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Home My WebLink About2525 El Camino Real; 218; CBC2017-0629; Permit( City of Carlsbad Commercial Permit Print Date: 06/07/2018 Permit No: CBC2017-0629 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2525 El Camino Real, 218 BLDG-Commercial 1563020900 $64,849.44 Work Class: Tenant Improvement Lot#: Reference#: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Description: GRUBBYS POKE & FISH MART: 1,002 SF T.I. SHELL TO RESTAURANT Applicant: Owner: STEPHEN RAY R Pt CARLSBAD LP 4041 Bonita Rd, Ste B Bonita, CA 91902-1350 619-361-1331 1114 Avenue Of The Americas, Floor 45 New York, NY 10036-7700 214-660-5232 x215232 BUILDING PERMIT FEE ($2000+) BUI LOI NG PLAN CHECK FEE (BLDG) ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL FIRE A-2 & A-3 Occupancies -Tl MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL PLUMBING BLDG COMMERCIAL NEW/ADDITION/REMODEL PUBLIC FACILITIES FEES -outside CFO 581473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $3,879.06 Total Payments To Date: $3,879.06 Status: Applied: Issued: Permit Finaled: Inspector: Fina! Inspection: Contractor: STEPHEN J DIEHL Po Box 1293 SPRING VALLEY, CA 91979 619-670-6717 Balance Due: 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. Closed -Finaled 12/01/2017 02/16/2018 MColl 6/7/2018 1:52:56PM $0.00 $472.45 $330.72 $60.00 $609.00 $45.00 $71.00 $2,269.73 $3.00 $18.16 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov fHE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: Ccityof Carlsbad JOB ADDRESS CT/PROJECT# LOT# 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 SW PPP -ro G XISTI AJC--t vA;-c.-J>,i01 spA-c,6, ;.../cw ;.1P1/:::,JXWcW~ tJA-tt<:,, k..1m-,€J,,/{;'.'Qffa1 r:: M GC/4,/1c,_,4, {,, , 'x/0 G;XTl:Jt.CtOIC t,Jdi.LIC" /,.a)2 EXISTING USE GARAGE (SF) PATIOS (SF) DECKS (SF) PROPERTY OWNER NAME FAX~!, (Sec, 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair an)'. structure, prior to its issuance, also requires the apphcant for such permit to file a signed statement that he is hcensed pursuant to the provisions of the Contractor's License Law fChapter 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 1031.5 t:Jy 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 heteby affirm under penalty of perjury one of the following declarations: Q have and will maintain a certificate of consent to self-Insure for IMlrkers' compensation as provided by Section 3700 of the Labor Code, for the performance of the YJOr1i: for which this pelTTlit is issued. (gl I have and will maintain workers' cpmpit~ond.5 ~iu,~RY ~~·37~?' th! ~r ~· for the perfonnance of the wor1i: for which this pelTTlit is issued. My wor1i:ers' compens~tt;i :~urance carrier and ~I icy number ara: Insurance Co. N (> ~{).) .J~ Ci). Pol<Y No. filWC. 'b32.'.I O\ Expiration Date ~q!LJ'ft.c2u.lJ,.,/8"----- ]!!.m.section need not be completed if the permit is for one hundred dollars ($100) or less. LJ Certificate of Exemption: I certify that in the perfonnance of the YJOr1i: for which this pennl! is issued, I shall not employ any person ln any manner so as to become subject to the Wor1i:ers' Compensation Laws of California. WARNING: Fallure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and clvll fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, dama 'ded for In ~ 37 of the Labor code, Interest and attorney's fees. I ,. ,If$ CONTRACTORSlGNATURE i-Ile 2.Df 'l I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: D D D I, as owner of the property or my employees with wages as their sole compensation, will do the wor1i: 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 wor1i: himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he dici not build or improve for the purixise 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, clld contracts for such projects with contraciof{s) licensed pursuant to the Contractor's License Law). I am exempt under Section Business and Professions Code for this reason: 1. l personally plcJ'I to provide the major labor and materials for construction of the pro~sed property improvement. Oves 0No 2. I (have I have not) signed an application for a bulkling pelTTlit for the pro~sed YJOr1i:. 3. I have contracted with the following person (finn) to provide the proposed construction (include name address I phone I contractors' license number): 4. I plan to provide ~rtions of the wor1i:, but I have hired the following person to coordinate, supervise and provide the major wor1i: (include name I address I phone I contractors' license number): 5. 1 will provide some of the wor1i:, but I have contracted (hired) the following persons to provide the wor1i: indicated (include name I address I itione I type of wor1i:): ,6$ PROPERTY OWNER SIGNATURE 0AGENT DATE !if ' -~ ' 1 t,COMPLETE THIS SE(:TIOfll FOR NON·RE$Jl)ENTIA!t BUII.OING PERMITS ONLY . Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act:? Yes No Is the applicant or future building occupant required to obtain a pennit from the air pollution control disbict or air Quality management district? Yes No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the above Information Is conec:tand that the infonnation on the plans Is accurate. I agree to comply with all Clfy ordinances and State l8YiS relating to building <XlllStructlon. I hereby aulhorize representative of the Ci1y of Carlsbad to enter upin the atx>.< menion<,i property ilr ins;,,clon purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP HARMLESS THE CITY OF CARLSEWJ AGAINST AlL LINllLITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CITY IN CCNSWJENCE OF THE GRANTING OF THIS PERMIT. OSHA: M OSHA permtt is requred tir excavations over 5'0' deep and derrdltbn or coostruction of structures over 3 stories i1 he,;Jhl EXPIRATION: Every permit issued by the Building Offdal under the p,lvisbns of this Code shall expire by linitaoon ald become null and YOO if the buik:ling or 'Mll'k authorized by sudl permit is not commenced v.tthin 100days from the date of such permit or if the buiklhg or'MJl'k authorized by such permit is suspended or abandoned at any time after the 'M)rl( is commenced t>r a perxx:l of 100days (Secoon 100.4.4 Uniform Building Code) . ...@S" 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 Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, 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. LIC. No. DEi.NERY 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/FAXTOOTHER: _______________ _ ,Ji! APPLICANT'S SIGNATURE ASSOCIATED CB#•------------ NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION DATE ZIP «f iJ v{ ,, ';., ' ' ii R • w ' 'i ' 'Jt,, ,';;Jct ,,c\\' ;f\ ,:-"~ J!li: '/ .1~ · ;;J ,~11111+ 1NsP11fTt~N HitoRJ1~e~~Rif:fce~o11:os29J ·," ._ · ,\, Penn it Type: BLDG-Commercial Application Date: 12/01/2017 Work Class: Tenant Improvement Issue Data: 02/16/2018 Status: Closed -Finaled Expiration Date: 10/29/2018 IVR Nun1bcr: 8090 --··-·--- Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status 06/06/2018 06/06/2018 06/07/2018 06/07/2018 June 07, 2018 BLDG-Final Inspection BLDG-Final Inspection 060186-2018 Checklist ltetn BLDG-Building Deficiency 060359-2018 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final BLOG-Building Deficiency Falled COMMENTS Not ready, see card Passed COMMENTS Not ready, see card _____ , ___ _ Owner: R P I CARLSBAD LP Subdivision: CARLSBAD TCT#76-18 Address: 2525 El Camino Real , 218 Carlsbad, CA 92008-1208 Primary Inspector Reinspection Complete ------------------------ Michael Collins Michael Collins Reinspection Passed No Passed Yes Yes Yes Yes Yes No Complete Complete Page 3 of 3 Pcnnit Type: Work Class: Statos: Scheduled Date BLDG-Commercial Tenant Improvement Closed -Finaled Actual Start Date Inspection Type Application Date: 12/01/2017 Owner: Issue Data: 02/16/2018 Subdivision: , Expiration Date: 10/29/2018 Address: IVR Number: 8090 Inspection No. Inspection Status Primary Inspector ---------------------------- 03/02/2018 03/02/2018 03/09/2018 03/09/2018 03/12/2018 03/12/2018 03/15/2018 03/15/2018 03/26/2018 03/26/2018 04/24/2018 04/24/2018 BLDG-21 Underground/Underf loor Plumbing 050609-2018 Checklist Item BLDG-Building Deficiency BLDG-24 051164-2018 Rough/Topout Checklist Item BLDG-Building Deficiency BLDG-14 051442-2018 Frame/SteelfBoltlng/ Welding (Decks) Checklist Item BLDG-Building Deficiency BLDG-34 Rough 051443-2018 Electrical Checklist Item BLDG-Building Deficiency BLDG-17 Interior 051842-2018 Lath/Drywall Checklist lte1n BLDG-Building Deficiency BLDG-17 Interior 052620-2018 Lath/Drywall Checklist Item BLDG-Building Deficiency BLDG-34 Rough 052621-2018 Electrical Checklist Item BLDG-Building Deficiency BLDG-43 Air 055915-2018 Cond./Furnace Set Checklist ltorn BLDG-Building Deficiency BLDG-85 T-Bar, 055913-2018 Ceiling Grids, Overhead Passed Michael Collins COMMENTS Grease & sanitary to POC Passed Paul Burnette COMMENTS Passed Michael Collins COMMENTS Walls, see card for exception Passed Michael Collins COMMENTS Walls Passed Michael Collins COMMENTS Wall drywall & dura rock only. Passed Tim Frazee COMMENTS Screws OK Passed Tim Frazee COMMENTS Ground tails OK and rough in to Panel OK Failed Michael Colllns COMMENTS Not ready Failed Michael Collins ---· .. ·--·-··---------···--··--------------·-------- June 07, 2018 R P I CARLSBAD LP CARLSBAD TCT#76-18 2525 El Camino Real , 218 Carlsbad, CA 92008-1208 Reinspection Complete Complete Passed Yes Complete Passed Yes Complete Passed Yes Complete Passed Yes Complete Passed Yes Complete Passed Yes Complete Passed Yes Reinspection Complete Passed No Reinspection Complete Page 1 of 3 ;1TJ, ~ • ' ~ P , f+"; "'"~~ " 4S'fe'-':,S 9t-'';! ,~&j,~ ~ '"'ft, ' y, ' " . , .. : . \:. · \~1~ ,: :~1:~MIJ' IN~i:CTI.ON Jitt:STO~Y R.~P~J (C.BC203, ~9j :\ , , .. ,.. Permit Typo: BLDG-Commercial Application Date: 12/01/2017 Owner: Work Class: Status: Scheduled Date 05102/2018 05/08/2018 06/05/2018 Tenant Improvement Issue Dato: 02/16/2018 Closed -Finaled Expiration Date: 10/29/2018 Actual Start Date 05102/2018 IVR Number: 8090 Inspection Type Inspection No. Inspection Status Checklist Item COMMENTS BLDG-Building Deficiency Not ready BLOG-Final Inspection BLDG-14 Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-44 Rough-Ducts-Dampers 055916-2018 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final ' BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final BLOG-85 T -Bar, 056768-2018 Ceiling Grids, Overhead Checklist Item BLDG-Building Deficiency BLDG-Building Deficiency BLDG-44 Rough-Ducts-Dampers Failed COMMENTS Not ready Passed COMMENTS Not ready Subdivision: Address: Primary Inspector Michael Collins Michael Collins BLDG-14 Ok to drop tiles, see card Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-14 Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-44 Rough-Ducts-Dampers 0510812018 BLDG-Electric Meter 057392-2018 Passed Mlchael Collins Release Checklist Item COMMENTS BLDG-Building Deficiency EMR emailed to SDGE (216C) 06/0512018 BLDG-Fire Final 059761-2018 Passed Cindy Wong Checklist lte1n COMMENTS FIRE· Building Final ·--.. -·-------------------------------June 07, 2018 R P I CARLSBAD LP CARLSBAD TCT#76-18 2525 El Camino Real, 218 Carlsbad, CA 92008-1208 Reinspection Passed No No No No No Reinspection Passed No No No No No Passed Yes No Yes Yes Yes Yes No No No No Passed Yes Passed Yes Complete Complete Complete Complete Complete Page 2 of 3 t.._(;,,"> ~ CITY Of :ARLSBAD luilding Division INSPECTION RECORI ;:! INSPECTION RECORD CARD WITH APPROVED CBC2017-0629 # 218 2525 EL CAMINO REAL GRUB8YS POKE & FISH MART: 1,002 SF T.I SHELL TO RESTAURANT PLANS MUST BE KEPT ON THE JOB PM i'.!CALLBEFORE3:00pmFORNEXTWORK!)AYINSPECTIO~, · '"'ORD co · 1 1563020900 <'I FOR BUILDING INSPECTION CALL: 760-602-2725 · ,{t(.; 12/1/2011 _oRGOTO:www.~ar~~badca.gov/BuildinqANDCLICKON CBC201 7 0629 'Request Inspection • · IATE: 2-\(,Jl -\'o IF MARKED 'YEs·. IT IS REQUIRED PRIOR TO ANY CONSmUCTION STORM WATER PRECON MEETING REQUIRED 760-602-2725 Allow 24 hours IF MARKED 'YES", APPROVAL REQUIRED PRIOR TO REQUESTING BUILDING COPY OF CARD REQUIRED Fire Prevention 760-602-4660 Allow 48 hours Planning/L3ndscape 760-944-8463 Allow 48 hours 76Q-438-3891 Call before 2 pm CODE# BUILDING Type of Inspection Date Inspector· Date Inspector #11 FOUNDATION #12 REINFORCED STEEL #34 #66 MASONRY PRE GROUT #33 D GROUT D WALL DRAINS #35 PHOTO VOLTAIC #10 TILT PANELS #38 SIGNS #11 POUR STRIPS #11 COLUMN FOOTINGS CODE# MECHANICAL Date Ins ctor #14 SUBFRAME D FLOOR O CEILING #41 UNDERGROUND DUCTS & PIPING #15 ROOF SHEATHING #44 D DUCT & PLENUM D REF. PIPING #13 EXT. SHEAR PANELS #43 HEAT-AIR COND. SYSTEMS #16 INSULATION #18 EXTERIOR LATH BLDG-FINAL mm!, m Date Inspector #17 INTERIOR LATH & DRYWALL UNDERGROUND (11,12,21,31) BLDG-FINAL #82 DRYWALL,EXT LATH, GAS TES (17,18,23) #83 ROOFSHEATING, EXT SHEAR (13,15) 0 SEWER & BL/CO O PL/CO #21 UNDERGROUN ASTE O WTR #24 TOPOUT OWASTE OWTR #27 TUB & SHOWER PAN tor #23 0 GAS TEST O GAS PIPING A/S UNDERGROUND VISUAL #25 WATER HEATER A/S UNDERGROUND HYDRO #28 SOLAR WATER A/S UNDERGROUND FLUSH BLDG-FINAL A/S OVERHEAD VISUAL CODE# POOLS Date Ins ector A/S OVERHEAD HYDROSTATIC #51 POOL EXCAV I STEEL A/S FINAL #52 PLUMBING F/AROUGH·IN #53 ELEC /CONDUIT/WIRING F/AFINAL #54 EQUIPOTENTIAL BOND AXED EXTINGUISHING SYSTEM ROUGH-IN #55 PREPLASTER / FENCE/ ALARMS AXED EXTING SYSTEM HYDROSTATIC TEST #57 GUNITE AXED EXTINGUISHING SYSTEM ANAL BlDG-FINAL MEDICAL GAS PRESSURE TEST MEDICAL GAS FINAL EV 9/17' SEE BACK FOR SPECIAL NOTES DATE: 2/12/2018 JURISDICTION: City of Carlsbad PLAN CHECK#.: CBC2017-0629 ~ EsG1I SET IV PROJECT ADDRESS: 2525 El Camino Real Suite 218 PROJECT NAME: Grubby's Poke & Fish Market -TI D APPLICANT ~URIS ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil 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 staff did not advise the applicant that the plan check has been completed. D EsGil staff did advise the applicant that the plan check has been completed. Person contacted-· -- Date contacted: -Telephone#: ~) Email: Mail Telephone D REMARKS: By: Jason Pasiut EsGil Fax In Person Enclosures: 2/8/2018 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 DATE: 2/6/2018 JURISDICTION: City of Carlsbad PLAN CHECK#.: CBC2017-0629 /. EsG1I SET: III PROJECT ADDRESS: 2525 El Camino Real Suite 218 PROJECT NAME: Grubby's Poke & Fish Market -TI D bPPLICANT ..,..0""JURIS 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. [SJ The check list transmitted herewith is for your information. The plans are being held at EsGil 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 staff did not advise the applicant that the plan check has been completed. [SJ EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Stephen Ray Telephone#: 619-361-1331 ".'.!?ate contacted:!/('.:}-(by:Y'(j Email: jr@raydev.net i'fA,ail Telephone Fax In Person D REMARKS: By: Jason Pasiut EsGil Enclosures: 2/2/2018 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 ' City of Carlsbad CBC201 7-0629 2/6/2018 Please make all corrections on the original tracings, as requested in the correction list. Submit four 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 sets 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. 1. Provide evidence of Health Department approval (for restaurants), where regulated by the local Health Department. There was no indication of this submitted with set Ill plans. If the city has a copy please print one out and submit with set IV. 4. Provide complete plumbing plans, including: a) Complete drain, waste and vent plans to show all pipes and all fixtures vented. Sheet P1 waste and vent floor plan shows the grease waste pipe on the left side. Sheet P2 shows the grease waste pipe on the right side. Please clarify the pipe layout to be consistent. b) This was not addressed on the set Ill plans. Currently, the restroom fixtures are shown flowing through the grease waste and the grease waste fixtures are shown flowing through the waste pipe on sheet 2. Please revise the plumbing lay-out. • END OF REVIEW To speed up the review process, please 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 briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate: D Yes D No The jurisdiction has contracted with EsGil, located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review for your project. If you have any questions regarding these plan review items, please contact Jason Pasiut at Esgil. Thank you. DATE: 1/29/2018 JURISDICTION: City of Carlsbad PLAN CHECK#.: CBC2017-0629 -I. EsG1I SET II PROJECT ADDRESS: 2525 El Camino Real Suite 218 PROJECT NAME: Grubby's Poke & Fish Market -TI CJ 3BPLICANT ,,zr JURIS. 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. [SJ The check list transmitted herewith is for your information. The plans are being held at EsGil 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 staff did not advise the applicant that the plan check has been completed. [SJ EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Stephen Ray Telephone#: 619-361-1331 ))ate contacted: I \ '2,P\ ~ail Telephone Fax D REMARKS: By: Jason Pasiut EsGil (by: Yb, Email: jr@raydev.net In Person Enclosures: 1/22/2018 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 ., City of Carlsbad CBC2017-0629 1/29/2018 Please make all corrections on the original tracings, as requested in the correction list. Submit four 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 sets 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. 1. Provide evidence of Health Department approval (for restaurants), where regulated by the local Health Department. There was no indication of this submitted with set II plans. 4. Provide complete plumbing plans, including: a) Complete drain, waste and vent plans to show all pipes and all fixtures vented. Sheet P1 waste and vent floor plan shows the grease waste pipe on the left side. Sheet P2 shows the grease waste pipe on the right side. Please clarify the pipe layout to be consistent. 6. Please indicate on the plans the location of the electrical panel and detail the required working clearance. 110.26 A2 The 30" required width will not be possible with the prep table proposed. Please show the 30" required width at the electric panel. 9. Please review the requirements, revise the plans appropriately and imprint on the plans the City of Carlsbad Policies and Procedures for Roof Mounted Equipment to the plans. There is no indication of this on sheet E1. Perhaps sheet E2 would be a better place to address the screening of rooftop equipment per City of Carlsbad policy. 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. DATE: 12/12/17 JURISDICTION: City of Carlsbad PLAN CHECK#.: CBC2017-0629 ~ EsG1I A S.l\FEbu1lf Company SET: I PROJECT ADDRESS: 2525 El Camino Real Suite 218 PROJECT NAME: Grubby's Poke & Fish Market -TI D APPLICANT ..,.rfURIS 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. [Xi The check list transmitted herewith is for your information. The plans are being held at EsGil 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 staff did not advise the applicant that the plan check has been completed. [Xi EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Stephen Ray Telephone#: 619-361-1331 ~ate conJacted: \~ \'1---(byr'C-,) Email: jr@raydev.net "vMail ""relephone Fax In Person D REMARKS: By: Doug Moody EsGil Enclosures: 12/4/17 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 ' City of Carlsbad CBC2017-0629 12/12/17 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK#.: CBC2017-0629 OCCUPANCY: B TYPE OF CONSTRUCTION: IIB ALLOWABLE FLOOR AREA: SPRINKLERS?: YES REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 12/1/17 DATE INITIAL PLAN REVIEW COMPLETED: 12/ 12/ 17 FOREWORD (PLEASE READ): JURISDICTION: City of Carlsbad USE: Restaurant ACTUAL AREA: 1002sf STORIES: 1 HEIGHT: OCCUPANTLOAD: 35 DATE PLANS RECEIVED BY ESGIL CORPORATION: 12/4/17 PLAN REVIEWER: Doug Moody 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 CBC2017-0629 12/12/17 Please make all corrections on the original tracings, as requested in the correction list. Submit four 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 sets 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. 1. Provide evidence of Health Department approval (for restaurants), where regulated by the local Health Department. 2. Provide a section view of all new interior partitions. Show: a) Type, size and spacing of studs. Indicate gauge for metal studs. Specify manufacturer and approval number or indicate "to be ICC approved". b) Method of attaching top and bottom plates to structure. (NOTE: Top of partition must be secured to roof or floor framing, unless suspended ceiling has been designed for partition lateral load). c) Show height of partition and suspended ceiling, and height from floor to roof framing or floor framing. 3. Provide a section view of the new soffits. Show: a) Method of attaching top to the structure and lateral bracing. b) Show height of the soffit from floor, soffit to roof framing or floor framing. 4. Provide complete plumbing plans, including: a) Complete drain, waste and vent plans to show all pipes and all fixtures vented. b) Provide gas line plans and calculations, showing pipe lengths and gas demands. UPC Section 1217.0 5. Hot water supplied to a public use lavatory is limited to a maximum temperature potential of 120 degrees by a device that conforms to ASSE 1070 or CSA 8125.3; please provide the manufacturer's listing showing compliance. Detail how this temperature limitation is achieved. The water heater thermostat may not be used for compliance with this Code section. UPC 413.1 & UPC 414 City of Carlsbad CBC2017-0629 12/12/17 6. Please indicate on the plans the location of the electrical panel and detail the required working clearance. 7. Please have the document author sign the imprinted L Tl forms. 8. Please complete the L Tl-02 forms to show the occupancy sensor and time clock in the mandatory measure section. 9. Please review the requirements, revise the plans appropriately and imprint on the plans the City of Carlsbad Policies and Procedures for Roof Mounted Equipment to the plans. 10. Please note or show that all electrical penetrations into the cooler shall be sealed per section 300-7 of the NEC. 11. Sales and service counters shall have a portion of the counter which is at least 36" in length with a maximum height of 34 inches. Section 11 B-904.4.1. 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 briefly describe 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 D No D The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform 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 CBC2017-0629 12/12/17 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: Doug Moody PLAN CHECK#.: CBC2017-0629 DATE: 12/12/17 BUILDING ADDRESS: 2525 El Camino Real Suite 218 BUILDING OCCUPANCY: B BUILDING AREA Valuation PORTION ( Sq. Ft.) Multiplier Tl 1002 64.72 Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code Cb By Ordinance Plan Check Fee by Ordinance Type of Review: 0 Complete Review D Repetitive Fee .... -~] Repeats Comments: D Other D Hourly EsGil Fee Reg. VALUE Mod. D Structural Only ($) 64,849 64,849 $467.55j $303.911 $266.501 Sheet 1 of 1 { { Cicyof NONRESIDENTIAL GREEN Deve/012.ment Services BUILDING CODE STANDARDS Building Division MANDATORY MEASURES 1635 Faraday Avenue Carlsbad CERTIFICATION CHECKLIST 760-602-2719 B-52 www.carlsbadca.gov This form, signed and completed, and all receipts for the recycled materials shall be submitted to the Bui/ding Inspector prior to Final Inspection. Site Development Mandatory 5.106.1 Storm water pollution prevention plan. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan (SWPPP) that has been designed specific to its site, conforming to {X) the State Storm water NP DES Construction Permit or local ordinance, whichever is stricter, as is required for projects over one acre. The plan should cover prevention of soil loss by storm water run-off and/or wind erosion, of sedimentation and/or of dust/particulate matter air oollution. 5.106.4 Bicycle parking and changing rooms. Comply with Sections 5.106.4.1 and 5.106.4.2; or (X) meet local ordinance, whichever is stricter. 5.106.4.1 Short-Term bicycle parking. If the project is expected to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitor's entrance, readily visible to (X) passers-by, for 5 percent of visitor motorized vehicle parking capacity, with a minimum of one two- bike capacity rack. 5.106.4.2 Long Term bicycle parking. For buildings with over 10 tenant-occupants, provide secure bicycle parking for 5 percent of tenant-occupied motorized vehicle parking capacity, with a minimum (X) of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low emitting, fuel-efficient and carpool/van pool vehicles as shown in Table 5.106.5.3.1. {X) 5.106.8 Light pollution reduction. Comply with lighting power requirements in the California Energy Code and design interior lighting such that zero direct-beam illumination leaves the building {X) site. Meet or exceed exterior light levels and uniformity ratios for lighting zones 1-4 as defined in Chapter 10 of the California Administrative Code, using the following strategies: 1. Shield all exterior luminaries or use cutoff luminaries {X) 2. Contain interior lighting within each source {X) 3. Allow no more than .01 horizontal foot candle 15ft. beyond the site {X) 4. Contain all exterior lighting within property boundaries {X) Exception: See part 2, Chapter 12, Section 1205.6 for campus lighting requirements for parking facilities and walkwavs. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or drainage system will {X) manage all surface water flows. Water Efficiency and Conservation Indoor Water Use 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 (X) through 503.1.3. 5303.1.1 Buildings in excess of 50,000 square feet. Separate sub-meters shall be installed as follows: (X) 1. For each individual leased, rented, or other tenant space within the building projected to consume more than 100 gal/day. 2. For spaces used for laundry or cleaners, restaurant or food service, medical or dental office, laboratorv or beauty salon or barber shop proiected to consume more than 100 aal/dav. B-52 Page 1 of 5 Rev. 5/17 5.303.1.2 Excess consumption. Any building within a project or space within a building that is projected to consume more than 1,000 gal/day. (X) 5.303 Percent savings. A schedule of plumbing fixtures and fixture fittings that will reduce the overall use of potable water within the building by 20 percent shall be provided (Calculate (X) savings by Water Use Worksheets or utilize Table 5.303.2.3). 5.303.2.1 Multiple showerheads serving one shower. When single shower fixtures are served by more than one showerhead, the combined flow rate of all the showerheads shall not (X) exceed the maximum flow rates specified in the 20 percent reduction column contained in Table 5.303.2.3 or the shower shall be designed to allow only one showerhead to be in oneration at a ti me. 5.303.6 Plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the requirements listed As applicable for each type in items listed in Table 5.303.6. 1. Water closets (toilets) -flushometer type (X) 2. Water closets (toilets) -tank type (X) 3. Urinals (X) 4. Public lavatory faucets {X) 5. Public metering self-closing faucets (X) 6. Residential bathroom lavatory sink faucets (X) 7. Residential bathroom lavatory sinks (X) 8. Residential showerheads (X) 9. Sinale shower fixtures served bv more than one showerhead (Xl Outdoor Water Use 5.304.1 Water Budget. A water budget shall be developed for landscaping irrigation use. (X) 5.304.2 Outdoor potable water use. For new water service, separate meters or submeters shall be installed for indoor and outdoor potable water use for landscaped areas between 1,000 and 5,000 square feet. (X) 5.304.3 Irrigation design. In new nonresidential projects with between 1,000 and 2,500 square feet of landscaped area (the level at which the MLO applies), install irrigation controllers and sensors which include the following criteria and meet manufacturer's recommendations. 5.304.1.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather-or soil moisture-based controllers that automatically adjust irrigation in response to changes in plant's needs as weather conditions change. {X) 2. Weather based controllers without integral rain sensors or communication systems that As applicable account for local rainfall shall have separate wired or wireless rain sensors which connects or (X) communicates with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. Construction Waste Management Plan 5.408.1 Construction waste diversion. Establish a construction waste management plan or (X) meet local ordinance, whichever is more stringent. (X) 5.408.2 Construction waste management plan. Submit plan per this section to enforcement authority within the city. 5.408.1.4 Documentation. Provide documentation of the waste management plan (see form (X) B-59) that meets the requirements listed in Section 5.408.1.1 thru 5.408.1.3 and the plan is accessible to the enforcement authority. 5.408.3 Construction waste. Recycle and/or salvage for reuse a minimum of 50 percent of nonhazardous construction and demolition debris or meet local ordinance, whichever is more stringent. (X) Exceptions: 1. Excavated soil and land-clearing debris 2. Alternate waste reduction methods, developed by working with local agencies if diversion or recycle facilities capable of compliance with this item do not exist. 5.408.3 Excavated soil and land clearina debris. 100 nercent of trees. Stu mos, rocks and 8-52 Page2 of 5 Rev. 5/17 / associated vegetation and soils resulting primarily from land clearing shall be reused or recvcled. Building Maintenance and Operation 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection of nonhazardous materials ( X) for recycling. 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building (X) commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. - 5.410.2.6 (X) 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the QPR shall include items listed in Section 5.410.4. (X) 5.410.2.2 Basis of Design (BOD). A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems listed in Section 5.410.2.2. ( X) 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of the building project and shall include items listed in Section 5.410.2.3. (X) 5.410.2.4 Functional performance testing shall demonstrate the correct installation and operation of each component, system and system-to-system interface in accordance with the ( X) approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. ( X) 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall include the items listed in Section 5.410.2.5.1. ( X) 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type and/or system shall include items listed in Section 5.410.2.5.2. (X) 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and reporting recommendations for post construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for (X) buildings less than 10,000 square feet. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. (X) Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section 5.410.3.2. (X) 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards on each system. ( X) 5.410.4.3 HVAC balancing. Before a new space-conditioned system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by national standards listed in Section 5.410.3.3.1. ( X) 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report ( x) of testing signed by the individual responsible for performing those services. maintenance instructions and copies of guaranties/warranties for each system prior to final inspection. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance manual 5.410.4.5.1 Inspection and reports. Include a copy of all inspection verifications and reports required by the enforcing agency. 8-52 Page 3 of 5 Rev. 5/17 Environmental Quality Fireplaces 5.503.1 Install only a direct-vent sealed-combustion gas or sealed wood-burning fireplace or a (X} sealed woodstove and refer to residential requirements in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. As Applicable 5.503.1.1 Woodstoves. Woodstoves shall comolv with US EPA Phase II emission limits. (X) Weather Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather-resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2 and California Energy Code Section 150, (X) manufacturer's installation instruction instructions or local ordinance, whichever is more stringent. 5.407.2 Moisture control. Employ moisture control measured by the following methods: 5.407 .2.1 Sprinklers. Prevent irrigation spray on structures. (X) 5.407 .2.2 Entries and openings. Design exterior entries and openings to prevent water intrusion (X) into buildinns. Pollution Control 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final start up of the heating and cooling equipment, all duct and other related air distribution (X) component openings shall be covered with tape, plastic, sheet metal or other methods to reduce the amount of debris or duct which mav collect in the svstem. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the buildina with outside and return air orior to occuoancv that orovides at least a MERV of 8. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.6 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards: (X} 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or SCAQMD Rule 1168 VOC limits as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide voe standards and other requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paint and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 5.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product- Weighted MIR limits for ROC in Section 94522 (a)(3) and other requirements, including prohibition on use of certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq.). 5.504.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of one of the standards listed in Section 5.504.4.4. 50504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute Green Label Program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 804.4.1. 5.504.4.5 Composite wood products. Hardwood, plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for formaldehyde as specified in Table 5.504.4. 5.504.4.5.2 Documentation. Verification of compliance with this section shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following: 1. Product certification and specifications 2. Chain of custody certifications 3. Other methods acceptable to the enforcing agency 5.504.4.6 Resilient flooring systems. Comply with the VOC emission limits defined in the 2009 (X) CHPS criteria and listed on its Low-emitting Materials List (or product registry) or certified under the FloorScore nroaram of the Resilient Floor Coverina Institute. 8-52 Page 4 of 5 Rev. 5/17 I Indoor Moisture and Radon Control 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of the California Buildina Code, Title 24 Part 2, Sections 1203 (Ventilation) Chaoter 14.1. (X\ Air quality and Exhaust 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the (X) minimum requirements of Section 121 of the California Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent. 5.506.2 Carbon DIOXIDE (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be specified and installed in accordance with the (X) requirements of the latest edition of the California Enerav Code, Title 24, Part 6, Section 120.1.IC\ (4). Outdoor Air Quality 5.508.1 Ozone depletion and global warming reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. As 5.508.1 CFCs. Install HVAC and refrigeration equipment that does not contain CFCs. applicable 5.508.1.2 Halons. Install fire suppression equipment that does not contain Halons. (X) ( X) I, as the professional responsible for this project, certify that, to the best of my knowledge, the mandatory items listed on this form have been incorporated into the project in order to comply with Title 24, Part 11 of the 2016 California Green Building Standards. All receipts for recycled materials have been attached to this form. Project Address: :JSi-:{ t:L CAutoJo fiE~L--~ 2/e:. Plan Check Number C&::2C>r)-(X$f Print Name: ~IE»taJ } i)lt_[R. Signed:~). ~ License Number: -44-31£4 Date: ~-G,~ 2C>l~ B-52 Page 5 of 5 Rev. 5117 ,. .. (city of Carlsbad owner: WASTE MANAGEMENT PLAN B-59 Contractor: Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov Job Address: 252$ i;_l~I/\X) rzti4L ?,<d;c Z/8, Phone Number:._G?_f<t_-57_/_-/_0~f_Z., ________ _ Estimated Cost of Project: $_/_,f5'.:ic..+CCV_· _· -~----------- Type of Project: D New Construction 11i:]'Remodel or T.I. D Residential D Commercial D Demolition (check all that apply) D Other ------------------------------~ Non-hazardous construction waste generated during the course of this project shall be recycled and/or salvaged for re-use at a minimum of 65% per CALGreen Sec. 5.408.1. Failure to comply may result in a penalty fee up to $1,000. For projects which consist of mainly equipment and/or racking, that have a combined weight of new construction disposal that does not exceed 2 lbs per square foot of building area affected by this permit, may be deemed to meet the 65% minimum requirement upon approval of Building Department. ALTERNATIVE FORMS OF COMPLIANCE: (If selected, do not complete Tables 1 & 2 below) D Construction waste shall not exceed 2 lbs. per sf. of area. All receipts shall be provided to the Building Official prior to final. (This option not applicable for mo5.!'J'jlstruction projects.) . Square feet of construction area I~ X 2 lbs. ~ :2lffi, lbs. of allowable waste. D I plan on using a WASTE MANAGEMENT roll-off bin. All receipts shall be provided to the Building Official prior to final. Table 1 -Estimated Waste (To be filled out priorto permit issuance-refer to example on Page 2.) MATERIALS lbs. of waste to be taken to lbs. of waste to be Waste Hauling Company or Re-Use Method LANDFILL RE-USED or RECYCLED Asphalt/ Concrete b l1f) I, 1,1..,:;-rt:' .U J\.1\/M-1:::-if,:OA, '1 Brick/ Masonry (;, t> Gard board 0 1~ 1o i~'TZ:-Mi .1. .. l,A/, "JJ,, f"J\Jl Drywall t, JIQ.6 J.>.JA4rz:'" ,1 fl,. , ,l ~ ~ w Landscape Debris 0 0 Lumber/ Wood 0 I oo I, I Iv....< 11,l J l:A£-::i11.=-A"f Metals 0 (t<...., : 1..,,~ l,AA .. l,A.£r,,,01.)," Mixed Waste SD 0 IA l.Y".f"C" M A ,,i. .--"°' rlt\T Trash I Garba.e:e ,,., "'"' C, I• ) A.,4.,c;;: J,I ' A • J r:A,erv1 Other: ,IU: , " .. I ",f', D ti 1,,..__,.;.c J.t{.A ... 1., ,,. __ , -fl . TOTAL lbs: 3?'SD / is,<;>.o Estimated Percentage to be Re-Used or Recycled , f22 % Official Use Only D Plan Approved D Plan Denied D Project Valuation Approved Reviewed/ Approved by: _________________ _ Page 1 of 2 REV.01-2017 Table 2 -Actual Waste (To be completed after construction.) MATERIALS lbs. of waste taken to lbs. of waste Waste Hauling Company or Re-Use Method LANDFILL RE-USED or RECYCLED (complete only if different than Table 1) Asphalt/ Concrete Brick/ Masonry cardboard Drywall landscape Debris Lumber/ Wood Metals Mixed Waste Trash I Garbaae Other: TOTAL lbs.: Actual Percentage Re-Used or Recycled ______ % Official Use Only D 65% Goal Achieved D 65% Goal Not Achieved D Alternative Compliance Achieved Penalty Paid $ _______ _ Reviewed/ Approved by:. _________________ _ EXAMPLE: Use the following example as a guide to completing this form. MATERIALS lbs. of waste to be token to lbs. of waste to be LANDFILL RE-USED or RECYCLED Asphalt I Concrete 0 3000 Brick I Masonry 100 050 Cardboard 0 ""'D Drywall 0 50 Landscape Debris 0 120 Lumber I Wood 500 0 Metals 300 ::I.DO Mixed Waste 1500 0 Trash I Garbage 300 0 Other: Pool yUll\,Lte 0 900 TOTAL lbs.: 2700 5,3;1-0 Percentage to be Re-Used or Recycled 6 7 % Formula: Total Re-used or Recycled X 100 = % Re-Used or Recycled (Total Combined Waste) Waste Hauling Company or Re-Use Method A1sC f-tG!L<L[.,,n Co. WM I R.e-L,\Secl B.vlck, 011\,-slte "-1sC '-'aul , .. ~ ro. A1sC rtauLill\,o Co. MuLcviecl c; Re-used 011\,-slte waste Ma.,,aoeV\,\.ell\,t WM I AlsC f-taLA.lcvcg WM WM L,\Secl as cvusviecl 1sase 011\,-site 5370 X 100 = 67% Re-Used or Recycled (2700 + 5370) Since 67% exceeds the minimum requirement of 65%, this plan complies. Page 2 of 2 INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date /21! /[f Business1N1ime ca,tuf;Jt/5 fcJJg; d f;<;/1 JJ4f/l!J<ef StreetAddress ,zs-zs-: EL CA:J,·Vll"-1() ~Ak Atl lB' CAieJs M:i2 Email Address d:U21J t:J@ £A;! C1\,l!.vl (EY> . U>l'.':'.1 PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK lYPE OF BUSINESS) ~ Check all below that are present at your facility: Acid Cleaning Ink Manufacturing Nutritional Supplement I Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining I Milling Painting I Finishing Battery Manufacturing Manufacturing Paint Manufacturing Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (i.e. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting I Forming Pesticide Manufacturing I Car Wash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification Electroplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameling Electrical Component Anodizing Power Generation Manufacturing Coating (i.e. phosphating) Print Shop Fertilizer Manufacturing Chemical Etching I Milling Research and Development Film I X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap I Detergent Manufacturing Industrial Laundry Waste Treatment/ Storage SIC Code(s) (if known):---------------------- Brief description of business activities (Production I Manufacturing Operations):. _____ _ Description of operations generating wastewater ( discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal I day): -------- List hazardous wastes generated (type I volume):---------------- Date operation began/or will begin at this location: ---------------- r,,.-.. -,tor a Wastewater Discharge Permit from the Encina Wastewater Authority? lfyes,when: ____________________ _ DISCHARGE PERMIT EXEMPT LIST The commercial enterprises listed below are a partial listing of businesses that are exempt from industrial wastewater discharge permitting under normal operating conditions. They are exempt because (a) they discharge no process wastewater (i.e., they only discharge sanitary wastewater with no pollutants exceeding any local limits}, and (b) they have no potential to negatively impact the EWPCF or other wastewater treatment plants in the ESS. Any questions regarding exemptions should be referred to EWA Source Control staff. Automobile Detailers Barber/Beauty Shops Business/Sales Offices Carpet/Upholstery Cleaning Services Childcare Facilities Churches Community Centers Consulting Services Contractors Counseling Services Educational Services (no auto repair/film developing) Financial Institutions/Services Fitness Centers Gas Stations (no car wash/auto repair) Grocery Stores (no film developing) Home-based Businesses Hotels/Motels (no laundry) Laundromats Libraries Medical Offices (no x-ray developing) Mortuaries Museums Nail Salons Nursing Homes Office Buildings (no process flow) Optical Services Pest Control Services (no pesticide repackaging for sale) Pet Boarding/Grooming Facilities Postal Services Public Storage Facilities -~><-Restaurants/Bars Retail/Wholesale Stores (no auto repair/film developing) Theaters (Movie/Live) SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY RECORDID#~~~~~~~~~~~~~~~~~-1 PLANCHECK#~~~~~~~~~~~~~~~~-1 BP DATE Zip Code 'a .O,.PN# ?,, q;a}o I 'ob· ;vl -OS The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTh'IENT-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 prop~ed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART 11: SAN DIEGO COUNTY DEPARTh'IENT 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 11 O, San Diego, CA 92123. Call {858) 505-6700 prior to the issuance of a building pem,it. D CalARP Exempt I FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: 1. Is your business listed on the reverse side of this fom,? (check all that apply). YB 0 ES g {for new construction or remodeling projects) Date Initials 2. Will your business dispose of Hazardous Substances or Medical Waste in any amount? 0 CalARP Required I 3. Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 4. 5. 6. 7. 8. D D D D D pounds and/or 200 cubic feet? [A'" Will your business store or handle carcinogens/reproductive toxins in any quantity? 12] Will your business use an existing or install an underground storage tank? Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? j Will your business store or handle Regulated Substances (CalARP)? 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 0 CalARP Complete I Date Initials PART 111: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCDl: Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San Diego, CA 92131 apcdcomp@sdcounty.ga.qov (858) 586-2650). (*No stamp required if Q1 Yes i!IDi Q3 Yes fil]g Q4-Q6 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 bums; residences fanning part of a larger project. r+Excludes garages & small outbuildings.] 1. 2. 3. 4. 5. 6. YES NO B i Will the project disturb 160 square feet or more of existing b.uilding 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 pertormed by a Certified Asbestos Consultant or Site Surveillance Technician? D D D D D D (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification may be required 1 O working days prior to commencing asbestos removal. D Will the project or associated construction equipment emit air contaminants? See the reverse side of this fom, or APCD factsheet (www.sdapcd.org/info/facts}pem1its.pdf) for typical equipment requiring an APCD pennit. D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bound a Briefly describe business activities: ,e r. 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 m this box only exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other pem11tt1ng requirements may still apply. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division ELISE ROTHSCHILD Director QCountp of ~an 1JBiego DEPARTMENT OF ENVIRONMENTAL HEALTH FOOD AND HOUSING DIVISION P.O. BOX 129261, SAN DIEGO, CA 92112-9261 Phone: (858) 505-6659 FAX: (858) 505-6824 1 (800) 253-9933 www.sdcdeh.org PLAN APPROVAL SHEET RECEIVED FEB 15 2018 CITY OF CARLSBAD BUJ~t~!D'JSJON DBA: Grubby's Poke and Fish MArket DATE: 2/5/2018 SITE: 2525 El Camino Real Ste 216C Carlsbad 92008 BUSINESS OWNER: Justin Jachura Plans are approved contingent upon the following: PC#: DEH2017-FFPP-009004 I} Department of Environmental Health {DEB) 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 PRIOR TO FINAL INSPECTION AND APPROVAL TO OPERATE BY THIS DEPARTMENT. 4) All food and utensil-related equipment shall be certified to applicable sanitation standards by an ANSI accredited testing agency. 5) Upon completion of 50%-80% of construction, call (858) 505-6660 to schedule inspection. In lieu of a plumbing inspection by DEH, ensure that the plumbing is constructed to these standards: a. Floor sinks shall be installed Y, exposed and equipped with an appropriate grill cover if no access is provided for cleaning. b. Drain lines shall slope V,'' per foot, shall not exceed 15' in length and shall terminate a minimum of I" above the floor sink with a legal air gap or otherwise approved by the enforcing agency. Drain lines shall not intersect walkways or door ways. c. No condensate drainage of any kind can drain to the mop sink. d. 3-compartment sinks, preparation sinks, dump sinks, and any other plumbed equipment must drain indirect to a floor sink. e. Grease traps/interceptors, if required by the local waste water authority must be located outside of the food preparation, food storage, or warewashing areas. f. Floor surfaces must be sloped l :50 to required floor drains. g. 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. 6) 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 final inspection. 7) All equipment is to be in place and functional. At the time when the final inspection is requested, the facility shall have all utilities operational and all refrigeration shall have an ambient air temperature of 38°F or below and shall be equipped with a thermotneter accurate to+/-2"F in the warmest section of the unit. 8) Seal all cracks, gaps and crevices in counters, cabinets, around metal flashing, sink backsplashes, around pipes and conduits with silicone sealant. 9) AN AIR BALANCE REPORT IS REQUIRED IF THE FACILITY HAS VENTILATION HOODS. 10) ANY FOOD PROCESSING AREAS MUST BE COMPLETELY ENCLOSED. OPERABLE WINDOWS, MOVEABLE WALL PANELS. GARAGE ROLL-UP DOORS. OR OTHER MEANS OF RENDERING FOOD PROCESSING AREAS NOT FULLY ENCLOSED ARE NOT APPROVED. 11) Be advised, applicable jurisdiction requirements that result in changes to approved plans may require revisions to the Department of Environmental Health plans. Plans reviewed by: Celeste Penn, REHS and Chris Cardwell, EHT CALL (858) 505-6660 AT LEAST 10 WORKING DAYS IN ADVANCE TO SCHEDULE INSPECTIONS. A FINAL INSPECTION MUST BE CONDUCTED AND AN ENVIRONMENTAL HEALTH PERMIT SHALL BE ISSUED PRIOR TO OPENING AND OPERATING THIS FOOD ESTABLISHMENT. "Environmental and public health through leadership, partnership and science 11 ELISE ROTHSCHILD Director Qtountp of ~an 11Biego DEPARTMENT OF ENVIRONMENTAL HEAL TH FOOD AND HOUSING DIVISION P.O. BOX 129261, SAN DIEGO, CA 92112-9261 Phone: (858) 505-6659 FAX: (858) 505-6824 1 (800) 253-9933 www.sdcdeh.org PLAN APPROVAL SHEET AMY HARBERT Assistant Director DBA: Grubby's Poke and Fish MArket DATE: 2/5/2018 SITE: 2525 El Camino Real Ste 216C Carlsbad 92008 BUSINESS OWNER: Justin Jachura Plans are approved contingent upon the following: PC#: DEH2017-FFPP-009004 1) Department of Environmental Health (DEB) 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 DepartmC!ll and all applicable agencies permits and approvals PRIOR TO FINAL INSPECTION AND APPROVALTOOPERAtEBYTHISDEPARTMENT. 4) All food and utensil-related equipment shall be certified to applicable sanitation standards by an ANSI accredited testing agency. 5) Upon completion of 50%-80% of construction, call (858) 505-6660 to schedule inspection. In lieu of a plumbing inspection by DEH, ensure that the plumbing is constructed to these standards: a. Floor sinks shall be installed Y2 exposed and equipped with an appropriate grill cover if no access is provided for cleaning. b. Drain lines shall slope W' per foot, shall not exceed 15' in length and shall terminate a minimum of I" above the floor sink with a legal air gap or otherwise approved by the enforcing agency. Drain lines shall not intersect walkways or door ways. c. No condensate drainage of any kind can drain to the mop sink. d. 3-compartment sinks, preparation sinks, dump sinks, and any other plumbed equipment must drain indirect to a floor sink. e. Grease traps/interceptors, if required by the local waste water authority must be located outside of the food preparation, food storage, or warewashing areas. f. Floor surfaces must be sloped I :50 to required floor drains. g. 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. 6) 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 final inspection. 7) All equipment is to be in place and functional. At the time when the final inspection is requested, the facility shall have all utilities operational and all refrigeration shall have an ambient air temperature of 38QF or below and shall be equipped with a thermometer accurate to+/-2°F in the warmest section of the unit. 8) Seal all cracks, gaps and crevices in counters, cabinets, around metal flashing, sink backsplashes, around pipes and conduits with silicone sealant. 9) AN A1R BALANCE REPORT JS REQUIRED IF THE FACILITY HAS VENTILATION HOODS. 10) ANY FOOD PROCESSING AREAs MUST BE COMPLETELY ENCLOSED. OPERABLE WINDOWS. MOVEABLE WALL PANELS. GARAGE.ROLL-UP DOORS. OR OTHER MEANS OF RENDERING FOOD PROCESSING AREAS NOT FULLY ENCLOSED ARE NOT APPROVED. 11) Be advised, applicable jurisdiction n;9uirements that result in changes to approved plans may require revisions to the Department of Environmental Health plans. Plans reviewed by: Celeste Penn, REHS and Chris Cardwell, EHT CALL (858) 505-6660 AT LEAST 10 WORKING DAYS IN ADVANCE TO SCHEDULE INSPECTIONS. A FINAL INSPECTION MUST BE CONDUCTED AND AN ENVIRONMENTAL HEALTH PERMIT SHALL BE ISSUED PRIOR TO OPENING AND OPERATING THIS FOOD ESTABLISHMENT. "Environmental and public health through leadership, partnership and science11 CHECK APPLICATION -OFFICE USE ONLY SAN DIEGO -COC OFFICE 5500 OVERLAND A VE #110 SAN DIEGO, CA 92123 MAILING ADDRESS PO BOX 129261 PC RECORD #:-:i:a:IZ.017 · fff P· OgtQ)l.,1 SAN DIEGO, CA 92Jl2 INTAKEDATE: \2-) · IJ (858) 505-6660 FAX (858) 467-9282 PAYMENTTYPE: "" \2_&_tf_.___ __ FOOD FACILITY BUSINESS AND CONTACT INFORMATION - j&'IEW FOOD FACILITY O REMODEL CURRENT PERMIT DcoNSULT-NEW, 0CONSULTATION 0REVIS1D1l 0BODY ART CHANGE OF OWNER CURRENT PERMIT _.J....2=~=...L..~!,,,!C,:::!.'..+-!...L.LLL.L:£rLJL~c...L----Assessor's Parcel No.: /5& J02 · ()/3-/1} City:(Afl!~_Q_ Zip: qz_oofj BUSINESS O~ER: L ,, Name: JlAS!l\:::\ QN::f:iA""'A-Company: _____________ _ Mailing Address: 3rf: CA-d--SB4Q \hti~ :gl-City:CA1L0f,,A,v State: cA Zip:"J2CV8 Phone: ,1'fa0) 93 {Jlf!j) Fax: E-Mail:~sn~§):fArviie,<A0B0, co VETERANS MAY QUALIFY FOR FEE EXEMPTION (complete additional application tor consideration', 0 Yes, I am a Veteran. ·o~CONTRACTOR: Name: -S~ ~ Company:_'l?d :ru.}B~ Mailing Address: L/Otf/ c'3?<t/7;;4 &/.) 5,t;, B City: ~Al/77-1-State: cA-Zip:<J't90Z Phone: <f/JCf l Jh/-f 5 3/ E-Mail: j'e-@ j2'.R[ Dfa/ NJ3C . CA. Contractor's License (if applicable): __ _ CONTACT PERSON FOR PLAN ~JATl,IS N9l'IFICATION: Contact Person: :zt1::; 'f'Eifil:J_ ~ Max.~ of EmplO.',"H':.\!,"er Shift: i2t'['.-1D D11-25026-1DD0100+ Sealing: Do 01-20 21-50 051-100 0101 + Projected # Meals to be Served: __ Breakfast -A,-unch L_Dinner Customer Utensils: ingle Use DMulti-Use Is there outdoor dining, outdoor bar, barbecue, wood oven etc. associated with the food facility? DY es _0No If yes, explain: Grease Trap/Interceptor required: l;Z]Yes 0No; If yes indicate location -.a<LccX=t5~T,~Z~N~"'~' ------------ SEWER: jZf Public-OSeptic/ Private WATER: J:aPublic-DWell/ Private (If private contact Land Use at (858) 565-5173) Identify the municipal water and wastewater district(s), ______________________ _ DEH:FH-177 (Rev. 04/17) FOOD & HOUSING DIVISION -PLAN CHECK P-1 f)JJJA FOOD FActt,rv olv ", • INDICATE THE SERVICES OR TYPE OF F,OOD~ACILITY PROVIDED (Check alltllpt apply) 0 RestauranVDeli O Market-Packaged ~··.. . -Pre~~ .. · ing [). Sch"-1. -.. ,. rJv·o· n Kitchen O School Satellite Site D Licensed Health Care D Boat D Retail . . e · i1t9 GJ Mi~'!I Ji.ocfl (froze!f ream. dipping, hot dogs, beverages) D Commissary-For Food PrepO Commiss . ft Paci<01Jlf)(for ~ending'Mac ne HO D Wholesale Warehouse D Packaged Non-Potentially Hazard Food D Food Delivery.Service cl Caterin;fe ui~nt Rental D Swap Meet Vendor MOBILE FOOD FACILITY ONLY MOBILE FOOD CART:0 PACKAGED FOOD OR PRODUCE ONLY O LIMITED FOOD PREPARATION (LFP) Up To 4 Carts May Operate at a SINGLE SITE D -Number of LPF Carts Number of Packaged Carts. ___ _ MOBILE SUPPORT UNIT FOR CART REPORTS TO COMMISSARY: 0 MOBILE FOOD 'fRUCKNEHICLE ONLY: 0 Packaged/Produce O Limited Food Prep (LFP) 0 Full Food Prep MOBILE FOOD FAl~ILITIES MUST SUBMIT COMMISSARY AGREEMENT LETTER (TOILET FACILITY LETTER IF APPLICABLE} NOTE: J. LL FOOD FACILITIES INCLUDING MOBILES MUST SUBMIT MENUS WITH APPL/CATION BODY ABT FACILITY ONLY INDICATE THE SERVICES YOU WILL BE PROVIDING (Check all that apply) D Tattooing D Permanent Cosmetics D Body Piercing D Branding D Mobile Vehicle INFECTION PREVENTION & CONTROL PLAN (/PCP) TO BE SUBMITTED FOR REVIEW PRIOR TO OPERATING OTHER AGENCIES: a BLDG DEPARTMENT a FIRE DEPARTMENT a ZONING a WATER/WASTEWATER DISTRICTS a APCD a 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 infonnation 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 andttl"le opefat.ion of this business. I also agree to conform to all conditions; orders,· iind directions, issued pursuant to the California Health and Safety Coo:e, and all applicable County and City Ordinances. I understand that ~ 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 refun-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 submltted and filed with the County of San Diego, Department of.Environment Health.~/ ~ Authorized Signature: ---------------= ::7 Date: q/1,/17- ----------------------------------------... ,. ... ---.-----·--·--·--·------··-···· ················-···-·-·----·--··----- Print Name and Title Here: ~:t:PP l±ErJ {ZAY , ,-:c:?:1?'.2 l VI ,._J 5,./!_ (For office use only) PLAN CHECK #/:. ________ PERMIT TYPE: __________ CENSUS TRACT: ____ _ ASSIGNED TO: ROUTE CODE:----- \ PLAN STATUS0APPROVE DISAPPROVED0 BLUE TAG;PC INITIALS _ _._4-_ REVIEW D~TE,/.:: =:..Jc~'..L.L ~:~:~~t: STATUS 0APPROVED~APPR04f~~~~A~;~ ~R~V:~A_T_E_· ======j,,l:: DEH:FH-1 TJ. (Rev, 04/17) FOOD & HOUSING DIVISION -PLA!>I CHECK P-2