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Home My WebLink About1911 Calle Barcelona; 151; CBC2018-0332; Permit(city of Carlsbad Commercial Permit Print Date: 10/15/2018 Permit No: CBC2018-0332 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: 1911 Calle Barcelona, 151 BLDG-Commercial 2550120400 $68,000.00 Work Class: Lot#: Reference #: Construction Type: Bathrooms: Orig. Plan Check#: Tenant Improvement Status: Applied: Issued: Permit Finaled: Inspector: Closed -Finaled 06/18/2018 07/25/2018 TFraz Plan Check#: Final Inspection: 10/15/2018 9:34:lOAM Project Title: Description: SEDERA: REPLACE EXTERIOR FACADE AND STOREFRONT Applicant: Owner: Contractor: STEVEN KOHN 9939 Hibert St, 202 T-C FORUM AT CARLSBAD LLC DAVIS AND ADAMS CONSTRUCTION INC San Diego, CA 92131-1029 858-874-1812 BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $847.80 4675 Macarthur Ct Tiaa-Cref, 110 NEWPORT BEACH, CA 92660 Total Payments To Date: $847.80 7848 Convoy Ct SAN DIEGO, CA 92111-1210 858-268-9831 Ba la nee 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 City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure t o 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. $0.00 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov $485.74 $340.02 $3.00 $19.04 .... • THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: •PLANNING •ENGINEERING C City of Carlsbad JOB ADDRESS Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov 1911 Calle Barcelona SUITEI/SPACEI/UNIT# •BUILDING •FIRE Plan Check No. Est. Value Plan Ck. Deposit Date APN 151 255 012 04 00 CT/PROJECT# LOT # PHASE# #OFUNITS # BEDROOMS # BATHROOMS CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) Remove existing facade/marquee structure. Replace with new facade and storefront EXISTING USE APPLICANT NAME Primary Contact ADDRESS ~J~ i6 iu6,et:0 ,c0 PROPOSED USE GARAGE (SF) Steven Kohn PATIOS (SF) DECKS (SF) PROPERTY OWNER NAME ADDRESS FIREPLACE YESO AIR CONDITIONING N<O YES•No• TIAA Cref c/o JLL FIRE SPRINKLERS YES•No• 9939 Hibert Street, Suite 202 1905 Calle Barcelona, Suite 200 ZIP CITY STATE ZIP CITY San Dieqo STATE CA 92131 Carlsbad CA 92026 PHONE FAX 858.274.1812 858.227 .5720 PHONE 760.635.9168 FAX EMAIL EMAIL steven@kohndesign.com raj.chandani@am.jll.com DESIGN PROFESSIONAL Kohn Architecture CONTRACTOR BUS. NAME I-AccDccDccRccEc=S-=s------------ 9939 Hibet Street, Suite 202 CITY STATE San Dieqo CA PHONE ZIP 92131 ! FAX 858.27 4.1812 ZIP er ·2.. 1, 1 EMAIL steven@kohndesign.com STATE UC.# C 26624 (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or !hat 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 lot/owing 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 perfonnance of the won< for which this pennit is issued. ~ve and will maintain ws~n5;!;~s required b Section 370 of the.Labor Code, for the perfonnan<:8 of the work for which this permit is issued, My workers· compensation insurance carrier and policy number are: Insurance Co. • o ~SJ;: Policy No. j09 '{3<?' 3 Expiration Date 'i / I /I 'f ~ secton need not be completed 1f the permit is for one hundred dollars ($100) or less. LJ Certificate of Exemption: I certify that in the perfonnance of the work for which this pennit is issued, I shall not employ any person in any manner so as to become subject to the Worl<ers' 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, dama es as provided for i Section 3706 of the Labor code, interest and attorney's fees. Ji:S CONTRACTOR SIGNATURE ~~--.Lo. ' •AGENT DATE 7/2SJ I g' I hereby affirm that I am exempt from Contractor's License Law for the following reason: • • • 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 contraclors 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. O Yes 0 No 2. I (have/ have not) signed an application for a building pennit for the proposed work. 3. I have contracted with the following person (finn) to provide the proposed construction (include name address / phone/ contractors· license number): 4, I plan lo provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address/ phone I contractors· license number): 5. I will provide some of the won<, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone / type of work): Ji:S PROPERTY OWNER SIGNATURE •AGENT DATE • Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Aci? • Yes • No Is the applicant or future building occupant required to obtain a pennit 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 of 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 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 I certifythatl have read the application and state that the above lnfonnation is correct and that the infonnation on the plans Is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection puiposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: /vi 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 limnation and become null and void if the building or woc1< authorized by such permit is not commenced within 180 days from the date of such pennit or if the building orworl< authorized bys · is suspended or abandoned at anytime after the worl< is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). 2S APPLICANT'S SIGNATURE DATE /6 JUH.,t. Z..016 . ' '.' ,: }. "'; ! ·, ., ·. · , . PERMIT INSPECTION HISTORY REPORT (CBC2018-0332) ~ . \ ~ Permit Type BLDG-Commercial Application Dato: 06/18/2018 Owner: Work Class: Tenant Improvement Issue Date: 07125/2018 Subdivision: Status: Closed -Finaled Expiration Date: 03125/2019 Address: IVR Number: 11988 Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector 08/09/2018 08/09/2018 BLDG-11 066494-2018 Passed Tim Frazee Foundation/Ftg/Pier s (Rebar) Checklist Item COMMENTS BLDG-Building Deficiency 08/21/2018 08/21/2018 BLDG-14 067602-2018 Passed Tim Frazee Frame/Steel/Bolting/ Welding (Decks) Checklist Item COMMENTS BLDG-Building Deficiency 08/22/2018 08/22/2018 BLDG-13 Shear 067745-2018 Passed Tim Frazee Panels/HD (ok to wrap) Checklist Item COMMENTS BLDG-Building Deficiency 09/06/2018 09/06/2018 BLDG-Fire Final 069398-2018 Passed Cindy Wong Checklist Item COMMENTS FIRE-Building Final 09/14/2018 09/14/2018 BLDG-18 Exterior 070082-2018 Partial Pass Tim Frazee Lath/Drywall Checklist Item COMMENTS BLDG-Building Deficiency Waterproofing material in place, ready to lath 09/26/2018 09/26/2018 BLDG-18 Exterior 071191-2018 Passed Tim Frazee Lath/Drywall Checklist Item COMMENTS BLDG-Building Deficiency Waterproofing material in place, ready to lath Ext lath OK 10/15/2018 10/15/2018 BLDG-Final 072982-2018 Passed Tim Frazee Inspection Checklist Item COMMENTS BLDG-Building Deficiency BLDG-Structural Final BLDG-Electrical Final October 15, 2018 T-C FORVM AT CARLSBAD LLC CARLSBAD TCT#92-08 GREEN VALLEY 1911 Calle Barcelona , 151 Carlsbad, CA 92009-8454 Re inspection Passed Yes Passed No Passed Yes Passed Yes Reinspection Passed Yes Passed Yes Passed Yes Yes Yes Complete Complete Complete Complete Complete Incomplete Complete Complete Page 1 of 1 ,i~~ ~ CITY O F CARLSBAD Building Division INSPECTION RECORD 0 INSPECTION RECORD CARD WITH APPROVED CBC2018-0332 1911 CALLE BARCELONA SEDERA: REPLACE EXTERIOR FACADE AND STOREFRONT (e050 # 151 PLANS MUST BE l(EPT ON THE JOB 0 CALL BEFORE 3:00 pm FOR NEXT WORK DAY INSPECTION RECORD COPY2sso120400 0 FOR BUILDING INSPECTION CALL: 760-602-2725 6/18/2018 OR GO TO: www.Carlsbadca.gov/Building AND CLICK ON "Request Inspection" CBC2018-0332 DATE: If "YES" is checked below that Division's approval is required rior to re uestin a Final Building Inspection. If you have any questions please call the applicable divisions at the phone numbers provided below. After all required approvals are signed off-fax to 760-602-8560, email to bid ins ections@carlsbadca. ov or bring in a COPY of this card to: 1635 Faraday Ave., Carlsbad. ; 01) .',I)•, I·' If I I 1 ! I I 'r • I' I 'Ii / , I I i I ', /I! I) I, I ) ( ) I 11 I i: It I I I 'I'/ I\ j' 1/ I) 11 1' i ! l.' ! ) .• I ( i I) 1 l IF MARl<ED 'YES", IT IS REQUIRED PRIOR TO ANY CONSTRUCTION STORM WATER PRECON MEETING REQUIRED 760-602-2725 1----4--1---- Allow 24 hours IF MARl(ED 'YES", APPROVAL REQUIRED PRIOR TO REQUESTING BUILDING Fire Prevention 760-602-4660 Allow 48 hours Planning/Landscape 760-944-8463 Allow 48 hours CM&I (Engineering Inspections) 760-438-389 l Call before 2 pm Type of Inspection CODE # ELECTRICAL #31 0 ELECTRIC UNDERGROUND O UFER #12 REINFORCED STEEL #34 ROUGH ELECTRIC/ EV CHARGER #66 MASON RY PRE GROUT #33 0 ELEC SERVICE #32O TEMPORARY 0 GROUT 0 WALL DRAINS #35 PHOTO VOLTAIC #10 TILT PANELS #38 SIGNS #11 POUR STRIPS #11 COLUMN FOOTINGS #14 SUBFRAME O FLOOR 0 CEILING #15 ROOF SHEATHING #13 EXT. SHEAR PANELS #16 INSULATION #18 EXTERIOR LATH #17 INTERIOR LATH & DRYWALL BLDG-FINAL #82 DRYWALL,EXT LATH, GAS TES (17,18,23) Date Ins ector #83 ROOFSHEATING, EXTSHEAR(13,15) #22 ·• SEWER & BL/CO O PL/CO #84 FRAME ROUGH COMBO (14,24,34,44) #21 UNDERGROUND •WASTE • WTR #85 T-Bar (14,24,34,44) #24 TOP OUT O WASTE O WTR BLDG-FINAL OCCUPANCY #27 TUB & SHOWER PAN #23 0 GAS TEST O GAS PIPING #25 WATER HEATER A/S UNDERGROUND HYDRO #28 SOLAR WATER A S UNDERGROUND FLUSH BLDG-FINAL A/S OVERHEAD VISUAL CODE# POOLS Date Ins ector A S OVERHEAD HYDROSTATIC #51 POOL EXCAV / STEEL A/S FINAL #52 PLUMBING F / A ROUGH-IN #53 ELEC CONDUIT WIRING F/A FINAL #54 EQUIPOTENTIAL BOND FIXED EXTINGUISHING SYSTEM ROUGH-IN #55 PREP LASTER FENCE/ ALARMS FIXED EXTING SYSTEM HYDROSTATIC TEST #57 GUNITE FIXED EXTINGUISHING SYSTEM FINAL BLDG-FINAL MEDICAL GAS PRESSURE TEST MEDI CAL GAS FINAL REV 6/18 Date Date Date Date COPY OF CARD REQUIRED Inspector Ins ector Ins ector Ins ector , SEE BACK FOR SPECIAL NOTES DATE: June 26, 2018 JURISDICTION: Carlsbad PLAN CHECK#.: CBC2018-0332 ✓• EsG1I A SAFEbuilt Company SET: I PROJECT ADDRESS: 1911 Calle Barcelona PROJECT NAME: Replacement of Fa~ade and Store Front 0 APPLICANT • JURIS. ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D 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. 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 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: ~ EsGil staff did not advise the applicant that the plan check has been completed. D EsGil staff did advise the applicant that the plan check has been completed. Person contacted: / .. O) Telephone#: Date contacted: / (b~ ) Email: Mail Telephone Fax In Person ~ REMARKS: This is a minor exterior alteration. Provisions for the disabled access will be field verified by city staff. By: Abe Doliente EsGil 6/19/18 Enclosures: 9320 Chesapeake Drive, Suite 208 • San Diego, California 92 123 • (858) 560-1468 • Fax (858) 560-1576 Carlsbad CBC2018-0332 June 26, 2018 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Abe Doliente PLAN CHECK#.: CBC2018-0332 DATE: June 26, 2018 BUILDING ADDRESS: 1911 Calle Barcelona BUILDING OCCUPANCY: M BUILDING AREA Valuation PORTION ( Sq. Ft.) Multiplier Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance 1997 UBC Building Permit Fee ,.. I 1997 UBC Plan Check Fee ~ Type of Review: G Complete Review Reg. VALUE Mod. D Structural Only D Repetitive Fee ____3 Repeats D Other D Hourly EsGil Fee 1--------11 Hr @ ' Comments: Per city estimate. ($) 68,000 $274.081 Sheet 1 of 1 , -.. RECEIVED JUN 1 8 2018 CITY OF CARLSBAD BUILDING DIVISION MESRI ENGINEERING STRUCTURAL CONSULTING PROJECT: FACADE REMODEL AT 1911 CALLE BARCELONA, CARLSBAD, CA ROOF LOADS (FLAT): ROOFING 3.0 (NO GRAVEL) PLYWOOD 1.8 RAFTERS 3.0 CLO.+ INSULATION 3.0 SPRINKLER 2.0 MISC. 2.2 ROOF LOADS {SLPOED): MANSARDS / TOWERS ROOFING 12.0 DEAD LOAD 15.0 PSF DEAD LOAD LIVE LOAD 20.0 PSF LIVE LOAD PLYWOOD 1.8 AT TOWERS ADD CLG LOAD, AND STUCCO AS REQUIRED=l0.0 PSF RAFTERS 3.0 CLG. + INSULATION 0.0 SPRINKLER 0.0 MISC. 1.2 18.0 PSI' 20.0 PSF TOTAL LOAD 35.0 PSF TOTAL LOAD 38.0 PSI' WALL(EXT.): 16.0 PSF WALL (INT.): 10.0 PSF BEAMS:111 POSTS: 111 JOIST & BLOCKING:112 OR #I .'i._ 'fr~..,,, i ,., .;I ;.c .-: STIJDS&PLATES:#2ORIII U.ON. «·:;-.,_.,i,._.· ALL CONCRETE TO BE A MIN. OF 3000 PSI AT 28 DAYS STRENGTH. (SEE PLANS FOR SPECIAL INSPECTION REQUIREMENTS) Ss = 1.089 Fa= 1.064 Sms•l.1 59, Sds -0.773, R=6.5, 1=1.0, SITE CLASS D, P•l.3 WIND: CBC 2013 EXP. B, 110 MPH, 3 SEC GUST ~.-.---, &'!.11., ':!,' ~J.i. -=l::l ~ SOIL PRESSURE: 1500 psf@ 18" OELOWGRADE BY: CBC MIN. •t• ~ '. THESE CALCULATIONS ARE NOT VALID OR USABLE WITHOUT THE WET SIGNATURE OF ONF. OF THE PRINCIPALS OF THE MESRI ENGINEERING. THESE CALCULATIONS ARE ONLY FOR THE ITEMS INCLUDED HEREIN, SPECIFIED BY THE CLIENT AND DO NOT IMPLY APPROVAL OF ANY OTHER PART OF THE STRUCI'URE BY THIS OFFICE. JOB NO.: 018090 DATE: 06-05-18 DFSIGNED BY: M.M CHECKED BY: __ _ PAGE:! Ii- N = ' S '# o t ~ ,,.~ ,L. -i. r-?5: , \ 'b~ ~') c Ol.) Vs \ggc ~ rv' &: 1~ 1r I z OFFICE USE ONLY SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE RECORD ID # __________________ 1 PLAN CHECK# _________________ _ BP DATE Business Name Business Contact Telephone# Project Address A~# z.SS-DIZ-ot.t ·co Mailing Address Plan File# Project Contact S-f Wt-Yi The following questions represent the facility's activities, NOT the spe · 1c project description. PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects within the City of San Diego): Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Facility's Square Footage (including proposed project): 1. Explosive or Blasting Agents 2. Compressed Gases 3. Flammable/Combustible Liquids 5. Organic Peroxides 9. Water Reactives 6. Oxidizers 10. Cryogenics 7. Pyrophorics 11. Highly Toxic or Toxic Materials 13. Corrosives 14. Other Health Hazards 15. None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMO): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: YES N(), (for new construction or remodeling projects) 1. D El_/'fs your business listed on the reverse side of this form? (check all that apply). 2. D ~Will your business dispose of Hazardous Substances or Medical Waste in any amount? 3. D E"f" Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 _/ pounds and/or 200 cubic feet? 4. D ~ Will your business store or handle carcinogens/reproductive toxins in any quantity? 5. D ~Will your business use an existing or install an underground storage tank? 6. D ~ your business store or handle Regulated Substances (CalARP)? 7. D your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 8. D your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or realer than 1,320 aliens? California's Above round Petroleum Stora e Act . 0 CalARP Exempt I Date Initials 0 CalARP Required I Date Initials 0 CalARP Complete I Date Initials PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT APCD : Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San Diego, CA 92131 ape comp@sdcounty.ca.gov (858) 586-2650). [•No stamp required if Q1 Yes and Q3 Yes and Q4-Q6 No]. The following questions are intended to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive requirements contact APCD. Residences are typically exempt, except -those with more than one building• on the property; single buildings with more than four dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. [•Excludes garages & small outbuildings.] YES No,,-' 1. 0/ [!f Will the project disturb 160 square feet or more of existing building materials? 2. §[.,, D Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition. 3. M D (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance _/ Technician? 4. D 00 (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification ./ffiay be required 1 O working days prior to commencing asbestos removal. 5. D ~ Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet (www.sdapcd.org/info/facts/permits.pdf) for typical equipment requiring an APCD permit. D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school 6. • bounda Briefly describe business activities: . -ce l-G~ 1 I /1, J/8 Name of Owner or Authorized Agent Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: _______________________________ _ BY· DATE· I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO• COUNTY-HMO APCD COUNTY-HMO APCD •A stamp m this box only exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other permitting requirements may still apply. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division ' INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date{a, /6 • /o Business Name·------,~~..a.-..lJ~~---,.-.,---r---...-----r---------------- Street Address_....LE ....... 1Ji.-i~-_.:.'.,J£.5'--'/LJ~.Q,t:O,~&:""'-rc~e~Jolo£.!>1~aL__ ________ _ 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 Ink Manufacturing Nutritional Supplement/ Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining/ Milling Painting / Finishing Battery Manufacturing Manufacturing Paint Manufacturing Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i.e. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting/ Forming Pesticide Manufacturing / Car Wash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification Electroplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameling Electrical Component Anodizing Power Generation Manufacturing Coating (i.e. phosphating) Print Shop Fertilizer Manufacturing Chemical Etching / Milling Research and Development FIim / X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap/ Detergent Manufacturing Industrial Laundry Waste Treatment/ Storage SIC Code(s) (if known): ______________________ _ Brief description of business activities (Production / Manufacturing Operations): _____ _ Sib 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): _______________ _ 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 Contact~~) /[;;!i)'\ Title A I' .,\i'.:::,,;;.::i Signature. __ ~--1..=-'----,___,.'++~~~~::::::_:_-_: __ Phone No. ___________ _ ENCINA WASTEWATER AUHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941 FAX: (760) 476-9852