HomeMy WebLinkAbout2365 MARRON RD; ; CB100748; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
05-21-2010 ' Commercial/industrial Permit Permit No: CB100748
Building Inspection Request Line (760).602-2725
Job Address: 2365 MARRON RD CBAD
Permit Type: TI SubType: COMM -.
Parcel No: 1563021900 . Lot #: 0 Status: ISSUED
Valuation: $47,846.00 Construction Type: 5B . Applied: 04/30/2010
Occupãncy Group: - ," Reference #: , Entered By: RMA
Project Title: 1ST NATIONAL BANK- 1018 SF Plan Approved: 05/21/2010
OFFICE,TO OFFICE Issued: 05/21/2010
Inspect Area: - - .
. . Plan Check#:
Applicant: * Owner.---.. .
TRIVISTA INC PLAZA CAMINOREAL
/C/OFIRSTNATLBKOF'NOCOU
STE 423 (1I SAN MARINODR,.
970 W VALLEY PARKWAY 92025 MARCOS CA-'19k78
7602940277
.
'.
Building Pemit / . 7 $405.42 Meter Size .\ .
Add'l Building Permit Fee $0.00). Add'l Recl-Water Con. Fee $0.00
Plan Check / . / $263.52 Meter Fee \ $0.00
Add'l Plan Check Fee, / $0.00 SDCWA Fee .\ . $0.00
Plan Check Discount / ..$0.00.-'--.CFD Payoff Fee ' - \ V $0.00
Strong Motion Fee f L'-.. / $10.O5PFF (3105540) \ $0.00
Park Fee f / $0.00.FF.(4305540) . $0.00
LEM Fee License Tax (3104193) A ' rj $0.00
"Bridge Fee I - $0.00 tLicense Tax (4304193) 1 $0.00
BTD#2Fee. I I $0.00 . tJrffic Impact Fee (3i0554i) I $0.00
BTD #3 Fee . $0.00 ! tTffic Impact Fee(4305541) j . - $0.00
-Renewal Fee . $0.00 PLUMBINGTOTAL r(J / $76.00
Add'l Renewal Fee $0.00 \ 1ELECTRICALTOTAL J ii -.1 $20.00
Other Building Fee $0.00 % lMECHANICAL1TOTALf / ,. -$3700
Pot. Water Con. Fee\ $0.00 - •:MasterDrainagFee $0.00
Meter Size • \ " %Seer Fe(6'._/ 00
Add'l Pot. Water Con. Fee \ $0.00 tR1ev Parking Fee -
Red. Water Con. Fee .\ \. • $0.00.0RFAdditi0i9al Fees \1G 15.00)
Green Bldg Stands (5B1473)'Fee $1.00- 1,HMP Fee \\...O / ??
Fire Expedited Plan Review\ $115.00
PERMITFEES $812.99
'j /çj -•
Total Fees: $812.99 Total PaymentsTo'Dfe: 1$812.99 Balance Due: $0.00
. . . .
I ' •. - -
- ..
'FINAL APPROVAL :
Inspector. Date. Clearance.
NOTICE: Please take NOTICE that approval of yoi'r project includes the "Imposition" of tees, dedications, reservations, or other exactions hereafter collectively
referred to as 'lees/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 imposifion . . ..
You are hereby FURTHER NOTIFIED that your right to protest the speif led 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/exOctions of which you have greviously been given a NOTICE similar to this, or as to which the statute of limitations has -previously otherwise expired... -
CITY OF
, I
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-2717 / 2718/ 2719 -
Plan Check No. /00
-Est. Value 74/J
1DU-OUL-ZO "ARLSBAD rdx:
www.carIsbadca.ov Date !~~20&0
JOB ADDRESS SUITE#/SPACE#/UNIT# APN
156 -301 - 19 13 , 5 MR-200 COAD - CO
Jr/PROJECT B LOT # I PHASE # B OF UNITS # BEDROOMS B BATHROOMS TENANT BUSINESS NAME cONSTR. TYPE 0CC, GROUP
DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) -
Tt - r IMP aoUM - ço FST rfrTLOL ,C&OM
rPA itt rt L v tJuJ C MCI - OtJ LI -rç, 9=L?L4& cz cc Li ,i
2CL6gm Li64Ts' P)o!-- ffo/&C totAL 4110116 & EXISTING USE PROPOSED USE GARAGE (IF) PATIOS (SF) DECKS (SF) FIREPLAC AIR CONDITIONING FIRE SPRINKLERS
rc c cIfrséel YES 0 #_ NOD YES 0 NOD YES 0 NOD
CONTACT NAME (If Different Fom Applicant) , APPLICANT NAME T12-J1A C-c'4'.
ADDRESS - - - ADDRESS
940 LJ. fAU( ?ALWA 4Z-3
CITY STATE ZIP , CITY • STATE ZIP
Co i P id"
PHONE - FAX PHONE FAX
"-1 ti4-ót i 7,4 i --
EMAIL EMAIL
r;Ji~4r4Core.COv%1
-
PROPERTY OWNER NAME w CST 1Lp --
CONTRACTOiBUS. NAME -J'-rA. C04'
ADDRESS
W1tS1+1t2 BtNp. U1I1
ADDRESS
'??° (' VA tu'j 4i_ -
CITY STATE ZIP CITY STATE ZIP L oi ic&6V 900 ?—.1c, 6 ( çt
PHONE . FAR PHONE FAX -
-. 44 Sr, 4é.310 —5,41-57 _. V4-ot Z<14- 01-176 EMAIL EMAIL
4Y.,U'I
-
Ma A 'vt- ARCH/DESIGNER NAME & ADDRESS
Th%)l(D-- (oRJ SC0,tiP0 (A
STATE UC. B
e8Obf
STATE LIC.# r
0_5 to/ CLASS CITY US. LIC.# a.?
Isec. (u1.o uusiness ano i-'roreSSronS Coce: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its iSsuance, also requires the'. applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law IChapter 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 l$50011.
vow 00,W11 .,' 1 -: ': ',- --: T•:'
Workers' Compensation Declaration: I hereby aftbra under penalty of perjury one of the following declarations:
IJ I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 370001 the Labor Code, for the performance of the work for which this permit is issued.
have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of th orb for whih.j permit is issued. My workers' compensation i urancè carrier and policy
number are: Insurance Co. 'tA'r -(Jt'. p9 Policy No. I__-.c'_If_£7 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 permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California. WARNING: Failure to secure workepq compensation covioe is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (5100,000), in
addition to the cost of compensation, damage providec.to in n 3706 of the Labor code, interest and attorney's fees.
CONTRACTOR SIGNATURE AGENT DATE o1 -i,_ ,o
I hereby affirm that lam exempt from Contractor's License Law for the following reason:
0 I, as owner of the properly or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The.Contraclor's
License Law does not apply loan owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for
sate. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sate).
O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of
properly who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
-
O I am exempt under Section ______________Business and Professions Code for this reason: -
1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. DYes 0 No
I (have! have not) signed an application for a building permit for the proposed work.
I have contracted with the following person (firm) to provide the proposed construction (include name address! phone! contractors' license number):
I plan to provide portions of the work, bull have hired the following person to coordinate, supervise and provide the major work (include name I address! phone I contractors' license number):
twill provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name address/phone! type of work):
-
.PROPERTY OWNER SIGNATURE ' . . . . 0 AGENT DATE
Is the applicant or future building occupant required to submit a business pta cutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the
PresTanner Hazardous Substance Account Act? D Yes o -
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 Yes No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 Yes &Vo
f 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.
I hereby affirm that there is a construcfion lending agency for the performance of the work this permit is issued (Sec. 3097 (I) Civil Code).
Lender's Name Lender's Address
I certify that l have read the application and state thatthe above information is correct and that the information on the plans Is accurate. I agree to comply with all City ordinancesand State laws retatingto 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 ANYWAY ACCRUE AGAINST SAID CITY INCONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA. An OSHA permit is requited for excavations over 50' deep and demolitV
peis
don of structures over 3 stories to height. -
EXPIRATION: Every permit issued by the Building Official 7nf;m pmovinions shall expire by limitation and become null and void if the building or work authorized by suth permit in not commenced within
180 days from the date of suth permrritorifthebutding or orized by such uspended 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 04- Z
City of Carlsbad Bldg Inspection Request
For: 07/02/2010
Permit# CB100748
Title: 1ST NATIONAL BANK- 1018 SF
Description: OFFICE TO OFFICE
Type: TI Sub Type: COMM
Job Address: 2365 MARRON RD
Suite: Lot: 0
Location:
OWNER PLAZA CAMINO REAL
Owner:
Remarks:
Inspector Assignment: TP
Phone: 7606440043
Inspector:
Total Time.: Requested By: PHILLIP
Entered By: CHRISTINE
CD Description Act Comments
' 19 Final Structural ft P '749 ,C, , , .
29 Final Plumbing 1
39 Final Electrical / 0
49 Final Mechanical (
• Comments/Notices/Holds
Associated PCRs/CVs Original PC#
Inspection History
Date Description Act lnsp, Comments
06/23/2010 84 Rough Combo AP RB T-BAR SYSTEM
06/08/2010 17 Interior Lath/Drywall AP TP
06/08/2010 21 Underground/Under Floor WC TP
06/04/2010 14 Frame/Steel/Bolting/Welding PA RB MISSING WALL BRACING
06/04/2010 21 Underground/Under'Floor AP RB UNDER GRND PLUMBING
06/04/2010 24 Rough/Topout • AP RB
06/04/2010 34 Rough Electric AP RB WALLS ONLY
06/04/2010 44 Rough/Ducts/Dampers WC RB
06/01/2010 14 Frame/Steel/Bolting/Welding CA PD BY PHILLIP
06/01/2010 21 Underground/Under Floor CA PD
06/01/2010 24 Rough/Topout CA PD
06/01/2010 34 Rough Electric CA PD
05/28/2010 21 Underground/Under Floor NR TP
BUILDING Development Services
CITY OF Plan Check Building Division
1635 Faraday Avenue CARLSBAD Comments 760-602-2719
www.carlsbadca.gov'
By Steve Borossay Email: steve.borosSay(äcartsbadca.qov Phone: 760-602-7541
(Contact Hours for Steve: Tues.-Fri., 1pm - 5pm)
Address: __RA ________
When corrections from all departments are received please run new prints..
Provide: A statement on the Title Sheet of the plans staling that the project shall comply with the 2007 CA Building Code,
2007 CMC, 2007 CPC, 2007 CEC and the 2008 CA Energy Efficiency Standards. 5 1l'd 'i$ 2 541er At Oj
LI Provide: A note titled Scope of Works descnbinthe work to be performed under this permit.
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CfCJ r beccL ; 6,
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4..E UISL
5A eeT A04
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Approved on: By: I
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB /ô - 7 C( DATE_______________
ADDRESS 3 '
• RESIDENTIAL ' TENANT IMPROVEMENT
RESIDENTIAL ADDITION MINOR PLAZA CAMINO REAL
(<$17,000.00) '
CARLSBAD COMPANY STORES.
VILLAGE FAIRE' '
COMPLETE OFFICE BUILDING
OTHER
PLANNER ,72 DATE
ENGINEER/ DATE________________
Doc&Mi8fom&PIanning Engineenng Approvals -
PLANNING DEPARTMENT
BUILDING PLAN CHECK REVIEW CHECKLIST o.
7 % Plan Check No. CB 10-0748 Address 2365 Marion Rd
Tj Planner Chris Sexton Phone (760) 602-4624
JZJr. APN: 156-302-19
1121 Type of Project & Use: fl Net Project Density:N/ADU/AC
° Zoning: 0-2 General Plan: R Facilities Management Zone: 1
CFD (in/out) #_Date of participation:______ Remaining net dev acres:______
. (For non-residential development: Type of land used created by this permit: Circle One t • ___ . . - U U C) G) ) 1)
. Legend: Z Item Complete LI Item Incomplete - Needs your action
LI Environmental Review Required: YES LI NO LI TYPE
DATE OF COMPLETION:
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval:
LI Discretionary Action Required: YES LII NOEl] TYPE
APPROVAL/RESO. NO. DATE
PROJECT NO.
OTHER RELATED CASES:
Compliance with conditions or approval? If not, state conditions which require action.
Conditions of Approval:
LI Coastal Zone Assessment/Compliance
( Project site located in Coastal Zone? YES Li NO Li
CA Coastal Commission Authority? YES Li NO Li
If California Coastal Commission Authority: Contact them at - 7575 Metropolitan Drive, Suite 103,
• San Diego, CA 92108-4402; (619) 767-2370 .
Determine status (Coastal Permit Required or Exempt):
ELI Habitat Management Plan
Data Entry Completed? YES LI NO LI
If property has Habitat Type identified in Table 11 of HMP, complete HMP Permit application and
assess fees in Permits Plus
(A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, HMP Fees, Enter Acres of Habitat Type
impacted/taken, UPDATE!)
LI Inclusionary Housing Fee required: YES LI NO LI
(Effective date of Inclusionary Housing Ordinance - May 21, 1993.)
Data Entry Completed? YES LI NO LI
(A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, Housing Fees, Construct Housing Y/N,
Enter Fee, UPDATE!)
H:'ADMIN\Template\Building Plancheck Review checklist.doc • Rev 4/08
Site Plan:
T U Provide a fully dimensional site plan drawn to scale. Show: North arrow, property lines, easements,
existing and proposed structures, streets, existing street improvements, right-of-way width,
dimensional setbacks and existing topographical lines (including all side and rear yard slopes).
Provide legal description of property and assessor's parcel number.
Policy 44 - Neighborhood Architectural Design Guidelines
[7I LI .1. Applicability: YES LI NO LI
LI h1ji LI 2. Project complies: YES LI NOD
Zoning:
LI Setbacks:
Front: Required Shown
• Interior Side: Required Shown
Street Side: Required Shown
Rear: Required Shown
Top of slope: Required Shown
'1I LI Accessory structure setbacks:
Front: • Required Shown
Interior Side: Required Shown
Street Side: Required Shown
Rear: Required Shown
Structure separation: Required Shown
~(E] . Lot Coverage: Required Shown
LI Height: Required Shown
LI Parking: Spaces Required Shown
(breakdown by uses for commercial and industrial projects required)
Residential Guest Spaces Required Shown
(.LiIj)II3I LI Additional Comments 1) Will the new ductwork require new roof mounted equipment? If so, please
I show how the equipment will be screened. Please see handout.
OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE
H:\ADMIN\Template\Building Plancheck Review Checklist.doc - Rev 4/08
Carlsbad Fire Department
Plan Review Requirements Category.' TI, COMM
Date of Report: 05-20-20 10
Name: TRIVISTA INC
Address:
STE 423
970 W VALLEY PARKWAY
ESCONDIDO CA 92025
Permit #: CB 100748
Job Name: 1ST NATIONAL BANK- 1018 SF
Job Address: 2365 MARRON RD CBAD
Reviewed by:.
time, this office cannot
adequately conduct areviewto,detefT51ne compliance witE the pp1rabiec d dYörstandads. Please review
carefully all comnantfched. Please resubmit the necessary plans and/or speififibns, wifficha&es "clouded",
to this ofVfview and approval.
Conditions:
Cond: C0N0004025
[MET]
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 05/20/2010 By cwong
Carlsbad Fire Department
Plan Review Requirements Category: TI , COMM
Date of Report: 05-20-2010
Name: TRIVISTA INC
Address:
STE 423
970 W VALLEY PARKWAY
ESCONDIDO CA 92025
Permit #: CB 100748
Job Name: 151 NATIONAL BANK- 1018 SF'
Job Address: 2365 MARRON RD CBAD
Reviewed by:
INCOMPLETE The item you have submitted for review is incomplete. At this time, this office cannot
adequately conduct a review to determine compliance with the applicable codes and/or standards. Please review
carefully all comments attached. Please resubmit the necessary plans and/or specifications, with changes "clouded",
to this office for review and approval. ' ..
Conditions:
Cond: C0N0004025
[MET]
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: 05/20/2010 By: cwong Action: AP
_2\çO
J4
CARLSBAD FIRE DEPAETMENT
EXPEDITED PLAN CHECK REQUEST
CB _/007
I am requesting Expedited Fire Plan Check and understand I will
be assessed an additional fee at the rate of $90 00 dollars per
hour plus $25 00 dollars administration fee Plans will not be
released until all fees are paid Applicant is responsible for all
expedited fees should the project not be completed
Turnaround time for the expedited fire plan review will be 14
calendar days with a turnaround time for re-checks of seven
calendar days Plans check by the Fire Department will be
checked on a first come, first serve basis and could take up to
60 days or more to be completed
YES NO .."
. PLEASE CIRCLE YOUR SELECTION
Applicant Signatur J Date
Copy t Building file and
__V i
-:
Fire Prevention
O) SAN DIEGO REGIONAL
OCCC HAZARDOUS MATERIALS QUESTIONNAIRE
OFFICE USE ONLY
UPFP#
HV#
BP DATE I
Business Name Business Contact Telephone #
F) V-1 ti&L r* (1 4 i -
Project Addr ss Cif-y- y Stat Zip Code APN#
RIP. j-p CL~p -x ej
Mailing Address City State Zi Code Plan File#
6-5'pp. (
Project Contact Telephone #
rhe 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.
-
Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives
Compressed Gases 6. Oxidizers 10. Cryogenics ther Health Hazards
Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials . one of These.
Flammable Solids 8. Unstable Reactives 12. Radioactives
[Il
Call (619) 338-2222 prior to the issuance of a permit.
FEES ARE REQUIRED. Expected Date of Occupancy:
YES NO
1. Li 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?
0 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?
0 AX Will your business use an existing or install an underground storage tank?
0 Will your business store or handle Regulated Substances (CaIARP)?
0 Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
If the answer to any of the
qo, CA 92101.
CaIARP Exempt
Date Initials
CaIARP Required
Date Initials
CaIARP Complete
Date Initials
PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the 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 ND 0 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.or/infoIfacts/permits.df, and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). 0 0 (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 htto://www.cde.ca.gov/re/sd/; or contact the appropriate school district). 0 Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? 0 ill there be demolition involving the removal of a load supporting structural member?
Briefly describe business activities: I Briefly describe proposed project
I declare under of gçrjury that to the best of my knowledge and belief the renses ma herein are true arf'd correct.
(1~ MAc~ i LO fin dv-.& Name of owner or Authorized Agent Signature irized Agent
/ V: i !o
Date
FOR OFFICIAL USE ONLY:
FIRE DEPARTMENT OCCUPANCY CLASSIFICA
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-HMO APCD
HM-9171 (04/07) County of San Diego— DEH - Hazardous Materials Division