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Home My WebLink About2131 Palomar Airport Rd; ; CBC2017-0604; Permit(city of Carlsbad Commercial Permit Print Date: 05/04/2018 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2131 Palomar Airport Rd BLDG-Commercial 2130702700 $121,000.00 Work Class: Lot#: Reference#: Construction Type: Bathrooms: Orig. Plan Check#: Pian Check #: Description: BROOKWOOD: INSTALL 10 EVC STATIONS Applicant: Owner: Cogen PAMELA SMITH BROOKWOOD CARLSBAD EXECUTIVE PLAZA 8330 Century Park Ct LLC San Diego, CA 92123-1530 760-298-9023 72 Cherry Hill Dr BERVERLY, MA 01915 BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE {BLDG) SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $1,229.81 Total Payments To Date: $1,229.81 Status: Applied: Issued: Permit Finaled: Inspector: Final Inspection: Balance Due: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." 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 other required information with the City Manager for processing 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 APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Permit No: CBC2017-0604 Closed -Finaled 11/15/2017 03/05/2018 TFraz 5/4/2018 9:26:16AM $0.00 $700.55 $490.38 $5.00 $33.88 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov THE FOLLOWING APPROVALS REQUIRED PR!OR TO PERAAIT ISSUANCE. ENGINEERING ~ Cicyof Carlsbad JOB ADDRESS Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph· 760-602-2719 Fax: 760-602-8558 email: building@cartsbadca.gov BUILDING FIRE Plan Check No. Est. Value Plan Ck. Deposit 070 -28 PTIDN O WORK: Include ua,w Ffft 1) Installation of 10 new electric vehicle charging stations, 4 dual & 2 single charging stations. 8 standard, 1 van accessible, 1 I standard accessible. tSrtMAicD COS,,., $12,131 l'f;l2. SrA-!.L-:) *12../,ooo EXISTING PROPOSED USE GARAGE (SF) Commercial PATIOS (SF) DECKS (SF) FIREP1..AC£ AIR CONO!TIONING FIRE SPRINKLERS Commercial YES[) N<O mO NoO YESONOO APf'UCAHT NAME Pamela Smith for SDG&E PROPERTY OWNER NAME Prlml Contact Brookwood Executive ADDRESS ADDRESS 8326 Century Park Court CITY STATE ZIP CflY 2131 Palomar Airport Rd STATE ZIP San Diego CA 92123 Carlsbad CA 92011 PHONE FAX PHONE 760-298·9023 FAX EMAIL EMAIL pamelas@c2group.us, pyddocs@c2group.us 0£SION l'ROFUSIONAl Yolanda Calvo ADDRESS 9707 Waples St. 92121 CITY San Oieao STATE CA ZIP PHONE FAX 858-335-8423 EMAIL 0 ycalvo@hunsakersd.com ~-~~~~~--''--~__...:;~~~~~~~St=A~~~UC~.l~~~~~l...,:~~..!...::l.ll.?:U...U..i.::..::~:=.~!.......'..~~-=-.::....:._;;:~.,...;..~~~~~~~~ 61827 (Sec. 7031.5 Business and Professions Code: Any City or Counl)' which requires a permit to construct. attar. improve, demolish or ~pair an~ structure. prior to Its Issuance, al9o requires the apptlalnt for such permit to Ille a signed statement that he IS licensed pursuant to the provisions of the Contractor's ucense Law ICllapter 9, commendini with Section 7000 of Division 3 of the Business and Professions Code) or that he is exem..Qt therefrom. and the basis for the alle&e<l exeml)tlon. Ally violation of Section 7031.5 Dy any applicam for a permit subjects the applicant to a cMI penalty of not more than five hundred dollars (5500)). Woritars' CompenS1tion Otciaration. I hereby affirm under penally of peqUf)' one of the /ollowtng dedelllhons 0 .1 have and will maintain a certiftc.ate of consent to self-Insure for WOl1ter; comoensatJOO as prov,aed Dy SecbOn 3700 or lhe Labor COde. for lhe performance of lhe 'M>!l< for wt1ICh lhis pe!TT\lt 1s Issued ~ I have and wlh maintain workers' compensation as reQUired bv Sea.on 3700 of the Labor Code. !or the perloonance of 1he ~ for wNcf1 tn.s oem,11 IS issuea My won<ers Cllml)ellS3bOn Insurance earner and policy numberare.lnS\JranceCoJY"-Yck r s. Yrop~ C1.1.s"o.."'3 (p ot:P.~ Vlt1.)ljf?:\4C,liAt,:)1-13: Exp,ratlonO.te =2-I -I~ This sectoon need not be completed d the permit is fot one hundred dolars (S100) oc less 0 Certificate of Ellemptlon: I a:rtlfy Iha! m Ille performance of lhe worlc for which this permit ,s issued I sha9 nol employ any person in any manner so as to become subject to the Wockers· CompensatJoo Laws of Catifcmta. WARHING: Failure to secure worken' compenaation coverage is unlawful, and shall subject an employer 10 Cttmlnal pen1ltlts llld clVII fines up to one hundred lhousand dollars (& 100,000), In addition to the CQSt of COITlpenNUon, damages II provided for in Section 3706 of the Labor code, lnttrest and attorney's lees. Jt5 CONTRACTOR SIGNATURE -n_ . ..-.. ~ 0 AGENT DATE <.-5'-I~ I hereby affirm /hilt I am exemp/ Imm (hlfr&Clors License L8w for the follo>tir.g reason O 1. as owrer or tne property or my employees \\11/l wages as lhett sole compensaoon. wil oo me WQl1< and tne Sll\JCIUre IS not intended or offered fol sale (Sec. 7044, Business and Prof8ssl00s Code. The Contractoc's LJcense Law does not apply IO an owner of p(operty who builds or improves thereon. and who dOes SUd1 \\'Of't< himsel: or through hi$ own emp!Oyees provided that sueh mprovements are not Intended oc offered for sale II however the building or improvement is sold with,n one year of complebon the owner-builder will have lhe burden of prov,ng that he did no1 build or rnprove fol the purpose of sale) 0 1. as owner of the property. am exduSNety contrac11ng 'M1h IICensed con~ to oonsll\JCI the pr()fed (Sec. 7044. Business an<I Prolesst0n$ Code The Con!rador s ucense Law dOes not apply to an owner of property who bullds or Improves \11ereoll and contracts lot sucn prtlfects with contractor(s) ricenseo P1J15uam 10 the Conlraetor's License La-N) D 1 am e,emp1 under Sect!Oll Bus,oess aoo Prcless.ons Cooe foe lhis teaso!l 1 I per,or,ally plan to DrOVlde the ffiaJOl labOr and mateoals for C0<1struction of the proposed property improvement O vet O;o 2 1 {have I have noo signed an applicatlon for a bulkling pe,mst tor~ proposed wort< 3 I have contracted wll/1 Ille follolwlg l)elSOl1 (finn) lo p<OVMle the proposed construction (include name aOdress I phone I contractors license number): 4 I plan 10 provtOe portions of the WOt1I. but t have hll1!d Ille folloWlng person to coordlllate SupeMSO and f)ttMde the maier worf< {tndude name address I phone =traetors IICeflse number) 5 I Wlll Pl'OY'de some of !he work. cut I nave cootraaed (hired) ?he follOW!ng ~s to provide tne wort< 111docaled (1flC!ude n~ I address I pllOne 11ype ol WOik) Jt5 PROPERTY OWNER SIGNATURE DATE Is lhe al)liiccnt °' Mure bulldlng occupant required to submtt a buslntSS plan. acutety hazardous mattltals rtglstratt011 lorm or ri~ management and p<ll\'Snbcn program under Sections 25505, 25533 or 25534 of the Presley-Ta!11ler Hazardcus Substance Account Aci? Y9'S No Is !he applicant or future budding occupant require<! to obtain a pemtil IIQffl tile air pollubon cantrOI district or air Quality management otsli1ct'? Y~ No Is lhe facility to be consuucted Within 1,000 feet of tile outer boundary of a SCtiool srte? Y~ No IF ANY OF THE ANSWERS A.Rf 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 TME AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there Is a construction lending agency for the perfonnance of the wor1c this permit is issued (Sec. 3097 (i) Civil Code). Lende(s Name Lende(s Address I telllfy1113t 11\M readlhe appltcal!onand 5tate lhatthe abM tnformal!on Is comictand that tile lnfOllnation on the plans lsilCQlrate. I agree to c:omplywtdl all CltyOldlnances and State Jaws relating to boildtngc:onsllUdk>n. I he®/ authorize reimentafive of the City of Car1sbad t> er\U!rupon the above mri:loed prolJErt'f b-iispeaoc1 purposes. I ~SO AGREE TO SAVE, INOE~IFY AND KEEP HARMLESS THE CITY Of CARLSBAD AGAINST ,6U l.lA8lt.JTlES, JIJOGMENTS, COSTS ANO EXPENSES 'MJICH MAY IN /JmWAV ACCRU£ AGAINST SAD CITY IN CONSEQUENCE Of THE GRAl'fTING Of THIS PERMIT. OSHA."" OSHA pemi ls requied klr excavam over 5'0' deep arl:I delroitiJn rx ooostrucoon of slrucliJTeS over 3 Sbi!s il l'E91t. EXPIRATION. Eve!ypennit issued by lhe &.ifr,g Otfdal lnlerlhe proy;si)nsof Ns Code shalexpre by lrnda1iln and beCXlme rul and\Ul d lhe bt*lr,g or 'M)llt autiorized by such penm is not(IOIT1!lel"(.ed 'M1llll 180days from the dale of such penni ()( ~1he bul:frg()('M)llt · ed by such peimil IS suspended ()(abandoned at ~line aflertie'M)llt is cormieoced b-a perod ol 180days (Seclol 106.4.4 Ullbm Buik!ilg Code~ NS APPLICANT'S SIGNAT\JRE J'.,V. DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONL V if a Certificate of Occupancy will be requested at final inspection. CERTIFICATE OF OCCUPANCY (Commcrc1c1I Pro1cc ts On I y I Fax (760) 602-8560. Email building@carlsbadca.gov or Mail the completed form to City or cansbad, Buildu~ Division 1635 Faraday Avenue. Carlsbad. carrtomia 92008. r CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP carlsbad CA PHONE I FAX EMAIL OCCUPANT'S BUS. UC. No. OEUV£RY OPTIONS PICK UP: CONTACT (Usted above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) ASSOCIATED CBI -MAIL TO: CONTACT (Usted al>OVe) OCCUPANT (Usteo above) CONTRACTOR (On Pg. 1) NO CHANGE IN USE / NO CONSTRUCTION MAIL I FAX TO OTNER: CHANGE OF USE / NO CONSTRUCTION IS APPLICANT'S SIGNATURE DATE '• s4f~ "' ... ~ CITY OF PLUMBING, ELECTRICAL, MECHANICAL WORKSHEET Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov Building@carlsbadca.gov CARLSBAD B-18 Project Address: Zl31 PA-/..OMAIC. Al~Po~r l?P. Permit No~ lnfoonatlon provided below refen to worll being done on the above mentlonld permt only. This form must be completed and returned to the Building Division before the permit can be issued. B-18 Building Dept. Fax: (760) 602-8558 Number of new or relocated fixtures, traps, or floor drains ....................................................... __ New building sewer line? ......................................................................................... Ves __ No __ Number of new roof drains? .............................................................................................................. . Install/alter water line? .............................................................................. -....................................... . Number of new water heaters? ........................................................................................................ . Number of new, relocated or replaced gas outlets? .................................................................... __ Number of new hose bibs? ................................................................................................................. . Residential Permits: New/expanded seivke: Number of new amin: ------- Minor Remodel only: Yes__ No Commerdalnndustrlab Tenant Improvement: Number of existing amps involved in thb proiect: Number of new amps Involved In th/1 proiect: New Construction, Amps per Panel: Single Phase ............................................................... Number of new amperes ______ _ Three Phase ................................................................. Number of new amperes ______ _ Three Phase 480 ........................................................ Number of new amperes ______ _ Number of new fumaces, A/C. or heat pumps? ............................................................................ __ New or relocated duct worl:!? .......................................................................... Yes No __ _ Number of new fireplaces? ................................................................................................................. __ Number of new exhaust fans? ............................................................................................................ __ Relocate/Install vent? ............................................................................................................................ __ Number of new exhaust hoods? ........................................................................................................ __ Number of new boilers or compr<Hsors7 ........................................................... Number of HP Page 1 of 1 Rev. 03/09 PERMIT INSPECTION HISTORY REPORT (CBC2017-0604) Permit Type: BLDG-Commercial Application Date: 11/15/2017 Owner: BROOKWOOD CARLSBAD EXECUTIVE PLAZA LLC Work Class: Cogen Issue Date: 03/05/2018 Subdivision: CARLSBAD TCT#83-10 Status: Closed -Finaled Expiration Date: 10/31/2018 Address: 2131 Palomar Airport Rd Carlsbad, CA 92011-1433 IVR Number: 7765 Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete 03/21/2018 03/21/2018 BLDG-31 052289-2018 Cancelled Andy Krogh Reinspection Complete Underground/Condu it-Wiring Checklist Item COMMENTS Passed BLOG-Building Deficiency No 04/02/2018 04!02/2018 BLOG-31 053433-2018 Passed Andy Krogh Complete Underground/Condu it -Wiring 04/05/2018 04/05/2018 BLDG-11 054011-2018 Partial Pass Andy Krogh Reinspection Incomplete Foundation/Ftg/Pler s (Rebar) Checklist Item COMMENTS Passed BLDG-Building Deficiency Footings and transformer pad as noted on Yes plans 04(1612018 04/16/2018 BLOG-34 Rough 055087-2018 Cancelled Andy Krogh Reinspection Complete Electrical Checklist ltern COMMENTS Passed BLOG-Building Deficiency No BLDG·Electrlc Meter 055086-2018 Cancelled Andy Krogh Reinspection Complete Release Checklist Item COMMENTS Passed BLOG-Building Deficiency No BLOG-Final 055088-2018 Cancelled Andy Krogh Relnspection Complete Inspection Checklist Item COMMENTS Passed BLDG-Building Deficiency No BLDG-Plumbing Final No BLDG-Mechanical Final No BLDG-Structural Final No BLDG-Electrical Final No 04/19/2018 04/19/2018 BLDG•34 Rough 055498·2018 Cancelled Tim Frazee Reinspection Complete Electrical Checklist Item COMMENTS Passed BLDG-Building Deficiency No 04/20/2018 04/20/2018 BLDG-Final 055499-2018 Cancelled Tim Frazee Reinspection Complete Inspection May 04, 2018 Page 1 of 2 , · PERMIT INSPECTION HISTORY REPORT (CBC2017-0604) Permit Type: Work Class: Status: Scheduled Date BLDG-Commercial Application Date: 11/15/2017 Owner: Cogen Issue Date: 03/05/2018 Subdivision: Closed -Finaled Expiration Date: 10/31/2018 Address: IVR Number: 7765 Actual Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final COMMENTS 04/27/2018 04/2712018 BLDG-Electric Meter 056323-2018 Passed Andy Krogh 05/04/2018 05/04/2018 May 04, 2018 Release BLDG-Final Inspection Checklist Item BLDG-Building Deficiency 056324-2018 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final BLDG-34 Rough Electrical 057106-2018 BLDG-Final Inspection Checklist Item BLDG-Building Deficiency 057107-2018 Checklist Item BLDG-Building Deficiency BLDG-Structural Final BLDG-Electrical Final COMMENTS Meter designated as FM1 Failed Andy Krogh COMMENTS Active hold to be resolved Passed Tim Frazee COMMENTS Passed Tim Frazee COMMENTS Active hold to be resolved BROOKWOOD CARLSBAD EXECUTIVE PLAZA LLC CARLSBAD TCT#83-10 2131 Palomar Airport Rd Carlsbad, CA 92011-1433 Reinspection Complete Passed No No No No No Complete Passed Yes Reinspection Complete Passed No No No No No Complete Passed Yes Complete Passed Yes Yes Yes Page2of2 DATE: 12/01/17 JURISDICTION: City of Carlsbad PLAN CHECK NO.: Cbc2017-0604 ~ EsG1I A SA.FFhuilt Company SET: I PROJECT ADDRESS: 2131 Palomar Airport Road PROJECT NAME: 10 Car EV Chargers and electrical srrvice 0 APPLICANT JY.)URIS 0 PLAN REVIEWER D FILE ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D 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. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D 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. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone#: ---Date contacted: ~ (by:'(\(..},' Email: Mail Telephone Fax In Person D REMARKS: By: Morteza Beheshti EsGil Corporation D GA D EJ D MB D PC Enclosures: 11/20/17 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560· 1468 + Fax (858) 560· 1576 City of Carlsbad Cbc201 7-0604 12/01/17 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PLAN CHECK NO.: Cbc2017-0604 PREPARED BY: Morteza Beheshti DATE: 12/01/ 17 BUILDING ADDRESS: 2131 Palomar Airport Road BUILDING OCCUPANCY: BUILDING PORTION Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code Type of Review: D Repetitive Fee =--=""_l Repeats Comments: AREA Valuation (Sq.Ft.) Multiplier cb By Ordinance 0 Complete Review D Other D Hourly EsGil Fee Reg. VALUE Mod. D Structural Only 1------11 Hr @ * ($) 121,000 121,000 $700.61 ! $455.401 $392.341 Sheet 1 of 1 macvalue.doc + .,:E SAN DIEGO REGIONAL OFFICE USE ONLY • . - HAZARDOUS MATERIALS RECORO ID# PLAN CHECK# "'°'o G ,·· QUESTIONNAIRE BP DATE I I Business Name Business Contad Telephone# 51WOl:-WOO D MANA<.r6M6Nr Project Address City State Zip Code APN# 2.l '31 PA-LOMA-II!. ·A lilPO!f!.T fl.I> CA1!,(.SB,4-0 Cf\ ,2.011 2-13-0=J-0-2-8 Mailing Address City State Zip Code Plan Fne# Project Contact fer s Di &G Applicant E.mail Telephone# 'PAM E:1..4 SMLTH PAM61.Asec1qrzoc..<P. i.ts ··H,0-2'318-302 3 The following quHtions represent lho laclllty's 1ctlvltles, NOT Iha specific project descnpllon. PART I; FIRE DEPARTMENT -HAZARDOUS MA~RIALS QIYISIQN; OCCUPANCY C~§IEl~ATION; (not r:,qulrJd for p~ts ~llhlD lb• Clty of San Q!!sg}: indicate by cirding the item, 'Mlether youfUsiness will use. process, or store aO'fO the Towing hazardous materials.an; 0 the Items are circied. applicant must contad the ·J=lre Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Facility's Square Footage (including proposed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 3. Flammable/Combustible Liquids 7. Pyrophoncs 11. Highly Toxic or Toxic Matenals 4. Flammable Solids 8. Unstabfe Reactives 12. Radioactives PART U; SAN QIEGQ COUNTY DEPARTMENT Of ENVIRONM!!'NTAL HEAL TH -HAZARDOUS MATERIALS DIVISION IHMDl: If lhe anower to any of the questions ls Yes, applfcant must contact the County of San biegoH3zardous Materials Division. 5500 Overiand Avenue, Surte 110, San Diego, CA 92123. Call (858) 50~700 prior to the issuance of a building pennit. FEES ARE REQUIRED Project Completion Date· Expected Date ol Occupancy: 0 CalARP Exempt YES NO (for new construction or remodeling projects) ~---'/ ___ _ 1. 0 i ls your business listed on the reverse side of this form? (check all that apply), Date 1nrua:1s 2. D Will your business dispose of Hazardous Substances or Medical Waste in any amount? 3. 0 Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 D CalARP Required pounds and/or 200 cubic feet? ----''---- 4. 0 I Will your business store or handle carcinogens/reproductive toxins in any quantity? Date Initials 5. 0 Will your business use an existing or install an underground storage tank? 6. D Will your business store or handle Regulated Substances (CalARP)? O CalARP Complete 7. D Will your business use or install a Hazardous Waste Tank Sygtem (Title 22, Articie 10)? --~le_ __ _ 8 0 Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to Date Initials or rester than 1,320 aliens? California's Abo round Petroleum Stora e Act . P CD· Any YES" answer requires a stamp from APCD 10124 Old Grove Road. San ego, 21 1 apcdcomp@sdcounty.ca gov (858) 5 • ). • o stamp required if Q1 Yes i!!!I 03 Yes i!!!I 04-06 No]. The followin~ queotiono are intended to identtfy the majority of air pollutk>n Issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive requirements contact APCO. Residences ere typically exempt, except -those wtth more than one building~ on the property; single buildings with more than four dwelling units; townhomes; condos; mixed-commercial use; deliberate bums; residences fanning part of a larger project. rExcludes garages & small outbuildings.) 1. 2. 3. YES NO D D D D D D Will the project disturb 160 square leet or more ol exioting building ma1enals? Will any load supporting structural members be removed? Notification may be required 1 O wor1<ing days prior to commencing demolition. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been perfonned by a Certified Asbestos Consultant or Site Surveillance Technician? 4. D D (ANSWER ONLY IF QUESTION 3 IS YES} Based on the survey results. will !he project disturb any asbestos containing material? Notification may be required 10 wort<lng days pnor to commencing asbes1os removal 5. D D 6. D Will the project or associated construction equipment emit air contaminants? See the reverse side of this fonn or APCD factsheet (www.sdapcd.org!infolfactsfpennits.pdQ for typical equipment requiring an APCD permft. O (ANSWER ONLY IF QUESTION 515 YES) Will the project or associated construction equipment be loceted within 1,000 leet of a school bounds Bnefly describe business activities: Bnefly descrtbe proposed project: I declare under penalty of pe1ury that to the best of my knowledge and belief t responses made herein are true and correct_ I I Name of Owner or Authorized Agent Signature of Owner or Authorized Agent Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ________________________________ _ BY· DATE· I I EXEMPT 0111: NO FURTHER INFORMATION REQUIR&O REL&ASEO FOR 9UILD1NO PSJllMIT 8UT NOT FOR OCCUPANCY RELEASED l"QR OCCUPANCY COUNTY-HMO" APCD COUNTY-HMO APCD COUNTY-HMO APCD . A stamp in thrs box 2n!x exempts businesses from completing or updating a Hazardous Matenals Business Plan Other permitting requirements may still apply . HM-9171 (08115) County of San Diego -OEH -Hazardous Materials Division LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO DEPARTMENT OF ENVIRONMENTAL HEAL TH -HAZARDOUS MATERIALS DIVISION Check all that apply: AUTOMOTIVE 0 Battery Manufacturing/Recycling 0 Boat Yam 0 Car Wash 0 Dealership Maintenance/Painting 0 Machine Shop 0 Painting 0 Radiator Shop 0 Rental Yam Equipment D Repairl?reventive Maintenance 0 Spray Booth D Transportation Services 0 Wrecking/Recycling CHEMICAL HANDLING 0 Agricultural supplier/distributor 0 Chemlcol Manufacturer 0 Chemical Supplier/Distributor 0 Coatings/Adhesiw 0 Compressed Gas Supplier/Distributor 0 D,y Cleaning 0 Fiberglass/Resin Application 0 Gas Station 0 Industrial Laundry 0 Laboratory 0 Laboratory Supplier/Distributor 0 Oil and Fuel Bulk Supply 0 Pesticide Operator/Distributor CHEMICAL HANDLING 0 Photographic Processing O Pool Supplies/Maintenance 0 Printing/Blue Printing 0 Road Coatings 0 Swimming Pool D Toxic Gas Handier 0 Toxic Gas Manufadurer METAL WORKING 0 Anodizing 0 Chemical Milling/Etching D Finish-Coating/Painting O Flame Spraying 0 Foundry O Machine Shop-Drilllng/Lathe$/Mills O Metal Plating 0 Metal Prepping/Chemical Coating 0 Precious Metal Recovery 0 Sand Blasting/Grinding 0 Steel Fabricator D Wrought Iron Manufacturing AEROSPACE O Aerospace Industry D Aircraft Maintenance D Aircraft Manufacturing OTHERS AND MISCELLANEOUS 0 Asphalt Plant 0 Biotechnology/Research 0 Chiropractic Office 0 Co-Generation Plant 0 Dental Clinic/Office D Dialysis Center 0 Emergency Generator O Frozen Food Processing Facility D Hazardous Waste Hauler D Hospital/Convalescent Home 0 Laboratory/Biological Lab D Medical Clinio'Office 0 Nitrous Oxide (NO.) Control System 0 Phannaceuticals 0 Public Lltility D Refrigeration System 0 Rock Quanry 0 Ship Repair/Construction 0 Telecommunications Cell Site D Veterinary Clinic/Hospital 0 Wood/Fumiture Manufacturing/Refinishing ELECTRONICS 0 Electronic Assembly/Sub-Assembly 0 Electronic Components Manufacturtng 0 Printed Circuit Board Manufacturing NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES. ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES. USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE HAZARDOUS MATERIALS DIVISION (HMO) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (858) 505-6880. LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District. CHEMICAL 47 -Organic Gas Sterilizers 32 -Acid Chemical MIiiing 33 -Can & Coil Manufacturing 44 -Evaporators, Dryers & Stills Processing Organic Materials 24 -Dry Chemical Mixing & Detergent Spray Towers 35 -Bulk Dry Chemicals Storage 55 -Chrome Electroplating Tanks COATINGS & ORGANIC SOLVENTS 27 -Coating & Painting 37 -Plasma Arc & Ceramic Deposition Spray Booths 38 -Paint. Stain & Ink Mfg 27 -Printing 27 -Polyester Resin/Fiberglass Operations METALS 18 -Metal Melting Devices 19 -OH Quenching & Salt Baths 32 -Hot Dip Galvanizing 39 -Precious Metals Refining ORGANIC COMPOUND MARKETING (GASOLINE. ETC) 25 -Gasoline & Alcohol Bulk Plants & Tenninats 25 -Intermediate Refuelers 26 -Gasoline & Alcohol Fuel Dispensing COMBUSTION ROCK AND MINERAL 34 -Piston Internal -Combustion Engines 04 -Hot Asphalt Batch Plants 13 -Boilers & Heaters (1 million BTU/hr or larger) 05-Rock Drills 14 -Incinerators & Crematories 06 -Screening Operations 15 -Bum Out Ovens 07 -Sand Rock & Aggregate Plants 16 -Core Ovens 08-Concrete Batch, CTB, Concrete Mixers, Mixers 20 -Gas Turbines, and Turbine Test Cells & Stands & Silos 48 -Landfill and/or Digester Gas Flares 10 -Brick Manufaduring ELECTRONICS 29 -Automated Soldering 42 -Electronic Companent Mfg FOOD 12 -Fish Canneries 12 -Smoke Houses 50 -Coffee Roasters 35 -Bulk Flour & Powered Sugar Storage SOLVENT USE 28 -Vapor & Cold Degreasing 30 -Solvent & Extract Driers 31 -Dry Cleaning OTHER 01 -Abrasive Blasting Equipment 03 -Asphalt Roofing Kettles & Tankers 46 -Reverse Osmosis Membrane Mfg 51 -Aqueous Waste Neutralization 11 -Tire Butlers 17 -Brake Debonders 23 -Bulk Grain & Dry Chemical Transfer & Storage 45 -Rubber Mixers 21 -Waste Disposal & Reclamation Units 36 -Grinding Booths & Rooms 40 -Asphalt Pavement Heaters 43 -Ceramic Slip Casting 41 -Per11te Processing 40 -Cooling Towers -Registration Only 91 -Fumigation Operations 56 -VW{TP (1 million gal/day or larger) & Pump Station NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600 HM-9171 (08115) County of San Diego -DEH -Hazardous Materials Division " INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date 11/14: /t 9- Business Name BR.QO~WoO P M.~t{l\<gETMENT l'AArN&fZ.S,__,,,,l-t..-=:C.,,._ ___ _ Street Address _~13 I 'PA-LO Mt\-12-.. A-t~R..=po-"-"ie,=-c,L.....r&,,_,'l>'------------ Email Address PAMEL.ASe C2W?-Ol..y?. US, pyppoc.s.er,2~\M"-YS _____ _ PLEASE CHECK HERE IF YOUR BUSINESS IS EXF.MPT· 1_r,c, REVERSE SIDE CHECK TYPE OF BUSINESS) 1\71 Check all below that are present at your facility ~ Acid Cleaning Assembly Ink Manufacturing Laboratory Machining I Milling Manufacturing Membrane Manufacturing (i.e. water filter membranes) Metal Casting I Forming Metal Fabrication Nutritional Supplement I Vitamin Manufacturing Painting I Finishing Paint Manufacturing Personal Care Products Manufacturing Pesticide Manufacturing I Packaging --, Automotive Repair Battery Manufacturing Biofuel Manufacturing Biotech Laboratory Bulk Chemical Storage Car Wash Chemical Manufacturing Chemical Purification Dry Cleaning Metal Finishing Electroplating Eleclroless plating Anodizing Pharmaceutical Manufacturing (including precursors) Porcelain Enameling Electrical Component Manufacturing Fertilizer Manufacturing Film I X-ray Processing Food Processing Glass Manufacturing Industrial Laundry --- Coating (i.e. phosphating) Chemical Etching I Milling Printed Circuit Board Manufacturing Metal Powders Forming SIC Cocle(s) (if known): _________ _ Power Generation Print Shop Research and Development Rubber Manufacturing Semiconductor Manufacturing I Soap I Detergent Manufacturing . Waste Treatment I Storage J Brief description of business activities (Production I Manufacturing Operations): _____ _ Description of operations generating wastewater (discharged to sewer. hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal I day): List hazardous wastes generated (type I volume): __ _ Dale 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: ____ _ Site Contact Title __ _ -----· ------------------ Signature Phone No __________ _ ENCINA WASTEW/\TER AUTHORITY. 6200 Avenida Enc111as Ca1lsbad CA 92011 1760) 438-3941 FAX· (760! 476-9852 DISCHARGE PERMIT EXEMPT LIST The commercial enterprises listed below are a partial listing of businesses that are exempt from industrial wastewater discharge permitting under normal operating conditions. They are exempt because (a) they discharge no process wastewater (i.e., they only discharge sanitary wastewater with no pollutants exceeding any local limits), and (b) they have no potential to negatively impact the EWPCF or other wastewater treatment plants in the ESS. Any questions regarding exemptions should be referred to EWA Source Control staff. .X Automobile Detailers Barber/Beauty Shops Business/Sales Offices Carpet/Upholstery Cleaning Services Childcare Facilities Churches Community Centers Consulting Services Contractors Counseling Services Educational Services (no auto repair/film developing) Financial Institutions/Services Fitness Centers Gas Stations (no car wash/auto repair) Grocery Stores (no film developing) Home-based Businesses Hotels/Motels (no laundry) Laundromats Libraries Medical Offices (no x-ray developing) Mortuaries Museums Nail Salons Nursing Homes Office Buildings (no process flow) Optical Services Pest Control Services (no pesticide repackaging for sale) Pet Boarding/Grooming Facilities Postal Services Public Storage Facilities Restaurants/Bars Retail/Wholesale Stores (no auto repair/film developing) Theaters (Movie/Live)