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Home My WebLink About1905 Calle Barcelona; 211; CBC2017-0324; PermitPrint Date: 10/05/2017 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 1905 Calle Barcelona, 211 BLDG-Commercial 2550120400 $100,121.84 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial Permit www.carlsbadca.gov Work Class: Tenant Improvement Lot#: Reference#: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Description: PERLMAN CLINIC: 1,547 SF GYM TO MEDICAL OFFICE Applicant: Owner: JESUS GOMEZ T-C FORUM AT CARLSBAD LLC 619-299-0011 4675 Macarthur Ct Tiaa-Cref, 110 NEWPORT BEACH, CA 92660 BUILDING PERMIT FEE $2000+ BUILDING PLAN CHECK FEE (BLDG) ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL PLUMBING BLDG COMMERCIAL NEW/ADDITION/REMODEL SB1473 BUILDING STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $1,245.00 Total Payments To Date: $1,245.00 Status: Applied: Issued: Finaled: Inspector: Balance Due: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." 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 Citv 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 you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Permit No: CBC2017-0324 Closed -Finaled 06/14/2017 07/25/2017 PB urn $0.00 $629.55 $352.42 $89.00 $55.00 $86.00 $5.00 $28.03 ITHE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0PLANNING [:)ENGINEERING 0BUILDING OFIRE OHEALTH 0HAZMAT/APCD (_ Cicyof Building Permit Application Plan Check No.~z.Dl,-Qoi-L\ 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value 1\ ,C\':)f) Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 . . email: building@carlsbadca.gov Plan Ck. Deposit www.carlsbadca.gov Date l O -\\...\-rl ISWPPP JOB ADDRESS 1905 Calle Barcelona, Carlsbad, CA 92009 SUITE#/SPACE#/UNIT# rPN 255 211 -012 -04 - Cf/PROJECT# ILOT# I PHASE# I# OF UNITS I# BEDROOMS # BATHROOMS I TENANT BUSINESS NAME I CONSTR. TYPE I occ. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Ar,ea(s) the built out o'f new tenant improvements medical office to medical office 1, S-'"{1 t7f" EXISTING USE I PROPOSED use I GARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS {1 "-'\f\\ B YESO No[ZJ vES[Z]NoD YES[Z]NoO APPLICAIU NAME jesus gomez PROPERTY OWNER NAME Norma Salazar Primary Contact ADDRESS ADDRESS 3900 5th Ave suite290 3900 5th Ave suite 300 CITY STATE ZIP CITY STATE ZIP san dieao ca 92103 san dieao ca 92103 PHONE I FAX PHONE [FAX 619-299-0011 X 204 619-299-5544 858.220.2920 EMAIL EMAIL jesus@dpdesignin,c.com norma@monrocapital.com DESIGN PROFESSIONAL jesus !Qomez CONTRACTOR BUS. NAME /J.,:2...,J,·,,.-... J A,(}..,,.,_.:..--s (o..._s}.1..,,,:\-Y,,--J~ ADDRESS ADDRESS 7'6L\ ~ C(},,AVCY ~, 3900 5th Ave suite 290 CITY STATE ZIP CITY STATE CA-ZIP q2 i1\ san dieao ca 92103 s.---. D;~~ PHONE [FAX PHONE I./ [FAX 1'5"'D :2_(ti 1/t'b "?:>} 619-299-0011 X 204 619-299-5544 EMAIL EMAIL (,av·le,s \/ e})c~J'.-5 qc)d'-___....,; jesus@dpdesigninc.com C o ,,_.,_ I STATE UC.# STATE UC.# 57 (p5' (!,) _e;-I CLASS I CITY BUS. UC.# (3 l?._e>G,O 2~ (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 mat he is licensed pursuantto the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500)). Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1#11 have and will maintain workers' compens~tion, as req~ired by Sectj_on_ 37~0. of the La~ Cod~~or the _performance of the work for whfh thi: permit is issued. My wo~er~· compensation i sur nee carrier and policy number are: Insurance Co. ::,±,,, +? C,a,.,,,-~ ft, A'S,&; .\,J'-"-v J.JJ,; /< .. ,,"' u Policy No. q O q Y. S 4-, S Z C.., I 'l Expiration Date l/ ?... ClJ l ~ This section need not be completed if the permit is for one hundred dollars ($100) or less. 0 Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, dam,5s a} prov· for in Section 3706 of the Labor code, interest and attorney's fees. . l 25 CONTRACTOR SIGNATURE ~ e"°~ 0AGENT 7 Z-< ,ZC> \I I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: D D D I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0Yes 0No 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address I phone I contractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supeivise and provide the major work (include name I address I phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone I type of work): 25 PROPERTY OWNER SIGNATURE 0AGENT DATE 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? Yes No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Yes No Is the facility to be constructed within 1,000 feet of the outer boundary o'f a school site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the above informalDon is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws rela!Dngto building construction. 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 AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days rrom the date of such permit or if the b -ork authorized by such permit is suspended or abandoned at anytime after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). ~;\ .R:!APPLICANT'SSIGNATURE ': =----=--~ DATE bC I STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (Listed above) CONTRACTOR (On Pg. 1) OCCUPANT (Listed above) MAIL/ FAX TO OTHER: _________________ _ JiS APPLICANT'S SIGNATURE ASSOCIATED CB#------------ NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION DATE ZIP Tenant Improvement 07/25/2017 CARLSBAD TCT#92-08 GREEN VALLEY Closed -Finaled 02/19/2018 1905 Calle Barcelona , 211 Carlsbad, CA 92009-8452 4359 Scheduled Actual Inspection Type Date Start Date Inspection No. Inspection Status Primary Inspector Reinspection Complete 07/27/2017 07/27/2017 BLDG-21 1)29876-2017 Passed Paul Burnette Complete Underground/Underf loor Plumbing Passed BLDG-Building Deficiency Yes BLDG-84 Rough 1029877-2017 Passed Paul Burnette Complete Combo(14,24,34,44) COMMENTS Passed BLDG-Building Deficiency Yes BLDG-14 Yes Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout Yes BLDG-34 Rough Electrical Yes BLDG-44 Yes Rough-Ducts-Dampers 08/02/2017 08/02/2017 BLDG-17 Interior 030344-2017 Passed Paul Burnette Complete Lath/Drywall Passed BLDG-Building Deficiency Yes 08/22/2017 08/22/2017 BLDG-85 T-Bar, 032353-2017 Passed Paul Burnette Complete Ceiling Grids, Overhead Pflssed BLDG-Building Deficiency Yes BLDG-14 Yes Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout Yes BLDG-34 Rough Electrical Yes BLDG-44 Yes Rough-Ducts-Dampers 10/05/2017 10/05/2017 BLDG-Final 036859-2017 Passed Paul Burnette Complete Inspection Passed BLDG-Building Deficiency Yes BLDG-Plumbing Final Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes October 05, 2017 Page 1 of 1 City of Carlsbad CBC2017-0324 7/20/17 EsGil Corporation In (!'artnersliip witli (Jovernment for (}3ui{aing Safety DATE: 7/20/17 JURISDICTION: City of Carlsbad PLAN CHECK NO.: CBC2017-0324 SET: II PROJECT ADDRESS: 1905 Calle Barcelona Suite 211 PROJECT NAME: Perlman Clinic -TI D APPLICANT }iI. JURIS. / D PLAN REVIEWER D FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. cg] The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: cg] EsGil Corporation staff did not advise the applicant that the plan check has been completed. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: (;~ DO Tel~one #: Date contacted: >'-· (b~ Email: Mail Telephone Fax In Person [',<'] REMARKS: Applicant to sl~ets at the city. By: Morteza Beheshti Enclosures: EsGil Corporation D GA D EJ D MB D PC 7/14 EsGil Corporation 1n (l'artnersnip witn (]overnment for c.Bui{tfin9 Safety DATE: 6/26/17 PLICANT RIS. JURISDICTION: City of Carlsbad PLAN CHECK NO.: CBC201"/-0324 SET: I AN REVIEWER D FILE PROJECT ADDRESS: 1905 Calle Barcelona Suite 211 PROJECT NAME: Perlman Clinic -TI D D D D D D 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 se~t 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: Jesus G~/j Telephone#: 619-299-0011 Ext 204 Date contacted: ~-'2-,~ (b~ ) Email: jesus@dpdesigninc.com Jl.!Ylail X Telephoi ~ Fax In Person REMARKS: By: Doug Moody EsGil Corporation D GA D EJ D MEI D PC Enclosures: 6/15/17 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 City of Carlsbad CBC201 7-0324 6/26/17 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: CBC2017-0324 OCCUPANCY: B TYPE OF CONSTRUCTIOIN: VB ALLOWABLE FLOOR AREA: SPRINKLERS?: YES REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 6/14/17 DATE INITIAL PLAN REVIIEW COMPLETED: 6/26/ 17 FOREWORD (PLEASE READ): JURISDICTION: City of Carlsbad USE: Medical Office ACTUALAREA: 1547~ STORIES: 2 HEIGHT: OCCUPANT LOAD: 29 DATE PLANS RECEIVED BY ESGIL CORPORATION: 6/15/17 PLAN REVIEWER: Doug Moody This plan review is limited to the technical requirements contained in the California version of 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 2016 CBC, which adopts the 2015 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 2015 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 beeni 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 CBC201 7-0324 6/26/17 Please make alll 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 two corrected sets 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 Lobby hard-lid ceiling. Show: a) Type, size and spacing of studs. Indicate gauge for metal studs. Specify manufacturer and approval number or indicate "to be ICC approved". b) Method of attaching top to the structure and lateral bracing. c) Show height of the hard-lid ceiling from floor, hard-lid ceiling to roof framing or floor framing. 2. Glazing in the following locations should be of safety glazing material in accordance with Section 2406.3 at the new storefront. d) Fixed and sliding panels of sliding door assemblies and panels in swinging doors other than wardrobe doors. e) Fixed or operable panels adjacent to a door where the nearest exposed edge of the glazing is within a 24-inch arc of either vertical edge of the door in a closed position. And where the bottom exposed edge of the glazing is less than 60 inches above the walking surface. 3. Please note on the plans "All patient care receptacles and fixed equipment shall comply with Section 517.13(A) and 517.13 (8). All patient care receptacles and fixed equipment be grounded by an insulated copper conductor sized per Table 250-122. In addition the circuits serving patient care receptacles and fixed equipment shall be installed in a metal raceway or cable that qualifies as an equipment grounding return path in accordance with section 250-118. 4. Specify on the plans: Water conserving fixtures: New water closets shall use no more than 1.28: gallons of water per flush, lavatories and kitchen faucets may not exceed 2.2 GPM, and showers may not exceed 2.5 GPM of flow. CPC Section 402.0. 5. Hot water supplied to a public use lavatory is limited to a maximum temperature potential of 120 degrees by a device that conforms to ASSE 1070 or CSA City of Carlsbad CBC201 7-0324 6/26/17 8125.3; please provide the manufacturer's listing showing compliance. Detail how this temperature limitation is achieved. The water heater thermostat may not be used for compliance with this Code section. UPC 413.1 & UPC 414. 6. Please clarify tlhe plans to show the minimum clearance from the restroom exhaust fan discharge to the adjacent door opening minimum 3'. Advisory Note : When alterations, structural repairs or additions are made to an existing buildinu, that building, or portion of the building affected, is required to comply with all of the following requirements, per Section 11 B-202.4: • The area of specific alteration, repair or addition must comply as "new" construction. • A primary entrance to the building and the primary path of travel to the altered are,~ must be shown to comply with all accessibility features. • The path of travel shall include the existing parking. • Existing toilet and bathing facilities that serve the remodeled area must be shown to comply with all accessibility features. • Please address the following comments that are the result of the alterations. 7. Please clarify the accessible path of travel to the entrance to the tenant space and show the elevator that serves the 2nd floor. 8. Show or note that all hand-activated door opening hardware meets the following requirements, per Section 11 B-404.2.7: a) Latching, or locking, doors in a path of travel are operated with a single effort by lever type hardware, by panic bars, push-pull activating bars, or other hardware designed to provide passage without requiring the ability to grasp the opening hardware. b) Is to be centered ~34" but :544" above floor. 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 D No D City of Carlsbad CBC2017-0324 6/26/17 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 CBC201 7-0324 6/26/17 [DO NOT PAY -THIS JS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PLAN CHECK NO.: CBC2017-0324 PREPARED BY: Doug Mot0dy DATE: 6/26/17 BUILDING ADDRESS: 1905 Calle Barcelona Suite 211 BUILDING OCCUPANCY: B BUILDING AREAJ Valuation PORTION ( Sq. Ft.) Multiplier Tl 1547 64.72 Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance Bldg. Permit Fee by Ordinance Plan Check Fee by Ordinance Type of Review: 0 Complete Review D Repetitive Fee -~ Repeats ~:~ Comments: D Other 0 Hourly EsGil Fee Reg. VALUE Mod. D Structural Only i-------11 Hr. @ • ($) 100,122 100,122 $629.61 I $409.25! $352.581 Sheet 1 of 1 macvalue.doc + Electrical Efficacy Consulting, Inc. IENERGYICONSULTINGIDESIGNICOMPLIANCEI CALCTP ACCEPTANCE-CERTIFICATION FOR DR. PERLMAN CLINIC 1905 Calle Barcelona Suite 211 CARLSBAD, CA 92009 PREPARED 09/05/2017 PROJECT: 170100 ELECTRICAL EFFICACY CONSULTING, INC. 13100 .KIRKHAM WAY, SUITE 205, POWAY, CA 92064-7128 858/748-2060 858/748-6012-FAX CI.SB 1002594 AIT CERTIFICATION# ATE-0112 Electrical Efficacy Consulting, Inc. I ENERGY I CONSUVI~ING I DESIGN I COMPLIANCE I CALCTP ACCEPTANCE CERTIFICATION CORRECfION/DEFECIENTCIES/NOTES PERMIT NUMBER: #\CBC2017-0324 ENFORCEMENTAGENCY: CITY OF CARLSBAD SYSTEM.A AT CERTIFICl.\TF #TC-A8'i3666 Electrical Efficacy Consulting, INC. 13100KIRKHAMWAY,SUITE205,POWAY,CA 92064-7128 858/7 48-2060 858/7 48-6012-FAX CI.SB, 1002594 ATICERTIFICATION#TC..A813666 I SAN DIEGC> REGIONAL HAZARDOUlS MATERIALS QUESTIONNAIRE 111rc.c. lt1111! J" -« A cl .c. C . ""' .,r1 State &'J'I State OFFICE USE ONLY Telephone# 8 S"8 lo/. I a.. Zip Code APN# 'r1. () Zip Code Plan File# Telephone# Data lnlllal1 0 CalARP Required I Date lnltlals D catARP Complete I Date Initials PART IU: SAN DIEGO COU AIR POLLUTION CONTROL DISTRICT APCD : The following questions are intended to Identify the majority of air pollution asues a nn ng a ge. our pro e may requ re a ona measures no enllfied by these questions. Some residential projects may be exempt from APCD requlraments. For more compra ensive requirements, please contact APCD al apcdcomp@sdcounty.ca.gov; (858) 586-2650; or 10124 Old Grove Road, San Diego, CA 92131. YES J 1. B WIii the project disturb 160 square feet or more of existing building materials? 2. ' Will any load supporting structural members be removed? If yes, contact APCD prlor to Issuance of a building or demolition permit A notification may be required at least 10 working days prior to commencing demolition. 3. B B (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed? 4. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Based on the survey results, will the project disturb any asbestos containing material? If yes, contact APCD prior to the issuance of a building or demolition permit. A notification may be required at least 10 working days prior to • commencing asbestos removal .. 5. 0 1Zl Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or the APCD factsheet r (www.sdapcd.org/info/facts/permits.pd[) for typical equipment requiring an APCD permit. If yes, contact APCD prior to the Issuance of a building permit. 6. 0 01 (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school E._boundary? Briefly describe business activities: Briefly scribe proposed project: ~'If.th r;ed,c-'II Id t ,U, I? Data EXEMPT OR NOFURlHEfl INFORMATION REQUIREIII RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY APCD COUNTY-HMO APCD COUNTY-HMO APCD "]Pis businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply. County of San Diego -DEH -Hazardous Materials Division COUNTY OF SAN DIEGO CUPA DEPARTMENT OF ENVIRONMENTAL HEALTH HAZARDOUS MATERIALS DIVISION P.O. BOX 129261, SAN DIEGO, CA 92112-9261 PHONE: (858) 505-6990; FAX: (858) 505-6786; EMAIL: hmdutyeh@sdcounty.ca.gov UESTFORM All Certified Unified Program Agency (CUPA) regulated businesses are required by law (Assembly Bill 2286) to submit business infonnation electronically through the California Environmental Reporting System (CERS). This includes information related to your: • Unified Program Facility Permit • Remote Waste Consolidation • Hazardous Materials Busiµess Plan • Recyclable Materials Reports • Hazardous Waste ' • Underground Storage Tanks • Hazardous Waste Onsite Treatment • Aboveground petroleum storage over 1,320 gallons • Hazardous Waste Tank Closures • Medical Waste** A CERS I.D. is required in order to obtain or maintain a valid Unified Program Facility Permit. Please send your completed form to the County of San Diego Hazrn:c!ous Materials Division (address above). When your CERS account is established, your designated lead users will receive an email with directions to begin electronic repo1iing. ** In San Die o Coun , Medical Waste Generators are required to report in CERS in order to receive a valid ermit. Change of Owner (C/0): a business is sold to a new owner. D Relocation: a business moves to a new address and owner remains the same. ~New Business: a business opens in a vacant or newly constructed building. PERMIT/RECORD NUMBER CERS ID NUMBER SI Saine as FA IUTYNAME or DBA-Do\ng B1isincss As)* ·. . BUSINESS PHONE* ***Please Note: for ousiness name changes only, ao not complete this form; please make changes in CERS. 8 $ 0 S 5 4 fv\ o r"-, c. et-. ..e. r· / 1-r,, er~,, /~')-~/_,-1~c ___ ·_· -----------r ___ o----,---,--.c==--,---~/ _()__1_;;.. __ ---1 SITE ADDRESS* SUITE NUMBER* f C>/ 0 5 C: ¥7 /1-e /3crrc.· ·< /,~ n" f'I ;;i. I/ 'Tl ;;)._ II CITY* ZIP* DATE ASSUMED OWNERSHIP* c ti r u b .,,.., ot CA ? :2. o o CJ BUSINESS ORGANIZATION, CORPORATE NAME, LLC, or OWNER FIRST AND LAST NAME* BUSINESS OWNER PHONE* MoM,'C.c-P--e.r!Wl"'fl", 1 IV/D li1c: 8S8 (oq;,. DOO(p II. PREVIOUS ADDRESS (IF APPLICABLE) PREVIOUS SITE ADDRESS PREVIOUS CITY III. CERS LEAD USERS -PRIMARY- NAME* R,OV\0\ c4 TITLE* Cf D BUSINESS PHONE* gsg 0'?d.. voo(;; E-MAIL:* rp G ~crll"-"lqv\ c .. /;v,, C *Required ZIP CA -SECONDARY- NAME TITLE • fvli-tc.h-("...ll Cfo BUSINESS PHONE PREVIOUS PERMIT/RECORD NUMBER PREVIOUS CERS ID 8S'11 wt:J;;, OD"lB E-MAIL: I authorize the Hazardous Materials Division to create my CERS ID. I understand that I am responsible for completing and maintaining my facility information in CERS as required by law. I certify under penalty of law that I have personally examined and am familiar with the information submitted on this form and believe the information is true, accurate, and complete. NAME OF SIGNER (print)* TITLE OF SIGNER* Last Inspection date: ~--------0 Added Lead Users (date: ~--------~ Received by Completed by (initials: County of San Diego CUPA Departmient of Environmental Health -Hazardous Materials Division HM-907 (12/15)