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HomeMy WebLinkAbout2325 CAMINO VIDA ROBLE; ; 86-91; PermitDECLARATIONSLENDER OWNER/BUILDER CONTRACTOR• SO™SSlaJ- o - c ->" &5 * 31 n *-i. L-1 <n1 S"D ^ SPECIAL CONDITIONS<BUILDING-•^t?1=*.(>-MECHANICALX.rd. .\ELECTRICAL>N.x PLUMBING•\•nZ1-or—r~Tl-O°2T^moS5Si*171i£llROPHIATm VENTILATING SYSTEMSImH133OOpenm<:enb>^>gacoHTJmgmT|TliMECHANK*.*i—gCDOZozogoo1—,u ELECTRIC SERVICEi iHmTJO3333K— .ROUGH ELECTRICK g ELECTRIC UNDERGROc:ancTlm33s ELECTRICg WATER HEATER C! SO33>HTl OcnHmcn.| |TUB AND SHOWER PAN<,— .TOP OUT g WASTEnmjj-"~^UNDERGROUND g WAmsHm33\C?x [J SEWER AND BL/CO1 iT3r~-nO"*PLUMBINO •---.zHm33O3)HXO33f~l~^1INSULATION\EXTERIOR LATH• — -FRAMESHEATHING g ROOFg£?u>m33 SUB FRAME LJ FLOOR^Omr^"Z.O GUNITE OR GROUTMASONRYREINFORCED STEELFOUNDATIONBUILDINGH13maHmINSPEClO33 City of Carlsbad 1200 ELM, CARLSBAD, CA 92008 • TEt!<619) 438-5525 MISCELLANEOUS RECEIPT ( .- , ,. .''I,, .V;i.,'lC r.n>~:L, rj t.; • Job _Address 2V=>^ CAvllMO VI CA (SoSut: Owner PALOMA/S. AKcPoer cmct PA€C LTO- MailingAddress g^x S&'S City ZIP Tel. gAMCHO ^AMIM^G1 ^ ZotTy . ,2.-;fe>-3"S£,Q Contractor - ,(C^LuiUtb £Sew££AL Cc.MT<eACTcy2 Address - . . •. . inso'So(2.eewTo VALLEY S.o City " Zip T»l.^AM QE^O ^zt?» z.7fe.-3i>so State Lie. ,. Cityaciasgrt. ••^34,^3 ; _:_ -. 'Ufc-No. . COMPLETE FOR PLAN GH€CK ONLY LEGAL DESCRIPTION "PV^CfcL, A ' C^" MAP * ICOfo 1 OM plL-C IW ClTT OF CA-e^fS'XO AWO LOT E OF MAi^ Mo ^ie^ OM ni-e WITH 'T\ie--'. 5AM- Dt&^o CouOTV (tecof^cr . AS^SSbRSf ARCEL NO- DESCRtPT^tQN OF WORK orrice iHFvacA/fcp'vierCfTS IM AtJ l£rx-i <5-n'Kjx=, (Z^^^o Sf "SHfcliC'" •'.-'-• ^BUI c-Ot (U^ '( U Ti tE P^LCMA-Z- AI^P^^T ^r^\c€ P^x^^ . PLAN ID NO. : xT^ "" /A' • cxxui.rc^OfA £o^'ioe^2co^ DESIGNER ADDHEssZ5Sfc> *T-' AVE SAM OfE^o PHONE "2-1 fc* ^"^^^ CONTACT- PERSON E_O (V\OO£-C. £* R|^ptMroglAppli«apl<V^^^y^'M>-' n«ia 2 ' Z-4 C6* ^ ' ^^|^S*i*if**^ -»*^ • ' '^'^ ^^ MISCELLANEOUS FEE RECEIPT n • PLAN CHECK FEE 00l-810-00-00-fl806 D VALUAT.ON //*?&% PI DEMOLITION PI HOUSE MOVING PI PARKS AND RFHRFATWIN FFF Ft PUBLIC FACI1 ITIFS FFE I) Enelnitfls ll San n(«go PI San MwrrnR PI CERTIFICATE OF OCCUPANCY D n ' n '"-.•' n • •'•' -• : •• n • n '• • - • n ' n n n • - D • /• •' ' ' • ! - ' •TOTAL FEE' A 1* 4/&1': ' * *.</*<. '~ 'WARNING: PLAN CHECK FEES, WHERE NO ACTION tS TAKEN BY THE APPLICANT IN 180 DAYS AND NO BUILDING PERMIT IS ISSUED. ARE FORFEITED TO THE CITY. COMMENTS: •:,-.- . .- . .::',:• > . . .-.•••.. '. ' J , -T- A^pllfiant ;_ Yellow v- FHo , PinH — (1) f Gpld — Assessor ESGIL CORPORATION 932O CHESAPEAKE DR.. SUITE 2O8 SAN DIEGO, CA 92123 (619) 5<>O-I4<>8 DATE: JURISDICTION: C^&? & <^S ft/9& _ __ H PLAN CHECKER QFILE COPY PLAN CHECK NO: $?£ " *?/ -jgT _ Q UPS & [] DESIGNER •PROJECT ADDRESS: jS^^tfT &tf-&7/&O 1//0/1 PROJECT NAME: ~ 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 deficien- I I cies identified ; 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 the jurisdiction's || copy for your information. The plans are being held at Esgil Corp. until corrected plans are submitted for recheck. I—. The applicant's copy of the check list is enclosed for the I I jurisdiction to return to the applicant contact person. The applicant's copy of the check list has been sent to: Esgil staff did not advise the applicant contact person that plan check has been completed. Esgil staff did advise applicant that the plan check has | ) been completed. Person contacted: ^_____ Date contacted: Telephone # REMARKS: BY: \ ' ^^^O--<*Ax*-^ ENCL: ESGIL CORPORATION ESGIL CORPORATION 932O CHESAPEAKE DR.. SUITE 2O8 SAN DIEGO, CA 92123 (<» 1 !)) 5<iO- DATE: Z2f n APPLICANT _<rri JURISDICTION* JURISDICTION: (&f&L£>& sKD _ QPLAN CHECKER QFILE COPY PLAN CHECK NO: s*3£, -9/ —-2T _ Q UPS DESIGNER PROJECT ADDRESS: ~ PROJECT NAME: . — | The plans transmitted herewith have been corrected where I _ | 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 deficien- I _ | cies identified _ ; _ are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies | 1 identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is the jurisdiction's IB copy for your information. The plans are being held at Esgil Corp. until corrected plans are submitted for recheck. • — . The applicant's copy of the check list is enclosed for the I _ I jurisdiction to return to the applicant contact person. The applicant's copy of the check list has been sent to:1 cTo t- 1- < N <, <S<5v>j(=7E.n"L. Co NTteyq-c-raig,. mgo <Sro a K.IJ-N TO H Esgil staff did not advise the applicant contact person that plan check has been completed. Esgil staff did advise applicant that the plan check has |J been completed. Person contacted: __ _ Date contacted: Telephone #. REMARKS : BY ; • K^^o^ ENCL: £SGb:L CORPORATION CC*. C A i- \^-o 12. si i ^ i_?vu(j»- Co- JURISDICTION OF TO: Coit-iisJg, C*S*L?L. Con-re- [ ] APPLICANT COPY VfriUgy go- t 1 JURISDICTION frj£l2.1 [ 1 PLAN CHECKER COPY [ 1 ESGIL FILE COPY TENANT IMPROVEMENT & INTERIOR ALTERATION CORRECTION SHEET A. Plan Check Number Qc* -*\\-T B. Site Address ^^-^g. CA-^MAJO VlPfl C. Owner ryyu-ov-vi^a. /^ii^o^T Ol^Ug >%vre.k=. t-TO • D. Building Code Applicable 1982 U.B.C. E. Occupant Load \rj.(o — Stories i Previous Proposed F. Proposed Occupancy B-Z- Occupancy ^v^LL, Use G. Type of Construction V—NJ Sprinklers : /Xyes No H. Allowable Floor Area "T* \. Actual IZ I. Basis for Area Increase no fOOmij^agt-i- ss^uevu^g J. Remarks g<\XLC6€P QMUf TVlOSg fi^GS H-AUMiUfy Date Plan Submitted:to Jurisdiction Date Initial Plan Check Completed Toe.^^ By Applicant Contact Person CTp ^loMfcog Tel._ FOREWORD: PLEASE READ 1. This plan check is limited to technical requirements contained in the Uniform Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and State laws regulating energy conservation, noise attenuation and access for the handicapped. The plan check is based on regulations enforced by the Building Inspection Department. 2. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department or other departments. For information regarding those departments, please contact those departments. 3. The items listed below require plan clarification, modification or change. All items have to be satisfied before the plans will be in conformance with the cited codes and regulations. Per Section 303(c), 1982 Uniform Building Code, the approval of the plans does not permit the violation of any State, County or City law. 4. Please submit two sets of corrected plans and enclose a copy of this list with your notes indicating where corrections were made i-e., sheet, detail, etc.. .return corrected plans and documents ONLY to the locations checked below: QEsgil Corporation at 9320 Chesapeake Dr., Suite 208, San Diego, CA, 92123 Telephone (619) 560-1468 Q Jurisdiction Building Department 10/22/85 26. Two complying exits are required from Exits must be, and maintain, a distance apart of at least 1/2 the maximum diagonal dimension of the area served by the exits. Section 3303 27. Assembly rooms with more than 50 occupants shall not have a lock or latch on exit doors unless they are equipped with panic hardware. Section 3318. Note on the plans: "All exits are to be openable from inside without use of a key or special know- ledge". Section 3304(c). Or NOTE: "Provide a sign on or near the exit doors reading: THIS DOOR TO REMAIN UNLOCKED DURING BUSINESS HOURS", and meet all other criteria of Section 3304(c) 1. 29. Required exit doorways shall be not less than 36 inches in width and not less than 6 feet - 8 inches in height. Section 3304(e) 30. Exit doors shall swing in the direction of exit travel (occupant load exceeds 50). Section 3304(b). 31. Show the locations of existing exits from the build- ing and show the path of travel from the remodel area to the existing exits. 32. Corridors must provide continuous protection to the exterior of the building. Interruptions by inter- vening room is not permitted. Foyers, lobbies or reception rooms constructed as required for corridors are not considered intervening rooms. r' CQL.UP :r>\ ae 38 If the tenant improvement area will not have a comfort heating or cooling system consuming more than 5 BTU per hour per square foot, note on the plan "Tenant Improvement area is not heated or cooled more than 5 BTU per hour per square foot and is exempt from Energy Conservation Regulations". If the tenant improvement area will have a comfort heating or cooling system consuming more than 5 BTU per hour per square foot, note on the plan "Tenant Improvement must comply with Energy Conservation Regulations". If the tenant improvement area must comply with the energy conservation regulations and the exist- ing building was originally constructed in com- pliance with the energy conservation regulations, provide two copies of the original Energy Com- pliance Documentation forms. If the tenant improvement area must comply with the Energy Conservation Regulations and the exist- ing building was not originally constructed in compliance with the Energy Conservation Regulations, address the appropriate items that will follow If HVAC is to be installed, provide two sets of energy conservation compliance forms 1, 2, 3, 4, 5 and 6. Title 24 Section 2-5312. If HVAC is to be installed, provide two sets of HVAC plans. Title 24 Section 2-5306. If lighting is to be installed, provide two sets of energy conservation compliance form 5. Title 24 Sections 2-5343 & 2-5344. If HVAC is to be installed, incorporate in the plans or specifications, the attached "Title 24 Mandatory Requirements". If HVAC is to be installed, the required energy documentation required to show compliance with the energy conservation requirements, is required to be signed by the California licensed person responsible for its preparation. Title 20 Section 1403(a)l. If HVAC is to be installed, recent charges in the regulations required specific signed construction compliance statements be filed with the Building Department prior to use or occupancy of the im- proved area. Incorporate in the plans or specifications the attached "Title 24-Construction Compliance Statement Requirements". Structural design calculations are required to show code compliance if any of the following conditions exist. Section 302(b): (a) Alteration of existing vertical or horizontal load carrying structure. (b) Increase in live or dead loads on floors or roof. (c) Other U B TITLE 24 MANDATORY REQUIREMENTS (To be noted on plans or specifications) HVAC Controls Sec. 2-5315. (a) Each HVAC system shall: 1. Be equipped with at least one automatic device for reducing HVAC energy use during periods of nonuse or alternate uses of the building spaces or zones served by the system; 2. Be able to maintain space temperature set points from 55°F to 85°F. Two or more replaceable fixed set-point devices shall be permitted if installed so as to maintain space temperature set points in the zone that they control; 3. Be able to provide sequential temperature control of heating and cooling capacity in each zone, if both heating and cooling are provided; 4. Provide a range of temperatures up to 10°F in which no heating or cooling is provided to the space, if the HVAC system has both heating and cooling capability; 5. Be able to terminate all heating at 70°F or less; and 6. Be able to terminate all cooling at 78°F or more. EXCEPTION: Multiple zone HVAC sytems requiring concurrent operation of independent heating and cooling systems need not comply with Section 2-5315(a) 4, 2-5315 (a)5, and 2-5315(a)6. (b) Zoning. Each zone shall be provided with at least one of the devices specified in subsection (a) to control the HVAC system which serves the zone. Each floor of a building with conditioned space shall contain at least one zone. Ventilation Systems Sec. 2-5316. On mechanical ventilation supply and exhaust systems capable of moving more than 5,000 cfm of air, auto- matic dampers interlocked and closed on fan shut- down shall be provided. On gravity ventilating systems, either automatic or readily accessible manually operated dampers in all openings to the outside, other than combustion air openings, shall be provided. Doors and Windows Section 2-5317. (a) Doors and windows between conditioned and uncon- ditioned spaces, such as garages and closets for central forced air gas furnaces using outside air for combustion, shall be designed to limit air leakage into or from the building envelope. Control Devices for Indoor Lighting Sec. 2-5319. Controls for lighting loads within the building envelope shall meet each of the following re- quirements. (a) Each area enclosed by ceiling-height partitions shall have independent control of the lighting within that area. (b) Each area enclosed by ceiling-height partitions shall have at least one readily accessible manually operated switching device to control lighting within the area. For lighting controls, "readily accessible" means located so that a person using the device can see the controlled lights or the area being lit. Switching devices in addition to, but not instead of, the required readily accessible manually operated switching devices shall also be permitted. (c) The general lighting of any area 100 square feet or larger in which the connected lighting load equals or exceeds 1.0 watt per square foot throughout the entire area shall be controlled so that the load may be reduced by at least one-half while maintain- ing a reasonably uniform level of illumination throughout the area. Readily accessible switches, that control each luminaire in a space with more than one luminaire, or that control each lamp in a space independently meet the requirements of this section. (d) In all areas where effective use may be made of natural light, lighting circuiting shall be arranged so that units, in all portions of the area where natural light is available at the same time, are switched independently of the remainder of the area. Occupant Operating and Maintenance Information to be Provided by Builder The builder shall provide the building owner, manager, and the original occupants a list of the heating, cooling, water heating, and lighting systems and features, materials, components, and mechanical devices conservation or solar devices installed in the building, and instructions on how to use them efficiently. The instructions shall be con- sistent with specifications set forth by the Executive Director. Water Heaters and Plumbing Fixtures Water heaters, showerheads, lavatory faucets and sink faucets must be certified by the California Energy Commission (Excluding: waterheaters of the non-storage electric type and lavatories in public facilities having devices that limit the flow of hot water or have self-closing faucets or having devices that limit the outlet temperature to a maximum of 110°F) Section 2-5314, Table 2-53G. TITLE 24 CONSTRUCTION COMPLIANCE STATEMENT REQUIREMENTS (To be noted on plans or specifications) CONSTRUCTION COMPLIANCE (a) Prior to occupancy of the building; the person responsible for the construction or installation shall provide the building department a signed statement, showing the building permit number, and listing all the manufactured devices in- stalled, including the name of the manufacturer, model number date of manufacture, manufacturer's stated efficiency, including the source cooling power index, source heating power index and fan performance index of each HVAC system. In lieu of the list reference may be made to the plans and specifications, if all the above in- formation was contained in the plans and specifications. Each document shall be signed by the person re- sponsible for its preparation. The signer shall be a civil engineer, mechanical engineer, electrical engineer, architect, building designer, general building contractor, or specialty con- tractor, licensed or registered to practice by the State of California; or shall be the building owner if he or she is allowed by law to prepare the document. If more than one person has responsibility for building design or construc- tion, each person may prepare and sign the document or documents applicable to that portion of the design or construction for which the person was responsible; or the person with chief responsibility for design or construction may prepare and sign the document for the entire design.or construction. INSULATION CERTIFICATION Prior to occupancy the insulation installer shall post in a conspicuous location in the build- ing, a signed certificate containing the build- ing permit number and stating the insulation was installed in accordance with the approved plans and specifications. The certificate should also show the manufacturer's name, material identifi- cation, "R" value and, for blown insulation, the minimum weight per square foot consistent with manufacturer's design data. Date: ^y^^/S'^y Jurisdiction C^ &rZ£~5&*?C) Prepared byi v!7//r7 VALUATION AND PLAN CHECK FEE PLAN CHECK NO. $&> '?/ --C" Q Eldg. Dept. D Esgil BUILDING ADDRESS '%323'S (?S?fr7//l>O !//£& h£>&{~&~ APPLICANT/CONTACT (SO fll QtilZdts' PHONE NO. Z*7(e 333 £? BUILDING OCCUPANCY S'2- TYPE OF CONSTRUCTION V'^ BUILDING PORTION fjJft^P&fe&S O/^^SfS Air Conditioning Commercial Residential Res. or Comm. Fire S-orinklers Total Value EUILDING AREA <^=" / ^^ : / /$. 6>77/ ( W*2 S- ?-3# ^^ si ^ DESIGNER PHONE " CONTRACTOR VALUATION MULTIPLIER , ^ <&& s^\ tf&s ^ 7,^ -/?>#* } ia @ § ' • PHONE VALUE 2£ = V&f'g* * * 2?6>%2>l \ ! 3o^ S-S3 Fee Adjusted To Reflect D Energy Regulations (Fee x 1.1) QHandicapped Regulations (Fee x 1.065) tyLL<~ ^TTOBuilding Permit Fee $ / / — ' ' — ' . J / I ll £-'7Plan Check Fee $ G? ' Y"' U / $ COM M E N TS: B/4/82 a LU D-a IUJQT in O a)ua: PLAN CHECK NUMBER ADDREESS SCHOOL FEES: SAN DIEGUITO CARLSBAD SETBACKS: FRONT DISCRETIONARY ACTIONS: REDEVELOPMENT PERMIT REQUIRED LANDSCAPE PLAN COMMENTS: ENVIRONMENTAL REQUIRED: ADDITIONAL COMMENTS: PLANNING OK TO ISSUE: SIDE ENCINITAS __ SAN MARCOS REAR DATE: CLU OC aLU-CE: (/> 34 U JjLU * Q£ U O o>UQ1 10 LEGAL DESCRIPTION VERIFIED? P.F.F.; RIGHT-OF-WAY; |Kj /A ENGINEERING APN CHECKED? PARK-IN-LIEU QUADRANT: -27 , FEE PER UNIT: EASEMENTS :___N/A IMPROVEMENTS: LATERAL: GRADING PERMIT: DRAINAGE: ADDITIONAL COMMENTS: TRAFFIC IMPACT FEE PER UNIT: /\/ DRIVEWAY: . N/A FIELD CHECK DATE:INITIALS: INDUSTRIAL WASTE PERMIT^ GRADING COMPLETION CERTIFIED: OK TO ISSUE \ DPD2:DPD6:01/86 DATE: 3/tO/BCs 1200 ELM AVENUE CARLSBAD, CA 92008-1989 TELEPHONE (619) 438-5523 Citp of Cartebab FIRE DEPARTMENT PLAN CHECK REPORT PAGE 1 OF APPROVED DISAPPROVED PLAN CHECK* ~ 97 PRO.IFfVr T&tfJffi/ Mtftt KflMK. <?///, ARp.HiTFrrr C*&\ s'/^t-tfjwrit*'* M^K^ nWNFR ffs ADDRESS ' , ADDRESS ADDRESS . r/iib fiAMttJ aitf* fn,^n- ^ c;.n. tf i'/J/f/* ypc^ i^tL PHONE PHONE _ fa/f #7(*~3?flO CONST. W7-N ^JSPRINKLERED ^TENANT IMP. TOTAL SQ. FT.STORIES ff'A^v /-* APPROVAL OF PLANS IS PREDICATED ON CONFORMING TO THE FOLLOWING CONDITIONS AND/OR MAKING THE FOLLOWING CORRECTIONS: 1. 2. 3. 4. 5. 6. 7. g. 11 X 12. _ X13. PLANS, SPECIFICATIONS, AND PERMITS Provide one copy of: floor plan(s); site plan; sheets Provide two site plans showing the location of all existing fire hydrants within 200 feet of the project. Provide specifications for the following: Permits are required for the installation of all fire protection systems (sprinklers, stand pipes, dry chemical, halon, COa, alarms, hydrants). Plan must be approved by the fire department prior to installation. The business owner shall complete a building information letter and return it to the fire department. FIRE PROTECTION SYSTEMS AND EQUIPMENT The following fire protection systems are required: B Automatic fire sprinklers (Design Criteria: fttPA D Dry Chemical, Halon, CO2 (Location: D Stand Pipes (Type: D Fire Alarm (Type/Location: Fire Extinguisher Requirements: ^ One 2A rated ABC extinguisher for each extinguisher not to exceed 75 feet of travel. D An extinguisher with a minimum rating of sq. ft. or portion thereof with a travel distance to the nearest to be located: _ Other: 8. Additional fire hydrant(s) shall be provided EXITS Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort. A sign stating, " This door to remain unlocked during business hours" shall be placed above the main exit and f M^/ft* 0*"^$ &a f^~ _doors 1 i A & EXIT signs (6" x 3/*" letters) shall be placed over all required exi'lts and directional signs located as necessary to clearly indicate the location of exit doors. GENERAL Storage, dispensing or use of any flammable or combustible liquids, flammable liquids, flammable gases and hazardous chemicals shall comply with Uniform Fire Code. Building(s) not approved for high piled combustible stock. Storage in closely packed piles shall not exceed 15 feet in height, 12 feet on pallets or in racks and 6 feet for tires, plastics and some flammable liquids. If high stock pil- ing is to be done, comply with Uniform Fire Code, Article 81. 14. Additional Requirements. P.-") /) 7 .15. Comply with regulations on attached sheet(s). Plan Examiner 7s ^ Date-_£LJe_ Report mailed to architect Met with .Attach to Plans 1200 ELM AVENUE CARLSBAD, CA 92008-1989 Offlct of the City Enginwf TELEPHONE (819) 438-5541 dtp of Cartebab DATE;2O.J98& Jack Thomas County of San Diego Department of Public Works Building 1, Operations Center 5555 Overland Avenue San Diego, CA 92123 INDUSTRIAL WASTE PERMIT APPLICATION 'NO'." Enclosed is a copy of the application for an Industrial Waste Discharge Permit from the subject applicant. Your review and recommendations on this application will be appreciated prior to the issuance of a waste disposal permit. DONALD E. DONOVAN City Engineer Enclosure: Application No. CC: Dave Sautter, Encinas Plant Linda Pratt, Dept. of Health Services DEDtJMilch APPLICATION FORM FOR INDUSTRIAL WASTE DISCHARGE PERMIT CITY OF CARLSBAD Application! New. (Check One) Revised Application No. 2&H Industrial Class 3J Date 3-20 ~ of City Representative APPLICATION FOR INDUSTRIAL WASTE DISCHARGE PERMIT A. GENERAL: Applicant \ (Owner, Lessee, Tenant, etc.) Site Address *£\M.oo\X .g* Phona:(Applicant's Address) Type of Business: B. INDUSTRIAL WASTES AND PROCESSING: General description of chemical and physical characteristics of existing proposed waste General description of process, (If applicable) C. WASTES TO BE DISCHARGED TO SEWER: Waste Treated. (Check One) Untre ated X Applicant or Representative of Firm Title Signature Quantity : Average (Daily) Maximum GPP GPD (Print) Date s