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Home My WebLink About2056 PALOMAR AIRPORT RD; ; CB983515; PermitB U I L* D. I N G P E R.M I T Permit No: CB83515 0 10/28/98 11:46 . Project No: ,A9804576 Page 1 of I Development No Job Address 2056 PALOMAR AIRPORT RD Suite Permit Type COMMERCIAL TENANT IMPROVEMENT,4 Parcel No: * Lot#:' Valuation 50,000 Construction Type NEW Occupancy Group: Referencé#: _2769 10/28/~Otat)jl~j IUED Description REPLACE EXISTING FUEL TANK ..Appj.4 14~31.%@. H CINEMA JET CENTER . .\ .-Apr/Issue: 10/28/98 Entered By: JM, Appl/Ownr CULVER JOGN - 760 743-0518 -' 959 W MISSION AVENUE ESCONDIDO CA 92025 *** Fees Required Fees Collected & Credits Fees: 674O0 p... - Adjustments: ' .0 o, .00 Total Fees: 1674.O0 T- .t1Pa'vrnent's: 261.00 Baicn.ceçDue: 413.00 . Fee description Ext fee Date 1'- r Building Permit j 'V ., \ ' 402.00 Plan Check \ .261.00 Strong Motion Fee . .1100 INCORPORATED .1952 011 < $ "' J rLR çs EPIREQIN ORDANCE WITH U.B.C. iSECTION1O&4 4u DATE./ SIGNATURE SIGNATURE..#.7 FIN[Ap OVAL 4 \ , INSP DATE CLEARANZ .-.•. - -4 . ( 4 . -• ..-,- * -' - FIRE PREVENTION BUREAU, - •. - . 2560 ORION WAY, CARLSBAD, CA 92008-7280 - •,, - * (619)931-2121 -- - - FOR OFFICE USE ON V. B 3 PERMIT APPLIcATIoN 'Y ...• PLAN CHECKO. CITY OF CARLSBAD BUILDING DEPARTMENT EST VAL I 2075 Las Palmas Dr, Carlsbad CA 92009 - Plan Ck Depos c.....' Validated " J(760)438-11.61 * - , B JNF —7 Date 'lALfrAiL Ai Poar C:pJ -JET- CEpTEstJ Address ,.(include Bldg/Suite #) Business Name (at this address) ' Legal - Lot No Subdivision Name/Number . .rC Uit No. . Phase No...,t,- Total #.óf units C1 - 013c Assessors Parcel # / Existing Us Mfoalii -0001 01 02 TjK L uY- A) C-NMT 261-00 pescriptuon of Work - SQ.FT #of Stories . # of Bedrooms # of Bathroom -- ,... ,- ..••-- -:4. .- Name-. ... -- ... Address City, - -. . State/Zip - Telephonè,#; Fax 3 APPtJCANT AgntThr Contc E 0 nor Ag it for &wner ye 3j Jj C LVP -dAL't4t)I N. 4. LVE- LC SLi kiss Ib A, eJc,r 4r D3 Name - - Address I • , .State/Zip,, Telephone ..- - rr(PRopERTY OW çr2-T 7ij3OSI COJI'JTV bFS-yi4 6p A Jc€i çyA ELcA Ci4 9iw Name I Addreo City State/Zip Telephone # - i )Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, imprbve.demolish orlrepair any structure- prior'to its ..issuance, also requires the applicant for such permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's Licene Law lChapter 9 commending with Section 7.000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged ex ption. Any violatjon f Se tion 7031.5 by any applicant for a ermit subjects t pplicant to a ci 'I penalty of n 11 ot mor than five hundeed d ars l$5001). Au (L9 Ttt. 9S9 L) JL Name - ;.' ,-. I A'ddress- --,. City .. State/Zi ,- Telh ne # State License License Class .4 / ' /iJf 2.- City Business License # !k117 '(3 'OSf 2s Designer Name Address City State/Zip Telephone I State License # - - '. - ', 4 'Workers' Compensation Declaration. I herebyaltirm under penalty of perjury one of the foIling delarations: and will maintain a certificate of onsent to self-insure for workers"compesation as rvided by Section 3700 of the Labor Code for the performance ,of the wo or which this permit is issued. -lhave-and will maintain workers' compensation, as required by SèctiM 3700. of. the Labor Code, for the pçrformance of the work for which,this permit us issued. My worker's compensation insuran arrier and policy number are: - LIM' / 77 - .:lrsurane Company jA-T Policy 'No. -c" COO 73S Expiration Date_______________ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS)., ,D CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which thisperrnit is issued,. I sha!l',not -emloy1 any person in any manner so as to become subject to the r ers' Co ensatio Lwsof lifornia'.-- :'WARNING: Failure to ecure workers' ompe tio c erage nlawful. and shall subject.an employer.togcriminal penalties iaid civil ,iihes.up to one ,'hundred., thousand dollars ($104,000), in additio tot cos comp ation, damages as provided for in Section 3706 of the Labor cq'e, inter stand attorney's fees. SIGNZTURE___________________________________________ DATE - I hereby affirm that I am axe t from the Contractor's License Law for the following reason: o I, as owner of the property or yemplies iA,i'ti w'agés as their oie c eisati&n, will'd6 he wok and the structUre i not intended 6 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; hwever, the building or improvem'ent'is sold within one.year of completion,-the owner-builder, will have the.burdan of proving that he did not build or improye for the purposef.salel'.- 0 I, as owner of the property, am exclusively contracting- with licensed contractors to constructthe project ,(Sec. -7,044, Business and, Professions Code: ,The - C'nrac'ttors'Ucénse Law dos not apply o'an owner of propert'f who b'uilds or imroves thereon, and contracts'for such projects with contractor(s) licensed-' pursuant to the Contractor's License Law). 0 I am exempt under Section Business and Professions Code for this reason 1 I personally plan to provide the major labor and materials for construction of the proposed property improvement 0 YES ((have / have not) signed an applicatiOn for a building permit for the proposed work: 3 I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number) 'l plan tprovidd portions Of the work,bUt I have hired the following person to coordinate; supervise and provide the major work (include name-/addre'ss/phone number / contractors license number): -. .. . I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number I type of work): - - ------------------- ---. - - - - - - - '- .'PROPERTY OWNER SIGNATURE DATE --_-.-.- __. _' -g -------- I NOfS,DENT!AUIIDINGPEMJS'ONLY — '9 j Is the applicant or future building occupant required to submit a business plan, autely IazardouC materials registrétion 'form ut risk management and pevention - - program under Sections 25505 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 . NO: Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 NO Is the,fbcility to be constructed within 1,000 feet of the outer boundary ofa school Sit?? 0 YES - IF ANY OF THE ANSWERS'AREtYES. A FINAL CERTIFICATE OF OCCUPANCY WAY 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. r8 CONSTRUCTION_LENDING_AGENCYi4 I hereby affirm that there is ,a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code) LEFDER'S NAME5 _'---.. _- --------- LENDER'S ADDRESS r9. APPLICAN T IIifl - - - I certify-that I-have read the àpplicatioñ ánd-state.that the above information is correct and that the information on the, plans is accurate.-: I agree t omplywith aIl. Cit- ordinances and State laws trelating to building,constrdction. I hereby authorize representatives, of the Citiof Carlsbad. to enter upon the above mentioned - - property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD, AGAINST ALL LIABILITIES, ) JUDGMENTS; COSTS AND WHICH' MAY IN ANY-WAY ACCRUE AGAINST SAID CITY-IN CONSEQUENCE OF THE GRANTING OF-THIS PERMIT: - -- '.1 -, -- - - - - - OSHA An OSHA perm is required for e avations over 5'0"' deep and demolition or Construction of structures over 3 stories in height EXPIRATION:- Every p0 mit-issued by the nilding.Offi un er'the- provisions o this-Codeshall expir .by.limitation and,beome null'and void if, the building ort work authorized by such ermit is not corn riced,w' in 3 d from the date of such permit or ifthe building or work ,authorized by such permit is suspended '-or abandoned at any time er ihe work is mm - e for od of'lBO days (Section 106.4.4 Uniform Building Code) APPLICANT S SIGNATURE DATE ,- -----------,- - ' ----- 'WHITE: File°- YELLOW: Applicant' PlNK-sFinanceo - :" -' - - , -- l---------- - -: 0cç lictober 5, 1999 CINEMA AIR JET CENTER 2056 PALOMAR AIRPORT RD CARLSBAD CA 92008 RE: BUILDING PERMIT EXPIRATION PERMIT TYPE: CTI of Carlsbad Permit Number: CB983515 Issue Date: 10/28/98 ADDRESS: 2056 PALOMAR AIRPORT RD PLEASE CALL FOR AN INSPECTION IF WORK IS COMPLETE Our records indicate that your building permit will expire by limitation of time on 10/28/99. The provisions of UBC, Section 106.4.4 as amended by the Carlsbad Municipal Code state: "EXPIRATION. Every permit issued by the Building Official under the provisions of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within one calendar year from the date of such permit, or if the building or work authorized by such permit is stopped at any time after the work is commenced for a period of six consecutive calendar months or if the building or work authorized by such permit exceeds three calendar years from the issuance date of permit. Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work authorized by the permit by the Building Official within one year of the date of permit issuance. Work shall be presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building Official within each six month period upon the initial commencement of work authorized by such permit." Before such work can be recommenced, a new permit, or a renewal permit as specified in the attached copy of the code, shall be obtained. Any person holding an unexpired permit may apply for an extension of the time within which he may commence work under that permit when he is unable to commence work within the time required by this section for good and satisfactory reasons. The Building Official may extend the time for action by the permittee for a period not exceeding 180 days upon written request by the permittee showing that circumstances beyond the control of the permittee have prevented action from being taken. No permit shall be extended more than once. Please check below indicating your intentions and return this letter to us. Project abandoned. A new permit will be obtained prior to commencing work. No fee extension requested for 180 days. (attach a letter of explanation) Renewal permit requested. If the project has been completed and only a final inspection is needed, please call the inspection request line at (760) 438-3101. If you have any questions, please contact the Building Inspection Department at (760) 438-3550. PAT KELLEY Principal Building Inspector Attachment 2075 Las Palmas Dr. • Carlsbad, CA 92009-1576 • (760) 438-1161 • FAX (760) 438-0894 Inspection List Permit#: CB983515 Type: CTI REPLACE EXISTING FUEL TANK CINEMA JET CENTER Date Inspection Item Inspector Act Comments 10/28/1999 14 Frame/Steel/Bolting/Weldin DM CO 10/25/1999 14 Frame/Steel/Bolting/Weldin DM NR 10/7/1999 19 Final Structural PS CO NO ACCESS 10/7/1999 19 Final Structural PS CO NO ACCESS OP I Friday, December 17, 1999 Page 1 of 1 EsGil Corporation. In Partnership with government for Bui&uing Safety DATE: 10/23/98 lzc JURIS. ANT JURISDICTION: Carlsbad 0 PLAN REVIEWER 0 FILE PLAN CHECK NO.: 98-3515 SET:I PROJECT ADDRESS: 2056 Palomar Airport Rd. PROJECT NAME: Tank Replacement The plans transmitted herewith have been corrected where necessary and substantially comply Mth the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified in Remarks 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. The check list transmitted herewith is for your information. The plans are being held at Esgil. Corporation until corrected plans are submitted for recheck. LI 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: U 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: A123 (b.y?'.) Fax #: Mail Telephone Fax In Person REMARKS: The Building Department to please verify approvals from APCD, HAZ MAT, and Fire Department. Please make the notes as circled in red on sheet I of the Owner - Set I plans to the City Set I plans and attach the NEC Table 5141.2 to the plans. By: Mike Puckett Enclosures: Esgil Corporation 0 GA fl MB D EJ 0 PC 10/15/98 tmsmtLdot 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (619) 560-1468 • Fax (619) 560-1576 VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: 98-3515 PREPARED BY: Mike Puckett DATE: 10/23/98 BUILDING ADDRESS: 2056 Palomar Airport Rd. BUILDING OCCUPANCY: S3 TYPE OF CONSTRUCTION: NA BUILDING PORTION BUILDING AREA (ft. 2) VALUATION MULTIPLIER VALUE ($) Replace Existing Tank No change City Value 50,000.00 Air Conditioning Fire Sprinklers TOTAL VALUE 50,000.00 F] 1994 UBC Building Permit Fee I Bldg. Permit Fee by ordinance: $ 402.33 fl 1994 UBC Plan Check Fee U Plan Check Fee by ordinance: .$ 261.51 Type of Review: LI Complete Review LI Structural Only LI Hourly LI Repetitive Fee Applicable LI Other: EsgiI Plan Review Fee: $ 209.21 Comments: Sheet of 1 macvalue.doc 5196 PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB 1' 3 5 I DATE O l(r- ' ADDRESS 4(tk6Mi,,t Pt'r,)1I+ 12rL RESIDENTIAL, TENANT IMPROVEMENT RESIDENTIAL ADDITION MINOR PLAZA CAMINO REAL (<$10,000.00) CARLSBAD COMPANY STORES VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER PLANNER DATE ENGINEER1IIIID DATE / ( )/ z ~Af OocslMisforms/Pianning Engineering Approvals UNDERGROUND HAZARDOUS MATERIALS STORAGE TANK FACILITY OFFICE USE ONLY EST#: PLAN CK#: DATE RECEIVED: FEE PAID: PLAN APPROVAL: HYDRO UNIT: BENEF. USE: PERMIT APPLICATION PART I GENERAL PROJECT INFORMATION SITE NAME: I Al fr-IA A i - Joz C-ri SiTE ADDRESS: rcO (L?pa.r i2- City Zip PROPERTY OWNER: Assessors Parcel No. 97r-0/39 -4 ARr1ViSIo,i - - - -: Company pFt&O PF?uLi3C(L.Contact L y f ?it* Mailing Address / -JO E (SSo ,..I DR. City L 6i-oJ State cA Zip.?.O /c'3( Phone (,t) S- .24Hr.EmergencyContact LO.J Phone (-74o) 41.o4( TANK OPERATOR: Company C. E-iA A tZ J r- Contact Mailing Address r, City Zip V0 Phone) 3-077 24 Hr. Emergency Contact STEVE L)i€/L' Phone CONTRACTOR: Primary Contractor _ Contact C.4e'-1 QIALVE(2.. Mailing Address q S9 U. t..-A i p /. (5- City 0 Zip 0 S Phone (7) 7'/3 State Contractor License 7023 Hazardous Substances Certificate A 4 I 70 Worker's Compensation Insurance Company 5T,4 r& ED i'. APPLICATION SUBMITTAL, PLAN APPROVAL, PERMIT ISSUANCE, AND REQUIRED INSPECTIONS Submit one (1) original and two (2) copies of this application package, including plan drawings with the required fee to the Department of Environmental Health, Site Assessment and Mitigation Division (SAM). 1255 Imperial Avenue, San Diego, CA 92101: Or mail to P. 0. Box 85261, San Diego, CA 92186-5261. Checks should be made payable to the County of San Diego. A permit will be issued by SAM upon review and approval of the application and plans. The required fees must be submitted with the application package. Information in addition to that presented in the application package may be needed in order to obtain final approval. No work is to begin on the proposed project until a permit has been issued. The required inspections cannot be scheduled until a permit is issued.- Once the permit has been issued, it is the responsibility of the permittce to notify SAM at least two (2) working days in advance to schedule each required inspection. Construction stages at which inspections arc required are indicated in each subpart of this application form (i.e., Part II, III, IV, & V). County of San'Diego DEH:SAM-915 (Rev. 8/96) 1-1 Department of Environmental Health F. PROJECT WORK TO BE COMPLETED: -' COMPLETE Chec'T Applicable Box APPLICATION FEB CODE -- PARTS .' TABLEG" 0 Installation/Construction of 'new tank(s) systems only' I & U 1 (without closing any existing tanks) O Closure of existing tank(s) systems with installation-of new tanks (tank I, U & III 1 & 2 replacement) .. . . 0 Closure of existing tank(s) systems with no new tank installation I & UI - 2 Ti D.interior coating/repair of an existing underground storage tank I & IV . 3 j :i.cpipc/pipe-repair piping upgrade of an existing underground storage tank I & V . 4 'facility ' . •., . . . O Installation/Construction of vaulted tanks . . VI . 5. FEES:. The fee shown below covers plan review, plan re-review and approval.' The required field inspections and the first year's operating permit fees. Use the appropriate Fee Code as determined in Section F above FEE CODE . Installation fee for first tanks $600;00 .' .. • . Fee: :5 . .:........... • Installation fee for each additional tank No. X $100.00 Fee: $ , Establishment Base Fee $160.00 . 'Fee: j (Applies to establishments not currently under permit with -DEH), . . •.:: Operating Permit Fee per tank No. .X $120.00 .. ' . Fee: $ S (Does, not apply to replacement tanks if the existing tank to be replaced has . .. paid current operating permit fees) ., . . . Closure fee for first tank $375.00 •0• ' '# .... Fee: $ • . - . ... . Closure fee for each additional tank-No. X $50.00 . Fee: $ . . . Repair/Interior coating fee for first tank $600.00' . ' , Fee: '5 • RepairfInterior coating fee for each additional tank No. •' X $100.00 Fee: $ •.Y .'• Repipe/Piping upgrade, pipe repair of an existing tank facility $600.00 Fee: '5' 'Co c . ' Consultation fee (e.g. vaulted tank: minimum 2 hours) ' ' Fee: 5' Hours X80.00 . . .6.. ' Re-inspection fee $300.00 .. Fee.: $ ". , .f Plan Re-Review $200.00 ' Fee $ . TOTAL- FEE: $' L' PERMITS REQUIRED BY OTHER AGENCIES ' I FIRE DEPARTMENT APCD X BUILDING DEPARTMENT • OTHER"_______ 1 Provide copies of approved applications from these departments and others if needed County ofSan Diego DEH:SAM-9 15 (Rev. 8/96) 1-2 Department of Environmental' Health : osott7,Jfl . W Is 42 t J\% IC • PERMIT APPLICATION 4 o c" CC PART 11 APPLICATION FOR PERMIT TO CONSTRUCT UNDERGROUND STORAGE TANK FACILITY BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER-Call (916) 739-2582 for information TY(TK)HQI4I4I -I 'II(C.l9I3I NOTE: Application will be disapproved without this information TOTAL NUMBER OF TANKS TO BE INSTALLED I TYPE OF PRIMARY CONTAINMENT TANK NO. MANUFACTURER COMPOSITION CAPACITY STORAGE MATERIAL X- d7 c&-rr. .JrA C:-'TYPE OF SECONDARY CONTA1I4MENT 0 Multiple compartment double wall tanks Eg,-Vouble wall tanks [] Concrete Vault 0 Flexible liner (manufacturer) Other, briefly describe D. MANUFACTURER DISPENSER CONTAINMENT t/' ,4 and CA /0 4 ,sPW2.S) 0 Mechanical Monitoring El Electronic Monitoring .J...J Co fri 7-S-1000 Model Other UNDERGROUND STORAGE TANK LEAK DETECTION SYSTEM [ Continuous leak detection device within the secondary containment, connected to an audible/visual alarm system Manufacturer/Model No. .1C_Ofrl T'S - 0 Daily monitoring of the space between the primary and secondary containments using' "dip stick" readings. NOTE: THIS METHOD IS AVAILABLE FOR MOTOR VEHICLE FUEL STORAGE ONLY. O Other, briefly describe - UNDERGROUND STORAGE TANK PIPING MATERIALS AND CONSTRUCTION PRODUCT PIPING: Primary containment A. 9222 , ,, ,t.. 14., eo,/ Secondary containment ,4. c2, , 77,' 0 L. E,<,-O( VAPOR. VENT. FILL PIPING: Primary containment c rw 6xc'A/ (fittings and unused bungs) Secondary containment County of San Diego DEH:SAM-915 (Rev. 8/96) 11-1 Department of Environmental Health TYPE OF PRODUCT DELIVERY/FILL SYST E M ( I . E . , P R E S S U R I Z E D , S U C T I O N , R E M O T E FILL) Motor vehicle fuel tanks Waste oil tanks ,- Other tanks, briefly describe %.JiET NOTE: MANIFOLDED PRODUCT-DELIVERY S Y S T E M S R E Q U I R E , SECONDARY CONTAINMENT AND CONTINUOU S M O N I T O R I N G UNDERGROUND STORAGE TANK PIPING LEAK D E T E C T I O N S Y S T E M . Continuous monitoring device within the secondary co n t a i n m e n t Manufacturer ) S-loOO14 -AND- Leak detector on pressurizd line (must 1shut down pump and activate alarm)* - Manufacturer (rgop,! SVrEi) / '-OR- ' Continuous monitoring device shuts down pump and a c t i v a t e s a l a r m * *NOTE: not required for non pressurized systems (i.e., suction, remote-fill) CORROSION PROTECTION FOR UNDERGROU N D PIPING -. - - O Coated and Cathodically Protected Steel Fiberglass - UNDERGROUND STORAGE TANK SPILL/OVER F I L L P R E V E N T I O N , SYSTEM Catchment Basin surrounding the product fill pipe. ' Manufacturer XEJ—XE o(- Q,cL- -AND- -, O Secondary containment for vent, vapor, and tank riser p i p i n g w i t h B a l l F l o a t V a l v e s o r P r o d u c t L e v e l S e n s i n g D e v i c e w i t h H i g h Level Alarm Manufacturer --OR- Positive shutoff device in fill pipe at 95% full Manufacturer -OR- - [.Product Level Sensing Device with High Level Al a r m a n d B a l l F l o a t V a l v e s 'Manufacturer ...L C-0 p,% j TYPE/MANUFACTURER OF VAPOR RECOVERY SYSTEM TO BE USED - Stage I Recovery System - - ' - Stage II Recovery System 4AJ DESCRIBE HOW YOU PROPOSE TO BALLAST T H E T A N K S F R O M F L O T A T I O N ' * (TANKS MUST BE BALLASTED IF HIGHEST ANTICIPATED GROUNDWATER IS AT LEAST 25' BELOW GROUND SURFACE) 0 Anchor Straps perManufacturer's specification with deadma n a n d / o r s l a b .—Buoyancy Calculations (must be submitted) .-Depth of Groundwater: County of San Diego 'EftSAM-915 (Rev. 8/96) 11-2 ' Department of Environmental Health CERTIFICtLTION Attach a certification from the manufacturer, or his authorized representative, of the tank and piping materials as to the capability of the tank and piping materials to store the proposed hazardous materials. ATTACH THREE COPIES OF PLANS SHOWING THE FOLLOWING: Location of all existing and proposed structures. '- Location of all existing underground tanks and piping (indicate if tanks areto be closed or replaced). 3 Location of all proposed tanks and piping. Cross section of tank and piping system. This drawing must show secondary containment of tank and piping, spill/overfill prevention devices, leak detection equipment with the correct number of sensing probes and extension of all pipes and ancillary equipment to finish grade. ' S Location of underground utility vaults and lines. - Site plan showing site address, nearest cross street and property lines (scale and noah arrow must be used). th REQUIRED INSPECTIONS - NEW UNDERGROUND STORAGE TANK INSTALLATIONS EACH NEW TANK INSTALLATION MUST BE INSPECTED BY SAM. TWO INSPECTIONS ARE REQUIRED. I. FIRST INSPECTION: CERTIFICATION AND PRESSURE TEST INSPECTION - pressure test of entire primary system (tank, product, vent, vapor, fill). 2. SECOND INSPECTION: MONITORING EQUIPMENT AND INTEGRITY TEST VERIFICATIO N - performance check of the monitoring system. Tank manufacturer's certification, SAM's Certification of Tank System installation, Certification of Monitoring Equipment, Integrity Test Report, Form C, and Mni'toring an d Response Plans must be submitted to the inspector at the, time of inspection. All documents must be submit t e d before final operating permit will be issued. P. DECLARATION I declare that to the best of my knowledge and belief the statements and information provided alone are corre c t a n d t r u e . I u n d e r s t a n d that information in addition to that provided above may be needed in order to obtain a permit from the Site As s e s s m e n t a n d M i t i g a t i o n Division and that no work is to begin on this project until the permit is issued. I understand that any changes in design, materials or equipment will void my permit to construct if prior appro v a l i s n o t o b t a i n e d . I further understand, that a permit to operate the underground storage tank will not be issued until the SAM inspe c t o r a p p r o v e s t h e s e c o n d inspection. S S I will notify the Site Assessmentat11iigatio Division at least two working days (48 hours) in advance to schedule each required inspection. I understand that/site and worker \safety olely the responsibility of the, property owner or his agent and that this responsibility is not.shared or assumed by Diego. ' S SIGNATURE & TITLE: PRINT NAME: JOH J kAL TELEPHoNE (7w 743O6 DATE l 3 I 8 County of San Diego DEH:SAM-915 (Rev. 8/96) 11-3 Department of Environmental Health' 1.. . •• . ...:.PERMIT APPLICATIONV. cce, . •: •. 0 •.• PART III I APPLICATION FOR PERMIT TO CLOSE UNDERGROUND STORAGE TANK SYSTEM . TOTAL NUMBER OF TANK SYSTEMS FQ BE CLOSED_______ NOTE UST SYSTEMS INCLUDE TANK AND ALL ASSOCIATED PIPING B DESCRIPTION OF TANKS TO BE CLOSED: 0•S DATE TANK TANK MATERIALS T..No CAPACITY INSTALLED. coMposiTIoN: PRESENTLY IN USE? .__.:' .STORED.]NTANK JeTA C. HAS THF TANK SYSTEM EVER FAILED OR LEAKED? YES El NO UNKNOWN 0 D REASON FOR TANKS TO BE CLOSED La4eet current statelfederal requirements ..... . . ...S 0 Replacement of existing tanks O Tank system failure, briefly. describe 0 Other, briefly describe J I K. PREVIOUS OWNERS AND OPERATORS OF TUE TANKS Dates Owner/Operator ¶ / I frJOT KOL&)S c - S. I County of San Diego EI:SAM-915 (Rev. 8/96) 0 111-1 Department of Environmental Health F. PROPOSD METHOD OF CLOSURE (B'REMOVAL 0 CLOSURE IN PLACE SAMPLING PROTOCOL Tank owner/authorized representative responsible for all sampling analyses and associated costs' qi - for tank systems that are to be removed.: The excavation. shall be' exposed prior to the scheduled 'inspection and sampling points identified by the SAM 'inspector. Sampling is required for both tank and piping. The tank and piping must remain in the excavation until the SAM inspector approves the removal. - tank systems to be closed in place Submit an alternate plan which must include soil sampling, reason for closing the tank system in place and type of material to be used to fill the tank. Soil sampling and/or hydrostatic testing is also, required for piping closures. Tank syetàm' closure in place will only be considered after. evaluatingth&risks hazards if the tank system were removed. G..-.' DISPOSAL SITE OF TANK: .t\iPc1ThO4AL S\Ett_) ST)2& Note 'You must inform SAM of the address of where the tank and piping is to be disposed. Plans will be disapproved without this information IV: -ATTACH THREE COPIES OF PLANS SHOWING THE FOLLOWING: 0 , ....L - Property lines, site address, scale, north arrow.. 2. Location of all existing structures. .. . ' 3:Location of all existing underground storage tank facilities. . . 4. Location of underground storage tanks and piping to be closed. 'of underground utility lines and vaults. L REQUIRED INSPECTION-PERMIT TO CLOSE .'''r'Arepresentative from SAM must be on site at the time the tank(s) are closed. 1. TANK SYSTEM CLOSURE. BY REMOVAL: - excavation shall be exposed prior to the scheduled inspection The tank owner/authorized representative on site must submit a uniform hazardous-waste manifest demonstrating that the tank has been properly decontaminated. A combustible gas instrument and soil sampling equipment must be on site. The SAM inspector will identify.':` sampling points The tank and piping must remain in the excavation until SAM approves the removal. 3 DECLARATION I declare that to the best of my knowledge and belief, the statements and information provided are correct and true I understand that information in addition to that provided above may be needed in order to obtain final approval by the Site Assessment and Mitigation Division I understand that tests and procedures that may be required by other departments and agencies to demonstrate adequate site safety or suitability for further development (e g soil compaction testing) are in addition to the requirements of the Site Assessment and Mitigation Division I will notify thr, Site Assessment and Mitigation Division at least two working days (48 hours) before work is to begin in order to schedule the rc.quircd inspections I understand that site and worker safety are solely the responsibility of the property owner or his agent and that this responsibility is not shared or assumed by the County of San Diego SIGNATURE &TITLE PRINT NAME jo H ' TELEPHONE (7 7'/3 —0516 DATE 1'J.3oJ9 S County of San Die. DEH:SAM-9 15 (Rev. 8/96) 111-2 Dcpatment of Environmental HeaJ a PERMIT APPLICATION PART V. APPLICATION FOR REPIPE, PIPING UPGRADE OR PIPE REPAIR OF AN EXISTING TANK FACILITY BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER-Call (916) 3224289 for information F 4 I 4 I - I J'q 1J. 1 NOTE: Application will be disapproved without this information TOTAL NUMBER OF TANKS WHERE PIPING IS TO BE REPIPED, REPAIRED OR UPGRADED____ DESCRIPTION OF TANKS WHERE PIPING IS TO BE REPIPED, REPAIRED OR UPGRADED TANK NO. TANK CAPACITY PRODUCT TYPE COMPOSITION OK J Er __________• __________ Ac ________ JIATE6 - 4 K.. A V QA S bt. 0 y CHECK BELOW WHAT PIPING IS TO BE REPLACED, REPAIRED OR UPGRADED. PRODUCT VAPOR VENT FILL LINES TANK NO. 1 - J or A A/4 TANK NO. 2 .JETP1\ TANK NO. A\ a s — TANK NO.4 A U 6 REASON FOR TANKS TO BE REPIPEDFREPAIREDIUPGRADED: Upgrade to meet current state/federal requirements CJ Piping system failure - EJ Other, briefly describe PIPING MATERIALS AND CONSflWCTION: Primary containment /C/ lC- Manufacturer/model _4.0 ,fl7# 77? O,t. Secondary containment Manufacturer/model .10 Dispenser Containment /14. Manufacturer/model TYPE OF PRODUCT DELIVERYIFILL SYSTEM: EJ Pressurized Suction EJ Gravity EJ Direct Fill EJ Manifolded System PIPING LEAK DETECTIONIMONITORING SYSTEM: (J Leak detector on pressurized line: Manufacturer EE Continuous monitoring device within the secondary containment: Manufacturer iL-,L c2.D T-S 1000/4 [] Leak detector on pressurized line (must shut down pump and activate alarm) (pressured lines only) IJ Continuous monitoring device shuts down pump and activates alarm (pressurized lines only) DISPENSER CONTAINMENT MONITORING: (at a minimum must shut do'n dispenser) tI Mechanical monitoring LJ Electronic monitoring Model S CJ Other ' County of San Diego DEH:SAM-915 (Rev. 8/95) v-I - Dcnartmcntof Rnvirr,nrr...ntt UIt. It TANK OVERFILL PREVENTION: S Catchment Basin surrounding the pro uct fill pipe: Manufacturcr LETE L)L-t -AND- Secondary containment for vent, vapor, and tank riser piping with Ball Float Valves or Product Level Sensing Device with High Level Alarm Manufacturer .J(!0 T - 105z/4 -OR- E] Positive shutoff device in till pipe at 95% full Manufacturer Product Level Level Sensing Device with High Level Alaimand Ball Float Valves Manufacturer PIPING UPGRADE REQUIREMENT: S Cathodic protection for all product piping in dret contact with backfill-material, including turbine, flex connectors and all other appurtenances containing product 0 1J2' Secondary containment of all product piping including turbines, dispenser piping, and all other appurtenances containing product. J. PROPOSED METHOD OF PIPE CLOSURE: EEF REMOVAL EJ CLOSURE IN PLACE SAMPLING PROTOCOL Tank owner/authorized representative responsible for all sampling analyses and associated costs. - for piping that is to be removed, the trenching shall be exposed prior to thescheduled inspection, sampling points will be identified by the SAM inspector and samples taken every 20 feet. - piping to be closed in place may be considered only if the removal might damage structures. Submit an alternate plan which must include, soil sampling and/or hydrostatic testing: K. ATTACH THREE COPIES OF PLANS SHOWING THE FOLLOWING (Must be drawn to scale): Location of existing and proposed structures. Location of all existing underground tanks and piping. (Indicate what piping is to be closed in place or by removal) Location of new piping, secondary containment, leak detection, and overfill prevention. L. REQUIRED INSPECTIONS-PIPING RE, PAIRJREPLACEMENTIPIPING UPGRADE: EACH PIPING REPAIRIREPLACEMENT AND/OR PIPING UPGRADE MUST BE INSPECTED BY SAM. TWO 1. FIRST INSPECTION: - piping to be closed by removal. Trenching shall be exposed prior to the scheduled inspection and sampling .' points identified by the SAM inspector. - piping to be closed in place. Piping shall be capped and, drained and per alternate approved plan, samples collected and/or hydrostatic testing witnessed by the SAM Inspector. 2. SECOND INSPECTION: - pressure test of all piping repaired replaced or upgraded - verification of cathodic protection. - verification of leak detection devices/secondary containment. - verification of overfill Drevention. M. DECLARATION I declare that to the best of my knowledge and belief the statements and information provided are correct and true. 'I understand that ijiformationin addition to that provided above may be needed in order to final approval by the Site Assessment and Mitigation Division.. I understand. that tests and procedures that may be required by other departments and agencies to demonstrate adequate site safety or suitability for further development (e.g., soil compaction testing) are in addition to the requirements of the Site Assessment and Mitigation Division. I will notify the Site'Assessment and the required insp tions. I underst the responsibilitçis not shared o/a SIGNATURE & TITLE _ PRINT NAME _UQI.4Pi t.ALVElt/ TELEPHONE (70) 7 — ôj ibn at least two working days (48 hours) before work is to begin in order to schedule worker safety are solely the responsibility of the property owner or his agent-and that County of San Diego. County of San Diego DEH:SAM-915 (Rev. 8/95) V-2 Department of Environmental Health A& 5c /P oF 1ILOjX,- ¶ ATCT Air TroUic ConL,oiTowor BBacon / —•----- GS Glido Slope Ii - LOC Locazer I MALSfl MALSA Approoch Lights 7/ HElL RiNiway End Identification Lights - p •._—.;. U RPZ Runway Protection Zeno V2 VASI2 - 1 ).-• .- -•,tp *• \ VASI-4 - J//, RI \ 1 — — -- Airporl PopurLy Line - — — Ile- V d - pa GS Vj oc ATCT. 13 .\ . -Th iI4J r /•) I - II SCALE IN TCEI 4 A)GA TWO WoRc si-rc Rpz