HomeMy WebLinkAbout2173 SALK AVE; 220; CB100398; Permit03-26-2010
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Commercial/Industrial Permit Permit No: CB100398
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
Project Title:
2173 SALK AV CBAD St: 220
Tl
2120210200
$40,000.00
Sub Type:
Lot#:
Construction Type:
Reference #:
VENTANA REAL
SPLIT SUITE 200 AND CREATE STE 220
COMM
0
5A
Applicant:
DESIGN CORP
STE 175
444 S. CEDROS AVE
SOLANA BEACH, CA 92075
858 794-3222
Status: ISSUED
Applied: 03/05/2010
Entered By: MDP
Plan Approved: 03/26/2010
OFFICE TO OFFICE Issued: 03/26/2010
Inspect Area:
Plan Check#:
Owner:
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l Plan Check Fee
Plan Check Discount
Strong Motion Fee
Park Fee
LFM Fee
Bridge Fee
BTD #2 Fee
BTD #3 Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
Pot. Water Con. Fee
Meter Size
Add'l Pot. Water Con. Fee
Reel. Water Con. Fee
Green Bldg Stands (SB1473) Fee
Fire Expedited Plan Review
$352.86 Meter Size
$0.00 Add'l Reel. Water Con. Fee
$229.36 Meter Fee
$0.00 SDCWA Fee
$0.00 CFD Payoff Fee
$8.40 PFF (3105540)
$0.00 PFF (4305540)
$0.00 License Tax (3104193)
$0.00 License Tax (4304193)
$0.00 Traffic Impact Fee (3105541)
$0.00 Traffic Impact Fee (4305541)
$0.00 PLUMBING TOTAL
$0.00 ELECTRICAL TOTAL
$0.00 MECHANICAL TOTAL
$0.00 Master Drainage Fee
Sewer Fee
$0.00 Redev Parking Fee
$0.00 Additional Fees
$1.00 HMPFee
$0.00
TOTAL PERMIT FEES
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$56.00
$185.00
$37.00
$0.00
$0.00
$0.00
$205.00
$1,074.62
Total Fees:$1,074.62 Total Payments To $1,074.62 Balance Due:$0.00
fSl A V
Inspector:
FINAL APPROVAL
Date:Clearance:
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in 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 limitations has previously otherwise expired.
CITY OF
CARLSBAD
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-2717/2718/2719
Fax 760-602-8558
www.carlsbadca.gov
Plan Check No.
Est. Value U Q
Plan Ck. Deposit
Date
JOB ADDRESS 2173 Salk Ave. Carlsbad, CA 92008 SUITE*/SPACE*/UNIT*
220J&T 212 02 10
CT/PROJECT ## BATHROOMS TENANT BUSINESS NAME
Beyond Trust
CONSTR. TYPE
B
DESCRIPTION OF WORK: Include Square Feet of Affected Areafs)
TENANT IMPROVEMENT IN EXISTING OFFICE BUILDING
EXISTING SUITE 200 BEING DEMISED INTO TWO SEPARATE SUITES. NEW SUITE 220 CREATED.
EXISTING USE
Office
PROPOSED USE
Office
GARAGE (SF)PATIOS (SF)
231
DECKS (SF)
0
FIREPLACE
YESf"k NOf/l
AIR CONDITIONING
YES I I I
FIRE SPRINKLERS
Desiqncorp - Chie Honda
444 South Cedros Ave. #175
vx.-o to A PHONE
858-794-3222
FAX 858-794-3220EMAILXMAILchonda@designcorpsd.com
PROPERTY OWNER NAME Ventana Real Master, LLC fcld
ADDRESS
1525 Faradav Ave. Suite 100
ADDRESS
CITY
Carlsbad
STATE CA ZIP
92008
CITY STATE ZIP
PHONE
760-607-4282
FAX
760-607-4286
PHONE FAX
EMAIL
Jbrusseau@newportnational.biz
EMAIL
ARCH/DESIGNER NAME 4 ADDRESS
Desiancoro (Same as above)
STATE LIC. #
3850
CLASS CITY BUS. LIC.#
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires theapplicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of theBusiness and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars ($500)).
WORKERS1 COMPENSATION
Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations:
B l 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 carrier and policy
number are: Insurance Co Policy No. Expiration Date
This section need not be completed if the permit is for one hundred dollars ($100) or less.
I | 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.
j£f CONTRACTOR SIGNATURE AGENT DATE
V
OWNER-BUILDER DECLARATION
/ hereby affirm that I am exempt from Contractor's License Law tor the following reason;
| [ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's
License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
I am exempt under Section Business and Professions Code for this reason:
1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. I |Yes I iNo
2.1 (have / have not) signed an application for a building permit for the proposed work.
3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number):
4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone /contractors' license number):
5.1 will provide somejjfthe work, but I have, contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work):
D
QAGENT DATE
CO MPLETETHIS SECTION FOR NON-RESIDENTIAL (BUILDING PERMITS ONLY
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? I I Yes I JNo
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or aircjuality management district? IfVes I I No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? I JYes I iNo
IF ANY OF THE ANSWERS ARE YES, /
EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
CONSTRUCTION LENDING AGENCY
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 Lender's Address
APPLICANT CERTIFICATION
I hereby authorize representative of the City of Carlsbad to enter upon the above mentbned 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 SO 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 null and void if the building or work authorized by such permit is not commenced within
180 days from the date of such permit or if the building or work authorized by^uch permit is suspended or abandoned at any time after the work is commenced for a ceriod of 180 days (Section 106.4.4 Uniform BuikJing Code).
ICANT'S SIGNATURE DATE
City of Carlsbad Bldg Inspection Request
For: 04/06/2010
Permit* CB100398
Title: VENTANAREAL
Inspector Assignment: PY
Description: SPLIT SUITE 200 AND CREATE STE 220. OFFICE TO
OFFICE
Type:TI Sub Type: COMM
Job Address:
Suite: Lot: 0
Location:
APPLICANT DESIGN CORP
Owner: RIO SD PLAZA II MASTER LLC
Remarks:
Phone: 8589670880
Total Time:
CD Description
19 Final Structural
29 Final Plumbing
39 Final Electrical
49 Final Mechanical
Requested By: DAVID ERB
Entered By: CHRISTINE
Act Comments
.Q J?H
Comments/Notices/Holds
Associated PCRs/CVs Original PC#
Inspection History
Description Act Insp CommentsDate
04/05/2010 89 Final Combo
04/01/2010 84 Rough Combo
CA PD
AP PY EMR - T-BAR OK
03/29/2010 14 Frame/Steel/Bolting/Welding AP PY
03/29/2010 24 Rough/Topout
03/29/2010 34 Rough Electric
AP PY
AP PY
EsGil Corporation
In Partners/tip with (government for (Buifding Safety
DATE: 3/25/10
JURIS^
JURISDICTION: City of Carlsbad rJTTDtfTREVIEWER
a FILE
PLAN CHECK NO.: 10-0398 SET: II
PROJECT ADDRESS: 2173 Salk Ave Suite 220
PROJECT NAME: Beyond Trust Suite 220- TI
XI The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted 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.
2<] Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: ) Fax #:
Mail Telephone Fax In Person
A] REMARKS: Applicant to hand carry the plans directly to the City of Carlsbad this does not
assure a permit will be issued the city may have other corrections.
By: Doug Moody Enclosures:
EsGil Corporation
D GA D EJ D PC 3/19/10
9320 Chesapeake Drive, Suite 208 4 San Diego, California 92123 + (858)560-1468 + Fax (858) 560-1576
EsGil Corporation
In Partnership with government for (Building Safety
DATE: 3/15/10 a AEELJCANT
JUf
JURISDICTION: City of Carlsbad Q PLAN REVIEWER
Q FILE
PLAN CHECK NO.: 10-0398 SET: I
PROJECT ADDRESS: 2173 Salk Ave Suite 22O
PROJECT NAME: Beyond Trust Suite 220- TI
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
XI 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.
XI The applicant's copy of the check list has been sent to:
Designcorp / Chie Honda
444 South Cedros Ave Suite 175, Solana Beach, CA 92075
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
XI Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted:, Chie/Honda Telephone #: 858-794-3222
Date contacted?/ !5//0(byV^ Fax #: 858-794-3220/^ ' /Maili/ Telephone Faxy In Person
REMARKS:
By: Doug Moody Enclosures:
EsGil Corporation
n GA n EJ n PC 3/9/10
9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 + (858)560-1468 + Fax (858) 560-1576
City of Carlsbad 1O-O398
3/15/10
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK NO.: 1O-O398
OCCUPANCY: B
TYPE OF CONSTRUCTION: IIA
ALLOWABLE FLOOR AREA:
SPRINKLERS?: Yes
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 3/8/10
DATE INITIAL PLAN REVIEW
COMPLETED: 3/15/10
JURISDICTION: City of Carlsbad
USE: Office
ACTUAL AREA: 3275sf
STORIES: 2
HEIGHT:
OCCUPANT LOAD: 56
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 3/9/10
PLAN REVIEWER: Doug Moody
FOREWORD (PLEASE READ):
This plan review is limited to the technical requirements contained in the International Building
Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state
laws regulating energy conservation, noise attenuation and access for the disabled. This plan
review is based on regulations enforced by the Building Department. You may have other
corrections based on laws and ordinances enforced by the Planning Department, Engineering
Department, Fire Department or other departments. Clearance from those departments may be
required prior to the issuance of a building permit.
Code sections cited are based on the 2007 CBC, which adopts the 2006 IBC.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of
the 2006 International Building Code, the approval of the plans does not permit the violation of
any state, county or city law.
To speed up the recheck process, please note on this list (or a copy) where each
correction item has been addressed, i.e.. plan sheet number, specification section, etc.
Be sure to enclose the marked up list when you submit the revised plans.
City of Carlsbad 10-0398
3./15/10
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:
1. 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.
2. Bring one corrected set 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.
1. Provide a section view of the extended interior partitions. Show:
a) Type, size and spacing of studs. Indicate gauge for metal studs. Specify
manufacturer and approval number or indicate "to be ICBO approved".
b) Method of attaching top and bottom plates to structure. (NOTE: Top of
partition must be secured to roof or floor framing, unless suspended
ceiling has been designed for partition lateral load).
2. Doors and fire shutters in fire barriers shall comply with the following table for the
new door to the exit enclosure door #5. Table 715.4.
FIRE BARRIER RATING
(hours)
1
MINIMUM OPENING PROTECTION ASSEMBLY
(hours)
1
3. In rooms or areas where the occupant load exceeds the values in the table
below, two exits shall be provided. Please revise the plans the occupant load of
suite 220 is 56 requiring two exits Section 1015.1.
OCCUPANCY
A, B, E, F, M, U
MAXIMUM OCCUPANT LOAD
49
Exits should have a minimum separation of one-half the maximum overall
diagonal dimension of the building or area served. Section 1015.2.1. Where a
building is equipped throughout with an automatic sprinkler system, the
separation distance may be reduced to one-third of the diagonal.
City of Carlsbad 10-0398
3/15/10
5. Exit signs are required whenever two exits are required. Show all required exit
sign locations. Section 1011.1.
6. Show separate sources of power may be required for exit illumination. Review
Section 1006.3.
7. Please note in the general wiring notes on the plans "AC Cable is not allowed in
A, B, E, H, F, M, S and I occupancies. NM cable is restricted (without City
approval) to one and two family dwellings. Note on plans that an equipment
ground conductor is to be installed in all flexible conduits".
8. Please indicate if the ceiling space in the tenant improvement is being used as a
plenum? If so on the mechanical plans clearly show the limits of ceiling space
used as duct or plenum.
a) Clearly show that all material exposed within the plenum complies with
UMC Section 604.2. "Materials shall have a mold-, humidity-, and
erosion-resistant face that meets the requirements of UL 181."
b) Combustibles within the plenum space must comply with UMC Section
601.3. Flame-spread index of not more than 25 and a smoke-developed
rating of not more than 50.
c) Environmental duct systems and product conveying duct systems shall
not extend into or through ducts or plenums. UMC Section 504.1. and
UMC Section 505.1.
d) UMC. Section 602.1 does not allow negative pressure ducts in the
plenum. UMC, Section 602.1, states: "See Chapter 5 for limitations on
environmental air systems exhaust ducts extending into or through ducts
or plenums." And: "Exhaust ducts under positive pressure and venting
systems shall not extend into or pass through ducts or plenums.")
9. Provide complete plumbing plans, including:
a) Provide complete water line sizing plans and developed pipe lengths.
UPC Section 610.0
10. Please revise the plans to show the non-commercial kitchen sink in the
employee staff room to provide the following:
a) A clear floor space at least 30"x 48" shall be provided for forward
approach.
b) The clear space shall extend a maximum of 19" underneath the sink.
c) The accessible sink shall be a maximum of 6 Yz" deep.
d) The sink shall be mounted with the counter or rim no higher than 34"
e) Knee clearance that is at least 27" high, 30" side and 19" underneath the
sink shall be provided.
f) Hot water and drain shall be insulated.
g) There shall be no sharp or abrasive surfaces under sinks.
City of Carlsbad 1O-0398
3/15/1O
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 a No a
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.
City of Carlsbad 10-O398
3/15/10
[DO NOT PAY- THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad PLAN CHECK NO.: 10-O398
PREPARED BY: Doug Moody DATE: 3/15/10
BUILDING ADDRESS: 2173 Salk Ave Suite 220
BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: IIA
BUILDING
PORTION
Tl
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code
AREA
( Sq. Ft.)
570
cb
Rlrln Pprmit FPP hv Orrlinanrp TV
Valuation
Multiplier
City Estimate
By Ordinance
Reg.
Mod.
VALUE ($)
40,000
40,000
$352.86
Plan Check Fee by Ordinance
Type of Review:
I I Repetitive Fee
Repeats
Complete Review
D Other
,—I Hourly
EsGil Fee
Structural Only
Hr. @
$229.36
$197.60
Comments:
Sheet 1 of 1
macvalue.doc +
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB 10-0398 DATE 3/10/10
ADDRESS 2173 Salk Avenue
RESIDENTIAL ADDITION-
MINOR (<17,000.00)
RETAINING WALL
VILLAGE FAIRE
POOL/SPA
TENANT IMPROVEMENT
COMPLETE OFFICE BUILDING
OTHER office to office, no new roof mounted equipment
PLANNER Chris Sexton
ENGINEER
DATE 3/10/10
DATE
J lC0 220
H:\ADMIN\Cni)NTER/PLANNING/HNCINEEKINC APPROVALS
Carlsbad Fire Department
Plan Review Requirements Category: TI, COMM
Date of Report: 03-25-2010 Reviewed by:
Name:
Address:
DESIGN CORP
STE 175
444 S. CEDROS AVE
SOLANA BEACH, CA
92075
Permit #: CB100398
Job Name: VENTANAREAL ->"7/
Job Address: 2 1 73 SALK AV CBAD St: 220
^SV
incomplete. At this time, this office cannot
. Please review
ges "clouded",
INCOMPLETE The item you have submitt
conduct a review
carefully all commenJ^**Sc1ied. Please resubmit the necessary plans and/or specifications, wT
to this office foi^eview and approval.
Conditions:
Cond: CON0003933
[MET]
** APPROVED:
THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUEANCE OF A
BUILDING PERMIT.
THIS APPROVAL IS SUBJECT TO FIELD INSPECTIONS, ANY REQUIRED TESTS, FIRE DEPARTMENT
NOTATIONS,
CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND
REGULATIONS.
THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW.
Entry: 03/25/2010 By: DKJ/cw Action: AP
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS QUESTIONNAIRE
OFFICE USE ONLY
UPFP#
HV#
BP DATE /
Business Name Business Contact Telephone #
Project Aadress City State Zip Code APN#
02-
Mailing Address City State Zip Code Plan File*
Project Contact Telephone #
3222
The following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business
will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with
jurisdiction prior to plan submittal.
5. Organic Peroxides 9.
6. Oxidizers 10.
7. Pyrophorics 11.
8. Unstable Reactives 12.
1. Explosive or Blasting Agents
2. Compressed Gases
3. Flammable/Combustible Liquids
A. Flammable Solids
Water Reactives
Cryogenics
Highly Toxic or Toxic Materials
Radioactives
13. Corrosives
14. Other Health Hazards
dSPNone of These.
PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD): If the answer to any of thequestions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 3'° flo
Call (619) 338-2222 prior to the issuance of a building permit.
FEES ARE REQUIRED.
YES NO
Expected Date of Occupancy:
floor, San Diego, CA 92101.
D CalARP Exempt
Is your business listed on the reverse side of this form? (check all that apply).
Will your business dispose of Hazardous Substances or Medical Waste in any amount?
Will your business store or handle Hazardous Substances in quantities equal to or greater than
55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity?
Will your business use an existing or install an underground storage tank?
Will your business store or handle Regulated Substances (CalARP)?
Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
Date Initials
D CalARP Required
Date Initials
D CalARP Complete
Date Initials
PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the AirPollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition
permit. Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to
commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information.
1.Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See theAPCD factsheet at http://www.sdapcd.org/info/facts/permits.pdf, and the list of typical equipment requiring an APCD permit on the reverse side
of this from. Contact APCD if you have any questions).
(ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)?
(Public and private schools may be found after search of the California School Directory at http://www.cde.ca.qov/re/sd/: or contact the
appropriate school district).
Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos?
Will there be demolition involving the removal of a load supporting structural member?
Briefly describe business activities:Briefly describe proposed project:
H*pt
made therein aie true and correct.I declare under penalty of perjury that to the best of my knowledge and belief the rei
'
Name of owner or Authorized Agent Signature of Owner oKAutnorized Agent
I I'D
Date
FOR OFFICIAL USE ONLY:FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:,
BY:DATE:
EXEMPT OR NO FURTHER INFORMATION REQUIRED
COUNTY-HMD APCD
RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY
COUNTY-HMD APCD
RELEASED FOR OCCUPANCY
COUNTY-HMD APCD
HM-9171 (04/07)County of San Diego DEH - Hazardous Materials Division
CB100398 2173 SALKAV 220
VENT ANA REAL
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3/I5-//0
3 1*3/10 Ce^/i &P tiJT tffao TD
t 72%
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s\
Approved
BUILDING
ENGINEERING
Forms/Fees
HazHealthAPCD
School
5 -
CFD: Y N LandUse:
PFF:
Date
im_
/M/t-
ImpArea: FY:
Comments Date
Building
Planning
Engineering
Application Complete?
Fees Complete?
N
N
By:
By: