HomeMy WebLinkAbout1820 MARRON RD; 110; CB050335; PermitCity of Carlsbad 4
1635 Fáraday.Av Carlsbad, CA 92008
06-14-2005 : - Commercial/industrial Permit Permit No: CB050335
Building Inspection Request Line (760) 602-2725
Job Address: 1820 MARRON RD CBAD St 110
Permit Type: TI . Sub Type: ,COMM
Parcel No: 1563011600 Lot #: 0 Status: ISSUED
Valuation: . $119322.00 . Construction Type: NEW 'Applied: 02/02/2005
Occupancy Group: Reference #: Entered By: LSM
Project Title: ' PLAN PARENTHOOD-2841 SF . Plan Approved: 04/20/2005
'OFFICE TO OFFICE . Issued: 04/20/2005
Inspect Area: PC
. Plan Check#:
Applicant: Owner: -
WARNER ARCHITECTURE DESIGN PAN PACIFIC RETAIL PROPERTIES
STE 200 1631 S MELROSE DR #B'
427C5T 92010. .' . VISTA CA 92081
. .
(619)238-6009.
•Building Permit . $608.16 Meter Size .
Add'I Building. Permit Fee $0.00. Add'l Red. Water Con. Fee $0.00
Plan Check . $395.30 Meter Fee . $0.00
Addi Plan Check Fee . - $0.00 SDCWA Fee ', . . . ' $0.00
Plan Check Discount . $0:00 CFD Payoff Fee . $0.00 .
Strong Motion Fee . . . $25:06 PFF '' $0.00 .
Park Fee . . $0.00 PFF (CFD Fund) $0.00
. . LFM Fee . - $0.00. License Tax -. . $0.00
Bridge Fee . . $0.00 License Tax (CFD Fund) $0.00
BTD #2 Fee . . . $0.00 . Traffic Impact Fee - . $0.00
BTD#3 Fee . $0.00 Traffic Impact (CFD Fund) '. . $0.00.
Renewal Fee - $0.00 PLUMBING TOTAL , $118.00
AddI Renewal Fee . . $0.00 ELECTRICAL TOTAL . $124.00
Other Building Fee ' $0.00 MECHANICAL TOTAL . $15.00
Pot Water Con. Fee . . $0.00 . Master Drainage Fee. : . $0.00
. Meter Size . '. • . Sewer Fee $0.00
Add'l Pot. Water Con. Fee $0.00 Redev Parking Fee $0.00
Rel. Water Con. Fee , . . . $0.00 Additional Fees . . . $0.00
- . TOTAL PERMIT-FEES
. -.
$1,285.52
Total Fees: . $1,285.52 Total Payments.To Date: $0.00 $1,285.52 Balance Due:
-_ATTACHED
.
FINIAL
fl ' Inspector: Date Clearance:
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservation, or other exactions hereafter collectively
referred to as "feds/exactions.". You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other rquired.information with the City Manager for
processing in accordance with Carlsbad Municipal.Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to'water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar aplication processing or service fees in connection'with this project. NOR DOES IT APPLY to any
fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise exoired. "
yflct Ve(11f223 OD
FOR OFFICE USE ONLY
PERMIT APPLICATION PLAN CHECK NO.ôS 3
CITY OF CARLSBAD BUILDING DEPARTMENT xtif1I. ESTVAL
1635'F` raday Aye, Carlsb'äd, CA 92008
Pn Ck Deposit 3 9 ?
.:
hdatedB
Date
Y/..1
..
.;
rL'F.XJ.CT INFORMATION * Mñ uo mc p1iieou
Add e s (i lude Bldg/Suite #). . ..-. .. . BusinessName (at this address)
'A_T: Ma14AA tc7 ,., ,. .. ... .,C.: . ,.,7094 API /A^ HO
LeaI,Descrip n . '. : Lot . : ubdivisioNee/Number. . '-Unit No. p .02 VotaI #units f (P 395 30 Assessors Pa 81 # Existing Use
D scription of Work.- SQ FT #of Stories # of Bedrooms # of Bathrooms
/
N PP [R~NA.(i=f-alffe
— * F~A
Name Addrpp . . Ci to• p
UPRLICANT—. or Owner
. Tr' n S -
—ontra Agent for Co"t*~
2-
Name Address
/ I 2b P p Te e o P
rLPROPEYOER . 'Pry jft
Na- . ,- Addre . City Stoto Zip Teeph'ne P
frEt. -.
-. (Sec 7031.5 Business and Professions Códe: Any City orCointy which requires a-perrnitto construct, alter, irnprove;demolish oçrepair any structure prior To it
issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor s License Law
IChapter 9 commending with Section 7000 of Division 3 of the Business and Professions Codel or, that he is exempt therefrom and the basis for the alleged
exemptio ny iolatiaJa.f ectior'iJ71 5 b pplicant for a permit suble the applic t to civil penalty of n more than five hundred dollars 1$ 5001)
/ ieleti, øi a.- a 9//r d'SJ/'Y
Name . Address City State/Zip Telephone #
State License # p 3 I License — '3 I.> 75 City Business License # , ppe_i.e•.c:a
................. .- ,
,.A .:..
.-. ,':
Designer Name Address City State/Zip Telephone
State License
( Workers Compensation Declaration I hereby affirm under penalty of perjury one of the follovong declarations
0 I have and will maintain a certificate of cons ent to self insure for workers compensation as provided by Section 3700 of the Labor Code fo the performani. ce
of the work for which this permit is issued
0 I have and will maintain workers compensation as required by Section 3700 of the Labor Code for the per of the work for which this permit is
issued My worker's compensation insurance carrier and policy number are - )
Insurance Company Policy No.' Expiration Date__________________
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$ 1001 OR LESS)
CERTIFICATE OF EXEMPTION ertify 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 Wor C pensation Laws of Ca rnia
WARNING Failure to se re era o a is unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars ($1 00 addi 0 nsation damages as provided for in Section 3706 of the Labor code interest and attorney s fees
SIGNATURE ___./ DATE 4• /
LOWN.BUIt5 ECLARATION$ I her affirm that I am exempt from the Contractor's Licei ise Law for the following reason
0 I as owner of the property or my employees with wsge. 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 'a 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)
0 I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec 7044 Business and Professions Code The
Coitractor 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) .
0 jJ am exempt under. Section Business and Professions Code for this reason
1 I personally plan to provide the major labor, and materials for construction of the proposed property improvee mnt 0 YES ONO
2 I (have/ have not) signed an application for a building permit for the proposed worke.
3 I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number/ contractors license number)
4 I plan to provide portions of the work but I àve hired the following person to coordinate supervise and provide the major work (include name,;/ address,/ phone
number / contractors license number)
5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated (include name address / phone number I type
w ofork) - a / c •
PROPERTY OWNER-SIGNATURE ..- .çDATE
Is the aplicant or future building occupant required to submit a business plan actte1v hazardous materials registration form or r k rn rn p rr t rod pr v I tiorl
program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act? 0 YES 0 NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES 0 NO
Is the facility to be constructed within 1,000 feet of the,outer boundary Iof a school site? 0 YES ICj 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
REQEMENTSOF THE OFFICE OFEMERGENCY SERVICES AND-THE AIR POLLUTION CONTROL DISTRICT. UIR - -'. 0 ...............,. At F CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lending sg n for tha pwformarice ol the ork for v.rhirh ph ' rmit I I jyd 't'li Civil Code)
LENDERS NAME- ., . LENDER'S ADPESS
' _AP- N, -.
I certify that I have read the application and state that the above information correct and that the information on theplans is accurate I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit' 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>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 permit is rquired for excavations over 5 0 deep and demolition or construction of structures over 3 stories in height
EXPIRATION Every permit sued by the buildingfficial 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 n t c mmenced within 80 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned
at any time after the work is c e ced..for a ri 0)180 days (Section-106.4.4,Uniform Building Code)
APPLICANT S SIGNATURE — DATE
WHITE File'-f YELLOW Applicant PINK Finanie -
4
City of Carlsbad Bldg Inspection Request
For 06/13/2005
Permit# CB050335 : . 0 Inspector Assignment: PC .
Title: PLAN PARENTHOOD-2841 SF .. '• : 0 •0
Description OFFICE TO OFFICE
Type: TI " ,
0
Sub Type: COMM
0 ' 0 . : . . .•
Phone: 8584050285'
Job Address: 1820, MARRON RD '
'
•" 0 ' 0 '
0
0: ..
. , 0 0
0 ' Suite. 110
0
,
0
0 Lot 0
,
Location Inspector
APPLICANT WARNER ARCHITECTURE DESIGN ,
" 0
,
0• 0
, •, 0
0 0 Owner:
O Remarks: '
-
:
0
, 0 0
•,
,
0, 0
Total Time: 0
, 0
, ,0 0
, Requested By:. BOB KANE
0 ' 0 0 .,
0
: , 0
0
o ,,,, , , , , Entered By:. KAREN "
0
, CD 0 Description
.• . . . 0 .Act
19 Final Structural.. 0
0
•
0 0 , '
, 0
,Final Plumbing
39 Final Electrical- , .
0, , , 0 ' 0
49 Final Mechanical , . 0 . '..
.
0 ' 0
,
0 Associated PCRs/CVs
cv030729 UNFOUND 0-SEEPAGE COMING.THRU SLAB;'CARPET IS DISCOLORED0 0, 0 • ' •
0
0 0 Inspection History
O Date. Description . . Act lnsp' Comments 0
' 0 - ' 0
05/27/2005 ' 14 Frame/Steel/Bolting/Welding AP PC ABOVE CEILING
05/27/2005 34 Rough Electric • . AP PC: . . ' . . 0 0 ' '0' 0 •
05/27/2005 44 Rough/Ducts/Dampers •' AP PC
05/10/2005 '0 17 Interior Lath/Drywall • AP PC', ,
0 -.
0
O 05/06/2005 16 insulation , • ' AP PC
0
05/06/2005 24 Rough/Topout . AP PC • . , . , • ' . :
,'
,
' .05/05/2005 16 insulation .AP PC RESCHEDULE FOR FRIDAY AM' - 0
05/05/2005 ' 24 Rough/Topout NR PC , ' ' , ,
. : • . •,
05/04/2005 14 Frame/Steel/Bolting/Welding PA 'PCI WALLS 0, 0 , , o 0
05/04/2005 34 Rough Electric . ' PA PC '
0
04/21/2005 21 Underground/Under Floor - : -. AP PC ' ' • 0
. 0
•
04/21/2005 24 'Rough/Topout ' AP PC
Carlsbad 050335 -
4/15/05
V EsGil Corporation ,
In Partnership with qovernment for Budding Safe t9
DATE: 4/15/05 -
V U APPLICANT
- V U JURIS.
JURISDICTION: Carlsbad . U PLAN REVIEWER
U FILE
PLAN CHECKNO.: 050335. * SET: III
PROJECT ADDRESS: 1820 Marron Rd, Suite 110. V
V PROJECT NAME: Planned Parenthood Medical Clinic
The plans transmitted herewith have been corrected where necessary and substantially comply
V with the jurisdiction's building codes. V
V V V
LI The plans transmitted herewith will substantially comply with the jurisdiction's building codes when
V minor deficiencies identified below are resolved and checked by building department staff. V
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck. V V
V
V
V
LI The check list transmitted herewith VS for your information. The plans are being held at Esgil V
V
-Corporation until corrected plans are submitted for recheck. V
V
V
V
El the applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant.
V contact person.
U The applicant's copy of the check list has been, sent to: V
V
• VV
V
V
V
• Esgil Corporation staff did not advise the applicant that the plan ,check has been completed.' V
U Esgil Corporation staff dud advise the applicant that the plan check has been completed
Person contacted Kellie Force Telephone # In Person
Date contacted: 4/15/05 (by: CM) V Fax #: V V
V Mail Telephone Fax In Person
U REMARKS NOTE This is an OSHPD3 clinic and must be inspected and certified by the
V city for compliance with the OSHPD3 standards for medical 'clinic. The plans are approved -
, for compliance with, OSHP3 requirements..
V: V - •
V V V
V ' By: Chuck Mendenhall V V Enclosures:' V V
Esgil Corporation
LI GA IJ MBV LI EJV
' PC Walk In VV V V ' V
tmsmtlVdotV'
,.. . .
.
'
- -
-t -
EsGil Corporation
- In Partnership with government for Building Safety
DATE: 4/1/05 . '. U NT
OJURIS.
4JURlSDlCTlON: Carlsbad 0 PLAN REVIEWER
:* .0 FILE
PLAN-CHECKNO.: 050335 SET: II .
PROJECT ADDRESS: 1820 Marron Rd, Suite 110 .
PROJECT NAME: Planned Parenthood Medical Clinic
El The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes. . - . . •
H 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.
H The plans transmitted herewith have significant deficiencies identified on .the enclosed checklist
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. . . .
H The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
The applicant's coy of the check list has been sent to: . .•
Kellie Force, Architect S •
427 'C, St., Suite 200, San Diego, CA921 01
H 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 j.e)JIe Force Telephone ,#: (619) 238-6009
Date contacted t7U/0 (byje) Fax # (619) 238-6042
Mail ---Telephone Fax —1?erson
LI REMARKS
By Chuck Mendenhall Enclosures
Esgil Corporation • .. . • . - • .
- LI. GA LI MB LI EJ LI PC - 3/28/05 • trnsinti.dot
d 9320 Chesapeake Drive, Suite 208 *.*San Diego, California 92123 • (858).560-1468 • Fax (858) 560-1576
--
Carlsbad 050335
4/1/05
Please make all corrections on the original tracings, as requested in the.
correction list. Submit three sets of plans for commercial/industrial projects
(two sets of plans for residential projects). For-expeditious processing,
corrected sets can be submitted in one of two ways:
Deliver allcorrected sets of plans and calculations/reports directly to the
City of Carlsbad i Building Department, 1635 Faraday Aie., Carlsbad, CA
92009, (760) 602-2700. The City will route the plans to EsGil Corporation and
the Carlsbad Planning, Engineering and Fire Departments.
Bring one 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.
NOTE: The items listed below are from the previous correction list. These
remaining items have not been adequately addressed. The numbers of
- the items are from the previous check list and may not necessarily be in
sequence. The notes in bold are current.
-The Title sheet of the plans. indicate that this facility is an OSHPD3
licensed clinic. The plans comply with the OSHPD3 requirements
except that there is no solid waste/ trash room that is a mm. of 25 sq
ft with mm. dimension of 4ft as required by CBC Section 422A.12.
The electrical and plumbing sheets of the plans must be signed and.
sealed by the engineer, architect or contractor who is assuming
design and construction responsibility. • .
PLUMBING
8. Provide complete plumbing plans, including: The DWV plans have been
provided and are OK however, the plumbing sheet ,P-1, shows water
lines that appear to be under sized for the number of fixtures served.
Provide water pipe sizing plans for the CW and HW system per the
UPC to the line sizes listed on the plans comply with the code.
a) Complete drain, waste and vent plans.
10. Show on the plans the required combustion air for the water heater
located in the utility closet. The response indicates "Not required,
electric WH" If the water heater is electric it must be listed on the
electrical panel schedule found on sheet-E-1.
DISABLED ACCESS REVIEW LIST
Carlsbad 050335
4/1/05 '
DEPARTMENT-OF STATE ARCHITECT' '
TITLE 24
COUNTERS
17 The tops of reception counters shall be 28" to 34" from the floor Section
112213.4. This applies to the front reception windows with the bullet
proof glass and the check out counter at the reception desk. The
' detail you reference is the hallway work station counter. .V
V
V
,• ENDOFPLAN REVIEW- .
To speed u 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.
,
' ' ' •
The jurisdiction has contracted with Esgil Corporation located at'9320
'
. . ChesapeakeDrive, Suite 208,San Diego, California 92123; telephone...V ,
number of 858/560-1468, to perforrh the pIanréview for yourproject. If ' •
V
you have any questions regarding these plan review items, please contact
Chuck Mendenhall at Esgil Corporation...Thank you. •' " V, '
'1 V V • V
V '
EsGil Corporation
In Partnership wt/ government for Burtzng Safety
DATE'.'2/15/05 NT
S.
JURISDICTION: Carlsbad U PLAN REVIEWER .
OFILE.
PLAN CHECK NO.: 05O335 SET: I . .
• PROJECT ADDRESS:-182O MarronRd, Suite 110
PROJECT NAME: Planned Parenthood Medical Clinic •
The plans transmitted herewith have been corrected where necessary and substantially c6thpl,
with the jurisdiction's building codes
The plans transmitted herewith will substantially comply with the jurisdiction's building4codes
when minor deficiencies identified below are resolved and checked by building department stiff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted fora complete recheck -
U The check lisftransmittedherewith is-for your inforrñation: The plans are beingheld at Esgil
Corporation until corrected plans are submitted for recheck.
The applicant's copy of the checklist is'-enclosed for the jurisdiction to forward to the applicant
contact person :
U The applicant's copy of the check list has been sent4to
Kellie Force, Architect
427 'C, St., Suite 200, SánDiego, CA 92101
Esgil Corporation staff did not advise the applicant that the plan check has been completed
U: EgiI Corporation staff did advise the applicant that the plan check has been completed.
Person'contactëth K,llie Force Telephone #: (619) 238-6009 x
Date contacted (by:- by A- ) Fax # (619) 238-6042--
Mail .—flephone' Fax '-KIn Person (• .•
REMARKS
• -, • •
- By: Chuck Mendenhall Enclosures::
Esgil Corporation - - : • -
GA D MB. EJ fl PC. 2/3/05 tmsmtl.dot
9320 Chesapeake Drive, Suite 208 • • Sn Diego, California 02123 • (858) 560-1468 • Fax (858) 5601576
F
PLAN REVIEW CORRECTION LIST
TENANT 'IMPROVEMENTS
PLAN CHECK NO.: 050335. JURISDICTION: Carlsbad
OCCUPANCY: 'B USE: Medical Clinic
TYPE OF CONSTRUCTION V N ACTUAL AREA 2841
ALLOWABLE FLOOR AREA no change STORIES: no change
HEIGHT: no change ' .•
SPRINKLERS#? No OCCUPANT LOAD 38
REMARKS:
DATE PLANS RECEIVED BY " ' DATE PLANS RECEIVED BY
JURISDICTION:. ESGI'L CORPORATION: 2/3/05
•
DATEIINITIAL PLAN REVIEW . , , PLAN REVIEWER: Chuck Mendenhàll
COMPLETED: 2/15/05
FOREWORD (PLEASE READ)
- This plan review is limited to the technical. reuirements contaired in the Uniform Building Code,
Uniform, Plumbing Code, Uniform Mechanical .Cbde, 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 havebther corrections
based on laws and ordinances enforced by the Planning Department, Engineering Department,
Fire Depaitment or .ther departments. Clearance from those departments may be required
prior. to the issCjance of a building permit.
'Code sections cited are based on the 1997 UBC.
* The following items listed need clarification, modification or change. All items must be -satisfied
before the plans will be in confôrrnancé with the cited.codes and regulations. Per Sec. 106.4.3,
1997 Uniform 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.
TENANT IMPROVEMENTS WITHOUT SPECIFIC ENERGY DATA OR POLICY SUPPLEMENTS (1997UBC) tiforw.dot ,
* •,... ...•
k *
* ' .. • . *
Carlsbad 050335
2/15/05
Please make all corrections on the original tracings, as requested in the correction list
Submit three sets of plans for commercial/industrial projects (two 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., Cauisbad, CA 92009, (760) .602-
2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning,
Engineering and Fire Departments. .
2 Bring one 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. The lans show that you have chosen to use the exit hallway as a fire rated.
corridor rather than a non rated hallway per UBC 1004.3.3. The corridor may not
have other uses within the corridor per UBC 1004.3.4.4. The storage closet and,
cabinets shown may not be within the corridor. All doors must be 20 min. as
noted on the plans but must also be self closing, smoke and draft assemblies.
2 Show on the reflected ceiling plan on sheet A-2 exit' signs within the corridor at
the exit doors to the reception lobby and at the jog in the corridor at the utility
closet. . . . S... -
3 The suppy and R/A ducts penetrating the ceiling of the fire rated corridor must be
equipped with smoke and fire dampers UBC 713.10 & 11 Detail 5/A-2 shows
fire "dumpers"
4.. Show rated corridors, lobbies; reception or foyers cross-hatched on the floor-
plans
ELECTRICAL
5 Submit plan showing location of all panels -
6. Submit panels schedules. . .
MECHANICAL
7 Include as part of the notes for the mechanical that all air intakes for the HVAC
units must be a mm of 25ft from exhaust outlets such as bath room exhaust
outlets CBC 406.3.2.11F
PLUMBING .
8 Provide complete plumbing plans, including
Carlsbad 050335
2/15/05
a) 'Complete drain, ,aste and, •vnt plans. -
9. Show 1/4" per 12" slope on drain and waste Iines.UPCSêction 708.0.
10 Show on the plans the required combustion air for the water heater located in the
utility closet
ENERGY . -•
Provide plans, calculations and worksheets to showcómpliance with current
energy standards for new electrical fixtures
Provide complete energy designs for the proposed changes in envelope, lighting,
and mechanica! systems; Provide the completed LTG-, forms showing energy,,
compliance
13 The completed nd signed LTG-1, form must be imprinted on the plans
DISABLED ACCESS REVIEW LIST .
DEPARTMENT OF STATE ARCHITECT
TITLE 24 ..' . . . ,•
ACCESSIBLE PARKING —
14 The words "NO PARKING" shall be painted on the ground within each loading and
' unloading access-aisle (inwhite letters no less than 12" high and located so'.that it
is visible to traffic enforcement officials) Section 1129B.4.2.
Ramps shall not encrocli into any accessible parking space or-the adjacent
access aisle Section 1129B.43.
Ole DOORS '
Note, that the doorways leading to sanitary facilities shall be identified, per Section
.111 5B.5, as follows: '
.
. . .. .
An equilateral triangle 1/4" thick with edges 12" long and a vortex pointing.
upward at men's rest rooms. .. .
•. -
A circle 14" thick 12' in diameter at women's 'rest rooms. -
• A 12" diameter circle'with a triangle superimposed on the circle and. within *
the 12" diameter at unisex rest rooms
The required symbols.shàll be centered on the door at a height of 60".
-
'
. Braille signage shall also be located on the wall adlacentto thelatch
outside of the doorways leading to the sanitary facilities, per Section '
- 1117B.5.7. . '• - • . , .
. * .- ..-
- - • . COUNTERS . •. . .•,
4 . •
Carlsbad 050335
2/15/05-,'
VALUATION AND PLAN CHECK FEE
JURISDICTION Carlsbad PLAN CHECK NO 050335
PREPARED BY Chuck Mendenhall DATE 2/15/05
BUILDING ADDRESS 1820 Marron Rd, Suite 1..10
BUILDING OCCUPANCY: B TYP OF, CONSTRUCTION: V
BUILDING.,AREA Valuation Reg..VALUE ($)
PORTION (Sq. Ft) Multiplier Mod
S TI 2841 City Est. -. 119,322
• Air Conditioning
Fire Sprinklers
TOTAL VALUE . . . .
119,322
- Jurisdiction Code cb By Ordinance . .
I $608161. Bldg Permit Fee by Ordinance
Plan check Fee by Ordinance V I $395.301','
Type of Review j Complete Review U Structural Only
. . S UI '
S . U Repetitive Fee Other
•
* - . . S
Repeats . Hourly. . Hour * El
.
• •
.
.
S •
'
S
Esgil Plan Review Fee • . $34057.
Comments: • - - . . . , S '
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PLANNING DEPARTMENT
BUILDING PLAN CHECK REVIEW CHECKLIST .. -.
'• -
Plan Check No. CB 050A Address 1 M&rrcll V?d +e UO
Planner Chris Sexton . Phone (760) 602-4624
APN: IS(-OI -It •. :\
Type of Project & Use:-TI Net Project Density: DU/AC
Zoninr,C-I-Q General Plan-';R FaiIities Managerrnt Zone:
CFD (in)iout) #_Date of participation Remaining net dev acres
(For non-residential development: Type of land used ceated by this
Circle One permit
I I . Legend: Item Complete 0 Item Incomplete - Neds your action
0 Environmental Review Required: YES NO V TYPE .
DATE OF COMPLETION
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval
Discretionary Action Required YES NO V'TYPE
APPROVAL/RESO. NO. - DATE
PROJECT NO. '-
'OTHER RELATED CASES: •_•._.
Compliance with conditions or-approval? If not, state conditions which require action.
Conditions of Approval: '_._._._•:
LjEJ 0 Coastal Zone Assessment/Compliance
Project site located in Coastal Zone" YESZ NO____
CA Coastal Commission Authority? YES NO____
If California Coastal Commission Authority: Contact them at - 7575 Metropolitan Drive, Suite 103,
San Diego CA 92108-4402; (619) 767-2370 . . . .
Determine status (Coastal Permit Required or Exempt): . . ._._.
Coastal Permit Determination Form already completed? t~'ES ____ _. NO
If NO, complet le, CoastalPermit D.eterminationForrn now. , • . .
,. . ., .•
Cthstal 'Permit Determination-Log#: .. . .. . . .
4...' •. . ., ..' . • '.. .
-o .* . . ° • - - , I -
Follow-Up Actions: -- , - •
. ' - - 1) Stamp Building Plans as "Exempt" or "Coàstàl Permit Reuired(t minimum FlOor Plans).
2) Complete Coastal Permit Determination Log as needed r
Inclusionary Housing Fee required YES NO 1
(Effective date of lnclusionary.- Housing Ordinance - May 21, 1993.) :
- - • . • Data Entry Completed? YES 'NO NO - • ••• •, . •
• - --
• (AiPIDs, Activity Maintenance, enter CB#, toolbar, Screens, Housing Fees, Construct Housing V/N,
Enter Fee, UPDATE!)
Site Plan
H:\ADMIMCOUNTER\BldgPinchkRevChkist Rev 9/01
4 - -
- •.•-:.
D E 0 1 Provide a fully dimensional site plan drawn to scale Show North arrow property hnes
easements, existing and proposed structures streets, existing street improvements right.-of a' width, dimensional setbacks and existing topographical lines (including all side and rear yard
" '\slopes) ' -t -
4i)
0 0 2..",-Provide legal description of property and assessor's parcel number.'-
Polity Neighborhood Architectural Design Guidelines
I Applicability YES NO________
0 0 0 2 Project complies YES NO________
Zoning
0 0 1 Setbacks
Front ' Required Shown ________________
Interior Side: -•. Required - Shown - :-
Street Side: Required - Shown S
• Rear: : ReqUired Shown
Top of slope Required Shown ___
O 0 0 2 Accessory structure setbacks
• Front: - Required - Shown -'
Interior Side: - Required - Shown ,- -
Street Side: Required Shown
Rear: -- •- .5 Required - - Shown ________________ • -
Structure separation -'Required, Shown
O 0 0 3 Lot Coverage - Required Shown
O 0 0 4 'Height Required Shown
0 0 0 5 Parking %Spaces Required Shown'
(breakdown by uses for commercial and industrial projects required)
Residential Guest Spaces Required - Shown
- 11ij
•
'Additional On S '&fl tJ''
w t Ioeikd, ) P1ects! f+c
tthe+ie 44VAC. 10ib pé*.. (spLc
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pp,pl PShbw ev
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* - -..• • •.55 •, 4...
--
OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE _34OS
H \ADMiNCOUNTER\BldgPInchkRevChkIst Rev 9101
Carlsbad. Fire Depament (,
"
. 050335
1635 Faraday Ave. Fire Prevention
Carlsbad, CA 92008 " - (760) 602-4660
Plan Review Requirements Category. Building Plan 4
Date of Report: 02/07/2005 Reviewed by: '
Name: Warner Architecture
'Address: 427 "C" Street Suite 200
City, State: Sari Diegb CA 92101
Plan Checker: '1 Job #: 050335
Job Name: Planned Parenthood. .. Bldg#CB05,P335-
• Job Address: kMarroh Rd. S " Ste. or Bldg. No.
Approved The item you have submitted'for review has been approved. The approval is
based on plans,. information and I or specifications prdvided in your submittal; .T
therefore any changes to these items after this date, including field '
modifications, must be reviewed by this office to insure continued conformance
with applicable codes and standards. Please review carefully all comments
attached as failure to comply with instructions inthis report can result in
suspension of permit to construct or install improvements.
U Approved The item you have submittethfor' review has been approved subject to the
Subject to , attached conditions. The approval is based on plans, information and/Or
specifications provided in your submittal. Please review carefully all comments;
attached, as failure to comply with instructions in this report can result in
suspension of permit to construct or install improvements. Please resubmit to
this office the necessary plans and / or specifications required to indicate
compliance with applicable codes and, standards. -
U Incomplete The item you have submitted for review is incomplete'. At this time, this office
cannot adequately conduct a review to determine, compliance with the '
. applicable codes and / or standards,. Please review carefully all comments
attached. Please resubmit' the, necessary plans and / orspecification&to this
.
'S
office for review and approval. .
Review , 1st __________ 2nd. __________ 3rd • . Other Agency ID
FD Job .# '050335 .' •' ED File #
04/19/2005 11:08 FAX 619 291 0510 Planned Parenthood
Cifycif San Diego 1FtAvi.. MS-301
it . Oewopmslltcrbioe3 San DIego. C A 92101
krnaatApSeri* (819)448.5300
HAZARDOUS MATERIALS QUESTIONNAIRE
Q001/001
fl1to Jc-M12J'
OFFICE USE..ON V
UPR1I: -
KV
OP PAM I i_
mefdlowthg quesdomirepreawtowfiscKWsactIvltlss,NOT , spedfIepr*ddsscurflon.
MRT.t'4.PFPAMThW!IY —HAZARDOUS IAThIALS_ W8 your business use, store orclsperisa aiy of the
follorang lredaus matenals? If any dams are didad (e)wept ), a an Dingo Fbe Depretmort lssardotis Matertale lrormalion Shoot ((cmi FPB.500) must
besnIadpr*ctrev$ew to: PtaMng & Development RøileW. Me Hazardous Mdds Pan R 'EY f P4lh loor. San Diego. CA
92101(610)44644W. r4.
1. EploakacwBlastngAgents S. Organic Peroxldes 9. YIreRea'ea itS. Corvostves 64680
Compressed Gases 6. O,dzere 10. Cryoger*s Y3. Other Heath H
FlarnmsbiolCorubuslibte Uqutds 7. Pyrophotics 11. HIghly TtodciToidcMatedata 15. None of These
Flammable Solids & Unstable Reacthes 12. Roodhres
PART_lk 8AN CL COUN1Y DEPA1UIT cc EXVNMEWTAL I_LThIIAZRDOt1S MA1_ALBOIOI flk If ifie arvow to any at the
questions is yes. 9gd yset acnta the CowtyofSan lego Haoan Malivials DivIsion 155 toW Avenue. 3' Icc,. SanDisgo CA 92101.
Cat (619) 338.22fl pcior(c lie beueri000f. bcU pern*
FEES ARE REQUIRED. rpected data at Occxipancy ..1 -L
0 IsJr b1sbess $ed on the revere. side of 6th tern?
0 WIt yergbithiess e of HorardstmSuises or Medical Waate in any aitiowit?
Will your business store or horatio Prdous In quwøties equal to or vester than
ag500 pounds, 200 oublcfeet, or r&cqeiepmdudlve trednain arcrquanlW?
0 ourbu*iees use on e,dsting or insf an wsieraund storsoe tank?
S. I] E. Will your business atom or handle Regulated Strices (CalARP?
6. 0 Will your business use insilaff Ndous Waste Tank System (This 2Z Article 10)?
coax it so "M zqm Ab ftadft 290d Dr If the answer to any ci the quealoe below is quptcant m contact the Air Pdlutkin Cer*d
Gesda CA 92123w telephone (858) 650-4550 pdo to the Isauorian of a bulkllng or demolition permIt. P(c1e if the
snswortequestione 3 or 4 (eyes. appilnert must also submIt an asbeston nollftcatlon form to the APCD at least 10 working days prior to commencing dornoflion
or renovallon, except demolibmi or renovaten of residential stnzetrnes of four units or teas. Ccrthc the APCO*i more bitimlettan.
YES E3 IF WIll the subject fodily or constiudlon aclMtles Include operatiens or equlpessr that amt or are capable of emitting an air contaminant? (See
the APCD fact sheet at _,ernits.odf. and the list cityptcat equtgofl mqusmg on APCD permit on the irs.
sidecIttsfotTn. Contact
0 0 (ANSWER ONLY IF QUETION 1YES) WI the stil4ectfoiybo test wI Ian 1.000 feet of the outer boundary of a sdl (t( tivaugh 12)?
(Public and private schools may be found after search of the Cefibmla S:tmd Ilectory at ht_/Fvww.cde.caaov/r&sd/: or amtact the
apprcqvtafa adioct dbeld.) C)
Wm
them be renovation that involves handteig of any friable asbestos material, ori;tatlathç any material Swt codains non4o asbestos?
0 WIll there be demolition ImdvInq the remi,rel cia load SUWtki sbuslurel member?____________________________________
4r/ 4!!?4z',4 I 29's,r, ldñt/ VW96n t
FOR OF1CIAL USE ONLY' FIRE DWAR1P.6T OCCUPANCY Q.ASSIRCA11CWt_________________________________________________
Div. DILTL F
EXUtOR NO FUR"fM aiFTI REQUIRED
APCD
RELEAasO con eun.ci,so PERT BUT NOT FOR (3coIJPAICY
COUNTY NOD
R!I.fMW FOROCC1W*11V
10UNTY44tM11 APCO
EVIED '
\C0N?9Q
-ti ED
ALS
A
. DATE
OFSO
fIATE
M/04) DS-3163 (OW04) County .if San Diego —DEB —Uamrdous Matesials Division
ooj xvi s;T 900,6T,t'o
E3 IalAHP Etusnpt
0 CalARP Regbed
D CelARP Complete
I Date Inimals
02/23/2005 16:44 FAX I003
SAN DIEGO COUNTY
DEPARTMEI IT OF ENVIRONMENTAL HEALTH - CUPA
HAzARI:'ous MATERIALS DIVISION
P.O. RIM 120261, SAN DIEGO, CA 92112-9261
:619) 338-2222 FAX (6) 338-2377
1-800-253-9933
Dcc '
BISINESS ACTIVITIES
-Page of
LFACILITYIDENTIMCATION
FACILiTY ID # 1 31 71 1 I ] I I I I 1 I I I I EPA II) # (Hazardous Waste Only) 2
BUSINESS NAME (Same as Facility Name of DBA.Doing Business 'a) CjI( >,,
PLANNED PARENTHOOD OF SAN DIEGO AND RIVERSIDE COUNTIES - CARlSBAD (MARG SPGEI
D. ACIIVITLES DECLARATION
NOTE: If on check YES to any part of this list,
please submit the Business ( twner/Operator Identification page (OES Form 2730).
Does your facility... If Yes, please complete these pages of the UPLr. -
A. HAZARDOUS MATERIALS
Have on Site (for any purpose) hazardous materials at or alt ova 55 gallons for
liquids, 500 pounds for solids, or 200 cubic feet for comprmt used gases (include 0 E - HAZARDOUS MATERIALS INVENTORY
liquids in ASTs and USTs): or the applicable Federal thret-sold quantity for an YES NO 4 CHEMICAL DESCRIPTION (OES 273 1)
extremely hazardous substance specified in 40 CFR Part 3 6, Appendix A or
B, or handle radiological materials in quantities for which at i emergency plan is
required pursuant to 10 CFR Parts 30,40 or 70?
BJJNDERGROUND STORAGE TANKS (USTs1 UST FACILITY (FormeflySWRCBFonuA)
Own or operate underground storage tanks? 0 YES 0 NO 5 UST TANK (one page per Sot) (Foanaiy Torus B)
Intend to upgrade existing or install new USTs? 0 YES (XI NO 6 UST FACILITY
UST TANK (oat per taut)
UST INSTALLATION -CERTIFICATE OF
COMPLIANCE (out page per tank) (Fonnerly Tom C)
. Need to report closing a UST? 0 YES 0 NO 7 UST TANK (dome pcflioa-one page per tank)
CABOVE GROUND PETROLEUM STORAGE TANES (ASTs)
Own or operate ASTs above these thresholds:
—any tank capacity is greater than 660 gallons, or 0 YES LXI NO 8 NO FORM REQUIRED TO CUPAS
—the total capacity for the facility is greater than 1,320 gtllons?
D. HAZARDOUS WAS
Generate hazardous waste? 0 YES C3 NO 9 EPA ID NUMBER -provide at the top of this page
Recycle more than 100 kg/month of excluded or exert ipted recyclable
materiali (per HSC 25143.2)? 0 YES [XI NO 10 RECYCLABLE MATERIALS REPORT (oat per
,t)5))
Treat hazardous waste on site? 0 YES ( NO 11 ONSITE HAZARDOUS WASTE TREATMENT
-FACILITY (Formerly DTSCFo,ma 1772)
ONSITE HAZARDOUS WASTE TR.EATh'IENT
- UNIT (one page per writ) (Formerly DTSC Form, 1772 A.
B. C. D onri L)
Treatment subject to financial assurance requirement:; (for Permit by Rule CERTIFICATION OF FINANCIAL
and Conditional Authorization)? V O YES O NO 12 ASSURANCE (Formerly DTSC Farm 1232)
Consolidate hazardous waste generated at a remote sic? 0 YES NO 13
REMOTE WASTE I CONSOLIDATION SITE
ANNUAL NOTIFICATION ff.roatdy 02SC Tom
1196) V
Need to report the closure/removal of a tank that watt classified as HAZARDOUS WASTE TANK CLOSURE
hazardous waste and cleaned onsite? 0 YES NO 14 6CERTXFICAI1ON (Fonucoy DTSC Form 1249)
E. LOCAL REQJ1REMENTS
IS
MEDICAL WASTE /
Generate <200 lbs/month of Medical/Biohazart 0us Waste? [XI YES D NO V
Generate 200 lbs/month of Medical/Biohazard ous Waste? 0 YES O NO
Generate 2:200 lbs/month ofMedical/Biohazarl:-ous Waste and treat any amount of medical waste 0 YES O NO
Handle Toxic gases with threshold limit conceit ration (TLV) # 10 ppm in any quantity? 0 YES (XI NO
I
DEH:HM-UPCF.-BUSINESS ACTIVITIES (08I0) V 2
02/23/2005 16:45 FAX .005
UPF Permit#:
DATE INSPECrED
UNIFIED PROGRAM FACILITY PERMIT APPLICATION
D This business or service is requiredto obtain a Unified Program Facility Permit from the San Diego County
Department of Environmental Health. I inswered "yes" to one or more of the questions on the "Business Activitie&'
fonn. . .
Date assumed business ownership at this location: 05 /_02 1 _2005 .
This permit does not excuse any owner or operator from complying with all applicable federal, state,.
county or local laws, ordinances or regulations. The owner or operator is required to determine if
another permit or approval from any other agency or department Is necessary. The County, by issuing
this permit, does not relinquih its rig lit to enforce any violation of law.
0 I have determined that this business or service does not require a Unified Program Facility Permit frornthe San
Diego County Department of Envimnxiental Health.
I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are correct -
and true. I consent to all necessary inspections allowed by law and incidental to the issuance of required permit(s) and
the operation of this business.
Signature': - Title:
•
Senior Di-rector of-Clinic Systems
PrintedName: Elizabeth A. Obrégon Date: 03/08/05
Type of Business' Phoiie#:( 69_) 881-4511
Community Clinic Ana Code
Please complete the business information on the following page and return this applicütion to the San Diego:
County Department of Environmental H aith at:.
SAN DIEGO COUNTY . .
DEPARTMENT OF ENVIRONMENTAL HEALTH .
HAZARDOUS MATERIALS r: IVISION
P.O. BOX 129261
SAN DIEGO CA 92112-9261
If a San Diego County Unified Program Fa ility Pemut is required for your -business or service a representative of this
Department will contact your business. Peniut fees will be detenmned from the contact and a billing statement will be
mailed.'
NOTE: If you do not use hazardous materials, generate hazardous waste, or have underground storage tanks
you are still required to rcftml, k this form - - -
A representative of the San Li iego County Department of Enviróñrnental Health may contact you to wrif) -
- the information provided on iiis pplication. • -
DEH:HM-906 (05/04)
- ,, • .4
02/23/2005 16:46 FAX Ij 006
SAN DiEGO COuNTY
DEPARIMEN r OFENVU(ONMENTALHEALTII - CUPA
BAZRDOIJS MtTER1ALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(6111) 338-2222 FAX (619) 338-2377
nccc
BUSINESS owr' [ER/OPERATOR IDENTIFICATION
Page _of
LIDENTIFICATION
I I BEGINNING DATE 100 DATE
FACILITYID# 1317110 10 101'
I 1 1 I I I 05/02/2005
)ENDING
BUSINESS NAME (same as FACUlTY NAME or DEA_Doing Business As)
PLANNED PARENTHOOD - CARlSBAD (MARGARET SANGER CLINIC)
BUSINESS PHONE 102
1(619 ' 881-4571
BUSINESS SITE ADDRESS
103
1820 MPSRRON ROAD, SUITE 110
CITY
l04 CA ZIP CODE 105
CAR1SBAD i 92008-1177
tool
DUN & BRADSTREET (4 digit #) 107
I
SIC CODE
COUNTY
lot
BUSINESS OPERATOR NAME
LO
PLANNED PARENTHOOD OF SAN DIEGO AND RIVERSIDE COUNTIES I(
BUSINESS OPERATOR PHONE liD
619 ' 881-4537
IL BUSINESS OWNER
OWNER NAME
111 1 0WNER PHONE 112
PLANNED PARENTHOOD OF SAN DIEGO AND RIVERSIDE COUNTIES 619 - 881-4537
OWNER MAILING ADDRESS
III
1075 CN"IINO DEL RIO SOUTH, SUITE 200
CITY STATE
1151
CA ZIP CO 108
116
SAN DIEGO
11LEN0 CONTACT'
CONTACT NAME 117 CONTACT PHONE 118
ELIZABETH A. OBREGON ( 619) 881-4511-
CONTACT MAILING ADDRESS
119
1075 CAIVIINO DEL RIO SOUTH, SUITE 200
CITY 1201 STATE 1211 ZIP CODE In
SAN DIEGO CA I 92108
-PRIMARY- IV. EMERGENCY CONTACT'S -SECONDARY
-
NAME 123 NAME 120
JEANETI5E REDDEN AMY HILLEY
TITLE 124 TITLE ( 129
CENTER MANAGER ASSISTANT CENTER MANAGER
BUSINESS PHONE 125 BUSINESS PHONE 130
(619' 881-4571 f 6191 881-4571
24-HOUR PHONE 126 24-HOUR PHONE 131
L619 ' 778-6819 ( 619) 778-6819
PAGER # 127
L N/A
PAGER # 132
( N/A
AF)I21TIONAT. I (Y'AT IV COI lrrrFr msr(-IRMA't-ION:
E-MAIL: * I E-MAIL: °
jredden@planned.org f ahilley@planned.org
*ThI lnfonatIon is ontionpl and Wilt remain ronfldentltL Conintete If you want to receive neñodlc oroaram uradates from HMD -
ALWAYS SUBMIT A COPY OF THIS COMPLETEII I PAGE WITH SUBMITTAL OF ANY OTHER UNIFIED PROGRAM CONSOUDATED FORM.
Certification: Based on my inqaiiy of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with
the information submitted and believe the information is true, accui ate, and complete.
R/OP&RATOLOR DESIGNATED REPRES NTATIVE DATE 134 I NAME OF DOCUMENT PREPARER 135
Elizabeth A. Obregon
NAME OF SIGNER (print) 136
J 03/08/05
TITLE OF SIGNER 137
Elizabeth A. Senior Director of Clinic Systems
DEH:HM-UPCF-BUSINESS OWNER/OPERATOR IDENTIFICATION (8/02) 5
• OFFICE) USE ONLY
. V
DATE I
V. MEDICAL WASTE MANAGEMENT PLAN V
Planned Parenthood - Carlsbad
BusinessName: (Margaret Sanger Clinic), Type OfBusiness/Practice: Community Clinic V
SiteAddress: 1820 Marron Road, Suite 110, CarlsbadZip: 92008_1177Phone: (619) 8814571
Contact Person: Jeanette Redden * V Title: Center Manager
24 Hour Emergency Phone: ( 619) 778-6819 V
V V
GENERATION AND STORAGE OF BIOHAZARDOUS WASTE: V
Describe below the type and quantity of biohaardous waste generated and managed at this facility. SEE SAMPLE PLAN AND ATTACHMENT
rnDn1?LMTT1fl1.lflL"rVDMQITa'flTN THIN MAN V
E iV
VtMV VV
QUANTITY STOIAGE 4 TREATMENT r ON OF'- JIAULERNAME
(lbImonth) otmjor'type3 METHOD ShE SITE
BIOHAZARDOUS WASTE V
Shari) Waste V 20 V V Sharps Autoclaving X Steri-cycle
Needles/syringes/slides V container V
Non-sharp Waste 0 Biohazard Autoclaving - X Stericycle Articles containing Fludd Blood bag (gauze, bandages tubing, etc.)
Solids (cultures lab waste, etc.)
Liquids (wine, etc.)
Trace chemotherapy waste
Contaminated animal carcasses V
Oth
MEDICAL SOLID WASTE
V
-
Locked Waste Gloves,empty J)Jfl5
containers, gauze with thy blood, Duirpster N/A N/A N/A Management
treated biohazardous waste
If applicable, attach a copy or biohazardous waste hauler contractor Limited Quantity Hauler exemption.
Biohazardous WASTE STORAGE LOCATION: [Please check the appropriate box(es)].
Biohazardous Waste: b&Inside establishment in secured area I I Outside in posted, secure area. V
Medical Solid Waste: I I Inside establishment V I Outside in Locked/secured dumpster
V
V
PERSONNEL TRAINING: V
All personnel handling biohazardous waste have been trained in all aspects of this maiagement plan. Training includes the legal definition of biohazardous
waste, separation and proper storage, transportation, treatment; and disposal of biohazardous waste. Documentation for completed employee training will be
kept onsite.
CERTIFICATION STATEMENT: V V •V
I certify that the above management plan is complete and accurate, and that this business will adhere to all aspects of the plan. I further understand that any
violation of this plan or any applicable law or regulation may result in legal action. V -
V Senior Director of Clinic Systems
SIGNATURE OF RESPONPERSON TITLE
Elizabeth A. Obregon V 031 08 / 2005 V
NAME OF RESPONSIBLE PERSON (please print or type) DATE
DISTRIBUTION: WHITE RETURN TO HMD
V YELLOW - BUSINESS RETAINS
I DEH:HM-9209 NCR (Rev. 8/99) • V• Page 2 of 5 V • County Of San Diego