HomeMy WebLinkAbout1808 ASTON AVE; ; PC100015; PermitG>uildiBuilding Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-27 17/2718/2719
Fax 760-602-8558
www.carlsbadca.gov
Plan Check I
Est. Value
Plan Ck. Deposit
DESCRIPTION OF WORK: /nc/ude Square Feet of Affected Area(s)
l U
CONTACT NAME (If Different Pom Applicant)
(Sec. 7031.5 BusinessfandlProfessions Code: Any City or County which requ/res a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires theapplicant for such permit tc*file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law {Chapters, commending with Section 7000 of Division 3 of theBusiness 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 subjects the applicant to acivil penalty of not more than five hundred dollars {$500}).
Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations:
fh have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
JXJ I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy
• \iumber are: Insurance Co Policy No. Expiration Date
This section need not be completed if the permit is for one hundred dollars ($100) or less.
| | Certificate of Exemption: 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in
addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
JS$ CONTRACTOR SIGNATURE QAGENT DATE
/ hereby affirm that I am exempt from Contractor's License Law for the following reason:
| [ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's
License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
[ [ I am exempt under Section Business and Professions Code for this reason:
1.1 BWgeqally plan to provide the major labor and materials for construction of the proposed property improvement. I lYes
2. l(havej(have not) signed an application for a building permit for the proposed work.
3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number):
4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone / contractors' license number):
5.1 will provide some of the work, but I have contracted (hjierj) thejojlflwjrio. persons to provide the work indicated (include name / address / phone / type of work):
^"PROPERTY OWNER SIGNATURE AGENT DATE
Is the applicant or future building occupant required to submit a business plaf. acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the
Presley-Tanner Hazardous Substance Account ACT? | |Yes J^lNo _ «x
Is the applicant or future building occupant required to obtain a permit from The air pollution control district or &irqM01ity management district? I JYes ]f I No
t \Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
I JYes No
I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code).
Lender's Name Lender's Address
I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes, I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD
OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within
180 days from tte date of such permit wif the building or i^autho/^
^APPLICANT'S SIGNATURE |P
EsGil Corporation
In Partnership with government for <BuiCding Safety
DATE: 4/9/1O O_APPJJCANT
JURISDICTION: City of Carlsbad O^FtTWREVIEWER
a FILE
PLAN CHECK NO.: PC10-15 SET: I
PROJECT ADDRESS: 1808 Aston Ave Suites 260-265
PROJECT NAME: Spec Suites 26O-265 - TI
X3 The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
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.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
The applicant's copy of the check list has been sent to:
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: ) Fax #:
Mail Telephone Fax In Person
REMARKS:
By: Doug Moody Enclosures:
EsGil Corporation
D GA D EJ D PC 4/5/10
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 * (858)560-1468 + Fax (858) 560-1576
City of Carlsbad PC1O-15
4/9/10
[DO NOT PAY- THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad PLAN CHECK NO.: PC1O-15
PREPARED BY: Doug Moody DATE: 4/9/10
BUILDING ADDRESS: 1808 Aston Ave Suites 260-265
BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: VA
BUILDING
PORTION
Tl
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code
AREA
( Sq. Ft.)
6107
cb
Valuation
Multiplier
34.37
By Ordinance
Reg.
Mod.
VALUE ($)
209,898
209,898
$1,046.33
Plan Check Fee by Ordinance
Type of Review:
Repetitive Fee
Repeats
Complete Review
D Other
r—I Hourly
EsGil Fee
Structural Only
Hr. @
$680.11
$585.94
Comments:
Sheet 1 of 1
macvalue.doc +
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER PC 10-15 DATE 4/2/10
ADDRESS 1808 Aston Ave
RESIDENTIAL ADDITION-
MINOR (<17,000.00)
RETAINING WALL
VILLAGE FAIRE
POOL/SPA
TENANT IMPROVEMENT
COMPLETE OFFICE BUILDING
OTHER office to office no new structural work
PLANNER Chris Sexton
ENGINEER I ci (> (Ac cc.
DATE 4/2/10
DATE
H:\ADMIN\COUNTER/PUNNINC/ENGlNEERlNC APPROVALS
CORRECTION LIST Page: 1 of 1
Daryl K. James & Associates, Inc.
205 Colina Terrace
Vista, CA 92084
T. (760) 724-7001 Email: kitfire@sbcglobal.net
Checked by: Daryl Kit James
Date: Aprils. 2010
APPLICANT: Tara Norton JURISDICTION: Carlsbad Fire Department
PROJECT NAME: Wells Fargo PROJECT ADDRESS: 1808 Aston Avenue Ste 260 & 265
PROJECT DESCRIPTION: CB100553 & CB100554 PC No.100015 HLDO, DEPT COPY
INSTRUCTIONS
• This plan review has been conducted in order to verify conformance to minimum requirements of codes
adopted by the Carlsbad Fire Department.
• The items below require correction, clarification or additional information before this plan check can be
approved for permit issuance.
« Corrections or modifications to the plans must be clouded and provided with numbered deltas and revision
dates along with a descriptive narrative of corrections addressing all comments.
• Please direct any questions regarding this review to: Daryl Kit James (760) 724-7001 or
kitfire@sbcglobal.net
• This Correction List and Revised Fire Set Plans to be Delivered Directly to:
Daryl K. James & Associates, Inc.
205 Colina Terrace
Vista, CA 92084
T1-1 TITLE SHEET -
Code References (under Sheet Index)
a Add NFPA 13 2002 Edition and NFPA 72 2007 Edition
TI-3 EXIT PLAN
Legend
a Denote sq. ft. area, no. of occupants and occupant load factor in each room on floor plan based on the
use of each area. i.e. denote an occupant load factor of 15 in Room 200-Reception.
TI-4 PARTITION PLAN
a Add note: rated doors will be equipped with label specifying fire resistive rating.
a Add note: Egress doors shall be readily operable from the egress side without the use of a key or special
knowledge or effort.
a Denote type, location, height of fire extinguisher in accordance with NFPA 10 requirements and denote
location.
TI-6 REFLECTED CEILING PLAN
Reflected Ceiling Legend
a Provide 90 minutes battery back up for internally lit exit signs and emergency lighting
a Denote locations of exit signs and emergency lighting in corridor on plan
a Denote location of emergency lighting and reference Sheet E-2.
E-2 Lighting Plan
Lighting Legend
a Provide 90 minute battery pack for emergency lighting & exit signs.
a Relocate exit sign to entrance of Room 200.
a Denote emergency lighting and exit signs on plan.
Carlsbad Fire Department
Plan Review Requirements Category: 11, INDUST
Date of Report: 04-08-2010 Reviewed by:
Name: ROBERTS & BENNETT
Address: 1010 UNIVERSITY AVE
STE C203
SAN DIEGO p, v .,. ,. „
CA92103 t'jLiKj. i.;.,../;"! COPY
Permit #:CB 100370
Job Name: WELLS FARGO: 2,958SF TI/ OFF
Job Address: 1808 ASTON AV CBAD St. 270
INCOMPEETE" TEenftem^3j£Ii3X^^ is incomplete. At this time, this office cannot
adequately conduct ajew«w""fb determine compliance with"Inapplicable codes and/or standards. Please review
carefully all comrffents attached. Please resubmit the necessary plans and/of specifications, with changes "clouded",
to this office for review and approval. "~-~-«.
Conditions:
Cond: CON0003959
[NOT MET]
CORRECTIONS
Tl-1 TITLE SHEET -
Project Data
Occupancy - Justify classification of conference room, with an area greater than 750 square feet as
a Group B Occupancy and not as an Assembly Occupancy (CBC 303.1). Address CBC Chapter 5
requirements in a code analysis for mixed use occupancy.
General Notes, and Under Separate Submittals Notes
Note 19 - Revise code section to CFC 505.1
Reflected Ceiling Plan Notes
Remove reference to UFC Section 12.108
Door & Hardware Notes
Note 4. Revise references to CBC Sec. 803, 804 & 806.
Note 5. Revise to 34" minimum and 48" maximum
Fire Protection Notes
Note 6. Revise reference to CFC 712.3.3 to CBC 712.3.3
Under Separate Submittal
Revise hazardous materials table references from UBC Table 3-D & 3E to CBC Tables 307.1(1) and
307.1(2)
Code References (under Sheet Index)
Revise reference to 2006 IEBC to IBC
Add NFPA 13 2002 Edition and NFPA 72 2002 Edition
Page: 2 of 2
Vicinity Map
Provide a north directional arrow
Sign (typical all sheets)
TI-2 SITE ACCESS
Mark this sheet FOR REFERENCE ONLY
Provide a north directional arrow
TI-3 EXIT PLAN
Provide room numbers on plan.
Revise # of occupants and occupant load factor in Conference Room. See Room Legend on sheets TI-5 &
TI-8.
Revise total occupant load
Justify exiting into non-continuous 1-hr rated corridor in path of egress. All interior partitions
and rated per CBC Table 601 for Type VA construction type? Please clarify on plans.
Provide egress analysis for all areas in accordance with CBC Section 1004. Compute the number of
occupants at the rate of one occupant per unit of area as prescribed in CBC Table 1004.1.1.
Determine the use based on a listed use that most resembles the proposed
Provide suite address specifications
Provide a north directional arrow
TI-5 PARTITION PLAN
Add note: rated doors will be equipped with label specifying fire resistive rating.
Add note: All doors are operable without the use of a key, special knowledge or effort.
Denote height of fire extinguisher in accordance with NFPA 10 requirements and denote location.
TI-7 REFLECTED CEILING PLAN
Reflected Ceiling Legend
Provide 90 minutes battery back up for internally lit exit signs
Denote locations of directional exit signs in corridor on plan Condition of recommended approval
Denote location of emergency lighting and reference Sheet E2.
TI.9 DETAIL SHEET
Detail 1
Revise reference from UBC to CBC Table 720 Item #
Details 2 & 3
Provide listed design numbers for rated walls or reference CBC Table 720 item number.
E-2 Lighting Plan
Lighting Legend
Provide 90 minute battery pack for emergency lighting & exit signs.
Lighting Plan
Denote directional exit signs in corridor Condition of recommended approval
RECOMMENDED APPROVAL CONTINGENT UPON EXIT SIGNS IN CORRIDOR
TO BE ADDED BY DESIGNER OVER THE COUNTER
Entry: 03/08/2010 By: JJK/cw Action: CO
Cond: CON0003960
[MET]
**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 DEPARTMENT
NOTATIONS,
CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND
REGULATIONS.
THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW.
Entry: 04/06/2010 By: JJK/cw Action: AP
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST
(Part 1 of 5)MECH-1C
Project Name
Spec Suites 260&265
Date
3/26/2010
Project Address
1 808 Aston Ave Carlsbad
Climate Zone Total Cond. Floor Area
1,000
Addition Floor Area
0
GENERAL INFORMATION
Building Type:Nonresidential D High-Rise Residential D Hotel/Motel Guest Room
D Schools (Public School) D Relocatable Public School Bldg. 0 Conditioned Spaces
Phase of Construction:D New Construction D Addition Alteration
Approach of Compliance:D Component 0 Overall Envelope TDV
n unconditioned (file affidavit)
Front Orientation: N, E, S, W or in Degrees: 180 deg
HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST
Equipment2
Item or System Tags
(i.e.AC-1,RTU-1,HP-1)
Equipment Type4:
Number of Systems
Max Allowed Heating Capacity
Minimum Heating Efficiency
Max Allowed Cooling Capacity
Cooling Efficiency
Duct Location/ R-Value
Duct Leakage Testing - If Yes, a
MECH-4A must be submitted
Economizer
Thermostat
Fan Control
Equipment2
Item or System Tags
(i.e.AC-1,RTU-1,HP-1)
Equipment Type":
Number of Systems
Max Allowed Heating Capacity
Minimum Heating Efficiency
Max Allowed Cooling Capacity
Cooling Efficiency
Duct Location/ R-Value
Duct Leakage Testing - If Yes, a
MECH-4A must be submitted
Economizer
Thermostat
Fan Control
Meets Criteria or Requirements
Inspection Criteria Special Feature1
HP-1
Hydronic Heat Pump
1
42,800 Btu/hr
4.10 COP
34,000 Btu/hr
12.6 EER
R-4.2
No
No Economizer
Setback Required
Constant Volume
FIELD INSPECTION ENERGY CHECKLIST
Inspection Criteria Special Feature1
n
a
D
1 . Indicate special feature DETAILS on Page 2 of the Inspection Checklist Form.
2. If the Actual installed equipment performance efficiency and capacity is less than the Proposed (from the energy compliance submittal or from
the building plans) the responsible party shall resubmit energy compliance to include the new changes.
3. For additional detailed discrepancy use Page 2 of the Inspection Checklist Form.
4. Indicate Equipment Type: Gas (Pkg or, Split), VAV, HP (Pkg or split), Hydronic, PTAC, or other.
EnergyProS-ObyEnergySott User Number: 3051 RunCode: 2010-03-26711:23:01 ID:Page 1 of 8
Project Name
Spec Suites 260&265
Date
3/26/2010
CERTIFICATE OF COMPLIANCE and (Part 2 of 5) MECH-1C
FIELD INSPECTION ENERGY CHECKLIST
SPECIAL FEATURES INSPECTION CHECKLIST
The local enforcement agency should pay special attention to the items specified in this checklist. These items require
special written justification and documentation, and special verification. The local enforcement agency determines the
adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the
special justification and documentation submitted.
Discrepancies:
EnergyPro 5.0 by EnergySoft User Number: 3051 RunCode: 2010-03-26711:23:01 ID: Page 2 of 8
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CERTIFICATE OF COMPLIANCE (Part 5 of 5)MECH-1C
Project Name
Spec Suites 260&265
Date
3/26/2010
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and complete.
Name Lee Sautereau Signature
Company Brian Cox Mechanical, Inc.Date 3/26/2010
Address 12155 Kirkham Road EA#
CEPE#
City/State/Zip Powayi CA 92064 Phone 858-679-5757
The Principal Mechanical Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the mechanical
design.
• This Certificate of Compliance identifies the mechanical features and performance specifications required for compliance
with Title-24, Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name Brian Cox
Company Brian Cox Mechanical, Inc.Date
Address 12155 Kirkham Road License #
City/State/Zip Poway, CA 92064 Phone 858-679-5757
Mandatory Measures
Indicate location on building plans of Note Block lor Mandatory Measures.
MECHANICAL COMPLIANCE FORMS & WORKSHEETS (check box If worksheet is included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the 2008 Nonresidential Manual.
Note: The Enforcement Agency may require all forms to be incorporated onto the building plans.
H MECH-1C Certificate of Compliance. Required on plans for all submittals.
El MECH-2C Mechanical Equipment Summary is required for all submittals.
El MECH-3C Mechanical Ventilation and Reheat is required for all submittals with mechanical ventilation.
El MECH-4C Fan Power Consumption is required for all prescriptive submittals.
EnergyPro 5.0 by EnergySoft User Number: 3051 RunCode: 2010-03-26711:23:0 ID:Page 5 of 8
AIR SYSTEM REQUIREMENTS (Part 1 of 2) MECH-2C
Project Name Date
Spec Suites 260&265 3/26/2010
Item or System Tags
(i.e. AC-1,RTU-1,HP-1)
Number of Systems
MANDATORY MEASURES
Heating Equipment Efficiency
Cooling Equipment Efficiency
HVAC Heat Pump Thermostat
Furnace Controls/Thermostat
Natural Ventilation
Mechanical Ventilation
VAV Minimum Position Control
Demand Control Ventilation
Time Control
Setback and Setup Control
Outdoor Damper Control
Isolation Zones
Pipe Insulation
Duct Insulation
PRESCRIPTIVE MEASURES
Calculated Design Heating Load
Proposed Heating Capacity
Calculated Design Cooling Load
Proposed Cooling Capacity
Fan Control
DP Sensor Location
Supply Pressure Reset (DDC only)
Simultaneous Heat/Cool
Economizer
Heat and Cool Air Supply Reset
Electric Resistance Heating1
Air Cooled Chiller Limitation
Duct Leakage Sealing. If Yes, a
MECH-4-A must be submitted
Indicate Air Systems Type (Central, Single Zone, Package, VAV, or etc...)
|1H|HJWB|HP-1
1
Indicate Page Reference on Plans or Schedule and indicate the applicable exception(s)
T-24 Sections
112(a)
112(a)
112(b), 112(c)
112(c),115(a)
121(b)
121(b)
121(c)
121(0
122(e)
122(e)
122(f)
122(g)
123
124
4.10 COP
12.6EER
Yes
n/a
Yes
150 cfm
No
No
Programmable Switch
Setback Required
Auto
n/a
R-4.2
144(a & b)
144(a&b)
144(a&b)
144(a&b)
144(c)
144(c)
144(c)
144(d)
144(e)
144(f)
144(g)
144(i)
144(k)
11, 029 Btu/hr
38,095 Btu/hr
32,421 Btu/hr
31,974 Btu/hr
Constant Volume
Yes
No
No Economizer
Constant Temp
Constant Temp
No
1 . Total installed capacity (MBtu/hr) of all electric heat on this project exclusive of electric auxiliary heat for heat pumps. If electric heat is used
explain which exception(s) to §144(g) apply.
EnergyProS.ObyEnergySoft User Number: 3051 RunCode: 2010-03-26T1 i :23:0 ID: Page6of8
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FAN POWER CONSUMPTION MECH-4C
Project Name Date
Spec Suites 260&265 3/26/2010
NOTE: Provide one copy of this worksheet for each fan system with a total fan system horsepower greater than 25 hp for Constant Air Volume (CAV)
Fan Systems or Variable Air Volume (VAV) Systems when using the Prescriptive Approach. See Power Consumption of fan §144(c).
A
Fan Description
Supply Fan
B
Design Brake
HP
0.250
C D
Efficiency
Motor
64.0%
Drive
700.0 %
E
Number of
Fans
1.0
F
Peak Watts
B X E X 746 /
(CXD)
291
TOTALS AND ADJUSTMENTS
FILTER PRESSURE ADJUSTMENT Equation 144-A in §144(c) „ TQTAL FAN sySTEM pQWER (WATTS SUM CQWM R
2) SUPPLY DESIGN AIRFLOW (CFM)
A) If flta- pressure drop (SPJ is greater, to IhchW.C. or ffl TOTAL FAN SYSTEM POWER INDEX (Row 1 / Row 2)
pressure drop across the fan (SP() on Line 5. 4) SP,
5) SP,
B) Calculate Fan Adjustment and enter on line 6. 6) Fan Adjustment = 1-( SPa-1)/SPi
C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1
291
1,200
W/CFM
0.243 W/CFM
1 . TOTAL FAN SYSTEM POWER INDEX or ADJUSTED FAN POWER INDEX must not exceed 0.8 W/CFM for Constant Volume systems or 1 .25
W/CFM for VAV systems.
EnergyPro 5.0 by EnergySoft User Number: 3051 RunCode: 2010-03-26T1 1:23:0 ID: Page 8 of 8
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS QUESTIONNAIRE
OFFICE USE ONLY
UPFP#.
HV#
BP DATE J I
he following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business
will 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 submittal.
5. Organic Peroxides 9. Water Reactives 13. Corrosives
6. Oxidizers 10. Cryogenics l^^Other Health Hazards
7. Pyrophorics 11. Highly Toxic or Toxic Materials /\ 5. >lone of These.
8. Unstable Reactives 12. Radioactives
1. Explosive or Blasting Agents
2. Compressed Gases
3. Flammable/Combustible Liquids
4. Flammable Solids
PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD): If
questions is y
Call (61 9) 338
FEES ARE R[
YES \1. n (
2. D C3. n c
4. n c5. n [e. n c
as, applicant must contact the County of San Diego Hazardous Materials Division, 1 255 Imperial Avenue. 3m floor San Diec
-2222 prior to the issuance of a building permit. f~~~ I ]f~\
EQUIRED. Expected Date of Occupancy: ~/ / (. 1 /(_/
1?] Is your business listed on the reverse side of this form? (check all that apply).
] Will your business dispose of Hazardous Substances or Medical Waste in any amount?
] Will your business store or handle Hazardous Substances in quantities equal to or greater than
55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity?
] Will your business use an existing or install an underground storage tank?
I Will your business store or handle Regulated Substances (CalARP)?
] Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
the answer to any of the
o, CA 92101.
D CalARP Exempt
/
Date Initials
D CalARP Required
/
Date Initials
D CalARP Complete
/
Date Initials
PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air
Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition
permit. Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to
commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information.
1.
YES
D
nn
Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the
APCD factsheet at http://www.sdapcd.org/info/facts/permits.pdf, and the list of typical equipment requiring an APCD permit on the reverse side
of this from. Contact APCD if you have any questions).
(ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)?
(Public and private schools may be found after search of the California School Directory at http://www.cde.ca.gov/re/sd/: or contact the
appropriate school district).
Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos?
Will there be demolition involving the removal of a load supporting structural member?
efri&Jk
Briefly describe busini Briefly describe proposed project:
bin are true and Correct.it Jb the best of my knowledge and
Name of owner or
FOR OFFICIAL USE ONLY:FIRE DEPARTMENT OCCUPANCY CLASSIFICATION.
BY:
EXEMPT OR NO FURTHER INFORMATION REQUIRED
COUNTY-HMD APCD
RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY
COUNTY-HMD APCD
RELEASED FOR OCCUPANCY
COUNTY-HMD APCD
HM-9171 (04/07)County of San Diego - DEH - Hazardous Materials Division