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Home My WebLink About1281 CARLSBAD VILLAGE DR; ; CB151646; Permit06-08-2015 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: Building Inspection Request Line (760) 602-2725 CB151646 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: 1281 CARLSBAD VILLAGE DR CBAD Tl Sub Type: COMM 1561907010 Lot#: 0 $162,843.00 Construction Type: 5B Reference # PACKARD DENTAL: 2,701 OFF (MED TO DENTAL OFFICE Status: ISSUED Applied: 05/29/2015 Entered By: JMA Plan Approved: 06/08/2015 Issued: 06/08/2015 Inspect Area Plan Check #: Applicant: PACKARD CONSTRUCTION, GARTH 2057 CHESTNUT AV CARLSBAD, CA 92008 619-729-7447 Owner: CARLSBAD MEDICAL VILLAGE L P C/O RUSS RIES P O BOX 1422 LA JOLLA CA 92038 Building Permit $848.45 Meter Size Add'l Building Permit Fee $0.00 Add'l Red. Water Con. Fee $0.00 Plan Check $593.91 Meter Fee $0.00 Add'l Building Permit Fee $0.00 SDCWA Fee $0.00 Plan Check Discount $0.00 CFD Payoff Fee $0.00 Strong Motion Fee $45.60 PFF (3105540) $0.00 Park Fee $0.00 PFF (4305540) $0.00 LFM Fee $0.00 License Tax (3104193) $0.00 Bridge Fee $0.00 License Tax (4304193) $0.00 BTD #2 Fee $0.00 Traffic Impact Fee (3105541) $0.00 BTD #3 Fee $0.00 Traffic Impact Fee (4305541) $0.00 Renewal Fee $0.00 PLUMBING TOTAL $175.00 Add'l Renewal Fee $0.00 ELECTRICAL TOTAL $45.00 Other Building Fee $0.00 MECHANICAL TOTAL $44.59 Pot. Water Con. Fee $0.00 Master Drainage Fee $0.00 Meter Size Sewer Fee $0.00 Add'l Pot. Water Con. Fee $0.00 Redev Parking Fee $0.00 Red. Water Con. Fee $0.00 Additional Fees $0.00 Green Bldg Stands (SB1473) Fee $7.00 HMP Fee ?? Fire Expedidted Plan Review $0.00 Green Bldg Standards Plan Chk ?? TOTAL PERMIT FEES $1,759.55 Total Fees: $1,759.55 Total Payments To Date: $1,759.55 Balance Due: $0.00 Inspector FINAL APPROVAL Date: Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively refemed to as 'fees/exactions." You have 90 days from the date this pemiit was issued to protest imposition of these fees/exactions. If you protest them, you must follovi the protest procedures set forth in Govemment Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carisbad 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 vou have previouslv been given a NOTICE similar to this, or as to which the statute of limitations has previouslv othenvise expired. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMrr ISSUANCE: nPLANNING •ENGINEERING CliBUILDiNG •FIRE • HEALTH n HAZMAT/APCD Ccity of Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph; 760-602-2719 Fax; 760-602-8558 email: buildingtgcarlsbadca.gov vvww.carisbaclca.gov Plan Check No. )S • / 4gMjb Est Value <ft/3. Plan Ck. Deposit Date APN SWPPP JOBADDRESS LOTS |F>HASE# #OFUMTS |#BEDI SUrrEf/SPACEf/UNIT* /r^ - m -s/ CT/PROJECT# # BEDROOMS # BATHROOMS TENANT njSINESS NAME CONSTR. TYPE DESCRIPTION OF WORK:/mdude Square Fleet Of AffiecfiedAiea(s) j j, _ / » - / ^ M 2^;iO f SF EXISTING USE PROPOSEDUSE 1 GARAGE (SF) PATIOS (SF) DECKS (SF) RREPLACE AIR CONDmONING RRE SPRINKLERS ^<^' YESQ* N0(S YES"^N0Q YEsj^hioQ APPUCANTNAME >9 /J T\ /I J Primaiy Contact CTAJ'TM. riAKJL^rti PROPERTVOWNERNAME . .y . . ^ ADDRESS ^ ^ ADDRESS . , . t tt \ CITY ^ » STATE ZIP aTY It/) STATE C/ ZIP ^ PHONE. ^ FAX PHONE l^-'73^9'''f9o^ FAX ENMIL DEMGN/ROFBSIONAL iC, ADDRESS " f . . t t\ A ADDRESS -x -\ CITY «. STATE - ZIP aVf t STATE ZIP PHONF / . „ FAX PHONE . FAX ^ , lk?-&>X -S/07 7(>o ' S'X? - 993/ EMAIL STATE LIC. # CLASS QTY BUS. aSS" / (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter. Improve, demolisti or repair any structure, prior to its Issuance, also requires the applicant for such permrt to file a signed statement that he is licensed pursuant to the provisions of the Contracttw's License Law (Chapter 9, commending 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 subjetits the appticam to a civil penalty of not more ttian five hundred dollars ($500)). — . . .I:i7¥: ----OS Workers' Compensation Dedaratton: (fiensby afiimi under penalty ofpeijury one of Oie fo/towrng dedarstions: LJ I have and wili inaintain a certificate of consent to self-insure for woriters' compensation as provided by Section 3700 of the Labor Code, for the perfonnance of the worit for which this pemiit is Issued. I have and wiH maintain woriteis' comiieasstion, as reouired bv SecGon 3700 of the L^xx Code, for the performance of the wortt for whk:h this pemiit is Issued. My woriters' compensatkin insurance earner and polk:y number are: Insurance J^tt/r rtLMjL Policy Ma.. Expiratkxi Date. Bsection need not be ctxnpl^ed if the perniit is for one huntt^ed dollars ($100) or less. Certificate of Exemption: I certliy that In the peribmiance of the wortt for whteh this peimit is issued, I shal not employ any person In any manner so as to become subject to the Woriters' Compensation Laws of Calilomia WARNING: Failure to secure workers' compensation coverage is uidawfuL and shall subject an employer to criminal pendties and civil fines up to one hundied thousand dollars (&100,000), in addition to the cost of compensatkin, damage^^^provided farjfi Sectio])J70J of thej^bor code, ig)erest and attomey's fees. CONTRACTOR SIGNATURE \QAGENT DATE S"^^"/^ •y^ • ' ' •. / hereby atfirm that I am exempt fmm Contractor's Ucense Law for ihe Mmung reason; I I I, as owner of the property or my empkiyees with wages as their sde compensatkin, will do the worit and the stmcture is not kitended or ofiered for sale (Sec 7044, Business and Professkins Code: The Cknlractor's License Law does not apply to an owner of properfy who buikis or improves thereon, and who does such worit himself or through his own empkiyees, provided that such unprovements are not intended or ofi^ed for sale If, however, the building or improvement is sold withki one year of comptetkm, the owner-builder win have the bunlen of proving that he did not buikl or improve kir the purpose of sale). I I 1. as owner ofthe pmperty, am exckisively contracting with ikxnsed contractois to construct the projed 7044, Busmess and Professkxis Code: The Contrai^oi's Lkxnse Law does not apply to an owner of properiy who buMs or knproves thereon, and contracts for such projects with contiactor(s) licensed pursuant to Sie Contractor's Lk^nse Law). I am exempt under Sectkin Buskiess and Professions Code for this reason: 1.1 personally plan to pravkie 8ie major labor and materials for constmctkin of the proposed property improvemenL •Yes r~|No 2.1 (have / have not) signed an appiication for a building pemiit for the proposed worit. 3.1 have contracted with the following person (fimi) to provide the proposed constmdion (indude name address / phone / contradors' license number): 4.1 plan to proude portkms of the worit, but 1 have hked the foUoMring person to coordinate, si^ienrise and pmvkle the n^cs worit (kiclude nane / address / phone / contradors' icense number): 5.1 will provide some of the worit, but I have contraded (hired) the followkig persons to provide the worit kidicated (Indude name / address / phone / type of worit): jgS'pROPERTY OWNER SIGNATURE AGENT DATE -_ i. Is the applicant ot future buiif ng occupani required to submit a business i4ai, acutely hazaidous materials registration form or risk management and preventian program under Sections 25505,25533 or 25534 of Ihe Presley-Tanner Hazardous Substance Account Ad? Yes X, t*) Is the applicant or future bulding occupant required to obtain a permit froni the air poHulion contrd distrid or wqud^^ Yes Ito Is the fadlity to be constmcted witNn 1,000 feet of the outer boundaiy of a schod site? Yes "NCNo ' IF ANY OF THE ANSWERS ARE YES, A RNAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. J... .A,..!.>..,aA.J>8ik&dfcJ.a^A.j»iiu^^^^ i,t k.,- .^.i .n ^ .„- „. hereby affirm that there is a construction lending agency for the perfbrmance of the work this permit is issued (Sec 3097 (i) Chril Code). Lender's Address Lender's Name t ceiti^ tbat I haw read tbe ^iplkatioii aod slate tlmt the above infoimatkm is collect aid I hereby authorize representatiiie of the (3^ of Carisbad to enter upon the above mentkined propel AGAINST Aa LIABimES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CPTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT (381^ An (3SHA perniit is requied kr excavalkins over 5'0'deep and demditkin a constiuclnn of skuctur^ EXI^RAT1(3N: Every perrnit issued by the Buikting OAksal under the pmvisk^ 180 days korn the date of such permit or if the buldiig orworit authorized by ygTAPPUCANTS SIGNATURE cJ^^t/(^6^ 6%CJLB^ STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the foilowing ONLY If a Certificate of Occupancy wiil be requested at final inspection. Fax (760) 602-8560, Einail building(S)carisbadca.qov or Mall the completed form to City of Carisbad, Bulding Division 1635 Faraday Avenue, Carisbad, Califomia 92008. C0#: (Off li» Use Only) CONTACTNAME OCCUPANT NAME ADDRESS BUILDING AODRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EIVIAIL OCCUPANTS BUS. UC. No. DELIVERY OPTIONS PICKUP: CONTACT (Listed atKwe) OCCUPANT (Usted above) CONTRACTOR (On Pg. 1) IVIAiLTO: CONTACT (Usted above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL/FAX TO OTHER: ASSOCIATED CB# NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION ASSOCIATED CB# NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION ^APPLICANT'S SIGNATURE DATE Inspection List Permit*: CB151646 Type: Tl COIVIIVI PACKARD DENTAL: 2,701 OFF (MED TO DENTAL OFFICE Date Inspection Item Inspector Act 08/27/2015 89 Final Combo -Rl 08/27/2015 89 Final Combo PB AP 08/26/2015 89 Final Combo -Rl 08/26/2015 89 Final Combo PB NR 08/06/2015 85 T-Bar PB AP 08/05/2015 85 T-Bar PB NR 07/20/2015 17 Interior Lath/Drywall PD AP 07/06/2015 14 Frame/Steel/Bolting/Weldin PY AP 07/06/2015 24 Rough/Topout PY AP 07/06/2015 34 Rough Electric PY AP 06/22/2015 31 Underground/Conduit-Wirin PB AP 06/18/2015 23 Gas/Test/Repairs PB AP 06/17/2015 21 Underground/Under Floor PB AP Comments AM PLEASE/ COF AM PLEASE COF Friday, August 28, 2015 Page 1 of 1 ^ CARLSBAD www.carlsbadca.gov Coinir.umry 61 Economic Development Paul Burnette Building Inspector T 760-602-2707 F 760-602-8560 paul.burnette@carlsbadca.gov Building Division 1635 FaradayAvenue, Carlsbad, CA 92008-7314 ION i CB151646 1281 CARLSBAD VILLAGE DR PACKARD DENTAL: 2,701 OFF (MED TO DENTAL OFFICE Tl COIVIIVI Lot#; PACKARD COimRyCXlDW.eARTH RECORD COPY DATE: IF "YFS" IS CHECKED BELOW THAT DIVISION S ,\PPROVAL IS REQUIRED PF^ ICR jJDJ^EQUES Tl r^G A FiN \ L Hi JII DINC, iNSr'l CT lor^. IF YOU HAVE ANY QUESTIONS PLEASE CALL rHE APPLICABLE DIVISIONS AT IHE PHONE NUMUFRS I'RijVIDl D H(,l(jVV AHER ALL REQUIRED APPROVALS A R E SI G N ED O FF - FAX TO 760 602 8560 FMAIL TO II LD G I NS p i r i | ( , r j s (M^l ,FAIK \ <;0\/ OR [3RING IN A COPY OF THIS CARD TO: 1 635 F'ARADAY AVE.. CARLSBAD. CA 92008. BUILDirJG INSFFC lORS C \N HE REACHED AT 760 602-2700 BETWEEN 7:30 Alvl - 8:00 AM THE DAY OF YOUR INSPECTION. YES Required Prior to Requesting Buiiding Final If Cliecked YES Date Inspector Notes Plannln^Landscape 760-944-8463 Allow 48 hours CM&I (Engineering Inspections) 760-438-3891 Call before 2 pm Fire Prevention 760-602-4660 Aiiow 48 hours Type of Inspection CODE « BUILDING Date #11 FOUNDATION inspector Type of Inspection COOK tt ELECTRICAL Date #31 •ELECTWICUNDERGROUND DUFER (p^2Z'/^ inspector it #12 REINFORCED STEEL #34 ROUQH ELECTRIC #66 MASONRT PRE GROUT #33 •ELECTRICSERVICE •TEMPORART • GROUT • WALL DRAINS #35 PHOTOVOLTAIC #10 TILTPANELS #11 POUR STRIPS #11 COLUMN FOOTINGS #39 FINAL ror.E tt MECHANICAL #41 UNDERGROUND DUCTS a PIPING #14 SUBFRAME • FLOOR • CEIUNG ^ • DUCT&PLENUM • REF.PIPING #15 ROOFSHEATHING #43 HEAT-AIR COND. SVSTEMS #13 EXT. SHEAR PANELS #16 INSULATION #18 EXIERIOR IATH #49 RNAL coDttt COMBO INSPECTION #81 UNDERGROUND (11,12^1,31) #17 INTERIOR LATH & DRYWALL #82 DRVWALL,EXT LATH, GAS TES (17,18,23) #51 POOLEXCA/STEEL/BOND/FENCE #83 ROOF SHEATINO, EXTSHEAR (13,15) #55 PREPLASTER/RNAL #84 FRAME ROUGH COMBO (14,24,34,44) #19 FINAL CODE « PLUMBING #22 • SEWER a BL/CO #85 T-Bar (14,24,34,44) #89 HNAL OCCUPANCY (19,29,39,49) REV 10/2012 SEE BACK FOR SPECIAL NOTES Carlsbad 15-1646 6/1/15 EsGll Corporation In (PartnersHip witfi Qovemment for (BuiCtfing Safety DATE: 6/1/15 • APPLICANT • JURIS. JURISDICTION: Carlsbad • PLANREVIEWER • FILE PLANCHECKNO.: 15-1646 SET: I PROJECTADDRESS: 1281 Carlsbad village Dr. PROJECT NAME: Packard Dental Group, Dental office TI I I The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. XI The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. I I The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. I I The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. I I The applicant's copy of the check list has been sent to: Ixl EsGil Corporation staff did not advise the applicant that the plan check has been completed. I I EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Email: XI REMARKS: A. City staff to verify |^§i(9'5*CJ^l|E£''oval forthe installation of the X-Ray equipment cy:^or to fii^a^ approval of the Tl B. The notes clouded in red on sheets fi^<^^^2JJ^2^8(P2^ the approved plans from EsGil must be made to the City sets of plans to make additional sets of approved plans. By: Chuck Mendenhall Enclosures: EsGil Corporation • GA • EJ • MB • PC 5/28/15 Carlsbad 15-1646 6/1/15 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: 15-1646 PREPARED BY: Chuck Mendenhall DATE: 6/1/15 BUILDING ADDRESS: 1281 Carlsbad village Dr. BUILDING OCCUPANCY: B BUILDING PORTION AREA ( Sq. Ft.) Valu ation Multiplier Reg. Mod. VALUE ($) Dental off Tl 2700 City Est 162,843 Air Conditioning Fire Sprinklers TOTAL VALUE 162,843 Jurisdiction Code cb By Ordinance Bldg. Permit Fee by Ordinanoe Plan Check Fee by Ordinance Type of Review: ED Complete Review • Structural Only •Repetitive Fee ^ Repeats • Other |—I Hourly EsGil Fee Hr. @ * $849.71 $552.31 $475.84 Comments: N/A In addition to the above fee, an additional fee of $ $ /hr.) for the CalGreen review. is due ( hour @ Sheet 1 of 1 macvalue.doc + CARLSBAD CITY OF PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www.carlsbadca.gov DATE: 6/04/2015PROJECT NAME: Packard Dental Group (Carlsbad Med Viii) PROJECT ID: CT 05-19 PLAN CHECK NO: CB 15-1646 SET#: I ADDRESS: 1281 Carlsbad Village Dr APN: 156-190-70-10 VALUATION: $162,843 APPLICANT CONTACT: gfpackard@gmail.com TKs plan check review transmittal is to notify you of clearance by: LAND DEVELOPMENT ENGINEERING DIVISION Final Inspe ction by the Construction & Inspection Division is required: Yes No X I'or statLLS frora a division not marked below, please call 760'-6o2-27i9 This plan check review is NCX'COMPLETE Items missing or incorrect are listed onthe attached checklist. Please resubmit amended plans as required. LAND DEVELOPMENT ENG. 760-602-2750 \ 1 \/ linda Ontiveros /\. 760 -602-2773 Linda.Ontiveros@carlsbadca.gov Remarks: impact fees assessed on original building permit, CB061884. CITY OF CARLSBAD PLANNING DIVISION BUILDING PLAN CHECK APPROVAL P-29 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.eov DATE: 6-2-15 PROJECTNAME: PROJECTID: PUN CHECK NO: CB 15-1646 SET#: 1 ADDRESS: 1281 Carlsbad Village Dr APN: 156-190-51 ^ This plan check review is complete and has been APPROVED by the Planning Division. By: Chris Sexton A Final Inspection by the Planning Division is required • Yes ^ No Vou may also have corrections from one or more of the divisions Hsted below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. • This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check APPROVAL has been sent to: gfpackard@gmail.com For questions or clarifications on the attached checklist please contact the foliowing reviewer as marked: PLANNING 760-602-4610 ENGINEERING 760-602-2750 FIRE PREVENTION 760-602-4665 X Chris Sexton 760-602-4624 Chrls.Sexton@carlsbadca.fiov Ct- Chris Glassen 760-602-2784 iristODlier.Glassen@carlsbadca.gov I 1 Greg Ryan 760-602-4663 Gregorv.Rvan@carlsbadca.gov 1 1 Gina Ruiz 760-602-4675 Gina.Rulz@carlsbadca.fiov QJ ValRay IVIarshall 760-602-2741 ValRav.IVlarshall@carlsbadca.gov Cindy Wong 760-602-4662 Cvnthia.Wong@carlsbadca.gov • 1 Linda Ontiveros 760-602-2773 Jnda.Ontiveros@carlsbadca.gov Dominic Fieri 760-602-4664 Dominic.Fieri@carlsbadca.gov Remarks: ^ CITY OF PLAN CHECK Community & Economic ^ CITY OF REVIEW Development Department 1635 Faraday Avenue CARLSBAD TRANSMITTAL Carlsbad CA 92008 www.carlsbadca.gov DATE: 06-02-2015 PROJECT NAME: Packard Dental Group PROJECT ID: PLAN CHECK NO: CB15-1646 SET#: I ADDRESS: 1281 CVD APN: 156-190-510 • This pl^jiiilieok review is complete and has been APPROVED by the Flre Division. ly: R. Metz AFmaTTnspeGtion by the Flre Division is required • Yes ^ No This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check Comments have been sent to You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should Include corrections from all divisions. For questions or clarifications on the attached checklist please contact the following reviewer as marked: iMWEERINGI FIREfmSNTKMI 1 1 Chris Sexton 760-602-4624 Chris.Sexton@carlsbadca.fiov 1 1 Kathleen Lawrence 760-602-2741 Kathleen.Lawrence@carlsbadca:gov 1 1 Greg Ryan 760-602-4663 GregorY.Ryan@carlsbaclca.gov 1 1 Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov 1 1 Linda Ontiveros 760-602-2773 Linda.Ontiveros@carlsbadca.gov Q] Cindy Wong 760-602-4662 Cvnthia.Wong@carlsbadca.fiov • • 1 1 Dominic Fieri 760-602-4664 Dominic.Fieri@carlsbadca.gov Remarks: **APPROVED: THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUEANCE OF A BUILDING PERMIT. THIS APPROVAL IS SUBJECT TO FIELD INSPECTIONS, ANY REQUIRED TESTS, FIRE DEPARTIVIENT NOTATIONS, CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND REGUUTIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW. Page 1 of 1 Carlsbad Fire Department BLDG. DEPT COPY Plan Review Requirements Category: TI, COMM Date of Report: 06-02-2015 Reviewed by: Name: PACKARD CONSTRUCTION, GARTH —^ Address: 2057 CHESTNUT AV CARLSBAD, CA 92008 Permit #: CBI51646 Job Name: PACKARD DENTAL: 2,701 OFF (MED Job Address: 1281 CARLSBAD VILLAGE DR CBAD COMPLETE The item you have submitted for review is complete. Please review carefully all comments attached. Conditions: SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY RECORD ID # HHMBP # BP DATE / Business Name ness name . Business Contact Telephone # -—^ . . y state Zip Code Mailing Address (/Mxjiess ^ M City , , ^ vjL<r ^^-a^ /he ra^AAcJ state Zip Code Plan File# Project Contact Telephone # The foliowing quosUons rapreMnt tlw faculty's acUvlttM, NOT tho spocific proioct doscription. PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects within tho Citv of San Dleaot: Indicate by circling the item, whether your business wil use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan sutxnittal. Occupancy i^ng: Facility's Square Footage (induding proposed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 4. Flammable Solids 8. Unstable Reactives 12. Radioactives 13. Corrosives 14. Other Health Hazards 15. None of These. PART II: 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, 5500 Overiand Avenue, Suite 170, San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED. YEa- NO 1. 2. 3. 4. 5. 6. 7. 8. % EZ • • • • • • Project Completion Date: Expected Date of Occupancy: (for new construction or remodeling projects) Is your business listed on tlie reverse side of this fomi? (check all that apply). • n^Wili your business dispose of Hazardous Substances or Medical Waste in any amount? 0^ Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? M WiH your business store or handle carcinogens/reproductive toxins in arty quantity? wn your business use an existing or install an underground storage tank? • wai your business store or handle Regulated Substances (CalARP)? Q^Wdl your business use or install a Hazardous Waste Tank System (Title 22, Artk:le 10)? WW your business store petroleum in tanks or containers at your f^lity with a total ^cility storage capacity equal to or greater than 1,320 gallons? (Califomia's Aboveground Petroleum Storage Act). • CalARP Exempt I Date Initials • CalARP Required / Date Initials • CalARP Complete I Date Initials PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): If the answer to Questions #2-5 is yes, applnant must contact the APCD at 10124 OM Grove Road, San Diego, CA 92131 of a building or demolition permit. If the answer to questions #4 or #5 is yes, applicant must also submi woridng days prior to commencing demolition or renovatioa (Some residential projects may be exempt ftptn more infonnation.) iiiBHiim m\ hniniif in nn nr ti^ff jtnswBr to anv of the 1649 or telephone (858) 586-2600 prior to tneiissuance YES • • • • NO. ET: an asbestos notiflcMipfiff«rm to the APCD a least 10 the notification MuiMments. Contact the |^PCD for Has a survey been perfonned to determine the presence of Asbestos Containing Materit Is? Will the subject facility or construction activities include operations or equipment that em I or are capable of emitting an air cpntaminantp (See the APCD factsheet at httD://www.sdaDcd.orq/info/facts/pemiits.Ddf. and the list of typical e ^uipment remigriq aw ABCD JUN 08 REC'D of this from. Contact APCD if you have any questfons). • (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,0t ^^(Search the Califomia School Directory at hltp.7/www.cde.ca.aov/re/sd/ for public and pri El .^Vill there be renovation that involves handling of any friable asbestos materials, or disturbing any materia inai contains no Briefly desaibe business activities: Briefly describe proposed project: 1 dadare under pen&i^of penury that to the best of my knowledge and be|i6f tl^ e i^pj|iis^^ad^erein^ap true and correct. Name of Owner or Authorized Agent Signature 5j,Owner or Authorized Agent Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION.. BY: DATE: EXEMPT OR NO FURTHER INFORMAnON RECIUIRED RELEASED FOR BULDING PERMfr BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY APCD COUNTY-HMD APCD COUNTY-HMD APCD l' *A staiflBg^th^i|ayx'antifcfetempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may stiH apply. HM-9171 (03/14) County of San Diego- DEH - Hazanlous Materials Division INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date . /7 \ J/) Z' Business Name /^LcJte^ Jje-tCM^ Q^Tj^y Street Address /XB/ C&^ /iUJl i/i^fi^ A- C^f<l>dL£ Email Address PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) Check all below that are present at your facility: Acid Cleaning Ink Manufacturing Nutritional Supplement/ Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining/Milling Painting / Finishing Battery IVIanufacturing Manufacturing Paint Manufacturing Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i.e. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting / Fonning Pesticide Manufacturing / Car Wash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification Electroplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameling Electrical Component Anodizing Power Generation Manufacturing Coating (i.e. phosphating) Print Shop Fertilizer Manufacturing Chemical Etching / Milling Research and Development Film / X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap / Detergent Manufacturing Industrial Laundry Waste Treatment / Storage SIC Code(s) (if known): Brief description of business activities (Production / Manufacturing Operations):, Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal / day): List hazardous wastes generated (type / volume): Date operation began/or will begin at this location: Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes No If yes, when: Title Site Contact Signature, ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941 FAX: (760)476-9852 Phone No. 760-^9-'^/07 PLUMBING, Development Services <^'^\ ELECTRICAL, Building Division CITY OF MECHANICAL ""'"'^TeoTiTil r^ARI ^RAP) WORKSHEET www.carlsbadca.gov ^-/^IALOD/AL/ B-18 Building^carlsbadca.gov Project Address: Permit No.: Informotun provided below refers to work being done on the above mentioned permit only. This form must be compieted and returned fo fhe Building Division before Hie permit can be issued. Building Dept. Fax: (760) 602-8558 Number of new or relocated fixtures, traps, or floor drains. 1$ New building sewer line? Ves No Numt>er of new roof drains? Install/aKer water line? ^ Number of new water heaters? I Number of new, relocated or replaced gas outlets?.. MA. ~ Number of new hose bibs?... 4^. 4tL Residenticd Permitt: New/expancJed service: Number of new amps: Minor Remodel emfy: Ves No Commeracd/lndustridl: Tenant Improv/ement: Number of existing amps invohedin this prcyeet: Number of new amps im/ohedin tha proiect: New Construction: Amps per Panel: Single Phase Number of new amperes. Three Phase. Number of new amperes_ Three Phase 480 Number of new amperes Number of new fumaces, A/C, or heat pumps? New or relocated duct worb? y<fVes ^ j No Number of new fireplaces? A//d Number of new exhaust fans? Relocate/install vent? . Number of new exhaust hoods? Number of new boilers or compressors? Number of HP B-18 Page 1 of 1 Rev. 03/09 CB151646 1281 (MRLSBAD VILLAGEDR fll 5 /JTu Final Inspection required by: a Plan a CM&I SW •iSSUEIjl) Approved yV^ PLANNING ENGINEERING FIRE Expedite? y^'y^ DIGITAL FILES Required? Y N HazMat \ _ APCD Health //I//? Forms/Fees Ha2HealthAPCD Stormwater Special Inspection CFD: Y C3J) LandUse; Density; ImpArea; PFF: Comments Building Planning Engineering Fire