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HomeMy WebLinkAboutRALT-19-2266 • .. City of Arcadia, CA Permit NO. RALT-19-2266 y• Development Services Department Permit Type:Residential Addition/Alteration 240 West Huntington Drive,Post Office Box 60021 Work Classification:Res-Addition/Alteration Arcadia,CA 91066-6021 (626)574-5416 Permit Status:Issued ARCADIA Issue Date:03/23/2020 Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 275 W LEMON AVE Arcadia,CA 91007-8032 5785006010 Contacts JENG LIN Owner Robert Tsay Architect,Inc Applicant 275 LEMON AVE,ARCADIA,CA 91007 682 BLUEFIELD AVE,CLAREMONT,CA 91711 (626)566-5940 hwe3419@yahoo.com (626)927-6316 rtarchitecting@gmail.com KYO CONSTRUCTION* Contractor 422 Cortez RD,Arcadia,CA 91007 (626)905-5398 733023 wasion. Description:ADDITION OF MASTER BED AND DEN(479 SQ). Valuation: $ 104,324.10 Tenant REMODEL BATH#2,MASTER BATH AND KITCHEN. 252 SQ OF COVERED PATIO. Total Sq Feet: 495.00 Plan Check#19-2266 Plan# 241 L TOTAL 3 BED 3.5 BATH Fees Amount Payments Amount Paid Building Issuing Fee S47.01 Total Fees $3,892.62 Building Permit Fees $1,258.50 Cash/Receipt#REC-03028-19 $1,151.54 Building Plan Review Fee $818.03 Cash/Receipt#REC-04132-20 $2,741.08 Cal Green Plan Check $81.81 Amount Due: $0.00 Energy Plan Review Fee $251.70 Green Building Standard $5.00 ~ Parks&Recreation Fee(SFR) $1,410.75 Solid Waste Management Fee $6.25 Strong Motion Inst.Program Res $13.57 Total: $3,892.62 CALLS FOR INSPECTIONS Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days Eil TED from the date of plan submittal.This permit expires and becomes null and ��� void if any work authorized by this permit is suspended or abandoned for 180 CO consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. • March 23, 2020 Issued By: Date March 23,2020 Page 1 of 1 V l,I Y !! 1 PERMIT/PLAN REVIEW APPLICATION -' YIN .4 Development Services Department,240 West Huntington Drive,Post Office Box 60021 e >r/.. Arcadia, CA 91066-6021,(626)574-5416,Fax(626)447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION • ❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: \i\ Chapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code and my license is in full force and effect. 0 I have and will maintain a certificate of consent to self-insure for workers' License Class icensNo. l 3 Exp. Date _e compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Contractor b - performance of the work for which this permit is issued. OWNER-BUILDER DECLARATION , a I have and will maintain workers'compensation insurance,as required by Section ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3 I I of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'•_,�, nsa'on insuranc er and po)igy,ummbers'are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier _ demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number �,in._ for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify in the performance of the work for which this permit is issued,I shall Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the .rkers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole orthwith comply with those provisions. . \/� L \._,compensation,will do the work,and the structure is not intended or offered for �l "�"` sale(Section 7044,Business and Professions Code:The Contractors License Date l Z~I Z b Signature Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT:APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for further information./� '` ,, // NCtlfy e MI 01 -L M L _� f icy° COAStHn mONTitle O �"� PRINT NAME ,\1 that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of dia to e r upon the above-mentioned property for inspection purposes. Si Date (2 ( 2o 4City of Arcadia, CA Permit NO. RALT-20-1149 Development Services Department Permit Type:Residential Addition/Alteration 240 West Huntington Drive,Post Office Box 60021 i Work Classification:Res-Addition/Alteration Arcadia,CA 91066-6021 (626)574-5416 Permit Status:Issued ARCA DIA Issue Date:07/27/2020 Expiration: 07/27/2021 , Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number I. 275 W LEMON AVE Arcadia,CA 91007-8032 5785006010 WIIIIWINEMMOSTAIIIMISIMMIPMKAMENIZOSIMIIIIIIIIIIIIIIIEW Contacts JENG LIN Owner KYO CONSTRUCTION* Contractor 4 275 LEMON AVE,ARCADIA,CA 91007 422 Cortez RD,Arcadia,CA 91007 (626)566-5940 hwe3419@yahoo.com (626)905-5398 733023 Commimamsommummismommoim. -, Description:REPLACE ALL WINDOWS, NEW CONSTRUCTION, Valuation: $ 80,000.00 Tenant RE-STUCCO THE HOUSE,REPLACE DRYWALL AND INSULATE c ENTIRE HOUSE,DRYWALL DETACH.GARAGE COMPLETE REPIPE Total Sq Feet: 0.00 Plan Check q Plan q FROM METER TO EACH FIXURE AND VALVE,REWIRE HOUSE, -, NW UPGRADE ELECTRICAL SERVICE 200 AMP,TWO 100 AMP SUB PANELS,REMODEL ALL FOUR BATHS,KITCHEN,LAUNDRY,NEW HVAC SYSTEM AS PER PLANS. Fees Amount Payments Amount Paid Bar Sink $13.21 Total Fees $2,877.27 Bathtubs/or Combo $13.21 Cash/Receipt q REC-05059-20 $2,877.27 Building Issuing Fee $47.01 Amount Due: $0.00 Building Permit Fees 51,057.00 Building Plan Review Fee 5687.05 Cal Green Pian Check $68.71 Clothes Washer 513.21 Compressor 3-5 Ton(3 to 15 hp) 536.35 Dishwasher 513.21 Distribution Panel $32.96 Electrical Permit Issuance Fee $47.01 CALLS FOR INSPECTIONS Energy Plan Review Fee $211.40 Request for inspection by telephone at 626-574-5450. Leave a message Furnace or Burner<-100,000 BTU $19.86 requesting the address,timeframe and what inspection item is needed. Garbage Disposal Fee $13.21 Gas System(Outlets) $77.75 Green Building Standard $4.00 This permit/plan review expires by time limitation and becomes null and Install,Relocate Appliance Vent/Hood $9.94 void if the work authorized by the permit is not commenced within 180 days Kitchen Sink $13.21 from the date of issuance or if the permit is not obtained within 180 days Laundry Trays $13.21 from the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 Lavatories $66.05 consecutive days or if no progressive work has been verified by a City of Mechanical Permit Issuance Fee $47.01 Arcadia building inspector for a period of 180 consecutive days. Total: $2,877.27 , 7--1 1'2'1 r44- DCOMPLETED� July 27, 2020 Issued By: Date July 27,2020 Page 1 of 1 .F AR 4 PERMIT/PLAN REVIEW APPLICATION too, Development Services Department,240 West Huntington Drive, Post Office Box 60021 Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION ptI hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: Chapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code,and my license is in full force and effect. 0 I have and will maintain a certificate of consent to self-insure for workers' License Class License No. 7 f• Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Contractor OWNER-BUILDER DECLARATION 0 I have and will maintain workers'compensation insurance,as required by Section ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of Pa,I certify that in the performance of the work for which this permit is issued,I shall Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions. compensation,will do the work,and the structure is not intended or offered for `n ` �l - sale(Section 7044,Business and Professions Code:The Contractors License Date ��27 ? (� Signature V 1�✓V Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for further information. Name EWER Title C v / C t/ L PRINT NAME I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter upo the above-mentio�ed property for inspection purposes. Yv\ � � Signature `� ` Date NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. 275- , /- 46j„fO� 100. Setbacks 210. Under ft./bldg. y 2- bldg.drain 8- a Asv l.•� 101. Rough grade 11. Copper underslab S y Zv r61- LT I q -Zz` 102. Figs.&forms e� ,� 212. Rough plumbing �si?Pit(...../ FEAPKir Rac-r• Zp_1 y1 103. Pre slab o 213. Rough gas Mi� 104. Floor joists 214. Shower pan I--ii-Z° J 105. Steel 215. Water heater ` 106. Grout lift 16. Roof drains 107. Shear nailing fly-/'{-u► 217. Building sewer (Z-1-2-0 i i 1 k ,,', 108. Diaph nailing 218. Water service 12-/-20 109. Roof nailing a-(1-2.4 219. Final gas 110. Framing 12-25-20 220. Fixtures . -6-2. 1' cv 111. 0c./Area Sept.Wall 221. Final plumbing 7 13-Z� Y1 112. Sound walls 222. Sewer cap/demo. 113. T-bar.rid • S 1z-/-z gj 114. Insulation-Flr. Pool Inspections I Date Insp. 115. Insulation-Wall /2- !Kl✓ 240. Excavation/steel /� 116. Insulation-Ceil. , 1. Rough plumbing 117. Drywall nailing 12-37- ".242. Light shell/bonding 118. Interior lath 1-01-t( 243. Underground conduit 119. Exterior lath r 2-29 2a 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building 7-iq-2.1 1'v 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical Inspections Date Insp. 249. Final.lumbin. 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Under.round conduit 153. Underslab conduit Reroof Inspections I Date Insp. 154. UFER ground S-11/4-4 F/�"" 270. Pre-reroof insp. _ 155. Water ground t 5i2V v' 271. Roof framing 156. Rough electrical (� 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. E..t.bondi L ',Wag Sign Inspections Date Insp. 160. Service panel / 280. Setback/overhang 7.4F 161. Final electric . 4 281. Footing 282. Conduit/wirin• Mechanical Inspections Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rouch HVAC 1 k-5-2.0 A". . ' Miscellaneous Insp. I Date I Insp. 183. Fire dampers 290. Fire alarm 184. Furnace compartment 291. Underground supply 185. Combustion air 292. Fire sprinklers 186. Smoke detectors 293. Monitor system 187. Metal F.P.rough 294. Hood dry chem. 188. Compressor setback 295. Final 189. Commercial hood 190. Duct shaft Sewers&Offsite Insp. I Date Insp. 191. Final mechanical -7-{'- n 300. Lateral(main to P/L) 301. Saddle/Y Block Wall Inspections Date Insp. 302. Gess.•.l filled 200. Footings 303. Sidewalk - 201. Steel/rebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin City of Arcadia, CA Permit NO. RALT-20-1487 Development Services Department Permit Type:Residential Addition/Alteration 240 West Huntington Drive,Post Office Box 60021 Arcadia,CA 91066-6021 Work Classification:Res-Addition/Alteration (626)574-5416 Permit Status:Issued ARCADIA Issue Date:09/17/2020 Expiration: 09/17/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 275 W LEMON AVE Arcadia,CA 91007-8032 5785006010 Contacts JENG LIN Owner KYO CONSTRUCTION* Contractor 275 LEMON AVE,ARCADIA,CA 91007 422 Cortez RD,Arcadia,CA 91007 (626)566-5940 hwe3419@yahoo.com (626)905-5398 733023 Description:REFRAME ROOF,REPLACE SHEAR WALLS,NEW Valuation: $8,000.00 Tenant STUCCO AND ROOF ON EXISTING DETACHED GARAGE Total Sq Feet: 0.00 Plan Check# Plan# Fees Amount Payments Amount Paid Building Issuing Fee $47.01 Total Fees $404.92 Building Permit Fees $203.85 Cash/Receipt#REC-05491-20 $404.92 Building Plan Review Fee $132.51 Cal Green Plan Check $13.26 Amount Due: $0.00 Green Building Standard $1.00 Solid Waste Management Fee $6.25 Strong Motion Inst.Program Res $1.04 Total: $404.92 CALLS FOR INSPECTIONS Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 C colpciED� consecutive days or if no progressive work has been verified bya City of Y P g Arcadia building inspector for a period of 180 consecutive days. September 17, 2020 Issued By: Date September 17,2020 Page 1 of 1 E A a0dvoit'yQi 4 0061im h PERMIT/PLAN REVIEW APPLICATION 44=j Development Services Department,240 West Huntington Drive, Post Office Box 60021 Arcadia, CA 91066-6021, (626) 574-5416, Fax (626)447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION ❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: Chapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code,and my license is in full force aneffect. gr ZGZ ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class t7 License No.—7 27- al 77 Exp. Date7(7 a/ compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Contractor � ll� performance of the work for which this permit is issued. ` , - OWNER-BUILDER DECLARATION tj I have and will maintain workers'compensation insurance,as required by Section ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, forthwith..m ly i • ose provisions. or my employees with wages as their sole �� �!l compensation,will do the work,and the structure is not intended or offered for Z� sale(Section 7044,Business and Professions Code:The Contractors License Date Signature Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date 6/Z Signature Li‘ ` Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: I. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for further information.M (� r/� Name C r l/k �-- (v' Title - ' PRINT NAME I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to ent upon the above-mentioned property for inspection purposes. �J Signature V V - "�-� Date �� ` U� `� NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. Z7,5 �..1 L�.�re.J ��f�•�Gc' 100. Setbacks 210. Under ft./bldg.drain 101. Rough grade 211. Copper underslab 102. Figs.&forms 212. Rough plumbing 103. Pre-slab 213. Rough gas 104. Floor joists 214. Shower pan 105. Steel 215. Water heater 106. Grout lift 6. Roof drains 107. Shear nailing icr-/51-7A 217. Building sewer 108. Diaph nailing 8. Water service 109. Roof nailing (d-/Y/ 219. Final gas 110. Framing /2..0r1-2-`5- 220. Fixtures 111. 0cc./Area Sept.Wall 221. Final plumbing 112. Sound walls 222. Sewer cap/demo. 113. T-bar.rid 114. Insulation-Flr. Pool Inspections Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Ceil. 241. Rough plumbing w 117. Drywall nailing a-n- -- 242. Light shell/bonding118. Interior lath /! ` �J243. Underground conduit 119. Exterior lath (2 2/-2e " �"' 244. P-trap 120. Finish grade < 245. Gas line&test 121. Final building 7-13-21 41.-1,,\I 246. Fence,gates&signs 122. Final demolot clear 247. Pool heater 248. Final electric Electrical Inspections Date Insp. 249. Final.lumbin. 150. Power pole 250. Pool cover 151. Sales lot lighting �51. Pool final 152. Underground conduit (2-/-2-(-> 153. Underslab conduit Reroof Inspections Date Insp. 154. UFER ground 270. Pre-reroof insp. 155. Water ground 271. Roof framing 156. Rough electrical 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. E..t.bondin. Sign Inspections I Date Insp. 160. Service panel 280. Setback/overhang 161. Final electric 713-z1 281. Footing 282. Conduit/wirin. Mechanical Inspections Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rouch HVAC r Date Insp. 183. Fire dampers 290. Fire alarm 184. Furnace compartment 291. Underground supply 185. Combustion air 292. Fire sprinklers 186. Smoke detectors 293. Monitor system 187. Metal F.P.rough 294. Hood dry chem. 188. Compressor setback 295. Final 189. Commercial hood 190. Duct shaft Sewers&Offsite Insp. I Date Insp. 191. Final mechanical 300. Lateral(main to P/L) 301. Saddle/Y Block Wall Inspections Date Insp. 302. Cess•.•l filled 200. Footings 303. Sidewalk 201. Steel/rebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin W., City of Arcadia, CA Permit NO. FIRE-20-1549 Development Services Department Permit Type:Fire 240 West Huntington Drive,Post Office Box 60021 Arcadia,CA 91066-6021 Work Classification:Fire Sprinkler (626)574-5416 Permit Stotus:Approved ARCADIA 11,6(.2.024 Issue Date: Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 275 W LEMON AVE Arcadia,CA 91007-8032 5785006010 Contacts JENG LIN Owner SUPERIOR FIRE PROTECTION* Contractor 275 W LEMON AVE,Arcadia,CA 91007-8032 18120 ROWLAND ST,CITY OF INDUSTRY,CA 91748 (626)905-5398 HWE3419@YAHOO.COM (626)965-6900 664427 Description: FIRE SPRINKS FOR ADDITION 29 HEADS Valuation: $ 7,500.00 Tenant Total Sq Feet: 0.00 Plan Check#20-1549 Plan# 1 1 Fees Amount Payments Amount Paid Fire Issuance $47.01 Total Fees $951.86 Fire Permit Fees $203.85 Cash/Receipt#REC-05596-20 $700.00 Solid Waste Management Fee 2 $1.00 Cash/Receipt#REC-06002-20 $251.86 Sprinkler Heads $700.00 Amount Due: $0.00 Total: $951.86 , CALLS FOR INSPECTIONS Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. 51 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days �OMPETEO from the date of issuance or if the permit is not obtained within 180 days from the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. Issued By: Date November 09,2020 Page 1 of 1 t 4`r,,IFORge �4 PERMIT/PLAN REVIEW APPLICATION erile �®a Development Services Department,240 West Huntington Drive, Post Office Box 60021 Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: Chapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code,and my license is in ful force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class C i b License No. 6��Z� Exp. Dated/ LI compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Contractor ❑ I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER DECLARATION ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:Code.Any city or county which requires a permit to construct,alter,improve, Carrier OA€,i IC- demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions. compensation,will do the work,and the structure is not intended or offered for I 1/Q(1I Zero I sale(Section 7044,Business and Professions Code:The Contractors License Date Signature Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature_ Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for further information. Name S iU1ne7 \Title (()A174(/ PRINT NAME I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. I agree to comply with all City ordinances and State Laws relating to buildin construction. I hereby authorize representatives of the City of Arcadia to enter upon theabove-mentioned property for inspection purposes. I (l Qf f) Signature 1),-/--'1,---:— fate I I /0 / /7d Z v ' 1. ,• City of Arcadia, CA Permit NO. ROOF-20-1150 Development Services Department Permit Type:Roof 240 West Huntington Drive,Post Office Box 60021 Arcadia,CA 91066-6021 Work Classification:Reroof-Residential (626)574-5416 A Permit Status:Issued A RCA I)1 A Issue Date:07/27/2020 I Expiration: 07/27/2021 - Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 1 275 W LEMON AVE Arcadia,CA 91007-8032 5785006010 Contacts r - - -.._._... �..—... - .... i JENG LIN Owner KVO CONSTRUCTION" _ _ _ Contractor -'` 275 LEMON AVE,ARCADIA,CA 91007 422 Cortez RD,Arcadia,CA 91007 I (626)566-5940 hwe3419@yahoo.com (626)905-5398 733023 2 I Description:T/O AND REROOF HOUSE AND DETACHED Valuation: $ 18,000.00 Tenant GARAGE WITH BORAL SLATE 600,COLOR BUCKSKIN OVER EXISTING SHEATHING TO MATCH ADDITION Total Sq Feet: 0.00 Plan Check q Plan q ...I Fees Amount Payments Amount.Paid Building Issuing Fee 547.01 Total Fees $424.11 Building Permit Fees $370.85 Cash/Receipt q REC-05060-20 S424.11 Solid Waste Management Fee $6.25 Amount Due: $0.00 Total: $424.11 - 74 Y-2-, fiwAL 4 CALLS FOR INSPECTIONS Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 comptETED consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. July 27, 2020 Issued By: Date July 27,2020 Page 1 of 1 4 • PERMIT/PLAN REVIEW APPLICATION El;f' Development Services Department,240 West Huntington Drive,Post Office Box 60021 '� /e. Arcadia,CA 91066-6021,(626)574-5416,Fax(626)447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION pkthereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: hapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class I) License No.117'00 Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Contractor 0 I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER DECLARATION 0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit is issued.My workers'compensation insurance carrier and policy numbers are: License Law for the following reason(Section 7031.5,Business and Professions Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is A I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions. compensation,will do the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The Contractors License �l/ 1-7/-4 Z V Signature \L.....)\ Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. j]I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for further information. Name p� L } Name Y'`1C�f� , '`�'. Title Ct ictt4 `4-tiV PRINT NAME I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to ent upon the above-m ntioned roperty for inspection purposes. • Signature • Date NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. 2 75- LA/. / 100. Setbacks 210. Under W./bldg.drain fJ 101. Rough grade 211. Copper underslab I e/QMt i 2 O-I 1 5-6 102. Figs.&forms 212. Rough plumbing 103. Pre-slab 213. Rough gas , / 104. Floor joists 214. Shower pan _1 9 -2-0 i!noc t f/&O E-2(1 S;G 105. Steel 215. Water heater PLyW O o D art ittocas !T1 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service 109. Roof nailing 219. Final gas 110. Framing 220. Fixtures 111. OCC./Area Sept.Wall 221. Final plumbing 112. Sound walls 222. Sewer capi'demo. 113. T-bar.rid 114. Insulation-Flr. Pool Inspections Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Cell. 241. Rough plumbing 117. Drywall nailing 242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical Inspections Date Insp. 249. Final.lumbin. 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Underground conduit 153. Underslab conduit Reroof Inspections Date Insp. 154. UFER ground 270. Pre-reroof insp. 155. Water ground 271. Roof framing 156. Rough electrical 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. E.It.bondin. Sign Inspections I Date Insp. 160. Service panel 280. Setback/overhang 161. Final electric 281. Footing 282. Conduitiwirin. Mechanical Inspections Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rouch HVAC Miscellaneous Insp. Date Insp. 183. Fire dampers 290. Fire alarm 184. Furnace compartment 291. Underground supply 185. Combustion air 292. Fire sprinklers 186. Smoke detectors 293. Monitor system 187. Metal F.P.rough 294. Hood dry chem. 188. Compressor setback 295. Final 189. Commercial hood 190. Duct shaft Sewers&Offsite Insp. Date I Insp. 191. Final mechanical 300. Lateral(main to Pt) 301. SaddleiY Block Wall Inspections Date Insp. 302. Cess...I filled 200. Footings 303. Sidewalk - 201. Steel/rebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin •. City of Arcadia, CA Permit NO. Elec-20-0876 Development Services Department Permit Type:Electrical 240 West Huntington Drive,Post Office Box 60021 Arcadia,CA 91066-6021 Work Classification:Elec-Temporary Power Pole (626)574-5416 Permit Status:Issued ARCADIA Issue Date:06/15/2020 f Expiration: 06/15/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number L 275 W LEMON AVE Arcadia,CA 91007-8032 5785006010 L Contacts JENG LIN Owner KYO CONSTRUCTION' Contractor 275 LEMON AVE,ARCADIA,CA 91007 422 Cortez RD,Arcadia,CA 91007 (626)566-5940 hwe3419@yahoo.com (626)905-5398 733023 r Description:TPP FOR SF NEW ( Valuation: $ 0.00 Tenant Total Sq Feet: 0.00 Plan Check# Plan# Fees Amount Payments Amount Paid Electrical Permit Issuance Fee $47.01 Total Fees $81.40 Solid Waste Management Fee 2 $1.00 Cash/Receipt#REC-04700-20 $81.40 Temp Power Pole(auto) $33.39 Amount Due: $0.00 Total: $81.40 4106 ' L dvj CALLS FOR INSPECTIONS Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days COMPLETEDfrom the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. • June 15, 2020 Issued By: Date June 15,2020 Page 1 of 1 i A. . PERMIT/PLAN REVIEW APPLICATION ,04, 40, Development Services Department, 240 West Huntington Drive, Post Office Box 60021 Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: Chapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code,and my license is in full force and effect. License Class (} ❑ I have and will maintain a certificate of consent to self insure for workers' License No. Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the '1 performance of the work for which this permit is issued. Signature of Contractor V� • .l� OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of I certify that in the performance of the work for which this permit is issued,I shall Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply 'th those provisions. compensation,will do the work,and the structure is not intended or offered for // '� 1 ..sale(Section 7044,Business and Professions Code:The Contractors License V/ Date Signature Law does not apply to an owner of property who builds or improves thereon, 1! or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings ii and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909) 396-2000 for further r information. /� ( .� me I"��C�1•��L `Al `.lel` Title PRINT NAME I certify that I have read this application and state that the above information is c rect and that I am the owner or duly authorized agent of the owner. I gree to comply with all City ordinances and State Laws relating to build' g construction. I hereby authorize representatives of the City of adia to enter upon the above-mentioned property for inspection purposes. ignature \A ..•" "' l- UN._ Date 7I / t) ~ ,�FF ARC G4! y it .1....i,.;':.;s AVN. , 901 MEMORANDUM Fire Department DATE: July 19, 2021 TO: BUILDING DEPARTMENT INSPECTOR Henry Kemich FROM: FIRE DEPARTMENT SUBJECT: FIELD INSPECTION ADDRESS: 275 W. Lemon Avenue THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE DEPARTMENT REQUIREMENTS: TYPE OF INSPECTION DATE / INITIAL FINAL INSPECTION FIRE SPRINKLERS (PC# 20-1549) 7-14-2021 Lili Huang FIRE ALARMS HOOD & DUCT KNOX BOX OCCUPANCY 7-14-2021 Lili Huang COMMENTS: Emailed Bldg. Dept. 7-14-2021 Rita DEPARTMENT OF BUILDING AND SAFETY STRUCTURAL OBSERVATION REPORT FORM REPORT NO. THIS REPORT INCLUDES ALL CONSTRUCTION WORK THROUGH '%' DAY OF _57g/i79, 7.0 z.---0 At N! U�£ PAGE NO. OF G PROJECT ADDRESS 2 7..' iv, STRUCT RAL OBSERVER STRUC.OBS.PHONE NO. 74-, tee- q/od 6 'I-- (6u..).-c7/— `1000 OWNER UC. R REGISTRATION NO. ILDI PEMIT NO. OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS LOCATION AND PORTION OF BLDG. DATE ❑- FOUNDATION [WALL ❑- FRAMES ❑- FLOOR ❑-GJCTINGS,SLAB&STEM VvALLS ❑-CONCRETE ❑- STEEL MOMENT-SFECO;L 0- CONCRETE ❑-PFESTRESSED CONCRETE SUES ❑- MASONRY 0- STEEL MOMENT-ORDINARY ❑- STEEL DECK 0-CAISSONS,PILES,(FADE BUMS Er WOOD ❑- STEEL BRACED ❑- WOOD ❑-HILLSIDE RLDGS-SPECIAL ❑- ❑- CONCRETE-DUCTILE ❑- FCUINDATICN ANCHORS 0- El" ❑- CONCRETE-NON-DUCTILE ❑- rU( r-/iii-pit 7.2v14- I El- El- OBSERVED -❑-OBSERVED DEFICIENCIES: AIditi y- 1;42. 0174tAt5.--s "--#--zr 1-A✓dr-- 11 7),LJ . ❑- DEFICIENCIES CONTINUED ON ATTACHED FORM(B&S 261 A) Q�pfESS N`N ��O `(-0N T•-A' f, ' ~ /0 co •ni c i • , 71,2 AT "0--t 4-t At"--CA Nb.C682 �' SIGNED OF91301 � ) xp �.;1 DAY MONTH AR CITY -�' 6,41:( CIV1� ����f rq�OF C ' .-'; X WET SIGNATURE OF"•EGISTERED CML OR SIHUCTURAL ENGINEER OR UCENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT r STRUCTURAL OBS •VATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT DISTRIBUTION:STRUCTURAL OBSERVER TO SENO ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS. DEPARTMENT OF BUILDING AND SAFETY STRUCTURAL OBSERVATION REPORT FORM �C/ �2.-o REPORT NO. THIS REPORT INCLUDES ALL CONSTRUCTION WORK THROUGH 0 q DAY OFC-1,I PAGE NO. / OF 1 PROJECT ADDRESS 2. 75- /t/ / ,4-t/. STRUCT RAL OBSERVgR STRUC.OBS.PHONE NO. OWNER LI .OR REGISTRATION NO. ILDING PERMIT NO. 61 g CLC OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS LOCATION AND PORTION OF BLDG. DATE ❑- FOUNDATION 0- WALL ❑- FRAMES ❑- FLOOR ❑-FCCTINGS,SLAB&STEM WALLS ❑-CONCRETE p- STEEL MOMENT-SPECIAL ❑- CONCRETE ❑-PRESTRESSED CCNCRETE SUES p-MASONRY ❑- STEEL MOMENT-CREINARY ❑- STEEL DECK ❑-CUSSCNS,PILES,GR/OE BEWS [WOOD ❑- STEEL BRACED ❑- WOOD .-A ❑- HILLSIDE BLDGS-SPECIAL ❑- ❑- CONCRETE-DUCT1LE FOUNDATION ANCHORS ❑- Cl- ❑- CONCRETE-NON-DUCTILE ❑- OBSERVED DEFICIENCIES:T/4-m �tf/ �✓ I j ❑- DEFICIENCIES CONTINUED ON ATTACHED FORM(B&S 261 Al „oESS 1;-",--p44t$ CO SIGNED 0 7 OF Off- 1. , 702 e AT 1:eP7-71CA ..C6B205 73'I DAY MONTH YEAR CITY d xp.91301 , *s, CML r�� X WET SIGNATURE OF R ISIERED CML CR STRUCTURAL ENGINEER OR UCENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE.ATTACH THE FIRST COPY TO THE APPROVED PLANS.AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS. CITY OF REGISTERED DEPUTY INSPECTOR'S Arcadia CERTIFICATE OF COMPLIANCE DEPARTMENT OF BUILDING AND SAFETY BUILDING INSPECTION Address 275 W Lemon Ave Date of Certificate 10-1-2020 Fabricator LARR 25744 SET-XP Permit RALT-20-1487 TO THE SUPERINTENDENT OF BUILDING: CITY INSPECTOR: I hereby certify that the following portion of the work at the above job address which required continuous and/or periodic inspection,and which I was employed to inspect,was inspected and approved by me and complies with provisions of the building Codes applicable thereto: Type of inspection: ❑ Steel Construction ❑ Sprayed Fire-Resistant Materials El Prestressed Concrete El Concrete Construction ❑ Smoke Control • Drilled-in Anchor El Masonry Construction ❑ Methane ❑ Gunite/Shotcrete ❑ Wood Construction ❑ Exterior Insulation&Finish System ❑ Seismic Resistance ❑ Wind Resistance ❑ Other: Location and Description of work completed Observation of rods all threat (5/8) placement at perimeter (E) garage with min embedment 7in at 16in o/c (44) and ,HD 5/8 with min 12in emb at post 4x4(6) and, (4) 3/4 rods at SW w/min embedment 15in at (E) concrete per Plans see Si.All holes clean w/brush and blow with air compressor. Size of Structure: Time Arrived: 1:00pm No.of Stories: Time Left Job: 2:30pm Conc.Mix Design No.: P.S.I.: Registration Number: P021602(LA CITY) Employed by: Lab: Independent: III Signature: Registered Deputy Building Inspector: Print Full Name: Charles Madrid Cell Phone Number: 310-387-4884 E-Mail Address: chartesmadrld45@yahoo.com DO NOT AMEND,ALTER,CHANGE,DELETE OR APPEND ANY PRINTED PORTION OF THIS CERTIFICATE AS IT WILL RENDER IT NULL AND VOID. As a covered entity under Title II of the Americans with Disabilities Act,the City of Los Angeles does not discriminate on the basis of disability,and upon request,will provide reasonable accommodation to ensure equal access to its programs,services and activities. IN.Form 07(Rev.03-18-2016) www.ladbs.org CITY OF REGISTERED DEPUTY INSPECTOR'S Arcadia CERTIFICATE OF COMPLIANCE DEPARTMENT OF BUILDING AND SAFETY BUILDING INSPECTION Address 27.5 braRAPAOAdujilj , Date of Certificate 7-8-20 �f Fabricator 1g/Z 25.720 Permit /2$9,77:-.167— 224, TO THE SUPERINTENDENT OF BUILDING: CITY INSPECTOR: 1, eej1C.eA I hereby certify that the following portion of the work at the above job address which required continuous and/or periodic inspection,and which I was employed to inspect,was inspected and approved by me and complies with provisions of the building Codes applicable thereto: Type of inspection: ❑ Steel Construction ❑ Sprayed Fire-Resistant Materials ❑ Prestressed Concrete ❑ Concrete Construction ❑ Smoke Control ❑ Drilled-in Anchor ❑ Masonry Construction ❑ Methane ❑ Gunite/Shotcrete ❑ Wood Construction ❑ Exterior Insulation&Finish System ❑ Seismicst ce ❑ Wind Resistance Other: !$ "�� Loc. 'on and Description of w•rk completed i4I. _ . �rOice• i 1/ � !� � .rte ��_/ - —4 4 ‘4°._ /"-uJiz eck Q _51W,ac' ! .� mil �:irt, 1�_ . L. . i '.. I, fiy."Mteeds . dr--4.147/4,404•4taite-5P__ Size of Structure: f 12A 2-1/ _Seel, // Time Arrived: f.'&i/4' No.of Stories: Time Left Job: /40./40 *1V Conc.Mix Design No.: P.S.I.: Registration Number: P021602(LA CITY) Employed by: Lab: Independent: ❑ ' : stered Deputy Buil.'r g Inspector: Print Full Name: Charles Madrid Cell Phone Number: 310-387-4884 E-Mail Address: charlesmadrtd450yahoo.com DO NOT AMEND,ALTER,CHANGE,DELETE OR APPEND ANY PRINTED PORTION OF THIS CERTIFICATE AS IT WILL • RENDER TT NULL AND VOID. As a covered entity under Title II of the Americans with Disabilities Act,the City of Los Angeles does not discriminate on the basis of disability,and upon request,will provide reasonable accommodation to ensure equal access to its programs,services and activities. IN.Form 07(Rev.03-18-2016) www.ladbs.org DEPARTMENT OF BUILDING AND SAFETY STRUCTURAL OBSERVATION REPORT FORM THIS REPORT INCLUDES ALL CONSTRUCTION WORK THROUGH 0 REPOOPT NO. DAY OF 20 yt) PAGE NO. f OF i PROJECT ADDRESS .7.7_.c- /4) h'iii 7` - STRUCTURAL OB ERVER STRUC.OBS.PHONE NO. Afe-All 74'V J c,¢ q/eeC C6 7t)- . 7/•-il OWNER LIC.OR REGISTRATION NO. BUILDING PERMIT NO. C_.6 g :?-0� OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS LOCATION AND PORTION OF BLDG. DATE iFOUNDATION ❑- WALL 0- FRAMES 0- FLOOR - CCTI &STEM VIALS ❑-CONCRETE 0- STEEL MOMENT-SPECIAL ❑- CONCRETE ❑-PRESTFESSED CCNCREIE SLABS ❑-MASONRY ❑- STEEL MCWENT-ORCINARY 0- STEEL DECK ❑-CASSCNS,PILES,GRPDE BEAMS ❑- WOOD 0- STEEL BRACED ❑- WOOD 0- HILLSIDE BLDG-SPECIAL ❑- 0- CONCRETE-DUCTILE 0- FOUNDATION ANCHORS 0- 0- 0- CONCRETE-NON-DUCT1LE ❑- ❑- ❑- ❑- OBSERVED DEFICIENCIES:_ / 541-?-. ,� ,74,---- s �.�j - t' ,,I, ` 7I /1�r� a c .7.,- 8..,,,k) 6— 5- _,.-t F- (/Ce-'e --/z'--s — ‘?.0 kl Air-a. Is. tt---4 , ❑- DEFICIENCIES CONTINUED ON ATTACHED FORMIB&S 261 A) QEi)FEB'/p:'- , 4,4,c -sosTifreal,\. %, SIGNED v' OF , -J x(7 AT CI 7 CA L I o.C68205 DAY MONTH' YEAR CITY , ' Exp.9/30/Z/ ,,r kr), CNN. ,r' .,41P., r,y,,-%.elz `� -/ X WET SIGMA ' OF REGISTERED CML OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS. 62.-5"± 12'-0• 1 4) .g ‘ V '—' .'"' °.- ® � _ 0. Ja�.i 1) [ " i : III 011j 1 e.. A y� a.off. 1��I 1 c°. I II II CIOf N0. w ; (N t" $ A W ti I µ 4 1f r CJ ® `V �vuuvw, _� Ki \ a 1 _ � � 1� 4. ` r'-. I ® . --hmn itmtit y4_ Elp 0, __ J O alili t' — " „ t,,, ,I —. �� A i . Egli �. MI6 . • a. 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Bair = -14 A south Coi)SL Air itli.ialitv Msan,$) .rYILI DIN-sic ,... ..-.. 21865 Copley Drive,Diamond Bar,CA 91765-4182 Notification Number Phone:(909)396-2336 .:3:1-a:1.T215 www.agmd.gov Rade 1403 Sl>9zig alkicr of Lorooszltrire 2 Asbe;dos Removal) Please maintain a copy of this Notification at the job site,either electronic or paper. Project:Type Project Type • Asbestos Removal Project Urgency Routine Completed By Reynaldo Rivera Phone Number (562)249-8231-1(Ex.) Contractor Information Company Name EAGLE CONTRACTING,INC Address 6720 HOOVER AVE City WHITTIER State CA Zip 90601 CSLB license# 970089 OSHA REG# 1044 Supervisor#1 Gerardo Zavala Phone (562)249-8131 Supervisor#2 Lingbert Rueda Phone (562)249-8131 Supervisor#3 Freddy Evangs Phone (562)249-8131 Site Information • Site Name Leo Residents Project# 20-039 Site Street# 275 Street Name W Lemon Ave Cross Street Holly Ave Site County Los Angeles City Arcadia State CA Zip 91007 Contact Name F Prado Contact Phone (562)2.49-8131 Site Owner Michael M Lea Owner Address 275 W.Lemon Ave City Arcadia State CA Zip 91007 Project Start Date 6/2/2020 Project End Date 6/12/2020 Project Work Shift(s) Day Building Size in Sq.ft 2500 Number of Floors 1 Building Age(years) 65 Number of Building/Dwelling Units 1 Building Prior Use House Asbestos Survey Yes Asbestos Found Yes • Asbestos Removed No Building to be Demolished No Describe Work removal of ACM roof mastic,putty, Describe Work Location Roof,kitchen,bathroom,attic, flooring,Insulation Project Information Asbestos Information Amount of Asbestos in each type In Sq.Ft Acoustic Ceiling 0 •Linoleum 310 Insulation 0 Fire Proofing 0 Ducting 380 Dry Wall 0 HEPA Vacuum&wet wipe 0 Mastic(Non-friable) 1 Floor Tiles(Non-friable) 0 Translte 20 Roofing 0 Stucco 0 Plaster 0 Other(Friable) 0 Coal Tar Wrap 0 Mastic(Friable) 0 Floor Tile(Friable) 0 Other(Non-friable) 21 Contaminated Soil 0 Asbeskos Atiiount to be Removed In Eq.i"r. FRIABLE 690 CLASS I 42 CLASS II q Total 732 • Asbestos Removal From Surfaces,Pipes Control Procedures 3 Asbestos Detection Procedure(s) Survey,Bulk Sampling,Inspection, PLN Waste Information Waste Transporter#1 EAGLE CONTRACTING INC Address 7331 SHELBY PL STE 156 City RANCHO CUCAnMONGA State CA Zip 91739 Waste Transporter#2 ECTI Address 953 WEST REECE STREET City SAN BERNARDINO State CA Zip 92411 Waste Storage Site EAGLE CONTRACTING,INC Address 6720 HOOVER AVE City WHITTIER State CA Zip 90601 Landfill Azusa Land Reclamation Address 1211 W Gladstone St City Azusa State CA Zip 91 702 • Fee Payment Total Amount of Asbestos to be Removed in sq.ft 732 Tracking Number 3653015 Project Size Fee 65.12 Additional Fee 0 Total Fee $65.12 Payment Made $65.12 Balance Due $0 By clicking the Sign&Submit button,I certify that an individual trained in the provisions of SCAQMD Rule 1403 and the Asbestos NESHAP(CFR Title 40,Part 61,Subpart M)will be onsite during the demolition or renovation and evidence that the required training has been accomplished by this person will he available for inspection during normal business hours.In addition,I certify that all of the information contained herein and information submitted with tris Notification is true and correct. • STATE OP CALIFORNIA _ Edmund G.Brown r.,Governor DEPARTMENT OF INDUSTRIAL RELATIONS `�;�4' DIVISION OF OCCUPATIONAL SAFETY AND HEALTH MAILING/FAX ADDRESS: �- .. .Occupational Carcinogen Control Unit&Asbestus Unit ?`1 iise Nearest AOSIi District Ojjice DTR Home Page:http//www.dir.ca.gov .414, • Title 8 CCR Section 5203 Temporary iry Worksite Natifsati©nn (Report off Regunilaied Carcinogen Use including Asbestos-Related Work) Company/Employer Name: Eagle Contracting, Inc. Headquarters Address: 8204 Garfield Ave. Bell Gardens, CA 90201 Title 8 Regulated Carcinogen used: "Report of Use"Registry Number:.__ Address of Temporary Worksite and Precise Location: Residents 275 W. Lemon Ave. Arcadia, CA 91007 . Nearest Intersection: Hof ly Ave. Type of Business: Residents Contractors State License Board License Number: 970089 *DOSH-Asbestos Unit(Cal/OSHA)Asbestos Registration Number: 1044 "Name of Certified Supervisor/contact information; Jose C, Josias V, Lingbert R, Gerardo Z, Freddy E *Name/contact info of Qualified Person(s)in Charge of Air Monitoring/Lab Analysis and site safety: Rey Rivera *Name/contact info of DOSH Certified Asbestos Consultant(s)and Technician(s): TB Projected Job Start Date: 6/02/20 Projected Completion Date: 6/12/20 • Describe Type, Scope and Work Practices of the Job; Removal of ACCM and/or ACM M utilizing safe work practices.and required engineering controls. • Evaluation of Potential for Exposure: LOW • • Estimated Number of Employees on this Job: 2-5 • Provide at least 24 hours notice to the nearest D0511 district office prior tothe start of any regulated carcinogen temporary worksite regulated by section 5203(e). Additional information marked with a * are required for a job or phase of asbestos-related work requiring the employer or contractor to be registered by section 341.9. Do not send this notification to DOSE Headquarters or to DOSE Consultation. This will not satisfy the notification requirement and could result in citation. Note: Any change in the information provided to the District Office by the written notice shall be • reported to the District Office within 24 hours of such change. CAL/OSHA Form 183E(Revised 06/2014) A. & irk /— ni �l. '- %�v' P.O.Dox 7818 INnJSRrr1,rs11.111/7Z117231 .8£iH I3ei'ilavtiIRo,Cit 92411 ii Nvnrra z 6Tra.miv mPJ.r :dirlUitl, Phone(309)084-7424 gNc Fax(909)884-8744 A NON-HAZARDOUS i.Generator US EPA D No. 2.Page 1 of Emergency Response Phone No. 4.Manifest No. ' WASTE MANIFEST itii A (0,--V r-45---jv)7S- 5.Generator's Flame and Mailing Address Generator's Site Address(N different than mailing address In item 5) s qi.x. tit L r'.o'.J dA"-a. IN. �,.cs 6�t9rr/ ?[ • Generators Phone No.: I 6.Transporter No.1 Company Name U.S.EPA ID No. EAGLE C04111/.0'r IMC,!MC.8720 HOOVi iI AVE,WHiTT'IF.A CA 9Q801 I CAL000400337 7.Transporter No.2 Company Name U.S.EPA ID IFo. E.C.1.I..^-O GQX 731S Sis:r;:!;::r7l?,eA.o,OA024'i'I (304)33!-7773 I CAROOGD4£•�?' 8.Designated Facility flame and She Address U.S.EPA MM. ?ZUS:1 I nrfl?i:ECL'irlrl'IO.�I • 7211 h•'.0.1..AOS i Olvei 5f • C.1De0S007828 ZUSA,Ci 01"/07 Facility's Phone No3.23-224-91', I . 9.Waste Shipping Name and Description 10.Containers 11.Total 12.110 ^� Ho. Type Quantity VANol. r,: a. qO,t ilIl',0!'.AS;1ESTOS`l:AVr • _ 11,4 1 uaj b. -- ___, c. 13.Special Handling Instructions and Adddlonal information - -- E.P.A.RECION IX 75 H.ANVTP!ORNIESY,SAW FRANCISCO,OA. 0.1103 05-7(ii'-1059'lMt=O'i F.r`,CI,CCOUNT 781412 S.C.i...0.M.r3-21863E.00 'LE`i 17''' J'A 40's'r7 _ r901:'-300-2338 <. -3it4Cr; �. ���, C/�,.9 i 7Ga I�rorll_t 10�:, 2.IHOUR E:•AERGEi!CY (SOD).3Z.3-3.0.53.ECTI E.33W. Et CE ST..SAhlE.11W:RRDli•:O.CA.92411 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal cf hazardous Waste. Generator's/Olferor s Typed/Printed Name Signature Month Day Year V I - L I I r j 15.Transporter Aclmoldedgment of Receipt of Materlakc — giTransporter 1 Typed/Printed Name Signature Month Day Year , I Transporter 2 Typed/Printed flame �– -�l_---- Signature Month Day Year PE A 16.Discrepancy 16a.Discrepancy lnd'caGon Space. ❑Quantity i[]type • ❑Residue ❑Partial Rejection L I Full Rejection Manifest Reference No: 16b.Alternate Facility(or Generator) U.S.EPA ID No. U ' . Facility's Phone No.: I 0 16c.Signature of Alternate FaC ity(or Generator) Month Day Year I • I .11_� N rU Cl i 17.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted In hem 16a . Typed/Printed Name Signature Month Day Year Y--- -- I I 1 I Please print or type, A I.Generator ID Number Form Approved,OMB No.2050.0039 UNIFORM HAZARDOUS 2.Page 1 of 3. ,,.rgency Response Phone 4.Manifest Tracking!lumbar WASTE MANIFEST CA4 ®��Io ' � I I '�.�.�,.�-.� S5 J OO 1 31 6/16114 FIE 5.GeirelaG gMeng Address • Y(y�• (� agd��� �� Generator's Site Address(if different than ma9ing address) 2-9-514A),et LM4a� �`rm - ECJ.� e,0✓��a/e E . • Generator's hone: 6.Transporter 1 Company Name U.S.EPA ID Number Ei.GL is CON-fl RACTING,ir:C.6-/2C. O3!,_,',,: ;=,' 111,1 n C.,£3 31 I C.,_ aOCC J337 7.Transporter 2 Company Name _ U.S.EPA 10 Number C.C.'i.I.PO BOX 731857:,E.; l,.r u,CA 0241'. (:?05)33.:-i i'r3 CPi:CSC^;c^ 8.Designated Facility Name and Site Address U.S.EPA ID Number V /1.Z11SA 1.1J\ID RECLA,r,•t.T lOi••f 1i 21"i\.:r.G'. OS I'as'F.f:z.'I' - CA000. 'Jt i326 AZIJSA,CA 91702 Fadrrty's Phone:i2&.22c1 g j2',• 9a. 9b.U.S.DOT Description(umctudng ProperSNppag Name,Hazard Class,ID Number, 112.Unit 13.10.Containers tit., and Packing Group(deny)) I 11.Total _ No. T Quantity tiSl/Vol. Waste Codes ce 1. 1.:.0.NL x%212,AS:1 Si OS,£,^C-)1I1 i C'1 n�� �..... W._.v w 2• CD 3. E 14.Special Handl g Instruction and Additional Information E.:� EC Ji;l:'- ' ilrliili ':!-� ,Si...!i'. :df!?.^u C. . yi,..Ca:.' ,i-7%4-,'_ .•I\FCT�.r.C, '.CCCJ:0"r.. :107";z.1s .# c.,.) "rf63F..0 -„ • ,:,, ,7C3SO.,;--2,2J.:-2333 'ra3:. ICi3".w` 24 I'Ol �E .^:�Ll �,�•:,(i_ ) '..Z-ZfC�S. �C71>='::2 k'r.EZIE7.CIESI.E•il •--y!:!7;i1'.(.0, CA.92,;11 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are ruy and accurately described above by the proper stepping name,and are classified,packaged, malted and labeled/placarded,and are in all respects In proper condition for transport acceding to appticabte International and national governmental regulations.If export sl,�ment and I ant the Primary Exporter, certify that the contents of this consignment conform to the terms of the attached EPAAccnoviedgment of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a)Of I am a large quantity generator)or(b)(di am a small quant'tygenerator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year I• I16.International Shipments I ❑Import to U.S. ❑Export from U.S. Port of entryloxil• Transporter signature(for exports only): Dale IeaVrg U.S.: IX 17.Transpoder Adamar/edgmenl of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Q Transporter 2 Printed/Typed Name I I Signature Month Day I Year g I I I I I. 18.D:saepancy CI ISa.Discrepancy Ind calbn Space ❑Quarmtity ❑Type U Residue t leni'est Reference Number: ❑Faucial Rejection ❑lo ot Re)ection ' 18b.Alternate Facility(or Generator)• - U.S.EPA ID Number , U • u. Fealty's Plane: I 19 18c.Signature of Alternate Facility(or Generator) MontlmII Day Year CD 1 I co 19.Hazardous Waste Report Management Method Codes g.e.,codes for hazardous waste treatment,dsposal,and recya5ng systems) Ill 1. cm 2• 3. 41 20,Designated FaoTrty Or ner or Operator.Certification of receipt of hazardous materials covered by the manyest except as noted N Item 18a • Printed/Typed Name Signature Month Day Year I I I :PA Form 8700-22(Rev.12-17) Previous editions are obsolete. ONI/'PAIR)F/(:I1.1 lY 1'0:.::PM:r;•0,A.Ii1I'It 1.SYS 1•(:I • ;'!',tlfhrss.. •,3.�,L,u1,Z<4',1�'rl:.(r5i,'1115•SPI���1.�_:._�:��._�t" 1_ lp ...-z•��� - - --- ....... . ..... _ L•. (n� E. D) C If1 y'A 11t1111r,11A1•0411r1,1 1 et A t�t/1J tw+ FhrelA xuRAf f. ro' ea Al 0 atWI110Ur•el Me f�. S Pe T' 1:3m • 2 D4 V6�NAis`1in-AGrili�n t1F D la i, `a Y,..) 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'cell I.111,bell'.111 • eo.ac�a•aaes,yk rs.kuaa o EAGLE CONTRACTING INC. O.Qt+Dyr""'4A'''6"61A1Ce Oat• CONSTRUCTION&EHVIROlYAfENTALSERVICE .,W.;1 CD?11 COURSE COMPLETION FURti fa++lrea AMO TRAJJ1I110 CERTIFICATE •••-.�.�:' Instructions:17w lop haTaeis Allen h bay cw As wi 4y On u�.M-'- .. ...�.--.- VeWeg tions:.TM p a: _11 F WI+h to be rral went to.tuck.(and pia bat4m am k b b eerr(ue...ed by Ow amew2V • .�`---__ . )Y:OA)eep:lsbi,l Y,Ldydn`Jfi JO eeLerdtrd an, +:p("1re)«plc11.41 fvenh CUPS and OratM tan WAX 11•11 . la pals AMiar et)NA,lsnf.+b(wawa am'm-... sr,. es•.+OrassV oprKl(vsp11 tit N•Pug etarRaXn,tA1saecAfnn: s dr•4.'tn. Cl Pra.1V•lar del aleenrrvb rens y stia n'.aj n an,•a h48yhs,in el Aamai ry cosn dY RESPIRATORY TRAINING and FIT TEST CERTIFICATION eat�a.:b 01....."debt. /*NsVOA,Ni NAVA.. ►Jo tacrr .eaten•CTPfB yNa«;:�r rorcdr ye+ynle d 65r1taltb .r+ba-P>Jhlea'✓et rwrrmv.;.rwF-e+Actaiae.K•sre(�rraes ahoaennOra-sa ro,ttadruy EMPLOYEE(Print): i"1.s-1....1 V'et-.� SW: Va�(aYtyr:op xet Mrys wA.i 1" ir . ```{J1 a r�e1s�t`�'+ieiki�"' - FIT TESTA'RAII,RNO DATE: 'i Ill)2A K:e•swf{tee,.a+tiz+�r+�uT41L'.nn.ey u oo ge4sp,y eitetn:obp;v�-q as.l.:;�.•lay �]j NOM Trete.m112<1..0,4 xaln;l.nFc;k/..(Test ant nt/Jda rwcidepolya'a4l �1� - '� fhb copy of the EC/Respiratory.Protection pr p Wart rums of the risks • 14;LID S 4mil j' -..,.r.......-. . <bnJnlyy I 1�{ Program importance ! to t. O.,e err iEti auoclatsd Isla=brans roruain(gq materials and titin+ uociew • RrtArlretiao "[.'le; L- pwlarua of wearing a rece respirator,as text rye ntB as hav to proper]ynaWaln that respirator.Along with Me training Nu hent rttthrdlhb r/10)01 -gial Wbt'.t<e elItue•iide[W Y M��++rill be followed haa we often I/it L deemedntM,umj: urreYahevrtere•. Jfr•Narie'-+rni-Alyd•>.;rau-ire•mc MYyk 4a'tbr<ey O OCVOto'.ogoND(,:aryt),.rq.r) It b roldemfadablt that juu may not want to wear a respirator while working In eontalnment and aka'operator may sere sovrrcemary,but 3uuAgin'realize that the deadliest aw a.+ particles ralo7ot be seen orf di. Wear • 4ra)ura rzspbotor of all times while in containment will Orvt<rc4,c s s a r.- rax v help protea3nufrom serious and sometmmes fatal health risks t the Moe.Asbestos fibers stay �r1�� _ Nor►.y�/ttPl.aArraDVn F.-5ltl.- D (Is)Ufa(ralgsfal aha left ofy'aw-lifi m»mapeolrn to easese luisg cancer. • • •• r .. NdSiaOcr'J'aM+MreMWidera+ _ --__---- L<ndRM l4AAlEOFTRALNER/[>SIPR:� --. �-� A TYPE OF TPSTi AOhTli. ' rg.nead ne PrtaNa•erniend elm Moored,n,Ne wdaasr bon wIcetos • Matsdr y,kaisOetipeaNyitcteabPrArot.4po>ahhmvandob ynos deAs see Prink" AfAKE,AfODEL,ANDSI2EOFRESPIRATOR(S):Chiekteuhlhotopplp aTSlidal3v11J1rTirN •4 -.v:.At i- /s T1a(,o-rr.,t,yrragap - n2 r�L9 iYorth33IkeAlePuril)in8r Model 7700 Site:Lrg Med Sm • Tra:ahyssisuetitin-ueerayealhrmesJttal+tapmy.Yamenta. MwM. rarsesrmaarr,•wra-,asafi. [%13MPowered MrPu g p g OxolATIOUAL IRAI(IInIO tl1SFITUxC 't i1e'e+ lie` t1Q1u Res kalor: Afode)680pPF She.Lr Med Sm e21 Al'LAthIC Ave _ ❑ 1/�t:C 0114(31, CR 90001E tamaerrW OTEU:Rt She: mat--- OCC-0db-57% +• ------ Fih s�ilta •�- I hereby certify lb!i have been treinc3 in the proper use and limitations of the Ann A.U`yt 0ColnfreCeAte keWent" ALFRCOJ AMARO tespfntor(a)rstualtomc.7befreirdlllguneludai: OI OA srYr1 • O�'a'�CeK^fi)E4n1%s• • How to don a mptrtint properly dad cheek the fit with the ahro and pressure O Cored F»Y+W tf a t, OS.sentslma-n Ino3 anxeseM • tests h time the respirator is worn; n� positive a&wool'rdsa to On sto,)51aivecot atl p p'4� q b.7:aA • How to inspect the respirator for defects,end how to clean and maintain the respirator; tavlace.l'tz,Yhf dSlrist • Etplanadon of the dangers telltedd to improper use,as well as the limitations of the K.,NrIllamadtwr es.vnasya„raan,.e,'ah an • ..,, -aa resplraos;and lastructionsfor emergency silultianF. drrt.w,mttta C& f.in..,S¢rn(,rlLg) OiiCRaa.ear.-ta 02 I OLI_)y , 42_t_9.i_1_19 24 tan* i. 9 1, 11. EMPLOYEE'S SIGNATURE:„.•-•''/'"7..-.._4•-•-;/".'..----/, •.•,=0. _-; t't1 f.YAAr,[IC AVC. U\C IICACRe CA 38.478% 90602 • tersotstti(.rib)t1 •�• / 47rdS 0"ie<br lrar eeyr(3j,lntw (LI entp l,6rts,rgt •S/eJFea�nbbeY p4aaaeef< I r �� e=aafYsrleL-I�e111etyv tut/100 :hserrake TRAINFR/fE$iER'SSfONATi)RE: 41votA AYALA ' Hal - - ti /1 l0(r 7 7331 Shelby rlxn R o nga A,91739 iM/FR'/•Ct1s9 C.•MY•�`+1.•q-.• - 01".4,71. MC. •n.)niter 44-0-61.A. 13CEA;CEN91WS4 Phone 3A2 70tS-SS45 ( ) Far{909)4362927 0111411(4171 - • Meld) 1 11le VA-ft-tri'Ti15a.'i7A'f i7F-ltifS'�p'riT`gfid5 i •y�1i(} `ifq"avT;,%.,• ,..,.i.,..:7.:"'7.7 • . • t,kt W �t�. S U[LU hICO1GLGR0UP INC ^-' it.) ; P)11•Id S.tNJVA7IAV� p• [r1� lWla t_� ta: t 30U111 C.tTf.CA P.1)N �+ O �a 0 Q 1 I Emus tort DUTY torte! } Ilii ! C) Q W 'KO PATE OP EXAM:6(VhOph) •i t M Z ? N [j NAME:TORO,OCNI.MI DOD:QUfllJP7i ACE:el YEARSOLP SIN:XXX•XXJf72 r •^ 111 ...• 4.-:- Z ., TYPE Or E\AHIYAl10X:(X)re<-Erap�)mm/(X)Pariptk()OOT Oren<u()ltelan ff\York 617UUO. Q Ma i B'• (1.)PalcoonfrrAtoettoo(X)Asbeaaf )etF.ers H W U P ?t �. ca r...6 CCS ( RECONNE�DATIO,YA —.•• QQQ of - 1Q The(Maoist collo)mom:eadaOla or Lazed to arakna tilt bald YUtLe tUnload:a 1Ff1! s 11.1in edited loll ex alteltf and the rpm Ind 0)4o1 tyodel°regokod(trete Nikko 1" W a applied Ay or tweedy hal by the meal e. t,' z U A (W O ., t . �� _J W m , I !a (C)The combat'.Iadrtolaoro fp if Al ran eloskal ecae;tW.Cate he (0 W Z e.ds.ed h say work tc Ablest w A rOh/ AD& b_.-..a !A )-. ; ()The a umhalUa tdkatts a eaps07amlyenhofaskal AaAAA.CAI be fie g.1., - � a J falbatd b)the penofal pz)slel Ge Maal1aNbamy work teadneot `-" } W wkatf04fod Wobbly.. J F 2 O 0 ()The...do bedlam nae ertapnHal ptio:41W eo-ditNy to be �1 t O o < y" ,- !:Boned by Ike pow rbtde4.Aceepktk 6,work,bat fb:aU a:l be Q Q pf) / �� L{' aad<ted withaata codon from h e.lkal Pepteteseel. Z 3 p 11 e / \ $i 1 0Ttr cuobati;a ltdksles th7e pllidnital toadni!.old which wet 3W/7a aa(Aiwa: a.. tv K (n �. MOQf�. �1 !. t A (.X)hledkaU)gaafRtd who nnlitMot/on a•ray tweeted �- ,.'r• O . Q V O t+o"• % I ()II(U.gover ()Ikea belling p, ,cII,a dt•ku 5 Q� p` !(t} Oct. b i 0the art/mike Roma 2�) M 1.-c Z y@ I-- 7r' . O a( / # ()Ct ab.'oL ()\\'what•>e art mid 33 `.' -- p( t ()nudist ()StIPOmeNnt work i !! f 1 J _ mmW�p ()P la: I 0°pa amjanmtry rp4 !� r� W )/j _ ()Oben LlafUl pOpenMs marllaep iS .•.-gY tC� a CO pN . (J Eliza&tor opalelate asslya Iereeento mel !ae J • ; 8 O ()Ameba steeebakerk tea ii ekales sip)Ikaal threttotd AIR slate hydrae } p f7 ;?t� 'ed;opato.Adabed W um tat A gprole/Doa.Aadbjr,e.()to be()•N ie tv r� ,Jtet W ,..; b aCa)'' reputed €) `✓ -1 EC tel ARs7YW ofaadyndrkasa is katal gNenle Yentas last �{ Q �- N h r A itrod()Deco ace met war oin Dr a $$$ ! () yodel e11tU lime C y W $�� 1 CERTIFICATION: JUN 967.: r)• W cc0 10 ^" 0Za iL9 �' (h)Approtd tor work MtLtwrdau as 1 C6 (2)Ape...edfarateor,,, tars 1 B918S_IJUANAVUP g F z Fn J E9f8S�d1JUA1h1/i. 5, ] r O ) h. ' DOApra,61Waleofpenoealrrieth eyatpmeet SOUli1L'/itl?.CRf'w:46O C'' �_, co Q Q Q (-)pledkal q*Arad tot teaplyd. (, A pA.n7.IoI mtterapkkd. TEL )Sii•1193,1 :(t .tr,411:0 �e Q f,`, a e L ()Meoha.kal.n.sl tnna4jtet-cI ed. J ,`'` 4V1i �i (U Ne paRcWAkal madkko he WIG del ted he the ob.a'mot Whaby yrl late litre el Mk naleciaf r.'1 ¢ 0 a.: pG £' rmrykmeot Dna opome lot .-- k p lot t111 WWW¢ w7 i. (X)no Weal beta Woe of plot wealea&.• i:.�itt�1.f�'1t•t a 01 4 . _ _ i m In MUM&O701' ala d Lre:b-part.a'd mr n Sestet tote f ).•a iyt. P:rff,y07n ui:<3 001054 LtM'adhlk/VD7 }err.'l.rca CDPrI COURSE COiiPLPT(Oil FORit�Jmtt.dwhvc°AeY g'-`\ Ila,.70!70�rUftLrRev Item'!; Olr Ili Iltte 07t7<!}97d awe.* AIDTRAMIRO CERTIFICAT,R, M1N [2 Ito In 71 e10 1705. 10380411one!TM k9 held e:,L.,n la la beo meated Uy Dos a/)cML rid M tie.,MT la b be torr _1 ILiI/,1 1D 7.i5 fs..M.4 wen;peal..The.a,e(Yd Paw'a0)rordder,twl.ebe)Ps lac(AAU)tM/dlY•a dletrdu tr7 D.(Irk ed no tato Ibeir we•K tyc,x, Cr.eliclod tlIS Vela./eep b Al sallaµMD%32 c.,aand dM f>mb CIPe,-i Imeo,,..a v6 fit I.Oa R. IDA Faiaa dhykj t� ,Fp 1cth,fstl wrepblek Pa nulerar neYaal 16.4b4tu: epvlx tie es.*Pw 0N/fa Fqr tf'themes f b pbla Arab.le cac R'artdx sosOylo ek/ ec:.w.xre mb. O(F:n*0Y del e:sen.rient7/erre Ore sandy es egpb Mos.•tkPPO.y/a1 tc9;ef ro11W y rru:el eJ 1f.f.re ekdWebes ahayzef o.,! dadFu..dy Asper afdall.+eYh fro(, LGYlV1.LrE 4 ICLfIF-fll•E castes itad,r .e3a.-7aam-Wit,peters Panap11 4t1 a-ry Oevicope".palevt sr/h,;.d tv.y-iias7cy,�twaro•,_ t•IflffJ py�re' Raf4 I te{•era a(>n oast miliowda D.I hateome3v/Korade&Ain IVs) !C/.e.0 y{ (I 7nE Is) .r/Amtl- J1 oTttr 1-13i1a • Pare ret a~ea s vee.•dntcaratn rtv,M nnw/PiarApd-eacat%rarsoiasy-eye 1 Co n f-I • krfo I 117 �rI11HIma.e 0WIFe-.-e, r -2s72m " •i ; ! 0 A -e2 13 . i 16.. . it < S (-1 tt7.OIEI1.) 7 Price leeteita.teed to Pttzcy6Y,enmi end Mad t.kmv[M tei De biloYdthe lima I ' Mitt di Pow,lea Fa DochmednSoteela laMnefe{y tela httmscYn bei. d.elyf de elle Amehnj. ' fA e I tr7a7Rat. 7HraMneda a (wNsena)Iler f<ee?lj4) Ira. p b...4..-,' o.Pp /�'J 3 J ,, 7•lttfs):iEA Pr Ileted J -! rrak/ lefom70ett Titoar•:aititanal rcl • Amodus ws}F]1tT'[Y raw aatarix3rmn +Af�tv.P<ntY tote•Pace l:t. Weed. OCCUPATIONAL.TRAINING INSTITUTE rEVG L 5.15 021 ATLANTIC AVE X682 812-31Q9 fEvi L €4.30 18 <.ct y3 LONG BEACH,CA 90802 L.582))61 fEVUPCLR = 3.177 to OCC-048-WA 0z•9 fE/' L/s 06.0JO, em>as[2 — 10.`7 11.26 tel t.lts a) • i[Fi5-75 Lis <.3) <.2683 107 6�PLk O Or.71.4-16+td'm kr Wien ret I. 5.3! 117 OtdfetCrnrUfmszrat gGerantO,r:it)r3Edas5Yi ALFREDO MARC fEVI/fit 3 83.0 <'� 87 OCett!df kdaS>g ltfyttstl OSreniiart erdf .t L4iiCdr3 PAUL EUBANKS E6.0 LOS ' 08Wimp Trlr.'ein 0840Teat S.leretoi adProixt LV tetba OI fresh ' 7MEhfiiElRlltrL• Ce>saec.11-2311 - Qpgrlsiay three!Sotto-ttiv N Ob[sr� A+^lsrtteoeatwa Olt t\ptpw,>etewuomA.� en r p 11) 01)-18 b 11 03 r 19 da 2 ..relies NaLsfnlara.:'oeoerXJA) w.rw•,eiwmsdarw sr cwnss rcAtcRoup -laCom� ow ii ,s 9916S JUANAVI 021ATLANTICAVE,LONGBEACH,CA 90802 Cor MONpe.TP/,J r5011Tr�G•TE,CA00280 MTISA1O)«tVltelblWV/A PlidysioW Pa1Re{ =1 Rl323)66111 ',FAX On)6:64.110'• rs:.dt.ray6Jmxa-fbalPltalra t�tkr sa+farattL — NUBIA AYALA ' rr '• ,i 0.-4% �ti.... -ear P Etga_ 9 ¢a.yy7 �.. f- Maria.L. .toieor, 51.0. Co-TILIOParn . • 1 !, aril .4E r.(> .f.. l�f!:1 F. T`tM.:. f F.`.5. Iw--vr.•.�-F-- .�.4_-t �Lf:,. ��.�����.:.Y�il...�`l,?a'���,•_tet?�;.�Gjk�:_'L��"/�efc�! f " il` 'J..) tut ;� DELLA MEDICAI,GROOM INC 1 �� CO 91/6SAX t.LX ACG '! d .-t rsf 90VIN OATL CA 9)13) C. r I11/ ,••• "` JEl,iJU 4.Ilb)FLCI 31Y4bllyl f I7XFSS f0R bUIY fORl) 7 c u. PA7L'OI'I.xA,,o(4,?M4 • 1�J,6 PUG �..� U o - i' Q Lb: . I,y \. l t2 rql Z �( JiANf:l'ALEAZ('tL.A,\70\70 DOD:6YIN14lU AGfe)3 1RAIt$OLD SS,Y:XXX:CX•\XXX �/!�! ! (0 2 t*.) ME OF EXAu XATIDYcp)PmLopS>)nnt(X)Perhdk()DOT O.eneu()RHna/e Wook • �' d W %. , Z> (gPulmonary nea<dta(X)Asbesloa()owtra �� a ¢ < w 50 g -, F- D „,, ) -.C.:) y 4 pDL `- RECOMMENDATIONS: �••� LL �, cc 4 i lie hCfebj ntdkalen<umnd.tHaart bu<de.areek.Dobe atak►algnry rtanhN{>a / __j Q Q • [) :a fiedbj edited kW erao.uiaad tat tpetltk pb)tkalnpatkka molted rertbefwl•{# es el Q T 2 yt •- applied Cr eratutt)leU 6116<eualan L7 1^- U Q'I' i (y Tit e.aalaatY.a 4dk tp.odpllkaM pa(iof;Q<altoadi!t».Cos be ml-- ..... - Q fn VW} TT t] (.' auilaW tonal.ark mutate WO a►iDf bal.hF a.•m W yr 077t taaobad:e Oat leo aagtawpad>W Welei>L1<at eeedhhae.11a bt �a . I- ct Q G. S (It by O. �`!falaiuL Caa to ats/ZaW(oagwork ro•dnn( 6,� C ,� t!; [L) mutt I u • I N W (,1G ' Ont etouts Mew hdkaM aur at.(unf.olpeibetejkat roadit:at,to be CC ���ttt 1-ii p .._` r77 ro8>eed by ate fvnoalf6)4(t e.Ampubk for wed,bat Ami•the �] 0 Od �ii i' �, sniped M!boat a totem rem Medleal DeptetmfaL Q Ssjj Q % o J'7?:�,......-. a` Oft tunbeG>a Wka!s Vu a pod eloykol coteDdo.ab(wfka week l '7j (j - 1 C I auipulas Das.: �'1 Q r n Va) Z a: �Q ,al. ......i: . �Y' (7011.41Mb gunned w.l,o renrkikaa f ae.rip aeWN oo U - ��Y�a++ Z 0•-'• (f- Q t i=_ i s =•is.,.., ()Willie ow_ O4r ofinaaa peNNO>a d<okn I.L.. f •C ¢ cn(7 C t:• •,5•l _ 3 O Wt b!. ()Work antvacorrettleo k.fea [jj Z) Q {•).. ) - OQlablaa (11Tork aboreyot.d 1 Y )GIl Q a F- zj ::LS'• r$, ()DetdeL ()Sa(nvttrfk.e.eek E _ ril Yl ()Temp Links OOptab'stl6ep .0 CO - (la►en ,,,.r"r�'� ((0 Q a ()Elie*for<arWbe.teseponl troffsets trout ?,I ,`,.„ rr. 0 W Q c y ()Rualtt ofae.lkmrbkeam ladkateatWuk)altlrttbeN)bllldote bak9ae aJ < - -•; V C __ atdl>�ne.&bleedto our ludas puttedfa Agawam O le bt Oaotto bt Al © } .... repeated ( J q ` ()Reel Its et*1141.otb t nam Mks led w.:.knfe burfaafxs _ J Y Maud N wear barba peok<d>e a}' 0 I.... LL r0 11 i.:4 � ()D:u sot mat triode for eapl>,mnt at alb Mae • l _W .^- w w a 8 0 W '- ` cERnnclno-t APS:12 1P: p l.l. C1 W Z F. (.)Lppteed fot meek*Dilate Woos tuterkl 1':�I o;o W O F. (X)A(pm d for me of taptutoea 1;111tir-<)('' ('�()1' U Z ���??? aro pe v tomcat MS;IrAl!P t!a.'1., ig (X)A mod for es>ad rda<thef9al •(-•:.t, (''r• r l 6Medical 16Md to. W z (•h. 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DeLeon, M. D, l . • • ENVIRONMENTAL, INC. DEMOLITION ASBESTOS SURVEY OF SINGLE—FAMILY RESIDENCE AND GARAGE 275 WEST LEMON AVENUE ARCADIA, CALIFORNIA 91007 PREPARED FOR MR.MICHAEL M. LEE 275 WEST LEMON AVENUE ARCADIA, CALIFORNIA 91007 PREPARED BY CNS ENVIRONMENTAL,INC. 650 NORTH ROSE DRIVE,SUITE#616 PLACENTIA,CALIFORNIA 92870 CNS PROJECT#: 20-163 APRIL 7,2020 650 North Rose Drive Suite 616, Placentia,CA.92870 www.cnscnvironmental.com Phone(714)525-5115,Fax(714)526-5445 • ? f • ENVIRONMENTAL, INC. April 7,2020 CNS Project: 20-163 Mr. Michael M. Lee 275 West Lemon Avenue Arcadia, California 91007 E-mail: Tagcool@aol.com Ph#: (626)905-5398 Subject: Demolition Asbestos Survey Single-Family Residence and Garage 275 West Lemon Avenue Arcadia, California 91007 Dear Mr. Michael M. Lee: CNS Environmental, Inc. (CNS) is pleased to present this Asbestos Survey for the above referenced site. Our services were conducted in accordance with our proposal #032420 dated March 27,2020. Thank you for this opportunity to be of service. If you have any questions concerning our report, or if CNS can be of additional service, please do not hesitate to contact our office at (714) 525- 5115. Sincerely, CNS Environmental, Inc. c7 04#, Edward D. Spinney,CAC. President Enclosures • 650 North Rose Drive Suite 616, Placentia,CA.92870 www.cnscnvironmental.com Phone(714)525-5115,Fax(714)526-5445 SENVIRONMENTAL, INC. TABLE OF CONTENTS 1.0 EXECUTIVE SUMMARY 1 1.1 CONCLUSIONS 1 1.2 RECOMMENDATIONS 2 2.0 INTRODUCTION 3 2.1 PURPOSE 3 2.2.1 ASBESTOS SURVEY 3 2.3 THIRD PARTY RELIANCE 4 3.0 METHODOLOGY 5 3.1 VISUAL INSPECTION 5 3.2 SAMPLE PROCEDURES 5 3.3 LABORATORY PROCEDURES 5 3.3.1 METHOD OF ANALYSIS 5 3.3.2 LABORATORY QUALITY CONTROL PROGRAM 5 4.0 FINDINGS 6 4.1 GENERAL SUMMARY 6 4.2 FINDINGS AND OBSERVATIONS 6 4.3 ANALYTICAL RESULTS TABLE 7 5.0 CONCLUSIONS AND RECOMMENDATIONS 9 5.1 CONCLUSIONS 9 5.2 RECOMMENDATIONS 9 6.0 LIMITATIONS 11 6.1 SPECIAL TERMS AND CONDITIONS 1 1 6.2 LIMITATIONS AND EXCEPTIONS OF ASSESSMENT 11 LIST OF APPENDICES APPENDIX A-CHAIN OF CUSTODY APPENDIX B-ANALYTICAL RESULTS APPENDIX C- SITE DRAWING APPENDIX D-CERTIFICATIONS 7 t f 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 1 of 11 April 7,2020 1.0 EXECUTIVE SUMMARY CNS Environmental, Inc. (CNS) has performed an Asbestos Survey for the residential demolition project located at 275 West Lemon Avenue, in the city of Arcadia, California. Any additions or deletions from our scope of work are discussed in the appropriate sections of this assessment. The subject building currently consists of a single-family residence and detached residential garage. The buildings are of wood frame construction, with exterior stucco. The interior walls and ceilings of the residence are finished with plaster over drywall (gypsum wallboard). The interior walls and ceiling of the garage are finished with drywall. The project calls for the demolition of the residence and garage. The Asbestos Survey was performed on March 31, 2020 by Mr. Ahmad Abdollahian, a California Division of Occupational Safety and Health, Certified Asbestos Consultant, (#02- 3251). Suspect asbestos containing materials (ACMs) sampled during the survey included friable and non-friable materials. Roofing materials were also included in this survey. 1.1 CONCLUSIONS This Demolition Asbestos Survey detected asbestos in the materials sampled. The materials that were determined to contain asbestos are presented below: ❖ The roof penetration mastic was analyzed and found to contain 3% Chrysotile asbestos. This material was observed to be non-friable and in a good condition. ❖ The window putty was analyzed and found to contain 3%Chrysotile asbestos. This material was observed to be non-friable and in a fair condition. ❖ The multi-layered linoleum flooring in the Kitchen, west entry and west bathroom was analyzed and found to contain up to 5% Chrysotile asbestos. This material should be removed as a friable material and is in good condition. ❖ The multi-layered linoleum flooring in the East bathroom was analyzed and found to contain 5%Chrysotile asbestos. This material should be removed as a friable material and is in good condition. ❖ The insulation on the ducting and register boots in the attic was analyzed and found to contain 10% Chrysotile asbestos. This material was observed to be friable and in good condition. ❖ Two Transite vent pipes were observed in the attic space. Transite is known to contain >1% Chrysotile asbestos. This material was observed to be non-friable, in a good condition and is a Presumed Asbestos Containing Material. i ...T.N S ENVIRONMENTAL, INC. r i i 9 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 2 of 11 April 7.2020 1.2 RECOMMENDATIONS ➢ Prior to any building renovations, the owner must comply with Federal Regulation 40 CFR 61, Subpart M (NESHAP), Subsection 61.147. This regulation states that all friable asbestos containing materials must be removed prior to the building being demolished. However, the SCAQMD's Rule 1403 refers to building renovations or demolition activities, which impact friable and non-friable ACM. State Assembly Bill Number 2791, relating to building demolition, became law effective January 1, 1991. It requires all city and county building departments to require that an applicant submit a copy of the asbestos notification, required by NESHAP, when applying for a demolition or renovation permit. > Any materials that have been determined to contain asbestos at the site that may be affected by demolition activities, should be isolated and/or abated by a licensed asbestos contractor. ➢ Quantities and locations in this report are estimates. Abatement contractors should confirm all quantities and locations before bidding on the project. > Proper notifications should be made to tenants, contractors, and employees that may come in contact with materials that have been determined to contain asbestos. Notification should be made within fifteen days of identification of asbestos containing materials and annually thereafter. For additional information on notifications see California Health and Safety Code 25915-25919.7 and Assembly Bill 3713. ➢ Abatement of asbestos containing materials should be monitored and the area cleared by a Certified Asbestos Consultant prior to re-entry by non-abatement personnel. > Additional testing should be performed if suspect materials are discovered during demolition. This executive summary does not contain all the information that is found in the full report. The report should be read in its entirety to obtain a more complete understanding of the information provided and to aid in any decisions made or actions taken based on this information. i leraNt..._ S ENVIRONMENTAL, INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 3 of I I April 7.2020 2.0 INTRODUCTION 2.1 PURPOSE The Asbestos Survey was performed to identify the presence of building materials commonly known to potentially contain asbestos. Suspect and/or confirmed Asbestos Containing Materials (ACMs) discussed below are assumed to be present on similar components throughout the facility, unless determined otherwise. The survey consisted of noting observable materials (materials, which are readily accessible and visible in areas accessed by the inspector) that are commonly known to potentially contain asbestos. Materials sampled during the Asbestos Survey included friable and non-friable suspect asbestos containing materials. The Asbestos Survey was performed on March 31, 2020 by Mr. Ahmad Abdollahian, a California Division of Occupational Safety and Health, Certified Asbestos Consultant, (#02- 3251). 2.2.1 ASBESTOS SURVEY In accordance with the Scope of Services, CNS has conducted an Asbestos Survey at the subject site. The objective of this Asbestos Survey was to identify materials for sampling and analysis to determine the presence or absence of Asbestos Containing Materials that may be disturbed during the proposed renovation of the buildings. The following services were provided for the survey: 1. Noting observable materials (materials which are readily accessible and visible in areas accessed by the inspector)which are commonly known to potentially contain asbestos; 2. Collection of samples of building materials identified as suspect ACMs. 3. Preparation of this report that relates the findings of the Asbestos Survey and presents CNS's conclusions and recommendations. A lead-based-paint survey was not requested or performed as part of this Asbestos Survey. 4tr'-$N NJS ENVIRONMENTAL, INC. • i 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 4 of I I April 7,2020 2.3 THIRD PARTY RELIANCE Third party reliance letters may be issued upon request and upon the payment of the, then current fee for such letters. All third parties relying on CNS's reports, by such reliance, agree to be bound by CNS Environmental, Inc. General Conditions and limitations. No reliance by any party is permitted without such agreement, regardless of the content of the reliance letter itself. SENVIRONMENTAL, INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 5 of 11 April 7,2020 3.0 METHODOLOGY 3.1 VISUAL INSPECTION An initial building walkthrough was conducted to determine the presence of suspect materials that were accessible and/or exposed. Materials that were similar in general appearance were grouped into homogeneous sampling areas. Only materials that were accessible and/or exposed and suspected to contain asbestos were identified. 3.2 SAMPLE PROCEDURES Selected samples of exposed and/or accessible materials were identified as suspect ACMs. 3.3 LABORATORY PROCEDURES 3.3.1 METHOD OF ANALYSIS The bulk samples were prepared and analyzed by Polarized Light Microscopy (PLM), by EPA method EPA600/M4-82-020 per Code of Federal Regulations, Volume 40, Section 763, Subpart F, Appendix A. This is a standard method of analysis in optical mineralogy and the currently accepted method for the determination of asbestos in bulk samples. A suspect material is immersed in a solution of known refractive index and subjected to illumination by polarized light. The characteristic color displays which result enable mineral identification. It should be noted that some ACBMs might not be accurately identified and/or quantified by PLM. 3.3.2 LABORATORY QUALITY CONTROL PROGRAM Patriot Environmental Laboratory Services, Inc., located at 1041 South Placentia Avenue, Fullerton California is a licensed laboratory, which maintains an in-house quality control program, and is NVLAP accredited (#200358). This program involves blind reanalysis of ten percent of all samples, precision and accuracy controls, and use of standard bulk reference materials. SENVIRONMENTAL, INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 6 of 11 April 7,2020 4.0 FINDINGS 4.1 GENERAL SUMMARY The Asbestos Hazard Emergency Response Act (AHERA) regulations define an asbestos containing material as a material containing greater than one percent(>1%) asbestos. California OSHA defines an asbestos containing construction material as a material containing greater than one tenth of one percent (>0.1%) asbestos. Asbestos-containing materials are regulated by federal,state,and local agencies. The EPA National Emission Standards for Hazardous Air Pollutants (NESHAP) requires an inspection for asbestos be done on facilities which are to undergo demolition or renovation work. Materials found to contain asbestos may need to be removed prior to the start of such demolition/renovation work. Friable materials are defined as materials which, when dry, may be crumbled, pulverized, or reduced to powder by hand pressure. Due to the higher likelihood of fiber release from these materials, friable asbestos containing materials are considered hazardous. 4.2 FINDINGS AND OBSERVATIONS The subject building currently consists of a single-family residence and detached residential garage. The buildings are of wood frame construction, with exterior stucco. The interior walls and ceilings of the residence are finished with plaster over drywall (gypsum wallboard). The interior walls and ceiling of the garage are finished with drywall. The project calls for the demolition of the residence and garage. Suspect asbestos containing materials (ACMs) sampled during the survey included friable and non-friable materials. Roofing materials were also included in this survey. SENVIRONMENTAL, INC. • I 275 West Lemon Avenue CNS Project No.:20-163 Arcadia.California 91007 Page 7 of 11 April 7.2020 4.3 ANALYTICAL RESULTS TABLE The results of the Asbestos Survey are presented below. Please refer to Appendix A (Chain of Custody) for a more detailed description of the microscopic analysis of these samples. Sample IMMIIMIRr Material Material Location F./INF Cond. Qty.' AnalyticnlResult Number 1-1,2,3 Roofing felt Roof under ceramic tile NF Good NA None Detected 2-1.2 3 Cementitious penetration Roof penetrations NF Good NA None Detected sealant on roof 3-1,2.3 Roof penetration mastic 2 3%Chrysotile (black) Roof penetration NF Good 1 ft Asbestos 4-1,2,3 Stucco Exterior of residence and garage NI' Goin N,\ None Detected 5-1,2,3 Vapor Barrier paperExterior walls of residence and garage under stucco NF Good NA None Detected 6-1.2.3 Window putty Exterior windows NF Good 21 3%Chrysotile windows Asbestos 7H 2.i Shingle Rooting Garage roof NF Good NA None Detected 8-1.2,3 Drywall with Joint Garage interior walls NI: Good NA Drywall—ND Compound Joint compound—ND `)- Plaster walls and ceilings 1.2.?.-1.5.67 of residence Interior N%ails and ceilings throughout NP Good NA None Detected I 0-1,2 3 Multi-layered linoleum Kitchen,west entry and west F Good 250 re Chrysotile flooring bathroom Asbestos 1 1 1 2 3 Multi-layered linoleum East Bathroom F' Good 60 ft= 5%Chrysotile flooring Asbestos Spray on acoustic ceiling 12-I,23 Livine room and bedrooms F God NA None Detected material _ 13-1,2,3 Ducting insulation paper Ducting and register boots in attic F Good 3811 ft' 10%Chrysotile Asbestos 14 no sample Transite vent pipe(2 20 linear Presumed>1% P Attic NF Good feet Asbestos tttttt , C '—araNI. S ENVIRONMENTAL,INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 8 of I I April 7.2020 F=Friable NF=Non-Friable NA=None Applicable ND=None Detected The following condition types were used to assess the ACMs. GOOD No damage or deterioration,material is intact and shows little or no signs of damage or deterioration. No debris was present. FAIR Moderate damage or deterioration,material is breaking up into layers or beginning to come loose from the substrate. There are small areas where the material is deteriorating. Minor debris may be present. POOR Severe damage or deterioration. The material is non-cohesive. Pieces are dislodged and debris is evident. Non-friable material has become friable. 111MENVIRONMENTAL,INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 9 of I 1 April 7,2020 5.0 CONCLUSIONS AND RECOMMENDATIONS 5.1 CONCLUSIONS ❖ The roof penetration mastic was analyzed and found to contain 3% Chrysotile asbestos. This material was observed to be non-friable and in a good condition. ❖ The window putty was analyzed and found to contain 3%Chrysotile asbestos. This material was observed to be non-friable and in a fair condition. • The multi-layered linoleum flooring in the Kitchen, west entry and west bathroom was analyzed and found to contain up to 5% Chrysotile asbestos. This material should be removed as a friable material and is in good condition. ❖ The multi-layered linoleum flooring in the East bathroom was analyzed and found to contain 5%Chrysotile asbestos. This material should be removed as a friable material and is in good condition. ❖ The insulation on the ducting and register boots in the attic was analyzed and found to contain 10% Chrysotile asbestos. This material was observed to be friable and in good condition. ❖ Two Transite vent pipes were observed in the attic space. Transite is known to contain >1% Chrysotile asbestos. This material was observed to be non-friable, in a good condition and is a Presumed Asbestos Containing Material. 5.2 RECOMMENDATIONS > Prior to any building renovations, the owner must comply with Federal Regulation 40 CFR 61, Subpart M (NESHAP), Subsection 61.147. This regulation states that all friable asbestos containing materials must be removed prior to the building being demolished. However, the SCAQMD's Rule 1403 refers to building renovations or demolition activities, which impact friable and non-friable ACM. State Assembly Bill Number 2791, relating to building demolition, became law effective January 1, 1991. It requires all city and county building departments to require that an applicant submit a copy of the asbestos notification, required by NESHAP, when applying for a demolition or renovation permit. > Any materials that have been determined to contain asbestos at the site that may be affected by demolition activities, should be isolated and/or abated by a licensed asbestos contractor. > Quantities and locations in this report are estimates. Abatement contractors should confirm all quantities and locations before bidding on the project. > Proper notifications should be made to tenants, contractors, and employees that may come in contact with materials that have been determined to contain asbestos. Notification should be made within fifteen days of identification of asbestos containing materials and annually .11 14SENVIRONMENTAL, INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 10 of 11 April 7.2020 thereafter. For additional information on notifications see California Health and Safety Code 25915-25919.7 and Assembly Bill 3713. > Abatement of asbestos containing materials should be monitored and the area cleared by a Certified Asbestos Consultant prior to re-entry by non-abatement personnel. Y Additional testing should be performed if suspect materials are discovered during demolition. IMIMP SENVIRONMENTAL, INC. 275 West Lemon Avenue CNS Project No.:20-163 Arcadia,California 91007 Page 11 of 11 April 7.2020 4112 6.0 LIMITATIONS 6.1 SPECIAL TERMS AND CONDITIONS CNS conducted an Asbestos Survey in general accordance with an agreement with Mr. Michael M. Lee. This survey does not include sampling of soil,ground water and/or the debris on-site for environmental testing. This report is intended for the use of Mr. Michael M. Lee and his immediate assignees. The contents should not be relied upon by any party other than the aforementioned without the express written consent of CNS. 6.2 LIMITATIONS AND EXCEPTIONS OF ASSESSMENT The findings, conclusions and recommendations made in this report are based on the information that was made available to CNS, in most instances by the owner. The information is relevant to the date of our site work and should not be relied on to represent conditions at any later date. The opinions and conclusions expressed herein are based on information obtained during our assessment and on our experience and current standards of technical practice. CNS makes no other warranties, either express or implied, concerning the completeness of the data furnished to us. CNS cannot be responsible for conditions or consequences arising from relevant facts that were concealed, withheld, or not fully disclosed at the time our assessment was undertaken. CNS is neither responsible nor liable for work, testing or recommendations performed or provided by others. This Asbestos Survey is not and should not be construed as a warranty or guarantee about the presence or absence of environmental hazards or contaminants that may affect the subject site. Facts, conditions, and acceptable risk factors change with time; accordingly,this report should be viewed within this context. ENVIRONMENTAL, INC. APPENDIX A CHAIN OF CUSTODY Li I • 0 �, / , J 44-- a, 1111 r4 N `J iiil O O c'A o —7 1 R 11) ,.... —f I n o M � amdvd a ;5 , \S \S I EEEE 01 F- f= Fh r Z o000 i 1111 . Cho r �. .„ �z • Z m ro a IlU v i. NI 2 c c o acn _s klJ j 3 V1 gii: 4 m II c 0 m4 , a .__,I 4 .< 1 �. ° 111 a °a W x M . i i Z. • E V I� O th r -3 4 a t A6d t 'M' le w s 2 - ii ` .. E:E E E._ :)4 cCcF N h H =- ;3 3 3 3 ]ii�I� ii IN . 4 .0E � 4 q. . Zy R; - 3 • > ... ••i Q th O ✓ I j `� �, a 0. 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L. m L 4 ® 'z t `' _• to 0 N 4 cId M i 0' 40 ( 14. o tn EEEE C) �,/ ° v 7' sr. cccea " � l0 •• LL w 3 1 ,U . 3 v n 3 L a tp C -,0ca a a 1 WW mi4.- IN J J J O 0, , Z t. a: a ' eS ' ' = in \. Ct CIILI I I I I J �S 5 (` ` d —0 --� - - - t a E E E E il "( \ L - F- I- I- I- t •.. a d a 10 e v •o a n[ 3 7 3 3 ./ r L2C3 EEEE N lk 3 2 3 3 ca Z •N ( \s' t CD z as v h .. .. .. .. ;> N a �' 0 z to W � o Q , .'0, j � aaWN O ANce T. +� , .� mHao 0 > L c 'nv 3 ta:0 O sis in N N u1 cip O f0 coN -j1 y, z m 0i � re z M m m y N .° " U i. C LC w ~N t5 I; '' C'V Mai 0 = a� -• u 7 lel rn u> N a 14 APPENDIX B ANALYTICAL RESULTS • Certificate of Analysis .?.:77PLM Asbestos Identification tel 714-899-8900 v free-888-143-0998 pA11111111 fax•114.849-1188 � t Patriotiab.com 1041 S.Placentia Avenue,Fullerton,(A 92831 Environmental Laboratory Services, Inc. CNS Environmental,inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition 810145-001 Under Ceramic Tile on the Felt I',yprr Black 60%Cellulose 1-1 Roof Main House West 40%Tar Wing NE Total Asbestos None Detected 810145-002 Under Ceramic Tile on the Felt Paper Black 60%Cellulose 1-2 Roof Main House Center 40%Tar North Total Asbestos None Detected 810145-003 Under Ceramic Tile on the Felt Paper Black 60%Cellulose 1-3 Roof Main House SE 40%Tar Total Asbestos None Detected 810145-004 Roof Main House AA Cementious Sealant Grey 100%Non- 2-1 Around Pipes Roof Peek Penetration Fibrous Material Top of Chimeney West Total Asbestos None Detected 810145-005 Roof Main House AA Cementious Sealant Grey 100%Non- Around Pipes Roof Peek Penetration Fibrous Material Top of Chimeney NW Total Asbestos None Detected 810145-006 Roof Main House AA Cementious Sealant Grey 100%Non- 2-3 Around Pipes Roof Peek Penetration Fibrous Material Top of Chimeney NE Total Asbestos None Detected Page 1 of 9 • Certificate of Analysis PLM Asbestos Identification tel-714-899-8900 tree-888-743-0998 fax-714-899-1188 Patriotlab.com 1041 S.Placentia Avenue,Fullerton,(A 92831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition (( ) 810145-007 Roof Main House Center Pen Mastic Black 97'4 I di 3-1 Chrysotile 3 % Total Asbestos 3 % 810145-008 Main House Exterior and Exterior Stucco Grey 100%Non- 4-1 Garage Main House SW Fibrous Material Total Asbestos None Detected 810145-009 Main House Exterior and Exterior Stucco Grey 100%Non- 4-2 Garage Main House NE Fibrous Material Total Asbestos None Detected 810145-010 Main House Exterior and Exterior Stucco Grey 100%Non- 4-3 Garage-Garage SE Fibrous Material Total Asbestos None Detected 810145-01 I Main House Exterior and Vapor Barrier Paper Brown 70%Tar 5-1 Garage Under Ext Stucco 30%Cellulose Main House SW Total Asbestos None Detected 810145-012 Main House Exterior and Vapor Barrier Paper Brown 70%Tar 5-2 Garage Under Ext Stucco 30%Cellulose Main House NE Total Asbestos None Detected Page 2 of 9 Certificate of Analysis PLM Asbestos Identification tel-714-899-8900 free-888-743-0998 fax-714-899-1188 Patriotlab.com 1041 S.Placentia Avenue,Fullerton,(A 92831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(C4) 810145-013 Main House Exterior and Vapor Barrier Paper Brown 70%Tar 5-3 Garage Under Ext Stucco 30%Cellulose Garage SE Total Asbestos None Detected 810145-014 Main House SW Window Putty White 97%Non- 6-I Fibrous Material Chrysotile 3 % Total Asbestos 3 % 810145-017 Garage Shingles Roofing Shingles Roofing Black 60%Tar ?-1 Garage South 15%Glass Fibers 10%Non- Fibrous Material 15%Cellulose Total Asbestos None Detected 810145-018 Garage Shingles Roofing Shingles Roofing Black 60%Tar 7.2 Garage North 15%Glass Fibers 10%Non- Fibrous Material 15%Cellulose Total Asbestos None Detected Page 3of9 • Certificate of Analysis PLM Asbestos Identification tel-714-899-8900 free-888-743-0998 fax-714-899-1188 Patriottab.com 1041 S.Placentia Avenue,Fullerton,(A 92831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(%) 810145-019 Garage Shingles Roofing Shingles Roofing Black 60%Tar 7-3 Garage SE 15%Glass Fibers 10%Non- Fibrous Material 15%Cellulose Total Asbestos None Detected 810145-020A Garage Walls SE Drywall Wall White 80%Non- 8-I Fibrous Material 10%Cellulose 10%Glass Fibers Total Asbestos None Detected 810145-020B Garage Walls SE Joint Compound White 100%Non- 8-1 Fibrous Material Total Asbestos None Detected 810145-021A Garage Walls NE Drywall Wall White 80%Non- 8-2 Fibrous Material 10%Cellulose 10%Glass Fibers Total Asbestos None Detected 810145-021B Garage Walls NE Joint Compound White 100%Non- 8-2 Fibrous Material Total Asbestos None Detected Page 4 of 9 • Certificate of Analysis PLM Asbestos Identification tel-714-899-8900 free-888-743-0998 fax-714-899-1188 Patriottab.com 1041S.Placentia Avenue,Fullerton,(A 91831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(%) 810145-022A Garage Walls SW Drywall Wall White 80%Non- 8-3 Fibrous Material 10%Cellulose 10%Glass Fibers Total Asbestos None Detected 810145-022B Garage Walls SW Joint Compound White 100%Non- 8-3 Fibrous Material Total Asbestos None Detected 810145-023 Throughout the House on Plaster Walls Ceilingi g White 100%Non- 9-1 NE Wall Restroom NW Fibrous Material Total Asbestos None Detected 810145-024 Throughout the House Plaster Walls Ceiling White 100%Non- 9-2 Bedrm SW North East Fibrous Material Total Asbestos None Detected 810145-025 Throughout the House Plaster Walls Ceiling White 100%Non- 9-3 Hallway Closet N Wall Fibrous Material Total Asbestos None Detected 810145-026 Throughout the House Plaster Walls Ceiling White 100%Non- 9-4 Ceiling Dining Rm Middle Fibrous Material Total Asbestos None Detected Page 5 of 9 • Certificate of Analysis PLM Asbestos Identification tel-714-899-8900 free-888-743-0998 fax-714-899-1188 Patriotiab.com 1041 S.Placentia Avenue,Fullerton,fA 92831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(%) 810145-027 Throughout the House Plaster Walls Ceiling White 100%Non- 9-5 Office North Closet West Fibrous Material Wall Total Asbestos None Detected 810145-028 Throughout the House Plaster Walls Ceiling White 100%Non- 9-6 Bedrm NE S East Wall Fibrous Material Total Asbestos None Detected 810145-029 Throughout the House Plaster Walls Ceiling White 100%Non- 9-7 Bedrm SE N West Wall Fibrous Material Total Asbestos None Detected 810145-030A Kitchen West Entry and Multilayer Linoleum White 70%Non- 10-1 West Bathroom Kitchen Fibrous Material South 25%Cellulose 5%Glass Fibers Total Asbestos None Detected 810145-030B Kitchen West Entry and Multilayer Linoleum Brown 95%Cellulose 10-1 West Bathroom Kitchen South Chrysotile 5 % Total Asbestos 5 % Page 6 of 9 • Certificate of Analysis PLM Asbestos Identification tel-114-899-8900 free-888-143-0998 fax-714-899-1188 Patriotlab.com 1041 S.Placentia Avenue,Fullerton,(A 92831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(%) 810145-030C Kitchen West Entry and Top Bottom Blue 45%Non- 10-1 West Bathroom Kitchen Fibrous Material South 32%Cellulose 20%Tar Chrysotile 3 % Total Asbestos 3 % 810145-031A Kitchen West Entry and Multilayer Linoleum White 70%Non- 10-2 West Bathroom West Fibrous Material Bathroom NE 25%Cellulose 5%Glass Fibers Total Asbestos None Detected 810145-032A Kitchen West Entry and Multilayer Linoleum White 70%Non- 10-3 West Bathroom West Entry Fibrous Material NW 25%Cellulose 5%Glass Fibers Total Asbestos None Detected 810145-033A Bathroom East Side NW Multilayer Linoleum Pink 95%Cellulose 11-1 Chrysotile 5 % Total Asbestos 5 % 810145-033B Bathroom East Side NW Multilayer Linoleum Beige 45%Non- 11-1 Fibrous Material 40%Cellulose 15%Tar Total Asbestos None Detected Page 7 of 9 • Certificate of Analysis PLM Asbestos Identification tel-114-899-8900 free-888-743-0998 fax-714-899-1188 Patriottab.com 10415.Placentia Avenue,Fullerton,(A91831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(%) 810145-034B Bathroom East Side SW Multilayer Linoleum Beige 45%Non- 11-2 • Fibrous Material 40%Cellulose 15%Tar Total Asbestos None Detected 810145-035B Bathroom East Side SE l\lultilavcrl.inoleum l3cige 45%Non- 11-3 Fibrous Material 40%Cellulose 15%Tar Total Asbestos None Detected 810145-036 Living Rm and Bedrm SW Spray on Acoustic White 100%Non- 12-1 SE by Entrance Fibrous Material Total Asbestos None Detected 810145-037 Living Rm and Bedrm SW Spray.on Acoustic White 100%Non- 12-2 Living North Fibrous Material Total Asbestos None Detected 810145-038 Living Rm and Bedrm SW Spray on Acoustic White 100%Non- 12-3 Bedrm SW NE Fibrous Material Total Asbestos None Detected Page 8 of 9 Certificate of Analysis PLM Asbestos Identification tel-714-899-8900 free-888-743-0998 fax-714.899-1188 Patriottah.com 1041 S.Placentia Avenue,Fullerton,(A 92831 CNS Environmental,Inc. Report Number: 810145 650 North Rose Dr.Suite 616 Project Number: 20-163 Placentia,CA 92870 Project Name: Optimum Project Location: 27 West Lemon Avenue Arcadia,CA 91007 Date Collected: 3/31/2020 Collected By: Ahmad Abdollahian Date Received: 3/31/2020 Claim Number: Date Analyzed: 4/3/2020 PO Number: Date Reported: 4/3/2020 Number of Samples: 43 Lab/Client ID/Layer Location Material Description Color Composition(%) 810145-039 Attic Ducts and Register Ducting Paper Brown 90%Cellulose 13-1 Boots Attic Middle Covering Chrysotile 10 % Total Asbestos 10 % 810145-014 Stopped at First Positive 810145-030B Stopped at First Positive 810145-030C Stopped at First Positive 810145-033A Stopped at First Positive 810145-039 Stopped at First Positive 4 Carla Ruiz-Analyst Kwin Sheena Legaspi-Approved By Bulk sample(s)submitted was(were)analyzed in accordance with the procedure outlined in the US Federal Register 40 CFR 763.Subpart F,Appendix A;EPA-600/R-93/116(Method for Determination of Asbestos in Building Materials),and EPA-600/M4-82-020(US EPA Interim Method for the Determination of Asbestos in Bulk Insulation Samplcs).Samplcs were analyzed using Calibrated Visual Estimations(CVES);therefore,results may not be reliable for samples of low asbestos concentration levels.Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individual layers.This report applies only to the items tested.Results are representative of the samples submitted and may not represent the entire material from which the samples were collected. "None Detected"means that no asbestos was observed in the sample. "<1%"(less than one percent)means that asbestos was observed in the sample but the concentration is below the quantifiable level of 1%.This report was issued by a NIST/NVLAP(Lab Code 200358-0)and CADOHS-ELAP(Cert.No. 2540)accredited laboratory and may not be reproduced,except in full without the expressed written consent of Patriot Environmental Laboratory Services, Inc.This report may not be used to claim product certification,approval or endorsement by NIST,NVLAP,ELAP or any government agency. Asb_Rep_8.14 Page 9 of 9 APPENDIX C SITE DRAWINGS Garage I] lice Bedroom o f Closet ////f Dining Room iii Living Room ' Bedroom Bedroom MiN * Roof Penetration Mastic Not Shown(1ft2) = Asbestos Containing Linoleum Flooring =Asbestos Containing Window Putty =Transite Vent Pipes =Asbestos Containing Insulation on Ducting and Register Boots in Attic Asbestos NORTH Single-Family Residence and Garage wk. Material Location 275 West Lemon Avenue Map Arcadia,California 91007 ENVIRONMENTAL Not To Scale CNS Project Number: 20-163 APPENDIX D CERTIFICATIONS ENVIRONMENTAL, INC. te�f�e39tui;:i;gt= tf,rrassyg n, >a Ana.; State of California '1� tiT1 Division of Occupational Safety and Health �t) 1 ; Certified Asbestos Consultant o ..AhmaciN• ;e Iu j Ex+ . u 1 ]. a4 � i ThisC6 ) yy yy. P (` t ti*41 HbOCCUE)r71I0 J •,,}�+ +Y kr}Sections 1,40 QISIn9:0.1 end i'rotess*ns Gr+de. I 9th'' 650 N.Rose Drive,Suite 616,Placentia,California 92870-7513 www.cnsenvironmcntal.com Phone:(714)525-5115,Fax:(714)526-5445 ENVIRONMENTAL, INC. ) State of California Division of Occupational Safety and Health :' Certified Asbestos Consultant •• s Edward Dean Spinney ` �Ia,rtu - _ t E Plrns i 1 U/1844 1 t A , . . This cee J bed jky.d ivision of Occupat ; .. Yh aut prized by Sections h, c usiness and . ,i s Professions Code 11 650 N.Rose Drive,Suite 616,Placentia,California 92870-7513 www.cnsenvironmental.com Phone:(714)525-5115,Fax:(714)526-5445