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Home My WebLink About2710 Loker Ave W; CS; CBC2018-0266; Permit(city of Carlsbad Commercial Permit Print Date: 02/27/2019 Permit No: CBC2018-0266 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2710 Loker Ave W, Cs BLDG-Commercial 2090813100 $15,000.00 VERIZON WIRELESS FACILITY Work Class: Tenant Improvement Lot#: Reference #: DEV05013 Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Status: Applied: Issued: Permit Finaled: Inspector: Final Inspection: Description: VERIZON: REPLACE ALL ANTE NAE WTIH 6 NEW PANEL ANTENAE, ADD 6 NEW REMOTE RADIO UNITS, ADD 6 NEW COMBINERS Applicant: JACOBS KIM ICE 2600 Michelson Dr Irvine, CA 92612-1550 760-6S0-6268 BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) Owner: FRANZ ATRIUM II LP 949-788-4900 ELECTRICAL BLOG COMMERCIAL NEW/ADDITION/REMODEL MECHANICAL BLOG COMMERCIAL NEW/ADDITION/REMODEL 5B1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $356.03 Total Payments To Date: $3S6.03 Contractor: WAVCOMM INC 1429 S Cucamonga Ave Ontario, CA 91761-4510 909-923-08S2 Balance Due: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Closed -Finaled 05/17/2018 10/16/2018 TFraz 2/27/2019 9:04:52AM $0.00 $1S9.31 $111.S2 $41.00 $39.00 $1.00 $4.20 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov rtl~ fOLLOWIHG APPIIOVAI.I ll&OUIUO PRIOll TO P£llllltT 1111/AHCfi: i,"""'PI.AHHIHG (_ Cicyof Carlsbad ,oeADOttus Bulldlng Permit Appllcatlon 1635 Faraday Ave., Certtbed, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 emal: bulldlng@car1abade&.gov www.cal1sbadc:a.gov '=]FIRE O NEAi.TH OHAZMAVAPCO Est. Value Plan Ck. Deposit A~ TE#'/~ , tZ€.P&Ac,.£ t.411i"SO u,.,s-r, TO ~z,), ~ ~£w (I.) fA,Jf l ~~A Avo (C.) ""'""' 2~f'fl ~A-9Jz:> vA.1'1'C"S C " ) A> e,., c.o""' ~ ~9-1 STATE l/P e,.,,,~ -~-----o/u~d-=-u~.._4=__._,.=~=-----.-,-::_------L.-:X:~---1 PHONE • FAX FAA 7f-O-~-~¼~ . <' • I' Workers' Compenullon DKl111don:, ,,.,..,..__.,,_.,d,.,,,_d,_...,..,,.,. 0 lh.veand wlUm1lntaln1 c,rtiff'-'I• o,_.. .. ...._,......, ...... , .. pRM!lldl!rSedlor, fflOol,.llllarC., 1ar111,.._d .. tallkfarllNcill .. ,.ntll--. .C8J I h,ve 1ndwiD m,lnllln w,,rlu1r1' com ............. !lrldlltfflOd .. lllllwQidt.iwh ~d .. 1111Uir .... lillllllllltll .... Mywo1tfrs' ~-----palay rurrbeure:lnsllrlll(#C4:[NSl,t&CO af PA PollcyNo. '2:2'-l'lf1'11/i' ~blDate s-t5-l8 l].9,aedion need notbe ~ lfhe per~ll•-IIIMld.._. 1$100)orlnl. LJ C1rtlftc1to ol&omptlon: I certilyfhlllln .. ,..._d .. lllllkfarl!NdllillpnlllllMd, 11111111111 ..... PIIIOll~IIIJ-•••--.. • .. Warlln'C ' -.,i.-d ca11om11. WARNING: failure lo oocur, _..,.. CH.Ulllleft -·ta ......... Md thall lUlljecl an llllployertl> Cl1ffllrlol ,.,..,.M 111d cMI llnM u,to_ ........,llletlulld Nla,a(l111,0IOl, In acldlllon lo lhe coot ol com....,ullon, dllUIN • pNWldN ttr In ledlon 3111 al Illa I.Mar coclt,......, arid •mtr• flN. ,65 CONTRACTOR SIGNATURE AGE/fl DATE ,,_.,.._..,, .. -,,i._Carltlcw',u..at.w11e...,_ □ 1,.-ol .. flllipal\yot"ff..,.._ ........................... .., ....... nat.....,otolir ...... ~ 1044,..._and ....... C...11110111ncWI Lkwlladoelllll-lD•-d'"""°'lllo..._w...,_IIIIIIOll,llldw•IUdlwadl......,or....,_.ltll_......,.....,,lllll_....,_,,.illwnol .... ., .... .._.,,_, .. ~« .. utllltll_,wNl_,-dCIOIIINIIOn,lllw......_ ........... olf'IM'IIMll9•111tW11ot.,._1Dr ......... ol..,_ 0 l.•-ol .. ~.1111......,_....wllt_,_CIIMldl,altCOIWd .. ,...-(8ec. ?OU,llunallldl'IIIMlbwCOdl:1111Cdw:IDr'•Uonel.-cloal nc:illplliJloan-ol ~'llloWldtor..-.--.lllllOINICllfDrllldl ...... lillcinldlr(t)__,JMMM• .. CGrncW•l.lcanaL-,. □ , ......... llclb!__....11111 ....... C-.... _ 1.1,-..,,...,_... .............. ..-.-a1 .. ...-~"""'-...-DY• C:,. 2.1e-111M,iao..,..~ ................. ,,....--. ,. ...................... (hlltpNlt .. ~..., ..... -..... ,..-, ........ ....,: ................... o1 ......... , .............. jllllOll.~ .............. .., ...... _,..._,,,..,Cllllhcm' ... IMll!IIII): s.1•..---a1 .. -..._, .... _....lllhdl .. ...._,.,...11p11111a11aW1111.,._.~-,..._,,,_., .. o1~ DATE Is the applicant or Mure buffding OCC1Jpant required to submit a business plan, acutely hazardous materials registration fonn or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account ArKI D Yes D No Is the applicant or Mure building occupant required to obtain a permit from the air pollution control district or air quality management district? D Yes D No Is the facility to be constructed wi1hin 1,000 feet of the outer bounda,y of a school site? D Yes D No IF ANY OFTHE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address I certify thatl have read the application and state that the aboYe Information Is OOIT'l!CI and that the lnfonnation on the plans Is accurate. I agee to complywfth all City ordinances and State laws relating to building construction. I hereby authorize representatlve of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS TI-iE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN mY WAY ACCRUE AGAINST SAJD CITY IN CONSEQUENCE OF TI-iE GRANTING OF TI-ilS PERMIT. OSHA: An OSHA pennit is required for excavations over 5'0' deep and demolition or construction of stnJctures over 3 stories In height. EXPIRATION: Eve,y permit issued by the Building OffidaJ under the pr0','islons of this Code shall expire by limitation and beoome nul and void W the building or WOO( authorized by such permit Is not commenood within 180 days from the date of such permit or W the bui(Jing or WOO( authorized by such permit Is suspended or abandoned at any time after the WOO( is oorrvnenced for a period of 180 days (Sedi>n 106.4.4 UnWonn Buildng Code). 2.) APPLICANT'S SIGNATURE '-/( ~ '~ DATE ~ / y Pnrinit Type: Work Class: St:Hus.: Scheduled Date PERMIT INSPECTION HISTORY REPORT (CBC2018-0266) BLDG-Commercial Tenant Improvement Closed -Finaled Actual Start Date Inspection Type Application Date; 05/17/2018 Issue Date: 10/16/2018 Expiration Date: 08/26/2019 IVR Number: 11438 Inspection No. Inspection Status Owner: FRANZ ATRIUM II LP Subdivision: PARCEL MAP NO 18720 Address: 271 O Loker Avew , Cs Carlsbad, CA 92010-6609 Primary Inspector Reinspection Complete --•·---------·-··------------------------------------------ 02/27/2019 02/27/2019 BLDG-34 Rough Electrical 084719-2019 BLDG-Final Inspection Checklist Item BLDG-Building Deficiency 084720-2019 Checklist Item BLDG-Electrical Final Passed Tim Frazee Complete COMMENTS Passed Yes Passed Tim Frazee Complete COMMENTS Passed Yes ---··------.. ------------------------------------------------- February 27, 2019 Page 1 of 1 DATE: 5/30/2018 JURISDICTION: City of Carlsbad PLAN CHECK#.: CBC2018-0266 ✓• EsG1I SET: I PROJECT ADDRESS: 2710 Loker Ave. West D APPLICANT D JURIS. PROJECT NAME: Verizon McClellan Site modification AWS3/PCS ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: ~ EsGil staff did not advise the applicant that the plan check has been completed. D EsGil staff did advise the applicant that the plan check has been completed. Person contacted: I'/ Date contacted: / Telephone#: (b~) Email: Mail Telephone Fax In Person 0 REMARKS: By: David Yao EsGil Enclosures: 5/21/18 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 City of Carlsbad CBC2018-0266 5/30/2018 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: David Yao PLAN CHECK#.: CBC2018-0266 DATE: 5/30/2018 BUILDING ADDRESS: 2710 Loker Ave. West BUILDING OCCUPANCY: BUILDING AREA Valuation PORTION (Sq.Ft.) Multiplier cell site revisions Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance -- Bid . Permit Fee b Ordinance ... g y ---~ Plan Check Fee by Ordinance __ :':_] Type of Review: Complete Review Reg. VALUE Mod. per city D Structural Only D Repetitive Fee 3 Repeats D Other D Hourly EsGil Fee f--------,1 Hr. @ * Comments: ($) 15,000 15,000 $90.60J Sheet of • • REGEi r~o MAY 1 7 2018 CITY OF CAr .__.,l, !\l) BUILDING D\v'ISlvN JACOes· McClellan Verizon Wireless Structural Calculations for Equipment Anchorage U@hi-1:■-Description 0 02128/18 Structural Report -1111. -······-Issued to 0 RAK 02/28/18 Verizon Wireless ZB Comments EUVZ0105 IO February 28, 2018 McClellan Document history and status Review Approved RAK RAK Distribution of copies ,. . ._ •'• CBC2018-0266 2710 LOKER AVE # CS VERIZON: REPLACE ALL ANTENAE WTIH 6 NEW PANEL ANTENAE. ADD 6 NEW REMOTE RADIO UNITS. ADD 6 NEW COMBINERS 2090813100 5/17/2018 CBC2018-0266 Structural Calculations for Equipment Anchorage Birmingham Project no: Document title: Document No.: Revision: Date: Client name: Client no: Project manager: Author: EUVZ0105 Structural Calculations for Equipment Anchorage EUVZ0105 0 February 28, 2018 Verizon Wireless Birmingham Robert A. Kitsteiner Zoljargal Badral • • JAcoes· File name: C:\Users\ZBadral\Desktop\Birmingham\Structural Calculations\Report\Structural Report - McClellan .docx Jacobs Technology Inc. 3161 Michelson Drive, Suite 500 Irvine, California 92612 United States T +1.949.224.7500 F +1 .949.224.7501 www.jacobs.com IC> Copyright 2015 Jacobs Technology Inc .. The concepts and information contained m !his document are the property of Jacobs. Use or copying of this document in whole or In part without the written permission of Jacobs constitutes an Infringement of copyright. Um1tat1on: This report has been prepared on behalf of, and for the exclusive use of Jacobs" Client. and Is sub1ec1 10, and issued ,n accordance w11h. the provisions of the contract between Jacobs and the Client. Jacobs accepts no liability or responsIbilily whatsoever for. or in respect of, any use of. or reliance upon. this report by any third party Structural Calculations for Equipment Anchorage JACOBS. Contents Project Description ............................................................................................................................................... 1 1. Design Basis ............................................................................................................................................. 2 1.1 Structural Design Basis ............................................................................................................................... 3 1.2 Design Loads .............................................................................................................................................. 4 2. Equipment Anchorage .............................................................................................................................. 5 2.1 Equipment Anchorage ................................................................................................................................ 6 ... ' Structural Calculations for Equipment Anchorage JACOBS. Project Description The project consists of adding new telecommunication equipment for Verizon Wireless on a rooftop of an existing building at 2710 Loker Avenue West, Carlsbad, CA 92010. (6) new RRUS are to be attached to P1000 unistrut brackets. (6) new antenna panels and combiners are to be added inside existing screen boxes. The equipment are to be attached to wall using ½" 0 thru-bolts. Structural Calculations for Equipment Anchorage JAcoes· 1. Design Basis The design loads are in conformance with ASCE 7-10. Thru-bolts are checked in Section 2. Per CBC 2016 Section 3403.4 exception, any existing lateral load carrying structural element for which demand- capacity ratio with the addition considered is no more than 10 percent greater than its demand-capacity ratio with the addition ignored shall be permitted to remain unaltered. Added new equipment weight/mass to the building is very small compared to the overall mass of the existing building and shall not result in any excess demand on existing lateral force resisting system. Structural Calculations for Equipment Anchorage 1.1 Structural Design Basis SEISMICITY • SITE CLASS = "D" • S5 = 1.046g S1 = 0.405g • Fa= 1.082, Fv = 1.595 • SMs =1.131g, SM1=0.647g • S05 = 0.754g, S0 1 = 0.431g THE SEISMIC DESIGN CRITERIA: • OCCUPANCY CATEGORY= II • IMPORTANCE FACTOR , 1=1 .00 • SEISMIC DESIGN CATEGORY= D COMMUNICATION EQUIPMENT ap = 1.0 Rp = 2.5 0 = 2.5 CODES & STANDARDS • 2016 CALIFORNIA BUILDING CODE • ASCE 7 -10 Minimum Design Loads for Buildings • ACI 318 -14 for Concrete • AISC 360 -10 for Steel • AISC 341 -10 Steel Seismic Provisions JACOes· (ASCE7-Table 1.5-1) (ASCE7-Table 1.5.-2) (ASCE7-Table 11 .6-1 , All OCCUPANCIES) (ASCE 7-10 TABLE13.6-1) Structural Calculations for Equipment Anchorage JACOBS' 1.2 Design Loads ~USGS Design Maps Summary Report User-Specified Input Report Title McClellan I 1 h I '01 l C Building Code Reference Document 2012/2015 International Building Code hi 1 Site Coordinates 33.13228°N, 117.26031°W Site Soil Classification Site Class D -"Stiff Soil" Risk Category I/II/III USGS-Provided Output 55 = 1.046 g 51 = 0.405 g SMS = 1.131 g SMl = 0.647 g 'Vl!tl.d Sr1n Marco!> . r ~,on dido• 5 05 = 0.754 g 5 01 = 0.431 g .,. _v .. 11 y C nttt For 1nformat1on on how the SS and Sl values above have been calculated from probab1l1st1c (risk-targeted) and deterministic ground motions in the direction of maximum horizontal response, please return to the application and select the "2009 NEHRP" building code reference document. n , A 'ho g!"l thi. in1~rr1.it1on 1s c.1 product of the U S G,,, le,q1~nl Survey w prov d no IVdrrdnly 0 xprP<sed or 1nphed. as t tt>c JCCl a,y oi the dat, contained Lhere1n This tool is rot a ~;hst1tutr> fu1 techrn,~I subJect rn,,tter knowll"dq'!. '-• Project Name: McClellan JACOes· Created On: 2/1/2018 ProJccl Number: Checked By: Job Nwnber: Revised On: Oat..:: 2 28 2018 J acobs E n gineering Grou p. I nc. Revision No.: SEISMIC LOADING -APPURTENANCE (ASCE 7-10) 1.11\PUTS ,kg min sec dccini:ils Sile l.at11udc: 33 7 56.2 33. IJ23 Site Longitude -117 15 37.1 -1 17.2603 De,1gn Spectral Response i\ccclcmllon P,1r,1mctc1 al Shon Period: Sus 0.754 l g fl'S(,S PrO\ 1dcJ Output] P,imt of All,lchmcnt Height i\, cragc Roof Height: ,h 1.0 Co111poncnt l111ponane,· ~,1ctor: Ir 1.0 [Sec 13.1.3 I Component fypc· Communication equipment, computers, mstrumentation, and controls •\mplilication F,1etor: ar 1.0 [Tabh: I U-1] Rc,ponse l\lod1licMion Cod'lieicnt. Rr ::!.5 [Tabh: IJ.6-1 [ 2. SEIS\IIC DESIG:\ FORCE [Secuon 15.-l I [ 0.4 • a1, • S0 ~ z Se1'1111c Design l·orce: I 0.3619 I·" r [Fq. 1.U-1 J FP = R . • (1 + 2 • -) = ::.I!. It ,,, l\la, Seh1mc Design fore,·· F,,.mt1.< = 1.6 • Sos ,,, = I 1.2064 I*\\ r fllJ. IJ.J-21 l\fo1 Sci,mic Design Force. Fp.min = 0.3 • So,· • 11, = I 0.2262 i•Wp [fq 1.U-.11 r .,.,. l·;,,,,w., < F,, I l*Wp F,, = F,,, F,,.111111 < r,, < Fµ.m11x = 0.3619 F,,mm• F,, < 1-,,,,,,,, J .. \PPURTE\.\KCE · SEIS\IIC DESIG\ FORCE wc,glll. S~l"llill.; Wp \\r l·orcc. Fp i\ppuncn,1nce: (lb) (lb) JAHH-6SA·R3B 52.90 19.15 JAHH-658 R38 63.30 22.91 , , RRU 2212 102.00 36.92 0.00 fp ... ... 0.00 0.00 f, 16 92 lb 1s controll1ng 7 .. Structural Calculations for Equipment Anchorage JACOes· 2. Equipment Anchorage Structural Calculations for Equipment Anchorage 2.1 Equipment Anchorage PRE-MOLDCD Rf----, TRANSPAAEW SCRUM BOX Flt61 TO ~TCH O:tSTING BR:CK VENEER. NEW ANTD.INA -----,J',J PER PUN ANTENNA SCREEN SECTION PER N...AN JACOBS. -----rtP. U'.OCOI L6x6J.. SlID. ANGLE W/ 1/2"ill THRV-OOLl 16" OC TO eu<c, (() BIIICI< VENFF__R ONISH (E) MET>.L SlUD WAU. V(, "ti ~IOU'ITING PIP( W/ .1$"1 U-80t.'fS T&B l'YV. LC.OGER L6x6,.}, • STEEL AHGtE W/ 1/2"• ™RV-aoLT 0 u;• 0 C. TO BLICG ~----~· l( 4. \W)O() 8lOCKINC TYP. 1 JACOes· Authored by iB P Yo1. ,, --- v~ :: )On2 ti (!11.'a I/; c 1 t '1/jPtLt lt~rt'~«?_) Ft ~ 36, 92 U, ( tot?/10/~y fv~) rt><.- Ak1e : lfJ7"" f t1•1(, u ,.,: .rf,"t¼/ L.1 .sr,a;n. /i~Stunt : /J!,O;; v LC.:::-l:lJ;~/.OE I/ ' / _f'_ .:_~ --/-/.{) ,< r ;:: f.=:-j,,.2(t,1/x;7• ) S-ft >< R ;,, /.(t ,P 0/L pV > V n I/ Ot Sheet No of Date 1/l.o/18 Checked by 8t, Date P I• D ""9ations la yes, ml.ISi oonlact the nty of San ego Cal (858) 505-6700 prior to the issuance of a building pennH. FEES ARE REQUIRED Project Complellon Dale: E11pected Date of Occupancy: YES NO ~:~I 3. ~ '@I 4. □ l!!I 5. D !ill 6. 0 lil 1. □ 2 s. D i21 (for new constNction or f9ffl0dellng projeC1s) Is your business listed on the reverae :side of this form? (check all that apply). Wil your business dispose of l-lazardous Substances or Medical Waste in any amount? WII your business slOre or handle Hazardous SUbstances in quantities greater than or equal to 55 galons, 500 pounds andlor 200 cubic feet? Will your busil1888 store or handle carcinogens/reproductive toxins in any quantity? Will your business use an existing or install an underground slorage tank? Will your business store or handle Regulated SUbstances (CalARP)? Wil YOU' business """or lnslall a Hazardolls Waste T'"1k System (Trtle 22, Article 10)? WNI your business store petroleum ITT tanks or containers at YQur facility with a total facility storage capacity equal to or reater than f 320 llons? California's A round Petroleum Sto Ad . I -:IJ 0 CalARP Exempt Dalo Initials 0 CalARP Required 0 Ca!ARP Complete I Data lniti;tls PART~-SAN DIE~co~~~ ~TRICT (AP::S,l; Any YES' answer reqllirN a 11amp trom APCO 10124 Old Grove Road, San DI .A92131 a on\ . 6-cf. Os1amprequiedif01 Yes 03YE1Ji.lOQ04-Q6'4-o).!h9~~ingquestlonsare·.1ended to tfentHy lhe maJOlity ot air po11u1:7sues at lhe✓.,;n:; stage, Projecls may requtre addltlona~easures not identliad' by'th8" qu. estion&. For comp~1~nsive requlramenls contact APCO. Residences are typically exempt. except -those with more than one buildir~f on the property; s~buikings with mo,e·~n four dweltiino units: townhomae; condos; mixed-commerciaf use; deliberate bums; residences tonning part of a larger project. rexcludes garages & smaU outbuldngs.] YES NO 1. 2. 3. 4. 5. 6. □ jil □ Bl D D WiH the prc;ecl disturb 160 square feel or more of existing building materials? .. ~,,; :, \: ;: ; ' , . WiR any load supporting slructural members be removed? i'lolifiCalion may be ruquired 10 worl<ing days p/tottcreolnn\wlci~g damolition. (ANSWER ONLY IF QUESTION 1 o, 2 IS YES) Has an aabeatos survey been penonned by a CeflWlod Asbeslos Consul1anl or Sile Su1Wilanco Technician? · D D D 0 (ANSWER Ol'ILY IF QUESTION 3 IS YES) Ba&ed on Iha survey resulls, wll lhe prajOCI clsMbany ontaining material? Notification may be required 10 working days prior to convnencing nbestos removal, ,Z, Will the Proiect or associalacl construction equipment emit air contaminants? See the reverse sid C..... Wlf'M-9(lt~1t~I for typical oquipmenl requiring an APCD penn~. \.___,,a,.,_ ___ _ 0 (ANSWER ONLY IF OUESTIOl'l 5 IS YES) Win lhe pmjecl or aaaocialed conslrucllon oqulpmoni be loca or APCD lac111leol · ·n 1,000feet of a school bou Name of Owner or Aulhorized Agent Signature of Owner or Aulhortzed Agent Date FOR OFFICAL USE ONLY: FIRE OEPARTMEl'IT OCCUPANCY ClASSIFICATIOl'l.: ______________________________ _ BY: DATE: REl.11:ASED FOR BUILDINQ PIERIIIT ■VT NOT l"OR OCCUPANCV RELEASED FOR OCCUPANCY APCO COUNTY•HMD APCO COUNTY-HMO APCO !!!l!! exempts busir'18NeS, from completing or updating a Hazardous Materials Business Plan. other pennitting requirements may still apply. HM-9171 (06/15) County of San Oiego -OEH -Hazardolls Malerlalo Division