HomeMy WebLinkAbout2714 Loker Av West; 200; CB163997; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Print Date: 01/10/2017 Commercial Permit Permit No: CB163997
www.carlsbadca.gov
Job Address:2714 Loker Av West, 200
Permit Type:BLDG-Commercial Work Class:Tenant Improvement Status:Closed -Finaled
Parcel No:2090813200 Lot #:Applied:10/25/2016
Valuation:$609,881.00 Reference #:Issued:12/09/2016Occupancy Group:Construction Type:Finaled:
# Dwelling Units:Bathrooms:Inspector:AKrog
Bedrooms:Orig. Plan Check #:
Plan Check #:
Project Title:
Description:TI -INDUST VERTIFLEX: 13,322 SF TI AT 1ST & 2ND FLOOR -OFFICE TO OFFICE
Applicant:Contractor:
TRI VISTA,INC.TRI VISTA, INC.
JOSH GIBBS
116 Market PI 116 Market PI
Escondido,CA 92029-1352 Escondido, CA 92029-1352
760-294-0277 760-294-0277
BUILDING PERMIT FEE $2000+$2,367.00
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL $242.00
GREEN BUILDING STANDARDS PLAN CHECK $166.00
PLUMBING BLDG COMMERCIAL NEW/ADDITION/REMODEL $124.00
SB1473 BUILDING STANDARDS FEE $25.00
STRONG MOTION-COMMERCIAL $170.77
Total Fees:$3,094.77 Total Payments To Date:$3,094.77 Balance Due:$0.00
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.
THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE:PLANNING nENGINEERING i_im BUILDING EFIRE 71 HEALTH 77HAZMAT/APCD
Building Permit Application Plan Check No.eibiu3=to,--4
4‘,..._".City of 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value cDOCA V&I —
Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 1
email: building@carlsbadca.gov Plan Ck. Deposit
www.carlsbadca.gov Date 110—as_ iu SWPPP
JOB ADDRESS _SUITE#/SPACE#/UNIT#APN
2714 Loker Ave, West goo U..zoo i ?1.5151:186 209 -081 -32 -00
CT/PROJECT #LOT#PHASE ##OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP
1 2 NA 4 VertiFlex V B
DESCRIPTION OF WORK:Include Square Feet of Affected Area(s)
Tenant Improvement for tenant taking the 1st & 2nd floor.Minor demo of interior partition walls, new interior partition
walls, new E &P.No NEW mechanical -reduct only.No exterior or structural.
1st floor area: 3,958 2nd floor area: 9,364
EXISTING USE PROPOSED USE GARAGE (SF)PATIOS (SF)DECKS (SF)FIREPLACE AIR CONDITIONING FIRE SPRINKLERS
B,Office B,Office NA NA NA YESOlt NOED YES M NOID YES El NOD
APPLICANT NAME PROPERTY OWNER NAME
Primary Contact Josh Gibbs, TriVista Inc Blue Hat, LLC
ADDRESS ADDRESS
116 Market Place 6965 El Camino Real, #105-441
CITY STATE ZIP CITY STATE ZIP
Escondido CA 92029 Carlsbad CA 92009
PHONE FAX PHONE FAX
760.294.0277 760.294.0278 760.431.8014
EMAIL EMAIL
josh@trivistacorp.com jaydew@a4d.com
DESIGN PROFESSIONAL CONTRACTOR BUS. NAMEsame as above TriVista, Inc
ADDRESS ADDRESS
116 Market Place
CITY STATE ZIP CITY STATE ZIP
Escondido CA 92029
PHONE FAX PHONE FAX
760.294.0277 760.294.0278I
EMAIL EMAIL
karrie@trivistacorp.com
STATE LIC. #STATE LIC.#CLASS 'CITY BUS. LIC.#
680561 B 1226286
(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 theapplicant 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 theBusiness 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 acivil penalty of not more than five hundred dollars ($5001).
Workers' Compensation Declaration:I hereby affirm under penalty of perjury one of the following declarations:
El 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 work for which this permit is issued.
EiI have 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 workers' compensation insurance carrier and policy
number are: Insurance Co.Zenith Insurance Company Policy No.Z127364801 Expiration Date 9/11/17
This section need not be completed if the permit is for one hundred dollars ($100) or less.
DCertificate 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
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'
ass.1/led
for in Section 3706 of the Labor code, interest and attorney's fees.
JE5'CONTRACTOR
SIGNATUFc\--.
—,--"'"".."-ElAGENT DATE 10(04i!i
i
o
I hereby affirm that tam exempt from Contractor's License Law for the following reason:0 I,as owner of the property or my employees with wages as their sole compensation, will do the work and the structureis 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).DI,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 theContractoes 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.0Yes No
2.I (have / have not) signed an application for a building permit 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.I 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 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone I type of work):
./t5PROPERTY OWNER SIGNATURE DAGENT DATE
L
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the
Presley-Tanner Hazardous Substance Account Act?Yes No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?Yes No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?Yes No
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF
EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code).
Lenders Name Lenders Address
Icertify thatI have read the application and state that the above information is correct and that the information on the plans is accurate.I agree to comply with all City ordinances and State laws 'elating to building construction.
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 THEcrry 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 over50'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 become null and void if the building or work authorized by such permitisnot commenced within
180 days from the date of such permit or if the buildi •or work authorized by such permit 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).
AKAPPLICANT'S SIGNATUR '-------.DATEir (0/2.4)/h.
.,i.
STOP:THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection.
CERTIFICATE CF OCCUPANCY ((cm mercial Pfojects OrT.I'y
Fax (760) 602-8560, Email buildingacarisbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008.
CO#:(Office Use Only)
CONTACT NAME OCCUPANT NAME
ADDRESS BUILDING ADDRESS
CITY STATE ZIP CITY STATE ZIP
Carlsbad CA
PHONE FAX
EMAIL OCCUPANT'S BUS. LIC. No.
DELIVERY OPTIONS
PICK UP:CONTACT (Listed above)OCCUPANT (Listed above)
CONTRACTOR (On Pg. 1)
ASSOCIATED CB#MAIL TO:CONTACT (Listed above)OCCUPANT (Listed above)
CONTRACTOR (On Pg. 1)NO CHANGE IN USE /NO CONSTRUCTION
MAIL /FAX TO OTHER:
CHANGE OF USE /NO CONSTRUCTION
J/KAPPLICANT'S SIGNATURE DATE
,,
PERMIT INSPECTION HISTORY REPORT (CB163997)
Permit Type:BLDG-Commercial Application Date:10/25/2016 Owner:
Work Class:Tenant Improvement Issue Date:12/09/2016 Subdivision:
Status:Closed -Finaled Expiration Date:06/07/2017 Address:2714 Loker Av West ,200
Carlsbad, CA 92008
IVR Number:717904
Scheduled Actual
Date Start Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection Complete
12/12/2016 12/12/2016 BLDG-21 005090-2016 Passed Andy Krogh Complete
Underground/Underf
loor Plumbing
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-31 005091 -2016 Passed Andy Krogh Complete
Underground/Condu
it -Wiring
Checklist Item COMMENTS Passed
BLDG-Building Deficiency 1st floor 1 run Yes
BLDG-84 Rough 005089-2016 Passed Andy Krogh Complete
Combo(14,24,34,44)
Checklist Item COMMENTS Passed
BLDG-14 1st floor partial and 2cd floor 3 offices Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topout 1st floor sink and tie in Yes
BLDG-34 Rough Electrical 1st floor partial and 2cd floor partial 3 Yes
offices and 2cd floor lights
12/14/2016 12/14/2016 BLDG-17 Interior 005375-2016 Passed Andy Krogh Complete
Lath/Drywall
12/21/2016 12/21/2016 BLDG-85 T-Bar,006456-2016 Passed Andy Krogh Complete
Ceiling Grids,
Overhead
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-14 Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topout Yes
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
01/04/2017 01/04/2017 BLDG-Fire Final 008166-2017 Passed Cindy Wong Complete
Checklist Item COMMENTS Passed
FIRE-Building Final Yes
01/05/2017 01/05/2017 BLDG-Final 008341-2017 Partial Pass Andy Krogh Reinspection Incomplete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Ok to occupy Yes
BLDG-Plumbing Final Yes
BLDG-Mechanical Final Yes
BLDG-Structural Final Door and window in lab No
BLDG-Electrical Final Lights in wear house No
January 10, 2017 Page 1 of 2
PERMIT INSPECTION HISTORY REPORT (C13163997)
Permit Type:BLDG-Commercial Application Date:10/25/2016 Owner:
Work Class:Tenant Improvement Issue Date:12/09/2016 Subdivision:
Status:Closed -Finaled Expiration Date:06/07/2017 Address:2714 Loker Av West ,200
Carlsbad, CA 92008
IVR Number:717904
Scheduled Actual
Date Start Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection Complete
01/10/2017 01/10/2017 BLDG-Final 009023-2017 Passed Andy Krogh Complete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Ok to occupy Yes
BLDG-Plumbing Final Yes
BLDG-Mechanical Final Yes
BLDG-Structural Final Yes
BLDG-Electrical Final Yes
January 10, 2017 Page 2 of 2
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EsGil Corporation
In Partnership with governmentfor Building Safety
DATE:11/23/2016 APPLICANT
JURISDICTION:City of Carlsbad PLAN REVIEWER
FILE
PLAN CHECK NO.:16-3997 SET:II
PROJECT ADDRESS:2714 Loker Ave West
PROJECT NAME:Vertiflex -TI
X 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
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:
X 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:2)Email:
Mail Telephone Fax In Person
REMARKS:
By:Sergio Azuela for (DM)Enclosures:
EsGil Corporation
GA EJ MB PC 11/17/2016
9320 Chesapeake Drive, Suite 208 San Diego, California 92123 (858) 560-1468 Fax (858) 560-1576
PLANNING DIVISIONdi>BUILDINGDevelopment ServicesPLAN CHECK Planning Division
\,7`CITY OF REVIEW CHECKLIST 1635 Faraday Avenue
CARLSBAD P -28 (760) 602-4610
www.carlsbadca.gov
DATE:10/25/2016 PROJECT NAME:TENANT IMPROVEMENT PROJECT ID:
PLAN CHECK NO: CB163997 SET#: 1 ADDRESS:2714 LOKER AV WEST APN:
[
-
I This plan check review is complete and has been APPROVED by the
Planning Division.
By:Veronica Morones
A Final Inspection by the Planning Division is required El Yes Z No
You may also have corrections from one or more of the 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.
M 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:josh@trivistacorp.com
For questions or clarifications on the attached checklist please contact the following reviewer as
marked:
PLANNING ENGINEERING FIRE PREVENTION
760-602-4610 760-602-2750 760-602-4665
pi Chris Sexton Chris Glassen Greg Ryan
760-602-4624 760-602-2784 760-602-4663
Chris.Sexton@carlsbadca.gov Christopher.Glassen@carlsbadca.gov Gregory.Ryan@carlsbadca.gov
Gina Ruiz ValRay Marshall Cindy Wong
760-602-4675 760-602-2741 760-602-4662
Gina.Ruiz@carlsbadca.gov ValRay.Marshall@carlsbadca.gov Cynthia.Wong@carlsbadca.gov
X Veronica Morones Linda Ontiveros Dominic Fieri
760-602-4619 760-602-2773 760-602-4664
Veronica.Morones@carlsbadca.gov Linda.Ontiveros@carlsbadca.gov Dominic.Fieri@carlsbadca.gov
Remarks:
P-28 Page 1 of 4 07/11
PLANNING DIVISION Development Services(v BUILDING BUILDING PLAN CHECK Planning Division
\\7./'CITY OF REVIEW CHECKLIST 1635 Faraday Avenue
CARLSBAD P-28 (760) 602-4610
www.carlsbadca.gov
Plan Check No.CB163997 Address 2714 LOKER AV WEST Date 10/25/2016
Review # 1
Planner Veronica Morones Phone (760) 602-4619
APN:
Type of Project & Use: TENANT IMPROVEMENT Net Project Density:DU/AC
Zoning: P-M General Plan: PI Facilities Management Zone: 5
CFD (in/out) #_Date of participation:Remaining net dev acres:
(For non-residential development: Type of land use created by this permit:
REVIEW #:
1 2 3 Legend:El Item Complete 111 Item Incomplete -Needs your action
Environmental Review Required:YES El NO LE]TYPE
DATE OF COMPLETION:
Compliance with conditions of approval?If not, state conditions which require action.
Conditions of Approval:
Z 111 CI Discretionary Action Required:YES NO Z 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:
Z El Coastal Zone Assessment/Compliance
Project site located in Coastal Zone?YES D NO El
CA Coastal Commission Authority?YES D NO fE
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):N/A
Z CI El Habitat Management Plan
Data Entry Completed? YES El NO El
If property has Habitat Type identified in Table 11 of HMP, complete HMP Permit application
and assess fees in Permits Plus
(A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, HMP Fees, Enter Acres of Habitat
Type impacted/taken, UPDATE!)
Z 111 Inclusionary Housing Fee required:YES NO
(Effective date of Inclusionary Housing Ordinance -May 21,1993.)
Data Entry Completed? YES El NO El
(A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, Housing Fees, Construct Housing
Y/N, Enter Fee, UPDATE!)
P-28 Page 2 of 4 07/11
PLANNING DIVISION Development ServicesBUILDING PLAN CHECK Planning Division
CITY OF REVIEW CHECKLIST 1635 Faraday Avenue
CARLSBAD P-28 (760) 602-4610
www.carlsbadca.gov
El LI Housing Tracking Form (form P-20) completed:YES NO N/A IZ
Site Plan:
El 0 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.
City Council Policy 44 —Neighborhood Architectural Design Guidelines
[21 LI 1.Applicability: YES NO El
® 2.Project complies: YES NoEi
Zoning:
Z 111 1.Setbacks:
Front:Required Shown
Interior Side:Required Shown
Street Side:Required Shown
Rear:Required Shown
Top of slope:Required Shown
®2.Accessory structure setbacks:
Front:Required Shown
Interior Side:Required Shown
Street Side:Required Shown
Rear:Required Shown
Structure separation:Required Shown
Z 0 3.Lot Coverage:
Required Shown
® 4.Height:
Required Shown 5.Parking: BLDG PERMIT APPLICATION STATES THAT THE USE IS OFFICE TO OFFICE
TENANT IMPROVEMENT,BUT THE PROPOSED FLOOR PLAN SHOWN ON SHEET
A1.1 SHOWS WAREHOUSE AND R&D USE.PLEASE PROVIDE A PARKING
BREAKDOWN OF THE SQUARE FOOTAGE PER USE FOR THE ENTIRE BLDG AND
THE TOTAL PARKING SPACES ON SITE. PLEASE REFER TO SECTION 21.44 OF THE
CARLSBAD MUNICIPAL CODE AND THE ATTACHED DOCUMENT.
Spaces Required Shown
(breakdown by uses for commercial and industrial projects required)
P-28 Page 3 of 4 07/11
PLANNING DIVISION
Atdi>Development Services
.„,*4.
BUILDING PLAN CHECK Planning Division
`7../CITY OF REVIEW CHECKLIST 1635 Faraday Avenue
CARLSBAD P -28 (760) 602-4610
www.carlsbadca.gov
Residential Guest Spaces Required Shown
El Ill El 6.Floor Area Ratio:Required Shown
El CI 0 Additional Comments
OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE
P-28 Page 4 of 4 07/11
Shay Even
•
From:Amber Ressmer
Sent:Wednesday, October 26, 2016 10:23 AM
To:josh@trivistacorp.com
Cc:Building
Subject:CB163997 VERTIFLEX plan does not require a fire dept. review
Good morning Josh,
You are receiving this email because you are the applicant on permit #CB163997 'VertiFlex' at 2714 Loker Ave, West in
Carlsbad, CA.The fire marshal has determined that the fire department does not need to review these plans and no fire
inspection is necessary.
Thank you,
Amber
City of
Carlsbad
Amber Ressmer
Administrative Assistant
Fire Prevention
City of Carlsbad
1635 Faraday Ave
Carlsbad, CA 92008-7314
www.carlsbadca.gov
P 760-602-4665
F 760-602-8561
1
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.,.,,,':-.*:,,OFFICE USE ONLY.,„4
4.4.a Ikli*ftik.5.RECORD ID #0 :,,.,...i._..
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•..ii SAN DIEGO REGIONAL HHMBP #
..A4-ez.0*HAZARDOUS MATERIALS QUESTIONNAIRE BP DATE //
Business Name Business Contact Telephone #
Vertiflex. Inc.Jan McAndrew 949-940.1400
Project Address .City State Zip Code APN#
2714 Loker Avenue West. Suite 100 Carlsbad, CA 92010 209-081 -32
Mailing Address City State Zip Code Plan Fite#
2714 Laker Avenue West. Suite 100 Carlsbad, CA 92010
Project Contact Telephone #
Patrick Wiltamson (7601716-5285 (Cell)
The following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTMENT —HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects within the City of San
Dietto): Indicate try circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled,
applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal.
Occupancy Rating:Facility's Square Footage (including proposed project):
1.Explosive or Blasting Agents 5.Organic Peroxides 9.Water Reactives 13.Corrosives
2.Compressed Gases 6.Oxidizers 10.Cryogenics 14.Other Health Hazards
3.Flammable/Combustible Liquids 7.Pyrophorics 11.Highly Toxic or Toxic Materials 15.None of These.
4.Flammable Solids 8.Unstable Reactives 12.Radioactives
PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH —HAZARDOUS MATERIALS DIVISION (HMO):If the answer to any of the
questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 170, San Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building permit.
FEES ARE REQUIRED.Project Completion Date:Expected Date of Occupancy:0
CaIARP Exempt/YES NO (for new construction or remodeling projects)Date Initials1.0 0 Is your business listed on the reverse side of this form? (check all that apply).
2.0 0 WO your business dispose of Hazardous Substances or Medical Waste in any amount?0 CaIARP Required3.0 0 Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons,500 /pounds and/or 200 cubic feet?Date Initials4.0 0 Will your business store or handle carcinogens/reproductive toxins in any quantity?
5.0 0 WiN your business use an existing or install an underground storage tank?0 CaIARP Complete6.1:1 GI Will your business store or handle Regulated Substances (Ca1ARP)?/7.0 El Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?Date Initials8.0 0 Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to
or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act).
PART ill:SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD):If the answer to Question #1 below is no or the answer to any of the
Questions #2-5 is yes,applicant must contact the APCD at 10124 Old Grove Road, San Diego, CA 92131-1649 or telephone (858) 586-2600 prior to the issuance
of a building or demolition permit. 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. (Some residential projects may be exempt from the notification requirements.Contact the APCD formore information.)
YES NO
1.0 0 Has a survey been performed to determine the presence of Asbestos Containing Materials?
2.0 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 factsheet at htto iiwww.sdapcd.orqiinfolfactsiperrnits 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).
3.0 121 (ANSWER ONLY IF QUESTION 1 IS YES) Wdl 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 govireisd/ for public and private schools or contact the appropriate school district).
4.0 0 Will there be renovation that involves handling of any friable asbestos mated -s,or disturbing any material that contains non-friable asbestos?
5.0 0 Will there be demolition involving the removal of a load supporting structure ember?
Briefly describe business activities::deny d ••'.-proposed project:
General office, CAD modeling and warehouse C.men .i a -•t Improvement
I declare under penalty of perjury that to the best of my knowledge and belief t e re -•oti-c -i .e -rein are true and correct.Jeff Sveecki r(-f tt /t t /ZOI‘o
Name of Owner or Authorized Agent Signature of e -r or Authorized Agent Date
FOR OFFICAL USE ONLY:
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:
BY:DATE://
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMD*APCD COUNTY-HMO APCD COUNTY-HMO APCD
*A stamp in this box onto exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply.
I IM-9171 tO3/141 County ofSan Diego 01.1 I 11u/unions Matenak; Division
LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION
Check all that apply:
AUTOMOTIVE CHEMICAL HANDLING OTHERS AND MISCELLANEOUS
0 Battery Manufacturing/Recycling 0 Photographic Processing 0 Asphalt Plant0Boat Yard 0 Pool Supplies/Maintenance 0 Biotechnology/Research0Car Wash 0 Printing/Blue Printing 0 Chiropractic Office0Dealership Maintenance/Painting 0 Road Coatings 0 Co-Generation Plant0Machine Shop 0 Swimming Pool 0 Dental Clinic/Office0Painting0Toxic Gas Handler 0 Dialysis Center0Radiator Shop 0 Toxic Gas Manufacturer 0 Emergency Generator0Rental Yard Equipment 0 Frozen Food Processing Facility0Repair/Preventive Maintenance METAL WORKING 0 Hazardous Waste Hauler0Spray Booth 0 Anodizing 0 Hospital/Convalescent Home0Transportation Services 0 Chemical Milling/Etching 0 Laboratory/Biological Lab0Wrecking/Recycling 0 Finish-Coating/Painting 0 Medical Clinic/Office0Flame Spraying 0 Nitrous Oxide (N0x) Control System
CHEMICAL HANDLING El Foundry 0 Pharmaceuticals0Agricultural supplier/distributor 0 Machine Shop-Drilling/Lathes/Mills 0 Public Utility
0 Chemical Manufacturer 0 Metal Plating 0 Refrigeration System
0 Chemical Supplier/Distributor 0 Metal Prepping/Chemical Coating 0 Rock Quarry
0 Coatings/Adhesive 0 Precious Metal Recovery 0 Ship Repair/Construction
0 Compressed Gas Supplier/Distributor 0 Sand Blasting/Grinding 0 Telecommunications Cell Site
0 Dry Cleaning 0 Steel Fabricator 0 Veterinary Clinic/Hospital
0 Fiberglass/Resin Application 0 Wrought Iron Manufacturing 0 Wood/Furniture Manufacturing/Refinishing
0 Gas Station0Industrial Laundry AEROSPACE ELECTRONICS0Laboratory0Aerospace Industry 0 Electronic Assembly/Sub-Assembly0Laboratory Supplier/Distributor 0 Aircraft Maintenance 0 Electronic Components Manufacturing0Oil and Fuel Bulk Supply 0 Aircraft Manufacturing 0 Printed Circuit Board Manufacturing0Pesticide Operator/Distributor
NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE. HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES.
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 (858) 505-6880.
LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES
Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District.
CHEMICAL COMBUSTION ROCK AND MINERAL
47 -Organic Gas Sterilizers 34 -Piston Internal -Combustion Engines 04 -Hot Asphalt Batch Plants
32 -Acid Chemical Milling 13 -Boilers & Heaters (1 millionl3TUIhr or larger)05 -Rock Drills
33 -Can & Coil Manufacturing 14 -Incinerators &Crematories 06 -Screening Operations
44 -Evaporators, Dryers &Stills Processing 15 -Bum Out Ovens 07 -Sand Rock &Aggregate Plants
Organic Materials 16 -Core Ovens 08 -Concrete Batch, CTB, Concrete Mixers, Mixers
24 -Dry Chemical Mixing & Detergent Spray 20 -Gas Turbines, and Turbine Test Cells & Stands & Silos
Towers 48 -Landfill and/or Digester Gas Flares 10 -Brick Manufacturing
35 Bulk Dry Chemicals Storage
55 -Chrome Electroplating Tanks ELECTRONICS OTHER
29 -Automated Soldering 01 -Abrasive Blasting Equipment
COATINGS & ORGANIC SOLVENTS 42 -Electronic Component Mfg 03 -Asphalt Roofing Kettles & Tankers
27 -Coating &Painting 46 -Reverse Osmosis Membrane Mfg
37 -Plasma Arc &Ceramic Deposition Spray FOOD 51 -Aqueous Waste Neutralization
Booths 12 -Fish Canneries 11 -Tire Buffers
38 Paint, Stain & Ink Mfg 12 -Smoke Houses 17 -Brake Debonders
27 -Printing 50 Coffee Roasters 23 -Bulk Grain &Dry Chemical Transfer & Storage
27 -Polyester Resin/Fiberglass Operations 35 -Bulk Flour & Powered Sugar Storage 45 -Rubber Mixers
21 -Waste Disposal & Reclamation Units
METALS SOLVENT USE 36 -Grinding Booths &Rooms
18 -Metal Melting Devices 28 -Vapor & Cold Degreasing 40 -Asphalt Pavement Heaters
19 -Oil Quenching &Salt Baths 30 Solvent & Extract Driers 43 -Ceramic Slip Casting
32 -Hot Dip Galvanizing 31 -Dry Cleaning 41 -Perlite Processing
39 -Precious Metals Refining 40 -Cooling Towers -Registration Only
91 -Fumigation Operations
ORGANIC COMPOUND MARKETING 56 -WWTP (1 million gal/day or larger) & Pump
(GASOLINE. ETC)Station
25 -Gasoline & Alcohol Bulk Plants &Terminals
25 -Intermediate Refuelers
26 -Gasoline &Alcohol Fuel Dispensing
NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION
CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600.
IM-9171 iO3!14 County ofSan Diego •Mil Ilarardous Materials Division