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1287 CARLSBAD VILLAGE DR; ; CB161605; Permit
City of Carlsbad 05-25-2016 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB161605 Building Inspection Request Line (760) 602-2725 Job Address: 1287 CARLSBAD VILLAGE DR CBAD Permit Type: Tl Sub Type: COMM Status: ISSUED Applied: 04/27/2016 Entered By: SLE Parcel No: 1561907007 Lot#: 0 Valuation: $115,934.00 Construction Type: 58 Occupancy Group: Reference# Plan Approved: 05/25/2016 Issued: 05/25/2016 Inspect Area Plan Check #: Project Title: CARSLBADDS PEDIATRIC SMILES: 1,820 SF SHELL TO DENTAL OFFICE Applicant: Owner: KUI TAN DESIGN TSAI CHIN-ZONG&CHIN-CHIANG 11849 RAMSDELL CT SAN DIEGO CA 92131-3611 619-757-8877 Building Permit Add'l Building Permit Fee Plan Check Add'l Building Permit Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Fire Expedidted Plan Review Total Fees: $5,528.67 $682.86 $0.00 $478.00 $0.00 $0.00 $32.46 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $0.00 Date: 1521 VIRGINIA RD SAN MARINO CA 91108 Meter Size Add'l Reel. Water Con. Fee Meter Fee SDCWA Fee CFD Payoff Fee PFF (3105540) PFF (4305540) License Tax (3104193) License Tax (4304193) Traffic Impact Fee (3105541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee Green Bldg Standards Plan Chk TOTAL PERMIT FEES $5,528.67 Balance Due: Clearance: $0.00 $0.00 $0.00 $0.00 $2,110.00 $1,947.69 $0.00 $0.00 $0.00 $0.00 $115.00 $89.00 $68.66 $0.00 $0.00 $0.00 $0.00 ?? ?? $5,528.67 $0.00 ciyw: pqa:i irdl.das tre "I ·c:r~· ri tees, da:icai01S, resavai01S, or cther eccdials ImBler mla::tiwly re'ened to as ''fees! ." Yoo ro days fran tre date !lis pemit v.as issl.ed to prd:est irrpositia1 ri these fees!ea:iiCJlS. If }W prctest them }W m.st fdiON tre prctest pocaiJes set forth in GMmrert Code Sec:tial Eam:a), a"d file tre prctest a"d <rrf cther ra:,..ira:l irlaTl""aia1 wth treaty l'v1rlcger for JJOOSSSirg in amdaw:eW!h Ca1sl:a:l Mridpal CodeSediCJ13.32.0ll FaiiLretotirrelyfdiONthat (l"CXBirewll l:a' <rrJSlb:a:f.stlega !diontoattOO<, reMe.v, set aside. \tid, or ~ their irrposition Yoo ae hefebt R..Rll-ER I'OTIR8:> that yw: rigt to prdest tre ~oo fees!ea:iicrs !XES IIDr PPPl... Yto WiJ.a' a"d !iSNf!r CXJTBdiCJl fees a"d a:pedty cha-ges, nor panrg, zoirg, ga:irg or cther sinila-~icaiCJl JJOOSSSirg a SE!Mca fees in CXJTBdiCJl wth !lis pqeci N:R !XES IT PPPL Y to <rrf . . . . 'nil . y,tj lini . . . . THE FOLLOWING APPROVALS REQUIRED PRIQBITO PERMI'ti)SUANCE: D PLANNUIUI D ENGINf:DING {'city of Building Permit Application Plan Check No. C£) \ LD \ lo05 1635 Faraday Ave., Carisbad, CA 92008 Est. Value \Po.~ ~4-- Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Deposit email: building@carlsbadca.gov www.carlsbadca.gov Date '-\ -ZI-llD SWPPP JOB ADDRESS 1287 CARLSBAD VILLAGE DR. SUiftf/SPIWI:I{UIIID rPN 156 190 53 54 --- CT/PROJECT f I LOT# rHA5Et r OF UNm; r St:UROOM::s I !i~~THROOMS ITUIIIIT --NAME JCONSTR. TYPE I occ. GROUP ~RLSBADDS PEDIATRIC SMILI DESCRIPTION OF WORK: Include Squ•re Feet of Aw.ot.cl AIN(a) TENANT IMPROVEMENT, MECHANICAL, ELECTRICAL, PLUMBING, DUCT WORK & PARTITION WALLS 1820 SF EXISTING USE I PROPOSED USE rARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE r'R CONDITIONING ~riRESPRINKLERS VACANT DENTAL OFFICE vESD-NO vESDNoD v~Na APPLICANT NAME KUI TAN DESIGN PROPERTY OWNER NAME DR. LINH & JAMES TSAI ADDRESS 11849 RAMSDELL CT ADDRESS 1285 CARLSBAD VILLAGE DR. CITY SAN DIEGO STATE CA ZIP 92131 CITY CARLSBAD STATE CA ZIP 92008 PHONE 619-757-8877 rAX PHONE 760-730-3456 I FAX EMAIL KUI@KUITANDESIGN.COM EMAIL TSAIJI@HOTMAIL.COM DESIGN PROFESSIONAL KUI TAN DESIGN CONTRACTOR BUS. NAME UTGARD CONSTRUCTION INC. ADDRESS 11849 RAMSDELL CT ADDRESS 12225 WORLD TRADE DR. SUITE L CITY SAN DIEGO STATE CA ZIP 92131 CITY SAN DIEGO STATE CA ZIP 92128 PHONE 619-757-8877 rAX PHONE 858-67 4-8040 rAX EMAIL KUI@KUITANDESIGN.COM EMAIL STEPHANIE@UTGARDCONSTRUCTION.COM ISTATEUC.II STATELIC.I !CLASS B rrzz:q ~4'---l 563379 (Sec. 7031.5 Bus~ness and Professions Code: Any City or County which reqUires a perm1t to construct. alter. 1m prove. demolish or repa1r any structure. pnor to 1ts 1ssuance. also requ1res the applicant for such permit to file a signed statement ttiat he is licensed pursuant to the provisions of the Contractor's License Law /Chapter 9. commendinl! with Section 7000 of Division 3 of the Business and Professions Code} or fhat he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicanfl'or a permit subjects the applicant to a civil penalty of not more than fiVe hundred dollars {$500}). WORKERS' COMPENSATION Workn' COmpeneallon Decllrallon: I hereby affirm under penalty of perfil)' one ct the following declarai/Ons: D I hmtllld wllllllllrdlln 1 certlllcate of conaent 1111 lllf-insure ror workeiS' compensation as provided by Section 3700 rA the Labor Code, for the performance of the work for which this pennn is issued. ~ I hmt and will mllnfllln work .. ' ill!'!ll-~. as ~ired !!LS!!_Ction 3700 of ll-1 Labor Code, for the performance of the work for which this ~rt is issued. My work91S' compensation insurance carrier and policy mrnberare: Insurance Co. PAul DULE INSUKANCE AuENCY Policy No. 9083553·2U16 Expiration Date 1/1/17 ~section need nct ba completed if the pennrt is for one hundred dollars ($100) or less. U C.unc:.te of Exemption: I certify that in the performance of the work ror which this pennrt is issued, I shaH not erJlliO}' any person in any manner so as to bacan9 Slbject to the WorkeiS' Ccmpensation Laws of California. WARNING: Failure 1111 sec:ure work .. ' c:ompensat1on CliiVWige Ia unllwful, and shall subject an employa' 1111 Cllmlnll panaltlesand clvlllnes up 1111 0111 hundred thousand dollll'l (&100,000), In addition to the cost of compenutlon, clemages • Section 3706 of the Labor code, lntlrest llld 111Dm8(1 r-. 65 CONTRACTOR SIGNATURE pV'\1\ I hereby affirm that I am elf9mpt from Contrador's Uce!IS9 Law for the following reason: 0 I, as owner of the prqJerty or my emplcyees wrth wages as their sole canpensation, 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 prcperty who builds or improves thereon, and who does such work himself or thi'OlJ!jl his own 911lpk7Jees, provided that such improvements are not intended or offered for sale. If, however, the blildng or improvemenl is sold within one year of c:ornpetion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). D I, as owner rA the prqlerty, am exclusively contracting wrth lioansed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's Ucense Law does not apply to an owner of property who blilds or inproves thereon, and contracts for such projects wrth contractor(s) licensed puiSUant to the Contractor's Ucense Law). D I am axertljj under Section Business and Professions Code tor this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Oves Do 2. I (have I have rd) signed an lWication for a building pennrt for the prq:JOSed work. 3. I have contracted with the following p91SDn (firm) to provide the proposed construction (include name octctess I phone I contractors' license mmbar): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, sLpeiVise and provide the major work (include name I acttress I phone I contractors' license nunbar): 5. I will provide some of the work, but I have contracted (hired} the folla.ving persons to provide the work indcated (include name I address I phone I type of work): 65 PROPERTY OWNER SIGNATURE DA'Il; COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Acr? (] Yes (] No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? (] Yes Cl No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? (] Yes Cl No IF ANY OF THE ANSWERS ARE YES, A FINAL 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. I certify that I have read the application and state that the abolle ini:ltmation Is correct and that the lnfonnation on the plans Is accurale.l agree to comply with all City ordinances and State lav4 relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property br inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSEVID AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA perm~ is required br excavations over 5'0' deep and demoliOOn or construction of structures over 3 sbies i1 height. EXPIRATION: Every permtt issued by the aJilding Oflk:ial under the provisilns of this Code shall expire by lin~tion and berome null and vokl ~the building or v.ork authorized by such is not rommenoed .,;thin 180 days from the dale of such perrntt or if the building or v.ork authorized by such permtt is suspended or abandoned at any time after the v.ork is cornmenoed for a period of 180 106.4.4 Uniform aJilding Code). Af APPLICANT'S SIGNATURE DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail tihe completed form to City of Cartsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. EMAIL DELIVERY OPTIONS PICK UP: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) MAIL TO: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) MAIL/ FAX TO OTHER:----------------- AS APPLICANT'S SIGNATURE (Office Use Only) CA o ASSOCIATEDCB#•------------ o NO CHANGE IN USE/ NO CONSTRUCTION o CHANGE OF USE/ NO CONSTRUCTION DATE Inspection List Permit#: CB161605 Type: Tl Date Inspection Item 09/28/2016 89 Final Combo 09/28/2016 89 Final Combo 09/16/2016 39 Final Electrical 09/16/2016 39 Final Electrical 08/04/2016 85 T-Bar 07/12/2016 17 Interior Lath/Drywall 07/05/2016 84 Rough Combo 06/09/2016 21 Underground/Under Floor 06/09/2016 31 Underground/Conduit-Wirin Thursday, September 29, 2016 COMM Inspector Act Rl py AP Rl PB AP py PA PY AP py AP py AP py AP CARSLBADDS PEDIATRIC SMILES: 1,820 SF SHELL TO DENTAL OFFICE Comments NRR METER RELEASE conduit only Page 1 of 1 EsGil Corporation In ll'artnersliip witli qo'flernment for (]Jui(aino Safety DATE: 05/25/2016 JURISDICTION: Carlsbad PLAN CHECK NO.: CB16-1605 PROJECT ADDRESS: 1287 Carlsbad Village Dr. PROJECT NAME: Carlsbad Pediatric Smiles TI SET: II Cl APPLICANT Cl JURIS. Cl PLAN REVIEWER Cl FILE ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: [gl EsGil Corporation staff did not advise the applicant that the plan check has been completed. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Email: Mail Telephone Fax In Person D REMARKS: By: John Le Vey Enclosures: EsGil Corporation 0 GA 0 EJ 0 MB 0 PC 05/25/2016 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 EsGil Corporation In q!artnersf&ip witf& government for <BuiCtfing Safety DATE: 05/09/2016 JURISDICTION: Carlsbad PLAN CHECK NO.: CB16-1605 PROJECT ADDRESS: 1287 Carlsbad Village Dr. PROJECT NAME: Carlsbad Pediatric Smiles TI SET: I ~3fPLICANT ~~URIS. .. Q PLAN REVIEWER Q FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed c~eck list and should be corrected and resubmitted for a complete recheck. C8J The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: D EsGil Corporation staff did not advise the applicant that the plan check has been completed. C8J EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Kui Tan Design Telephone#: 619-757-8877 ~Date c~acted:D /4 (byY'U Email: kui@kuitandesign.com 't;7Mail /Telephone Fax In Person D REMARKS: By: John Le Vey EsGil Corporation D GA D EJ D MB D PC Enclosures: 04/28/2016 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 Carlsbad CB16-1605 05]09/2016 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: CB16-1605 OCCUPANCY: B TYPE OF CONSTRUCTION: VB ALLOWABLE FLOOR AREA: SPRINKLERS?: Yes REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 04/27/2016 DATE INITIAL PLAN REVIEW COMPLETED: 05/09/2016 FOREWORD (PLEASE READ): JURISDICTION: Carlsbad USE: Dental office ACTUAL AREA: 1,820 STORIES: 1 HEIGHT: unknown OCCUPANT LOAD: 20 DATE PLANS RECEIVED BY ESGIL CORPORATION: 04/28/2016 PLAN REVIEWER: John LeVey This plan review is limited to the technical requirements contained in the California version of the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 2013 CBC, which adopts the 2012 IBC. The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of the 2012 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list when you submit the revised plans. Carlsbad CB 16-1605 . 05/09/2016 Please make all corrections, as requested in the correction list. Submit FOUR new complete sets of plans for commercial/industrial projects (THREE sets of plans for residential projects). For expeditious processing, corrected sets can be submitted in one of two ways: 1. Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760) 602-2700. The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments. 2. Bring TWO corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil Corporation is complete. 1. Please provide the UL listing and manufacturer's installation information for all new equipment to be installed. Show all electrical requirements, plumbing requirements, exhaust or mechanical requirements, operational weight, anchorage and seismic restraints if required etc. Section 1 07.2. in particular the compressor and the vacuum pump 2. Please provide the required plumbing waste venting to comply with the required aggregated area of the largest building sewer per the CPC section 904.0 3. Please provide any require backflow prevention to the potable water system per the CPC table 603.2 4. Please clearly show the locations of the vacuum and the compressor intake and exhaust termination on the roof plan to comply with the CPC section 1324.4 and 1325.3. 10 feet from any intake into the building 5. Hot water supplied to a public use lavatory is limited to a maximum temperature potential of 120 degrees by a device that conforms to ASSE 1 070 or CSA B125.3; please provide the manufacturer's listing showing compliance. Detail how this temperature limitation is achieved. The water heater thermostat may not be used for compliance with this Code section. UPC 421.2 To speed up the review process, note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. Please indicate here if any changes have been made to the plans that are not a result of corrections from this list. If there are other changes, please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate: 0 Yes 0 No The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review for your project. If you have any questions regarding these plan review items, please contact John Le Vey at Esgil Corporation. Thank you. Carlsbad CB 16-1605 ' 05/09/2016 C~rlsbad CB 16-1605 05/09/2016 [DO NOT PAY-THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: CB16-1605 PREPARED BY: John LeVey DATE: 05/09/2016 BUILDING ADDRESS: 1287 Carlsbad Village Dr. BUILDING OCCUPANCY: B BUILDING AREA Valuation PORTION (Sq. Ft.) Multiplier Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance Bldg. Permit Fee by Ordinance Plan Check Fee by Ordinance Type of Review: 0 Complete Review 0 Repetitive Fee 3 Repeats Comments: D Other D Hourly EsGil Fee Reg. VALUE Mod. D Structural Only 1--------11 Hr. @ • Sheet of ($) 115,934 115,934 $682.861 $443.861 $382.401 macvalue.doc + «~ ~ CITY OF CARLSBAD PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www.carlsbadca.gov DATE: 04/28/20HJROJECT NAME: CARLSBAD PEDIATRIC SMILE PROJECTID:CB161605 PLAN CHECK NO: 1 VALUATION: $115,934 SET#:1 ADDRESS: 1287 CARLSBAD VILLAGE DR APN: 1561905354 APPLICANT CONTACT: KUI@KUITANDESIGN.COM /~A olb \ '\9-~ tP Tlis plan check review transmittal is to notify you of clearance by: LAND DEVELOPl\llENT ENGINEERING DIVISION Final Impe ction by the Construction & Inspection Division is required: Yes No X ~ For status from a division not marked below, please call 760-602-2719 This plan check review is N<I'COMPLETE Items missing or incorrect are listed on the attached checklist. Please resubmit arne nded plans as required. Kathleen Lawrence 760-602-27 41 760-602-2773 Unda.Ontiveros@Carlsbadca.gov VALRAY MARSHALL 760-602-27 41 VALRA Y.MARSHALL@CARLSBADCA.GOV Remarks: BUILDING FEE'D AS MEDICAL. EXISTING MEDICAL COMPLEX CB061885. NO IMPACT FEE'S *****PLEASE VERIFY WHAT SIZE WATER METER WILL BE NEEDED****** FEE'S ASSESSED WILL BE WATER METER FEE'S ONLY FIWM LDE «~ ~ 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: 4/28/2016 PROJECT NAME: TENANT IMPROVEMENT PROJECT ID: PLAN CHECK NO: CB161605 SET#: 1 ADDRESS: 1287 CARLSBAD VILLAGE DR APN: [gl This plan check review is complete and has been APPROVED by the PLANNING Division. · By: VERONICA MORONES A Final Inspection by the PLANNING Division is required 0 Yes [gl No 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. D 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: KUI@KUITANDESIGN.COM For questions or clarifications on the attached checklist please contact the following reviewer as marked: D Chris Sexton D Chris Glassen D Greg Ryan 76Q-602-4624 760-602-2784 760-602-4663 Chris.Sexton@carlsbadca.gov Christopher.Giassen@carlsbadca.gov Gregory.Ryan@carlsbadca.gov D Gina Ruiz D VaiRay Marshall D Cindy Wong 760-602-4675 760-602-27 41 760-602-4662 Gina.Ruiz@carlsbadca.gov Val Ray. Marshall@carlsbadca.gov Cynthia.Wong@carlsbadca.gov ~ Veronica Morones D Linda Ontiveros D Dominic Fieri 760-602-4619 760-602-2773 760-602-4664 Veronica.Moron~s@cj;!rlsb"dca.gov Linda.Ontiveros@carlsbadca.gov Dominic.Fieri@carlsbadca.gov Remarks: TENANT IMPROVEMENT OF MECHANICAL, ELECTRICAL, PLUMBING, DUCT WORK AND WALL PARTITIONS. NO CHANGE IN PARKING/BLDG SQ FT. ._][ ·--------------~ Shay Even From: Sent: To: Cc: Subject: Good morning Kui, Amber Ressmer Wednesday, May 04, 2016 10:19 AM kui@kuitandesign.com Building CB161605 Carlsbad Pediatric Smiles CB161605 Carlsbad Pediatric Smiles plan does not require Carlsbad Fire Department fire plan review. Thank you, Amber Ca!Yof Carlsbad Amber Ressmer Administrative Assistant Fire Prevention City of Carlsbad 1635 Faraday Ave Carlsbad, CA 92008-7314 www.carlsbadca.gov p 760-602-4665 I F 760-602-8561 1 BUILDING ENERGY ANALYSIS REPORT PROJECT: CARLSBAD PEDIATRIC SMILES 1287 CARSBAD VILLAGE DR. CARLSBAD, CA 92008 Project Designer: Report Prepared by: HADI MAHZARI ENERGY CONSULTING GROUP 8015 BALBOA AVE. SAN DIEGO, CA 92111 858-268-0660 Job Number: Date~ RECEIVED APR 2 7 ZOl6 CITY OF CARLSBAD BUILDING DIVISION 1287 CARLSBAD VILLAGE 4/14/20 DR 1561907007 Tl The EnergyPro computer program has been used to perform the calculations s1 authorized by the California Energy Commission for use with both the ResidE This program developed by EnergySo1 EnefJJYPro 6. 7 by EnergySoft User Number: 2984 04-27-2016 CB161605 TABLE OF CONTENTS Cover Page 1 Table of Contents 2 Form PRF-01-E Certificate of Compliance 3 EnergyPro 6.7 by EnergySoft Job Number: 10: User Number: 2984 Project Name: Project NRCC-PRF-01-E Page 1 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml A. PROJECT GENERAL INFORMATION 1. Project Location (city) CARLSBAD 7. #of dwelling units 0 2. CAZip Code 92008 8. Standards Version Compliance2015 3. Climate Zone 7 9. Compliance Software (version) EnergyPro 6. 7 4. Total Conditioned Floor Area 1,820 ft2 10. Building Orientation (deg) (N) 0 deg 5. Total Unconditioned Floor Area 0 ft2 11. Permitted Scope of Work ExistingAiteration 6. #of Stories (Habitable Above Grade) 1 12 Building Type(s) Nonresidential I B. COMPLIANCE RESULTS FOR PERFORMANCE COMPONENTS 1§ 140.1 ! BUILDING COMPLIES 1. Energy Component 2. Standard Design (TDV) 3. Proposed Design (TDV) 4. Compliance Margin (TDV) 5. Percent Better than Standard Space Heating 0.6 0.8 -0.2 -33.3% Space Cooling 91.9 48.9 43.0 46.8% Indoor Fans 138.1 69.9 68.2 49.4% Heat Rejection -------- Pumps & Misc. -------- Domestic Hot Water -------- Indoor Lighting 43.6 43.6 --0.0% COMPLIANCE TOTAL 274.2 163.2 111.0 40.5% Receptacle 112.8 112.8 0.0 0.0% Process 112.8 112.8 0.0 0.0% Process Ltg -------- TOTAL 499.8 388.8 111.0 22.2% CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 2 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40,Thu,Apr14,2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml C. PRIORITY PLAN CHECK/INSPECTION ITEMS (in order of highest to lowest TDV energy savings) 1st Indoor Fans: Check envelope and mechanical 2nd Space Cooling: Check envelope and mechanical 3rd Heat Rejection: Check envelope and mechanical 4th Pumps & Misc.: Check mechanical 5th Domestic Hot Water: Check mechanical 6th Indoor Lighting: Check lighting 7th I Space Heating: Check envelope and mechanical D. EXCEPTIONAL CONDITIONS Compliance Margin By Energy Component (from Table B column 4) Indoor Fans Space Cooling Heat Rejection Pumps & Misc. Domestic Hot Water Indoor Lighting Space Heating The building does not include service water heating. Verify that service water heating is not required and is not included in the design. E. HERS VERIFICATION This Section Does Not Apply F. ADDITIONAL REMARKS Standard Building (Compliance) CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 3 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml G. COMPLIANCE PATH & CERTIFICATE OF COMPLIANCE SUMMARY Identify which building components use the performance or prescriptive path for compliance. "NA"= not in project For components that utilize the performance path, indicate the sheet number that includes mandatory notes on plans. Building Component Compliance Path Compliance Forms (required for submittal} Location of Mandatory Notes on Plans D Performance NRCC-PRF-ENV-DETAILS (section of the NRCC-PRF-01-E) Envelope D Prescriptive NRCC-ENV-01 I 02 I 03/ 04/ 05/ 06-E 181 NA 181 Performance NRCC-PRF-MCH-DETAILS (section of the NRCC-PRF-01-E) Mechanical D Prescriptive NRCC-MCH-01/ 02/03 I 04 I 05/06/ 07-E D NA D Performance NRCC-PRF-PLB-DETAILS (section of the NRCC-PRF-01-E) I Domestic Hot Water D Prescriptive NRCC-PLB-01-E I I 181 NA ' D Performance NRCC-PRF-LTI-DETAILS (section of the NRCC-PRF-01-E) Lighting (Indoor Conditioned) D Prescriptive NRCC-LTI-01/ 02/ 03/ 04/ 05-E 181 NA D Performance 52 (section of the NRCC-PRF-01-E) Covered Process: D Prescriptive NRCC-PRC-01/ 03-E Commercial Kitchens 181 NA D Performance 53 (section of the NRCC-PRF-01-E) Covered Process: D Prescriptive NRCC-PRC-01/ 04-E Computer Rooms 181 NA D Performance 54 (section of the NRCC-PRF-01-E) Covered Process: D Prescriptive NRCC-PRC-011 09-E Laboratory Exhaust 181 NA -------- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 4 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40,Thu,Apr14,2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml ------------- G. COMPLIANCE PATH & CERTIFICATE OF COMPLIANCE SUMMARY The following building components are only eligible for prescriptive compliance. Indicate which are The following building components may have mandatory requirements per Part 6. Indicate relevant to the project. which are relevant to the project. Yes NA Prescriptive Requirement Compliance Forms Yes NA Mandatory Requirement Compliance Forms Lighting (Indoor Commissioning: §120.8 D ~ NRCC-LTI-01 I 02 I 03 I 04 I 05-E D ~ Simple Systems NRCC-CXR-01 I 02 I 03 I 05-E Unconditioned) §140.6 D 181 Complex Systems NRCC-CXR-01 I 02 I 04 I 05-E D ~ Lighting (Outdoor) §140.7 NRCC-LT0-01 I 02 I 03-E D 181 Electrical: §130.5 NRCC-ELC-01-E D 181 Lighting (Sign) §140.8 NRCC-LTS-01-E D 181 Solar Ready: §110.10 NRCC-SRA-01 I 02-E Covere~ Process: §120.6 NRCC-PRC-01-E D 181 Parking Garage NRCC-PRC-02-E I D 181 Solar Thermal Water D 181 Commercial Refrigeration NRCC-PRC-05-E Heating: §140.5 NRCC-STH-01-E D 181 Warehouse Refrigeration NRCC-PRC-06107 108-E D 181 Compressed Air NRCC-PRC-10-E I D 181 Process Boilers NRCC-PRC-11-E ----------------------L__ CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 5 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml H. CERTIFICATE OF INSTALLATION, CERTIFICATE OF ACCEPTANCE & CERTIFICATE OF VERIFICATION SUMMARY (NRCI/NRCA/NRCV) - Documentation Author to indicate which Certificates must be submitted for the features to be recognized for compliance Confirmed (Retain copies and verify forms are completed and signed to post in field for Field Inspector to verify). See Tables G. and H. in MCH and LTI Details Sections for Acceptance Tests and forms by equipment. Building Component Compliance Forms (required for submittal} Pass Fail D NRCI-ENV-01-E-For all buildings D D Envelope D NRCA-ENV-02-F-NFRC label verification for fenestration D D I2S:I NRCI-MCH-01-E-For all buildings with Mechanical Systems D D I2S:I NRCA-MCH-02-A-Outdoor Air D D I2S:I NRCA-MCH-03-A-Constant Volume Single Zone HVAC D D D NRCA-MCH-04-H-Air Distribution Duct Leakage D D D NRCA-MCH-05-A~ Air Economizer Controls D D D NRCA-MCH-06-A-Demand Control Ventilation D D D NRCA-MCH-07-A-Supply Fan Variable Flow Controls D D 0 NRCA-MCH-08-A-Valve Leakage Test D D D N RCA-MCH-09-A-Supply Water Temp Reset Controls D D Mechanical D NRCA-MCH-10-A-Hydronic System Variable Flow Controls D D D N RCA-MCH-11-A-Auto Demand Shed Controls D D D NRCA-MCH-12-A-Packaged Direct Expansion Units D D D NRCA-MCH-13-A-Air Handling Units and Zone Terminal Units D D D NRCA-MCH-14-A-Distributed Energy Storage D D 0 NRCA-MCH-15-A-Thermal Energy Storage D D D NRCA-MCH-16-A-Supply Air Temp Reset Controls D D D N RCA-MCH-17-A-Condensate Water Temp Reset Controls D D D NRCA-MCH-18-A-Energy Management Controls Systems D D D NRCV-MCH-04-H-Duct Leakage Test D D ----------------------- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 6 of 17 ' Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu,Apr14,2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml ------- H. CERTIFICATE OF INSTALLATION, CERTIFICATE OF ACCEPTANCE & CERTIFICATE OF VERIFICATION SUMMARY (NRCI/NRCA/NRCV) - Documentation Author to indicate which Certificates must be submitted for the features to be recognized for compliance Confirmed (Retain copies and verify forms are completed and signed to post in field for Field Inspector to verify). See Tables G. and H. in MCH and LTI Details Sections for Acceptance Tests and forms by equipment. Building Component Compliance Forms (required for submittal} Pass Fail 0 NRCI-PLB-01-E-For all buildings with Plumbing Systems 0 0 0 NRCI-PLB-02-E-required on central systems in high-rise residential, hotel/motel application. 0 0 0 NRCI-PLB-03-E-Single dwelling unit systems in high-rise residential, hotel/motel application. 0 0 0 NRCI-PLB-21-E-HERS verified central systems in high-rise residential, hotel/motel application. 0 0 Plumbing 0 NRCI-PLB-22-E-HERS verified single dwelling unit systems in high-rise residential, hotel/motel application. 0 0 0 NRCV-PLB-21-H-HERS verified central systems in high-rise residential, hotel/motel application. 0 0 0 NRCV-PLB-22-H -HERS verified single dwelling unit systems in high-rise residential, hotel/motel application. 0 0 0 NRCI-STH-01-E-Any solar water heating 0 0 0 NRCI-LTI-01-E-For all buildings 0 0 0 NRCI-LTI-02-E-Lighting control system, or for an Energy Management Control System (EMCS) 0 0 0 NRCI-LTI-03-E-Line-voltage track lighting integral current limiter, or for a supplementary overcurrent protection panel used to 0 0 energize only line-voltage track lighting 0 NRCI-LTI-04-E-Two interlocked systems serving an auditorium, a convention center, a conference room, or a theater 0 0 Indoor Lighting 0 NRCI-LTI-05-E-Lighting Control Credit Power Adjustment Factor (PAF) D 0 0 NRCI-LTI-06-E-Additional wattage installed in a video conferencing studio 0 0 0 NRCA-LTI-02-A-Occupancy sensors and automatic time switch controls. 0 0 0 NRCA-LTI-03-A-Automatic daylighting controls D 0 0 NRCA-LTI-04-A-Demand responsive lighting controls 0 0 0 NRCI-LT0-01-E-Outdoor Lighting 0 0 Outdoor Lighting 0 NRCI-LT0-02-E-EMCS Lighting Control System 0 D 0 NRCA-LT0-02-A-Outdoor Lighting Control 0 0 Sign Lighting 0 NRCI-LTS-01-E-Sign Lighting 0 0 Electrical 0 NRCI-ELC-01-E-Electrical Power Distribution D 0 Photovoltaic 0 NRCI-SPV-01-E Photovoltaic Systems 0 0 ------------------ CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 7 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml --- H. CERTIFICATE OF INSTALLATION, CERTIFICATE OF ACCEPTANCE & CERTIFICATE OF VERIFICATION SUMMARY (NRCI/NRCA/NRCV) - Documentation Author to indicate which Certificates must be submitted for the features to be recognized for compliance Confirmed (Retain copies and verify forms are completed and signed to post in field for Field Inspector to verify). See Tables G. and H. in MCH and LTI Details Sections for Acceptance Tests and forms by equipment. Building Component Compliance Forms (required for submittal) Pass Fail D NRCI-PRC-01-E Refrigerated Warehouse. D D D NRCA-PRC-01-F-Compressed Air Systems D D D NRCA-PRC-02-F-Kitchen Exhaust D D D NRCA-PRC-03-F-Garage Exhaust D D Covered Process D NRCA-PRC-04-F-Refrigerated Warehouse-Evaporator Fan Motor Controls D D D NRCA-PRC-05-F-Refrigerated Warehouse-Evaporative Condenser Controls D 0 D NRCA-PRC-06-F-Refrigerated Warehouse-Air Cooled Condenser Controls D D D NRCA-PRC-07F-Refrigerated Warehouse-Variable Speed Compressor D D D NRCA-PRC-08-F-Electrical Resistance Underslab Heating System D D ·---· I. ENVELOPE GENERAL INFORMATION (See NRCC-PRF-ENV-DETAILS for more information) I 1. Total Conditioned Floor Area 1,820 ft2 5. Number of Floors Above Grade 1 Confirmed I 2. Total Unconditioned Floor Area 0 ft2 6. Number of Floors Below Grade 0 I 3. Addition Conditioned Floor Area 0 ft2 'a ., Dl Dl ! 4. Addition Unconditioned Floor Area 0 ft2 "' -"' 7. Opaque Surfaces & Orientation 8. Total Gross Surface Area 9. Total Fenestration Area 10. Window to Wall Ratio North Wall 585 ft2 150 ft2 25.6% D D East Wall 650 ft2 120 ft2 18.5% D D South Wall 585 ft2 150 ft2 25.6% D D West Wall 0 ft2 0 ft2 00.0% D D Total 1,820 ft2 420 ftZ 23.1% D D Roof 1,820 ft2 0 ft2 00.0% D D ------- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 8 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml J. FENESTRATION ASSEMBLY SUMMARY § 110.6 Confirmed 1. 2. 3. 4. 5. 6. 7. 8. 9. ~ ~ Fenestration Assembly Name I Overall Overall Overall ~ Ill Certification Method1 Assembly Method Area ft1 Ill "' Fenestration Type ... "' Tagori.D. U-factor 5HGC VT c "' ... Tinted Glass VerticaiFenestration NFRCRated Manufactured 420 o.ss 0.35 0.50 E 0 0 -------------------------------L___ 1 Newly installed fenestration shall have a certified NFRC Label Certificate or use the CEC default tables found in Table 110.6-A and Table 110.6-8. Site-built fenestration less than 1,000 ft2, or more than ar equal to 1,000 ~see Reference Nonresidential Appendix NA6. 2 Status: N-New, A-Altered, E-Existing Taking compliance credit for fenestration shading devices? (if "Yes", see NRCC-PRF-ENV-DETAILS for more information) K. OPAQUE SURFACE ASSEMBLY SUMMARY § 120.7/ § 140.3 Confirmed J 1. 2. 3. 4. 5. 6. 7. 8. I ~ .., I s rf N S rf T (f Z) Framing Cavity Continuous U-Factor I F-Factor S ~ ~ . u ace arne u ace ype Area t Type R-Value R-Value I C-Factor ~ I 2X6IR-197 ExteriorWall 1820 Wood 19 NA U-Factor: 0.072 E 0 0 R-19 Roof Attic14 Roof 1820 Wood 30 NA U-Factor: 0.035 E 0 0 · Slab On Grade16 Und~rgrol.JI1dFioor _ _ 1820 _ ___I'IA _ _ O_ _ N~ ~-Factor: 0.730 E 0 0 1 Status: N-New, A -Altered, E-Existing L. ROOFING PRODUCT SUMMARY 1 § 140.3 Confirmed 1. 2. 3. 4. 5. 6. 7. ~ .., Aged Solar Thermal Cool Roof Ill ~ Product Type Product 1!!25 lb ft1 CRRC Product ID Number "' SRI "' Reflectance Emittance Credit R-19 Roof Attic14 No 0.08 0.75 NA No NA 0 0 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 9 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml M. HVAC SYSTEM SUMMARY (see NRCC-PRF-MCH-DETAILS for more information) § 110.1/ § 110.2 Dry System Equipment 1 (Fan & Economizer info included below in Table N) 1. 2. 3. 4. s. 6. 7. 8. 9. 10. 11. Acceptance System Type Total Heating Supp Heat Total Cooling !!;! Supp Heat Efficiency Testing Equip Name Equip Type (Simple 3 or ~ Qty Output Output Output Source (Y/N) Complex 4) (kBtu/h) (kBtuh) (kBtu/h) FC-12/CU-121 SZHP (Split3Phase) Simple 2 33 Wet System Equipment 2 12. 13. 14. 1S. 16. Equip Name Equip Type Qty Vol (gal) Rated Capacity 1 Dry System Equipment includes furnaces, air handling units, heat pumps, etc. 2 Wet System Equipment includes bailers, chillers, coaling towers, water heaters, etc. 3 Simple Systems must complete NRCC-CXR-03-E commissioning design review form 4 Complex Systems must complete NRCC-CXR-04-E commissioning design review form 5 A summary of which acceptance tests are applicable is provided in NRCC-PRF-MCH-DETAILS 6 Status: N-New, A -Altered, E-Existing (kBtu/h) Cooling No 0 36 SEER-15.0 17. 18. 19. 20. Tank Efficiency Standby Loss Ext. R Qty Value Discrepancy between modeled and designed equipment sizing? (if "Yes", see Table F. "Additional Remarks" for an explanation) N. ECONOMIZER & FAN SYSTEMS SUMMARY1 1. 2. 3. 4. Outside Supply Fan Return Fan Air Equip Name TSP TSP CFM CFM HP BHP (inch Control CFM HP BHP (inch WC) WC) FC-12/CU-121 137 1200 0.500 0.500 1.32 ConstantVolume NA NA NA NA --1 Mechanical ventilation calculations and exhaust fans are included in the NRCC-PRF-MCH-DETAILS section Required? (Y/N) c "' Heating 5 "' HSPF-8.0 Yes N Pumps 21. 22. 23. 24. ~ VSD GPM HP Ill ... (Y/N) c "' "' No § 140.4 s. Economizer Type Control (if present) NA NoEconomizer --- I Confirmed "0 ~ Ill "' "' 0 0 Confirmed "0 .... Ill l'l: "' "' Confirmed "0 ~ Ill "' "' I 0 _gj L_ ~- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 10 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration ~tFileName: CARLSBAD PEDIATRIC SMILES.xml ----------------------- 0. EQUIPMENT CONTROLS 1 § 120.2 Confirmed 1. 2. 3. '1:1 ... Ill ~ Equip Type Controls "' Equip Name "' No DCV Controls FC-12/CU-121 SZHP No Economizer D D No Supply Air Temp. Control P. SYSTEM DISTRIBUTION SUMMARY 1 § 120.4/ § 140.4(1) This Section Does Not Apply Does the Project Include Zonal Systems? (if "Yes", see NRCC-PRF•MCH-DETAILS for system information) No Does the Project Include a Solar Hot Water System? (If "Yes", see NRCC-PRf-MCH-DETAILS for system information) No Multifamily or Hotel/ Motel Occupancy? (if "Yes", see NRCC-PR~-MCH-DETAILS for DHW system information) No ------- Q. INDOOR CONDITIONED LIGHTING GENERAL INFO (see.NRCC-PRF-LTI-DETAILS for more info)3 § 140.6 Confirmed 1. 2. 3. 4. s. '1:1 ... Conditioned Floor Area 2 Installed Lighting Power Lighting Control Credits Ill ~ Occupancy Type 1 Additional (Custom) Allowance "' "' (ft2) (Watts) (Watts) Area Category Footnotes Tailored Method (Watts) 0 0 (Watts) Office (Greater than 250 1,820 1,365 0 0 0 D D square feet in floor area) Building Totals: 1,820 1,365 0 1 See Table 140.6-C 2 See NRCC-LTI-01-E for unconditioned spaces 3 Lighting information tor existing spaces modeled is not included in the table ~~~~~~~~~~~~~~~~,---------------------------------------------------------J-~§-13!!:] R. INDOOR CONDITIONED LIGHTING SCHEDULE (Adapted from NRCC-LTI-01-E)l Luminaire Schedule (includes all permanent installed lighting in conditioned space, and portable lighting over 0.3 w/ft2 in offices) Installed Watts (Conditioned) Confirmed Name or Item Tag T Complete Luminaire Description Watts per luminaire I How Wattage is Determined I I Installed Watts Pass I Fail CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Compliance Scope: ExistingAiteration ------------ (i.e., 3-lamp fluorescent troffer, F3ZT8, one dimmable electronic ballast) -- NRCC-PRF-01-E Calculation Date/Time: ------ ~t File Name_: ___ CEC Default According to from NAS §130.0(c) Page 11 of 17 09:40, Thu, Apr 14, 2016 CARLSBAD PEDIATRIC SMILES.xml L__ ____ Total Number Luminaires 11f lighting power densities were used in the compliance model Building Departments will need to check prescriptive forms for Lumina ire Schedule details. I I I I 51. COVERED PROCESS SUMMARY-ENCLOSED PARKING GARAGES 1§ 140.9 This Section Does Not Apply 52. COVERED PROCESS SUMMARY-COMMERCIAL KITCHENS j§ 140.9 This Section Does Not Apply 53. COVERED PROCESS SUMMARY-COMPUTER ROOMS l§ 140.9 This Section Does Not Apply 54. COVERED PROCESS SUMMARY-LABORATORY EXHAUSTS T§ 140.9 This Section Does Not Apply T. UNMET LOAD HOURS This Section Does Not Apply U. ENERGY USE SUMMARY Electric Natural Gas (kWh/yr) (therms/yr) Total Annual Baseline 35089.7 6.04398 Total Annual Proposed 26993.5 0 L_ -------------__ L__ ---------- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 ----------·-···-·-·· -·. Project Name: Project NRCC-PRF-01-E Page 12 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml ·--·--·--·--··-----··----···---- DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1§ 10-1o3 I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: HADI MAHZARI Signature: Company: ENERGY CONSULTING GROUP Address: 801S BALBOA AVE. Signature Date: City/State/Zip: SAN DIEGO CA 92111 CEA Identification (If applicable): Phone:858-268-0660 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1 1 hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for its preparation; and that I am I licensed in the State of California as a civil engineer, mechanical engineer, electrical engineer, or I am a licensed architect. 2 I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. 3 I affirm that I am eligible under DiVision 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described as exempt pursuant to Business and Professions Code Sections 5537, 5538 and 6737.1. Responsible Envelope Designer Name: ignature: NOT IN SCOPE Company: Address: Date Signed: City/State/Zip: Declaration Statement Type: Phone: Title: Jucense #: Responsible Lighting Designer Name: ignature: NOT IN SCOPE Company: Address: Date Signed: City/State/Zip: Declaration Statement Type: Phone: Title: I License#: Responsible Mechanical Designer Name: DAN SCHAEFFER ignature: Company: LANDMARK MECHANICAL Address: 801S BALBOA AVE. Date Signed: City/State/Zip: SAN DIEGO CA 92111 Declaration Statement Type: Phone:858-279-1222 Title: I License#: ·-·------- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 13 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml ----------------------- NRCC-PRF-ENV-DETAILS -SECTION START- A. OPAQUE SURFACE ASSEMBLY DETAILS Confirmed 1. 2. 3. 4. "1:1 ~ Ill Surface Name Surface Type Description of Assembly Layers Ill Notes Ill Stucco -7/8 in. 2X6/R-197 ExteriorWall Vapor permeable felt-1/8 in. D D Wood framed wall, 16in. OC, S.Sin., R-19 Gypsum Board-1/2 in. ! Asphalt shingles-1/4 in. Vapor permeable felt-1/8 in. R-19 Roof Attic14 Roof Plywood -1/2 in. D D Air-Cavity-Wall Roof Ceiling-4 in. or more Wood framed roof, 16in. OC, 9.25in., R-30 Gypsum Board-1/2 in. Slab On Grade16 UndergroundFioor D D B. OVERHANG DETAILS (Adapted from NRCC-ENV-02-E) This Section Does Not Apply C. OPAQUE DOOR SUMMARY This Section Does Not Apply CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 14 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml NRCC-PRF-MCH-DETAILS -SECTION START- A. MECHANICAL VENTILATION AND REHEAT {Adapted from 2013-NRCC-MCH-03-E) Confirmed 1. DESIGN AIR FLOWS 2. VENTILATION (§ 120.1) :X: .c c , -1 m m m s: s: s: n c m ~ Ill s: .q c , Ill 0 m > iii iii 'n~ ~ 'n~ c s: Ill m z z z c Ill z >Z c < c z Ci iii Cl z 5S: -n3: 53: n -n< < Ill ;;-a m 3 z m 'n -"a -n2!! :ec:: 5C:: :ec:: n z -< -nm z z m c n , 0 -1 0 nm z s:z -1 -< , ~ "a 'n CONDITIONED _o n3: 5S: 'ns: :eS: -nS: z ~ z -nz c:: _ .... ~ nm ~ Ill ~ s: .... ~ -nZ "' co 'n> :e~ ~~ -:X: ::U:x; -1 m 'CI "a , i:< "' ZONE NAME ,.. s:, nm >m , c ;:r-a ID m , S:-1 'n z -< -< Q3: ~~ g~ 0 m > Nm 0 iii , 'n -> ~ § > Qs: ,.. s: , _, 'n 0 "a ~ ;; p Cl -> !::< ;; s:-o, -z oz m > "a :I m 'n ~ -~ Z< Cl ZCI ~ 6 > , m -, ,.. n 'n ;t m 0 Ill 0 ,.. s: ~ ;!!: > p > "a 0 n :e 'n m ~ c:: , , ;; ~ ,.. z 'n ~ s: s: m ~ 1-FC-12/CU-12 FC-12/CU-1,200 NA NA NA NA N FC-12/CU-1,820 0.15 18 15.0 273 273 NA N 0 0 121 121 TOTAL 1,820 18 273 273 NA 0 0 B. ZONAL SYSTEM AND TERMINAL UNIT SUMMARY § 140.4 1. 2. 3. 4. 5. 6. 7. 8. Confirmed Rated Capacity Airflow (cfm) Fan (kBtuh) Economizer "a 'n System ID System Type Qty Zone Name Ill ~ "' Min. ECM Ill Heating Cooling Design Min. Ratio BHP Cycles Motor FC-12/CU-123-TRM Uncontrolled 2 NA NA NA 1-FC-12/CU-12 1200 NA NA NA NA 0 0 0 C. EXHAUST FAN SUMMARY This Section Does Not Apply D. DHW EQUIPMENT SUMMARY-{Adapted from NRCC-PLB-01) This Section Does Not Apply CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 15 of 17 I Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40,Thu,Apr14,2016 I Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml ----------------------------- E. MULTI-FAMILY CENTRAL DHW SYSTEM DETAILS This Section Does Not Apply F. SOLAR HOT WATER HEATING SUMMARY (Adapted from NRCC-STH-01) This Section Does Not Apply G. MECHANICAL HVAC ACCEPTANCE TESTS & FORMS {Adapted from 2013-NRCC-MCH-01-E) § RA4 Declaration of Required Acceptance Certificates (NRCA)-Acceptance Certificates that may be submitted. (Retain copies and verify forms are completed and signed to post in field for Field Inspector to verify). 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: 3: Test Description n n n n n n n n n n n n n n n n n Confirmed ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: ::1: I I I I 0 0 I I I I I .!-I I I .!-I 0 0 0 0 0 0 ... ... ... ... ... ... ... N w ..,. 111 ~ .... 00 tD 0 ... N w ..,. 111 en .... 00 )> )> )> )> )> )> )> )> )> )> )> )> )> )> )> )> V> \!! m V> )> )> 0 c: n c: :I: " ~· '0 (") ::I 0 V> '0 ·< c: c: '0 ;;oO OQ )> ::I c: ~ a. ... 0 ... 0 iii' 0 '0 0 0 0 -i < t1) ::I Equipment .... '0 < m m "' a. c: 3 ~ (")~ nO " )> ... N 0 "0 0' 0::::1 V> t1) t1) #of < ~~ 0 t1) NO ... ::I m Requiring a. 0 v;· ;::;· 0 0 .... .... X~ ~ .... (") "1:1 ~ 0 ::I ... t1) (") " iii' ::I -· ::I 3 0 0 )>~ i»' (")II\ s: Ill 0 .... ~ ~ """' ... "' 0 ::I-)!1. 0 t1) "' Testing or units t1) < "' "' .... 0'" -.... 0 (") ::I @ ....... 0 -Q.a_ X t1) Q (")VI t1) 3 ::I .... V> Ill Verification :!=: c c: 0 -ro c ... 3 "0 ~ :E ::I n );: i»' )> .... ;:::;: ... ::I (IQ " V> ::I 0 "' 0 "' "' "' ... < t1) 3 0 :r ;:::;: .... Cil ::>:1 VI~ < a ::E t1) "' !20 (IQ t1) .... v;-"0 a. t1) "' t1) ... FC-12/CU-2 X X ----------------0 0 121 -- -- -- -- ------ NRCC-PRF-LTI-DETAILS -SECTION START- A. INDOOR CONDITIONED LIGHTING CONTROL CREDITS (Adapted from NRCC-LTI-Q2-E) T§ 140.6 This Section Does Not Apply B. INDOOR CONDITIONED LIGHTING MANDATORY LIGHTING CONTROLS (Adapted from NRCC-LTI-02-E) 1§ 130.1 This Section Does Not Apply §130.1(a) =Manual area controls; §130.0/b) =Multi liivet,· §130.1(c} =Auto Shut-Oft §i30.l{d) =Mandatory Daylight; §130.1(e) =Demand Responsive CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 16 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 ! Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml C. TAILORED METHOD LIGHTING POWER ALLOWANCE SUMMARY AND CHECKLIST (Adapted from NRCC-LTI-04-E) § 140.6 General lighting power (see Table D) 0 General lighting power from special function areas (see Table E) NA Additional "use it or lose it" (See Table G) 0 Total watts 0 D. GENERAL LIGHTING POWER (Adapted from NRCC-LTI-04-E) -~§ 140.6-D This Section Does Not Apply E. GENERAL LIGHTING FROM SPECIAL FUNCTION AREAS (Adapted from NRCC-LTI-04-E) § 140.6(c) 3H Illuminance Value Room Cavity Ratio Confirmed Room Number Primary Function Area (LUX) (Table G) Allowed LPD Floor Area (ft2) Allowed Watts Pass Fail NA NA NA NA NA NA NA D D Note: Tailored Method for Special Function Areas is not currently implemented F. ROOM CAVITY RATIO (Adapted from NRCC-LTI-04-E) Rectangular Spaces Confirmed Room Number Task/Activity Description Room Length (ft) Room Width (ft) Room Cavity Height (ft) RCR Pass Fail NA NA NA NA NA NA D D Non-Rectangular Spaces This Section Does Not Apply Note: All applicable spaces are listed under the Non-Rectangular Spaces table G. ADDITIONAL "USE IT OR LOSE IT" (Adapted from NRCC-LTI-04-E) I 1. 2. 3. 4. Confirmed I Wall Display Combined Floor Display and Task Combined Ornamental and Special Allowed Watts ., ., I Lighting Effects Lighting Very Valuable Merchandise Ill ~ Ill Ill 0 0 0 0 0 D _g_j -----··-----···-------'--·----- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 Project Name: Project NRCC-PRF-01-E Page 17 of 17 Project Address: 1287 CARSBAD VILLAGE DR. CARLSBAD 92008 Calculation Date/Time: 09:40, Thu, Apr 14, 2016 Compliance Scope: ExistingAiteration Input File Name: CARLSBAD PEDIATRIC SMILES.xml S. Wall Display This Section Does Not Apply 6. Floor Display and Task Lighting This Section Does Not Apply 7. Combined Ornamental and Special Effects Lighting This Section Does Not Apply 8. Very Valuable Merchandise This Section Does Not Apply H. INDOOR & OUTDOOR LIGHTING ACCEPTANCE TESTS & FORMS (Adapted from NRCC-LTI-01-E and NRCC-LT0-01-E) § 130.4 Declaration of Required Acceptance Certificates (NRCA) -Acceptance Certificates that must be verified in the field. (Retain copies and verify forms are completed and signed to post in field for ! Field Inspector to verify). Indoor Outdoor Confirmed Test Description NRCA-LTI-02-A NRCA-LTI-03-A NRCA-LTI-04-A NRCA-LTO-oZ-A , ., Equipment Requiring Occ Sensors I Auto Time Ill ?b #of units Auto Daylight Demand Responsive Outdoor Controls "' "' Testing or Verification Switch I Occupant Sensors 0 D D D D D 01 Automatic Time Switch 0 D D D D D D Automatic Daylighting 0 D D D D D D Demand Responsive 0 D D D D D D Outdoor Controls 0 D D D D D D -------~- CA Building Energy Efficiency Standards-2013 Nonresidential Compliance Report Version: NRCC-PRF-01-E-04052016-760 Report Generated at: 2016-04-14 09:40:24 ~ I I COUNTY OF SAN DIEGO Department of Environmental Health Community Health Division RadiOlogical Health Program PLAN CHECK II: /5-o 3 q 5500 Overland Ave Ste 110, San Diego, CA 92123 Tel (858)694-3621 Fax (858)694-3629 ACrJVUU 10C1jf I FEE AMOUNTS: c (}() PAYMENT TYPE: RADIATION SHIELDING PLAN CHECK APPLICATION Plans submitted by: ~i TAn D'C!'~at'\ . . Phone#: ('I") 75 7 ·6~ 71 FacilityName/Owner'sName: CAv\~b~~4-e, I}Jc·er\vjG ~~~4& Phone#: <1iJO) ~fJ· 3fS&, Job Site Address: I 2f>1 CAvl~ Vt~~c {A,o. Zip: t:tU~ MailingAddress,ifdifferent: 1Zf>5 U.v\~.-u~ \1(\\~1' J;¥. Zip: 4zoo~ X-RAY MACIDNE INFORMATION #ofRooms I Manufacturer ?tmo · ModeVfype OWNERIREPllESENTATIVI DECLARATION: IIUMientad t.tdset'Cie ,.Wit.,.._ enmyledara«<eel of die rHIIdlln lllleltllac............,., •rthe Mdaratioa It flleerreet, I_.,.._. lllat b appllcatlea wll net be llppftt\'ed lllldl tile apprap!We fee It paltl. This space for Oft'ke Use Only: COtF~Tf OF SAN DIEGO . O£PARTMENT OF ENViRONMENTAl HEALTH ;. ·~ -RADIOLOGICAL HEALTH . ~.:.: RADIATION SHIELDING APPROVED RECEIVED APR 2 7 2016 CITY OF CARLSBAD BUILDING DIVISION This facility will. meet t e structural shielding requirements of the California ~ RadiatiO!I Control Regulations { 1 . · ~ 4 1-u 1.-0\yr·· a, Date · I ~~~ .. s\~~~o :·- CLASSIFICATION OEIIITAL, MEDICAL, cr INDUSTRIAL HM-9901 (07-15) FIRST TWO ROOMS (6CRAD---..0) . EACH AOOI''L RCOI! UP TO 6 (6CRAD--..O) MORE THAN 6 ROOMS (6CRAJ.>HR-..O) NO. OF ROOMS FEESFY '15-1 84.00 45.00EACH IN ADDITION TO $264 BASE FEE, HOURLY FEE BASED ON REVIEW TIME TOTAL REM MEDICAL RADIATION PHYSICS P. 0. Box 1668 April 06, 2016 Carlsbad Pediatrics Dentistry Kui Tan, kui@kuitandesgn.com 1285 Carlsbad Village Dr. Carlsbad, CA 92008 Capitola, CA 95010-1668 Tel/fax (888) 736-7497 remdeh@att.net RE: Dental X-ray Suite, Carlsbad Pediatric Smiles, Carlsbad, CA The following recommendations. for radiation shielding have been made in accordance with recommendations ofNCRP #147, #145 and the California Radiation Control Regulations, Title 17. Recommendations for the facility were made from information supplied by Kui Tan ofKui . Tan Design in the form of a facility plan and equipment information. The assumptions below are consistent with the information supplied. If any changes are made in the site layout or equipment, then please notify this office so that appropriate modifications in these recommendations can be made. Assumptions 1. Workload (W): The Workload (W) factor in units of milliamperes-minutes per week or milliroentgen per week is supplied from customer, or is assumed that which represents a common value for the specified use (for example, see NCRP Report No. 145, Table F.3). 2. Use (U): The Use (U) factor indicates the fraction of exposure to Primary beam (U =an assigned value) or the Scattered beam (U = 1 for a dental facility). 3. Occupancy (T): The occupancy (T) factor indicates the fraction of time of exposure at a specific location~ NCRP Report No.145, Table F.l is generally followed for non-controlled areas. · 4. Weekly Exposure Limit (P): The Weekly Exposure Limit (P) is 2 mrem per week (0.002 factors) for non-radiation workers and is 100 mrem per week (0.1 factors) for occupational radiation workers. 5. Kilo Voltage Potential (kVp): The Kilo Voltage potential (kVp) is assumed to be an average of 70 for scattered dental X-rays. 6. Distance (d): The.Distance (d) used in shielding calculations is the distance from the scattering object to the position of occupancy. RE: Dental X-ray Suite, -3- RECOMMENDATIONS FOR SHIELDING: · BARRIERA: Use: scattered X-ray barrier (U = l) Adjacent space: exterior Occupancy: 3% Distance: 8' 04/06/16 Shielding Recomniendation: Use common construction in this wall. Read the paragraphs for dental -, X-ray operators and dental X-ray assistants at the end of this report. BARRIERB: Use: scattered X-ray barrier (U = 1) Adjacent space: adjacent X-ray rooms Occupancy: 50% Distance: 1 0' Shielding Recommendation: Use common construction. BARRIERC: Use: scattered X-ray barrier (U = 1) Adjacent space: hallway Occupancy: 20% Distance: 6' Shielding Recommendation: Use common construction. Close any doors when obtaining X-ray images. If an open area, then assure that no persons other than the X-ray operator is in this immediate area during the taking of radiographs. BARRIERC*: Use: scattered X-ray barrier (U = 1) Adjacent space: operatory Occupancy: 75% Distance: 10' Shielding Recommendation: Since the panoramic X-ray unit is essentially self-shielded, the radiation scatter from the patient is the only concern. Therefore, use common construction materials. Because this area may be an open area, assure that no persons other than the X-ray operator is in this immediate area during the taking of radiographs. BARRIERD: Use: scattered X-ray barrier (U = 1) Adjacent space: operatory Occupancy: 75% Distance: 8' Shielding Recommendation: Use common construction. RE: Dental X-ray Suite BARRIERK: Use: scattered X-ray barrier (U = 1) Adjacent space: adjacent dental facility Occupancy: 90% . Distance: 10' :-5- Shielding Recommendation: Use common construction in this barrier. BARRIERL: Use: scattered X-ray barrier (U = 1) Adjacent space: operatory Occupancy: 75% Distance: 6' Shielding Recommendation: Use common construction. BARRIERP1: Use: scattered X-ray barrier (U = 1) Adjacent space: hallway Occupancy: 20% Distance: 4' Shielding Recommendation: Use common construction. BARRIERP2: Use: scattered X-ray barrier (U = 1) Adjacent space: control area next to adjacent secondary hallway to exterior Occupancy: 100% for X-ray technologist; 3% for public Distance: 4' . 04/06/16 Shielding Recommendation: Use common construction materials. Any window in the P2 wall must be W' glass. Because the adjacent area may be an open area, assure that no persons other ·than the X-ray operator is in the adjacent area during the taking of radiographs. BARRIERM: Use: scattered X-ray barrier (U = 1) Adjacent space: ceiling/floor of area above Occupancy: 90% Distance: 9' Shielding Recommendation: Use common construction materials in floor above. BARRIERN: Use: scattered X-ray barrier (U;, 1) Adjacent space: on grade floor Occupancy: 0% Distance: 4' Shielding Recommendation: Use common construction on grade floor materials. !)(fltiN6. P!NfAL .C)flll1(2 ~ ® ..t.)rt~l ~~· (jj) . Lb:£12 ;.a J 1\ CERTIFICATE OF COMPLIANCE CertHicate Number 20150327 -E202227 Report Reference E202227 -20120120 Issue Date 2015-MARCH-27 Issued to: AIR TECHNIQUES INC 1295 WALT WHITMAN RD MELVILLE NY 11747 Thlsls to certify that MEDICAL EQUIPMENT representative samples of MOJAVE Dry Vacuum System, V3, V5, 2V3, 2V3CT, 2V5, 2V5CT, 3V5, 4V5, V7, 2V7, 3V7, 4V7, V15, 2V15, 3V15, and 4V15. Standard(&) for Safety: Have been investigated by UL in accordance with the Standard(s) indicated on this Certificate. UL 60601-1, Medical Electrical Equipment, Part 1: General Requirements for Safety CAN/CSA C22.2 No. 601.1, Medical Electrical Equipment - Part 1: General Requirements for Safety Additional Information: See the UL Online Certifications Directory at www.ul.com/database for additional information Only those products bearing the UL Certification Mark should be considered as being covered by UL's Certification and Follow-Up Service. Look for the UL Certification Mark on the product. 3-.~S- BIIIftMIIII-aiZ, -CIII.rEng-,G-.._uon_Fleld_ ® UI.LLC Page 1 of 1 MOJAVE DRY VACUUM SYSTEM PART NUMBERS V3, V5, 2V3, 2V3CT, 2V5, 2V5CT, 3V5 AND 4V5 PRE-INSTALLATION GUIDE MOJAVE System being installed: (AS CHECKED) 0 V3 0 VS 0 2V3 0 2V3CT 0 2V5 0 2VSCT 0 3V5 0 4V5 All installations must conform to local codes. Doctor: Address: Phone#: Dealer: Dealer Address: All pumps comply with NFPA 99C level 3 requirements .HN1CiUES ~!a~ 1110 13411t!S FOHMP COMPliANT MOJAVE is a trademark of Air Techniques, Inc. C Air Techniques, Inc. Copyright 2012 • P/N H5187, Rev. A, March 2012 V3 Pump Assembly V5 Pump Assembly MT1 0 Tank Assembly CT20 Tank Assembly Master Controller Assembly Maximum Users Master Controller Assembly Width 11 in. (28 em) Depth 3 in. (8 em) Height 10 in. (24 em) VVeight 20 Lbs. (9 kg) MDJAV£' SYSTEM CDNF/GURAT/DNS Gas/Liquids/ From Solids Treatment ==-=i> " Room MT10 Separator Tank Liquids/Solids - Gas - Exhaust to Outside Vent Typical MOJAVE System Installation Recommended Number of Simultaneous HVE/SE Users " . " "'~. -,, ·'·' .• • c ' 4 + 2 9 + 2 18 + 4 2 + 6 7 + 6 13 + 14 0 + 10 5 + 10 10 + 20 3 + 14 8 + 24 HVE = 2 SE's 1 + 18 5 + 30 1 HVE = 2 Nitrous Scavengers 0 + 20 0 + 40 Physical Characteristics Tanks Typical V3 or V5 System Pump Configurations MT10 CT20 MT10 Tank Stacked onto One Two V3 or V5 Pumps Three 10 Gallon Continuum One V3 or V5 PumJ) V3 orV5 Pump Stacked V5 Pumps Stacked 25 in. (64 em) 25 in. (64 em) 25 in. (64 em) 25 in. (64 em) 25 in. (64 em) 25 in. (64 em) 17 in. (43 em) 20 in. (51 em) 19 in. (48 em) 19 in. (48 em) 19 in. (48 em) 19 in. (48 em) 23 in. (58 em) 42 in. (107 em) 50 in. (127 em) 17 in. (43 em) 34 in. (86 em) 51 in. (130 em) 75 Lbs. (34 kg) 150 Lbs. (68 kg) 220 Lbs. (100 kg) 145 Lbs. (66 kg) 290 Lbs. (132 kg) 435 Lbs. (197 kg) -----·---------------- 11 in. (28!=1 .,._ 13.5 in. (34 em) 11 in. (28 em) b &ooo M MOJAVE ,00 Pallo in. 10 (24 em) 0 lla]IQ) .GI Master Controller Assembly Dimensions V3 and V5 Vacuum Pump Dimensions 1111 81·11 2V3 or 2V5 System Installation Recommended Stacked Pumps with Tank on Side 34in. (86_cm) ASSEMBLY DIMENSIDNS Important: Never stack a CT20 Tank on top of any Pump. Never stack a Pump on top of any Tank. Recommend pumps only be stacked a maximum of two high. Leave a 4 inch service space around the Master Controller. All units shipped with all leveling feet set to lowest position. ·t· ·~ MT1 0 10 Gallon Tank Dimensions CT20 Continuum Tank Dimensions 34 in. (86_cm) V3 & V5 System Dimensions 2V3CT or 2V5CT System Installation Recommended Stacked Pumps with CT20 Tank on Side TREATMENT ROOM PLUMBING INSTALLATIONS SUB FLOOR INSTALLATION -Notes: Recommended system installation layout should be used whenever possible. 1. 10-foot Maximum Height from Main Line to Tank. I' Ceiling +--Interior Wal~ 2. Consult Dental Unit Manufacturer's Guidelines for correct reduced size and height of termination of vacuum line inside junction box. Junction Box :--5~-b-Fi~;;--: : Riser : : Connection : L_ __ ~!'~-~-----1 3. Limit branches. Orient main line under junction box or cabinet. 4. When piping line is above 3/4" I. D. or larger, use 45° Y1S & elbows only. 5. Recommend installing separate line connection for scavenger when using Nitrous scavengers in overhead piping installations. Main Line Riser for connection to tank input. See Note 1. ·-----'---------· : Main : : Line Turn : : Connedion : : SeeA. : ·--------------· OVERHEAD INSTALLATION- Alternate system installation layout should be used only when unable to use the sub-floor plumbing layout. 112-lnch Diameter Riser . . 1O-FT Maximum Height from Riser Trap to Main Line :o¥8-.:haac"rRis&r: -"t _____ s§§_c .. _____ : Junction Box ' ·-----\.----· I I !Riser Trap! : SeeD. : ~----------! MAIN LINE See Notes 2, 3 4 &5. CONNECTOR DETAILS -ALL INSTALLATIONS 0 Use only 45° elbows to make turns in main line. 0 Make sure to use the proper pipe type for associated system. 0 If piping is diverted to clear an obstruction, po NOT MAKE A TRAP. See detail A, Main Line Tum Connections. 0 DO NOT use standard 90° elbows. ,-.--------------------------------~ I A I ,_, ~ Making Turns Clearing~ .& Obstrucfio~ .45° Elbow Main Line Tum Connections ,-~------------------------------~ I B .... ,_, 45"EL Main Line To Dental Unit .r--Jundion Box To Tank Sub Floor Riser to Main Line Detail Important: All installation pipes and fittings provided by plumber. All installations must conform to local codes. 45"Eibow I ,,"],,~To Tank Overhead Riser to Main Line Detail (Prevents liquids from draining down the 112" riser.) 'o' I I ,,., To Main Line To 1/2-lnch Riser~ Dental Unit Jundion Box ~~2~1~;h Riser Trap Detail (45° Elbows) INSTALLATION NOTES: TYPICAL EQUIPMENT RDDM FLDDR PLAN LAYDUT ~ 62" ~m_A ~L&J l!Jl_j 4'~ [H Pul£k Conr- ao· j ~':~ 1 0om;"«/J~ 0 Bottom 3 Inch 45"Y Bottom 2 Inch 45"Y 2* Pipe for Addition of W .., Drip Leg. See Note c. Notes: See Installation Note K below for required pipe material. a. A third 45" Y fitting may be added when preparing the site for a 3-pump system. All piping and fittings must be 4-inch instead of 3-inch on dual systems. b. Use a second dual 45• Y fitting configuration when preparing the site for a 4-pump system. c. Pipe required for the installation of a Drip Leg kit supplied with each pump. See exhaust ventilation requirements proved on the beck cover. A. PUMP INSTALLATION SPACE -Area for stacked V3 or VS pumps in typical side by side installations. Only stack up to 2 pumps in one area. B. TANK INSTALLATION SPACE -Area for MTl 0 or CT20 tank in typical side by side installations. Never install the CT20 tank on top of a pump. C. SEWER DRAIN • Provide a drain for the removal of waste liquids from the MOJAVE tank. Use an open drain pipe {1 Yz" inch P-Trap with 1 inch air gap or floor sink) or a closed vented drain. See detail 1. D. TANK WASHOUT -Provide a water source terminated with a W inch FNPT shut-off valve providing water pressure between 20 and 100 psi for daily tank washout. Valve location must be no more than 1 0 feet from the tank installation to allow connection of supplied 1 0-foot 3/8-inch Poly tubing to the tank washout port. Provisions for backflow prevention may be required. Check local code requirements. E. MASTER CONTROLLER UNIT -Locate near pump and also allow a space around the Master Controller of at least 4 inches for the connection of wiring and the line cord during installation and servicing. F. MASTER CONTROLLER ELECTRIC OUTLET -Master Controller requires a dedicated standalone 120V, 5 AMP grounded receptacle. G. PUMP ELECTRIC SERVICE -Each Mojave pump is wired directly with a dedicated 220V, 20 AMP, single phase 60 Hz circuit. If Main Circuit panel is not located in equipment room, a d1sconnect box with approved ground is needed for each pump. Disconnect boxes should be mounted no more than 3 feet of each other and 3 feet of installation center line . .H. SUB FLOOR INSTALLATION VACUUM LINE -See Plumbing Requirements for connection to tank input via supplied hose. -J. OVERHEAD INSTALLATION VACUUM LINE -See Plumbing Requirements for connection to tank input via supplied hose. K. HEAT EXHAUST -See Plumbing Requirements for the exhaust vent line required for specific Mojave configurations. Use metal pipe on systems whenever the Heat Exchanger is removea. Schedule 40 pipe can normally be used on typical Mojave configuration installations with a Heat Exchanger. When installing two pumps, a reducing Y adapter (shown by detail 2 above) is needed to connect both vent tubes to a common 3-inch exhaust vent line. L. PUMP/TANK MANIFOLD -User fabricated to connect 3 or 4 pumps to a tank Used with 3V5 and 4V5 systems. See Pump/Tank Connection Manifold. SIT£ R£QU/R£M£NTS Eledrical V3 vs 2V3 & 2V3CT 2V5 & 2V5CT 3V5 4V5 Master Controller Voltage Rating All pumps 220 Volts Single PhaseAC, 60Hz 120 Voltage Minimum/Maximum 205/240 Volts AC All pumps 108/132 Volts AC Wire Size AWG Minimum Gauge #12AWG #12AWG #12AWG #12AWG #12AWG #12AWG #14AWG {Qty 1) (Qty 1) (Qty 2) (Qty 2) (Qty 3) {Qty 4) Minimum Circuit Breaker Rating 20A 20A 20A (Qty 2) 20A (Qty 2) 20A (Qty 3) 20A (Qty 4) 15A Incoming Power Hard wire Connection (Each pump is supplied with a 4 x 4 handy box and a 4 foot whip) NEMA 5-15R (Supplied 6 ft. line cord) Plumbing V3 vs 2V3 OR2V3CT 2V5 OR2V5CT 3V5 4V5 Exhaust Vent Pipe Using 2" PVC Sch. 40 2" PVC Sch. 40 One 3" or two 2" PVC One 3" or two 2" PVC One 4" or three 2" Two 3" or four 2" PVC Heat Exchanger Sch.40 Sch.40 PVC Sch. 40 Sch. 40 Exhaust Vent Pipe Not One 3" or two 2" Metal One 3" or two 2" Metal One 4" or three 2" Two 3" or four 2" Using Heat Exchanger 2" Metal Pipe 2" Metal Pipe Pipe Pipe Metal Pipe Metal Pipe (See note 1) Minimum Suction Line Pipe 1" PVC Sch. 40 1 Yl" PVC Sch. 40 1 W PVC Sch. 40 2" PVC Sch. 40 3" PVC Sch. 40 3" PVC Sch. 40 Maximum Suction Line Pipe 1 Yi' PVC Sch. 40 2" PVC Sch. 40 2" PVC Sch. 40 2 Yi' PVC Sch. 40 4" PVC Sch. 40 4" PVC Sch. 40 (See note 2) Riser Pipe Yl" PVC Sch. 40 Yi' PVC Sch. 40 Y2" PVCSch. 40 Y2" PVCSch. 40 Y2" PVC Sch. 40 Yl" PVC Sch. 40 Vacuum Line Termination 1 Y2" FNPT 2"FNPT 2" FNPT 2" FNPT 2" FNPT 2" FNPT Branch Line Pipe Size requirement of Branch piping differs by the number of operatories being serviced. Up to two operatories use 1" PVC Schedule 40 Three to six operatories use 1 Yz" PVC Schedule 40 More that six operatories use 2" PVC Schedule 40 Drain Line Pipe 1 Y2" PVC Sch. 40 Wash-Out Water Line W FNPT Shut-off Valve NOTES 1. Recommended for all new installations. 2. Use maximum internal diameter for the main line when preparing any new installation. PUMP/TANK CONNECTION MANIFOLD Pump/Tank Connection Manifold Using Accessory Kit 3" PVC or Copper Tubing & Elbow (Supplied by Plumber) Sanitary Tee with 1-1 /2" FNPT End FiHing. 3 or 4 depending on system configuration. (Supplied by Plumber) 3" PVC or Copper Clean-out Plug Used with P/N MIK4 (Supplied by Plumber) 2" PVC or Copper Tubins for Tank Hose (Supplied by Plumber) ,""----... illllo._. .. .. ' \ ' ' I I I I ........ ~'~ ... ____ .... Note: Hang using at least 3 pipe supports supplied by Plumber. Hose Between Manifold and CT20 Tank Secured by Flexible Couplers 3 or 4 Supplied Check Valve Assemblies - See Kit PIN MIK4 Check Valve Installed Flat Side Facing Up Horizontal to Floor Flat Side Installed 1-1 /2" FNPT to ... _____ , ~:t.:.Com~~~~gUp n (i'a~TM Hoses From Manifold To Pumps Hose Between Manifold and CT20 Tank Secured by Flexible Couplers V3&V5 PUMP HOSE CONNECTION DETAIL Hose from Manifold Connected to Pump via Air Input Filter Barbed Adapter Check Valve Assembly Side View Hoses From Manifold To Pumps ~·':t. ~~ .. MEDICAL ELECTRICAL EQUIPMENT WITH RESPECT TO ELECTRICAL SHOCK. FIRE. MECHANICAL AND OTHER SPECIFIED HAZARDS ONLY IN ACCORDANCE WITH UL-60601-1. CANICSAC22.2 N0.601.1 66CA EXHAUST V£NTILAT/DN R£QUIR£M£NTS HEAT EXHAUST CONNECTION NOTES 1. VENT LINE -The exhaust vent line required for MOJAVE systems using the Heat Exchanger and systems with the Heat Exchanger removed have different requirements. ~ Exhaust Vent See Note 1. Use metal pipe on systems without a Heat Exchanger while PVC Schedule 40 pipe can be used on systems with a Heat Exchanger. Do not make a trap in the exhaust vent piping. Also see Exhaust Vent Protection and Ventilation Requirements below. 2. V3 & VS PUMP EXHAUST VENT CONNECTION -Connection between the pump and exhaust vent piping is typically made via the supplied 2-inch Black Flex tubing. Drip leg See Detail & Note 3. V3 or V5 Pump Top View i 2" Flexible Coupler 2" PVC Reducing Bushing 3/4" MNPT X 1/4' FNPT PVC Bushing 114' MNPT X 1/4' Push Elbow Drip Leg Detail View 3. DRIP LEG -The supplied drip leg must be installed at the lower end of the vent pipe to collect condensation produced during pump operation. The bottom of drip leg should be located a minimum of 4 inches from floor. Attach the drain tube to the drip leg quick-connect fitting to allow drainage into floor drain/sink. V3 & V5 Pump Heat Exchanger Connection Exhaust Vent Protection. If the exhaust piping is venting to the outside of the building, precautions must be taken to protect the equipment room from weather elements and animal intrusion. This can be accomplished by using one of the three methods shown on the right. Exhaust Vent Requirements. The MOJAVE equipment must be used in a controlled-temperature environment. Maintain equipment room temperature between 40 and 105 degrees Fahrenheit. An exhaust fan is necessary if room temperature is not maintained by other methods. Adequate forced ventilation must be provided across the unit by placing an appropriate exhaust fan opposite an equivalent air intake vent . The fan should be placed higher than the associated intake vent. Recommended minimum exhaust fan requirements for each MOJAVE unit are listed to the right. Roof-Mounted Outside Vent Protection 0 jfhroud& Screen ere en ~hroud& ,_,- Wall-Mounted Outside Vent Protection MOJAVE I Watts I Watts Unit (Idle) (Max) ~w, :'.l J• ;I ~ .• ~ V5 I 1,800 I 3,500 ~:l~t .. ~.-•... r····~~ .. 2V5 & 2V5CTI 3,600 I 7,000 . _.,. . l •• ~J 7$00 .. ~ ... J,, l ., 4V5 7,200 14,000 BTU I BTU (Idle) (Max) . ~~~~~I~~~ 6,140 I 12,942 1~~· ;J=:il:.ttP: 12,280 I 25,884 ,.~ l3$.a 24,560 I 51,768 • CERTIFICATE OF COMPLIANCE Certificate Number 20150 130-E202227 Report Reference E202227-20041217 Issue Date 20 15-JANUARY -30 Issued to: AIR TECHNIQUES INC 1295 WALT WHITMAN RD MELVILLE NY 11747 This is to certify that MEDICAL EQUIPMENT representative samples of Dental Air Compressors, AirStar Series with optional sound covers, Models AS10, AS12, AS21, AS22, AS30, AS50, AS70 and AS40. Have been investigated by UL in accordance with the Standard(s) indicated on this Certificate. Standard(s) for Safety: UL 60601-1 and CAN/CSA C22.2 601.1-M90-Medical Electrical Equipment, Part 1: General Requirements for Safety Additional Information: See the UL Online Certifications Directory at www.ul.com/database for additional information Only those products bearing the UL Certification Mark should be considered as being covered by UL's Certification and Follow-Up Service. Look for the UL Certification Mark on the product. $-.~ Bruce --holz, Aaslsllnt Chief Englnar, Globallnspoctlon and Field SeMcee ULLLC Alf'J lnfonnaaon and documenta11on ln""'vlna UL Marl< ..-.,. proVIded on behalf or UL LLC (UL) or Blf'J authorized I lean-of UL. For queaaons, pleeee contact a loCal UL Cuttomer servtce Reprt~~e~~tltiva at www ul samlcontas;tus Page 1 of 1 PRE-INSTALLATION GUIDE AirStar l 0, AirStar 21, AirStar 22, AirStar 30, AirStar 50, AirStar 70 Doctor: Address: Phone#: Dealer: Dealer Mdress: --------------------------------------------- All Installations must conform to local codes! This AirStar Model is being installed: D AirStar 10 D AirStar 22 D AirStar 50 D AirStar 21 D AirStar 30 D AirStar 70 Type Style Connection to 24 V Switch Onl Connection without 24 V Switch Compressor Interconnect Cable Remote Swrtch AS10 5-20R Green~· .. NEMA* Dot Yellow2 )) ):@·II ,~J' AS21 AS22 6-20R Green........:· .. Brown4 ) ) ) 4 AS30 NEMA* Dot Orapqe3 ) ) ) 3 3 4 ASSO Hard Org Brn Wired** for Future Use AS70 ~" ~D Use 18 Gauge, 4 Cond.dor, Interconnect Coote Between Compressor and Rernde Swrtch Interior Electncal Box Connections *Hospital Grade Receptacle **Disconnect Needed for Service Building Power Supply Panel Buck/Boost Transformer: Model AS-1 0 Part No. 67005 Remote Air Intake Kits: Model />S-1 0 Part No. 85491 I • " ,, ,, ,, II ,, II ,, I I It It I t I t I t I t I t I />S-21 67005 />S-21 85492 Air System Plumbing Connection Control Cable 18 3 Conductor Connect to orange, yellow & brown wire />S-22 67002 />S-22 85492 />S -30 67002 AS-30 85492 OUTSIDE AIR PIPE 2-lnch Pipe for Air Intake. Must be protected from rain and animals JO.lL'~=· Screen Shroud & Screen Remote Air Intake Kit Manifold Kit includes 70' of clear PVC Tubing per Number of Cylinders 13" l'l'B( AS-50 67002 AS-50 85493 Service Clearance AS-70 67000-1 AS-70 85494 -Allow 12" on all sides for all units -1 /2" FNPT Shut-off valve and a 4ft. pressure hose (supplied) 1 Ambient Temperature Air distribution piping for all models -/2", 1ype "L" or 1ype "K'' copper M t t d 1 05oF If pipe volume is too great, more than 235 in3 or more than 1 00 -us no excee o ft. of 1 /2" diameter pipe, a pressure regulator should be installed -Must be above 40 F between the main tank and the distribution piping and set to 80 psi. All AirStar compressors comply with NFPA 99C level 3 requirements Site Requirements AlrStar 10 AlrStar21 AlrStar 22 AlrStar30 AlrStar&O AlrStar70 Voltage Min./Max. 105/125* 105/125* 200/250* 200/250* 200/250* 200/250* Full Load Amps in. Circuit 8.0 15.0 8.0 8.0 16.0 24.0 Breaker Rating (Amps) 20 30 20 20 30 40 Min. Wire Size (AWG) 12 10 12 12 10 8 watts per Hour 330 640 640 660 1280 1920 BTU per Hour 1126 2184 2184 2252 4368 6552 */nstalf a buck/boost transformer if service is above/below these ratings. Product Specifications -Dimensions AlrStar AlrStar AlrStar AlrStar AlrStar AlrStar 70 10 21 22 30 60 Horsepower/Kilowatts 0.75/0.56 1.5/1.1 1.5/1.1 1.5/1.1 3.0/2.2 4.5/3.3 Voltage Rating 115 115 208/230 2081230 208/230 208/230 CFM 2.5 5.0 5.0 5.0 10.0 15.0 (Cubic Ft./Min)@ 80 psi Pump-up Time 165 145 145 150 135 120 0..100 PSI (sec.} %5% Recovery Time 48 45 45 45 43 37 80-100 PSI (sec.) ±5% Purge Time 35-50 75-90 75-90 75-90 90-105 130-145 100-0 PSI (sec.) Tank Size (cu. ft.) 0.8 1.6 1.6 1.6 2.7 4.0 (US Gal.) 6 12 12 12 20 30 Shipping Weight (Approximate lbs) without Sound Reducing Cover 160 210 210 255 320 430 with Sound Reducing Cover 200 250 250 300 380 N/A Dimensions H 27.5 28.25 28.25 30.0 31.0 32.5 (inches) w 24.5 29.0 29.0 29.0 36.0 42.5 D 21.0 21.0 21.0 21.0 24.0 25.0 Dimensions with H 31.5 32.0 32.0 32.5 33.0 36.5 Sound Reducing Cover w 24.5 32.0 32.0 32.0 27.0 43.5 (inches) D 22.5 22.5 22.5 22.5 24.0 31.0 *A/tow 6 inches to height for removal of sound cover top panel during servicing . . You can obtain more information about Air Techniques' products by visiting our web site at www.alrtechnlques.com Additional installation information is available on our Authorized Air Techniques Dealer web site at hHp:/ /dealers.alrtechnlques.com AI• TEc••••EI PERFECTING YOUR PRACTICE Air Techniques Inc. 1295 Walt Whitman Road, Melville NY 11747 www.airtechniques.com Airstar is a trademark of Air Techniques, Inc. © 2006 Air Techniques, Inc. PN 85654 Rev. K Business Name SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE CARLSBADDS PEDIATRIC SMILES Business Contact JAMESTSAI Project Address 1287 CARLSBAD VILLAGE OR MaiBng Adltess 1285 CARLSBAD VILLAGE DR. Project Contact KUI TAN DESIGN City CARLSBAD City CARLSBAD Applicant E-mail 5. Organic Peroxides 6. Oxidizers 7. Pyrophorlcs 8. Unstable Reactlves Telephone# State 13. Corrosives 1•. Other Health Hazards 15. None of These. qu . yea, nt must contact the of · go ~dous Mate t._ s~qo Ov Avenue, ite 110. San Diego, CA 92123. Call (858) 505-8700 prior to the issuance of a ng permit. ey.. pu.t(lA t..on D;-C e1Y\l:Q.( _ 6 1 Ct FEES ARE REQUIRED Project Completion Date: JULY 2016 Expected Date of Occupancy: 2016-07 -Q1_ 0 CaiARP Exempt YES NO (for new construction or remodeling projects) __ ... L'::""-:-__ 1. ~ [J Is your business listed on the reverse side of1hls fonn? (check a1 that apply). Data Initials 2. 18 0 WI your business clspose of Hazardous Substances or Meclcal Wale in any amount? 3. D D VIII your business store or hande Hazardous Substanoes In quantities "eater than or equal to 55 gallons, 500 0 CaiARP Required I 4. 5. 6. 7. 8. D 0 0 D 0 pounds and/or 200 GUblc feet? D \Mil your busine1s store or hancle carclnogenslreproduotive toxiM in any quantity? 0 \/WI your business use an existing or lnstan an under"o1.11d storage tank? 0 \/WI your business store or hancle Regulated Substances (CalARP)? 0 VWI your business uee or ln&taU a Hazardous Waste Tank System (11tle 22, Ar11cle 10)? 0 \Mil your bu8lness store pefl'oleum in tanka or container. at your faGIIity wllh a total facility storage capacity equal to or terthan 1 320 ? Callfornla'sNJ d Petroleum lnltiallt 0 CaiARP Complete I lnitiUJ PAIJT ltl: SAN DIEGO coum AIR POLLUTION CONT..JLOL DISTRICT «A~P): The folowlng questione are intended to Identify the maJority of air pollution issues at the planning stag;:Vour project may require aadliiOnat measures not identified by IIese que8tions. Some resldenlfal projeciB rriay be exempt tom APCD requirements. For more comprehensive requirements, please contact APCO at apcdeonmllbdcountv.ca.ggv; (858) 586-2850; or 10124 Old Grove Road, San Diego, CA 92131. YES NO 1. 0 a \MIIhe project disturb 160 square feet or more of existing building materials? 2. 0 a \MI any load suppo111ng structulal members be removed? If yes, contact APCD prior to Issuance of a building or demolition permit. A 3. 0 4. 0 5. 0 6. D notilc:atlon may be required at least 10 working days prior to COIMiencing demolition. 0 (ANSWER ONlY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been p81fonned? 0 (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Based on the survey results, wil lhe project disturb any asbestos containing material? If yes, contact APCD prior to the iaeuance of a build"mg or demolition permit. A notification may be required at least 10 worldng days prfot' to commencing asbestos removal. 1m V\lllhe project or 8180Ciated construction equipment emit air contaminants? See the reverse side of this fonn or the APCD fac:tsheet (~gapc;d.orglinJ~mlP.!i!!:l'l~,ruW for typical equipment requiring an APCD permit. If yes, contact APCO prior to the Issuance of a buDding perrnlt. 0 (ANSWER ONLY IF QUESTION 5 IS YES) WiR lhe project or associated construction equipment be located within 1,000 feet of a school 1 Briefly describe business activities: Briely describe proposed project: IENI'IL T.l 1t lt::IJ I/(, Date FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ---------------. --------·--·----- BY: DATE: ____ L ___ L __ _ RELEAS£0 FOR BUII.DING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY APCD COUNTY-HMO APCO COUNTY-HMO APCD xempta buaine$$88 from completing or updating a Hazardous Materials BUIIineaa Plan. 01her permitting requirements may still apply. County of San Diego-DEH-Hazardous Materials Division {'Cicyof Carlsbad PLUMBING, ELECTRICAL, MECHANICAL WORKSHEET Development Services Building Division 1635 Faraday Avenue 760-602-2719 www .carlsbadca.gov Building@carlsbadca.gov B-18 Project Address: Permit No.:~\l.Q \ Lc?05 Information provided below refers to wom being done on the above mentioned permit only. This form must be completed and returned to the Building Division before the permit can be issued. B-18 Building Dept. Fax: (760) 602-8558 Number of new or relocated fixtures, traps, or floor drains ....................................................... _1_ New building sewer line? ......................................................................................... Yes __ No~ Number of new roof drains? ............................................................................................................... _::&:._ Install/alter water line? ......................................................................................................................... _fr_ Number of new water heaters?......................................................................................................... l Number of new, relocated or replaced gas outlets? .................................................................... tr Number of new hose bibs?.................................................................................................................. 9 Residential Permits: New/expanded service: Number of new amps: ------- Minor Remodel only: Yes__ No Commercial/Industrial: Tenant Improvement: Number of existing amps involved in this project: Number of new amps involved in this project: N~ Construdion: Amps per Panel: zoo Single Phase ............................................................... Number of new amperes ___ --fr....!:o<:, __ _ Three Phase ................................................................. Number of new amperes __ --'-2_00~::.:...._ __ Three Phase 480 ........................................................ Number of new amperes ___ ....;:G-=---- Number of new furnaces, A/C, or heat pumps? ............................................................................ ~ New or relocated duct wo~? .......................................................................... Yes ~ No • Number of new fireplaces? ................................................................................................................. ~ 0 Number of new exhaust fans? ............................................................................................................ ..:!l!t:.:l- Relocate/install vent?............................................................................................................................ -f:T Number of new exhaust hoods?........................................................................................................ -6- -&-Number of new boilers or compressors? ........................................................... Number of HP _..;;;;__ Page 1 of 1 Rev. 03/09