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Home My WebLink About2020 CASSIA RD; 102; CB080109; Permit02-04-2008 City of Carlsbad 1635 Faraday Av Carlsbad CA 92008 Commercial/Industrial Peimit Permit No Building Inspection Request Line (760) 602-2725 CB080109 Job Address Permit Type Parcel No Valuation Occupancy Group Project Title 2020 CASSIA RD CBAD St 102 Tl Sub Type 2150210200 Lot# $87 655 00 Construction Type Reference # HULSE SHELL TO OFFICE/1865SF Tl COMM 0 VN Applicant UTGARD CONSTRUCTION STEL 12225 WORLD TRADE DR SAN DIEGO CA 92108 6192930234 Status ISSUED Applied 01/15/2008 Entered By JMA Plan Approved 02/04/2008 Issued 02/04/2008 Inspect Area Plan Check* Owner FRANZ FAMILY REVOCABLE TRUST 06 26 96 P 0 BOX 2711 RANCHOSANTAFECA 92067 Building Permit Add I Building Permit Fee Plan Check Add I Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add I Renewal Fee Other Building Fee Pot Water Con Fee Meter Size Add I Pot Water Con Fee Reel Water Con Fee $545 86 $000 $354 81 $000 $000 $1841 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 Meter Size Add I Reel Water Con Fee Meter Fee SDCWA Fee CFD Payoff Fee PFF (3 105540) PFF (4305540) License Tax (3104193) License Tax (4304 193) Traffic Impact Fee (3105541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fe< Additional Fees HMP Fee TOTAL PERMIT FEES , $000 $000 $000 $000 $1 595 32 $000 $000 $000 $2 520 00 $000 $3400 $2000 $5900 $000 $1 326 60 $000 $000 9? $6 474 00 Total Fees $6 474 00 Total Payments To Date $354 81 Balance Due $611919 BUILDING FLANb IN STORAGE ATTACHED Inspector Clearance NOTICE Please take NOTICE that approval of your project includes the Imposition of fees dedications resftvations 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 Government Code Section 66020(a) and file the protest and any othe r required information with the City Manager for proce sing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will bar any subsequent legal action to attack review set aside void or annul their imposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPL < 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 limitations has previously otherwise expired City of Carlsbad 1635 Faraday Ave Carlsbad CA 92008 760-602 2717 / 2718 / 2719/2721 Fax 760-602-8558 Building Permit Application Est Value S""7y PlanCk Deposit Date JOBADORESS 2Q20 Cassig R()ad / RO CI AS re 0 OO 0 /s / BA 00 0 102 215 020 26 Cameron Hulse D D S Orthodontic VN B TI Partition Wall Mechanical Electrical & plumbing EXISTING USE P Vacant ROPOSED USE GARAGE (SF) Dentist 0 CONTACT NAME Rague + Assoc|ates ADDRESS r^ r* CI7Y San Diego PHONE6192930234 STATCCA Z'P 92108 FAX 619 293 0484 EMAIL kui@ragueassoc com PROPERTY OWNER NAME g Qyf COPSUltantS 2710 Loker Ave West Suite 100 CITY , .Carlsbad PHONE 760 931 7700 STATECA Z'P 92010 FAX 760 931 8680 EMAIL lupeo@odayconsultants com RC / E E4ADD ESS Rague+ Associates ST T PATIOS (SF) DECKS (SFI FIREPLACE AIR CONDITIONING FIRE SPRINKLERS 0 0 YESQ* N00 YES[7] NOD YESd N0l~l APPLICANT NAME Rague + Assoc|ates (Ku| Tan) ADDRESS CITY STATE ZIP PHONE FAX EMAIL CONTRACTOR BUS NAME utgard Construction Co Inc ADDRESS _. o12225 World Trsds Dr Suits L CITY SanD,ego STATCCA Z'P 92128 PHONE 858 674 8040 ™ 858 673 1 064 EMAIL stephanie@utgardconstruction com EUC LASS TV 563379 B 1221657 (St 7011 SB and Pr f Cod Am Gt» Cou ty tudi q p mm en tract, alt , imp w d mot tt or ... ___. „ . , „r mti Dunuarit Itbprov fthCoUenUtw (Qiapt 9 co me d g th Sector) 7000 f 0 3 f th Bus cu and Profmon Cod > th t h S 01011 7031S by nyapplon fo p rmit b]e th appltantt cml ptnalty I not or than five h d d d Han {$500}) theapplcanf chpnnttW HI d t tthath p tt« Km, md th tas for III allttid mpti Any 1 mm of W ke Compe sati Decl rata I hereby ffirm de p a/fy fpequryon fth Mow gdecl radon || I have dwillma ta certificate of co se t to self-i ref work rs compe sat asprovdedby Sect 3700 f the Labo Cod f theperfonn nee fthewoikf whchth permt ss ed l/j | have d Will ma fa w kers compe sab as req red by Seed 3700 f the Labo Code f the perf mi nee f the work fo wh h th permit issued My work rs co pe ato ns ce came d pol cy mbe re I ranceCo State Fund P licyNo 3006531 2008 Exp at D te 01 01 2009 Th sectro eed tbeco pi ted if the permit f h dred doll rs ($100) less [~~| Certfcate fExempti Icertrfythat the performance of the work fo whchth permt issued I hallnot ploy nyperson any ne soast become ubjectt th W rk rs Compe at Laws f Califom WARNING F I re to sec rework rs compe sat cove age lawf I d hall subject empl ye to tmnalpe Ities nd civil fi pto neh dredtho sandd II re(&100000) ddb toth cost f compe sab damages^ p videdf Sect 3706 fth Labo cod tere t nd tto ney1 fee ^CONTRACTORSIGNATURE |6VM 0W DATE is Ih rvby ffifm that I am mpt from Contractor* Uc Lawforth foil wi ore on [ | I as wne fth property y ployee with wages as th sol compensatio willdoth work ndthe truct re not tended fferedfo sale(Sec 7044 B ess ndProfess nsCode Th Co tract r1 — Uce se Law does not appry t owne of property who b Id mprov thereo d who does uch work h self through h ow ployees provKjed that uch mpro me ts are not t nded off red f sal If howe th b Idng mprov m I soldwith ney ofcompl li th owne b Ide wiilhav theb rd ofprovngth thedid tb rid pro f th p rpose f al ) I I I as wne fth property xd elyco tracti gwithiK^nsedco tractorst constructth project(Se 7044 Bu ess ndProfess Cod Th Co tract ? UcenseLawdoes tapplyt wne f — propertywhob Id pro esth reo ndco tract fo oh projects with co tractor) (tee sedp rs It Ih Co tractor1 UcenseLaw) | | I mpl nde Sect B ess ndProfess nsCodefo th reaso 1 Ipersoallypl to pro Kl themjolabo ndmat al fo con tructio f the proposed property mprovem t [ [Yes | |N 2 I (hav / hav not) igned pplicat fo b Id g perm t fo the proposed work 3lh co t acted with th foil wing peison (firm) to provKte th proposedco trucwo ( dud am address/pho /co tact rs Ice se mbe) 4 I pi tpovideport fthework butlhav hredthef llowngperso tocoord at pervise ndprovde the map work ( d de me / addres /ph ne/co tact rs Ice se mbe) Slwtllproid som f the vrork b 11 hav co tracted (h red) the followi g p rson t provrie the work ndicated ( dude ame/add ss/pho /type fwork) xgfpROPERTY OWNER SIGNATURE DATE es^poora POQ GSOGJ ESSTJDQCDTJD.QII, Qtuaaqoocg I th appl ca t ft b Id ng occ pant req red to b t bus ness plan tely hazard mat I reg trat form k m agem t nd prev t prog am nde Sect ns 25505 25533 25534 f th Presley! Hazardous S b t nee Acco (At nYes D^ I (h applica t fut re b ild g occup t req ed t obt permit from the pollut co trol d tnct a q I ty management d tnct EHYes [~~|NO th facltyt be constnKrted with 10OOfeetofthe te bo d ry f school it [I]Yes |)N : AUVflCTUC AM.QUUPRR A PC VPS A PIMAI HFRTIFirATF nF nrrilPAUrV MAV MflT RPICCJ icn IIMI PCCTUC ADDIIPAUTUAI I hereby afiim that there s a construction lend ng agency for the performance of the work this perm t is issued (Sec 3097 (i) C /il Code) Lender's Name Lender's Address Icertrfymatltiavereadmeapplcatjo d state that t)i above nformati is correct dtjiattti nformatio ontti pla accurate. I agree to omply with all City id a ces and State laws relati gtob M ngconstnidjo I hereby uthonze representative ftheQtyofCarboarJtoenter pon the atnvementmed property for inspecton|Xin^iS8& OSHAAnOSHApermitsrequiedfbr xr^ations(MiffO'o^andd8trajltCT(jcxxisSijctnnof strudijesOTerSstones height EXPIRATION Ewi^F«™1'ss^'>V*eBu>^w'adu^a^P''i™wB<i''tiKCodeshaI xpre by imtolion and become null and vorirfth buWng or work aulhonzed by such permit is not commenced w*i 180daysframtMdateofsuchpermitrxiftjBburJiivjaautliori^^su^ suspended a abandoned al any tone after the work oommenoed for pnod of 180rfays (Section 106 44 Urefcrm BuiMmg Code) ^•APPLICANTSSIGNATURE DA1E Inspection List Permit# CB080109 Date Inspection Item 04/10/2008 89 Final Combo 04/10/200889 Final Combo 03/06/2008 84 02/19/2008 17 02/12/2008 84 02/05/2008 21 02/05/2008 24 Type Tl Rough Combo Interior Lath/Drywall Rough Combo Underground/Under Floor Rough/Topout COMM Inspector Act Rl HULSE SHELL TO OFFICE/1865SF Tl Comments PD PC PC PC PC PC 02/05/2008 31 Underground/Conduit Winn PC AP AP AP PA AP PA AP EMRFORSTE102 WALLS & HARD LIDS OK TO D W WASTE ONLY Monday April 14 2008 Page 1 of 1 City of Carlsbad Bldg Inspection Request For 04/10/2008 Permit# CB080109 Title HULSE SHELL TO OFFICE/1865SF Description Tl Inspector Assignment PC Sub Type COMM 2020 CASSIA RD 102 Lot Type Tl Job Address Suite Location OWNER FRANZ FAMILY REVOCABLE TRUST 06 26 96 Owner AMHERST PROPERTIES INC Remarks Phone 6198405551 lnsp( ctar Total Time CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Requested By STEVE Entered By JANEAN Act Comment Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 03/06/2008 84 Rough Combo 02/19/2008 17 Interior Lath/Drywall 02/12/2008 84 Rough Combo 02/05/2008 21 Underground/Under Floor 02/05/2008 24 Rough/Topout 02/05/2008 31 Underground/Conduit Wiring AP PC EMR FOR STE 102 AP PC PA PC WALLS & HARD LIDS OK 10 D W AP PC PA PC WASTE ONLY AP PC EsGil Corporation In Partners Kip with government for <Bui(cfiitg Safety DATE January 31, 2008 a APPLICANT a JURIS JURISDICTION Carlsbad a PLAN REVIEWER a FILE PLAN CHECK NO 08 0109 SET II PROJECT ADDRESS 2020 Cassia Road PROJECT NAME Dr Hulse TI XI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction s building codes The plans transmitted herewith will substantially comply with the jurisdiction s building codes when minor deficiencies identified below are resolved and checked by building department staff The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted fora complete re check The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck The applicant s copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person The applicant s copy of the check list has been sent to XI 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 Telephone # Date contacted (by ) Fax # Mail Telephone Fax In Person REMARKS By Bryan Zuppiger Enclosures Esgil Corporation D GA D MB D EJ D PC LOG trnsmtl dot 9320 Chesapeake Drive Suite 208 * San Diego California 92123 ^ (858)560 1468 * Fax (858) 560 1576 EsGil Corporation In Partners Kip -with government for (Building Safety DATE January 25, 2008 a APPLICANT JURISDICTION Carlsbad tTTD^TREVIEWER a FILE PLAN CHECK NO 08 0109 SET I PROJECT ADDRESS 2020 Cassia Roadpie. PROJECT NAME Hulse TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction s building codes The plans transmitted herewith will substantially comply with the jurisdiction s building codes when minor deficiencies identified below are resolved and checked by building department staff The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck X3 The check list transmitted herewith is for your information 1 he plans are being held at Esgil Corporation until corrected plans are submitted for recheck The applicant s copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person XI The applicant s copy of the check list has been sent to Kui Esgil Corporation staff did not advise the applicant that the plan check has been completed X] Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Kui/ (Y Telephone #619 293 0234 BhYIQS l*~ Date contacted *(by x ) Fax # 619 293 0484 Mail Telephone / Fax y/ln Person REMARKS By Bryan Zuppiger Enclosures Esgil Corporation D GA D MB D EJ D PC 01/17/2008 trnsmtl dot 9j20 Chesapeake Drive Suite 208 * San Diego California 92123 + (558)560 1468 + Fax (858) 560 1576 \ Carlsbad O8 0109 January 25,2008 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO 080109 OCCUPANCY B TYPE OF CONSTRUCTION VN SPRINKLERS'? unknown DATE PLANS RECEIVED BY JURISDICTION DATE INITIAL PLAN REVIEW COMPLETED January 25, 2008 JURISDICTION Carlsbad USE medical office ACTUAL AREA 1865ft2 OCCUPANTLO^D 18 DATE PLANS RECEIVED BY ESGIL CORPORATION O1/17/2008 PLAN REVIEWER Bryan Zuppiger This plan review is limited to the technical requirements contained in 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 2007 CBC that adopts the 2006 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 IBC Section 105 4 of the 2006 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, spec ification section, etc Be sure to enclose the marked up list when you submit the revised plans Carlsbad O8-O1O9 January 25, 2O08 . PLANS 1 Please make all corrections on the original tracings as requested in the correction list Submit three sets of plans for commercial/industrial projects (two sets of plans for residential projects) For expeditious processing corrected sets can be submitted in one of two ways a) Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department 1635 Faraday Avenue Carlsbad CA 92008 and (760) 602-2700 The City will route the plans to EsGil Corporation arid the Carlsbad Planning Engineering and Fire Departments b) Bring one corrected set of plans and calculations/reports to EsGil Corporation 9320 Chesapeake Drive Suite 208 San Diego CA 92123 and (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 2 Provide a statement on the Title Sheet of the plans This project shall comply with the 2007 California Building Code that adopts the 2006 IBC 2006 UMC 2006 UPC and 2005 NEC 3 Please revise the section numbers and notes on the plans to match the 2006 IBC as adopted by California 4 Please include the following in the Building Data on the Title Sheet • Occupancy Classification(s) o For Mixed Occupancy Buildings, state whether the non separated or separated option was chosen from IBC Section 508 3 • Description of Use * Type of Construction * Sprinklers Yes or No « Stories « Height * Floor Area • Occupant Load 5 Unable to locate 13/D2 as referenced on Sheet A-1 in window schedule 6 Please revise the plans to show a disabled accessible transaction counter located at a section of counter that is at least 36 long and no more than 28 to 34 high CBC Section 1122B 4 Carlsbad O8 O109 January 25, 20O8 The person responsible for their preparation must sign all final sheets of plans (California Business and Professions Code) 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 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 Bryan Zuppiger at Esgil Corporation Thank you Carlsbad O8 0109 January 25, 2008 JURISDICTION Carlsbad VALUATION AND PLAN CHECK FEE PLAN CHECK NO O8-01O9 PREPARED BY Bryan Zuppiger BUILDING ADDRESS 2020 Cassia Road BUILDING OCCUPANCY B DATE January 25, 2008 TYPE OF CONSTRUCTION VN BUILDING PORTION tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code AREA (Sq Ft) Valuation Multiplier 1865 "34^7 cb RIHn Pprmif FPP hv OrHtn^nro ^ i-noo By Ordinance Reg Mod >» VALUE ($) 64 100 *7,frS£m> 64,100 $449 25 Plan Check Fee by Ordinance Type of Review I I Repetitive FeeRepeats Complete Review D Other ,—i Hourly Structural Only Hour * $29201 Esgil Plan Review Fee $251 581 Comments macvalue doc Awifo r ks —; -IE n g i n eeriin g \ BUILDING PLANCHECK CHECKLIST DATE BUILDING PROJECT DESCRIPTION ASSESSOR S PARCEL NUMBER PLANCHECK NO CB Ofy-(QjQ -Svirr 102- ENGINEERING DEPARTMENT APPROVAL The item you have submitted for review has been approved The approval is based on plans information and/or specifications provided in your submittal therefore any changes to these items after this date including field modifications must be reviewed by this office to insure continued conformance with applicable codes Please review carefully all comments attached as failure to comply with instructions in this report can result in suspension of permit to build D A Right of Way permit is required prior to construction of the following improvements EST VALUE DENIAL Please see the attached report of deficiencies marked with D Make necessary corrections to plans or specifications for compliance with applicable codes and standards Submit corrected plans and/or specifications to this office for review By By By Date Date Date FOR OFFICIAL USE ONLY ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT 111Date ATTACHMENTS D Dedication Application D Dedication Checklist U Improvement Application D Improvement Checklist D Grading Permit Application D Grading Submittal Checklist D Neighborhood Improvement Agreement D Right of Way Permit Application [] Right of Way Permit Submittal Checklist and Information Sheet 0 Storm Water Applicability Checklist ENGINEERING DEPT CONTACT PERSON Name Linda Ontiveros City of Carlsbad Address 1635 F-araday Avenue Carlsbad CA 92008 Phone (760) 602 2773 CFD INFORMATION Parcel Map No Lots Recordation Carlsbad Tract 1635 Faraday Avenue • Carlsbad CA 920O8 7314 « (76O) 602 272O • FAX (760) 602 8562 ,.ST BUILDING PLANCHECK CHECKLIST SITE PLAN 1 Provide a fully dimensioned site plan drawn to scale Show A North Arrow F Right-of-Way Width & Adjacent Streets B Existing & Proposed Structures G Driveway widths C Existing Street Improvements H Existing or proposed sewer lateral D Property Lines I Existing or proposed water service E Easements J Existing or proposed irrigation service D D 2 Show on site plan A Drainage Patterns 1 Building pad surface drainage must maintain a minimum slope of one percent towards an adjoining street or an approved drainage course 2 ADD THE FOLLOWING NOTE Finish grade will provide a minimum positive drainage of 2% to swale 5 away from building B Existing & Proposed Slopes and Topography C Size type location alignment of existing or proposed sewer and water service (s) that serves the project Each unit requires a separate service however second dwelling units and apartment complexes are an exception D Sewer and water laterals should not be located within proposed driveways per standards 3 Include on title sheet A Site address B Assessor s Parcel Number C Legal Description For commercial/industrial buildings and tenant improvement projects include total building square footage with the square footage for each different use existing sewer permits showing square footage of different uses (manufacturing warehouse office etc ) previously approved EXISTING PERMIT NUMBER DESCRIPTION BUILDING PLANCHECK CHECKLIST ST1 D ..ND •vRD DISCRETIONARY APPROVAL COMPLIANCE 4a Project does not comply with the following Engineering Conditions of approval for Project No 4b All conditions are in compliance Date DEDICATION REQUIREMENTS 5 Dedication for all street Rights-of Way adjacent to the building site and any storm dram or utility easements on the building site is required for all new buildings and for remodels with a value at or exceeding $ 17,000 pursuant to Carlsbad Municipal Code Section 18 40 030 Dedication required as follows Dedication required Please have a registered Civil Engineer or Land Surveyor prepare the appropriate legal description together with an 8 Yz x 11 plat map and submit with a title report All easement documents must be approved and signed by owner(s) prior to issuance of Building Permit Attached please find an application form and submittal checklist for the dedication process Submit the completed application form with the required checklist items and fees to the Engineering Department in person Applications will not be accept by mail or fax Dedication completed by Date IMPROVEMENT REQUIREMENTS CH 6a All needed public improvements upon and adjacent to the building site must be constructed at time of building construction whenever the value of the construction exceeds $ 82,000 pursuant to Carlsbad Municipal Code Section 1840040 Public improvements required as follows Attached please find an application form and submittal checklist for the public improvement requirements A registered Civil Engineer must prepare the appropriate improvement plans and submit them together with the requirements on the attached checklist to the Engineering Department through a separate plan check process The completed application form and the requirements on the 3RD BUILDING PLANCHECK CHECKLIST checklist must be submitted in person Applications by mail or fax are not accepted Improvement plans must be approved appropriate securities posted and fees paid prior to issuance of building permit Improvement Plans signed by Date D 6b Construction of the public improvements may be deferred pursuant to Carlsbad Municipal Code Section 18 40 Please c ubmit a recent property title report or current grant deed on the property and processing fee of $430 so we may prepare the necessary Neighborhood Improvement Agreement This agreement must be signed notarized and approved by the City prior to issuance of a Building permit i Future public improvements required as follows D D 6c Enclosed please find your Neighborhood Improvement Agreement Please return agreement signed and notarized to the Engineering Department Neighborhood Improvement Agreement completed by Date D D D 6d No Public Improvements required SPECIAL NOTE Damaged or defective improvements found adiacent to building c ite must be repaired to the satisfaction of the City Inspector prior to occupancy GRADING PERMIT REQUIREMENTS The conditions that invoke the need for a grading permit are found in Section 15 16 010 of the Municipal Code D D 7a Inadequate information available on Site Plan to make a determination on grading requirements Include accurate grading quantities (cut fill import export) D D 7b Grading Permit required A separate grading plan prepared by a registered Civil Engineer must be submitted together with the completed application form attached NOTE The Grading Permit must be issued and rough grading approval obtained prior to issuance of a Building Permit Grading Inspector sign off by Date D D 7c Graded Pad Certification required (Note Pad certification may be required even if a grading permit is not required ) BUILDING PLANCHECK CHECKLIST ,.ST ^ND oRDI ^ O CH EH ED 7d No Grading Permit required D D D 7e If grading is not required write No Grading on plot plan MISCELLANEOUS PERMITS ED D RIGHT OF WAY PERMIT 8 A Right of Way permit is required to do work in City Right of Way and/or private work adjacent to the public Right of Way Types of work include but are not limited to street improvements tree trimming driveway construction tying into public storm dram sewer and water utilities To see requirements visit our website www carlsbadca/gov/engineenng Right of-Way permit required for INDUSTRIAL WASTE PERMIT 9 If your facility is located in the City of Carlsbad sewer service area you need to contact the Carlsbad Municipal Water District located at 5950 El Cammo Real Carlsbad CA 92008 District personnel can provide forms and assistance and will check to see if your business enterprise is on the EWA Exempt List You may telephone (760) 438 2722 extension 7153 for assistance Industrial Waste permit accepted by Date D D NPDES PERMIT 10 Complies with the Citys requirements of the National Pollutant Discharge Elimination System (NPDES) permit The applicant shall provide best management practices to reduce surface pollutants to an acceptable level prior to discharge to sensitive areas Plans for such improvements shall be approved by the City Engineer prior to issuance of grading or building permit whichever occurs first D D D STORM WATER APPLICABILITY CHECKLIST 10a D Requires PSWP (project storm water permit) # D Not required §4 D Q 11 II Required fees are-attaehed v\(\\s(z V?e*«»/ ^> \ \ U No fees required ^^ "^-fdJ-e d BUILDING PLANCHECK CHECKLIST . ST •>ND ,RD D D D WATER METER REVIEW 12a Domestic (potable) Use Ensure that the meter proposed by the owner/developer is not oversized Oversized meters are inaccurate during low-flow conditions If it is oversized for the life of the meter the City will not accurately bill the owner for the water used • All single family dwelling units receive standard 1 service with 5/8 service • If owner/developer proposes a size other than the standard then owner/developer must provide potable water demand calculations, which include total fixture counts and maximum water demand in gallons per minute (gpm) A typical fixture count and water demand worksheet is attached Once the gpm is provided check against the meter sizing schedule to verify the anticipated meler size for the unit • Maximum service and meter size is a 2 service with a 2 meter • If a developer is proposing a meter greater than 2 suggest the installation of multiple 2 services as needed to provide the anticipated demand (manifolds are considered on case by case basis to limit multiple trenching into the street) 12b Irrigation Use (where recycled water is not available) All irrigation meters must be sized via irrigation calculations (in gpm) prior to approval The developer must provide these calculations Please follow these guidelines 1 If the project is a newer developme nt (newer than 1998) check the recent improvement plans and observe if Ihe new irrigation service is reflected on the improvement sheets If so at the water meter station the demand in gpm may be listed there Irrigation services are listed with a circled I and potable water is typically a circled W The irrigation service should look like STA 1+00 Install 2 service and 1 5 meter (estimated 100 gpm) If the improvement plans do not list the irrigation meter and the service/meter will be installed via another instrument such as the building plans or grading plans (w/ a right of way permit of course) then the applicant must provide irrigation calculations for estimated worst-case irrigation demand (largest zone with the farthest reach) Once you have received a good example of irrigation calculations keep a set for your reference In general the calculations will include • Hydraulic grade line • Elevation at point of connection (POC) • Pressure at POC in pounds per square inch (PSI) • Worse case zone (largest farthest away from valve • Total Sprinkler heads listed (with gpm use per head) • Include a 10% residual pressure at point of connection .-ST «ND BUILDING PLANCHECK CHECKLIST 3 In general all major sloped areas of a subdivision/project are to be irrigated via separate irrigation meters (unless the project is only SFD with no HOA) As long as the project is located within the City recycled water service boundary the City intends on switching these irrigation services/meters to a new recycled water line in the future D 12c Irrigation Use (where recycled water is available) 1 Recycled water meters are sized the same as the irrigation meter above 2 If a project fronts a street with recycled water then they should be connecting to this line to irrigate slopes within the development For subdivisions this should have been identified and implemented on the improvement plans Installing recycled water meters is a benefit for the applicant since they are exempt from paying the San Diego County Water Capacity fees However if they front a street which the recycled water is there but is not live (sometimes they are charged with potable water until recycled water is available) then the applicant must pay the San Diego Water Capacity Charge If within three years the recycled water line is v charged with recycled water by CMWD then the applicant can apply for a refund to the San Diego County Water Authority (SDCWA) for a refund However let the applicant know that we cannot guarantee the refund and they must deal with the SDCWA for this n 13 Additional Comments ENGINEERING DEPARTMENT FEE CALCULATION WORKSHEET Address Prepared by Estimate based on unconfirmed information from applicant Calculation based on building plancheck plan submittal (LBldg Permit No C&f<$ Checked by Date EDU CALCULATIONS List types andlsquare footages for all usesj^e Types of Use M(?D LyrFtC^'sq Ft /Units (fabS" _ EDU s Types of Use _ Sq Ft /Units __ EDU s APT CALCULATIONS List types and square footages for all Types of Use /l( ^>UF^\Ct^ Sa Ft /Units t Types of Use _ Sq Ft /Units for ADTs ADTs FEES REQUIRED" WITHIN CFD 5/YES (no bridge & thoroughfare fee in District #1 reduced Traffic Impact Fee)D NO D 1 PARK IN LIEU FEE FEE/UNIT D 12/TRAFFIC IMPACT FEE ADTs/UNITS PARK AREA & # X NO UNITS FEE/ADT =$ D 3 BRIDGE AND THOROUGHFARE FEE (DIST #1 DIST #2 DIST #3 ADTs/UNITS D 4 FACILITIES MANAGEMENT FEE UNIT/SO FT 5 SEWER FEE EDUs X FEE/ADT ZONE X FEE/SO FT/UNIT. X FEE/EDU /. =$ =$ BENEFIT AREA fj,&T =S EDUS D 6 SEWER LATERAL ($2 500) D 7 DRAINAGE FEES PLDA _ ACRES _ X D 8 POTABLE WATER FEES UNITS CODE CONNECTION FEE FEE/EDU HIGH FEE/AC ^Z^ =$6/7 =$ /LOW METER FEE SDCWA FEE IRRIGATION 1 of 2 H\De el pment S rv ces\MASTERS\FORMS MISCELLANEOUS \FEECALCULATIONWORKSHEETdoc Re 7/14/00 ENGINEERING DEPARTMENT FEE CALCULATION WORKSHEET D 9 RECLAIMED WATER FEES UNITS CODE CONNECTION FEE METER FEE TOTAL OF ABOVE FEES* $ *NOTE This calculation sheet is NOT a complete list of all fees which may be due Dedications and Improvements may also be required with Building Permits ~,37 03 2 of 2 H ^Development Services\MASTERS\FORMS MISCELLANEOUS \FEECALCULATIONWORKSHEETdoc Rev 7/14/00 £ & & Q Q Q •g -S -8<L> <D fl)666 J c ceg CD Q- Q- D. H D D D DD D PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No CB080109 Address 2020 Cassia Rd Planner Deborah Milam Phone (760) 602 4619 APN 215021 0200 Type of Project & Use JJ Net Project Density DU/AC Zoning O General Plan O Facilities Management Zone 1.0 CFD (in/out) #_Date of participation Remaining net dev acres Circle One (For non residential development Type of land used created by this permit \ Legend ^ Item Complete Environmental Review Required DATE OF COMPLETION Item Incomplete Needs your action YES D NO 13 TYPE Compliance with conditions of approval7 If not state conditions which require action Conditions of Approval Discretionary Action Required APPROVAL/RESO NO DATE. PROJECT NO OTHER RELATED CASES YES PI NO K| TYPE Compliance with conditions or approval7 If not state conditions which require action Conditions of Approval Coastal Zone Assessment/Compliance Project site located in Coastal Zone7 YES D NO JE1 CA Coastal Commission Authority7 YES D NO D If California Coastal Commission Authority Contact them at - 7575 Metropolitan Drive Suite 103 San Diego CA 921084402 (619)7672370 Determine status (Coastal Permit Required or Exempt) Habitat Management Plan NA Data Entry Completed7 YES D NO D If property has Habitat Type identified in Table 11 of HMP complete HMP Permit application and assess fees in Permits Plus (A/P/Ds Activity Maintenance enter CB# toolbar Screens HMP Fees Enter Acres of Habitat Type impacted/taken UPDATE') Inclusionary Housing Fee required YES D NO E<] (Effective date of Inclusionary Housing Ordinance May 21 1993 ) Data Entry Completed7 YES D NO D (A/P/Ds Activity Maintenance enter CB# toolbar Screens Housing Fees Construct Housing Y/N Enter Fee UPDATE') F \Plan Checks\CB080109 doc Rev 3/06 Site Plan l~l Provide a fully dimensional site plan drawn to scale Show North arrow property lines easements existing and proposed structures streets existing etreet improvements right of way width dimensional setbacks and existing topographical lines (including all side and rear yard slopes) Provide legal description of property and assessors parcel number Policy 44 - Neighborhood Architectural Design Guidelines D 1 Applicability YES D NO G3 2 Project complies YES D NOQ Zoning 1 Setbacks not changed Front Interior Side Street Side Rear Top of slope 2 Accessory structure setbacks NA Front Required Interior Side Required. Street Side Required Rear Required. Structure separation Required Required Required Required Required Required Shown Shown Shown Shown Shown Shown. Shown Shown. Shown Shown 3 Lot Coverage not changed Required.Shown 4 Height not changed Required Shown D D D D D D Spaces Required.Shown5 Parking not shown (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required Shown Additional Comments #1 Please change the APN to 215 021 02 and add the legal description to the Legal Info section of the title page #2 If there will be roof mounted equipment, please show side building elevations to demonstrate how it will be screened from street level view If there won t be, please state so on the title page #3 Please a table with number of required and provided parking spaces Required parking spaces can be calculated based on Chapter 21 44 of the Carlsbad Municipal Code at one required space per 200 square feet of gross floor area OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE F \Plan Checks\CB080109 doc Rev 3/06 J>0 O IIIQ a o o o oc c c(0 ro co a. Q. a.a a an a PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No CB080109 Address 2020 Cassia Rd Planner Deborah Milam Phone (760) 602 4619 APN 215021 0200 Type of Project & Use J_l Net Project Density DU/AC Zoning O General Plan O Facilities Management Zone K) CFD (in/out) #_Date of participation Remaining net dev acres _ Circle One (For non residential development Type of land used created by this permit Legend Item Complete Environmental Review Required DATE OF COMPLETION Item Incomplete Needs your action YES D NO EX] TYPE Compliance with conditions of approval9 If not state conditions which require action Conditions of Approval Discretionary Action Required APPROVAL/RESO NO DATE. PROJECT NO OTHER RELATED CASES YES D NO M TYPE Compliance with conditions or approval9 If not state conditions which require action Conditions of Approval Coastal Zone Assessment/Compliance Project site located in Coastal Zone9 YES Q NO M CA Coastal Commission Authority9 YES Q NO Q If California Coastal Commission Authority Contact them at - 7575 Metropolitan Drive Suite 103 San Diego CA 921084402 (619)7672370 Determine status (Coastal Permit Required or Exempt) Habitat Management Plan NA Data Entry Completed9 YES D NO D If property has Habitat Type identified in Table 11 of HMP complete HMP Permit application and assess fees in Permits Plus (A/P/Ds Activity Maintenance enter CB# toolbar Screens HMP Fees Enter Acres of Habitat Type impacted/taken UPDATE') Inclusionary Housing Fee required YES Q NO [X] (Effective date of Inclusionary Housing Ordinance May 21 1993) Data Entry Completed9 YES D NO D (A/P/Ds Activity Maintenance enter CB# toolbar Screens Housing Fees Construct Housing Y/N Enter Fee UPDATE') F \Plan Checks\CB080109 doc Rev 3/06 D Site Plan Provide a fully dimensional site plan drawn to scale Show North arrow property lines easements existing and proposed structures streets existing ctreet improvements right of way width dimensional setbacks and existing topographical lines (including all side and rear yard slopes) Provide legal description of property and assessors parcel number Policy 44 - Neighborhood Architectural Design Guidelines 1 Applicability YES D NO IEI 2 Project complies YES D NOQ D D D Zoning 1 Setbacks not changed Front Interior Side Street Side Rear Top of slope 2 Accessory structure setbacks NA Front Required Interior Side Required. Street Side Required Rear Required Structure separation Required Required Required Required Required Required Shown Shown Shown Shown Shown Shown. Shown Shown. Shown Shown D 3 Lot Coverage not changed Required Shown 4 Height not changed Required Shown Spaces Required Shown5 Parking not shown (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required _ Shown _ 9\JiO Additional Comments #1 Please change the APN to 215 021 02 and add the legal description to the Legal Info section of the title page %qf If there will be roof mounted equipment, please show side building elevations to demonstrate how it will be screened from street level view If there won t be. please state so on the title page #3 Please a table with number of required and provided parking spaces Required parking spaces can be calculated based on Chapter 21 44 of the Carlsbad Municipal Code at one required space per 200 square feet of gross floor area •*~^r OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE F \Plan Checks\CB080109 doc Rev 3/06 Carlsbad Fire Department Plan Review Requirements Category TI , COMM Date of Report 01-25-2008 Reviewed by Name UTGARD CONSTRUCTION ^ Address STE L 12225 WORLD TRADE DR SAN DIEGO CA 92108 Permit # CB080109 Job Name HULSE SHELL TO OFFICE/1 865SF Job Address 2020 CASSIA RD CBAD St 102 INCOMPLETE — foOTtemyou^wimbmttted-fo^ Conditions <; Cond CON0002572 ' [MET] ** APPROVED THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUEANCE OF A BUILDING PERMIT THIS APPROVAL IS SUBJECT TO FIELD INSPECTIONS ANY REQUIRED TESTS, FIRE DEPARTMENT NOTATIONS, CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND REGULATIONS THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW Entry 01/25/2008 By cwong Action AP Dec 18 07 07 29p Rague Hssociates 6192930484 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY 6P DATE_ The following questions represent the facility s activities NOT iho specific project description PART I FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION OCCUPANC* CLASSIFICATION Indicate by circling tho item whether your business will use process or ^tore any of the following hazardous materials It any of the items are circled applicant must contact the Fire Protection Agency with jurisdiction prior to pi \f\ subinlttal 1 Explosive or Bhstinq Agents 5 Org^rilc Peroxide^ & W iter Roactives 13 Corrosive,, 2 Compressed Gasas 6 Oxldlzcrs 10 Cryogenic^ 14 Other Health Hazards 3 Flammable/Combustible Liquids 7 Pyrophoncs 11 Highly Toxic or Toxic Matenals ^j5>None of These 4 FUmmablo Solids 8 Unstable Rwactlvcs 12 Radioactive^ PART II SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD) If the answer to any Ot iho questions is yeo applicant must contact the County of San Diego Hazardous Materials Division 12i>5 Imperial Avenue 3™ floor San Ologo CA 92101 FEES ARE REQUIRED Exoecfed Dale of Occuoanev / / YES 2 JzT 3 D 4 D 5 D 6 D NO Q L your business listed on the reverse side of this form? (check all that apply) D Will your business dispose of Hazardous Substances or Medical Wdste In any amount? JZ Will your busine^o store or handle Hazardous Substances in quantities equal to or greater than bb gallon,, 500 pounds 200 cubic tp«st or caicmogens/reproductlvo toxins in any qu intity? Ji? Will your business USH =m existing or install an underground storage tank'' J3^ Will your business store or handle Regulated Substances (C<*IARP)7 _<J3*^Wi)l your busineoo use or install a Hazardous Waste Tank System (Tiile 22 Article 10)? Q CalARP Exempt Date Initials d CalARP Required / Date Initials D CalARP Complete Date Initials PART 111 SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT If the answer to any of the questions below is yes applicant must contact the Air Pollution Control District (APCD) 20124 Old Grove Road San Diego CA J2131 1649 telephone (858) 58S 2600 prior to the Issuance of a building or demolition permit Nolo If the answer to quc^tlono 3 or 54 is yti'-, applicant must also submit an asbestos notification form to tha APCD at least 10 working days prior to commencing dernolltion or renovation except demolition or renovation of residential structure., of four units or less Contact the APCD for more Information YES NO 1 n J3*~ Will the subject facility or conotruction activities. Include operations or equipment that emit or arc capable of emitting an air contaminant? (See the APCD factsheet at mtp //www sdapcd om/info/facts/pcnrilL pdf and the list of typical equipment requiring an APCD permit on the revoke side of this from Contact APCD~if you have any questions) J3 (ANSWER ONLY IF QUESTION 1 IS YEb) Will the subject facility be located within 1 000 feol of the outer boundary of a school (K through 12)7 (Public ind prlvata schools may be found after »carch of Ihe California School Directory at http //w\vw rdp ca dov/re/sd/ or contact the ^^appropriate school district) *" J2tVJ\\\ thoro be renovation that involves handling of any friable asbestos materials or disturbing any material that contains non friable asbestos? Will than, be demolition involving iho romoval of a lodd supporting structural member? D D Briefly describe buslnes^, activities Briefly describe proposed project I declare under penalty of penujy that to the best of my knowledge and belief the n Namo of owner or Authorised Agent made here In are true and correct Signature of Owner or Authorised Agent Date FOR orriCAL USE ONLY FIRE DEPARTMENT OCCUPANCY CLASSIFICATION. BY DATE tXCMPT OR NO rURTHER INFORMATION BtQUIRCD RELEASED FOR BUILDING PERMIT BUT NOT FOR OCC UPANCY RELEASED FOR OCCUPANCY COUNTY HMD APCD COUNTY HMD APCD COUNTY HMD APCD HM 3171 County ol San Oicgo - UBII -1 lu/arijwu!. Mnkrmli Di COUNTY OF SAN DIEGO Department of Environmental Health Radiological Health Program 9325 Hazard Way San Diego CA92123 Tel (858) 694 3621 Fax (858) 694 3629 KIVA#rixR.5 PLAN CHECKS ACTIVITY # FFE AMOUNTS fiD 0® PAYMENT TYPE DCASH DCHECK Plans submitted by RADIATION SHIELDING PLAN CHECK APPLICATION Phone #(Gft). Facility Name/ Owner s Name Job Site Address 1-02-0 , \> \> S S|c 102, Phone # (^60) . CA Mailing Address if different "_Zip # ot Rooms X-RAY MACHINE INFORMATION Manufacturer Model/Type OWNER/REPRFSENTATIVE DECLARATION I understand that the fee paid is based on my declaration of the radiation shielding classification If the dec) iration is incorrect I understand that this application will not be approved until the appropriate fee is paid Signature 9^C^T.tle Date This space for Office Use Only CGtHTYOFSWDltCOOEPARTVENi Or FNVrONnD* , AL HEALTHRADIOLOGICAL htA 1H PO1ATION ^H!5rLDiNG At'fuQVFD Based on the C3ii wbmitted the proposed ra^d.afon 'htcWflginstallation is a^^roved for (type of oatsbi 7WSICI&T By. Tnisf. /1y * II nest the struck ishield nr *qu» -Tents of ttr C* hR&diai,on Control R^eulati>« j, Dj > *-' * V. a CLASSIFICATION NO OFROOMS TOTAL DENTAL MEDICAL or INDUSTRIAL FIRST TWO ROOMS (6CRAD O)80 00 Q&oo EACH ADDT L ROOM UP TO 6 (6CRAD O)42 00 EACH MORE THAN 6 ROOMS (6CRADHR O)IN ADDITION TO $248 BASE FEE HOURLY FLt BASED ON REVIEW TIME HM 9901 (10 07) REM MEDICAL RADIATION PHYSICS P 0 BOX460490 Escondido, CA 92046-0490 Tel/fax (888) 736-7497 remdeh@aol com November 8, 2007 Dr C Hulse, D D S C/o Kin, Rague, Assoc kui@ragueassoc com Fax 619-293-0484 tel 0234 6623 Santa Isabel St, #121 Carlsbad, CA 92009 RE Dental X-ray Suite, Dr C Hulse, D D S, Carlsbad, CA The following recommendations for radiation shielding have been made in accordance with recommendations of NCRP #147 and the California Radiation Control Regulations, Title 17 Recommendations for the facility were made from information supplied by Dr C Hulse, D D S in the form of a facility plan and equipment information The assumptions below are consistent with the information supplied If any changes are made in the site layout or equipment, then please notify this office so that appropriate modifications in these recommendations can be made Assumptions 1 Workload (W) The Workload (W) factor in units of milliamperes-mmutes per week or milhroentgen per week is supplied from customer, or is assumed that which represents a common value for the specified use (for example, see NCRP Report No 145, Table F 3) 2 Use (U) The Use (U) factor indicates the fraction of exposure to Primary beam (U = an assigned value) or the Scattered beam (U = I for a dental facility) 3 Occupancy (T) The occupancy (T) factor indicates the fraction of time of exposure at a specific location NCRP Report No 145, Table F 1 is generally followed for non-controlled areas 4 Weekly Exposure Limit (P) The Weekly Exposure Limit (P) is 2 mrem per week (0 002 factors) for non-radiation workers and is 100 mrem per week (0 1 factors) for occupational radiation workers RE Dental X-ray Suite -2- 11/08/07 5 KiloVoltage Potential (kVp) The KiloVoltage potential (kVp) is assumed to be an average of 70 for scattered dental X-rays 6 Distance (d) The Distance (d) used in shielding calculations is the distance from the scattering object to the position of occupancy 7 Walls The walls of the rooms, unless otherwise noted are assumed to consist of one 5/8" layer of sheetrock on each side of a 3 inch or greater wall stud This is approximately equivalent to 0 08 mm lead 8 Doors The doors of the rooms are assumed to be solid core doors 9 Windows The windows of the room are assumed to be generally of minor shielding significance 10 Floor/Ceiling The Floor and Ceiling occupancies must be specified 11 Height of Shielding The height of shielding must be 80 inches (or more if specified) as per California Radiation Control Regulations, Title 17 12 Primary Barrier The primary barrier is not utilized in a dental facility (secondary scatter shielding only) 13 Half-Value-Layer (HVL) These values at specific kVp values are taken from NCRP Report No 145, Table F 11 14 Shielding Value Minimum The values of shielding are minimum values Larger values can be used if cost effective RE Dental X-ray Suite -3- 11/08/07 FACILITY INFORMATION Name Dr C Hulse, D D S Address 2020 Cassia Rd , Ste 102, Carlsbad, CA 92009 Level single story on grade Ceiling roof Floor on grade Walls, interior 2 layers of 5/8" gypsum board (assumed) Workload, X-ray 30 mA-mm/week @70 kVp each X-ray room Equipment, X-ray 1 wall mount unit, 1 panoramic/cephlametric unit RECOMMENDATIONS FOR SHIELDING BARRIER A Use scattered X-ray barrier (U = 1) Adjacent space toothbrush area Occupancy 3% Distance 4' Shielding Recommendation Use common construction materials No persons should be in this area except the X-ray operator Read x-ray operator's instructions at the end of this report BARRIER B Use scattered X-ray barrier (U = 1) Adjacent space hallway/ control area Occupancy 20% Distance 5' Shielding Recommendation Since the panoramic X-ray unit is essentially self-shielded, then radiation scatter from the patient is the only concern Therefore, use common construction materials However, the area around the panoramic x-ray unit may be an open area, therefore, the X-ray operator should be aware of persons in that area so that they might caution such persons not to be in the area during the taking of X-rays Read dental X-ray assistant's instructions at the end of this report BARRIER C Use scattered X-ray barrier (U = 1) Adjacent space consult room Occupancy 24% Distance 4' Shielding Recommendation Add 1 extra layer of sheet ro< k for a total of 3 layers in wall RE Dental X-ray Suite -4- 11/08/07 BARRIER D Use scattered X-ray barrier (U = 1) Adjacent space office Occupancy 85% Distance 4' Shielding Recommendation Add 1 extra layer of sheet rock for a total of 3 layers in wall BARRIER E Use scattered X-ray barrier (U = 1) Adjacent space office Occupancy 85% Distance 4' Shielding Recommendation On the wall (C or E) where the cephalometnc X-ray beam would strike the wall if no patient were present, place a 1/128" thick lead or 18 gage steel 1 ft square in size The center of this lead or steel should be 5 5' up from the floor BARRIER F Use scattered X-ray barrier (U = 1) Adjacent space ceiling/roof Occupancy 3% Distance 9' Shielding Recommendation Use common construction materials BARRIER G Use scattered X-ray barrier (U = 1) Adjacent space on grade floor Occupancy 0% Distance 4' Shielding Recommendation Use common construction materials RE Dental X-ray Suite -5- 11/08/07 X-Ray Operators It is important that the control units for each x-ray machine be mounted in such a manner that the x-ray dental X-ray operators are protected by at least two layers of 5/8" sheetrock or equivalent at a distance of at least 5', or at least one layer of 5/8" sheetrock or equivalent at a distance of 6', or if no shielding is present, they must stand at a distance of at least 10' from the source of scattered x-rays Those operators should be cautioned that their standing position must be such that the x-ray tube is not pointing in their direction Note that the patient must be observed during the taking of radiographs Dental X-ray Assistants Since the doorways into the >-ray rooms may be open doorways, then the x-ray assistants should be aware of persons in those doorway areas so that they might caution such persons not to be in the doorway areas during the taking of radiographs If I might be of further assistance on the above project, then please contact me RE Dental X-ray Suite -6- 11/08/07 CERTIFICATION FOR RADIATION PROTECTION NAME OF FACILITY Dr C Hulse, DOS ADDRESS 2020 Cassia Rd , Ste 102, Carlsbad, CA DESCRIPTION OF PROPOSED PROJECT Dental X-ray Rooms Based on my assumptions and calculations, I declare under penalty of perjury, that the radiation protection design for the above project** will conform to the applicable provisions of Title 17, California Administrative Code, relating to radiation protections I further declare that I am a certified radiation physicist, health physicist and medical physicist See NOTE 1 NAME DONALD E HOLMES, Ph D TITLE Professor Emeritus of Medical Physics SIGNATURE **as per my radiation shielding report of November 8, 2007 and any following addenda NOTE 1 My responsibility is for the design of the radiation shielding and not for the installation of the shielding Enclosures Floor plan with shielded areas marked PAGt 02 TITLE 24 REPORT Title 24 Report for DR CAMERON HULSE 2020 CASSIA RD .SUITE 102 CARLSBAD, CA 92011 Project Designer Report Prepared By HADI MAHZARI ENERGY CONSULTING GROUP 8015 BALBOA AVENUE. SAN DIEGO, CA 92111 (858) 268-0660 Job Number Date 1/9/2008 The EnergyPro computer program has been used to perform the calculations summarized in thi compliance report This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonreside ntial 2005 Building Energy Efficiency Standards This program developed by EnergySoft LLC www energysoft com EnergyPro 4 4 by EnergySoft Job Number User Number 2984 POLICY-HOLDER COPY SO COMPENSATION INSURANCE PO BOX 420807 SAN FRANCISCO CA 94142-0807 CERTIFICATE OF WORKERS COMPENSATION! INSURANCE ISSUE DATE 01-01 2O08 GROUP POLICY NUMBER 3006531 2008 CERTIF'CATE ID 79 CERTIFICATE EXPIRES 01-01 2009 O1-01-20O8/O1 O1 2009 UTGARD CONSTRUCTION CO INC 12225 WORLD TRAOE DRIVE ffl SAN 01EGO CA 92128 SO JOB EVIDENCE OF INSURANCE This is to certify tha we have issued a valid Workers Compensation insurance policy in a form approved by the California Insurance Commissioner to the emplo>er named below for the policy period indicated This policy is not subject to cancellation by the Fund except upon ^Q da/s advance written notice to the employer We will also give you JQ days adwve notice should this policy be cancelled prior to its normal expiration Ihts certificate of insurance is not an insurance pel cy and does not amend exltnd or alter tne coverage afforded by the policy listed herein Notwithstanding any reqi/i client term or condi ion of an/ contract or other documentwith respec' to wh ch this certificate of nsu ance may be issued or to wh ch it may pertain the in^u ance afforded bv thf pol cy described heron is subject to II the terms exclusion and conditions or such policy JTIIOR ZED REPRESENT A~ EMPLOYER S IIABILITV LIMIT INCLUDING DEFENSE COSTS PRESIDENT $1 000 000 PER OCCURRCNCE EMPLOYER UTGARD CONSTRUCTION COMPANY INC PO BOX SO 1047 SAN DIEGO CA 92150 SO (REV 2 05)PRINTED 12-19 2007 M0410 01/14/2008 17 24 FTP UTGARD CONSTRUCTION -> BJ s Scans il 001/002 CONSTRUCTION COMPANY INC 12225 World Trade Drive Suite L San Diego CA92128 • CA #563379 AZ #103885 (858)6748040 FAX (858) 673 1064 January 14 2008 Rague & Associates 7540 Metropolitan Drive #101 San Diego CA 92108 RE Job #08002 Dr Hulse 2020 Cassia Rd #102 Carlsbad CA 92011 To Whom It May Concern Utgard Construction Company Inc hereby gives permission to Architects Rague and Associates to pull permits on behalf of UCC Inc for the above referenced project Also attached please find Evidence of Worker s Compensation Insurance Any questions or concerns please phone our office at (858) 674-8040 Thank you Yours truly Utgard Construction Company Inc BJ Utgard VP President BJdd Mailing Address PO Box 501047 San Diego CA92150 1047 r— <- CW 00 " ~TT ~~3. 1 "*Q r r o -t r d 0 m (£> 05" m 2*8*