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Home My WebLink About1950 CALLE BARCELONA; ; CB142190; Permit09-30-2014 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB142190 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: 1950 CALLE BARCELONA CBAD Tl Sub Type: COMM 2550121500 Lot#: 0 $22,635.00 Construction Type: 5B Reference # LA COSTA GLEN: 450 SF Tl OFFIC TO OFFICE Status: ISSUED Applied: 08/27/2014 Entered By: JMA Plan Approved: 09/30/2014 Issued: 09/30/2014 Inspect Area Plan Check #: Applicant: JONATHAN MA STE 500 19000 MACARTHUR BLVD IRVINE CA 92612-1460 949-720-3850 Owner: CONTINUING LIFE COMMUNITIES CHC LLC 1940LEVANTE ST CARLSBADCA 92009 Building Permit $254.27 Meter Size Add1 Building Permit Fee $0.00 Add'l Red. Water Con. Fee $0.00 Plan Check $177.99 Meter Fee $0.00 Add1 Building Permit Fee $0.00 SDCWA Fee $0.00 Plan Check Discount $0.00 CFD Payoff Fee $0.00 Strong Motion Fee $4.75 PFF (3105540) $0.00 Park Fee $0.00 PFF (4305540) $0.00 LFM Fee $0.00 License Tax (3104193) $0.00 Bridge Fee $0.00 License Tax (4304193) $0.00 BTD #2 Fee $0.00 Traffic Impact Fee (3105541) $0.00 BTD #3 Fee $0.00 Traffic Impact Fee (4305541) $0.00 Renewal Fee $0.00 PLUMBING TOTAL $47.00 Add1 Renewal Fee $0.00 ELECTRICAL TOTAL $0.00 Other Building Fee $0.00 MECHANICAL TOTAL $42.45 Pot. Water Con. Fee $0.00 Master Drainage Fee $0.00 Meter Size Sewer Fee $0.00 Add1 Pot. Water Con. Fee $0.00 Redev Parking Fee $0.00 Reel. Water Con. Fee $0.00 Additional Fees $0.00 Green Bldg Stands (SB1473) Fee $1.00 HMP Fee ?? Fire Expedidted Plan Review $0.00 Green Bldg Standards Plan Chk ?? TOTAL PERMIT FEES $527.46 Total Fees: $527.46 Total Payments To Date: $527.46 Balance Due: $0.00 Inspector: FINAL A Date: '\BPROyAL Clearance: NOTICE: Please take NOTlCE'that approval of your project includes the Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions, if you protest them, you must follow the protest procedures set forth in Govemment Code Section 66020(a), and fiie the protest and any other required infonnation with the City Manager for processing in accordance with Carlsbad IWunicipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which vou have oreviouslv been given a NOTICE similar to this, or as to which the statute of limitations has oreviouslv otherwise expired. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: (ZlPLANNiNG nENGINEERING •BUILDING nFIRE nHEALTH IZlHAZMAT/APCD ^ CITY OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax:760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Plan Check No. (^fe\^-'2i "T^D Est. Value f 7^Z^(p3S. Plan Ck. Deposit Date SWPPP JOB ADDRESS 1950 Calle Barcelona SUITE#/SPACE#/UNIT# CT/PROJECT # # BEDROOMS # BATHROOMS 0 TENANT BUSINESS NAME enbrook Assisted Living FagMj CONSTR. TYPE V OCC. GROUP R.2.1 DESCRIPTION OF WORK: /nc/ude SQuare Feet of Affected Area(s) 450 sq.ft. area of modification wliich includes exterior window modification, interior wall infill, roof framing renovation, interior mechanical, plumbing work^t^tjjB^^^fi^^l^^i^ht&^^^i^n^/ EXISTING USE R-2.1 PROPOSED USE Same GARAGE (SF) 0 PATIOS (SF) 0 DECKS (SF) FIREPI_ACE YES I |# N0[7] AIR CONDITIONING YES I iNofTj FlRESPRINKLERS YES I iNOin APPLICANT NAIVIE Jonathan Ma PROPERTYOWNER NAIVIE Continuing Life Communities ADDRESS Same as Design Professional ADDRESS 1940 Levante Street CITY STATE ZIP CITY Carlsbad STATE CA ZIP 92009 PHONE FAX PHONE 760-704-6255 FAX 760-704-6262 EMAIL EMAIL jwilson@spk.com DESIGN PROFESSIONAL Douglas Pancake Architects CONTRACTOR BUS. NAME RD Olson ADDRESS 19000 l\<lacArthur Blvd, Suite 500 ADDRESS 2955 Main Street, 3rd Floor CITY STATE Irvine CA ZIP 92612 CITY Irvine STATE ZIP CA926|a PHONE 949-720-3850 FAX 949-720-3843 PHONE 949-474-2001 FAX 949-474-1534 EMAIL jonathanm@pancakearchitects.com EMAIL dcromelin@rdolson.com STATE LIC. # C-27254 B-953845 CLASS B CITY BUS. LIC.# 1233612 (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, aiter, improve, demolish or repair any structure, prior to its issuance, also requires the applioantfor such permit to file a signed statement that he is licensed pursuant to the provisions ofthe Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 ofthe Business and Professions Code} or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 civil penally of not more than five hundred dollars ($500)). ling 5 by any applicant for a permit subjects the applicant to a WORKERS' COMPENSATI Workers' Compensation Declaration: / hereby affirm under penalty ofpeijury one ofthe foltowing declarations: I i have and will maintain a certificate of consent to self-insure for worl<ers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I I have and will maintain worlters' compensation, as required by Section 3700 of the Labor Code, for the performance of the yioik lor which this permit is issued. My worlters' compensatioivinsurance canier and policy number are: insurance Co. ^/( f/xvi-f 'I?y>-t> ijrjxyvf c fyi'^T'^jC^ Policy No. _ fOf)m%<C>^0-lHl Expiration Dale 7// /^gjO This section need not be completed if the permit is for one hundred dollars ($100) or less. I I Certificate of Exemption: i certify that In the performance of the worl( 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 Califomia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an empioyer to criminal penalties and civil fines up to one hundred thousand doiiars (&100,000), in addition to the cost of compensation, 6awe§St as provided for in Section 3706 of the Labor code, interest and attorney's fees. CONTRACTOR SIGNATURE T/-^X^/l~^tA(^ S^J^ ^AA ^ 2^ QAGENT DATE O W N E R - B (/I I. D E R D E C L A R A T I O N / hereby affirm that I am exempt from Contractor's License Law for the following reason: I I 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 I 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 I I am exempt under Section _ .Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for constnjction of the proposed property improvement. I lYes •NO 2.1 (have / have not) signed an application for a building pemiit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed constnjction (include name address / phone / contractors' license number): 4.1 plan to provide portions of the wor1<, but I have hired the following person to coordinate, supen/ise and provide the major work (include name / address / phone / contractors' license number): 6.1 wili provide some of the work, but I have contracted (hired) Ihe following persons to provide the work indicated (include name / address / phone / type of work): >£f PROPERTY OWNER SIGNATURE •AGENT DATE COM IP LETE THIS SECTION FOR NON-RESIDENTIAt BUILDING PER 1$ the applkant or future bulking occup»it required to submit a business plan, acutely hazardous materials registiation form or risk management and prevenlfon program under Sections 25505,25533 or 25534 of the Pf8»l»y-Tann«r Hazardous Subslance Account Act? Yes No Is the applicaiTtw future bulking occupant required to obtain a pennit from the air pollutwn control district or ai^ Yes •/ No Is the fac% to be constructed within 1,000 feet of the outer boundary of a school site? Yes •/ No IF AMY 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. CONSTRUCTION L E N D i N G A GEN C Y I hereby affirm that there is a construction lending agency for the perfomiance of the work this pernilt Is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address APPLICANT C E R T I F f C A T ION I carter th« I hM i«sd the applkathw and slate tM the abcm Infi^^ IherebyauftorizBiepreswitaSw of»» City of Cailsbad ID enteric AGAINST ALL UAaUTlES, JUDGfceJTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAWST SAID COY IN CONSEQUENCE OF THE GRANTING OF THIS PERMfF. OSHA An (3SHA pernilt is lequired for e)ovations (wer 511'deep and demoffon w consln^^ E)ff^TKM: B«ry pemiit Issued by tw Buiding OlSdal under the pRWi^^ 180 days liom lie dale of such pemt or if Sie bulding or wnk authorized by such perr^ >£^APPUCANTS SIGNATURE DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the foiiowing ONLY if a Certificate of Occupancy will be requested at finai inspection. Fax (760) 602-«560, Email building(5)cai1sbadca.gov or Man the c»mpieted fomi to Dty of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, Califbmia 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADORESS CITY STATE ZIP cmr STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANTS BUS. UC. No. DEUVERY OPnONS PICK UP: CONTACT (Listed above) OCCUPANT (Usted above) CONTRACTOR (On Pg. 1) MAILTO: CONTACT (Usted above) OCCUPAT^ (Usted above) CONTRACTOR (On Pg. 1) MAIL/FAX TO OTHER: ASSOCIATED CB* NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION ASSOCIATED CB* NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION .CS'APPUCANrS SIGNATURE OATE Inspection List Permit#: CB142190 Date Inspection Item 02/02/2015 89 Final Combo 02/02/2015 89 01/21/2015 85 01/21/2015 85 12/10/2014 17 12/08/2014 17 12/02/2014 84 Type: Tl Final Combo T-Bar T-Bar Interior Lath/Drywall Interior Lath/Drywall Rough Combo COMM Inspector PY PY PY PY PY Act Rl AP Rl AP AP CA AP LA COSTA GLEN: 450 SF Tl OFFIC TO OFFICE Comments Tuesday, February 03, 2015 Page 1 of 1 Carlsbad 14-2190 9/9/14 EsGil Corporation In (Partnership witH government for (BuUding Safety DATE: 9/9/14 • APPLICANT • JURIS, JURISDICTION: Carlsbad • PLAN REVIEWER • FILE PLANCHECKNO.: 14-2190 SET: I PROJECT ADDRESS: 1950 Calle Barcelona PROJECT NAME: New HVAC and Misc. Remodel Of Admin. Office Xl The plans transmittecJ herewith have been corrected where necessary ancd substantially comply with the jurisdiction's building codes. I I 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. I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. I I The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. I I The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. I I The applicant's copy of the check list has been sent to: EsGil Corporation staff did not advise the applicant that the plan check has been completed. I I EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Email: Fax #: Mail Telephone Fax In Person • REMARKS: By: Chuck Mendenhall Enclosures: EsGil Corporation • GA • EJ • MB • PC 9/2/14 Carlsbad 14-2190 9/9714 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLANCHECKNO.: 14-2190 PREPARED BY: Chuck Mendenhall DATE: 9/9/14 BUILDING ADDRESS: 1950 Calle Barcelona BUILDING OCCUPANCY: 1-2 BUILDING PORTION AREA ( Sq. Ft.) Valu ation Multiplier Reg. Mod. VALUE ($) Misc Remodel NA Hrly Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdlctbn Co6e Cb By Ordinance Bldg. Permit Fee by Ordinance ^ Plan Check Fee by Ordinance Type of Review: • Connplete Review • structural Only •Repetitive Fee Repeats Based on hourly rate • Other y Hourlv EsGil Fee 1.5 Hrs. @ * $150.00 Comments: NA |n addition to the above fee, an additional fee of $ $ /hr.) for the CalGreen review. is due ( hours @ Sheet 1 of 1 macvalue.doc + PLAN CHECK PLAN CHECK Community & Economic CITY OF REVIEW Development Department 1635 Faraday Avenue CARLSBAD TRANSMITTAL Carlsbad CA 92008 www.carlsbadca.gov DATE: 9/02/14 PROJECT NAME:Glenbrook Skilled Nursing Facility expansionpROJECT ID: PLAN CHECK NO: CB14-2190 SET#: I ADDRESS: 1950 Calle Barcelona APN:255-012-15 VALUATION: $22,635 APPLICANT CONTACT: jonathanm@pancakearchitects.com X THs plan check review transmittal is to notify you of clearance by: LAND DEVELOPMENT ENGINEERING DIVISION Final Inspe ction by the Construction & Inspection Division is required: Yes No X fSSf For status from a division not marked below, please call 760-602-2719 This plan check review is NOTCOMPLETE Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. LAND DEVELOPMENT ENG. 760-602-2750 \/ Linda Ontiveros X\ 760-602-2773 Linda.Qntiveros@carlsbadca.gov : 1 ! Remarks: ^ CITY OF CARLSBAD PLANNING DIVISION BUILDING PLAN CHECK APPROVAL P-29 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carisbadca.eov DATE: 8-28-14 PROJECTNAME: PROJECT ID: PLAN CHECK NO: CB 14-2190 SET#: 1 ADDRESS: 1950 Calle Barcelona APN: ^ This plan check review is connplete and has been APPROVED by the Planning Division. By: Chris Sexton A Final Inspection by the Planning Division is required • Yes ^ 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. []] 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: jwilson@spk.com For questions or clarifications on the attached checl<list please contact the following reviewer as marked: PLANNING 760-602-4610 ENGINEERING 760-602-2750 FIRE PREVENTION 760-602-4665 X Chris Sexton 760-602-4624 Chrls.Sexton@carlsbadca.gov 1 1 Kathleen Lawrence 760-602-2741 Kathleen.Lawrence@carlsbadca.gov 1 1 Greg Ryan 760-602-4663 G regorv. R va n@ca rlsbadca.gov 1 1 Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov 1 1 Linda Ontiveros 760-602-2773 Linda.Ontiveros@carlsbadca.gov Q Cindy Wong 760-602-4662 Cvnthia.Wong@carlsbadca.gov • • 1 1 Dominic Fieri 760-602-4664 Dominic.Fieri@carlsbadca.gov Remarks: ^ CITY OF CARLSBAD PLAN CHECK REVIEW TRANSMITTAL COPY Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www.carlsbadca.gov DATE: 09.10.2014 PROJECT NAME: GLENBROOK ASSISTED LIVING FAC. PROJECT ID: CB142190 PLAN CHECK NO: 1 SET#: 1 ADDRESS: 1950 CALLE BARCELOIVA APN: • This plan check review Is complete and has been APPROVED by the FIRE Division. By: G. RYAN A Final Inspection by the FiRE 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: You may also have corrections from one or more of the divisions Usted below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted pians should include corrections from ali divisions. For questions or clarifications on the attached checklist please contact the following reviewer as marked: £x^^^?^^^^S9HHBHHH&lfiHi»l^^il^^^.'' 1 1 Chris Sexton 760-602-4624 Chris.Sexton@carlsbadca.gov 1 1 Kathleen Lawrence 760-602-2741 Kathleen.Lawrence@carlsbadca.gov X Greg Ryan 760-602-4663 Gregory.Ryan@carlsbadca.gov 1 1 Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov 1 1 Linda Ontiveros 760-602-2773 Linda.Ontiveros@carlsbadca.gov Q Cindy Wong 760-602-4662 Cvnthia.Wong@carlsbadca.gov • • 1 1 Dominic Fieri 760-602-4664 Dominic.Fleri@carlsbadca.gov Remarks: See Attached Carlsbad Fire Department BUILDING DEPT, COPY Plan Review Date ofReport: Requirements Category: TI, COMM 09-10-2014 Reviewed by: Name: Address: JONATHAN MA 19000 MACARTHUR BLVD STE 500 IRVINE CA 92612-1460 Permit #: CB142190 Job Name: Job Address: LA COSTA GLEN: 450 SF TI OFFIC 1950 CALLE BARCELONA CBAD Please review carefully all comments attached. Conditions: CITY OF CARLSBAD FIRE DEPARTMENT - APPROVED: THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF BUILDING PERMIT. THIS APPROVAL IS SUBJECT TO FIELD INSPECTION AND REQUIRED TEST, NOTATIONS HEREON, CONDITIONS IN CORRESPONDENCE AND CONFORMANCE WITH ALL APPLICABLE REGULATIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE THE VIOLATION OF ANY LAW. Entry: 09/10/2014 By: GR Action: AP PLUMBING, Development Services ELECTRICAL, Building Division CITY OF MECHANICAL 1635 Faraday Avenue 760-602-2719 CARLSBAD WORKSHEET B-18 www.carisbadca.eov BuildineOcarlsbadca.sov Project Address: / 9ro <^A*t.-e- /S^ve^ei-^A Pemiit No.: Information provided bsiow refers to wortt being done an the above mentioned permit only. This form must be completed and returned to the Building Division before the pennit con be issued. Building Dept Fax: (760) 602-8558 Numfc>er of new or relocated fixtures, traps, or floor drains. New building sewer line? » ....... . .. .... Ves No. Number of new roof drains? _ Install/alter water line?.... Number of new water heaters?., Number of new, relocated or replaced gas outlets?. Number of new hose bibs?. Residential Pennits: New/expanded service: Number of new amps: Minor Remodel onfy: Ves No Commercial/Industrial: Tenant Improyement: Number of existing amps involve in this project Number of new amps involved in this proiect New Construction: Amps per Panel: Single Phase Number of new amperes_ Three Phase . Numlaer of new amperes_ Three Phase 480 ............. ..... Number of new amperes_ Number of new furnaces, A/C, or heat pumps?. New or relocated duct wori?? Ves Xi No. Number of new fireplaces?. Number of new exhaust fans?.. Relocate/install vent? _^_J.^ Number of new exhaust hoods? ... „—.—«... y Numlier of new boilers or compressors? —.~ . .....— Number of HP B-18 Page 1 of 1 Rev. 03/09 INDUSTRIAL WASTEWATER DISCHARGE PERMIT ^ / / SCREENING SURVEY Date ^A//// Business Name <^t^rsri^fc. ^ <^^7^ Qroe^ Street Address /9 rt> C-^^-c^^ ^it^tcei^jf Email Address ^6^CI?^A.A^/^ ^ AA^r^j^jLr-cAi-f-ejeJf. com WASTEWATRV PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) Check all below that are present at your facility: m Acid Gleaning Assembly Automotive Repair Battery Manufacturing Biofuel Manufacturing Biotech Laboratory Bulk Chemical Storage Car Wash Chemical Manufacturing Chemical Purification Dry Cleaning Electrical Component Manufacturing Fertilizer Manufacturing Film / X-ray Processing Food Processing Glass Manufacturing Industrial Laundry Ink Manufacturing Laboratory Machining / Milling Manufacturing Membrane Manufacturing (i.e. water filter membranes) Metal Casting / Fomning Metal Fabrication Metal Finishing Electroplating Electroless plating Anodizing Coating (i.e. phosphating) Chemical Etching / Milling Printed Circuit Board Manufacturing Metal Powders Fomning Nutritional Supplement/ Vitamin Manufacturing Painting / Finishing Paint Manufacturing Personal Care Products Manufacturing Pesticide Manufacturing / Packaging Phannaceutical Manufacturing (including precursors) Porcelain Enameling Power Generation Print Shop Research and Development Rubber Manufacturing Semiconductor Manufacturing Soap / Detergent Manufacturing Waste Treatment / Storage SIC Code(s) (if known): Brief description of business activities (Production / Manufacturing Operations):. Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal / day): List hazardous wastes generated (type/volume): Date operation began/or will begin at this location: Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes No Ifyes. when: Site Contact ^^^^^^^^.J^f^^h^iH^uU^ Title f^^ecT /U4^4ffsr^ Signature, Phone No. ENCINA WASTEWA*Fei^ AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760)438-3941 ' X 2- FAX: (760)476-9852 ^ SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE / Business Name Business Contact <C^r^f/NUf^£r £^f« ^t^mi/A/lTie^ r/i^'WiKl *VIU&A/ Telephone # {7^o \ Project Address City state zip Code APN# Mailing Address City state Zip Code Plan File* Project Contact , •J<H^A- nh^ HA- Telephone # 72^- The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIViSION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items arecircled, applicant must contact the Fire ProtectionAgency with jurisdiction prior to plan submittal. Facility's Square Footage (including proposed project): r-«r-o Occupancy Rating: p / 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 DIVISIONS (HMD): If the answer to anv of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overiand Ave., Suite 110, San Diego, CA 92123. CaH (858) 505-6700 prior to the issuance of a building pennit. Project Completion Date:, / / Expected Date of Occupancy:. / / Date Initials • CalARP Required I Date Initials FEES ARE REQUIRED. YES NO (for new construction or remodeling projects) 1 • • 31 Is your business listed on the reverse side of this form? (check all that apply). 2. • ^ 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 equal to or greater than 55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity? 4. • ^ WHI your business use an existing or install an underground storage tank? 5. • S Will your business store or handle Regulated Substances (CalARP)? 6. • Sl Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 7. • Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below Is yes, applicant must contact the Air Poikition Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit Note: if the answer to questions 4 or 5 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 wori<ing days prior to cc»Timencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information. • CalARP Exempt I • CalARP Complete I Date initials YES • 2. • • 3. 4. 5. • • • 9^ Will the subject facility or constructkjn activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at http://www.sdaDcd.ora/info/facts/Dermits.Ddf, and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)? (Search the Califomia School Directory at httD://www.cde.ca.gov/re/sd/ for public and private schools or contact the appropriate school district). Has a survey been performed to detennine the presence of Asbestos Containing Materials? WHI there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? WHI there be demolition involving the removal of a load supporting structural member? Briefly descn°be business activities: Briefly describe proposed project: I dedare.under pena|ty of perjury that to the best of my knowledge and belief thejsspoa Name of Owner or Authorized Agent lecein are true and correct. Signaturgi^i^wnel- or Authorized Agent S I Z.7 I l<f Date ' FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. BY: FOR OFFICIAL USE ONLY: DATE: EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMTr BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY cou^m'-HMD* APCD COIMTY-HMD APCD COUNTY-HMD APCD HM-9171 (02/11) County of San Diego - DEH - Hazardous Materials Division CB142190 1950 CALLE BARCELONA LA COSTA GLEN: 450 SF Tl OFFIC TO OFFICE 3/?8//y pUJiui- CO Final Inspection required by: • Plan • CM&I • Fire QissuED I acv. Approved Date Bv BUILDING om PLANNING ENGINEERING 9'/^7/L/ FIRE Expedite? Y(^^ DIGn-AL FILES Required? Y N Si ^ HazMat APCD Health Forms/Fees sent Rec'd Due? By Encina Y N Fire Y N HazHealthAPCD Y N PE&IVI Y N School ^r—*(' 1 Y N Sewer Y N Stormwater Y N Special Inspection Y N CFD: Y N 1 LandUse; Density: ImpArea: FY: Annex: Factor: PFF: Y N Comments Date Date Date Building Planning Engineering Fire Need? ' u • • 01 Done • Done • Done