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Home My WebLink About1925 PALOMAR OAKS WAY; 200; CB900002; Permit· . .__ .·-··· 4 B U I L D I N G P E R M I T 01/18/90 14:16 Page 1 of 1 Job ,Address: 19·25 PALOMAR OAKS WY Str: .Permit Type : COMMERCIAL TENANT IMPROVEMENT Parcel No: Valuation: 29,741 Co~stru.ction· Type: NEW Occupancy Group: B-2 Class Code~ V-N Description: .1545 SF TI _g;y~,7'E..., 29.£ CONTRACTOR OWNER CITY OF CARLSBAD - Permit Project D~ve.lopment Fl:. . Ste:· No:~ C:B9000-.0-2 No: .A90Q00-03 . No: 27-i'i {,11.18/90 0001 {).l 02 · c~PRMT ·1409;00 --~2p3~uJ'· ·, Status: ISSUED Applied Oi/02/90 Apr/Issue .. 01/18/90 Validated By: Jpy· . 9·. 00_ · 587-,-1901 619---931:...2.600 N: 5.00 Y 50.00 55. o,o 15._00 Y . 9-. 00 :.24 ;00. 207S I.as Palm.as Dr., Carlsbad· CA 92009 .(619) ·438-116:J: ., . r PERMIT.APPLICATION • City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 . 1. PERMI~ TYPE . A • 8£0MMERCIAL B -D INDUSTRIAL C • D RESIDENTIAL D APARTMENT TENANT IMPROVEMENT 0 TENANT IMP~OVEMENT OCONDO QSINGLE FAMitY,DIIELLING 'DADD I TION/ALTERAT ION ,0DUPLEX []DEMOLITION' ORELOCATION OHOBILE HOME OELE.CTRICAL OPLUMBING nMECHANICAL OPOOL OSPA ORETAINING WALL OSOLAR O0THER.~-~--- 185 .. -00 2 .. PROJECT INFORMATION PLAN (HECK No. Address \'I.Z..S' ~Af'l-, O~ WH{ Near.est Cross Streets 'PM-ol"I\A-f2-A-\P.fbr--1 12¢,rQ ~EGAL DESCJUPTION Lot No. Subdivision Name/N~er Unit No. 02 Structural Cales '2. ~ Addressed Envelo EXISTING USE OFF.-l~ BLDG.'.sa. FTG. I~ \~ E=Xl~IU'=> o~tc.E. $LO(:., # OF STORIES .z -YL.ot>VZ . 4'~ ~. Rhase No:· 3. CONTACT PERSON NAME [9~'-( "f,O-cJl'rfl-0 1 CHY ADDRESS STATE C-A-· ZIP CODE ~$'" ~ 1#->c viOA-~ 1 sk I o"'1 DAY TELEPHONE, U9 IC,°'.) ..::t·.-'.bB-S' I"").\ ~4 5. PROPERTY OWNER OWNER tooo Hot..,zerz.... ::~i.~isee OTENANr NAME 6PU!> ~ CDf.2-'rt't-A'fli'"-t ADDREss (92.\ PA<..oY\1~ oAl<'s ~f i. StJrT'E-~'f cm -~e,A,-0 STATE l,11\--ZIP CODE 41.«:>6 DAY TELEPHONE :i'.3 ,--21eoo. 6. CONTRACTOR NAME 13'(t,oj.2- STATE C,p;. ADDRESS ZIP CODE lo2>l41 N-M~ ~t<l'¥-12d . . 4112..-1 Cl DAYTEf(pHONE ~---z,,..;1qcr1 7. CITY ~,t~ 'Dlqf SIGNATURE DES.I GNER NAME CITY STATE LIC. # WORKERS' COMPENSATION LICENSE qAss -~---CITY 'BUSINESS LIC. # ., ·:440. TITLE STATE ,D,AY· TELEPHONE STATE LIC. # ·workers' C~nsation Declaration: I hereby affirm that I have a certificate of consent to'self·insure issued.by.the Director of Industrial Relations, or a certificate of Workers' C~nsation Insurance by an adnitted insurer, or an exact copy or duplicate thereof certifi'1(1 by the Director of the. insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). · INSURANCE COMPANY POLICY NO. El(PIRATJON ,DATE Certificate of Exemption: I certify that in the performance of the work for which this ~rmi,t is issued, I shall ·not employ any person in any manner so as to become subject to the Workers' C~nsation Laws of California. SIGNATURE DATE 8. OWNER-BUILDER DECLARATION owner-Builder Declaration: I hereby affirm that I am exempt from the·contractor's License Law for the fonowing .reason: D I. as owner of the proper.ty or my employees wi.th wages as their sole compensation, will do the work ·and·the structur~ is not intended or.of.fe·red for sa,le (Sec. 7044, Business and Professions Code; The Contractor's License Law does not apply to an owner of .property who, btiil'ds or i"!proves thereon., a119 .who does such work himself or through his own employees, provided that such improvements are ·not intensJed or offered for sale •. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden ot proving that he did not buila or improve for the purpose of. sale.). 0 L, as owner of' the property, am exclusively contracting wi.th 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, <!nd contracts for such projects wfth, contractor(s)· licensed pursuant to the Contractor's License Lal(). ,D I .am exempt under Section __________ Business and Professions Code for this. reason: (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, al"ter, improve, demolish, or repair any struc·ture,' prior to i'ts issuance, also requires the applicant for such permit tc;, file a signed statement that tie is licensed .pursuant to the prqv.isions of the Contractor's License Law (Chapter 9, .conmencing with Section 7000 of Div.ision 3 of the Business and Pr·otessions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any viola.ti on of Section 7031.5 by any applicant for a permlt ·subjects the· applicant to a chi.H ·penalt.y of ·not more than five hundred dollars [$500)). · SIGNATURE DATE tOMPLETE THIS SECTION FOR NON·RESIOENHAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardou·s materials·regist;ratibri' form or risk management and'pr-e'i'ention' program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance ·Account Act? DYES ONO Is the applicant or future bui:lding occ,upant required to obtain a permit from the air pollution ·control district or ~ir, qual i.ty management district? DYES ONO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES IF ANY OF THE ANSIIERS ARE YES, A FINAL l;ERTIFICATE OF. OClllPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET. OR IS MEETING' THE REQUIREMENTS OF THE Off.ICE OF EMERGENCY SERVICES ANO. THE AIR POLLUTION CONTROL DISTRICT. 9. CONSTRUCTION LENDING AGENCY herel:!y aft i rm that there is a construction lending agency for the performance of the work for, !'hi ch th·i s permit fs i SS\led (Sec· 3097( i) Civ.il Code). LENDER'S NAME LENDER'S ADDRESS 10. APPLICANT'S SIGNATURE I certify that I have read the application arid state that the above information is correct'. I agree to' comply with all City ordinances line! State laws relating to buil'ding construction. I hereby authorize representatives of the City of Carlsbad to enter upori the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JWGMENTS, COSTS AND EXPENSES ,IIHICH MAY IN ANl IIAY·ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.. Exp'iration. Every permit issuea by the Building Official under the provisions ot this Code shall, expire by :t imi.tatiori ,,md become nuU and void H the bui ldi~g, authorized by such permit is not conmenced within 180 days from the date of such permit or H the building or ijock authoriz<?d by such permit, is suspendecf oned at any time af er the woe s onmenced for a period of 180 days (S~ction 303(d) Uniform Building Code.). D OWNER D CONTRACTOR D BY PHONE ', . I-2-~O WHITE: File YELLOW: Applicant PINK: Finance - UNSCHEDULED INSPECTION DATE ___ O---+-,/_;i._.s_,./_9_0 __ INSPECTOR 4-£,------ Pi:c;#. ---------PERMIT # CJ6' '90 ooD(../ JOB ADDRESS ___ / ...... ?....,:2 ...... ~ __ /1 ...... ~_LO. __ ~ ____ M., _____ ~ ........... J'S---~---w----------------__,.. 61/1% ,2.tf)O TIME ARRIVE: TIME LEAVE: ----------- LVL DESCRIPl'ION ACT COMMENTS • PERMIT# CB900002 DESCRIPTION: 1545 SF TI CITY OF C~LSBAD INSPECTION REQUEST FOR 02/22/90 SUITE 200 LOT 14 INSPECTOR AREA MC PLANCK# CB900002 OCC GRP TYPE: CTI JOB ADDRESS: 1925 PALOMAR OAKS WY APPLICANT: SEWARD, GARY CONTRACTOR: BYCOR GENERAL CONT. OWNER: OPUS SOUTHWEST CORP REMARKS: T3/MH/BOB/ SPECIAL INSTRUCT: STR: CONSTR. FL: PHONE: 438-5191 PHONE: 587-1901 PHONE: 619-931-2600 TYPE NEW STE: vd ~ INSPECTOR A/Vf~ -1---~--1----- TOTAL TIME: --RELATED PERMITS--PERMIT# TYPE CB880494 COM. STATUS ISSUED CD LVL DESCRIPTION 19 29 39 49 ST Final Structural PL Final Plumbing EL Final Electrical ME Final Mechanical ACT COMMENTS N_ ---'--------.-------~ e;<1s7JA.lc ~ -------,---~-----¥ _____ __.___,__ _______ _ -------------'--------------'----------------~----------------~--------- ***** INSPECTION HISTORY***** DATE 022090 022090 022090 022090 021690 021690 021690 021690 021690 020990 013090 012990 012990 012390 012390 DESCRIPTION Final structural Final Plumbing Final Electrical Final Mechanical Frame/Steel/Bolting/Welding Rough/Topout Rough Electric Rough/Ducts/Dampers Interior Lath/Drywall Rough Combo Insulation Interior Lath/Drywall Frame/Steel/Bolting/Welding Frame/Steel/Bolting/Welding Rough Electric ACT INSP CO MPC CO MPC CO MPC CO MPC AP MPC AP MPC AP MPC AP MPC AP MPC NR MPC AP MPC PA MPC CO MPC CO MPC PA MPC COM?1ENTS NOS LABELED FIRE DOOR NDS LABELED SFTY GLASS NDS FIRE DEPTS OK CEILING GRID SYSTEMS ];JIGHT FIXTURES DUCTS AND REGISTORS PATCH ON 1 HR CORR WALL DIMINISHING WALLS DIMINISHING WALLS & BATHROOMS STOREFRONT NEEDS BRACING ND KICKERS/PRTNS PER 3/Tl-3 WALLS ONLY ,", ) ' ' ' --~·' '.,' ' ~ ... , ' ' .. , \ :. ',,, PLAN·~li'ECK NUMBER: FINAL BUILDING -INSPECTION 89-702 ' • • ·-• -~ •'lj, DATE: 2-21 ... 90 . :1 PROJECT NO.: _______ UNIT NUMBER: --~~---PHASE NQ.: --~-----'--- TYPE OF UNIT: ___ C_T_l ________ NUM~ER .OF UNITS: CONTACT ·PERSON-· ------~b_'o_b _______ ----'-----'--~--,-,--~-'---- CONTACT TE~EPHONE-· __ ....,.58_7_-_1_9_0_1 ______ --,-____ --'~--'-----'--''-'-"~-- Bldg, Eng., Pire INS~~E BY: _,. _ __..'--"-...----PECTED: · .. -~ . . . IN~PEGTED BY: __ -'--------- INSPECTED BY: __________ _ DATE INSPECTED: Q.ATE INSPECTED: ____ _ . . ··APPROVED· ~APPROVED._· -~ APPROVED __ _ . DISAPPROVED _. -~ ' ,, APPROVED ~~~ DISAPPROVED ·--'---'-- ·, C_OMMENTS: ------~'---""----'-------'-------------'-~---'---'------'- Rev.1/86 WHf(E: Suspense BLUE: Water District GREEN: Engineering. CANARY: Utilities PINK: Planning GOLD: F!r~ f. FINAL BUILDING INSPECTION . ,1,1 RECEIVED FEB 2 1 1990 PLAN CHECK NUMBER: DATE: PROJECT NAME: _____ O_P_U_S ___________ --'------------- ADDRESS: ___ 19_2_5_P_a_fo_m_ar_G_1a_k_·_s_i_tl_Il'-c..Y _ __,$_' u_r_rE_~_i_n_,:o_o_L_o_t_1 f_! _________ _ PROJECT NO.: _______ UNIT NUMBER: _______ PHASE NO.: ------~ .TYPE OF UNIT: c·ri -----'---------NUMBER OF UNITS: CONTACT PERSON~· ______ '_B_o_b _____________________ ~ CONTACTTELEPHONE: ___ 5_8_7-_1_9_0_1 _____ -,---~~------------ INSPECTE~ BY: --",,l-f-+-1'1--'-"--=--=---- INSPECTED BY: _________ _ INSPECTED BY: _________ _ DATE / / A INSPECTED: ;), /~;)-,L qv APPROVED V DISAPPROVED ~- DATE INSPECTED: DATE INSPECTED: APPROVED DISAPPROVED __ _ APPROVED __ _ DISAPPROVED __ _ COMMENTS:------'--~------------------------- Rev. 1/86 WHITE: Suspense BLUE: Water District GREEN: Engineering CANARY: Utilities PINK: Planning GOLD: Fire ESGIL CORPORATION. 9320 CHESAPEAKE DR., SUITE 208 'fi..-=~.:-p,-~I«---1\s\ go SAN DIEGO, CA 92123 (619) 560-14-68 DATE: JURISDICTION: PLAN CHECK NO: 00 -'2-SET: -:C. PROJECT ADDRESS: \~'2,S ('f't-\...()Y'()Y}:,2. ~ ~ ·PROJECT-NAME: ______ "$,.,_;_\~±~<E",c_,_·_2-_o_,;::o=-------- · fWA The plans transmitted herewith have been corrected where ~·necessary and substantially comply with the .jurisdiction's D ... o D D building codes. The plaris transmitted herewith will substa~tially.ciomply with the jurisdiction's building codes when.minor deficien- cies identified · . are resolved and ~hecked by building department staf~. • • .... •'4 •IJ···' The plans transmitted herewith have significant.¢l.ef.t'ciencies identified on the .enclosed check list and should be co·rrected and resubmitted for .a complete recheck. ·· The check list transmitted herewith is for your information. The plans are being held ·at Esgil ~orp. until corrected plans are submitted for .recheck. The applicant's copy -of the cheek lis~ is enclosed for the jurisdiction to return to. the applicant·contact person. . . . . 0 The applicant's copy of the check list has been sent to: ---,..-------,---......... ---------------------.··. ---------------~----------------'·-; ... ~ ~sgil staff did not advise.the applicant contact person that plan check has been completed. · O Esgil staff did.advise _applicant-that the plan check has · been completed. Person contacted: ------------- Date contacted: Telephone# ------------------0 REMARKS=-------------------=------ By : .::fi'N] G,. I\ ... ~ \-:t-I 'P.rf'+ ESGIL CORPORATION -~~..Qvw'~ Enclosures: Y~'f.lt-\~~ ------'--=-------- ·,, .. Jurisdiction c~~:ero . .::: . Date, t/5/~o . Prepa~d by, .JtVV\ VALUATION AND PLAN CHECK FEE o Bldg. Dept • 0 Esgil PLAN CHECK NO. · C::,o -2.. BUILDING ADDRESS \'12-S \'.'fh-oVVI fu'.4 APPLICANT/CONTACT ~}4@'-1 S§½J111"2-Q I BUILDING occuPANcY s ;:z: Gu , .) -ti::: o~~ ~*:( &oo PHONE NO. .q-38-S) 3 ( DESIGNER PHONE ~ TYPE OF CONSTRUCTION . V-tJ . CONTRACTOR PHONE ----- BUILDING PORTION BUILDING AREA VALUATION VALUE MULTIPLIER - Ov?'' -:(, I I lt545" I~ I '7 .-z;s--= Z°l :, 41 I I ,. .. ... . Air Conditioninl:!: Commercial .. @ .. Residential (a ' Res. or Comm. Fire· Snrinklers @ Total Value ', iC/ ,1·4-r Building Permit fee.$ 26 4, ~ 0 ________________ _..._ _____ _ Plan Check f ee__,$'--__ ___.\--=8 ___ 4 ___ r_.<)..,,_. _.._3_. ___________ $ __________ _ COMMENTS._: -------------------------- SHEET OF -----12/87 :··. >,. >,. ~ .Q .Q ; N ~ 'It -"' -"' -"' (J (J (J ~ QI QI .&! .&! u u C: C: co co --Cl. Cl. ~DD Jioo PLANNING _CHECKLIST Plan Check No. -~..,,..0_-_Z--___ Address /CJZ:s: iahmar CbJfs C-Ju. APN: 91 Q :<Wrlo/.= -t;:J Planner -·-+-/1lL. ........... &:._-=---•~ ......... ~....._ ________ Phone ---'4=38=---=-1=16=1:...-__ _ {Name) Type of Project and Use-----,..--~=...:.~·~'-~-~~~--·------~---- Zone ,~/JJ Facilities Management Zone ___ 3-: ____ _ Legend [Z] @ Item Complete Item Incomplete -Needs your action 1, 2, 3 Number in circle indicates plancheck number that deficiency was identified Environmental Review Required: YES __ NO~ TYPE--.---- DATE OF COMPLETION: Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval _________________ _ Discretionary Action Required: YES __ NO \( TYPE ftp '6;-Z- APPROVAL/RESO. NO. ______ _ DATE: ___________ _ PROJECT NO.·------OTHER RELATED CASES: _________________ ____,;,._ Compliance with conditions of approval? If not, state conditions which require action. /1 J . /Jf, . "'1 Conditions of Approval (Md-, ffz,,, J;C:;:;,,p ,):pdi,:y efl,, 1JtJf!4L CUJ, 8~ +-. Coastal: YES __ NO -¥-DATE OF APPROVAL: Compliance with conditions of approval? Ir not, state conditions which require action. Conditions of Approval.------------------ _ DD[;]__ DDfJ ODD ODD ·-,:DD D ODO ODD ODD ODO DOD .;, .... Landscape Plan Required: YES __ NO __ See .attached submittal requirements for landscape plans Site Plan: 1. 2. 3. 4 . . Zoning: 1. 2. 3. 4. Provide a fully dimensioned site plan drawn to scale. Show: North arrow, property 1 i.nes, easements, existing and proposed structures, streets, existing street tmproijements, right-of-way width and dimensioned setbacks. : Show on Sit& Plan: Finish floor elevattons, elevations of finish grade adjacent to building, existing topographical lines, existing and proposed s 1 opes and driveway. . ... ,: Provide legal description of property. Provide assessor's parcel number. Setbacks: Front: Required __ Shown __ Int. Side: Required Shown __ Street Side: Required Shown __ Rear: Required Shown __ Lot coverage: Requir~d Shown __ Height: Required Shown __ Parking: Spaces Required __ Shown __ Guest Spaces Required Shown __ Additional connents and remarks have been aade on the building plans. These marked-up plans aay be picked up at the Building Depart~nt. These marked- up plans must be resubllitted with the revised plans for this project. Have plans been marked up? YES __ NO __ Additional Comments _____________________ _ -. OK TO ISSUE~ ... ._ DATE ____,,,/ /4_@+-/4 ___ -o_-__ j/ PLNCK.FRM 2560 ORION WAY CARLSB~D, CA 92008 <lCitp of Carlsbab FIRE DEPARTMENT . PAGE 1 OF _j_ TELEPHONE ,, (619) 931-2121 _ APPROVED ',(_ DISAPPROVED PLAN CHECK REPORT PLAN CHECK# c!.R-9n-2. PF.!OJECT &~<?C<A,, ~S: Awt:K';cAi-..1 ADDRESS \925: 't1.lrrn,1:,!Z. ()AK~ 0..JAy· SJE" Zoe') -· r --, ARCHITECT Pr Ao, CT: Coot< ADDRESS ~ A RLSP-A,i) PHONE f--{,?,f?-S/9 / OWNER Or-?u S. 5oqJ1:llAlf:ST Coi?:?, ADDRESS f A,R1 S MIJ -PHONE q3'/ -2foQ1") OCCUPANCY. · =i32 CONST. 7V /t / TOTALSQ. FT. ------'~-STORIES _l~rf._1G~t:.c. __ _ . 'I;iSPRINKLERED ~TENANT IMP. _,_, __ .. ~~'-~'-S'~~='=F-_ -· ~2=A~'=lJ~f-~-=L~0~0~{2.~--~----~~------ __ ·1. __ 2. _-·_,3. ~' 4. __ 5, +6. APPROVAL OF PLANS IS PREDICATED ON CONFORMING TO THE FOLLOWING CONDITIONS AND/OR MAKING THI: FOLLOWING ·CORRECTIONS: PLANS, SPECIFICATIONS, AND P.E-R'MITS Provide one copy of: floor plan(s); site plan; sheets ~-~-------------,-----,-- Provide two site plans showing the location of all existing fire hydrants within 200 feet of the project. Provide specifications for the following: Perm.its are required for the installation of ~II fire protection systems~stan9 pipes, dry chemical, halon, CO2, alarms, hydrants). Plan must be approved by the fir·e department prior to installation. The b1,1siness owner shall complete a building information letter ,and return it to the fire department. FIRE PROTECTIO.N SYSTEMS AND EQUIPMENT -• . t The following fire protection systems are required: · , '~ Automatic fire sprinklers (Design Criteria: -1-f1......,.'S~P.-"Fa....,,_R__,,A=J_.£_P,_,_A.,_____,_1_'<.._~--~-~~----) D Dry Chemical, Halon, CO2 (Lqcation:· _,, ) D Stand Pipes (Type: ) D Fire Alarm (Type/Location: · ) · Fire i;:xtinguisher Requirements: · · . . . ~One 2A rated ABC extinguisher tor each boo O s(i .. ft. 9r por-tion thereof with a travel distance. to the riearest . extinguisher not to exc.eed 75 feet of travel. D An extinguisher with a minimum rating of · · to be located: D Other: ____ ___,_-------~,---,---~-~--~------------- --R Additional fire hydr.ant(s) shall be provided .c..---------~~-~----~------ EXITS 'j-9. Exit doors shall be openable from the inside without the use of. a key or any special knowledge or effort. ___ 10. A ·sign stating, "-This door to remain unlocked during business hours" shall be placed above the main exit and · doors-----~---'----~--~----'-----'--'-------------- ·_·_ 1:1. EXIT signs (6'} x ¾" ·1etters) shall be placed over all required exiits ahd di.rectional signs· located as necessary to clearly lndicate the loc~tion of exit doors .. · · GENERAL __ 12. Storage, dispensing or use of any-flammable or combustible liquids, flammable liquids, flammable gas1;3s and . hazardous chemicals shall comply with_ Uniform Fire Code.· · ____ 13. . Building(s) not approved for high piled combustible stock. Storage]n closely packed piles'sha11· not exceed 15 feet ·in heigh~, 12 feet on pallets or !n racks and 6 feet for tires, plastics and some flammable liquids, If high stock pil- ing is to be done, comply with Unfform Fire Code, .Article 81. . · · · ' · __ 14. Additional Requirements. -----------~---=--------~-------- --15. Comply with regulati_ons on attached sheet(s). . Plan Examinera..t.:.-~---r,..--, -b ,' ' i- Date~l.,,_/_4-+, -,,./-?+-'=?Ji------- Repor:t mailed to architect ___ Met with:-----------'-~-------"~~-__ Attach to Plans ,, . . . COMMERCIAL/INDUSTRIAL APPLICATION FORM FOR INDUSTRIAL WASTE DISCH~RGE PERMIT CITY OF CARLSBAD APPLICATION: NEW -----(CHE~K ONE) REVISED ___ _., ~~~<?: < ~ature of City Representative BUILDING P.C. NO. :CJ io ... z_ APPLICATION NO. : -----INDUSTRIAL CLASS: -----DATE: ---------- APPLICATION FOR INDUSTRIAL WASTE DISCHARGE PERMIT A. GENERAL: APPLICANT: ~1..A'f'1~ ,AmQUC4,-J SITE ADDRESS: -------- TYPE Of BUSINESS: .~c...E" ( r1t.1ANC-t'AW APPLICANT'S ADDRESS: 2o\ SoJ-r1.¼ 112-fo~ S:f I 'P,6 p;.o;< -:ol4B€> C k\av-lo±l.e. J N,G z.0z:2_. \ 8. WASTES AND PROCESSING: (Check where applicable) 1:1 Domestic Waste Only 1:1 I~dustrial Waste )21 I~dustrial Waste NOT Discharged to Sewer Discharged to Sewer GENERAL DESCRIPTION OF WASTE (Chemical and Physical Characteristics Qf proposed waste): Tet::1!\:NT :Cmpnre..mrn +:: in :5bcll e,ld::~r N.o PdnLho-r-iJl f\y,.J."n~ . I ~4$ 9f' OF "*-RI'.£ SPl'U. GENERAL DESCRIPTION Of PROCESS (If Applicabie): ----------- C. WASTES TO BE DISCHARGED TO SEWER: WASTE: TREATED: ( Ch.eek One) UNTREA T,.,,Ell"'"':-. -- QUANTITY: AVERAGE ____ GPO (Daily) MAXIMUM....----,..--....-GPD (Gallons Per Day) APPLICANT OR REPRESENTATIVE Of FIRM: J:1.-t:NT· ~ ----"'------(,...P-ri ..... n_t ___ ) ______ _ TITLE' 17,,;,T SIGNAT-UR_E __ = ---~~-wi-.-< -o-~--~ DATE: ___ \_• "2._·_,....,D ______ _