HomeMy WebLinkAbout2659 GATEWAY RD; 104; CB112406; Permit01-19-2012
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Commercial/Industrial Permit Permit No:
Building Inspection Request Line (760) 602-2725
CBl 12406
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy GroUp:
Project Title:
Applicant:
RON BARTLO
2659 GATEWAY RD CBAD St: 104
Tl Sub Type: COMM
2131912500 Lot#: 0
$32,963.00 Construction Type: 58
FR6f6r6nc6
KYSS BOUTIQUE- ADD WALLS TO
MAKE ACCESSIBLE DRESSING ROOM, UGHTING
19522 JASPER HILL RD
TRABUCO CANYON CA 92679
949-456-9494
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
Plan Check#:
Owner:
LNR CPI BRESSI RETAIL LLC
C/O LNR PROPERTY CORP
4350 VON KARMAN AVE #200
NEWPORT BEACH CA 92660
ISSUED
11/10/2011
LSM
12/09/2011
12/09/2011
TP
Building Permit $330.43 Meter Size
Add'l Building Permit Fee $4.00 Add'l Red. Water Con. Fee $0.00
Plan Check $231.30 Meter Fee $0.00
Add'l Plan Check Fee $50.00 SDCWA Fee $0.00
Plan Check Discount $0.00 CFD Payoff Fee $0.00
Strong Motion Fee $6.92 PFF (3105540) $0.00
Park Fee $0.00 PFF (4305540) $0.00
LFM Fee $0.00 License Tax (3104193) $0.00
Bridge Fee $0.00 License Tax (4304193) $0.00
BTD #2 Fee $0.00 Traffic Impact Fee (3105541) $0.00
BTD #3 Fee $0.00 Traffic Impact Fee (4305541) $0,00
Renewal Fee $0.00 PLUMBING TOTAL $0.00
Add'l Renewal Fee $0.00 ELECTRICAL TOTAL $150.00
Other Building Fee $0.00 MECHANICAL TOTAL $0.00
Pot. Water Con. Fee $0.00 Master Drainage Fee $0.00
Meter Size Sewer Fee $0.00
Add'l Pot. Water Con. Fee $0.00 Redev Parking Fee $0.00
Reel. Water Con. Fee $0.00 Additional Fees $0.00
Green BIdg Stands (SB1473) Fee $1.00 HMP Fee ??
Fire Expedited Plan Review $0.00 Green BIdg Standards Plan Chk ??
TOTAL PERMIT FEES $773.65
Total Fees: $773.65 Total Payments To Date: $773.65 Balance Due: $0.00
Inspector:
FINAL
Date: -I
APPROVAL
Clearance:
NOTICE: Please take NOTICE that approval of your project Includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
refen-ed to as "fees/exactlons." 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/exactlons 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 /^PLY to any
fees/exactions of which vou have prewuslv been oiven a NOTICE similar to this, or as to which tt]e statute of limitations fias previouslv othenvise expired.
^ CITY OF
CARLSBAD
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-2717/2718/2719
Fax: 760-602-8558
www.carlsbadca.gov
Plan Check fio.(V^ [ \ cQHQ(g
Est. Value
Plan Ck. Deposit
Date I f SWPP
JOB ADDRESS ^^^^ ^^/7ffi//^y
m)T# " PH1SSE# ' # OF ffNITS # Bl
SUITE#/SPACE#/UNIT#
# BATHROOMS ' CT/PROJECT # TENANT BUSINESS NAMI CONSTR. TYPE OCC GROUP
DESCRIFTION OF WORK: Include Square Feet of Affected Areafs;
-TV 11) pfirOcutify 1^7
EXISTING USE P ROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS
YES • # NO • YES • NO D YES O NO •
APPLICANT NAME (Secontfaiy Contact)
ADDRESS
CITY, ' . ' - r gy^yg CITY STATE ZIP
FAX PHONE FAX
EMAIL
PROP^V^E^ ^^^^^^ ^^^J^^^^J^^f pONTRACTOR BUS. NAME "J^ ^ 11 ^
ADDRESS - ' ~ A
CITY--, STAIE , ZIP
PHONE^ , ^ - , ^ FAX " ' ^ PHONE FAX
EMAIL • r - - -EMAIL
ARCM^niSIGNER NAMLMDDBES^ STATE LIC. # \ STATE LIC.» _
. ^^-73 ^ r
CLASS CITY BUS. LIC.* _
^ i^fPueo <Sec,^7031.5 Business and Professions Code: Any City or County wtiich requires a pernnit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he • " ^- . - - - • - - • -Jmsiness and Professions Code) or that he is exempt theref 'civil penalty of not more than five hundred dollars ($500)).
aMlicant for such permit to file a signed statement that he is licensed pursuant to the provisions ofthe Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the "Xisiness and_Professions Code) or tnat he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any appiicant for a permit subjects the appiicant to a
WORKEIitS COMPCNSATiON
npensatlon Declaration: / hereby afSim under penalty peijury one ofthe follomng declarations:
fiave and will maintain a certificate of consent to self-lnsuiv for workers'compensation as provided by Section 3700 of tlie Labor Code, forthe performance of the work for which this permit is issued.
I have and will maintain work«r|,' compensation, asjeauired tot SactiorU7(X) qlthe Labor Cgile, for the performance of the work for whichJhis permit is Issued. My workers' compensation iQ^rara^ager a^djpolicy
r are Insurance Co Nh U G^ tXMdl Policy No 1^400^0 , Policy No.. Expiration Date _
Th|»<ection need not be completed ifthe pemiit is for one hundred dollars ($1(X)) orTess.
Certificate of Exemption: I certify that in the perfomiance of the work for which this pennit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
Califbmia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employerto criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in
addition to the cost of compensation, dam^« as provided for In Section 3706 of the Labor code, Interest and attorney's fees.
Jt^ CONTRACTOR SIGNATURE ^^^^J^T^^^^^^^^ DAGENT DATE f ^ —'^"^^
<Oi"W NER-auiiOeia, o%ci.A^ ATXOH
I hereby affinn that I am exempt from Contractor's Ucense Law for the following reason:
n i, as owner of the property or my employees with wages as their soie compensation, will do the work and the structure is not intended or offered for saie (Sec. 7044, Business and Professions Code: The (Contractor's
License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for
sale. If, however, the buiiding or improvement is soid 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 saie).
• I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
• I am exempt under Section Business and Professions Code for this reason:
1.1 personally plan to provkie the major labor and materials for construction of the proposed property improvement • Yes • No
2. i (have / have not) signed an application for a buiiding pemiit for the proposed work.
3. i have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number):
4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (Include name / address / phone / contractors' license number):
5.1 wi|i provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work):
VCTPROPERTY OWNER SIGNATURE •AGENT DATE
COMPLETE THIS SECTION FOR NON-ltESIDENTIAL BUILOING PERMITS ONLY
Is the appiicant or future building occupant required to submit a business pian, acutely hazardous materials registration forni or risk management and prevention program under Sections 25505,25533 or 25534 of the
Presley-Tanner Hazardous Substance Account Act? OYes DNo
is the applicant or future building occupant required ID obtain a pemiit from the air pollution control district or air quality management district? • Yes • No
Is the faciiity to be constmcted within 1,000 feet of the outer boundary of a school site? 13 Yes ONo
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 ANO THE AIR POLLUTION CONTROL DISTRICT.
CONSTRUCTION LENDING AGENCY
I liereby afUrm that there Is a construction lending agency for the perfonnance of the work this pemiit is issued (Sec. 3097 (i) Civil Code).
Lender's Name Lender's Address
APIPLICANT CBRTIFICATION
I certif that I have lead the applk»tk)n and state thatthe abine Infbimation Is correct and thatthe infon^
i hereby authorize repiEsentalive ofthe Qty of Carlsbad to enter upon the abcve mentioned property fbr inspection puiposes. i ALSO AGREE TO SAVE, iNDEH^Nil^ AND KEEP HAIRH^LESS THE CiTY OF CAIRLSBAD
AGAINST ALL UABIUTIES, JUDGMENTS, COSTS AND EXPENSES WHICH H^AY iN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMfT.
OSHA:An(DSHApemiitiSfequirBdfbr excavations overSO'deepanddemolltionor construction of stnictures overSstoriesinheight.
EXPIRATION: Every permit issued by the BuiJ(linjCiftial under thejitawsjons of this Code shall expire by limitation and become null and void if the building or vay. authorized by such permit is not commenced wilhin
180 days from Ihe date of such permit or if)he bujiJin^or v«rt( aulfioicBrfDy such pemiit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code).
VSTAPPUCANT'S SIGNATURE
Inspection List
P6rmit#: CB112406 Type: Tl
Date Inspection Jtem
COMM
Inspector Act
01/19/2012 89 Final Combo IVIP Fl
01/10/2012 89 Final Combo -Rl
01/10/2012 89 Final Combo MC PA
01/09/2012 308 Final DF Fl
01/09/2012 89 Final Combo MC CO
12/12/2011 14 Frame/Steel/Boltlng/Weldin TP AP
12/12/2011 34 Rough Electric TP AP
KYSS BOUTIQUE- ADD WALLS TO
MAKE ACCESSIBLE DRESSING ROOM, Ll
Comments
SEE CARD, NEED TRUNCATED DOMES
AT RAMP OK TO OCCUPY
COMPLETE ALL WORK & FIRE DEPT
CORRECTION
Thursday, January 19, 2012 Page 1 of 1
EsGli Corporation
In Partnersliip •witli government for (BuiUing Safety
DATE: 12/5/11 CUAREUqANT
JURISDICTION: City of Carlsbad • PLAN REVIEWER
• FILE
PLAN CHECK NO.: 11-2406 SET: II
PROJECT ADDRESS: 2659 Gateway Rd Suite 104
PROJECT NAME: Kyss Boutique - TI
I I The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's codes.
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
I I The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
I I The applicant's copy of the check list is enclosed for the jurisdiction to fonward to the applicant
contact person.
I I 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.
I I EsGil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: ) Email: Fax #:
Mail Telephone Fax In Person
3 REMARKS: Applicant to add notes in red on sheet A-1 to City held sets.
By: Doug Moody Enclosures:
EsGil Corporation
• GA • EJ • PC 11/28/11
9320 Chesapeake Drive, Suite 208 • San Diego, Califomia 92123 • (858)560-1468 • Fax (858) 560-1576
EsGil Corporation
In (Partnership witH government for (BuiCifing Safety
DATE: 11/21/11 • APPLIGANT
•CRURIS.
JURISDICTION: City of Carlsbad • PLAN REVIEWER
• FILE
PLAN CHECK NO.: 11-2406 SET; I
PROJECT ADDRESS: 2659 Gateway Rd Suite 104
PROJECT NAME: Kyss Boutique - TI
I I The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's codes.
I I The plans transmitted herewith will substantially comply with the jurisdiction's
codes when minor deficiencies identified below are resolved and checked by building
department staff.
I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
3 The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
I I The applicant's copy of the check list is enclosed for the jurisdiction to fonward to the applicant
contact person.
^ The applicant's copy of the check list has been sent to:
Ron Bartio
19522 Jasper Hill Rd, Trubuco Canyon, CA 92679
I I EsGil Corporation staff did not advise the applicant that the plan check has been completed.
IXI EsGil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Ron Bartio (V.M,^ Telephone #: 949-459-9494
Date contacted: u (by: ^) Email: rbararchitect(a)cox.net Fax #: 949-459-1539
£ Mail ^ Telephone ^ Fax-^ In Person
• REMARKS:
By: Doug Moody Enclosures:
EsGil Corporation
• GA • EJ • PC 11/15/11
9320 Chesapeake Drive, Suite 208 • San Diego, Califomia 92123 • (858)560-1468 • Fax (858) 560-1576
City of Carlsbad
11/21/11
11-2406
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK NO.: 11-2406 JURISDICTION: City ofCarlsbad
OCCUPANCY: M USE: Retail
TYPE OF CONSTRUCTION: VB ACTUALAREA: 938sf
ALLOWABLE FLOOR AREA: STORIES: 1
HEIGHT:
SPRINKLERS?: YES OCCUPANT LOAD: 28
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 11/10/11
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 11/15/11
DATE INITIAL PLAN REVIEW
COMPLETED: 11/21/11
PLAN REVIEWER: Doug Moody
FOREWORD (PLEASE READ):
This plan review is limited to the technical requirements contained in 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 2010 CBC, which adopts the 2009 IBC.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of
the 2009 International Building Code, the approval of the plans does not permit the violation of
any state, county or city law.
To speed up the recheck process, piease 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 vou submit the revised plans.
City of Carlsbad 11-2406
11/21/11
Please make all corrections on the original tracings, as requested in the correction
list. Submit three sets of plans for commercial/industrial projects (two sets of plans
for residential projects). For expeditious processing, corrected sets can be
submitted in one of two ways:
1. Deliver all corrected sets of plans and calculations/reports directly to the City of
Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760)
602-2700. The City will route the plans to EsGil Corporation and the Carlsbad
Planning, Engineering and Fire Departments.
2. Bring one corrected set of plans and calculations/reports to EsGil Corporation,
9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468.
Deliver all remaining sets of plans and calculations/reports directly to the City of
Carlsbad Building Department for routing to their Planning, 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. Please provide a statement on the Title Sheet of the plans to show compliance
with the current Codes. The following are the correct current Codes:
a) The 2010 edition of the California Building Code (CBC) adopts the 2009
International Building Code (IBC) and the 2010 California Amendments.
b) The 2010 edition of the California Electrical Code (CEC) adopts the 2008
National Electrical Code (NEC) and the 2008 California Amendments.
c) The 2010 edition of the California Mechanical Code (CMC) adopts the
2009 Uniform Mechanical Code (UMC) and the 2009 California
Amendments.
d) The 2010 edition of the California Plumbing Code (CPC) adopts the 2009
Uniform Plumbing Code (UPC) and the 2009 California Amendments.
e) The 2010 edition of the California Fire Code (CFC) adopts the 2009
Uniform Fire Code (UFC) and the 2007 California Amendments.
f) The 2008 edition ofthe California Energy Efficiency Standards.
2. Provide automatic shut-off controls for lighting as per Title 24, Part 6, Section
131(d).
3. Please complete the LTG-1-C part 3 of 4 mandatory automatic controls portion
of the LTG-1-C forms.
4. Please have the principle designer check the appropriate box(s) and complete
the Statement of Compliance System Acceptance section ofthe LTG-1-C part 4
of 4 documents.
5. Please revise the lighting plan to show the dimmers indicated in the lighting
control credit form.
City of Carlsbad 11-2406
11/21/11
6. Please revise the plans to show >1 fitting room or dressing room for the customers
shall be provided as follows:
i) Show a wardrobe hook mounted <_48" from the floor.
ii) Show a 24" x 48" bench:
a) Fixed along the wall at the 48" dimension.
b) Mounted >17" but < 19".
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 • No •
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 11-2406
11/21/11
[DO NOT PAY- THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad PLAN CHECK NO.: 11-2406
PREPARED BY: Doug Moody DATE: 11/21/11
BUILDING ADDRESS: 2659 Gateway Rd Suite 104
BUILDING OCCUPANCY: M TYPE OF CONSTRUCTION: VB
BUILDING
PORTION
AREA
( Sq. Ft.)
Valuation
Multiplier
Reg.
Mod.
VALUE ($)
Tl 888 37.12 32,963
Air Conditioning
Fire Sprinklers
TOTAL VALUE 32,963
Jurisdiction Code cb By Ordinance
BIdg. Permit Fee by Ordinanoe
Plan deck Fee by Ordinance
Type of Review:
I [Repetitive Fee
~ Repeats
0 Complete Review
• Other
j—I Hourly
EsGil Fee
• Structural Only
Hr. @ *
$330.43
$214.78
$185.04
Comments:
Sheet 1 of 1
macvalue.doc +
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB 11-2406 DATE 11/10/11
ADDRESS 2659 Gateway Road
RESIDENTIAL ADDITION-
MINOR (<17,000.00)
RETAINING WALL
VILLAGE FAIRE
POOL/SPA
COMPLETE OFFICE BUILDING
SOLAR PANELS
OTHER
PLANNER CJ(A^^ jd<Jcfrn^ DATE 11 -1Q-Jf
H:\ADM1N\C0IINTER/PLANNINC/ENGINEERINC APPROVALS
CITY OF
CARLSBAD
STORM WATER
COMPLIANCE
ASSESSMENT
B-24
Development Services
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
I am applying to the City of Carlsbad for the following type{s) of construction permit:
Juilding Permit • Right-of-Way Permit
• My project is categorically EXEMPT from
the requirement to prepare a storm water
pollution prevention plan (SWPPP) because it
only requires issuance of one or more of ttie
following permit types:
Electrical
Fire Additional
Fire Alarm
Fixed Systems
Mechanical
Mobile Home
Plumbing
Patio/Deck
Photo Voltaic
Re-Roofing
Sign
Spa-Factory
Sprinkler
Water Discharge
Project Storm Water Threat Assessment Criteria'*
No Threat Assessment Criteria
fljy'My project qualifies as NO THREAT and is exempt from the requirement to prepare a storm water pollution prevention plan (SWPPP) because
/ It meets the "no threaf assessment criteria on the City's Project Threat Assessment Worksheet for Detennination of Construction SWPPP Tier
^ Level. My project does not meet any of the High, Moderate or Low Threat criteria described below.
Tierl - Low Threat Assessment Criteria
• My project does not meet any of the Significant or Moderate Threat criteria, is not an exempt permit type (See list above) and the project
meets one or more of the following criteria:
• Results in some soil disturbance; and/or
• Includes outdoor construction activities (such as saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling).
Tier 2 - Moderate Threat Assessment Criteria
• My project does not meet any of the Significant Threat assessment Criteria described below and meets one or more of the following criteria:
• Project requires a grading plan pursuant to the Carisbad Grading Ordinance (Chapter 15.16 ofthe Carisbad Municipal Code); or,
• Project will result In 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement
removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria:
• Located within 200 feet of an environmentally sensitive area or the Pacifk; Ocean, and/or
• Disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical, and/or
• Disturbed area is located along or within 30 feet of a storm drain Inlet, an open drainage channel or watercourse, and/or
• Construction will be Initiated during the rainy season or will extend Into the rainy season (Oct. 1 through April 30).
Tier 3 - Significant Threat Assessment Criteria
• My project includes clearing, grading or other disturbances to the ground resulting In soil disturbance totaling one or more acres Including any
associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas: and/or
• My project is part of a phased development plan that will cumulatively result In soil disturbance totaling one or more acres including any
associated construction staging, equipment storage, refueling and maintenance areas: or,
• My project Is located Inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant
potential for contributing pollutants to nearby receiving waters by way of stomi water runoff or non-storm water dlscharge(s).
/ certify to the best of my Imowledge ttiat the above
checlced statements are true and correct I understand
and acknowledge that even though this project does
not require preparation of a construction SWPP, I must
st/// adhere to, and at all times during construction
activities for the permit type(s) check above comply
witti the storm water best management practices
pursuant to We 15 of the Carlsbad Municipal Code
and to City Standards.
"The City Engineer may authorize minor variances from the Storm
Water Threat Assessment Criteria in special circumstances where it
can be shown that a lesser or higher Constmction SWPPP Tier Level is
warranted.
Project Address: Assessor Parcel No.
Gwner/pwner's AuthorizedAoent Name: Title:
Owrier/0lfner?^uthoriz! id AmUT^nature: Date:
I city Ceneurrence:
/PES QNO (iWv
B-24 Page 1 of 1 Rev.03/09
Carlsbad Fire Department
Plan Review Requirements Category: TI, COMM
Date of Report: Tl -21 -2011 Reviewed by:
Name:
Address:
RON BARTLO
19522 JASPER HILL RD
TRABUCO CANYON CA
92679
Permit #: CBl 12406
Job Name: KYSS BOUTIQUE- ADD WALLS TO
Job Address: 2659 GATEWAY RD CBAD St: 104
INCOMPLETE—The item-you have-fmbmitted-for review is incomplete. At this time» this office cannot
•adequately conduct a review to determine compliance with the applicable codes and/or standards. Ploaoo roviow •
•cMefuUy all eonnments attached. Please resubmit the necessary plans and/or specifications, with changes "clouded"-,
•to this office for review and approval.
Conditions;
Cond: CON0005076
[MET]
APPROVED:
THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF
BUILDING PERMIT.
THIS APPROVAL IS SUBJECT TO FIELD INSPECTION AND REQUIRED TEST, NOTATIONS HEREON,
CONDITIONS IN
CORRESPONDENCE AND CONFORMANCE WITH ALL APPLICABLE REGULATIONS.
THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE THE VIOLATION OF ANY LAW.
Entry: 11/21/2011 By: df Action: AP
BUILDING ENERGY ANALYSIS REPORT
PROJECT:
Kyss Boutique
2659 Gateway Road Suite 104
Carlsbad, CA 92009
Project Designer:
Ron Bartio & Associates
19522 Jasper HIII Road
Trabuco Canyon, CA
(949) 459-9494
Report Prepared by:
Timothy Carstairs
Carstairs Energy Calculations
P.O. 80x4736
San Luis Obispo, CA 93403
(805) 904-9048
Job Number:
11-1109
Date:
11/9/2011
The EraigyPro computer program has been used to peffiQ^
authonzed by ths Catfonia Energy Commission for use wtth both the RBsidemiai and NonresUentiai 2006 Buidino Energy Efficiency Standards
TNs program developed by EnergySoft, LLC - www.energy80ft.com.
Energ^^v^Jb^Emtg^SoR KunCode: 2011-11-09720:01:18 ID: 11-1109
TABLE OF CONTENTS
Cover Page 1
Table of Contents 2
Form LTG-1 -C Certificate of Compliance 3
Form LTG-2-C Lighting Controls Credit Worksheet 7
Form LTG-3-C Indoor Lighting Power Allowance 8
Form LTG-MM Lighting Mandatory Measures 9
EnergyPro 5.1 by EnergySoft Job Number ID: 11-1109 User Number 6249
CEPmFICATE QF COMPUANCE (Part i of 4) LTG-IC
PiQlMit Name
KyssBou^m
Dale
Protect Addrsss
26S9 Getaway Road Suite 104 Carisbad
Ctknste Zbne Total Cond. Floor Aiga
886
Unoondifloned Roar Alia
0
tmmii^wmuArtoH
Buiktrig Type: Gl ftortresidential
RaiocaMiiePiMk:
Sehooi
• High-rase fteidentiai • Hotel/MoteJ Guest Roow
• Stitmdi a B Condittoned ^>ac88 • UncontSKMiecf^Ges
Phase erf donsbut^n: • New Cot^friKtion • Addition Q AReraMon
Mettiod of GoR^pfiance: • Compiefe Biding B Area Category • Taflored
Documentatfon Author's Oeeiiwafion ^atmnent
I oertffy that Ws Cergfioale of ConH3>iance dooimentedfon Is aoiurate and complete.
Name TmathyCarstaks
Compare
Ckustars Energy C^cutaSons
Signature
Oate
iijaaoii
Address
P.O. Bm 4736
CEA«
CEPE#
Ctty/State/Zip Phone
San liife OtKSPO. OA a34m (80^904-9048
The IHIneiiMl UflMiiig Desi^^ OedaialiOfi Sttrtemont
• i am eiigMbJe und» Oi^ion 3 of the CeWon^ Bu^iwss and ProfessionaJ Code to acceiirt reqponstbiiity for ttte
lighting desigri.
• ThisCertfftsBteofOjrnpfianoeidertttfiesthefi^
oMnptiancewfth TiHe 24. Pages t snd 6 of 9ie (^MomiaCode ofllegi^rtions.
• The des^ feaAuresrepBseraed on tt^Certi&:^e of Compliance an o^
to documertf tns de^gn on tr» oVier ^spticabie corr^sisnee Icrnns, worksHieels, cadctriations, piaris and
i^Dec^cafons strimitted to the ^iforc^nent agem^ for approval tMs bdritfjing pep^ app^al6m.
Name
Company RonBarto&AssoctstBS (949)459^494
Address Lioenae*
19522Ja^m Road
aty/Stetemp Date
Tralmeo Canyon, CA
UgMtas HaiMMery Meeeuiee
Mk»tB )o(»£of) on fauUtaffplens ef Mande^^
lJSHy««5 tsmmmme. FOBMS * M«>BI@HEETS (eha<dc IKW tf wotiahaats le tedadedB
For drtaiW te^nitaicw jjw tta twe of IWB and att enemy Efflciwicy Stancfciitte cowpiance fornie; pteaae refer.<» Ndiiieakfcmelal Manual puMtehed
by <te CaMomia BwwGonwibBioa '
Q LT6*1GPaoBSlttw(High4 CerMcaie of CompHanoe. AB Pages required on plans for all submittals.
Q LTG-2C Ughting ConBDis Credit Worksheet
Q LTG-3C Indoor UgMng Power AHowiance
• I.T&4C Pagm 1 through 4 Taaoied Method Worlaheet
• LTG-5C Pages l and 2 Une Vottaae Track Ughting Worksheet
Bneis^^lt^&efa^ UserNma>erS2^ Kaiiia>aK20l1.ii-anVkattU tD:11-U09 Paae3df9
CERTIFICATE OF COMPUANCE (Part 2 of 4) LTG-1 C
Project Name
Kyss Boutique
Date
11/9/2011
INDOOR LIGHTING SCHEDULE and WELD INSPECnON ENERGY CHECKLIST
Installation Certiflcate, LTQ-1 - IHST <Relahi a copy and vei% form is completed and sigwd.) Field Inspector
Certiflcate of Acceptance, LT0-2A snd LTG^SA (Retain a copy and verify town Is compiwed and signed.) Flaw Inspector •
A separate Ughting Schedule Msi& Be FHed Out for Conditioned and Unconditioned Spaces Installed Ughting Power listed on
this Urfrtino St^iedtile is only ton
OOWPmONED SPACE • llNCOWDmOt*ED SPACE
m The actual indoor fighting power listed below nidudes al insUAed pwmanent and portalOle ighting systems in accordance
wah§t46<a).
Only for offi<»s: Up to tiie first 0.2 watts pa* square foot of portable Nghtaig shal not be required to be included in the
• calculation of actual indoor lighti'ng power density in accordance wtfi the Exception to §146(a). All portable lighting in excess of
0^ walls per square foot is totaled below.
Uimtnaire (Type, Lamps. Ballasts) In^iied Watts
B H
None
or
Item
Tag
How watlage
Was detemiined FleM
Comptete Luniinaire Description'
(Le, 3 lamp ftuorescem iniHer,
F32T8s one cBmmable eleclronlc ballasts) II
CEC
From
NAS
li
!i2 z n
2x4 Fluorescent Fixture (3) 3278 96.0 • 864
Wall Sconce SOW 50.0 • 100 •
Ctiand0lier(4OOW) 400.0 • • 400 • •
4' Track Light Fixture (45W/ft.) 180.0 m 180 •
Surface Mounted Fluorescent (2)18T5 36.0 m • 36 •
•
• • •
• •
• •
a
•
• •
• •
•
•
• •
o a
Installed Watts Paae Total:
Building total number cA pages:
InstetHed WaOs BtMlding Totsd
(Sum of all panes)
Enter mto LTG-t 0 Page 4 of 4 1580
t. Wattage shal be det«rnined accordbig to Section 130 (d and e). Wattage shal be rathig Of ^
2. if Fail then desGitoe on Page 2 of the Inspection ChecMiGtForin and taiw appropriate atam Verttybuldktg plans if necessary.
EnergyPro 5.1 by EnergySoft User Number 6249 RunCode: 2011-11-09720:01:18 ID: 11-1109 Page 4 of 9
CERTIRCATE OF COMPLIANCE (Part 3 of 4) LTG-1 C
Project Name
Kyss Boutique
Oate
11/9/2011
INDOOR UQHTIW) SCHEDULE and RELD INSPECTION ENERGY CHECKUST
RH in controls for all spaces: a) area controls, b) multi-level controls, c) manu^ daylighting controls for daylit areas > 250 ft^,
automidic di^i(^ng oonttois for daylit areas > 2,500 ft, d) ^wt-crff contr<^, e) d^pteiy Hf^'tting oontrc^, t) tailored lighting controls -
general lighing oonlroled separate from di^ilay, ornamental and display case ttgf^^
consols for r^il stores > 50,000 fl% in accordance with Section 131.
MANDATORY UGHTINQ CONTROLS - RELD INSPECTION ENERGY CHECKLIST Plsld
InsiMclor
Type^ Descr^Mion
timber
of Unite Locsaion in BuUdina
Special
Features Pass Fail
• • •
• • •
• • •
• • •
• • •
• • •
• a
• • a
• • •
• • •
• • •
• • o
• • •
• • •
• • •
• • •
• • o
• • •
• • •
• : • •
• Q a
• • o
• •
• • •
SPEaAL FEATURES INSPECTION CHECKLIST (See Page 2 of 4 of LTG-IC)
The kx^ enfbroemmt agency shoirtd pay spedai attention to the items specified in tiis dieckli^. These Herns require special written
justification and documentation, and spedsri verification. The local enforcement agency determines ttie adequacy of the ^stification,
and may reject a buiding or design that ottwnMse compNes based on the adequacy of the special ^istilication and documentation
submitted.
Field Inspeetoi's Notes or Discrepancies:
EnergyPro 51 by EnergySoft User Number 6249 RunCode: 2O11-11-09T2OM1:1t 10:11-1109 PageSofO
CERTIFICATE OF COMPLIANCE (Part 4 of 4) LTG-1 C
Project Name
Kyss Boutique
Date
11/9/2011
CONDITIONED AND UNCONDITIONED SPACE LIGHTING MUST NOT BE COMBINED FOR COMPLIANCE
Indoor Lighting Power for Conditioned Spaces Indoor Ugliting Power fbr lincondifloned Spaces
Watts Watts
Installed Lighting
(from Conditioned LTG-IC, Page 2) J,580 Installed Lighting
(from UrKonditioned LTG-IC, Page2) 0
Lighting Control Credit
Conditioned Spaces (from LTG-2C) 68 Lighting Contiol Credit
Uncondltk>ned Spaces (Irom LTG-2C) 0
Adjusted liwtalled _
Lighting Power *,5f2 Adjusted Installed _
Ugliting Power 0
Complies If Installed ^ Allowed >' Complies if Installed ^ Allowed ''
Allowed Lighting Power
Conditioned Spaces (fipom LTG-3C or PERF-1) 1,514 Allowed Lighting Power
Unconditioned Spaces (from LTG-3C) 0
Required Acceptance Tests
Designer:
This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system,
LTG-2A and LTG-3A. The designer is required to checit the acceptance tests and list all control devices serving the building or space
shall be certified as meeting the Acceptance Requirements for Code Compliance. If all the lighting system or control of a certain type
requires a test, list the different lighting and the number of systems. The NA7 Section in the Appendix of ihe Nonresidential
Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the
r^ponsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled.
Enforcement Agency:
Systems Acceptance. Before Occupancy Permit is granted fbr a newly constructed building or space or when ever new lighting
system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements.
The LTG-2A and LT6-3A forms are not considered complete forms and are mt to be accepted by the enforcement agency unless
the boxes are checked and/or filled and signed. In addition, a Certifteate of Acceptance forms shall be submitted to ttw enforcement
agency that certifies plans, specifications, installation certificates, and operating and maintenance infonnation meet ttie requirements
of §10-103(b) af Titie 24 Part 6. Ttie field inspector must receive the properly filled out and signed forms before ttie building can
receive final occupancy. A copy of the LTG-2A and LTG-3A fbr each different lighting luminaire contot}|(s) must be provided to the
owner of the building for their records.
Luminaires Controlled
LTG'.ZAand
LTG-3A
Equipoiertt Requiring Testing Description
Numbar of
Luminaires
controlled Location
Controls and
Sensors and
Automatic
Daylighting Controls
Acceptance
Dimming - Manua/ Wall Sconce 50W 2 Retail m
Dimming - Manual Ct>andelier(400W) 1 Retea IZI
Dimming - Manual 4' Track Ligtit Fixture (45Wm.) 1 RetaH m
a
•
•
•
•
•
•
•
•
•
•
•
•
EnergyPro 5.1 by EnergySofi User Number 6249 RunCode: 2011-11-09720:01:18 ID: 11-1109 Page6of9
UGHTING CONTROLS CREDIT WORKSHEET (Part 1 of 2) LTG-2C
Project Name Date
Kyss Boutique 11/9/2011
POWER ADJUSTMENT FACTORS (PAF) FOR NON-DAYUGHT CONTROLS
A Separate PAF Worksheet Must Be Filled Out for Conditioned and Unconditioned Spaces. Control Cre<m8 Hated on this
ediedule are milyfor:
• CONDITKMiED SPACES • UNCONDITIONED SPACES
A B C D E F Q
Room # Zone to
Uohling Contral Description^
Plan
Reference
Room Area
(ft*)
Watts of
Control
Uohttno
Power
Adjustments
Factor*
Control
Credit Watts
(ExF)
Retail Dimming - Manuaf 2 922 700 o.to 10
Retail Dimming - Manual 3 922 400 0.10 40
Retail Dimming - Manual 4 922 180 0.10 18
PAGE TOTAL 68
Note:
Conmonedand
Uncoodhtoned
Space shal be
separately
toUded
BuidN} totai of non-dayi^ control credit watts for aH pa^ Of LT&2C Page 1 (rf 2 Note:
Conmonedand
Uncoodhtoned
Space shal be
separately
toUded
Eriter buldbio total of al daylkltt GOttrals ciedk watts from LTG% P^ 0
Note:
Conmonedand
Uncoodhtoned
Space shal be
separately
toUded
BtlHJlMQ TOTAL OF ALL COKTROL CRBXr WATTS
(FOR BOTH IMON-DAYUGHT AMD DAYUQHT COfsfTROL CREDITS)
Enter \n LTG-IC; Page 4: Ughting Control Credft as appropriate for CONDiTIOIsEO
or UNCONOmONED Spaces
68
1. Description shal be consisteft with Type Control dtfined in Table 146-C
2. Power Aofustmert Fai^ taken fram Tatiie 146-C
BnergvPro5.1 bvEneravSrm User Number 6249 RunCode: 2011-11-09720:01:18 ID: 11-1109 Paoe7of9
INDOOR LIGHTING POWER ALLOWANCE LTG-3C
Project Nsffne
Kyss Boutique
Oate
11/9/2011
ALLOWED LIGHTING POWER (Chose Om Method)
A Separate LTG-3C must be filled out for Conditioned and Unconditioned Spaces. Indoor Ughting Power Allowances listed on this
page are only for: • co^o^'lo^cD SPACES a UNCGNDITICX^ED SPACES
COMPLETE BUILDING METHOD
BUILDING CATEGORY (Fran S146 TadJie 146-E)
WATTS
PER(fA X
COMPLETE
BLOa. AREA
ALLOWED
WATTS X X X X X X X X X X X X X X X
TOTALS
AREA WATTS
AREA CATEGORY METHOD
BUILDING CATEGORY (From §146 Table 146-R
WATTS
PER (If) X AreafP
ALLOWED
WATTS
Retail Sales, Wholesale 1.60
X
922 f,475
Conidor/Restroom/Support 0.60
X
64 38
X X X X X X X X X X X X
TOTALS 986 1,514
AREA WATTS
TAILORED METHOD
Total AUowed Watts using the TaHored Method taken trom LTG-4C (Paae 1 of 4) Row 3 0
The indoor lighting power alowance using the Taitored Mettiod of compBance sheM t>e determined usftig ttie LTG-4C set of forms A separate set of LTQ-
40 tarns shai be tiled out for CONOITKINEO and UNCOMMTIONED spaces
EneravPro 5.1 bv EnemvSoft User Number 6249 RunCode: 2011-11-09720:01:18 10:11-1109 Paae 8 of 9
LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG-MM
Project hSame
Kyss Boutique
Date
11/9/2011
Indoor Lighting Measures:
§131(d). Shut-off Controls
1.
For every ftoor, aA interior lighting sysiems shall be equipped vvith a separate autoinatic c^
This automatic conbxrf shall meet the requirements of Section 119 and may be an occupancy sensor, automatic time
switch, or other device capable of airtomatically shutting off tfie lighting.
2. Ovenide for Building Li^ng Shut-off: The automatic buflding shut-off system is provided witii a manual, accessible
ovenide switch ai siilit of the tights. The area of override is not to exceed 5,000 square feet.
§119(h): Automatic Contiol Devices Certified: Al automatic control devices specified are certified, all alternate equipment shall
be certified and inslatted as directed by the manufataurer.
§11f. FhioresoentBttfast and Luminaires Certified: All luoresoent fixtures specked for the prcjed are codified and listed in ttte
CKrectory. AH instaNed fixturss shal t>e certified.
§131 (a): Individual Room/Area Corrtrols: Each room and area in tNs buikfing is equi(^)ed witfi a separate switch or occupancy
sensor device for each area with ffow-to-ce^ waUs.
§131(b):
Uniform Reduction for Imfividual Rooms: All rooms and areas greater ttian 100 square feet and more than 0.8 wratts
per square foot of lighting load shaH be controlled witt) bi-level switching for unifonn reckiction of lighting wittiin ttie
room.
§131 (c):
Daylight Area Gontioi: AH RX)nis witti windows and sicyightsttial are greater than 250 square fert and tfiat allow for
the effective use of daylight in the area shaH have 50% of the lamps in each daylit area controlled by a separate switch;
or the effective use of daylight cannot be aocompi^ed because ttie windows are continuously shaded by a building on
tiie adiacent k^. Diaivamof blading <jkiring(fiitorert times of ttie year is Hiduded on t^a^
§131 (c): Display Li^ng. Display lighting shaH be separately switched on circuits that are 20 amps or less.6.
Outdoor Ughting Measures:
§130(c)1: K^vidatory lighting power detenra'natfion for medum base sockets without permanentiy installed ballasts
§132(a): All pemnanentiy installed lunMnan'es witfi lamps rated ovm 100 Watts eitiier have a lan^) effuacy of at least 60 lumens
per Watt or are oontrofied t>y a motion sensor.
§132(b): All Luminaires witti teunps rated greater than 175 Watts in hardscape area, including parking tots, building entrances,
canopies, snd outdoor sales areas meet the OaM Requiremenls.
§132(c)1: Att pwmanentty mstatted outdoor Kiting meets the control requirernerAs Ksted.
§132(c): Bifllding tecades, parking tots, garages, canoptos, and outdoor sales areas me^ the Multi-Level Lighting Requirements
listed.
EnergyPro S. 1 by EnergySoft User Number 6249 RunCode: X11-11-09720:01:18 ID: 11-1109 Page 9 of 9
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS QUESTIONNAIRE
OFFiCE USE ONLY
UPFP#
HV#
BP DATE / /
Plan File#
-i-Project Contai Tell
(
Tfie following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTIMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicatf by circling the item, whether your business
will use, process, or store any of the following hazardous materials. If any of the items are cjKled, applicant must contact the Fire Protection Agency with
jurisdiction prior to plan submittal. Facility's Square Footage (Including proposed project): ^ ^ Occupancy Rating: Lf/^
1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water ReKitivM 13. Corrosives
2. Compressed Gases 6. Oxidizers 10. Cryogenics Hither Health Hazards
3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials ^^^one of These.
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIViSIONS tWHiDY If the answer to any of the
questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Ave., Suite 110, San Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building permit.
Project Complefion Date: / / Expected Date of Occupancy: / / FEES ARE REQUIRED
YES Nl
•
• CalARP Exempt
/ Date Initials
• CalARP Required
I
Date Initials
• CalARP Complete
I
Date Initials
(for new construction or remodeling pnjjects)
1. • Iffl^ Is your business listed on the reverse side of this form? (check all that apply).
2. n Will your business dispose of Hazardous Substances or Medical Waste in any amount?
3. n ^qP Will your business store or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 pounds,
200 cubic feet, or carcinogens/reproductive toxins in any quantity?
4. • Will your business use an existing or install an underground storage tank?
5. • Will your business store or handle Regulated Substances (CalARP)?
6. • Will your business use or Install a Hazardous Waste Tank System (Title 22, Article 10)?
7. • ^ff Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to
^ or greater than 1,320 gallons? (Califomla's Aboveground Petroleum Storage Act).
PART lil: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air
Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition
permit. Note: if the answer to questions 4 or 5 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to
commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information.
YES NO
n Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the
APCD fectsheet at http://www.sdaDCd.orq/info/facts/pennits.pdf. and the list of typical equipment requiring an APCD permit on the reverse side
of this from. Contact APCD if you have any questions).
(ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)?
(Search the California School Directory at http://www.cde.ca.qov/re/sd/ for public and private schools or contact the appropriate school district).
Has a survey been performed to determine the presence of Asbestos Containing Materials?
Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos?
Will there be demolition involving the removal of a load supporting structural member?
1.
Briefly describe business activities: Briefly describe proposed project:
the best of my knowledge and belli isponsj^made herajnare true and correct.
ignature of Owner or Authorized Agent
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:.
BY:
FOR OFFICIAL USE ONLY:
DATE:
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMD* APCD COUNTY-HMD APCD COUNTY-HMD APCD
A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other pennitting requirements may still apply.
HM-9171 (02/11) County of San Diego - DEH - Hazardous Materials Division
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
, ^ SCREENING SURVEY
Busi/iess Name /C/g*^ ^^2S>f?f^4
Street Address C^(^ ^ ^ "*
Efnail Address
PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSES1D)6 CHECK TYPE OF BUSINESS)
Check all below that are present at your facility:
Acid Cleaning
Assembly
Automotive Repair
Battery Maniifa<*jring
Biofuel Manufaeturing
Biotech Laboratory
Bulk Chemicaf Storage
Car Wash
Chemical Manufacturing
Chemical Purification
Dry Cleaning
Electrical Component
Manufactuiing
Fertilizer Manufacturing
Film / X-ray Processing
Food Processing
Glass Manufacturing
Industrial Laundry
Ink Manufacturing
Laboratory
Machining/Milling
Manufacturing
Membrane Manufacturing
(i.e. water filter membranes)
Metal Casting/Forming
Metal Fabrication
Metal Finishing
Electroplating
Electroless plating
Anodizing
Coating (i.e. phosphating)
Chemical Etching / Milling
Printed Circuit Board
Manufacturing
Metal Powders Forming
Nutritional Supplement/
Vitamin Manufacturing
Painting/Finishing
Paint Manufacturing
Personal Care Products
Manufacturing
Pesticide Manufacturing/
Packaging
Pharmaceutical Manufacturing
(including precursors)
Porcelain Enameling
Power Generation
Print Shop
Research and Development
Rubber Manufacturing
Semiconductor Manufacturing
Soap / Detergent Manufacturing
Waste Treatment/Storage
SIC Code(s) (if known):
Brief description of business activities (Production / Manufacturing Operations):.
Description of operations genei^ting wastewater (discharged to sewer, hauled or evaporated):
Estimated volume of industrial wastewater to be discharged (gal/day):
List hazardous wastes generated (type / volume):
Date operation began/or will begin at this location:
Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority?
Yes No
Site Contact,
3 yes, when:
/rm^ /^/f^rco Title z^^///:^ r
IC Signature/A^:^^ Phone NO. ^^f^^ff^'fC
'^"^CINAyVASTEWATER AUTHORITY. 6200 Avenida Encinas Carlsbad. OA 92011 (760)438-^3941
FAX: (760) 476-9852
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