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Home My WebLink About2502 GATEWAY RD; ; CB154123; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 01-29-2016 Commercial/Industrial Permit Permit No: CB154123 Building Inspection Request Line (760) 602-2725 Job Address: 2502 GATEWAY RD CBAD Permit Type: Tl Sub Type: COMM Status: ISSUED Applied: 11/25/2015 Entered By: SLE Parcel No: 2132612000 Lot#: 0 Valuation: $0.00 Construction Type: 3B Occupancy Group: Reference# Plan Approved: 01/29/2016 Issued: 01/29/2016 Inspect Area Plan Check #: Project Title: VIASAT:8' STEEL ROOF SCREEN TO SCREEN EXISTING MECHANICAL EQUIPMENT & PIPING Applicant: SMITH CONSULTING ARCHITECTS STE 125 13280 EVENING CREEK DR SAN DIEGO CA 92128 858 793-4 777 Building Permit Add'l Building Permit Fee Plan Check Add'l Building Permit Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Fire Expedidted Plan Review $0.00 $65.00 $0.00 $258.00 $0.00 $1.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $0.00 Owner: Meter Size Add'l Reel. Water Con. Fee Meter Fee SDCWA Fee CFD Payoff Fee PFF (3105540) PFF (4305540) License Tax (3104193) License Tax (4304193) Traffic Impact Fee (3105541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee Green Bldg Standards Plan Chk TOTAL PERMIT FEES Total Fees: $325.00 Total Payments To Date: $325.00 Balance Due: Inspector: FINAL APPROVAL Date: I,(·C(...-Ib Clearance: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ?? ?? $325.00 $0.00 NOnCE: Please take I'OllCE that~ cf yrur prqect irdudes tre "lrrp::sition'' cffees, OOdications, reservations, or otrer exactions hereafter wlectively referred to as "fees' exactions." You have 00 days from the date this pernit '>J'.m issued to protest irrp::sitirn cf trese fees'exa-iions. If yru potest them yru rrust fdlovvtre protest procedures set forth in GNemrrent Ccx:le Sedirn ffiJ20(a), and file tre potest and any otrer req..ired inforrratirn v..ith the Oty ~for p-ocessing in a:xm:lancewth Carlsba:J M.Jridpal Ccx:le Sedirn3.32.030. Failuretotirrelyfdlovvthat procedurewll bar anysu008quent legal oction to attack, review, set aside, vdd, or anr-U their irrp::sition. You are hereby FURl1-£R I'OllFlED that yrur right to protest the sp:dfied fees'exa-iions IX:ES NOr .APPLY to Wc!ler and ~r mnned:irn fees and mpacity dlanges, nor planning, zaing, graJing or otrer sinilar applicatirn prooessing or servioe fees in mnnectirn wth this prqect. t-rn IX:ES IT .APPLY to any fees' exactions cf Vl.lich have viousi been "vena NOnCE sinilar to this or as to Vl.lich tre statute cf linitatirns has "ousi otherWse e ·red. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0PLANNING 0ENGINEERING 0BUILDING OF IRE 0HEALTH OHAZMAT/APCD Building Permit Application Plan Check No.C/?)1 ':Y412, .. ~ 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value CITY OF Ph: 760-602-2719 Fax: 760-602-8558 CARLSBAD email: building@carlsbadca.gov Plan Ck. Deposit www.carlsbadca.gov Date f 1-· 25-16 !swPPP JOB ADDRESS 2502 Gateway Road SUITE#/SPACE#/UNITII IAPN I 3 12 -261 -UJ, 2.1,2-2,23 CT/PROJECT # I LOT# I PHASE# 1 , OF UNITS r BEDROOMS #BATHROOMS I TENANT BUSINESS NAME I coN~~;~E I occ~;~uP Via Sat DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) 8'·0" High steel frame roof screen to screen existing mechanical equipment and piping EXISTING USE I PROPOSED USE I GARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE II AIR CONDITIONING I FIRE SPRINKLERS N/A N/A YESO NoiZJ YEsONo[Z) YEsONo[Z) APPLICANT NAME (Primary Contact) Milos Makaric APPLICANT NAME (Secondary Contact) Mark Langan ADDRESS ADDRESS 13280 Evening Creek Drv South, Suite 125 13280 Evening Creek Drv South, Suite 125 CITY STATE ZIP CITY STATE ZIP San Diego CA 92128 San Diego CA 92128 PHONE I FAX PHONE I FAX 858.793.4777 858.793.4787 858.793.4777 858.793.4787 EMAIL EMAIL milosm@sca-sd.com markl@sca-sd.com PROPERTY OWNER NAME Pivotal 650 California St. LLC CONTRACTOR BUS. NAME Whiting-Turner Contracting Company ADDRESS ADDRESS 2201 E. Camelback Rd. , Suite 650 4747 Executive Drv CITY STATE ZIP CITY STATE ZIP Phoenix AZ 85016 San Diego CA 92121 PHONE I FAX PHONE I FAX 602.248.8181 858.792.0600 EMAIL EMAIL tony@levineinvestments.com nick.schmidt@whiting-turner.com ARCH/DESIGNER NAME & ADDRESS ISTATELIC. # STATE LIC.# I CLASS I/TY;3~~() Smith Consulting Architects C-11701 311 iO/ .. (Sec. 7031.5 Busmess and Professions Code: Any C1ty or County wh1ch requ1res a perm1t to construct, alter, Improve, demolish or repa1r an~ structure, r:morto 1ts Issuance, also re(!Uires the applicant for such permit to file a signed statement tnat he 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 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)). Workers' Compensation Declaration: I hereby affirm under penaffy of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. D I have and will maintain workers' compensation, as reQuired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insu ance carrier and policy number are: Insurance Co. /1""'~~ Policy No. V r C....~ /.C:.J ~ V f3 ~ "/ Expiration Date ----"'"-1-'-J -=----- This section need not be completed if the perm~ is for one hundred dollars ($1 00) or less. I;(;).. S 't 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 Califomia. WARNING: Failure to secure workers' compensation coverage is and 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 arEo~ided for in Section fees. 25 CONTRACTOR SIGNATURE , ':ft ) /l \() 1- I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: D D 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 Contracto~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 Contracto~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 Contracto~s License Law). 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. DYes 0No 2. I (have I 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 I phone I contractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address I phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone I type of work): 25 PROPERTY OWNER SIGNATURE 0AGENT DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Yes v 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 v No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes v 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. I certify that I have read the application and state that the above infonnation is correct and that the infonnation on the plans is accurate.! 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 ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA penni! is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every penni! issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void ~the building or work authorized by such penni! is not commenced within 180 days from the date of such penni! or if the i or work authorized by such is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Unifonn Building Code). ~APPLICANT'S SIGNATURE DATE 11/25/2015 STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. STATE DELIVERY OPTIONS PICK UP: CONTACT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (listed above) CONTRACTOR (On Pg. 1) MAIL I FAX TO OTHER: OCCUPANT (Listed above) OCCUPANT (Listed above) ·---------------------------~-------·---- Lf APPLICANT'S SIGNATURE CO#: (Office Use Only) ZIP STATE CA ASSOCIATED CB#'------------ NO CHANGE IN USE I NO CONSTRUCTION CHANGE OF USE I NO CONSTRUCTION DATE I n Permit#: CB154123 Type: Tl Date _Jilspection Item 04/04/2016 19 Final Structural 04/04/2016 19 Final Structural 03/29/2016 19 Final Structural 03/29/2016 19 Final Structural 03/16/2016 12 Steel/Bond Beam Monday, April 04, 2016 COMM Inspector Act PB PB PB Rl AP Rl NR NR VIASAT:8' STEEL ROOF SCREEN TO SCREEN EXISTING MECHANICAL EQ Comments COF WAITING FOR PLANNING SIGN-OFF Page 1 of 1 American Welding Society t ~41271 Michael J Diaz Has complied wi.tlr tiM req,i.rements of A JJlS QCJ, Sta~rdardfor AW-:5' Certificatioll of Weldi11g ltrspectors. _,.;.~~· .:{!'4~l:a-1~ AwS "Certification Chair / ~~~:1 Apr2018 Without Eye Correction 1111111111111~111111111111111111111111111111 8165616 2 '502 t:Jp±v.D~ Rd . v~?GJ 10~-10 k(X) t ~(_f1(_Q_i\_ EsGil Corporation In Cl'artnersfiip witfi government for CBui{cfing Safety DATE: 12/08/2015 JURISDICTION: Carlsbad PLAN CHECK NO.: CB15-4123 PROJECT ADDRESS: 2502 Gateway Rd. SET: I PROJECT NAME: Vasat "Roof screening for equipment" D APPLICANT D JURIS. D PLAN REVIEWER D FILE ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D 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. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D 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. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone#: Date contacted: (by: ) Email: Mail Telephone Fax In Person D REMARKS: By: John LeVey Enclosures: EsGil Corporation 0 GA 0 EJ 0 MB 0 PC 11/30/2015 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 Carlsbad CB15-4123 12/08/2015 [DO NOT PAY-THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: CB15-4123 PREPARED BY: John LeVey BUILDING ADDRESS: 2502 Gateway Rd. BUILDING OCCUPANCY: B/Fl BUILDING AREA Valuation PORTION (Sq. Ft.) Multiplier Tl Roof screening Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance Plan Check Fee by Ordinance -..;-~ -------··--·-------~~------<«« "'J Type of Review: D Complete Review 0 Repetitive Fee ----------R t ,..j epea s --~""'"'~,-~) * Based on hourly rate Comments: D Other 0 Hourly EsGil Fee DATE: 12/08/2015 Reg. VALUE Mod. 0 Structural Only 1-------131 H rs. @ • $86.00_ ($) $258.001 Sheet of macvalue.doc + PLANNING DIVISION BUILDING PLAN CHECK REVIEW CHECKLIST P-28 Planning Division 1635 Faraday Avenue (760) 602-4610 www .ca rlsbadca .2ov DATE: December 2, 2015 PROJECT NAME: ViaSat Building 10 Roof Screeing PROJECT ID: SUP 13-0 CB 15-4123 PLAN CHECK NO: 1 SET#: 1 ADDRESS: 2502 Gateway Road APN: 213-261-20, 21, 22, 23 ~ This plan check review is complete and has been APPROVED by the Planning Division. By: Greg Fisher A Final Inspection by the Planning Division is required [g) Yes D No You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. D This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check Comments have been sent to: For questions or clarifications on the attached checklist please contact the following reviewer as marked: Chris Sexton 760-602-4624 Chris.Sexton@carlsbadca.gov Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov Greg Fisher 760-602-4629 Remarks: Consistent with SUP 13-03. Proposed structure is smaller in size, open on two sides with screening and adding additional parking spaces. Shay Even From: Sent: To: Cc: Subject: Hello Milos, RE ORO COP't Amber Ressmer Monday, December 07, 2015 1:46 PM milosm@sca-sd.com Building CB154123 -ViaSat CB154123 ViaSat plan does not require Carlsbad Fire Department fire plan review. Thank you, Amber Amber Ressmer Fire Prevention Office Specialist City of Carlsbad 1635 Faraday Ave Carlsbad, CA 92008-7314 p 760-602-4665 I F 760-602-8561 1 9915 Mira Mesa Blvd. TEL (858) 536-5166 I AN ROHY STRUCTURAL ENGINEERS STRUCTURAL CALCULATIONS FOR Via Sat Building 1 0 Roof Screen Carlsbad, CA RECEIVED NOV 2 5 2015 CITY OF CARLSBAD BUILDING DIVISION ~)- NOVEMBER 24; 2015 W + R JOB #15-119 Suite 200 WRENGINEERS.COM C C) San Diego, CA 92131 FAX. (858) 536-5163 CA \~ A-r2:3 DATE __ _ WISEMAN + ROHY STIUJCTURAL ENGINEERS SHEET NO. ---OF --- JOB NO.------- Loads: LC 1, Dead t· Wind Results for lC 1, Dead + Wind 7J Y·direction Reaction Units are k and k·ft ··"~·,--~~-·---~----~---~--· Wiseman + Rohy Structural ···--···----·~-~~--~~--~---· ·Uk --A4k -5.5 Nov 24,2015 at 9:12AM ·--~------·······: ViaSat 810 Screen Column.r2d TECHNOLOGIES Company Designer Job Number Model Name Hot Rolled Steel Properties Wiseman + Rohy Structural Engineers DM 15-018 Restaurant Depot-Moment Frame Joint Coordinates and Temperatures Nov 24,2015 Checked RISA-20 Version 13.0.0 [\ ... \ ... \ ... \ ... \ 15\15-119 ViaS at 810 Roof Scren\ViaSat 810 Screen Column.r2d) Page 1 TECHNOLOGIES Joint Reactions Company Designer Job Number Model Name Wiseman + Rohy Structural Engineers DM 15-018 Restaurant Depot-Moment Frame Nov 24, 2015 Checked R!SA-20 Version 13.0.0 [\ ... \ ... \ ... \ ... \15\15-119 ViaSat 810 Roof Scren\ViaSat 810 Screen Column.r2d] Page 2 TECHNOLOGIES Company Designer Job Number Model Name Wiseman + Rohy Structural ~"n'''n~"""' DM 15-018 Restaurant Depot-Moment Frame Nov 24, 2015 Checked By: __ RISA-20 Version 13.0.0 [\ ... \ ... \ ... L\15\15-119 ViaSat 810 Roof Scren\ViaSat 810 Screen Column.r2d] Page 3 KEI-lZ Supplement 200 Kwik Bolt TZ anchors in sand-lightweight concrete TABLE 3 -Factored Strength Design Loads for Kwik Bolt TZ (KB~ TZ} Carbon Steel for installation on the top of concrete-filled profile steel deck assemblies1,2,:~.4 DESIGN INFORMATION Loads according to Figure 3 Symbol Units Nominal Anchor Diameter (in.) 3/8 1/2 Effective embedment h,,, in. 2 2 Minimum concrete thickness hmin,<lHt:k in. 3-i/4 3-1/4 Critical edge distance Cac.cteck.lop in. 9 9 Minimum edge distance Cmrn,Clm.:k.t~;p in. 3 4-1/2 Minimum spacing Smtn,ctnck.top in. 4 6-1/2 Factored Tension Resistance, uncracked concrete ¢Np,un~! lb 1 ,075' 1,4507 Factored Tension Resistance, uncracked concrete ¢Np,cr lb 7255 ??Oil Factored Shear Resistance, uncracked concrete9•111 ¢V~p.unc• lb 1,562 1,562 Factored Shear Resistance, cracked concrete8·" ¢Vcp,cr lb 1,106 1,106 Factored Shear Resistance, cracked concrete, seismic0·'2 ¢Vcp,cr.,~t lb 830 830 Tension Test Load"\ cracked concrete Ntost, $Np,ct lb 910 965 Torque Test Load'3 Ttest ft-lb 25 40 Installation must comply with Figure 3 and the instructions for use provided with the anchor packaging box. 2 Applicable for anchors installed in 3-1/4 in. ~ h,, < 4 in. concrete cover on steel profile deck. For h""';;: 4 in., referto ESR-1917, Tables 1 and 3. 3 Strength design capacities determined in accordance with ACI 318 Appendix 0 and ESR-19i 7. 4 Strength design capacities based on concrete compressive strength of 3,000 psi. The characteristic pullout resistance for concrete strengths greater than 3,000 psi may be increased by multiplying the value by (f 'c/ 3,000)'12• 5 Factored characteristic tension design resistance for 3/8-in. anchors calculated by normalizing N,·""' from ESR-i 917, TABLE 3, to 3,000 psi concrete. is multiplied by strength reduction phi faciors 0.65 for Category 1 and lambda factor 0.6 for sand-lightweight concrete. 6 Factored characteristic tension design resistance for 3/8-in. anchors calculated by normalizing N0." from ESR-1917, TABLE 3, to 3,000 psi concrete. N,."'""" is mulliplied by strength reduction phi factors 0.65 for Category 1, seismic factor 0.75 and lambda factor 0.6 !or sand-lightweight concrete. 7 Concrete breakout controls for 1/2-inch anchors. No is calculated using a lambda factor of 0.6. See ESR-1917, Section 4.1.12. No is murtiplied by strength reduction phi factor 0.65 for Category 1. 8 Concrete breakout controls for 1/2-inch anchors. N,. is calculated using a lambda factor of 0.6. See ESR-1917, Section 4.1.12. Nn is multiplied by strength reduction phi factor 0.65 for Category 1 and strength reduction phi factor 0. 75 for seismic. 9 Shear is governed by pryout. See ESR-1917, Section 4.1.12 for lambda factor to calculate No. 1 0 Factored characteristic shear load ¢lV op,uncc, is calculated by multiplying the characteristic resistance times strength reduction phi factor oi 0. 7 tor Category and lambda factor 0.6 for sand-lightweight concrete. i i F adored characteristic shear load ClJV ""·"' is calculated by multiplying the characteristic resistance by strength reduction phi factor ot 0. 7 for Category 1 and lambda factor 0.6 for send-lightweight concrete. 12 Factored characteristic shear load <PV,p.oc,oq is calculated by multiplying the characteristic resistance by strength reduction phi factor of 0.7 lor Category 1, 0.75 for seismic and lambda factor 0.6 for sand-lightweight concrete. 13 Test Loads according to 2010 California Building Code, Section 1916A 7.2. The Tension Test load is 1.25 times the maximum design strength. ¢lN0.," was used as an example in this table, The Califcmia Building Code allows a torque test to be used instead of the tension test Hi!li, Inc. (US) 1-800-879-8000 1 www.us.hilti.com I en espafiol1-800-879-5000 l Hilti (Canada) Corp. 1-800-363-4458 www.hilti.ca I KB-TZ Supplement 2011 5 OFFICE USE ONLY SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE UPFP# ______ _ HV# _____________ __ BPDATE __ ~----~--- Business Name Business Contact Telephone# ViaSat, Inc. Bob Rota ( 760 \ 476.2202 City State Zip Code APN# Project Address 2502 Gateway Road Carlsbad CA 92009 213-261-20,21 ,22,23 Mailing Address City State Zig Code Plan File# 6155 El Camino Real Carlsbad CA 2009 Project Contact Telephone# Bob Rota ( 760 ) 476.2202 .. The following questions represent the facility's activities, NOT the spec1fic project descnpt1on. PART 1: 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. Facility's Square Footage (including proposed project): N/ A Occupancy Rating: _N:..=/ Ac..:... _____ _ 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH-HAZARDOUS MATERIALS DIVISIONS CHMDl: If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Ave., Suite 110, San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED. Project Completion Date: _3_t1__jt_6 __ Expected Date of Occupancy: _3 __ /_1 __ 1_6 __ YES NO (for new construction or remodeling projects) 1. D lXI Is your business listed on the reverse side of this form? (check all that apply). 2. D lXI Will your business dispose of Hazardous Substances or Medical Waste in any amount? 3. D lXI 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? 4. 5. 6. 7. D D D D I:ZI Will your business use an existing or install an underground storage tank? lXI Will your business store or handle Regulated Substances (CaiARP)? lXI Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? lXI Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). D CaiARP Exempt I Date Initials D CaiARP Required I Date Initials D CaiARP Complete I Date Initials PART Ill: 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 4 or 5 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 NO 1. 0 00 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.org/info/facts/permits.odf, and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). 2. D D (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)? (Search the California School Directory at http:l/www.cde.ca.gov/re/sd/ for public and private schools or contact the appropriate school district). 3. D 00 Has a survey been performed to determine the presence of Asbestos Containing Materials? 4. D IZl Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? 5. D lXI Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities: Briefly describe proposed project: Telecommunication ~ 11 I 19 /15 Date FOR OFFICIAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. ___________________________________________ _ BY: ______________________________________________ __ DATE:-~/..__ _ ___,/..__ __ EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO* APCO COUNTY-HMO APCO COUNTY-HMO APCO .. * A stamp 1n th1s box only exempts busmesses from completing or updat1ng a Hazardous Matenals Bus1ness Plan. Other perrmttmg requirements may still apply. HM-9171 (02/11) County of San Diego -DEH-Hazardous Materials Division