420 S. State College
1:20 ~. .(-fote {o I (eJE'
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
, SCREl;NBY
MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA90074-5641
RECE;IVED' '
':'POSTMARK'
'ENTERED BY
NOTIFICATID/'I #
COMPLETED BY 1')' 'N '( 11" n, c, '''"'l,COMPANY
, ( u. ~,. _.'.1. Cl.l. ;tj
CHECK# 8/ bY
Hi\R'l'f.':CF:t,f) CONS,
FEE$ 3'1 ~
PHONE
PROJECT#
~
REVISION DATES
REVISION OTHER (highlight)
CANCELlATION
PROJECT TYPE
ORDEREO DEMOLITION
RENOVATION (removal)
EMERGENCY REMOVAL PlANNED RENO (annual)
SITE INFORMATION
SITE OWNER
CITY l.
REQUiRED BUILDING
INFORMATION
HOSPITAL CEe.UsTRiAl)Other OFFICE PUBUCBLOG, HOUSE
.&-~~
n\vJ. ~ we5ro(' CR~SSSTRE~: lVJ.~\)~,
gc{ COUNTY 6rc.-.",- ~
\. b~: \J ~
BUILDING AGE (YEARS)Sl) NUMBER OF DWELLING UNITS g
CiTY \'
A~,IN'
DESCRIBE WORK AND LOCATION
BUILDING SIZE (SQ FT) (, 6-0
SLOG PRIOR i PRESENT USE
<.~
NUMBER OF FLOORS
'~J DtuJ
ZIP9ro 25 CONTACT """-4!fV\ L; PHON 't2t)f15-az.
ASBESTOS YES 6Itt> 1 ASBESTOS ~ NO ASBESTOS YES @ BUiLDING TO BE <::'W NO
PRESENT? SURVEY? REMOVED? M DEMOLISHED?
SCHOOL SHIP UNIV/COLLEGE
PROJECT DATES
START h
END
'ASBESTOS AMOUNT TO BE
REMOVED (in square feet)
CLASS i
CLASS II
WORK SHIFT @, swing, night)
TOTAIL AMOUNT (add row)
'ASBESTOS REMOVAL FROM
SURFACES
PIPES
COMPONENTS
'AMOUNT OF EACH TYPE OF
ASBESTOS (in square feet)
ACOUSTIC CEILING LINOLEUM INSULA nON FIRE PROOFING DUCTING
STUCCO
MASTIC
OTHER (describe)
AQMDJD# 97250
NAME Hartfield Construction Corp. ADDRESS 11908 Clark St 1/ A
CITY
.1l,rcadia STATE Ca
ZIP91006
SITESUPVR John Hartfield PHONE 626 255 3541
WASTE TRANSPORTER #1
LANDFILL Puente Hills
ADDRESS
ADDRESS 1955 Workman Mill Rd.
CITY
STATE
ZIP
CiTY
Whittier
STATEca
ZI~ 0 6 07
, Not required for demolition notifications 1 asbestos surveys are required prior to Demolition and Renovation.
Form~ instrlJr:tinn.~ ::lnn th,o Rult:l1A,f'l":l ("::an h,., ........*.....;........... f~__ ^r.u,", ..._'_ .. ... ..
SCAQMD NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL
MAIL FORM AND FEE TO SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641
WASTE TRANSPORTER #2 . WASTE STORAGE SITE
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
. CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED A TTHE RENOVATION AND DEMOLITION SITE. Procedure # 1, 2, 3, 4, 5 or Olher
For asbestos removals circle the combination of Rule 1403 procedures used. Procedure 4 and 5 submit plans for AOMD prior approval (See procedure 4/5 guidelines)
. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND ANAL YT/CAL METHODS USED TO DETERMINE ASBESTOS IN THE BUilDING:
Survey, Bulk Sampling, Inspection, PLM, PCM, TEM, Assumed as Asbestos-PACM, Describe Other (See survey guidelines checklist):
FOR DEMOLlTIONS GIVE THE COMPANY NAME AND DATES OF THE ASB~TOS REM~~L: ~~'C-~~~ ~ eV\.V'L~~~l1:~ tf./ro
FOR ORDERED DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME & PHONE #
AUTHORIZING PERSON: TITLE
DATF. OF ORDER: I DATE ORDERED TO BEGIN:
. FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OFTHE PERSON DECLARING/AUTHORIZING THE EMERGENCY, DATE AND HOUR OF
EMERGENCY AND DESCRIBE THE SUDDEN. UNEXPECTED EVENT:
EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS, EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN:
CONTINGENCY PLAN: DESCRIBE ACTIONS TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR ASBESTOS MATERIAL BECOME
DISTURBED, CRUMBLED, PULVER/ZED, OR REDUCED TO POWDER.
Secure area call an abatement contractor.
. TRAINING CERTIFICATION: I cerlily that an individual trained in the provisions of regulation AQMD Rule 1403 and NESHAP will be on site during Ihe removal and
evidence that the required training has been accomplished by this person will be available for inspection dunng normal business hours.
Company Name Print name of owner/operator Signalure of owner/operalor Tittle of owner/operator Dale
.._-"'''''''''''''','''''~~--"-~, ~-""......- W ~tO!05
Hartfield Constr Corp. John Hartfield ~~
Company Name Print name of owner/operator Signature of ownerloperator JfTil!l~ of 0 er/op ator Dale
Notifications can nol be accepted wlthoutlhe required fee (Rule 301 ). Asbestos removals of less than 100 square feet are exempt from notification and fee,.
Please make checks payabie to "SCAOMD". Fees are per nolificatlon, nol refundable, and vary according 10 Ihe project size, Fees are as follows:
PR lIT' N OR REMOVAL PROCEDURE40r5PLAN SERVICE CHARGE
i f.OOO.; 100' - --. .-'0 -- ~~ ~- $ 450.91 Special Handling Fee -- $ 36.90
1,001 to 5,000 --- $ 112.80 -.---_._._____ $ 526.81 Revision to Notlfication.- $ 36.90
1001 to 10,000-- $ 264.03 -----_________ $ 678,04 Returned Check Fee -- $ 29.28
10,001 to 50,000--. $ 414.01------________ $ 828.02 Planned Renovation - $ 408.3B
50,001 to 100,000-- $ 600.00 ----___._____ $1,014.01
100,001 or more - - $1,000 .- - $1,414.01
. .
ATTENTION: . Keep a copy of your notification. Slate law requires thaI you provide a copy of the demolition notification to Building and Safety before issuance of a
demoiitlon permit. For questions call 909-396-2336. Piease mail the form and fee to AOMD. Mailing saves lime, money and reduces traffic and air pollution
MAlL FORM AND FEE TO: SCAQMD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 90074-5641 Page 2 of 2
TELEPHONE: (909)396.2336 FAX: (909)396.3342 Form REV 20040623
FORMS, tNSTRUCTlONS, AND THE RULE 1403 CAN BE OBTAINED FROM AOMD WEB SITE AT HTTP://WWW.AOMD.GOV
SCAQMD is located at 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396.2000
TYPE OF PERMIT CITY
Demolition
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 649
QUARTER SECTION: 113
BUILDING PERMIT NO. BLD2005-01964
DATE: 6/27/2005
JOB ADDRESS: 420 S STATE COLLEGE BLVD
LEGAL DESCRIPTION: TR 3288 LOT 1 ALL -EX ST-
CONTRACTOR INFORMATION:
HARTFIELD CONSTRUCTION CORP
11908 CLARK ST #A
ARCADIA, CA 910060000
BUSINESS PHONE: 626301-9122
JOB DESCRIPTION:Demolish single story Auto Shop building (600 square feet)
VALUATION: 4,000.00 PROCESSED BY: JNJ
I OWNER-BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atl:er, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licE!nsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit sutjects the applicant to a civil penalty of not more than five hundred dollars
($500).
D I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertywho builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker'~compensation,
as provided for by Section 3700 of the Labor Code, for the performance of th(! work for which
this permit is issued.
B-1 have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carlier and policy are:
Carrier: STATE FU NO
APPLICANT: SEAN HARTFIELD
OWNER INFORMATION:
Joel Sanzburg
18022 Medley Dr
Encino, CA 91316
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Oivsion 3 of th siness
Professions Code.
6/27/2005
Date:
Policy Numbe" 1814239
NUMBER
478529
TYPE
TYPE
TYPE
EXPIRATION DATE
4/30/2007
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the perfonnance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
Provisions~tion ~f bor Code, I shall forthwith comply with those provisions.
{/VI- < "
Date: 6/27/ Ii: 't \ c:J
WARNING: FAILURE T SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONe; HUNDRe;D THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
B
A
C12 PAV
Construcion Tvpes:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of enter upon the above mentioned property for
inspection poses.
Date: 6/27/2005
Fees paid for Permit:
Total:
393,73
plicant or gent
The permit shall expire b limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new Dermit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
DATE
INSPECTOR
INSPECTION DATE INSPECTOR Engineering/Grading Final 765-5126
Temporary Power Pole Fire Dept. Final 765-4040
Plumbing (Drain/Waste Pipe) Water Engineering 765-5268
Electrical Ground Electrode/Ufer Sub List/Business License 765-5194
SetbacklFormsITrenches (Footings) Zoning 765-5139
Do not install subfloor or pour floor slab until the Building Final (Last Inspection - Only ~JL~1<
following applicable items have been signed: After Above Complete) t-,,"J .Ii
Plumbing (Water Pipe/Sprinkler Valves) /
Mechanical (Groundwork) PARTIAL INSPECTIONS
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.) Buildina Inspections
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (SheathinalDiaphragmlFrame)
Masonry (RelnfJBond Beam/Pre-Grout) Mechanicallnsoections
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed: Plumbina Inspections
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat) Electrical Inspections
T -Ilar Electrical
T -Bar Mechanical
T-Bar Structural ..
Sewer ~" "*- ;,..-Z-~.c r ~ ':::z"7 (. -
Water Engineering Backflow C/
Water Service
-/3 'Ai 0(2 s-k-rnt <!-&-r/ '" ,....-. <1.+wc-> .
to-
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PUBLIC WORKS DEPARTMENT FEES
',C __TRAFFIC ENGINEERING FEES--
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TE # 78.
o EASTERN TRANSPORT ~TION CORRIDOR FEE:
101.412-F724-67~V\ ~ ~ 0 ~ \
COMMENT: Sc).b leG- FI 'oto."O f...Q/\..;..... \
REVIEWED BY: ALFRED YALDA (714) 765-5183 A 1 DATE: 1-2.D-~
__DEVELOPMENT SERVICES FEES-- (
RlGHTOFWAY ~~ ~CA~VIEWEDBYfW, DATE:
o OLD ZONING CODE (t., i. ,'" ,h~k " .\;\\;/...~, '"" to July 8,2004) I -u,jr:I;
~W ZONING CODE
DEDICATION ~ Cur ~\
CREDIT ISfJrp y. [O.<6t'i ~11{lq,09
STREET lMPROVEMENTIREP AIR
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SEWER CONNECTION FEE ;//1>-
ACCT #
CITY SEWER ASSESSMENT /'1 If:>.
DRAINAGE ASSESSMENT FEE filA
ACCT #
ACCT #
GRADING: Gtp.. '7-005_ 0'?-'2..9' C-v!'-\'-f..J\"'V v:.J~J>-- 1<JLV'lb'<.!
'f"i~/>..v,
WATER QUALITY MANAGEMENT PLAN (WQMP) Cl"l1-l U>o.,,_ o02./f /.w,,-o';A<.- Q.<<.&!
LANDSUBDIVlSlON: LoT d.. D~ ,Tt"f-tc;<;f :5?,~J
REVlEWEDBY: ,Av'fJ.
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PUBLIC WORKS DEPARTMENT FEES
__TRAFFIC ENGINEERING FEES--
BUlLD# OS...otJ flfcP
PROJECT srr~: 4- '2.P ". ..q. S -f.... -e:..., c.., / L..~
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o TRAFFIC SANTA ANA CANYON FEE:
278-412-F724-2001
SEWER CONNECTION FEE tI/;A
ACCT #
CITY SEWER ASSESSMENT ;Y /,1:>.
ACCT #
DRAINAGE ASSESSMENT FEE ft/I~
ACCT 1#
GRADING: GE.P- 9..00.$_ 0'2-7..9(, C-<)!'-I'l.€-,J,"V v;.J!~J1--- lULV'/,",<<.I
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WATER QUALITY MANAGEMENT PLAN (WQMP) C,l'l'\-( ~cll_ oCLlf I>Wr,o~"'" Q.J1..&!
LAND SUBDIVISION: L01- 1. D~ 'Tfl-f-l-C1' 3"2-~J
REVIEWED BY: ,AVP
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City of Anaheim
DEPARTMENT OF PUBLIC WORKS
March 09, 2005
Mr. Joel Saltzburg
18022 Medley Drive
Encino, California 91316
SUBJECT: NEW COMMERCIAL CONSTRUCTION (D-I13)
420 S. State College Blvd.
BLD2005-00 146
Dear Applicant:
The Public Works Department has reviewed the plans for your, building permit
application at the subject location for conformance with City req\lirements associated
with street right-of-way, traffic, sanitation, street improvements, sewer, drainage,
grading, and land subdivision. The information in this letter is intended to help you to
complete your building project with as little inconvenience as possible.
STREET RIGHT -OF- WAY
The legal property owner shall irrevocably offer to dedicate to the City of Anaheim, an
easement for comer cut off at State College Blvd. and Westport Ave. The above
dedication must be completed prior to the issuance of a building permit. Contact Mrs.
Christine Pilapil in the Real Property Section at (714) 765-5100 ext. 5818 if you need
additional information.
TRAFFIC AND TRANSPORTATION
The following traffic related fees are due. The fees will be collected at the Building
Division counter prior to issuance of your building permit.
Transportation Impact and Improvement
Traffic Signal
$ 8,416.96
$ 2,555.00
If you need additional information concerning these fees, contact Mr. Alfred Yalda in the
Traffic Engineering Division at (714) 765-5183.
SANITATION
Trash storage areas shall be provided and maintained in a location acceptable to the
Public Works Department. A plan for trash storage, collection and a plan for recycling
shall be submitted and approved prior to issuance of building permit. An on-site trash
truck turn around is also required. Contact Ms. Dora Monzon in Streets and Sanitation
Division at (714) 765-6836 if you have any questions concerning these requirements.
P.O. Box 3222.
Anaheim, California 92803
TEL (714) 765.5176
FAX (7141765.5225
.\ .,
Page 2 of2
Date: February, 23, 2005
SUBJECT: New Commercial Construction (01131)
420 S State College Blvd.
BLDZ005-00146
SEWER
No City of Anaheim sewer assessment fees are applicable to this project.
LAND SUBDNISION
The legal property is Lot I of Tract 3288.
GRADING
The grading plan GRA2005-02296 is currently under review by the Subdivision
Department. The grading plan needs to be approved prior to issuance of grading permit.
STREET IMPROVEMENTS
A cash payment of $ 31,675.00 for future improvements of State College Boulevard shall
be paid to the Public Works Department, Development Services Division prior to
issuance of a building permit.
The developer shall post a bond in the amount of $ 12,000.00 for street improvements of
Westport Drive in conformance with Public Works Standard Detail 160-A.
Improvements shall be shown on the grading plan.
A Right of Way Construction Permit shall be obtained from the Development Services
Division for all work performed in the public right of way.
Any improvements damaged prior to or during construction at your site must be repaired
prior to clearance for certificate of occupancy (reference Section 18.04.080.020 of the
Anaheim Municipal Code).
DRAINAGE
A final Water Quality. Management Plan (WQMP) 0TH2004-00218 needs to be
approved prior to issuance of building permit.
Drainage assessment fees are not applicable to this project
If you need additional information concerning street improvements/repair, sewer and
drainage fees, water quality management, grading, and/or land subdivision please contact
the undersigned at (714) 765-5100 extension 5816.
Res/(f'
Adrian V. Pa a
Principal Engineering Aide
o FILENAME \p klMRY ACUB.docO
c: Gary E. Johnson, Director of Public Works and City Engineer
T. W. Layman Associates
16633 Ventura Blvd. Suite 1320, Encino, CA. 91436-1801
Chris Lee, Building Plan Check Supervisor
Doug Faullrner, Zoning Plan Check Supervisor
File