HomeMy WebLinkAbout2700 RANCHO PANCHO; ; CB143247; Permit12-11-2014
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Commercial/Industrial Permit Permit No: CB143247
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
Project Title:
2700 RANCHO PANCHO CBAD
Tl
2226000100
$14,000.00
Sub Type: COMM
Lot #: 0
Construction Type: NEW
Reference #
Status: ISSUED
Applied: 11/20/2014
Entered By: LSM
Plan Approved: 12/11/2014
Issued: 12/11/2014
Inspect Area
Plan Checl<#:
FAITH COMM CHURCH= CONSTRUCT
A 618 SF RAISED STAGE (16" HIGH) W/ ONE RAMP AND 3 STAIRS
IN SANCTUARY
Applicant:
KENNETH SMITH, ARCHITECT
STE 102
500 FESLER ST
EL CAJON CA 92020
619-444-2182
Owner:
FAITH COMMUNITY CHURCH BY-THE-SEA
POBOX 231460
ENCINITAS CA 92023
Building Permit $149.47 Meter Size
Add'l Building Permit Fee $0.00 Add'l Red. Water Con. Fee $0.00
Plan Check $104.63 Meter Fee $0.00
Add'l Building Permit Fee $50.00 SDCWA Fee $0.00
Plan Checl< Discount $0.00 CFD Payoff Fee $0.00
Strong Motion Fee $3.92 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 $0.00
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 Bldg Stands (SB1473) Fee $1.00 HMP Fee ??
Fire Expedidted Plan Review $0.00 Green Bldg Standards Plan Chk ??
TOTAL PERMIT FEES $309.02
Total Fees: $309.02 Total Payments To Date: $309.02 Balance Due: $0.00
Inspector:
FINAL APPROVAL
Date: Clearance:
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
refened to as "fees/exactions." You have 90 days from the date this pemiit 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 IVlanager 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 sewice fees in connection with this project. NOR DOES IT APPLY to any
fees/exactions of which vou have previouslv been oiven a NOTICE similar to this, or as to which the statute of limitations has oreviouslv othew/ise expired.
THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: nPLANNING nENGINEERING •BUILDING nFIRE DHEALTH nHAZMAT/APCD
mm,.
\^ City of
Carlsbad
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
Ph: 760-602-2719 Fax:760-602-8558
email; building@carlsbadca.gov
www.carlsbadca.gov
Plan Check No. (2&IL[ 3 "7
Est. Value ) L[-rf^
Plan Ck. Deposit /OH^.C^'S
Date /1 .50 / < SWPPP
JOB ADDRESS 2700 iRAiuko SUITE#/SPACE#/UNIT# 222 - ^Ofi - 0\ -OX)
CT/PROJECT # LOT* PHASE* # OF UNITS
—
* BATHROOMS TENANT BUSINESS NAIVIE , • k,ui>ibiK. irrt uuu vjHUUf CONSTR. TYPE
DESCRIPTION OF WORK: /nc/ude Sguare Feet of Affected Area(s)
EXISTING PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE
YES|~|# N0|
AIR CONDITiONING
YEsf
MDITj.ONING FIRE SPRINKLERS
YESCTNOI I
PROPERTY OWNER NAME
2^5"
PHONE- , ^ ^ _ ^ _ I FAX
EMAIL EI^AIL
V-DESIGN PROFES! CONTRACTOR BUS. NAME
VDDRESS ADDRESS I OOP P\o\M^^ (jO^
I • STATE CITY
OA
STATE ZIP CITY ZIP
PHONE PHONE
EMAIL EMAIL
^7314g. ;LiSS, ^ I CITY BUS. Lie*
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit 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 Is licensed pursuantto the provisions ofthe Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars ($500)).
I WORKERS- COMPENSATI O N
Workers' Compensation Declaration: / hereby affinn under penalty ofpeijury one ofthe following declarations:
• I have and will maintain a certificate of consent to self-Insure for workers' compensation as provided by Section 3700 of the Labor Code, for the perfonnance of the worit for which this permit is Issued.
1^21 have and will maintain workers' compensation, as reguired by Section 3700 ofthe Labor Code, for the performanceofthewqrk for which this permit is issued. My workers' compensation insurance carrier and policy
number are: Insurance Co ^{j.^ ( C>^^((>U<rQ Policy No ((J^£>tC(l lf)fi- Expiration Date (Q // / l~>
This section need not be completed if the permit is for one hundred dollars ($100) or less.
I I Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
Califomia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), In
addition to the cost of compensation, d£lm»esias provided for in Section 3706 of the Labor code, interest and attorney's fees.
^ CONTRACTOR SIGNATURE M/Xj/j^/T^i^^ 't/]AGENT DATE /(J " //" / V
OWNEir-BUiLOER DECLARATION
/ hereby affirm that I am exempt from Contractor's Ucense Law for the foliowing reason:
I I I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's
License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale).
•
I I I am exempt under Section
I, as owner of the properfy, 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).
_Business and Professions Code for this reason:
1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. QYes I iNo
2.1 (have / have not) signed an application for a building permit for the proposed work.
3.1 have contracted with Ihe 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, supen/ise and provide the major work (include name / address / phone / contractors' license number):
5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the mrk indicated (Include name / address / phone / type of work):
PROPERTY OWNER SIGNATURE •AGENT DATE
•MiCiilZZII £l 21 ^£i^3iiJi!i^BJi^nP* THHtHa ni. i
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? OYes D No
Is the applicant or future building occupant required to obtain a pemiit from the air poiiution control district or air quality management district? • Yes O No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? • 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 AND THE AIR POLLUTION CONTROL DISTRICT.
_J EHi>ltHS -AG BMIIIIIM^^^^^^^^ I f I Illi •••••^^
— -www^^ l^'r'm *—^ "wr-'
I hereby aflirm that there is a construction lending agency for the performance of the work this pennit Is issued (Sec 3097 (i) Civil Code).
• ON t
Lender's Name Lender's Address
p p 11 c AM/T 'C1 n.rft i:cmi.T:i 0 N:
I certif thati have read the applkation and state that the above Information IS collect and that the informatk)^
I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD
AGAINST ALL LlABlLlTiES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA pemiit is required fbr excavations over 5'0' deep and demolitbn or constnjction of stnjctures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Oflicial under the provistons of this Q)de shall expire by limitation and become null and void if the building or wo* authorized by such pennit is not commenced within
180 days from the date of such pemiit or if thajpuildiDg or vwrk authorized by such p&wit is suspended or abandoned at any time after the viork is commenced for a period of 180 days (Sectton 106.4.4 Unifomi Building Code).
vgS" APPLICANT'S SIGNATURE CT/CL^ J\ A JSJLA—^ DATE
X City of
Carlsbad
Building Permit Appiication
1635 Faraday Ave., Carlsbad, CA 92008
Ph: 760-602-2719 Fax: 760-602-8558
email: buildlng@carlsbadca.gov
www.carlsbadca.gov
Plan Check No.
Est. Value
Plan Ck. Deposit
Date SWPP
JOB ADDRESS SUITE#/SPACE#/UNIT#
CT/PROJECT # LOT# PHASE# # OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE occ. GROUP
DESCRIPTION OF WORK: fncfiide SQuare Feet of Affected Area(s)
EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE
YESD # NOD
AIR CONDITIONING
YES O NOO
FlRESPRINKLERS
YES • NOD
APPLICANT NAME
Primary Contact
PROPERTY OH fNER NAME
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE FAX PHONE FAX
EUMl EMAIL
DESIGN PROFESSIONAL NAME CONTRACTOR BUS. NAME
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE FAX PHONE FAX
EMAIL EMAIL
STATE LIC. # STATE LIC.# CLASS CITY BUS. Lia#
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicanffor such permit to file a signed statement that he is licensed pursuantto the provisions ofthe Contractor's License Law {Chapter 9, commending with Section 7000 of Division 3 ofthe Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applioantfor a permit subjects the appiicantto a civil penalty of not more than five hundred dollars ($500)).
WORKERS' COMPENSATION
Workers' Compensation Declaration: / hereby afTm under penalty of perjury one ofthe following declarations:
Ci I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the wori< for which this pemiit is issued,
n I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the perfomiance of the work for which this pemiit is issued. My workers' compensation insurance carrier and policy
number are: Insurance Co. Policy No. Expiration Date
This section need not be completed if the pemiit is for one hundred dollars ($100) or less.
^ Certificate of Exemption: I certify that in the perfonnance of the wori< for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
Califomia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), In
addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
CONTRACTOR SIGNATURE •AGENT DATE
OWNER-BUILDER OECLARAT
I hereby affinn that I am exempt fi'om Contractor's License Law for the following reason:
d I, as owner of the properfy or my employees with wages as their sole compensation, will do the wori( and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's
Ucense Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale).
O 1, 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).
0 I am exempt under Section Business and Professions Code for this reason:
1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement • Yes O No
2.1 (have / have not) signed an application for a building pemnit for the proposed wort(.
3.1 have contracted with the following person (firni) to provide the proposed construction (include name address / phone / contractors' license number):
4.1 plan to provide portions of the wori<, but I have hired the following person to coordinate, supenrise and provide the major worit (include name / address / phone / contractors' license number):
5.1 will pmvide some of the worit, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of worit):
PROPERTY OWNER SIGNATURE •AGENT DATE
Inspection List
Permit*: CB143247 Type: Tl COMM FAITH COMM CHURCH= CONSTRUCT
A 618 SF RAISED STAGE (16" HIGH) W/ O
Date Inspection Item Inspector Act Comments
02/02/2015 19 Final Structural - Rl
02/02/2015 19 Final Structural PB AP
01/16/2015 11 Ftg/Foundation/Piers PD AP
Tuesday, February 03, 2015 Page 1 of 1
EsGil Corporation
In (PartnersRip witti government for (BuiCcCing Safety
DATE: 12/4/14 • APPLICANT
• JURIS.
JURISDICTION: City of Carlsbad • PLAN REVIEWER
• FILE
PLANCHECKNO.: 14-3247 SET: I
PROJECT ADDRESS: 2700 Rancho Pancho
PROJECT NAME: Faith Community Church Stage and Ramp - TI
I I The plans transmitted herewith have.been corrected where necessary and substantially comply
with the jurisdiction's building codes.
xl The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified in the remarks below are resolved and checked by building
department staff.
I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
I I The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
I I The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
I I The applicant's copy of the check list has been sent to:
[XI 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:
Mail Teiephone Fax In Person
^ REMARKS: Applicant to add notes in red on cover sheet.
By: Doug Moody Enclosures:
EsGil Corporation
• GA • EJ • MB • PC 11/24/14
9320 Chesapeake Drive, Suite 208 • San Diego, Califomia 92123 • (858) 560-1468 • Fax (858) 560-1576
City of Carlsbad 14-3247
12/4/14
[DO NOT PAY- THIS IS NOT AN INVOICEI
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad
PREPARED BY: Doug Moody
BUILDING ADDRESS: 2700 Rancho Pancho
BUILDING OCCUPANCY: A3
PLANCHECKNO.: 14-3247
DATE: 12/4/14
BUILDING
PORTION
AREA
( Sq. Ft.)
Valuation
Multiplier
Reg.
Mod.
VALUE ($)
Tl 618 City Valuation 14,000
Air Conditioning
Fire Sprinklers
TOTAL VALUE 14,000
Jurisdiction Code cb By Ordinance
Bldg. Permt Fee by Ordranoe •
Plan Oieck Fee by Ordinance •
Type of Review: 0 Connplete Review
[^Repetitive Fee
^ Repeats
• Other
|—J Hourly
EsGil Fee
• Structural Only
Hr.
$150.07
$97.55
$84.04
Comments:
Sheet 1 of 1
macvalue.doc +
CITY OF
CARLSBAD
PLANNING DIVISION
BUILDING PLAN CHECK
APPROVAL
P-29
Development Services
Planning Division
1635 Faraday Avenue
(760) 602-4610
www-carl.sbadca.eov
DATE: 11/25/2014 PROJECT NAME: Faith Community Cliurch stage PROJECT ID:
PLAN CHECK NO: CB 14-3247 SET#: 1 ADDRESS: 2700 Ranclio Panclio APN: 222-600-01-00
^ This plan check review is complete and has been APPROVED by the Pianning
Division.
By: Ciirister Westman
A Final Inspection by the Pianning Division is required • Yes ^ No
you may also iiave corrections from one or more of ttie divisions listed beiow. Approval
from ttiese divisions may be required prior to the issuance of a buiiding permit
Resubmitted plans stiouid include corrections from ali divisions.
[] This plan check review is NOT COMPLETE. Items missing or incorrect are listed on
the attached checklist. Please resubmit amended plans as required.
Plan Check APPROVAL has been sent to: l<smitli@l«Jsarch.com
For questions or clarifications on the attached checklist please contact the following reviewer as marked:
PLANNING
760-602-4610
ENGINEERING
760-602-2750
FIRE PREVENTION
760-602^665
1 Chris Sexton
760-602-4624
Chris.Sexton@carlsbadca.gov
1 1 Kathleen Lawrence
760-602-2741
Kathleen.Lawrence@carlsbadca.gov
Greg Ryan
760-602-4663
Gregorv.Rvan@carlsbadca.gov
1 1 Gina Ruiz
760-602-4675
Glna.Ruiz@carlsbadca.gov
Linda Ontiveros
760-602-2773
Linda.Ontiveros@carlsbadca.gov
Q Cindy Wong
760-602-4662
Cvnthia.Wong@carlsbadca.gov
• • 1 1 Dominic Fieri
760-602-4664
Dominic.Fieri@carlsbadca.gov
Remarks:
Carlsbad Fire Department
Plan Review
Date of Report: 12-09-2014
Requirements Category: Tl, COMM
Reviewed by: ^, R^Q/(
Name:
Address:
Permit #:
KENNETH SMITH, ARCHITECT
500 FESLER ST STE 102
EL CAJON CA
92020
CB143247
Job Name:
Job Address:
FAITH COMM CHURCH= CONSTRUCT
2700 RANCHO PANCHO CBAD
Please review carefully all comments attached.
Conditions:
CITY OF CARLSBAD FIRE DEPARTMENT - APPROVED:
THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF BUILDING PERMIT
THIS APPROVAL IS SUBJECTTO 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: 12/09/2014 By: GR Action: AP
PLAN CHECK PLAN CHECK Community & Economic
^ CITY OF REVIEW Development Department
1635 Faraday Avenue
CARLSBAD TRANSMITTAL Carlsbad CA 92008
www.carlsbadca.gov
DATE: 12/09/2014
PLAN CHECK NO: 1 SET#: 1
PROJECT NAIVIE: FAiTH COIVIfVIUNITY CHURCH PROJECT ID: CB143247
ADDRESS: 2700 RANCHO PANCHO RD APN: 222-600-01
•
This plan check review Is complete and has been APPROVED by the FIRE Division.
By: GR
A Final Inspection by the FIRE Division is required ^ Yes • No
This plan check review is NOT COMPLETE. Items missing or incorrect are listed on
the attached checklist. Please resubmit amended plans as required.
Plan Check Comments have been sent to: K. SMITH @ KDS ARCH
You may also tiave corrections from one or more of ttie divisions listed below. Approval
from these divisions may be required prior to the issuance of a building permit.
Resubmitted plans should include corrections from all divisions.
For questions or clarifications on the attached checklist please contact the following reviewer as marked:
PLANNING
76D€02-4610
ENGINEERING
760-602-2750
FIRE PREVENTION
760-602-4665
1 1 Chris Sexton
760-602-4624
Chrls.Sexton@carlsbadca.gov
1 1 Kathleen Lawrence
760-602-2741
Kathleen.Lawrence@carlsbadca.gov
X Greg Ryan
760-602-4663
Gregory.Ryan@carlsbadca.gov
1 1 Gina Ruiz
760-602-4675
Gina.Ruiz@carlsbadca.gov
1 1 Linda Ontiveros
760-602-2773
Linda.Ontiveros@carlsbadca.gov
1 1 Cindy Wong
760-602-4662
Cynthia.Wong@carlsbadca.gov
• 1 1 Dominic Fieri
760-602-4664
Dominic.Fierl@carlsbadca.gov
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS QUESTIONNAIRE
OFFICE USE ONLY
UPFP#
HV#
BP DATE / /
Business Nama 41 Busine^ Contact , ?tgg,' ilZ-¥690
Zip Code ^2Z'(fD6-Of
Zip Code Plan File#
The following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTMENT - HAZARDOUS MATEftlALS DIVISION: OCCUPANCY CUVSSIFICATION: Indicate by Circling the item, whether your business
will use, process, or store any of the following hazardous materials. If any of the Items are circled, applicant must contact the Fire Protection Agency with
jurisdiction prior to plan submittal. Facility's Square Footage (induding proposed project): Occupancy Rating:
1. Explosive or Blasting Agents 5. Organic Peroxides 9. V\fater Reactives 13. Corrosives
2. Compressed Gases 6. Oxidizers 10. Cryogenics 1^^^ Other Health Hazards
3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials None of These.
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
-PART irrSAWTmro COOnnTT)EPART18IEl}T^?^^ MATERIALS DIVISIONS fHMDl: If the answer to any of the
questions is yes, applicant must contact the County of San Oiego Hazardous Materials Division, 5500 Overland Ave., Suite 110,
Call (858) 505-6700 prior to fhe issuance of a building perm't „ Lj /
FEES ARE REQUIRED. Project Completion Date: '7 I^Tf /»_ Expected Date of Occuoancv:, I
ian Diego, CA 92123.
• CalARP Exempt
I
Date Initials
• CalARP Required
/ Date Initials
• CalARP Complete
/ Date Initials
Expected Date of Occupancy: ^
YES NO^ ' ' (for new construction or remo*
1. • gl Is your business listed on the reverse side of this form? (check all that apply).
2. • Gg^Will your business dispose of Hazardous Substances or Medical Waste in any amount?
3. • H^Wiil 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. • ^L, Will your business use an existing or install an underground storage tank?
5. • [5 Will your business store or handle Regulated Substances (CalARP)?
6. • BVWill your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
7. • H'^Wil! your business store petroleum in tanks or containers at your facility with a total storage capacity equal to
or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act).
PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, appiicant must contact the Air
Pollution Control District (APCD), 10124 Old Grove Road, San Disgo, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition
permit. Note: if Ihe answer to questions 4 or 5 is yes, appiicant must also submit an asbestos notification form to the APCD at least 10 woridng days prior to
commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information.
YES NO,
1. • Ifl Will the subject faciiity or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the
APCD factsheet at http://www.sdapcd .orq/info/facts/oermits.pdf. and the list of typical equipment requiring an APCD pemiit on the reverse side
of this from. Contact APCD if you have any questions).
2. • • (ANSWER ONLY IF QUESTION 1 IS YES) Will the subjeU facility be located within 1,000 feet of the outer boundary of a school (K through 12)? ^/(Search the Caiifomia School Directory at http://www.cde.ca.qov/re/sd/ for pubiic and private schools or contact the appropriate school district).
• B^^las a survey been performed to determine the presence of Asbestos Containing Materiais?
• HCVWII there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos?
• I2 VWil there be demolition involving the removal of a load supporting structural member?
3.
4.
5.
Briefly describe busings activities: . Briefly c ps^be qrq sed project: -
I deotare under penalty qf periury thaLI
pg/1 further ll
,to the best of my knowledge arid belief tfie re;
Name of Owner or Authorized Agent Signature 0?Owner or Authorized Agent Date
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:,
BY:
FOR OFFICIAL USE ONLY;
DATE;
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUIUMNG PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMD* APCD COUNTY-HMD APCD COUNTY-HMD APCD
"A stamp in Ihis box onl^ exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply.
HM-9171 (02/11) County ofSan Diego-DEH-Hazardous Materials Division
CB143247 2700 RANCHO PANCHO
FAITH COMM CHURCH= CONSTRUCT
A 618 SF RAISED .STAf^P l^ R" u\i^u\ IA,/ ^«,,- r,..
i^l^j.sf p^i^ "^'^
Final Inspection required by:
• Plan • CM&I J3^ri a
SW •ISSUED Dev.
Approved Date .By
BUILDING / m PLANNING
ENGINEERING
FIRE Expedite? Y^N) O) •
DIGfTAL FILES Required? Y N
HazMat
APCD
Health
Forms/Fees Sent Rec'd Due? By
Encina Y N
Fire Y N
HazHealthAPCD V N
PE&M y N
School Y N
Sewer Y N
Stormwater Y N
Special Inspection Y N
CFD: N
LandUse:
CFD: N
LandUse: 'Density: ImpArea: ( FY: Annex; z^y^Factor:
PFF: Y ^)
Comments Date Date Date Date
Building
Planning
Engineering
Fire
Need?
QT(^\' & \.cJ> ^ Done
• Done
• Done
• Done