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Home My WebLink About2463 Impala Dr; ; CBC2020-0068; PermitBuilding Permit Finaled Commercial Permit Print Date: 06/17/2020 Job Address: (City of Carlsbad Permit No: CBC2020-0068 Permit Type: 2463 Impala Dr BLDG-Commercial 2090411500 $9,240.00 Work Class: Tenant Improvement Status: Closed -Fina led Parcel No: Lot#: Applied: 02/20/2020 Valuation: Occupancy Group: Reference#: Issued: 03/04/2020 Construction Type PermitFinal Close Out: # Dwelling Units: Bathrooms: Inspector: CRenf Bedrooms: Orig. Plan Check#: Final Plan Check#: Inspection: 06/17/2020 Project Title: Description: IMPALA: 1500 SF INTERIOR DEMO// MINOR Tl AND FINISHES FOR FUTURE TENANT Applicant: SP W CONSTRUCTION INC 2524 Gateway Rd Carlsbad, CA 92009-1742 760-931-1130 Owner: RI F Ill-IMPALA LLC 11620 Wilshire Blvd, 300 LOS ANGELES, CA 90025 Contractor: SP W CONSTRUCTION INC 2524 Gateway Rd Carlsbad, CA 92009-1742 760-931-1130 FEE AMOUNT BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $279.02 Total Payments To Date: $279.02 Balance Due: $114.96 $80.47 $41.00 $39.00 $LOO $2.59 $0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Buildin Division 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov Page 1 of 1 { Cicyof Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check (~CJ.o2%--._o_o68 Est. Value _i:£2. _! PC De posit ---"'SF-'J5"'-"0"-"-'-'-f'----- Date 2 -2.o -2 0 2 c) Job Address 246:; ' Impala Drive, Carlsbad, CA. 92008 Suite: ____ APN: _________ _ Tenant Name: _ _,.s~·h,IJe__..1..:.1 _,(.....,.P__..o'--'t.....,e.""n'-""'J<..::.:....,_J __ CT/Project #: ________ Lot#: __ _ Fire Sprinklers: yes / no Air Conditioning: yes/ no BRIEF DESCRIPTION OF WORK: ___________________________ _ D Addition/New: ___________ .New SF and Use, ___________ New SF and Use, ____ Deck SF, Patio Cover SF (not including flatwork) ~enant Improvement: _____ SF, Existing Use tJl1/e,~c,IJ-S,(.proposed Use V~e_hc)~$; e.._ _____ SF, Existing Use czff; r k Proposed Use dff/ce □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ____________ _ D Solar: ___ KW, __ Modules, ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No D Plumbing/Mechanical/Electrical Only: ________________________ _ Other:~IS-o~ ~ ~ Demo, Gt.I( f'i.conc:Cl~Lh_ ' ,'n f«,'otf APPLICANT (PRIMARY) Name: SPW Cosntruction PROPERTY OWNER Name: RIF Ill Impala LLC Address: 2524 Gateway Road Address: 8930 Activity Road, Suite H City: Carlsbad State: CA Zip: 92009 Phone: 760-931-1130 Fvt, \04: City: San Diego State: CA Zip: 92126 Phone: 858-346-6321 Email: sean@whiteconstructioninc.com Email: kvega@rexfordindustrial.com DESIGN PROFESSIONAL CONTRACTOR BUSINESS Name: ________________ _ Name: SPW Cosntruction Address: ________________ _ Address: 2524 Gateway Road City: ________ State: ___ .Zip: ___ _ City: Carlsbad State: CA Zip: 92009 Phone: ________________ _ Phone: 760-931-1130 Email: ________________ _ Email: Sean@whiteconstructioninc.com Architect State License: __________ _ State License: 1023856 Bus. License: BLNR1202380 (Sec. 7031.S 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/she is licensed pursuant to the provisions of the Contractor's License Law {Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he/she is e)(empt therefrom, and the basis for the alleged exemption. Any violatlon 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}). 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph: 760-602-2719 Fax: 760-602-8558 Page 1 of 2 Email: Building@carlsbadca.gov Rev. 06/18 ( OPTION A): WORKERS'COMPENSAJION DECLARATION: I hearby affirm under penalty of perjury one of the following declarations: □ I have and will maintain a certificate of consent to seff•lnsure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. ~ have and will maintain worker's compensation, as required by Section 3700 of 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 Name: State Compensation Ins. Fund Policy No. 9243036-19 Expiration Date: 01/01/2020 □ Certificate of Exemption: I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner so as to be come subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for In Section 3706 of the Labor Code, ;nterest and attomey's fees. .. l l~ (\ ~- CONTRACTOR SIGNATURE: y OJ!,Gb.V,,: [y, ~ j ( OPTION B ): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: LJAGENT DATE: 0 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). □ 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). n I am exempt under Section ________ ,Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. □ Yes □ No 2. I (have/ have not) 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/ contractors' license number): 4. I plan to provide portions of the work, but I have hired the foltowing person to coordinate, supervise and provide the major work (include name/ address/ phone/ contractors' license number): 5. I will provide some of the work, but 1 have contracted (hired) the following persons to provide the work indicated (include name/ address/ phone/ type of work); OWNER SIGNATURE: LJAGENT DATE: _____ _ --------------------- CONSTRUCTION LENDING AGENCY. IF ANY: I hereby affirm that there 1s a construction tending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). lender's Name: ____________________ _ lender's Address: ____________________ _ ONLY COMPLETE THE FOLLOWING 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 rlsk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ Yes □ No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT, APPLICANT CERTIFICATION: 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 representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I A!.50 AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIAB1LITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required for excavations over S'O' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work Is commenced for a period of180 days (Section 106.4.4 Uniform Building Code). APPLICANT SIGNATURE: ----r------------DATE: ___,l~l"'-'/8"'-/~19'----- 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph: 760-602-2719 Fax: 760-602-8558 Page 2 of 2 Email: Building@carlsbadca.gov Rev. 06/18 Building Permit Inspection History Finaled (city of Carlsbad PERMIT INSPECTION HISTORY for (CBC2020-0068) Permit Type: BLDG-Commercial Application Date: 02/20/2020 Owner: RI F Ill-IMPALA LLC Work Class: Tenant Improvement Issue Date: 03/04/2020 Subdivision: PARCEL MAP NO 12561 Status: Closed -Finaled Expiration Date: 05/19/2021 Address: 2463 IMPALA DR IVR Number: 24953 CARLSBAD, CA 92010-7227 Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection Date Start Date Status 05119/2020 05/19/2020 BLDG-84 Rough 127877-2020 Passed Chris Renfro Complete Combo(14,24,34,44) Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes BLDG-14 Yes Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout Yes BLDG-34 Rough Electrical Yes BLDG-44 Yes Rough-Ducts-Dampers 06/17/2020 06/17/2020 BLDG-Final Inspection 130410-2020 Passed Chris Renfro Complete Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes BLDG-Plumbing Final Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes Wednesday, June 17, 2020 Page 1 of 1 Certificate of Analysis PLM Asbestos Identification tel· 858·617·8900 free -855• 781-4S22 fax · 858·617-9009 Patriotlab.com 6640 Lusk Blvd" Suite A-100, San Diego, CA 92121 White Construction Inc. Natalie Molina-Ortega 2524 Gateway Road Carlsbad, CA 92009 Date Collected: 2/24/2020 Date Received: 2/24/2020 Date Analyzed: 2/24/2020 Date Reported: 2/24/2020 Lab/Client ID/Layer Location 805132-001 Total Asbestos 805132-002 2 Total Asbestos 805 l 32-002C 2 Total Asbestos 805132-003 3 Total Asbestos 805132-004 4 Total Asbestos Entry Wall None Detected Entry Wall None Detected Entry Wall None Detected Corridor Wall None Detected Corridor Wall None Detected Report Number: 805132 Project Number: Project Name: SDl37997 . r::r.J=!\!ED 2463 Impala Dnve Properfl. ~.,. •-' '· ·• Project Location: 2463 Impala Drive fi:,'IJ O 4 ZC20 Carlsbad, 920 IO Collected By: Francisco Barney Claim Number: 13864 PO Number: Number of Samples: 21 Material Description Color Composition ( % ) Drywall Joint Compound Drywall and Joint Compound Drywall Joint Compound White White White White White 85% Sulfate 12% Cellulose 3% Glass Fibers 94% Carbonate 6% Paint 80% Sulfate I 0% Cellulose 6% Carbonate 2% Glass Fibers 2% Paint 85% Sulfate 12 % Cellulose 3% Glass Fibers 94% Carbonate 6% Paint Page I of5 , Certificate of Analysis PLM Asbestos Identification White Construction Inc. Natalie Molina-Ortega 2524 Gateway Road Carlsbad, CA 92009 Date Collected: 2/24/2020 Date Received: 2/24/2020 Date Analyzed: 2/24/2020 Date Reported: 2/24/2020 Lab/Client ID/Layer Location 805132-004C Corridor Wall 4 Total Asbestos None Detected 805132-005 Corridor Wall 5 Total Asbestos None Detected 805132-006 Corridor Wall 6 Total Asbestos None Detected 805 l 32-006C Corridor Wall 6 Total Asbestos None Detected 805132-007 Warehouse Wall 7 Total Asbestos None Detected Report Number: Project Number: Project Name: Project Location: Collected By: Claim Number: PO Number: Number of Samples: tel-858-671-8900 free -855-787-4522 fax -858-677-9009 Patriotlab.rom 6640 Lusk Blvd, Suile A-100, San Diego, CA 92121 805132 SDl37997 2463 Impala Drive Property 2463 Impala Drive Carlsbad, 920 lO Francisco Barney 13864 21 Material Description Color Composition ( % ) Drywall and Joint Wbite 80% Sulfate Compound 10% Cellulose 6% Carbonate 2% Glass Fibers 2% Paint Drywall White 85% Sulfate 12% Cellulose 3% Glass Fibers Joint Compound Wbite 94% Carbonate 6% Paint Drywall and Joint White 80% Sulfate Compound l0% Cellulose 6% Carbonate 2% Glass Fibers 2% Paint Drywall Wbite 85% Sulfate 12% Cellulose 3 % Glass Fibers Page 2 of5 Certificate of Analysis PLM Asbestos Identification White Construction Inc. Natalie Molina-Ortega 2524 Gateway Road Carlsbad, CA 92009 Date Collected: 2/24/2020 Date Received: 2/24/2020 Date Analyzed: 2/24/2020 Date Reported: 2/24/2020 Lab/Client ID/Layer Location 805132-008 Warehouse Wall 8 Total Asbestos None Detected 805 l 32-008C Warehouse Wall 8 Total Asbestos None Detected 805132-009 Warehouse Wall 9 Total Asbestos None Detected 805132-010 Warehouse Wall 10 Total Asbestos None Detected 805132-0IOC Warehouse Wall 10 Total Asbestos None Detected Report Number: Project Number: Project Name: Project Location: Collected By: Claim Number: PO Number: Number of Samples: tel· 858·677-8900 free • 855-787-4522 fai · ~-677-9009 Patriotlab.(00) 6640 Lusk Blvd, Suite A-100, San Oiego, CA 9n21 805132 SDI37997 2463 Impala Drive Property 2463 Impala Drive Carlsbad, 920 I 0 Francisco Barney 13864 21 Material Description Color Composition ( % ) Joint Compound White 94% Carbonate 6% Paint Drywall and Joint White 80% Sulfate Compound I 0% Cellulose 6% Carbonate 2 % Glass Fibers 2% Paint Drywall White 85% Sulfate 12% Cellulose 3% Glass Fibers Joint Compound White 94% Carbonate 6% Paint Drywall and Joint White 80% Sulfate Compound 10% Cellulose 6% Carbonate 2% Glass Fibers 2% Paint Page 3 of5 ' Certificate of Analysis PLM Asbestos Identification White Construction Inc. Natalie Molina-Ortega 2524 Gateway Road Carlsbad, CA 92009 Date Collected: 2/24/2020 Date Received: 2/24/2020 Date Analyzed: 2/24/2020 Date Reported: 2/24/2020 Lab/Client ID/Layer Location 805132-011 Warehouse Wall 11 Total Asbestos None Detected 805132-012 Warehouse Wall 12 Total Asbestos None Detected 805132-012C Warehouse Wall 12 Total Asbestos None Detected 805132-013 Warehouse Wall 13 Total Asbestos None Detected 805132-014 Ware house Wall 14 Total Asbestos None Detected Report Number: Project Number: Project Name: Project Location: Collected By: Claim Number: PO Number: Number of Samples: tel· 858-677-8900 free · 855-787-4512 fax · 858-677-9009 Patriotlab.oom 6640 Lusk Blvd, Suite A-100, San Diego, CA 92121 805132 SD137997 2463 Impala Drive Property 2463 Impala Drive Carlsbad, 920 IO Francisco Barney 13864 21 Material Description Color Composition ( % ) Drywall White 85% Sulfate 12% Cellulose 3 % Glass Fibers Joint Compound White 94% Carbonate 6% Paint Drywall and Joint White 80% Sulfate Compound I 0% Cellulose 6% Carbonate 2 % Glass Fibers 2% Paint Drywall White 85% Sulfate 12% Cellulose 3 % Glass Fibers Joint Compound White 94% Carbonate 6% Paint Page 4 of 5 Certificate of Analysis PLM Asbestos Identification White Construction Inc. Natalie Molina-Ortega 2524 Gateway Road Carlsbad, CA 92009 Date Collected: 2/24/2020 Date Received: 2/24/2020 Date Analyzed: 2/24/2020 Date Reported: 2/24/2020 Lab/Client ID/Layer 805132-014C 14 Location Warehouse Wall Total Asbestos None Detected Emily Lopez -Analyst Report Number: Project Number: Project Name: Project Location: Collected By: Claim Number: PO Number: tel · 858·611-8900 free· 855-781-4522 fax -858·671-9009 Patriotlab.com 66-40 Lusk Blvd, Suite A-100, San Diego, CA 92121 805132 SD137997 2463 Impala Drive Property 2463 Impala Drive Carlsbad, 92010 Francisco Barney 13864 Number of Samples: 21 Material Description Drywall and Joint Compound Color White Composition ( % ) 80% Sulfate 10% Cellulose 6% Carbonate 2 % Glass Fibers 2% Paint Michelle Lavallee -Approved By Bulk sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US Federal Register 40 CFR 763, Subpart F, Appendix A; EPA-600/R-93/116 (Method for Determination of Asbestos in Building Materials), and EPA-600/M4-82-020 (US EPA Interim Method for the Determination of Asbestos in Bulk Insulation Samples).Samples were analyzed using Calibrated Visual Estimations (CVES); therefore, results may not be reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individual layers. This report applies only to the items tested. Results are representative of the samples submitted and may not represent the entire material from which the samples were collected. "None Detected" means that no asbestos wa,; observed in the sample. "< l %" (less than one percent) means that asbestos was observed in the sample but the concentration is below the quantifiable level of I%. This report was issued by a NIST/NVLAP (Lab Code 200982-0) and CADOHS-ELAP (Cert. No. 2805) accredited laboratory and may not be reproduced, except in full without the expressed written consent of Patriot Environmental Laboratory Services, Tnc. This report may not be used to claim product certification, approval or endorsement by NIST, NVLAP, ELAP or any government agency. Asb_Rep_R.14 Page 5 of5 Lab Use Only: <aOt; 13d"-te1-as8-6n-a100 free· 855-l8H5!2 tax-858-6n-9D09 Tum Around Time: Palrloflab.com 6640 Lusk Blvd., SuiteA-100, San Diego, CA 9Zll1 ( ) ERS ( ) 24 HRS ( ) 48 HRS ( ) 72 HRS ASBESTOS FIELD BULK SAMPLE COC Project Nam-2.'-I-' rs. \. ~ --I lh ~ Proj~\ '3.-AC\ 1 I Office Use Only: D MH Project Address: " City: Zip: ~ ~ It..\."<::.~ A. "t-, Sample Sample Location Material Type F NF Condition Notes ' ID 1,1.. : .; .... •• ,. ll .-:7~/r(c_. ~ C....-i i'( c.....J . I r ·" , l""iclt:.r v--'Z,. l l I <flA L ?,x ~\ ·-· .r-__ I. •. c l~ . o/1/D t--> /1;/J._ ~ n b)lf .. -...!-~-·-Q , --- ' 241:£.1' ~,q ;(rt.P ' - ,........._ " .. ' ' ' Samoled/Relinnuished Bv: Sian: '\. • ~ /_/ Date:/ I 2,l ime: \ '!, · \ <; <'>11..J Samples Received Bv: Sign: \. y Date: ', 11 ge: ' • I -. Page ~ T of \ Bulk Sample coc Rev 12.27 2017 Business Name N/A Project Address SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE Business Contact RECORD ID# PLAN CHECK# State OFFICE USE ONLY BP DATE Telephone# Zip Code APN# 2463 Im ala Drive City Carlsbad CA 92008 Mailing Address Project Contact Sean Malley City State Zip Code Plan File# Applicant E-mail Telephone# sean@whiteconstructioninc.com 760-473-2401 The following questions represent the facility's actlvlUes, NOT the specific project description. PART I· I E DEP RTMENT -HAZARDO M TERIALS DIVISI N· CCUPA CY C SSIFICA ON· n t re Ir d f r ro I hln the C f n Diego): Indicate by c rel ng the Item, whether your business will use, process, or store any o the ollowlng hazardous mate als. I any of the Items are c rcled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Facility's Square Footage (including proposed project): RECEIVED 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 2. Compressed Gases 6. Oxidizers 10. Cryogenics )f /l~f fTf p4t,zards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 4. Flammable Solids 8. Unstable Reactives 12. Radioactives CITY OE CARI SBAQ PART Iii ~AN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEAL TH -HAZARDOUS MATERIAL~g 'MD;}.!( \ll~a?l\lf(<fr to any of the questlonss yes. applicant must contact the County of San Dlego Hazardous Materials Division, 5600 Overland Av ~ i f ~s Dfe!}0/ 'G'A 'g2123. Call (858) 505-6700 prior to the issuance of a building permit. 0 CalARP Exempt I FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: 1. 2. 3. 4. 5. 6. 7. 8. YES NO (for new construction or remodeling projects) Is your business listed on the reverse side of this form? (check all that apply). □ 129 B ~ Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? □ □ □ □ □ 129 Will your business store or handle carcinogens/reproductive toxins in any quantity? Oil Will your business use an existing or install an underground storage tank? 129 Will your business store or handle Regulated Substances (CalARP)? IXl Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? Dll Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or realer than 1,320 allons? Califomla's Above round Petroleum Stora e Act • Date Initials 0 CalARP Required I Date Initials 0 CalARP Complete I Date Initials PART lllj SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT CAPCD): Any YES· answer requires a stamp from APCD 10124 Old Grove Road, San Diego. CA 92131 aQ9<1craJp@sdcoun1v.ca.goy (858) 586-2650). [·No stamp requlred If Q1 Yes fill2 Q3 Yes illil Q4-Q6 No). The following questions are intended to Identify the majority oar pollutlon Issues at the planning stage. Projects may require additional measures not Identified by these questions. For comprehenslve requirements contact APCD. Residences are typically exempt, except • those with more than one building' on the property: single buildings with more than four dwelling units: townhomes; condos: mixed-commercial use; deliberate bums; residences forming part of a larger project ("Excludes garages & small outbuildings.) 1. 2. 3. 4. 5. 6. YES NO Oil □ Will the project disturb 160 square feet or more of existing building materials? ~ ~ Will any load supporting structural members be removed? Notification may be required 1 o working days prior to commencing demolition. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance Technician? □ □ □ Ix) (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification may be required 10 working days prior to commencing asbestos removal. 129 Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet Cwww.sdapcd.org/infolfacts/perynils,pdO for typical equipment requiring an APCD permit. D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bounda Briefly describe business activities: Briefly describe proposed project: 1,500 sf demo, interior finished 1,500 sf demo, interior finished I declare under penalty of perjury that to the best of my knowledge and belief t e responses made herein are true and correct. Sean Malley, Vice President --~-~-""""'/''"". ____________ _ 03 / 04 / 2020 Date Name of Owner or Authorized Agent Signature of Owner or Authorized Agent FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. ________________________________ _ BY· DATE· I I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO" APCD COUNTY-HMO APCD COUNTY-HMO APCD '. "A stamp in this box only exempts busmesses from completmg or updating a Hazardous Materials Business Plan. other permitting requtrements may still apply. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division Date- -l_N_DUSTRIAL WASTEWATER DISCHARGE PERMIT ~ SCREENING SURVEY w Business Name ~ ~ ~u ~ ~::~It:::;:: ~Mf,~c:::h~~,~£~0::00 q PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) refl Check all below that are present at your facility: ~ Acid Cleaning Ink Manufacturing Nutritional Supplement I Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining / Milling Painting I Finishing Battery Manufacturing Manufacturing Paint Manufacturing Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i.e. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting I Forming Pesticide Manufacturing I Car Wash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification Electroplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameling Electrical Component Anodizing Power Generation Manufacturing Coating (i.e. phosphating) Print Shop Fertilizer Manufacturing Chemical Etching I Milling Research and Development Film/ X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap I Detergent Manufacturing Industrial Laundry Waste Treatment I Storage SIC Code(s) (if known): _____________________ _ Brief description of business activities (Production I Manufacturing Operations):. _____ _ Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal I day): _______ _ List hazardous wastes generated (type I volume): _______________ _ Date operation began/or will begin at this location: _______________ _ Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes No If yes, when: ____________________ _ Site Contact~ ______________ Title ____________ _ Signature. _______________ P.hone No •. ___________ _ ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941 FAX: (760) 476-9852