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HomeMy Public PortalAbout4874 ARDSLEY DR_Miscellaneous_11/3/2015_South Coast Air Quality Management District (www.aamd clov) Mail Form and Fee To: 21865 Copley Drive, Diamond Bar, CA 91765-4182 Phone: (909)396-2336 SCAQMD7 Rule 1403 Form Asbestos Notification File # 55641 Notification of Demolition or Asbestos Removal Los Angeles, CA 90074-5641 t Fax these type of Notification Forms to (919)396.3342 and mail the originals within 48 hrs Pro DEMOLITION DEMOLITION ASBESTOS REMOVAL PLANNED RENO 1 PROCEDURE 4 PLAN 1 PROCEDURE 5 PLAN P�� EMERGENCY ORDERED j ectT yl� 0 .(Firer par) ( El 0 � U cY ❑ 11— ORIGINAL(�otkf"tcation Type ORIGINAL t CANCELLATION t REVISION AMOUNT t REVISION DATES t REVISION OTHER Explain revision amount and other (includes previously notified) 91 11 11 13 0 4 Contractor Information: Notifications should be submitted by the contractor performing the project =um=765620 mosww none Aw D none Om FM DATE PRow#4874 Company Name SOUTH GATE STONE COMPANY t.istslle supervisors) Phone Address 4921 FIRESTONE BLVD. MARTIN LOZANO 213-300-5891 qy SOUTH GA I E SCA 491780 CompleW by MARTIN LOZAN O Phone 213-300-5891 Site Information: Copies of this notification and the CAC asbestos survey report must be kept at the worksite during this project site Name 4.874 ARDSLEY DR. TEMPLE CITY, CA 91780 sbAddress 4874 ARDSLEY DR. Crossstreet SPARKLETT ST sitemy TEMPEL CITY state CA zp 91780 County LOS ANGELES siteowt er RENZHONG LIU & YANAN SUN contact NANCY YANAN SUN Phone 626-780-8858 ownerAddress4874 ARDSLEY DR. . City TEMPLE CITY state CA zp 91780 De;cxt'beWork DEMOLITION EXTERIOR STUCCO, ROOFING, FAMILY ROOM & KITCHEN WALL DesatbeworkLocdon(s) 4874 ARDSLEY DR.. TEMPLE CITY. CA 91780 Project start Date 11/03/2015 Project End Date 11/18/201 5Work Shift Day ID Swhg © Night 0 'BUILDING SIZE In sq ft 16705 F Numberd Floors 1 Bui d' Ing Age (veaas)19467/5/1962 Number of Buildings or Dwelling Units 1 Eluding Priori SCHOOL HOSPITAL CONDOIAPT PUBLIC BLDG. INDUSTRIAL COMMERCIAL OFFICE UNVaXLEGE HOUSE SHIP OTHER Presenttlse ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ Required Building 6tfortriatim ASBESTOS SURVEY? ASBESTOS FOUND? ASBESTOS REMOVED? BUILDING TO BE DEMOLISHED? YES 0 No p - YES 0 NO ® YES 0 No © YES © NO 0 Asbestos Information: Do not provide this information in demolition notifications, see pg 2 NOT APPLICABLE Asbestos Amount to be Removed FRIABLE CLASS I CLASS f1 2 TOTAL in sq ft AMOUNr 0.00 AmountofEach ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC FLOOR TILES (VAT) Type of Asbestos in soft DRYWALL PLASTER TRANSITE ROOFING OTHER PLEASE DESCRIBE OTHER TYPE OF ASBESTOS: Asbestos Removal From SURFACES ❑ PIPES ❑ COMPONENTS ❑ Asbestos Detection Procedures: Check the procedures and analytical methods used to determine the presence of asbestos in the building. See Stmv Ched6st SURVEY ❑ BULK SAMPLING ❑ INSPECTION ❑ CAC ASSUMED AS ASBESTOS-PACM ❑ PLM ❑ PCM ❑ TEM ❑ Controls: Check the combination of Rule 1403 procedures used to control asbestos emissions. (Procedure 4 and 5 submit plans for AQMD prior approval) PROCEDURE NUMBER 1 ❑ 2 ❑ 3 ❑ 4 ❑ 5 ❑ Emergency Asbestos Removal: Check the sudden unexpected event and attach a letter from the person affected by the emergency explaining how this event caused unsafe conditions, equipment damage or unreasonable financial burden. For disturbed/damaged asbestos materials see Procedure 5 Gujnes. FIRE FLOOD WATER DAMAGE EARTHQUAKE NUISANCE VANDALISM HEALTHISAFETY FINANCIAL BURDEN EQUIPMENT DAMAGE OTHER ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Named Person Declaring! Date of Hour of Authorizing the Emergetq Phone Emergency Emergency 2 Fees are per Notification and vary according to the 2TOTAL AMOUNT of asbestos removed or the demolition 2BUILDING SIZE ®South Coast Air Quality Management District, Notification of Demolition or Asbestos Removal Form (2015.07) Page 1 of 2 South Coast Air Quality Management District (www.aamd.aov) Mail Form and Fee To: - 21865 Copley Drive, Diamond Bar, CA 91765-4182 Phone: (909)396-2336 SCAQMD Rule 1403 Form Asbestos Notification File # 55641 Notification of Demolition or Asbestos Removal Los Angeles, CA 90074-5641 Demolition Information: All asbestos containing materials must be removed prior to any demolition activity NOT APPLICABLE Asbestos Removal Company Name Date of Asbeft Removal Check work practices to prevent, suppress and contain dust, and dust controls to be use at the demolition site SPRAY WATER EXIT GRATES TARP TRUCKSIBINS FENCE SCREENS STONE TRUCK PADS TIRE WASHING SOIL STABILIZERS OTHER ❑ ❑ ❑ ❑ ❑ ❑ ❑ Contingency Demolition Plan: Check actions to be followed if unexpected asbestos is found during demolition or asbestos material becomes disturbed, crum- bled, pulverized or reduced to powder. Disturbed/Damaged ACM requires a Procedure 5 Plan Approval prior to clean-up ( See Procedure 5 Guidekw) STOP WORK NOTIFY OWNER SECURE . STABILIZE POST SIGNS ISOLATE WORK AREA SURVEY CHARACTERIZE WASTE OTHER ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Ordered Demolition: Attach a copy of the agency order Agency Name Phone Date of Order Authorizing Person Tide Date Ordered to Begin Waste Information WAMTtM9WMR #1 ANTHENS SERVICES wASTESTOPMESITE Ad&= 127 VAN NORMAN RD. Address city MONTEBELLO state CA 7,p 90640 City State Zip WASTETRANSI of M#2 Lm13FdL.L ANTHENS SERVICES Address Address 2390 N ALDER AVE Cay state Zip Cfty RIALTO State CA Zjp 92377 Contractor Certification: All contractors or owner/operator submitting this notification must sign this form I certify that an individual trained !n the provisions of regulations AQMD Rule 1403 and the Asbed o NESHAP Tile 40 CFR Part 69 SubmI Mwiil be on site during the demolition or renovation and evidence that the required training has been accomplished by this person wil be avallable for inspection during normal business hours. I hereby certify that ail of the inhmation contained herein and Information subrnided with this nodcation is true and owed. Company Name SOUTH GATE STONE COMPANY Tide of operator OWNER Print Name of Owned mabor MARTIN LOZAN O signature of Owned Date 10119/2015 Notification Fee: No rnotiflcations shag be considered received pursuant to Rule 1403, unless it is aoconmparued bythe leq�uired payment R�301 TableVO. Please make check payable to "SCAQMD". Fees are per notification and vary according to the 2TOTAL AMOUNTof asbestos removed or the d&Tdton 2BULLOWG SIZE The Revision Amount fee is the difference between the new PmjectSW Fee category and the original Project Size Fee category (See Fee Information) PrgectSize Fee: $57.98 Fee Based on Project Size (sq ft) Additional Fees Addrtionai Fee: 1,000 or less❑ $ 57.98 ® Special Handling Fee $ 57.98 Total Fee Due: $57.98 1,001 to 5,000 $177.28 Revision to Notification $ 57.98 ❑ 5,001 to 10,000 $ 414.99 [] Returned Check Fec $ 25.00 ❑ 10,001 to 50,000 $ 650.71 Planned Renovation $ 650.71 [j 50,001 to 100,000 $ 94.3,05 Procedure 4 or 5 Plar $650.71- 650.71-100,001 100,001 or more $1,571,74 Expedited 4 or 5 Plan $ 325.35 Attention Keep Three (3) Copies of This Ndf' nation Form for your records, to post at the worksite, and to obtain a city demolition permit See Cafrfomia Health and Safefv Code 1982Z5ft requires that you provide a copy of the derndCltion nofifrcation to Building and Safety before issuance of a demotion permit. For questions call 908396.2336. Forms, instructions and Rule 9403 can be obtained from the AQMD website at hthYA aaw aamd acv. Please mail this signed original noftailm form, fee, and any attachments to SCAQMD Asbestos Notifi- cation File # 55641 Los Angeles, CA 90074-5641. Maft saves time, money and reduces tratiic and air pollution. Project # 4874 m3outh Coast Air Quality Management District, Notification of Demolition or Asbestos Removal Form (2015.07) Page 2 of 2 .Q ARBA STRUCTURAL INSPECTION { AND TESTING INC. , 1215 North Dominion Avenue • Pasadena, California 91104 • (626) 487-1488 - Area4lnc@aol.com JOB NO: DATE: Alf ._C-9-1-11 1-IT17. Tl Id REINFORCEMENT INSPECTED BY: S' PERMIT NO: ISL)—S�/9ii El CONCRETE ❑ POST TF�NSION El MASONRY ❑OTHER GEN. CONTRACTOR:'�s.'_-- SUB CONTRACTOR: CONCRETE SUPPLIER: REINFORCEMENT SUPPLIER: Locations of Work Inspected, Work Rejected, Problems, LOCATION SAMPLED DESIGN STRENGTH MIX DESIGN CEMENT TYPE TICKET NO. SLUMP DATE INSPECTED: Remarks Etc: &0 // AGE TO BE TESTED: @ 7 DAYS, @28 DAYS, @ DAYS, OTHER: INSPECTOR'S NAME: &24:M 4'I -d1 D �'� SIGNATURE: TOWS: M a4M ALL REPORTS WLJ. BE HBD uNTTL ACCOUNT 1S AW W nXL SF.RVtGFrS AUED Ar s AND 8 FXWA U90MUM WITH A 4 HOLM CHARGE FOR AND TWE ASHD A h1ALF FOR SATLMMAM ShIO= AREA s WM BE REWRW 7D WS7nVM LBGAL ACTION FOR THE OOLLF.CnON OF A DF.ST V*W!RRED AS A RESt1Y.YOUR ACCrEP- UAICE OF TWX REPORT: AREA 4 WC. WFLL BE ENTITLED TO ATTORNEY FEES AND CCv''TS MCURRED IN 241D SUM TMS RELD RFF+QRTPRESENTS A Si�Y OF 08SERVATiONS AND TESTM BY AR54 s WIC. PERSONNEL. OUR WORK DOES NOT V40LLOE SUP MSiON OR DMECTION OF THE Al WORK OF THE CONTRACTOR FUS &APLOl OR AGENTS TME C enmCTDR SHONLO BE 90:CWWED MAT NETTWR THE FREMiCE OF OUR FTFJ,D REPRE.SENTArW NOR THE 0899 WATION AAD T WT;NG BY OUR FM SMALL EXCUSE mim W ANY WAY FOR DEFECTS DWOVERED IN HM WORK R /S tMWERSTOOD THAT OUR FIRM WILL NOT BE REALE FOR JOB OR WE SAFETY ON TMS PMWr NO. OF HOURS REGULAR: OVERTIME: AUTHORIZED BY: County of Los Angeles PUBLIC WORKS DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION Los Angeles Regional Uniform Code Program STRUCTURAL OBSERVATION REPORT FORM STRUCTURAL OBSERVATION means the visual observation of the structural system, forgeneral conformance to the approved plans and specifications, at significant construction stages and at completion of the structural system. Structural observation does not include or waive the responsibility for the inspections required by Section 108, 1704 qr other sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709) Report No. ©'Z This report includes all construction work through � fµ day of FCO 20 16o Page No. f of Pro1'ect Address: Structural Observer of Record (SOR): SOR Phone No.: 48.74- IWZutel '64 j=WfZe1J"i/WO V. Grwkk�% iio 9Cg-a�7 Building Permit No.: tructural Observation Observr Professional Lic./Reg. No. Observer Phone No.: ' 8L 15�8i3o(D3:� Performed by: ��I�� G � �W�9 OBSERVED STRUCTURAL ELEMENTS AND THYIR CONNECTIONS FOUNDATION WALL FRAMFT� ❑ Footing, Strem Walls ❑ Concrete ❑ Steel Momrent Frame ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Caisso , Piles, [&Wood ❑ Concretd Moment ISradeams Z Frame 1 ❑ Ret ing Foundation "thers: ❑ MasoWall Hill ide Special Anchors j J/}/t rhlG Fram FLOOR ELEMENTS/CONNECTION OBSERVATION LOCATION ❑ Concrete 40L)C- a"i F- LAit-1 /AX� ❑ Steel Deck SS kk/ ❑ Wood ❑ Others: Z 00/1ers: Sof r yxt❑ Otheits: ' SS W NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general conformance with the approved plans or in the load path: (A final report by the structural observer which states that all observed deficiencies have been resolved is required before acceptance of the work by the building officials.) NpA)C - oke /o C(DV6-4 I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE: 1. 1 AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE I'q� CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS OF THE COUNTY OF LOS ANGELES. \' \NO 11'Q �A- 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT 0 9� EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE Is IN No 03$659 � GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED Exp. 3-31-17 ABOVE; (S1j�./ C/V1� 4. 1 RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY 9Tle nVV�111 OF LOS ANGELES E WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE C 1. 431GTUREOFSTRU ECT (STAMP OF STRUCTURAL OBS4Rv URAL OBSERVER DATE Version 1.0 (2008 LACBC) Jan. 10 2008 County of Los Angeles PUBLIC WORKS DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION Los Angeles Regional Uniform Code Program STRUCTURAL OBSERVATION REPORT FORM STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specifications, at significant construction stages and at completion of the structural system. Structural observation does not include or waive the responsibility for the inspections required by Section 108, 1704 Or other sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709) ST Report No. O This report includes all construction work through 'L / day of NOV, 20 If page No. -j—of _L Project Addres Structural Observer of Record (SOR): t Q Q7c ,"sce-{ ,() , fcsa�7iN� e�uf'+O T Building�/ ermit No.: Structural Observation Observr Professional Lic./Reg. No.: �L 1S0d lz0QSj performed by: F- V 6)U 017 SOR Phone No.. 310 8 07 9-7q Observer Phone No.: 360 P07 -57E OBSERVED STRUCTURAL ELEMENTS At D THEIR CONNECTIONS FOUNDATION WAUL FRAME FLO R ELEMENTS/CONNECTION / OBSERVATION LOCATION mooting, Stem Walls ElCon/rete El Steel Momint Frame ❑ Con rete AcaEbA-pj ,(yuc-ob(2-1 I❑ Mat Foundation ❑ Me onry ❑ Steel Bra ed Frame ❑ Ste Deck i Caisson, Piles, ❑ W od ❑ Concret oment ❑ W od I❑ Grade Beams Frame ❑ Retaining Foundation ❑ 0 hers: ❑ Mason rjy Wall ❑ thers: Hillside Special Anchors Frame hers:,O)c4mg- I ❑ Others: NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general conformance with the approved plans or in the load path: (A final report by the structural observer which states that all observed deficiencies have been resolved is required before acceptance of the work by the building officials.) kx l)C — © L TD PI L- I I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE: 1. 1 AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS OF THE COUNTY OF LOS ANGELES. 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED ABOVE; 4. 1 RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE CQ9RECTED. 11 /2,( 7.0%1 SIGN RE OF STRIJCTURAL OBSERVER DATE (STAMP OF STRUCTURAL Version 1 0 (2008 LACBC) Jan. 10 2006