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HomeMy WebLinkAbout1905 CALLE BARCELONA; 211; CB111095; Permit07-13-2011 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB111095 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: 1905 CALLE BARCELONA CBAD St: 211 Tl Sub Type: 2550120400 Lot#: $55,643.00 Construction Type: Reference #: BODYROK: 1499 SF RETAIL TO EXERCISE STUDIO COMM 0 5B Applicant: KAL PACIFIC 31045 TEMECULA PARKWAY TEMECULA CA 92592 951-587-9450 Status: ISSUED Applied: 05/24/2011 Entered By: JMA Plan Approved: 07/13/2011 Issued: 07/13/2011 Inspect Area: Plan Check*: Owner: FOURTH QUARTER PROPERTIES XXX L L C C/O THOMAS TROPEA 45 ANSLEY DR NEWNAN GA 30263 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Fire Expedited Plan Review $445.73 $0.00 $289.72 $0.00 $0.00 $11.69 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $272.50 Meter Size Add'l Reel. Water Con. Fee Meter Fee SDCWA Fee CFD Payoff Fee PFF (31 05540) PFF (4305540) License Tax (31 041 93) License Tax (4304 193) Traffic Impact Fee (3105541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $24.00 $0.00 $0.00 $0.00 $0.00 ?? TOTAL PERMIT FEES $1,064.64 Total Fees:$1,064,64 Total Payments To Date:$1,064.64 Balance Due:$0.00 Inspector: FINAL APPROVAL Date:Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as lees/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 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, 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 application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which vou have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. CITY OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717/2718/2719 Fax: 760-602-8558 www.carlsbadca.gov Plan Check No. Q£>/ I Est. Value Plan Ck. Deposit Date SWPPP JOB ADDRESS I<to6 SUITE#/SPACE#/UNIT#__.355 -60- - CT/PROJECT ## OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) A A) ~,tl Ho USB EXISTING USE PROPOSED USE GARAGE (SF)PATIOS (SF)DECKS (SF)FIREPLACE YES D # AIR CONDITIONING YES'K.NOD FIRE SPRINKLERS YES X" CONTACT NAME (It Different Font Applicant)—APPLICANT NAME ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE PHONE FAX EMAIL NAME CONTRACTOR BUS. NAME AL ADDRESS CITY STATE ZIP.STAT ZIP PHONE FAX Q,EMAIL ARCH/DESIGN£R~NAME & ADDRESS STATE LIC.#11130$ (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 issjil^e, USTrequires 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, commending with SecttD/7000 of Division 3 of theBusiness and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars ($500)). WORKERS' COMPENSATION Wortiers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: STufave 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 perm it is issued. 0 I have and will maintain workers'cpmpensation, as required by Section 3700 of the Labor Code, for the performance of the work for which thispermit is issued. My workers' compensation insurance carrier and policy S£number are: Insurance Co. 3tm£ CJ) WpEKSfrTl&V ) flSVf- > f(Sftl> Policy No. ttfj-000 Hfftf Expiration Date _ mis section need not be completed if the permit is for one hundred dollars ($10 O Certificate of Exemption: I certifftrtat in the performance of the work for Jihich ihjs permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secureWrWs' compensation coveragi is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100.000), in addition to the cost of compensation, damages as provided fir in Section 3^06 oJjHie Labor code, jnterest and attorney's fees. J&$ CONTRACTOR SIGNATURE 3AGENT DATE O W N E R - B U I L D E R D E C L A R A T JO N / hereby affirm that I am exempt from Contractor's License Lai* for the following reason: O I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). O 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 contractors) licensed pursuant to the Contractor's License Law). O I am exempt under Section Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. O Yes D No 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone /contractors' license number): 4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): ^PROPERTY OWNER SIGNATURE I I DAGENT DATE COM P L ETE TH I S S E CTI ON FOR NO N-R E S I DE NTIAL B UIL D I N G P E R Wl I T S ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505,25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? I I Yes I iNo Is the applicant or future building occupant required to obtain a permit from the air pollution control district or aircwality management district? I lYes I I No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? I lYes I [NO EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CO N S TR U CT I ON LEND IN G A GENC Y I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address AP PL I CAN T I certify that I have read the application and state thatthe above information is correct and that the information on Uie plans is acoi rate, lagree to romply with all Cit^ordinarK>2sand State laws relatingto building constniction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Ofjtel under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such rjemiWriftteJ)i!i™§ or work authorized by such permit is suspended/or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). ^APPLICANT'S SIGNATURE DATE Rial Building Inspection Dept: Building Engineering Planning CMWD St Lite Fire Plan Check #: Permit #: Project Name: Address: Contact Person: Sewer Dist: Inspect^. Bv: \J4* Inspected Bv: Inspected Bv: Comments: CB111095 BODYROK: 1499 SF RETAIL TO EXERCISE STUDIO 1 905 CALLE BARCELONA #211 Phone: LC Water Dist: O PJ\ 1 Date ^^vX Inspected: \C M Date Inspected: Date Inspected: Date: Permit Type: Sub Type: Lot: 0 /\T/ // a***""/ j/ ft Approved:' 1 Approved: Approved: 10/05/2011 Tl COMM •"•*"'' Disapproved: Disapproved: Disapproved: City of Carlsbad Bldg Inspection Request For: 10/17/2011 Permit* CB111095 Title: BODYROK: 1499 SF RETAIL TO Description: EXERCISE STUDIO Inspector Assignment: TP 1905 CALLE BARCELONA 211 Lot: 0 Type:TI Sub Type: COMM Job Address: Suite: Location: OWNER FOURTH QUARTER PROPERTIES XXX L L C Owner: Remarks: call with ETA for Monday or Tuesday Total Time: Phone: 8583538140 Inspector: Requested By: LISA Entered By: CHRISTINE CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Act Comments Comments/Notices/Holds Associated PCRs/CVs/SWPPPs Original PC# Inspection History Date Description Act Insp Comments 10/05/2011 89 Final Combo CO TP SEE CARD 08/10/2011 17 Interior Lath/Drywall AP TP 08/08/2011 14 Frame/Steel/Bolting/Welding AP TP 08/08/2011 34 Rough Electric AP TP EsGil Corporation In (Partnennip witR government for <BuiCiCing Safety DATE: 6/29/11 a APPLICANT a JURIS. JURISDICTION: City of Carlsbad a PLAN REVIEWER a FILE PLAN CHECK NO.: 11-1095 SET: I PROJECT ADDRESS: 1905 Calle Barcelona Suite 211 PROJECT NAME: BodyRok - TI XI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: Esgil Corporation staff did not advise the applicant that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Email: Mail Telephone Fax In Person REMARKS: By: Doug Moody Enclosures: EsGil Corporation D GA D EJ D PC 5/26/11 9320 Chesapeake Drive, Suite 208 4 San Diego, California 92123 * (858)560-1468 4 Fax (858) 560-1576 EsGil Corporation In <PartnersHip witR government for <BuiC<fing Safety DATE: 6/6/11 a APPLICANT a^JURif^) JURISDICTION: City of Carlsbad a PLTttT^EVIEWER a FILE PLAN CHECK NO.: 11-1095 SET: I PROJECT ADDRESS: 1905 Calle Barcelona Suite 211 PROJECT NAME: BodyRok - TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. XI The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. X] The applicant's copy of the check list has been sent to: KP& Associates / Steven Enzio 31045 Temecula Parkway, Temecula, CA 92592 Esgil Corporation staff did not advise the applicant that the plan check has been completed. XI Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Steven Enzio Telephone #: 951-316-9272 Date contacted: M u ! IF (by: p^] Email:senzio@hotmail.com Fax #: 951-587-9451 Y, Mail ^ Telephone -^ Fax In Person REMARKS: By: Doug Moody Enclosures: EsGil Corporation D GA D EJ D PC 5/26/11 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 4 (858)560-1468 * Fax (858) 560-1576 City of Carlsbad 11-1095 6/6/11 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: 11-1095 OCCUPANCY: B TYPE OF CONSTRUCTION: VB ALLOWABLE FLOOR AREA: SPRINKLERS?: YES REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 5/24/11 DATE INITIAL PLAN REVIEW COMPLETED: 6/6/11 JURISDICTION: City of Carlsbad USE: Exercise Studio ACTUAL AREA: 1498sf STORIES: 1 HEIGHT: OCCUPANT LOAD: 29 DATE PLANS RECEIVED BY ESGIL CORPORATION: 5/26/11 PLAN REVIEWER: Doug Moody FOREWORD (PLEASE READ): This plan review is limited to the technical requirements contained in the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 2010 CBC, which adopts the 2009 IBC. The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of the 2009 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e.. plan sheet number, specification section, etc. Be sure to enclose the marked up list when you submit the revised plans. City of Carlsbad 11-1095 6/6/11 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., Carlsbad, CA 92008, (760) 602-2700. The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments. 2. Bring 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. Provide a section view of the new interior glazed partition. Show: a) Specify manufacturer and approval number or indicate "to be ICBO approved". b) Method of attaching top and bottom plates to structure. (NOTE: Top of partition must be secured to roof or floor framing). 2. Please revise the plans to show the panel locations for the individual suites demonstrating compliance with section 240-24 of the2002 NEC. 3. Please note in the general wiring notes on the plans "AC Cable is not allowed in A, B, E, H, F, M, S and I occupancies. NM cable is restricted (without City approval) to one and two family dwellings. Note on plans that an equipment ground conductor is to be installed in all flexible conduits". 4. Please correct the LTG-1C forms to show the area category to be for exercise and not retail. To speed up the review process, note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. Please indicate here if any changes have been made to the plans that are not a result of corrections from this list. If there are other changes, please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate: Yes a No a City of Carlsbad 11-1095 6/6/11 The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review for your project. If you have any questions regarding these plan review items, please contact Doug Moody at Esgil Corporation. Thank you. City of Carlsbad 11-1095 6/6/11 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PLAN CHECK NO.: 11-1095 PREPARED BY: Doug Moody DATE: 6/6/11 BUILDING ADDRESS: 1905 Calle Barcelona Suite 211 BUILDING OCCUPANCY:TYPE OF CONSTRUCTION: BUILDING PORTION Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code AREA II Valuation ( Sq. Ft.) Multiplier 1498 cb 37.12 By Ordinance Reg. Mod. VALUE ($) 55,606 55,606 $445.73 Plan Check Fee by Ordinance Type of Review: Q Repetitive FeeRepeats Complete Review D Other i—| Hourly EsGil Fee Structural Only Hr. @ $289.72 $249.61 Comments: Sheet 1 of 1 macvalue.doc + *• r * PLANNING/ENGINEERING APPROVALS PERMIT NUMBER ADDRESS DATE ^ RESIDENTIAL TENANT IMPROVEMENT RESIDENTIAL ADDITION MINOR « $20,000.00) SOLAR PANELS PLAZA CAMINO REAL PREMIER OUTLETS VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER PLANNER ENGINEER DATE DATE Docs/Mlsforms/Planning Engineering Approvals CITY OF CARLSBAD STORM WATER COMPLIANCE ASSESSMENT B-24 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov am applying to the City of Carlsbad for the following type(s) of construction permit: Building Permit Q Right-of-Way Permit Q My project is categorically EXEMPT from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it only requires issuance of one or more of the following permit types: Electrical Fire Additional Fire Alarm Fixed Systems Mechanical Mobile Home Plumbing reject Storm Water Threat Assessment Criteria4 ment Criteria Patio/Deck Photo Voltaic Re-Roofing Sign Spa-Factory Sprinkler Water Discharge My project qualifies 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. Tierl - Low Threat Assessment Criteria Q 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 Q 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 located 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 Q 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, refueling and maintenance areas: and/or Q 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, G 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). / 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 City 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. Owner/Owner's Authorized Agent Name: B-24 Page 1 of 1 Rev.03/09 STORM WATERk " CT A Kin A one Development Services STANDARDS Engineering Department CITY OF QUESTIONNAIRE 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov INSTRUCTIONS: To address post-development pollutants that may be generated from development projects, the City requires that new development and significant redevelopment priority projects incorporate Permanent Storm Water Best Management Practices (BMP's) into the project design per the City's Standard Urban Stormwater Management Plan (SUSMP). Initially this questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary permits and/or construction permits). The results of the questionnaire determine the level of storm water standards that must be applied to a proposed development or redevelopment project. Depending on the outcome, your project will either be subject to 'Standard Stormwater Requirements' or be subject additional criteria called 'Priority Development Project Requirements'. Many aspects of project site design are dependent upon the storm water standards applied to a project. Applicant responses to the questionnaire represent an initial assessment of the proposed project conditions and impacts. City staff has responsibility for making the final assessment after submission of the development application. If staff determines that the questionnaire was incorrectly filled out and is subject to more stringent storm water standards than initially assessed by the applicant, this will result in the return of the development application as incomplete. In this case, please make the changes to the questionnaire and resubmit to the City. If applicants are unsure about the meaning of a question or need help in determining how to respond to one or more of the questions, they are advised to seek assistance from Land Development Engineering staff. A separate completed and signed questionnaire must be submitted for each new development application submission. Only one completed and signed questionnaire is required when multiple development applications for the same project are submitted concurrently. In addition to this questionnaire, applicants for construction permits must also complete, sign and submit a Project Threat Assessment Form to address construction aspects of the project. Please answer the questions below, follow the instructions and sign the form at the end. 1. Is your project a significant redevelopment? . DEFINITION: Significant redevelopment is defined as the creation, addition or replacement of at least 5,000 square feet of impervious surface on an already existing developed site. Significant redevelopment includes, but is not limited to: the expansion of a building footprint; addition to or replacement of a structure; structural development including an increase in gross floor area and/or exterior construction remodeling; replacement of an impervious surface that is not part of a routine maintenance activity; and land disturbing activities related with structural or impervious surfaces. Replacement of impervious surfaces includes any activity that is not part of a routine maintenance activity where impervious material(s) are removed, exposing underlying soil during construction. If your project IS considered significant redevelopment, then please skip Section 1 and proceed with Section 2. If your project IS NOT considered significant redevelopment, then please proceed to Section 1. E-34 Page 1 of 3 REV 3/23/10 CITY OF CARLSBAD STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Engineering Department 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov SECTION 2 SIGNIFICANT REDEVELOPMENT Complete the questions below regarding your redevelopment project: 1 . Project results in the disturbance of more than 1 -acre or more of land and is considered a Pollutant-generating Development Project (see definition in Section 1 ). YES If you answered NO, please proceed to question 2. If you answered YES, then you ARE a significant redevelopment and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirements. Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 below. 2. Is the project redeveloping an existing priority project type? (Priority projects are defined in Section 1) If you answered YES, please proceed to question 3. If you answered NO, then you ARE NOT a significant redevelopment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check the "does not meet POP requirements" box in Section 3 below. 3. Is the project solely limited to just one of the following: a. Trenching and resurfacing associated with utility work? b. Resurfacing and reconfiguring existing surface parking lots? c. New sidewalk construction, pedestrian ramps, or bike lane on public and/or private existing roads? d. Replacement of existing damaged pavement? If you answered NO to ALL of the questions, then proceed to question 4. If you answered YES to ANY of the questions then you ARE NOT a significant redevelopment and your project is subject to Standard Stormwater Requirements. Please check the "does not meet PDP requirements" box in Section 3 below. 4. Will your redevelopment project create, replace, or add at least 5,000 square feet of impervious surfaces on an existing development or, be located within 200 feet of the Pacific Ocean and (1 )create more than 2500 square feet of impermeable surface or (2) increases impermeable surface on the property by more than 10%? If you answered YES, you ARE a significant redevelopment, and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirement Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 below. If you answered NO, then you ARE NOT a significant redevelopment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check the "does not meet PDP requirements" box in Section 3 below. SECTION 3 NO, Questionnaire Results: My project meets PRIORITY DEVELOPMENT PROJECT (PDP) requirements and must comply with additional Stormwater criteria per the SUSMP and must prepare a Storm Water Management Plan for submittal at time of application. My project does not meet PDP requirements and must only comply with STANDARD STORMWATER REQUIREMENTS per the SUSMP. Applicant Information and Signature Box Assessor's Parcel Number(s): E-34 Page 3 of 3 REV 3/23/10 ^. CITY OF CARLSBAD STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Engineering Department 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov [SECTION 1 NEW DEVELOPMENT PRIORITY PROJECT TYPE Does you project meet one or more of the following criteria:YES NO 1. Housing subdivisions of 10 or more dwelling units. Examples: single family homes, multi-family homes, condominium and apartments 2. Commercial- greater than 1-acre. Any development other than heavy industry or residential. Examples: hospitals; laboratories and other medical facilities; educational institutions; recreational facilities; municipal facilities; commercial nurseries; multi-apartment buildings; car wash facilities; mini-malls and other business complexes; shopping malls; hotels; office buildings; public warehouses; automotive dealerships; airfields; and other light industrial facilities. 3. Heavy Industrial / Industry- greater than 1 acre. Examples: manufacturing plants, food processing plants, metal working facilities, printing plants, and fleet storage areas (bus, truck, etc.). 4. Automotive repair shoo. A facility categorized in any one of Standard Industrial Classification (SIC) codes 5013, 5014, 5541, 7532-7534, and 7536-7539 5. Restaurants. Any facility that sells prepared foods and drinks for consumption, including stationary lunch counters and refreshment stands selling prepared foods and drinks for immediate consumption (SIC code 5812), where the land area for development is greater than 5,000 square feet. Restaurants where land development is less than 5,000 square feet shall meet all SUSMP requirements except for structural treatment BMP and numeric sizing criteria requirements and hydromodification requirements. Hillside development. Any development that creates 5,000 square feet of impervious surface and is located in an area with known erosive soil conditions, where the development will grade on any natural slope that is twenty-five percent (25%) or greater. Environmentally Sensitive Area (ESA)1. All development located within or directly adjacent2 to or discharging directly3 to an ESA (where discharges from the development or redevelopment will enter receiving waters within the ESA), which either creates 2,500 square feet of impervious surface on a proposed project site or increases the area of imperviousness of a proposed project site to 10% or more of its naturally occurring condition. 8.Parking lot. Area of 5,000 square feet or more, or with 15 or more parking spaces, and potentially exposed to urban runoff 9. Streets, roads, highways, and freeways. Any paved surface that is 5,000 square feet or greater used for the transportation of automobiles, trucks, motorcycles, and other vehicles 10. Refa/7 Gasoline Outlets. Serving more than 100 vehicles per day and greater than 5,000 square feet 11. Coastal Development Zone. Any project located within 200 feet of the Pacific Ocean and (1) creates more than 2500 square feet of impermeable surface or (2) increases impermeable surface on property by more than 10%. 12. More than 1-acre of disturbance. Project results in the disturbance of more than 1-acre or more of land and is considered a Pollutant-generating Development Project4. 1 Environmentally Sensitive Areas include but are not limited to all Clean Water Act Section 303(d) impaired water bodies; areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); water bodies designated with the RARE beneficial use by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); areas designated as preserves or their equivalent under the Multi Species Conservation Program within the Cities and County of San Diego; and any other equivalent environmentally sensitive areas which have been identified by the Copermittees. 2 "Directly adjacent" means situated within 200 feet of the Environmentally Sensitive Area. 3 "Discharging directly to" means outflow from a drainage conveyance system that is composed entirely of flows from the subject development or redevelopment site, and not commingled with flow from adjacent lands. 4 Pollutant-generating Development Projects are those projects that generate pollutants at levels greater than background levels. In general, these include all projects that contribute to an exceedance to an impaired water body or which create new impervious surfaces greater than 5000 square feet and/or introduce new landscaping areas that require routine use of fertilizers and pesticides. In most cases linear pathway projects that are for infrequent vehicle use, such as emergency or maintenance access, or for pedestrian or bicycle use, are not considered Pollutant-generating Development Projects if they are built with pervious surfaces or if they sheet flow to surrounding pervious surfaces. Section 1 Results: .If you answered YES to ANY of the questions above your project is subject to Priority Development Project requirements. Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3. A Storm Water Management Plan, prepared in accordance with City Storm Water Standards, must be submitted at time of application. If you answered NO to ALL of the questions above, then your project is subject to Standard Stormwater Requirements. Please'check the "does not meet PDF requirements" box in Section 3. E-34 Page 2 of 3 REV 3/23/10 PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB 11-1095 DATE 5/24/11 ADDRESS 1905 Calle Barcelona #211 RESIDENTIAL ADDITION- MINOR (<17,000.00) RETAINING WALL VILLAGE FAIRE POOL/SPA TENANT IMPROVEMENT COMPLETE OFFICE BUILDING SOLAR PANELS OTHER PLANNER ENGINEER .DATE DATE H:\ADMlN\CO[]NTER/PUNNING/ENGINEEIllNG APPROVALS Fire Department Plan Review Requirements Category: TI, COMM Date of Report: 06-29-2011 Reviewed by: Name: KAL PACIFIC Address: 31045 TEMECULA PARKWAY TEMECULA CA 92592 Permit #: CB111095 Job Name: BODYROK: 1499 SF RETAIL TO Job Address: 1905 CALLE BARCELONA CBAD St: 211 ^___- Conditions: Cond: CON0004730 [MET] ** CITY OF CARLSBAD FIRE DEPARTMENT - APPROVED: THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF BUILDING PERMIT. THIS APPROVAL IS SUBJECT TO FIELD INSPECTION AND REQUIRED TEST, NOTATIONS HEREON, CONDITIONS IN CORRESPONDENCE AND CONFORMANCE WITH ALL APPLICABLE REGULATIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE THE VIOLATION OF ANY LAW. Entry: 06/29/2011 By: GR Action: AP RECOMMENDATION FOR APPROVAL Page: 1 of1 Daryl K. James & Associates, Inc. Checked by: Matthew Ernau Date: 6/24/2offiLDG, DEPT COPY APPLICANT: KP & Assoc Steven Enzio JURISDICTION: Carlsbad Fire Department PROJECT NAME: BODYROK PROJECT ADDRESS: 1905 Calle Barcelona Suite 211 PROJECT DESCRIPTION: CB111095 INSTRUCTIONS • This plan review has been conducted in order to verify conformance to minimum requirements of codes adopted by the Carlsbad Fire Department. • The items below require correction, clarification or additional information before this plan check can be approved for permit issuance. A0.1 • In Deferred Submittal Section add Design automatic fire sprinkler system in accordance with 2010 ed. ofNFPA13. OK 6/24/11 A1.0 • Add to floor plan general notes section. Complete plans and specifications for fire- extinguishing system, including fire alarm systems, automatic sprinkler systems, and wet and dry standpipes; halon systems and other special type automatic fire-extinguishing systems; basement pipe onlets; and other fire-protection systems and appurtenances therto shall be submitted to Fire and Life safety for review and approval prior to installation. OK 6/24/11 BUILDING ENERGY ANALYSIS REPORT PROJECT: BODYROK 1905 CALLE BARCELONA CARLSBAD, CA 92009 Project Designer: KP & ASSOCIATES 41951 REMINGTON AVE. SUITE 110 TEMECULA, CA 92590 951 587 9450 Report Prepared by: NORM THOMAS T&K Engineering 30535 AVE BUENA SUERTE TEMECULA, CA 92591 951 699 0436 TKENERGY.COM Job Number: ORIG 5-7-11 Date: 5/7/2011 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is ' authorized by the California Energy Commission for use with both the Residential and IMonresidential 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC-www.energysoft.com. EnergyPro 5.1 by EnergySofi User Number: 3089 RunCode: 2011-05-07717:55:12 ID: ORIG 5-7-11 TABLE OF CONTENTS Cover Page 1 Table of Contents 2 Nonresidential Performance Title 24 Forms 3 Form ENV-MM Envelope Mandatory Measures 15 Form MECH-MM Mechanical Mandatory Measures 16 HVAC System Heating and Cooling Loads Summary 17 EnergyPro 5.1 byEnergySoft Job Number: ID: PRIG 5-7-11 User Number: 3089 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 1 of 3)PERF-1C Project Name BODYROK Date 5/7/2011 Project Address 1905 CALLE BARCELONA CARLSBAD Climate Zone CA Climate Zone 07 Total Cond. Floor Area 1,560 Addition Floor Area n/a -GENERAL INFORMATION Building Type:El Nonresidential D D Relocatable - indicate D High-Rise Residential D specific climate zone D Hotel/Motel Guest Room all climates Phase of Construction: D New Construction D Addition D Alteration STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to a Building using the performance compliance approach. The documentation author hereby certifies that the documentation is accurate and coi Documentation Author Name NORM THOMAS Signature Company T&K Engineering Date 5/7/2011 Address 30535 A VE BUENA SUERTE Phone 957 699 0436 City/State/Zip TEMHCt/M_ CA 92591 The Principal Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The proposed building has been designed to meet the energy efficiency requirements contained in sections 110, 116 through 118, and 140 through 149 of Title 24, Part 6. Please check one: ENV. LTG. MECH. D D I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for its preparation; and that I am licensed in the State of California as a civil engineer, mechanical engineer, electrical engineer, or I am a licensed architect. I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. I affirm that I am eligible under Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described as exempj^pursuant to Business and Professions Code Sections 5537, 5538 and 6737.1. Principal Envelope Designer Name KP & ASSOCIATES Signature Company KP & ASSOCIATES Address 41951 REMINGTONAVE. SUITE 110 City/State/Zip TEMECULA> CA 925go Phone 951 5g7 9450 Principal Mechanical Designer Name A. D. FLORES Signature Company AIR DIRECT Date Address PO BOX 2213 License # City/State/Zip p£RR/s CA g2572 Phone gog 241 14Q4 Principal Lighting Designer Name Signature Company Lighting Compliance Not In The Scope Of This Submittal Date Address License # City/State/Zip Phone INSTRUCTIONS TO APPLICANT COMPLIANCE & WORKSHEETS (check box if worksheets are included) 0 ENV-1C Certificate of Compliance. Required on plans. El MECH-1C D LTG-1C Certificate of Compliance. Required on plans. El MECH-2C D LTG-2C Lighting Controls Credit Worksheet. El MECH-3C D LTG-3C Indoor Lighting Power Allowance. 0 MECH-5C Certificate of Compliance. Required on plans. Air/Water Side/Service Hot Water & Pool Requirements. Mechanical Ventilation and Reheat. Mechanical Equipment Details. EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07717:55:12 ID: ORIG 5-7-11 Page 3 of 17 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 2 of 3)PERF-1C Project Name BODYROK Date 5/7/2011 ANNUAL TDV ENERGY USE SUMMARY (kBtu/sqft-yr) Energy Component Space Heating Space Cooling Indoor Fans Heat Rejection Pumps & Misc. Domestic Hot Water Lighting Receptacle Process Process Lighting TOTALS Standard Design 7.82 162.92 32.27 0.00 0.00 0.00 56.64 25.49 0.00 0.00 285.14 Percent better than Standard Proposed Design 7.45 753.90 32.20 0.00 0.00 0.00 56.64 25.49 0.00 0.00 275.68 3.3% Compliance Margin 0.37 9.02 0.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.46 Heating Cooling Fans Heat Rej Pumps DHW Lighting Receptacle Process Process Ltg i ( 3.3 % excluding process) BUILDING COMPLIES GENERAL INFORMATION Building Orientation Number of Stories Number of Systems Number of Zones (N) 0 deg 1 Conditioned Floor Area Unconditioned Floor Area Conditioned Footprint Area Natural Gas Available On Site 7,560 7,560 A/o sqft. sqft. sqft. Orientation Gross Area Front Elevation Left Elevation Rear Elevation Right Elevation Roof Total (N) (E) (S) (W) 360 975 360 975 2,670 1,560 sqft. sqft. sqft. sqft. sqft. sqft. Glazing Area 780 0 0 0 780 0 sqft. sqft. sqft. sqft. sqft. sqft. Glazing Ratio 50.0% 0.0% 0.0% 0.0% 6.7% 0.0% Standard Prescriptive Lighting Power Density Prescriptive Envelope TDV Energy 7.000 47,969 W/sqft. Proposed 7.000 54,675 Prescriptive Values for W/sqft. Comparison only. See LTG-1C for allowed LPD. Remarks: EnerqyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07715:44:06 ID: PRIG 5-7-77 Page 4 of 17 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 3 of 3)PERF-1C Project Name BODYROK Date 5/7/2011 ZONE INFORMATION System Name Zone Name Occupancy Type Floor Area (sqft.) Inst. LPD (W/sf)1 Ctrl. Credits (W/sf)2 Allowed LPD Area (W/sf)3 Tailored (W/sf)4 Proc. Loads (W/sf) 5 TON 3 Phase HVAC BodyRok Fitness Exercise, Gymnasium 1,560 "1.000 Notes: 1. See LTG-1C (items marked with asterisk, see LTG-t -C by others)2. See LTG-2C 3. See LTG-3C (by others) 4. See LTG-4C Items above require special documentation EXCEPTIONAL CONDITIONS COMPLIANCE CHECKLIST The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local enforcement agency determines the adequacy of the justifications, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. The Roof Roof has been designated as an alteration, however the Roof Surface is NOT being replaced. The exceptional features listed in this performance approach application have specifically been reviewed. Adequate written justification and documentation for their use have been provided by the applicant. Authorized Signature or Stamp EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07T15:44:06 ID: ORIG 5-7-11 Page 5 of 17 CERTIFICATE OF COMPLIANCE (Part AND FIELD INSPECTION ENERGY CHECKLIST 1 of 3) Project Name BODYROK Project Address 7905 CALLE BARCELONA CARLSBAD Climate Zone 7 Total Cond. Floor Area 1,560 ENV-1C Date 5/7/2011 Addition Floor Area n/a GENERAL INFORMATION Building Type: El D Schools (Public School) D Nonresidential Relocatable Bldg. D Skylight Area for Large Enclosed Space Phase of Construction: D Approach of Compliance: D Dublic School D High-Rise Residential D 13 Conditioned Spaces Hotel/Motel Guest Room D Unconditioned Spaces > 8000 ft2 (If checked include the ENV-4C with submittal) New Construction Component Front Orientation: N, E, S, W or in Degrees:Odeg D Addition D 13 Overall Envelope D Alteration Unconditioned (file affidavit) FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS Tag/ID 1 2 3 4 5 6 Assembly Type Roof Wall Wall Slab Wall Wall "fc CO0> < 1,560 180 975 1,560 360 975 OrientationN, E, S, W(N) (N) (E) (N) (S) (W)U-Factor0.049 0.1 1C 0.102 0.73C 0.1 1C 0.102 INSULATION CavityR-ValueR-1 R-1 R-1 Non R-1 R-1 Exterior R-Value9 1 3 3 1 3 ExteriorFurring3Interior R-ValueMJ; o>S c CD t JEif JointAppendix 44.2.1-A4 4.3.1-A2 4.3.1-A3 4.4.7-A1 4.3.1-A2 4.3.1-A3 coS m•0 3iSo en Altered Existing Existing Existing Existing Existing ininCO OL D D D D D D D D D D N 'au. D D D D D n n n D n 1 . See Instructions in the Nonresidential Compliance Manual, page 3-96. 2. If Fail, then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. A fail does not meet compliance. FENESTRATION SURFACE DETAILS Tag/ID 1 Fenestration Type Window KT- 180 OrientationN, E, S, W(N)MaxU-Factor0.990 U-FactorSourceNFRC o C3 X CO18 ;=•EE. 0.600 O osien en NFRC Overhangn n n a n n a a a n ConditionsStatusExisting inin£ n D n D D n n n D D 'caLL n D n D D n n n n n 1. See Instructions in the Nonresidential Compliance Manual, page 3-96. 2. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. EnergyPro 5. 1 by EnergySoft User Number: 3089 RunCode: 2011-05-07715:44:06 ID: ORIG 5-7-1 1 Page 6 of 17 Project Name BODYROK Date 5/7/2011 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION ENERGY CHECKLIST (Part 2 of 3)ENV-1C ROOFING PRODUCT (COOL ROOFS) (Note if the roofing product is not CRRC certified, this compliance approach cannot be used). Go to Overall Envelope Approach or Performance Approach. CHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT "COOL ROOF" REQUIREMENTS:Pass Fail1 N/A D Roofing compliance not required in Climate Zones 1 and16 with a Low-Sloped. 2:12 pitch or less. D Roofing compliance not required in Climate Zone 1 with a Steep-Sloped with less than 5 Ib/ft2. Greater than 2:12 pitch.n n Low-sloped Wood framed roofs in Climate Zones 3 and 5 are exempted, solar reflectance and thermal emittance or SRI that have a U-factor of 0.039 or lower. See Opaque Surface Details roof assembly, Column H of ENV-2C.n n Low-sloped Metal building roofs in Climate Zone 3 and 5 are exempted, solar relectance and thermal emittance or SRI that have a U-factor ot 0.048 or lower. See Opaque Surface Details roof assembly below, Column H of ENV-2C.D The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempted. Solar reflectance and thermal emittance or SRI, see spreadsheet calculator at www.energy.ca.gov/title24/ Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 Ib/ft2 are exempt from the Cool Roof criteria below.D n High-rise residential buildings and hotels and motels with low-sloped roofs in Climate Zones 1 through 9,12 and 16 are exempted from the low-sloped roofing criteria.D D 1. If Fail then describe on this page of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. CRRC Product ID Number1 Roof Slope Z 2:12 >2:12 n n n n D n n n n n D n Product Weight < Slb/ft2 > 5lb/ft2 n n n n n n n n n D n n Product Type2 Aged Solar Reflectance3 D4 a4 a4 n4 a4 n4 Thermal Emmitance SRI5 Pass D n n n n n Fail6 n n n n n n 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.org/products/search.php 2. Indicate the type of product is being used for the roof top, i.e. single-ply roof, asphalt roof, metal roof, etc. 3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(pinitiai - 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance from the Cool Roof Rating Council's Rated Product Directory. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. The SRI value needs to be calculated from a spreadsheet calculator at http://www.enerav.ca.gov/title24/ 6. If Fail then describe on this page of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating: D Aluminum-Pigmented Asphalt Roof Coating D Cement-Based Roof Coating D Other Discrepancies: EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07T15:44:06 ID: ORIG 5-7-11 Page 7 of 17 CERTIFICATE OF COMPLIANCE (Part 3 of 3) ENV-1C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date BODYROK 5/7/2011 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for Envelope Fenestrations system. The designer is required to check the acceptance tests and list all the fenestration products that require an acceptance test. If all the site-built fenestration of a certain type requires a test, list the different fenestration products and the number of systems. The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or whenever new fenestration is installed in the building or space shall be certified as meeting the Acceptance Requirements. The ENV-2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition, a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) of Title 24 Part 6. The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the ENV-2A for each different fenestration product line must be provided to the owner of the building for their records. Test Description Fenestration Products Name or ID Requiring Testing or Verification Area of like Products ENV-2A Building Envelope Acceptance Test D D D D D D D D D D D D D D D D D D D D D n D n D n Test Performed By: EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07715:44:06 ID: ORIG 5-7-11 Page 8 of 17 CERTIFICATE OF COMPLIANCE and (Part 1 of 4) MECH-1 C FIELD INSPECTION ENERGY CHECKLIST Project Name Date BODYROK 5/7/2011 Project Address Climate Zone Total Cond. Floor Area Addition Floor Area 1 905 CALLE BARCELONA CARLSBAD 7 1,560 n/a GENERAL INFORMATION Building Type: H Nonresidential D High-Rise Residential D Hotel/Motel Guest Room D Schools (Public School) D Relocatable Public School Bldg. 0 Conditioned Spaces D Unc°nd'tloned Spaces(aTTidavitj Phase of Construction: D New Construction D Addition D Alteration Approach of Compliance: D Component D Overall Envelope TDV n Uncondjtionec| (fi|e affidavit) Front Orientation: N, E, S, W or in Degrees: o deg HVAC SYSTEM DETAILS Equipment2 Item or System Tags (i.e. AC-1,RTU-1,HP-1) Equipment Type3: Number of Systems Max Allowed Heating Capacity1 Minimum Heating Efficiency1 Max Allowed Cooling Capacity1 Cooling Efficiency1 Duct Location/ R-Value When duct testing is required, submit MECH-4A & MECH-4-HERS Economizer Thermostat Fan Control Equipment2 Item or System Tags (i.e. AC-1,RTU-1,HP-1) Equipment Type3: Number of Systems Max Allowed Heating Capacity1 Minimum Heating Efficiency1 Max Allowed Coolinq Capacity1 Cooling Efficiency1 Duct Location/ R-Value When duct testing is required, submit MECH-4A & MECH-4-HERS Economizer Thermostat Fan Control Inspection Criteria 5 TON 3 Phase HVAC Packaged DX 1 59,300 Btu/hr 7.60 HSPF 57,000 Btu/hr 10.1 SEER/ 13.3 EER Conditioned/ 6.0 No No Economizer Setback Required Constant Volume Inspection Criteria FIELD INSPECTION ENERGY CHECKLIST Meets Criteria or Requirements Pass D n n n n n n n n n n n Fail - Describe Reason2 n n D n n n n n n n n n FIELD INSPECTION ENERGY CHECKLIST Pass D n n n n n n n n n n n Fail - Describe Reason2 n D D n n n n D n n n n 1 . If the Actual installed equipment performance efficiency and capacity is less than the Proposed (from the energy compliance submittal or from the building plans) the responsible party shall resubmit energy compliance to include the new changes. 2. For additional detailed discrepancy use Page 2 of the Inspection Checklist Form. Compliance fails if a Fail box is checked. 3. Indicate Equipment Type: Gas (Pkg or, Split), VAV, HP (Pkg or split), Hydronic, PTAC, or other. EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07715:44:06 ID: ORIG 5-7-1 1 Page 9 of 17 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 2 of 4) MECH-1C Project Name BODYROK Date 5/7/2011 Discrepancies: EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07T15:44:06 ID: PRIG 5-7-11 Page 10 of 17 AIR SYSTEM REQUIREMENTS (Part 1 of 2) MECH-2C Project Name Date BODYROK 5/7/2011 Item or System Tags (i.e. AC-1,RTU-1,HP-1) Number of Systems MANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value PRESCRIPTIVE MEASURES Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating1 Air Cooled Chiller Limitation Duct Leakage Sealing. If Yes, a MECH-4-A must be submitted 1 . Total installed capacity (MBtu/hr explain which exception(s) to §1 4< Indicate Air Systems Type (Central, Single Zone, Package, VAV, or etc...) '","'•5 TON 3 Phase HVAC 1 Indicate Page Reference on Plans or Schedule and indicate the applicable exception(s) T-24 Sections 112(a) 112(a) 112(b), 112(c) 112(c), 11 5(a) 121(b) 121(b) 121(o) 121(c) 122(e) 122(e) 122(f) 122(g) 123 124 7.60 HSPF 10.1 SEER /1 3.3 EER Yes n/a Yes 390 cfm No No Programmable Switch Setback Required Auto n/a Conditioned / 6.0 144(a&b) 144(a&b) 144(a&b) 144(a&b) 144(c) 144(c) 144(c) 144(d) 144(e) 144(f) 144(f) 144(g) 144(i) 144(k) n/a 45,364 Btu/hr n/a 47,725 Btu/hr Constant Volume Yes No No Economizer Constant Temp Constant Temp No Df all electric heat on this project exclusive of electric auxiliary heat for heat pumps. If electric heat is used *(g) apply. EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07T1 5:44:06 ID: ORIG 5-7-11 Page 11 of 17 O CO± LU H LU X LUtr, < zoij Fz LU O •^| MECHAIx-~\^ 3'a Project NameBODYROK*G yz o t j LU UJ CC S n VENTILATIHANICALO UJS 3 Z E CO 8m AONVdflCO 0 !EA BASIS< Z = - * - - X C5 LL UJ Q 0 CO TransferAirli^f^ c oIS CO Max. ofColumnsH, J, K,300 CFMo --50% ofDesign ZoneSupplyCFMc § P .'SCD3 < x £ 2 'H1 fO LL ° J31 §"X ^ O O °- Q) Q) ,0) Z £ 2 CO LL CD O ^ CD ^ QJ tX- CO 8*& Ico1 o 1 o0) CO o0)CO o0> K 0si co-CM o I 1 BodyRok Fitneso 0) o0> m (2 o || 5 TON 3 Phaseco's Design VentColumn 1 Totaltoro "o cvi _o) c\i o otDCO CDa 1 o Minimum ventilato enc td 0)to -°s without fixerposes for spacefor egress pucupant loacof the CBC ocs and 50%§a §o•n jcted numberS0) 0).c B sat or the greaterBased on fixed seLU O o Q BASIS (ColumnOCCUPANCY^ BASIS orLU 5 cM CO •o es calculatentilation ratarger of the ve'.A.) is the 1on Air (REQ'D \"c(D 73CD '5CT0)or X difference.ake up thet 0 Z c E insfer Air (coll1, or use Tro "3 1o §Must be greater t-per §121.airflow ratene outdoorthe design zoo oID X «£LLO 1 LL O 15a tn c .£? - o 2)x0.4CFM/ft2Condition area (ft^ LL0 O8 o ^f -3 x" tnc Maximum of Colu- ton Q.of Columns Hto the sumto 1o cCO t5 fo 2O) T3C _l C E •§O "a | o I This must be less- ocra be greater thsfer air mustc: T3"0) 5cr0) 1 ~ c 2'E mum Air (Colmn M), ColumDesign Minm Air (Colusater than theDesign MinimuO) Q)w .cflFID -1- "5 P£§ |g uired VentilatiVentilation Asre the Recne Requirecbe provided wh(ence between tCTransfer Air mustsqual to the differ^e 12 of 17 |Q_ uS <3 Q | 10 e: 201 1 -05-01cS I 0> COoCO tEja User Numby Energy-Soft1 EnergyPro 5. 1 | MECHANICAL EQUIPMENT DETAILS (Part 1 of 2) MECH-5C |Date I5/7/2011Project NameBODYROK| CHILLER AND TOWER SUMMARY IPUMPS |0.0 II Q. CQ (5 5 <fl &Efficiency* 0)Q. 0) Co> Q '5CTUJ | DHW / BOILER SUMMARY10 1 Tank Ext.R-ValueStandby Lossor PilotEnergy Factoror RE_: "of °~a £Rated Input5 Distribution1 01 !(/>| MULTI-FAMILY CENTRAL WATER HEATING DETAILS IHot Water Piping Length (ft) I| Hot Water PumpAdd Vz" Insulation |1 CO Outside |In PlenumI Q. 5 | ControlD D D | CENTRAL SYSTEM RATINGS ICOOLINGHEATING(/> 155 EfficiencyI o Efficiency1 X I IO 5 Q> £ 0) n 1 O)c«3 10. 1 SEER/ 13.3 EERo §rC^0 7.60 HSPFoo oon 01T>Packaged DX\ CARRIER 48TMD006 3 phase\ CENTRAL SYSTEM FAN SUMMARY IRETURN FAN |SUPPLY FANQ. 00 u.o Q.Xm u.u | Economizer TypeFan Type1 System Name0)coc cr>to 0 CM"1 No EconomizerConstant Volume| CARRIER 48TMD006 3 phaseN. "on Q> ? ^~ 1^. J> O KO Q <oo ? >o Cs.oj § 13 K s8 o3« 1 fc t 1 5 ^, -Q T—>o1 of iS I MECHANICAL EQUIPMENT DETAILS (Part 2 of 2) MECH-5C |Date 15/7/2011IProject NameBODYROK| ZONE SYSTEM SUMMARY IOutsideAirJOJOIAI W03 sajoAo UBJ £ |SYSTEMQ. m Eo Reheat CoilMin CFMRatio2 §o D)£ to0 I 1 0) a I(/) 0) oc rS a a a a a a a a a a a a a a a a a a D a a a a a n a a a a a a a a a n a n a n a I EXHAUST FAN SUMMARY IEXHAUST FAN |EXHAUST FAN| EXHAUST FANa. ea o 6 Room NameQ. 00 Eo 1 <1> n oocc Q. m Io 5 Room Name8o o00 0 1 10 ^_l <N1w s. "6•**~ 0>o c? V-T- 1^. uS CD § Q § 5« £ j S ^8 I 0)00o001 5 II1 iSX-Q T) I5 (D .5 Project Name BODYROK Date 5/7/2011 ENVELOPE MANDATORY MEASURES: NONRESIDENTIAL ENV-MM DESCRIPTION Building Envelope Measures: §118(a):Installed insulating material shall have been certified by the manufacturer to comply with the California Quality Standards for insulating material, Title 20 Chapter 4, Article 3. §118(c):All Insulating Materials shall be installed in compliance with the flame spread rating and smoke density requirements of Sections 2602 and 707 of Title 24, Part 2. §118(f):The opaque portions of framed demising walls in nonresidential buildings shall have insulation with an installed R-value of no less than R-13 between framing members. §117(a):All Exterior Joints and openings in the building that are observable sources of air leakage shall be caulked, gasketed, weatherstripped or otherwise sealed. Manufactured fenestration products and exterior doors shall have air infiltration rates not exceeding 0.3 cfm/ft.2 of §116(a) 1: window area, 0.3 cfm/ft.2 of door area for residential doors, 0.3 cfm/ft.2 of door area for nonresidential single doors (swinging and sliding), and 1.0 cfm/ft.2 for nonresidential double doors (swinging). §116(a) 2: Fenestration U-factor shall be rated in accordance with NFRC 100, or the applicable default U-factor. Fenestration SHGC shall be rated in accordance with NFRC 200, or NFRC 100 for site-built fenestration, or the defau|t SHGC. S11 RlbY ^e Constructed Doors, Windows and Skylights shall be caulked between the unit and the building, and shall be ^ ^ '' weatherstripped (except for unframed glass doors and fire doors). EneravPro 5.1 by EnerqySoft User Number: 3089 RunCode: 2011-05-07715:44:06 ID: PRIG 5-7-11 Page 15 of 17 Project Name , BODYROK Date 5/7/2011 MECHANICAL MANDATORY MEASURES: NONRESIDENTIAL MECH-MM Equipment and System Efficiencies §111:Any appliance for which there is a California standard established in the Appliance Efficiency Regulations will comply with the applicable standard. §115(a): Fan type central furnaces shall not have a pilot light. §123:Piping, except that conveying fluids at temperatures between 60 and 105 degrees Fahrenheit, or within HVAC equipment, shall be insulated in accordance with Standards Section 123. §124:Air handling duct systems shall be installed and insulated in compliance with Sections 601, 602, 603, 604, and 605 of the CMC Standards. Controls §122(e): Each space conditioning system shall be installed with one of the following: 1 A. Each space conditioning system serving building types such as offices and manufacturing facilities (and all others not explicitly exempt from the requirements of Section 112 (d)) shall be installed with an automatic time switch with an accessible manual override that allows operation of the system during off-hours for up to 4 hours. The time switch shall be capable of programming different schedules for weekdays and weekends and have program backup capabilities that prevent the loss of the device's program and time setting for at least 10 hours if power is interrupted; or 1B. An occupancy sensor to control the operating period of the system; or 1C. A 4-hour timer that can be manually operated to control the operating period of the system. 2.Each space conditioning system shall be installed with controls that temporarily restart and temporarily operate the system as required to maintain a setback heating and/or a setup cooling thermostat setpoint. §122(g): Each space conditioning system serving multiple zones with a combined conditioned floor area more than 25,000 square feet shall be provided with isolation zones. Each zone: shall not exceed 25,000 square feet; shall be provided with isolation devices, such as valves or dampers that allow the supply of heating or cooling to be setback or shut off independently of other isolation areas; and shall be controlled by a time control device as described above. §122(c):Thermostats shall have numeric setpoints in degrees Fahrenheit (F) and adjustable setpoint stops accessible only to authorized personnel. §122(b):Heat pumps shall be installed with controls to prevent electric resistance supplementary heater operation when the heating load can be met by the heat pump alone Each space conditioning system shall be controlled by an individual thermostat that responds to temperature within the zone. Where used to control heating, the control shall be adjustable down to 55 degrees F or lower. For cooling, the §122(a&b): control shall be adjustable up to 85 degrees F or higher. Where used for both heating and cooling, the control shall be capable of providing a deadband of at least 5 degrees F within which the supply of heating and cooling is shut off or reduced to a minimum. Ventilation §121(e):Controls shall be provided to allow outside air dampers or devices to be operated at the ventilation rates as specified on these plans. §122(f):All gravity ventilating systems shall be provided with automatic or readily accessible manually operated dampers in all openings to the outside, except for combustion air openings. Ventilation System Acceptance. Before an occupancy permit is granted for a newly constructed building or space, or a §121(f): new ventilating system serving a building or space is operated for normal use, all ventilation systems serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance Service Water Heating Systems §113(c)Installation 3. Temperature controls for public lavatories. The controls shall limit the outlet Temperature to 110 ° F. 2 Circulating service water-heating systems shall have a control capable of automatically turning off the circulating pump when hot water is not required. EnergyPro 5.1 bvEnergySott User Number: 3089 RunCode: 2011-05-07715:44:06 ID: ORIG 5-7-11 Page 16 of 17 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name BODYROK Date 5/7/2011 System Name 5 TON 3 Phase HVAC Floor Area 1,560 ENGINEERING CHECKS SYSTEM LOAD Number of Systems Heating System Output per System Total Output (Btuh) Output (Btuh/sqft) 59,300 59,300 38.0 Cooling System Output per System Total Output (Btuh) Total Output (Tons) Total Output (Btuh/sqft) Total Output (sqft/Ton) 57,000 57,000 4.8 36.5 328.4 Total Room Loads Return Vented Lighting Return Air Ducts Return Fan Ventilation Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COIL COOLING PEAK CFM 1,619 390 Sensible 33,143 1,657 3,462 1,657 Latent 13,000 COIL HTG. PEAK CFM 1,645 2,785 39,919 15,785 390 Sensible 23,144 1,157 14,913 1,157 40,371 Air System CFM per System 2,000 HVAC EQUIPMENT SELECTION Airflow (cfm)2,000 CARRIER 48TMD006 3 phase Airflow (cfm/sqft)1.28 Airflow (cfm/Ton)421.1 Outside Air (%)19.5 % Outside Air (cfm/sqft)0.25 Note: values above given at ARI conditions Total Adjusted System Output (Adjusted for Peak Design conditions) TIME OF SYSTEM PEAK 47,725 47,725 9,710 9,710 Jul 3 PM 45,364 45,364 Jan 1 AM HEATING SYSTEM PSYCHROMETRICS (Airstream Temperatures at Time of Heating Peak) 34 °F 63 °F 63 °F 84 °F -»—(ih Outside Air 390 cfm 69 °F Supply Fan Heating Coil 2,000 cfm 83 °F 70 °F COOLING SYSTEM PSYCHROMETICS (Airstream Temperatures at Time of Cooling Peak) 83/68°F 76 / 64 °F 76 / 64 °F 54 / 53 °F Outside Air 390 cfm 75 / 63 °F Supply Fan 2,000 cfm Cooling Coil 55 / 53 °F 53.6 %ROOM 74 / 63 °F EnergyPro 5.1 by EnergySoft User Number: 3089 RunCode: 2011-05-07715:44:06 ID: PRIG 5-7-11 Page 17 of 17 N ^Norm Thomas:i \\f*\ \r \\ v^\ \A ft x 3" a1a! 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P 000 in <S ^ jSo o o -1 H H H0) 0) 0)CT CT CT CD CD CD J>. *. ^. | SJ.o«t / 1 ^"8—i T3 Q)Exhaust71 Q)ro it ^ ^Tl 33 im NJ _v Q) CT CD O> i. 3 d CMC Table 4-4 x SFASHRAE minimiB 'i to' o §* o OTl 3- Q) r-«-(Minimui3 Exhaust R0)r» (D (ft •D(D Sj. c? 3 0) 0)3 to OoQ.(D CO1o CJ °l || cfU BODYROIire Footage5' IT to ® S o O {0 rzzz ' ' (D COQJ o 6" COc _, ^1 Carlsbad60 square feel•^ c? a ¥ ?. H X mZOHI EERING TEN^MFT!o 1 S VD U1h* Ot VO 2w ^m p- — i Oz mOc rn mz CO COzoo3o H CD" NJ •a Bl3. u a. O H CD" •oto m — SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE / / Business Name Business Contact Telephone # Project Address'City te ip Code Mailing Address State Oft Plan File# Project Contact 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 submitted. Facility's Square Footage (including proposed project): Occupancy Rating: 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials /^S^None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD): If questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Ave., Suite 110, San Diec Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED. Project Completion Date: / / Expected Date of Occupancy: / / 1 . D ,0- Is your business listed on the reverse side of this form? (check all that apply). 2. D J2- Will your business dispose of Hazardous Substances or Medical Waste in any amount? 3. D £3. 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? 4. D $5- Will your business use an existing or install an underground storage tank? 5. D IS- Will your business store or handle Regulated Substances (CalARP)? 6 I I y^~ Will your business use or install a Hazardous Waste Tank System (Title 22 Article 10)^ 7. D M Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to or greater than 1 ,320 gallons? (California's Aboveground Petroleum Storage Act). the answer to any of the o, CA 92123. D CalARP Exempt / Date Initials D CalARP Required / Date Initials D CalARP Complete / Date Initials PART III: SAN DIEGO COUNTY AIR P'OLLU OldGi TION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit. Note: if the answer to questions 4 or 5 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information. YES NO 1 • D 2. D D 3. 4. 5. D D D Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at httD://www.sdapcd.orci/info/facts/permits.pdf. and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)? (Search the California School Directory at http://www.cde.ca.qov/re/sd/ for public and private schools or contact the appropriate school district). Has a survey been performed to determine the presence of Asbestos Containing Materials? J3-. Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities:Briefly describe proposed project: Idecl laity t to the best of my knowledge and belief Name of Owner or Authorized Agent made her^iOjareJaie and correct.i // ror Date FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. BY: FOR OFFICIAL USE ONLY: DATE: EXEMPT OR NO FURTHER INFORMATION REQUIRED COUNTY-HMD*APCD RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY COUNTY-HMD APCD RELEASED FOR OCCUPANCY COUNTY-HMD APCD *A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply. HM-9171 (02/11) County of San Diego-DEH-Hazardous Materials Division INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Business Name_ Street Address_ Email Address PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) Check all below that are present at your facility: Acid Cleaning Assembly Automotive Repair Battery Manufacturing Biofuel Manufacturing Biotech Laboratory Bulk Chemical Storage Car Wash Chemical Manufacturing Chemical Purification Dry Cleaning Electrical Component Manufacturing Fertilizer Manufacturing Film /X-ray Processing Food Processing Glass Manufacturing Industrial Laundry Ink Manufacturing Laboratory Machining / Milling Manufacturing Membrane Manufacturing (i.e. water filter membranes) Metal Casting / Forming Metal Fabrication Metal Finishing Electroplating Electroless plating Anodizing Coating (i.e. phosphating) Chemical Etching / Milling Printed Circuit Board Manufacturing Metal Powders Forming Nutritional Supplement/ Vitamin Manufacturing Painting / Finishing Paint Manufacturing Personal Care Products Manufacturing Pesticide Manufacturing / Packaging Pharmaceutical Manufacturing (including precursors) Porcelain Enameling Power Generation Print Shop Research and Development Rubber Manufacturing Semiconductor Manufacturing Soap / Detergent Manufacturing Waste Treatment / Storage SIC Code(s) (if known): Brief description of business activities (Production / Manufacturing Operations):, Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal / day): List hazardous wastes generated (type/volume): r Date operation began/or will begin at this location: Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes No If yes, when: Site Cont;Title Signature^ ENCINA WAfeTEWATER AVfJ-JORI Phone No. 6200 Avenida Encinas Carlsbad, CA 92011 (760)438-3941 FAX: (760)476-9852 CITY OF CARLSBAD PLUMBING, ELECTRICAL, MECHANICAL WORKSHEET B-18 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov Project Address: Permit No.: Information provided below refers to work being done on the above mentioned permit only. This form must be completed and returned to the Building Division before the permit can be issued. Building Dept. Fax: (76O) 6O2-8558 Number of new or relocated fixtures, traps, or floor drains New building sewer line? ......................................................................................... Ves _ No \s Number of new roof drains? Install/alter water line? ............................ , Number of new water heaters? Number of new, relocated or replaced gas outlets? Number of new hose bibs? ............................................................................................................... Upgrade existing panel? Ves No From Amps to Amps Number of new panels or subpanels? Single Phase Number of new amperes Three Phase Number of new amperes Three Phase 48O Number of new amperes Remodel (relocate existing outlets/switches or add outlets/switches)? . VVes No Number of new furnaces, A/C, or heat pumps? New or relocated duct work? Ves >X Number of new fireplaces? Number of new exhaust fans? Relocate/installment? Number of new exhaust hoods? No -0- Number of new boilers or compressors? Number of HP •£/ B-18 Page 1 of 1 Rev. 03/09 i a n> O n> •«=- \ O n> ^v (j^ ^•v ft£<<o ?V, 1 , 1n> fc ? * •ts,& *» \\f ID I fc. \ s I •n % -T** 1 — — .Engineering1 1 CD g (D X . t ^ ft § ^ S 1 a5 1 -< ^. V f y TS QJ 5 R Ig 5» § -< ?1 < z 1X11 ^) ? ^ •< z p 1 -< z 1^? 5 s 1 J -< z i PE&M!P •A)2_ -< z \HazHealthAPCD( i ^W^ c- •< 2 ^•\r 3 n> •< z S m3g-El] ^ X < Z Forms/FeesU11 i?d P 5, , I § ZOl ^ ! IV\ 3 S -*j -< *»— Z 1 ~x ^ENGINEERING) !s. "Xj M y\ V PLANNINGLl 1 •X ^'BUILDING— . X ^ ^t ApprovedL ii» \a 5 D 2 10 a vn ia