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Home My WebLink About2850 PIO PICO DR; ; 87-228; Permit- hereby affirm that I am licensed under Ip o alone of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. hereby affirm that t am exempt from the Contrac-tor's License Law lor the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which re quires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the ap- plicant to, such permit to tile a signed statement that he is I -. licensed pursuant to the provisions of the contractor's License Law (Chapter 9 commencing with Section 7000 01 Division 301 the Business and Professions Code) or that is ex- empt therefrom and the basis for the alleged exemption- Any violation 01 Section 7031.5 by an applicant for a permit sub- - edo the applicant to a civil penalty 01 not more than live hun- dred dollars 105001. I I, as owner 01 the property, or my employees with wages I - as their sole compensation, will do the work, and the Struc- t ure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractors License Law does I - not apply to an owner 01 property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intend- I ed or uttered for sate. II, however, the building or improve' mont is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or im-prove for the purpose 01 sale). 0 I, us owner 01 the property, am exclusively contracting I 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 im- I proves thereon, and who contracts for each projects with a contractor(s) license pursuant to the Contractors License Law). . • . As a homeowner lam improving my home, and the follow' ing conditions exist: . . The work is being performed prior to sale. I have lived in my home for twelve months prior to completion of this work. 3. I have not claimed this exemption during the last three years. lam exempt under Sec. ___________________ , B & P.C. for this reason O I hereby affirm that t have a certificate Of Consent to sell-insure, or a certificate of Workers Compensation In. I surance. or a certilivd copy thereof (Sec. 3800. Labor Code) POLICY NO. - COMPANY F O Copy is filed with the City .0 Certified Copy is hereby furnished CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit / is to, one hundred dollars 101001 or less) I certify, that in the performance of the work to, which this permit is issued. I shall not employ any person in any manner soas to become subject to the Workers Compen- I sation Laws of California. NOTICE TO APPLICANT: It, after making this Certificate) of Exemption, you should become subject to the Workers Compensation provisions 01 the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - '0 I hereby affirm that there is a construction lending) agency for the performance of the work for which this per. mit is issued (Sec. 3097. Civil Code) Lender's Name Lender's Address . I- C., 4 I.- Z 0 0 01 151 0 -a 2 Ui Z 0 II) U- >'• I.) 0 0, E a) I— '0 0 0 C 10 I,) 0, 0, C 0 I/o on Ii) 0) (,) 0 C) >- 0 U a) 0. on C USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. \..CARLSBAD BUILDING DEPARTMENT - APPLICATION & PERMIT - . $ 207 'Ls'aImas Dr., Carlsbad, CA 92009-4859 (619) 438.1161 - .106 ADDRESS • • - Av. ST. RD. NEAREST CROSS ST. (DATE "-.-\ ''• 2850 Plo Pico t i D • I rive Elm Avenue I OF APPLICATIONI I I 4/28/87 BUSINESS LICE ,j,,, 76 VALUATION ZONE - PERMIT T NUMBER — , LOT 55 I BLOCK -- I SUBDIVISION I -- i ASSESSOR PARCEL NO. 156-164-55 00 CONTRACTOR Stuckey Development Inc. I OWNER'S PHONE CONTRACTORS PHONE (619)727-4570 OWNER'S NAME VICTORIAN INVESTMENT GROUP . 1(619) 723-8141 CONTRACTOR'S ADDRESS 515 Wildhorse, Vista, CA STATE LICENSE NO, 445034 BUILDING SO. FOOTAGE OWNER'S MAILING ADDRESS S. Mission Road, Suite C, Fallbrook,CA 92028 DESIGNER Patrick James Taylor DESIGNER'S PHONE 723-0793 Not Valid Unless Machine Certified - PTION OF WORK Tenant improvement to r DESIGNER'S ADDRESS 1667 S. Mission, "C",Fallbroo STATE LICENSE NO. 35546 -- existing office, building -- - F/P FLR ELEV. YDNO_— NO I STORIES EDU OCCGP _____ PARKING SPACE RES UNITS GRADING PERMIT ISSUED 0 0 I I REDEVELOPMENT AREA . YO NO I TYPE CO fr'tI 0CC LOAD I FIRE SPR J YO NEI CITY. PLUMBING PERMIT - ISSUE 1 CITY. MECHANICAL PERMIT- ISSUE SUMMARY/ACCOUNT NUMBER - - FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100.000 BTU , BUILDING PERMIT 001-810-00-00-8220 EACH BUILDI'NG SEWER' OVER 100,000 BTJI OVER , SIGN PERMIT .01 02B].dPmt -732-51) EACH WATER HEATER ND/OR V ENT BOILER/COMPRESSOR UP TO 3 HP 9/' PLAN CHECK 001-8(0-00-00-8821 EACH GAS SYSTEM I TO 4 OUTLETS / _______ 8OILERICOMPRESSOR 3.15 HP TOTAL PLUMBING 001-810-00-00-8222 EACH GAS SYSTEMS OR MORE METAL FIREPLACE - ELECTRICAL 001-810-00-00-8223 EACH INSTAL.,'ALTER, REPAIR WAT PIPE VENT FAN SINGLE - HANICAL_ .001-810-00-00-8224 EACH VACUUM BREAKER MECHEXHAUST%6lDU_s WATER SOFTNER RELOCATION OF E FURNACE/HEATER , SOLAR 001-810-00-00-8226 _OBILEHOME 001-810-00-00-8225 EACH ROOF DRAIN (INSIDE) DRYER VENT - (.' RDNG MOTION 880-519-92-33 TOTAL MECHANICAL . 1/001-810-00-00-8227 TOTAL PLUMBING FIRE SPRIRS OO'8227 C__320-810-00-00-8740 IR 360-810-00-00-8740OOl'8lO'OO CITY. ELECTRICAL PERMIT - ISSUE ' QTY. MOBILE HOME SETUP OA- IN-LIEU(AREA NEW CDNST EA AMP!SWT1BKR CARPORT TIE ,v,134-810-00-00-8835 I PH. - 3 PH , AWNING LA COSTA TIF 133-810-00-00-8835 EXIST BLDG EA AMP/SWT/BKR GARAGE FMF 1 P 3P X OY LICENSE TA _001-810-00-00-8162 REMDOEL,'ALTER PER CIRC I MFF A'/ ,1q_880-519-92-57 - MP PD LE " 200 AM PS / ,i OVER 200 AMPS TEMP OCCUPANCY (3O CREDIT DEPOSIT - <_14/-> TOTAL ELECTRICAL TOTAL. t TOTAL FEES PAYABLE I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HERESY Expiration Every permit issued by the Building Official under the provisions of this * AN OSHA PERM:T IS REQUIRED FOR EXCAVATIONS OVER CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREOF') INCLUDING THE I Code shall expire by limitation and become null and void It the building or work so" DEEP AND DEMOLITION OR CONSTRUCTION OF authorized by such permit is not Commenced within 180 days from the date of such HEHTIG DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the building or work authorized by such permit is suspended or STRUCTURES OVER 3 STORIES IN ISSUED: TO COMPLY WITH ALL CITY. COUNTY AND STATE LAWS GOVERNING BUILDING CON abaroned at any time after the work is commenced for a period of180days, STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND APP LICAN'ta) SIGNATURE OWNER 0 00NTRACTOR o APPROVED BY _ DAT KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY INCONSEOUENCE OF THE 'BYPHONE 0 GRANTING OF THIS PERMIT. TYPE - DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL 1 MASONRY GUNITE OR GROUT SUB FRAME LI FLOOR Li SHEATHING Li ROOF ESIEAR FRAME -"-- EXTERIOR LATH 1 INSULATION INTERIOR LATH & DRYWALL PLUMBING LI SEWER AND BL/CO LI Fj'L/CO UNDERGROUND 0 WASTE TOP OUT Li WASTE Li WATER TUB AND SHOWER PAN GAS TEST O WATER HEATER 0 SOLAR VjIATER ELECTRICAL Li ELECTRIC UNDERGROUND EJ UFFER ROUGH ELECTRIC O ELECTRIC SERVICE Li TEMPORARY Li BONDING 0 POOL MECHANICAL__I Li DUCT & PLEM., Li REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS GALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ITEMS ABOVE HAIVE BEEN APPROVED FINAL PLUMBING ELECTRICAL MECHANICAL GAS BUILDING SPECAL CONDITIONS FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES - INSPECTION REQ. IF CHECKED INSPECTORS APPROVAL DAT E : SOILS COMPLIANCE PRIOR TO FOUNDATION INSP SJRUCTURAL CONCRETE OVR 2000 PSI - - PRE1RESSED CONCRETE TENSIONED CJCRETE FIELO WELDING (c BOLTS HIGH STRENGTH SPECIAL MASONRY ... t p. PILES CAISSONS FINAL BUILDING INSPECTION . RECEIVED JUL "1 1987 PLAN CHECK NUMBER: DATE: Juno 29 1987 PROJECT NAME: Victorian tCflZ Group ADDRESS: 2850 ?io Pico Djo PROJECT NO.: / UNIT NUMBER: PHASE NO.: TYPE OF UNIT: NUMBER OF UNITS: CONTACT PERSON: Bob Stuckey CONTACT TELEPHONE: 74570 BUMING ) FIRE DEPARTMNT3 INSPECTED DATEECTED: APPROVED DISAPPROVED INSPECTED DATE BY: INSPECTED: _____________ APPROVED ______ DISAPPROVED INSPECTED DATE BY: INSPECTED: ____________ APPROVED ______ DISAPPROVED COMMENTS: 9. Rev. 1186 WHITE: Suspense BLUE: Water District GREEN: Engineering CANARY: Utilities PINK: Planning GOLD: Fire fe(mcopL1cnf iie. GENERAL CONTRACTOR 445034 515 Wiidhorse Lane Vista, CA 92083 (619) 727-4570 CONTRACT VICTORIAN INVESTMENT GROUP - 1667 South Mission Road 1 • Suite Falibrok, CA 92028 JOB LOCATION: Plo Pico North 2850 Plo Pico Drive Carlsbad, CA JOB DESCRIPTION: Demolition and removal of all walls, carpet, glass, debris, etc. from job site as per plan. Construction of all new walls, installation of any new doors and windows as per plan All new and existing wallsto be finished with a knock down firish and painted Navajo White Portions of ceiling will be repaired or replaced if necessary. Addition and/or relocating of possibly six (6) lighting fixtures. Addition and/or relocating of possibly six (6) electrical outlets. Relocate four (4) existing doors, add four (4) new doors and finish to match existing doors. Install interior windows as per plan Remove all wallpaper from walls Box in structural column as per plan. - 11) All finish work to include a) Base board d) Hardware Ceiling molding e) Painting • • •: Door casings • • f) Staining This contract does not include the following: Plans • d) Engineering Fees Pexnits e) Heating and Air Conditioning Architectural Fees f) Flooring or Carpets 22I Stuckey Development/Victorian Investment Page 2 Contract Total Contract Price $4,000.00 Stuckey Development Inc., will supply all labor and materials as required to complete all improvements to Suites A & B as per plans. STUCKEY DEVELOPMENT INC. VICTORIAN INVESTMENT GROUP i-j /--0 ROBERLTUCKesiden Da//' U Date ESGIL CORPORATION - 9320 CHESAPEAKE DR., SUITE 208 j le i SAN DIEGO, CA 92123 (619) 560-1468 DATE: O APPLICAN1T JURISDICTION: PLAN CHECK NO: 7- J 233 —CE PROJECT ADDRESS: PROJECT NAME: 2' YrLT. [JPLAN CHECKER []FILE COPY [jtfPS ]DESIGNER U 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 L with the jurisdiction's building codes when minor deficien- cies identified 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. U The check list transmitted herewith is for your information. The plans are being held at Esgil Corp. until corrected plans are submitted for recheck. U The applicant's copy of the check list is enclosed for the jurisdiction to return to the applicant contact person. Li The applicant's copy of the check list has been sent to: Esgil staff did not advise the applicant contact person that plan check has been completed. [1 Esgil staff did advise applicant that the plan check has been completed. Person contacted:______________________ Date contacted: Telephone # REMARKS: cij<f- -r-- P2)E C-. 2- TE ON 54-ç I ?P'.oQ.. 1D 2.4 Th ( '-'-- J(?.rfliZ.. -r1? k11i r. i-r2. SH-L, -.r)t i=- T1- By : -, es: LL-GeIPRAT ION C ,1,t LGrD .) P-- .o r 0 C a '. Date z I Jurisdiction .Prep-axed byi FEE I r.81 PLAN CHECK S BUILDING AD _____ co _______________________ APPLICANT/CO TACT BUILDING OCCUPANCY TYPE OF CONSTRUCTION Bldg. Dept. 0 Esgil PHONE NO. '723 6 14-) DESIGNER PHONE_____________ CONTRACTOR PHONE___________ BUILDING PORTION BUILDING AREA VALUATION MULTIPLIER VALUE Sr I- C1 1 . -- —Air Conditioning Commercial - Residential Res. or Comm. Fire Sprinklers @ . . -- Total Value Fee Adjusted To Reflect 0 Energy Regulations (Fee x 1.1) 0 Handicapped Regulations (Fee x 1.065) Building Permit Fee. Plan Check Fee $4o, c, 5 $ C 0 M ME N TS 8/4/82 • - ENGINEERING CHECKLIST . . . Date:_ C Plan ________________________ heck No. 87-Zt& Project Address: Project Name: Field Check Date: By: C) C) C) LEGAL REQUIREMENTS . .; > Site Plan LEGEND L3' Item Complete Item Incomplete - Needs Your Action 1,2,3 Number in circle indicate plancheck number that deficiency was identified D 1. Provide a fully dimensioned site plan drawn to scale. m Show: North arrow, property lines, easements, existing and proposed structures, streets, existing Street improve- o ments, right-of-way width and dimensioned setbacks. CL 2. Show on Site Plan: Finish floor elevations, elevationsof finish grade adjacent to building, existing topographical lines, existing and proposed slopes, driveway and percent (%) grade and drainage patterns. O 3. Provide legal description of property. 4. Provide assessor's parcel number. PERMITS REQUIRED Grading S. Grading permit required. El 6. Grading plans in plan check. PE 7. Need the following completed prior to building permit issuance: Grading plans signed. Grading permit issued. 0 C. Grading completed. D. Certification letter and compaction reports submitted. 0 E. Grading inspected and permit signed off by City inspector. 8. Right-of-Way Permit required for work in public right-of-way (e.g., driveway approach, sidewalk, connection to water main,etc). D 9. Industrial Waste Permit application required. To be filled out completely and returned to Development Processing. FEES REQUIRED 10. Park-in-Lieu fees required. Quadrant: Fee Per Unit: Total Fee: E 11. Traffic impact fee required. Fee Per Unit: Total Fee: 12.. Bridge and Thoroughfare fee required. Fee Per Unit: , Total Fee: LY1IE1 E 13. Public facilities fee required. Facilities management fee required. Additional EDU's required: Sewer connection fee: Sewer permit no. E 16. Sewer lateral required:. . 0. K. to Issue:' , Date:SIA)A 2 If you have any questions about any of the above items identified on this plan check, please call the Development Processing Department at 438-1161. 4. a. w - - - PLANNING CHECKLIST Plan Check No.97--=g Address Type of Project and Use j7J 5,'L Zone Use Allowed' YES ?Z NO Setback: Front .Side Rear Discretionary Action Required YES NO N Type Environmental Required YES NO Landscape Plan Required . YES NO Comments Coastal Permit Required YES NO Additional Comments CAL59 OK TO ISSUE - DATE 2560 ORION WAY CARLSBAD, CA 92008 TELEPHONE (619) 931-2121 itp at Carlobab FIRE DEPARTMENT PLAN CHECK REPORT PAGE 1 OF APPROVED X DISAPPROVED PLAN CHECK# PROJECT JeNn,Jr o1-Nr ADDRESS 850 14,ô /co DIVL / ARCHITECT ADDRESS /'0? <oMrioi 414, PHONE i6l I OWNER ''esrn&r ADDRESS •$t4 ,16 C 1 ///Rtao,& PHONE 9010 8 OCCUPANCY __R—A _____ CONST. ___________ TOTAL SQ. FT. STORIES DSPRINKLERED ITENANTIMP. APPROVAL OF PLANS IS PREDICATED ON CONFORMING TO THE FOLLOWING CONDITIONS AND/OR MAKING THE FOLLOWING CORRECTIONS: PLANS, SPECIFICATIONS, AND PERMITS Provide one copy of: floor plan(s); site plan; sheets Provide two site plans showing the location of all existing fire hydrants within 200 feet of the project. Provide specifications for the following: Permits are required for the installation of all fire protection systems (sprinklers, stand pipes, dry chemical, halon, CO2, alarms, hydrants). Plan must be approved by the fire department prior to installation. The business owner shall complete a building information letter and return it to the fire department. FIRE PROTECTION SYSTEMS AND EQUIPMENT The following fire protection systems are required: O Automatic fire sprinklers (Design Criteria: o Dry Chemical, Halon, CO2 (Location: O Stand Pipes (Type: O Fire Alarm (Type/Location: Fire Extinguisher Requirements: Orie 2A rated ABC extinguisher for each OOO sq. ft. or portion thereof with a travej,distance to the nearest extinguisher not to exceed.75 feet of travel: - 0 An extinguisher with aminimum rating of tote located: 0 Other: 8. Additional fire hydrant(s) shall be provided EXITS _X... 9. Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort. A sign stating, This door to remain unlocked during business hours" shall be placed abbve the main exit and doors EXIT signs (6" x 3/4" letters) shall be placed over all required exilts and directional signs located as necessary to clearly indicate the location of exit doors. GENERAL Storage, dispensing or use of any flammable or combustible liquids, flammable liquids, flammable gases and hazardous chemicals shall comply with Uniform Fire Code. Building(s) not approved for high piled combustible stock. Storage in closely packed piles shall not exceed 15 feet in height, 12 feet on pallets or in racks and 6 feet for tires, plastics and some flammable liquids. If high stock pil- ing is to be done, comply with Uniform Fire Code, Article 81. Additional Requirements. &,r,?,97b,' •ctJ, 7),/ /A'Q 5 - \f V, g/ \ srA'- ,1. ?;o9'/ 15: Comply with regulations on tacked sheet(s). - Plan Examiner - Date Report-mailed to architect \ Attach to Plans 'CT . SUBJECT .?MOV( o' 7 CHRIS CHRISTAKOS ENGINEERING or E,i5r. 4' E44? '/1(- STRUCTURAL DESIGN JOB 20 p,o Pic o BY C 260-12 South Orange St. Escondido, Calif. 92025 (619) 489-1139 .. JOB NO. - - DATE 4L r7 PAGE/-' /Voi-6• MOl)t D?/uJ/V-1 ?1Yood Fgo,-1 oe OtJ)/) pLil SUBJECT CHRIS CHRISTAKOS ENGINEERING STRUCTURAL DESIGN JOB to5t f,'o ?'co 260-12 South Orange St. Escondido, Calif. 92025 (619) 489-1139 BY CS JOB NO.— ____________________________________ DATE 4.9- 37 PAGE Z- /1fC :5/(L 7 Fooi-,1J6- 9/flfJ wDCr ,itJCi.ofL i.r-.BOit 1-5-77- 001' . /O ~'1r1P OA) 2x 5/Li. tA7 -,!5 (A-0-Ob ve.vtJS) fi4?AtLEt Tb -Pi4iJ, 4f/J&L c1 E-R No. OF 10C-YR4).r- 570 131 )(l33 = 11.31 (j;Ir (5) If 4 45 12 E9 -HE-t;) 7.,--i-s - q.)LLy f),4c&j7 frf/,J. 01ffjg,,j/,iJ(j _"J-' 7 ipp(1Z uM(.L:. Pipc >i/.r s qf-. .q/'4" -U_- I Li-, L- (.k.- (IL. p( c If= ,C,L(Lo' gC - Z 6 50 t - I I 2> •.. 77° (ioo c) Z65° I I LL uN. /7/ c ' I 1•u1$ - 7 95 2,S + /7,)('& V50 -- 770, 17.73- -- 6 )(2-SLf - r P t7./2_ (-z ct-i- 114 tcc' r5 ± iq poV 7, ,toop_ / r.' ' 'c - / - 6(0 ,q'° / CE . SUBJECT CHRIS CHRISTAKOS ENGINEERING '1' çHCñE uL--- STRUCTURAL DESIGN JOB Z..° 5 9 FfJ Ft c. 260-12 South Orange St. Escondido, Calif.92025 (619) 489-1139 BY £-.S.c. I JOB N O. DATE '-i-17 I PAGE 34 JD I? ('ic? X19-" /4OG (9AC F/i.e '/T#- oR E-vA-L iV-cg,#uv.ic CYOJ ICrJ D'1G STIZU t -7 20 =31600-tr j#i-r' e1L 'Hjr48 OfrJTOuJ,t&L 0 ZAe (IT (J15& IlDi AT 5 pticc- TL z' (i )f/Ic+ M w 3fl pooP UAfL 13 m z8 ,o Ito o z. vi T Z,7.67 3t4)( /. iO x CII CJV 8iJ A-,4L 2° V7L~ o o //00[1 y ( )] t[ T. 7ero/7 .C. 1c - 14i3.( ?' r.0 ... • i - 331 o. o V 6r 674 HPS #4. &t-'p or,i71pIi'J6t ;4/c 45 19ijo gjr uj /1Jr- 4o' .7v 77 77C /( 7 f/1C77/L i,fu 7 u c C) E-rq I L-. wle)- 10617,a /)/,cr(oAi Lc /17- ,'AJ6 (,q) (8 V 0 Wo No -rq - u T / cr' 0 C5 Cq) ~ (R) v/i. P .rD700 570 $ j51t O1t. p/zy.u4'-<-- Or— _ __ or 99c1 /Msp- 4LL) _____ I I6d etz"•'" . -A.-449 1 A3cl, 4e • 4i*I I4s.r1&•..•1 • ••JL1 Lir I •:.I - • •.:-.• -J•-. • ) I - ••-:-A ____ 7 - ~ . ) 2)- T? -:_I'j - To '-ft"-' ' • .)'I-T 6 Arm ,5 • ' '- - - • •• - • - • • -3/9 I A1tb Wf/ - - • -. .. ---:-; - • • -• • - : - t -I • ••• • • - . 31 .P - ry p i - •- -. I : F No PrlO'(1 19 E T - - -- - - T61 pu p.cup3 T ) J AC P.J9 IE4EL29 - I . .- I ( z-r , . . • . 5" - • zi • • &A#/ U2O- • : /5'wAi - COMMERCIAL/INDUSTRIAL APPLICATION FORM FOR INDUSTRIAL WASTE DISCHARGE PERMIT CITY OF CARLSBAD APPLICATION: NEW (CHECK ONE) REVISED__________ j Iature of City Representative BUILDING P.C. NO.: e722 APPLICATION NO.:____________ INDUSTRIAL CLASS:— -3 / DATE: 6--15--67- APPLICATION FOR INDUSTRIAL WASTE DISCHARGE PERMIT GENERAL: SITE APPLICANT:NT . ADDRESS: 2J) TYPE OF BUSINESS: APPLICANT'S ADDRESS:24kQ) / X c 0 WASTES AND PROCESSING: (Check where applicable) Domestic Waste Only J Industrial Waste Jj Industrial Waste NOT Discharged to Sewer Discharged to Sewer GENERAL DESCRIPTION OF WASTE (Chemical and Physical Characteristics of proposed waste): - ''4'S72c /7,VL GENERAL DESCRIPTION OF PROCESS (If Applicable):__________________________ WASTES TO BE DISCHARGED TO SEWER: WASTE: TREATED: QUANTITY: AVERAGE 2 o o GPO (Check One) UNTREATED: V17 (Daily) MAXIMUM GPO (Gallons Per Day) APPLICANT OR REPRESENTATIVE OF FIRM: TITLE: , (Print) SIGNATURE: DATE 'ç27