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HomeMy WebLinkAbout2200 FARADAY AVE; 210; CB111242; PermitCity-of Carlsbad 07-27-2011 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB111242 Building Inspection Request Line (760) 602-2725 Job Address: 2200 FARADAY AV CBAD St: 210 Permit Type: Tl Sub Type: COMM 0 NEW Parcel No: 2121206000 Lot#: Status: Valuation: $69,000.00 Construction·Type: Applied: Occupancy Gro1,1p: Reference #: Entered By: Project Title: SPEC STE -T.I. TO CREATE STE STE 210 -Sl.)SPENED T-BAR CEILING Applicant: ORA ADVISORS 90 NEW MONTGOMERY ST SAN FRANSICO CA 94105 415-243-8009 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD#3 Fee Renewal Fee Add'I Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'I Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Fire Expedited Plan Review $504.88 $0.00 $328.17 $0.00 $0.00 $14.49 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.0Q $0.00 $1.00 $0.00 Plan Approved: Issued: Inspect Area: Plan Check#: Owner: D L FARADAY LP C/O ORA ADVISORS LLC 220 E 42ND ST 27TH FLOOR NEW YORK NY 10017 Meter Size Add'I Reel. Water Con. Fee Meter Fee SDCWAFee CFO Payoff Fee PFF (3105540) PFF (4305540) License Tax (3104193) License Tax (4304193) Traffic Impact Fee (3105541) Traffic Impact Fee ( 4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee TOTAL PERMIT FEES ISSUED 06/08/2011 JANEAN 07/27/2011 07/27/2011 Total Fees: . . $870.29 Total Payments To Date: $870.29 Balance Due: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $21.75 $0.00 $0.00 $0.00 $0.00 $0.00 ?? $870.29 $0.00 Inspector: Clearance: _____ _ NOTICE: Please take NOTIC 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 ou have reviousl been iven a NOTICE similar to this or as to which the statute of limitations has reviousl otherwise ex ired. /.;if,;'r~:,. "~ ~')/ ~ CITY OF CARLSBAD Building Pern'fat Ap(tlication 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 Fax 760-602-8558 www.carlsbadca.gov JOB ADDRESS 2200 FARADAY, CARLSBAD CA 92008 SUITE#/SPACE#/UNIT# Est. Value Plan Ck. Deposit Date(.o SWPPP 210 120 41 CT/PROJECT# LOU PHASE# 11 OF UNITS II BEDROOMS II BATHROOMS TENANT BUSINESS NAME CONSTR. lYPE OCC. GROUP 44&45 SUITE 210 Ill B DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) INTERIOR OFFICE TENANT IMPROVEMENTS1N'etUBffi'&N'™1:Rl;!QTl tf?A.L Ja=AR=FIONS'; SUSPENDED T-BAR CEILING EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINl~LERS OFFICE OFFICE YES011 NOIZ) YES0Nor2:) YES0N00 CONTACT NAME (If Dlfforont Fom Appl/cant) APPLICANT NAME JESUS GOMEZ ADDRESS ADDRESS 3900 FIFTH AVENUE SUITE 290 CITY STATE ZIP CITY STATE ZIP SAN DIEGO CA 92103 PHONE FAX PHONE FAX 6192990011 6192995544 EMAIL EMAIL JESUS(ii2DPDESIGNINC.COM . . PROPERlY OWNER NAME DRA ADVISORS ADDRESS 90 NEW MONTGOMERY ST <' CITY STATE ZIP STATE ZIP SAN FRANSICO CA 94105 cA PHONE FAX (415) 243-8009 EMAIL jchristian@2draadvisors.com ARCH/DESIGNER NAME & ADDRESS STATELIC.# STATELIC.11 ROBERT CAVIGLI C8237 ~o '1$-7 I (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, Improve, demolish or repair anr structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement tl\at he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business 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 a civil penalty of not more than five hundred dollars ($500)) • . -' -, W$f.iJ({sl.1Ht?$'. €@@f.P@ilt~-!;)ij'IJ©QJ Workers' Componsallon Declaration: / hereby affirm under penalty of perjury one oi the following declarations: D I havo and will maintain a cortlllcato of consent to self.Insure forworkers' compensalion as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain wor ers' ompensaUo as required bv ection 3700 oflhe Labor Code, for the performance of the work lorwhich this permit is issued. My workers' compensation i;ura;.ce carrier and policy number are: Insurance Co • Policy No. l,J t. 1./0,210 '1 {;,.$ / <f Expiration Dale _._/~o~l!.~//'-'-'/'------ Thls secUon need not be completed if the permit Is for one hundred dollars ($100) or less. 0 Certificate of Exemption: I certify that in the performance of the work for which I his permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' CompensaUon Laws of California. WARNING: Failure to securo workers' compensation coverage Is unlawful, and shall subject an employer to criminal ponallles and civil flnos up to ono hundred thousand dollars (&100,000), In addition to tho cost of compensation, d agos provided f In S ttlon 3706 of the Labor code, lnterest and attorney's fees. JiS CONTRACTOR SIGNATURE 0AGENT DATE I hereby affirm that I em exempt from Controctor's License law for the following reason: D 0 D I, as owner of lhe property or my employees with wages as their sole compensalion, vnil do the work and lhe structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conlractor's License law does nol apply to an owner of property who builds or improves I hereon, and who does such work himself or through his own employees, provided lhat such Improvements are not intended or offered tor sale. If, however, the building or improvement Is sold 1•nlhin one yearof complelion, 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 lhe project (Sec. 7044, Business and Professions Code: The Contraclofs License Law does not apply to an 01•mer of property who builds or Improves thereon, and conlracts for such projects wilh contractor(s) licensed pursuant to the Conlractofs License Law). I am exempt under Seclion ____ Buslness and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property lmprovemenL 0Yes 0No 2. I (have/ have not) signed an application for a building permit for the proposed work. 3. I have contracted wilh the following person (firm) to provide the proposed construction (include name address / phone/ contractors' license number): 4. I plan to provide portions of the work, but I have hired lhe following person to coordinate, supervise and provide tho major work (Include name/ address/ phone/ contractors' license number): 5. I will provide some of the work, but I have contracted (hired) lhe following persons to provide the work indicated (include name/ address I phone/ type of work): JiS PROPERTY OWNER SIGNATURE 0AGENT DATE ,. l · €®®@0.,@u-@ u-roo@ ~@@u-0®6!1 @®@-G9®@0 ID@~O0@6!Ju'O&O., ©{!)OQ,0OW© (P@ffi®Otf~ @Wl1'7 .. ... Is the applicant or future building occupant required to submit a businessdj, acutely hazardous material'," regisli.ition fl)nm or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? D Yes ./ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or a0ality management district? Oves IZI No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Dves ,/ 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. @®W~H?ffi(!)@'i.7O0@ 11CWJ0OG9© &©@W@~ ' 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 &@@110@&6!1 tr @@C&trO@O@& u'O®W ' I certifythatl have read the application and statethatthe above lnfonmation Is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relatingto 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 penmit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height EXPIRATION: Every penmit issued by the Building Official uter the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such penmit is not commenced within 180 days from the date of such permit or if the bi 4 rk authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). ~ APPLICANT'S SIGNATURE ~ DATE C --1--{ I I ,, Cltv of Carlsbad · Final Building Inspection . Dept: Building Engineering Planning CMWD St Lite E:ir..e Plan Check #: Permit#: Project Name: Address: Contact Person: Sewer Dist: CB111242 SPEC STE-T.I. TO CREATE STE STE 210-SUSPENED T-BAR CEILING 2200 FARADAY AV #210 DIRK Phone: 6192478119 CA Water Dist: CA . Date: 09/02/2011 Permit Type: Tl Sub Type: COMM Lot: 0 ..................................................................................................................... ···································· ~:pected&~ Date / & Approved: Disapproved: __ Inspected: i _3~ ll t Inspected Date By: Inspected: Approved:· Disapproved: __ Inspected Date By: Inspected: Approved: Disapproved: __ .......................................................................................................................................................... , Comments: ______________________________ _ City of Carlsbad Bldg Inspection Request For: 09/02/2011 Permit# CB111242 Title: SPEC STE-T.I. TO CREATE STE Description: STE 210 -SUSPENED T-BAR CEILING Type:TI Job Address: Sub Type: COMM 2200 FARADAY AV Suite: 210 Location: APPLICANT DRA ADVISORS Owner: D L FARADAY LP Remarks: Total Time: CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Lot: 0 Comments/Notices/Holds Associated PCRs/CVs/SWPPPs Original PC# lnsgection Histo!Y Date Description Act lnsp Comments Inspector Assignment: TP Phone: 6192478119 Inspector:~ Requested By: DIRK · Entered By: CHRISTINE 07/29/2011 14 Frame/Steel/Bolting/Welding AP TP T-CLNG SHOW RM AREA ONLY 07/29/2011 17 Interior Lath/Drywall AP TP NEW ENTY/INFILL 07/29/2011 24 Rough/Topout AP TP 07/29/2011 34 Rough Electric AP TP CLNG LITES 07/29/2011 44 Rough/Ducts/Dampers WC TP NO MECH 07/28/2011 14 Frame/Steel/Bolting/Welding co -TP T-CLNG GRID 07/28/2011 14 Frame/Steel/Bolting/Welding AP TP NEW ENTRY EsGil Corporation In <Partnership witli. (}overnment for <Buifaing Safety DATE: 7/6/11 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 11-1242 PROJECT ADDRESS: 2200 Faraday Suite 210 PROJECT NAME: Spec Suite 210 -TI SET: II CJ APPi:: ANT JURI . CJ PLAN REVIEWER CJ 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: Fax#: Mail Telephone Fax In Person D REMARKS: By: Doug Moody EsGil Corporation D GA D EJ D PC Enclosures: 6/28/11 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 ' EsGil Corporation In (J'artners/i.ip wit/i. <;;overnmentfor(J3ui[aing Safety . DATE: 6/17/11 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 11-1242 PROJECT.ADDRESS: 2200 Faraday Suite 210 PROJECT NAME: Spec Suite 210 -TI SET: I ~NT ~ D PLAN REVIEWER D FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's 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 here\A._'ith have significant deficiencies identified on the enclosed check list anq sh_ould be corrected and resubmitted for a complete recheck. IZ] 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. · C8J The applicant's copy of the check list has been sent to: Donald Pitman Design Inc. / Jesus Gomez 3900 Fifth Ave Suite 290, San Diego, CA 92103 D Esgil Corporation staff did not advise the applicant that the plan check has beeri completed. IZ] Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Jesus Gomez Telephone#: 619-299-0011 x 204 Date contacted: <.o { 11 / 1, (by: \U--) Email: jesus@dpdesigninc.com Fax #: 619-299-5544 E. Mail....--Telephone -Fax In Person D REMARKS: By; Doug Moody EsGil Corporation D GA D EJ D PC Enclosures: 6/9/11 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 j City of Carlsbad 11-1242 6/17/11 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: 11-1242 OCCUPANCY: B TYPE OF CONSTRUCTION: IIIB ALLOWABLE FLOOR AREA: SPRINKLERS?: Yes REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 6/8/11 DATE INITIAL PLAN REVIEW COMPLETED: 6/ 17 / l l FOREWORD (PLEASE .READ): JURISDICTION: City of Carlsbad USE: Office . ACTUALAREA: 14891~ STORIES: 2 HEIGHT: OCCUPANT LOAD: 148 DATE PLANS RECEIVED BY ESGIL CORPORATION: 6/9/11 PLAN REVIEWER: Doug Moody 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 atten·uation 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 p.ermit. Code sections cited are based on the 2010 CBC, which adopts the 2009 180. 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 2009 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, pleas·e 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 11-1242 6/.17/11 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. Please indicate the loc;ation of panel 2LD and show how it complies with section 240-24 access to over-current device. 2. Please complete the LTG-1-C part 3 of 4 mandatory automatic controls portion of the L TG-1-C forms to be consistent with the plans. 3. Please have the principle designer check the appropriate box(s) and complete the Statement of Compliance System Acceptance section of the L TG-1-C part 4 of 4 documents. 4. Please revise the plans to show the required emergency egress lighting per · section 1006.3 of the CBC. 5. . Please note in the general wiring notes on the plans "AC Cable is not allowed in A, B, E, H, F, M, Sand 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". 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 no_t resulting from this correction list? Please indicate: ' City of Carlsbad 11-1242 6/17/11 Yes CJ No CJ 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. i' J City of Carlsbad 11-1242. 6/17/11 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: Doug Moody PLAN CHECK NO.: 11-1242 DATE: 6/17/11 BUILDING ADDRESS: 2200 Faraday Suite 210 BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: IIIB BUILDING AREA Valuation Reg. VALUE PORTION ( Sq. Ft.) Multiplier Mod. Tl 12295 Desii:iner Esti Air Conditioning Fir~ -Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance· Bldg. Permit Fee by Ordinance 1..-1 Plan Check Fee by Ordinance I • J Type of Review: 0 Complete Review D Structural Only D Repetitive Fee =8 Repeats Comments: D Other D Hourly EsGil Fee ,___ ___ ,Hr.@• ($) 69,000 69,000 $504.88j $328.171 $282.731 Sheet 1 of 1 macvalue.doc + PLANNING/ENGINEERING APPROVALS ADDRESS __ L-_~_t>_L)_-L---1--~-(;..__-Jl_CL----1-_-EF __ 2-_[_(J=-- RESIDENTIAL RESIDENTIAL ADDITION MINOR C < $20,000.00) SOLAR PANELS OTHER TENANT IMPROVEMENT PLAZA CAMINO REAL PREMIER OUTLETS VILLAGE FAIRE COMPLETE OFFICE BUILDING --------------- PLANNER -n DATE ENGINEER-(<:J-12-+~---·--- 1 -L.-<l_--DATE ==la==l =1 ~=)=_l-l==== /Do U-._ a-:._ 'g-~ u__ ~ 1'§~ ~ ~JL, (Nt:, ~ p ~ ~ > oocs/Mlsforms/Plannlng Engineering Approvals PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB111242 DATE 6/9/11 ADDRESS 2200 FARADAYAV #210 RESIDENTIAL ADDITION- MINOR (<17,000.00) RETAINING 'if/A.LL VILLAGE FAIRE POOL/SPA jTENANT IMPROVEMENT! COMPLETE OFFICE BUILDING SOLAR PANELS OTHER (NO MECHANICAL STATED AS PART OF THIS PERMIT} PLANNER GINA RUIZ DATE 6/9/11 ENGINEER,_____ _______ _ DATE ______ _ H:\ADMIN\COUNTER/PLANNING/ENGINEERING Al'l'IIO\'AJ,S > . . m . . Carlsbad Fire Department Plan Review Requirements Category: TI , COMM Date of Report: 07-19-2011 Name: Address: Permit#: CBll 1242 DRA ADVISORS 90 NEW MONTGOMERY ST SAN FRANSICO CA 94105 Job Name: SPEC STE-T.L TO CREATE STE Job Address: 2200 FARADAY AV CBAD St: 210 INCOMPLE u have submitted for review is incomplete. At this time, this office cannot / adequately conduct a review to detenm Hance wit .. : ~-·~/or standards. Please review carefully all comments attached. Please lans and/or specifications, with changes "clouded", to this. office for review and a a. Conditions: Cond: CON0004679 [NOT MET] *** Bubble All Changes*** 1. The means of egress, including the exit discharge, shall be illuminated at all times the space served by the means of egress is occupied. The means of egress illumination level shall not be less than 1-foot candle at the walking surface. CFC 1006 Entry: 06/15/2011 By: cwong Action: CO Cond: CON0004769 [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: 07/19/2011 By: cwong Action: AP INDUSTRIAL WASTEWATER DISCHARGE PERMDT SCREENING SURVEY Date ---- Business Name ___ S._u""--'"t ...... I: ..... f...._....:::~;...,l=O~------------------ Street Address. _ _...,,9...,;;:;.;Klrx,..__""'-E="?t="=A;~r-~A=w."'-+-11 e,.,...A='-1.-U=~"-«.=-'-'~C~~L----------- Email Address. __________________________ _ PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE 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 Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i.e. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting I Forming Pesticide Manufacturing/ CarWash 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 / Milling Research and Development Film / X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing 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 wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal/ day): _______ _ List hazardous wastes generated (type/ volume): ______________ _ 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:--------------,,,...---------=---If Site Contact &*2 \<. n~Wc Trtle 6[M;;:Q Cul\¥~ Signature. ___________ PhoneNo. (,J> \.q ~1 -Jt,/oY ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941 FAX: (760) 476-9852 Business Name Project Contact SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE Business Contact Telephone# State Zip Code ~ CA :JtJ(/'I State Zip Code Telephone# OFFICE USE ONLY UPFP# _______ _ HV# _______ _ BP DATE. _ __. _ __._ __ _ APN# .:2( ., -'l{ Plan File# 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. 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 of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISIONS (HMD): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 31" floor, San Diego, CA 92101. Call (619) 338-2222 prior to the issuance of a building permit. FEES ARE REQUIRED. Expected Date of Occupancy: ___ '""/ _____ / __ _ YES NO 1. D ~ 2. D ~ 3. D 12 4. 5. 6. D D D I ~ 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)? 0 CalARP Exempt I Date Initials 0 CalARP Required I Date Initials 0 CalARP Complete I Date Initials PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air Pollution 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. YES NO 1. D '&a: Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD 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). 2. 3. 4. D D D Q (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.gov/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: I declare under penalty of perjury that to the best of my knowledge and belief t e re ponses made herein are true and correct. D"M" p;f-AMid --J;/f.~(!,.·~--------- Name of owner or Authorized Agent Signat re Owner or Authorized Agent 611-tll Date FOR OFFICIAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: _______________________________ _ 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 HM-9171 (04/07) County of San Diego -DEH -Hazardous Materials Division CB111242 2200 FARADAY AV 210 SPEC STE -TI. 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