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Home My WebLink About2375 CAMINO VIDA ROBLE; BLDG 6; CB961826; PermitCJL BUILDING PERMIT 11/01/96' 09 Page 1 of Job Address 41 1 Permit No Project No Development No CB961826 A9602576 2375 CAMIWO VIDA ROBLE Suite Permit Type :. INDUSTRIAL TENANT IMPROVEMENT Parcel No: 213-050-27-00 Lot* : Valuation: 50,336 Occupancy Groups « Refer ence#: Description: TI-MOVE WALLS , LIGHTS , CEILINGS 02 540-00 Appl/Ownr : CHAPO & HALL ARCHITECTS 777 A HWY 101, STE 210 SOLANA BEACH CA 92075 * * Fees Required * * * 619 0706 U/Oi/96 0001 01 C-PRHT Construction Type: VN Status: ISSUED Applied: OS/23/36 Apr/Issue : 11/01/96 Entered By : RMA 481-4141 lected & Credits Fees : Adjustments: Total Fees: Fee description Building Permit Plan Check Strong Motion Fee * BUILDING TOTAL * Enter "Y" for Elect Enter "Y" for Remod * ELECTRICAL TOTAL Ente,r 'Y' for Mechan Install Furn/Ducts/He * MECHANICAL TOTAL 746 *** ,00 206.00 540.00 Ext fee Data 419 272 11 702 10 10 20 15 9 24 00 00 00 00 00 00 00 00 00 00 CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Caiisbed, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 1. PERMIT TYPE From List 1 (see back) give code of Permit-Type: For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: Net Loss/Gain of Dwelling Units 2. PROJECT INFORMATION PLAN CHECK NO. EST.VAL -Jj.nOfJ ~ ,./ — "" PLAN CK DEPOSIT VALID. BY ^-, DATE ^[ 1 ' ~\ t^JU& /IA- ti/ <*f !'-*i i t-J FOR OFFICE USE ONLY Address Nearest Cross Street BuiHing or Suite No. LEGAL DESCRIPTION Lot No.Subdivision Name/Number Unit No.Phase No. CHECK BELOW IF SUBMITTED: D 2 Energy Gales D 2 Structural Gales D 2 Soils Report D 1 Addressed Envelope DESCRIPTION OF WORK C/t- "SQ. FT.# OF STORIES # OF BEDROOMS # OF BATHROOMS smJNTAcrr PERSON ut auterent Irom a NAME (last name ___ ADDRESSf?! STATQfr ZIPCQDFP DAY TELEPHONE 4. APPLICANT ^CONTRACTOR OAGENT_FOR CONTRACIXm DOWNER UAGENI tOR OWNhH NAME (last namCfirst)^J(Z^S' /E^JIP ADDRESS CITY DAY TELEPHONE 5. FKUPEKTY OWNER NAME (last name first) DAY TELEPHONE O. UUNTKAUIUK NAME (last name ZIP CODE^ LICENSE CLASS STATE STATE LIC. # DAY TELEPHONE CITY BUSINESS IJC. # ULMGNhK NAML (.last name CITY DAY TELEPHONE 7. WORKI Workers' Compensation Declaration: Thereby amrm that I have a certificate of consent to self-insure issued by the Director of Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY $ TAlfc feufp on: f certify that in th POLICY NO. .y-^EXPIRATlON DATE //?- /- f7 Certificate of Exemption: certify that in the performance ot the work tor so as to become subject to the Workers' Compensation Laws of California. hich thfs permit is issued, I shall not employ any person in any manner SIGNATURE DATE 8. OWNER-BUILDER DECLARATION Uwner-Builaer Declaration: 1 nereDy artirm that 1 am exempt trom tne Contractors License Law tor the following reason: D I, as owner of the property 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 Contractor's License Law does not apply to an 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 sale. 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 sale.). D 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 contractor(s) licensed pursuant to the Contractor's License Law). D I am exempt under Section Business and Professions Code for this reason: (Sec. 7031.5 Business and Professions Code: 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 (Chapter 9, commencing 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]). SIGNATURE DATE COMPLETE! THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: 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 2S505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? P YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1,1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 9. UDNS'lHUCllON LENDING AGENCY ITiereby atlirm that there is a construction lending agency for the performance ot the work tor which this permit is issued (Sec 3097U) Civil Code). LENDER'S NAME LENDER'S ADDRESS 10. APPLICANT (JKHTIFICMION I certify that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREETC-SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WIOenjHAY IN ANY WAY ACCRUE AGAINST SATO CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the onzed by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized b.y ded or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Buildjr .__ . = . _... ,„ DATE: YELLOW: Applicant PINK: Finance DEPT : BUILDING FINAL BUILDING INSPECTION ENGINEERING * FIRE PLANNING U/M PLAN CHECK#: CB961826 PERMIT*: CB961826 PROJECT NAME: TI-MOVE WALLS,LIGHTS, CEILINGS ADDRESS: 2375 CAMINO VIDA ROBLE f CONTACT PERSON/PHONE*: MW/DAVID/633-1734 SEWER DIST: CA WATER DIST: CA WATER DATE: 12/11/96 PERMIT TYPE: ITI HI DEC 16 1996b i r By INSPECTED BY: h-^. DATE INSPECTED: //) I INSPECTED BY: INSPECTED BY: DATE INSPECTED: DATE INSPECTED: APPROVED APPROVED APPROVED DISAPPROVED DISAPPROVED DISAPPROVED COMMENTS: CITY OF CARLSBAD _ ' INSPECTION REQUEST PERMIT* CB961826 FOR 12/11/96 DESCRIPTION: TI-MOVE WALLS,LIGHTS, CEILINGS TYPE: ITI JOB ADDRESS APPLICANT: CONTRACTOR: OWNER: 2375 CAMINO VIDA ROBLE CHAPO & HALL ARCHITECTS PHONE: PHONE: PHONE: INSPECTOR AREA TP PLANCK! CB961826 OCC GRP CONSTR. TYPE VN STE: LOT: 619 481-4141 REMARKS: MW/DAVID/633-1734 SPECIAL INSTRUCT: INSPECTOR TOTAL TIME: —RELATED PERMITS—PERMIT# TYPE FAD93008 FADD CB962311 SIGN STATUS ISSUED ISSUED CD 19 29 39 49 LVL DESCRIPTION ST Final Structural PL Final Plumbing EL Final Electrical ME Final Mechanical ACT COMMENTS ***** INSPECTION HISTORY ***** DATE DESCRIPTION 111596 Frame/Steel/Bolting/Welding 111596 Rough Electric 111596 Rough/Ducts/Dampers 110696 Interior Lath/Drywall 110596 Frame/Steel/Bolting/Welding 110596 Rough Electric 110496 Frame/Steel/Bolting/Welding 110496 Rough Electric ACT INSP AP TP AP TP TP TP TP TP TP TP AP AP AP AP CO CO COMMENTS T-BAR GRID CEIL LITES RE-LOC DUCTS RE-LOC REG ND STUD SIZE REV SEE JOB CARD EsGil Corporation n Review "Engineers DATE: 10/21/96 Q APPUQANT JURIS.^) Q FIRE JURISDICTION: Carlsbad Q FILE PLAN CHECK NO.: 96-1826 SET: II PROJECT ADDRESS: 2375 Camino Via Roble PROJECT NAME: AT&T Capital Corp. TI I 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 ********** codes when minor deficiencies identified below 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 for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. 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. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Date contacted: (by: ) Telephone #: REMARKS: By: CHUCK MENDENHALL Enclosures: Esgil Corporation GA D CM G EJ D PC 10/14/96 trnsmtl.dot 9320 Chesapeake Drive, Suite 208 ^ San Diego, California 92123 + (619) 560-1468 + Fax (619) 560-1576 EsGil Corporation Professional'$[an Review 'Engineers DATE: 1O/2/96 Q APELJCANT " a FIRE JURISDICTION: Carlsbad 1TTLANREV1EWER Q FILE PLAN CHECK NO.: 96-1826 SET: I PROJECT ADDRESS: 2375 Camino Via Roble PROJECT NAME: AT&T Capital Corp. TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's *********** codes. The remarks below are transmitted herewith for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: Chapo & Hall Architects 777 S. Hwy 101, suite 210, Solana Beach, CA 92075 Esgil Corporation staff did not advise the applicant (except by mail) that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Date contacted: (by: ) Telephone #: REMARKS: 1. How do you intend to exit from new office 107? The manufacturing area may not be use as an exit. UBC 1003.5 2. If you intend to use UBC Sec 1005.7 Exc, # 8 to eleiminate the 1 HR corridor in the office area, the manufacturing rm 111 may not exit into the corridor. The exception applies to office space only. Delete the exit sign at door 8. 3. Dead end corridors may not exceed 20. Provide a door across the corridor leading to open office 121. 4. Provide energy compliance documentation for the new lighting, imprint on the plans a signed copy of energy form LTG-1. 5. Show on the lighting plan dual switch controls for the new lighting. By: CHUCK MENDENHALL Enclosures: Esgil Corporation 0 GA D CM O EJ Q PC 9/24/96 trnsmtl.dot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 4- (619) 560-1468 4- Fax (619) 560-1576 VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: CM BUILDING ADDRESS: 2375 Camino Vida Roble BUILDING OCCUPANCY: B,F1,S1 PLAN CHECK NO.: 96-1826 DATE: 10/2/96 TYPE OF CONSTRUCTION: VN BUILDING PORTION Tl Air Conditioning Fire Sprinklers TOTAL VALUE BUILDING AREA (ft.2) 1936 VALUATION II VALUE I MULTIPLIER I ($) I 26 50336 50336 • 1991 UBC Building Permit Fee G Bldg. Permit Fee by ordinance: $ 419.00 • 1991 UBC Plan Check Fee D Plan Check Fee by ordinance: $ 272.35 Type of Review: • Complete Review G Structural Only G Hourly G Repetitive Fee Applicable G Other: Esgil Plan Review Fee. $ 217.88 Comments: Fire Services Review: G Fire Alarm G Complete Review Other: G Suppression System Esgil Fire Services Review Fee: Comments: $ Sheet 1 of 1 macvalue.doc 5196 City of Carlsbad Engineering Department BUILDING PLANCHECK CHECKLIST PLANCHECK NO.:DATE: BUILDING ADDRESS: £3 7 S PROJECT DESCRIPTION: -rJT_ ASSESSOR'S PARCEL NUMBER: £L/3-O&O - ^ 7 CB ENGINEERING DEPARTMENT APPROVAL EST. VALUE: DENIAL The item you have submitted for review has been approved. The approval is based on plans, information and/or specifications provided in your submit! a I; 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. D A Right-of-Way permit is required prior to construction of the following improvements: Please see the/-attached report of deficiencies marked with 3\' Make necessary corrections to plans or specifications for compliance with codes and standards. Submit corrected speifications to this office for review. applicable ins and/or 1- C£*&£ • C&^L C^£X_ ^t^-. &**£-%<-£>>£^^eL^C^c^ p y ? « By: By: Date: Date: ;:;h;:>:::M::;!::i^^ ENGINEERING A%HOR^ ATTACHMENTS D Dedication Application D Dedication Checklist L-l Improvement Application d Improvement Checklist D Future Improvement Agreement Q Grading Permit Application D Grading Submittal Checklist D Right-of-Way Permit Application [] Right-of-Way Permit Submittal Checklist and Information Sheet U Sewer Fee Information Sheet 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 \UASPALMAS\SYS\LIBRARY\EN3WVORDMX)CSCHKLST\BiiUna Phndwefc CkM BP0001 Fwm hM.doc 2O75 Las Palmas Dr. • Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-O894 BUILDING PLANCHECK CHECKLIST SITE PLAN 1ST//2ND/ 3RD/ O/ Q Q 1. Provide a fully dimensioned site plan drawn to scale. Show: A. North Arrow D. Property Lines Easements B. Existing & Proposed Structures E. Easements C. Existing Street Improvements F. Right-of-Way Width & Adjacent Streets Q Q 2. Show on site plan: A. Drainage Patterns B. Existing & Proposed Slopes C. Existing Topography Q 3. Include note: "Surface water to be directed away from the building foundation at a 2% gradient for no less than 5' or 2/3 the distance to the property line (whichever is less)." [Per 1985 UBC 2907(d)5] On graded sites, the top of any exterior foundation shall extend above the elevation of the street gutter at point of discharge or the inlet of an approved drainage device a minimum of 12 inches plus two percent." [Per 1990 UBC 2907(d)5] Q 4. Include on title sheet: A. Site address B. 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 Page 1 of 4 G:\LIBRARY\eNG\WORD\DOCaCHKLST\Bdkinfl Ptandwck CUM BPO001 Form hM.doc BUILDING PLANCHECK CHECKLIST Q Q DISCRETIONARY APPROVAL COMPLIANCE 5. Project does not comply with the following Engineering Conditions of approval for Project No. Conditions were complied with by: DEDICATION REQUIREMENTS Date: 6.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 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 V? 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. Provide the completed application form and the requirements on the checklist at the time of resubmittal. Dedication completed by:Date: IMPROVEMENT REQUIREMENTS 7a. 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 Code Section 18.40.040. Public improvements required as follows: Please have a registered Civil Engineer prepare appropriate improvement plans and submit them together with the requirements on the attached checklist for a separate plancheck process through the Engineering Department. Improvement plans must be approved, appropriate securities posted and fees paid prior to issuance of permit. Attached please find an application form and submittal checklist for the public improvement requirements. Provide the completed application form and the requirements on the checklist at the time of resubmittal. Improvement Plans signed by:Date: Page 2 of 4 e:\LIBRARV\ENQ\WORD\DOCS\CHKLST\ewlding PttncTwck CWM BPOO01 form MM Doc BUILDING PLANCHECK CHECKLIST A si/ 2nd/ 3"*^ Q Q Q 7b. Constnjction of the public improvements may be deferred pursuant to 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: _ Improvement Plans signed by: Date: Q Q Q 7c. Enclosed please find your Future Improvement Agreement. Please return agreement signed and notarized to the Engineering Department. Future Improvement Agreement completed by: Date: Q Q 7d. No Public Improvements required. SPECIAL NOTE: Damaged or defective improvements found adjacent to building site must be repaired to the satisfaction of the Citv 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. Q Q Q 8a. Inadequate information available on Site Plan to make a determination on grading requirements. Include accurate grading quantities (cut, fill import, export). Q Q Q 8b. 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: Q 8c. No Grading Permit required. Page 3 of 4 6:U.JBRARY\E^VTOROUXX:SO*USTOufktng Pkndwck CUrt BP0001 Form MM.doc BUILDING PLANCHECK CHECKLIST 2nd/ 3 Q Q MISCELLANEOUS PERMITS 9. 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, trees, driveways, tieing into public storm drain, sewer and water utilities. Right-of-Way permit required for: A separate Right-of-Way permit issued by the Engineering Department is required for the following: a Q Q 10. A SEWER PERMIT is required concurrent with the building permit issuance. The fee is noted in the fees section on the following page. 11. 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: Q Q Q 12. NPDES 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 occurs first. Page 4 of 4 G:\LIBRARY\ENGVWOfitKOOCS\CHKLSTBiJ*)!) Pfcnctwcfc CMrt BP0001 form kM.fec a Q Q Q T- CM * *o o o J= .c .cO O O Q. Q. CL Plan Check No. Planner Van Lynch PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Address Utftfi- (Name) APN: ZII-OK?-* 7 Phone (619) 438-1161 ext. 4325 Type of Project and Use: Zone: p IW Facilities Management Zone:. CFD (in/but); # (If property in, complete SPECIAL TAX CALCULATION WORKSHEET provided by Building Department) Legend /& Item Complete Item Incomplete * Needs your action Environmental Review Required: YES DATE OF COMPLETION: NOA TYPE Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval D Discretionary Action Required: YES NO A. TYPE APPROVAL/RESO. NO. PROJECT NO. DATE OTHER RELATED CASES: Compliance with conditions or approval? If not, state conditions which require action. Conditions of Approval D California Coastal Commission Permit Required: YES DATE OF APPROVAL: NO San Diego Coast District, 3111 Camino Del Rio North, Suite 200, San Diego, CA 92108 (619) 521-8036 Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval Q Inclusionary Housing Fee required: YES N Gr D D D c^cD D (Effective date of Inclusionary Housing Ordinance - May 21, 1993). Site Plan: 1. Provide a fully dimensioned site plan drawn to scale. Show: North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements, right-of-way width, dimensioned setbacks and existing topographical lines. 2. Provide legal description of property, and assessor's parcel number. Zoning: 1. Setbacks: fVJF^ G^D DAJ /g-y 1J) n n Front: Int. Side: Street Side: Rear: ^2. Lot Coverage: /jp&fc Height: 4. Parking: Guest Additional Comments yflc 56Uj/}/U3~~ E&o7%0& a Pfifl-frstb £J?/)C~&Z. Required Required Rea ui red Required Reauired Required Spaces Required Spaces Required M/KT PAV*(, ,*J& ^ &k CM c/s&~ C?A} 9 Shown Shown Shown Shown Shown Shown Shown Shown IMWHO/V &/J AKJ/V- ffr&£\j /T^T* A&& 2SS00J /3 i/Afidfrt(s- OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER\DATE K:\ADMIN\COUNTER\PLANCK-FRM 1-17-96 City of Carlsbad 96277 Fire Department • Bureau of Prevention Plan Review: Requirements Category: Building Plan Check Date of Report: Wednesday, October 16, 1996 Reviewed by:_ Contact Name Stephen Hall ________^__ Address 777 S. Highway 101 Ste210 City, State Soiana Beach CA 92075 Bldg. Dept. No. 96-1826 Planning No. Job Name AT&T Capitol Corp Job Address 2375 Camino Vida Roble .^___ Ste. or Bldg. No. K Approved - The item you have submitted for review has been approved. 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 modifica- tions, 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 construct or install improvements. D Disapproved - Please see the attached report of deficiencies. Please make corrections to plans or specifications necessary to indicate compliance with applicable codes and standards. Submit corrected plans and/or specifications to this office for review. For Fire Department Use Only Review 1 st 2nd 3rd Other Agency ID CFD Job# 96277 File# 2560 Orion Way * Carlsbad, California 92008 • (619) 931-2121 City of Carlsbad Building Department WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for A. workers' compensation as provided by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation, as required by section 3700 B. \>f the Labor Code, for the performance of the work for which this permit is issued. My workers' 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 ($100) OR LESS) I certify that in the performapc'e of ihe work for which this permit is issued, I shall not employ^any person n C. workers comj3ep$litR>ja J6ws 'manner so as to become subject to the fifornia. Signature .Date Warning: Failure to secure workers' compensation coverage is unlawful, and shall be subject an employer 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 Code, Interest and attorney's fees. March 3, 1995 2O75 Las Palmas Dr. - Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-O894 Hazardous Materials SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE Management Division CIMM »r in gtiM Business Name Contact Person AT&T SYSTEMS LEASING CORPORATION Mailing Address 2375 CAMINO VIDA ROBLE Site Address SAME AS ABOVE Citv CARLSBAD CA City Telephone (610) 431-4135 State Zip 92009-1505 . State Zip Plan File* Plan File* PART I: FIRE DEPARTMENT • HAZARDOUS MATERIALS MANAGEMENT DIVISION: OCCUPANCY CLASSIFICATION indicate by circling the item, whether your business will use, process, or store any of tht following hazardous materials. If any or the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. 1. Explosive or Blasting Agents 4. Flammable Solids 2. Compressed Gases 5. Organic Peroxides CJJ3Flammable or Combustible Liquids 6. Oxidizer« 7. Pyrophorice 10. Cryogenics S. Unstable Reactivee 11. Highly Toxic or Toxic Materials 9. Water Reactivee 12. Radioactive* 1 3. Corrosives 14. Other Health Hazards 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 must contact the County of San Diego Hazardous Materials Management Division, 1 255 Imperial Avsnue, 3rd Floor, San Diego, CA 92186-5261. Telephone (619) 338-2222 prior to the issuance of e building permit. FEES MAY BE REQUIRED Yes s-a Is your business listed on the reverse side of this form? Will your business dispose of Hazardous Substance* 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 Acutely Hazardous Materials? OFFICE USE ONLY | | RMPP Exempt Date Initials {""] RMPP Required Date Initials [""] RMPP Completed Date initials PART 111: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT if the answer to any of the question! it yes, applicant muat contact the Air Pollution Control District, 9150 Chesapeake Drive, San Diego, CA 92123. Telephone (619) 694-3307 prior to the issuance of a building permit. YES NO 1. r^J f~~l Will the intended occupant install or use any of the equipment listed on the Listing of Air Pollution Control District Permit Categories, on the reverse side of this form? 2. rn m (ANSWER ONLY IF QUESTION 1 IS YES.) Will the subject facility be located within 1,OOO feet of the outer boundary of a school IK through 1 2) as listed in the current Directory of School and Community Collage Districts, published by the San Diego County Office of Education and the current California Private School Directory, compiled in accordance with provisions of Education Code Section 33190? Sale and refurbish laser printers. Name of Owner or Authorized Agent: BARRY N. LYNN Signature of OwrjtrdV Authorized Agent: I declare and correct. Do not writ* below this line f •penalty of perjury that to the best of my knowledge and belief the responses made herein are true . —_ Date: 1 n-^1 -Qfi FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: BY:Data: APMOVBD KM tULDINa P0UMIT SUT NOT OCCUPANCY COUNTY-HMMO APCO APMtOVfO POH OCCUPANCY COUNTY-HMMO APCD Enviroaanui Health ScrvicM DHS HM-9171 (6/92) Couny of SIB Diefo DepwfeM* of Hca«fe Sovicea SD P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 FUND ISSUE DATE 10-01-96 : : POLICY NUMBER: 1^80434 - 96 CERTIFICATE EXPIRES: 10*01-97 CITY OF CARLSBAD ATTN: BUILDING DEPARTMENT 2075 LAS PALMAS DRIVE CARLSBAD CA 92009-4859 JOB: ALL OPERATIONS is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the;'f" ; California Insurance Commissioner to the employer named below for the policy period indicated. •^T*% "'*,Jhis policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. -•"-%-i."^, •£• " „••"•' " '•' iH ^ •- ?•' - * . " • . •^"flr:^ ••" - ' • ' ;• . ' •wilt also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. "V^*",*' ~. .certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document. with respect to which this certificate of insurance may be issued or may- pertain, the insurance afforded by the ^ policies described herein is subject to all the terms, exclusions and conditions of such policies. • •- ^PRESIDENT ^.^EMPLOYER/S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $ 1,0001OOO.00 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10/01/96 IS ATTACHED TO AND A PART OF THIS POLICY. EMPLOYER DESIGN WEST BUILDERS 3328 PIRAGUA ST CARLSBAD CA 92009 LEGAL NAME DESIGN WEST ENTERPRISES, INC PRINTED: 09-18-96 pn410 THI&DOCOJMENT. H AS* A.BUI£ PATTERN ED BACKGROUNDL