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Home My WebLink About2791 LOKER AVE W; ; CB110485; Permit.. .. City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-21-2011 Commercial/Industrial Permit Permit No: CB110485 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: Applicant: 2791 LOKER AV WEST CBAD Tl Sub Type: 2090814900 Lot#: $2,041.60 Construction Type: Reference #: LG DISPLAY: ADD 55 SF SINGLE USE TOILET INDUST 0 NEW Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Plan Check#: ISSUED 03/08/2011 JMA 03/21/2011 03/21/2011 MICHAEL KINOSHITA 7510 CLAIRMONT MESA BL #207 LBA/MET PARTNERS II-COMPANY II LL C ATTN: HILARY RAYMOND SAN DIEGO 92111 858-268-8176 X 101 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'I Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'I Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473} Fee Fire Expedited Plan Review $54.11 $0.00 $35.17 $0.00 $0.00 $1.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $182.50 2235 FARADAY AVE #0 CARLSBAD CA 92008 Meter Size Add'I Reel. Water Con. Fee Meter Fee SDCWA Fee CFO Payoff Fee PFF (3105540) PFF (4305540) License Tax (3104193) License Tax (4304193) Traffic Impact Fee (3105541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee TOTAL PERMIT FEES Total Fees: $363.28 Total Payments To Date: $363.28 Balance Due: Inspector: ~ FINAL APPROVAL Date: II Clearance: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.00 $20.00 $21.50 $0.00 $0.00 $0.00 $0.00 ?? $363.28 $0.00 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 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. ~ «~~'\ ~ CITY OF CARLSBAD ADDRESS CITY PHONE EMAIL PROPERTY OWNER NAME ADDRESS CITY PHONE EMAIL ARCH/DESIGNER NAME & ADDRESS Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 I 2718 / 2719 STATE FAX STATE FAX Fax: 760-602-8558 www.carlsbadca.gov #BEDROOMS -- SUITE#/SPACE#/UNIT# - # BATHROOMS GARAGE (SF) PATIOS (SF) - ZIP ZIP STATE UC.# STATELIC.# <-/? /-~ Plan Check No. Est. Value Plan Ck. Deposit Date SWPPP ~P~INKLERS Y~NOO (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 issu , also requir the applicant for such permit to file a sil(ned 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 the Business and Professions Code} or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). orkers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Cl 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. 0 I have and will maintain workers' compensation, as r uired by Section 3700 of the Labor Code, for the perfor % the work for which this P,enni~ issued. My workers' compensatio'1tu carrier and policy number are: Insurance Co. '-.l c.. · No. ~d-0 t> u:a. I. V t Expiration Date U IA U -i I, as owner of the property or my em oyees wit es 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 o,.m...,.Hllinnerty 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). D I, 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 the Contractor's License Law). D 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. D Yes D 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 I phone/ type of work): ..@S" PROPERTY OWNER SIGNATURE D OAGENT DATE ~-----~-- is the applicant or future building occupant required to submit a busi~an, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanne, Hazardous SUbstance Account Act? Cl Yes 1!I No '-- is lhe applicant or future building occupant required to obtain a pennit from the air pollution control district dlllli[. quality management district? Cl Yes ~ No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Cl 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 certify that I have read the application and state that the above Information is conect and that the infonnation on the plans is accurate. I agree to comptyv.ffll all City ordinances and Slate laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above menooned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAIDCITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: All OSHA permit is required for excavatioos over 5'0' deep and demolition or construction of structures over 3 stories in height EXPIRATION: Eve,y permit issued bY. the Building Ofocial under the provisions of this Code shall expire by linitalion and become null and void W the building or work authorized by such permit is not oommenced 'Mthin 180 days from the date of such · W the buiding or work authorized by such permit is suspended or abandoned at any time after the work is oommenced a period of 180 days (Section 106.4.4 Uniform Building Code). ...@$' APPLICANT'S SIGNATURE DATE 1 City of Carlsbad Bldg Inspection Request For: 04/25/2011 Permit# CB110485 Title: LG DISPLAY: ADD 55 SF SINGLE Description: USE TOILET Type: Tl Sub Type: INDUST Job Address: 2791 LOKER AV WEST Suite: Lot 0 Inspector Assignment: TP --- Location: Inspector: ---- OWNER LBA/MET PARTNERS II-COMPANY II LL C Owner: LBA/MET PARTNERS II-COMPANY II L L C Remarks: Total Time: CD Description Act Comments Requested By: NIA Entered By: KATHY 19 Final Structural __fJf_ C~M11?/Jeb>-L .l?/Z11V1tle ,RI/Mc' /'/?~bf ~AA-/)./If/. 29 Final Plumbing ..;-/l~v!Jht7 1:uvf. /t,,JO,,../., 39 Final Electrical 49 Final Mechanical Comments/Notices/Holds Associated PCRs/CVs/SWPPPs Original PC# lns12ection HistoD'. Date Description Act lnsp Comments 04/21/2011 89 Final Combo PA TP SEE CARD OK TO USE 04/19/2011 308 Final AP OF 04/11/2011 17 Interior Lath/Drywall AP TP 04/08/2011 84 Rough Combo AP TP 1. ~ «~ ~ CITY OF CARLSBAD BUILDING Plan Check Comments Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov By: Steve Borossay (Contact Hours for Steve: Tues.-Fri., 1pm -5pm) Phone: 760-602-7541 Permit: C-:e> l \ 0 48.S-Address: 219':> \ \ o ke..r Av~ vJ Date: ¥10/ fJ • When corrections from all departments are received please run new prints • • Please respond by indicating location of Plan Check items on plans • D Provide: A statement on the Title Sheet of the plans stating that the project shall comply with the 2010 CA Building Code, 201 0 CA Residential Code, 2010 CA Green Code, 2010 CMC, 2010 CPC, 2010 CEC, 2008 CA Energy Efficiency Standards, 2010 CA Fire Code and the Carlsbad Municipal Code D Provide: A note titled "Scope of Work" describing the work to be performed under this permit. WlC\.~ doz::>r +.o }ke. ou.½~ J.(L Co_\\ ovJ-Ce-Lt~ IA..~ ~ o( s.+ <-~V\..e~-::)"'-~ ~r· rt_ · Approved on:-----=--+~/4__,__f!>l.£..1-1----1Vi-Z----By:--~7f2---------- PLANNING/ENGINEERING APPROVALS PERMIT NUMBER / Ct3!/-Vf J DATE ------ ADDRESS ____ d-_1_~_/_&_~ __ qy-( __ uJ_c_if ___ _ RESIDENTIAL RESIDENTIAL ADDITION MINOR (<$17,000.00) SOLAR PANELS TENANT IMPROVEMENT PLAZA CAMINO REAL PREMIER OUTLETS VILLAGE FAIRE -~--~ COMPLETE OFFICE. BUILDING PLANNER ___ ....,.-...-r---- ENGINEER ~ c.e____,, DATE -------- DATE_~-31_/-'-'-'<//_~_,_/ __ Docs/Misforms/Planning Engineering Approvals PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB 11-0485 DATE 3/9/11 ADDRESS 2791 Loker Avenue West RESIDENTIAL ADDITION- MINOR (<17,000.00) RETAINING WALL VILLAGE FAIRE OTHER -- PLANNER ClvtiA JtkUM POOL/SPA ~ ~ANT IMPROVEMENT ~ .... , ...... -=~:·,,..,..,,,,,,,.. ... ,~ ... ,~~1:lr.¢1~~ COMPLETE OFFICE BUILDING DATE 3-2-// ENGINEER'-----------DATE ______ _ It \ADMIN\COUNTER/PLANNING /ENGINEERING APPROV AlS C . [I . Carlsbad Fire Department Plan Review Requirements Category: TI , INDUST Date of Report: 03-20-2011 Name: Address: Permit #: CB 110485 MICHAEL KINOSHITA 7510 CLAIRMONT MESA BL #207 SAN DIEGO CA 92111 Job Name: LG DISPLAY: ADD 55 SF SINGLE Job Address: 2791 LOKER AV WEST CBAD !~-~ Reviewed by: ---!Z/--'--¾-~--1---- tNeO"ff'LECfE The item :,ott h:ttve 3m,mi;teti fer re.ten is ineeffl}'le1!e. ht :tnis time, :tftis oftiee et1Met allel!fY&tei,, eot18tlet e. 11ei,•iew to aete1Mie0 eoMpliMoe wiih-tkr, RppM@Mde H@eo QRri.'011 studHilH, PIHH 11111i1• , ••1iuU9 ill: HMMitltli llii&ik@il, Pht8:88 P@liHMMt ilt• 11eeei,sew,1 }MftM:entli'e• !J!'@oiiiotttiou~, ,,ith: ehmt~cs lfelc adcd'', •• titie 111!iiu Mr ,er.•ie1;1; MA 8f'p18 ,at Conditions: Cond: CON0004502 [MET] CITY OF CARLSBAD FIRE DEPARTMEN THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF BUILDING PERMIT. THIS APPROVAL IS SUBJECT TO FIELD 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: 03/20/2011 By: gr Action: AP Daryl K. James & Associates, Inc. 205 Colina Terrace Vista, CA 92084 T. (760) 724-7001 Email: kitfire@sbcglobal.net Plan Checker: Daryl K. James Date: March 17, 2011 Page: 1 of 2 'B~ T r~c, DT E1-·1,-,:--, ,~,r-..o·.,-r · LJ • J,J, , l 't.,l.lt 'J. APPLICANT: Michael Kinoshita PROJECT NAME: LG Display JURISDICTION: Carlsbad Fire Department PROJECT ADDRESS: 2791 Loker Ave West PROJECT DESCRIPTION: CB110485 Add 55 s.f. single use restroom INSTRUCTIONS • This plan review has been conducted in order to verify conformance to minimum requirements of codes adopted by the Carlsbad Fire Department. • The items below require correction, clarification or additional information before this plan check can be approved for permit issuance. • To expedite the recheck process, please note on this list (or copy) where each correction item has been addressed, i.e. sheet number, note number, detail number, legend number, etc Corrections or modifications to the plans must be clouded and provided with numbered deltas and revision dates. • Please direct any questions regarding this review directly to: Daryl K. James kitfire@sbcglobal.net T1-0.0 Fire Notes ..J Remove notes 12 -18 not applicable to this project. Code references are not accurate. v Add List of Deferred Submittals and Applicable Standards 2010 NFPA 13 Deferred fire sprinkler design 2010 NFPA 72 Deferred fire alarm design. --./ Building Data Revise Type of Construction. See CBC Table 601 -v A1. Provide a note stating door hardware shall be openable from the egress side without the use of a key or special knowledge or effort. vADA1 Remove reference to smoke/alarm. This is a deferred submittal. v E1 Stamp & sig11 plan Denote emergency lighting ..J P1 Stamp & sign plan «~ ~ CITY OF CARLSBAD STORM WATER COMPLIANCE ASSESSMENT B-24 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov I am appl~g to the City of Carlsbad for the following type(s) of construction permit: ~ Building Permit D Right-of-Way Permit Patio/Deck Re-Roofing Sign Spa-Factory Sprinkler D My project is categorically EXEMPT from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it only requires issuance of one or more of the following permit types: Electrical Fire Additional Fire Alarm Fixed Systems Mechanical Mobile Home Plumbing Water Discharge Project Storm Water Threat Assessment Criteria* "'le. Threat Assessment Criteria ~ My project qualifies as NO THREAT and is exempt from the requirement to prepare a stonn water pollution prevention plan (SWPPP) because it meets the "no threat" assessment criteria on the City's Project Threat Assessment Worksheet for Detennination of Construction SWPPP Tier Level. My project does not meet any of the High, Moderate or. Low Threat criteria described below. Tier 1 -Low Threat Assessment Criteria 0 My project does not meet any of the Significant or Moderate Threat criteria, is not an exempt pennit type (See list above) and the project meets one or more of the following criteria: • Results in some soil disturbance; and/or • Includes outdoor construction activities (such as saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling). Tier 2 -Moderate Threat Assessment Criteria 0 My project does not meet any of the Significant Threat assessment Criteria described below and meets one or more of the following criteria: • Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 of the Carlsbad Municipal Code); or, • Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria: • Located within 200 feet of an environmentally sensitive area or the Pacific Ocean, and/or • Disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical, and/or • Disturbed area is located along or within 30 feet of a stonn drain inlet, an open drainage channel or watercourse, and/or • Construction will be initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). Tier 3 -Significant Threat Assessment Criteria 0 My project includes clearing, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas: and/or 0 My project is part of a phased development plan that will cumulatively result in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, refueling and maintenance areas: or, 0 My project is located inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant potential for contributing pollutants to nearby receiving waters by way of stonn water runoff or non-stonn water discharge(s). I certify to the best of my knowledge that the above checked statements are true and correct. I understand and acknowledge that even though this project does not require preparation of a construction SWPP, I must still adhere to, and at all times during construction activities for the permit type(s) check above comply with the storm water best management practices pursuant to Title 15 of the Carlsbad Municipal Code and to Citv Standards. 'The City Engineer may authorize minor variances from the Storm Water Threat Assessment Criteria in special circumstances where it can be shown that a lesser or higher Construction SWPPP Tier Level is warranted. 8-24 Page 1 of 1 Rev.03/09 «~ ~ CITY OF CONSTRUCTION THREAT ASSESSMENT WORKSHEET FOR DETERMINATION OF PROJECT'S PERCEIVED THREAT TO STORM WATER QUALITY E-33 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov CARLSBAD Construction Perceived SWPPPTier Construction Threat Assessment Criteria* Threat to Storm Water Level Quality Tier 3 -High Construction Threat Assessment Criteria D Project site is 50 acres or more and grading will occur during the rainy season D Project site is 1 acre or more in size and is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA High D Soil at site is moderately to highly erosive (defined as having a predominance of soils with Tier3 USDA-NRCS Erosion factors kt greater than or equal to 0.4) D Site slope is 5 to 1 or steeper D Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 D through April 30). Owner/contractor received a Storm Water Notice of Violation within past two years Tier 3 -Medium Construction Threat Assessment Criteria Medium D All projects not meeting Tier 3 High Construction Threat Assessment Criteria Tier 2 High Construction Threat Assessment Criteria D Project is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA D Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kt greater than or equal to 0.4) High D Site slope is 5 to 1 or steeper Tier2 D Construction is initiated during the rainy season or will extend into the rainy season {Oct. 1 through April 30). D Owner/contractor received a Storm Water Notice of Violation within past two years D Site results in one half acre or more of soil disturbance Tier 2 -Medium Construction Threat Assessment Criteria Medium D All projects not meeting Tier 2 High Construction Threat Assessment Criteria Tier 1 -Medium lns12ection Threat Assessment Criteria D Project is located within the Buena Vista or Agua Hedionda Lagoon watershed, within or directly adjacent to an environmentally sensitive area (ESA) or discharges directly to an ESA D Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kt greater than or equal to 0.4) Medium D Site slope is 5 to 1 or steeper Tier 1 D Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). D Owner/contractor received a Storm Water Notice of Violation within past two years D Site results in one half acre or more of soil disturbance Tier 1 -Low lns12ection Threat Assessment Criteria Low D All projects not meeting Tier 1 Medium Construction Threat Assessment Criteria Exempt -Not Applicable -Exempt *The city engineer may authorize minor variances from the construction threat assessment criteria in special circumstances where it can be shown that a lesser or higher amount of storm water compliance inspection is warranted in the opinion of the city engineer E-33 Page 1 of 1 REV 4/30/10 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# _______ _ HV# _______ _ BP DATE. _ _,_ _ _._ __ _ T e following questi ns represent the facility's activities, NOT the specific project description. 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 ~ther Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials . one of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISIONS {HMO): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 316 floor, San Diego, CA 92101. Call (619) 338-2222 prior to the issuance of a building permit. e,. I JI FEES ARE REQUIRED. Expected Date of Occupancy: 0 / / 0 CalARP Exempt YES NO Date ~nitials 1. O ~ Is your business listed on the reverse side of this form? (check all that apply). 2. D -~ Will your business dispose of Hazardous Substances or Medical Waste in any amount? O CalARP Required 3. 0 ~ Will your business store or handle Hazardous Substances in quantities equal to or greater than / 4. 5. 6. D D D 55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity? Date Initials ~ Will your business use an existing or install an underground storage tank? "f! Will your business store or handle Regulated Substances (CalARP)? ~ Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 0 CalARP Complete I 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), 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 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. 1_ YE]S ~O 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.org/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). 2. 3. 4. D D D O (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 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). Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities: Sig FOR OFFICIAL 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-HMO APCO COUNTY-HMO APCO COUNTY-HMO APCO HM-9171{04/07) County of San Diego -DEH -Hazardous Materials Division .. . INDUSTRIAL WASTEWATER DISCHARGE PERMIT .,. ~ _ J J . SCREENING SURVEY -::;-..., ~3~h · · Business Name~ ~ . Street Address i:J-i l JAj4if ij'i VM, J~P-1) .l~ qe.4~/"' Eman Address ·--------------------------- PLEASE CHECK HERE I.F .YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) m, ~' cf__ Check all below that are present at your facility: r Acid Cleaning Ink Manufacturing Nutritional Supplement/ Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining/ Milling Painting/ Finishing Battery Manufacturing Manufacturing Paint Manufacturing Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (Le. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting/ Forming Pesticide Manufacturing / CarWash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification Electroplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameiing Electrical Component Anodizing Power Generation Manufacturing Coating (i.e. phosphating) Print Shop Fertilizer Manufacturing Chemical Etching/ Milling Research and Development Film/ x~ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap I Detergent Manufacturing Industrial Laundry Wasfe Treatment/ Storage SICCode{s) (if known): _____________________ _ Brief description of business actMties (Production I Manufacturing Operations): _____ _ Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal /day}: _______ _ List hazardous wastes generated (type/ volume): ______________ _ Date operation began/or will begin at this location: ______________ _ Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes No lfyes, when: ___________________ _ Site Contact._. ______________ Title. ____________ _ Signature. ______________ Phone No .. ___________ _ ENCINA WASTEWATERAUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438--3941 FAX: (760)476-9852 CB110485 2791 LOKERAVWEST LG DISPLAY ADD 55 SF SINGLE I JC::,C: T(')II C:T -,PUl·NU-.- (\JC) FE~ TR Kt=,\j' i?(q(,,-To C<-~, hre ~s+2-Ve- s( IO ( l l ~ ~ fZ:.__ 3--N-II 1f fr -/4 3(17 / II -7i ,5ftwe. / (!, o/~'5 TO f"r>l!E vM t9/'f"I. 3-/<i-/ /-M~ fo fJ-fC ' /), . _ (J 3-21-11-,£r1:--AJ ~f ~--~ Approved Qate BUILDING . '>-1<5-// PLANNING -clq/ H ENGINEERING ~_:./¥-// FIRE Expedite? r Y) N ~-211-,-, HazMat APCD Health Forms/Fees Sent Rec'd Encina 3. 7. // Fire HazHealthAPCD i5 · "7·1/ PE&M .5.Cj,1/ School - Sewer Stormwater, 3. '7.// Special Inspection CFO: y 0:0 LandUse: Density: lmpArea: FY: Annex: PFF: y /N l CommenS-Date Date Date Building 5ltohl I Planning Engineering Fire ·:;--//-// Need? f>,,lf7/_,7,;;a. ~re<,.; _;_ ./2 ~- SW CJCV .,...By V ~ 'f&. 'LIL ;;'. / / Due? By y N y N y N y N y N y N y N y N Factor: Date ... ~ VDone 'dDone a Done a Done a Done a Issued