r FOR EMERGENCY ASBESTOS REMOVAL GKTFE ib1►.IC 1ND?I0L`.W,fOt R CF TH=_IFERSM,r=LARWiLAUTHORONG THE!h EFGENCY.DATE ANC HOUR C R[eETlCY MO UESWtSc Tlr a;=-K ILWSTE-Cr -cVEEHr: �C-.i►NrlOIV:: ��1T1�'t�iLGC.sifSE�SeL== C.`tS.E0 O�jUfIi=CSGwwdLE ?PtRNCiALDIkZCEN i CONU NGENCY PLAN:?ESCRIEE ACTdM S TO SE ft'Lt LWO IF J:.''aY'r_T ASSES$IS FO O C--:.:RING C_CL110N OR ASSESI OS NWTERAL BE-Cat 3a"TiTnEEC.l�titVFt.c:?.?ULtiER�.OR�LC�Tt==+PJ=Z TRAINNG CF-:Z tCATi0N:;asr&l k.a jrt ir6mim;rained fr.live of redv&n l;C.'AO Rwme 1433 arc-NESHAP wr"be on site during the mmovat arts =tr cerio8 2LEt&a regured L nee-:+e;'t d-.G,!trts rare-::wd to-vvaiabb is inat .during na:mai Business rovers. t1 c�G-� Irlf Lr-rL.En .jt►��;'�� . .'rtn ��'��`�° 1 :anx yNam Tittleo;owmmoereur Oae INFORMATION CERTGCiTI1f:I cerk tat the abm t--&m z'ar.Is=rw am 1 Rave an d cry rec:dreo attacments. i ,.may iVane F-di a_-me af ammaccenmr Im of owner/operalo Date . NoffcalimS C.:rt V.ze acwpea wit, .-I tr`.e racuked flee-(.tt K-ace C 1k Aste:tts mwrats of less Than 190 square feet are exempt`Tom rwtificahon ana fem itease r�ak6 s ae►aoie to'SC:+C Fee:3r W•X&,—.aft-7,rct ief=alb alp vary a=t:n5 ic the orgem size. Fbp-c are as fo.7o": j :rfAOLiTIC2; ,,5°ESTS REI:'AVii': PROCEDUIR=4 OR 9 PLAN S;13;1.2 I -nOU,1103 TO t,r}y0 SOitFFt r i 5 X52 SPECIAL.FAh`i, NG FK— =-t0id I,Ct1 TOSAMSC{!t$FE T S ;i:2? ReeVISi,^mo.=Ner.ICATION =,ZO,t/i S.Ct':O t0;}�SQU14R:F'r=Ts21 Ill Ac i tIRNE^C`{ECn C.HP.KGt - S'39.23 b TH`N t9,QQ0 SQUARE FEET a:4:l WIC1'veTF:N OF NOTIFICATION S 0.3 :=1110L1'IOIti O;LcSS;Nl+t�'1 SO F•' S i 12 ASBEST==S 4E.'AQVALAT:owner- S 2-9a2 xaaav,sr ate-t:nii dKrellina ATTENTION: Keep a copy of-you:notd'rcacon. Sfinelan:ead'es 7-a;*Ict:pr•vloe a Copy x Me ftmmotw,mdmfion,e 8ulldrng and Safety pion issuance ti cema itiav cfr:ra :x 44.'_sdo;u cd 0-093.Q6-2M Fx rci:.C,v env s,:Q 08sse ma!fire Torn eru r'=&and cc not hand Tarry to A::Mo 11-ML FORM AMD FEE TO:SCAUD,ASBESTCS 40TIFICA;I0Na,RLE :�45641.LOS ANGE ES CA 90014.5645 Page 2 of TELEPHONE: (909)325.2336 FAX: (90913M.U4i corm F. :' on, =wV-1S.O ST'FTb3NS,,*X TFE RJAES It433 CAN K- :3T.3dIED Ft?r,;I1 A7v0:+E;:Sf E AT SIT P' .W"XrW.A 0 M D GO SCA;2MD is located-at 21865 E Cx4ey uldve.Ciamond tom.:.-°;?_.`.=982 :.n31 19S.2C'LG City of Lake Elsinore- 130 South Main Street APPLICATION FOR H Bw LD ime, F ' At-W W25q BUILDING PERMIT APPLICATION RECEIVED DATE AP It BY VALUATION CALCULATIONS 3$I — oSo' OoZ 1st FLOOR ZDd D SF BUILDING ADDRES1/�i�INC TRACT BLOCKIPAGE LOTIPARCEL Znd FLOOR �IASF -� AM Jrd FLOOR SF o 1.AKf t 5,#L)� (/«GR4EI 11 r,06 -4 2 W N _ GARAGE WA SF N ADDRESS 43S29 99biz E STORAGE SAA. SF R GU t-ll1 L 2� hereby affirm that 1 am licensed under provisions of chapter commencing DECK 3 BALCONIES SF with section 70W)of division 3 of the business and professions code.and my C license is in full force and effect- OTHER: A SF O LICENSE s t: CITY BUSINESS N AND CLASS TAX a* T VALUATION: R N v A MAILING C ADDRESS 3 y CC v FEES T CI STAT IP HONE e I O V ` 4 BUILDING PERMIT S R I CONTRACTOR'SSIGNATURE A PLAN CHECK NAM . ` LICENSE A Ili PLAN REVIEW R MA LIN JJIA C ADDRESS SEISMIC H 1 TA I ri4it, PHONE PLAN RETENTION ❑NEW OCC GRP./ CONST. ❑ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF Q OTHER STORIES: BEDROOMS: ❑SINGLE FAMILY ZONE: ❑APARTMENTS 141 certify that I have read Uds application and state that the ❑CONDOMINIUMS HAZARD YES above information is Correa.I agree to comply wreh d city ❑TOWN HOMES AREA? NO and county ordinances and state laws relating to building ❑COMMERCIAL SPRINKLERS YES Construction,and hereby autnorxe representatives of this (]INDUSTRIAL REOUIRED? NO city to enter upon the above-mentioned property for irtsp- ❑REPAIR PROPOSED USE OF BLDG: bore pure OEMOLISH PRESENT USE OF BLDG: JOB DESCRIPTION /a Z4/ 6r xtsi Signature of Applicant or Agent Date r Agent for ❑ contractor {t owner Agents Name &!6 VA&J MY' Agents Address �ib4 4FOR!L AW, CA ` 62 h Street City State Zip r r x ti.rx Qu,!1"�F qw r •�. r . Tyr i'�._" •� _ ,.r,.. E111 IKEDOMM �' t tK`J �P" i�1� tr 4 •'..: �1✓ li i ��.�ic�{L d / I oY+ra� fP�- ,easy;: '1 n��`t""'°s�r�' �►.r�c _;.?a.r_�.aa7�c�aom� �Ol�� 9 �d'�iflS�if i�c.s-a� .'r T ZL am �ye R �_ CA IFi L 4lax y a G•, aaGG �� o CL > C A,- CIA ; Z o 4116 O r Q i a4 oc r v o IS o , LCOA- cc VWA 67LLSZE09L 6i:EZ D2eZlOE/E0 '� po �? ka 8 1 + 1 e � pyICY ti a, { rA �' sue---5do o 43 IL I 31 � Q � � _� �' �i �'• of �? � � I � ^ s f dcr a e >f,]4 3 ELa L C u v s 1.L 8 U. l u .�, � �_'_� � a -s�r'•`3, q.,� Oa , -ter-'• s: CU at Ji O a O ��3� yr �� ✓1 �� ` -T_r � ! �� •v eN °� ��py dOL o "y �• O A S h--a �' � � �" 1 ...�� I o 1 � i Q ze d t=��sze$cc ,:EZ VIN OC/E© ti A b ! i i Ica 14 IW + I �� II f� r -MF ! ma tr 9 f t v I v F g*4 su i l Q c o� Z oL o�c o Lg o d N ¢ u Z CP- U � • � �.� �� $ � � � � aim a9 fd £VLLEZEBSL 6T:EZ OBBZ/BE/EB SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOUITION OR ASBESTOS RBNOVAL MAL RM AND FEE TO SCAQUIX ASBESTOS NOTIFICATIONS,FILE#NMI,LOS ANGELES CA 9W4M41 AMD USE ONLY Scram BY RECEM POSTmw- ENT13M BY NOTIFICATION# COMPLETED BY G Van Houten COMPANY Envirwnenbd Contrd Solutions Inc PHONE (951)7MI483 DATE October Sh.2004 CHECK# 1651 FEES 33121 PROJECT #D83DO4R NOTIFICATION TYPE Otemm loot RHrr"DATrs REVIWN GFHM(highlight) CANCE ATM PROJECT TYPE DBAMMO+ OFDm m Dexir= RDWATrent(rerrrav81) Ts+ratcacv RBmAL RmN®Rao(annuap soot SITE INFORMATION TSITE NAME Form ElsQrare Naval&Mftry Sd od SITE ADDRESS ISM Grar►d Avenue CROSS STREET Riverside Drive CITY Lake Elsinore STATE California ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Demos bri d Structures BUILDING SIZE(SOFT) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)50-70 NUMBER OF DWEWNG UNITS 11 BLDG PRIOR I PRESENT USE Ccw43xK HOswTAL bMUSTRW ORM OF Pueuc arc. HOUSE ScHoa SHIP UNNICauEGE XXX o= SITE OWNER Lake Elsinore Village 1,I.I.C. ADDRESS 43529 Ridge Park Drive CITY Tennecula STATE California ZIP 92590 CONTACT John Leway PHONE(951)506-6558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10105f04 END IW30104 WORK SHIFT(day,swing,nigh DAY ASBESTOS AMOUNT TO BE FRIABLE NIA CLASS I WA CLASS 11 WA TOTAL AMOUNT(add row)WA REMOVED tin square fees ASBESTOS REMOVAL FROM SURFACES NIA PIPES NIA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING UNOLEU.IA INSULATION FIRE PROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m square feel) WA WA I I WA WA WA FLOOR TILES(VAT) DRYWALL PLASTER TRANSITE ROOFING OTHER WA WA WA WA WA (describe)WA CONTRACTOR INFORMATION I CSLB LICENSE#W=7 OSHA REG# AOMD ID# NAME Emaonmental Conyttil Sulu Wm Inc. ADDRESS 3654 Central Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Genre Van Houten PHONE 951-788-1483 WASTE TRANSPORTER#1 LANDFILL ADDRESS WA ADDRESS VIA CITY WA STATE WA ZIP WA ! CITY WA I STATE WA ZIP WA Asbestos surveys are feq med prior to Dernalaw and Renovation Page 1 of 2 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES CA 9W74-5641 WASTE TRANSPORTER#2 NIA WASTE STORAGE SITE NIA ADDRESS NIA ADDRESS NIA CITY WA STATE NIA ZIP WA CITY Na STATE Na ZIP Na CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1,2.3.4,5 or Other. For asbes6os removals code the con iatfaim of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AOMD prior approvaL ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Sunray,Bulk Samp trig,irspw5m PLM,PCM,TEK Assurrrted as Asbestos-PACM.Describe Other. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec-2 BM 04 TO 10/05/04 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME&PHONE# AUTHORIZING PERSON:Carol Gordon TITLE Senior Code Enforcement Officer DATE OF ORDER ASAP OATS ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUIVEER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY.DATE AND HOUR OF EY!ERGEMCY AND DESCRIBE THE SUDDEN,IIN0TKTF.D EVENT: R9A EtPWN HOW THE-/ENT WOULD CAUSE UNSAFE CONDITIONS.EQUlPldENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN CONTINGENCY PLAN:DESCRIBE 1,CTKM TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED.CRUN$LED PULVERIZED,OR REDUCED TO POWDER NIA TRAINING CERTIFICATION:I certify that an individual trained in the provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required training has been accomplished by this person will be avaitab!e for inspection during normal business hours Company Name NIA Print name of avvnerloperator Signature of otawdoperaior Tittle of auuerloperator Date INFORMATION CERTIFICATION 1 cerfdy that the above infortna ,and I -e enclosed any required attachments. Company Name ECS PriN name of ownerloperator mina Mperator Tittle ofowner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER Notifications can nail be accepted w.thow fhe regrared fee(AOMD Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks payab5:to'SCAQMO•. Fees are per notiftwatibrm,not ref uKlable.and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FROM 100 TO 1.000 SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5.000 SQUARE FEET S 90.24 REVISION OF NOTIFICATION $11.94 FROM 5.001 TO 10.000 SQUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10.000 SQUARE FEET $331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- $29.52 nit dwelling ATTENTION: Keep a copy of your notification. State taw mgxftes that you provide a copy of the demolition notification to Building and Safety before issuance of a demolition puenk For questions call 909.395-2335. For your convenwice please mail the form and fee and do not hand carry to AOMD. MAIL FORM AND FEE TO:SCAQMD.ASBESTOS NOTIFICATIONS,FILE #55641.LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)396-ZI36 FAX: (909)396-3342 Form REV 200M7 Faints,irtstructioM and We 1403 ate available at AOMD's web site www.aqmd.gov SCAQMD is located at 21865 Coolev Odd Oiarrlond Bar.CA 917654182 (9091396-2000 r - SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL r • MAL FORM AND FEE TO SCAOMD,ASBESTOS NOT09CATIONS,FILE 055M,LOS ANGELES CA 90074.5641 J Co,/,PLUOB By I LLIE NyIA699Saffy E Ec— PHONE sroz-2.os—zr DATE 0?,q(g -CKe ;Lg-G0 FEES3312d- PRCJECT-* p 0 ! O NOTW=TION TYPE t3ac6r4L RRfym tt DATO RMDN OMER;hkjhfighO CANCELLATION PROJECT TYi~ toacuTm Olw-m D;WTW Ij;AnO„iram a � &AERGENcr i^EMOVAL PCAr,NED READ(aMU21) SIME INFORMATION � SITE NAME F0l4M E r% E LS t G 6 N-A-vAL j M I L I :5 c+4 DO L I Srr .eD t q 00 cq K�tN A,v lF N u c— cizoss s RE=r Crry LacKG- EL5jrJV0,E STATE CALI#0je.JV/A aQ 9L530C:UNTY 9,1V6tL-5IbE DESCRIBE VOW AND LOCO gat' P2.aP-44-1- Ri;PliauRL_ OF A-SSESti?� �-e)f}70 Lf oe-/AL 11�.01ACs�i NU+:6CER L'F r_01W SUILL!NG AGE(vEARS) ^_•F JWE__;f:G UNITS 9LDO PRIORI PRESENT USE 1=20AL 'fawmm ctie- CRM OUauc 3WG. F!ausE Swot. sip r p. Sie_C��`'v j` �T+..�-,-- L L C :s:' E ,qua �R I✓e _I>f i "•EGv�il ET�T= Jr Qr'1 7 7� �""\�;,CT `�� i1 y`f L�cNR�, "H ONE�951}-$Ar9 ite Kf3U pM BLgL-WGG =S=EST.�,S j ASKS-C. C NO AS 0,3 S YES EUILZi1IG r� - � I WFORMAnOff i ra\i^ ! SLr,,vE% :_'nOv�; %E►dCLS-.?7 `$Dr++L ?,OJEL!3r?TES fry 7 �L„ G °I:L' ^4�_ _.:p* 'V,U� .a+si:i da swric,runt L AStsEST,^.55?Ih10L:YT TO BE f FRi;,bL[ =_=.sa"I; i TOTAL AMOUNT(BW rov .=iSOVED;en I . tla^r:tseg ASSESTOS.RMOVAL FROM N'ENT S a I AMOUIrT OF EACB n FE OF ;=usx cm C:v I :J '�J1S I UL�ii.�� ' =i`?:=ecC�=ING I DU,-TM ! =7(;C., i.=E ASBESTOS (inw� }sa ��ilLrar':`ki� goo mmam PtY.qrEZ -oaFm � C-T:e7-. j 15 70G i / 5-00 F3ascn`.a CONiP.ACTOR.WFORMATION ! ZS,S:J=u:s'=: iffy v` G.'KZLeccG- Tr AODR=a c f U e 4 C,A.=tl t,►-�' siniE r.& t!' q0 � 'TE w°t!= 1PASr MANSMR7 ER Bi c G�I � LMOFIL A` ,,t 5� '•!V �-. :L_ 11 _aRE s P. iJ�XC�ss `P , ,C �. L a 71 J "�''�7 � �i f•I t} e I n� i — .� !� i� CIT4 �%�, :"Ufa i n J° a , A.son'los sumrs are recur d.pwr to Dmo ti' n aW.Renovaw >i w,ms.-nshckns.and the Rule 140'31 can be obmined Win:ACiriD we;site hnz:;iwwy.a urn d.gov =aaa: -,_ =crm RE 200 .: SCAOMO NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL AWL FORM AND F=-zE TO SirAQ61D,ASBESTOS NOTWICATIOW F-0—C 8 6S$41,LOS ANGELES CA 00074.941 WASTE TRX4MRTF-R r2 WASTE STORAGE SITE ADDRESS / ADDRESS . CRY STATE 2,"A CITY STATE 2J? CONTROLS: DESCR12E VKft. PRACTICCES AND COW TWLS TO 43E USED AT THE R90VATION AND DEMOLITION SUE ?rocedure#i 1,204,S or C4ht ':x as ,roa maavals dide me axnb6rasion of RtEa 1403 mcedum tcspm Pmce&n 4 and 5 submit Mans for ACIPID pda approval. ASSES=DETECTION PROC CIRCLE:de PROCEDURES AND ANALYTICAL,'��i FI00.s USED TO f?ETE?ldIRE ASBESTOS IN THE BUILDING: der,Sulk Sarap9rig,lrs PC!A.:EAL Ai-sened as Asbestos-PACM,Deembe Cmer. FOR DEMOLITIONS GIVE T 1E CCMPANY W.&Ic A•ND SATES OF t HEASSESTOS REMOVAL-• � FOR ORDERED SEhl"IOH wxo A COPY OF Trl=_CRUDER AND GIVE THE-AGENCY NAME b PHONE 4 AUT};OR01%Pe-RS011: TIPS DATE.OF CADE.R , . ilf TE INDERED TO EEG!h FOR EMERGENCY ASBESTOS REMOVAL t:PF TF :tAMc 0*r'Ha_.VW ER CF HE PERS04 DECLAR*WAUTF:ORONG THE EMERGENCY.DA T E Atic HOUR C =VFRGENCf AND QESME T}r SSL ?K IJWi7-CTej EVEW I E 4 hN iDW 7r{_-- T'Am M'LCCAUSE 1VE,4r=wMMIIS,E'.FP11,ENT0AMAZ-9:0 RUNRESS0NA3LE F:NANCIALSU+iCDL t CGt IN6ENa PLAN::=xRt�AGT1ONS TO9E FOUiaV c1 IF'J:.'E CZ C -zMS IS FasC MI;aN0 0FJ.Cu1-6 M OR 4S9E5T0S MATERIAL 3=fit: 3a'TvnfiEC.u'YtU5�3.c?.?IILVFRI�.OF.�;!G'TJTGPC+7'J_-i. TRAINING CE.ZTIFTCATI[OW;csrW mm sn i;.&mva 7dned In Ilia crovkiam of regtd2kn A01.10 Rule 1433 arc:fESHiAP wail be on site during the moral and w.cerloe iLat d1a n:a�5rxf L- natt}ite:: 1 z i J. i;�pus vans►::wS to 2vaaatta ic:inscr.Jon duAns normal�usinm home. c EG-S. W f L F-O-C-D P&A-6960 G Vvn ft 17 fnlr�j S'If u f� 00-ro 1 ::�Rasa PejU nix of wsftemor 5x3.:e a-s �� Tiflle o:ovrnerrooeratcr Dme INFORMATION CER"7:i..;T1O1t I tear,}-,z the er're kdhmwhm k=aea am 1 home rely fecuked aftacments. :w.edMr9 I m of o nerl'iperalo Dale ya^i c---3-:3e amppea xI cm t:`.e mund leas(AWE RWe a:t)_j2Ata norris of Ms then 100 square Not are exemot ftan naification as fem ?!ease riaka peyxa to'SCAGW' Fee:ar.pa: rf-.,act rafl.-nca'ote,aW vary accf- n5 i%the ptc;em Wze. Fees are as follows: I C°I.i(2UT!Ch CRrSEcST`S PEMOVAL ( aPOCEDIIRc'4OR 5 rF-W4 S;33.;. ROM i OD TM 1AD SQrWLC Fr S "i•.52 SPECIAL(',ANGLING FEE b =-CM i.Ci I TO 5�&m SC4l FcI RE _ 3 ZJ.2t � REVISr,,N OF NOT,F!G;TION ': 0%A 5.CD1:O 1t1,>}W SQUARE FE=T 3211.E RE-11I NED CHSCK CHARGE $19.23 %DR=THAN l%0W SQUARE FEF QUICa ANION OF NOTrICATION $0.11 tdOl7 ON 0:Liss►cf,;N*3 SQ FT a .:? ASSES OS REMOVAL AS mk7*r- 5 2f.52 om.-oise.s'mIe+rul dwdrtna j ATTEN i ION: Keep a copy of you:notMcatton. S(reb n requires Mai ie':pmida a copy d 09 dana5'don noiiflcadon m SOI&y and Safety ne-rom,ssuar:::e O F car fti cfrrra. Far q_s.c,u Ai%9,39VcM z W fWCM-Sia?-lu Hesse matt the imm and`ee and cc not nand am to ACMD XML FORM AND FEE i0:SCAWD,AWEST-CS NOTIFICAT IONS,FILE r 45641.LOS At,'G�:S CA 80074-5641 °age 2 of's TELEPHONE: (90313M2336 FAX: (909133i.3341 Form P 12L'030E2? ?�15,i.VST?!1�iIGNS,r,VC Thi-ULS f 4J3 CAN SE_3i.4ttiED FPGM A:1140.WE SITE AT :iill- :r_�WW .:�QIVIl?.0 V SC42MD is iocaated at 21865 E.Cazkv Cdve.Diamond Ear. ?i?L 1EE (3fJ3F 395.2QQtl .... . .... -e.n . �c.�n?�.�., : rrr, Jni. in :n nr. gnu i City of Lake Elsinore 130 South Main Street � a APPLICATION FOR ba I alix AP B S BUILDING PERMIT APPLICATION RECEIVED DATE AP 0 BY VALUATION-CALCULATIONS 391 — �e,-�Z EE�) l y SF 1 1 Ap Lv XM14 BLOCK/PAGELOT/PARCEL 2nd FLOOR lJJB_SF — AM 3rd FLOOR NJA SF O JAKf �Q51AJA U«LA6E� LLrC l -�l 2 W MAILING GARAGE IAJ A SF N ADDRESS 4 3S'Z9 121 A6� STORAGE _ (�!/�l� SF R Gu ` TA 2 1 hereby affirm that f m Imens under provisions o chapter commencing DECK&BALCONIES SF with section i000)of division 3 of the business and professions code.and my C ficense is in full force and effect OTHER: A SF O LICENSE s to CITY BUSINESS N AND CLAWTAX fl T NA VALUATION: R (f✓v( A MAILING C ADDRESS 35&y CFA17RAiV FEES T C STATE/ZIP IP HONE O IV `12s 7 BUILDING PERMIT S R NTRACTOR'S SIGNATURE TE PLAN CHECK NAME LICENSE# A PLAN REVIEW R AIA UN C ADDRESS SEISMIC H CITY E21P PHONE/ PLAN RETENTION ❑NEW OCC GRP./ CONST. O ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF ❑OTHER STORIES: BEDROOMS: SINGLE FAMILY ZONE: ❑APARTMENTS JA 1 cer fy Btat I horns read Uds apocadon and state dot the D CONDOMINIUMS HAZARD YES abo a informaoon is correct.I agree to cornply with al city ❑TOWN HOMES AREA 7 NO and county ordinances and state taws relathg to bugling ❑COMMERCIAL SPRINKLERS YES construction,and hereby authorize representatives of this ❑INDUSTRIAL REQUIRED 7 NO city to enter upon the above-mentioned property for romp- ❑REPAIR PROPOSED USE OF BLDG: Lion purpeits. X DEMOLISH PRESENT USE OF BLDG: /l 1A eJ JOB DESCRIPTION Signature of Applicant or A ent Date Agent for ❑ contractor {i owner Agents Name&,3 VArJ Agents Addresses 5,64 avgUL �AAVE 1 G A ¢_ Street city State Zip r A L Al.J Al I..'A -r- -1 LF uCM.rva_ an sas super ----- _ lXh1 I I I 1 • ®CEV; aCa _ r 1 ------ '------I I ! y_•e�—�...�..e.- ` ` F' �T�B�1{ }., me -- ---- I .. nw- SYCHY BAG ' j 1 i I j r a l �m " a !�•. i I � - o ' I I � �y,• I I I I I 1 D —�_ -- - a - -- - —�--'----3- y A. GRAVID AV1 --------—T------—---- �� SCAM------ ----------------------------------------------------------------- -------- i /ply 1111 �� ELSINORE , �t ell 1=lwG DIN/ISION �^ ^ r ERM IT # APPROVE® ! ' • r.6 bL .. o Z s NNV _ U/ IQ c T V IT C v v I t= o e 96 IL zr L 4 = o E l o a 4 rJ fig �0 31rd ErLLEZE6SL ET:EZ, b00Z/0E/60 4 a p � I i 4 --� a IPC _ > :3 cy— sc I i �• C:s �i I C i 44 zz cr dia _3y it �y o � d . ze g vU a. in e�r Uwi Ila go ro �� F'.�L►�7.FB�i 6'i:EZ bB�ZrG£/60 'SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOUTION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAUR ASBESTOS NOTIFICATIONS,FILE#55641.LOS ANGEL ES CA 90074a41 AM USE ONLY SCREEN @r RECEIVED POSTMARK ENTERED BY NOTIFICATION# COMPLETED BY G Van Houton COMPANY Envim vmW Control Solu6orrs,I= PHONE (951)788.1483 7 DATE October Sh.2004 CHECK# 1651 FEES 33121 PROJECT #OB3004R NOTIFICATION TYPE Oa:PMW soot Rave DATES REvrsm OMER(Aig W*4 CANcetATM PROJECT TYPE DErsarrroN Ommm De mmorr PM MATH(removaq E-AsmoCY REMovAL PLANNED RENO(annua4 SITE INFORMATION SITE NAME Fww esinore Nava18 MUoy School SITE ADDRESS 15M Grand Avenue CROSS STREET Riverside Drive CITY Lake Elsinore STATE Cdbrda ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper DerrrolrTio' n of Shuchm BUILDING SIZE(SOFT) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)50.70 NUMBER OF DWELLING UNITS 11 SLOG PRIOR I PRESENT USE Cm&mKm HosRTAL Gmrsm m Odw OnrcE Pumm mm HOUSE SCHOOL SHIP UNMCouECE xroocroa SITE OWNER Lake Elsinore Village 1.LLC. ADDRESS 43529 Ridge Park Drive CITY Temecula STATE Cal'rk"da ZIP 92590 CONTACT John Leway PHONE(951)506-6558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10105/04 END 10I30104 WORK SHIFT(day,swing,nights DAY ASBESTOS AMOUNT TO BE FRIABLE NIA CLASS I NIA CLASS II WA TOTAL AMOUNT(add row)WA REMOVED#un square feet) ASBESTOS REMOVAL FROM SURFACES NIA PIPES WA COMPONENTS NIA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM I INSULATION I FIREPROOFING DUCTING STUCCO MASTIC WA ASBESTOS #m square feeQ WA NIA NIA WA WA FLOOR TILES(VAT) DRY WALL PLASTER I TRANSITS I ROOFING OTHER WA WA NIA WA WA (descfe)NIA CONTRACTOR INFORMATION CSLB LICENSE#80=7 OSHA REG# AOMD ID# NAME Emriromnentaf Cony[d Solutions,Inc. ADDRESS 3654 Central Avenue,Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER#1 LANDFILL ADDRESS WA ADDRESS NIA CITY i'VA ( STATE WA ZIP NIA CITY WA STATE NIA ZIP WA Asbestos surreys are regAmd mor to DenWitilon and Renovation Page 1 of 2 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,ALE 0 55641,LOS ANGELES CA 9WT4.5641 WASTE TRANSPORTER#2 NIA WASTE STORAGE SITE NIA ADDRESS WA ADDRESS NIA CITY WA STATE WA ZIP WA CITY Na STATE Na ZIP n/a CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1.2,3,4,5 or Other. For asbestos removals chda the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey,Bulk Santpf%Iruspec6oru,PLM,PCM.TEM.Ammned as AdmsbOACM.Desmbe Outer. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eac-2 8/06104 TO 10/05/04 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME&PHONE# AUTHORIZING PERSON:Carol Garden TITLE Senior Code Enforcement Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAN E AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY.DATE AND HOUR OF E?ZER ENCY AKD OE SCRIBE THE SUDDEN.UNEWEECTED ENEMT- NIA 6YPLAIN HOW THE EVENT'+RXWCAUSE UNSAFE CONDITIONS.EOUP PENT DAMAGE OR LWREA.SONABLE FINANCIAL BURDEN CONTINGENCY PLAN:DESCRIBE ACTIONS TO EF FOLLONED IF UNE(PECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED.CRILWI LED.PULVERIZED.OR REDUCED TO PAR ?NA TRAINING CERTIFICATION:I certify that an individual trained in the provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidence that the regrered training has been aaoorruplished by this person wig be available for motion during normal business hours. Company Name NIA Print name of cvmerloperamr Signature of oe-mer/operator Tittle of owner/operator Date INFORMATION CERTIFICATION:I certify that the above 6tforr am reaueed attachmentsd Company Name ECS Printnameofowneoparator tor Tittle of owner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER Notifirmin iscan trot be accepted wolio ut the reaured fee(AChMD Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks payab5:b'SCAOMD'. Fees are per notifrcation,not refundable,and vary according to the project tee. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FROM 100 TO 1,00D SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5,000 SQUIRE FEET S 90.24 REVISION OF NOTIFICATION $11.94 FROM 5.001 TO 10,ODD SQUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10,0W SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- $29.52 nit dwelling ATTENTION: Keep a copy of your notification. Shale law mquaes that you provide a copy of the demolition notification to Building and Safety before issuance of a deurw5tion perml For questions call 909.'f96-2 35. For your convenience please maul the form and fee and do not hand carry to AOMD. MAIL FORM AND FEE TO:SCAQMD,ASBESTOS NOTIFICATIONS.FILE #55641,LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)396.2336 FAX: (W9)396MQ Form REV 20030627 Forms,instrus.and We 1403 are avadable at AOMD's web site www.aqmd.gov SCAQ,'JIO is IocaLed at 218M Caofev Drive.Diamond Bar.CA 917654182 (9091396-2000 r ` SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTiFICAMN OF DEMOLMON OR ASBESTOS REMOVAL MAIL FMM AND FEE TO SCAGMIX ASBESTOS NOTIFICATIONS.F U$55641,LOS ANGELES CA 800746641 1' -W- 5 CO.Y.PLEi'OBY LUE NWA6802 - '-� C-CG- FtiONESroZ^2D$-Zf DATE OF o(q- =CK.m P-g-Cl a Fs S 331 JLL PROJECT-4 NOTIFICATION TYPE �9_41t RemmDrlt:s :iEmomOrH=_R(hofigho CMCELtAnON PROJECT TYPS 1 l0a win O.V CRw.;m D--Ymn r r'm+vrattor trewva C EMERmucr RENWAL R-AtmEO READ(arniai) SITE INFORMATION , SITE ePUY.E r0 f�M B r% E L,S( 5 N. 4 A M I L l e e C)C L j SITe AODIL-S. I S OG G tL+sf-1 h -10,,V lF N U E CROSS STREer LCfiY 1'AK.c ELSIIVD�+r, ST'fc CALIFW..,v/A 3' LSDCC:�UNTY bFs DESCRIBE%%Rri.LtiR LOCATION P.tZ.0P_r-f_ RSMovAL_ OF Q-sSES-ms SAG Sir,X13 F-11 NUMBER CF FLOM UM6'JG AGE ivEa+'•S) 4UM8=.:•^_F 01affLiNG UNITS SLOG PRIOR 1 PIMSENT USE 7•ovmL :mx 4zl cow ONCE 'rreuc j=. roLtl= a-r• unn,�as r 6= S(t:GtiR I -� LLG ACCRE3S !j' e? .Q!rJGi- ?f ,)Oe i✓� r'rly i "•EG�;� SF�T=_ =;d ZI q 1 S9 ,O.'rACT R OUIPM 6Lrfl0INu' e =FcEST'.:`5 _11 1I_ •I V _--nS S i i r.; IC-!- a. t!0 I ASE�: :'E �J) 2JI_.\� 3'c !NFORMAWN `S��►+c ?. JE•TOATES ; __Ar_ 'Y�; r^ °M^ !��_ :.*op:=)',iF 7 ^a swing,rio:V ASSESM''S AAMIXT TO SE CGS r Ci hSS: ( =--& i, i TOTAL AMOUNT facto rr i PEMOVEO!'h! ^�ieeet ' r MESTOS REUCIVIL FROM I SLRFACES 1P:E.`,TS AMOUNT OF EACH TYPE OF i V::STIC C=:L j UW- O � cT' VlA+J4! O'•Stl�airt�N =Lt:_=r<v.kNr�. ! DJ�TItiG t:� 1 ASBESTOS (m s.:_aa lei j 1 f goo 1 q4p_,5- I % �� ( /� , 2 Cc =CAR �m o ' a `.'"a A,._ � 15'ooG ^� CONTRACTOR.'..!FORMATIDN + CS::!M:.._.- O � 'ri+.:s=G F 1�i :.nlaO Ir- ,i g•q5— J L rr NAME VS I''f.Y 1 �.' ggoo V. S.7E&I V; 'fti! 10 =HJN� � a WASTE-,PANSPPOIT°S a. � G`! � !�L'VDFRL AZ Sr=E ! .iOrrt�v. '1� ; ;�,r T% L:5•,4 70- C N, 9 -I'''�;%r• ''�f'P�.j,r10 --.�._ � == :a-� .r ;� (:fi- �;�^^ _�.,:�,,�q ST.;rE � : �' 41... fscesiO=su:Jeys rwe reccuffe_ :ra;to snt Rlera:at n fa-.s.:.avus :s,am ov!.Ruia can be oh_rnd t-r,-=%Q' :;'viet sRa ftz:;iwwN.aa.-nd.gov imago 1 1,2 =CT1 FLY 1. Z; - - - __C!0- : - - 7 . - - : L.^ :r. or. 2^u SCACMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAGIRD.ASBESTOS NOTIFICATIO-W ME#sWI,LOS ANGELES CA 90074-5641 WASTE TRANSPORTER 02 WASTE STOOGE SITE r ADDRESS / ADDRESS . CITY STATE Lip CITY STA7c ZIP CONTROLS: DEXR12E WORK PRACTICES AND CO i RO'a TO SE USM AT THE Ra40VAM APO DEMOLITION SITE ?r�urs#1.204,S or Ctnr tx rsl Am,tenor&dde Lis caa6bOn d Rule u03 procedures um Fmcedire 4 and 5 submit Warts for ACLUD pricy approval. ASSESTGS DETECTION PROCEOL12E.: CMLE.4E PIROCEDU+ES AND ANALYT ICk W-i MODS USED TO DE:ErPNINE ASBESTOS IN THE SUILCINO: _%vey,Sttilt Saran .tr. PCM.:EAL kwmed as A3omtat-PACM,Dewrft Cq,'ter: FOR DWOLITIONS GIVE THE CCAAPAW WIDE AND DATES OF'AHE ASBESTOS REMOVAL j FOR ORDERED DEMOLITION SEND COPY OF THE ORDER AND GWE THE AGrENCY I'I AE S.—HOME a i A!!iNDFN7JM FERSSOIJ: ` DATE.pPOADE t asTE�tD_--RED TO EEW.i: FOR EMERGENCY ASBESTOS RUOVA,L GIVE T}a I1NAk.�"r(:?Ir.O L!1tiM°°?CF T 45 PEA L=CUARWjJ4 n-'.0;t0NG THE S:r?GEIiCY.Dik i c AtIC HOUR C ZeRGSIXY&ND GESMSE T)+a R;3CEN,LWEJC'c'CT't: EV'~YF " iVt}juCAUSE s4sArz i.t�tD.rz?IS.Et�nr MEIN?J►tL: _O?IF2t_C5�.+d�31E=N4NCc�LaURCEN: CONTINGENCY PLAN: Ec_CRM-c AcTivm YCr 9E Ft%_ U5WM IF'la£(r?_T'�AWES—MS iE FCJ,I C::R1NG QFE,M TION OR ASSE5 03 MAT-cR,f+L ii-XNE , TRAINING CE-M-CATION: cw.tf mis -Rge t e?3 arc�fESFAP wl„be cr,se during the re.•ravai 3W grce zr rrls urv-.wg t.;ava�ia�Lla:�w ins:e_`h:duriry na srb:xs, hour. :an;m Nara Peml mmi of Cwr;,wkpemtor .z::.2 sarrtesf�-er c: 1 We a:ommie etaicr Oae INFORMATION CER T 94CATIO11:1 t:etff�tet the'�r��\m imfomra'-vr k c=:s.,am 1 AN-we anted ery rec are^attacmnanis. gftr. !U!.i J+1�+�11} jt1s0 i�lnf { �L' �,W`�,Z- 0 Fri O&-U , C.wgmy Nem =icy z;�a tsrmux�tasa,er ;rg,,m►- -,w etefor ntde ofow/a�e�s-1..:�at> Date Noct cat am ma x_ze =..de_30 Asbmtcs:emw als at IEstt than 190 square feet are exem]t Sort►nouf adon arro fees. ' F 2se ram chains mwc&m'S A0!lr' Fee_we pam,..�--ac.-,an reh=abte,am va y a=.dm5;the Drc;ect sl e. Fees are as follows: I SEUCUT Gh C-7%ASEESTCS FEUOVAL i ?RO CEDWE 4 OR E FW4 3 331.2- ?OI A i0D TO i 0W S0'A;,!E F T = a12 SP=VAL i=ANCU,W-F•-: a c FROTH 1 Ca.i TO 5.&M SOV rC F-c=r ( =A „ '. -r�ONf S.0 1'O t0� � cr_- S21 i.� REVISI:.N 4. C?T:=!GTI"rr r ,?�O SGUkR= E REFURNED CHECK CHP.RCE I WU TuON 13.00 SWARE FE- aii.=1 + -1:110ELLr.TI'JN OF NL%rFi.'T.V,, b Cf.) ' mmol loin OF ruSS,riw SC-.SO r t 3<.:? 1 kt3ESTCE:�EIIDVAL AT:Caner- 5 2-.52 o=zg;: srote•t rdi dwdfyta iATTENTION: Keep a cony of-you:notMcsdon. �Ra a tan:eatri etc_-p--v da a copy d I'rs dwnoLfian nolikAden to Sulldrng and Sa( _-afore issuance L can.obar,aersra io.n. em`ee end cc rwI nand carry tc.;C-`.,0 AWL FORM AHO FEE T&SC.%CMD,.SEESi 4S NOTIFICATIONS.FiL? =`56dt.LOS AN%_ =_S C„20074.5641 Page 2 of TELEPHONE: (209)3MU36 :AX. (9419133o334; =Orin RE-a 2on,) -- .:R1d3.64STj C71?NS,.;Lv-r R-S RULE:403 C4? _3tAdic9 FrttiM. s n_ We A7 �.OMD GOV SCAOMD is bated at 21865_ Caley;:,'ive.Ciamond Car. ?17="f—,- '?-33t S9S.2C'CtL-- Tnu Cityof Labe Elsinore 130 South Main Street APPLICATION FOR FUtL 046 y APPjf�q N 5 BUILDING PERMIT APPLICATION RECEIVED DATE VALUATION CALCULATIONS Ei� 1 5 SF BUIt DIN O tMr"Z f C TMACT L A LOTIPARCEL Znd FLOOR rJ/ASF -� NAME 3rd FLOOR , ' /- SF O "Kir F151 JM (1I LGA46lT I ZC �1 2 GARAGE N!A SF N ADDRESS 14 3S21I 1 I VC STORAGE �SF R GL J" ` A 2.5- 0 that I am licensed under provisions of chapter commencing DECK&BALCONIES Ai SF with section 7000)of division 3 of the business and professions code.and my C license is in M force and effect OTHER: A SF O LICENSE* G CITY BUSINESS N AND CLASS TAX# T NVE VALUATION: R rm f J A MAILING _ C ADDRESS Y �/ FEES T C STATE/ZIP HONE 0 IV `�2S 7 BUILDING PERMIT S R NTRACTOR'S SIGNATUREA PLAN CHECK NAME LICENSE A PLAN REVIEW R MA N C ADDRESS SEISMIC H 1 STATE/ZIP PHONE PLAN RETENTION O NEW OCC GRP.I CONST. ❑ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF ❑OTHER STORIES: BEDROOMS: O SINGLE FAMILY ZONE: O APARTMENTS 511 certify that 1 have read this application and state that the ❑CONOOMINIUMS HAZARD YES above Information is correct.I agree to comply with a0 city p TOWN HOMES AREA? NO and county ordinances and state laws relating to building Q COMMERCIAL SPRINKLERS YES. construction.and hereby authorize representatives of this ❑INDUSTRIAL REQUIRED? NO city to enter upon the above-mentioned property for atsp- O REPAIR IMPOSED USE OF BLDG: 'Ma NJ DEMOLISH 1PRESENT USE OF BLDG: JOB DESCRIPTION �14C7 o n X LS%t Signature of Applicant or Agen Date Agent for ❑ contractor 19 owner Agents Name F;IJE A*J MT Agents Address also 4EWMAL AVE -�214 granDE .CA iZ6Db Street City State Zip ._�-..>- • .l�. 4, F' • ice_' �'`�•'��,ii�� '�-!�I i9 iris �,r��r ,:- .sue+''• .. � i. •� 7 � �i� �ti�l�i 1 f elb �I czf U JCL ICI 3 i Q a. tie - .rx s f�Gl z► -c T3 �rs 4- o it Ad U o i e u. ? ch 16 GO 0 ii 0 g I� c0 39tld EPLLELEBSL 6T:Eb tr99Z/9E169 4 d O v► � Q V � rJ i Y Y -• fie \ ` h I I % CPO 2 1 I I 1 U� cb 4 L. a ra mr c16sk g r4 :tom v r I a 1 j oe lw rn Its �: N 'ram• �3 ' � ' 3 0 I OON 4-0 in it- 40 Et:EZ t)012Z/GE/6© �p �L1RlJ SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FIE M SCAQMD,ASBESTOS NOTIFICATIONS,FILE 0 55641 LOS ANGELES CA 900745641 AM USE ONLY I SCREEN EN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION 0 COMPLETED BY G Van H iten COMPANY Enwwrtm W Control Sohrftons•Inc. PHONE (951)7884483 DATE October Sm,2004 CHECK# 1651 FEES 33111 PROJECT #083W4R NOTIFICATION TYPE OMGM rove Ream DAB Rt vsm Omer""o CAKEIJA oN PROJECT TYPE Dana mom Ommm Damn= REROVATM(rernavah ErAesercY RBmAL PL#x m REND(annuah soot SITE INFORMATION SITE NAME Fanner Elsinore Naval&Merry Sdnool SITE ADDRESS 15900 Grand Avenue CROSS STREET Riverside Drive CITY Lake Elshwre STATE Cdkmia ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Derrotition at Shftres BUILDING SIZE(SOFi) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)%70 NUMBER OF DWELLING UNITS 11 BIM PRIOR V PRESENT USE Cann& MWAL Wusra& 09w OFFICE PuauC MM HOME Su 40M SHP UNFV CMEGE xxr0000c SITE OWNER Lake Elshm VMege 1,LLC. ADDRESS 43529 Ridge Paris Drive CITY Temecula STATE Caf mfia ZIP 92590 CONTACT John Leway PHONE(951)5064558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? ' REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10/05004 END 10V30I04 WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRIABLE WA CLASS I WA CLASS II WA TOTAL AMOUNT(add row)WA REMOVED(in square feet) ASBESTOS REMOVAL FROM SURFACES WA PIPES WA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC WA ASBESTOS (In spn W WA I WA I I WA WA WA FLOOR TILES(VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER WA WA WA WA WA (describe)WA CONTRACTOR INFORMATION CSLB LICENSE#8=7 OSHA REG# AOMD ID# NAME Envirorn mud ConyW Soh tEom Inc. ADDRESS 3654 Cenral Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gee Van Houten PHONE 951-788-1483 WASTE TRANSPORTER 91 LANDFILL ADDRESS WA ADDRESS NIA CITY WA 9 STATE WA ZIP NIA ) CITY WA STATE NIA ZIP WA Asbestos surveys are mmdred prior to Demolition and Reravadon Page 1 of 2 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE 955641,LOS ANGELES CA 90074-5641 WASTE TRANSPORTER#2 WA WASTE STORAGE SITE NIA ADDRESS WA ADDRESS WA CITY WA STATE WA ZIP WA CITY Na STATE Na ZIP Na CONTROLS: DESCRIBE WORT(PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1,2,3,4.5 or Other. For asbestos renMvabckfeftcembbmdonofRLdeMpmcedwastmd. Procedure 4 and 5 submit plans for AOMD prior approval. ASBESTOS DETECTION PROCEDURE CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey,Butt Sartp:in IrspecEon,PLM.PCM.TEM.Assumed as Asbestos-PACM.Describe 011w. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec-2 &W=TO 10/05104 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME 8 PHONE# AUTHORIZING PERSON:Carol Gordon TITLE Senior Code Enforcement Officer DATE OF ORDER ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAUX AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY,DATE AND HOUR OF II+XRGENCY APID DESCRIBE THE SUDDEN.UME V ECTED EVENT. NIA EXPLAIN HOW THE EVENT WOULD CAUSE LINSAFE CONDITIONS.EOUIPMENT DAMAGE OR UNREASONA13LE FINANCIAL BURDEN" CONTINGENCY PLAN:DESCRM AGnONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED.CF=BLED.FULVERFZED.OR REDUCED TO POWDER %VA TRAINING CERTIFICATION:I certify that an hxlkidtMl trained in the provisions of regutabon AOMD Rule 1403 and NESHAP will be on site during the removal and evdence that the remised training has been a000rrtplshed by the person will be available tar inspection during normal business hours Company Mame ?VA Print name of ownedoperator Signature of ovmerMperator Tittle of owner/operator Date INFORMATION CERTIFICATION:I certify that the above hilki rrta' and 1 We any required attachments Company Name ECS Print aorta of ovatedoperal®rS45MORLierator Tilde of owner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER Noiificabors can not be accepted vrooid Die requirW fee(AOMD Rule 301). Asbestos removals of less than 10D square feet are exempt from notification and fees. Please make t,-I q payaWe to'SCAOMD'. Fees are per notif=1on,not refundable,and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FROt.1100 TO 1,000 SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5.W0 SQUARE FEET S 9024 REVISION OF NOTIFICATION $11.94 FROM 5.001 TO 10.11M SQUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10.000 SQUIRE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- $29.52 occxpiett it dwelling ATTENTION: Keep a copy of your notification. State law recluses that you provide a copy of the demolition notification to Building and Safety before issuance of a derrrolition perinit. For quescons call 909,396-2336. For your convenience please mail the form and fee and do not hand carry to AOMD. MAIL FORM AND FEE TO:SCAQMD,ASBESTOS NOTIFICATIONS,FILE #55641,LOS ANGELES CA W074-5641 Page 2 of 2 TELEPHONE: (W9)396-2336 FAX: (909)396.3U2 Form REV 20030627 Fomes.instrimik ns,artd We 1403 are avalade at AWN web site www.aqmd.gov SCAQJ'AD is located at 21865 Coolev Drive.Diamond Bat CA 91765-4182 (9091396-2000 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL • • MAL FORM AND FEE TO SCAQMD.ASBESTOS NOTIFICATIONS.FILE 155W,LOS ANGELES CA 9007"641 ,4 1 �a'aPtETEt3BY LLIE Ny�R63oS�caNr �E�- FaiaNEs�Z-Zn$-zr - OATE 0�-919 P155 , �gc�_ �s331�-- FRc,IEcr'$ NOTIFICATION TYPE _ 2c¢+_a_ Rp4mm q;ES lZansm OiHER,hi,}mghb CMCV-L+n0Il P.QOJEC-17YF_ 0-cwtmv QlvD Qiamav E+vrAm immoral+ \ F1Aumucy REMR'AL PLArtNEO FLcho(argu ol) SITE INFORMATION � SIT`-�E PO A-M E r% E;LS ilk E N-A A $ N1)L I :5 atiDOL SITE aoD25� vc �q KFr1�l R A�J E f V u E CROSS S T RE=- C1iY LAv,E. ELigNoKE STATE CALIF-oR.v/AZIP �53 o c:,uNTY (ZtVE2.�r1,c DfS'vilEE:+'DRit A.��_�G:TIO.ti' iP.2J?-oZ ,2lrpnovAL- OF ,ds8Es; BulaNGSc=\"S_►FO 5Rl.`rz:--RCF�_:)ORS -=uILD`C-AGE(`•'EAPS) _F,7WE!jNGUNITS SLOG PIUCR I PMENT USE i b6v& ,,;am Rm ouw C-r m Nsuc noc. i,au, C-CWxx S -P I ' c :_ riV' 1 Fi i f SIT=CIr1,�'L l .C- LLC- :r'y ! Ef'.v 5't::_ `ra :1r Q 5io :.' ,T„CT GHOidt`9Sr)-�(j-1 e .\ ,isOU1PM HUI'—rINv :c_EST;S •� ASS'Ga � i10 + �S3 CIS YES z'UILING 3c4 i 91FORMAn N =-=,:�i= : SLr,%V� ! :_.' 0`/_. [E!ACL:SriI;'? -IROJECT 4a'_5 Y=%- _�� _.r 'v CR::SHIFT da ,sw ric,ognt J t ,ASSEST--S AMOUNT TO BE FWELE CLASS! II i TOTAL AMOUNTiedd rcr a� D.0 i —ter--. ASSES T OS REMOVAL FROM SURFACES i^ --ZM;k—)NEWT S AMOUh'T OF EACH n7E OF +'e� PIPE i UNMF M INSULA-500 i .IPE FROOF-1:`.: I DKTI,VG � Tip- � MAE ASBESTOS [W s��T=_ / i �GD ! it�S i % ( ! �•cc i j 15 00C i / / SGJ ! ttl2arn'Je CQNT ACTOR..WFORMATIOH CS !Si:s=.' �� j tGi'i�q.G a i6 ()' "•G'�.9�{�= /� gq'L '` �:fv Cl C` - =T= �� `1' �Q I� T E -��~ f J a ram' 'HQN= '�� ` A WIASTE Yi?hNS.=CiT:z a G G I.aNDFAi A- --4 5' -IL nDGtt':S3 Pe d _P _�-� :' i� '�fii ✓1: "' ��„•N�q ST--.'E �i� A -� Aloe im suri s are te--ufe—,:;(10i Fa J`f•.leoddoi and Renwrown Pegs. -r-uu:d,-s 3im:,Rna i1M can bs ob:am +`mm:10?4 we sii=_hlTp:,iww\Y.aord.gov zags : Corm REP 20 W - - - - --- ��..�.?a 1- - ... - :L^ tin or 2ru SCAOMO NOTIFICATION OF DEMOUTION OR ASBESTOS REMOVAL IML FORM AND Mr.TO SCAGMD,ASBESTOS NOTIFICATIONS,r11.E 15011,LOS ANGELES CA 900T4.5641 WASTE TRANSPORTER 02 WASTE STORAGE SITE AOOf ESS / ADDRESS . CITY STATE ZIP CITY STATE 21P CONTROLS: tY-3r.»ME WORK PRACTP..ES AND CONTROLS TO BE USED AT,HE R30VATION AND GEMOLRION SITE Procedwe#1,204,5 or Cth! =at est`estros teaw&drte Lis cm*& m d Rula 14M procedtltes tom. Pmjam%n 4 and 5 subfrot Flans for ACMD plies soproraL ASSES=DETECTION PROC CIRCLE:zE?ROCEDWES AND ARALYTI:,,1L ME—i MODS USED TO DETERMINE ASUSTOS IN THE BUILDING: an'ey,8Wk SW-",Ir. pec!an, MA,MAL Assumed as Asomws-PACM,Desaibe Cger: FQR DEMOLTRONS GPrE THE CCUIPaNY MAME 0M 3AiES OF THEASSE=TOS REMOVAL: / FOR ORDERED VELMLIT10!!SEENU.COPY OF THE ORDER AND GIVE THE AGaiCY NAME 3 PHONE# iAUTHORIZIIe"G PERSON: TmP= CATE.OF-Cfz .R: --*, . I DATE-MD-E-FIED TO EEG'N: FOR EMERGENCY ASBESTOS REMOVAL GIVE 7HE-1r-Me AM MCM Yill`f°=.?CF T WE PEP.SOu CSCLARMAt fri-ORRING THE SkIESGENCY.DATE AtIC HOUR C �RCENL'Y.�Jt±'OEa�.4l8E�St:3r:.?N:ITI�LT-1cYENT: l �.ieN''901Y'�?=Z'��YdO1lLC CAiiSE.e'�A:_�!:D'sZCe`!S.:.�'.fu�M.Ei1T i?AMi+:�Oi U:�R°CSCNAdtE r"TIAhCial�URCr?d: . r , t CONTINGENCY PLAN'.DESCRIES AMM!TC BE K-LL':9v0 IF Il.'E--rPS_A aES—MS K FOUND O;.:itNG QVAMTION OR ASBESTOS MATERt.1.a:x1= • - ,vrp. , TIWN114G CFR1TFiCAT10R::carity t-.a P.t i:z& .--a;rainedf in ON cmria.km of rgt92fan�;OI.ID Fete t 433 arc VESFAP xrill be_n site Curing the raa mom I a vcanoa Z.-I the mqLww imnm has----n ar.., --a5sl--w N Ills peJss:%-Z to ava�a&aa iw im- edm derin5 nairac ousiness nots- �G lgwo i,-Su GwNe-tz-- 00-06--. =many Akita Pfra, a�flcwnsrkPer=_tor .r:;t wmertt:�a;a rifle o:ovamxxxmw Dare I INFORMATICH CERT7 :.TKRl-i ceti4,16 v.the eccre ru`a.•maim k=I-i1 and 1 haves and% a w recarea attacnments. ! �C+� it!!!..H�>r��►Ao IvVl1 po(o-a campgm Nape :-4 u-e=!a�icctra:c�r 3,9aaxe of:xredopercja T!!de o!owierhoerator Date No"it1it m caa-n-—n amepea%W v:!to mctttrsd flea OWE ade"sulk Asbtcs rawats at less flan 100 square feet are exempt from nodficaJon ono tees. ?&use nam%-,*=awmalIG'SCA0.5 V Fees-are o mffxz sr,net ra dnzaole,am vay ac -&g;c the oryem size. fees are as Um: ! -EldCL1T!C1�r.�rS:ESYS R=Z!O1rA:l ?R.XEDUFE 4 OR z PLAN S;13;1. i =DMl1>33a 1. WA FEc-i : M=2 SAEC3AL P;UN CLING FEE h =C1.111 Z1'775irk!SEDUAREF-E_n R M314314OFhOT,=1C;TIZN -:ZO!A S.C-E 010,030 SQUARE FE_=t S211.21f. RE-RMED C'i=CK CRA.RGt S 9.143 OR=i%?AN 13XM SQUARE FEET t"aii.:l <llC3.A.TlCN Or NCT'FICAT.0. so." :_MOU-lON G;L=SS'I•lW tile]SO F- �:r? � ASBESTOS RVADVALAT--%,ner- S 29.52 r=-mad.Smoie-t.-nii&allo- ! ATTF.IVT?ON: Keep a copy of your notJttaran. 13+n mta'S c 8i; _pmiae a i^t.y d Lys',fmoftn nalca.ion;c SOlding and Safety oeiore issuance of ! ceala-do:cer. For quesd mis W'009-3,06--2 M- c'-';tllj CM-WEA'PlUz elease nth the iort em�se and ac not nand am to A3U0 Y-ML FORM AND FEE 70:SCAM.ASBSSMS NOTTFICA'PONS.FILE .=9564i.LOS ANG3_S CA 20074-564i Page 2 of� TELEPHONE: (309)3W2336 FAX: (9091336aU41 ►orrn REV 20030E27, =CITAS.LWMIC-7h?AlS,AM it:_ed11=:4x C:,N'SE--=FA I---9 FPS IZ:i i E=s_A ��!Tn:'f V�X'V-.r.A 0NM.G0V SCAOMD is Imtee at 21865 E-C3aey Ddve.Siamoad Set.:.r?17c°.-1E2 .?r331 gnu g5/14/2884 :5:2S 7S83237743 _-_-- _ . _ _.. SCOTT I+ORRISON & ASS PAGE 01 SCOTT MORRISON & ASSOCIATES P.O.Bcm 35329 31955 Date Pa1tn Drive.Ste.03-507 .._.. Rivera CA 92517 Cwhe&W City.CA=4 (909)624-1663 (76D)323-7743 ASBESTOS SURVEY REPORT CompWW On Marsh 12, 2004 PLM0302013501 Cuent: Conscucow Testing anc Engineering 2414 Vineyard Avenue; Suite G Eacarwado.CA 22029 Project:Elsinore Naval and Military Scftol 15500 Grand Avenue Lake Els6 win.CA 92530 On Martin 02,Mandl 03.and March 10,2004 an asbestos inspection and bulk sampling was conducted at the above project address. Bulk samples were taken of all suspect asbestos containing building materials(AC3M)at the request of Me dient named soon. A total of(135)bulk samples were submittec to Carolina Ernvinarhmantal. Inc. looted at: 107 New Edition Court in Cary, NC(NVLAP Code 101768-0 and Cal. Finviron. Lab. Can.#2483)to estimate the percentage of asbestos by volume and determine the typs(a)present Carolina Environmental, Lnnc. cetermines percentages and type of asbestos by using EPA approved mettod 60Q/M4-e24)20: Interim Method for Cne Determination of Asbestos :n Bulk Samples. Bulk samples are anah/ud by PLM (Polarized Light Microscopy). Asbestos is quentfRed by using me visual arena estimation technique am can only astermine the aoF,oximate percentage of asbestos present. after a thorough search is con_ucted and no asbestos is detec:W'none detected' will be noted in :he report. The "series of pclarizec ligm miawcopy is not to errnp:•haticelly determine that no sebestcs is present.me"that none was detected or. if it was. :t was likely to be less tren 1.0%of the sample. When finings reveal less Chan or close to i.0%asbestos contained in a sample, further analysis may be _ called for on additknal samples to infirm or denounce Me Initial findings. The Calftrnla Code of Regulations (CCR 1529) rsgt5res bul ke conducted according to the A.H.E.R.A protocol proviskm of 40 CFR Part 783.96. A rsurfacing samples from a homogerw1� an determined to be non-asbestos aonta,ni . 8 Vswaates con cts as�iosin veysfollowingtheAH.E.R.1 i►tspectno N G EAVISION ASBESTOS INSPECTION BY: Scud Morison, DOSH 092-0246 BULK SAMPLES ANALYZED BY: Carolina Environmwital, Inc., NV(AP#101768-0 PrL7- IT # 0q- 0Sq5 A'P-�R 0 V E® 85/14/2884 15:26 7603237743 9Mrr MOWISON & ASS PAGE 02 SCOTT MORRISON & ASSOCIATES Hex SS329 31855 Date Palm Drive,03-307 P.O.Box P.O. CA 9 t 7 Cathedral City,CA 92U4 Rive(909)624.1669 (7aor3z3-ra3 PLM03M3501 The results an the fbtowing pages)indicate that asbestos(greabsr tin 1.0%)was doteetsd in 38 of the 135 samples analyxed. Samples MA-01 thru NENA-26 wore Mm than the IrW floor of main bulliding.&*diagrams. Sample SENA411 Type of mtaterlat:9'floor tile%tan/orarpY(1 rat layer) locetiort:floor of library Aran:apprm.840 9% ft. (11brary) •Appromx.820o total sal.fL fir flow the rwougr+out 1 rat fir Fibfe:no Real 10%Chrywdle aebestoa Semple SENAA2 Type of..tom of:flow the mastic.black(2nd layer) Locod a is under sample SEN"'.1 Area:apprax.840 s 1. ft. Frfsble:no Rewt s: none detected Same SENA-03 Type of rraterist:surfadrtg material-ti fte I.ccatiorr.interior south vmN library, by window Ares:unable to determine; believed to be<000 sq. ft. Friable:no Results:3%Clhrysogb asbestos Sample IfENA-04 Type of materiel:9'floor tile'-red(1 rst layer) Locatlon:floor of library Are@: •epprax 8200 toted sq.IL 9'the throughout 1 rat fir FriaDlemo Resuitw IQ%Chrysotfte asbestos Sample OENA-05 Type of materiel:flow file mastic-black(2nd layer) locatiw under sample OENA-04 Ass: epprox SM total sq.R. 9' floor file mastic throughout Irat flr Friabtwno Rases:none dsm=w Semple SENAa6 Type of mstsrfet:flnel cost-tan(trot layer) Location: interior coiling of library Ares:throughout interior ailing of room Friablema Results: none detected Semple SENA-07 Type of material:brown coat(2nd layer) I , ,Il n:behind sample OEMA48 Area,throughout interior ceiling of room Frtablemo, Results; none detected (2) 85/14/2884 15:2S 7S83237743 - 9COTT MORRISON & ASS PAGE 03 SCOTT MORRISON & ASSOCIATES P.O.Box SS3Z9 31633 Date Palm Drive,#3-307 Riverside,CA 92517 Catlbdra!City; 33 -7743 (909)624-1665 (760pZ37743 PLM0302I13501 Sample#ENA-08 Type of mWerial it floor tile*-preen(1 rat layer) Location:floor of hallway under Carpet Area:'lopproor.G2W total se,.ft. throughout 1 rst floor Friablemo Resufta:10%CArys010 asbeseos Sample SENA-09 Type of material:floor the mastic-black(2nd layer) Loeatlore under sample NENA-XI Area:approx..a=total se,.fL throughout 1 rat floor Friable:no Rewft none detected Sample OEMA-10 Type of ma6Kfal: 1 Y floor tile-grey/tan(1 rot layer) Locoftm floor of after quarters Area: oppr= 700 total sq.fir (1 at floor) Friablemo Rewlkw 2%Vvywdle nbeetea Sample#'ENA-11 Type of material:Aoor file, ic-yeftftwn(2nd layer) Location:under sample OMA-10 Area apMx. 700 total sq.ft. Fdable:no Results: none dstscted Ser V*SENA-12 Type of material 2'x 4'ailing We Loear OM interior ceiling of hallway for officers quarters Aron:though A Interior coling of hallway Friable:.as Resuf:nods detected Sample SENA-13 Type of material 12-floor UW greylb(aac(1 rst layer) Loation:floor of toilet room southwest officers quarters Area approx.40 sq.A.I. Frie t mo Rswits:3%ChrysatiN asbestos Sample MENA-td Type of-material floor III*maatio-yttwtbr+wn (2nd inyer) Location:under sample#ENA-13 Ares:approx.60 sq.ft. Friable-no Results: rem deoctoo Sample SENA-15 Type of mahwW. 129 floor tile-redlwhfte(1 rat layer) Locatim floor of toilet room southeast cfficers quarter's Area:aaprox.25 sq.ft. Friable:no Results:6%ghryeattle asbeetos (3) 8 14/2884 15:25 7683237743 SCUTT BISON 8 ASS PAGE 04 F PLPA0302#13501 Sample#ENA-15 Type of material:floor the mastic-yllwforwn(2no layer) Location:under sample NENA-15 Area:approx.26 sq.R. Friablemo Results: none detected sample OENA-17 Type of material:vinyl flcoring-tan Location floor of toilet room eastcentral officers quart. Ares approx.20 sq.fl. Friablemo Results:25%Chrysaile aabeetas Sample rIIEMW13 Type of material:drywall Location: interior west wall hallway outside I lbrary Area: throughout interior wall Frialue:no Results: none dahmned Sample#ENA-19 Type cf materiat: interior well plaster Location: interior east wall lobby Area throughout interior wells Of!ObCy Friabte:no Results: none detected Sample#ENA-20 Type of material:9'floor ble•-grey(1r3t layer) Location:floor of library Area:`spprox t3200 total sq.ft. 9'rile throughout 1rst fir Fnable:no Resins: 1S%Chrywdle abatos Sample#ENA-21 Type of materiel:floor the mastic-black(2nd layer) Lowbom under sample OEM-20 Area approx. 6200 total sq.ft. 9'floor tile mastic tnroulgim 1 rot floor Friace•no Results: none detected Sample#ENA-22 Type of material:9'floor tile--tan/brown(1 rsi layer) Location:floor of ballroom under floor fen Area: apprax 1600 so.fL (ballroom) _ 'aparox.SM total sq.R. 9'floor tile throughout Irst flr Friaale:nc Results: 16%Chrysc the asbsatos SanM!e#ENA-23 Type of material:final coat-white(1 rst layer) Location: interior soutrt well classroom Area:throughout Interior walls of room Fnaolwnc Results: none oeteced (4) 85/14/2aad 15t 2a 7M237743 — SMTT MORRISW & ASS -- PA 05 - — PLNM302#13501 Sample OENA-24 Type of material: brown Coat(2nd layer) Location. behind sample*ENA-23 Area: ttroulpma Interior walls of room Friabtemo Results: none datectsd Sample OENA-25 Type d material: aoo,site coiling spray Location: interior ceiling stairwell to basement Area:appm. 100 sq.ft. Fria wyes Results: none detected Sample#ENA-25 Type of material:Cement plaster-dark grey Location: interior vast mall of basement stairwell Area throughot walls of sW wall Friabiamo Results: none detected Samples SENA-V thru OENA-47 were taken from the basameM of to main building.See diagram. Sample MENA-27 Type of materiel:pipe insulation'(see note below) Location:4'diameter pipe run on ceiling in storage rm Area: 'apprx 300-400 total tin. ft. throughout basement Friabie:yes Results:20%Chrysottle A 15%Crocidolite asbestos Sample SENA-28 Type of material:pipe Insulation'(see note beolwi Location.3'diameter rm on ceding in storage room Anse:'appm 300-400 total Iln. ft. throughout basamern Frial»e:yes Resutss:30%Chrysadle b 3%Crocldolfte asbestos Sample#ENA-29 Type of matertat wall plaster-grey Location Interior east wall of storage room Anse:throughout interior walls of room Fnableme Resuits: nomastected Sample#M4-30 Type of material:pipe insulation, Location:a-diameter pipe run on ceiling of hallway nerd to stabs Area:'apprx 300-400 total In.ft. throughout basement Fnaola:no Results:20%Cfhrysotlle:116%Crocidoltte; and lass than I%Arimite asbestos Sampe#ENA-31 Type o1 matenat 12"coiling fife Location: interior ceiling of photo room Area:throughout interior cel:ing of roam Friacle:nc Resutt none deteoted (5) 95/14/2U4 15:25 7093237743 SCUTT MOMISON & A55 PAGE 95 PLN 302111113501 Sample NENA 32 Type of material:final Coat-white Location:interior north wall of photo room in office Ares[throughout Interior wells of room FdaVe:no Results: lap than 1%Chrysotlle asbestoe Sample OENA-33 Type of material: acoustic ceiling spray Location: Interior ceiling south stairwell to basement Area: approx. 100 sq.ft. FriabWyes Results: none detected Sample AENA-34 Type of materiel:fire hose Location: northwest comer of diningroom Area:two(2)fire hoses in comer Fdoble:no Results: norm detected Sample#ENA-35 Type of material:2'x 4'ceiling tile-random hole pattern Location: interior ceiling of kitchen AresL distributed throughout interior ceiling of kitchen Fnable:yes Results: :horse detected Sample OENA-36 Type of material:2'x 4'ceiling tile-no holes Locedom Interior Ceding kitchen Area: diaMbuted throughout interior Ceiling of kitchen Friabte:yes Results: none detected Semple PENAL-37 Type of material:final coat Locatlam intariorwell above drop ceiling in kitchen Area:walls above drop ceiling Fnable:rto Results: ncne detected Sample#ti:NA-38 Type of material: plaster Location: Interior west wall of kitchen storage area Area:-throughout interior west wall of kitchen storage Frtabtemo, Results: none dateceo Sample OENA-39 Type of matertak pipe insulatitm- Locatiom interior west wall of northwest room kitchen Area:appnt. 300.400 total in. ft.throughout basement FRaote.yes Results:20%ChrysatUs ssbast'os Sample aENA-40 Type of material haler tank insulation Location: around boiler tank Area: approx.65 sq. and 10 linear ft. Fnable yes Results:3%Chrysodle A 20%Anwalte asbasto9 (6) 95/14/2a84 15:25 7583237743 _ - - SCOrr btOMISW & ASS -PAGE 97 PLN K)3Q2it135M Sample SENA-ai Type of material:plaster-tan Lowdorx it W*r weal wail cleswoom south of boiler Area:throughout interior west wall of classroom F&We:nc Rewlty none detected Sample NENA-42 Type of materiat final coat(1 rat layer) Location: Interior east vmh of shower room Area throughout interior wells of shower room Friable:no Results: his than 1.0%Ghrywdle wMmm tas Sample*ENA-43 Type of material: brown cost(2nd layer) Location: behind sample 00-NA-42 Area:throughout interior walls of shower Friabts:no Results: none detecxsd Sample#ENA.44 Type of material: drywall(3rd layer) Location: behind sample#ENA-43 Ares:throughout interior wells of shower Fnabte:no Resuft none detected Sample SENA-46 Type of matenal:2'x 4'ceiling tile-hoes pattern Location: Interior ceding of east ciessroom Area throughout interior ceiling of classroom Friat:le:yes Results: none asteaeo Sample SEM-46 Type of material:textured ceiling paint(1 rst layer) Location: interior calling of central toilets Ares:throughout interior coiling of toilets Friablamo Resuits: none detected Sample ff-MA-47 Type of material:ceiling arywall(2nd layer; Locations:behind sample SENA-46 Area:throughout interior ceiling of toilets Friaclemo Results: *tone detecteo Samples NENA-48 thru*ENA-78 wets taken from the 2nd floor of the main building. See dlaUmms. Sample AIfNA4a Type of material: acoustic coiling spray Locedom interior ceiling of southwest office Area throughout interior ceiling of southwest orrice Frioele:yes Results: ports detected (7) 85/14/2a84 15:25 7583237743 SCM7 M OWISON rZ ASS PAGE Oe PUM0302111113501 Sample#ENA49 Type of material: 12'floor tile-yllwlgold(1 rat layer) Location:floor of kitchen to southwest office Area:apprax-55 sq.ft. Friable-.no Results:5%Chrysattle anbeatas Sample NENA-60 Type of material:floor tile mastic-yllw1bnyn(2nd layer) Location:under sample#ENA-49 Area:approx 56 sq,ft. Frlablemo Rasutta:norm detected Sample OENA-61 Type of material:floor Ilia-grey(3rd layer) Locatlon: under sample#ENA-u0 Area:approx 55 sq.ft. Frtablemo Remits:5%Chrysatlle asbestos Sample#ENA- 2 Type of material:floor Ills mastic,black(4th layer) Location: under sample AIENA.51 Area: aporox 55 sq.fl. FriaDW:no Results:none detected Sample OENA•53 Type of material:vinyl floor-white/purple 0 rat Iayer) Location: floor of east-central toilet Area:approx 25 sq.ft. Fdable•no Results: none detected Sample#ENA-54 Type of material- floor masftc/leveling compound Location: under sample#ENA-53 Area:approx.25 sq.ft. Friabre no Results:none detected Sample#ENA-55 Type of material:final coat--white Location: interior east wall of east-comai rocm Area:throughout interior walla of room Fnable:no ResuRs:none detected Sample#ENA-56 Type of material:floor vinyl-txwn/black Location:floor Of satntlleast toilet Area:approx.20 sq.rt. ::nabfe.-no Resufts: 259E Chrysotfte asbestos Sample#ENA-`-T Type cf material:W floor tile'-tan(1 rst layer) Location:floor of south hallway Area lapprx. -;%=total so.ft. 9'tila throughout 2nd floor Fnable:nc Results: 109E Chryaotpe asbestos 85/14/2384 15:2S 7503237743 SCQrr MORRISON & AS5 PAGE 09 PLM0302013501 Sample#FNA-W Type of material:floor the mastic-black(2nd layer) Locatiore uncw sample#ENA-W Area:approx 5000 totat sq.ft. W floor fife mastic tltrCughan 2nd floor Friablemo Results none detected Sample S NA-59 Type of material:9'floor tile'-dark brown(trot layer) Location floor of scuttt waW room Area'apprx MW total sq. R 9'the throughout 2nd floor Friablemo Results: 10%Chryeottle aabestoe Semple 11EHA-60 Type of materiel:floor the mastic-Mack(2nd layer) Location:under sample SENA-59 Area:approx 50DO total sq.ft. 9'the mastic on 2nd fir Frablema Results none detected Sample OENA-61 Type of material:wall plaster Location: lntsrior soutn wall on'SW2'rm. Sae diagram Area: ttuo.rghout interior walls of room Friable:no Results: none detected Sample#ENA-62 Type of meteftf: acoustic ceiling spray Locator: fnttitrfor ceiling of`SE5'room Area:approx 400 total sq.ft Friable:yes Resuks: none defected Semple JtENA-63 Type of material: interior well stucco-final coat Location: interior out wall of'SE5' Area:throughout interior east wail of room Friable:nc Results: none defected Sample NENA-64 Type cf material:floor linoleum-tan/brwn Location:floor of toilet'SE5' Area: approx. 25 sq. fl. Friwe:no Rasufts; 26%Chrywdle asbestos _ Sample SENA-65 Type of material:floor iinoleum-tan/arange(4 rst layer) Locators floor oaf southeast kitcnren Area: sop ox. 100 sq. ft. Fr:aolesto Results: 25%Chrysodle asbestos (�i 85/34/2a84 35:2S 7SO3237743� SMTT MOMISON & ASS PAGE -s -� PLM0302013501 Sample PENA M Type of material: 12'floor tile-blackhvhite(2nd foyer) Location:under sample OENA-65 Ares:approx 100 sq.ft Friabie:no Results:S%ChrysoMe asbestos Sample PENA`87 Type of material:floor the mastic-black(3ro layer) Location:under sample#ENA-W Arse:approx. 100 sq.R FriebW= Results: none detected Sample#ENA-W Type of matarlal: 9'floor tile•-yllw Bola(1 rst layer) Location:floor of southwest kitchen Area:approx. 5000 total sq.ft. throughout 2nd floor Friabixno Results 10%ChrysWe asbestos Sample SENA49 Type of material:floor the mastic-yltwAxwn(2nd layer) Location: under sample#ENA-0 Area: approx 70 sq.R Friable:no Results:ncne detected Sampw 9ENA-70 Type of material:final coat stucoo Location: interior west wall 3outttwesi-0entral=m Aree:throughout interior walls of room Frietste::m Results:none detected Sample#ENA-71 Type of material: 9'floor tile•-green/gray(1 rat foyer) Location:floor cf southwest-central room Aree:'apprx 5000 aq.ft 9'floor the thrnugnout 2nd floor Friaotano Results: 169E C"eadle asbestos Sample#ENA-72 Type of material:floor the mastic-black (2nd layer; Location: under sample SENA-71 Area:approx 500 total so. ft 9'the mastic on 2no fir Friaclwno Resuite: none detectea Sample SENA-73 Type of matenei:floor vinyi-blackiten(1 rst iayerl Location:floor of east-central kitchen Area: approx 100 sq.ft. Fnaflte:na Results:2S%Gtrysotile Asbestos Sample t1eENA-74 Type of material:floor tile mastic(2rd layer) Location:under sample SENA-73 Area:approx 100 sq.ft. Fnable:nc Results:none detected (101 85/14/2384 15:25 7S832377d3 SCOTT MORRISON & ASS PAGE 11 - PLAA03OW 3501 Sample#ENA-75 Type of material:9'floor tile'-black(1rst layer) Location floor of northeast-central room under carpet Area:'apprx 5000 sq. tL 9'the throughout 2nd foor Friablemo Resultx 16%Chrysotils asbestos Sample#ENA-76 Type of material:T floor the mastic-black(2na layer) Location:under sample#ENA-75 Ares:approx 5000 total sq.ft. 9'the mastic on 2nd fir Friable:no Results: none detected Sample OENA-77 Type of material:ceiling sty spray Location. Urtertor ceiling northeast-centrai room Area:throughout interior ceiling of room Friablemo Results: none detectso Sample#ENA-78 Type of material:drywall Location: interior north wall northeast-central room Area:throughout interior walls of room Frlable_no Results: none detected Samples XEMA-79 thru 0ENA-88 were taken frorn the eato or of the main building. Sample#D(A-:9 Type of material: rolled roofing-grey(last layer) Location: exterior west-central flat roof lower level Area: throughout flat tcww roof Fnacis:no Results: none detected Sample#ENA-00 Type cf material:roof felt(2nd layer) Locetiom under sampie OENA-7 9 Area: throughout flat lower roof Friar le.rtc Results: none detectec Sample*ENA-01 Type of material: roof mastic Location Ioww roof perimeter, penetrations HVAC Area: approx 100 linear ft- Fnaole:no Results:none detected Sample#ENA-e2 Type of materiatoderior wall stucco-tan Locadon:exterior went wall Area:throughout exterior walls Friaae:no Results: none detected (i1) 85/14/2884 15:25 -_ 768323?7d3 SCOTT MORRISCjq $ ASS PAGE 12 PLRM3029M3501 Semple NENA-83 Type of material:roiled roofing-grey(1 rat layer) Location:exterior west-central roof upper flat level Aron: appr=SM sq.ft. FrWble:no Results:none detected Sample SENA4 4 Type of material:rolled roofing-grey/black(2nd layer) Location:under trample SENA-3 Mee: eppmx 500 eq.R Friabxema Reeuttte:3%Chrysotlis asbestos Sample SENA45 Type of material root fait Ord layer) Location: under sample*ENA-a4 Area: aomx. SW sq.ft. Friablemo ResuRs:3%Chrysotlle asbestos(in silver paint) Sample*ENA-36• Type of material:roof felt Location:exterior west roof under Gay tiles Area throughout exterior upper roof Friablemo Results: none detected Sample#ENA-87 Type of material:exterior wail stucoo-tan(lrst layer) Locadom exterior east wall Area throughout exterior walls Friable:r+o Results: none detected Sample aENA-a8 Type of material:exterior wail plaster-grey(2nd !ayer) Location: behind sample PENA-87 Area:twoughout exterior walls F:iable:no Results: none detecleo Samples NENA41:9 thru#ENA-46 were taken horn aradl"building"A".See diagrams. Sample#EMA-89 Type of materiel: IT vinyl the(t rst layer) Location:floor of kitchen Area:awmx 200 sG.ft. Friablemo Results:none detecteo Sample OENA-90 Type of material:floor tile mastic 12nd layer) Location:udder sample SENA-89 Area: approx. 200 sq. ft. Fnebte•no Results:none detected (12) e5/14/2884 15:25 7683237743 SCOTT MOWISCN & ASS PAGE 13 r PL%40302#135O1 Sample OENA-91 Type of material:texture coat(1 rst layer) Lamill n:interior west wall of southeast room Area: throughout interior walls Friable:no Results:none detected Sample MENA-22 Type of material:drywall Location: behind sample SENA-91 Area: throughou interior walls Friabl&no Results:none detected Sample SEN46-93 Type cf material: rolled vinyl flooring-Wage Location:floor of kitchen in ncrth unit Area: approx. 200 sq.ft. Fnable:no Results: none detected Sample SENA 94 Type of material:roiled roofing-grey(I rst layer! Location: exterior roof of building Area:throughout exdenor roof Friable:no Results::none detected Sample SENA-SS Tyce of material: roof felt Location: under sample#ENA-94 Area: throughout extenor roof Friaolmno Results: nano detected Samples#ENA-"thru XENA-97 were taken from auxiliary building"9". See diagrams. Sample#ENA-96 Type of material:rollea roofing-grey Location: exterior roof yf building Area: throughout exterior roof Fnecle.-na Results:none detected Sample#ERA-97 Type of material:final coat(1 rst layer) Location:interior weak wall Area:throughout interior walls Friable.= Results: none detected Samples WMA-U thm WENA-100 were taken from mWilary building"C"(Gym).Sea diagrams. Sample t#ENA-W Type of matenai:roiled roofing-red(1 rst layer) Location:exterior nonh roof of gym Area:throughout exterior north roof' Fnaote:no Results none detectea (13) GS/Z�T/Z084- rJ:Z8`-7603Z3770.9 9COTT MOI�CISQ'1 a 455 PAW 14 PLM030Y#13501 Sample SENA-99 Typo of material: rolled roofing-brown(2nd layer) Location:under sample SENA-98 Area: throughout exterior north roof Friable:no Results:none detected Samp!e SENA-WO Type of material:roof felt-black(3ro layer) Location:under sample OENA-99 Area:throughout exterior north roof Friable--no Results: none detected SanVtes NUM-101 thru NENA-109 were taken from awdlb uy building"D". See dlagl'ame. Sample OENA 101 Type of material:roiled roofing-brown Location:exterior roof of building Area:throughout exterior roof Fdable.no Results: none detected Sample#ENA-102 Type of material: vinyl floor-yltwibleck Lowtion:floor of sinkroorn in northeast,South-central rm Area:ratable to determine due to floor debris Friac!e:no Results: none detected Sample NENA-103 Type of material:mudoed drywall tape Location: interior Best well sinkroom northeast roorr Area: distributed throughout drywall seams F,Iaole:nc Results: none detected Sample#ENA-104 Type of material: 12'floor tile-white Location:floor south-central roam Area: approx 120 sq. It. Friaole:nc Results: 5%Chrysotile asbestos Sample#ENA-105 Type o1 material: 12"floor tile-tan/black(I rst layer) Location:floor of north-central room Area: approx 105 sq. ft Friat!emo Results: 5%Chryaotile asbestos Sample#ENA-106 Type of matenal: 12- the mastlayllw/brwr+(2no layer) Locetian:under sample OENA-105 Area:approx 105 so. ft. Fnaole:rto Results:none datectec (14) 05/14/2084 15:2-5 7003237743 `- - 9MTT MOMISION & ASS PAGE :5 -- -- PLM0302013601 Sample BENA-107 Type Of metal al:ROM IinOioum-yllw/brwn location:floor of southwest bathroom Afsa:approat.40 40.M Friablema Results: 25%Cttrysodle asbestos Sample MENA-108 Type of material: 12-calling tile-white Location. interior ceiling west'A hallway Area:ttroughout Interior ceiling west"A hallway Friable.- s Results:none detected Sample f1ENA-109 Type of material:ceiling the mastic-brown Location: behind tarnpls OENA-108 Area.throughout Interior ceiling west'A hallway Fdabie:no Results:none detected Safnples MENA-110 MM SENA-112 were taken from allXUlary butfding Ov. Sao diagrams. Semple OENA-110 Type of material: 12'floor tile-grey(I rat layer) Location:floor of eoutheset room Area:apprax 270 sq.ft. Friable:no Results:3%Chrysolite asbestos Sample OENA-111 Type of material: floor the mastic-black(2nd!ayer) Location:under sample#ENA-110 Area. appr=.270 sq.ft. Friablemo Results: 10%Chrysotiie asbestos Sample#ENA-112 Type of material:roof shingle-grey/rea Location: exterior rod Area:throughout a3derior roof Fdable:no Results:none astected Samples FENA-113 thru OENA-116 were taken from building 0F".Sae diagrams. Sample#tENA-113 Type of material:exterior stucco-tan Location:exterior east wall Area_throughout exterior walls Friable:no Results:none detected Sample BENA-114 Type of matenaC 9'floor tile-tanibrow n(1 rst !ayer; Location:interior north rooms(2) Area:unable to determine due to'loor deDds Friabiemo Results* 15%Chrysolite asbestos (15) -- 05/14/2a94 15:25 7603237743 SCO17 MOMISON & ASS PAGE' :5 PUA03Q23135M Sample NENA-115 Type of material:floor tile mastic(2nd layer) location: under sample#ENA-114 Area:unable to deburnine clue to floor debris s ftWe:no Results: 3%Chrysodle asbestos Sample*ENA-116 Type cf materiak asphalt roof Lotxtlon.wderior roof Area throughout exterior roof Friable-no Result:none dstedeo Samoss NENA-117 thru AENA-121 were taken h+om owd lary building"C" 3se diagrams. Sample#ENA-117 Type of material:ceiling plaster Location:interior ceiling and floor debris Area:distributed throughout room Friablwnc Results: none detected Sample#ENA-118 Type of material: 17 floor tile-nxVbrown(i rst layer) Location floor of southwest room' Area: sap,ox. 20 sq. ft. Friabiema Results:5%Chfysotile asbestos Too much debris an intenor floor tc Sample all potential ttoortng material(s) Sample A*NA-119 Tvpe of material:floor tale mastic-black(2nd layer) Location under sample#ENA-11a Area: approx.20 sq. R. Fracts:no Results: 5%Chrysotlie ssbomos Sample#ENA-120 Type of material:exterior well plaster-grey Location:exterior west well Area:throughout exterior walls Fnable:nc Results:none detoctso Sample SENA-121 Type of matertal:roof felt-orowm Location: extencr rani Area: throughout exterior mores buildings G thru L Fnable.na Results:crone detected Samples#ENA-122 thru dENA-123 were taken from auxiliary building"N".See diagrams. Sa{ptple#ENA-122 Type of matenat acoustic ceiling spray Location.interior coifing ooudAvest unit Area:approx.300 sq.ft. Fnaolo:yes Ra3subw none detectea (15) 05/14/2384 i5:2o` 75832377a3 SCUTT MORRISON Z ASS PAGE 17 PLW302013501 Sample SENA423 Type of material:final coat Locahon: interior west mall of southwest unit Area throughout Interior walls F.*able:no Resuft less than 1%Chryeodle asbestos Sample SENA-124 was taken trimft auxiaary building"I". See diagrams. Sample#ENA-124 Type of material:coiling plaster Location: interior ceiling southwest unit Area throughout interior oiling of unit Friable= Results: none detected Samples#ENA-125 thru#ENA-128 wars taken from autlliary building"J".See dlagrarns. Sample#ENA-125 Type of material: exterior wall stucco-tan Location: exterior weal wall Area:throughout exterior wads Friable_no Results: none detected Sample tt£NA-126 Type of material 8'floor tile-tan(1 rst layer) Locattom floor of north unit; buildings-J'.'K".*V Area: approx. 3750 total aq. R (throughout bldg9. JAL) Friable:no Results: 5%Chrysodle asbestos Sample#ENA-127 Tvpe of materiel:floor We mastic black (2nd layer) Location: under sample SENA.128 Area:approx. 3750 total sq. ft. Fnable.no Results:none detected Sarnple SEN/1-128 Type of material acoustic ceiling spray Location: interior calling of north unit Area: approx. 300 as fL Friable.ves Results: none detecteo Samples#ENA-129 thru#ENA431 were taken from auxiliary building"K". See diagrams. Sample SENA-129 Type of rnaterlar acoustic csiting spray Location:floor debris Area:distributed thmugrtout building interior floors Fnacle:ves Results: none detected Sarnple#ENA-130 Type of material:final coat Location: interior west wail north unit Area: throughout intenor yells '=nscla:nr. Results:none detectea (17) 05/14/2ee4 15:26 7Sa3237743 — - -- - SCOTT MORRISON & ASS - - --- PAGE 13 - a PLM0302*13501 Sample PENA-131 Type of material: roof 101t Location:exterior roof Arm:throughout eMenor roof Friable:no Results:none detected Samples ffM-132 tlhru#ENA-136 were taken f1Tvm auxiliary building"L". See diagrams. Sample#ENA-132 Type of material: acoustic ceiling spray Location:interior ceiling of north unit Arse:approtr.300 sq.R Frtable:yes Results: none deter m Sample OENA-133 Type of material:color coat-green(IM layer) Loeatlqn: Interior rpnh wall of joh unit Ama:throughout interior walls Friable:ro Results: lees than 1.0%Chrytl We pWoop Sample VENM13a Type of material:plaster-white(2nd layer) Lcestion: behind sample#ENA-136 Area:throughout Interior walls Friable3m Results:none detected Sample SENA-135 Type of matorial:exterior wall stucco-tan Locatbn exterior east wall of north unit Area:throughout exterior walls Frieolemo :Results:none detected Note:The approximately 1W linear it. of piping in the maintenance room is Asbestos Containing Material (ACM).There is agwoxirrmtely 300-400 total linear it of ACM piping throughout the basement. Note:The two(2)transile p•pss an the exierior west rcof of auxiiiary building`D' are ore9umed ACM. Note:The r-fastic around the five(5)roof penetrations of aLrdlMry ouilding-A"!s presumed ACM. Note:The north fide of the;ymrasiurn was looked at the time of inspection. The S. rooms of auxu*.ary bidg.'F'were locked 31 tYne of Vmoectlon. The SE units of auxitlary bldg. W-ware locked ai time of Inspection Therefore no camp es were taken from those areas. Note:Au:siestas containing building maienal(si containing greater than 1.0%asbestos by volume or weight,muss be removed by a state certlfled ast:es abatemeni contractor prior to any damolitior cr renovation of the property. %specter, u Sco.C. rrison Ceedfled Asbestos Consultant DOSMS92-029L8 �13) 05/I4/2884 13:81 768323?7a3 SCU17 MOMSON & ASS PACE 19 P1 Sample NENL-W Type of htaterW:paint chip/white, pink Location:Wftfiw It wefl,blog. -G- AreaeinWor mall, bldg. 40' -- Results: c0.006% lead by weight Sample AENL-66 Type of=too al:palnt chip)tan LogUomexterW W. eaves Anra:roof eaves, bldg. 't3' Results:0.24% lead by weight Sample#ENL•67 Type of rneteri8 paint chip/red Location:extedor rod pwimter Arecroof perimeter, bldg*. -G thru'L' Resultx.0.2D% lead by weight Sample#ENL-88 Type of metwial:point chip/white LocatfonAnterior door frame Ares:N. unit, Mo. "K' Results:0.099% Ioad by weight Inspeear Sc=C. Morrison certified Lead Inspector Cal.Can.AU-71-W i�0) Cityof Labe Elsinore 130 South Main Street y APPLICATION FOR BUILDING PERMIT APPLICATION RECEIVED DATE VALUATION CALCULATIONS .�ji DSO' OoZ BUILDING ADDRESS _ 1st FLOOR 2- D SF AC'M L4 C TRACTL A LOTIPARCEL Znd FLOOR tJ/A SF NAM 3rd FLOOR SF O LAKf EL51NMW (11I.Wi r J Z4 slopW MAILING - 2 GARAGE )A SF N ADDRESS 4 3SZ9 (DI6E (Ve STORAGE [�JLLL SF R GV LASTATE/ZIP am IWAMed under provisions of chapter commencing DECK 3 BALCONIES SF with section 7000)of division 3 of the business and professions code•and my C license is in full force and effect- OTHER: WA SF O LICENSE* G CITY BUSINESS N AND CLASS TAX It T NABE VALUATION: R N A MAILING C ADDRESS 35 Y C417PA i AIJJ� FEES T CI STAT P HONE CK O V �ZS 7 BUILDING PERMIT S R CONTRACTOW5 SIGNATUREAT PLAN CHECK AM ` , LICENSE# A 0i PLAN REVIEW R MAILING C ADDRESS SEISMIC H MY S rATE/ZIP PHONE 1j. AL PLAN RETENTION O NEW OCC GRP.f CONST. ❑ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF Q OTHER STORIES: BEDROOMS-- 0 SINGLE FAMILY ZONE: O APARTMENTS 1 certify 11W 1 have read this applicatio:l and state that the ❑CONDOMINIUMS HAZARD YES above information is correct.)agree to comply with all city ❑TOWN HOMES AREA? NO and county onfinances and state laws relating to budding ❑COMMERCIAL SPRINKLERS YES con stnraion.and hereby authorize representatives of this p INDUSTRIAL REQUIRED? NO diy to enter upon the above-mentioned property for insp- O REPAIR PROPOSED USE OF BLDG: tion purposes. 14 DEMOLISH 1PRESENT USE OF BLDG: JOB DESCRIPTIONV>CIS 14"10 .. Signature of piicant or Agent Date , Agent for ❑ contractor {j owner Agents Name i aE Awi r%Y Agents Address X64 GtAlMAL A+t MjTE 20 oraoDG Iri&,- Street City State Zip AL 1,1 A A L-J.�.\Aj i Z, UAWMVE-SEE sheer 4 -—--—-—--—--—--—-- AlK -------------- AZIST.5mm sm -------- 7ii -L EMS S70fty BLDG. OR at -- --------------- �44- T J.L-------L------i A* > N-1 D GRAN A ----------Wl- ------------r--------------------- ---------------------------------------------------------------- ------ < GRAPMC SCALE N®RE—gal III n1hin millimml V%j L.�f IV MRIN7" PERMIT # r Jo 1 , U .� �� C •Y. 1 `�rT 1 f i rA . v. 21 Qk- Fr r_ ' _ 111 1 v, i 5L 4 lza in Gq z i 75 s o Q a > Q 3 a VCA `a c 79 • 42 ray i= � o � •` a oa.. - �.Q s ; U Y ` � u C cp 35vd EVILELEOSL 6i:EZ AOOVOE/69 0 8 ,N O �. � Nf ai b _ _� 4 of � of � ! �� U r, e v, . q G ! 33 1-4 Ito W cc ac. ac is � � �y p� �t wi •�. f � '_j ' r) g "Ilk 11�4 3Z '7Y u y � _ � a �•�_ a � .�� y r. � i 5 v ��/.i ET.f Q9i E�i:EL t+A�ZJGE/Ep SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF OEMOLITION OR ASBESTOS REMOVAL MAIL FORA!AND FEE TO SCA011111%ASBESTOS NOTIFICATIONS,FILE 0 SS641,LOS ANGE ES CA 9W45841 AM USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION# COMPLETED BY G Van Hou1Er1 COMPANY Ertvimrrnental Control Saluti ts,Inc. PHONE (951)788-1483 DATE October Sm.20M CHECK# 1651 FEES 331.21 PROJECT #083004R NOTIFICATION TYPE Oemm root REvlsron DATES FkV=r Onim(highlight)- CAKELLanoH PROJECT TYPE DBwunoH Ors Demxmorr PaWAMN(removary Em+stomy RBmA)- PLAmm REND(annuah roor SITE INFORMATION SITE NAME Fanner Eisinae Naval&Merry Scrod SITE ADDRESS 159M Grand Avenue CROSS STREET Riverside Drive CITY Lake Elsinore STATE Ca6(omia ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Dertro5tion ol Structaes BUILDING SIZE(SOFn 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)%70 NUMBER OF DWELLING UNITS 11 BLDG PRIOR I PRESENT USE CCUMERMAL HospiTa WD mm Other OFFicE Pueue eloo HOUSE SCHM SMP UrNiviCOLLEGE XXXX)= SITE OWNER Lake Elsinore Village 1.LLC. ADDRESS 43529 Ridge Park Drive CITY Temecula STATE California ZIP 92590 CONTACT John Levey PHONE(951)506.6558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10105104 END 10✓d0104 WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRIABLE WA CLASS 1 NIA CLASS II WA TOTAL AMOUNT(add row)WA REMOVED(m square feet) ASBESTOS REMOVAL FROM SURFACES WA PIPES NIA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM! INSULATION FIRE PROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m square teat) WA WA I I WA WA WA FLOOR TILES(VAT) DRYWALL I PLASTER TRANSITS ROOFING OTHER WA I NIA WA WA WA (describe)WA CONTRACTOR INFORMATION CSLB LICENSE#809807 OSHA REG# AQMD ID# NAME Envircmnentid Canytcd Soa dons.Inc. ADDRESS 3654 Central Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER#1 LANDFILL ADDRESS WA ADDRESS WA CITY NIA STATE WA ZIP NIA CITY WA STATE WA ZIP WA Asbestos surveys are req Bred prior to Demolition and Renovation Page 1 of 2 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL &WL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES CA 900745641 WASTE TRANSPORTER 02 WA WASTE STORAGE SITE WA ADDRESS WA ADDRESS WA CITY WA STATE WA ZIP WA CITY n(a STATE Na ZIP n/a CONTROLS DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1.2,3,4,5 or Other. For asbestos reetor&chcte the eonftotimr of Rule 1403 procedtm used. Procedwe 4 and 5 submit plans for AOMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey.Bulk SaTgft Iran,PI K PCM.TEM.Assuned as Asbe tos-PACM.Desatbe 00w: FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec-2 8I0M TO 1W05/04 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME&PHONE# AUTHORIZING PERSON:Caro!Gordon TITLE Senior Code Enforcement Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE MWIBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY.DATE AND HOUR OF EIMERGEI CY AND DESCRIBE TI M Sl!»t?EN,UNEXPECTED EVENT. MJA EXPLAIN TOW THE EVENT VMW CAFE UNWE CMRIONS.ECUPMENT DAMAGE OR UNREASONABLE:INANCIAL BLIRDEN CONTINGENCY PLAN:DEScmu ACTIONS TO tic FoucrNED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS'MATERIAL BECOME DISTURBED.C14LY.ILED.PULVERIZED,OR REDUCED TO PONDER WA TRAINING CERTIFICATION:I cer*that an htd'tvittual trained in the pmvsions of regtdafion AOMD Rule 1403 and NESHAP will be on site during the removal and evidence that the requhed iramaq has been accomplished by this person will be available for inspection durirg normal business hours Company Name WA Prim name of owmkperator SWebfe of owrtedaperator Tittle of owner/operator Date INFORMATION CERTIFICATION:I oer*dot the above irdomm and 1 PdVe enclosed any reaufed attachments Cornpany Name ECS P1ini narne of ewrterkper igim Boy Tittle of owner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER No6ficadons can not be aocep'ed wilhout the mqut W fee(A040 Rule 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks payab'x to'SCAOMD'. Fees are per notification,not refundable.and vary accordirV to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN S 331.21 FROM 100 TO 1,000 SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5,0W SQUARE FEET S 9024 REVISION OF NOTIFICATION S 11.94 FROM 5,001 TO 10.000 SQUARE FEET S21122 RETURNED CHECK CHARGE $29.28 MORE THAN 10,000 SOUARE FEET S33121 CANCELLATION OF NOTIFICATION S 0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- S 29.52 occupied.si t ATTENTION: Keep a copy of your notification. State taw fequ&s that you provide a copy of the dernofition nodliication to Building and Safety before issuance of a denwfi8oa permit. For questions call 909.3W2336. For ymf convenierrce please mad the form and fee and do not hand carry to AOMD. MAIL FORM AND FEE TO:SCAQMD,ASBESTOS NOTIFICATIONS.FILE #55641,LOS ANGELES CA 9W74-5641 Page 2 of 2 TELEPHONE: (909)396.2336 FAX: (909)3963342 =orm REV 20030627 Forms,irammdons,and Rtde 1403 are avAable at AOMD's web site www.agmd.gov SCACIMD is located at 21865 Codev Drive.Diamond Bar.CA 91765-4182 (90913.96-2000 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT 4OTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAOMD,ASBESTOS NOTOWATIONS,FU i 25641,LOS ANGELES GA 90074.5641 r- COtjpLE,--st8y LLlE W,4A6&RFo f-EC.-ZT PHO,4ES7oZ-ZD$-?j R. DATE 0?-o(q- --CIca a8-Cj0 RES33121 PRaECT-* a _ o o NOTW=TtdN TYPE RED fasces SON OTaER;higMNgnO CA NCE LATM PRWSCTTYP"c , i) ataav Qrax Oawu*2v Z9A�/A"itei Clle � EmEmEucY Reuov,kL PuuNED ono(aMM) SITE INFOR6l4TION Sf rm NAME rO r-- M E Ft c l_S tNJ E N-AxJ A MILT c c DC(_ S'rr-ff CROSS STRE-:r, - cf>i�r LPtKE- ELSfI+%tK6 STnTr CALIFW..'VIAzlP j LS3 C COUNTYfZ�yE2s Nt�F DFSCREEWMA.*DLOCATION' R.O�� r26fncyAL_ OF I1 AG ;St ,llf�4 .F r_�025 (ALCINJG AGE(`EAPS) '+llldd .CF OWEL JPNG UNITS SLOG PRIORI PRESENT USE ^-TM�"'*Gu ::�tsi +tvs�1; +7�s C•.,m, =vquc 3wo. Y.fl'iJ- so cm - �n:,�•�s , D q F- f L-LC a.Cr'sE3< �=�•7 Q .Q1 JGF ?f � Jed t ye erw t.A ST.; ZIP 0�� :;I,;CT 1 cl ?a'f�' L trti f��+ PHONE f�lSl�' r%EODU'r-WGLIBMG ES7*F S 't_ NC. • 5-ID :0 ; ASS=S"C3 �� N'01 i :S3 :^S '!ES `CT] EUI_:iNC_y 3= N NIFORMATION `S�n+c ?RWl:C*DAT:S ; _:��? 7( - t`• :t _DNL' ��_ �` ,,'�R,:SHi=i C'a ,sw ric,43i,, ASSESIX-S AMOUNT TO BE FRirSLE Ci:.SS: I =.SS i TOTAL AMOUNTi9GG MY i ?.61bOVED;m nrj;f .5 r, ASBESTOS REUMAL FROM AMOUNT(IF EACH nTE OF -.'Rv.-cum k:Su-A7,,0;4 ' =n_:R z ih� I dUE71VG STLO As$>:;TOs k41 J jcN _?0•-- 0T.; CQNITA.Aum PlfORMATtON t zs__ /�." •,r?A]IC? $�7 ESE Iray r--(4 G$ .Lj zr a- G r `, S;T=c, FVz _ WASTE TRANSPORTER al � L�Y LANDFILL :f?L'ti:ES 1� ;yC- fir- L: Asaesta=surveys are requve_pmw to I:>wmi-Ahai am Rem4atb,^. Femns..ask lK'it. -ns,and'khe RLNB f Yt:.can be ahmarred vjeE;sits m.::;iwwy.,aomd.go =a0a .._ =CTi R.EV"OLIZE- SCAGMD NOTIFICATION OF DEIAOI nMN OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQM .ASBES70S HOTfMATIONIS,FILE S 6s6N,LOS ARGELES CA 9007"641 WASTE TRANSPORTER 92 WASTE STORAGE SITE ADt)t'i6SS / AWRESS . CITY STATE Z;P CITY STA c Zip CONTROLS: DESCRISE WM PRACTICES AND CONTROLS TO SE USED AT THE RaNOVATION AND OUCLITiON SITE Procedure#1,204,5 or Cth! br as' tear,is adP t.ie aonlihWbn d itu!a 1tD;oroce w2s um Praoadn 4 and 5 sub nit Fans for AO,UD oricr 2o.pmvm. ASBESTOS DETECTfOH PROCFgPL Ch:b-.L-,ie PROCEDUFES AND ANALY ICAL M-i HODS USED TO C=TEPAtINE ASBESTOS IN T HE 3UIL-',INZ: Sulk San.*V.it-Vedm,"FG`A.:chi,Amned ass Asbe"as•FACU,Desaibe Cft,: FOR OEMOLIT IONS GN'T--HE CCIAPA'tY NKMrr ANS:ATES OF-,HE ASBESTOS RESAOV.m.:• j FOR ORDERED OF-WI RIN SEND A COPY OF THE CRbER AND Gt'E THE i+G--XCY NAME$PHONE 9 AUTHORIZING?rEMN: DATE.OF•ORDE:t- - ! DATE ORD—EAED TO E°G'N: FOR EMERGRCY ASBESTOS REMOVAL Grr-- =_P.aMc.�,VL'?NNQr�YUtI'�:.4 Cf T H=PEP.SON C=LMM.-M.T-C ONG THE�IMUGSUCf.D4TIE AIiC LOUR C RGN7[GY AND i1E- ETF+=S. K L4NEEC'eC1'c�a;YE.yr: '`_C-'�.,.tiN:t011='__=►'S?iVOULC G�i.`QE�'��r=fX{�'OT:�`!S,_�1:R?MEPii�C4:��2R UYR=45C.Y�3lE FsW,kCc�LdURCEN: ESC CAtTTNGi?tCY PLAN:, �R.IIEE �5 Tt:3E Fti.�Lr L'�1r� Uti'E =T ASos"3TCS E FOXE :SING OEL1.;L,10%OR ASBESTOS M:,TeR AL ' Yf f � F AIN LNG CERTIFKATiON�t::cm*t.y:a inar.' majr4d in u1e aerimm d tegtda�oi AGL1C� tie i-33 arc NE£HAP m1 be on snE during the r -M.-I and tsAoS rai dra requrea='�rtsig nas ass-. et ?r tLls fiats-::v+9 IA avaiable sc insc Jor.dudnb i3-tra:Business non;. C-C ryW An ��ii� QvJN-e-fL =r�Iair:a Pr<.rt:a y u,cwre eper_rer 5xj:a.•3 of�uv, «a . i;Ye o:cmwx)oe:a►cr Dare WFORlRAT1DN CFi2TNF)..;TtDNY.I certcj et the:rcve i*rrr>z,:at:it cmrw and N new an�Sed ary rec Brea ahac:.Tents. c-t�f •.�t'�Ftk�l�rrR►rt �Sovtn� + =�� ,� 0��4� C=wnyr Raw iSira i_r e ti:amr�rec�er 'ga�r.�_ ;wrer!operr�a I.deof ow-ner/ope'at•:- Date morftaltm can Y':!e S=Ppee witml to racuasd tee 0()Mr--V4 a 301) ASbe_NCS tenzC`M5W less than 100 square test are exemo,`ran r oiftadon sr iefmm IP mAe drams op "a lc'SCACz:f-:' Fee:x pa:-MtMa- don,nct r*Lffldaole,aW rey ac=db'-y 16;th tuclect s!ze. Fees are as iclows: sack 1Tm R ASSESt1'tiS REMOVAL I PP0T.E9UFE 4 OR 5 PLAN 3 331.2 t FROM•i0D TO 1-30 SQ?V.M cEE1 E Z�2 �'-C'r►1L rhiVOUNG�� b r =•CIA 1 CCI TO Sim,-d.L,RE rc=r S -0:24 REV ISi A' OF NOT�F!GTQN 51'34 =+iO.fA 5.01 TO.0,0JJ SO>d4RE;w=t 32112i RE UrZNED CHECK CHARGE S i9.23 MORE rrEAN 1910N1.D SOUARE FEET- WIC3 .-'iCA v?TION OF NCT• TION, a 0.7 MOLI?ION OF LEE SS.MN 10 SO Fr 3 Z.:;? ASBESTOS?E?40VAL AT;a►rer- S 2-9.52 I oata:aak sxtaie{,41 dwdlir.= ATTENTION: Keep a copy of your noUlcaeon. Slexbw:Mdw ma;yc pr--vide a copy at Me d mol ion nodca-n m Sulking and s ate; �erore 155L'e' 2 ti czrw�rna terra :a qu:r.o,t;>Axl°.�_o.",.w- rt jcl,CMa:•svak:c ctzaae mad tits roan am See and cc nm nand:any irAZAD MAL FORM Alta FEE TO:SCAQUI),ASBESTOS NtOTiFiCAII ONS,RUE A 15641.LOS ANGE ES CA 1t00744641 Page 2 oI TELEPHONE: (909)3Mn36 TAX: (939)336.3341 :orm R + :- �: _SrA =7F�Csn ' " � _AT P.r,� � �QVQ _ �.:P14&L%JST?`l Ms..uv;Ris AULS . % -SCAUD is Imtee at 21865_.Cagey Ddve.!:iamond Ear.CA?17_-4 <�3N 395•?L�qi � l L f City of Lake Elsinore 130 Soudt Main Street APPLICATION FOR E5 U►�Dt� y j N N�� BUILDING PERMIT APPUCATION RECEIVED DATE AP N BY VALUATION CALCULATIONS t q56 SF BUILDINGAD _ 1st FLOOR l/�I�I NC TRACT BLOCKIPAGE LOTIPARCEL Znd FLOOR #J/ASF M 3rdFLOOR NIA SF O JAKfEls[AJ4Q VIL(,A49rLGC �1 qjw— If GARAGE (A)JA SF N ADDRESS 4 3SZeI R l h& t 1�1r STORAGE I�)/LI. SF R CU LA L ATEIZIP� ZS- jD T� I nereby afftim UM 1 am licertsed under provisions of chapter commencing DECK 3 BALCONIES SF with section 7000)of division 3 of the business and professions c6de,2nd my C ficeense is in full force and effect_ OTHER: IJIA SF O LICENSE* G ` CITY BUSINESS N AND CLASS 8 TAX# T VALUATION: R N A IMAILING C ADDRESS Aj fiJ FEES T C STAT IP HONE BUILDING PERMIT O lV SIGNATURE DA PLAN CHECK NAME LICENSE# A M PLAN REVIEW R MA LIN C ADDRESS SEISMIC H CITY STATE/ZIP PHONE . uA &/A PLAN RETENTION 0 NEW OCC GRP./ CONST. ❑ADDITION DIVISION: TYPE: 0 ALTERATION NUMBER OF NUMBER OF O OTHER STORIES: BEDROOMS: Cl SINGLE FAMILY ZONE: ❑APARTMENTS 1 certify 11W t have read ttus application and state that the O CONDOMINIUMS HAZARD YES above Information is correct.I agree to comply with all city Q TOWN HOMES AREA? NO and county ordinances and state laws relating to building Q COMMERCIAL SPRINKLERS YES construction,and hereby authorize representatives of this O INDUSTRIAL REQUIRED? NO city to enter upon the above-nwrftned property for insp- ❑REPAIR PROPOSED USE OF BLDG: lion putpos _ 14 DEMOLISH ]PRESENT USE OF BLDG: JOB DESCRIPTION Signature of Appiica t or Agent Date Agent for ❑ contractor owner Agents Name/:it 0, Awl twT Agents Address X&H 6EAZAL AVE 59irrE�214 (RI QTR06 .LA 124 0 b Street City State Zip MA71C UVE-SEE SHEET o _—_-- ---------;--------�---------�----=--cam — — -- - — _� I I 1 � � .. � !r' d� • • 1 � ' i 1x1..�n. 1 I =T mad 91a �~ s F s � •`` a �' �.. m - ---��----' i 3 1 dmT.1BI/QDD17f•f- s4SIORY BLDG. I_ `- ' It�aa-F•�sw., 1 `• r• fj+s ' �l� t �� `�11 :1-_-_--i--_---_ � I i r i , ♦ \ •�. f 1 �i i� i •' ' f �' A> 11 I I I - � �•Y` I ! ! 11 I I � r s . GRAi1fD — AVE�17� — — — — — s ate— m ----------- --------------------------------------------------------------- ------ < 1 t EOSIN®RE _ G�MC 5� - �. -CM s a Q1 III m1hin millislohl "w I L-&.1 I 1 19%Z-.o &mf I W I Irmir. - X PERMIT # _ rFROVED P-z-I 3 ICI , ! 'aft L C _ Z t: $ , lu es 4,` ya ^' Z o - fix ` II 'C �` W 9 � I I 6 V wz 1 00 > ° ^ ✓ z jjA 106 ti Fa i•ia o 1� � � L G � a o SO add EPLLEZE09L ET:EZ b00Z/0E/E0 4 riz Y I 40 SViM tom. o t j 1 UZI o10 !� C-1 CD I i y v c st 'a T 56 ii 1 6J .� VJ ul v � tc i _ 1 U� 1 i 0 "1. gASV I e aG st44 ( Q II Is g v ti At. cp -='! A SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL BAIL FORM AND FEE TO SCAQIMD,ASBESTOS NOTIFICATIONS,FILE#551141,LOS ANGELES CA 9W4M41 AQYD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION# COMPLETED BY G Van'liouten COMPANY En*mrnmW Control Sdutions,Inc PHONE (951)788-1483 DATE October Sm,2004 CHECK# 1651 FEES 33121 PROJECT #083W4R NOTIFICATION TYPE OwcwAl root Pans ON DATES REv=N Orval(highlight) . CAK81ATION PROJECT TYPE Damuna r Ormsm Der RBWATM(remw84 Ememe+cr REMovAL PLwm Reno(annua4 poor SITE INFORMATION SITE NAME Farmer Elsinore Naval&MUwy Sdsocl SITE ADDRESS ISM Gland Avenue CROSS STREET Riverside Drive CITY Lake Elsinore STATE Caf nia ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Den aftn of Stntcdaes BUILDING SIZE(SO FT) 21.310 NUMBER OF FLOORS One BUILDING AGE(YEARS)%70 NUMBER OF DWELLING UNITS 11 BLDG PRIOR I PRESENT USE C130190A HOSPITAL rrJDU mt& 09m OFFICE Pueuc am HOUSE SCHOOL SHIP UNNICOI LEW xr00000c SITE OWNER Lake Elsinore Village 1,LLC_ ADDRESS 43529 Ridge Park Drive CITY Tememla STATE California ZIP 92590 CONTACT John Leway PHONE(951)506-6558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10/05104 END 1VAM WORK SHIFT(day,swing,night) DAY ASBESTOS AMOUNT TO BE FRUIBLE WA CLASS 1 WA CLASS II WA TOTAL AMOUNT(add row)WA REMOVED On square fens) ASBESTOS REMOVAL FROM SURFACES WA PIPES WA COMPONENTS WA AMOUNT OF EACH TYPE OF j ACOUSTIC CEILING I LINOLEUM 94SULATION FIREPROOFING DUCTING STUCCO MASTIC PIA ASBESTOS Cm spn W WA WA I WA WA WA FLOOR TILES(VAT) DRYWALL PLASTER TRANSITE ROOFING OTHER WA WA WA WA WA (desarbe)WA CONTRACTOR INFORMATION CSLB LICENSE#809807 OSHA REG# AOMD ID# NAME Enviramnentaf CorrjW Salu&m lint- ADDRESS 3654 Central Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER#1 LANDFILL ADDRESS WA ADDRESS NA CITY WA STATE WA ZIP WA I CITY WA STATE PIA ZIP WA I Asbestos mmveys are required prior to Demolition and Renovation Page 1 of 2 \ SCAM NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL IML FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE#55641,LOS ANGELES CA 9W4-5641 WASTE TRANSPORTER#2 NIA lam' WASTE STORAGE SITE NIA ADDRESS NIA ADDRESS WA CITY NIA STATE WA ZIP WA CITY nfa STATE nfa ZIP n/a CONTROLS: DESCRIBE WORK PRACTICES-AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1,2.3,4,5 or Other. For asbestos removals citae die combadw of Rule 1403 procedures used Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Swvey,Bi fk Sartp5ng,Irk.PLM.PCM.TEM.Assorted as Asbestos^PACM,Describe Other. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec-2 8106/04 TO 100M FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME 8 PHONE# AUTHORIZING PERSON:Carol Gordon TITLE Senior Code Enforcement Officer DATE OF ORDER ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAASE AND PHONE NUMBER OF THE PERSON DECLARINGIAUTHORIZING THE EMERGENCY,DATE AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN.tDECTEO EVENT. wA EtPLM MW THE EVENT IDUADCAUSE UNSAFE COMTIONS.EOU PIAENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN- CONTINGENCY PLAN:DESCRIBE ACTKM TO BE F(UG NED IF U NE)tPEC;ED ASBESTOS IS FaM DURING DEMOLITION OR ASBESTOS MATERIAL BECOME 015TUI1S .G3W4M.PULVERIZED.OR REDUCED TO PONDER MIA TRAINING CERTIFICATION:I certify that an fridii khW Gained in the provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidem that the required trakwig has been accompWted by dos person wA be avabble for inspection during normal business hours. Company Name MIA Print name of ou.merMpeator Signature of otwaftipeator Tittle of owner/operator Date INFORMATION CERTIFICATION:I cetfiy that the above hftmahmikirewect and I b0a enclosed any required attachments Company Name ECS- Print name of ownerMperator ' operator Tittle of owner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER Notifications can not be accepted wffl A the required fee(AQMD Rtde 301)_ Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make dtecits payable to'SCAOMD'. Fees are per notifcatim.not rebxtdable.and vary according to the project size. Fees are as follows: DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $331.21 FRObf 100 TO 1.000 SQUARE FEET S 29.52 SPECIAL HANDLING FEE $28.17 FRMIA 1.001 TO 5,000 SQUARE FEET S 90.24 REVISION OF NOTIFICATION $ 11.94 FROM 5.001 TO 10,00D SQUARE FEET $211.22 RETURNED CHECK CHARGE $29.28 MORE THAN 10,000 SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT $29.52 ASBESTOS REMOVAL AT owner- $29.52 occupied.single-unit dwelfing ATTENTION. Keep a copy of your notification. State law requkes that you provide a copy of the demolition notification to Building and Safety before issuance of a Fe to ba permiL For questions call 9094'i96-2336. For your convenience please mail the forth and fee and do not hand cant'to AOMD. I MAIL FORM AND FEE TO:SCAQMD,ASBESTOS NOTIFICATIONS.FILE #55641,LOS ANGELES CA 90074-5641 Page 2 of 2 TELEPHONE: (909)396.2336 FAX: (W9)396.3342 corm REV 20030627 Fomm,in mmlions,and Rule 1403 are available at AOMD's web site www.aqmd.gov SCAOIAD is located at 21865 Codev Drive.Diamond Bar.CA 91765-4182 (9091396-2000 •'r• 7cs.4ti: i-l�ae,_�.�:;� y�.i- r �.•.ice ti a3.'3`r:' -_�- :.,.= .- -. :. � , - '�•-�.�`-' -- - - -- SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF•DEMOLMON OR ASBESTOS REMOVAL 1 * MAR FORM AND FEE TO SCACIAD.ASBESTOS NOTIFICATIONS,FILE#55M,LOS ANGEUS CA 900745841 • Y } :, R }, COMPLETED BY I LLIE NWA6 r�cOMPANY 0 F G— PHONE 7s-2 I DATE 0?,Q"I-IECK# 07-�?' v FEEE$331z 1- FRQIECT4 p — O 1 O NOTIFICATION TYPE �RGWL RE1r sm DA7F-s RmtoN OmER(highiighq CMCELLAIION PROJECTTYP.E 0=—.mormoN OtMMM DOMTIO a Rr�+wATIQ a trerTaval F1eFl:c rtcr Rsuavu Pur,NEo fZho(mu* SITE INFOPKATION SITE LAME 90 RM E R c l..S rN 6 N-A*,JAL M i L I r-+4 DCL SITE ADQRES£ I,�•-- OD �� N U CROSS STREET CfTY �- EL�jNnV F— f'—'E CAL?#at lA `� L $� t7CCUNTY �SUE2S1bg DESCRIBE WORK AND LOCATION Rzt►F'~age— l�E+•rtwr�L. oi= a-s8E57Us GONTr}►��s, ,'»f} ,-1��2�R� BUIL.DRvG SiZE{SQr r) NUMBER OF F_DORS 'UILDIING AGE(YEARS) NUMBE`.OF OWP-WG UNITS BLDG PRIOR I PRESENT USE C0 m m!?Ox rosat& itrT AMAL od* OfFra =veuc qWG. rouse scram s,� Ubltis^,� i SITE GWNER f LLC 1 ADDRESS ? 1=t7Y ��ECu 4 cT"-= GA F �� g ;O�?MCT t� +1 L ,r�J PHONE if -f�S'Qt� _ it W 7 y REQUIRED BUILDING: 1 =SEEST,"j5 'c_ 4-a ASE�S703 � NO � ASBESTOS YES v EUIL^w-c-rc 3E <0 ( 11FORMATIsON ! =x3_5;T" SURV z • ! REMOVE- I GEMCLI-SHED? DROJECTDATES i 77a%7 C ENDda ,4wrc,rigttC �, 1 -- f. t ASBEST:,'S AMOUNT TO 8E I .RLAELE CiJ SSE -SS ii i TOTAL AMOUNT(-odd my i-.ENOVEfl ih%care feet)' i � f(Q-a G i 5�.0 ' ,rCDl�2fo5S.� ASBESTOS REMOVAL FROM 3UR.°ACE S rli=_ �Z1Ar^JrdEh i S r AMOUNT OF EACH TYPE OF .4C _=-10 CEi-I LNG LlNC-'°UM INSUL4i ON P =IRE FROOFIh3 DUCTING 3T(;C--- MAZ ! ASBESTOS (r scow-fe_;j FLOOR TILES 1:`AT) DRY WALLf PLASTER "R-NSITE ! ROOFING 0. t TD Id25d15e! I oc / �� - - CONTRACTOR INFORMATION .J_ ( i NAME ,��, G— 7S A[P-P,ES6 CITY —AT: Z:° q i^ &TES: V; 'fit?N=r1$C, fi WASTE�TRANSPORTER 91 � �--�—� � LANDFILL A` ,4 15f, ADDRESS _I.•. �' 'Tp e�,.�''? '.�'.•It 4.n I/l:C�"r `+ 71.-.ram :�Y Gl 17 1 ' Asbestos surveys are requiredlIpprior to Demoiition anc Renovation i-o arts,?nsfructions,and the Ruie UO2 can be obained from ACK web d.gov• =aaa F,nn REV Z003X" i SCAOMO NOTIFICATION OF DEMOLITION OR ASSUMS REMOVAL MML FORM AND FEE TO SCAM.ASBESTOS NOTMAT10NS,FILE S SSRI,LOS ANGELES CA 90GT"41 WASTE TRANSPORTER#2 WASTE STORAGE SITE ADDRESS / ADDRESS . CITY STATE, lip CRY STAT"t IJP CONTROLS- D=SCIMBE%%TM. PRACII:M AND CONTROLS TO BE 11SED AT THE RENOVATION AND DEMOUTION SITE .010=--ore#1,204,5 or cmf I Fw as' re�1s drde Me combat dRu!a 1tM omcsdwes tom. Procedtre 4 and 5 submit pans for A=Aria approval. ASBESTOS DETt:CT10N PROC CIr�L:r{EOCEDU, S AND#,tiALYTiCAL.1f~TlI00.c USED TO DETERMINE ASBESTOS IN THE BUIL►JIN3: a-covey,Bulk Sars>ilrtg,Irspec!ot, PM—tit Am RW as Asoes'.as-rACM,Describe Carter: FOR DEMOLITIONS GIVE TtE CCMPA Y tYl.1 i�AMD DATES OF-t HE AS13ErTOS REMOVAL:- � FOR ORDERED DEMOLITION.S n COPY OF T'vF-Ck-,ER-A.40&YE THE AGrERCY N!A`AE!<PRONE d I Alli}sORILNG PERSON: TTPLE DATE OF GRi1E.-t DATEDRDEERED TO E-r-GIN: 110, FM EMERGENCY ASBESTOS REAWAL G."fe THT2 Ph4Mc.o,\Q pKUIE VUUtz9R CF THE PEP.SD,v D5r-LAR7JGXLrrr0R0NG THE EMEFGENCY.D&M ANC HOUR C S.vFltGo+trr Ax0 afSGRIBE Ttr�.'�lN.L'NE7P_CTc1 c1fENf: l �C-LA,N 101�:j�1'E3\i I�OULC CAME D:sl--CCNDITi ANS.Z-aJ1PMENr0Atdr1.OR U..N.L45CNABLE F:NAR1C!AL3URDEN: CGAITINGENCY PLAN::ESCR�ACTiQ.T.':Tt;r 3E r11i1t�4t7 ff�J:.'E•�fr:T AS'oEo1'L'S 1:FG:Jr�tY�:�ING CJ.1il!i TOh C1Z AS5ESC•3 N41T6RAL E��Ch'c D75T'tbi6EC.SFti.LNEIc?.?U_VFlt2�.CR?.E�'GEi)IOF=:/'J'_R. TRAINWIS CERTMATiOW,cw*,,.at=,-O.;•xa_a uained It.the cmvWom of regtdz'9on A CIAO Rule 1433 or-d NESHAP w,l 5e c-n site doting t.tie ran%.GQI ano ar.cerioi otat tha imLsed L-jn*Iles t'eM ao:,.e'.,a5JzG al plc rer .wX to ava"bla fa:inser_'.ka:dudry axwa:3usiness nocrs. :Ni� !mLlany Noma i ejn nay_f cwrstleper_wr Sa3.:e:•.a of cwn C ! Tlttte o:owrmuci eraler Dme INFORMATION CERT5-r.±TION:I certll Zm Ur_atcve infoxaa+-oo Is C Tw and I N-4 any leered attamm nts. C- •,V!l.�'fLc�}4r�i ,tJsO 'v\!!l "Lsa 0 :aatyany Raw F;6v t-,e 1 c;mwAe*um 599,ir.-tee edoperalor '1-.A of ow-larkoewx Date M� can ?�a ten uiltc_T ri?e i-.ca'aed fee(AOL'I:ice; tI.AsLestm retarats of less amn 100 square feet are exemz-'rw nod ;aeon am fem Mase hake drams coyeore-'SCA=' Fe-ar 9 nodftaaw,no raifttaabl%and vay aomifiny tc the orNec:size. fees are as fosows: I ,MCLIT'.Cr:-:R;S=ES-i,'.-;S REMOVAL I PROCEDURE 4 OR 5 PLQJ 1331. i -:r OU'loo TO i,�0 SQCIiiL Fx7 : 2132 SPECIAL PANCL.ING FEE � =-OLI UK 1--0 5.tiM SCUAtF E FEE i -0.24 ` REVISI;nV OF ACT:.!G Tl--N 51',94 =KO-45.0!7.O t0,0W SGtt4fN_-FEE RE-TLIRNEDC lC,"CHA;;C-E 5.29.23 =C-is!N 13XM SG'UM� E FEE Sisi'sl QUIC31ATION OF NOT`Fi,"ATIOI: 5 0.7 n-14OU MN OF LESS THAN 10 so C-1 a SBESMC REMOVAL AT:.%ner- $2-0.52 rxcumse-smole-tr11 dwelt= ATTENTION: Keep a copy of-you:noMca:on. Ste--b n:° Wn%ma! p--vlde a copy d 09 d9:noOv..mS6caJw,o Sulldinc a,•1d Safety:eiore issuance di Geataadan ver-rn Fa =ssa, l' ?3.°S =w• r �e� ua Tease mad GIe fort ew fee and cc not nand--rtv-.0:.C4tD MAIL FORM AND FEE TO:SCAOUD,AU19SM-S NOTIFICATIONS,FiL= A!U41.LOS ANG ES CA 80074.5641 Page 2 oP; TELEPHONE: (309)38S2336 FAX: (944133o•334i =orm REV 2L':M20E2; =C--Plfs.i.VSTR!k--7kjXS.AX l-=RLU f 4x CAN BE C3 TVIr=D Whi AaVC t'&:-WE AT .It=- P:r.fW"%r i%-aQMD GO V SCAUD Is located at 21W E.Co*y Cqive,r'iamwd Ear.CA 91725r-'182 19M)Z96.2000 .... .-... - �... _ -.... . --t--,..-eo .- =- : c r-. fin_ L^ _n nr. '�•lu City of Lake Elsinore 130 South Main Street APPLICATION FOR Bu,Lp)#j6 I,K 4 AP I N N f BUILDING PERMIT APPLICATION RECEIVED DATE AP At By VALUATION CALCULATIONS C6'-0`OOZ BUILDING ADDRESS _ 1st FLOOR 12Po SF V &Irmt4C BLOCK/PAGEA L 2nd FLOOR J_�A SF AM 3rd FLOOR SF O -.4,er sw4w (11 ZGAa Lz-c A., `q 2. GARAGE AJ A SF N ADDRESS g3529 RIME 1 (VIr E I STORAGE SF R G(,(" L 2-5 0 h a that I am licensed under provisions of chapter Commencing DECK 3 BALCONIES SF wdh section 7900)of division 3 of the business and professions code,and my C license is in fun force and effect. OTHER: WA SF O LICENSE# to CITY BUSINESS N AND CLASS 8o 8 TAX# T ME VALUATION: R N V A MAILING C 1ADDRESS354 V FEES T C STAT P HONE C� O V �2S 7 BUILDING PERMIT S R I CONTRACTUR'SSIGNATUREA PLAN CHECK NAM . ` LICENSE# A RD PLAN REVIEW R MA N C ADDRESS SEISMIC H CITY bTA I PHONE/ PLAN RETENTION ❑NEW OCC GRP./ CONST. ❑ADDITION DIVISION: TYPE: ❑ALTERATION NUMBER OF NUMBER OF ❑OTHER STORIES: BEDROOMS: ❑SINGLE FAMILY ZONE: ❑APARTMENTS P1 1 certify that 1 have read this application and state that the ❑CONDOMINIUMS HAZARD YES above information is correct 1 agree to campy with all city ❑TOWN HOMES AREA? NO and county ordinances and state laws relating to building ❑COMMERCIAL SPRINKLERS YES. construction•and hereby autrwrize representatives of this ❑INDUSTRIAL REQUIRED? NO cdy to enter upon the above-mentioned property for imp- ❑REPAIR PROPOSED USE OF BLDG: Lion purpos14DEMOUSH PRESENT USE OF BLDG: JOB DESCRIPTION D 1 1110 6r b-'XIS-11 Signature of ApplicaWt or Agent Date t Agent for ❑ contractor owner Agents Name `rJE A,0 fnY� Agents Address 3ils� (`t AL AVE Street City State Zip �Lt A� il�J1V1 a MAMHLWE-SEE SHEET 0 ----------�---:__\------------- --_---��,,:`�-j ---- -- yes � - �------�-----�-� 40 Ant i _.-�_ — '•�!�' .i- Q67J I lalii..+o------------- ~ a __• r l , S70py BLOC- '• 1 t] 1 wr r• - i C 111 • 1 `fir`- �• � a I: i 1 mmI I 1 I•� Er - r,- T. a --- -- - - - -� • ---- GR�U�'D -- ----- — _____AVE �- — — — -- ' ---- ------ -- — _—_—T— —_---__--- —------------- 9- 1 SCALE C_i OEJ AK e SIN® >�� PERMIT # J I� • • 1 1 �• • 1 + I W T I � I� � I 71 r.- Qm4p pp 1 � v ._ 4.11 ++ � O! ta N � ul in RA 6 a. a > o W vC a , oC4 � 'Ell #s 3 U d acNP R 3 EL 1 0 gA ED 3SVd EPLLEZEBSL ET:EZ b99ZI9E/E9 O, 1 i I u � : N4 3 4 N I � v o Ca rE o t 1 I .14 A- < --I N; 1 11 .01 r > I i ! Ot t, ti IQ c , a 40 ci RDir�'7`r01�1 F�:F.'. flpSii/a�rcc� CQ �1ldri ' SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF DEMOUTION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQIIDQ ASBESTOS N07MCATIOK FILE 0 55841,LOS ANGELES CA 9W441141 ACID USE ONLY S0011 BY RECEIVED POSTMARK EN l-R- BY NOTIFICATION 0 COMPLETED BY G Van Houton COMPANY Errvirmiertal Como!Sdu6 m Inc. PHONE (951)7MI483 DATE October Sh,2004 CHECK# 1651 FEES 33121 PROJECT #083004R NOTIRCA710M TYPE ORWK= REv1swN DATES Rtff"Oust(highfighq CANCEUATM PROJECT TYPE Dsoounom Old DewtmoN RBMATM(rerravaq BeRGENCY REMOVAL PuwN®ReNo(annuap soot SITE INFORMATION SITE NAME Fenner Elsinore Naval&Merry SdwW SITE ADDRESS 15900 Grand Avenue CROSS STREET Riverside Drive CITY Lake Elsinore STATE Ca6tamia ZIP 92530 COUNTY Riverside DESCRIBE WORK AND LOCATION Proper Demolition of Stra hen BUILDING SIZE(SOFT) 21.310 NUMBER OF FLOORS One BUILDING AGE(YE,1RS)50.70 NUMBER OF DWELLING UNITS 11 BLDG PRIOR I PRESENT USE COMMERCrAL HosRTAL Dousmix 09m Omm Pm E mDG. MUSE SCHoa SHIP UNIVICdlEW XXXX)00( SITE OWNER Lake Elsinore Village L LLC. ADDRESS 43529 Ridge Park Drive CITY Temecula STATE Caftm ZIP 92590 CONTACT Jahn Leway PHONE(951)5064558 REQUIRED BUILDING ASBESTOS YES NO ASBESTOS YES NO ASBESTOS YES NO BUILDING TO BE YES NO INFORMATION PRESENT? SURVEY? • REMOVED? DEMOLISHED? NO YES YES YES PROJECT DATES START 10105104 END IW30104 WORK SHIFT(day,swing,night! DAY ASBESTOS AMOUNT TO BE FRIABLE WA CLASS I NIA CLASS 11 NIA TOTAL AMOUNT(add row)WA REMOVED(m square feet) ASBESTOS REMOVAL FROST SURFACES WA PIPES WA COMPONENTS WA AMOUNT OF EACH TYPE OF ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC WA ASBESTOS (m square feel) WA WA WA WA WA FLOOR TILES(VAT) DRY WALL PLASTER I TRANSITS ROOFING OTHER WA WA WA WA WA I (desarbe)WA CONTRACTOR INFORMATION CSLB LICENSE#809807 OSHA REG# AOMD ID# NAME Enwhmnertal CorrybW Sohrtkm hr. ADDRESS 3654 Central Avenue.Suite 2H CITY Riverside STATE CA ZIP 92506 SITE SUPVR Gene Van Houten PHONE 951-788-1483 WASTE TRANSPORTER 01 LANDFILL S WA ADDRESS WA [�EE:- CITY NIA STATE WA ZIP WA CITY WA STATE NIA ZIP WA Asbestos surveys are regtmed prior to Demolition and Renovation Page 1 of 2 SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAIL FORM AND FEE TO SCAQMD,ASBESTOS NOTIFICATIONS,FILE 0 55641,LOS ANGELES CA 90074. 41 WASTE TRANSPORTER 02 WA WASTE STORAGE SITE WA ADDRESS NIA ADDRESS WA CITY WA STATE WA ZIP WA CITY n/a STATE Na ZIP n/a CONTROLS DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE RENOVATION AND DEMOLITION SITE. Procedure#1,2,3,4,5 or Other. For asbestos removals chda the corniiinatiot of Rule 1403 procedtues used Procedure 4 and 5 submit plans for AQMD prior approval. ASBESTOS DETECTION PROCEDURE CIRCLE THE PROCEDURES AND ANALYTICAL METHODS USED TO DETERMINE ASBESTOS IN THE BUILDING: Survey.Bulk San 54 Irtsl. ..N .PLM.PCM.TEM.Assumed as Asbestos-PALM.Describe Other. FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL eec-2 8►O M T010/05104 FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME d PHONE# AUTHORIZING PERSON:Carob Gordan TITLE Senior Code Enforcement Officer DATE OF ORDER: ASAP DATE ORDERED TO BEGIN: IMMEDIATELY FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMB R OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY,DATE AND HOUR OF EH:ERMCY AND DESCRIBE THE SUDDEN.IPtWECTED EVENT. NIA E.KPLAIN IOW THE EVENT VKXLDCAUSE UNSAFE COXDITIONS.EOIAPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN: CONTINGENCY PLAN:DESCRIBE AcTmm TO BE FOUASVED IF UdEVECTED ASBESTOS IS FOUND DURR4G DEMOLITION OR ASBESTOS MATERIAL BECOME DISTURBED.CRUMBLED PULVERIZED.OR REDUCED TO PONDER NUA TRAINING CERTIFICATION:I cer*that an tnividual trained in the provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours I Company Name WA Print name of m►mwkperator Signature of o%wotoperator Tittle of owner/operator Date INFORMATION CERTIFICATION:i ore"that the abkrre infamria' Clelosed any required attactvnents rComparry Name ECS Print nameofowne*peratorfor Tittle of owner/operator Date 10/05/04 GENE VAN HOUTEN GENERAL MANAGER No Cations can riot be acceptedvAthma the mgzed fee(AQMD Ride 301). Asbestos removals of less than 100 square feet are exempt from notification and fees. Please make checks payab!e b'SCAOM(r. Fees are per nodcation,not reftindable.and vary Ong to the project size. Fees are as follows: - I DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN S 331.21 FROL t 100 TO I.CM SQUARE FIST S 29.52 SPECIAL HANDLING FEE $28.17 FROM 1.001 TO 5.CM SQUARE FEET S 90.24 REVISION OF NOTIFICATION $11.94 � FROL'J 5.001 TO 10.00 SQUARE FEET S211.22 RETURNED CHECK CHARGE $29.28 j MORE THAN 10,=SQUARE FEET S331.21 CANCELLATION OF NOTIFICATION $0.0 DEMOLITION OF LESS THAN 100 SO FT S 29.52 ASBESTOS REMOVAL AT owner- $29.52 rtit dwelling ATTENTION: Keep a copy of your notification. State Iav requires that you provide a copy of the demolition notification to Budding and Safety before issuance of a , demolition permit For questions call 909.39&-2336. For your convenience please mad the form and fee and do not hand carry to AQMD. i �iIAIL FORM AND FEE TO SCAQ,51D,ASBESTOS NOTIFICATIONS.FILE T 55641.LOS ANGELES CA 9007d-5641 Page 2 of 2 TELEPHONE: (90%39&ZM FAX: 01%396-IU2 Form REV' 03062- Forms.irutriA om and Ride 1403 are available at AOMD's web site www.aqmd.gov SCAGZ`AD is located at 21855 Codev Drive.Diamond Bar.CA 91755-4182 (9091396-2000 1 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT NOTIFICATION OF OF-MOLITION OR ASBESTOS REMOVAL. { MAIL FORM AND FE°TO SCAQW ASBESTOS NOTIFICAVONS.FILE 0 55641,LOS ANGELES CA 90074.5641 gialt a Op,1 LETEDSY ILLIE NWA6 W'� E Ec— E�EiO'NESToZ,--ZDS-Zr OkTE 0�-Q(,-t 'C-c,:; ;L g-G o FE s 33121 P RaeCTI _ o 10 NOTIFICATION TYPE aaGe+ai RRe =OATu SsmoN 01-HER(hiamigho CMW_tAnOn PROJECT 7YP= Dawtrtan Qrax.;m onmuar r�a+vranm(ram l EmF_Rw' ucr RELOVAL PtAtmm ono(aMum) SITEINFORKATION ! SITE!W.E POAM rsri ELS(NG 5 N•A A+ j M I L1 c.+-}DCL SITe 40DeR Sy 1 q flC (41L,C�•nj CROSS SIRE=! ' ClfY L�K,E" ELSI!��KE i7n7E CAi.IFsi12,'V1A 2L4 -2.5_:2 C C:,UNN 9,1yFe .s IT)g DES:icu-EV40RK AND_DCA MI P.:9_oP_41Z. ,26mcvAL_ Jr .dsSEs?Us GON74rJJr:J4- c J71G ,—� �2iflL ztJ �hG w'"r2FT) 4U.'=%F F.CORS =UP CING AG.(`.'EARS) '&lM2°.;;OF D`lle--iNG UNITS t rr6tl; oter =veuc atop. HOJ� SC o� 3-:=BLDG PRWrPRESENTUSE C inn { f Q�X '' L L G ,.i, �:r 5s Q .CC!rJ G E ,�i44R Ja¢I✓ W Fr- �� 7 y.. j REQUIRED BLIP—OM -CzSaTOS � V. � ES f� '� � --0-S v � ' . 3E •� `L.• AS S-�.'s �- t.L :Saw ES EUI iAG { NIFORMAWN CEMCL!S:iED? QSO/++E -WJE--TDzT_S ;;,r' �� _ G END Cry _ �Lf CF:,ahi.= (63a ,swnc,rlp ! �1 ASBESTOS AA MINT TO EE F.igBLE =_=SS II f � JTOTAL AMOUNT IAW myi?�DVEDiincouw--�+� � 1�.�` f(L?rr1y ! -co� ASBESTOS REMOVKL F Oa1 _LIRFA ES iAMOUNT Or-EACH Tt-Pe Of ;_=STtI Jw� EP uLf N,—iou =l?E=RCS:6r^s.I DUCTIVG :TUC..' ; 'J ASEEST0. {eisct.�r:i I r I .Zcc CONTA.A TOR WFORMTION I CS::+J"_'ENS y�; f 0c_W %EG= (� ":^_�4D IC= ,%� gqa A" .a I.05 y/ >L A.Ve JV u �:r3c$L=tZc R G¢e�i c-fP q�� S:T=S'�E`/= Arv- YIASTE ir.ANSF0iT!.rs 9� G ` ! LANDFILL A2 '4 54 _ '_ i� se !.11�j�^ �--• L ORESS 'J.�r ''� (' -t�l^il? .. A._ _fl .-. •t �J Jeri' IJ'�%l�j� 0 ST=.i'E 3Pa 1•+ soesic_sumeys are reoutreJ (:t3i io 1ri:t�7'llm{'1 anG REii?;attef' .� . Tcs. -tsumdc s.anti me Ririe i.su-1 can be ob-mwee f:Lre-`G!`AD wet site h-Im:,iwww.ao.-nd.gov- zap' _ ccrrr.?.Ev;0LIW-' SCAGMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL MAR FORM AND FEE TO SCAG6TD.ASBESTOS NOTIFICATIONS,FILE A 65641,LDS ANGELES CA 90074-6641 WASTE TRANSPORTER$2 WASTE STORAGE SITE ADDRESS / ADDRESS . i CITY STATE LIP CITY STATE ZIP CONTROLS: I]MIIP 11 WORK PRACTIC-ES AND CON,RO'S TO RE 11PSEr3 AT-HI R3-40VATICk AND 111MOUTION SITE. Procedure#1,2011 S or Othl �t asbMm immar&ade Lte c omlAr atloa of JWa itr;arooe ww mm a moedin 4 and S submit Ftatrs for ACINIC prkx approval. ASBESTOS DETECTION PROC OC KLE.-IE.--,.%OCEDURF-S AND ANALY nCk lA ,HODS U-SED TO DETERMINE ASBESTOS IN THE BUILDING: aver,Bulk Sant**.Ias ecDarl PC'A,ML Assumed as A5 nosatPACA1,Describe Ctlw. FOR DEMOLIITTONS GPr?HE CCMPANY NAME.UX;.;.TES OF TFIEi,.BESTOS RSAbV.4L- FOR ORDERED- TIONOIXMi %KDA COPY OF THE C.RRDER kND G',--THE-AGENCY NAME PFRINE 2 I AVTHC4tIZJNG PEFWI: TDP OATc0E-0r%CN:.R NTE ORD=RED T O EEG.'t:: FOR EMERGENCY ASBESTOS REMOVAL GFJE TF=_ttaMc.AND?!i(Trr Y11ct'E`P CF THE PEPSON VS--ARW3XL THORmNG THE EMERGENCY.DATE AJJC HOUR C ZVLRGENCY AND 0-03 3t -. Sl;XZ-K LWEXPe';T.--:E`lc-4r; =X=,IN tfp1Y x E�'3N7 VbO1JLC CAUSE�.iK�:= {sDT.C`JS.W_PACE1rT]AtdA�°O�U 1t�=9914A&E FWANCRUWRCEN_ t - t =OHMIDENCY PUW 02SCA E;ZRONS v 3E FCUL:-ram IF sk-JWz-- z--A aE=S F-FC.k%c.J0--itING 0a.mMon OR ASSES Tos MATetR�AL'oa:"fit }N'i'vn6EC.C mu--.PII.V£Rmm.ca ni Gm 70=_;.-SA. TRAIMG Cc.RWjCATiON:.cartes t—m an ina 7t_a aired Jr,hie cmvi,-ists of regtd25dn 4CJ.0 Rule t-03 arc NESLlAP vWl be on she Curing the ra-"al Ina ewcw oe a•.et dw motwed:gang he!o---% pE-,ram:r Mis:.a,•v,.wS to avaiabla k:iriueebr dudr,;n Trial�usinm not-. I EEC-1 Ir�INLr=2Et� �!4� � n�F�'�-� ,�fvysffu GwNc-2 g ( . npe Mama w Tittle a owmermma►cr Do e INFORMATION CJER.71-l'.'.TKNI.Icertd}-j Ei um atcnie ji ball lon is t~.•sW arty 1 have ari hasedgsnv vacate:attacnrnents. p o(c-v ! �zatyarty Raw =-wa-mme-n-'aaa•.e:,ccemor Srg>a.a=- xres+oper r THW of 0wnerroper31or Date Noefi atim Cox:me a eo�.CLy Ce racuaed fe--0 VE=:.de 30%P.s--=rrlraigs of tess Chart 100 Gquam teat are exemot'rem noti6cagon am fees Plem rlalta diam ar axz r:'S V:.C!r--' Fess 3r.-:a--M&E axon,nat raPtnraDL-_am raj accc.d%tc the Drgect size. Fees are as ibAm: ! =::ACllt!OJr�.Fcr�:=BYES REJ«Ovi,:. ?P.MEDUR-:4OR 5 FLAN S 331.2 I -ROJ 100 TO i-v:'D SQU!iZE F.=F : 23 2 SP=-C; i HANGUNG FEE 3 1 =,OM I.C.Cl TOS.&MSC4l.,JEFEET S sDi= � RE-vWrVOFNOT'r-r- ATON S 1',94 _;Q S.001170'RMO SOUA.RE FEET :2 D l c t RETURNED UrRNED CHECK CHA;ZGE S 29.23 MORE THAN 1100 SOUAnE FEET _i3t 1 WJC3i�.Th:)N OF NCT710ATION 50.0 C=.AIOt1T10w O:LESS-1HA►101)SQ :Z v � ASBEST=S RE.IA.OVAL AT mwier- 5 249.52 ncp:aa`.5mle-t.rSi dwagino ATTENT.+ON: Keep a copy oflour noilkation to 3tdidrng and Safety cebre issuance u ee+-w roan Cerrrii =al guessau 'r° .i0s" : ^:a e k=crease mad the iam a;w fie and cc not nand carry to ACMD AWL FORM AND F Ee TO:SCACMD,ASSES rC-S NOTTFICA-NONS,RL_ _15641.LCSS AfJG=_S C,�20074-564i Page 2 of TELEPHONE (309)3M2336 FAX: (90-0133iivs4b =orrn REV 20^30E2" -S.RJAS,LVSTRhiNGNS,rAVL'Ti=RUE- ,Q CAN�_`-%iJcn FAL,1 aJ fC'.'+i~SIT-;T `i I Z'a l,-T-TWL% .AQIVm GOO -3CAQMD Is brief at 21M E CaDley Naive.--iarraid Ee;... ?'?_ 18= ,.r,3139a-2(% en CITY OF LAKE ELSINORE BUILDING AND SAFETY DIVISION Date: NOTICE ❑ Stop Work (321 Correct Work Job Address I S V 1 g G r Permit Number o ` b 6 J v �a� S�. '�� h r door 't Poo\ g,I!-f—oN" Division Inspector