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Home My WebLink About1834 MARRON RD; ; CB110401; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 -' 04-18-2011 ,'.CommerciaI/ihdustriai Permit. Permit'No: C1311040i. - 1 7" --. BuiIding4Inspecon Request Line (760..) 602-2725 Job Address: 1834MARRONRDCBAD " PermitType: TI ' . Sub Type: COMM Parcel No: 0000000000 'Lot #: 0 ' Status: ISSUED - Valuation:. ', $33,556.00 Construction Type: 51]1, - Applied: 02/23/2011, ' ' •V Occupancy Group: ' -. . . . Reference #: ': Entered By: LSM Project Title: MARSHALLS- UPGRADE EXISTING / Plan Approved: 04/18/2011 904SF FITTING ROOMS t '' ,. Issued. 04/18/2011 Inspect Area: V V , ••_.r' - PIan Check#: 'Applicant: . . . - Owner: . . MICHAEL HAM 13025 CALLCOTr WAY SAN DIEGO 92130 858792 6855 V . I A '//: . \ Building Permit $313 , 44 Meter Size'- AddI Building Permit Fee 7. • $0.00 -p.,. AddI Red. Water Con.. Fee \.) \ ' -$0.00 - 'Plan Check / / $203.747.?P Meter Fee . \ . $0.00 AddI Plan Check Feel . / $0.00 SDCWA Fee ., $0.00 ,. Plan Check Discount / $0.00CFD Payoff Fee \ ç7 $0.00 Strbng Motion Fee 7 •. $7o5PFF(31O554o ' . \. $000 Park Fee 0.00-%~-PFF03 . . V 05540) LFM Fee . / $0.00 License Tax (3104193) , I $0.00 V Bridge Fee 1 $0.00 -ILise Tax (4304193) I . $0.00,. BTD #2 Fee. . . $0.00.: praffic Impct Fee (3105541) J •I. ' $000 BTD #3 Fee $0.00\ 'PLUMBING Fiee (4305541) 1 I ."10.00'. . $0 00. Renewal Fee V $0.00 % PLUMBING TOTAL\ I ! $0.00 • V Add'I Rehewal Fee $0.00 I IELECTRICALt.TOTALI 1.f :1 1 $20.00 Other Building Fee . . $0.00% iMECHANICAjTOTAy'. / / ' $0.00 Pot. Water Con. Fee ,. . $0.00 ,Master'DriFiagéFé'e / $000 - Meter Size' • . V . '- t(Se7erFeS...J'V / $0.00 AddI Pot. Water Con. Fee $0.00 , Rèdev P?king Fee . I $0.00 Red. Water Con. Fee \OR(Additiona!Fees . / $0.00 Green Bldg Stands (S81473) Fee ' $1.00 1. HMP Fee Fire Expedited Plan Reviev $182.50 -' $727.73 TOTAL PERMIT FEES /' / V Total Fees:. $727.73 Total PaymntsjoVbte:4 o\s7,~,7''78' Bala"nce Due: $0.00Li -' —. V.. - — FINAL APPROVAL Inspector Date '%//1 / Clearance NOTICE: Please take NOTICE that approval of your project inIudes the 'imposition" of fees, dedications, reservations, or other exactions hereafter col ectively - referred to as lees/exactions You have 90 days from the date this permit was issued to protest imposition of these tees/exactions If you protest them you must follow the protest procedures set forth in Government Code Section 66020(a) and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack r&view, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning,,zoning, grading or other similar application procesing 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 expired V V .4 .......... .............. ,.. C -V , - -. - '-f - ,''--'' :''I-'---',. '.'"' ' Workers' Compensation Declaration: I hereby affirm under penally of perjury one of the following declarations: 0 I 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 WI have and will maintain workers' pornpensation as requi d by Section 3700 of the Labor Code, for the performance of the work for which this it in issued. My workers' compensation insurance canter and policy ,number are: Insurance Co._ ' . Policy No. 1 C) 0 7'S'5 m S Expiration Date '. This section need not be completed it the permit is for one hundred dollars ($100) or less. ' 0 Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), In, addition to the cost of compensation, damages as pro ed f Sectio 3706 of the Labor code, interest and attorney's fees. , CONTRACTOR SIGNATURE rIAGENT DA OO1uDimooø thereby affirm that lam exempt from Contractor's License Lav for the following reason: Cl 1, as owner of the property or my employees with wages as their sole compensation, will do the work arid the structure is not intenàed or offered for sate (Sec. 7044, Business and Professions Code: The Contracto(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. It, 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). - O , I, as owner of the properly, 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 properly who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). O I am exempt under Section Business and Professions Code for this reason I personally plan to provide the major labor and materials for construction of the proposed properly improvement, 0 Yes ' Cl No I (have! have not) signed an application for a building permit for the proposed work. - 3. I have contracted with the following person (firm) to provide the proposed construction (include name address/ phone/ contractors' license number): - - - 4. I plan to provide portiOns of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name! uddreri /phone/ contractors' Iicene number): 5 I will provide some of the work bull have contracted (hired) the following persons to provide the work indicated (include name! address I phone type of work) ,.PROPERTY OWNER SIGNATURE - - -- . -- '' -. . , -- -- r, U DAGENT DATE ¼. 1 Building Permit Application Plan Check No c2.! I 0L40 I 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value ,3 S-51(0 \/ CITY OF. 760-602-2717/2718/2719 CARLSBAD Fax: 760-602-8558 ' Plan CK. ueposit "f Deposit - www,carlsbadca.ov Date t, SWPPP JOB ADDRESS - suiTEe/sPAcEe/uNiTe APN l -( koJccA.' Q. CT/PROJECT a LOT # PHASE # a OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME . CONSTR. TYPE OC GROUP DESCRIPTION OF WORK: Inc ude Squ e Feet of Affected Area(s) , . eLj L pcL 4 c4: 4-4 fFrtC 1—i.v OLi W *W) I EXISTING USE ' PROPOSED USE . GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING 'FIRE SPRINKLERS YES 0 # NO YES 0 NO* YES 0 NO t3 CONTACT NAME (If Different FomApplicant) . . ' APPLICANT NAME ' . ADDRESS "7 I __ ADDRESS - ________________ t3o-ic (Lcrtt. CITY - -. ' ' STATE ZIP ' CITY ' ',. , ' STATE -, &.b14n CA Z13O PHONE , . FAX . PHONE FAX - -r9z-c~5 5o99r EMAIL, . ' ' ' EMAIL . jcUo. c-o PROPERTY OW ER NAME -- CONTRACTOR BUS. NAME ,. , ' e iry %AA A n 'L. ic ' f)e./ R'- 3; 1 ADDRESS - ADDRESS A ((ttF WôJ-7' Cl'..- , ' STATE ',. - ZIP . -' CITY , STATE - Zl 11 A VA Hit 76VL CA- P ON , FAX PHONE FAX 56 -7?Z-(c?5' . EMAIL . . ", - ' ' '. . r EMAIL 6bvl¼1ahCô covt ARCH/DESIGNE NAME & AD R STATE LIC. # . STATE UC.# CLASS - CITY BUS. LlC.# - i) C.M'ti. c-4 'oz' I C) 'i 32-1 13 (Sec. 7031.5 Business and Professions Code:'Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its 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 Ucense Law jChapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of not more than five hundred dollars ($500)). - V C - PØVØ ØO V Is the applicant or future building occupant required to submit a business ptan.aitely hazardous materials registration form or risk management and prevention program under Sections 25505. 25533 or 25534 of the V V Presley-Tanner Hazardous Substance Account Act?. 0 Yes "No V l it, Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air qujimnanagement district? V 0 Yes V o Is the facility lobe constructed within 1000 feet of the outer boundary of a school site? 0 Yes 'I"lo 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. V V V 4eZu!ozjO " 'V 'V 7 I hereby affirm that there is a constru,ion lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). V V Lend 1) Lender's Name - ,,,/4_.- •. Lenders Address - V,• 4-V4.V V VV4V4.4VV2 - I certitythat I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. - I hereby authorize representative of the City of Carlsbad fo enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD V AGAINST ALL LLBILrnES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAiD CITY INCONSEQUENCE OF THE GRANTING OF THIS PERMIT. V V OSHA An OSHA permit is required for excavations over 50' deep and demolition or construction of structures over 3 storiesin height EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by Imitation and become null and void if the building or work authorized by such permits V not commenced within 180 days from the date of such permit or if the building or rk a ! rized by such permit is suspended or abandoned at any time after the work is commenced fora period of 180 days (Section 1064.4 Uniform Building Code). .'APPLICANTSSIGNATURE DATE 4- rI V V5V• '..'/ VVV ••V :-' V. ' :V -.4 4 •1' t 4 * -• - / "V 4V 4- ' 4 VV '' 4- - -4 a 4 - - - - - .7 r..' , :.4'V. - • .4' • - .44 4- VV .4 'V •V•• V•,_ - - V.> • . ' - -. . a_4-V V -. . 4 'c- .4 'l• / 4 -4 4* _*••. . .-. V4*V-.> '. -. '• . ' 4 ..#V , " 7 .4 ) 4V 4.. - I - 'V ' VVV1 '.V,4V. ' H ' .,k V.: - 4 - - V, • .Vt 4 • 47' 4- I . _ , . V t -, • V.. 4' - -'V - ' . ' .4 - •4V4 -, -- - - - 7 .fV V I •. . . -* . •-•. . - - 1 4 : - V ' .'- •- -. - - - • V - • V - -V V I. - r V r . ' V , 4, £ .-4 •*VVV 4, 4w 4.4 V, 4- 44 4. 44 'V . . ,4 .-• - . -• V .4 '4 4 I -. .. - . .>. •V 4 a 4f - V. V •V V - V - ' - " ' V - a . - V V V 4 0 ,V . - V . V V . - ' V V •V. - . . 4 47 V V V V ( Va - . V .4 V 4' ** • V ' V -4 V V V 4 - 4 -, V - - V V VV V - V . •. V 4•V .1 .4 I 4V • i-'-' 4- il i I, •- 1 44V I" 4 ' I - 1 V 4 - V • V_ . 4 4 00 oft City of Carlsbad Bldg Inspection Request For 05/12/2011 Permit# CBII040I S Inspector Assignment: TP Title: MARSHALLS- UPGRADE EXISTING Description: 904 SF FITTING ROOMS Type TI Sub Type COMM Phone: 7602070069 Job Address: 1834 MARRON RD Suite:Lot 0 Location Inspector ONTRACTOR DEL MAR BUILDERS Owner Remarks: A M PLEASE. Call Jose if there before9am Total Time Requested By JOSE GUERROLA Entered By:' CHRISTINE CD Description Act Comments 19 Final Structural' 29 Final Plumbing 39 Final Electrical ' 49 Final Mechanical Comments/Notices/Holds I Associated PCRs/CVs/SWPPPs Original PC# CV100519 CLOSED 0 NEED TAX VERIFICATION DOCS B L 936500 Inspection History Date Description Act insp Comments 05/04/2011 19 Final Structural - NR TP NEED FIRE APPROVAL 04/27/2011 14 Frame/Steel/Bolting/Welding AP TP T-CEIL PATCH IN , S 04/27/2011 34 Rough Electric AP TP 04/27/2011 44 Rough/Ducts/Dampers AP TP RE-LOC DUCTS 04/20/2011 17 Interior Lath/Drywall AP TP 04/19/2011 14 Frame/Steel/Bolting/Welding AP TP , S 04/19/2011 34 Rough Electric AP TP BUILDING Development Services Building Qivision CITY OF plan.Check 1635FaradayAvenue .CADI RAfl Comments 760-602-2719 ii .jIJUL www.carlsbadca.gov By: Steve Borossay (Contact Hours for Steve: Tues.-Fri., 1pm— 5pm) Phone: 760-602-7541 Permit:_217 lO 4-01 Address:_ '' Date:_1_/z4Jf When corrections from all departments are received please run new prints • Please respond by indicating location of Plan Check items on plans• Provide: A statement on the Title Sheet of the plans stating that the project shall comply with the 2010 CA Building Code, 2010 CA Residential Code, 2010 CA Green Code, 2010 CMC, .2010 CPC, 2010 CEC, 2008 CA Energy Efficiency Standards 2010 CA Fire Code and the Carlsbad Municipal Code LI Provide A note titled Scope of Work describing the work to be performed under this permit S so e - 5- I. I' 4- '.5. ¶ ,.- ''S. - '.•l• - - I I STORM WATER Development Services CITY OF COMPLIANCE . S Building Division 16 760-602-2719 CARLSBAD ASSESSMENT , 1635 Faraday Avenue B-24 www.carlsbadca.gov I am applying to the City of Carlsbad for the following type(s) of construction permit: /Building Permit U Right-of-Way Permit Wl~y project is categorically EXEMPT from Electrical Patio/Deck the requirement to prepare a storm water t '>1 '> Fire Additional Re Roofing Fire Alarm Sign pollution prevention plan (SWPPP) because it Fixed Systems Spa-Factory only requires issuance of one or more of the Mechanical . Sprinkler ' following permit types: - Mobile Home Water Discharge - Plumbing Project Storm Water Threat Assessment Criteria*' No Threjssessment Criteria &k' My project qualities as NO THREAT and is exempt from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it meets the "no threat' assessment criteria on the City's Project Threat Assessment Worksheet for Determination of construction SWPPP Tier -., Level. My project does not meet any of the High, Moderate or Low Threat criteria described below. I- , Tier I Low Threat Assessment Criteria . •,' Li My project does not meet any of the Significant or Moderate Threat criteria, is not an exempt permit type (See list above) and the project meets one or more of the following criteria: Results in some soil disturbance; and/or '• . - -.. • includes outdoor construction activities (such as saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling). Tier 2 Moderate Threat Assessment Criteria S Li - My project does not meet any of the Significant Threat assessment Criteria described below and meets one or more of the following criteria: Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 of the Carlsbad Municipal Code); or, Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria: ' • Located within 200 feet of an environmentally sensitive area or the Pacific Ocean, and/or Disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical, and/or Disturbed area' is iocated along or within 30 feet of a storm drain inlet, an open drainage channel or watercourse, and/or Construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). Tier 3 - Significant Threat Assessment Criteria . El My project includes clearing, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any - associated construction staging, equipment storage, stockpiling, pavement removal, refuéiing and maintenance areas: and/or U My project is part of a phased development plan that will cumulatively result in soil disturbance totaling one or more acres including any associated construction staging equipment storage refueling and maintenance areas or, My project is located inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant * potential for contributing pollutants to nearby receiving waters by way of storm water runoff or non-storm water discharge(s). ' 'I certify to the best of my knowledge that the above, checked statements are true and correct. I understand and acknowledge that even though this project does not require preparation of a construction SWPP, I must still adhere to, and at all times during construction activities for the permit type(s) check above comply with the storm water best management practices pursuant to Title 15 of the Carlsbad Municipal Code and to Cliv Standards. *The City Engineer may authorize minor variances from the storm Water Threat Assessment Criteria in special circumstances where it can be shown that a lesser or higher Construction SWPPP Tier Level is warranted. B-24 S ' Project Address: , , • Assessor Parcel No. Owner/Owner's Authorized Agent Name: - M ieJce\ Title: • u-r , Owner/Owner's Au • ed t Si na re: Date: .•___ 2-z3-1( 'City Concuiice: U NO B Date: 2k' I I Project ID: C.-'f Page lofi ' Rev.03/09 CITY OF CAR LS BAD CONSTRUCTION THREAT ASSESSMENT WORKSHEET FOR DETERMINATION OF PROJECT'S PERCEIVED THREAT TO STORM WATER QUALITY E-33 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov Construction Perceived SWPPP Tier Construction Threat Assessment Criteria* Threatto Level Storm Water Quality Tier 3 - High Construction Threat Assessment Criteria U Project site is 50 acres or more and grading will occur during the rainy season U Project site is 1 acre or more in size and is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA High U Soil at site is moderately to highly erosive (defined as having a predominance of soils with Tier 3 USDA-NRCS Erosion factors kf greater than or equal to 0.4) U Site slope is 5 to 1 or steeper U Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). U Owner/contractor received a Storm Water Notice of Violation within past two years Tier 3 - Medium Construction Threat Assessment Criteria V • Medium U All projects not meeting Tier 3 High Construction Threat Assessment Criteria Tier 2 High ConstructionThreat Assessment Criteria V U Project is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA U Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kf greater than or equal to 0.4) High U Site slope is 5 to 1 or steeper Tier 2 U Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). U Owner/contractor received a Storm Water Notice of Violation within past two years U Site results in one half acre or more of soil disturbance • Tier 2 - Medium Construction Threat Assessment Criteria . Medium U . All projects not meeting Tier 2 High Construction Threat Assessment Cnteria Tier 1 - Medium Inspection Threat Assessment Criteria U Project is located within the Buena Vista or Agua Hedionda Lagoon watershed, within or directly adjacent to an environmentally sensitive area (ESA) or discharges directly to an ESA U Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kf greater than or equal to 0.4) Medium U Site slope is 5 to 1 or steeper Tier 1 U Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). Owner/contractor received a Storm Water Notice of Violation within past two years V U Site results in one half acre or more of soil disturbance Tier 1 - Low Inspection Threat Assessment Criteria Low U All projects not meeting Tier 1 Medium Construction Threat Assessment Criteria Exempt f • V - Not Applicable - Exempt *The city engineer may authorize minor variances from the construction threat assessment criteria in special circumstances where it can be shown that a lesser or higher amount of storm water compliance inspection is warranted in the opinion of the city engineer • E-33 V Page 1 of 1 REV 4/30/10 ri A - BUILDING DEVE Carlsbad Fire Department COPY Plan Review Requirements Category:.TI , COMM Date of Report 03-15-2011 Reviewed by:. Name: DEL MAR BUILDERS Address: 13025 CALLCOTT WAY SAN DIEGO CA 92130 Permit# CB 110401 Job Name: MARSHALLS- UPGRADE EXISTING Job Address 1834 MARRON RD CBAD INQOMP11-- .Th item wLi e-410p1t@. AA-thioiMo, lhin nffimi trnnnot Paoo-o:io Z-'144A, to lhio óf&@for nw--prouaL Conditions 1 Cond C0N0004477 I [MET],,** CITY OF CARLSBAD FIRE DEPARTMENT APPROVED Subject to field inspection and required tests, notations hereon, conditions in correspondence and conformtance with applicable regulations The stamping of these plans shall not be held to permit or approve the violation of any law. Entry 03/15/2011 By SG/gr Action AP r I' f RECOMMENDED FOR,APPR6VXQ OPY BLDG, DEPT C Page: lofl Daryl K. James & Associates, Inc. Checked by: Susan Guzzetta -. Date: March 10, 2011 APPLICANT: Michael Ham . JURISDICTION: Carlsbad Fire Department PROJECT NAME: Marshalls PROJECT ADDRESS: 834 Marron Rd. S Carlsbad, Ca PROJECT DESCRIPTION: CB110401 Tenant Improvements for dressing rooms 904 Square feet. . S INSTRUCTIONS . . This plan review has been conducted in order to verify conformance to minimum requirements of codes adopted by the Carlsbad Fire Department. S The items below require correction, clarification or additional information before this plan check can be approved for permit issuance. S Please direct any questions regarding this review directly to: Susan Guzzetta at 949-573-1558 or stguzzettagmaiI.com : The above referenced project was reviewed on March 10, 2011. No fire comments were noted, therefore the plans are recommended for approval. S. S S •S S - SI S S S S S S 1 5 S. 5_ BüsinéssNariié Street Address EmailAddress____________________________________________________________________ PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT (ON REVERSE SIDE CHECK TYPE OF BUSINESS) Olheck all below that are present at your facility Acid Cleaning Ink Mañufaturing Nutritional Supplement/ Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining I Milling Painting / Finishing Battery Manufacturing Manufacturing Paint Manufacturing 4 Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i e water filter membranes) Manufacturing Bulk Chemical Storage Me tal Casting I Forming Pesticide Manufacturing I Car Wash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification. 'Elebtrpplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameling Electrical Component Anod izing Power Generation Manufacturing Coating (i e phosphating) Print Shop Fertilizer Manufacturing Chemical Etching I Milling Research and Development Film / X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Formin Soap / Detergent Manufacturing Industrial Laundry Waste Treatment/Storage ., SIC ).(if known) Briefdescriptionof business ctMties' (Produ tb n [Man. acturig O'perations):.. : Description of operations generating wastewater (discharged to sewer, hauled or evaporated) Estimated volume of industrial wastewater to bed' I d ischarged (gal ay) - -- List hazardous wastes generated (type / volume) / Date operation began/or will -begin.,-,at this location I ?: Have you a9"If a Wastewater Discharge Permit from the Encina Was Aithority Yes yes, when - Site Contact Title 44 'cki4/ Signature Phone No______________________ ENCINA WA TEWATER AUTHORITY 6200 Avenida Encinas Carlsbad CA 92011 (760) 438-3941 FAX (760) 476 9852 •.• •;. I • • I c. • - • * - SAN DIEGO REGIONAL DCCC HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE Busness Name Business contact Telephone # ( lb )79Z-5 Project Address State Zip Code I APN# P95 ilye7 I Mailing Address City State Zip Code Plan File# Project Contact Telephone# MikJIvi (j' Z- 6 5Y 5 The 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. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These. Flammable Solids 8. Unstable Reactives 12. Radioactives uestiuris is yes, dppllcani must contact me u..ouniy or ban iiuego hazaraous Materials uivision, I Zbb imperial Avenue, 3 tloor, San Call (619) 338-2222 prior to the issuance of a building permit. FEES ARE REQUIRED. Expected Date of Occupancy: YES NO 1. 0 d, Is your business listed on the reverse side of this form? (check all that apply). 0 0 El 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? 0 Ij Will your business use an existing or install an underground storage tank? 0 ,NilI your business store or handle Regulated Substances (CalARP)? 0 E3V Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? If the answer to any of the go, CA 92101. CalARP Exempt Date Initials CalARP Required Date Initials E] CalARP Complete Date Initials PARTIII:SANDIEGOCOUNTYAIRPOLLUTIONCONTROLDISTRICT: 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 demolitionorrenovation of residential structures of four units or less. Contact the APCD for more information. YES NO 1 RKWill 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 htt;//www.sdapcd.orci/info/facts/permits.ødf, and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). 0 0 (ANSWER ONLY IF QUESTION 1 I YES) Will the subject faOility 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). 0 LM",Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? 0 I' Will there be demolition involving the removal of a load supporting structural member? efly de cribe business activities: . Briefly describe proposed project: Y2i1c;)__/0th _0td o4Ll_ijroowL cttoc1c( 41 ury that /o best of my knowledge and M are true and correct. 2-12, > Name of owner or Authorized Agent Signature of Owner or Authorized Agent Date FOR OFFICIAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:_____________________________________________________________________ BY: DATE: EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OccupANcy RELEASED FOR OCCUPANCY COUNTY-HMD APCD . COUNTY-HMD APCD COUNTY-I-IMD APCD HM-9171 (04/07) County of San Diego - DEH - Hazardous Materials Division 13 C Approved - Dare , By BUILDING PLANNING -_ENGINEERING FIRE Expedite? YJ N HazMat ,AJPr APCD - Health. Forms/Fees Sent. Recd Due? ,18y Encina V N yc18__ Fire v N llazHealthAPCD €:9(~3J fl V N L/ P E & M 1 .L2,/ V N School v N Sewer v I N Stormwater.-- V N - Special Inspection V N LanciUse: CFO: Y N Density ImpArea: FY: Annex: Factor: PFF: Y N Comments Date Date Date Date Building Planning • - _____________ Engineering Fire • - Need7 i3rrM'r uiora e d 4bone Ll Done - - • C3 Done • 000ne SW - - • - U Issued CB110401 1834 MARRONRD MARSHALLS- UPGRADE EXISTING ona s IIM OUQ