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2521 PALOMAR AIRPORT RD; 100; CB130347; Permit
07-02-2013 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No Building Inspection Request Line (760) 602-2725 CBI 30347 Job Address Permit Type Parcel No Valuation Occupancy Group Project Title 2521 PALOMAR AIRPORT RD CBADSt 100 Tl Sub Type COMM 2130201800 Lot# 0 $196,673 00 Construction Type 5B Reference # PANERA BREAD- 3,910 SF SHELL TO BAKERY/CAFE Status Applied Entered By Plan Approved Issued Inspect Area Plan Check # ISSUED 02/12/2013 LSM 07/02/2013 07/02/2013 Applicant NIKKI STOUT Owner COUNTY OF SAN DIEGO 4635 CASS ST SAN DIEGO CA 92109 858-243-3240 PUBLIC AGENCY OOOOO Building Permit $1,075 86 Meter Size Add'l Building Permit Fee $0 00 Add'l Reel Water Con Fee $0 00 Plan Check $753 10 Meter Fee $0 00 Add'l Building Permit Fee $0 00 SDCWA Fee $0 00 Plan Check Discount $0 00 CFD Payoff Fee $0 00 Strong Motion Fee $41 30 PFF (3105540) $3,579 45 Park Fee $0 00 PFF (4305540) $0 00 LFM Fee $0 00 License Tax (3104193) $0 00 Bndge Fee $0 00 License Tax (4304193) $0 00 BTD #2 Fee $0 00 Traffic Impact Fee (3105541) $0 00 BTD #3 Fee $0 00 Traffic Impact Fee (4305541) $0 00 Renewal Fee $0 00 PLUMBING TOTAL $283 00 Add'l Renewal Fee $0 00 ELECTRICAL TOTAL $239 00 Other Building Fee $0 00 MECHANICAL TOTAL $141 48 Pot Water Con Fee $0 00 Master Drainage Fee $0 00 Meter Size Sewer Fee $0 00 Add'l Pot Water Con Fee $0 00 Redev Parking Fee $0 00 Reel Water Con Fee $0 00 Additional Fees $0 00 Green Bldg Stands (SB1473) Fee $4 00 HMP Fee 9? Fire Expedidted Plan Review $0 00 Green Bldg Standards Plan Chk 99 TOTAL PERMIT FEES $6,117 19 Total Fees $6,11719 Total Payments To Date $6,117 19 Balance Due-$0.00 Inspector LAPPROVAL FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions" You have 90 days from the date this permit was issued to protest imposition ol 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 nght 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 vou have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously othenwise expired Is the applicant or future building occupant required to submit a business.rfan, acutely hazardous matenals registration form or nsk management and prevention program under Sections 25505,25533 or 25534 of tl Presley-Tanner Hazardous Substance Account AcP ||*Yes y^No Yes ,No Is the applicant or future building occupant required to obtain a permit from the air pollution control distnct or air quality management distnct^ Is the facility to be constructed within 1,000 feet of ttie outer boundary of a school site' Yes 'X.'NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY IMAY NOT BE ISSUED UfjLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT I hereby affimi that there is a construction lending agency for the perfomiance of the wori< this permit is issued (Sec 3097 (i) Civil Code) Lender's Name , ^'^ . • Lender's Address I ceitly tliat I have read ttie applicaton and state ttiat the above infbnnaton is conect and that the infbrmaton on the plans is accurate I agree to comply with all City ordinances and State laws relatng to building constucton I hereby authonze representative ofthe City of Cailsbad to enter upon the above mentioned pnaperty for inspection puiposes 1 ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILrTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMfT OSHA An OSHA peimit IS required for excavations over 5'0' deep and demolition or constniction of stmctures over 3 stones in height EXPIRATION Eveiy peimit issued by the Building Official under the provisions of Siis Code shaii expire by limitation and become null and void if the building or work authonzed by such permit is not commenced within 180 days from the date of such perniit or if the building omiik authonzedhysuji ppmiit it BuircndH or abandoned at any time alter the woik is commenced for a penod of 180 days (Section 106 4 4 Unifonn Building Code) APPLICANT'S SIGNATURE DATE 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 bUildingfSicarlsbadca qov or Mail the completed form to City of Carisbad, Building Division 1635 Faraday Avenue, Carisbad, California 92008 C0#. (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS STATE _ ZIP CITY STATE ZIP CITY Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS UC No DEUVERY OPTIONS PICK UP ><lCONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg 1) MAILTO CONTACT (Usted above) , OCCUPANT (Listed above) CONTRACTOR (Qn Pg 1) MAIL/FAX TO OTHER " ' ASSOCIATED CB#- NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION >ef APPLICANT'S SIGNATURE DATE XfsX ve \ "^(PLANNING SifENGINEERING ISIBUILDING SI^/' S/HC THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE HEALTH n HAZMAT/APCD City OF CARLSBAD Building Permit Application 1635 Faraday Ave , Carlsbad, CA 92008 Ph 760-602-2719 Fax 760-602-8558 email building@carlsbadca gov www carlsbadca gov Plan Check^No. 6£> t?>0 S<47 Est. Value (^73 Plan Ck. Deposit 7 5"3.10 Date 3. i^|\3 SWPPP JOBADDRESS I I f\T a I DUACi: u * 1 4* f\a i IMITC JI U acr>,rtr\r\t. SUITE#/SPACE#/UNn# 106 APN 2.13 6%0-]%,XQO CT/PROJECT # LOT# PHASE# • # OF UNITS / i ....< ' ' ' / DESCRIPTION OF WORK /nc/ude Square feet of Affected Area(s) It BATHROOMS TENANT BUSINESS NAME CONSTR TYPE V-8> EXISTING USE I PROPOSED USE I GARAGE (SF) I D4Tin<! /cn I nprKC /«F\ ' I PIRI:PI anp ' I AIR mwniTinwiNr! PATIOS (SF) DECKS (SF) FIREPLACE YESr~l# - N0| I AIR CONDITIONING YES I INO I I FIRE SPRINKLERS YES^NOj I APPLICANT NAME (Primary Contact) l^itc Ki i)ttv-h APPLICANT NAME (Secondary Contact) i ADDRESS ADDRESS CITY STATE ZIP ^ ^ ^ CITY . ^ , . , STATE I tzU) * 6A- 21P PHONE ^% -^4-^-^7^^ l'' g% -2--7Z-8873 PHONE FAX EMAIL EMAIL PROPERTY OWNER NAME CONTRACTOR BUS NAME ADDRESS ADDRESS PHONE I EMAIL , STATE CITY STATE ZIP cx >^ r noiA '^ FAX PHONE FAX EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC # STATE LIC # CLASS CITY BUS LIC# I DUO UO « _ (Sec 70315 Business and Professions Code Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, pnor to its issuance, also requires the applicant for such permit to file a signed statement that he " ' .... - . ,.1-r» _< Business and Professions Code} or that he is exempt there! civil penalty of not more than five hundred dollars ($500)) applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of tlie Contraotor'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 70315 by any applicant for a permit subjects the applicant to a Workers' Compensation Declaration / hereby affm under penaity of perjury one of the foiiowing deciarations CZ 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 perfonnance of the work for vnhich this permit is issued d I have and will mamtain workeis' 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 earner and policy number are Insurance Co ^Y^'^^^T"" ' /i^J fiTT Pnlir.y No "7 C<>OOQg ' "1 JhJ-/ E^tJnn Dale // ^ This section need not be completed if the pemiil is for one hundred dollars ($100) or less I I Certificate of Exemption i certify that in the performance of the work for which this pennit 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 workers' compensation coverage is unlawful, and shall subject an employer to cnminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damagesas provided for in Section 3706 olthe Labor code, interest and attorney's fees > CONTRACTOR SIGNATURE X'Wt<Jvte JT^tAJ'^'^^ • AGENT DATE /P^/ 3 / hereby affirm that I am exempt from Contractor's Ucense Law for the following reason [ I I, as owner of the property or my employees with wages as their sole compensation, will do the work and the stmcture 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 bunJen of proving that he did not buiid or improve for the purpose of sale) I I i, as owner of the property, am exclusively contracting with licensed contractors to constnict the project (Sec 7044, Business and Professions Code The Contractor's 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 fo the Contractor's Lirense Law) [ I 1 am exempt under Section Business and Professions Code for this reason 1 I personally plan to provide the major labor and matenals for constmction of the proposed property improvement •Yes I INO 2 1 (have / have not) signed an application for a building pemiit for the proposed work 3 1 have contracted with the following peison (firni) to provide the proposed constmction (include name address / phone / contractors' license number) 4 I plan to provide portions of the work, but \ have hired the following person to coordinate, supervise and provide the major work (include name / address / phone / contractors license number) 5 I will provide some of the wori(, but I have contracted (hired) the following persons to provide the wort< indicated (include name / address / phone / type of work) >eS'pROPERTY OWNER SIGNATURE QAGENT DATE Inspection List Permit# CBI 30347 Type Tl COMM Date inspection Item 09/19/2013 89 Final Combo 09/05/2013 89 Final Combo 09/04/2013 92 Compliance Investigation 08/29/2013 84 Rough Combo 08/26/2013 23 Gas/Test/Repairs 08/23/2013 39 Final Electncal 08/22/2013 23 Gas/Test/Repairs 08/20/2013 23 Gas/Test/Repairs 08/02/2013 14 Frame/Steel/Bolting/Weldin 08/02/2013 24 Rough/Topout 08/02/2013 34 Rough Electnc 07/31/2013 16 Insulation 07/30/2013 16 Insulation 07/29/2013 17 Interior Lath/Drywall 07/22/2013 11 Ftg/Foundation/Piers 07/17/2013 21 Underground/Under Floor Inspector PD PD PD PD PD PB PD PD PD PD PD PD PD PD PD PD Act AP PA NR AP AP AP AP AP PA PA PA AP AP AP AP AP PANERA BREAD- 3,910 SF SHELL TO BAKERY/CAFE Comments Friday, September 20, 2013 Page 1 of 1 City of Carlsbad Permit No. VALUATION WORKSHEET Assessor Parcel No. Date Building Division By llfVpeiofyVpiKiflii mA#ajff|iork, • Multiplier VALUE SFD and Duplexes $110 17 $0 00 Residential Additions $13173 $0 00 Remodels / Lofts $57 48 $0 00 Apartments & Multi-family $98 20 $0 00 Garages/Sunrooms/Solariums $28 74 $0 00 Patio/Porch/Carport $9 58 $0 00 Enclosed Patio $15 51 $0 00 Decks/Balconies/Stairs $15 57 $0 00 Retaining Walls, concrete,masonry $19 16 $0 00 Pools/Spas-Gunite $40 72 $0 00 Tl/Stores, Offices $37 12 $0 00 Tl/Medical, restaurant, H occupancies 3910 $50 30 $196,673 00 Photovoltaic Systems/ # of panels $400 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 Fire Sprinkler System $3 11 $0 00 Air Conditioning - commercial $5 03 $0 00 Air Conditioning - residential $4 19 $0 00 Fireplace/ concrete, masonry $3,855 98 $0 00 Fireplace/ prefabricated Metal $2,621 34 $0 00 $0 00 $0 00 TOTAL $196,673 00 Valuation: $196,673 Comm/Res (C/R): C Building Fee $1,075 86 Plan Check Fee $753 10 Strong Motion Fee $41 00 Green Bldg Stand Fee $4 00 Green Bldg PC Fee $150 00 License Tax/PFF $6,883 56 License Tax/PFF (in CFD) $3,579 45 CFD 1st hour of Plan CheckFire Expedite Plumbing Mechanical Electncal TBD TBD TBD CFD 0 Yes (PFF= 1.82%) 0 No (PFF = 3.5%) Land Use. Density: Improve Area. Fiscal Year. Annex. Year: Factor: CREDITS PFF and/orCFD Explanation: ^^f^^^^ INSPECTION RECORD Building Division 13 INSPECTION RECORD CARD WITH APPROVED PLANS MUST BE KEPT ON THE JOB EI CALL BEFORE 3:30 pm FOR NEXT WORK DAY INSPECTION EI FOR BUIUDING INSPECTION CALL: 760-602-2725 OR GO TO: www.Carlsbadca.qov/Buildlng AND CUCK ON "Request Inspection" DATE; T/«^/3 CB130347 2521 PALOMAR AIRPORT RD 100 PANERA BREAD- 3,910 SF SHELL TO BAKERY/CAFE Tl COMM Lot# NIKKI STOUT RECORD COPY IF YES " IS CHECKED BELOW THAT DIVISION S APPROVAL IS REQUIRED PRIOR TO REQUESTING A FlNAL BUILDING INSPECTION. IF YOU HAVE ANY QUESTIONS PLEASE CALL THE APPLICABLE DIVISIONS AT THE PHONE NUMBERS PROVIDED BELOW. AFTER ALL REQUI RED APPROVALS ARE SIGNED OFF- FAX TO 760-602-8560. EW A\L TO BLDGINSPECTIONS@CARLSBADCA.GOV OR BRING IN A COPY OF THIS CARD TO: 1635 FARADAY AVE.. CARLSBAD. CA 92008. BUILDING INSPECTORS CAN BE REACHED /XT 760-602-2700 BETWEEN 7:30 AM - 8:00 AM THE DAY OF YOUR INSPECTION. YES Required for Building Final If Checked YES Date Inspector Notes Planning / Landscape 760-944-8463 Allow 48 hours / CM&I (Engineenng Inspections) 760-438-3891 Call before 2 pm si Fire Prevention 760-602-4660 Allow 48 hours Type of Inspection CODE # BUiLDING #11 FOUNDATION Date Inspector Type of Inspection # ELECTRICAL Date #31 ZrtLECTRICUNDERGROUND DUFER 7./7'/3 Inspector #12 REINFORCED STEEL #34 ROUGH ELECTRIC #66 IVIASONRY PRE GROUT #33 • ELECTRIC SERVICE •TEMPORARY • GROUT • WALL DRAINS #35 PHOTOVOLTAIC #10 TILT PAN ELS #11 POUR STRIPS #11 COLUiVIN FOOTINGS #39 FINAL CODE # MECHANICAL #41 UNDERGROUND DUCTS & PIPING #14 SUBFRAME • FLOOR DCEIUNG #44 • DUCT & PLENUM • REF. PIPING #15 ROOFSHEATHING #43 HEAT-AIR COND. SYSTEMS #13 EXT. SHEAR PANELS #16 INSULATION #18 EXTERIOR LATH #49 FINAL CODE # COMBQ INSPECTION #81 UNDERGROUND (11,12,21,31) #17 INTERIOR lATH&DRYWAU #82 DRYWALLEXT LI\TH, GAS TES (17,18,23) POOL EXCA/STEEty BOND/FENCE #83 ROOFSHEATING,EXTSHEAR(13,15) PREPLASTER CODE # PLUMBING . Date #22 • SEWER & BL/CO • PL/CO<^T^ ^ #84 FRAME ROUGH COMBO (14,24,34,44) #89 FINAL OCCUPANCY (19,29,39,49) #21 UNDERGROUND DWASTE • WTR' Inspector FIRE Date Inspector #24 TOPOUT DWASTE DWTR A/S UNDERGROUND VISUAL #27 TUB & SHOWER PAN $ '2,0. n A/S UNDERGROUND HYDRO #23 EGAS TEST g-GAS PIPING A/S UNDERGROUND FLUSH #25 WATER HEATER A/S OVERHEAD VISUAL #28 SOLAR WATER A/S OVERHEAD HYDROSTATIC f7X/l^/s^i #29 FINAL CODE # STORM WATER #600 PRE-CONSTRUCTION MEETING A/S FINAL F/A ROUGH-IN F/A FINAL #603 FOLLOW UP INSPECTION FIXED EXTINGUISHING SYSTEM ROUGH-IN #605 NOTICE TO CLEAN FIXED EXnNG SYSTEM HYDROSTATIC TEST #607 WRRTEN WARNING FDCED EXTINGUISHING SYSTEM FINAL #609 NOTICEOFVIOLATION MEDICAL GAS PRESSURETEST #610 VERBALWARNING MEDICAL GAS FINAL REV 10/2012 SEE BACK FOR SPECIAL NOTES Section 5416. Health and Safety Code, State of California (a) There shall be not less than one water closet for each 20 employees or fractional part thereof working at a construction job site The water closet shall consist of a patented chemical type toilet (b) For the purpose of this section the term construction site shall mean the location on which actual construction of a building is in progress (c) A violation of this section shaii constitute a misdemeanor Ali construction or work for which a permit is required shall be subject to inspection and all such construction or work shall remain accessible and exposed for inspection purposes until approved by the inspector Work shall not be done beyond the point indicated in each successive inspection without first obtaining the approval of the inspector DATE ADDITIONAL NOTES 7^ CEBVED JEP06 2013 CITY OF CARLSBAD BUILDING DIVISION Food Inspection Report County of San Diego, Department of Environmental Health PO Box 129261, San Diego, CA 92112-9261 . ; (858) 505-6900 (8001253-9933 www.sdcdeh.drg RiCORD COPY Inspection Date 09/06/2013 Record ID DEH2013-FFPP-001340 Inspection Seq No 4912292 • Business Type Restaurant Food Facility Guidesheet ID Facility Name ^ Address, ' PANERA BREAD BAKERY CAFE # 4296 2521 PALOMAR AIRPORT RD City SAN DIEGO Zip Code 92011 CT Distnct # of Employees 178 06 FG03 46 Pemiit Owner PANERA BREAD BAKERY Permit Exp Date ' f Record Status , Pending Inspection Inspection Type Routine > InspectHsn Status Complete Total Time hrs # Violations 2 Related Record Related Permit Exp Date Related Record Status Related Record Business Type RISK FACTORS AND INTERVENTIONS In = In Compliance Out = Out of Compliance N/O = Not Observed N/A = Not Applicable MAJ OUT = Major Violation Observed MIN OUT, = Minor Violation Observed COS = Corrected On Site SA = Sijitabie Altemative PTS = Pomts I*, N/O 1a Food Safety Certification and Exp Date'i /' „ ' ii • 2 . 2 N/O lb Food Handler Training , ' Sri • 2 2 A EMPLOYEE HEALTH ANDkY6iENlc'pRAcflCES'^3^'"tiSVfe^' '{^ftxXXh N/O 2 Communicable disease - reportng, restnctiors and exclusions i . ,! ' f • m t 4 4 N/O 3 No discharge from eyes, nose or mouth' ' n 2 2 N/O 4 Proper eating, tasting, dnnking or tobacco use • • 2 2 -V i-'pidvENTING CONTAMiNATibN BY MDslf«»lft':£*»« N/C 5 Hands clean and properly washed, gloves used properly t • , i 1 ^ • 4 4 in 6 Adequate handwashing facilities supplied and accessible *, • . H o 2 2 > 'CTIME'AND TEMPERATURE RELATlbNSHIPS?^3MI5!f In 7 Proper hot and cold holding temperatures • Hot • Cold ' , •* -• 4/2 4 N/A 8 Time as a public health control - procedures and records ' • ' J o • 4/2 4 N/O 9 Pnjper cooling methods • Xs 4 * 4 N/O 10 Proper cooking time and temperatures / ^ i • 4 4 N/O 11 Proper reheating procedures for hot holding ^' • mi 4 4 S^^'-^PROTECTION FROM CONTAMlNATION#¥MI4l^^?i#:!#'&'*V'.'^^^ iXi In 12 No retumed and reservice of food , . ' D ' 2 , 2 In 13 Food in good condition, safe and < , unadulterated • ' ' ' * • • 4/2 4 5 'fePROTECT10N FROMCONTAMINAT10N'(co«.|, Sft'ouT our SA X'"V EARNED In 14 Food contact surfaces clean and sanitized Sanibzer [B Chlonne ^ • Quat Amm • High Temp L.ocation and Concentrabon/Temp distunahine • • 4/2 4 ia'^i'FOOoVROM'APPROVEliVoURCES Is"''i 7'-iXXXS, '•4i In 15 Food obtained from approved source D I'ir 4 4 N/A 16 Compliance with shell stock tags, condition, display • Oysters D Mussels • Clams • Ottier • If/ 2 2 N/A 17 Compliance with Gulf Oyster Regulations • 2 2 •J^'McONFORMANCEWITO^APPROVEDP Vj' N/A 18 Compliance with • Vanance • Speaalized Process • HACCP plan • • 2 2 lndVlcoNSUMER-ADVisORYX«ivsc/,*>';ii As-V/rfS .''u. fc>s'^.»V f.r; N/A 19 Consumer advisory pre)vided for raw or undercooked foods • 2 2 HIGHLY,SUSCEPTiBt£ POPULATIONS ' -VVw'*'?i'r' '* i.'-.S rf. 4„,.VJ- *' N/A 20 Licensed he<ilth care facilities / public and pnvate schools - prohibited foods not offered • %" 4 4 i&SwATERfH0lwATERl;51fc4-^M^^^ In 21 Hot and cold water available Handsink 107°F~ Warewashing sink 127°F • a 4/2 4 ^?fiiLiQliiDWAsfi'DISPOSALW#»^^ In 22 Sewage and wastewater properly disposed • • 4 4 ^WERMwI^^'^ili^^l^Mt&ll^ij.Jti**: fiX XX 'it t In 23 No rodents, insects, birds or animals • • 4/2 4 ITEM /-LOCATION 'X'Xmi'-s^''iXX ymp'mg'Z'i' TEMP.fF),?; ambient/true Idr ,'34 ' ambient / true 2 dr , ' 37 ambient / walk in 41 ambient / table front '40 ambient / table rear 39. ' ambient / true bev 38 SUPERVISION "A\C XXk, 24 Person in charge present and performs duties " ^ • 1 ' ,1 ' 25 Personal cleanliness and hair restraints- "' ,'• ' a 1 1 GENElS^LiFOOD'sAFErCRE&IREMENT^^^ 26 Approved thawing methods used, frozen food ^' ' ' ' ' • •r 1 27 Food separated and protected f<' , > • 1 1 28 Fruits and vegetables washed • 1' 1 29 Toxic substances - properiy identified, stored, used • 1 1 FOOD STORAGE /.DISRII^AY} SERVICE^lf ?M^Si^l-#i'lS^.sS# Xifi 30 Food storage, food storage containers identified i' < " ^\," • -1 1' 31 Consumer seif-sen/ice ' i i ' > ^ • 1" 1' 32 Food properly labeled and honestly presented • 1 1 EQUIPMENT / UTENSILS / LINENS ,f»4il^ Af& 33 Nonfood contact surfaces clean ^ ', '^ 0 34 Warewashing facilities - installed, maintained, iised,, Test stnps available • • /> „' , ' • 1 1 35 Equipment / Utensils - approved, installed, good repair, capacity • 1 1 36 Equipment/utensils/Linens-storage, use • 1 1 ' EQUiPMENT7'UTENSillS'/"iilNENS'(iaMAK'^S^iM'*^^^ 37 Vending Machines , i • 1 1 38 Adequate ventilation / Lighting - designated areas, use • 1 1 39 Themiometers-piovided, accurate • 1 1 40 Wiping clothes - pioperly used, stored • 1 1 PHYSICAL fiMTmm&m£^XM^fXXXmX^ XCfi 41 Plumbing - proper backflow devices ' • 1 1 42 Garbage and refuse - property disposed, faalities maintained 1 1 43' Toilet facilities - properly constmcted, supplied, dean • 1 1 44 Premises, personal / cleaning items, vermin-proofing ~ • -_i 1 PERMANEI^iF06DVACIUT1ES»&Mf>%';M:l'V'f^^^^^^ ^-^^H'MXi 45 Floors, wails and ceilings - built, maintained, clean 1 46 No unapproved pnvate homes / living or sleeping quarters • 1 1 SIGN HEmmEukmsM^W'Bii^^ 47 Grade card, signs, last inspection report available i • 1 1 ; t , ) , Inspection Score: RECEIVED SEP 0'6 2013 ' ' 98% CITY OF CARLSBAD BUILDING DIVISION Received by (Pnnt) Mike Lavi/ler Received by (Signature) ^^^^^ Title contractor Specialist (Pnnt) Celeste Penn Specialist (Signature) , Q<!f1hjL-^ Title REHS Phone 760-940-2887 Secondary Inspectors Food Inspection Report Scored V33'(07/2012) ' • 09/06/2013 10 44 AM ' . ^ t' „ '"'• ' \ 1 ' i ' '' «^ ' X1' '.•)'''' ' ' , , ' Page lof 2 ^ ' ' • - ' 'F 'mm^'mm^' i>«^r^rN '/^>^ n(V/'" Inspection Date 09/06/2013 Food Inspection Report DEf fjlVl J C^LJK'Y' Record ID DEH2013-FFPP-001340 County of San Diego, Department of Enviifn^laliHeall^ l"^"^ ^^^^'"^ Inspection Seq No 4912292 PO Box 129261, San Diego, CA 92112-9261 •> - •, t - , ' ' ' i Business Type Restaurant Food Faality (858) 505-6900 (800) 253-9933 www.sdcdeh.orq' ,••!*«, , ' " v ' ' \ GuidesheetID Faality Name • Address ^ City • Zip Code CT Distnct # of Employees PANERA BREAD BAKERY CAFE #4296 2521 PALOMAR AIRPORT RD SAN DIEGO 92011 , 178 06 FG03 46 Pemiit Owner 1 ' Perniit Exp Dale' , Record Status f • , ^ Inspection Type Inspection Status Total Time # Violations PANERA BREAD BAKERY Pending Inspection ' Routine ' Complete hrs 2 Related Recort . j Record ID , - • Related Perniit Exp Date Related Record Status ' ' Related Record Business Typo '4-,.'-* Af-i«/s'''i'''5t^';''w'''»fc. X'''''"'fTXXi'\ 33 OBSERVATION , ' " , . CORRECTIVE ACTION All nonfood contact surfaces of equipment stiall be kept free of accumulation of dust, dtrt, food residue and debns [§114115(b)] 45 OBSERVATION • CORRECTIVE ACTION The walls/ceilings shall have durable, smooth, nonabsorbent, light-colored, and washable surfaces All floor surfaces, other than the customer service areas, shall be approved, smooth, durable and made of nonabsort>ent matenal that is easily deanable Approved t>ase coving shall be ' provided in all areas, except customer service areas and where food is stored in ongmal unopened containers Food facilities shall t>e fully enclosed All food facilities shall be kept clean and in good repair (§114143(d). §114266. §114268. §114268 1, t)114271. §114272) " final ,4" / , ' f " i , - ' v, ' • bldg cbl30347 ok to tram 9/5/13 ' '• " < . complete pass through door adjacent to BIB ' , , , , clean all surfaces , i ' '' . Then final approval granted to operate contingent upon approval from all applicable agencies Received by (Pnnt) Mike Lawler Received by (Signature) ^^^^^ Title contractor Specialist (Print) Celeste Penn Specialist (Signature) _ QX^"^!-^— „ Title REHS Phone 760-940-2887 Secxjndary Inspectors " , • , ' Food Inspection Report Scored V33 (07/2012) 09/06/201310 44 AM • • ', r\ '•• '' *. ' \ ' ( , -' •• ^ ( ' > , r - Page 2 Of 2 EsGil Corporation In (Partnersfiip witfi government for (BuiUing Safety DATE 6/13/13 • APPLICANT ET^RIS JURISDICTION City of Carlsbad • PLAN REVIEWER • FILE PLAN CHECK NO 13-0347 SET II PROJECT ADDRESS 2521 Palomar Airport Rd Suite 100 PROJECT NAME Panera Bread - TI XI The plans transmitted herewith have been correctecJ where necessary and substantially connply with the jurisdiction's building codes I I The plans transmitted herewith will substantially comply with the junsdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck I I The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person I I The applicant's copy of the check list has been sent to IXI EsGll Corporation staff did not advise the applicant that the plan check has been completed I I EsGll Corporation staff did advise the applicant that the plan check has been completed Person contacted Telephone # Date contacted (by ) Email Fax # Mail Telephone Fax In Person • REMARKS By Doug Moody Enclosures EsGll Corporation • GA • EJ • PC 6/6/13 9320 Chesapeake Dnve, Suite 208 • San Diego, California 92123 • (858)560-1468 • Fax (858) 560-157(.]'' EsGil Corporation In (PartnersHtp wttfi government for (BuiCrCtng Safety DATE 2/25/13 • APPLICANT a^juRis JURISDICTION City of Carlsbad • PLAN REVIEWER • FILE PLAN CHECK NO 13-0347 SET I PROJECT ADDRESS 2521 Palomar Airport Rd Suite 100 PROJECT NAME Panera Bread - TI I I The plans transmitted herewith have been corrected where necessary and substantially comply with the junsdiction's codes I I 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 I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck XI The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person X The applicant's copy of the check list has been sent to Russell Stout and Associates / Nikki Stout 4635 Cass Street, San Diego CA 92109 I I EsGll Corporation staff did not advise the applicant that the plan check has been completed IX EsGll Corporation staff did advise the applicant that the plan check has been completed Person contacted Nikki Stout Telephone # 858-243-3240 Date contacted "J 'llAJt (by fdx ) Email russ(a:)rusellstoutassoc com Fax # 858-272-8873 >/fvWlail vfelephone . v^ax In Person • REMARKS ' By Doug Moody Enclosures EsGll Corporation • GA • EJ • PC 2/14/13 9320 Chesapeake Dnve, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax (858) 560-1576 City of Carlsbad 2/25/13 13-0347 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO 13-0347 JURISDICTION City of Carlsbad OCCUPANCY A2 USE Restaurant TYPE OF CONSTRUCTION VB ACTUAL AREA 3910sf ALLOWABLE FLOOR AREA STORIES L HEIGHT SPRINKLERS'? Yes OCCUPANT LOAD 96 REMARKS DATE PLANS RECEIVED BY JURISDICTION 2/12/13 DATE PLANS RECEIVED BY ESGIL CORPORATION 2/14/13 DATE INITIAL PLAN REVIEW COMPLETED 2/25/13 PLAN REVIEWER Doug Moody FOREWORD (PLEASE READ): This plan review is limited to the technical requirements contained in the California version of the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled This plan review is based on regulations enforced by the Building Department You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineenng Department, Fire Department or other departments Clearance from those departments may be required pnor to the issuance of a building permit Code sections cited are based on the 2010 CBC, which adopts the 2009 IBC The following items listed need clarification, modification or change All items must be satisfied before the plans will be in conformance with the cited codes and regulations Per Sec 105 4 of the 2009 International Building Code, the approval of the plans does not permit the violation of any state, county or city law To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list when you submit the revised plans. City of Carlsbad 13-0347 2/25/13 Please make all corrections on the ongmal tracings, as requested in the correction list Submit three sets of plans for commercial/industnal projects (two sets of plans for residential projects) For expeditious processing, corrected sets can be submitted in one of two ways 1 Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave , Carlsbad, CA 92008, (760) 602-2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineenng and Fire Departments 2 Bnng one corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468 Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineenng and Fire Departments NOTE Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engineenng and Fire Departments until review by EsGll Corporation is complete 1 Rest Provide evidence of Health Department approval (for restaurants), where regulated by the local Health Department 2 Please provide plans and calculations signed by the California State licensed engineer or architect for the structural support of the 1000# rooftop air handler units Include all calculations and finding on the plans Please include the California license number, seal, date of license expiration and date plans are signed Business and Professions Code 3 Please review the requirements, revise the plans appropnately and impnnt on the plans the City of Carlsbad Policies and Procedures for Roof Mounted Equipment to the plans 4 Please revise the plumbing plans to show the gas line not to be on the roof (sheet PI 0) per City of Carlsbad policy 5 Please provide plumb/ng sheet P2 1, P3 0 and P3 1 for a review of the waste line and details 6 Please revise the key notes on sheet PI 2 to be consistent with the waste diagram (key note 32) 7 Please have the document author and pnnciple designers of the PERF-1 C document sign the impnnted forms 8 Please provide mechanical sheet M1 1, M1 2 and M2 0 so a review of the mechanical system can be performed 9 Please have the document author and the pnnciple designer of the OLTG-1C form sign the impnnted document City of Carlsbad 13-0347 2/25/13 10 Provide automatic shut-off controls for lighting as per Title 24, Part 6, Section 131(d) 11 Please complete the OLTG-1-C part 2 of 4 mandatory automatic controls portion of the LTG-1-C forms 12 Please have the pnnciple designer complete the Statement of Compliance System Acceptance section of the OLTG-1-C part 3 of 4 documents 13 Please provide the required LTG-5C form for the track lighting and show the current limiters on the plans 14 Please revise the lighting plan to show an exit sign at the side exit door #2 15 If the water closet compartment has an end-opening door (facing the water closet), the door shall be located on a diagonal to the water closet, mth a maximum stile width of 4 inches (see the figure below) Additionally, the door must be provided with a clearance of at least 18" at the stnke side FLUSH ACTIVATOR ON WIDE SIDE 4' MAX ACCESSIBLE WATER CLOSET COIMPARTMENT WITHIN A MULTIPLE-ACCOMMODATION TOILET FACILITY 16 Please correct the mounting schedule on sheet A4 1 to show that grab bars comply with the following, per Section 1115B 4 1 a) They shall be securely attached and centered 33" above the floor and parallel and not 36" NOTE Where a tank-type toilet is used which obstructs placement of the rear grab bar at 33", the rear grab bar only may be installed as high as 36" City of Carlsbad 13-0347 2/25/13 17 Show, or note, on the plans that accessible unnals meet the following requirements, per Section 1115B 4 2 a) >36" X 48" clear floor space is provided in front of the accessible unnal Section 1115B42 To speed up the review process, note on this list (or a copy) where each correction item has been addressed, i e , plan sheet, note or detail number, calculation page, etc Please indicate here if any changes have been made to the plans that are not a result of corrections from this list If there are other changes, please bnefly descnbe them and where they are located in the plans Have changes been made to the plans not resulting from this correction list? Please indicate Yes • No • The junsdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123, telephone number of 858/560-1468, to peri'orm the plan review for your project If you have any questions regarding these plan review items, please contact Doug Moody at Esgil Corporation Thank you City of Carlsbad 13-0347 2/25/13 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION City of Carlsbad PLAN CHECK NO 13-0347 PREPARED BY Doug Moody DATE 2/25/13 BUILDING ADDRESS 2521 Palomar Airport Rd Suite 100 BUILDING OCCUPANCY A2 TYPE OF CONSTRUCTION VB BUILDING PORTION AREA (Sq Ft) Valuation Multiplier Reg Mod VALUE ($) Tl 3910 50 30 196,6 73 Air Conditioning Fire Sprinklers TOTAL VALUE 196,673 Junsdction Code cb By Ordinance Bldg Permit Fee by Ordinance • $1,075.86 Plan Qieck Fee by Ordinance Type of Review QRepetitve Fee ~ Repeats X Complete Review • Other Q Hourly EsGil Fee • Structural Only Hr @ $699 31 $602 48 Connments Sheetl of 1 macvalue doc + ^ CITY OF CARLSBAD PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www carlsbadca gov DATE: 2/21/13 PROJECT NAME: Palomar Commons_ Tenant Imp Bldg 6 PROJECT ID: SDP 09-05 PLAN CHECK NO: CB130347 SET#: I ADDRESS: 2521 Palomar Airport Rd #100 ARN: 213-020-18 VALUATION: $196,673 You may have corrections from one or more of the divisions listed in the table below This plan check review transmittal is to notify you of clearance by: LAND DEVELOPMENT ENGINEERING DIVISION Final Inspection by the Construction & inspection Division is required: Yes Xj /vo @ For status from a division not marked below, please call 760-602-2719 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: .X^~ ,^,>'Ji60-602-4610;, r.'#;f, <l ||" : "i;^''t760-60,2-2750 t i?'£.FWE^PREVENTTO|NrK"'- 760^602-4665 :XM'' X^ I Ch.'ir Sexton | J 760-f;02-r.624 [ Chris Sextoii@carlsbadca gov j r 1 Kathleen Lawrence u—J 760-602-2741 Kathleen Lawrence@carlsbadca gov i Greg Ryan j L_! 760-602-4663 j Gregory RvanPcatIsbadca gov i j J Gi Tci RMZ 1 760-602-46 75 Gma Ruiz®carlsbadca gov j \/ Linda Ontiveros ^ /\ 760-602-2773 | Lmda Ontiveros@carlsbadca gov 1 XX Cindy Wong [ ' —i 760-602-4662 ; Cynthia WongOcarlsbadca gov j ri J I .... 1 1 1 Dommic Fieri j 760-602-4664 \ Dommic Fieri@carlsbadca gov s Remarks ^^es assessed on shell building permit, CBI20788. No additional fees are being assessed on this tenant improvement. ^ CITY OF' CARLSBAD BUILDING PLANCHECK CHECKLIST QUICK-CHECK/APPROVAL Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www carlsbadca gov ENGINEERING Plan Check for ^^130347 Date 2/21/13 Project Address 2521 Palomar Airport Rd #100 APN 213-020-18 Project Description Tenant improvement to building #6 to become Panera Bread bakery. Valuation $196,673 ENGINEERING Contact Linda OntlVerOS Phone 760-602-2773 Email Mnda.ontiveros@carlsbadca.gov Fax 760-602-1052 • RESIDENTIAL [Z] TENANT IMPROVEMENT • RESIDENTIAL ADDITION MINOR (<$20,000.00) PLAZA CAMINO REAL • CARLSBAD PREMIER OUTLETS • COMPLETE OFFICE BUILDING • OTHER: BY REMARKS OFFICIAL USE ONLY ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT DATE 2/21/13 fees assessed on shell building permit, CB120788. No additional fees are being assessed on this tenant improvement. iE-36 Page 1 of 1 REV 4/30/11 ^ CITY O F CARLSBAD STORM WATER COMPLIANCE ASSESSMENT B-24 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www carlsbadca gov am applying to the City of Carlsbad for the following type(s) of construction permit. ^ Building Permit • Right-of-Way Permit • My project is categorically EXEMPT from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it only requires issuance of one or more of the following permit types Electncal Fire Additional Fire Alarm Fixed Systems Mechanical Mobile Home Plumbing Patio/Deck Photo Voltaic Re-Roofing Sign Spa-Factory Spnnkler Water Discharge Project Storm Water Threat Assessment Criteria* No Threat Assessment Criteria My project qualifies as NO THREAT and is exempt from the requirement to prepare a storm water pollution prevention plan (SWPPP) because It meets the "no threaf assessment cntena on the City's Project Threat Assessment Worksheet for Detennination of Construction SWPPP Tier Level My project does not meet any of the High, Moderate or Low Threat cntena descnbed below Tierl - Low Threat Assessment Critena • My project does not meet any of the Significant or Moderate Threat cntena, is not an exempt pemiit type (See list above) and the project meets one or more of the following cntena • Results in some soil disturbance, and/or • Includes outdoor constaiction activities (such as saw cutting, equipment washing, matenal stockpiling, vehicle fueling, waste stockpiling) Tier 2 • Moderate Threat Assessment Criteria • My project does not meet any of the Significant Threat assessment Cntena descnbed below and meets one or more of the following cntena • Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15 16 of the Carlsbad Municipal Code), or, • Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following critena • Located within 200 feet of an environmentally sensitive area or the Pacific Ocean, and/or • Disturbed area is located on a slope with a grade at or exceeding 5 honzontal to 1 vertical, and/or • Disturbed area is located along or within 30 feet of a storm dram inlet, an open drainage channel or watercourse, and/or • Construction will be initiated dunng the rainy season or will extend into the rainy season (Oct 1 through Apnl 30) Tier 3 - Significant Threat Assessment Criteria • My project includes cleanng, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas and/or • My project is part of a phased development plan that will cumulatively result in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, refueling and maintenance areas or, • My project is located inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant potenfial for contnbufing pollutants to nearby receiving waters by way of storm water runoff or non-storm water discharge(s) / certify to the best of my knowledge that the above checked statements are true and correct I understand and acknowledge that even though this project does not require preparation of a construction SWPP, I must still adhere to, and at ali times during construction activities for the permit type(s) check above comply with the storm water best management practices pursuant to Title 15 of the Carlsbad Municipal Code and to Citv Standards 'The City Engineer may authorize minor vanances from the Storm Water Threat Assessment Cntena in special circumstances where it can be shown that a lesser or higher Construction SWPPP Tier Levei is warranted B-24 Project Address Assessor Parcel No iner/Owner s Authonzed AqenI Name Title Owner/Owners Auttionzed Agent Name ([t{\L(UiKKAjl(ji/ Date ' Jroiecl ID 6ftlT iXi Rev 03/09 ^ STORMWATER „ , ^ . 'f ^i^-^ f«-r*k.ir<k Development Services STANDARDS Engineering Department X^ 5 'IL ° QUESTIONNAIRE ISSS Faraday Avenue 760-602-2750 www carlsbadca gov CARLSBAD E-34 INSTRUCTIONS: To address post-development pollutants that may be generated from development projects, the City requires that new development and significant redevelopment pnonty projects incorporate Permanent Storm Water Best Management Practices (BMP's) into the project design per the City's Standard Urban Stormwater Management Plan (SUSMP) Initially this questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary permits and/or construction permits) The results of the questionnaire determine the level of storm water standards that must be applied to a proposed development or redevelopment project Depending on the outcome, your project will either be subject to 'Standard Stormwater Requirements' or be subject additional critena called 'Pnonty Development Project Requirements' Many aspects of project site design are dependent upon the storm water standards applied to a project Applicant responses to the questionnaire represent an initial assessment of the proposed project conditions and impacts City staff has responsibility for making the final assessment after submission of the development application If staff determines that the questionnaire was incorrectly filled out and is subject to more stnngent storm water standards than initially assessed by the applicant, this will result in the return of the development application as incomplete In this case, please make the changes to the questionnaire and resubmit to the City If applicants are unsure about the meaning of a question or need help in determining how to respond to one or more of the questions, they are advised to seek assistance from Land Development Engineenng staff A separate completed and signed questionnaire must be submitted for each new development application submission Only one completed and signed questionnaire is required when multiple development applications for the same project are submitted concurrently In addition to this questionnaire, applicants for construction permits must also complete, sign and submit a Project Threat Assessment Form to address construction aspects of the project Please answer the questions below, follow the instructions and sign the form at the end 1 Is your project a significant redevelopmenf^ - DEFINITION: Significant redevelopment is defined as the creation, addition or replacement of at least 5,000 square feet of impervious surface on an already existing developed site Significant redevelopment includes, but is not limited to the expansion of a building footprint, addition to or replacement of a structure, structural development including an increase in gross floor area and/or exterior construction remodeling, replacement of an impervious surface that is not part of a routine maintenance activity, and land disturbing activities related with structural or impervious surfaces Replacement of impervious surfaces includes any activity that is not part of a routine maintenance activity where impervious matenal(s) are removed, exposing underlying soil dunng construction If your project IS considered significant redevelopment, then please skip Section 1 and proceed with Section 2 If your project IS NOT considered significant redevelopment, then please proceed to Section 1 E-34 Pagel Of 3 REV 3/23/10 STORM WATER Development Services Engineering Department STANDARDS Development Services Engineering Department CITY OF QUESTIONNAIRE 1635 Faraday Avenue CARLSBAD E-34 760-602-2750 www carlsbadca gov SECTION 1 NEW DEVELOPMENT PRIORITY PROJECT TYPE Does you project meet one or more of the following criteria YES NO 1 Housina subdivisions of 10 or more dwelhna units Examoles sinale familv homes, multi-familv homes, condominium and apartments 2 Commercial - areater than 1-acre Anv develooment other than heavv industrv or residential Examples hosoitals. laboratones and other medical facilities, educational institutions, recreational facilities, municipal facilities, commercial nursenes, multi-apartment buildings, car wash facilities, mini-malls and other business complexes, shopping malls, hotels, office buildings, public warehouses, automotive dealerships, airfields, and other light industnal facilities > 3 Heavy Industrial / Industrv- areater than 1 acre Examoles manufactunna olants. food orocessina olants. metal working facilities, pnnting plants, and fleet storage areas (bus, toick, etc) 4 Aufo/nofive reoair shop A facilitv cateaorized in anv one of Standard Industnal Classification (S\C) codes 5013. 5014, 5541, 7532-7534, and 7536-7539 >^ 5 Restaurants Anv facilitv that sells oreoared foods and dnnks for con.sumption. includino stationarv lunch counters and refreshment stands selling prepared foods and drinks for immediate consumption (SIC code 5812), where the land area for development is greater than 5,000 square feet Restaurants where land development is less than 5,000 square feet shall meet all SUSMP requirements except for structural treatment BMP and numenc sizing cntena requirements and hydromodification requirements 6 Hillside develooment Anv development that creates 5.000 sauare feet of imoervious surface and is located in an area with known erosive soil conditions, where the development will grade on any natural slope that is twenty-five percent (25%) or greater >< 7 Environmentallv Sensitive Area (ESA)^ All develooment located within or directiv adiacent^ to or discharqina directly^ to an ESA (where discharges from the development or redevelopment will enter receiving waters within the ESA), which either creates 2,500 square feet of impervious surface on a proposed project site or increases the area of imperviousness of a proposed project site to 10% or more of its naturally occurnng condition > 8 Parkina lot Area of 5.000 sauare feet or more, or with 15 or more oarkina spaces, and ootentiallv exposed to urban runoff 9 Streets, roads, hiahwavs, and freewavs Anv oaved surface that is 5.000 sauare feet or qreater used for the transportation of automobiles, trucks, motorcycles, and other vehicles 10 Retail Gasoline Outlets Servina more than 100 vehicles oer dav and areater than 5,000 sauare feet 11 Coastal Development Zone Anv proiect located within 200 feet of the Pacific Ocean and (1) creates more than 2500 square feet of impermeable surface or (2) increases impermeable surface on property by more than 10% 12 More than 1-acre of disturbance Proiect results in the disturbance of more than 1-acre or more of land and is considered a Pollutant-generating Development Project'' 1 Environnnentally Sensitive Areas include but are not limited to all Clean Water Act Section 303(d) impaired water bodies, areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for ttie San Diego Basin (1994) and amendments), water bodies designated witti tlie RARE beneficial use by ttie State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments), areas designated as preserves or ttieir equivalent under the Multi Species Conservation Program within the Cities and County of San Diego, and any other equivalent environmentally sensitive areas which have been identified by the Copermittees 2 "Directly adjacent" means situated within 200 feet of the Environmentally Sensitive Area 3 "Discharging directiy to" means outfiow from a drainage conveyance system that is composed entirely of fiows from the subject development or redevelopment site, and not commingled with flow from adjacent lands 4 Pollutant-generating Development Projects are those projects that generate pollutants at levels greater than background levels In general, these include all projects that contnbute to an exceedance to an impaired water body or which create new impervious surfaces greater than 5000 square feet and/or introduce new landscaping areas that require routine use of fertilizers and pesticides In most cases linear pathway projects that are for infrequent vehicle use, such as emergency or maintenance access, or for pedestran or bicycle use, are not considered Pollutant-generating Development Projects it they are built with pen/ious surfaces or if they sheet flow to suaounding pervious surfaces Section 1 Results If you answered YES to ANY of the questions above your project is subject to Priority Development Project requirements Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 A Storm Water Management Plan, prepared in accordance with City Stomn Water Standards, must be submitted at time of application If you answered NO to ALL of the questions above, then your project is subject to Standard Stormwater Requirements Please check the "does not meet PDP requirements" box in Section 3 E-34 Page 2 of 3 REV 3/23/10 STORM WATER Development Services Engineering Department •^^^ STANDARDS Development Services Engineering Department •^^^ CITY OF QUESTIONNAIRE 1635 Faraday Avenue CAR LSBAD E-34 760-602-2750 www carlsbadca gov SECTION 2 SIGNIFICANT REDEVELOPMENT Complete the questions below regarding your redevelopment project YES NO 1 Project results in the disturbance of more than 1-acre or more of land and is considered a Pollutant-generating Development Project (see definition in Section 1) X If you answered NO, please proceed to question 2 If you answered YES, then you ARE a significant redevelopment and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirements Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 below 2 Is the project redeveloping an existing pnonty project type'' (Priority projects are defined in Section 1) If you answered YES, please proceed to question 3 If you answered NO, then you ARE NOT a significant redevelopment and your project is subject to STANDARO STORMWATER REQUIREMENTS Please check the "does not meet PDP requirements" box in Section 3 below 3 Is the project solely limited to just one of the following a Trenching and resurfacing associated with utility work"? b Resurfacing and reconfigunng existing surface parking lots'? c New sidewalk construction, pedestnan ramps, or bike lane on public and/or pnvate existing roads'? d Replacement of existing damaged pavemenf If you answered NO to ALL of the questions, then proceed to question 4 If you answered YES to ANY of the questions then you ARE NOT a significant redevelopment and your project is subject to Standard Stormwater Requirements Please check the "does not meet PDP requirements" box in Section 3 below 4 Will your redevelopment project create, replace, or add at least 5,000 square feet of impervious surfaces on an existing development or, be located within 200 feet of the Pacific Ocean and (1)create more than 2500 square feet of impermeable surface or (2) increases impermeable surface on the property by more than 10%'' If you answered YES, you ARE a significant redevelopment, and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirements Please check the "meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 below If you answered NO, then you ARE NOT a significant redevelopment and your project is subject to STANDARD STORMWATER REQUIREMENTS Please check the "does not meet PDP requirements" box in Section 3 below SECTION 3 Questionnaire Results a My project meets PRIORITY DEVELOPMENT PROJECT (PDP) requirements and must comply with additional stormwater cntena per the SUSMP and must prepare a Storm Water Management Plan for submittal at time of application My project does not meet PDP requirements and must only comply with STANDARD STORMWATER REQUIREMENTS per the SUSMP Applicant Information and Signature Box Tliis Box for City Use Only Address ^6zi ?AmiAv f^ymm Assessor's Parcel Number(s) ^3 - 020-1?' DO Applicant Name Applicant Title Office fAM^y(/(^ Applicant Signature Date , ([3 \ City Obncjifre YES/ NO ' Date aX^lxl \\ 2) Project ID E-34 Page 3 of 3 REV 3/23/10 -^3^ CITY OF ARLSBAD PLANNING DIVISION BUILDING PLAN CHECK APPROVAL P-28 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www carlsbadca eov DATE: 6/5/13 PROJECT NAME: T.I. PROJECTID: PLAN CHECK NO: CB130347 SET#: ADDRESS: 2521 PALOMAR AIRPORT RD APN: X] This plan check review is complete and has been APPROVED by the PLANNING Division. By: GINA RUIZ A Final Inspection by the PLANNING Division is required DYes ^ 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. []] 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 approval has been sent to: RUSS@RUSSELLSTOUTASSOC.COIVI For questions or clanfications on the attached checklist please contact the following reviewer as marked PLANNING '760-602-4610 ENGINEERING 760-602-2750 FIRE PREVENTION 760-602-4665 Chris Sexton 760-602-4624 Chris SextonOcarlsbadca fiov 1 1 Kathleen Lawrence 760-602-2741 Kathleen LawrenceOcarlsbadca fiov I Greg Ryan 760-602-4663 Grefiorv Rvan@carlsbadca gov X Gina Ruiz 760-602-4675 Gina Ruiz@carlsbadca gov I I Linda Ontiveros 760-602-2773 Linda Ontiveros@carlsbadca fiov I I Cindy Wong 760-602-4662 Cvnthia WongOcarlsbadca gov • 1 1 Dominic Fieri 760-602-4664 Dommic Fieri@carlsbadca gov Remarks: REVIEW # Plan Check No CB130347 Address 2521 PALOMAR AIRPORT RD Date 6/5/13 Review # 2 Planner GINARUIZ Phone (760) 602- 4675 Type of Project & Use H Net Project Density DU/AC Zoning M/P-M/C-2-Q General Plan G/PI/GC Facilities Management Zone 5 CFD (in/out) # Date of participation Remaining net dev acres (For non-residential development Type of land use created by this permit ) 12 3 Legend: ^ Item Complete Q Item Incomplete - Needs your action K • • Environmental Review Required YES • NO ^ TYPE DATE OF COMPLETION Compliance with conditions of approvaP If not, state conditions which require action Conditions of Approval 13 • • Discretionary Action Required YES • NO ^ 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 • • Coastal Zone Assessment/Compliance Project site located in Coastal Zone'? YES • NO CA Coastal Commission Authority? YES • NO M If California Coastal Commission Authonty Contact them at - 7575 Metropolitan Drive, Suite 103, San Diego, CA 92108-4402, (619) 767-2370 Determine status (Coastal Permit Required or Exempt) Q • Habitat Management Plan Data Entry Completed'? YES • NO ^ 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, UPDATEi) Q • Inclusionary Housing Fee required YES Q NO ^ (Effective date of Inclusionary Housing Ordinance - May 21, 1993 ) Data Entry Completed'? YES • NO • (A/P/Ds, Activity Maintenance, enter CB#, toolbar. Screens, Housing Fees, Construct Housing Y/N, Enter Fee, UPDATEi) • • Housing Tracking Form (form P-20) completed YE.S • NO • N/A P-28 Page 2 of 3 07/11 Site Plan. Kl • • City Council Policy 44 - Neighborhood Architectural Design Guidelines K • • 1 Applicability YES • NO ^ Kl • • 2 Project complies YES • NOQ • • • • Zoning 1 Setbacks Front Interior Side Street Side Rear Top of slope Required Required Required. Required Required 2 Accessory structure setbacks Front Required Interior Side Required Street Side Required. Rear Required, Structure separation Required. Shown Shown Shown Shown Shown Shown Shown Shown Shown Shown Kl • • • Kl • 3 Lot Coverage Required Shown Screening of Equipment Required YES Shown NO ROOF PLAN AND SECTIONS ARE MISSING PLANCHECK #2 SHEET A7 3 & A7 38 SHOW EQUIPMENT LOWER THAN PARAPET AND SCREENED K • • • Kl • 5 Parking Spaces Required Shown (breakdown by uses for commercial and industnal projects required) Residential Guest Spaces Required Shown Additional Commonts #1 IS THERE AN EXISTING PARAPET TO SCREEN THE NEW ROOF MOUNTED EQUIPMENT AS STATED ON SHEET MO 7'? AS THIS IS A HIGHLY VISIBLE INTERSECTION. AND PER THE CONDITIONS OF APPROVAL (SEE ATTACHMENT), PLEASE ADD SECTIONS SHOWING HOW THE PROPOSED ROOF MOUNTED EQUIPMENT WILL BE SCREENES-FROM VIEW FROM STREETS WITHIN 500 FEET #2 THE ROOF PLANS ARE MISSING FROM THIS SET PLEASE ADD WITH THE NEXT RESUBMITTAL OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER GINA RUIZ DATE 6/5/13 p-28 Page 3 of 3 07/11 CITY CARLSBAD O F PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 WWW carlsbadca gov DATE: 6/20/13 PROJECT NAME: panera bread PROJECTID: PUN CHECK NO: cbl30347 SET#: 11 ADDRESS: 25210r APN: This plan check review Is complete and has been APP^VED by the fire Division. By: cwong A Final Inspection by the Division Is required Kl Yes • No • 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: russ@russellstoutassoc.com (and via usps) Vou 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. For questions or clarifications on the attached checklist please contact the followmg reviewer as marked: PLANNING 760-602-4610 ENGINEERING 760-602-2750 FIRE PREVENTION 760-602-4665 1 1 Chris Sexton 760-602-4624 Chris Sexton@carlsbadca gov 1 1 Kathleen Lawrence 760-602-2741 Kathleen Lawrence@carlsbadca gov Q Greg Ryan 760-602-4663 Gregorv Ryan@carlsbadca gov 1 1 Gina Ruiz 760-602-4675 Gma Ruiz@carlsbadca gov 1 1 Linda Ontiveros 760-602-2773 Lmda Ontiveros@carlsbadca gov X Cindy Wong 760-602-4662 Cynthia Wong@carlsbadca gov • • 1 1 Dominic Fieri 760-602-4664 Dommic Fieri@carlsbadca gov Remarks: 6/20/13 **** Slip sheet of MOE shall be completed by June 25th. OTO appt schedule 4:00 PM. This Is a condition of the final fire sign off Page 1 of 2 **APPR0VED: 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. 2/27/2013 *** Bubble All Changes*** 1 Sheet A-2.1 A MOE. Show detail path of travel. This will used to coordinate EM lighting on reflective ceiling and electrical sheets. 2 Sheet A-3.2. Lighting Schedule Legend, FR5A-FEM and FR5-FEM and El. Add 90 minute battery back up to description. 3. Sheet G-SP3- Add note that signage will not obstruct sprinkler coverage. 4 Sheet A-5 1: Note 2.2 awning Provide manufacturers cut sheets on material and give dimensions. If under separate permit, omit this detail form this set of plans. 5. Sheet E3 1- Remove references to fire alarm systems. This shall be as a deferred submittal by licensed C-10 contractor Page 2 of2 Carlsbad Fire Department Plan Review Requirements Category TI, COMM Date of Report- 06-20-2013 NIKKI STOUT Reviewed by Name Address: 4635 CASS ST SAN DIEGO CA 92109 Permit #: CBI30347 Job Name: PANERA BREAD- 3,910 SF SHELL Job Address 2521 PALOMAR AIRPORT RD CBAD St 100 INCOMPLETE'~™4^*©44em^aujT^vesubmit^ for review is mcomplete At this time, this office cannot adequately conduct a review to dete^^a^^^^lK^^^^^^^licable codes and/or standards Please review carefully all commentsjttaeh^^Tlease resubmit the necessarypEnf^d^oE^^gcifications, with changes "clouded", to this office ^M€^^W and approval Conditions: Cond. CON0006112 [NOT MET] *** Bubble All Changes*** 1. Sheet A-2.1 A MOE Show detail path of travel This will used to coordinate EM lighting on reflective ceiling and electrical sheets. 2 Sheet A-3 2- Lighting Schedule Legend, FR5A-FEM and FR5-FEM and El Add 90 minute battery back up to description 3 Sheet G-SP3 Add note that signage will not obstruct spnnkler coverage 4. Sheet A-5 1. Note 2 2 awning Provide manufacturers cut sheets on material and give dimensions If under sepearate permit, omit this detail form this set of plans 5. Sheet E3 1 • Remove references to fire alarm systems This shall be as a deferred submittal by licensed C-10 contractor. Entry 02/27/2013 By cwong Action: CO Cond. CON0006423 [MET] **** Slip sheet of MOE shall be completed by June 25th OTC appt schedule 4.00 PM This is a condition of the fmal fire sign off*** ** APPROVED- 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- 06/20/2013 By. cwong Action-AP ^ CITY OF CARLSBAD PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 WWW carlsbadca gov DATE: 2/27/13 PROJECT NAME: panera bread PROJECTID. PLAN CHECK NO: cbl30347 SET#: I ADDRESS: 2521 par APN^ Q This plan check review is complete and has been APPROVED by the fire ^i^j^n. By: cwong A Final Inspection by the Division is required Kl Yes • No ^ 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: russ@russellstoutassoc.com (and via usps) 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. For questions or clarifications on the attached checklist please contact the following reviewer as marked. PLANNING 760-602-4610 ENGINEERING 760-602-2750 FIRE PREVENTION 760-602-4665 1 1 Chris Sexton 760-602-4624 Chris Sexton@carlsbadca gov 1 1 Kathleen Lawrence 760-602-2741 Kathleen.Lawrence@carlsbadca gov Q Greg Ryan 760-602-4663 Gregorv.Rvan@carlsbadca gov 1 1 Gina Ruiz 760-602-4675 Gma Ruiz@carlsbadca gov 1 1 Linda Ontiveros 760-602-2773 Linda Ontiveros@carlsbadca gov X Cindy Wong 760-602-4662 Cvnthia Wong@carlsbadca gov • • 1 1 Dominic Fieri 760-602-4664 Dommic Fieri@carlsbadca gov Remarks: 2/27/2013 *** Bubble All Changes*** Page 1 of 2 1. Sheet A-2.1 A MOE. Show detail path of travel. This will used to coordinate EM lighting on reflective ceiling and electrical sheets. 2 Sheet A-3.2: Lighting Schedule Legend, FR5A-FEM and FR5-FEM and El. Add 90 minute battery back up to description. 3. Sheet G-SP3: Add note that signage will not obstruct sprinkler coverage. 4. Sheet A-51: Note 2.2 awning. Provide manufacturers cut sheets on material and give dimensions. If under separate permit, omit this detail form this set of plans. 5. Sheet E3.1: Remove references to fire alarm systems. This shall be as a deferred submittal by licensed C-IO contractor. Page 2 of2 Carlsbad Fire Department Plan Review Requirements Category TI, COMM Date of Report 02-27-2013 Reviewed by Name: Address- NIKKI STOUT 4635 CASS ST SAN DIEGO CA 92109 Permit #- CB130347 Job Name. PANERA BREAD- 3,910 SF SHELL Job Address 2521 PALOMAR AIRPORT RD CBAD St 100 INCOKlPCFlT~™rBn^m°y^5'W^?5''^tr^^ adequately conduct a review to detenm^sisewf^l^ce with the applic^Ie'co^?^4i48JU,^^[dards Pleasb review carefully all comments attachg^»«*P^Se resubmit the necessary plans and/or specificationsTwi^rcbaaggs "clouded", to this office for revie^i*^!^^proval Conditions; Cond CON0006112 [NOT MET] * *(;';2§5iSSk4iL5ha 1. Sheet A-2.1 A MOE. Show detail path of travel. This will used to coordinate EM lighting on reflective ceiling and electrical sheets 2 Sheet A-3 2 Lighting Schedule Legend, FR5A-FEM and FR5-FEM and El Add 90 minute battery back up to description. 3 Sheet G-SP3: Add note that signage will not obstruct spnnkler coverage. 4. Sheet A-5.1. Note 2.2 awning Provide manufacturers cut sheets on material and give dimensions If under sepearate permit, omit this detail form this set of plans 5. Sheet E3.1 Remove references to fire alarm systems This shall be as a deferred submittal by licensed C-10 contractor. Entry: 02/27/2013 By-cwogr=Axtion--eO- Salehi Engineering^ Inc. Mechanical, Electrical and Plumbing Consulting Engineers with 25 years of experience Energy Analysis For Panera Bread Palomar Airport 2521 Palomar airport Rd #100 Carlsbad, CA 92011 o 8360 Ciairemont Mesa Blvd, Suite 111, San Diego, CA 92111 Telephone (858)277-5551 Fax (858)277-5544 BUILDING ENERGY ANALYSIS REPORT PROJECT: Panera Bread Palomar Airport 2521 Palomar airport Rd #100 Carlsbad, CA 92011 Project Designer: Russell Stout & Associates, Inc. 4635 Cass Street San Diego, CA 92109 619-581-2812 Report Prepared by: Rocky Salehi Salehi Engineering, Inc. 3680 Clairmont Mesa Blvd Suite 111 San Diego,, CA 92111 858-277-5551 Job Number: B115 Date: 2/7/2013 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards This program developed by EnergySoft, LLC - www energysoft com EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 TABLE OF CONTENTS Cover Page 1 Table of Contents 2 Nonresidential Performance Title 24 Forms 3 Form ENV-MM Envelope Mandatory Measures 19 Form MECH-MM Mechanical Mandatory Measures 20 HVAC System Heating and Cooling Loads Summary 21 EnergyPro 5 1 by EnergySoft Job Number ID B115 User Number 1233 PERFORIVIANCE CERTIFICATE OF COMPLIANCE (Part lof 3) PERF-1 C Project Name Panera Bread Palomar Airport Date 2/7/2013 Project Address 2527 Palomar airport Rd#100 Carlsbad Climate Zone CA Climate Zone 07 Total Cond Floor Area 3,963 Addition Floor Area n/a GENERAL INFORMATION Building Type El Nonresidential • • Relocatable - indicate • High-Rise Residential • specific climate zone • Hotel/Motel Guest Room all climates Phase of Construction IZl New Construction • Addition • Alteration STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations This certificate applies only to a Building using the performance compliance approach The documentation author hereby certifies that the documentation is accurate and complete Documentation Author Name Rocky Salehi Signature Company Salehi Engineenng, Inc Date 2/7/2013 Address 3680 Clairmont Mesa Blvd Suite 111 Phone 858-277-5551 City/State/Zip san Diego,, CA 92111 The Pnncipal Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application The proposed building has been designed to meet the energy efficiency requirements contained in sections 110,116 through 118, and 140 through 149 of Title 24, Part 6 Please check one ENV. LTG MECH • • I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for its preparation, and that I am licensed in the State of California as a civil engineer, mechanical engineer, electrical engineer, or I am a licensed architect I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section 5537 2 or 6737 3 to sign this document as the person responsible for its preparation, and that I am a licensed contractor performing this work I affirm thai I am eligible under Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described as exempt pursuant to Business and Professions Code Sections 5537, 5538 and 6737 1 Principal Envelope Designer Name Russell Stout & Associates, Inc Signature Company Russell stout & Associates, Inc Date Address 4635 Cass Street License # City/State/Zip Q/ego, CA 92109 Phone 619-581-2812 Principal Mechanical Designer Name Salehi & Salehi, Inc Signaturj Company Date Address License City/State/Zip Phone 858-277-5551 Principal Lighting Designer Name Signature Company Lighting Compliance Not In The Scope Of This Submittal Date Address License # City/Sfafe/Zip Phone INSTRUCTIONS TO APPLICANT COMPLIANCE & WORKSHEETS (check box If worksheets are Included) El ENV-IC Certificate of Compliance Required on plans El MECH-IC Certificate of Compliance Required on plans • LTG-1 C Certificate of Compliance Required on plans El MECH-2C Air/Water Side/Service Hot Water & Pool Requirements • LTG-2C Lighting Controls Credit Worksheet El MECH-3C Mechanical Ventilation and Reheat • LTG-3C Indoor Lighting Power Allowance El MECH-5C Mechanical Equipment Details EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07111 17 14 ID 8115 Page 3 of 22 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 2 of 3) PERF-1 C Project Name Date Panera Bread Palomar Airport 2/7/2013 ANNUAL TDV ENERGY USE SUMMARY (kBtu/sqft-yr) Energy Component Standard Design Proposed Design Compliance Margin Heating Space Heating 0 69 0 80 -0 11 Heating Space Cooling 160 69 152 96 7 73 Cooling Indoor Fans 51 16 50 32 0 84 Fans Heat Rejection 0 00 0 00 0 00 Heat Rej Pumps & Misc 0 00 0 00 0 00 Pumps Domestic Hot Water 90 28 83 88 6 40 DHW Lighting 71 69 71 69 0 00 Lighting Receptacle 42 38 42 38 0 00 Receptacle Process 169 52 169 52 0 00 Process Process Lighting 0 00 0 00 0 00 Process Ltg TOTALS 586 40 571 55 14 85 Percent better than Standard 25% ( 36% excluding process) BUILDING COMPLIES GENERAL INFORMATION Building Orientation (NV\0 315 deg Conditioned Floor Area 3,963 sqft Number of Stones 1 Unconditioned Floor Area 0 sqft Number of Systems 3 Conditioned Footpnnt Area 3,963 sqft Number of Zones 2 Natural Gas Available On Site yes sqft Onentation Gross Area Glazing Area Glazing Ratio Front Elevation (NW) 76) sqft 2)0 sqft 276% Left Elevation (NE) 170 sqft 60 sqft 353% Rear Elevation (SE) 1,414 sqft 0 sqft 00% Right Elevation (SW) 825 sqft 134 sqft 16 2% Total 3,170 sqft 404 sqft 12 7% Roof 3,963 sqft 0 sqft 00% Standard Prescnptive Lighting Power Density Prescnptive Envelope TDV Energy ) 266 104,980 w/sqft Proposed 1 266 127,863 Prescriptive Values for W/sqft Companson only See LTG-IC for allowed LPD Remarks: CONTRACTOR MUST COMPLY ALL FENESTRA TION MUST BE CERTIFIED BY NFRC INSTALLED FENESTRATION VALUES MUST HAVE EQUAL OR LOWER U FACTOR AND SHGC CALLED OUT IN THIS CALCULATION HVAC & W/H UNITS CALLED OUT IS FOR REFERENCE ONLY INSTALLED HVAC & W/H UNITS MUST HA VE EQUAL OR HIGHER EFFECIENCY THAN SPECIFIED IN THIS CALCULA TION EnergyPro 5 1 bv EnergySoft User Number 1233 RunCode 2013-02-07T11 17 14 ID B115 Page 4 of 22 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 3 of 3) PERF-1 C Project Name Panera Bread Palomar Airport Date 2/7/2013 ZONE INFORMATION System Name Zone Name Occupancy Type Floor Area (sqft) Inst LPD (W/sf)' Ctrl Credits (W/sf)^ Allowed LPD Proc Loads (W/sf) System Name Zone Name Occupancy Type Floor Area (sqft) Inst LPD (W/sf)' Ctrl Credits (W/sf)^ Area {\N/sff Tailored (W/sf)" Proc Loads (W/sf) Kitchen Kitchen Kitchen, Food Preparation f,3)3 *f 600 6 000 Dining Dining Dining 2,650 *1 100 2 000 Notes 1 See LTG-1 C 2SeeLTG-2C 3 See LTG-3C 4 See LTG-4C (items marked with asterisk, see LTG-1-C by others) (by others) Items above require special documentation EXCEPTIONAL CONDITIONS COMPLIANCE CHECKLIST The local enforcement agency should pay special attention to the items specified in this checklist These items require special written justification and documentation, and special verification to be used with the performance approach The local enforcement agency determines the adequacy of the justifications, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted The DHW System AO SMITH BTH-199 is a non-NAECA large storage gas water heater Verify DHW details The exceptional features listed in this performance approach application have specifically been reviewed Adequate written justification and documentation for their use have been provided by the applicant Authonzed Sianature or Stamo EnergyPro 51 by EnergySoft User Number 1233 RunCode 2013-02-07711 1714 ID B115 Page 5 of 22 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION ENERGY CHECKLIST (Parti Of3) ENV-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 Project Address 2521 Palomar airport Rd #100 Carlsbad Climate Zone Total Cond Floor Area 3,963 Addition Floor Area n/a GENERAL INFORMATION Building Type El Nonresidential • High-Rise Residential • Hotel/Motel Guest Room • Schools (Public School) Relocatable Public School Bldg IZl Conditioned Spaces • Unconditioned Spaces • Skylight Area for Large Enclosed Space s 8000 ft (If checked include the ENV-4G with submittal) Phase of Construction IZl New Construction • Addition • Alteration Approach of Compliance • Component • Overall Envelope • Unconditioned (file affidavit) Front Onentation N, E, S, W or in Degrees 315 deg FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS INSULATION Tag/10 Assembly Type n < Orientation N, E, S, W U-Factor Cavity R-Value Exterior R-Value o o z c 0) e 3 UJ u. interior R-Value Interior Furring^ Joint Appendix 4 Condition Status Pass f4 is u. 1 Wall 161 (s; 0 074 R-19 4 3 1-A5 Existing • • 2 Wall 733 (s; 0 074 R-19 4 3 1-A5 Existing • • 3 Door 40 (s; 1 45C None 4 5 1-A1 Existing • • 4 Roof 1,313 (N) 0 043 R-22 4 2 1-A6 Existing • • 5 Slab 1,313 (N) 0 73C None 4 4 7-A1 Existing • • 6 Wall 310 (N) 0 074 R-19 4 3 1-A5 Existing • • 7 Wall 691 (W) 0 074 R-19 4 3 1-A5 Existing • • 8 Roof 2,650 (N) 0 032 R-30 4 2 1-A8 Existing • • 9 Slab 2,650 (N) 0 73C None 4 4 7-A1 Existing • • 10 Wall 110 (NE) 0 074 R-19 4 3 1-A5 Existing • • 1 See Instructions in the Nonresidential Compliance Manual, page 3-96 2 If Fail, then describe on Page 2 of the Inspection Checklist Form and take appropnate action to correct A fail does not meet compliance FENESTRATION SURFACE DETAILS Tag/ID Fenestration Type £ IS a> < Orientation N, E, S, W Max U-Factor U-Factor Source Max (R)SHGC SHGC Source Overhang Conditions Status Pass (5 u. 1 Windov/ 210 (N) 1 190 Default 0 830 Default • Existing • • 2 Windovif 134 (W) 1 190 Default 0 830 Default • Existing • • 3 Window 60 (NE) 1 190 Default 0 830 Default • Existing • • • • • • • • • • • • • • • • • • • • • • • 1 See Instructions in the Nonresidential Compliance Manual, page 3-96 2 If Fail then descnbe on Page 2 of the Inspection Checklist Form and take appropnate action to correct Verify building plans if necessary EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 6 of 22 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION ENERGY CHECKLIST (Part 1 of 3) ENV-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 Project Address 2527 Palomar airport Rd #100 Carlsbad Climate Zone Total Cond Floor Area 3,963 Addition Floor Area n/a GENERAL INFORMATION Building Type IZl Nonresidential • High-Rise Residential • Hotel/Motel Guest Room • Schools (Public School) • Relocatable Public School Bldg EZI Conditioned Spaces • Unconditioned Spaces • Skylight Area for Large Enclosed Space s 8000 ft (If checked include the ENV-4C with submittal) Phase of Construction IZl New Construction • Addition • Alteration Approach of Compliance • Component IZl Overall Envelope • Unconditioned (file affidavit) Front Onentation N, E, S, W or in Degrees 315 deg FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS INSULATION Tag/ID Assembly Type 0) < <U UJ 0) ^> a "T u cc o C 0) 0) 3 S<-<5 UJ > O O) c _ UJ u. DC o 1$ X "6 c C Q. c o TJ 3 U (0 10 (0 (S Q. 11 Wall 241 (N) 0 074 R-19 4 3 1-A5 Existing 12 Wall 480 (S) 0 074 R-19 4 3 1-A5 Existing • • • • 1 See Instructions in fhe Nonresidential Compliance Manual, page 3-96 2 If Fail, then descnbe on Page 2 of the Inspection Checklist Fom and take appropnate action to correct A fail does not meet compliance FENESTRATION SURFACE DETAILS Tag/ID Fenestration Type % n a> < Orientation N, E, S,W Max U-Factor U-Factor Source Max (R)SHGC SHGC Source Overhang Conditions Status Pass i2 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 See Instructions in the Nonresidential Compliance Manual, page 3-96 2 If Fail then descnbe on Page 2 of the Inspection Checklist Form and take appropnate action to correct Venfy building plans if necessary EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 7 of 22 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION ENERGY CHECKLIST (Part 2 of 3) ENV-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 ROOFING PRODUCT (COOL ROOFS) (Note if the roofing product is not CRRC certified, this compliance approach cannot be used) Go to Overall Envelope Approach or Performance Approach CHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT "COOL ROOF" REQUIREMENTS Pass Fail' N/A • Roofing compliance not required in Climate Zones 1 and16 with a Low-Sloped 2 12 pitch or less • • Roofing compliance not required in Climate Zone 1 with a Steep-Sloped with less than 5 lt)/ft' Greater than 2 12 pitch Low-sloped Wood framed roofs in Climate Zones 3 and 5 are exempted, solar reflectance and themrial emittance or SRI that have a U-factor of 0 039 or lower See Opaque Surface Details roof assembly. Column H of ENV-2C • PI Low-sloped Metal building roofs in Climate Zone 3 and 5 are exempted, solar relectance and thermal emittance or SRI '-^ that have a U-factor of 0 048 or lower See Opaque Surface Details roof assembly below. Column H of ENV-2C (-. The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempted Solar reflectance and thermal emittance or SRI, see spreadsheet calculator at www enerav ca aov/title24/ Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 Ib/ff'are exempt from the Cool Roof cntena below • |-. High-nse residential buildings and hotels and motels with low-sloped roofs in Climate Zones 1 through 9,12 and 16 are exempted from the low-sloped roofing critena 1 If Fail then descnbe on this page of the Inspection Checklist Form and take appropriate action to con-ect Verify building plans if necessary CRRC Product ID Number' Roof Slope £ 2 12 >2 12 Product Weight < 5lb/ft^ S 5lb/ft' Product Type' Aged Solar Reflectance^ Thermal Emmitance SRI^ Pass Fail^ • • • • • • • • • • • • • • • • n* • • • • • • • • • • • • • • • • • • • • 1 The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www coolroofs org/products/search php 2 Indicate the type of product is being used for the roof top, i e single-ply roof, asphalt roof, metal roof, etc 3 If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0 2+0 7(p,ni,iai - 0 2) to obtain a calculated aged value Where p is the Initial Solar Reflectance from the Cool Roof Rating Council's Rated Product Directory 4 Check box if the Aged Reflectance is a calculated value using the equation above 5 The SRI value needs to be calculated from a spreadsheet calculator at http //www enerav ca aov/title24/ 6 If Fail then describe on this page of the Inspection Checklist Form and take appropnate action to con-ect Venfy building plans if necessary To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4 Select the applicable coating • Aluminum-Pigmented Asphalt Roof Coating • Cement-Based Roof Coaling • Other Discrepancies EnergyPro 5 1 by EnerqySoft User Number 1233 RunCode. 2013-02-07711 17 14 ID B115 Page 8 of 22 CERTIFICATE OF COMPLIANCE (Part 3 of 3) AND FIELD INSPECTION ENERGY CHECKLIST ENV-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans Listed below is the acceptance test for Envelope Fenestrations system The designer is required to check the acceptance tests and list all the fenestration products that require an acceptance test If all the site-built fenestration of a certain type requires a test, list the different fenestration products and the number of systems The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual descnbes the test Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropnately Enforcement Agency: Systems Acceptance Before Occupancy Permit is granted for a newly constructed building or space or whenever new fenestration is installed in the building or space shall be certified as meeting the Acceptance Requirements The ENV-2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed In addition, a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) of Title 24 Part 6 The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy A copy of the ENV-2A for each different fenestration product line must be provided to the owner of the building for their records Test Description ENV-2A Test Performed By: Fenestration Products Name or ID Requiring Testing or Venfication Area of like Products Building Envelope Acceptance Test • • • • • • • • • • • • • • • • • • • • • • • • • • EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 9 of 22 \ CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Parti of4) MECH-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 Project Address 2527 Palomar airport Rd #100 Carlsbad Climate Zone Total Cond Floor Area 3,963 Addition Floor Area n/a GENERAL INFORMATION Building Type Q Nonresidential • High-Rise Residential • Hotel/Motel Guest Room • Schools (Public School) • Relocatable Public School Bldg 0 Conditioned Spaces Unconditioned Spaces (affidavit) Phase of Construction • New Construction • Addition • Alteration Approach of Compliance • Component Overall Envelope Energy TDV • Unconditioned (file affidavit) Front Orientation N, E, S, W or in Degrees 315 deg HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST Equipment^ Inspection Critena Meets Criteria or Requirements Equipment^ Inspection Critena Pass Fail - Describe Reason^ Item or System Tags (1 e AC-1, RTU-1, HP-1) DHW Heater • • Equipment Type^ Gas Fired DHW Boiler • • Number of Systems 1 • • Max Allowed Heating Capacity^ 199,000 Btu/hr • • Minimum Heating Efficiency^ 95% • • Max Allowed Cooling Capacity^ n/a • • Cooling Efficiency' n/a • • Duct Location/ R-Value n/a • • When duct testing is required, submit MECH-4A & MECH-4-HERS n/a • • Economizer n/a • • Thermostat n/a • • Fan Control n/a • • Equipment^ Inspection Cnteria FIELD INSPECTION ENERGY CHECKLIST Equipment^ Inspection Cnteria Pass Fail - Descnbe Reason^ Item or System Tags (1 e AC-1, RTU-1, HP-1) Kitchen • • Equipment Type^ Packaged DX • • Number of Systems 1 • • Max Allowed Heating Capacity' 60,000 Btu/hr • • Minimum Heating Efficiency' 80% AFUE • • Max Allowed Cooling Capacity' 66,380 Btu/hr • • Cooling Efficiency' 11 OEER • • Duct Location/ R-Value Attic, Ceiling Ins, vented/4 0 • • When duct testing is required, submit MECH-4A & MECH-4-HERS No • • Economizer No Economizer • • Thermostat Setback Required • • Fan Control Constant Volume • • 1 If the Actual installed equipment performance efficiency and capacity is less than the Proposed (from the energy compliance submittal or from the building plans) the responsible party shall resubmit energy compliance to include the new changes 2 For additional detailed discrepancy use Page 2 of the Inspection Checklist Form Compliance fails if a Fail box is checked 3 Indicate Equipment Type Gas (Pkg or. Split), VAV, HP (Pkg or split), Hydronic, PTAC, or other EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 10 of 22 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 1 of 4) MECH-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 Project Address 2527 Palomar airport Rd #100 Carlsbad Climate Zone Total Cond Floor Area 3,963 Addition Floor Area n/a GENERAL INFORMATION Building Type • Nonresidential • High-Rise Residential • Hotel/Motel Guest Room • Schools (Public School) • Relocatable Public School Bldg Q Conditioned Spaces Unconditioned Spaces (affidavit) Phase of Construction • New Construction • Addition • Alteration Approach of Compliance • Component Overall Envelope Energy TDV • Unconditioned (file affidavit) Front Orientation N, E, S, W or in Degrees 315 deg HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST Equipment^ Inspection Cnteria Meets Critena or Requirements Equipment^ Inspection Cnteria Pass Fail - Descnbe Reason^ Item or System Tags (1 e AC-1, RTU-1, HP-1) Dining • • Equipment Type^ Packaged DX • • Number of Systems 2 • • Max Allowed Heating Capacity' 96,000 Btu/hr • • Minimum Heating Efficiency' 80% AFUE • • Max Allowed Cooling Capacity' 91.180 Btu/hr • • Cooling Efficiency' 11 2 EER • • Duct Location/ R-Value Attic, Ceiling Ins, vented / 40 • • When duct testing is required, submit MECH-4A & MECH-4-HERS No • • Economizer No Economizer • • Thermostat Setback Required • • Fan Control Constant Volume • • Equipment^ Inspection Criteria FIELD INSPECTION ENERGY CHECKLIST Equipment^ Inspection Criteria Pass Fail - Descnbe Reason^ Item or System Tags (1 e AC-1, RTU-1, HP-1) • • Equipment Type^ • • Number of Svstems • • Max Allowed Heating Capacity' • • Minimum Heating Efficiency' • • Max Allowed Cooling Capacity' • • Cooling Efficiency' • • Duct Location/ R-Value • • When duct testing is required, submit MECH-4A & MECH-4-HERS • • Economizer • • Thermostat • • Fan Control • • 1 If the Actual installed equipment performance efficiency and capacity is less than the Proposed (from the energy compliance submittal or from the building plans) the responsible party shall resubmit energy compliance to include the new changes 2 For additional detailed discrepancy use Page 2 of the Inspection Checklist Form Compliance fails if a Fail box is checked 3 Indicate Equipment Type Gas (Pkg or, Split), VAV, HP (Pkg or split), Hydronic, PTAC, or other EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 11 of 22 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 2 Of 4) MECH-IC Project Name Panera Bread Palomar Airport Date 2/7/2013 Discrepancies: EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 12of22 , CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 3 of 4) MECH-1 C Project Name Panera Bread Palomar Airport Date 2/7/2013 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans Listed below are all the acceptance tests for mechanical systems The designer is required to check the applicable boxes by all acceptance tests that apply and listed all equipment that requires an acceptance test If all equipment of a certain type requires a test, list the equipment description and the number of systems The NA number designates the Section in the Appendix of the Nonresidential Reference /\ppendices Manual that descnbes the test Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropnately Building Departments: Systems Acceptance: Before occupancy permit is granted for a newly constructed building or space, or a new space-conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance Systems Acceptance- Before occupancy permit is granted All newly installed HVAC equipment must be tested using the Acceptance Requirements The MECH-1 C form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked The equipment requinng testing, person performing the test (Example HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be conducted The following checked-off forms are required for ALL newly installed equipment In addition a Certificate of Acceptance forms shall be submitted to the building department that certifies plans, specifications, installation, certificates, and operating and maintenance information meet the requirements of §10-103(b) and Title-24 Part 6 The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy TEST DESCRIP-nON MECH-2A MECH-3A MECH-4A MECH-5A MECH-6A MECH-7A MECH-8A MECH-9A MECH-IOA MECH-11A Equipment Requinng Testing or Venfication Qty Outdoor Ventilation For VAV & CAV Constant Volume & Single-Zone Unitary Air Distnbution Ducts Economizer Controls Demand Control Ventilation DCV Supply Fan VAV Valve Leakage Test Supply Water Temp Reset Hydronic System Vanable Flow Control Automatic Demand Shed Control TRANE YSC060 1 • • • • • • • • m TRANE VSC090 2 • m • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • EnergyPro 5 1 by EnerqySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 13 of 22 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 4 of 4) MECH-IC Project Name Date Panera Bread Palomar Airport 2/7/2013 TEST DESCRIPTION MECH-12A MECH-13A MECH-14A MECH-15A Equipment Requinng Testing Qty Fault Detection & Diagnostics for DX Units Automatic Fault Detection & Diagnostics for Air & Zone Distnbuted Energy Storage DXAC Systems Thermal Energy Storage (TES) Systems Test Performed By TRANE YSC060 1 • • • • TRANE YSC090 2 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • EnerqyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 14 of 22 AIR SYSTEM REQUIREMENTS (Part 1 of 2) MECH-2C Project Name Date Panera Bread Palomar Airport 2/7/2013 Item or System Tags (le AC-1, RTU-1, HP-1) Indicate Air Systems Type (Central, Single Zone, Packag e, VAV, or etc ) Item or System Tags (le AC-1, RTU-1, HP-1) Kitchen Dining Number of Systems 1 2 IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value Indicate Pa ge Reference on Plans or Schedule and Indicate the applicable exception(s) IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value T-24 Sections IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 112(a) 80% AFUE 80% AFUE IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 112(a) 11 OEER 11 2 EER IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 112(b), 112(c) n/a n/a IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 112(c), 115(a) n/a n/a IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 121(b) Yes Yes IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 121(b) 197 cfm 1,325 cfm IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 121(c) No No IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 121(c) No No IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 122(e) Programmable Switch Programmable Switch IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 122(e) Setback Required Setback Required IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 122(f) Auto Auto IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 122(g) n/a n/a IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 123 IVIANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC Heat Pump Thermostat Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Location/ R-value 124 Attic, Ceiling Ins, vented/4 0 Attic, Ceiling Ins, vented/4 0 PRESCRIPTIVE IVIEASURES Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(a&b) n/a n/a Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(a&b) 60,000 Btu/hr 192,000 Btu/hr Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(a& b) n/a n/a Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(a&b) 39,752 Btu/hr 175,660 Btu/hr Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(c) Constant Volume Constant Volume Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(c) Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(c) Yes Yes Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(d) No No Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(e) No Economizer No Economizer Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(f) Constant Temp Constant Temp Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(f) Constant Temp Constant Temp Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(g) Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(1) Calculated Design Heating Load Proposed Heating Capacity Calculated Design Cooling Load Proposed Cooling Capacity Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat Air Supply Reset Cool Air Supply Reset Electric Resistance Heating' Air Cooled Chiller Limitation Duct Leakage Sealing If Yes, a MECH-4-A must be submitted 144(k) No No 1 Total installed capacity (MBtu/hr) of all electric heat on this project exclusive of electnc auxiliary heat for heat pumps If electnc heat is used explain which exception(s) to §144(g) apply EnergyPro 51 by EnergySoft User Number 1233 RunCode 2013-02-07711 1714 ID B115 Page15of22 WATER SIDE SYSTEM REQUIREMENTS (Part 2 Of 2) MECH-2C Project Name Date Panera Bread Palomar Airport 2/7/2013 Item or System Tags (le AC-1, RTU-1, HP-1)' Number of Systems MANDATORY MEASURES Equipment Efficiency Pipe Insulation PRESCRIPTIVE MEASURES Cooling Tower Fan Controls Cooling Tower Flow Controls Vanable Flow System Design Chiller and Boiler Isolation CHW and HHW Reset Controls WLHP Isolation Valves VSD on CHW, CW & WLHP Pumps>5HP DP Sensor Location WATER SIDE SYSTEMS: Chillers, Towers, Boilers, Hydronic Loops T-24 Sections 112(a) 123 Indicate Page Reference on Plans or Specification' 144(a&b) 144(h) 144(h) 144(1) 144(1) 144(1) 144(1) 144(1) 1 The proposed equipment need to match the building plans schedule or specifications If a requirement is not applicable, put "N/A" in the column next to applicable section 2 For each chiller, cooling tower, boiler, and hydronic loop (or groups of similar equipment) fill m the reference to sheet number and/or specification section and paragraph number where the required features are documented If a requirement is not applicable, put "N/A" in the column next to applicable section Service Hot Water, Pool Heating Item or System Tags (le WH-1, WHP, DHW, etc )' DHW Heater Number of Systems 1 Indicate Page Reference on Plans or Schedule^ MANDATORY MEASURES T-24 Sections SERVICE HOT WATER Certified Water Heater 111, 113(a) AO SMITH BTH-199 Water Heater Efficiency 113(b) 95% Service Water Heating Installation 113(c) Controls Req Pipe Insulation 123 Required POOL AND SPA Pool and Spa Efficiency and Control 114(a) n/a Pool and Spa Installation 114(b) n/a Pool Heater - No Pilot Light 115(c) n/a Spa Heater-No Pilot Light 115(d) n/a Pipe Insulation 123 n/a 1 The Proposed equipment needs to match the building plans schedule or specifications If a requirement is nol applicable, put "N/A" in the column next lo applicable section 2 For each water healer, pool healer and domestic water loop (or groups of similar equipment) fill in the reference lo sheet number and/or specification section and paragraph number where the required features are documented If a requirement is nol applicable, put "N/A" in the column EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 16 of 22 MECHANICAL VENTILATION AND REHEAT MECH-3C Project Name Panera Bread Palomar Airport Date 2/7/2013 MECHANICAL VENTILATION (§121(b)2) REHEAT LIMITATION (§144(d)) AREA BASIS OCCUPANCY BASIS VAV MINIMUM A B C D E F G H 1 J K L M N Zone/System Condition Area (fl') CFM per ft' Mm CFM By Area BXC Number Of People CFM per Person Mm CFM by Occupant EXF REQ'D VA Max of DorG Design Ventilation Air CFM 50% of Design Zone Supply CFM BX04 CFM / ft' Max of Columns H, J, K, 300 CFM Design Minimum Air Setpoint Transfer Air Kitchen 1,313 0 15 197 197 197 Kitchen Total 197 197 Dining 2,650 0 50 1,325 1,325 1,325 Dining Total 1,325 1,325 Totals Column 1 Totai Design Ventilation Air C Minimum ventilation rate per Section §121, Table 121-A E Based on fixed seat or the greater of the expected number of occupants and 50% of the CBC occupant load for egress purposes for spaces without fixed sealing H Required Ventilation Air (REQ'D V A) is the larqer of the ventilation rales calculated on an AREA BASIS or OCCUPANCY BASIS (Column D or G) 1 Must be qreater lhan or equal lo H, or use Transfer Air (column N) lo make up the difference J Desiqn fan supply CFM (Fan CFM) x 50%, or the desiqn zone outdoor airflow rate per §121 K Condition area (11^) x 0 4 CFM / ft^, or L Maximum of Columns H, J, K, or 300 CFM M This must be less lhan or equal lo Column L and greater lhan or equal to the sum of Columns H plus N N Transfer Air must be provided where the Required Ventilation Air (Column H) is greater than the Design Minimum Air (Column M) Where required, Iransfer air must be greater than or equal to the difference between the Required Ventilation Air (Column H) and the Design Minimum Air (Column M), Column H minus M EnergyPro 5 1 by EnerqySoft User Number 1233 RunCode 2013-02-07711 1714 ID B115 Page 17 of 22 MECHANICAL EQUIPMENT DETAILS (Part 1 of 2) MECH-5C Project Name Date Panera Bread Palomar Airport 2/7/2013 CHILLER AND TOWER SUIMMARY PUMPS Equipment Name Type Qty Efficiency Tons Qty GPM BHP Pump Control DHW / BOILER SUMIVIARY System Name Type Distnbution Qty Rated Input Voi. (Gals) Energy Factor or RE Standby Loss or Pilot Tank Ext. R-Value Status AO SMITH BTH-199 Large Gas Kitchen Pipe Ins 1 f 99,000 100 0 95 4 00% n/a New lUIULTI-FAMILY CENTRAL WATER HEATING DETAILS Hot Water Pump Hot Water Piping Length (ft) Control Qty. HP Type In Plenum Outside Buned Add Vi" Insulation • • • CENTRAL SYSTEM RATINGS HEATING COOLING System Name Type Oty Output Aux kW Efficiency Output Efficiency Status TRANE YSC060 Packaged DX 1 60,000 00 80% AFUE 66,380 11 OEER New TFiANE YSC090 Packaged DX 2 96,000 00 80% AFUE 91,180 11 2 EER New CENTRAL SYSTEM FAN SUMMARY SUPPLY FAN RETURN FAN System Name Fan Type Economizer Type CFM BHP CFM BHP TRANE yscoeo Constant Volume No Economizer 1,800 0 70 none TRANE YSC090 Constant Volume No Economizer 2,400 0 82 none EnergyPro 51 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page18of22 ENVELOPE MANDATORY MEASURES: NONRESIDENTIAL ENV-MM Project Name Panera Bread Palomar Airport Date 2/7/2013 DESCRIPTION Building Envelope Measures: „ . . Installed insulating matenal shall have been certified by the manufacturer to comply with the California Quality &i B(a) Standards for insulating matenal. Title 20 Chapter 4, Article 3 All Insulating Matenals shall be installed in compliance with the flame spread rating and smoke density requirements of 8^ ^ ^'^^1 Sections 2602 and 707 of Title 24, Part 2 „ , The opaque portions of framed demising walls in nonresidential buildings shall have insulation with an installed R-value ^ ^' of no less than R-13 between framing members R^.,.,yf ^ All Exterior Joints and openings in the building that are observable sources of air leakage shall be caulked, gasketed, s weatherstripped or otherwise sealed Manufactured fenestration products and exterior doors shall have air infiltration rates not exceeding 0 3 cfm/ft ^ of §116(a) 1 window area, 0 3 cfm/ft ^ of door area for residential doors, 0 3 cfm/ft = of door area for nonresidential single doors (swinging and sliding), and 1 0 cfm/ft ^ for nonresidential double doors (swinging) §116(a) 2 Fenestration U-factor shall be rated in accordance with NFRC 100, or the applicable default U-factor f....,-, . o Fenestration SHGC shall be rated in accordance with NFRC 200, or NFRC 100 for site-built fenestration, or the 911 b(a) d applicable default SHGC S116(b) Constructed Doors, Windows and Skylights shall be caulked between the unit and the building, and shall be ^ ^ ' weatherstripped (except for unframed glass doors and fire doors) EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 19 of 22 MECHANICAL MANDATORY MEASURES: NONRESIDENTIAL MECH-MM Project Name Panera Bread Palomar Airport Date 2/7/2013 Equipment and System Efficiencies §111 Any appliance for which there is a California standard established in the Appliance Efficiency Regulations will comply with the applicable standard §115(a) Fan type central furnaces shall not have a pilot light §123 Piping, except that conveying fluids at temperatures between 60 and 105 degrees Fahrenheit, or withm HVAC equipment, shall be insulated in accordance with Standards Section 123 §124 Air handling duct systems shall be installed and insulated in compliance with Sections 601, 602, 603, 604, and 605 of the CMC Standards Controls §122(e) Each space conditioning system shall be installed with one of the following IA Each space conditioning system serving building types such as offices and manufactunng facilities (and all others not explicitly exempt from the requirements of Section 112 (d)) shall be installed with an automatic time switch with an accessible manual overnde that allows operation of the system dunng off-hours for up to 4 hours The time switch shall be capable of programming different schedules for weekdays and weekends and have program backup capabilities that prevent the loss of the device's program and time setting for at least 10 hours if power is interrupted, or IB An occupancy sensor to control the operating penod of the system, or 1C A 4-hour timer that can be manually operated to control the operating penod of the system 2 Each space conditioning system shall be installed with controls that temporanly restart and temporanly operate the system as required to maintain a setback heating and/or a setup cooling thermostat setpoint §122(g) Each space conditioning system sen/ing multiple zones with a combined conditioned floor area more than 25,000 square feet shall be provided with isolation zones Each zone shall not exceed 25,000 square feet, shall be provided with isolation devices, such as valves or dampers that allow the supply of heating or cooling to be setback or shut off independently of other isolation areas, and shall be controlled by a time control device as descnbed above §122(0) Thermostats shall have numenc setpoints in degrees Fahrenheit (F) and adjustable setpoint stops accessible only to authonzed personnel §122(b) Heat pumps shall be installed with controls to prevent electnc resistance supplementary heater operation when the heating load can be met by the heat pump alone §122(a&b) Each space conditioning system shall be controlled by an individual thermostat that responds to temperature within the zone Where used to control heating, the control shall be adjustable down to 55 degrees F or lower For cooling, the control shall be adjustable up to 85 degrees F or higher Where used tor both heating and cooling, the control shall be capable of providing a deadband of at least 5 degrees F within which the supply of heating and cooling is shut off or reduced to a minimum Ventilation §121(e) Controls shall be provided to allow outside air dampers or devices to be operated at the ventilation rates as specified on these plans §122(f) All gravity ventilating systems shall be provided with automatic or readily accessible manually operated dampers in all openings to the outside, except for combustion air openings §121(f) Ventilation System Acceptance Before an occupancy permit is granted for a newly constructed building or space, or a new ventilating system serving a building or space is operated for normal use, all ventilation systems serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance Service Water Heating Systems §113(c) Installation 3 Temperature controls for public lavatones The controls shall limit the outlet Temperature to 110° F 2 Circulating sen/ice water-heating systems shall have a control capable of automatically turning off the circulating pump when hot water is not required EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 20 of 22 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name Panera Bread Palomar Airport Date 2/7/2013 System Name Kitchen Floor Area 1,313 ENGINEERING CHECKS SYSTEM LOAD Number of Systems 1 COIL COOLING PEAK COILHTG PEAK Heating System CFM Sensible Latent CFM Sensible Output per System 60,000 Total Room Loads 1,819 32,898 15,320 271 8,126 Totai Output (Btuh) 60,000 Return Vented Lighting 0 Output (Btuh/sqft) 45 7 Return Air Ducts 1,645 406 Cooling System Return Fan 0 0 Output per System 66,380 Ventilation 197 1,498 297 197 7,601 Total Output (Btuh) 66,380 Supply Fan 2,418 -2,418 Total Output (Tons) 55 Supply Air Ducts 1,645 406 Total Output (Btuh/sqft) 50 6 Totai Output (sqft/Ton) 237 4 TOTAL SYSTEM LOAD 40,104 15,616 14,121 Air System CFM per System 1,800 HVAC EQUIPMENT SELECTION Airflow (cfm) 1,800 TRANE YSC060 39,752 29,116 60,000 Airflow (cfm/sqft) 1 37 Airflow (cfm/Ton) 325 4 Outside Air (%) 10 9% Total Adjusted System Output 39,752 29,116 60,000 Outside Air (cfm/sqft) 0 15 (Adjusted for Peak Design conditions) Note values above given at ARI conditions TIME OF SYSTEM PEAK Aug 1 PM Jan 1 AM HEATING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Heating Peak) 34 °F 66 "F Outside Air 197 cfm 70 °F A 67 "F • 1 Supply Fan Heating Coil 1,800 cfm 98 "f ROOM 70 °F _J COOLING SYSTEM PSYCHROMETICS (Airstream Temperatures at Time of Cooling Peak) 82 / 67 °F Outside Air 197 cfm 75 / 65 "f 76 / 65 °F 77 / 65 °F 56 / 55 °F Supply Fan 1,800 cfm Cooling Coil 60 0 % ROOM 57 / 56 °F 74 / 64 °F I EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID B115 Page 21 of 22 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name Panera Bread Palomar Airport Date 2/7/2013 System Name Dining Floor Area 2,650 ENGINEERING CHECKS SYSTEM LOAD Number of Systems 2 COIL COOLING PEAK COIL HTG. PEAK Heating System CFM Sensible Latent CFM Sensible Output per System 96,000 Total Room Loads 2,893 93,509 36,939 994 28,604 Totai Output (Btuh) 192,000 Return Vented Lighting 0 Output (Btuh/sqft) 72 5 Return Air Ducts 4,675 1,430 Cooling System Return Fan 0 0 Output per System 91,180 Ventilation 1,325 11,139 26,931 1,325 51,038 Total Output (Btuh) 182,360 Supply Fan 0 0 Total Output (Tons) 152 Supply Air Ducts 4,675 1,430 Total Output (Btuh/sqft) 68 8 Totai Output (sqft/Ton) 174 4 TOTAL SYSTEM LOAD 113,999 63,870 82,503 Air System CFM per System 2,400 HVAC EQUIPMENT SELECTION Airflow (cfm) 4,800 TRANE YSC090 175,660 1,105 192,000 Airflow (cfm/sqft) 1 81 Airflow (cfm/Ton) 315 9 Outside Air (%) 27 6 % Total Adjusted System Output 175,660 1,105 192,000 Outside Air (cfm/sqft) 0 50 (Adjusted for Peak Design conditions) Note values above given at ARI conditions TIME OF SYSTEM PEAK Jul 4 PM Jan 1 AM HEATING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Heating Peak) 34 °F 60 °F Outside Air 1,325 cfm 70 °F M 60 "F • 97 Supply Fan Heating Coil 4,800 cfm 97 "F ROOM 70 °F COOLING SYSTEM PSYCHROMETICS (Airstream Temperatures at Time of Cooling Peak) 83 / 68 °F 77 / 61 °F 77 / 61 °F 43 / 42 °F Outside Air 1,325 cfm 75 / 59 °F Supply Fan 4,800 cfm Cooling Coil 44 / 42"F 38 5 % ROOM I. 74 / 58 °F EnergyPro 5 1 by EnergySoft User Number 1233 RunCode 2013-02-07711 17 14 ID 8115 Page 22 of 22 GHOSTRIDER INC PH. 619-379-0735 Fax 619-367-5791 \^ E-mail, Ghostriderinc@sbcglobal net m CLIENT DATE ARCHITECT ENGINEER Sudberry Development 7/23/2013 Russell Stout & Associates 4635 Cass Street San Diego, CA 92109 Not Applicable CONTRACTOR Mappa Copstructiop LLC Any Where Any Time Around the World, Around the Cloc P.O. Box 2009 El Cajon, Ca. 92021 _ _ . ^ _ E-mail, ghostriderinc@hotmail.com ^AILY iNSPECTION REPORT] PROJECT papera Bread ' ' ADDRESS 2521 Palomar Airport Road # 100 ' . ' CITY Carlsbad, CA 92011 JOB# Ghostrider, Inc. m^^^TZ^. BUILDING PERMIT/DSA/OSHPD# CB130347 PLAN FILE # Not Applicable w.o.# 858-220-7226 INSPECTION Reinforce Concrete SAMPLES Code CBC 2012 Concrete (5) Cyl MATERIAL DESCRIPTION Concrete,PSI/PSI # 3000/3000 PSI Mix # & Ticket Robertson 300P41, # 8828344 Truck # & Time # 1296, Time 7 45 AM Concrete Temp # 78 Degrees Air Temp # 71 Degrees Slump Inches #7 00" Brake Schedule # 1(5)7, 3(5)28,1-Hold Approved Plans Available Placement Concrete Pump Consolidation Hand Tools Rebar Clearances Approved Rebar Positions Approved Rebar Sizes Approved Rebar Laps Approved REMARKS: Inspected concrete placennent on slab-on-grade on project as shown on approved drawings. Contractor placed concrete by pump and consolidated placement by hand tools. Contractor completed placement on project. Work on project is ongoing. CERTIFICATION OF COMPLIANCE To the best of our knowledge, all ofthe reported work, unless otherwise noted, substantially complies with approved plans, specifications and applicable sections of the building codes For this report to be valid it must have a final report, signed by the special inspector, stating "Fmal Report of inspection and material testing" Without a final report this document is invalid This report covers the locations of the work reported only and doesn't constitute engineering opinion or project control Time in Time out Authorization THE DEPUTYS 'tit' • ^ ' Signature. Mots otslnger A. M/.S. & I.CC & San Diego #728 This IS not a government form The Fedetal. State, Countv and City seals only signify that InspecUomare conducted under Federal. State. Countv and City Codes (2010 CBC) This document Is not used for advertising, morketlna or oromotlons This document is used to convey compliance with the Codes W G A S A Inc /Ghostrider, Inc 01-2008 Rev (17) 10/12/2011 Countp of ^an Biego JACK MILLER , DEPARTMENT OF ENVIRONMENTAL HEALTH ELIZABETH POZZEBON niRcPTno • ^ FOOD AND HOUSING DIVISION ASSISTANT DIRECTOR PO BOX 129261, SAN DIEGO, CA 92112-9261 : •> - Phone (858)505-6660 FAX (858)505-6824 ' ' " 1 (800) 253-9933 , www sdcdeh org PLAN APPROVAL SHEET DBA: Panera Bread 6/17/2013 SITE: 2521 Palomar Airport Rd, Carlsbad 92011 DEH2013-FFPP- ^ 001340 BUSSINESS OWNER: Manna Development Group LLC Plans are approved contingent upon the following 1) Department of Environmental Health (DEH) stamped plans shall be maintained at the jobsite and available for review at the time of the inspection 2) Changes to equipment layout, menu, or application must be submitted for approval Changes made without approval will make the plan approval null and void 3) Obtain local Building Department and all applicable agencies permits and approvals 4) All food and utensil-related equipment shall be certified to applicable sanitation standards by an ANSI accredited testing agency 5) Upon completion of 60%-80% of construction, call (858) 505-6660 to schedule a mid inspection In lieu of a plumbing inspection by DEH a Floor sinks shall be installed Yi exposed and equipped with an appropnate gnll cover if no access is provided for cleaning b Dram lines shall slope %" per foot to gravity, shall not exceed 15' in length and shall terminate a minimum of 1" above the floor sink with a legal air gap Dram lines shall not intercept walkways or door ways c No condensate drainage of any kind, including HVAC can dram to the mop sink d The entire floor surface must be sloped to the floor drains approximately 1/8 inch per foot or a four feet diameter depression that slopes 1 50 (approximately % inch per foot) e Conduits of all types shall be installed within walls as practicable When otherwise installed, they shall be mounted or enclosed in a chase so as to facilitate cleaning f Backflow devices shall be provided and initially tested upon installation by a certified tester 6) An air balance test shall be furnished at the time of the final inspection for all hoods 7) The operational Health Permit may be applied for after the preliminary inspection New busmess owners are encouraged to be present at the time of the final inspection 8) Owners and/or operators must pass an approved and accredited Food Safety Certification course Proof of successful completion of this course is to be furnished at the fmal inspection 9) At the time when the final inspection is requested, the facility shall have all utilities operational and all refngeration shall have an ambient air temperature of 38°F or below and shall be equipped with a thermometer accurate to +/- 2°F in the warmest section of the unit All equipment is to be in place and functional Plans reviewed by Maria Oreqel / Sergio Gracia @ (858) 505-6659 CALL (858)505-6660 AT LEAST 5 WORKING DAYS IN ADVANCE TO SCHEDULE PRELIMENARY AND FINAL INSPECTIONS A FINAL INSPECTION SHALL BE CONDUCTED AND AN ENVIRONMENTAL HEALTH PERMIT SHALL BE ISSUED PRIOR TO OPENING AND OPERATING THIS FOOD ESTABLISHMENT CC File District Inspector "Environmental and public health through leadership, partnership and — noiivways ing HVAC can dram to the mop sink he floor drains approximately 1/8 inch per foot or a 50 (approximately % inch per foot) I walls as practicable When otherwise installed, le so as to facilitate cleaning ally tested upon installation by a certified tester ofthe final inspection for all hoods • after the preliminary inspection New business of the final inspection and accredited Food Safety Certification course I be furnished at the final inspection , the facility shall have all utilities operational and all e of 38T or below and shall be equipped with a ection of the unit All equipment is to be in place and 158) 505-6659 ADVANCE TO SCHEDULE PRELIMENARY AND FINAL :D AND AN ENVIRONMENTAL HEALTH PERMIT SHALL BE tATING THIS FOOD ESTABLISHMENT. h leadership, partnership and MENDED BY CITY ORDINANCE , , _ KON 2010 CALIFORNIA MECHANICAL CODE MENDED BY CITY ORDINANCE I ' - :D ON 2010 CALIFORNIA FIRE CODE [ STANDARDS AND LOCAL AMENDMENTS ID ON 2008 TITLE 24 ENERGY REGULATIONS D ON 2010 CALIFORNIA BUILDING :-CHAPTER11 )N. P PREVIOUS USE NEW CONSTRUCTION PROPOSED USE A-2 3TI0N TYPE V-B FULLY SPRINKLERED ES 1 )YEES PER SHIFT 6 - 8 NU DRAWINGS FOR A 3,910 SF '/CAFE J J: OCCUPANT LOAD ( EXCLUDES INTERIOR & EXTERIOR WALLS ) ROOM NAME AREA OCC FAC OCC LOAD DINING VESTIBULE/PUBLIC/OFFICE KITCHEN RESTROOMS/FREEZER 1214 SF 15 81 758 SF 100 8 1362 SF 200 7 415 SF 0 (ACCESS USE) 0 TOTAL OCC LOAD 96 NUMBER OF EXITS REQUIRED TWO PER CBC TABLE 10A MIN EGRESS REQUIREMENTS NUMBER OF EXITS PROVIDED THREE COUNTY OF SAN DIEGO DEPARTMENT OF ENVIRONMENTAL HEALTH PLAN CHECK NOTICE CALL 858-505-6660 TO SCHEDULE pMlMINARY, MID AND FINAL INSPECTION IF THERE IS NO CONSTRUCTION BEGUN A^^^^^^ ?HFN'VJE^'' FROM THE OATE THE PLANS WERE APPROVED, THEN THE APKED Pl ANS WILL BE VOIDED AND NEW PLANS MUST BE RESUBMITTED FOR APPROVAL COUNTY OF SAN DIEGO DEPARTMENTOF ENVIRONMENTAL HEALTH PLAN REVIEW PROVISIONAL APPROVAL PLANS ACCEPTED FOR CONSTRUCTION SUBJECT TO THE KEGUi'^tVlti^TS OF THE STATE AND LOCAL REGULATIONS '1 Hi:s STAWP IS NO ASSURANCE THATTHE PLANS OR SPECI- F'rCAnOiJS ARE CORRECT IN EVERY RESPECT ERRORS IN DESIGN OR CONSTRUCTION IslUST BE CORRECTED BY' APPROVED SET FOR PLANS MUSTi ^Ai: I ON THE JOB SITE DURING (lONSTR , J3 ONSTRU( TION 1 SHEETS REMARKS - FAX: 530-333-2219 „ PANERA BREAD FR/ MANNA DEVELOPMENT GR 2339 11 THST. ENCINITAS, CA 92024 PHONE 760 944 1070 FAX 760 944 1703 ARCHITECT: RUSSELL STOUT & ASSOC 4635 CASS ST SAN DIEGO, CA 92109 PHONE 858 581 2812 FAX 858 272 8873 MEP ENGINEER. SALEHI & SALEHI 8360 CLAIREMONT MESA Bl SAN DIEGO, CA 92111 PHONE 858 277 5551 FAX 8582775544 LANDLORD. SUDBERRY DEVELOPMEr JOE MADDEN5465 MOREl- SAN DIEGO, CA 92121 P) 858 220 7226 F) 858 546 3009 BUILDING DEPARTME CITY CARLSBAD - DEVELC DEPT. 1635 FARADAY AVE CARLSBAD, CA 92008 P) 760-602 4610 ELECTRICAL DEPARTf CITY CARLSBAD - DEVELOi DEPT 1635 FARADAY AVE CARLSBAD, CA 92008 P 760-602-^700 F 760-602-8558 PLUMBING DEPARTME CITY CARLSBAD - DEVELOP DEPT 1635 FARADAY AVE CARLSBAD. CA 92008 P) 760-602-^700 F) 760-602-8558 MECHANICAL DEPART^ CITY CARLSBAD - DEVELOP DEPT 1635 FARADAY AVE CARLSBAD, CA 92008 P) 760-602-2700 F) 760-602-8558 FIRE DEPARTMENT COI CITY CARLSBAD - DEVELOPf DEPT 1635 FARADAY AVE CARLSBAD, CA 92008 P) 661 267 5456 HEALTH DEPARTMENT ( COUNTY OF SAN DIEGO DEP 5500 OVERLAND AVE, SUITE SAN DIEGO, CA 92123 P) 858-505-6660 INDUSTRIAL WASTE: WASTE MANAGEMENT P) (760) 929-9400 WATER DISTRICT. CARLSBAD MUNICIPAL WATEI 5950 EL CAMINO REAL CARLSBAD, CA 92008 P)760-602-2420 SEWER DISTRICT: ENCINA WASTEWATER AUTHC 6200 AVENIDA ENCINAS, CARLSBAD, CA 92011 P)760-438-3941 CONTRACTOF ITISTHERESP OF CONTF CONTRACTOR SUBS TO C ARCHITECTURAL & MEP D FOR BIDDING & CONSTRU THERE ARE ITEMS ON AR( DRAWINGS THAT CANN01 M/E/P DRAWINGS & MUST IN M/E/P SUBS BIDS FOR CONSTRUCTION IT IS OF THE CONTRACTOR & fi REVIEW & INTEGRATE AP INTO RESPECTIVE M/E/P [ IN THE EVENT OF A CONFI PRICED SOLUTION IS ALV\ CONTRACTOR TO PROVID DIRECTION AND CLARIFIC rr^b^HJE'l!!?; Deve/ooment Services <W> ELECTRICAL, Building Division ^ CITY OF R/IECHANICAL 1635 Faraday Avenue r*ADI CDAPk WORKSHEET 76O602-2719 V^MKLODAL/ g_ig www carlsbadca gov Project Address: Permit No„- Information provided bebw refers to worb being done on the above mentioned permit onV- This form must be completed ond returned to the Buildinq DMsion before the permit con be issttcdl. Building Dept Fax: (760) 602-8558 Number of neyu or relocated fixtures, traps, or floor drains ....................... 52- New building sewer line? ... .... . ... .„ ... Ves No Number of new roof drains? „ „.. . . ...... "^//^ Install/alter water Iine?.» . . . .. .. .... t\0 Number of new water heaters?.^........... ..................................... . „ ............ I Number of new, relocated or replaced gas outlets?. Number of new hose bibs? ....„ . .... „ I Residential Permitst New/expanded service: Number of new amps: Minor Remodel onfy: Ves No Commercial/Industrial: Tenant Improvemenb Number of exitting amps involved In tha p/vJeO.' 2500 fxr^^ Number of new omps involvedin thh project: ftQQ Ar^P New Construction: Amps per Panel: Single Phase ................... .. . Number of new amperes Three Riase................ ..... ... ............ Number of new amperes Three Phase 480........ ..... ... ... Number of new amperes Number of new furnaces, A/C, or heat pumps?... .............. 3 New or relocated duct worb?......... „. . . .....Ves ^ No Number of new fireplaces?.. ... Numk>er of new exhaust fans? . ......... ......... . ...... .~. (Q Relocate/install vent?, jilfL Number of new exhaust hoods?. Number of new boilers or compressors?. .... ...................... Number of HP ^ B-18 Page 1 of 1 Rev 03/09 PROJECT NUMBER CARLSBAD FIRE DEPARTMENT EXPEDITED PLAN CHECK REQUEST I, am requesting 'Expedited Plan Check Services' and understand I will be levied an additional fee assessed at the rate of $90.00 dollars per hour plus $25.00 dollars administration fee. I understand that my plans shall not be released until all fees are paid. \, Your Name appHcant, am solely responsible for ail fees due should the project be withdrawn or otherwise not completed. And by signing below I acknowledge that my plans shall be iForwarded by the City of Carlsbad to an independent contractor/consultant. Your Name I, acknowledge that the 'first review' time for all expedited Fire plan reviews will be ten- (10) business days from date of submittal. These additional day account for acceptance and delivery of your plans and then the parcel return to our office if recommended for approval. Your Name I, the applicant, acknowledges that corrected or revised plans shall be sent directiv to the plan checker, at the address specified on the Correction List, at my cost, parcel post or other means. , acknowledge that a turn-around time for re-submittals is five- (5) business days from the date plans are received at the address specified by the plan checker on the Correction List. Once ali corrections are made, your plans are then returned to the Carlsbad Fire Department with a "Recommendation for Approval" based solely on the adopted Codes and Standards. This is not an aoproval. Your plans are then forwarded to the Carlsbad Fire Department, and once your plans are received by our office they are subject to an additional review to ensure conformance with Carlsbad Municipal Code. This additional review is subject to an additionai review period of seven- (7) 'Government Business' days from date that we receive the plans from the plan reviewer. The Carlsbad Fire Department does not perform 'Over-the-counter' plan review services. Plans submitted to the Carlsbad Fire Department for review by CFD staff shall be checked on a 'first come, first served' basis and could take 10 days or more for 'First' review. ^-^-'r-^ YES /^ NO ) PLEASE CIRCLE YOUR SELEaiON Applicant Signature N,—•—>r Date_ Copy to Building and Fire Prevention file Revised 06/13/2011 INDUSTRIAL WASTEWATER DISCHARGE PERI , , SCREENING SURVEY Business Name Street Address Email Address VT/^ ^ r?/^ GtTTV m (96- • Ooor\ PLEASE CHECK HERE IF YOUR BUSINESS IS EXEIVIPT {ON REVERSE SIDE CHECK TYPE OF BUSINESS) [ [ Check all below that are present at your facility Acid Cleaning Assembly Automotive Repair Battery Manufacturing Biofuel Manufacturing Biotech Laboratory Bulk Chemical Storage Car Wash Chemical Manufacturing Chemical Punfication Dry Cleaning Electncal Component Manufactunng Fertilizer Manufacturing Film / X-ray Processing Food Processing Glass Manufacturing Industnal Laundry Ink Manufactunng Laboratory Machining / Milling Manufactunng Membrane Manufactunng (i.e. water filter membranes) Metal Casting /'Fonning Metal Fabncation Metal Finishing Electroplating Electroless plating Anodizing Coating (i e phosphating) Chemical Etching / Milling Printed Circuit Board Manufacturing Metal Powders Forming Nutritional Supplement / Vitamin Manufactunng Painting / Finishing Paint Manufacturing Personal Care Products Manufacturing Pesticide Manufactunng / Packaging Pharmaceutical Manufactunng (including precursors) Porcelain Enameling Power Generation Print Shop Research and Development Rubber Manufactunng Semiconductor Manufacturing Soap / Detergent Manufactunng Waste Treatment / Storage SIC Code{s) (if known) Bnef description of business activities (Production / Manufactunng Operations) MA dr\^^ ^ ^p./x\ad^ , scvpg? nX\rX Cdf^r-^jz^ Descnption of operations generating wa^water (discharged to sewer, hayled or evaporated). Estimated volume of industrial wastewater to be discharged (gal/day). List hazardous wastes generated (type / volume) ^ IK Date operation began/or will begin at this location. _, Have you apDijed for a Wastewater Discharge Permit from the Enema Wastewater Authority? Yes Wo) If yes, when Site Contact Y.\(M/^A k\\i!MJIkJJ)r Title f/jYi^-tiA/r/H^ r/Vi^uiAf^---^ Signature ENCINA WASTEWATER A? Y, 6200 Avenida Enemas Carlsbad, CA 92011 (760)438-3941 FAX. (760)476-9852 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE / / Business Name p^j^^ Busi^js^ntac^ A\IUA;^ Telephone # ' \Olo y 3^2- Pro^eclAclclress^^^j ^^^^ ^- C^, ^ ^^^^^ S.a^ Zip Code APN# Mailing Address ' City v - State ZiDCode^ _ Plan File# Project Contact Telephone # (?<5g^ The following questions represent the facility's activities, NOT the specific project description PART I FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION OCCUPANCY CLASSIFICATION Indicate by circling the item, whether your business will use, process, or store any of the following hazardous matenals If any of the items are circled, applicant must contact the Fire Protection Agency with junsdiction prior to plan submittal Facility's Square Footage (including proposed project) '^''\ lO Occupancy Rating N/A ^ HZKAJ ^\)\\ci\wy 1 Explosive or Blasting Agents 5 Organic Peroxides 9 Water Reactives 13 Corrosives pfjpo^^ ' " 2 Compressed Gases 6 Oxidizers 10 Cryogenics 14 Other Health Hazsfrds 3 Flammable/Combustible Liquids 7 Pyrophoncs 11 Highly Toxic or Toxic Materials ^>^None of These A-Z 4 Flammable Solids 8 Unstable Reactives 12 Radioactives PART II SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD) If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Matenals Division, 5500 Overland Ave , Suite 110, San Diego, CA 92123 Call (858) 505-6700 pnor to the issuance of a building permit ^ I I / ^ Expected Date of Occupancv "7 / I ''-^ FEES ARE REQUIRED Project Completion Date / • CalARP Exempt I Date Initials • CalARP Required / Date Initials • CalARP Complete I Date Initials YES NO (for new construction or remodeling projects) 1 • 'Kl Is your business listed on the reverse side of this form' (check all that apply) 2 • IS Will your business dispose of Hazardous Substances or Medical Waste in any amounf 3 • 13- 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 • 13- Will your business use an existing or install an underground storage tank' 5 • Will your busmess store or handle Regulated Substances (CalARP)' 6 • "Sl. Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)' 7 • K]^ 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) PART HI 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 pnor 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 fonn 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 • ^ 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 oro/info/facts/permits pdf, and the list of typical equipment requinng an APCD permit on the reverse side of this from Contact APCD if you have any questions) (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 //www cde ca qov/re/sd/ for public and pnvate schools or contact the appropnate school distnct) Has a survey been performed to determine the presence of Asbestos Containing Matenals' Will there be renovation that involves handling of any fnable asbestos matenals, or disturbing any matenal that contains non-fnable asbestos' Will there be demolition involving the removal of a load supporting structural member' • • • • Bnefly descnbe business activities I declare under penaltstfof perjury that to tfte best of my knowledge and belief the Name of Owner or Authonzed Agent Bnefly describe proposed project A rQer.,^r,ooo '•gTigfem apc true and correct Signaiure^f r or Authorized Agent Date FIRE DEPARTMENT OCCUPANCY CLASSIFICATION . BY FOR OFFICIAL USE ONLY 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-HMD APCD HM-9171 (02/11) County of San Diego - DEH - Hazardous Matenals Division CB130347 2521 PALOMAR AIRPORT RD 100 -ii~Ar-i o run cC cuci I ,Zll3-jt^ TO puvo| e'lO'/(=1*2-1= yesoHL uo/gAe^gy iiSLccs a|i3|i% Pu^^f-^i • cv Final Insp Approved Date By BUILDING Pm PLANNING C>l<5li3> ENGINEERING //-) AO FIRE Expedite? Y(N) (LUJ AFS Checked by HazMat APCD Health Forms/Fees Sent Reed Due? By Enema Y N Fire Y N HazHealthAPCD Y N PE&M «a{iav(3» Y N School Y N Sewer Y N Stormwater Y N Special Inspection Y N CFoC^r^ CFoC^r^ Annex Factor PFF ^Vj N Comments Date Date Date Date Building ^2./2.f/l5 Planning Engineering Fire Need? r i^ioTrcucxBr* \iS)pn • Done • Done • Done • Done • Done SW • Issued