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Home My WebLink About2772 Roosevelt St; ; CBC2019-0007; PermitCcityof Carlsbad Print Date: 03/22/2019 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2772 Roosevelt St BLDG-Commercial 2031820800 $1,602.40 Commercial Permit Work Class: Tenant Improvement Lot#: Reference#: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check #: Description: USPS: STRUCTURAL ROOF REPAIR (80 SF AREA) Owner: Status: Applied: Issued: Permit Finaled: Inspector: Final Inspection: Contractor: Permit No: CBC2019-0007 Closed -Finaled 01/09/2019 02/05/2019 PBurn 3/22/2019 10:02:S2AM UNITED STATES POSTAL SERVICE AMERICAN TECHNOLOGIES INC BUILDING INSPECTION FEE BUILDING PERMIT FEE ($501-$2000) BUILDING PLAN CHECK FEE (BLDG) 5B1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $232.64 2772 Roosevelt St CARLSBAAD, CA 92008 Total Payments To Date: $232.64 210 Baywood Ave ORANGE, CA 92865-0000 760-559-0333 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. 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov $117.00 $67.14 $47.00 $1.00 so.so ( City of Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check r,&:001q-c.m1 Est. Value & I, <aOJ _y O PC Deposit ] 1 Date ___._[ .....,1..__._;_,_J 9...____ Job Address '2'(72 Roosevelt. Carlsbad CA 92008 Suite: APN: ?.L, 2> -I'>, 1 · 'b'--"() ----- TenantName: u1;1Te,f'\ ·.;1f\1L', fl.',H\L ,~,\LL CT/Project#: _________ Lot#: 7>L/·'>+ ,2., ''-e, kl \✓ d ·1 Occupancy:--=-~-'--------Construction Type: _v_~_ Fire Sprln ers: tes, no Air Con itioning: yes; no BRIEF DESCRIPTION OF WORK: Replace in-kind. collapsed roof ( <ID ~tare .,_(c.o,=I.:,_~+---------- lJ Addition/New: ___________ New SF and Use, ___________ New SF and Use, ____ Deck SF, Patio Cover SF (not including flatwork) D Tenant Improvement: ______ SF, Existing Use _______ Proposed Use ______ _ ______ SF, Existing Use Proposed Use ______ _ 0 Pool/Spa: ____ SF Additional Gas or Electrical Features? _____________ _ D Solar: ___ KW, __ Modules, ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No lJ Plumblng/Mechanlcal/Electrlcal Only: ________________________ _ ~ Other: CL:. ,--'Ll~Ct. \~-) \i \t~1~'} ,:u.:.r \· (2~-,M\t,J(I k:>iHr f 1<.... i1:0V\C n { t" l> CN Pu~N ,;_ APPLICANT (PRIMARY) PROPERTY OWNER Name: Candice Hanna Name: i.Jt--l\T!;:-1--., · ·11'\ Te:.·-, FC.S.\:f\L ;,Lf<,hC "- Address: _7490 Opportunity Rd, Suite 3500 ___ Address: 11 Tc ''•.c·. '.k ✓ "-'--' City: San Oiei:io State: CA Zip:_92111 _ City: Ciill L'0.C,f\\;) State: C(\ Zip: .,-,_-;z: 's. Phone: (619) 260-0057 Phone: ( ·-!,C(: l Z-:L, --Sl 7 ·1 Email:_ doddassociates@sbcglobal.net Email: ____________________ _ DESIGN PROFESSIONAL Name: Ju.Ty oc·,,G ( LNC,,"->LU·c.') Address: 1 L\ \(., c,:rt12:1u,.._,11r ec:. City: ,~•1'-l 015-C,1.. State: (.I\ Zip:') i') ) I Phone: (,\•1 2LC l <.. ~-, 1 Email: s,JccJcl q•:>'.:,.L,<.. ILi tc~-.() '..:.k..')I,. .: j\L n( l \ Architect State Ucense: _,-.:-':::,;;;:..'-i_Y..:..7 .. ,;.;c;.. ______ _ CONTRACTOR BUSINESS Name: AJI Address: '7,'14 'I City: . .-~·?nN C:,if C1L' State: ( l) Phone: (cl'l -b<\7, ·· 4f:j -I ilsi() Zip: •121'.2-l, Email: -------------,;c-,...,..---,,----- State license: '';,'1-lx'f.':1 Bus. License:,.J..!...LL..\~~:i;:::= N~ V3 12- (sec. 7031.S Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to 1 issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's license law (Chapter 9, commendmg with Section 7CXXJ of DiVlston 3 of the Business and Professions Code} or that he/she is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.S by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$S00}). 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph: 760-602-2719 Fax: 760-602-8558 Page 1 of 2 Email: Building@carlsbadca.gov Rev. 06/18 ( OPTION A): WORKERS'COMPENSATION DECLARATION: I hearby affirm under penalty of perjury one of the following declarations: □ I have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. 31 have and will mamtain worker's 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 earner and policy number are: Insurance Company Name: -r\,. ,:... \':__, H(\f:._\ N~ ~;?f\. .. l il·\\-1 I~~..,. l l· Polley No. I(\~ (1() '2 :;,C• -) Expiration Date: D'f_,, i 01 / ,~) □ 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 be come subject to the workers' compensation Laws of California. WARNING: failure to secure workers compensation coveraa:e is unlawful, and shall subject an employer to criminal penalties and cMI fines up to $100,000.00, In addition the to the cost of compensation, damages as provtded for In Section 3706 of the Labor Code, Interest and attorney's fees. CONTRACTOR SIGNATURE: ✓-~ , l I · I ... "" ,,.., ~ ,· . .., l' - , .. .--Y<•~--••' ....... -•• .:· lz c. LJAGENT DATE: _1_/3_12_0_1_9 __ ( OPTION B ): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law far the following reason: □ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for 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 him self or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the bullding or improvement is sold withln 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 elldus1vely 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 the Contractor's License law). □ I am exempt under Section ________ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement □ Yes □ No 2. I (have/ have not) signed an application for a buildina 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 ma1or work (include name/ address/ phone/ contractors' license number): S. I will provide some of the work, butt have contracted (hired) the followin8 persons to provide the work indicated (include name/ address/ phone/ type of work): OWNER SIGNATURE: ~AGENT DATE: _____ _ --------------------- CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lend ins agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name: _____________________ Lender's Address: ____________________ _ ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: 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 JS the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality manasement district? □ Yes □ No rs the facility to be constructed within l,IX)() 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 CONTRot. DISTRICT. APPLICANT CERTIFICATION: I certify that I 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 relating to building construction. I hereby authorize representative of the Oty of Carlsbad to enter upon the above mentioned property for Inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE OTY OF CARLSBAD AGAINST All LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories In height. EXPIRATION: Every permit ls.sued by the Building Offkial under the provisions of this Code shall expire by limitation and become null and VOid if the bulldlng or won<. authorized by such permit ls not commenced within 180 days from the date of such permit or if the building or wort authorized by such permit Is suspended or abandoned at any time after the work is commenced for a period of 180 ~a,f;iection 106.4.4 Uniform Building Code). APPLICANT SIGNATURE: __ ..;[;...).al-;..' '~-~_ .• _.,~_, __ . _____________ DATE: __ \~'~':_.,_/_Z_-L_I ·_) __ 1635 Faraday Ave Carlsbad, CA 92008 8-2 Ph: 760-602-2719 Fax: 760-602-8558 Page2of2 Email: Building@carlsbadca.gov Rev. 06/18 PERMIT INSPECTION HISTORY REPORT (CBC2019-0007) Permit Type: BLDG-Commercial Application Date: 01/09/2019 Work Class: Tenant Improvement Issue Date: 02/05/2019 Status: Closed -Finaled Expiration Date: 09/10/2019 Scheduled Date 03/08/2019 Actual Start Date 03/0812019 03/14/2019 03/14/2019 03/22/2019 03/22/2019 March 22, 2019 IVR Number: 16394 Inspection Type Inspection No. BLDG-14 F rame/Steel/Boltl ng/ Welding (Decks) Checklist Item BLOG-Building Deficiency BLDG-17 Interior Lath/Drywall 086057-2019 BLDG-Final Inspection Checklist Item BLDG-Building Deficiency Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final Inspection Status Passed COMMENTS Passed COMMENTS Pa&Sed COMMENTS Owner: UNITED STATES POSTAL SERVICE Subdivision: SEASIDE LANDS Address: 2772 Roosevelt St Carlsbad, CA 92008-1615 Primary Inspector Reinspection Paul Burnette Passed No Paul Burnette Passed No Paul Burnette Passed No No No No No Complete Complete Complete Complete Page 1 of1 , Field Daily Report Project# Job Name: United States Postal Services NIA Job Address: 2772 Roosevelt Street , Carlsbad, CA Report Date: 3-5-2019 Inspector. Edwin Jimenez Oient: United States PQstal ServiQeS .License # 8234467 Exp Date: 2022 Contractor. Jones Industries License Required for Inspection: Reinforced Concrete Contact at Site: N/R Permit# CBC2019 -007 Jurisdiction Carlsbad Offsite? [)'es ~o Offsite Location: _______________ _ TYPE OF WORK: (check one) (]Reinforced Concrete 0Pres1n:ssed Concrete 0Masomy □Welding ~ Torque Testing Description of Work: ____________________________ _ Per request of our client an ERJ inspections representative as conducted torque testing inspection . Structural Roof Repair: Arrived on site as requested by client to conduct continuous inspection and observation of 100 % of 3/4" 0 expansion bolts. 10% of the bolts were torque tested to 11 0 Ft-Lb utilizing a Kobalt tightening torque wrench following approved and signed structural plans and ESR-2502. Size embedment, location and clearance was in conformance with approved and signed plans Work performed at my departure time took place on the north corner of the DATE TASK# REGULAR O.T. TIME IN TIMEOUT 1-2-2019 4 8:00 amJ 11:00 am Inspector Name: Edwin Jlhlenez Signature: ro 1~~ ~ Q Approved by: _________________ Signature: ------------ (Print Name} Ccityof Carlsbad SPECIAL INSPECTION AGREEMENT B-45 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov In accordance with Chapter 17 of the California Building Code the following must be completed when work being performed requires special inspection, structural observation and construction material testing. Project/Permit· (1'C.'2 6 I q -000 ?-Project Address: r'.21:1 cl f?tJO ~reO-J A. THIS SECTION MUST BE COMPLETED BY THE PROPERTY OWNER/AUTHORIZED AGENT. Please check if you are Owner-Builder □. (If you checked as owner-builder you must also complete Section B of this agreement.) Name: (Please print,_ _________________________________ _ (First) (M.I.) (Last) Mailing Addres._.· ________________________________ _ Email,_· _______________________ Phone_· _________ _ I am: □Property Owner □Property Owner's Agent of Record □Architect of Record □Engineer of Record State of California Registration Numbe · Expiration Date: ________ _ AGREEMENT: I, the undersigned, declare under penalty of perjury under the laws of the State of California, that I have read, understand, acknowledge and promise to comply with the City of Carlsbad requirements for special inspections, structural observations, construction materials testing and off-site fabrication of building components, as prescribed in the statement of special inspections noted on the approved plans and, as required by the California Building Code. Signatur.,._· _______________________ Date: ___________ _ 8. CONTRACTOR'S STATEMENT OF RESPONSIBILITY (07 CBC, Ch 17, Section 1706). This section must be completed by the contractor I builder/ owner-builder. Ill. . ___._. Contractor's Company Name: r:'.bM--flCa v, I ULN, 1 'J'~' inc . Please check if you are owner-Builder □ Name: (Pleaseprint) ___ 71µ,.,n:,;.•,,.,,o0=.\--'G'-"''-"s>crbul1cl1D.1 _____ _1± _________ _,C..,,a-,:,s:-+tli.!i-"loCL _____ _ (First) (M.I.) (Last) Email: :Tual'W/e J:',..,-nllb@ b'r[I-l?.e.-tocq,17™ • c,,,,,, State of California Contractor's License Number: 5 ·--; 1 7 Q./,/- Phone· 7b.o · 5o'j-c,J33 Expiration Date: & · 2 O · • I 9 • I acknowledge and, am aware, of special requirements contained in the statement of special inspections noted on the approved plans; • I acknowledge that control will be exercised to obtain conformance with the construction documents approved by the building official; • I will have in-place procedures for exercising control within our (the contractor's) organization, for the method and frequency of reporting and the distribution of the reports; and • I certify that I will have a qualified person within our (the contractor's) organization to exercise such control. • I will provide a final report I letter in compliance with CBC Section 1704.1.2 prior to requesting final inspection. Signature: ~--"' Date: -~:2---_""=-·-_-_l _0,_ ____ _ 8-45 Page 1 of 1 Rev. 08/11 ' ✓• EsG1I A SAFEbuilfCompany DATE: 01/22/2019 □ APPLICANT ~RIS. JURISDICTION: City of Carlsbad PLAN CHECK#.: CBC2019-0007 PROJECT ADDRESS: 2772 Roosevelt St. PROJECT NAME: Post Office Repair SETI □ □ □ □ □ ~ □ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. See below. 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 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 staff did not advise the applicant that the plan check has been completed. EsGil staff did advise the applicant that the plan check has been completed. Person contacted: .__.:;;, ~ _Telephone#: Date contacted: (b . Email: Mail Telephone Fax n rson ~ REMARKS: Prior to final approval at the jurisdiction: Have pe~esponsible for the preperation of the plans sign sheets A1, A2, and A3, and have designer complete the City's Special Inspection Agreement. By: Ryan Murphy EsGil 01/11/2019 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: Ryan Murphy BUILDING ADDRESS: 2772 Roosevelt St, BUILDING OCCUPANCY: B BUILDING AREA Valuation PORTION ( Sq. Ft.) Multiplier Roof Reoair 80 citv est. Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance 1997 UBC Buildin g Permit Fee ... I 1997 USC Plan Check Fee I• Type of Review: r,; Complete Review r Other r Repetitive Fee ~ I';,;-: Repeats r Hourly EsGII Fee • • Comments: PLAN CHECK#.: CBC2019-0007 DATE: 01/22/2019 Reg. VALUE ($) Mod. 1,602 1,602 r Structural Only ]Hr.@• $23.16] Sheet 1 of 1 • SAN DIEGO REGIONAL OFFICE USE ONLY 0 RECORDIDt . HAZARDOUS MATERIALS PLANCHECKt . . , . QUESTIONNAIRE BP DATE I I Business Name Business Contact Telephonet ,.OJ\'\E-'::> ~,t i:ri;L "> fu'"t <~frlCL f211..,1' l!'\12.)-L.r\"-1\) (pl"\-{/--!; 4L"tl State APNt Pro)f!ct Address City Zip Code 2 1 12 '2\;.<...,"'-t-"~l...\ CJ\('-.:.t?.:,l"\'u c.A l 2 LL-',_. 2G'2 \ t:. l ·tc ca Mailing Address City State Zip Code PlanFilet Project Contact Applicant E-mail Telephone# [ ANDlC~ ~PINNA dc..dd (\~~CCJQ\<!~€-'~ q\c.bll\ ne~ ( ( I I') . (c_-(.. \ C" .... ➔ The following questions reprennt the flc1llty's 1ctiYltlH, NOT the specific project description. I r t : tcate by ci Ing t item, whet your usmess will use, process, or store any a ous matena s. ap ·cant must contact the Fire Protection Agere, with jurisdiction prior to plan submittal Occupancy Rating: B Facility's Squara Footage 0ncluding proposed proJect): , :>~-=¼'::> .. f \ 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 Hlghly ToXJc or Toxic Materials Q_5. None ofThese. ' 4 Flammable Solids 8. Unstable Reactives 12. Radioactives • If the answer to any of the questions 11 yes, applicant must contact t nty o n o Call (858) 505-6700 prior to the issuance of a building permit an Diego, CA 92123 FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy. 0 CalARP Exempt 1 2 3. 4 5 6 7. 8 YES NO D L'gl D ~ D ~ D D D D D f8I 18] [El 131 0 (for new construction or remodeling projects) Is your business listed on the reverse side of this form? (check all that apply). Will your business dispose of Hazardous Substances or Medical Waste in any amount? W~I your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pourlds arid/or 200 cubic feet? WiR your business store or harldle carcinogens/reproductive toXJns In any quantity? Wil yoUf" business use an existing or install an urldergrourld storage tank? Will your business store or harldle Regulated Substances (CalARP)? Will your business use or install a Hazardous Waste Tank System (Trtle 22, Article 10)? Wiff your business store petroleum in tanks or containers at your facility with a total facility storage capac,ty equal to or realer than 1 320 allons? California's Above round Petroleum Stora e Act . Date lntllala 0 CalARP Required Date ln1bals D CalARP Complete Date lnltlela ~ I~· S~ ~~!~~C-~~TRICT (APC~l: Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San ,A93 ~ 1 f )7 ostamp requ red if Q1 Yes llli1 Q3 Yes l!Hl 04-06 No]. The followi'"!ll questions are intended to identify the majontyoairpottUtiOnissues at the planning stage. Projects may require additional measures not identified by these questtonS For comprehensive requirements contact APCD Residences are typicaNy exempt, except -those with more than one building• on the property; single buildings with more than four d-Hing units, townhomes: condos: mixed-commercial use, deliberate bums; reStdences forming part of a larger project ('Excludes garages & small outbuildings.) 1 2. 3. YES NO B ~ D D WiU the project disturb 160 square feet or more of eXJsting building materials? Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demoUtion (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance Technician? 4 D 0 (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification may be required 10 wort<ing days prior to commencing asbestos removal. 5 6 D D ~ Win the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet (Www,ldaocd om(info{fagstpen:mts.pdf) for typical equipment requiring an APCD permit. 0 (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bounda Briefly describe business activities. Briefly describe proposed project· »T G\ \ 'be( '-I\ (...t ~ p<.,"'"-. \-C.., (( 1 ~(_ 1Cl(,, (~I ( I dedai;e under penalty of perjury that to the best of my knowledge and belief !)8 IJ!Sponses made herein are true and correct. CAN DI( !s, 1-\1\NNP. _ ....... _~-----------------r / v .... Name of Owner or Authorized Agent Signature of OINner or Authorized Agent Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION. ______________________________ _ BY: DATE: I I EXEMPT OR NO FUIITHEII INFOAMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT l'OA OCCUPANCY IUU.IASED FOR OCCUPANCY COUNTY-HMO• APCD COUNTY-HMO APCO COUNTY-HMO APCD •A stamp In lhts box 2nlx exempts busmesses from completing or updating a Hazardous Matenals BUIIOess Plan. Other permitting requirements may sWI apply HM-9171 (08115) County of San Diego -DEH -Hazardous Matenals Division