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Home My WebLink About1040 CARLSBAD VILLAGE DR; 102; CBC2025-0025; PermitPrint Date: 12/10/2025 Building Permit Finaled Commercial Permit CBC2025-0025Permit No: Job Address: Permit Type: Parcel #: Valuation: Occupancy Group: 1040 CARLSBAD VILLAGE DR, # 102, CARLSBAD, CA 92008 BLDG-Commercial 2033204900 $93,492.08 Work Class: Lot #: Project #: Tenant Improvement Status: Applied: Issued: 01/27/2025 04/10/2025 Finaled Close Out:09/22/2025B #of Dwelling Units: Track #: Plan #: Closed - Finaled Plan Check #: Orig. Plan Check #:Bathrooms: Final Inspection:09/22/2025Bedrooms:Construction Type:1-A 49Occupant Load: 2022Code Edition: YesSprinkled: INSPECTOR:McClane, Duncan Cornair, Brad Kersch, Tim PERLMAN CLINIC: 1622 SF TI - NEW UNISEX RESTROOM, CEILING, LIGHTING, AND FINISHES. (E-REVIEW)Description: Project Title: Applicant: PERMITS IN MOTION TERRY MONTELLO 4152 60TH ST SAN DIEGO, CA 92115-6301(619) 994-5557 Property Owner: WERMERS PROPERTIES CHRIS SCHOENECK 9191 TOWNE CENTRE DR, # STE 180 SAN DIEGO, CA 92122-6205(858) 623-4962 Contractor: DAVIS AND ADAMS CONSTRUCTION INC 7848 CONVOY CT SAN DIEGO, CA 92111-1210 (858) 268-9831 AMOUNTFEE BUILDING PLAN CHECK $665.64 BUILDING PLAN REVIEW – MINOR PROJECTS (LDE)$204.00 BUILDING PLAN REVIEW – MINOR PROJECTS (PLN)$107.00 CERTIFICATE OF OCCUPANCY $21.00 COMM/IND TI – NON-STRUCTURAL $1,024.06 SB1473 – GREEN BUILDING STATE STANDARDS FEE $4.00 STRONG MOTION – COMMERCIAL (SMIP)$26.18 TRAFFIC IMPACT Commercial-Industrial Outside CFD $3,472.00 Total Fees:$5,523.88 Total Payments To Date:$5,523.88 Balance Due:$0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. 1635 Faraday Avenue, Carlsbad CA 92008-7314 ï 442-339-2719 ï 760-602-8560 f ï www.carlsbadca.gov Building Division Page 1 of 1 {"Cityof Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check Est. Value PC Deposit Date Job Address Suite: APN: Tenant Name #: Lot #: Year Built: Year Built:_______ Occupancy:_______ Construction Type:______ Fire sprinklers: YES NO A/C: YES NO BRIEF DESCRIPTION OF WORK: TENANT IMPROVEMENT ON AN EXISTING SHELL BUILDING . OFFICE SPACE TENANT IMPROVEMENT TO COMPLY WITH CURRENT BUILDING CODE. NEW ADA UNISEX RESTROOM. NEW CEILING, LIGHTS AND FINISHES AS REQUIRED. NO DEMO PROPERTY OWNER Name: Address: State: Zip: City: State: Zip: Phone: Email: CONTRACTOR OF RECORD Business Name: State: Zip: APPLICANT (PRIMARY CONTACT) Name: Address: City: Phone: Email: DESIGN PROFESSIONAL Name: Address: City: Phone: Email: Architect State License: Address: City: State: Zip: Phone: Email: CSLB License #: Class: Carlsbad Business License # (Required): APPLICANT CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT):DATE: 1635 Faraday Ave Carlsbad, CA 92008 SIGN: Ph: 442-339‐2719 Fax: 760‐602‐8558 Email: Building@carlsbadca.gov 1 REV. 07/21 Solar: KW, Modules, Mounted: Roof Ground Reroof: Plumbing/Mechanical/Electrical Other: ______________________________________________________________________________________ Additional Gas or Electrical Features? Pool/Spa: SF Tenant Improvement: ___________ SF, Existing Use: ________________ Proposed Use: ________________ ___________ SF, Existing Use: ________________ Proposed Use: ________________ Addition/New:___________________________ New SF and Use, New SF and Use _______________ SF Deck, ________________SF Patio Cover, __________________ SF Other (Specify)__________ 1040 CARLSBAD VILLAGE DR. STE 102, CARLSBAD CA 92008 102 203-320-49 PERLMAN CLINIC ++2021 B TYPE 1A 1622 SQ FT OFFICE OFFICE/OUTPATIENT PERMITS IN MOTION - TERRY MONTELLO CARLSBAD VILLAGE INVESTORS, L.P. 4715 60TH STREET 9191 TOWNE CENTRE DRIVE #180 SAN DIEGO CA 92115 SAN DIEGO CA 92122 619-994-5557 858-623-4962 PERMITS@PERMITSINMOTION.COM DONALD PITMAN Davis & Adams Construction, Inc 3900 5TH AVE. STE 290 7848 Convoy Court SAN DIEGO CA 92103 SAN DIEGO CA 92111 619-299-001 X 2 858-268-9831 576505 B BLOS1206025 ADRIENNE MONTELLO 01-24-2025 4 □ □ □ □ □ □ □ ( City of Carlsbad ® 0 0 0 0 0 Mr~ M~ THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PElRMff CAN BE ISSUED TO EITHER . .I\ STATE llCEr'SED CON"JRACTOR OR A PROPERTY OWNER. IF THE PERSON SIGNING THIS FORM IS ,AN . .O.GF.N'T' FOR EiTHER ENrm· AN AUTHORIZATION 1=0RM OR UTTER IS REQUiRErJ PRIOR TO PERMIT ISSUANCE. {OPTION A): UCENSl:D C:ONTA...i\Ci'OR Dl:r;tARATIOfJ: I herebyaffirm under penal tyof perjury that I am licensed under provisions of Chapter 9 (commencing with Section lODO)of Division3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations(CHOOSE ONE): Dr have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. Policy No .. ____________________________________ _ A>R-~ have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier a d policy number are: lnsuranceCompany Name: t,,\\ !;)OUA~ l JJ~. CPH f' J/1,.,-!)"( PolicyNo. A.D "1 ExpirationDate: O':fblZn26 -OR- Ocertificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage is unlawful and shall subject an employer to criminal penaltles and clvll fines up to $100,000.00, in addition the to the cost of compensation, dama1es as provided for In Section 3706 of the Labor Code, interest and attorney's fees. CONSTRUCTION LENDiNG AGENt'Y, if AN'f': I hereby affirm that there is a construction lending agency for the performance of the work this permit is Issued (Sec. 3097 (i) Civil Code). Lender's Name:, ___________________ Lender'sAddress: ___________________ _ CONTRACTOR CERTIFICATION: I certify that/ have read the application and state that the above information is correct and that the information on theplansisaccurate. lagree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT): ~~t16'M-1f;$ SIGNATURE: DATE: 0 \ \ !>ZOZ.S"' Note; If the pen;on signing above is i n authorized agent for the contractor provide a letter of autho zation on contractor letterhead. -OR - l O!>T!ON B): OWNi:R-Biiii.DF.R DECLARATION: I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: n I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. ~44, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). -OR- D1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). -OR-□1 am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, D FORM B-61 "Owner Bullder Acknowledgement and Verification Form" is required for any permit issued to a property owner. By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder If it has not been constructed in its entirety by licensed contractors./ understand that a copy of theopplicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: http:l lwww.teginfo.ca.gov/calaw.htmt. OWNER CERT/FICA TION: I certify tho t I have read the application and state that theabove information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT): ________ _ SIGN: _________ DATE: _____ _ Note: If the person slgnin1 above is an authorized agent for the property owner Include form B-62 si1ned by property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Fax: 760-602-8558 Email: Buildlng@carlsbadca.gov 2 REV. 07/21 Building Permit Inspection History Finaled PERMIT INSPECTION HISTORY for (CBC2025-0025) BLDG-Commercial 01/27/2025Application Date:Permit Type:Owner:WERMERS PROPERTIES Tenant Improvement 04/10/2025Work Class:Issue Date:Subdivision:PARCEL MAP NO 21619 01/06/2026Expiration Date:Status: IVR Number: 61378 Closed - Finaled 1040 CARLSBAD VILLAGE DR, # 102 CARLSBAD, CA 92008 Address: Scheduled Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection InspectionActual Start Date 05/02/2025 05/02/2025 BLDG-16 Insulation 283694-2025 Passed Duncan McClane Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Including roughs on additional outlets No 05/09/2025 05/09/2025 BLDG-21 Underground/Underflo or Plumbing 284378-2025 Passed Duncan McClane Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes 05/15/2025 05/15/2025 BLDG-44 Rough/Ducts/Dampers 284929-2025 Passed Duncan McClane Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency DW 3 layers Yes 05/28/2025 05/28/2025 BLDG-14 Frame/Steel/Bolting/We lding (Decks) 286116-2025 Passed Tim Kersch Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes BLDG-34 Rough Electrical 286117-2025 Passed Tim Kersch Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes BLDG-SW-Inspection 286288-2025 Partial Pass Tim Kersch Reinspection Incomplete COMMENTS PassedChecklist Item Are erosion control BMPs functioning properly? Yes Are perimeter control BMPs maintained? Yes Is the entrance stabilized to prevent tracking? Yes Have sediments been tracked on to the street? Yes Has trash/debris accumulated throughout the site? Yes Are portable restrooms properly positioned? Yes Do portable restrooms have secondary containment? Yes Wednesday, December 10, 2025 Page 1 of 2 {cityof Carlsbad PERMIT INSPECTION HISTORY for (CBC2025-0025) BLDG-Commercial 01/27/2025Application Date:Permit Type:Owner:WERMERS PROPERTIES Tenant Improvement 04/10/2025Work Class:Issue Date:Subdivision:PARCEL MAP NO 21619 01/06/2026Expiration Date:Status: IVR Number: 61378 Closed - Finaled 1040 CARLSBAD VILLAGE DR, # 102 CARLSBAD, CA 92008 Address: Scheduled Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection InspectionActual Start Date 05/30/2025 05/30/2025 BLDG-16 Insulation 286384-2025 Passed Duncan McClane Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes BLDG-24 Rough/Topout 286383-2025 Passed Duncan McClane Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes 06/11/2025 06/11/2025 BLDG-17 Interior Lath/Drywall 287451-2025 Passed Duncan McClane Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes 07/10/2025 07/10/2025 BLDG-85 T-Bar, Ceiling Grids, Overhead 290021-2025 Passed Brad Cornair Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes BLDG-14 Frame-Steel-Bolting-Welding (Decks) Yes 08/05/2025 08/05/2025 BLDG-Final Inspection 292121-2025 Partial Pass Brad Cornair Reinspection Incomplete COMMENTS PassedChecklist Item BLDG-Building Deficiency No BLDG-Plumbing Final No BLDG-Mechanical Final No BLDG-Structural Final No BLDG-Electrical Final No NOTES Created By TEXT Created Date Brad Cornair Note: EV Spaces may need signage at wall/in front of space. RFI designating condensor units on roof (Not Garage as per plan) Partial inspection for plumbing final. 08/05/2025 09/22/2025 09/22/2025 BLDG-Final Inspection 293473-2025 Passed Brad Cornair Incomplete COMMENTS PassedChecklist Item BLDG-Building Deficiency Yes BLDG-Plumbing Final Sanitary covers on p traps Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Label sub panel Yes Wednesday, December 10, 2025 Page 2 of 2 True North Compliance Services, Inc. 8369 Vickers Street, Suite 207, San Diego, CA 92111 T | 562.733.8030 April 1, 2025 City of Carlsbad City of Carlsbad – FINAL REVIEW Community Development Department - Building Division City Permit No: CBC2025-0025 1635 Faraday Ave. True North No.: 25-018-090 Carlsbad, CA 92008 Plan Review: TI Perlman Clinic Address: 1040 Carlsbad Village Dr, Carlsbad CA Applicant Name: Terry Montello Applicant Email: permits@permitsinmotion.com OCCUPANCY AND BUILDING SUMMARY: Occupancy Groups: B Occupant Load: 49 Type of Construction: IA Sprinklers: Yes Stories: 1 Area of Work (sq. ft.): 1622 sq. ft. The plans have been reviewed for coordination with the permit application. Valuation: Confirmed Scope of Work: Confirmed Floor Area: Confirmed Attn: Building & Safety Department, True North Compliance Services, Inc. has completed the final review of the following documents for the project referenced above on behalf of the City of Carlsbad: 1. Drawings: Electronic copy dated March 21, 2025, by Pitman Design, Inc. The 2022 California Building, Mechanical, Plumbing, and Electrical Codes (i.e., 2021 IBC, UMC, UPC, and 2020 NEC, as amended by the State of California), 2022 California Green Building Standards Code, 2022 California Existing Building Code, and 2022 California Energy Code, as applicable, were used as the basis of our review. Please note that our review has been completed and we have no further comments, however, we bring the following to your attention: 1. In order to expedite the permitting process, we have made annotations (in red ink) to Title Page sheet Index. We have enclosed the above noted documents bearing our review stamps for your use. Please call if you have any questions or if we can be of further assistance. Sincerely, True North Compliance Services Review By: Ed Dion - Plan Review Engineer Quality Review By: Alaa Atassi - Plan Review Supervisor •', True North ....... ".,,~ COMPLIANCE SERVICES True North Compliance Services, Inc. 8369 Vickers Street, Suite 207, San Diego, CA 92111 T | 562.733.8030 February 5, 2025 City of Carlsbad City of Carlsbad– FIRST REVIEW Community Development Department - Building Division City Permit No: CBC2025-0025 1635 Faraday Ave. True North No.: 25-018-090 Carlsbad, CA 92008 Plan Review: TI Perlman Clinic Address: 1040 Carlsbad Village Dr, Carlsbad CA Applicant Name: Terry Montello Applicant Email: permits@permitsinmotion.com True North Compliance Services, Inc. has completed the review of the following documents for the project referenced above on behalf of the City of Carlsbad. Our comments can be found on the attached list. 1. Drawings: Electronic copy dated January 8, 2025, by Pitman Design, Inc.. 2. Other Documents: Electronic copy of Permit application Attn: Permit Technician, the scope of work on the plans has been reviewed for coordination with the scope of work on the permit application. See below for information if the scope of work on plans differs from the permit application: Valuation: See Notes Below Scope of Work: Confirmed Floor Area: Confirmed Note: No valuation provided Our comments follow on the attached list. Please call if you have any questions or if we can be of further assistance. Sincerely, True North Compliance Services Review By: Ed Dion - Plan Review Engineer Quality Review By: Alaa Atassi - Plan Review Supervisor .JTrue North ~ COMPLI ANCE SERV ICES TI Perlman Clinic City of Carlsbad– FIRST REVIEW 1040 Carlsbad Village Dr City Permit No.: CBC2025-0025 February 5, 2025 True North No.: 25-018-090 Page 2 Plan Review Comments ELECTRONIC - RESUBMITTAL INSTRUCTIONS: Please do not resubmit plans until all departments have completed their reviews. For status, please contact building@carlsbadca.gov Please make all corrections, as requested in the correction list. Corrected sets can be submitted as follows: Email the revised plans and comment response letter(s) to building@carlsbadca.gov for continued review. Note: If this project requires FIRE PREVENTION review, ensure that you follow their specific instructions for resubmittal review. The city will not route plans back to Dennis Grubb & Associates for continued Fire Prevention review. GENERAL INFORMATION: A. The following comments are referred to the 2022 California Building, Mechanical, Plumbing, Electrical Codes, California Green Building Standards Code, and Energy Code (i.e., 2021 IBC, UMC, UPC, and 2020 NEC, as amended by the State of California). B. There may be other comments generated by the Building Division and/or other City departments that will also require your attention and response. This attached list of comments, then, is only a portion of the plan review. Contact the City for other items. C. Respond in writing to each comment by marking the attached comment list or creating a response letter. Indicate which details, specification, or calculation shows the required information. Your complete and clear responses will expedite the re-check. D. Where applicable, be sure to include the architect and engineer’s stamp and signature on all sheets of the drawings and on the coversheets of specifications and calculations per CBPC 5536.1 and CBPC 6735. This item will be verified prior to plan approval. E. If you have any questions regarding the comments below, please contact Ed Dion via email edion@tncservices.com or telephone (562) 733-8030. OCCUPANCY & BUILDING SUMMARY: Occupancy Groups: B Occupant Load: 49 Type of Construction: IA Sprinklers: Yes Stories: 1 Area of Work (sq. ft.): 1622 sq. ft. ARCHITECTURAL COMMENTS: A1. Sheet Index: a) Sheets E302, E701 M006, M007, M008, M212, P004, P005, P212, S100 are not found in the plan set. TI Perlman Clinic City of Carlsbad– FIRST REVIEW 1040 Carlsbad Village Dr City Permit No.: CBC2025-0025 February 5, 2025 True North No.: 25-018-090 Page 3 b) Sheet P211 is listed twice in the sheet index. A2. Revise plans. Mop sink room not shown in MEP plans. MEP plans call out this location as the location of the electrical panel. ACCESSIBILITY COMMENTS: General: D1. Provide turning space per CBC 11B-304.3 and door maneuvering clearance per CBC 11B 404.2.4.1 (a) at room 8 D2. Provide grab bar in the following location for water closet per CBC 11B-604.5: a) Side wall per CBC 11B-604.5.1: i) Grab bar shall be a minimum length of 42 inches, ii) Located 12 inches maximum from the rear wall, iii) And extending 54 inches minimum from the rear wall with the front end positioned 24 inches minimum in front of the water closet. b) Rear wall per CBC 11B-604.5.2: i) Grab bar shall be a minimum length of 36 inches, ii) Extending a minimum of 12 inches on one side, iii) And 24 inches minimum on the other side D3. Water closet: b Jr---MOP Sl K U/C FRIDGE WITH CABINETS UPPERS AND LOWERS MEDI CAL WASTE UPPERS/LOWERS (E) COLUMN --~ .. -37 TI Perlman Clinic City of Carlsbad– FIRST REVIEW 1040 Carlsbad Village Dr City Permit No.: CBC2025-0025 February 5, 2025 True North No.: 25-018-090 Page 4 a) Dimension the centerline of the water closet to be 17” to 18” from the sidewall or partition. CBC 11B-604.2 b) Dimension a minimum clear floor space of 60” wide and 48” deep maneuvering clearance in front of the water closet. CBC 11B-604.3.1. c) Dimension the water closet seat to be 17” to 19” above the finish floor. CBC 11B-604.4 d) Specify the toilet paper dispenser to be 7” to 9” from the front of the water closet, measured from the centerline of the toilet paper dispenser. CBC 11B-604.7. D4. Provide information for the existing and proposed doors that are within the area of work. a) Confirm the clear width of the doorways are 32” minimum per CBC 11B-404.2.3. A 3 ft wide door provides 32” clear width. b) Specify door thresholds, if provided at doorways, to be ½ inch high maximum. Raised thresholds and changes in level at doorways shall comply with CBC Section 11B-302 and 11B-303. CBC 11B-404.2.5. c) Door opening hardware is mounted 34” to 44” above the finish floor per CBC 11B-404.2.7. d) Door hardware are operable with one hand and do not require tight grasping, pinching, or twisting of the hand. CBC 11B-404.2.7 and 11B-309.4. e) Door opening force is 5-pounds maximum for interior and exterior doors per CBC 11B-404.2.9. f) Lower 10 inch of the door surface is provided with a smooth surface for the full width of the door, at the push side of the door per CBC 11B-404.2.10. MECHANICAL COMMENTS: No Comments ELECTRICAL COMMENTS: No Comment PLUMBING COMMENTS: P1. Provide energy compliance forms for new water heaters. See link for forms resources https://energycodeace.com/content/get-forms. P2. Provide water fountain per CPC table 422.1. P3. Provide UL 499 listing for new water heater or provide 12 inch clearance all around per CBC 501.1 and 504.3.2 GREEN BUILDING COMMENTS: G1. Climate Action Plan requirements apply to all commercial projects equal to or exceeding $200,000 in valuation, City of Carlsbad requires that all projects that qualify for CAP compliance will require a completed Climate Action Plan (CAP) Consistency Checklists (city forms B-50) to be completed by the APPLICANT. https://www.carlsbadca.gov/home/showpublisheddocument/6878/638225157825900000 TI Perlman Clinic City of Carlsbad– FIRST REVIEW 1040 Carlsbad Village Dr City Permit No.: CBC2025-0025 February 5, 2025 True North No.: 25-018-090 Page 5 a) For plans submitted to the City the following Climate Action Plan requirements apply, per Carlsbad ordinance: b) The applicant is to fill out the B-50 CAP Consistency Checklist. The scope of work and project valuation will determine which sections of the CAP are required. c) Plan examiners review the B-50 CAP Consistency Checklist for completion. For example: If new residential construction is the scope of work, CAP sections 2A, 3A, and 4A are required to be filled on the B-50 checklist. ENERGY COMPLIANCE COMMENTS: See comment P1 STRUCTURAL COMMENTS: S1. See comment A1. a) If you have any questions regarding the above comments, please contact Ed Dion via email edion@tncservices.com or telephone (562) 733-8030. [END] Hazardous Materials Questionnaire County of San Diego, Department of Environmental Health and Quality PO Box 129261, San Diego, CA 92112-9261 (858) 505-6700 (800) 253-9933 www.sdcdehq.org Business Name PERLMAN CLINIC Project Address 1040 CARLSBAD VILLAGE DR, SUITE# 102 Applicant Jamie Colter Business Contact Monica Perlman MD Inc City CARLSBAD Applicant E-Mail jamie@perlmanclinic.com State CA Record ID #: Not in System Plan Check#: DEH2025-HHMBP-015070 Telephone# (858) 554-1212 Zip Code 92008 Applicant Telephone# (858) 554-1212 Plan File# APN# 203-320-49-00 The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT -HAZARDOUS METERIALS DIVISION: OCCUPANCY CLASSIFICATION: (Not required for projects within the City of San Diego.) Indicate by selecting the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are selected, Applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Facility's Square Footage (including proposed project): 1622 □ Explosive or Blasting Agents □ Organic Peroxides □ Water Reactives □ Corrosives ll!I ll!I Compressed Gases Flammable/Combustible Liquids ll!I □ Oxidizers Pyrophorics ll!I Cryogenics □ Other Health Hazards □ Highly Toxic or Toxic Materials □ None of These □ Flammable Solids □ Unstable Reactives □ Radioactives PART 11: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION {HMD): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, in person at 5500 Overland Ave., Suite 110, San Diego, CA 92123, or by phone at (858) 505-6700 prior to issuance of a building permit. FEES ARE REQUIRED. Project Completion Date: 6/30/2025 YES 1. ll!I 2. l!I 3. □ 4. □ 5. □ 6. □ 7. □ 8. □ NO □ □ l!I □ l!I l!I l!I l!I Is your business listed on the reverse side of this form? (check all that apply). Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business store or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet? Will your business handle carcinogens or reproductive toxins in any quantity? Will your business use an existing, or install an underground storage tank? Will your business store or handle Regulated Substances (CalARP)? Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). □ □ □ CalARP Exempt CalARP Required CalARP Complete Review Date: PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): If the answer to Question #1 is 'Yes' and the answer to Question #2 is 'No', the applicant must contact the APCD prior to the issuance of a building or demolition permit. If any answer to Questions #3, #4, or #5 is 'Yes', the applicant must contact the APCD prior to the issuance of a building or demolition permit. If the answer to Question #3 or #4 is 'Yes', the applicant may need to submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation (some residential projects may be exempt from the notification requirements). Contact the APCD at 10124 Old Grove Road, San Diego, CA 92131 or telephone (858) 586-2600 for more information. 1. 2. 3. 4. YES NO □ l!I □ □ □ □ □ l!I Will any existing building materials be disturbed as part of this project? (If the answer is 'Yes', an asbestos survey may be required.) Has a survey been performed to determine the presence of asbestos containing materials? Will the project involve handling or disturbance of any asbestos containing materials? Will the project involve the removal of any load supporting structural member? 5. 6. □ □ l!I Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at http://www.sdapcd.org/info/facts/permits.pdf □ (ANSWER ONLY IF QUESTION 5 IS 'YES') Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)? Search the California School Directory at http://www.cde.ca.gov/re/sd/ for public and private schools or contact the appropriate school district. Briefly describe business activities: MEDICAL CLINIC/OFFICE Briefly describe proposed project: THE ADDITION OF NEW TENANT IMPROVEMENTS NON STRUCTURAL OFFICE SPACE I declare under penalty of pe~ury that to the best of my knowledge and belief, the responses made herein are true and correct. l!I; Fees Acknowledged: l!I JAMIE COLTER 1/31/2025 Name of Owner or Authorized Agent Date FOR OFFICIAL USE ONLY FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: BY: DATE: __________ _ EXEMPT OR NO FURTHER INFORMATION RELEASED FOR BUILDING PERMIT BUT NOT FOR RELEASED FOR OCCUPANCY REQUIRED OCCUPANCY COUNTY-HMO* APCD COUNTY-HMO APCD COUNTY-HMO APCD a::Y. ~r.. ,..'fOF~~D u RE\1I EV'w'ED 'b M. Martinez SIG1'1ATU!!E 3/5/2025 0/.TE. 141~0 *A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply. DEHQ_HMD_HMBP _Questionnaire v 2.0 (8/2021) Printed on: 3/5/2025 @ 5:01 PM