HomeMy WebLinkAbout2722 LOKER AVE W; G; CB081963; PermitI.
City ofCarisbad '.
1635 Faraday Av Carlsbad, CA 92008 .
11-17-2008 Commercial/Industrial Permit Permit No CB081963
Building Inspection Request Line (760) 2.725 .
Job Address: 2722 LOKER AV WEST CBAD St: G
Permit Type: TI Sub Type: INDUST
Parcel No: . 2090812800 - . Lot #. 0 •. Status: ISSUED S.
Valuation: . $16,660.00 -'Co 'struction Type: 5B - !Aplied:' 10/21/2008
Occupancy Group: - 'h. Reference#:' . Entered By: JMA
Project Title: WINGED SERVICES: 476SF TI 27.7, Plan'Approved: 11/17/2008
SF OFFICE TOWAREHOUSE/199SF OFF TO OFF - Issued: 1.1/17/2008
Inspect Area: '
PIn Chêck# -
. Applicant:
DESIGN/BUILD TENANT IMP. FENTON H G COMPANY .
SUITE B-
9770 CARROLL CENTER RD. 2722-LOKER W #F
SAN DIEGO, CA 92126 CARLSBADCA 92010
619-954-9519
Building Permit / . (\ ''$18151 Meter Size •. Add'l Building Permit Fee 7' $o.007 Add'l Reel5 Water Con Fee 0 \ '
- $0.00
-. Plan Check / $117.98'7!Meter.Fe— . \ ' 0 $0:00
Add'l Plan Check Fee - / . $0 00 P'SDCWA Fee . \ $0.00
- Plan Check Discount / $0,00 ,CED Payoff ee -' $0.00
Strong Motion Fee /
7~~i&,00
$3T50—.---._PFF(3105540) $0.00
Park Fee - / 000"uuPEEi(4305540) '-
.$0.00
LFM Fee 5 / 000 Licse Tax (3104193) fl\ '$0.00
Bridge Fee j .Liôr'se Tax (4304193) /31 $0.00
BTD 42 Fee I $0.00 ,Traffic Impact Fee (3105541)1 $0.00
BTD#3 Fee . S $OPO Traffi'lrpact Feé"(4305541)j J $0.00
Renewal Fee •. ' , $0.00 PLUMBING TOTAL\\,5S / f $0.00
Addi Renewal Fee . $0.00 ELECTRICAL TOTAL1 J-" / f $20.00
Other Building Fee $0.00\. ME 76f-AL / I $24.00 I I Pot. Water Con. Fee ' $0 00\ Master Drnage Fee / $0.00
Meter Size Sr1Fè—'-' $0.00 ,
AddI Pot. Water Con. Fee
- \' $0 00 Re v Parking Fee / $0.00
Red. Water Con. Fee $0 0000fAdditional}Fees ' - 7 $0.00 - \ . HMPFee . . ??. \ TOTAL PERMIT FEES // $346.99
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Total Fees: - $346.99 TotalPaymets TóDte:
,,
j$346.99 Balance Due: $0.00
LE~UXJXNG PLANS -
-• •' -- .. ATTACHED
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City of Carlsbad / Plan Check NoCeKD v 1635 FaradayA',e.. Carlsbad, CA 92008
Est. Value (7,
Fax 7606028558 Plan Ck Deposit ( V7 'j 07 Building Permit Application Date to (zt (os'-
JOB ADDRESS SUITE#ISPACEN/UNIT# AP-1
. . H zc)9 t :2 CO ,T/PROJECT N LOT N PHASE N 1 90FUNITS
.-:. .
J #aEDROOMS - N BATHROOMS
.
TENANT OUSINESSNAME • CONSTR. TYPE I 0CC. GROUP
DESCRIPTION OF WORK: `14P . :i - 2-3 Kt-?t- P ttcNAN)P P1*
PAtW t\) Lflc-LftTThj-
'' EXISTING USE , USE GARAGE (SF)
MA
PATIOS (SF)
NA. I
JPROPOSED AIR CONDITIONING. DECKS (SF)
t.aA
FIREPLACE
YESO # NO. YES— NOD
FIRE SPRINKLERS
YES4 NOD
CONtACT NAME If Different Fern Applicant) ' n-Fl f7 &r R
APPL CANT NAME' ' 5
ADDRESS
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. ADDRESS
•A-R'LL I4 ski W CITY .' , STATE 'ZIP ' CITY . STATE ZIP
PHONE) FAX PHONE r IFAX
11-Il EMAIL C EMAILAJ rErJ ) I Pfl PROPER1YOWNER NAME - . ''--
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CONTRACTOR BUS. NAME r(\EJILD11 .• .. ADDRESS , . . - 1T1 MIE$k7J. VAU-1 t7 '
ADDRESS 111O Pc?bU- iT- -D CITY . . STATE. ZIP, - 2.1O3 CITY STATE ZIP
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PHONE)9
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STATE UC.# . - jr '.ifr4Lt .,. .
CITY BUS. LIC.#
(Sec. 1031.5 Business and Professions Coda: Any City or County which requires a permit to constants, alter improve, demolish or repair any structure -prior to .its issuance, also requires the applicant hr sigh permit to 'file a signed. itatementt(lat he is Ecensedjaursuant to the provisions of the Cynonctor's License law (Chapter 9, commending with Section boo of tOvision 3 of the Business and Profsoions Code
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is exempt therefrom, and the bans hr the alleged exemption. My violation of. Section 10313-by any applicant for a permit subjects die-applicant to a civil penalty of not more than live hundred dollars ($500)).
Workere' Compensation Declaration: l hereby affimr under penalty of perjury one of tile following declarations:, . • . . - - . . I have and will maintain a certificate of consent to atf.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. , I have and will maintain workers compensation, as required by Sectióh 3700 of the Labor Code, feir the performance of th work forw ich fIrms permit is issued.
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number are: Insurance o. __- Pdicy No. . '- - Expiration Dale t!7I This section treed not be completed if the permit is for onehundied ddlars ($100) or less.
•,' . - . . . CertIficate of Exemption: I certify that in the performance of the wor this permit is issued, I shall not em1oyOny person in any manner so as to become subject to the Workers' Compensation Laws of -California. WARNING: Failure to secure workers' compensation verag' Is un ful, and shall subject an employer to criminal penaltIes and civil tines up to one hundred thousand dollars (8,100,000), In,.
addition to the cost of compensation, damages as provided for In ctlon 06 of Labor code, Interest and attorns~s fees.
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I hereby elll,m that lens exempt from Contradiar's License Law for the Mlowiolg mason.- t, as owner of the prbpety or my employees with wages as their sole compensation, will do the work and the structure is not intended or off
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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 empl
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sale. If, however, the budding or improvement is sdd within one year of comp etion;the owner-builder will have the burden of proving that he did not bui
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- I, as owner of the property, am exclusively tontractinj with licensed con tractors to.conslruct Iheproject (Sec. 7044, Business and Professions C
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properly who builds or improves thereon and contracts for such projects with contractor(s) Itceesed pursuant to the Contractor's license Law)
- ' I am exempt under Section Business and Professions Code for this reason: ' .. ' - .. .
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- 1.1 personally 'pan to provide the major labor and material's for construction of the proposed property Improvement. I] Y
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as - 0 No I (have! have not) signed,an applica000 for a building permit for the proposed work. '. ' , I have contracted with the following p&soa (0 rm) to provide the proposed construction (include name address! phone I cooIractnr' license number):
- 4. I plan to provide portions of the work, but I have hired the following parses to coorcfinale, supervise and provide the major work (indude na
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- 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated (seclude name! address I phone! type of woile) , I
,.'PROPERTY OWNER SIGNATURE
- DATE
Is the applicant orfuturebuildng occupant required to sithmit a business pla'ii, acelely hazerdousmalanals registration form drrisk management and preve
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Presley-Tanner Hazardous Substance AccOunt Act? 0 Yes 0 No
- 10 the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management datrict?
0 Yes 0 No Is the facility lobe constructed within 1,000 feat of the outer boundary ole school site?
- 0 Yes "0 Na
' a ' '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 agencyfor the performance of the work this pa rmif is issued (Sea. 3097 (i) Civil Code). - ''- •.'- :- • Lender's Name Lender's Address
I certify that t haee read the applIcation and etate that the above Infonnatlota Is cursect and thotithe InformatIon on the plans Ia accurate I agree tocomplywlth all CRy orstlnarrona and State fawn relating to bulldlirg ooirstruaetlota
.1 herebyaulhotizerepowenlaliveof Itsealyof CarIsbadfoenIer eonlhe abowimenionedproperty formnspedion purposes. I ALSOAGREETO SAVE, INDE
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AGAINST ALL LIABIliTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACORUE AGe,INST SAID CITY IN CONSEQUENCE
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OSHA: An OSHA perrnt is reqidred f& ekcavahons over 50 deep and ctemoklión orcosskilclon of struduresove3slodesin heght.
- . - -
- EXPIRATION
'
Every penTlit 'issued by the Mcing Offidalunder the provisions of INS Code shall exore by liatitalionandbecomenuo ind void if the buildng or vok authorized by such permit is not ooriumnoadWINn 180 days trceui the dote of such permit or if the building a- work authorized by such 'I is sonpen or abandoned at any time after the work is rsrtuanovd for a period of 180 cfoys(Seclion 106.4.4 Uniform Buildr Code)..
APPLICANTSSlGNATURE l!k- DATE °1
2009/JAN/05/MON 1222 PM P 002 I
C6081963 2722 1O1(R AVWST Ii
WINGED SERVICES 476SF TI 277 ISIMPCOARD WITH APPROVEl3i
SF OFFICE TO WAREHoUSE,1995r OFF TO OFF
TI INDUST
)OB
L#: DESIGN/BUILD TENANT IMP. FOR NEXT WORK •CAL
DAY INSPECTION
BUILDING INSpECTION: 760-602-2725
Gi TO COVER DA://17 H.
Jispector —__ill W"i Notes
-
BUILDING
FO(_J8ID4l1ON
REINFORCED STEEL I I
I I I I
t4.iSOtlRY
0 GROUT 0 WALL DRAINS L II IIIAT:JI 1 1 Ii
TILT PANELS JjLk
POUR STRIPS -
COLUMN FOOTINGS — I
SUBFRAME .FLOOR DCEIUNG
ROOF SHEATHING
:'EXT.SHR PANELS
zz-,1.-v-
INSULATION
:.: EXTERIOR LATH
INTERIOR LATH & DRYWALL
FINAL
PLUMBING
DSEWERAND Bi/CO Dpi/CO
D\'ASTE :0WATER
TOP OUT -O WAS 0 WATER ii I I I
TUB AND SHOWER PAN I I I
11G,A.sTEST OGP1SPIPING I I IIi 1i I I
D WATER HEATER 0 SOLAR WATER
FINAL It
E?-ECTRJCAL 3
ELECTRIC UNDERGROUND IDLIFER I -
ROUGH ELECTRIC WALLS
ROUGH ELECTRIC CEILING
0 ELECTRIC SERVICE 0 TEMPORARY
0 BONDING C POOL' 11:
FINAL
MECHANICAL
UNDERGROUND DUCTS & PIPING
DUCT & ?LEM. 0 REF. PIPING 0
HEAT -AIR COND. SYSTEMS kji
_-VENTILATING SYSTEMS
FINAL I
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE.ITEMS ABOVE HAVE BEEN APPROVED'
FINAL Sign When Appropriate I
But lding Dept. (Inspecbori) (760) 602 2725 / - 2 - 1T7Li /.' I I ' t I i jjfi,:l I
FlreDêpartment (760) 602-4660 o.r Id: if I i' I IV ill '
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a lb City of Carlsbad Bldg Inspection Request
For 12/29/2008
Permit# CB081963 Inspector Assignment RB
Title: WINGED SERVICES: 476SF TI: 277
Description SF OFFICE TO WAREHOUSE/1995F OFF TO OFF
Type: TI Sub Type:, INDUST
Phone: '6199545234
Job Address: 2722 LOKER AV WEST ,
Suite: G Lot: 0
Location: , , Inspector:
APPLICANT DESIGN/BUILD TENANT IMP
Owner:
Remarks:
Total Time: Requested' By: ROBERT
' Entered By: JANEAN '
CD. Description 'Act Comments
19 ' Final Structural
29' Final Plumbing
39 Final Electrical /
49 Final Mechanical '•
Comments/Notices/Holds
Associated PCRs/CVs Original PC#
CV030299 CLOSED 0- BIZ LICENSE INCOMPLETE;
Inspection History
Date Description Act insp comments -
12/24/2008 89 Final combo PA RB SEE BACK OF JOB CARD
12/19/2008 17 interior Lath/Drywail AP PC
12/18/2008 14 Frame/Steel/Bolting/Welding AP RB COMPLETED
12/18/2008 • 16 Insulation - AP RB
12/18/2008 34 Rough Eiectric AP RB
12/17/2008 1,4 Frame/Steel/Bolting/Welding PA RB ON PHASE ii - OK TO INSULATE
11/25/2008 17 Interior Lath/Drywall. AP RB PHASE 1 •
11/24/2008 14 Frame/Steei/BoitinglWeiding • AP RB •@ PHASE 1 • - " •'
11/24/2008 24 Rough/Topout • AP RB • • • ,
11/24/2008 34 Rough Electric AP RB •
11/21/2008 14 Frame/Steei/BoltinglWelding CA RB ' • •. •
' 11/21/2008 17 interior Lath/Drywall , CA RB - ' - • • -
"
EsGiI. Corporation . ".
In Partners/iip with çovernmentforBui&uing Safety -
DATE: November 6, 2008 ' qu=A ANT
O JURIS.
JURISDICTION: Carlsbad N REVIEWER
0 FILE
PLAN CHECK- NO.: 08-1963 SET: II
PROJECT ADDRESS: 2722 Loker Avenue, West, Suite G"
PROJECT NAME: Winged Services and Sales
The plans transmitted herewith have been corrected where necessary and substantially comply,
with the jurisdiction's building codes. ..
LIII 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 checklist
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:
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 dóntactd: Telephone#: . . . ' ..
Date contacted: . • • (by: • , ) • • Fax #: '. • • •
Mail • Telephone Fax • In Person-
F-1 REMARKS:' . . •' •
By: Bryan Zuppiger • • : • • Enclosures: ' . • ' .
Esgil Corporation • • . .. • . • • t
• :'' :-:- •
: GA El MB.. El EJ El PC LOG . S • - • •
trnsmtl dot
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9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax (858)560-1576
S S • . S •
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EsGil Corporation
In Partnership with çovernment for cBui(ding Safety
3p 5 DATE: October 29, 2008 U APPLICANT - L/
UJURIS.
JURISDICTION: Carlsbad U PLAN REVIEWER
. UFILE.
PLAN CHECK NO.: 08-1963 'SET: I
PROJECT ADDRESS: 2722 Loker Avenue West, Suite "G"
PROJECT NAME: Winged Services and Sales
- ...- ..''','
El 'The plans transmitted herewith have.-been corrected .wheré necessary-and substantially cbrnply
with the jurisdiction's building codes
The plans transmitted herewith will substantially comply with the jurisdiction's building codas
whent minor deficiencies identified below are resolved and checked by building department staff.
El 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 Esil
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. - .•
joo ,
The applicant's cOr9 of the Check list hai been sent to:
Phillip Grice
2722.Loker Avenue West, Suite "?"
C arlsbad, CA 92010,
Esgil Corporation staff did not advise the applicant that the ,-plan check has been completed
Esgil Corporation staff Aid advise the applicant that the plan check has been completed
Person contacted: Phillip Grice Telephone #: 760 476 9711
. Date contactedr'I/V/°y>j) Fax #: 858-5301779, Mabell
- Mail Telephone ,Afi Person
- .. REMARKS: ('c1
By: Bryan Zuppiger. ) Enclosures:
Esgil Corporation • ' . '
JGA E MB II EJ . LI PC 10/23/2008
trnsmti.dot
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9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 •'(858) 560-1468 • Fax (858) 560-1576 • . -
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- :' -
Carlsbad 08-1963
October: 29, 2008,-,
- PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS•
1 9-. .9
PLAN CHECK NO.: 08-1963 •' JURISDICTION- Carlsbad
'4 •.,
•c. •--- . • . . 4
OCCUPANCY B/82 l USE office/warehouse
TYPE OF. CONSTRUCTION: IlIB. . ACTUAL 4AREA: 476 ft2
4 .. •••
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SPRINKLERS?: yes.: . --: - .•
• OCCUPANT LOAD: unknown . -'
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DATE PLANS RECEIVED BY •. DATE PLANS RECEIVED BY
JURISDICTION: .
4
.
. ESGIL CORPORATION: 10/23/2008 .
•
DATE INITIAL PLAN REVIEW -" -PLAN' REVIEWER: Bryan Zuppiger
COMPLETED: October 29,'2008 •-"
.
This plan review is limited to the technical requirements .contained jj- the International. Building Code,
Uniform Plumbing Code, Uniform -Mechanical . Code, National Electrical Code and state laws
regulating energy conservation, noise attenuation and access for the disabled. This plan review is
basedon-regülatiOns enforced by the Building Department. You may have other corrections based.on
laws and ordinances enforced. by the Planning Departnent, Engineering Department, Fire
Department or other departments. Clearance from those departments may be required prior to the.
- issuance of a building.perrnit..
• .. . . . .
Code sections cited-are based on the2007 CBC that'adopts the 2006 lBC I
The following items listed need clarificatidn, modification or change. All items must be satisfied before
the plans will be in conformance with the cited codes and regulations. Per IBC Section 105.4 of the
2006 International Building Code, the approval of the plans does not.permit the violation of any state, : county or city law. . . .•
1 . -
To speed up the recheck process, please, note on this list (or a copy) where each correction
item has been addressed, i.e., plan sheet number specification section, etc. Be sure to
enclose the marked up list when you submit the revised plans.
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Carlsbad 08-1963
October 29. 2008
. PLANS
1. Please make all corrections on the original tracings, as requested in the correction list Submit
three sets of plans for commercial/industrial projects (two sets of plans for resi. projects)
For expeditious processing corrected sets can be submitted in one of two ways:.
a) Deliver all corrected sets of plans and calculations/reports dirctly to the City of Carlsbad
Building Department, '1635 Faraday Avenue, Carlsbad, CA 92008, and (760) 602-2700.
The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering
and Fire Departments.
b)., Bring one corrected set of plans and calculations/reports to EsGil Corporation; 9320
..Chesapeake Drive; Suite 208, San Diego, CA 92123, and (858) 560-1468. Deliver all
remaining sets of plans and calculations/reports directly to the City of Carlsbad Building
Department for routing totheir Planning, Engineering and Fire Départments.
NOTE: Plans that are submitted directly to EsGil Corporation only will not be réviewéd by
the City Planning, Engineering and: Fire Departments until review byEsGil,Corporation is
complete.
' .
'...
2 Provide the names, addresses and telephone numbers of the owner on the Title Sheet CBC
Section A106.1 1 L
3. Provide a statement on the'Title Sheet of the'plans; "This project shall comply with the 2007
California BuildingCode that adopts the 2006 IBC, 2006 UMC, 2006 UPC and 2005 NEC."
4 Please revise the Building Code Data Legend, Section numbers and Notes on the Title Sheet
on the plans to match the 2006 IBC, as adopted by the State of California Please remove the
Uniform Code references from the Project Notes on the Cover Sheet of the plans.
5. ' Include the following code information for each building proposed:
Occupant Load
6., ,. A '1-hour fire barrier separation is 'required between the occupancy and the S2 occupancy.
CBC Table 508.3.3'(see exceptions) '
The person responsible for their preparation must sign all final sheets of plans. (California
Business and Profession's'Code). '
To speed up the review process, note on this list (or a copy) where each correction item has
been addressed, i.e., plan sheet, note or detail-number, calculation page, etc.
The jurisdiction has contracted'with Esgil Corporation located at 9320 Chesapeake Drive, '
Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perfortn tIi
plan review for your project. If you have any ,questions regarding 'these plan review items,
please contact Bryan Zuppigerat Esgil'Corporation. Thank you. '
I"..
Car4bad08-1963 L
October 29, 2008
'fDO NOT PAY.— THIS IS' NOT ANINVOICE] .'
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad PLAN CHECK NO..: 084963
PREPARED BY: Bryan Zuppiger DATE: October 29, 2008
BUILDING ADDRESS: 2722 Loker Avenue West, Suite "G"
BUILDING OCCUPANCY: B/S2 TYPE OF CONSTRUCTION: IlIB
1
BUILDING
PORTION
AREA
(Sq. Ft.)
Valuation
. Multiplier.
Reg:
Mod.
VALUE ($)
ti .476 34.37 - 16,360
Air-Conditioning
Fire Sprinklers .
TOTAL VALUE . . 16,360
Jurisdiction Code cb -. By Ordinance
I $181.511 Bldg. Permit Fee by Ordinance V . . . •, . -
I $117.98 PIa Check Fee by Ordinance
Type of Review: - - Complete Review . . El Structural Only.
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Repetitive Fee
El Other . ..•-
Repeats . Hourly Hour
Esgil Plan Review Fee I - $101 651
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iComments: .. 5_ . . . . . - . . .
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Carlsbad Fire Department
Plan Review Requirements Category TI, INDUST
Date of Report 11-05-2008 Reviewed. by
'Name: DESIGN/BUILD TENANT IMP. '
Address: SUITE B
9770.CARROLLCENTERRD.
SANDIEGO, CA 92126 W S
BLDG DEPT COPY
Perthit#:CB081963
Job Narie: :71NGED SERVICES:'4765F TI: 277 ,[ .
Job Address: •2722 LOKER AV WEST CBAD.St: G
INCOMPLETE' The item you have submitted for review is incomplete.- his office cannot
adequat7
'k6"min
e a licable codes and/or standards. Please re"'iew:
carefullall coents attached. - su mit the necessary plan an ions, with changes' !'clouded",
to this office for review proval. -• '
Conditions:
Cond: CON0003 142 '. . . -• •'
[MET] .
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THIS PROJECT HAS BEENREVIEWED AND APPROVED FOR THE PURPOSES OFISSUEANCE OEA
BUILDING PERMIT..
THIS APPROVAL IS SUBJECT TO FIELD INSPECTIO14S, ANY REQUIRED TESTS, -FIRE DEPARTMENT
NOTATIONS,
CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES; AND. 'i
I, REGULATIONS.
THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW.'
Entry 11/05/2008 By cwong iojijAP3
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%VEI5 OFFICE USE ONLY
-. SAN DIEGO REGIONAL UPFP#:
HAZARDOUS MATERIALS QUESTIONNAIRE BP DATE: I -I
OCCC
Business Name Business Contact
Nt It&uc p::
Telephone #
(.%) '-t1-tift.
Project Address 'City State
2-2Z L7
Zip Code Cr
,c to APN#
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Mailing Address City State Zip Code Plan File#
Project Contact : - Telephone #
I ii iuiiuvviuu uetuuis rprsr1L Lrle wiiiiy S activities, niu i me speciiic project aescription.
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.
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 DIVISIONS (HMD): If the answer 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. . . . .. . . . . .
FEES ARE REQUIRED. . . . . '-. Expected date of Occupancy I I 'CaIARP Exempt YES NO E]
D Is your business listed on the reverie side of this form?,
0- Will your business dispose of Hazardous Substances or Medical Waste in any amount? . 0 CalARP Required 3.- 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?
4. Will your business use an existing or install an underground storage tank? 0 CalARP Comrllete 5. . 0 Will your business store or handle Regulated Substances (CalARP)? .6. . Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?. . Date Initials
PART Ill: 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 . . .. .. . . . -S . .
1.' 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 http://www.sdapcd.org/info/facts/permits.pdf, and. the list of typical equipment requiring an APCD permit on the reverse
side of this form. Contact APCD if you have any questions.) I
2. 0 (ANSWER ONLY IF QUESTION 1 IS' YES) Will the subject facility be located wit Iin' 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 appropriate school district.) . . .
SWill there be renovation that involves handling of any friable asbestos material, or disturbing any material that contains non-friable asbestos?
0 . Will there be demolition involving the removal of a load supporting structural member?
Briefly describe business activities: . . . Briefly describe proposed project:
I dnder enalty of perjury that th best of my knowledge and beli t.
Name of owner or uthorized A9e . . .. . S Signature of Owner o(Authorized Agen ' ' Date
--_- FOR OFFICIAL USE ONLY:
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:
BY: . . . . ' DATE:'
EXEMPT OR NO FURTHER INFORMATION REQUIRED 1 RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY. RELEASED FOR occupANcY
COUNTY-HMD • APCD • •' ,' COUNTY-HMD ,. - APCD - CbUNTY-HMD ' • APCD
S , , . . . ''
, -:-
• ________
DEH:HM-917 1 -. (07/04) County of San Diego - DEH - Hazardous Materials Division