HomeMy WebLinkAbout1846 MARRON RD; ; CB910687; Permit:. .,;
-$ - 4- - - ¶ A 4 r -
k B U I'-L' D I N G E R M I T Permit No CB910687
05/10/91 10 10 Project No A9100818
Page 1 of 1 Development Nc3 /
Job Address 1846 MARRON RD Str - FP,:'Ste
Permit Type:COMME1.RCIAL TENANT IMPROVEMENT - O5/10/91O0010. 02 Parcel No... - . . -.• . _-r'-. - - - . - - -*MT - '-a. .40 5.. rr Valuation 8,036 -
Construction Type VN 131 CC-- //6Q.-5 OccupancyGroup B1/B2 '- Class Code Status ISSUED
-?-'Description:,392 SF PAC TEL CELLULAR Apliec 04/25/91
-
-:•,- - . ;- - Apr/Is-ue05/-10/91
. ValidatedBy:DC'
Appl/Ownr WHITE CONSTRUCIION COMPPNY 619753-9272
7720ELCAMINO REAL #2N .-
-
:- CARLSBAD, CA -92004.,-'.
- - •(
Fees Required
-
------- 1A1 7~11_lv
Fees:', I 47b\
,Adjustments 4- 0 TotaCraLt
13
Fee d6scri~i I _e
--
BUILDING' TOTAL
Ente 'Y for-Remodel / 10 00
108.-00
Y r fft(
* ELECTRICAL TOTAL %-f 0 M i mi mdK 15.00
p
• :
i-i \-n,- t
FALPPROVAL
4 CLEARANCE
,CITY OF CARLSBAD
2075 Las Palmas Dr, Carlsbad CA 92009 (619) 438-1161
5- "-
¶ S - - - - - - - - •S• -- - - - S 4 S'•
-'
I 1. - A.
PERMIT APPLICATION
City of Carlsbad Building Department . . •
2075. Las Palmas Dr., Carlsbad,• CA 92009 (619) 438-1161 • ,• EST. VAt._____________________________
PLAN IX DEPOSIT_____________________________
- . VALID. By
1. Pg.RMIT TYPE .- I . DATE /_9/
A ..a'tOMMERCIAL qNEW 'TENANT IMPROVEMENT / 1W (fl'f/25, 91 0"
B - 0 INDUSTRIAL UNEW - DTENANT IMPROVEMENT . .'. vi 02
C - RESIDENTIAL DAPARTHENT DCONDO DSINGIE FAMILY DWELLING DADDITION/ALTERAIoN C-P"MT 340-00
El DUPLEX DDEMOLITION[]RELOCATION UMOBILE HOME DELECTRICAL DPLUMB ING
Ilk MECHANICAL 0 POOL DSPA DRETAINING WALL DSOLAR EJOTHER ________ '. . ye ao 7
2. PROJECT INFORM ATION PLAN CHECK No. FOR _OFFICE _USE _ONLY
Address 'T Building or SLhTe No.
Nearest Cross Street',..j,,Ajp ,g2_.6Li
LEGAL DESCRIPTION Lot No. ulivision Name/Number Unit NO. . Phase No.
CHECK BEL(J4 IF SUBMITTED:
02 Energy Calcs 02 Structural Calcs 02 Soils Report' 01 Addressed Envelope
ASSESSOR 'S PARCEL ,p EXISTING USE ST ,J2SEP USE
157 ORK
3S7?
. BLDG. SO. FTC. H OF STORIES
3. CONTACT PERSON ,
NAME ADDRESS
STATE CtN--tCITY IP COOE DAY TELEPHONE ,••7 I'
SIGNATURE
-4. APPLICANT 0 CONTRACTOR 0 AGENT FOR CONTRACTOR DOWNER 0 AGENT FOR OWNER
NAME ADDRESS
CITY STATE • ZIP CODE DAY TELEPHONE
'PROPERTY OWNER OWNER []LESSEE'
ADDRESS
CITY &re_L_, ( * STATE ZIP CODE g e7 8 DAY TELEPHONE
CONTRACTOR NAME (/JHT TWCTh ADDRESS -7 7
CITY 24-&..L- 6.4' STATE CA ZIP CE DAY TELEPHONE 733
STATE LIC. H __ LICENSE CLASS ______________ CITY BUSINESS LIC. # _________________
SIGNATURE . TITLE DATE
DESIGNER NAME * ,- ADDRESS
CITY.'E. A' - STATE ZIP CODE DAY TELEPHONE STATE LIC.#
WORKERS' COMPENSATION
Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to seLf-insure issued by the Director of Industrial Relations,
ora certificate of Workers' Compensation Insurance by an admitted insurer, oran exact copy or duplicate thereof certified by the Director of the
insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY ' ' POLICY NO. EXPIRATION DATE
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. *
SIGNATURE • DATE
'OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractors License Law for the following reason:
0 I as owner of the property or my employees with wages as their sole compenation, 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.).
0 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).
0 I am exempt under Section '
' Business and Professions Code for this reason:
(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 License Law (Chapter 9, commencing 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 fora permit subjects the applicant to a civil penalty of not
more than five hundred dollars ($500)).
SIGNATURE . DATE
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program underSections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
F_1 YES , DNO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
DYES E] NO
Is the facility to be constructed within 1,000 feet of the outer boundary of,a school site?
DYES ' ONO
IF AHYOF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS
OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. .
'CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agóncy for theperformance of the work for which this permit is issued (Sec 30970) Civil Code).
LENDER'S NAME , . LENDER'S ADDRESS
APPLICANT'S SIGNATURE -
I certify that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating
to building construction. I hereby authorize representatives 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 AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH KAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
Expiration Every permit issued by the Building Official under the provisions of this Code shall expire by limitation arid become null and void if the building
or work 36/horized by such permit, is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended
or abared at any time afte work is commenced for a period of 180 days (Section 303(d) Uniform Building Code).
- APPLIS SIGNATURE ,/" ," DCONTRACTOR 0 BY PHONE - -
• _________DAfr
WH13E: File YELLOW: Applicant PINK: Finance
- $ $
- CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB910687 FOR 08/13/91 INSPECTOR AREA TP
DESCRIPTION: 392 -SF PAC TEL CELLULAR PLANCK# CB910687
OCCGRP
TYPE: CTI CONSTR. TYPE VN
JOB ADDRESS: 1846 MARRON RD STR: FL: STE:
'APPLICANT: WHITE CONSTRUCTION COMPANY PHONE: 619 753-9272
CONTRACTOR: - PHONE: V OWNER:
V
PHONE:
V
REMARKS: MH/TPAVIS/931-1130 INSPECTOR
SPECIAL INSTRUCT: V
V
TOTAL TIME: •'V
--RELATED PERMITS--..PERNIT# TYPE STATUS V
C0910115 COFO ISSUED
CD LVL DESCRIPTION ACT COMMENTS V V
19 ST Final Structural •-
V V
29 PL Final Plumbing V V
39 7 EL Final Electrical' V V V
V V V
V V
49
V ME Final Mechanical
V ***** INSPECTION HISTORY ***** V
V
V
DATE- DESCRIPTION ACT INSP COMMENTS
072591 Final,Combo V V
.. CO TP NEED INFO ON FIRE DAMPER WNDO
070591 Rough Combo V AP 'TP T-BAR/WALL PENT
070391 Rough Combo V
. NR TP V DUPJT-BAR. V -
070291 Frame/Steel/Bolting/Welding AP TP SEE INSP NOTES V
062191 Exterior Lath/Drywall CA TP V V• V
062091 Exterior Lath/Drywall V V AP TP
V V• V V
061891 Frame/Steel/Bolting/Welding AP TP 'METAL STUDS SEP.WALL ONLY
V 'V •V
V
- - k
RECEIVED JUL 2 9 FINAL BUILDING INSPECTION :
-DEPT: BUILDING ENGINEERING &FIREPLANNING U/M WATER
PLAN CHECK#: CB910687 DATE: 07/25/91
PERMIT#: CB910687 PERMIT TYPE: CTI
PROJECT NAME: 392 SF PAC TEL CELLULAR
ADDRESS:
CONTACT PERSON/PHÔNE#: NH/TRAVIS/931-1130 -
SEWER DIST: WATER DIST: -
INSPECT 'DATE
BY: INSPECTED: 7(3o/5( APPRQVEDL DISAPPROVED
INSPECTED DATE - -
BY: *
INSPECTED:
-
APPROVED DISAPPROVED -
INSPECTED DATE
BY: INSPECTED: APPROVED DISAPPROVED
COMMENTS: - -
• S
S •
S, p
I •I
S. S - S
J - • . -I .-
•
- * " -.
-
ESGIL CORPORATION
9320 CHESAPEAKE DR., SUITE 208 •
SAN DIEGO, CA92123
(619)560-1468
DATE: flAPPLICANT
RI DICTION JURISDICTION: CL-o [3PLAN CHECKER
- L'FILE COPY PLAN CHECK NO: 1 ' SET: . flUPS
. DESIGNER PROJECT ADDRESS
PROJECT-NAME: OFi T L •
.
.
The plans transmitted herewith have been corrected where
necessary and substantially comply with the jurisdiction's
.' building codes.
The plans transmitted herewith will substantiallycomply
with the jurisdiction's building codes when minor deficien-
cies identified _ - are resolvedand '
- checked by building department staff .
The plans transmitted herewith have significant deficiencies
identified on the encibsed check -fist 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 Corp. until corrected
• plans are submitted for recheck.
• .
The applicant'scopy of the check list is enclosed for the-
jurisdiction to return to the applicant -contact person. '-
---
fl The applicant's copy of the check list has been sent to
Esgil staff didhot advise the applicant contact person that
plan check has.been completed. -. ••t
• '• / -•• .•'
Esgil staff did advise applicant that the plan check has, •. - been completed. Person con •: _____________________
Date -contacted: • Telephone U • - •
REMARKS:(T) Ci TftIL
:.;:. S'PntflUC4_CO)_p fl0)4 _Fto f\JO1I_(a1 t_111$J(
)ru ® c-tii,rt:J Z
- - •.
, -~ •'' --,7/ 6/9, •
BY: %L-& Enclosures?L, •., - ESGIL- CORPORATION - -
-•
.
OGA EAA LIRN 0DM
Date ______ Jurisdiction________________
Prepared by: :. Bldg. Dept.
___________
VALUATION AND 'PLAN CHECK FEE E3 Esgil
PLAN CHECK NO. _(—_7 -,
BUILDING ADDRESS _4—(,, M4-c22.oJ '9r2 400 • •'
APPLICANT/CONTACT1 tkc_onPHONENO.7—itO27
•.
BUILDING OCCUPANCY.- -2- DESIGNER PHONE • • •
CONTRACTOR PHONE__________ TYPE OF CONSTRUCTION \JJ ••
BUILDING PLANCHECK
ENGINEERING CHECKLIST
DATE: 7 MAY I ITEM COMPLETE
PLANCHECK NO. __—O&Efl . ITEM INCOMPLETE
NEEDS YOUR ACTION
CZ 1 2 3 iS4(n MA2J0 PJ) ITEM SELECTED
T D D
C C C PROJECT ID:_____________________________
H H H • H ..
•0
E E E LEGAL REQUIREMENTS
K Site Plan
. . . . .
LV] 1. Provide a fully dimensioned site plan drawn to scale.
Show: north arrow, property lines, easements, existing and
proposed structures, streets, existing street improvements,
right-of-way width and'dimension setbacks.
L1 7 E 2. Show on site plan: Finish floor elevations, pad
elevations, elevations of finish grade adjacent to
. . building, existing topographical lines, existing and
proposed slopes, driveway' with percent (%) grade and
/ .. drainage patterns..
E1I Provide legal description and Assessors Parcel Number.
Discretionary Approval Compliance.-
1/61
No Discretionary'ápprovals were 'required.
Project'. complies with all Engineering Conditions of
Approval for Project No.
Project does not comply with the following Engineering
Conditions of Approval for Project No.
Conditions complied with by: . . ' Date:
Field Review
F71 E:1 7. Field review completed. No issues raised.
8.1 Field review, completed. The ' following issues or
discrepancies with the site, plan were found:
El El El 'A. ' Site lacks adequate public improvements . • , , ,
. , B. Existing drainage improvements , not shown or in
conflict with site plan.
0 El El
, • ,
C.. . Site, is.' served by overhead power lines.
P:\D0CS\MISF0RMS\FRMO010.DH . ' • ' , , ' ' 'REV. 02/27/91
El El 1:1 D Grading is required to access site, create pad or,
; provide for ultimate street improvement.'
E E E E. Site access visibility problems exist. Provide onsite
', turnaround or engineered solution to problem.
LIII E F1 F Other
-'
n
Dedication Requirements
E/Ei 9 No dedication required
10. Dedication required. Please have a registered Civil
Engineer or Land Surveyor prepare the appropriate legal
description together with an 8½" x 11" plat map and submit
with a title report and the required processing fee All
easement documents must be approved and signed by owner(s)
.• prior to issuance of Building Permit. The description of
the dedication is as follows
Dedication coinpleted Date By
Improvement Requirements
L!i E E 11. No public improvements required. SPECIAL NOTE: Damaged or
defective improvements fàund adjacent to building site must,
'• be repaired to the satisfaction of the City inspector prior
to occupancy.
12. • Public improvements required. This project requires
construction of public improvements pursuant to Section
18 40 of the City Code Please have a registered Civil
Engineer prepare appropriate improvement plans and submit
for separate plancheck. process through the Engineering
- Department. Improvement plans must be approved,
appropriate securities posted and fees paid prior to
issuance of permit The required improvements are
4 I
Improvement plans signed, Date
4,
P \DOCS\MISFORMS\FRMOO1O DH REV 02/27/91
4 4
Improvements are required. Construction of the public
improvements may be deferred in accordance with Section
18.40 of the City Code. Please submit a letter requesting
deferral of the required improvements together with a
recent title report on the property and the appropriate
processing fee so we may prepare the necessary Future
Improvement Agreement. The Future Improvement Agreement
• must be signed, notarized and approved by the City prior to
S issuance of a Building.Permit.
Future Improvement Agreement completed, Date:____________
By:____________________
13a. Inadequate information ,available on site plan to make a
determination on grading requirements. Please provide more
detailed proposed and existing elevations, and contours.
Include accurate estimates of the grading quantities (cut,
fill, import, export).
No grading required as determined by the information
provided on the site plan. - - -
Grading Permit required. A separate grading plan prepared
by a registered Civil Engineer must be submitted for
separate plan check and-approval through the Engineering
Department. NOTE: The Grading Permit must be issued and
grading substantially complete and found acceptable to the
City Inspector prior to issuance of Building Permits.
Grading Inspector sign off. Date: by:
Miscellaneous Permits
Right-of-Way Permit not required.
Right-of-Way Permit required. A separate Right-of-Way
Permit issued by the Engineering Department is required for
the following:
1 S. '• .
18. Sewer Permit is not required. • .
E E E '19. Sewer Permit is required. A sewer Permit is required
concurrent with Building Permit issuance. The fee required
• ', is noted below in the fees section. -
5
- do Ej 20. Industrial Waste Permit is not required. .•
P:\D0CS\MISF0RMS\FRM0010.DH
S
• • • S ' • REV. 02/27/91
i
t'(
El El 21 Industrial Waste Permit is required Applicant must
complete. Industrial Waste Permit Application Form and
submit for City approval prior to issuance of 'a Building
Permits. Permits must, be issued prior to occupancy.
Industrial Waster Permit accepted -
,,Date:By
Fees Required
D \I/A 27. Park-in-Lieu Fee
Quadrant:Fee per Unit
Total Fees
I K1 IA.- 23 Traffic Impact Fee
Fee Per Unit: Total Fee:__________
D t'.I/f4 24 Bridge and Thorough fare Fee
Fee Per Unit:--,__Total Fee
t'4/Fi '2 5 Public Facilities Fee required
0 NI/P 26 Facilities Management Fee Zone:—Fee:.,
O N/Pi 27 Sewer Fees Permit No.EDU's
Benefit Area Fee
I\)f 28 Sewer Lateral Required
Fee__________________
0 29..'REMARKS:
t
ENGINEERING 'AUTHORIZATION TO ISSUE PERMIT., , .•' -
BY DATE i I
,4
P:\DOCS\M1SFORMS\FRM0010 DH REV 02/27/91
- , -
PLANNING CHECKLIST
Plan Check No. 9'/-1 Address, tRV 1!6
Planner ½J Phone 438-116i ext.
(Name)
APN /c°—/6
.-A
40 Type of Project and Use 60,lfIL,1 /4 71
Zone CZ Facilities Management Zone
HL '
o>
C4 Pn
Legend
A
[tern Complete
13-
A
[tern Incomplete Needs your action
4'.
1, 2, 3 Number in circle indicates plancheck number where deficiency was
.' • identified
0 Ennmental Review Required YES - NO TYPE
DATE OF COMPLETION
Compliance vith conditions of approvaP If not, stat conditions which require action
Conditions of Approval
0 Discretionary Acndn Required YES - NO Y TYPE
44 /
APPROVALJRESO NO.'. DATE
PROJECT NO
OTHER RELATED CASES
Compliance with conditions of approval If not, state conditions which require acnon
Conditions of Approval
- •Y
0
q
A 4,
California Coastal Commission Permit Required YES - NO
DATE OF APPROVAL
4 'A " A
San Diego Coast District, 1333 Canuno Del Rio South, Suite 125, San Diego, CA. 92108-3520
(619) 297-9740
Compliance L with conditions of approval If not, state conditions which require action
Conditions of Approval
4 *4,
E Landscape Plan Required YES NO
See attached subxnittalrequirernents for landscape plans
Site Plan:
0 Provide a fully dimensioned site plan drawn to scale. Show: North
arrow, property lines, easements, existing and proposed structures,
streets, -existing street improvements, right-of-way width and
dimensioned setbacks.
0 Show on Site Plan: Finish floor elevations, elevations of finish grade
adjacent to building,- existing topographical lines, existing and proposed
slopes and driveway.
• Provide legal description of property.
• 4.. Provide assesss pacel :number.
Zoning:
E~6FI,1. Setbacks:
Front: hown
095 01
Required
Int. tide: Required
-S
- Sown
Street Side: Required Shown
Rear:
..
Required Shown
2 Lot coverage Required Shown
3. Height: Required Shown
D1'á 0D,
•
4. Parking: • SpacesRequired Shown
1V0 • . . . Guest Spaces. Required Shown
0 00 Additional Comments • . • .• •
OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE __________
• ..•
• •.
• PLNCK.F1
?f4 .
2560 ORION WAY Citp of Carldab PAGE 1 OF / CARLSBAD, CA 92008 FIRE DEPARTMENTS
TELEPHONE
(619) 931-2121 0 APPROVED
rLRIN tIjt\HtiUMI PLAN CHECK#
PROJECT:P T& e 6 R ADDRESS
ARQHITECT J1iJi Aj D .'/ ADDRESS S/V\i 4tE?O PHONE
OWNER _______________________________ ADDRESS PHONE
OCCUPANCY '2 VCONST. __________ TOTAL SQ. FT. STORIES
DSPRINKLERED TENANT IMP. 31-77
' .' : APPROVAL OF PLANS IS PREDICATED ON CONFORMING
TO THE FOLLOWING CONDITIONS AND/OR MAKING
THE FOLLOWING CORRECTIONS:
PLANS, SPECIFICATIONS, AND PERMITS
Provide one copy of: floor plan(s); site, plan; sheets
Provide two site plans showing the' location ofall existing'fire hydrants within'200 feet of the project.
3 Provide specifications for the following
4. Permits are required forthe installation of all fire protection systems (sprinklers, stand pipes, dry chemical, halon,
CO2 alarms hydrants) Plan must be approved by the fire department prior to installation
5 The business owner shall complete a building information letter and return it to the fire department
FIRE PROTECTION SYSTEMS AND EQUIPMENT
' •_.L,6; The foliowihg fire protection systems are required:
, •' 0 Automátic.f ire sprinklers (Design Criteria: - ' •• , ,
DryChemical, Halon, COx (Location: Stand Pipes (Type:
' 0 Fire Alarm (Type/Location:
7. Fire- Extinguisher Requirements: • ' ' •• V ' S ,
• . . _One 2A rated ABC.extin'guisher for eaich66iO C) 'sq. ft. or portion thereof with.a travel distance to the nearest
extinguisher not to' exceed2U.e of travel. V
0 An extinguisherwith a minimum rating of 'to be located:
V 0 Other:
8. Additional fire hydrant(s) shall.b'e provided VVVVV V . ••
.
V •V , , ./,• I 'V V
•0
EXITS
9 Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort
V. 10. A.sign stating, "This door to remain unlocked during business, hours" shall be placed above the main exit-and.
doors
EXIT signs (6 x 3/4 letters) shall be placed over all required exis and directional signs located as necessary to
clearly indicate the location of exit doors
GENERAL
Storage dispensing or use of any flammable or combustible liquids flammable liquids flammable gases and
hazardous chemicals shall comply with Uniform Fire Code
...._.L13: Building(s) not approved for high piled combustible stock. Storage in closely packed piles shall not exceed 15 feet V in height, 12 feet on pallets or in 'racks and 6'feet for tires, plastics andsome flammable liquids. If high stock pil-
ing is to be done,cornply. with' Uniform Fire Code, Article 81. • V • •
V
14. 'Additional Requirements. '0 • • 0 • •
• 0
V • V • • V • ' • •V • V, • • • 0
V • ' V V 5 • • V 0 ' • S •, • • •
•
0
•,, •' 'V • - • • • • V • 0 •
V
, * •• • V QQ/V @:r—• •, -• *•
V • •, • •''
V • • V, V :
• ......15: Coniply with regulations on attached sheet(s).. V V
• • • V V
Plan Examiner Date _ / / - • ' .
__' Report mailed to architect ' Met with '' • • Attach to Plans
COMMERCIAL/INDUSTRIAL
APPLICATION FORK FOR INDUSTRIAL WASTE DISCHARGE PERMIT
CITY OF CARLSBAD
APPLICATION: NEW BUILDING P.C. NO.:9V' g7
(CHECK ONE) REVISED APPLICATION NO.:_____________
INDUSTRIAL CLASS:3
BY: 2L-P LQ S DATE:________________
Signature"S City Representative
APPLICATION FOR INDUSTRIAL WASTE DISCHARGE PERMIT,
A. GENERAL:
SITE
APPLICANT:A_C e ADDRESS:___ 17', Xce4 __________
TYPE OF BUSINESS:
0
APPLICANT'S ADDRESS:_____________________________________________________
B. WASTES AND PROCESSING: (Check where applicable)
II-1estic Waste Only Industrial Waste Industrial Waste NOT
Discharged to Sewer Discharged to Sewer
GENERAL DESCRIPTION OF WASTE (Chemical and Physical Characteristics of
S proposed waste):______________________________________________________
GENERAL DESCRIPTION OF PROCESS (If Applicable):_______________________
C. WASTES TO BE DISCHARGED TO SEWER:
WASTE: • TREATED: QUANTITY: AVERAGE GPD
(Check One) UNTREATED: (Daily) MAXIMUM GPD
, • (Gallons Per Day)
• APPLICANT OR. REPRESENTATIVE OF FIRM: :
: (Print) •
TITLE: •
S
SIGNATURE:S • DATE:
•S - S •