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HomeMy WebLinkAbout2745 JEFFERSON ST; A; CB111525; PermitCity of Carlsbad . 1635 Faraday Av Carlsbad, CA 92008 08704-2011 Commercial/Industrial Permit Permit No: C131 11525 Building Inspection Request Line (760) 602-2725 Job Address: 2745 JEFFERSON ST CBAD St: A Permit Type: TI Sub Type: COMM Parcel No: 2031104400 Lot #: 0 Status: ISSUED Valuation: $81,850.00 Construction Type: 5B Applied: 07/11/2011 Occupancy Group: Reference #: Entered By: KG Project Title: CHIROPRACTIC CENTER-2205 SF Plan Approved: 08/04/2011 OFFICE TO OFFICE Issued: 08/04/2011 , . Inspect Area: Plan Check#: Applicant: . Owner:....._ GREG ZIOL CURTIN SONDRA'TRUST 10-09-90 538 SAN ANDRES DR . (ç REDR. SOLANA BCH, CA 92075 .\CLSBAD CA 92008 858-344-6734 Building Permit / / $564.03 Meter Size. '\ Add'I Building Permit Fee / $0.00 Add'I Red: Wter Con. Fee \.) $0.00 Plan Check / . •/ $366.62k"(Meter Fee '\ $0.00 Add'I Plan Check Feel • / $0.00 ' SDCWA Fee $0.00 'Plan Check Discount l / CFD Payoff Fee $0.00 Strong Motion Fee j / ... $1i9RFF,(3105510) $0.00 Park Fee . / $0.00 PFF(4305540) - $0.00 LFM Fee .1 $0.00. License Tax (3 04193) 1 " $0.00 '••.•. - I Bridge Fee . I $000 lLiense Tax (4304193) $0.00 BTD #2 Fee ( . $-01 O.0O rTraffic Impact Fee (31,05541) $0.00 BTD#3Fee ( $p.00\ Trffic,Impactee(4305541) I $0.00 Renewal Fee I : $.00 ! IFFLUMBINGjqTAL' j f $55.00 Add'I Renewal Fee 1 .$Q..0O •ELECiRICAITOTAI V I $70.00 Other Building Fee 1. . $0.00\.1 MECHANICAL TOTAL1 I $50.50 Pot. Water Con. Fee $'0.60 Aas r D e Fee / $0.00 Meter Size . \ sewer Fee-) / . . $0.00 Add'I Pot. Water Con. Fee ..\ $0.00 Redev Parking Fee • . $0.00 Red. Water Con. Fee \ . \ $Q00 OR rAdditonafrLees • $0.00 Green Bldg Stands (5B1473) Fee $1.00 1 HMP Fee ?? Fire Expedited Plan Review $ 1.82.50 V \\ ©7 TOTAL ERFv1T FEE $1306.84 Total Fees: $1,306.84 Total PaymtT6 Dtët J $1 3d684 Balnce Due: $0.00 Li FINAL APPROVAL Inspector: Date: r 2 /( 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 lees/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 limitations has previously otherwise expired. 14 ) Plan Check No. G3//40Ls Building Permit Application ,. - - • - 1635 Faraday Ave Carlsbad CA 92008 Est Value CITY OF 7606022717/2718/2719 CARLSBAD- ' Fax76b6O2L8558 . - '. Plan Ck. Deposit www carlsbadca OV Date 7_//_ 7/ sw y JOB ADDRESS ¶E#/YCE#/UNIT _47 APN - - - 0 CT/PROJECT # LOT # PHASE P P OF UNITS P BEDROOMS P BATHROOMS I TENANT SINESS N E CONS R. TYPE QC. GROUP 1 - DESCRIPTION OF WORK. Include Square Feet of Affected Area(s) 17ccP7 /Pv-(7 - F /7-7 WJA_cZ.-___7 -.i ___________________________ .EXISTING USE •- C.• - PROPOSED USE -.. GARAGE (SF) PA1195 (SF) DEC S (SF) FIREPLACE - R CONDITIONING FIRE SPRINKLERS -riT • .'•j YESO#..NOD YESDNOD.j 1:1 NO CONTACT NAME., (if Different Fom Applicant) APPLICANT NAME - '2ac2, ._-(OL- - -.• -•- . ..- .:- --- ADDRESS ADDRESS STATE 71P CITY STATE ZIP PHO .' FAX ' PHONE FAX EMAIL '7 -.i- -. EM IL - PROPERTY OWNER NAME CONTRACTOR BUS. NAME U L-4Q 7st ADDRESS N ADDRESS c> CITY SIATEQ gq- CIX -M STATE PHONE ' ' . FAX . PHONE - - / FAX,- EMAIL - .- ' - - ., EMAIL = G ' E & ADDRESS STATE LIC P STATE LIC '7L ..lt C. CITY 1BUS 0 I (Sec 70315 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 permitto file a signed statement that he islicensed pursuant to the provisions of the.Contractor's License La after 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 exemption. Any violation of Section 7031.5 by any applicant for a permit subjects-the applicant to n civil penalty of not more than five hundred dollars ($500)) Workers Compensation Declaration thereby affirm under penalty of pequiy one of the following declarafions IJ 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 have and will maintain workers' corn énsation, as required by Section 3700 of the Labor Code, for the èrfoimance of the work r vhich this permit is issued. Myworkers,compensatioti insurnce carrier and -DOlicy -number are Insurance Co FL.}IL(r) Policy No 2 Z,C) IC.) Expiration Date o ( 2o This section need not be completed if the permit is for one hundred dollars ($100) or. less )J CertifIcate of Exemption I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California WARNING Failure to secure wo mpensati age is up) u d shalt subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100 000) in addition to the cost of compensation, ages as ovide or in Sec 37Oif the La r code, i est-ait attorney's fees. - CONTRACTOR SIGNATUR D "(ENT DATE -, - I hereby affirm that lam exempt fronsnfrac or s L,cense Law for the following reason O I as owner of the properly or my employees with wages as their sole compensahon will do the work and the structure is not intended or offered for sale (Sec 7044 Business and Professions Code The Contracto"c License Law does not apply loan owner of property who builds or improves thereon and who does such work himself or through his own employees provided that such improvements are not intended or offered for sale If, however, the building or Improvement is sold within one year of completion the owner builder will have the burden of proving that he did not build or improve for the purpose of sale) I as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044 Business and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon and contracts for such projects with contractor(s) licensed pursuant to the Contractors License Law) I O I am exempt under Section Business and Professions Code for this reason':/ 1 1. I personally plan to provide the major labor and materials for construction of the proposed properly improvemenf 0 Yes 0 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) S I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated (include name ! address! phone / type of work) ..PROPERTY OWNER SIGNATURE EILJAGENT DATE I I + .. City of Carlsbad Bldg lnspectiàn Request For 08/30/2011 Permit# CB111525 Inspector Assignment PD Title: CHIROPRACTIC CENTER-2205 SF .# I * - ... Description: OFFICE TO OFFICE -. + j Type: TI Sub Type: COMM - Phone:, 76031561599 Job Address: 2745 JEFFERSON ST Suite A • Lot 0 Location: - Inspector: - APPLICANT GREG ZIOL - Owner: -CIJRTIN GREGORY L&CURTIN THOMAS C&CURTIN CHRISTOP - Remarks: AROUND 9:30FIREIN'AM. c-----..__ . ;-- ------- . Total Time:.,' Requested By KURT Enterd By: JANEAN CD Description . -. Act Comments : . . •. •19 . Final Structural . -, .• . . . -• 29 Final Plumbing 39 Final Electrical 49 . Final .'Mechanical • . • .:- • .- . • Corn mets/Notices/HoIds - - - Associated PCRs/CVs/SWPPPs Original PC# p. . . . . .. - *• . • Iñpection History , • . * Date. Description - Act. insp Comments . • .,. 08/23/2011 84 Rough Combo. -, AP PD CEILING 08/17/2011 17 interior Lath/Drywan AP PD • . . -. 08/15/011 14 Frame/Steei/Boiting/Wëiding AP PD WALLS .. . . 08/15/2011 24 Rough/Topout . • AP PD • ,. I • 08/15/2011 34 Rough Electric AP' PD • . . . * • ,. t . . .1 . . • . - - . ,.• - • -• ---.... ;• • I • *• I • - • * .. . - • .' . I . -- • - . . . . . . • p Cliv of COMM c te Rpt: Fin I Building Inspection Sing Engineering Planning CMWD St Lite Erre PlanCheck #: Date: 08/30/2011 Permit #,: CB111525 - Permit Type: T! Project Name: CHIROPRACTIC CENTER-2205 SF Sub Type: COMM OFFICE TO OFFICE 0 Address: 2745 JEFFERSON ST #A - Lot: 0 - Contact Person: KURT Phone: 7603156099 - Sewer Dist: CA • - • Water Dist: CA - Date By: Inspected 16 Inspected9'( 2&t( Approved:'Disapproved Inspected • Date 0 By:.. Inspected Approved Disapproved Inspected Date • • - - By Inspected Approved Disapproved Comments 0 0 0 0 • • I- • , V EsGul Corporation In Partnership with governnent for u1dng Safety DATES' 8/2/11 U APPL NT JURIS JURISDICTION: City of Carlsbad U PLAN REVIEWERr 0 FILE V PLAN CHECK NO.: 11-1525 SET: II PROJECT ADDRESS 2745 Jefferson Ave Suite A PROJECT NAME: Chiropractic & Therapy Center - TI V The plans transmitted herewith hive been corrected where necessary and substantially comply I . with the jurisdiction building codes. V V V The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building V department staff. ,. . . • V V LII The plans.tranVsmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted fora complete recheck. V V LI The check list .Vtransmifted herewith isforyour information: The plans are being held at EsgilV V Corporation until corrected plans ke submitted for rcheck. V V •V. - LI The applicant's copy of the check list is enclosed for the.jurisdidtion to, forwardto the applicant contact person: • V V V V V 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 LI Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted: . - . . V' Telephone #: V • Date contacted (by ) Email Fax # Mail Telephone Fax In Person -LI REMARKS: '.4 V V V •'V • ' By: Doug Mood . VV Enclosures: EsGil Corporation V .• . V El V GA i:i EJ [1 V PC 7/26/11 V V • V 'VV V V V V Vç. V V • V 9320 Chesapeake Drive, Suite 208 • San Diego, California 9213 •' (858) 560-1468 • Fax (858) 560-1576 - V V • •V - V V V V VV V - V :. ••' V - - V V V V - V V V.' V 1 EsGul Corporation In PartnersIi;p with Government for Buz(ding Safety DATE 7/21/11 ~'JLIRIS. JURISDICTION: City of Carlsbad El PLAN1VIEWER LJ FILE PLANCHECKNO 11-1525 SET! PROJECT ADDRESS 2745 Jefferson Ave Suite A PROJECT NAME Chiropractic & Therapy Center - TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. S 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: Greg Ziol 538 San Andres Dr, Solana Beach, CA 92075 LI 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: Greg Ziol Telephone #:.858-344-6734 Date contacted (by ps.) Email gregziol(äearth link. net Fax # 858-777-5414 Mail- Telephone .- Fax In Person Fill REMARKS By Doug Moody Enclosures EsGil Corporation S LI GA F1 EJ LI PC 7/14/11 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 •' Fax (858) 560-1576 L City of Carlsbad 11-1525 7/21/lI PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: 11-1525 .JURISDlCTION:City of Carlsbad OCCUPANCY B USE Medical Office TYPE OF CONSTRUCTION VB ACTUAL AREA 2205sf ALLOWABLE FLOOR AREA: STORIES: 1 HEIGHT SPRINKLERS?: NO OCCUPANT LOAD: 32 REMARKS DATE PLANS RECEIVED BY DATEPLANS. RECEIVED BY JURISDICTION: 7/11/11 ESGILCORPORATION: 7/14/11 DATE INITIAL PLAN REVIEW PLAN REVIEWER Doug Moody COMPLETED: 7/21/11 FOREWORD (PLEASE READ): . This plan review is limited to the technical requirements contained in 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 based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enfOrced by the Planning Department, Engineering Department, Fire Department or other departments.'Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 2010 CBC, which adopts the 2009 IBC The following items listed need clarification, modification or chrige. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of. the 2009 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. 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 City of Carlsbad 11-1525 7/21/li Please make all corrections on the original tracings, as requested in the correction list. Submit three sets of plans for commercial/ihdUstrial projects (two sets of plane for residential projects). For expeditious processing, corrected sets can be submitted in one of two ways: .1. Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave.-, Carlsbad, CA 92008, (760) 602-2700. The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments. 2. Bring one corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil Corporation is complete. • Each sheetof the plans must be signed by the person responsible for their preparation even though there are no structural changes. Business and Professions Code. Occupancy sensors are required for the following room types: Offices 250 square feet and smaller for office 104. Section 131. 3: Please clarify the LTG forms the 3 of 4 form shows 7 occupancy sensors and the 4 of 4 form shows 2 occupancy sensors? Please indicate on the lighting plans the location of the automatic time switch and the bypass switch indicated in the LTG-1-C documents Please revise the plans to show the restroom to be equipped with an environmental air exhaust fan sized to provide the minimum exhaust rate per Table 4-4 of the UMC. Please revise the plumbing plans to show the required clean-outs per section 707 and 719 of the UPC. Hot water supplied to a public use lavatory is limited to a maximum temperature potential of 120 degrees by a device that conforms to ASSE 1070 or CSA B125.3; please provide the manufacturer's listing showing compliance. Detail howthis temperature limitation is achieved. The water heater thermostat may not be used for compliance with this Code section. UPC 413.1 & UPC 414. 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. • • - City of Carlsbad 11-1525 . 7/21/11 . . Please indicate here if any changes have been made to the plans that are not a result of corrections from this list. If there., are other changes, please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate • . 0 Yes El No 13 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 perform the plan review for your project. If you have any questions regarding these plan review items, please contact Doug Moody at Esgil Corporation. Thank you. . 0 • •. 0 City of Carlsbad 11-1525 * 7/21/11 , [DO NOT PAY— THIS ISNOTAN INVOICE]- VALUATION- AND PLAN CHECK FEE' JURISDICTION: City f Carlsbad : PLAN CHECK NO.:11-1525 PREPARED BY: Doug Moody DATE: 7/21/11 ' BUILDING ADDRESS: 2745 Jefferson Ave SuiteA BUILDING OCCUPANCY: B ' TYPE OF CONSTRUCTION: VB BUILDING PORTION , AREA , (Sq. Ft.) Valuation Multiplier , Reg. Mod. VALUE ($) TI ' 2205 . 37.12 ' 81,850 Air Conditioning Fire Sprinklers TOTAL VALUE ' , : , 81,850 Jurisdiction Code cb ' By Ordinance , $564.03 1 Bldg. Permit Fee by Ordinance Plan Check Fe by Ordinance . L $366.621 Ty*pe of Review: LI Complete Review Structural Only LI Repetitive Fee LI] Other . . [1 Repeats LI Hourly .,. Hr. @ * . EsGil Fee , '$115.861 , I 404 h> BUILDING PLANCHECK Development Services CIT Y OF CHECKLIST L I and Development Engineering 1635 Faraday Avenue CAR LSBAD QUICK-CHECK/APPROVAL 760-602-2750 www.ca ENGINEERING Plan Check for CB 11-1525' Date:July 13, 2011 Project Address: 2745 Jefferson St - Suite A APN: 203-110-44-00 Project Description: 2205 sf office to office Valuation: 81,850 ENGINEERING Contact Linda Ontiveros Email: Iinda.ontiveroscarlsbadca.gov Phone: 760-602-2773 Fax: 760-602-1052 E RESIDENTIAL t7l TENANT IMPROVEMENT El RESIDENTIAL ADDITIONMINOR 0 PLAZA CAMINO REAL:. (<$20,000.00) El CARLSBAD COMPANY STORES. El COMPLETE OFFICEBUILDING EIOTHER: 1.... OFFICIAL U77 SE ONLY 17 ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT' •. :-:. BY DATE July 13,2011 REMARKS - - - - - • - .-._ •. * . .. -- - ,. -.. •'- / -' I... * - - - • - .• -. •- - I -_'_•, ,' j7.j •.. - - - -1 I —Ntufication of Engureering APPROVAL has been -sent to r,! on, -t_;' -'.: - • - .1 E-36 - Page 1 of 1 REV 4/30/11 REDEVELOPMENT DEPARTMENT BUILDING PLAN .CHECK REVIEW CHECKLIST Plan Check ' .No. CB UtS Address V'-ig 1ec -s o,cl. ,Le .10 Planner 4J5 j1yb— Phone (760) 434- 2-13 APN: 2-03 Type of Project & Use:¶. I. Net Project Density: w (A DU/AC Zoning:\J General Plan: Facilities Management Zone: 1 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: Item Complete D Item Incomplete - Needs your action. . El 0 Environmental Review Required: YES NO TYPE . DATE OF COMPLETION: Compliance with conditions of approval? If not, state conditions which require action. Conditions Of Approval: . Jl 0 0 Discretionary Action. Required: YES NO' -4 TYPE APPROVAL/RESO. NO. DATE PROJECT NO. OTHER RELATED CASES: Compliance with conditions drappróval? If not, state conditions which require action. . Conditions of Approval:___________________________________________________ 0. 0 Coastal Zone Assessment/Compliance 0 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): • - LI El Habitat Management Plan • Data Entry Completed? YES - NO .. If property has Habitat Type identified in Table 11 of HMP, complete HMP Permit application and assess fees in Permits Plus S (A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, HMP Fees, Enter Acres of Habitat Type impacted/taken, UPDATE!) S 'El El El • Inclusionary Housing Fee required: YES NO (Effective date of lnclusionary Housing. Ordinance. - May, 21., ) 993.) Data Entry. Completed? YES NO (AIP/Ds, Activity Maintenance, enter C13#, toolbar, Screens, Housing Fees, Construct Housing YIN, Enter Fee, UPDATE!) • . 0 0 • H:\ADMIN\COUNTER\BldgPlnchkRevChklst - . Rev 3/06 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. Pohcy 44 - Neighborhood Architectural Design Guidelines E E 1 Applicability YES NO________ 0 El D 2 Project complies YES NO________ Zoning 14 0 0 1 Setbacks Front Required Shown Interior Side Required Shown Street Side Required Shown Rear: Required Shown Top of slope Required Shown 0 11 FJ 2 Accessory structure setbacks Front Required Shown Interior Side Required Shown Street Side Required Shown Rear Required Shown Structure separation Required Shown 3 Lot Coverage Required Shown R. 4 Height Required Shown ( 0 0 0 5 Parking Spaces Required - Shown (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required Shown 0 Li .0 Additional Comments ee, A , Mo -JeJ- ) OK TO ISSUE AND ENTERED APPROVAL INTO COMPUER / DATE H.\ADMiN\COUNTER\BidgPlnchkRevChkist - • Rev 3/06 Carlsbad Fir& Department . LING DE,Ffr. COpy Plan Review - Requirements Category: TI, COMM . Date of Repo: 08-04-2011 Reviewed by: 4 Name: GREG ZIOL . Address: . 538 SAN ANDRESDR - SOLANABCH, CA. . . -92075 . Permit #:CB1115'25 . . . . . . Job Name: CHIROPRACTIC CENTER-2205 SF . Job Address: 2745 JEFFERSON ST CBAD St A . xxxy xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx Conditions: . Cond: C0N0004809 '[MET]. .. .• - ** CITY OF CARLSBAD FIRE DEPARTMENT - APPROVED: . . THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF. BUILDING PERMIT. . . . . . THIS APPROVAL IS SUBJECT TOFIELD INSPECTION AND REQUIRED TEST, NOTATIONS HEREON, CONDITIONS IN . . . . CORRESPONDENCE AND CONFORMANCE WITH ALL APPLICABLE REGULATIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE THE VIOLATION OF ANY LAW. Entry 08/04/2011 By GR Action AP (I . . I' A I SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE / I Business Name L-Pfl-4c7 (C _C 7LeAA Business Contact 7prv, (_97j 4 _/7f F-T ' Telephone # ( Project Address Z94'6_JJLc-( ' e. __24 rity 4P 4_1ZDe State Zir Code I . Mailing Address e5,79 IG4x-( L - City c.4 ?ç4 State Zip Code 2o - Plan Plan File# Project Contt E6 -cb C- - Telephone # ' The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT - HAZARDOUSMATERIALSDIVISION:OCCUPANCYCLASSIFICATION: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Facility's Square Footage (including proposed project): Occupancy Rating: 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 (HMD): If the answer to any of the San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED. Project Completion Date: CT/ Lj_(( Expected Date of occupancyO 'i(.( YES NO (for new construction or remodeling projects) 0 Is your business listed on the reverse side of this form? (check all that apply). 0 Will your business dispose of Hazardous Substances or Medical Waste in any amount? 0 Will your business store or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 poun 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 (CalARP)? 0 Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 0 Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). 0 CaIARP Exempt Date Initials El CaIARP Required Date Initials El CaIARP Complete Date Initials PARTIII:SANDIEGOCOUNTYAIRPOLLUTIONCONTROLDISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit. Note: 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, except demolitionorrenovation of residential structures of four units or less. Contact the APCD for more information. YES NO 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 http://www.sdapcd.orq/info/facts/permits.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). 0 0 (ANSWER ONLY IF QUESTION 1 I YES) Will 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.ciov/re/sd/ for public and private schools or contact the appropriate school district). 0 0 Has a survey been performed to determine the presence of Asbestos Containing Materials? 0 0 Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? 0 0 Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities: Briefly describe proposed project: 4 / _9 LZ (i L 0 PfZg7 (C_cce__(F-('7 /e-(P(lô V&CePt7 - ' c: 0 I declare underC4 penalty of perjury that to the best of my knowledge and respoade ___ re correct. ( ,(_/ 4" LE 'ZcD _c_ Name of Owner or Authorized Agent Sj? ___ Date FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: FOROFFICIAL USE ONLY: - DATE: II BY: EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTYHMD* APCD COUNTY-HMD APCD COUNTY-HMD APCD A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply. 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