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HomeMy WebLinkAbout2180 RUTHERFORD RD; ; CBC2017-0155; Permit'· } Print Date: 06/13/2017 Job Address: PermitType: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2180 Rutherford Rd BLDG-Commercial 2120702500 $73,625.33 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial Permit www.carlsbadca.gov Worl<Class: Tenaht lmpro~ement Status: Lot#: Applied: Reference #: Issued: Construction Type: Finaled: Bathrooms: Inspector: Orig. Plan Check#: Plan Check#: Description: CALLAWAY GOLF: 1,583 SF Tl OFFICE TO OFFICE// SOME MECHANICAL & ELECTRICAL WORK Applicant: ANDREW TARANGO BUILDING PERMIT FEE $2000+ BUILDING PLAN CHECK FEE (BLDG) Owner: CALLAWAY GOLF COMPANY 2180 Rutherford Rd CARLSBAD, CA 92008 ELECTRICAL BLDG COMMERCIAL NEW/~DDITION/REMODEL MANUAL BUILDING PERMIT FEE MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL SB1473 BUILDING STANDARDS FEE STRONG MOTION-~OMMERCIAL Total Fees: $999:56 Total Payments To Date: $999.56 1 Contractor: PACIFIC BUILDING GROUP 9752 Aspen Creek Ct SAN DIEGO, CA 92126 858-652-5088 Balance Due: Please take NO.TICE that approvaf,of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 cjays 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 procequre will bar any subsequent legai action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED thatyour right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity cnanges, nor planning, zoning, grading or other similar application piocessing 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: CBC2017-0155 Closed -Finaled 04/04/2017 04/21/2017 JWest $0.00 $512.32 $355.52 $60.00 $3.10 $45.00 $3.00 $20.62 THE FOLLOWIN'f APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: OEN GI NEERING ("atyof Carlsbad JOB ADDRESS CT/PROJECT# LOT# Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca:gov www.carlsbadca.gov 2180 Rutherford Road SUITEI/SPACEI/UNITI I BEDROOMS # BATHROOMS 070 -25 00 CONSTR. 1YPE OCC. GROUP Callaway Golf 111-B 111-B DESCRIPTION OF WORK: Include Square Feet 1,583 s.f. office to office tenant improvement within an existing building. Mechanical and electrical are included as part of this permit application. EXISTING USE PROPOSED USE GARAGE (SF) PATIOS(SF) DECKS(SF) FIREPLACE YES0, AIR CONDITIONING FIRE SPRINKLERS B-F1-S1 B-F1-S1 0 0 0 No(Z] YES 0No D YES0NoO APPLICANT NAME Primary Contact ADDRESS CITY PHONE Andrew Taran o-SCA 12380 Evening Creek Drive, Suite 125 STATE ZIP San Diego CA 92128 (85_8) 793-4777 (858 793-4787 EMAIL DESIGN PROFESSIONAL ADDRESS 12380 Evening Creek Drive, Suite 125 CITY STATE ZIP PROPERTY OWNER NAME Callaway Golf ADDRESS 2180 Rutherford Road CITY STATE ZIP Carlsbad CA 92008 PHONE FAX (760) 931-1771 n/a EMAIL mikema@calllawa golf.com CONTRACTOR BUS. NAME ADDRESS 9752 Aspen Court, Suite 150 CITY STATE ZIP San Die o CA 92128 San Diego CA 92126 . PHONE FAX PHONE FAX 858 793-4777 858 793-4787 858) 552-0600 (858 552-0602 EMAIL EMAIL sca-sd.com STATE UC.# C11,701 Worlltrs' Compensation Dtclll'lllon: I hereby affirm llldtr plllllly of p,tJury one of the fDl/ow/ng declanllions: 0 I have and wlll maintain a ctrtHlcatt of COllltllt to Hlf-111111l'I for WOll<ers' compensation as provided by Section 3700 of the La!)or Code, for the performance of the WOik for which this pennit is issued. ~ I have and wDI maintain workn' COIIIPt~on, as 19Qund by Section 3700 of:: Labpr Code, for the performance of the work for which this permit is issued. My workers' compensation in ran carrier and policy numberare:lnsuranceCo. b{J..~IC L<2::ua:aLTu, Polley No. A I ( 4,.) 5"?, g' L// 1 (.$ Expiration Date 7~ I J!J!§, section need not be completed if the permit is for hundred dolars ($100) or less. LJ Ctrtlflcatt of Extmptlon: I certH'y that in the performance of tht 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 MCUl'I worlln' compensation coverage II unlawful, and shall subject an employer to criminal penaHlts and clvll ffnts up to one hundred thousand dollars (&100,000), In addition to tht cost of compenllllon, damages u provided for In Section 3708 of tht Labor codt, lnttrtst and attorney's fits, Ji5 CONTRACTORSIGNATIJRE ~ .. 0AGENT DATE ©WG!H~IJ1~©©ff(~(•._. ···:~·,: . I hereby affimr that I am exempt from Contractor's l.ictnse I.aw for Ille following 1N1011: D I, as owner of the property or my employaas with wages as their sole compensation, wfll 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 !hereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, ~. the building or improvement Is 101d 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). • D I, as owner of the property, am exclusively contracting with lcented contractors lo construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon, and conlracls for auch projects with contractor(,) licensed pursuant lo the Contractor's License Law). D I am exempt under Section ___ ~Business and Professions Code for this reason: 1. I personally plan lo provide the major labor and materials for construction of the proposed property improvement. 0Yes Do 2. I (have / have not) signed an application for a bulldlng permit for the proposed work. 3. I have contracted with the following person (firm) lo provide the proposed construction Qnclude name address/ phone/ contractors' license number): 4. I plan to provide portions of the work, but I have hii9d the folowlng person to coordinate, supervise and provide the major work Qndude name /address/ phone / contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work Indicated (include name/ address/ phone I type of work): Ji5 PROPERTY OWNER SIGNATURE 0AGENT DATE 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 No Is the applicant or future building occupant required to obtain a permit from the air pollution control dis!Jicl or air quality management district? : Yes No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes 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. @@ro~vwco@'ti'00t~f~ ; I hereby affirm that there is a construction lending agency for the perfollllance of the work this permit is issued (~c. 3097 (0 Civil Code). Lender's Name Lender's Address I certify that I have read the application and statethattheaboYe lnfonnatlon is correct and that the infonnation on the plans is accurate. I agree to comply with all City ordinances and State laws relating to buildingconsbuction. I hereby authorize representative of lhe City of Carlsbad kl enter upon lhe above mentioned property for ilspectioil purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILmES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: AA 0$HA pennlt is requi"ed b' exca · over 5'0' geep and demolition or construction of structures over 3 stories in height EXPIRATION: Every pennlt issued by lhe · · Official under lhe pr0'lisions of · II expire by Imitation and become null and void if the building or work authorized by such permit is not commenced Ylithin 180 days fi'om the date of such permit if the b i1g or WOik authorized by · · suspended or abandoned at any time after the work is commenced for a ,nod of 180 days (Section 106.4.4 Uniform Building Code). ~ APPLICANT'S SIGNATU ~ DATE "1 3 · STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. CERTIFICATE 0 f OCCUPANCY /Commercic1I Projects 0 n IV I Fax (760) 602-8560, Email building@carlsbadca.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 BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE I FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICKUP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On pg. 1) MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) ASSOCIAl'ED CB# CONTRACTOR (On Pg. 1) NO CHANGE IN USE/ NO CONSTRUCTION MAIL/ FAX TO OTHER: CHANGE OF USE/ NO CONSTRUCTION .@S' APPLICANT'S SIGNATURE DATE Permit Type: BLDG-Commercial Application Date: 04/04/20.17 04/21/2017 1'2/0512017 Owner: CALLAWAY GOLF COMPANY Work Class: Tenant Improvement Issue Date: $tatus: Closed--Finaled Expiration Date: IVR Number: 2904 Subdivision: CARLSBAD TCT#81-10 UNIT#02A Address: 2180 Rutherford Rd Carlsbad, CA 92008-7328 Scheduled Actual Inspection Type Inspection No. Date Start Date-Inspection Status Primary Inspector Reinspection Complete 04/27/2017 04/27/2017 05/01/2017 05/01/2017 05/12/2017 05/12/2017 06/08/2017 06/08/2017 06/13/2017 06/13/2017 June 13, 2017 BLDG-84 Rough 021404-Z01,7 Combo(14,24,34,44) Checklist Item BLDG-Building Deficiency BLDG-14 'Frame-Steel0Bolting-Welding (Decks) BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-44 Rough-Ducts-Dampers BLDG-17 Interior 021652-2017 Lath/Drywall Checklist lt~m BLDG-Building Deficiency r BLDG-34 Rough 023234-2017 Electrical Checklist Item BLDG-Building Deficiency BLDG-85 T-Bar, Ceiling Grids, Overhead 025619-2017 BLDG-Final Inspection Checklist Item BLDG-Building Deficiency BLDG-14 Frame-Steel-Bolting-Welding (Decks) ' BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-44 Rough-Ducts-Dampers 026065-2017 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final BLDG-Fire Final 026010-2017 Checklist Item FIRE· Building Final Passed Jonathan West Complete COMMENTS Passed Yes Yes Yes Yes Yes Passed Jonathan West Complete COMMENTS Passed Yes Passed Jonathan West Complete COMMENTS Passed Yes Passed Jonathan West Complete C.OMMENTS Passed Yes Yes Yes Yes Yes Passed . Paul York Complete COMMENTS Passed Yes Yes Yes Yes Yes Passed Daniel Stowe Complete COMMENTS Passed Yes Page 1 of 2 , • V' Permit Type: BLDG-Commercial Work Class: Tenant Improvement Status: Closed -Finaled Scheduled Date June 13, 2017 Actual Start Date Inspection Type Application Date: Issue Date: Expiration Date: 04/04/2017 04/21/2017 12/05/2017 IVR Number: 2904 Owner: CALLAWAY GOLF COMPANY Subdivision: CARLSBAD TCT#81-10 UNIT#02A Address: 2180 Rutherford Rd Carlsbad, CA 92008-7328 Inspection No. Inspection Status Primary Inspector Reinspection Complete Page 2 of 2 EsGU Corporation In <Partnersli.ip witli government for (}Jui(aing Safety DATE: 4/17/17 JURISDICTION: Carlsbad PLAN CHECK NO.: CBC2017-0155 PROJECT ADDRESS: 2180 Rutherford Rd. SET:I PROJECT NAME: Callaway 0010 Conference Room TI 1:1 APPLICANT ~JURIS. 1:1 PLAN REVIEWER 1:1 FILE [g'J 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: [gj 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: Chuck Mendenhall EsGil Corporation D GA D EJ D MB D PC Enclosures: 4/6/17 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 --f Carlsbad CBC2017-0155 4/17/17 [DO NOT PAY-THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Chuck Mendenhall BUILDING ADDRESS: 2180 Rutherford Rd. BUILDING OCCUPANCY: B PLAN CHECK NO.: CBC2017-0155 DATE: 4/17/17 BUILDING AREA Valuation Reg. VALUE ($) PORTION ( Sq. Ft.) Multiplier Mod. Conf rm Tl 1583 City E;st 73,265 Air Conditioning Fire Sprinklers TOTAL VALUE 73,265 Jurisdiction Code cb By Ordinance Bldg. Permit Fee by Ordinance ! • I $507.42! Plan Check Fee by Ordinance / ... j $329.821 Type of Review: 0 Complete Review O Structural Only 0 Repetitive Fee · j ..., I Repeats D Other 0 Hourly EsGil Fee 1---------11 Hr. @ • $284.161 Comments: N/A rfr1 addition to.trie: a~~y~-f~;.;i~~~~cJitlq~:;u~~~bfJ . ;_is· d.qe ( . · .. l:lour@. :r ·. -~··11:1·r.) ·~or fi,e GalGree1J .. tE?Vi9-w. Sheet 1 of 1 macvalue.doc + ., GREEN BUILDING TEST & BALANCE CO. 663-S •. RANCHO SANTE FE ~D., SUITE# 203 $AN MARCOS, CA 92078 PH#.: 760-533-7171 FAX#: 760-842-1420 HVAC Systems Test . And Balance Report PROJECT NAME: CALLAWAY HEADQUARTERS BUILDING/ OGIO T.I. PROJECT LOCATION: 2180 RUTHERFORD ROAD CARLSBAD CA. 92008 The data presented in this report is an exact record of system performance and was obtained in accordance with NEBB standard procedures. Any variances from design quantities which exceed NEBB tolerances are noted throughout this report .. The system have been tested and balanced and final adjustments have been made in accordance with NEBB 11 Procedural Standards Job Number: Date: TAB Engineer: PATRICK DRAYTON DIRECTOR (?F OPERATIONS BUILDING COMMISSIONING TESTING-ADJUSTING-BALANCING 517-23 Thursday, May 25, 2017 Patrick Drayton NE,~!l CA UC. C-20 #805186 •' f PATRICK DRAYTON DIRECTOR OF OPERATIONS BUILDING COMMISSIONING TESTING·ADJUSTJNG•BALANCING JOB NAME: CALLAWAY HEADQUARTERS BU"!LDING OGIO T.I. ., GREEN BUILDING TEST & BALANCE CO. 663 S. RANCHO SANTE FE RD., SUITE# 203 . SAN MARCOS, CA 92078 PH#: 760-533-7171 FAX#: 760-842-1420 II VAV AIR OUTLET TEST REPORT II ZONE TERMINAL DESIGN NAME TYPE EFFECT.AREA NO. SIZE MAX MIN VAV # 3.-1-37 STORAGE S-1 C.D. 24"X24" FH 200 60 STORAGE S-2 C.D. 24"X24" FH 200 60 TOTAL 400 120 VAV #1-A SHOW RM. S-1 5.W.S. 12"X 12" 0.85 375 110 SHOW.RM. S-2 s.w.s. 12"X 12" 0.85 375 115 SHOW RM. S-3 s.w.s. 1211x 12" 0.85 375 115 SHOW RM. S-4 s.w.s. 12"X 12" 0.85 375 110 TOTAL 1500 450 . NOTES: ----------------------- READINGS BY: PATRICK DRAYTON TEST DATE: Thursday, May 25, 2017 ____ _.a.;...._~------- FINAL MAX 215 200 415 380 375 390 370 1515 •«'! __ ;:r' ;, .• ., NOTES MIN 65 60 125 115 112 115 105 447 -~ii&! . ·2\-? . ~i%:"~:~~ ... ~ ..... ~, ~: .. '\ ., ( f.:;;· NEl~§t CA UC. C-20 #805186 ' ' -, GREEN BUILDING TEST & BALANCE CO. 663 S. RANCHO SANTE FE RD., SUITE # 203 SAN MARCOS, CA 92078 PH#: 760-533-7171 FAX.#: 760-842-1420 PROJECT: CALLAWAY HEADQUARTERS/ OGIO T.I. LOCATION: CARLSBAD CA. SERVICE OR SIZE MODEL DESIGN GPM DESIGNATION (1/s) VAV#lA RE-HEAT COIL 3/4" 600-W06 2.9 BALANCE VALVE/FLOW METER TEST REPORT PATRICK DRAYTON DIRECTOR OF OPERATIONS BUILDING' COMMISSIONING TESTING-ADJUSTING-BALANCING SYSTEM/UNIT: VAV SYSTEM ----------- ACTUAL VALVE ' SETPOINT ACTUAL VALVE ACTUALGPM NOTES (DEGREE) P.O. (1/s) 2 -32 PSI 12 PSI 2.9 . REMARKS: ______ .;.__ ___________ -________________ _ TEST DATE: --------------- READINGS BY: PATRICK DRAYTON r{~~§ CA LIC. C-20 #805186 ). (E) T-STAT. CONNECT WITH VAV-1A. 14"0 ,-----------..,..,.,,,;,,s===-l ·r ' ,------7 S\\ol~°"OO~'\ :,. L ______ .J . . . ocsa 14"0 ..-<E) VAV-3~1-21 (E)8"0" rrt.===1/ TOREMAIN. 0 ~---'-'----II -SHOWN FOR REFERENCE ONLY AIR BALANCE BLUEPRINTS TRANSITION FROM 12"0 TO 7"0--........_ . DUCT, UPT028" BEFOREVAVJNLET. " (E) VAV-3-1--g· ~ (E) T-STAT. CONNECT WITH NEW LOCATION. . r-- RELOCATED {E)VAV-3-1-37. • 5'fC! 'R~~f:-- o~:co < ~ ~ ...... 8"0 NECK@ 200CFM A 8"0 ~[\,\J'J"\S \) fjh_~?r t S 2.) © (TYP) 8"0 NECK@ 200CFM A 8"0 (E) RETURN REGISTER WITH FLEX. DUCT TO BE REUSED (TYPx2) 12"0 (E) 11/2" HWS/HWR t;:\ TO REMAIN. \.:V SHOW FOR REFERENCE ONLY .. AIR BALANCE . BLUEPRINTS P.O.C."'- P.O.C.~ 0 E 0 E 0 ~ ~ D ~ w - \ SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE Business Name Callawa Golf Project Address 2180 Rutherford Road Mailing Ai:ldress same Business Contact Mike Ma'ors City Carlsbad City OFFICE USE ONLY RECORD ID# _________________ I PLAN CHECK# ________________ I State CA State BP DATE I Telephone# (760) 931-1771 Zip Code APN# 92008 212-075-25-00 Zip Code Plan File# Project Contact Applicant E-mail Telephone# Andrew Tarango-SCA andrewt@sca-sd.com (858) 793-4777 The following questions represent the faclllty's actlvltles, NOT the specific project description. PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: {not required for projects within the City of San Diego}: Indicate by circling the item, whettier 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. Occupancy Rating: Facility's Square Footage (including proposed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None ofThese. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives questions is yes, applicant must contact the nty o an . iego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San Diego, CA 92123. Call (858) 505-6700 prior to the Issuance of a building permit. D CalARP Exempt I FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: 1. 2. 3. 4. 5. 6. 7. 8. YES NO (for new construction or remodeling projects) Is your business listed on the reverse side of this form? (check all that apply). D • D •· Will your business dispose of Hazardous Substances or Medical Waste in any amount? D • Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? D D D D D • Will your business store or handle carcinogens/reproductive toxins in any quantity? • Will ypur 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 1 0)? • Will your business store petroleum In tanks or containers at your facility with a total facility storage capacity equal to or reater than 1,320 allons? California's Abov round Petroleum Stora e Act . Date Initials 0 CalARP Required I Date Initials 0 CalARP Complete I Date Initials PART Ill: SAN DIEG C U P L O T OL I CT AP D : Any YES* answer requires a stamp from APCD 10124 Old Grove Road, San Diego, CA 92131 a cdcom sdcoun .ca. ov 586-265 ). No stamp required if Q1 Yes and Q3 Yes and Q4-Q6 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. rexcludes garages & small outbuildings.] YES NO 1. • 0 Will the project disturb 160 square feet or more of existing building materials? 2. 0 • Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance Technician? 3. ff 0 4. 5. 6. D D D It (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. • Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet ~ (www.sdapcd.org/info/facts/permits.pdQ for typical equipment requiring an APCD permit. ~ (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school . bounda Briefly describe business activities: General office building im rovement J/7 FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. ____________________________ _ BY· DATE· I I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO• APCO COUNTY-HMO APCD COUNTY-HMO APCD . . *A stamp in this box only exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other permitting requirements may stdl apply . HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date 4/3/17 Business Name._...;;C;;.;;a=l=l;;.;;a=w.;..;:a;;.,y....,...:G:;;..;o;;.;;l=-=f=--------------------- Street Address. _ __.2 ..... 1.....,8,...,0.__.,R=u...,t...,.h=e.._.r=-=f....,o .... r....,d"'--"R..,.,o.._.a....,d..,. • .__,c .... a...,r....,1....,s .... b"'-la .... d.s._ _________ _ Email Address ___ m_i_k_e"'""m"'""a--=@--'c_a_l=l=a=w=a'-"'y...,q,..;;;o=l=f--' . ..:;c;..:;o=m;;..._---'-,-'------------ PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON Rf=V!;:RSE SIDE CHECK TYPE OF BUSINESS) • Check all below that are present at your facility: Acid Cleaning Ink Manufacturing Nutritional Supplement/ Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining / Milling Painting/ Finishing Battery Manufacturing Manufacturing Paint Manufacturing Biofuel Mam.ifacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i.e. water filter membranes.) Manufacturing Bulk Chemical Storage Metal Casting I Forrnfng Pesticide Manufacturing/ CarWash Metal F'abricatlon 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 / Milling Research and Development Film/ X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturlng Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap/ Detergent Manufacturing Industrial Laundry Waste Treatment/ Storage SIC Code(s) (if known): _____________________ _ Brief description of business activities (Production/ Manufacturing Operations):. _____ _ Description of operations generating wa_stewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (~al/ day): _______ _ List hazardous wastes generated (type/volume): _______________ _ Date operation began/or will be.gin at thi$ location: _______________ _ Have you applied for a Wastewater Discharge Permit from the i=ncina Wastewater Authority? Yes No If yes, when:.;...· --------------'------------ Site Contact,_____ ___________ ....;.._ ____ Title. ____________ _ Signature ______________ Phone No. _______________ _ ENCi NA WASTEWATER AUTHORITY, 6200 Avenida E;ncihas Ca_rlsb~cl. CA 92011 (760) 438-3941 FAX, (760) 476.-~852