HomeMy WebLinkAbout2111 PALOMAR AIRPORT RD; ; CBC2017-0019; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Print Date: 06/12/2017 Commercial Permit
www.carlsbadca.gov
Job Address: 2111 Palomar Airport Rd
Permit Type: BLDG-ommercial Work Class: Tenant Improvement Status:
Parcel No: 2130731400 Lot #: Applied:
Valuation: $6,976.50 Reference #: Issued:
Occupancy Group: Construction Type: Finaled:
# Dwelling Units: Bathrooms: Inspector:
Bedrooms: Orig. Plan Check 4:
Plan Check U:
Project Title:
Description: CARLS3AD EXEC SUITES: RENOVATE 150 SF ELEVATOR LOBBY AREA /I NEW LIGHTING, CEILING & FINISHES
Permit No: CBC2017-0019
Closed - Finaled
01/11/2017
04/03/2017
Applicant: Owner: Contractor:
HURKES HARRIS DESIGN ASSOCIATES BROOKWOOD CARLSBAD EXECUTIVE PLAZA S P WHITE CONSTRUCTION INC
JEFFERYHURKES LLC
2524 Gateway Rd
72 Cherry Hill or Carlsbad, CA 92009-1742
619-702-0380 BERVERLY, MA 01915 760-931-1130
BUILDING PERMIT FEE $2000+ $88.35
BUILDING PLAN CHECK FEE (BLDQ $61.84
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL S $41.00
MECHANICAL BLDG COMMERCIAl NEW/ADDITION/REMODEL $39.00
5B1473 BUILDING STANDARDS FEE $1.00
STRONG MOTION-COMMERCIAL $1.95
Total Fees: $233.14 Total Payments To Date: $233.14 Balance Due: $0.00
Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter
collectively referred to as "fees/eaction." You have 90 days from the date this permit was issued to protest imposition of these
fees/exactions. If you protest then, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the
protest and any Other required inbrmation with the City Manager for processing in accordance with Carlsbad Municipal Code Section
3.32.030. Failure to timely follow hat procedure will bar any subsequent legal action to attack, ieview, 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 an fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the
statute of limitation has previousl otherwise expired.
0
THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: DPLANNING DENGINEERING DBUILDING [--]FIRE DHEALTH DHAZMAT/APCD I
Building Permit Application Plan Check No. 19
Est. Value (, q ("City. of 1635 Faraday Ave., Carlsbad, CA 92008
CaFrisbad Ph: 760-602-2719 Fax: 760-602-8558 . Deposi It Plan Ck (o( ' email: building@carlsbadca.gov
Date 111041 1 - ISWPPP www.carlsbadca.gov
JOB ADDRESS 2111 Palomar Airport Rd, Carlsbad, CA 92011
I SUITE#/SPACE#/UNIT#
3by/ Restr(al
APNd
213 7 070 16 -
CT/PROJECT # LOT B PHASE B B OF UNITS B BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE I 0CC. GROUP J #BEDROOMS
Ill-A I B
DESCRIPTION OF WORK: Include Sqoare Feet of Affected Area(s)
- Renovation of 1st, t*-rd-fI'oe,'-elevator lobbies. New ceiling, lighting, and finishes.
1530
EXISTING USE I PROPOSED USE GARAGE (SF) PATIOS (SF) I DECKS (SF) I FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS
Office Office IYESD#. NOM YES ENO 0 YESNOE
APPLICANT NAME White Construction, Inc. PROPERTY OWNER NAME Brookwood Management Partners, LLC
ADDRESS ADDRESS
2524 Gateway Rd 2131 Palomar Airport Rd, Suite 203
CITY STATE ZIP CITY STATE ZIP Carlsbad CA 92009 Carlsbad CA 92011
PHONE PHONE IFAX
760-931-1130
rF
760-804-0340 I
EMAIL EMAIL
shelly@whiteconstructioninc.com svalentino@brookwoodfinancial.com
DESIGN PROFESSIONAL Hurkes Harris Design Associates . CONTRACTOR BUS NAME White Construction
ADDRESS ADDRESS
160 Fifth Ave. Suite 100 2524 Gateway Rd
CITY STATE ZIP CITY STATE ZIP
San Dieao CA 92101 Carlsbad CA 92009
PHONE IFA)( PHONE FAX
619-702-0380 I (760) 93101130 x 118 I EMAIL . EMAIL
lwise@hhdainc.com shelly@whiteconstructioninc.com
I STATE LIC. B STATE LIC.# I CLASS CITY BUS. LIC.#
JefferyHjrkes I 0807 452513 B 1 12023880
(Sec. (Q1.5 business and Professions:;ode: Any City or County which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to its issuance, also requires the - applicant for such permit to file a signec statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending h Section 7000 of Division 3 of the
Business and Professions Code) or that ie is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for
wit
a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)).
)ØOOOO° 300 YIIOGX3
Workers' Compensation Declaration: I hewby affirm under penalty of perjury one of the following declarations:
U I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. [] I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance cattier and policy
number are: Insurance Co. Everest National Insurance corn Policy No. 7600014150171 Expiration Date 011052018
This section need not be completed if the pem7it is for one hundred dollars ($100) or less. (TI Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in
addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
CONTRACTOR SIGNATURE flAGENT DATE 1/11/17
DO(0OO b 00
thereby affirm that lam exempt from Contra ifor's License Law for the following mason:
[J I, as owner of the property or my emp1c3'ees 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 ownw 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, as owner of the property, am exclusisIy 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 lherec'i, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
El I am exempt under Section ______________Business and Professions Code for this reason:
I personally plan to provide the ra ajor labor and materials for construction of the proposed property improvement. Dyes UNo
I (have / have not) signed an apiication for a building permit for the proposed work.
I have contracted with the followi'ig person (firm) to provide the proposed construction (include name address/phone / contractors' license number): -
- 4. I plan to provide portions of the vrk, but I have hired the following person to coordinate, supervise and provide the major work (include name / address I phone contractors' license number):
5. I will provide some of the work, WI Ihave contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work):
.PROPERTY OWNER SIGNATURE - - [—]AGENT DATE
Oti1?f vam fflav000 ow 01300maOIDGIOV0108 O(!)OO)@ JUO ®&KM7
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the
Presley-Tanner Hazardous Substance Account Act? - Yes I No - -
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air Quality management district? Yes I No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes I No
IF ANY 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.
iiuco W000M QW00V
I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code).
Lender's Name N/A Lender's Address
OQOGOØ1J
to ertitijthat I have read the application and state thatthe above infomration is conectand thatthe information on the plans is accurate. I agree to comptywith all City ordinances and State laws relating to building construction.
I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD
AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA An OSHA permit is required for excavations over 50' deep and demolition or construction of structures over 3 stories in height
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become nuil and void if the building or work authorized by such permit is not commenced within
180 days from the date of such permit orifth building or work authorized by such permit is suspended or abandoned at any time after the work is commenced bra period of 180 days (Section 106.4.4 Uniform Building Code).
..APPLICANT'S SIGNATURE - . DATE 1/11/2017 .
STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection.
UCERTIFICATE OF O CC U P ANCY lCom. c P rojects Onlyl
Fax (760) 602-8560, Email building(äCarIsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008.
CO#: (Office Use Only)
CONTACT NAME - - .. OCCUPANT NAME
ADDRESS - .
I
. BUILDING ADDRESS .
- .
CITY STATE ZIP CITY STATE . ZIP
Carlsbad CA
PHONE , FAX
EMAIL - - OCCUPANT'S BUS. LIC. No.
DELIVERY OPTIONS
PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) .. . . .
*
CONTRACTOR (On Pg. 1)
MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) ASSOCIATED CB #
CONTRACTOR (On Pg. 1)
NO CHANGE IN USE/ NO CONSTRUCTION
MAIL /FAX TO OTHER:
CHANGE OF USE/ NO CONSTRUCTION
,.APPLICANT'S SIGNATURE t , DATE .
p a
Permit Type BLDG-Commercial Application Date: 01/11/2017 Owner: BROOKWOOD CARLSBAD
a EXECUTIVE PLAZA LLC
Work Class: ' Tenant improvement Issue Date: 04/03/2017 Subdivision: CARLSBAD TCT#83-10
Status: Closed - Fir aled Expiration Date: 10/16/2017 Address: 2111 PalomarAirport Rd * Carlsbad, CA 92011
IVR Number: 1406
Scheduled Actual *
Date -. Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete
04/19/2017 04I19/2017 -BLDG-85T-Bar, 020489-2017 Passed Andy Krogh - Complete
• .Ceiling Grids,
- 04erhead - -
4 Checklist Item COMMENTS Passed
BLDG-Building Deficiency . Yes
BLDG-14 - . Yes
Frame-Steel-Bolting-Welding
(Decks) •-
.
. . . S
BLDG-24 Rough-Topout . - - Yes
- - . BLDG-34 Rough Electrical . Yes
BLDG-44 . . Yes
-Rough-Ducts-Dampers
06/12/2017 06/12/2017 BLDG-Final 026036-2017 • Passed Andy Krogh Complete
lnection • • . . -
Checklist Item COMMENTS Passed
-
. BLDG-Building Deficiency
.
- , . Yes
BLDG-Plumbing Final •
Yes •
BLDG-Mechanical Final • Yes
- • BLDG-Structural Final ' . Yes -
-
• , • BLDG-Electrical Final • Yes •
44
- .• . .
14 + 4
ra • __, ., .
--
'. . /
14 ,4 ., . ,
* . .
.
• * fl *
4 - - I • - ,- *
4, 1 ' • 4 .
. 4
4
- - 4.
* \- '4
-
0 I '
*
.0
-
*
June 12, 2017
:
, Page1ofi
B. Specific Exceptions Do not use this portion If partA has been completed
This part is generally used for remodels exceeding the threshold amount and where Title 24 provides an exemption from specific accessibility features.
Exceptions Requested Code Section/Exception Cost of Making Features Accessible
Attach Documentation
Water Closet proximity to partition door 11 B-604 - $ 74476.87
Total $ 74476.87
Description Existingbuildiny conditions orecludes moving the AQA stall water - closet. The building shaft does not have enough space to relocate
the ADA stall water closet to be farthest from the ADA stall door.
Please see attached scope of work required.
The cost of all construction contemplated is $
Permitted work (excluding carpet/ hail paint): $4393.75 + 7.5% Contractor Fee = $4723.28
The access feature increases the cost of construction by percentage ofconstruction cost 1582.52% permitted work only.
The impact on financial fiLaslblllty of the project, lithe requested exception Is not approved Is
Project will not be able to move forward if exception is not approved.
The facility Is used by the general public for the purpose of employee access, business activities.
The following individuals provided information listed above
Architect/Designer General Contractor- S.P. White Construction, Inc.
tlC-E'' Ip.ss )bjtM ctpcir5
Address Address
11OZO el s .
2524 Gateway Rd.
City ¶!.r plL6 State C1 City State Zip Zip-izlov ,[.\f/ / Carlsbad CA 92009
Signature Required Signature Required DateDate 03/08/11
Findings and dedsións'of the Enforcing Official
Request Granted
14 General Unreasonable Hardship Exception request Is approved based on Section 11 B-202.4 of the California Building Code Access features listed in part A of this form shall be provided as part of this permit.
O Specific Exception(s) request Is approval based on Section(s) . All other access features shall be provided as
specified in the California Building Code.
3.ZZe'7
Name of enforcing official - Please print Signature of enforcing official Date
B-29 Page 2 of 2 Rev. 02114
CrCity of
Carlsbad
UNREASONABLE
HARDSHIP EXCEPTION
TO DISABLED ACCESS
REQUIREMENTS
B-30
Development Services
Building Division
1635 Faraday Avenue
760-60-2719
www.carlsbadca.gov
Pr4fdlornar Airport Rd, Carlsbad, CA 92011
Permit // C2017-0019
Oumer
Brookwood Management Partners, LLC
Telephone 760-804-0340
AgtJwt wnite Construction, Inc. Telephone 760-931-1130
It Is request that the above named project be granted an exception from the accessibility requirements of the 2016 California Building
Code, as specifically noted below:
A. Section 118-202.4 General Exception: Applicable to existing building where the construction cost at mr,o,a Anwvnt this tenant space over the last three years does not exceed the valuation threshold amount. The spedfic i 54162.00 accessibility features that create a hardship may be exempted but not all the accessibility features. The
area of alteration Itself may not be exempted.
If not. Is this feature going to be if so what is the cost of making
Access Features Item Does this feature meet the made accessible as part of this feature accessible?
Provide description be/ow latest edition of Title 241 permit? Attach documentation
Path of travel to entrance
Entrance
Path of travel In bkf& to area of remodel
Elevator S
S. Sanitary facilities
Public Telephones /fpmvfded
Drinldn.g Fountains ifpvvtded
S. Other (Pai1iIn. slage. etc.) $peov
Total cost of accen features provided (A) $
Total cost of coraruction of this project and all other work performed
over the last 3 years In this tenant pace (8)
*Percentage of total cost of proje (20% mlnlmwn): (A #8) x 100* %
Description of access features to be provided
Alterations performed over the last three years In this tenant space. Include in total valuation B above unless 20% of valuation of
Individual remodel has already been expended on access feature (provide documentation).
Permit Number Date Description Valuation
B-29 Page 1 of 2 Rev. 02114
EsGil Corporation
In Partners/iip with government for Bui(uing Safety
DATE: 3/29/17
JURISDICTION: City ofiiElii4j
PLAN CHECK NO.: C2017-0019
APPLICANT
/4' JURIS.
U PLAN REVIEWER
U FILE
SET: II
PROJECT ADDRESS: 2111 Palomar Airport Rd 1st Floor Lobby
PROJECT NAME: Carlsbad Executive Plaza Lobby Renovation - TI
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's 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.
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:
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: 0Telephone #:
Date contacted: (by.-V Email:
Mail Telephone Fax In Person
Z
By: Doug Moody Enclosures:
EsGil Corporation
E GA E EJ E MB E PC LOG
0320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax(858)560-1576
EsGil Corporation
In Partnership with government for Bui(ding Safety
DATE: 2/21/17 U APPLICANT
4GRIS.
JURISDICTION: City of Carlsbad U PLAN REVIEWER
U FILE
PLAN CHECK NO.: C2017-0019 SET: II
PROJECT ADDRESS: 2111 Palomar Airport Rd 1st Floor Lobby
PROJECT NAME: Carlsbad Executive Plaza Lobby Renovation - TI
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's codes.
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.
El 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.
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:
EsGil Corporation staff did not advise the applicant that the plan check has been completed.
EsGil Corportion staff did advise the applicant that the plan check has been completed.
Person contacted: White Construction. Telephone #: 760-931-1130 ext. 118
Date contacted: I (by)/y Email: shellywhiteconstructioninc.com
all lTelephone Fax In Person
REMARKS:
By: Doug Moody Enclosures:
EsGil Corporation
LI GA i[:] EJ LI MB [1 PC 2/14/17
9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax (858) 560-1576
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:
Deliver all corrected sets of plans and calculations/reports directly to the City of
Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760)
602-2700. The City will route the plans to EsGil Corporation and the Carlsbad
Planning, Engineering and Fire Departments.
Bring two corrected sets of plans and calculations/reports to EsGil Corporation,
9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468.
Deliver all remaining sets of plans and calculations/reports directly to the City of
Carlsbad Building Department for routing to their Planning, Engineering and Fire
Departments.
NOTE: Plans that are submitted directly to EsGil Corporation only will not be
reviewed by the City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
These corrections are in response to items not fully addressed or as the
result of information provided, the text in bold print indicates the
unresolved issue.
Advisory Note : When alterations, structural repairs or additions are made to an
existing building, that building, or portion of the building affected, is required to
comply with all of the following requirements, per Section 11 B-202.4:
A primary entrance to the building and the primary path of travel to the
altered area, must be shown to comply with all accessibility features.
The path of travel shall include the existing parking.
Existing toilet and bathing facilities that serve the remodeled area must be
shown to comply with all accessibility features.
Please address the following comments that are the result of the alterations.
3. It is unclear from the plans if the restrooms servicing the tenant improvement are
disabled accessible, please provide a dimensioned restroom plans showing the
restroom to be accessible compliant. Please correct the plans to show the
accessible stall to be disabled accessible compliant. Sheet IA.2.1 shows
the water closet in the compartment to be located in the wrong location
and no mounting details or elevations were provided to determine if other
requirements are not in compliance. Please provide adequate notes, details
and elevations to show all of the requirements necessary to determine if
the restrooms are compliant. Show that the water closet fixture, located in a
compartment, shall provide the following, per Section 11 B-604:
For water closet compartments having side-opening doors, compliance with
the following figure must be shown on the plans. The door shall be in the
/ 1
C- 1
partition farthest from the water closet and shall be 4" maximum from the
front partition.
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.
Please indicate here if any changes have been made to the plans that are not a
result of corrections from this list. If there are other changes, please briefly
describe them and where they are located in the plans.
Have changes been made to the plans not resulting from this correction list?
Please indicate:
Yes El No U
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 Doug Moody at
Esgil Corporation. Thank you.
EsGil Corporation
In tE'artnership with government for Bui(iing Safety
DATE: 1/26/17
JURISDICTION: City of Carlsbad
PLAN CHECK NO.: C2017-0019 SET: I
U APPLICANT
URIS.
U PLAN REVIEWER
U FILE
PROJECT ADDRESS: 2111 Palomar Airport Rd 1st Floor Lobby
PROJECT NAME: Carlsbad Executive Plaza Lobby Renovation - TI
LII The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's codes.
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.
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.
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:
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: White Construction. Telephone #: 760-931-1130 ext. 118
sate conpcted: \J (byr\() Email: shellywhiteconstructioninc.com
VJnaiI 41ePh)eTh Fax In Person
LI REMAR 1"
By: Doug Moody . Enclosures:
EsGil Corporation
LI GA LI EJ LI MB LI PC 1/17/17
9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax(858)560-1576
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
J PLAN CHECK NO.: C2017-0019
IOCCUPANCY: B
TYPE OF CONSTRUCTION: lilA
ALLOWABLE FLOOR AREA:
SPRINKLERS?: YES
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 1/10/17
DATE INITIAL PLAN REVIEW
COMPLETED: 1/26/17
FOREWORD (PLEASE READ):
JURISDICTION: City of Carlsbad
USE: Elevator Lobby
ACTUAL AREA: 150sf
STORIES: 1
HEIGHT:
OCCUPANT LOAD: 5
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 1/17/17
PLAN REVIEWER: Doug Moody
This plan review is limited to the technical requirements contained in the California version of
the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National
Electrical Code and state laws regulating energy conservation, noise attenuation and access for
the disabled. This plan review is based on regulations enforced by the Building Department.
You may have other corrections based on laws and ordinances enforced by the Planning
Department, Engineering Department, Fire Department or other departments. Clearance from
those departments may be required prior to the issuance of a building permit.
Code sections cited are based on the 2013 CBC, which adopts the 2012 IBC.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of
the 2012 International Building Code, the approval of the plans does not permit the violation of
any state, county or city law.
To speed up the recheck process, please note on this list (or a copy) where each
correction item has been addressed, i.e., plan sheet number, specification section, etc.
Be sure to enclose the marked up list when you submit the revised plans.
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:
Deliver all corrected sets of plans and calculations/report directly to the City of
Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760)
602-2700. The City will route the plans to EsGil Corporation and the Carlsbad
Planning, Engineering and Fire Departments.
Bring two corrected sets of plans and calculations/reports to EsGil Corporation,
9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468.
Deliver all remaining sets of plans and calculations/reports directly to the City of
Carlsbad Building Department for routing to their Planning, Engineering and Fire
Departments.
NOTE: Plans that are submitted directly to EsGil Corporation only will not be
reviewed by the City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
Please clarify the plans to show the hard lid ceiling that is to be removed to not
be a 1 hour rated ceiling assembly as part of the elevator lobby. Section 107.2.
Advisory Note : When alterations, structural repairs or additions are made to an
existing building, that building, or portion of the building affected, is required to
comply with all of the following requirements, per Section 11 B-202.4:
A primary entrance to the building and the primary path of travel to the
altered area, must be shown to comply with all accessibility features.
The path of travel shall include the existing parking.
Existing toilet and bathing facilities that serve the remodeled area must be
shown to comply with all accessibility features.
Please address the following comments that are the result of the alterations.
2. Show on the site plan the complying disabled accessible path of travel from the
disabled accessible parking spaces to the primary entrance of the tenant space.
Please provide detailed plans of the path of travel, indicate slope and width, any
pedestrian ramps, curb ramps, walks, handrails, provide dimensioned parking
stall details etc.
3. It is unclear from the plans if the restrooms servicing the tenant improvement are
disabled accessible, please provide a dimensioned restroom plans showing the
restroom to be accessible compliant.
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.
Please indicate here if any changes have been made to the plans that are not a
result of corrections from this list. If there are other changes, please briefly
describe them and where they are located in the plans.
Have changes been made to the plans not resulting from this correction list?
Please indicate:
YesU No U
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 Doug Moody at
Esgil Corporation. Thank you.
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK NO.: C2017-0019
OCCUPANCY: B
TYPE OF CONSTRUCTION: lilA
ALLOWABLE FLOOR AREA:
SPRINKLERS?: YES
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 1/10/17
DATE INITIAL PLAN REVIEW
COMPLETED: 1/26/17
FOREWORD (PLEASE READ):
JURISDICTION: City of Carlsbad
USE: Elevator Lobby
ACTUAL AREA: 150sf
STORIES: 1
-HEIGHT:
OCCUPANT LOAD: 5
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 1/17/17
PLAN REVIEWER: Doug Moody
This plan review is limited to the technical requirements contained in the California version of
the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National
Electrical Code and state laws regulating energy conservation, noise attenuation and access for
the disabled. This plan review is based on regulations enforced by the Building Department.
You may have other corrections based on laws and ordinances enforced by the Planning
Department, Engineering Department, Fire Department or other departments. Clearance from
those departments may be required prior to the issuance of a building permit.
Code sections cited are based on the 2013 CBC, which adopts the 2012 IBC.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of
the 2012 International Building Code, the approval of the plans does not permit the violation of
any state, county or city law.
To speed up the recheck process, please note on this list (or a copy) where each
correction item has been addressed, i.e., plan sheet number, specification section, etc.
Be sure to enclose the marked up list when you submit the revised plans.
[DO NOT PAY - THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad PLAN CHECK NO.: C2017-0019
PREPARED. BY: Doug Moody DATE: 1/26/17
BUILDING ADDRESS: 2111 Palomar Airport Rd 1st Floor Lobby
BUILDING OCCUPANCY: B
BUILDING
PORTION
AREA
(Sq. Ft.)
Valuation
Multiplier
Reg.
Mod.
VALUE ($)
TI 150 46.51 6,977
Air Conditioning
Fire Sprinklers _
TOTAL VALUE 6,977
jurusaicipon uoae ICD 113y Ordinance
Bldg. Permit Fee by Ordinance I $87.981
Plan Check Fee by Ordinance I $57.191
Type of Review: E Complete Review Structural Only
Q Repetitive Fee E Other
Repeats El Hourly Hr. @ *
EsGil Fee I $49.271
Comments:
Sheet 1 of 1
macvalue.doc +
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:
Deliver all corrected sets of plans and calculations/reports directly to the City of
Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760)
602-2700. The City will route the plans to EsGil Corporation and the Carlsbad
Planning, Engineering and Fire Departments.
Bring two corrected sets of plans and calculations/reports to EsGil Corporation,
9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468.
Deliver all remaining sets of plans and calculations/reports directly to the City of
Carlsbad Building Department for routing to their Planning, Engineering and Fire
Departments.
NOTE: Plans that are submitted directly to EsGil Corporation only will not be
reviewed by the City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
Please clarify the plans to show the hard lid ceiling that is to be removed to not
be a 1 hour rated ceiling assembly as part of the elevator lobby. Section 107.2.
Advisory Note : When alterations, structural repairs or additions are made to an
existing building, that building, or portion of the building affected, is required to
comply with all of the following requirements, per Section 11 B-202.4:
A primary entrance to the building and the primary path of travel to the
altered area, must be shown to comply with all accessibility features.
. The path of travel shall include the existing parking.
Existing toilet and bathing facilities that serve the remodeled area must be
shown to comply with all accessibility features.
Please address the following comments that are the result of the alterations.
2. Show on the site plan the complying disabled accessible path of travel from the
disabled accessible parking spaces to the primary entrance of the tenant space.
Please provide detailed plans of the path of travel, indicate slope and width, any
pedestrian ramps, curb ramps, walks, handrails, provide dimensioned parking
stall details etc.
3. It is unclear from the plans if the restrooms servicing the tenant improvement are
disabled accessible, please provide a dimensioned restroom plans showing the
restroom to be accessible compliant.
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.
Please indicate here if any changes have been made to the plans that are not a
result of corrections from this list. If there are other changes, please briefly
describe them and where they are located in the plans.
Have changes been made to the plans not resulting from this correction list?
Please indicate:
Yes L] No U
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 Doug Moody at
Esgil Corporation. Thank you.
WA
'A
Jurisdiction Code [cb IBY Ordinance
Bldg. Permit Fee by Ordinance
V Plan Check Fee by Ordinance
Type of Review: LJ Complete Review
Repetitive Fee El Other
, Repeats El Hourly
EsGil Fee
I $87.981
I $57.191
U Structural Only
Hr. @
I $49.271
(DO NOT PAY— THIS IS NOT AN INVOICE)
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad PLAN CHECK NO.: C2017-0019
PREPARED BY: Doug Moody DATE: 1/26/17
BUILDING ADDRESS: 2111 Palomar Airport Rd 1st Floor Lobby
BUILDING OCCUPANCY: B
BUILDING
PORTION
AREA
(Sq. Ft.)
Valuation
Multiplier
Reg.
Mod.
VALUE ($)
TI 150 46.51 6,977
Air Conditioning
Fire Sprinklers
TOTAL VALUE 6,977
Comments:
Sheet 1 of 1
macvalue.doc +
4N&I STORM WATER . Development Services
C I I Y 0 F COMPLIANCE Building Division
CARLSBAD ASSESSMENT 1635 Faraday Avenue
760-602-2719
B-24 www.carlsbadca.gov
I am applying to the City of Carlsbad for the following type(s) of construction permit:
0 Building Permit U Right-of-Way Permit
U My project is categorically EXEMPT from ___________ Electrical Patio/Deck
the requirement to prepare a storm water Fire Additional Photo Voltaic
pollution prevention plan (SWPPP) because it Fire Alarm Re-Roofing
only requires issuance of one or more of the Fixed Systems
Mechanical
Sign
Spa-Factory following permit types: Mobile Home Sprinkler
Plumbing Water Discharge
Project Storm Water Threat Assessment Criteria*
No Threat Assessment Criteria
My project qualifies as NO THREAT and is exempt from the requirement to prepare a storm water pollution prevention plan (SWPPP) because
it meets the "no threat" assessment criteria on the City's Project Threat Assessment Worksheet for Determination of Construction SWPPP Tier
Level. My project does not meet any of the High, Moderate or Low Threat criteria described below.
Tier I - Low Threat Assessment Criteria
U My project does not meet any of the Significant or Moderate Threat criteria, is not an exempt permit type (See list above) and the project
meets one or more of the following criteria:
Results in some soil disturbance; and/or
Includes outdoor construction activities (such as saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling).
Tier 2 - Moderate Threat Assessment Criteria
U My project does not meet any of the Significant Threat assessment Criteria described below and meets one or more of the following criteria:
Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 of the Carlsbad Municipal Code); or,
Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement
removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria:
Located within 200 feet of an environmentally sensitive area or the Pacific Ocean, and/or
Disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical, and/or
Disturbed area is located along or within 30 feet of a storm drain inlet, an open drainage channel or watercourse, and/or
Construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30).
Tier 3 - Significant Threat Assessment Criteria
U My project includes clearing, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any
associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas: and/or
U My project is part of a phased development plan that will cumulatively result in soil disturbance totaling one or more acres including any
associated construction staging, equipment storage, refueling and maintenance areas: or,
U My project is located inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant
potential for contributing pollutants to nearby receiving waters by way of storm water runoff or non-storm water discharge(s).
I certify to the best of my knowledge that the above
checked statements are true and correct. I understand
and acknowledge that even though this project does
not require preparation of a construction SWPP, I must
still adhere to, and at all times during construction
activities for the permit type(s) check above comply
with the storm water best management practices
pursuant to Title 15 of the Carlsbad Municipal Code
and to City Standards.
*The City Engineer may authorize minor variances from the Storm
Water Threat Assessment Criteria in special circumstances where it
can be shown that a lesser or higher Construction SWPPP Tier Level is
warranted.
Project Address: Assessor Parcel No.
2111 Palomar Airport Rd, Carlsbad, CA 92011 213-070-16
Owner/Owner's Authorized Agent Name: Title:
Steve White, CEO C.E.O.
Owner/Owner's Authorized Agent Signature: Date:
1/11/2017
City Concurrence: By: Date: Project to:
UYES ONO
B-24 Page 1 of 1 Rev.03/09
SAN DIEGO REGIONAL OFFICE USE ONLY
OOoP\1I .
HAZARDOUS MATERIALS
RECORD ID # J ) PLAN CHECK #__________________
,ubOCCC'
QUESTIONNAIRE BP DATE I /
Business Name Business Contact Telephone #
Brookwood Management Partners, LLC Sunny Valentino 760-804-0340
Project Address City State Zip Code APN# 2111 Palomar Airport Rd Carlsbad CA 92011 213-070-16
Mailing Address City State Zip Code Plan File#
2131 Palomar Airport Rd Carlsbad CA 92011
Project Contact Applicant E-mail Telephone # Shelly Edwards shelly@whiteconstructioninc.com 760-931-1130
The following questions represent the facility's activities, NOT the specific project description.
I IvIrI I - IVIMIGMIML.0 UI V IIJI'I '.fl..I..urMrlI. T I..L1A3IrIL,M I IJI'4
idicate by circling the item, whether your business will use, process, or store any of the following
must contact the Fire Protection Agency with jurisdiction prior to plan submittal. None. any or me items are
Occupancy Rating: Facility's Square Footage (including proposed project):
Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives
Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards
Flammable/Combustible Liquids 7. Pyrophoncs 11. Highly Toxic or Toxic Materials 15. None of These.
Flammable Solids 8. Unstable Reactives 12. Radioactives
IAHI It: SAN DIE.00 COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISION (HMD): If the answer to any of the
questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building permit. I
FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy:
YES NO (for new construction or remodeling projects)
El IKI Is your business listed on the reverse side of this form? (check all that apply).
Q El Will your business dispose of Hazardous Substances or Medical Waste in any amount?
0 EX] Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
pounds and/or 200 cubic feet?
El IX] Will your business store or handle carcinogens/reproductive toxins in any quantity?
0 0 Will your business use an existing or install an underground storage tank?
0 El Will your business store or handle Regulated Substances (CalARP)?
0 Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
0 IX] Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to
or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act).
CalARP Exempt
Date Initials
CalARP Required
Date Initials
CalARP Complete
Date Initials
PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): Any YES* answer requires a stamp from APCD 10124 Old Grove Road, San Diego, CA 92131 apcdcomo(),sdcounty.ca.gov (858) 586-2650). [*No stamp required if Q1 Yes and 03 Yes and 04-06 No]. The following questions are intended
to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive
requirements contact APCD. Residences are typically exempt, except - those with more than one building on the property; single buildings with more than four dwelling units; townhomes; condos; mixed-commercial use; deliberate bums; residences forming part of a larger project. ['Excludes garages & small outbuildings.]
YES NO
EI 0 Will the project disturb 160 square feet or more of existing building materials?
0 IXI Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition.
El El (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance
Technician?
0 IX] (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification
may be required 10 working days prior to commencing asbestos removal.
0 IXI Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.sdaocd.org/irifo/facts/oermits.pdf) for typical equipment requiring an APCD permit.
El 0 (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
boundary
Briefly describe business activities: Briefly describe proposed project: Lobby of Commercial Office Replace ceiling tile, lighting, finishes
I declare under penalty of perjury that to the best of my knowledge and belief the responses made herein are true and correct. Steve WhiteC.E.O. 01/ 11 /2017
Name of Owner or Authorized Agent Signature of Owner or Authorized Agent v Date
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: FOR OFFICAL USE ONLY:
BY: DATE:
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMD APCD COUNTY-HMD APCD COUNTY-HMD APCD
/I stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply.
HM-9171 (08/15) County of San Dieao - DEH - Hazardous Materials Division
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
SCREENING SURVEY
Date 01/11/2017
Business Name_____________________________________ Brookwood Management Partners, LLC
Street Address2111 Palomar Airport Rd, Carlsbad, CA 92011
Email Address svaIentino@brookwoodfinancial.com
ENONA
WASTEWATER
AUTHORflY
PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS)
Check all below that are present at your facility: None
Acid Cleaning Ink Manufacturing Nutritional Supplement/
Assembly Laboratory Vitamin Manufacturing
Automotive Repair Machining / Milling Painting./ Finishing
Battery Manufacturing Manufacturing Paint Manufacturing
Biofuel Manufacturing Membrane Manufacturing Personal Care Products
Biotech Laboratory (i.e. water filter membranes) Manufacturing
Bulk Chemical Storage Metal Casting] Forming Pesticide Manufacturing /
Car Wash Metal Fabrication Packaging
Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing
Chemical Purification Electroplating (including precursors)
Dry Cleaning Electroless plating Porcelain Enameling
Electrical Component Anodizing Power Generation
Manufacturing Coating (i.e. phosphating) Print Shop
Fertilizer Manufacturing Chemical Etching I Milling Research and Development
Film /X-ray Processing Printed Circuit Board Rubber Manufacturing
Food Processing Manufacturing Semiconductor Manufacturing
Glass Manufacturing Metal Powders Forming Soap I Detergent Manufacturing
Industrial Laundry Waste Treatment/ Storage
SIC Code(s) (if known):
Brief description of business activities (Production I Manufacturing Operations):_______________
Business Office
Description of operations generating wastewater (discharged to sewer, hauled or evaporated):
None other than sanitary waste from restrooms.
Estimated volume of industrial wastewater to be discharged (gal / day): N/A
List hazardous wastes generated (type/ volume): N/A
Date operation began/or will begin at this location:
Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority?
Yes No If yes, when: No
Site Contact Sunny Valentino TitleProperty Manager
Signature Phone No. 7608040340
ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941
FAX: (760) 476-9852
4. City of
Carlsbad
WASTE MANAGEMENT
PLAN
B-59
Development Services
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
Owner:
Brookwood Management Partners, LLC
Contractor: White Construction, Inc.
2111 Palomar Airport Rd, Carlsbad, CA 92011
Job Address: Phone Number: 760-931-1130
Permit #: Estimated Cost of Project: $
85,000
Type of Project: o New Construction Remodel or 1.1. 0 Residential Commercial 0 Demolition
(check all that apply) 0 Other
Non-hazardous construction waste generated during the course of this project shall be recycled and/or salvaged for re-use at a
minimum of 50% per CALGreen Sec. 5.408.1. FailUre to comply may result in a penalty fee up to $1,000. For projects which
consist of mainly equipment and/or racking, that have a combined weight of new construction disposal that does not exceed 2
lbs per square foot of building area affected by this permit, may be deemed to meet the 50% minimum requirement upon
approval of Building Department.
ALTERNATIVE FORMS OF COMPLIANCE: (If selected, do not complete Tables 1 & 2 below)
0 Construction waste shall not exceed 2 lbs. per sf. of area. All receipts shall be provided to the Building Official prior to
final. (This option not applicable for most construction projects.)
Square feet of construction area X 2 lbs. = lbs. of allowable waste.
91 I plan on using a WASTE MANAGEMENT roll-off bin. All receipts shall be provided to the Building Official prior to final.
Table 1 - Estimated Waste (To be filled out prior to permit issuance - refer to example on Page 2.)
MATERIALS lbs. of waste to betaken to
LANDFILL
lbs. of waste to be
RE-USED or RECYCLED Waste Hauling Company or Re-Use Method
Asphalt/ Concrete N/A
Brick/ Masonry
N/A
Cardboard 10 lbs EDCO Drywall SO IhS
Landscape Debris N/A
Lumber/ Wood N/A Millwork sub will recycle at shop
Metals 20 EDCO
Mixed Waste 225 lbs EDCO
Trash / Garbage 25 lbs
Other:
TOTAL lbs: 1 75 2551bs
Estimated Percentage to be Re-Used or Recycled 60
I certify that the information provided herein, to the best of my knowledge, is true and correct. Steve White
Contractor or Owner (print name 01/11/2017
Contractor or Owner (signature) Date
Official Use Only
O Plan Approved 0 Plan Denied LI Project Valuation Approved
Reviewed/Approved by:_____________________________________
Page 1 of 2