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Home My WebLink About2525 El Camino Real; K206; CBC2017-0162; PermitCommercial Permit Print Date: 06/24/2019 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2525 El Camino Real, K206 BLDG-Commercial 1563020900 $ 42,990.00 Work Class: Tenant Improvement Lot#: Reference#: Construction Type Bathrooms: Orig. Plan Check#: Plan Check#: {city of Carlsbad Permit No: CBC2017-0162 Status: Closed -Expired Applied: 04/05/2017 Issued: 07/18/2017 Permit Finaled: Inspector: MColl Final Inspection: Description: WETZEL'S PRETZELS: 220 SF PREFABRICATED KIOSK FOR FOOD RETAIL NEW EQUIP/NEW LIGHTING/ PLUMBING Applicant: STARR DE LA CRUZ 2537 D Pacific Coast Highway, 113 TORRANCE, CA 90505 310-606-2078 xllO FEE BUILDING PERMIT FEE $2000+ BUILDING PLAN CHECK FEE (BLDG) Owner: R P I CARLSBAD LP 1114 Avenue OfThe Americas, Floor 45 New York, NY 10036-7700 214-660-5232 x215232 ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL SB1473 BUILDING STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $ 716.08 Total Payments To Date : $ 716.08 Balance Due: AMOUNT $361.20 $252.84 $43.00 $45.00 $2.00 $12.04 $0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees /exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees /exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Building Division 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov .. THE FOLL"--lVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING {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 Est. Value Plan Ck. Deposit Date JOBADDRESS6lS9 s b l Caf1\.MO ~ TE NT BUSINESS NAME t CT/PROJECT# LOT# PHASE# # OF UNITS # BEDROOMS # BA wrlz.eJ s B-~ oesc.,PTI~.;zo•=~:p:•FF-l+tb•~tJq/ KLo~ 1c_ cd ~hoppes tt¾-ui,y-\6bq_d <iJv £A ne:--> ? ~ -t-,,-ei shop. ~e w e1u1 pn-e.J-J ruw U sn:Jin~, mtnoYL-~c..ha n\o..Q OCC. GROUP EXISTING USE PROPOSED USE GARAGE {SF) PATIOS (SF) DECKS (SF) FIREPLACE vesO AIR CONDITIONING NO□ YES □No □ FIRE SPRINKLERS YESON0O APPLICANT NAME PROPERTY OWNER NAME ADDRESt?ads ll.ol (Sec .. 7031.5 Business ~nd P_rofes~ions Code: Any City or Cqun_ty which requires a permit to.construct, alter, improve, qemolish or repair any structure, p_rior to its issuance, also requires the applicant for such permit to file a signed statement that he 1s licensed pursuant to the prov1s1ons of the Contractor's License Law /Chapter 9, commend1ngw1th Section 7000 of Division 3 of the Business and Professions Code} or that he is exem_P.t therefrom, and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}). WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: B I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the perfor~ of the ~k for which this permit is issued. My workers' compensa · insurance carrier and policy number are: Insurance Co~ ,fo;zj)C) Policy No1Gb575C-, Expirahon Date _J,:;..>_:_~----1:_-_LJL--- This section need not be completed if the permit is for one hundred dollars ($100) or less D Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages as provided for I ection 3706 of the Labor code, interest and attorney's fees. ,I$ CONTRACTOR SIGNATURE r- I hereby affirm that I am exempt from Contractor's License Law for the following reason: □ □ □ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are 1101 intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with conlractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Section ____ ,Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. OYes Oo 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address I phone/ contractors' license number): 4, l plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address/ phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone I type of work): HS PROPERTY OWNER SIGNATURE □AGENT DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Pres!ey-T anner Hazardous Substance Account Act? Yes No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Yes No Is the facility to be constructed within 1,000 feet of ttle outer boundary of a school site? Yes No 1 IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the above information lscoll'eCf.and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to bulldlngconstructlon. I hereby authcxize representative of the Cly of Carlsbad to enter upon the alxwe mentioned prupertyfar inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILrTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is requred for excavations (1,Jef 5'0' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by Imitation and become null and void if the building orworK authorized by sudl permit is not commenced within 180 days from the date of such permit or if the b ilding oc authorized by such permit is sus or abandoned at any time after the work is commenced for peood of 180 days {Section 106.4.4 Unifoon Building Code). A5 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 building@carlsbadca.gov or Mail the completed form to City of cansbad, Building Division 1635 Faraday Avenue, Cansbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. UC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (Listed above) CONTRACTOR (On Pg. 1) OCCUPANT (Listed above) MAIL/ FAX TO OTHER: _______________ _ AS° APPLICANT'S SIGNATURE ASSOCIATED CB#------------ NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION DATE ZIP January 19, 2018 Owner/Tenant 2525 EL CAMINO REAL, Suite K206 Carlsbad CA 92008 (city of Carlsbad PERMIT NUMBER: CBC2017-0162 RE: BUILDING PERMIT EXPIRATION ISSUE DATE: 07/18/2017 PERMIT TYPE: BLDG-Commercial, Tenant Improvement ADDRESS: 2525 EL CAMINO REAL, Suite K206 Our records indicate that your building permit will expire by limitation of time on 02/19/2018. 18.04.030 Section 105.S amended -Expiration: Every permit issued by the Building Official under the provisions of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 calendar days from the date of such permit, or if the building or work authorized by such permit is stopped at any time after the work is commenced for a period of 180 calendar days, or if the building or work authorized by such permit exceeds three calendar years from the issuance date of the permit. Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work authorized by the permit by the Building Official within 180 calendar days of the date of permit issuance. Work shall be presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building Official within each 180 day period upon the initial commencement of work authorized by such permit. Before such work can be recommenced, a new permit shall be obtained to do so, and the fee therefore shall be one half the amount required for a new permit for such work, and provided that no changes have been made or will be made in the original plans and specifications for such work, and provided further that such suspension or abandonment has not exceeded one year. In order to renew action on a permit after expiration, the permittee shall pay a new permit fee. Any permittee holding an unexpired permit may apply for an extension of time within which work may commence under that permit when the permittee is unable to commence work within the time period required by this section for good and satisfactory reasons. Please check below indicating your intentions and return this letter to us. 0 Project abandoned. A new permit will be obtained prior to commencing work. 0 Permit 180 day extension request, with written explanation including phone number and email address. Request will not be considered without explanation D Renewal permit requested. If the project has been completed and only a final inspection is needed, please call the inspection request line at (760) 602-2725. If you have any questions, please contact the Building Inspection Division at 760-602-2700. Community & Economic Development Building Division I 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov PERMIT INSPECTION HISTORY REPORT (CBC2017-0162) Permit Type: BLDG-Commercial Application Date: 04/05/2017 Owner: R P I CARLSBAD LP Work Class: Tenant Improvement Issue Date: 07/18/2017 Subdivision: CARLSBAD TCT#76-18 Status: Closed -Expired Expiration Date: 03/06/2018 Address: 2525 El Camino Real , K206 Carlsbad, CA 92008 IVR Number: 2937 Scheduled Actual Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete Date Start Date 08/11/2017 08/11/2017 BLDG-21 031471-2017 Cancelled Paul Burnette Relnspection Complete Underground/Underf loor Plumbing Checklist Item COMMENTS Passed BLDG-Building Deficiency No 08/15/2017 08/15/2017 BLDG-21 031570-2017 Passed Michael Collins Complete Underground/Underf loor Plumbing Checklist Item COMMENTS Passed BLDG-Building Deficiency Waste to POC, need VTR completion(WT) Yes 08/21/2017 08/21/2017 BLDG-24 032288-2017 Passed Michael Collins Complete Rough/Topout Checklist Item COMMENTS Passed BLDG-Building Deficiency South wall only. Yes BLDG-34 Rough 032289-2017 Passed Michael Collins Complete Electrical Checklist Item COMMENTS Passed BLDG-Building Deficiency South wall only. Yes 08/28/2017 08/28/2017 BLDG-Final 032911-2017 Failed Michael Collins Relnspection Complete Inspection Checklist Item COMMENTS Passed BLDG-Building Deficiency No 09/06/2017 09/06/2017 BLDG-Final 033581-2017 Failed Michael Collins Relnspectlon Complete Inspection Checklist Item COMMENTS Passed BLDG-Building Deficiency See card No Checklist Item COMMENTS Passed BLDG-Building Deficiency See card No BLDG-Plumbing Final No BLDG-Electrical Final No 09/07/2017 09/07/2017 BLDG-Final 033912-2017 Partial Pass Michael Collins Relnspectlon Incomplete Inspection Checklist Item COMMENTS Passed BLDG-Building Deficiency Ok to occupy kiosk. Need final inspection Yes when main electrical service is complete. BLDG-Building Deficiency See card No June 28, 2019 Page 1 of 1 City of Carlsbad CBC2017-0162 5/26/2017 EsGil Corporation In <Partnersfiip witfi (jovernment for <Bui(ain9 Safety DATE: 5/26/2017 JURISDICTION: City of Carlsbad PLAN CHECK NO.: CBC2017-0162 PROJECT ADDRESS: 2525 El Camino Real SET: II PROJECT NAME: Prefabric:ated Kiosk for "Westzel's Pretzels" □ APPLICANT ~JURIS. □ PLAN REVIEWER □ FILE ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's Building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. 0 The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: ~ EsGil Corporation staff did not advise the applicant that the plan check has been completed. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: di Telephone#: Date contacted: ~ (by:J)f) Email: Mail Telephone Fax In Person 0 REMARKS: By: Morteza Beheshti EsGil Corporation D GA D EJ D MB D PC Enclosures: 5/18 EsGil Corporation In a?artnersnip witn (}overnmentfor<Builaing Safety DATE: 04/17/2017 JURISDICTION: City of Carlsbad PLAN CHECK NO.: CBC2017-0162 PROJECT ADDRESS: 2525 El Camino Real SET: I PROJECT NAME: Prefabricated Kiosk for "Westzel's Pretzels" □ APPLICANT ~URIS. □ PLAN REVIEWER □ FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. ~ The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: D EsGil Corporation staff did not advise the applicant that the plan check has been completed. ~ EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Starr De La Cruz Telephone#: 310-606-2078X110 k.ate col)tactedA'f \-=t-(by:(\(...L Email: starr@permitsdirect.com \-::'..Mail /Telephone Fax In Person 0 REMARKS: By: Sergio Azuela EsGil Corporation □ GA □ EJ □ MB □ PC Enclosures: 04/06/2017 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 City of Carlsbad CBC2017-0162 04/17/2017 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: CBC2017-0162 OCCUPANCY: M TYPE OF CONSTRUCTION: ALLOWABLE FLOOR AREA: SPRINKLERS?: REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 04/05/2017 DATE INITIAL PLAN REVIEW COMPLETED: 04/17/2017 FOREWORD (PLEASE READ): JURISDICTION: City of Carlsbad USE: Retail Store ACTUAL AREA: 220 SF (TI area only) STORIES: 2 (Mall) HEIGHT: OCCUPANT LOAD: 3 DATE PLANS RECEIVED BY ESGIL CORPORATION: 04/06/2017 PLAN REVIEWER: Sergio Azuela 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, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 2016 CBC, which adopts the 2015 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 2015 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 CBC2017-0162 04/17/2017 • GENERAL 1. Please make all corrections, as requested in the correction list. Submit FOUR new complete sets of plans for commercial/industrial projects (THREE 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, Engineering and Fire Departments. 2. Bring TWO 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, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil Corporation is complete. 2. Provide a statement on the Title Sheet of the plans, stating that this project shall comply with the 2016 California Building Code, which adopts the 2015 IBC, 2015 UMC, 2015 UPC and the 2014 NEC. Revise the plans to show the applicable code information on sheet K1 .1 3. Provide the UL listing and manufacturer's installation information for thel new PIZZA AND PRETTZEL OVEN equipment to be installed. Show all electrical requirements, plumbing requirements, exhaust or mechanical requirements, operational weight, anchorage and seismic restraints if required etc. Section 107.2. 4. Section 402.10.1 combustible construction shall not be located in a covered mall unless constructed of any of the following materials. a) Fire-retardant treated wood complying with Section 2303.2. b) Foam plastics having a maximum heat release rate not greater than 100kW when tested in accordance with the exhibit booth protocol in UL 1975. c) Aluminum composite material having a flame spread index of not more than 25 and a smoke developed index of not more than 450 when tested as an assembly in the maximum thickness intended for use in accordance with ASTM E 84. City of Carlsbad CBC2017-0162 0A-/17/2017 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: Sergio Azuela PLAN CHECK NO.: CBC2017-0162 DATE: 04/17/2017 BUILDING ADDRESS: 2525 El Camino Real BUILDING OCCUPANCY: M BUILDING AREA PORTION ( Sq. Ft.) New Kiosk 220 Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb ----.·-------- Bid . Permit Fee b Ordinance g y • --------------·---=-i ~_Ian C~~~k_Fee by_Ord_in~nce ·-'!J Valuation Multiplier By Ordinance Reg. VALUE ($) Mod. 42,990 42,990 Type of Review: Complete Review D Structural Only D Repetitive Fee -··. •J Repeats D Other D Hourly EsGil Fee 1-------11 Hr. @ • Comments: NA In addition to the above fee, an additional fee of $ $ /hr.) for the CalGreen review. $202.551 is due ( hour@ Sheet 1 of 1 macvalue.doc + llCouJtl o~ :mtego DEPARTMENT OF ENVIRONMENTAL HEAL TH ,~·\j'E-J)FOOD AND HOUSING DIVISION ~.c1:::.\ www.sdcdeh.org ~'ii;,.~~\.\.% 1Jtt.~-~:</~HECK APPLICATION SAN DIEGO OFFICE • (/·SAN:MARCOS OFFICE MAILING ADDRESS 5500 OVERLAND AVE# 110, ".( C< .. ·,, '.151 E. CARMEL ST. P.O. BOX 129261 SAN DIEGO, CA 92123 (,i°'-.•\ \'' .. SAN MARCOS, CA 92078 SAN DIEGO, CA 92112 (858) 505-6660 <;>\.: ·· (760) 471-0730 FAX (858) 467-9282 FOOD FACILITY BUSINESS AND CONTACT INFORMATION '< A,• .. •--... ..... ___ _ -OFFICE USE ONLY 'l:7t;:\1--Z,.,\'l --!"rfl' .. PC Record #: PO 7°1 'i 7 Intake Date: '1 / 3 // 7 Payment Type: 1 r1 LO ~EW FOOD FACILITY O REMODEL CURRENT PERMIT □CONSULT-NEW/ □CONSULTATION □REVISION □BODY ART CHANGE OF OWNER CURRENT PERMIT Facility Name: ?_e_ '5 rt t7e \) Assessor's Parcel No.:.-,-____ _ Facility/ Commissary Address: 62'$d-5 £/ (C/rntrz:d f?taQ -#K:JplcJ City:f!l!.lY-/Jh(IJ Zip: 9,Z.bb,Y BUSINESS OWNER: Name: :run {Z) CA1_o. Company:·----------~~-- Mailing Address: q(Jq Rflk. A:12£ DI<. Citv-SOO Mart¢ State:Ot Zip: 9::/.()'1. · Phone: r7UQ iYl1• /&OS Fax:< 310 i {JOfR, 'J.011 E-Mail: , ,a TzJl.lflrJ;)"f €r.Jo,fl@, VETERANS MAY QUALIFY FOR FEE EXEMPTION (complete additional application for consideration) 0 Yes, I am a Ve,an. FOR PERMANENT FOOD FACILITIES Total Square Feet of Facility: ..,:::"'-Cl!....J;_,,. __ Total# Slaff:.&..___ Max. # of Employees per Shift: 1-1 O D 11-25D26-1oo□100+ Projected # Meals to be Served: __ Break unch __ Dinner es □No; If yes indicate location o I Food Court? □Yes o--lf so Enclosed □Yes D No SEWER: ublic-DSeptic/ Private WATER: ~ublic-DWell/ Private (If private contact Land Use at (858) 565-5173) Identify the municipal water and wastewater district(s) ______________________ _ DEH:J:H~J77 (Rev. 01/15) FOOD & HOUSING DIVl~ION -PLAN CHECK P-1 FOOD FACILIIY ONLY IND/CA TE THE SERVICES OR TYPE OF FOOD FACILITY PROVIDED (Check all that apply) O Restaurant/Deli O Market-Packaged O Market-Pre~Catering O School-Preparation Kitchen O School Satellite Site O Licensed Health Care O Boat O Retail Processing inimal Food (frozen ice cream dipping, hot dogs, beverages)~ O Commissary-For Food Prep□ Commissary-For Pac aged Food or Vending Machine HQ O Wholesale Warehouse 0 Packaged Non-Potentially Hazard Food D Food Delivery Service O Catering Equipment Rental O Swap Meet Vendor MOBILE E POP FACILITY ONLY MOBILE FOOD CART:□ PACKAGED FOOD OR PRODUCE ONLY O LIMITED FOOD PREPARATION (LFP) Up To 4 Carts May Operate at a SINGLE SITE O -Number of LPF Carts. ____ Number of Packaged Carts ___ _ MOBILE SUPPORT UNIT FOR CART REPORTS TO COMMISSARY: 0 MOBILE FOOD TRUCKNEHICLE ONLY: 0 Packaged/Produce O Limited Food Prep (LFP) 0 Full Food Prep MOBILE FOOD FACILITIES MUST SUBMIT COMMISSARY AGREEMENT LETTER (TOILET FACILITY LETTER IF APPLICABLE) NOTE: ALL FOOD FACILITIES INCLUDING MOBILES MUST SUBMIT MENUS WITH APPL/CATION BODY ABT FACILITY ONLY IND/CA TE THE SERVICES YOU WILL BE PROVIDING (Check all that apply) 0 Tattooing O Permanent Cosmetics O Body Piercing O Branding O Mobile Vehicle INFECTION PREVENTION & CONTROL PLAN (/PCP) TO BE SUBMITTED FOR REVIEW PRIOR TO OPERA TING OTHER AGENCIES:□ BLDG DEPARTMENT □ FIRE DEPARTMENT □ZONING □ WATER/WASTEWATER DISTRICTS □ APCD □ DEH-LWQ (Note: If you are the sole business owner and an honorably discharged veteran you may be eligible for a fee exemption.) I declare under penalty of perjury that to the best of my knowledge and belief, the description of use and information contained on this application and plans are correct and true. I hereby consent to all necessary inspections made pursuant to law and incidental to the issuance of this review and the operation of this business. I also agree to conform to all conditions, orders, and directions, issued pursuant to the California Health and Safety Code, and all applicable County and City Ordinances. I understand that if the plans are incomplete due to a lack of any of the required information, the plans will be rejected and upon resubmission, a plan recheck fee will be charged. I am aware that plan check fees are not fully refundable and that plans, once reviewed, will be picked up within 60 days or they will be discarded. Plans are valid for one year after stamp. Any changes to the released documents will be submitted and filed with the County of San Diego, Department of Environment Health. Authorized Signatur~ ~ Date: Lf/8 /l ] Print Name and Title Here: (For office use only) PLAN CHECK #/: ________ PERMIT TYPE: _________ CENSUS TRACT: ____ _ ASSIGNED TO: ROUTE CODE: ____ _ PLAN STATUSOAPPROVED O DISAPPROVE BLUE TAG;PC INITIALS _....1...,,__REVIEW DATE -'-'t/...1.-=~!.._- RECHECK STATUS ~PPROVED0DISAPPROVED0BLUE TAG; PC INITIALS /1'1 L RECHECK DATE _ _,__,__ Comments T. DATE APPROVED ______ _ DEH:FH-177 (Rev. 01/15) FOOD & HOUSING DIVISION -PLAN CHECK P-2 ' SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE .) Business Contact un C.>no OFFICE USE ONLY RECORD ID# __________________ , PLAN CHECK# __________________ , BP DATE Telephone#7 loo. LJ 1 9. );;::ios Zip Code APN# oog 15/o, o2.;;J.7•oo Plan File# The follo · questions represent th facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects within the City of San Diego): Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Facility's Square Footage (including proposed project): 13. Corrosives 1. Explosive or Blasting Agents 2. Compressed Gases 3. Flammable/Combustible Liquids 5. Organic Peroxides 9. Water Reactives 6. Oxidizers 10. Cryogenics 7. Pyrophorics 11. Highly Toxic or Toxic Materials 14. Other Health Hazards @None ofThese. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMO): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building pennit. FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: □ CalARP Exempt I YBDES ' (for new construction or remodeling projects) 1. Is your business listed on the reverse side of this form? (check all that apply). 2. Will your business dispose of Hazardous Substances or Medical Waste in any amount? Date Initials 3. Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 □ CalARP Required I 4. 5. 6. 7. 8. □ □ □ □ □ pounds and/or 200 cubic feet? I Will your business store or handle carcinogens/reproductive toxins in any quantity? Will your business use an existing or install an underground storage tank? Will your business store or handle Regulated Substances (CalARP)? Will your business use or install a Hazardous Waste Tank System (Title 22, Article 1 O)? Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or reater than 1,320 allons? California's Above round Petroleum Stora e Act . Date Initials □ CalARP Complete I Date Initials PART 111: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT CAPCDl: Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San Diego, CA 92131 apcdcomp@sdcounty.ca.gov (858) 586-2650). [*No stamp required if 01 Yes and Q3 Yes and 04-06 No]. The following questions are intended to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive requirements contact APCD. Residences are typically exempt, except -those with more than one building+ on the property; single buildings with more than four dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. [+Excludes garages & small outbuildings.] YES N 1. 2. 3. 4. 5. 6. □ □ □ □ □ □ Briefly d r Will the project disturb 160 square feet or more of existing building materials? Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance Technician? (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification may be required 10 working days prior to commencing asbestos removal. Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet (www.sdapcd.org/info/facts/permits.pdf) for typical equipment requiring an APCD permit. (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bounda tz_v\f. and correct. it ,s 1(7 Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ________________________________ _ BY· DATE· I I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO* APCD COUNTY-HMO APCD COUNTY-HMO APCD *A stamp in this box only exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other permitting requirements may still apply. HM-9171 (08115) County of San Diego -DEH -Hazardous Materials Division