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HomeMy WebLinkAbout1925 CALLE BARCELONA; 160; CB153921; PermitCity of Carlsbad 12-18-2015 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB153921 Building Inspection Request Line (760) 602-2725 Job Address: 1925 CALLE BARCELONA CBADSt: 160 Permit Type: Tl Sub Type: COMM Status: ISSUED Applied: 11/12/2015 Entered By: SLE Parcel No: 2550120400 Lot#: 0 Valuation: $57,820.00 Construction Type: 58 Occupancy Group: Reference# Project Title: STUDIO 12.20: 1,263 SF Tl RETAIL TO RETAIL Applicant: STEVEN KOHN 13853 RECUERDO DR DEL MAR CA 92014-3126 858-27 4-1812 Building Permit Add'l Building Permit Fee Plan Check Add'l Building Permit 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 Expedidted Plan Review Total Fees: $958.95 Inspector:. $441.00 $0.00 $308.70 $0.00 $0.00 $16.19 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.00 $0.00 Date: Plan Approved: 12/18/2015 Issued: 12/18/2015 Inspect Area Plan Check #: Owner: T-C FORUM AT CARLSBAD L L C C/0 TIM-CREF 4675 MACARTHUR CT #11 00 NEWPORT BEACH CA 92660 Meter Size Add'l Reel. Water Con. Fee Meter Fee SDCWA Fee CFD Payoff Fee PFF (3105540) PFF (4305540) License Tax (31 04193) License Tax (4304193) Traffic Impact Fee (31 05541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee Green Bldg Standards Plan Chk TOTAL PERMIT FEES $958.95 Balance Due: Clearance: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $59.00 $89.00 $42.06 $0.00 $0.00 $0.00 $0.00 ?? ?? $958.95 $0.00 NOTlCE: Please take NOTl ci ya..~r rxcject irdudes tre "lrrpcsi ion'' ci lees, dedicatioos, reservatialS, or ctrer exa:.iialS hereafter cdledively referred to as ''fees'exa:.iialS.' You 00 days from the date tlis rmrit was issued tb protest irrpcsition ci these fees'exa:.iialS. If ya..1 potest them, ya..1 nust fdiCMitre potest procedures set forth in <?overrmant QxJe Section 60020(a), and file tre protest and my ctrer req..ired inforrration wth the Oty fvb1ager for pooessing in acx:.orclance wth Ca1sbad M.ulidp31 QxJe Section 3.32.030. Failure to tirrelyfdiOJVthat procedure '11.411 bar any sursequent legal action to attack, review, set aside, void, or anrR..d their irrpcsition. You ere rereby FURTHER I\OllRED that ya.Jr rig,t to putest the sp;dfied fees'exactialS OCES NOT ,APPI... Y to water and re-t<ff 001ned:ion fees and capacity dlanges, nor planring, zoning, gr-cdng or ctrer sinilar application pooessing or service fees in OO'lned:ion wth this rxcjed. 1\ffi OCES IT ,APP1... Y to any fees' exactions ci W"ich have "ousi been ·vena NOTICE sinilar to this or as to W"ich tre statute ci linitations has "ousi c.trerWse "red. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: []PLANNING 0ENGINEERING []BUILDING OFIRE 0HEALTH OHAZMATIAPCD (City of Building Permit Application Plan Check No. C-5 \5 3 9 LJ 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value ~~~~20- Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Deposit email: building@carlsbadca.gov www.carlsbadca.gov Date \\-\2..-1~ lsWPPP JOB ADDRESS SUITEII/SPACEII/UNITII rPN 1925 Calle Barcelona Suite 160 255 -012 -04 - CT/PROJECT # I LOT# I PHASE# I# OF UNITS I# BEDROOMS #BATHROOMS I TENANT BUSINESS NAME I CONSTR. TYPE I occ. GROUP Studio 12.20 V-B M DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) Tenant improvements to an existing warm, dark retail suite consisting of new walls, doors, storefront, power, lighting, toilet room, cash/wrap counter, and accessible toilet room. Proposed use is a retail store for the sale of clothing, shoes, and accessories. 11 Z(oS, t;G. fT. EXISTING USE I PROPOSED USE I GARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS Retail Retail YESO NO(Z] YES0No0 YES0NoD APPLICANT NAME Kohn Architects, P.C. PROPERTY OWNER NAME T-C Forum at Carlsbad, LLC (TIAA) Qsjn bsz Dpoubdu ADDRESS ADDRESS 9939 Hi bert Street 1905 Calle Barcelona, Suite 200 CITY STATE ZIP CITY STATE ZIP San Diego CA 92131 Carlsbad CA 90029 PHONE I FAX PHONE I FAX (858) 274-1812 {858) 227-5720 (760) 479-0166 (760) 479-0170 EMAIL EMAIL steven@kohndesign.com Raj.Chandani@am.jll.com DESIGN PROFESSIONAL Kohn Architects, P.C. CONTRACTOR BUS. NAME Davis and Adams Construction, Inc. ADDRESS ADDRESS 9939 Hi bert Street 7848 Convoy Court ----... CITY STATE ZIP CITY STATE ZIP San Diego CA 92131 San Diego CA 92111 PHONE-I FAX ·-· -··· PHONE I FAX (858) 274-1812 (858) 227-5720 - (858) 268-9831 (858) 268-9959 --···-------EMAIL EMAIL steven@kohndesign.com sonny@davisadams.com I STATE LICC26624 STATE LIC.# 57u?o5 I CLASSe, I CITY Busi~o ~ o25 (Sec. 7031.5 Busmess and Professions Code: Any City or County which requ1res a perm1t to construct, alter, 1m prove, demolish or repair any structure, pnor to 1ts Issuance, also requ1res the applicant for such permit to file a signed statement tnat 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 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: ~ve 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. M I have and will maintain workers' compensation, as require by Section 3700 of the Labor Code, f r the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. . Policy No. Cf 0~ LJ S S ~ ... \5 Expiration Date "i • I • 2.0 \ 1..1 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, for in Labor code, interest and attorney's fees. ,e5 CONTRACTOR SIGNATURE I hereby affirm that I am exempt from Contractor's License Law for the following reason: 0 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). D D I, as owner of lhe 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. DYes 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 coordinale, supervise 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 (h'~red) the following persons lo provide the work indicated (include name I address I phone I type of work): ,e5 PROPERTY OWNER SIGNATURE 0AGENT DATE I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad 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 ANY WAY 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 from the date of such permit or if the il work authorized by such or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). _iiS APPLICANT'S SIGNATURE DATE 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. STATE DELIVERY OPTIONS PICK UP: CONTACT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (Listed above) CONTRACTOR (On Pg. 1) OCCUPANT (Listed above) OCCUPANT (Listed above) MAIL/ FAX TO OTHER: ____________ _ JiS APPLICANT'S SIGNATURE ASSOCIATED CBL---------------------------------------------- NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION DATE EsGil Corporation In cpartnersfzip witfz government for CBuiCtfing Safety DATE: 12/14/2015 JURISDICTION: Carlsbad PLAN CHECK NO.: CB15-3921 SET: II PROJECT ADDRESS: 1925 Calle Barcelona Suite 160 PROJECT NAME: Studio 12.20 TI D APPLICANT D JURIS. D PLAN REVIEWER D FILE I2:J 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 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: I2:J 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: Telephone #: Date contacted: (by: Mail Telephone Fax In Person D REMARKS: By: John LeVey EsGil Corporation D GA D EJ D MB D PC Email: Enclosures: 12/07/2015 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 EsGil Corporation In CJ?artnersliip witli qovernment for (}3uiftfing Safety DATE: 11/24/2015 JURISDICTION: Carlsbad PLAN CHECK NO.: CB15-3921 SET: I PROJECT ADDRESS: 1925 Calle Barcelona Suite 160 PROJECT NAME: Studio 12.20 TI ~PLICANT _,A:J JURIS. D PLAN REVIEWER D FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's 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. cgj 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: D 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: ~h~n ~rchitects pate conY'cted:) \ J ~ (by)'"O 0ail ¢'elephone Fax In Person D REMARKS: By: John LeVey EsGil Corporation D GA D EJ D MB D PC Telephone#: 858-274-1812 Email: steven@kohndesign.com Enclosures: 11/17/2015 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 Carlsbad CB15-3921 11/24/2015 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: CB15-3921 OCCUPANCY: M TYPE OF CONSTRUCTION: VB ALLOWABLE FLOOR AREA: SPRINKLERS?: Yes REMARKS: DATE PLANS RECEIVED BY JURISDICTION: DATE INITIAL PLAN REVIEW COMPLETED: 11/24/2015 FOREWORD (PLEASE READ): JURISDICTION: Carlsbad USE: Retail ACTUAL AREA: 1 ,263 STORIES: 1 HEIGHT: 35 OCCUPANT LOAD: 38 DATE PLANS RECEIVED BY ESGIL CORPORATION: 11/17/2015 PLAN REVIEWER: John LeVey 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 2013 CBC, which adopts the 2012 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 2012 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. Carlsbad CB 15-3921 11/24/2015 Please make all corrections, as requested in the correction list. Submit FOUR new complete sets of plans for commercial/industrial projects (THREE 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. Please have the document author sign the N RCC-PRF-0 1-E page 12 of 17 2. Please have the responsible envelope designer sign the NRCC-PRF-01-E page 12 of 17 Advisory Note : When alterations, structural repairs or additions are made to an existing building, 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. • 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. 3. It is obvious from the plans the restroom servicing the tenant improvement is not disabled accessible, please provide a dimensioned restroom plans showing the restroom to be accessible compliant. 7 feet 4 inches minimum interior width 4. Please correct the accessible dressing room to be compliant CBC 11 B803, Mirror must be installed see CBC 11 B803.6, Bench must be per the CBC 11B903. 5. Please correct the paper dispenser for the restroom to be 7 inches to 9 inches maximum from the face of the water closet. CBC 11 B604. 7 6. Sales and service counters shall have a portion of the counter which is at least 36" in length with a maximum height of 34 inches. Section 11 B-904.4.1. 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. Carlsbad CB15-3921 11/24/2015 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: 0 Yes 0 No 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 John LeVey at Esgil Corporation. Thank you. Carlsbad CB15-3921 11/24/2015 [DO NOT PAY-THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: CB15-3921 PREPARED BY: John Le Vey DATE: 11/24/2015 BUILDING ADDRESS: 1925 Calle Barcelona Suite 160 BUILDING OCCUPANCY: M BUILDING AREA PORTION (Sq. Ft.) Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb Bldg. Permit Fee by Ordinance~-,;;-lj -------------~-~--~--- --·-·--------·-1 Plan Check Fee by Ordinance ..-' -----·-·---·---- Valuation Multiplier By Ordinance Type of Review: Complete Review 0 Repetitive Fee ~=~l Repeats Comments: D Other D Hourly EsGil Fee Reg. VALUE Mod. 0 Structural Only 1-------;1 Hr @ • Sheet of ($) 57,820 57,820 $436.541 $283.751 $244.461 macvalue.doc + DATE: PROJECT NAME: PLAN CHECK REVIEW TRANSMITTAL PLAN CHECK NO: SET#: 1 ADDRESS: VALUATION: Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www .carlsbadca.gov PROJECT 10: CB15-3921 APN: 255-012-04-00 This plan check review is complete and has been APPROVED by the ENGINEERING Division. By: A Final Inspection by the Division is required Yes No This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check Comments have been sent to: For questions or clarifications on the attached checklist please contact the following reviewer as marked: Gina Ruiz 760-602-4675 Remarks: Christopher.Giassen@carlsbadca.gov Linda Ontiveros 760-602-2773 Cindy Wong 760-602-4662 Dominic Fieri 760-602-4664 Do_minic.Fieri@carlsbadca.gov BUILDING PLANCHECK CHECKLIST QUICK-CHECK/APPROVAL Land Development Engineering 1635 Faraday Avenue 760-602-2 750 www.carlsbadca.gov ENGINEERING Plan Check for Date: 5 Project Address: 1 Project Description: ENGINEERING Contact : Phone: RESIDENTIAL INTERIOR RESIDENTIAL ADDITION MINOR (<$20,000.00) ,. CARLSBAD PREMIER OUTLETS OTHER: GYM APN: Valuation: Email: Fax: TENANT IMPROVEMENT , PLAZA CAMINO REAL 1 COMPLETE OFFICE BUILDING r··-··-··-··-··-··-··-··-··-··-··-··-··-··-··-··-··-··-··, OFFICIAL USE ONLY ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT BY: REMARKS: Notification of Engineering APPROVAL has been sent to via on E-36 Page 1 of 1 REV 4/30/11 PLANNING DIVISION BUILDING PLAN CHECK CITY OF APPROVAL CARLSBAD P-29 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.e:ov DATE: 11/13/2015 PROJECT NAME: RETAIL TO RETAIL TENANT IMPROVEMENT PROJECT ID: PLAN CHECK NO: CB153921 SET#: 1 ADDRESS: 1925 CALLE BARCELONA APN: ~ This plan check review is complete and has been APPROVED by the PLANNING Division. By: VERONICA MORONES A Final Inspection by the PLANNING Division is required 0 Yes 1ZJ No You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. D This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check APPROVAL has been sent to:stt-1/RAI@ /{p}tfJc{p/;1~-rl· C'---D!Yt For questions or clarifications on the attached checklist please contact the following reviewer as marked: PLANNING ENGINEERING 760~602-4665 D Chris Sexton Greg Ryan 760-602-4624 760-602-2784 760-602-4663 Chris.Sexton@carlsbadca.gov Christopher.Giassen@carlsbadca.gov Gr~orv.Ryan@carlsbad~ D Gina Ruiz VaiRay Marshall Cindy Wong 760-602-4675 760-602-27 41 760-602-4662 Gina.Ruiz@carlsbadca.gov VaiRay.Marshall@carlsbadci;t~ Cynthia.Wong@carlsbadca.gov [S] Veronica Morones linda Ontiveros Dominic Fieri 760-602-4619 760-602-2773 7 60-60 2-4664 Veronica.Moron{ls@carlsbadca.gov )..inda.Ontiveros@carlsbadca.ggy Doll"!inic.Fieri@carlsbadc~ Remarks: 1263 SF RETAIL TO RETAIL TENANT IMPROVEMENTS. NEW WALLS, DOORS, LIGHTING, POWER, TOILET ROOM, CASH WRAP. ADDITIONAL STOREFRONT CHANGES ARE MINIMAL AND FOLLOW ARCHITECTURAL AESTHETIC. P-29 Page 2 of2 07/11 Shay Even From: Sent: To: Subject: Steven, Christina Wilson Friday, November 13, 2015 U:l4 AM STEVEN@KOHNDESIGN.COM; Building CB153921 Studio 12.20 plans do not need Carlsbad Fire Dept. review CB153921 Studio 12.20 plans do not need Carlsbad Fire Dept. review. Thank you, Chris (City of Carlsbad Christina Wilson Fire Prevention Secretary City of Carlsbad 1635 Faraday Ave. Carlsbad, CA 92008-7314 www .carlsbadca .gov P 760-602-4665 phone IF 760-602-8561 1 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE RECORD ID# PLAN CHECK# OFFICEUSEONLY :==] BPDATE~ Project Address Mailing Address Project Contact The following questions represent the facility's activities, NO e specific project description. PART 1: 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 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 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 li_o/ (for new construction or remodeling projects) 1. 0 M" _/Is your business listed on the reverse side of this form? (check all that apply). 2. 0 ~Will your business dispose of Hazardous Substances or Medical Waste in any amount? 3. 0 ~ Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 4. 5. 6. 7. 8. 0 0 0 0 0 pounds and/or 200 cubic feet? ~Will your business store or handle carcinogens/reproductive toxins in any quantity? ~Will your business use an existing or install an underground storage tank? ~Will your business store or handle Regulated Substances (CaiARP)? ~./Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? ~ Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act . 0 CaiARP Exempt I Date Initials 0 CaiARP Required I Date Initials 0 CaiARP 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 apcdcomp@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; town homes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. [*Excludes garages & small outbuildings.] YES NO 1. 0 ~ill the project disturb 160 square feet or more of existing building materials? 2. 0 l!f Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition. 3. 0 0 (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. 0 0 (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification _J"may be required 10 working days prior to commencing asbestos removal. 5. 0 M Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet ~.sdapcd.org/info/facts/permits.pdf) for typical equipment requiring an APCD permit. 6. 0 ~ (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bound a I 2ol7 Date FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: _________________________________ _ BY" DATE· I I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO* APCD COUNTY-HMO APCD COUNTY-HMO APCD * .. A stamp 1n th1s box only exempts businesses from complet1ng or updatmg a Hazardous Matenals Bus1ness Plan. Other perm1ttmg requirements may st1ll apply. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date li·IZ · loiS Bus~ess Name~~~~~~~2~~~~~· StreetAddress l=tri CAlle r&YCL/aWA. S+-e. llPO urlstaJ 12tc01 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 f X-ray Processing Food Processing Glass Manufacturing Industrial Laundry Ink Manufacturing Laboratory Machining I Milling Manufacturing Membrane Manufacturing (i.e. water filter membranes) Metal Casting I Forming Metal Fabrication Metal Finishing Electroplating Electroless plating Anodizing Coating (i.e. phosphating) Chemical Etching I Milling Printed Circuit Board Manufacturing Metal Powders Forming Nutritional Supplement I Vitamin Manufacturing Painting I Finishing Paint Manufacturing Personal Care Products Manufactudng Pesticide Manufacturing I Packaging Pharmaceutical Manufacturing (including precursors) Porcelain Enameling Power Generation Print Shop Research and Development Rubber Manufacturing Semiconductor Manufacturing I I Soap I Detergent Manufacturing Waste Treatment I Storage SIC Code(s) (if known):~-------~~---------~- Brief description of business activities (Production I Manufacturing Operations): ___ _ Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal I day): _____ _ List hazardous wastes generated (type I 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 lfyes,when: _____________ ~------------------------ Site Contact _________________ Title _____________ _ Signature Phone No .. ---:----:-::-:----~-.-:--·---- ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941 FAX: (760) 476-9852 CITY OF CARLSBA PLUMBING, ELECTRICAL, MECHANICAL WORKSHEET B-18 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov Building@carlsbadca.gov Project Address:\~ 2 c::J CoJ\L ~~Permit No.: CJQ \ tS ~ q 2_( Information provided below refers to worR 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: (760) 602-8558 Number of new or relocated fixtures, traps, or floor drains....................................................... ~ New building sewer line? ......................................................................................... Yes __ No_ V Number of new roof drains? ............................................................................................................... _f2J Install/alter water line? ........................................................................................................................ . Number of new water heaters? ......................................................................................................... _L Number of new, relocated or replaced gas outlets? .................................................................... ft Number of new hose bibs? .................................................................................................................. ~ Residential Permits: New/expanded service: Number of new amps: ---'~-~_t;_A ___ _ Minor Remodel only: Yes__ No Commercial/Industrial: Tenant Improvement: Number of existing amps involved in this project: Number of new amps involved in this project: New Construction: Amps per Panel: Single Phase ............................................................... Number of new amperes _____ _ Three Phase ................................................................. Number of new amperes ______ , Three Phase 480 ........................................................ Number of new amperes _______ _ Number of new furnaces, A/C, or heat pumps? ............................................................................. _f!___ New or relocated duct worl:l? .......................................................................... Yes V No __ _ Number of new fireplaces? ................................................................................................................. _Jjf__ Number of new exhaust fans? ............................................................................................................ _j_ Relocate/install vent? ........................................................................................................................ "'". -1/!.__. Number of new exhaust hoods? ........................................................................................................ _flj__ Number of new boilers or compressors? ........................................................... Number of HP --f?J.._ B-18 Page 1 of 1 Rev. 03/09