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Home My WebLink About2708 LOKER AVE W; 105; CB061391; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 06-19-2006 Commercial/Industrial Permit Permit No CB061391 Building Inspection Request Line (760) 602-2725 Job Address: 2708 LOKER.AV WEST CBAD St: 105 Permit Type: . TI - Sub Type: COMM Parcel No: 2090810100 Lot #: 0 Status: ISSUED Valuation: $34,650.00. Construction Type: VN Applied: 05/17/2006 Occupancy Group: Reference #: Entered By: KG Project Title: DRYCLEAN AMERICA 990 SF FROM Plan Approved: 06/19/2006 • SHELL TO DRYCLEANER Issued: 06/19/2006 - Inspect Area: • . Plan Check#: Applicant: Owner: - BAE STEVEN -. FRANZ-LOKER L CC-_ 26 MEDLAR .- 2710 LOKER'AVE W - IRVINE CA 92618 - CARLSBAD CA 92010 - 949-654-8783 Building Permit Add 'I Building Permit Fee /' (\ , $270.79 - ', ' 00 \ $0 Meter Size "-) .•- \ Add 'I Red / Water Con Fee,-- j \ $0.00 Plan Check Add'I •-_...' .." $176.01 •- ' jMeterFee' - .' \() $0.00 Plan Check Fee Plan Check Discount / / 1 / $0.00 SDCWA Fee - - \ $0.00- Strong Motion Fee / --. / $0.00 " ,' N.. ..,:. $7.28 - - ..CFD Payoff Fee ...--, - PFF (3105540),,/ \ \ -,/ $0.00 - \ $630.63 Park Fee LFM Fee - '\ $0.00 -PFF (4305540) /' • V .• -• $o.00 License Tax (3104193) -, $0.00 $0.00 Bridge Fee BTD#2 Fee I L. ) $0.00 , \, -i) $0.00 License Tax (4304193) ,-"'/ -. $0.00 Traffic \.,J Impact Fee (3105541)' $0.00 BTD #3 Fee Renewal Fee '$0.00 '- ./ $0.00 ." Traffic Impact Fee(4305541) 1 PLUMBING TOTAL- ) / $0.00 / $48.00 Add'I Renewal Fee S' •' .j$0.0P ELECTRICAL! TOTAL 1 $110.00 Other Building-Fee \ $0. N 00. MECHANICAL TOTAL ,i $47.00 Pot. Water Con. Fee \ --- $O.00\ Master Drainage Fee- / - $0.00 Meter Size SewerFéi -" / $0.00. Add'l Pot. Water Con. Fee \ ( $0.00 , Redev Parking Fee ,. / V $0.00 Red. Water Con:Fee \ N '$0.00;CrjAdditionáI Fees - .. / $0.00 HMP Fee -TO TAL PERMIT FEES / $1,289.71 \ / / ? '\_-._ .: . / Total Fees: ' $1,289.71 TotalPaymeñts To Date: . I $1,289.71 Balance Due: $0.00 - "- - - BUILDING PLANS - 'ATTACHED Fl NALPP,ROt I Inspector:C Date: 6 hI\'yc.1 Clearance: NOTICE: Please take NOTICE that approval of your project includes the'Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as fees/exactions. You have 90 days from the date this permit was issued to protest imposition 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 — 12',O6137O1-2U05005/I7/200600133 FOR PERMIT APPLICATION PLAN _CH rw- EC,K rioCO(p ig / CITY OF CARLSBAD BUILDING DEPARTMENT EST. VAL: 1635 Faraday Ave., Carlsbad, CA 92008 Plan Ck Deposit . .. Validated. By ' .........................................................................Date: ..; j, P0JE .R A11MQN ............................................................... o ''AdcftessndudeBldg/Suite #) <'-i-- ~ .1 Business Name (at this address) Legal, Description '. .' . LotNo. Subdivision Name/Number U it No. ...Phase No. .'. Total #'of units ' ,: . ' I1•' . .. ' 'Assessor's Parcel # Existing Use Prqpose Use "Description of Work .. . . . . "i.. ' .SQ. FT. .. '. #of Stories ' . # of Bedrooms . :' " "' # of Bathrooms . OE TIERS 4ufferenjjurnpphcant) - & , Name . . .. . Address City State/Zip , Telephone # Fax # LP?!ICAN nor Cruct 1On r - n. A 4A2.fofE- 76 )rF 5A' kR &- C4z Name Address City State/Zip , Telephone # - - . . -7 M, -- M0 '': Name Address . . City . State/Zip. Telephone # ir .. I - (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 pursuant to the provisions of,the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the, basis for the alleged exam tion. Any, vi lation of Section 7031.5 by any applican for permit subjects the applicant t civil penalty.o not more than five undred..dollars 1$ 5001) -Vf tic -r7 4/-t -T ,JkiT ?.J 4 '7 Name , . Address City State/Zip , Telep one # State :License # .-L'273 License Class 8 C City Business License Designer Name • ' , . . . Address , ,. , .. . - . . City , ,State/Zip , ' '. .,Telephone . State' License # . Q11 PIMM Workers' Compensation Declaration: I hereby affirm under penalty of perjury one,of the following declarations: •. . . ., ,. 'l have, and will maintain a certificate of consent to self-insure for workers' compensatiOn as provided by Section 3700 of the Labor Code,forthe performance-r of the work for which this permit is issued. . . '• ' . . '. , . . [hive and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the' work for 'which this permit is issued. My worker's compensation insurance carrier and polity number are: , . . . , lnurai,ce Company ' 741' p't.1tJ !: Policy No. _/ . . Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this'permit.is issued, I shall not employ any persdn in any man'nerso as to become subject to the Workers' Compensation Laws of California. , WARNING: Failure to secure workers' compensation, coverage is unlawful, and shall subject, an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. 'SIGNATURE DATE WNERBOILDEARA1IWN ' : - : "i 'r .i hereby affirm that I am exempt from the Contractor's License Law for the following reason: "I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sate (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 havethe burden of proving that he did not build or improve for the purpose of sale)..' . I, as owner of the property, am exclusively contracting with licensed contractors to construct'the project (Sec. 7044,Business and Professions Code: 11 The, Contractor's License Law does not apply to an owner of property' who builds or improves thereon, and contracts for such projects with càntractor(s) licensed: pursuant to the Contractor's License Law) 0 I am exempt under Section Business and Professions Code for this reason 1 I personally plan to provide the major labor and materials for construction of the proposed property improvement 0 YES ONO - 2 I (have / have not) signed an application for .a building permit for the proposed work 3.....1 have contracted with the, following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number):' 4 I plan to provide portions of the work, but I have.hired the following person to coordinate, supervise and provide, the major work (inckide'name / address / phone number / contractors license number): , • __, _. ___.. ' , _, __.________'- __. _• 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number./ type of work): , ', . . . ' • . • . • . • . . . PROPERTY OWNER SIGNATURE . __- ___., ____• __. ____, _. DATE — — Is the applicant or future building, occupant required to submit a business plan,'acutely hazardous materials registration form or risk, management and prevention program.under Sections 25505, 25533 or 25534 of'the Presley-Tanner Hazardous Substance Account Act? 0 'YES' 0 NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? - 0 YES 0 NO Is the facility to be constructed within V,000 feet of the outer boundary of ,.a school site? 0 YES 0 i NO IF ANY OF THE ANSWERS ';ARE YES. AFINAL10ERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED, UNLESS THE APPLICANT,.HAS MET OR IS MEETING THE' '. REQUIREMENTS OF T11E'OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8 ON _ST hereby affirm that there is a construction (end ng agencv for the performance of the work for hich this permit is issued (Sic 5.) 71) Civil Code) ' LENdESNAME " . " ''' LENDER'S ADDRESS '.- 9 L -- - I certify that..l have read-the application.and state that the above information is correct and thatthe information on the-plans is accurate. I agree to comply with all ' City:ordinances and State,laws relating to' building constructiont' I hereby authorize representatives of the Cit'. 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 LIABILITIES, JUDGMENTS, COSTS AND EXPENSES-WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE'OF THE GRANTING OF THIS PERMIT. : OSHA An OSHA permit is required for excavations over 5 0 deep and demolition or construction of structures over 3 stories in height EXPIRATION: Every permit issued by-the building Official under the provisions of this'Code shall expire by limitatiOn' and becom'nulI-à'nd void if the bui)ding or work'..,.' authorized by such permit is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at anytime, after the work is commenced for 'a period of 180 days'L6ection 106.4.4'Uniform Building Code). APPLICANT'S SIGNATURE DATE WHITE Fil ELLOW Applicant PINK Finance I -' oo\T1\'ooeo0 26-wv -i'o List 1- Permit-Type • From the following usE determine the permit-type that best describes the work you propose to do. Please put the code of that permit-type.in the blank at the top of the page on the front of this application. Residential permits (only) also require the identification of the structure-type to be associated with the permit. Choose a structure-type from "List 2 - Structure-Types' and put its code in the appropriate blank on the front of this application. 'I Residential Permits Code Description APT 'Apartments - new construction. - .' , CONDO ,\! '• '.' ')l I /\ ,,'.. • - Condominiums --new construction. -. - CVNNR Conversion. Conrert all or a portion of a non-residential builliig t 1es1dentia1 use, creating one or more new residèntiál 'units.' CVNRN Conversion. Convert one or more residences in a building to non-residential usage. CVNRR Conversion. Increase or reduce the numbei, of dwelling units in a'residential structure through interior. modifications (i.e.: a four bedroom house converted to a duplex, with '2 bedrooms each). DEMO - . fS •...tI_-I - Demolition permit. (Also specify type of structure from List 2). - - i DUP Düplèx - new construction. MOHd Mo'bde home, ,reno n'eir or additionf a&sso uctiir not yieldiii nev living unit. - MOHON Mobile home, pre-fabricated house, or trailer installed (plumbed, wired) in a mobile home park (see distinction from single-family residence, below).' N >-'' , - I - r - 'i-i -' •. RAI) Residential addition/alteration, creating no new dwelling unit(s).' RREISSUE Residential permit re-issue. RREPAIR Residential building repair. Damage, fire, etc. RREPLACE Residential building replacement (no additional units). SFA i Single-family, attached - new construction. A one-family house attached to one or more other houses, with one or more common walls extending from foundation to roof' at, or forming, a lot line. Has own plumbing and heating system (e.g.: townhouse, row house, half-plex) SFD Single-family,, detached - new construction: A one-family house with open area on all four sides. May have an attached or detached garage, or a business. May be a detached 'granny flat'. May be a mobile home or trailer on an individual lot, but not in a mobile home park. Non-Residential/Accessory Permits Code Description COM Commercial structure, new construction. CREISSUE Commercial permit re-issue. CREPAIR Commercial building - repair. Damage, fire, etc. CREPLACE Commercial building - replacement. Cli Commercial tenant improvement. DEMO Demolition permit. ELEC Electrical permit, for electrical work only. HOTEL Hotel or motel (including Managed Living Unit hotel) - new construction. HOTELR Hotel renovation. INDUST Industrial structure, new construction. lTl Industrial tenant improvement. MECH Mechanical permit, for mechanical work only. MISC Miscellaneous. Use only if proposed work doesn't fit another activity type. PATIO Patio and/or deck. PLUM Plumbing permit, for plumbing work only. POOL Gunite pools and spas. RETAIN Retaining wall permit. SIGN Sign construction/installation permit. SOLAR Solar energy system installation permit (specify structure type to be served). SPA Factory-made or Gunite. - List 2 - Structure-Type (Use with Residential Permit Only) From the following list, determine the type of residential structure that best describes the structure on which you will be working. Please put the code of that structure-type in the appropriate blank at the top of the page on the front of this application. Code Description SFA Single-family, attached. A one-family house attached to one or more other houses, with one or more common walls extending from foundation to roof at, or forming, a lot line. Has own plumbing and heating system (e.g.: townhouse, row house, half-plex). SFD Single-family detached: A one-family house with open area on all four sides. May have an attached or detached garage, or a business. May be a detached 'granny flat'. May be a mobile home or trailer on an individual lot, but not in a mobile home park. M172-4 Multi-family, 2 to 4 units. A residential structure on a single lot, containing two, three, or four dwelling units. Units may share master heating, plumbing, or electrical service (e.g.: duplex, triplex, quad-plex). MF5+ Multi-family, 5 or more units. Same as MF2-4, except the building has a t least five attached units on the same lot. MOHO Mobile home,pre- fabricated house, or trailer installed (plumbed, wired) ma mobile home park (see distinction from single-family residence, above). CRY otCarlsbad • Final Building inspection - Dept: Building Engineering Planning CMWD St Lite Plan Check #: Date: 08/14/2006 Permit #: CB061391 Permit Type: TI Project Name: DRYCLEAN AMERICA 990 SF FROM Sub Type: COMM • SHELL TO DRYCLEANER Address: 2708 LOKER AV WEST #105 Lot: 0 Contact Person: JOHN Phone: 7604814989 Sewer Dist: CA Water Dist: CA Inspected /7 • Date By: Inspected: Approved: <.Disapproved.: Inspected Date By: Inspected: Approved: Disapproved: Inspected Date • By: Inspected: Approved: Disapproved: Comments: • - •. 1 -• City of Carlsbad Bldg Inspection Request For: 08/14/2006 Permit# CB061391 Inspector Assignment: PC Title: DRYCLEAN AMERICA 990 SF FROM Description: SHELL TO DRYCLEANER Type: TI Sub Type: COMM Job Address: 2708 LOKER AV WEST Suite: 105 Lot 0 Location: APPLICANT BAE STEVEN - Owner: Remarks: Phone: 7604814989 Inspector: Total Time: CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Act 1Comment Requested By: JOHN Entered By: KAREN 2 1 - ---- I Comments/Notices/Hold Associated PC Rs/CVs Original PC# Inspection History Date Description Act lnsp comments 07/31/2006 14 Frame/Steel/Bolting/Welding PA PC WALLS ABV CLG OK AFTER FIRE INSP 07/31/2006 24 Rough/Topout AP PC 07/31/2006 34 Rough Electric PA PC WALLS ABV CLG 07/31/2006 44 Rough/Ducts/Dampers PA PC ABV CLG OK AFTER FIRE INSP. 06/27/2006 21 Underground/Under Floor AP PC ov -ZQoB -oK&Jç AL), vl — (H hAP °? OF EL(AT 7_ M( tOL44f1 -HQ W TA H E C&7 q7 EsGil Corporation In (Partnership with covernmentor J3ui1&ng Safety DATE: May 30, 2006 JURISDICTION: Carlsbad PLAN CHECK NO.: 06-1391 SET:I PROJECT ADDRESS: 2708 Loker Avenue West PROJECT NAME: Dryclean America TI U APPLICANT U JURIS. U PLAN REVIEWER U FILE El The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building 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. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: Z Esgil Corporation staff did not advise the applicant that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Fax #: Mail Telephone Fax In Person / REMARKS: OK to issue with the applicant placing the following notes on the plans. 1. "Roof mounted equipment must be screened and roof penetrations should be minimized (City Po icy 80-6)." 2. "WIRING METHODST ciable is not allowed in A, B, E, H, and I occupancies. NM cable is restricted (without City approval) to one and two family dwelling Note on plans that( equipment ground conductor is to be installed in all flexible conduits * By: Bryan Zuppiger Enclosures: Esgil Corporation E GA E MB E EJ E PC 05/22/06 trnsmtl.dot 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax (858) 560-1576 Carlsb,d 06-1391 May.,-,3O, 2006 VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: 06-1391 PREPARED BY: Bryan Zuppiger DATE: May 30, 2006 BUILDING ADDRESS: 2708 Loker Avenue West BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: VN BUILDING PORTION AREA (Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE ($) ti 990 34.37 34,026 Air Conditioning Fire Sprinklers TOTAL VALUE j 34,026 Jurisdiction Code pcb IBY Ordinance Bldg. Permit Fee by Ordinance Plan Check Fee by Ordinance Type of Review: Complete Review Structural Only El Other Li Repetitive Fee Repeats Hourly Hour * - Esgil Plan Review Fee Comments: I $151.641 macvalue.doc PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB ' DATE_______________ ADDRESS J&2 Je = RESIDENTIAL RESIDENTIAL ADDITION MINOR PLAZA CAMINO REAL (410,000.00) CARLSBAD COMPANY STORES VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER PLANNER DATE ENGINE T <-_. DATE Docs/MlsforrmjPlanntng Engineering Approvals - PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST 9 - vtwe ;~.qb A Plan Check No. CBO1 '?( Address_________________ Planner Greg Fisher Phone (760) 602-4629 APN: 001 Type of Project & Use: Net Project Density: DU/AC Zoning:____________ General Plan: P_Facilities Management Zone: CFD (in/out) #_Date of participation:________ Remaining net dev acres:_____ Circle One (For non-residential development: Type of land used created by this . . permit: Legend: Z Item Complete Item Incomplete - Needs your action Environmental Review Required: YES - NO - TYPE 'I DATE OF COMPLETION: Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval: E 0 Discretionary Action Required: YES - NO TYPE APPROVAL/RESO. NO. DATE PROJECT NO. OTHER RELATED CASES: Compliance with conditions or approval? If not, state conditions which require action. Conditions of Approval:____________________________________________________ Coastal Zone Assessment/Compliance Project site located in Coastal Zone? YES_ NO CA Coastal Commission Authority? YES_ NO If California Coastal Commission Authority: Contact them at - 7575 Metropolitan Drive, Suite 103, San Diego CA 92108-4402; (619) 767-2370 Determine status (Coastal Permit Required or Exempt): Coastal Permit Determination Form already completed? YES NO If NO, complete Coastal Permit Determination Form now. Coastal Permit Determination Log #: Follow-Up Actions: Stamp Building Plans as "Exempt" or "Coastal Permit Required" (at minimum Floor Plans). CompleteCoastal Permit Determination Log as needed. ) . :..- _ ':/ • 0 0 Inclusionary Housing Fee required YES NO A (Effective date of Inclusionary Housing Ordinance May 21 M 993 ) , '. •. - •.•• . • - fr . • Data Entry Comp•leted? YES - NO ,(AIPIDs Activity Maintenance enter CB#, toolbar, Screens, Housing Fees Construct Housing 0 - Y/N, Enter Fee, UPDATE!) 0 H:\ADM1N\COUNTER\BidgPlnchkRevChkist 0 - •Rev 9/01 'I. Site Plan: Provide a fully,dimensional site plan drawn to scale. Show: North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements,' right- of-way width, dimensional setbacks and existing topographical lines (including all side and rear yard slopes). Provide legal description of property and assessor's parcel number. Policy 44 - Neighborhood ArchitetjI Design Guidelines Applicability: YES NO________ Project complies YES N Zoning: Setbacks: Front: Required Shown Interior Side: Required Shown Street Side: Required Shown Rear: Required Shown Top of slope: Required Shown Accessory structure setbacks: Front: Required Shown Interior Side: Required Shown Street Side: Required Shown Rear: Required Shown Structure separation: Required Shown Lot Coverage: Required 'Shown Height: Required Shown Parking: Spaces Required Shown (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required Shown Additional CommentsCFeGt1oP—#--1-- Pase-stuvv on Shee-t--1 the total number of-afknq spaes-evided-and reqttired en-si-te-for-each use perChaptef-2±-44. Correction #2 - Is there any proposed roof mounted equipment associated with this building permit? If so, will the equipment be screened by an existing parapet wall or is new screening material required? Please see the attached handouts for examples. OK TO ISSUE A H:\ADMINCOUNTER\BIdgPInchkRevchkIst Rev 9/01 Carlsbad Fire Department : ::: Requirements Category TI , COMM Reviewed 06 Name: BAE STEVEN / VkZ A Address. 26 MEDLAR IRVINE CA 92618 .• * Permit#:CB061391 Job Name: DRYCLEAN AMERICA 990 SF FROM Job Address: 2708 LOKER AV WEST CBAD St: 105 The item you have submitted for review is incomplete. At this time, this office cannot adequately conduct a review to determine anwor standards. 1-'lease review* carefully all comments attached necessary plans and/or spec ica , n es "clouded", to this offif.rkw and approval. • Conditions: Cond:C0N0001365 [MET] Approved: This project has been reviewed and approved for the purpose of issuance of a building permit. This approval is subject to field inspections, any required test, fire department notations, conditions in correspondence and compliance with all applicable codes and regulations. • This approval shall not be held to permit or approve the violation of any law. Entry: 05/18/2006 By: JV Action: AP . t-k Vlo-3'oc rr OFFICE USE ONLY ( ' SAN DIEGO REGIONAL UPFP#: QO C7 .. HAZARDOUS MATERIALS QUESTIONNAIRE BPDATE: OCCC I I Business Name Business Contact Telephone # DR -U AC-7g\ c-,s a I (7c() 33 -1 zz Project Address City State Zip Code APN# -7 10 Mailing Address State 3l / (O i)4:-7 ii€- Zip Code Plan File# ( Project Contact Telephone d (-~ - cp? (:Rm~V_,: The following questions represent the facility's activities, NOT the specific p(oject description. PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives Compressed Gases 6. Oxidizers 10. Cryogenics . 14. Other Health Hazards Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD): If the ansv'er to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, TO floor, San Diego, CA 92101. Call (619) 338-2222 prior to the issuance of a building permit. Expected date of Occupancy FEES ARE REQUIRED. YE$ NO 0 Is your business listed on the reverse side of this form? '_. 0 Will your business dispose of Hazardous Substances or Medical Waste in any amount? l 0 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? 0 "Will your business use an existing or install an underground storage tank? 0 Will your business store or handle Regulated Substances (CaIARP)? 0 Lg.' Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 0 CalARP Exempt CaIARP Required CaIARP Complete Date Initials PART III: 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), 9150 Chesapeake Drive, San Diego, CA 92123, telephone (858) 650-4550 prior to the issuance of a building or demolition permit. Note: if the answer to questions 3 or 4 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 0 0 Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD fact sheet at htt://www.sdacd.or/info/facts/ermits.pdf, and the list of typical equipment requiring an APCD permit on the reverse aide of this form. Contact APCD if you have any questions.) 0 L( (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)? (Public and private schools may be found after search of the California School Directory at http://www.cde.ca.gov/re/sd/; or contact the' Oil! ppropriate school district.) 0 there be renovation that involves handling of any friable asbestos material, or disturbing any material that contains non-friable asbestos? 0 there be demolition involvincj the removal of a load supporting structural member? d' Briefly describe business activities: I Briefly describe proposed project: - &1 ____________ de herein are true and correct. er__enalty of ____________ to th best of my knowledge and belief the I de perth 0 - Name of owner or Authorized Agent Signature of Owner or Authorized Age Date FOR OFFICIAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:, BY: DATE EXEMPT OR NO FURTHER INFORMATION REQUIRED COUNTY-HMD APCD RELEASED FOR BUILDING PERMIT BUT NOT FOR occucv ,COJf1YcH " APCD RELEASED FOR occupANcy COUNTY-NMD APCD 0C0N? jREV EWD '\41 0 REVIEW ED INITIALS kP _ ___ __ INITIALS _ DATE DATE DEH:HIVI-9 171(07/04) 0 County of San Diego - DEH - Hazardous Materials Di LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM COUNTY OF SAN DIEGO DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISION AUTOMOTIVE Battery Manufacturing/Recycling Boat Yard Car Wash Dealership Maintenance and Faint Machine Shop Painting. £-4 Radiator Shop Rental-Yard Eqiipment Repahçlajor Overhaul Spray Boothsl, - Trans&-tation'Services Wrecking andRecycling METAL WORKING Anodizing Chemical Milling/Etching Finish Coating, Painting Flame Spraying Machine Shop-Drilling, Lathes, Mills Metal Plating Metal Prepping/Chemical Coating Precious Metal Recovery Sand Blasting, Grinding Steel Fabricator Wrought Iron Manufacturing CHEMICAL HANDLING Agricultural Suppliers/Distributors Chemical Suppliers/Distributors Chemical Manufacturers Coatings/Adhesives Compressed Gases Suppliers/Distributors - Dry Cleaning Fiberglass/Resin Applications - -Gs Stations Industrial Laundry - Laboratories Labo'ratory Suppliers/Distributors Oil and Fuel Bulk Supply Pesticide Operators/Distributors Photographic Processing Pool Supplies/Maintenance Printing/Blue Printing Road Coatings Swimming Pool (Gas Chlorination Systems Only) Toxic Gas Handler Toxic Gas Mfg ELECTRONICS Electronics Components Manufacturing Electronics Assembly and Sub Assembly Printed Circuit Board Manufacturing OTHERS AND MISCELLANEOUS Refrigeration Systems Nitrous Oxide (NO.) Controi'Systems Asphalt Plant Chiropractic Offices Co-Generation Plant Dent'I Clinic/Office Frozen Food Processing Facilities Government Agencies Hazardous Waste Hauler Hospitals/Convalescent Homes Laboratories, Biological Laboratories Medical Clinics/Hospitals/Offices Pharmaceuticals - Biotech Laboratories Public Utilities Rock Quarry Veterinary Clinic/Hospitals Wood/Furniture Manufacturer/Refinishing Ship Repair/Construction Telecommunications Cell Sites Dialysis Centers AEROSPACE Aerospace Industry Aircraft Manufacturing Aircraft Maintenance NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCE. ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE HAZARDOUS MATERIALS DIVISION (HMD) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (619) 338-2222. LIST OF OPERATIONS OR EQUIPMENT REQUIRING PERMITS FROM THE AIR POLLUTION CONTROL DISTRICT Businesses that include any of the following operations or equipment will require clearance from the Air Pollution Control District. This list is not all-inclusive. For specific inquiries, call (858) 650-4550. 4/04 CHEMICAL Acid Chemical Milling Bulk Dry Chemical Storage Detergent Spray Towers Dry Chemical Mixing Organic Evaporators, Dryers & Stills Organic Gas Sterilizers Pharmaceutical Manufacturing COATINGS & SURFACE PREPARATION Abrasive Blasting Equipment Coating & Painting (Booths & Open): Auto Body Aerospace Can & Coil Graphic Arts Metal Parts Paper Fabric Ships & Boats Wood Products Other Industrial Paint, Stain & Ink Manufacturing Plasma Arc & Ceramic Deposition Spray BOoths Solvent Application Operations COMBUSTION Boilers & Heaters Burn Out Ovens COMBUSTION-cont'd Core Ovens Gas Turbines, Test Cells & Stands Incinerators & Crematories Non-Vehicular Piston I-C Engines ELECTRONICS Electronic Component Manufacturing Hydrosqueegees Solder Levelers FOOD Bulk Flour & Powdered Sugar Storage Coffee .Roasters Feed &Grain Mills & Kelp Processing Fish Canneries - Smoke Houses METALS Chrome Plating Chromic Acid Anodizing Hot Dip Galvanizing Metal Melting Devices Oil Quenching & Salt Baths Precious Metals Refining Fuel Dispensing Gasoline & Alcohol Bulk Storage Gasoline & Alcohol Fuel Dispensing Intermediate Refuelers ROCK AND MINERAL Brick Manufacturing Concrete Batch, CTB, Concrete Mixers& Silos Hot Asphalt Batch Plants Rock Drills Sand, Rock & Aggregate Plants SOLVENT USE Dry Cleaning Solvent & Extract Driers - Vapor & Cold Degreasing OTHER Aqueous Waste Neutralization -. 'Asphalt Pavement Heaters * Asphalt Roofing Kettles & Tankers Asphalt Pavement Grinders - Brake Debonders - Bulk Grain & Dry Chemical Transfer & Storage Ceramic Slip Casting Fiberglass Grinding Landfill Gas Flare or Recovery Systems Perlite Processing Reverse Osmosis Membrane Manufacturer Rubber Mixers - Tire Buffers Waste Disposal & Reclamation Units DEH:HM-9 171(07/04) County of San Diego - DEH - Hazardous Materials Division