The URL can be used to link to this page

Home My WebLink About2262 RUTHERFORD RD; 105; CB971158; PermitB TJ I P 8 R M IT Pernli:t No: CB97115:3 . Project Nu: A910149~ Deve 1 opmen t i'l,:; : OS/~8/97 1:;;:10 Page l of -::. ,Job Addres::::_!' 2262 · RUn-rE:?~?OI:D R[J Perroi t Type: Il\/';)!JS'IRIAL TEI\1.t~f,~'F !'1'/,P:?:OVEr--:sr~T ~~reel No: 212-061-08-0n Suite: 105 fl;'':7,•J I\;., · · · .,,.,p..t v)l 28/97 ()(){11 01 02 Lot#: C--Pr.:i1T 655~00 Valuation: 75,998 Occupancy Gr0t1p: Ref,?rence#: Description: NEW PART WALLS,DOORS,CE:1:L,ELEC 1 MECH DUCTS-CALLAWJ\ V GOLF Appl/Ownr 619" :Construction Typ~: Status·: ll~pplied: .Apr/'! s sue·: Entered By": 452-3188 I . ' . }'!_APPROVAL .· i ·i~S~ATE !!ldv CLEARANCE. I ' I -~ :,,... ' ,, ;. bi 1 I I, JI 1 · : I 4¥' CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-:-U61 II!N · ISSUED 05/.08/.9'7 05/28/97, RMA lK ~qqd-~ PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 FOR OF.F-ICE U$E ONI,. Y PLAN CHE.CK NO. ·q_] . ~l 5.f EST. VAL. !: ~ ~ . . Validated By~_,~4 .,,.....-+lio,..c.J~--- Date_...,..--==--1-A-,'2-+--+------ Total # of units Name Telephon . . =<=="-·----.-~.-------------E-·-~--,_,,_,.,,...,,,..,,,, , ----·----"''~~--L'llNN=W.,',.,_, _______ _ /~~~;:~~~!:!~:9 ;~·::~~~~~~-;i~~-:r' ~ounty which re~~;;~s·:;::;~~-:~~-~;t~~:!~;~;;:·=;:;;~~:~:~~~s~-o~ 1'~;~:~;~~~~~;:;~~;;;:':~;:;i~(~~1 issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provision~ of the Co.ntractor' s Liciinse 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 fiye hundred dollars l $ 500)). Name Address City State/Zip . Telephone # State License# _________ _ License Class _________ _ City Business-License it _______ _ Designer Name Address City State/Zip Telepho[le State License # :;;;;:;:;;;;;::;;;;;:;;;;:;;;;;;;;;;:=::::::=.._ , . ~..;.;.,•.:..;YI.QR,~iS!.ltPl1eBI.Jlm'.t<1::..--;.----· -~~.:..:...-...::....::...::.. :-.=~; ..,.;;,...:_,._; .. ~~:.:.-=:..-==:.~:.:.?;J;..,:,.·Y;~:,.:;I:.;-;}.flI.Z ~~ Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' -compensation as. provided by Section 3700 of the Labor Code, for the-performance of the work for which this permit is issued. ·.D I have and will maintain workers' compensation, as required by $action 3700 of the·Labor Code, for--the performance of the work for which this ·permit' is issued. My worker's compensation insurance carrier and policy number are: Insurance Company____________________ Policy No·------~--.,.,..--Expiration Date _______ _ (THIS SECTION 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 this p'erm'it is -issued, ·1 shall not employ any persori 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 ail e!llployer 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 CQde, interest·and·attorn!!y's fees. SIGNATURE.______________________________ DATE.,--------,---'-- £'t.2_~Q._1M_NEJ!~,PJ11QJ!,&QE_Q.~1l()N~-, 4-:~~,2. ~;,J ..,. =-~~Z?!,,;~-::--: , , :·' , ~j; ,, ;; ~-~\ '.: :-~-~~~ -; _ ,~-r~M~~J~~.:::,:~-w2':. 2~2~::~ 5:2:.J,-:~ -~i< i?;):;~'.-~:,,>ir2C:L..~~-_:M,::,t,:L.i I hereby affirm that I am exempt from the Contractor's License Law for the following reason: '[] I, ·as owner of the property or my employees with wages as their sole compensation, wilt d9 the work and t!ie stn,1cture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does ncit apply to an. owner of property who buiiils 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, th/l'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). 0 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 contraci:or(sl licensed pursuant to the Contractor's License Law). ·o I am exempt under Section ---'----Business and Professions Code for this reason: , 4791 05/~(}8~/·j;: \](!'01 J.1. 1. 2. I personally plan to provide the major labor and materials for construction of the proposed pr_ope(ty improvement. c;J YES ONO , C-P:{MT_ I (have / have riot) signed an application for a building permit for the proposed work. 3. I have contracted_with the following person (firm) to provide the proposed construction, (include name / address-/ phone number/ contractors license number): 4. I 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' number/ 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 number / type ~=~ . PROPERTY OWNER.SIGNATURE ______________________ . DATE _____ ..,.-__ _ ~taL~~~jif.Qflgw,QtY.:Bff'l~!'-'ti:,JJ;PlfifflBM•J:$L~N";.'L:;.;"'~;~<.:.::. .. '.:.L' ·-. 'Z:':1" ,..:;;.:t:0:.~1,·t:';'.":··:':~:s:,.=2rz.;:2t. 1;.:E·. -. -:.:.z~~-~:..;,i.:::0. -·~~1 -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? D YES • NO Is tfie applicant or future buildin_g occupant required to obtain a permit from the air .pollution control district _or ·air quality management districF _ 0 YES x-NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES ~ NO · IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED ~ESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. . . . ffiill"::'«cONR.!lOCTi.lP't{UN.m_~,&;v · ": .. · -.. 1" -:-: . ,: ·: ' ';,:, ~: · . ~"'~~ ._.::.... -• ,~· · .. ; -: 'i:,:7;::~3:2:;1;y,~r0:?'-~~-1;:~:J:}~:".:'·:·.:'.'.] .I ·hereby affirm that there is a construction lending agency for the performance qf the work for which th1s permit is issued (Sec. ·30971i) Civil Code). · ·LENDER'S NAME LENDER'S ADDRESS · I certify that-I have read the application and state that the above information is correct and that the'information on the plans is accurate. I agree to :comply with all ·City ordinances and State laws relating 'to -building construction. I hereby authorize representatives of the Cit~ of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAV , INDEMNIFY AND KEEP HARMLESS THE CITY OF CARL:SBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MA ANY. Y ACCRUE AGAINST SAID CITY IN CONSEQUENCE. bF THE:GRANTING OF THIS PERMIT. . EXPIRATION: Every ·permit issued work authorize<! by suqh permit i , or abandoned at any time after 'APPLICANT'S SIGNATURE deep and derT)olition or c9nstr_1,.1ction.of structures over 3. stories in height. · 1al under the provisions of this Code shall expire by limitation and become null and void if the building or thin 365 days from the date of !)UCh permit or if. ·the building or work 11uthorizeg -by such permit is suspended for a period of 180 days (Section 106.4.4 Unifo,rm Buildin:A~:de); ~ej,J. YELLOW: Applicaiit . PINK: Finance CITY ·op CARLSBAD INSPECTION REQUEST PERMIT# CB971158 . FOR 08/05/97 DESCRIPTION: NEW PART WALLS,DOORS,CEIL,ELEC MECH DUCTS-CALLAWAY GOLF TYPE: ITI INSPECTOR AREA TP PLANCK# CB971158 OCC GRP CONSTR. TYPE IIIN STE: 105 LOT: JOB ADDRESS: 2262 RUTHERFORD RD APPLICANT: SMITH CONSULTING ARCHITECTS CONTRACTOR: PHONE: 619 452-3188 OWNER: REMARKS: C/DICK/520-5777 SPECIAL INSTRUCT: ~::~~CTOR ~ --... --------- TOTAL TIME: --RELATED PERMITS--PERMIT# SE970086 AS970056 TYPE swow ASTI STATUS l;SSUED ISSUED CD LVL DESCRIPTION ACT COMMENTS 19 ST Final Structural ~---------29 PL Final Plumbing 39 EL Final Electrical 49 ME Final Mechanical +---- _, --· ---------------------- -------'----------------'-----· --------------------------------------,-- DATE 073197 073197 073197 072497 072497 072497 072397 ***** INSPECTION HISTORY***** DESCRIPTION Frame/Steel/Bolting/Welding Rough Electric Rough/Ducts/Dampers Frame/Steel/Bolting/Welding Rough Electric Rough/Topout Underground/Under Floor ACT INSP AP TP AP 'l1P AP TP AP TP AP Tl? AP TP Al? TP COMMENTS T-BAR GRID . CEIL LITES DUCT, REG FINAL BUILDING INSPECTION DEPT: BUILDING ENGINEERING PLAN CHECK#: CB971158 PERMIT#: CB971158 PROJECT NAME: NEW PART WALLS,DOORS,CEIL,ELEC MECH DUCTS-CALLAWAY GOLF ADDRESS: 2262 RUTHERFORD RD SUIT.E# 105 CONTACT PERSON/PHONE#: C/DICK/520-5777 SEWER DIST: ·wATER DIST: U/M WATER DATE: 08/05/97 RMIT TYP.E..L__ITI fril fE !G iE ij \P ~ ~ ~ AUG -6 1997 y By . INSPECTE? r2 . /J J__ BY: t_, '/O(JV( DATE . INSPECTED: /6/~1 APPROVED L._ DISAPPROVED I INSPECTED BY: INSPECTED BY: COMMENTS: DATE INSPECTED: DATE INSPECTED: ... ,_ ;~ APPROVED DISAPPROVED - APPROVED DISAPPROVED ?. City of Carlsbad · M#hi·ihi44ihi~i•24·iUih,i4UI BUILDING PLANCHECK CHECKLIST DATE: 5-/S-C/7 -PLANCHECKNO.: cs9'7#'SJ> BUILDING ADDRESS: dci\b~~ ~ ~ ~ ) PROJECTDESCRIPTION: o<CJ'===~JJjk('l 4~ ASSESSOR'S PARCEL NUMBER: _________ EST. VALUE: . ENGINEERING DEPARTMENT APPROVAL DENIAL The item you have submitted for review hE!S been 1:1pproved. The approval is based on plans, information and/or specifications provided. in your submittal; therefore any changes to these items after this date, including field modifications, must be reviewed by this office to insure continued conformance with applicable codes. Please review carefully all comments attached, as failure .to comply with instructions in this report can result in suspension of permit to build. A Right-of-Way permit is required prior to construction of the following improvements: Please see the attached report of deficiencies marked.with 0. Make necessary corrections to plans or specifications for compliance with applicable codes and standards. Submit corrected plans and/or sp~cifications to this office for review. By: Date: By: Date: ____ _._ __ _ By: Date: _...._ ________ _ FOR OFFICIAL USE ONLY -. ENGINEl:RING AUTHORIZATION TO ISSUE:BWltDING PERMIT: ATTACHMENTS Dedication Application Dedication Checklist Improvement Application Improvement Checklist Future Improvement Agreement Grading Permit Application Grading Submittal Checklist · -Right-of-Way Permit Application Right0of-Way Permit Submittal Checklist and Information Sheet Sewer Fee Information Sheet ·o~te:.~-/$-97. ENGINEERING DEPT. CONTACT PERSON Name: Michele Masterson City of Carlsbad Address: 2075 Las Palmas Dr., Carlsbad, CA 92009 Phone: (619) 438-1161, ext. 4315 A-4 \\LASPALMAS\SXS\UBBABY'ENG\WOBQ\QOCS\CHKLSnauilding Planr«baclc Ckkt RP0001 Enon MM doc Rev.12126~075 Las Palmas Dr:.• Carlsbad, CA 9.2009-1576,• (619) 438-1161 • FAX (619) 438-0894 ;;, \, Io o 0 0 0 0 0 BUILDING PLANCHECK CHECKLIST SITE.PLAN. 1. Provide a fully dimensioned site plan drawn to scale. Show: A North Arrow 8. Existing & Proposed Struct1.,1res C. Existing Street Improvements 2. Show on site plan: A Drainage Patterns · D. · Property Lines E. Easements F. Right-of-Way Width & Adjacent Streets G. Driveway widths 1. Building pad surface drainage must mair,tain a minimum slope of one percent towards an adjoining street or an approved drainage course . . 2. ADD THE FOLLOWING NOTE: "Finish grade will provide a minimum positive drainage of 2% to swale 5' away' from building." B. Existing & Proposed Slopes and Topography 3. Include on title sheet: A Site address 8. Assessor's Parcel Number C. Legal Description ·For commercial/industrial buildings and tenant improvement projects, include: total · building square footage with the square footage for each different use, · existing sewer permits showing square footage of different uses (manufacturing, warehouse, office, etc.) previously approved. EXISTING PERMIT NUMBER DESCRIPTION DISCRETIONARY APPROVAL COMPLIANCE 4a. Project does not comply with the following Engineering Conditions of approval for Project No. _______ --"------------------- 4b. All conditions are in compliance .. Date: ----------- 1\1.ASPALMAS\SYS\LIBRARY\ENG\WORD\DOCS\CHKLST\Bullding Plancheck Cklst BP0001 Form MM.doc ' Rev. 12/26/96 •' Q ,Q 'Q 'l:l , BUILDING PLANCHECK CHECKLIST DEDICATION REQUIREMENiS 5. Dedication for all street Rights-of-Way adjacent to the building site and any storm drain or utility easements on the building site is required for all new buildings and for remodels with a value at or exceeding $ . , pursuant to Carlsbad Municipal Code Section 18.40.030. Dedication required as follows: ---,.--------------- Dedication required. Please_ have a registered Civil Engineer or Land Surveyor prepare the· appropriate legal description together with an 8 ½" x 11" plat map and submit with a title report. All easement documents must be approved and signed by owner(s) prior to issuance of Building Permit. Attached please find an application form and submittal checklist for the dedication process. Submit the completed application form with the required checklist items and fees to the Engineering Department in per~on. Applications will not be accept by mail or fax. Dedication completed by:-------......,..------- IMPROVEMENT REQUIREMENTS . Date: ____ _ -6a. All needed public improvements upon and adjacent to the building site must be constructed at time of building construction whenever the value of the construction exceeds$ ___________ , pursuant to Carlsbad Municipal Code Section 18.40:040. Public improvements required as follows: _____________ _ Attached please find an application form and submittal checklist for the public improvement requirements. A registered Civil Engineer . must prepare the appropriate improvement plan_s and submit them together with the requirements on the attached checklist to the Engineering Department through a separate plan check process. The completed application form and the requirements on the checklist must be submitted in person. Applications by mail or fax are not accepted. Improvement plans must be approved, appropriate securities posted · and fees paid prior to. issuance of building permit. Improvement Plans signed by: _______________ _ Date: ____ _ 6b. Construction of the public improvements may be deferred pursuant to Carlsbad Municipal Code Section 18.40. Please submit a recent property title report or current grant deed on the property and processing fee of $ ____ -,---__ so we may prepare the necessary Future Improvement Agreement. This agreement must be signed, notarized and approved by the City prior to issuance of a Building permit. Future public improvements required as follows: I\LASPALMAS\SYS\LIBRARYIENGIWOROIOOCSICHKLST\Bulldlng Planchecl< Cklst BP0001 Forin MM,doc , Rev. 12126/96 I BUILDING PLANCHECK CHECKLIST 1st.I 2nd.I 3rd.I CJ CJ 6c. Enclosed please find your Future Improvement Agreement. Please return agreement signeo anq notarized to the Engineering Department. Future Improvement Agreement completed by: Date: CJ 6d. No Public Improvements required. SPECIAL NOTE: Damaged or defective Q ti CJ CJ CJ CJ 0 CJ CJ CJ improvements found adjacent to building site must be repaired to the satisfaction of the City Inspector prior to occupancy. GRADING PERMIT REQUIREMENTS The conditions that invoke the need for a grading permit are found in Section 11.06.030 of the Municipal Code. 7a. Inadequate information available on Site Plan to make a determination on grading requirements. Include accurate grading quantities (cut, fill import, export). 7b. Grading Permit required. A separate grading plan prepared by a registered Civil Engineer must be submitted together with the completed application form attached. NOTE: . The Grading Permit must be issued and rough grading -approval obtained prior to issuance of a Building Permit. Grading Inspector sign off by: Date: 7c. Graded Pad Certification required. (Note: Pad certification may be required even if a grading permit is not required.) 7d. No Grading Permit required. MISCELLANEOUS PERMITS 8. A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or private work adjacent to the public Right-of-Way. Types of work include, but are not limited to: street improvements, tree trimming, driveway construction, tieing into public storm drain, sewer and water utilities. Right-of-Way permit required for: 1\1.ASPALMASISYS\LIBRARY\ENG\WORDIOOCS\CHKLST\Bulldlng Plancheck Cklst BPOOOf Fonn MM.doc 4 Rev. 12126/96 • ,t a Q a BUILDING PLANCHECK CHECKLIST 9. A SEWER PERMIT is required concurrent with the building permit issuance. The fee is noted in the fees section on the following page. 10. INDUSTRIAL WASTE PERMIT is required. Applicant must complete Industrial Waste Permit Application Form and submit for City approval prior to issuance of a Permit. Industrial Waste permit accepted by: Date: 1 t. NPOES PERMIT Complies With the City's requirements of the National Pollutant Discharge Elimination System (NPDES) permit. The applicant shall provide best management practices to reduce surface pollutants to an acceptable level prior to discharge to sensitive areas. Plans for such improvements shall be approved by the City Engineer prior to issuance of grading or building permit, whichever occur~st. 12. g/R.equired fees are attached a No fees required 13. Additional Comments: ~~iti~:s6\SYS\l.lBRARY\ENGIWORD\DOCS\CHKLST18uildlng Plancheck Cklsl BP0001 Fonn MM.doc 5 I i::; ENGINEERING DEPARTMENT >if-Tofa.l T.:t. ts FEE CALCULATION WORKSHEET ;;)..1 t/ ;;).31?{ + · /)() 'So t;:t{ prev1o.i :::I.. 'd -P-e_e'd. ot-Cf as o+rl'ce_ by fr e(/1'01.,£.5 CJ Estimate based on unconfirmed information from applicant. -t--e VlCl tt;;t-. ~alculation based on building plancheck plan s ittal. . ~s , Address:~00 Bldg. Permit No.Ccf CJ 7//Sf: Prepared by: Date: Checked by: Date: ------------------------ EDU CALCULATIONS: List tyjs· and square footages for all uses. Types of usf!.!~ Sq. Ft./t:mits-1f??73 · EDU's: __ tJ_(o_]~_ ~ /F73f /800~ /0 04- 1~73 7". sa::o =-L" 3 -Z> ADT CALCULATIONS: List types and square footages for all uses . . ~~ TypesolUse:t'l.J'J-Sq. Ft.ll;J11it~ lf7 3 ADT's: 30 --=----- FEES REQUIRED: /f73 lf73 .;i~ax, = 40 :w1o~-:=LID> WITHIN CFO: DYES (no bridge & thoroughfare fee, reduced Traffic Impact Fee) ~RK-IN-LIEU FEE PARK AREA: __ _ FEE/UNIT: __ --'-----X NO. UNITS: __ _ ~RAFFIC IMPACT FEE ADT's/UNITS: s 7C) ~GE AND THOROUGHFARE FEE · ADT's/UNITS: ----------,. X FEE/ADT: old- X FEE/ADT: ___ _ *-FACILITIES MANAGEMENT FEE ZONE: ___ _ / UNIT/SO.FT.: . . X FEE/SO..FT./UNIT: ___ _ ty 5. SEWER FEE PERM;T No.,:)£ 17()02b EDU's: • (o 7 X FEE/EDU:12.LQ BENEFIT .AREA: __ F_______ DRAINAGE BASIN:-'=~=:;;..._ =$ EDU's: ., {p { X FEE/EDU: 8 7 °I ~RAINAGE FEES PLDA. ___ _ HIGH ___ /LOW __ _ =$ ACRES: ____ _ ~WER LATERAL ($2,500). X FEE/AC: __ _ =$ =$ I & d-1 2:> • 581 -0 =O TOTAL OF ABOVE FEES*:$ ;2_4 --/td-- *NOTE: -This calculation sheet is NOT a complete list of all fees which may be due. Dedications and Improvements may also be required with Building Permits. P:IDOCSIMISFORMSIFEE CALCULATION WORKSHEET REV 01/28/97 .... PLANNING/ENGINEERING APPROVALS 11-1158 PERMIT NUMBER -=CB=-------DATE~5i ___ /; ___ 3~_'77 __ ADDRESS_;J-_____ ,?_b_'J-.____,,;/2 _____ ~f)_iu_.;:;;;_. _rD_/2&._l!O _____ _ R,ESIDENTIAL RESIDENTIAL ADDITION MINOR ( < $10,000.00) PLAZA CAMINO REAL VILLAGE FAIRE COMPLETE OFFICE BUILDING · OTHER __ --h_.--_w--h_et-t_lJi._v_,,.,_~---------------------- ENGINEER _______________ DATE _______ _ C:\ WP51 \FILES\B~DG.FRM Rev 11 /15/90 ""'-Hazardous Materials SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE Management Division -. - -; . ~- • N111111 Clllll. llltllf CIIITT IP I.II 11111 -Business Name Contact Person Telephone Zip S,te Address City State Plen Filel PART 1: FIRE DEPARTMENT· HAZARDOUS MATERIALS MANAGEMENT DIVISION: OCCUPANCY CLASSIFICATION ind1cat'e by circling the item, whether your buainesi will use, process, or ·,fore any of the, following hazardous materials. If eny oi the items ere circle.d, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. 1 . Explosive or Blasting Agent• 4'. Flammable S6lid1 7. Pyrophorica 10. Cryogenics 13. Corrosives . 2. Compressed Gases 5. Orgenic Peroxides 8. Unstable Reactives 11. Highly Toxic or Toxic Materials 14. Other Health Hazards ~. !=lammable or Combustible Uquidt e. Oxidizers 9. Water Reactives 12. Redioactives PART II: COUNTY OF SAN .DIEGO HEALTH DEPARTMENT· HAZARDOUS MATERIALS MANAGEMENT DIVISION: CONTINGENCY PLAN REVIEW: -. . If the answer _to any of the questions is yes, applicant muat contact the County of San Diego Hazardous Materials Management D1v1sion, 1255 Imperial Avenue, 3rd Floor, Sen Diego, CA 92186-5261. Telephone (819) 338-2222 prior to the i11uance of a building permit. FEES MAY BE REQUIRED Yes No 1. t::J •. 11 your bu1in111 listed on tha reverse aide of this form? 2. D Will yQur bu1in111 dispoH of Hazardous ~ub1t1nc11 or Medical W11t1 in any amount? . 3. D Will your business store or handle H1zerdou1 Substances in quantities equal to or greater than 55 gallons, 500 pounds, 200 cubic fHt or carcinog1n1/r1productiv1 toxin~ in any quantity? 4. D Will your bu1in111 UH an 1xi1ting or install an underground 1torag1 tank? S. D Will your bu1in111_ store or handle Acutely Haz1rdcx.,1 Material a?. PART Ill: SAN DIEGO COUN:rY AIR POLLUTION CONTROL DISTRICT OFFICE use ONL y D RMPP Exempt I Date Initials 0 RMPP Required Date· Initials D RMPP Completed Data Initials If the answe'r to any of th• question, it y11, applicant muat contact the Air Pollution Conuol Oiatrict, 9150 Chesapeake Drive, San Diego, CA 92123. Telephone·(619l 694-3307 prior to the i1suanc1 of a building permit. · YES NO 1. D,2(1 Will th, intended occupant inttall or-uae 1nv of the equipment listed on tha Listing of Air Pollution Control District Permit Categories, on the reverse 1id• of thia form? · 2. 0 c:J (ANSWER ONLY IF QUESTION 1 IS YES.) Will the subject facility be located within 1,000 feet of the outer boundary of 1 1chool (K through · 1 2) as listed in tha current Directory of School end Convnunity College Oiitricta, publi1hed by the San Diego County Office of Education and the current California Private School Directory, compiled in ac·cordance with proviliont of Educ1tion Code Section 331907 Bneildp):J~ of th~ intended 6uaan111 activity: Name ~:?°jep .. / · : . ~~'""' .1,tlJ/1'11 {4f4:ltl.d, /IJtllll?/J2/'6 $ignature of Owner or Authorized Agent: {declare under penalty of perjury that to tha beat of my-knowledge and belief the respo and correct. 0~ not write below thia line· FIRE DEPARTMENT OCCUPANCY Cl.ASSIFICATION:_..,..... __________________________________ _ BY: ___ ...;.. _______ __. ___________________________ Date: _________________ _ EXEMPT f!IOM PEIWIT l'IEQUIMMDITI COUNTY-HMMO ' Envi1'0111Da11&1 Hcallll Servica DHS:HM-9171 (6192) APCO -"""OVID ·FOR IUILDINQ l"ll'IMIT IVT NOT OCCUf'AHCY COUNTY-HMMD APCO -"""OVED F0ft OCCUf'AHCY COUNTY-HMMO APCD . COUDl)' ol Sal, Dieco 0eprtc t af Hc:altll Services ,_ LJaT OF IUIINUaEI WHICH REQUIRE MV1IW AND APPROVAL FROM COUNTY OF SAN DIEGO HEALTH DEPARTMENT THI HAZAN>OUI MAT!RIALI MANAGEMENT DIVISION AUTOMOTIVE Battery Manufacturing/Racycline Boat Yard Car Wash Dealership Maintenance and Paint ~a~hine_ ~hop . Parnt1rig .. ' · • Riidia(or Shop ' • Rental Yard Equipment Repair., Preventive Maintenance Repair, Major Overhaul Transportation Service, Wrecking and Recycling METAL WORKINQ Anodizing Chemical Milling/Etching Finish-Coating, Painting Flame Spraying Foundry Machine Shop·Orilling, Lathes, Milla Metal Plating Metal .Prepping/Chemical Coating Precious Metal Recovery Sand Bl11ting, Grinding Steel Fabricator Wrought Iron Manufacturing CHEMICAL HANDLING Agricultural Suppliers/Oistributort Chemical Supplier1/Di1tributor1 Chemical Manufacturer Coatings/ Adh11iv11 Compre11ed Gas SupP.li.er/Oistributor ,, . Ory Cleaning · ' ,.~\\ ~ · · · ~· · .. \ ,'I""\ Fibergla11/R11in Application, Gas Station , ,. ~"' lnduatrial Laundry Lab'oratori11 • Laboratory Suppliers/Distributors '-" Oil and Fuel Bulk Supply • & " • Pi1ticida Op,rator/Oi1tribu',pr ·\ ~- Photographic Proc11sing Pool Suppli11/Meintenance Printing/Blue Printing Road Coatings Swimming Pool (Gaa Chlorination Syatema Only) Toxic Gaa Handler Toxic Ga, Mfg. ELECTRONICS Electronics Components Mfg. Electroni91 A11ambly and Sub A11embly Printed Circuit Board Mfg. OTHERS AND MISCELLANEOUS Asphalt Plant Chiropractic Offic11 Co-Generation Plant Dental Clinic/Offic11 Dialysia ~e'hter• '. · .· · ' · .. , , . ~ Frozen Food Processi·ng Facilities. ' Government Agenci11 Hazardous Waste Haulers p ., ', Hosp(fel.i·tConyalesc~nt f:toma~ , 1. , ~ ~ 11 Laboi'ltoriei. Bio1ogical Laboratories~ Medical Clinics/Offices Public Utili-tin• · 1 ~: •. 1,l'bck~Quarry, . .,, . • ' • .. .. • ,. Veterinary Clinici'Hospitalt · Wood/Furniture Manufacturer/Refinishing Ship Repair/Conetruction AEROSPACE Aerospace Industry Aircraft Manufacturing Aircraft Maintenance NOTE: THE ABOVE LIST INCLUDES BUSINESSES WHICH TYPICALLY USE, STORE, HANCLI! 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 MANAGEMENT DIVISION (HMMO) REVIEW OF BUSINESS Pl.ANS. FOR MORE INFORMATION CALL (819)331-2222. • UITJNQ OF AIII POUUTION CONTROL DISTRICT PERMIT CA TEGORJU Bu1in11111 which include any of the. following operation• or aquipmant will require clHranca fro_m th• Air Pollution Control Di1tnct. CHEMICAL 47-0rganic Gas Sterilizer• 32-Acid Chemical Milling 33-qan & Coil Manufacturing 44-Evaporatora, Cryera • $tilla Procesaing Organic Material• 24-Dry Chemical Mixing • Detergent Spray Towers 35-Bulk Ory Chemical Storage COATINGS • SURFACE PREPARATION 01 -Abr11ive Bleating Equipment 27-Coating & Painting · · 3 7-Plaama Arc & Caramio Deposition Spray Booth. 38-Paint, Stein ·t, 'Ink Mfg: ' METALS 1 8-Metel Malting D.a'Yicea 1 9-0il Quenching & Salt Bathe 32-Hot Dip Galvanizine 39-Pracioua Metal• Raflnlne CQMIUfDQN 34-Platon lnternal·Combuation Enginai 1 3-Boilera • HHtera ( 1 Million Btu/Hr. or larger) 13-GN Turbines, and Turbine Teat Celle • Stand• 14-lncinaratora • Crematoriea 1 S-.,m Out Own• 1 e-core O....na Nffl9NICI 21-So+dar ~Yelera · ·, •,, • · · ;, ' ~ -· 21-HydroaquHgHa 42-Electionic Component Manufacturine fmm. 1 2-Fleh Canneriea 12-Smoke Houaea !50-CoffN RoNte,. 35-lulk Aour Ii Powderlld Sugar Storage ORGANIC COMPOUND MARKETING (GAfOUNL ITC,I 25-Gasolina • Alcohol Bulk Plana• Terminal• 25-lntermediata Refueler• 26·G1101ina & Alcohol Fuel Ciepenaing ROCK AND MINERAL 04-Hot Asphalt Batch Plants OS-Rock Orille 07-Sand Rock • Aggregate Plants 01-Concreta Batch, CTB, Concrete Mlxara, Mlxa,. I& Silo• 10-Brick Manufacturing· .... SOLVENT use 28-Vapor & Cold DegrHaing 30-Sol"',tnt 'fl• ·extract Driers • 311 -Dry-CIHnfng• • . 03-Aaphalt Roofing Kettl•• and Tankers 48-Reveraa Otlmoaia Membrane Mfg. 51-Aquaou~ Waeta Neutralization 11-Tlre .,fftra 17-Brake Cabonda,. 23·.,lk Grain & Cry Chemical Tran1,ter & Storage 45-Rubbar Mlxara 41-Landflll Gaa Rare or Recovery Systama 21-WNta Ciapoaal & Reclamation Units 38-Grindlng Booth• & Room• 40-Aaphalt Pavement HHtara 43-Ceramic Slip Caating 41-Pertita Proceasing 40-Cooling Towera-Ragiatration Only 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 THI! AIR POLLUTION CONTROL DISTRICT AT (819) 894-3307. ____J . . INDUSTRIAL WASTE DISCHARGE PERMIT APPUCATf ON . 1 . . ;.·. : •' ' ... ··.· ....... ' ~ 4 • • • • si1s1NEss NAME · _sn'E ADDREss iJ.~ ~ 5'tlf. /t,~ · .CONTACT PERSON (at bu.sine_ss~---~ ........... ~ .............. --~---. ____ , _____ ------------------- 1:'HONE NUMBER (#~l ~,59,£'fJ · _ . . . .. : ..... · Typa of Business (cheqk· all .that apply) . . . ,. . . . . .. . ~ .. . D Agricultu'ral ' D Government . ..O.Assembly .. . -. D Laboratory . . D Automotive · ··· D Laundry .·. .. D.-chemical ·Handling. ,-,. . D Manufacturing , D 'Electronics , D Medical D Photo Lab· D Retail D Service Station Dwarehouse Cl Other · ------- D Footj ~S: ~~rk__ _ . , . DESCRIBE WASTE· OTHER. THAN DOMESTIC (Ch~tnlcal~,::par11culat~.s, etc.j_· __ -W-·--'M ... ~--------- • ·•• !' ·, · .... .: • • ,.. • .•• ,_., . . .: ... ! :-· ·, GENERAL DESCRIPTION .QF.. ONSITE WASTEWATER PR0CE~SING:· (chemical & physical char~cteristlcs)_ ...... NIIAI* . . . . . , . . . . . . . . , ·_ . . . ' ... .. . .· . ,• ... .,. . . .. I$· business pre~ently In operation at site? D :vesJ8rNo . . . . . . , . . .. fta_s Wastewater Dis?harge Permit been applied for through the Encina Water Authority? D YES D NO · . ,App1icant'~ Nr,m~/ · ''rtue/J1}1J/-11Fi11, f'h~ne ~'?/N!J , Please Pr nt 'I, · Agency:, ___________ ...,._ ___ ___, ___ ___ : ~. _:· .Signature: ____________ ....,.... __ ·. . . ~ .. . :., Signature of City. Representative ·. -0 · EXEMPT . · :0 NOT 8<!;MPT :.-- ... Data forwarded to Enctna ++·~:c:: ..... · ..... J • ______ __,_ __ _ Data ___________ _ Date ___________ _ .. , ·, I, . . ·. r ~. .. ,!·' .. ,. I~ .. l t . P''. ""'' ·:~-.:. · ... ·, ' · .... '' l ~; \, . ' ' . 1 ' . ~ ~ ,. ~--i~DUSTRIAL wASTE ,PERMIT APPLICATroN l> • ••• ~ ;, ~ ., 1, • • 1 ;,. , Sectj.on 13.16 of the Carlsbad Municipai -C~de requires. -cl.I· ·persons discharging industrial waste into the sewer system to apply for an .. Industrial Waste Permit. All process wastewater must meet the industrial waste discharge standards as set forth in the Pretreatment Ordinance adopted by the Encina Wastewater Authority AJ?ril-25~ 1990. The· application must b·e co111pleted and returned to the Engineering Department ·piior to building pennit issuance. An mcomplete application may· delay·approval of your building plans. · · I . The co'mpl~ted application will be reviewed and forwarded to the Encina Wastewater Authority and, if necessary to the San Diego County Department of Public Works for.further evaluation. ·At this time· a detemtlnation will be inade as to whether further investigation will be ;required. If pretreatment . is required, .a.. Wastewater Discharge Permit application· will be issued by eith.er staff at Encina 9r th:e Engin~erlng Department planchecker. Please call the Carlsbad Municipal Water District at 438-2722, extension 153, or the En9t-g.a-Wastewater Authority at '438-3941, extension 3713 if you need · further information· about this permit. · · · . . . . . Cop~es of the ~ewer Ordinance and the Pretreatment Ordinance are available upon request. Ques:tions "regarding fees fort:lie Wastewater Disch~ge Pennit should be directed to the Carlsbad Water· District at ·438-2722. .. ... ' • • \. , ' '< 1\1 .~ ' . • '\. ~ " .., ',There~ no fee fo~ the iru'tial Inclus'trial Waste Permit ~pplication t~qu.irec:t' at this time. Please return the completed application to the Carlsbad Municipal Water District at 5950 El Camino Real • .. :7-~'l llltt11-6 k.fl(f) /?.t> sre-10 '171/~J' j ________ ___./t'/.~Jtfl .zn;~flJak,,,~,~, 0, /fL,z,I. (-------~~- s/~(-~ 1 - t'..PPROVALS Date --+;;!,,!-,.,i-;i..,1-IIAZMATFORM --+>J.J..4.(.:1,.-/-INDWASnlAPP --+--.;._ 8CHOOI.FEEFORM ---+---P!ANCORR ---+---ENGRGCORR _____ oosuc ---1----WCOMP --+---A~PLANS ...,..--+---ASSESSORPLANS __ _.__ __ CoFO