HomeMy WebLinkAbout2820 ROOSEVELT ST; ; CBC2020-0378; PermitPrint Date: 12/01/2020 Permit No: CBC2020-0378
Building Permit Finaled
Commercial Permit
Job Address:
Permit Type:
Parcel #:
Valuation:
Occupancy Group:
2820 ROOSEVELT ST, CARLSBAD, CA 92008-1619
BLDG-Commercial
2031820400
$34,107.44
Work Class:
Lot #:
Project #:
Tenant Improvement
Status:
Applied:
Issued:
09/28/2020
10/07/2020
Finaled Close Out:
#of Dwelling Units:
Track #:
Plan #:
Closed - Finaled
CRenf
Plan Check #:
Project Title:
Inspector:Orig. Plan Check #:Bathrooms:
Description:CHIN'S: ADD PARTITION WALL IN LOBBY // SERVER WINDOW IN EXISTING WALL // MINOR ELECTRICAL // REMOVE ACOUTIC
CEILNIG TILES (E-REVIEW)
Final Inspection:12/01/2020
Bedrooms:Construction Type:
Property Owner:
ROOSEVELT TAMARACK INVESTMENTS
PROPERTY HOLDING LLC
3161 MICHELSON DRIRVINE, CA 92612-4400
(760) 487-8751
AMOUNTFEE
BUILDING PERMIT FEE ($2000+)$310.00 BUILDING PLAN CHECK FEE (BLDG)$217.00
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL $43.00
MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL $45.00
SB1473 GREEN BUILDING STATE STANDARDS FEE $2.00 STRONG MOTION-COMMERCIAL $9.55
Total Fees:$626.55 Total Payments To Date:$626.55 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 ï 760-602-2700 ï 760-602-8560 f ï www.carlsbadca.gov
Building Division Page 1 of 1
{"Cityof
Carlsbad
( City of
Carlsbad
COMMERCIAL
BUILDING PERMIT
APPLICATION
B-2
Plan Check ---------
Est. Val ue
PC Deposit ---------
Dat e ---------
Job Address
Tenant Name:
2-?>:u> ~+ st-. Suite: ___ APN:
C h, \ V\ 1
( f. :ie&i l,IJC-<.,n G-rfsl:::oJ.. CT /Project#: ______ Lot#:. ___ _
Occupancy: f?-o Construction Type: ____ Fire Sprinklers: 0 YES Cf NO Air Conditioning: ~SO NO
BRIEF DESCRIPTION OF WORK:
a&&14 £, 6L v(cl-er tt-'"'-\ l IA \o~b1
D Addition/New: ___________ New SF and Use, ___________ New SF and Use,
_____ Deck SF, Patio Cover SF (not including flatwork)
~enant Improvement: P CO SF, Existing Use __ ✓ _____ Proposed Use ______ _
_____ SF, Existing Use ______ Proposed Use ______ _
D Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _
□
□
□
Solar: ___ KW, __ Modules, ___ Mounted, Tilt: QYQN, RMA: Q Y Q N, Panel Upgrade: OY QN
Plumbing/Mechanical/Electrical Only: __________________________ _
Other: ____________________________________ _
APPLICANT (PRIMARY CONTACT PROPERTY OWNER
-~tl=.,_~-=:...i..:::.i.c!....!...1,.!:::.-4---=-----Name: ;:T clrV\ j --e \ u;LY\.ll
.....:....::;..;:::;..__;;::...._;____;__..%.,.:..=::..::~-=----':..........:=-____,....,.-Address: le vev-v\v,re. ) s-k ::2-t.s-
City: \flf,d::°'= State:C A Zip:9,:)u&Lf City: :Crv•~ State:CA Zip: q ~c.,,,<l,
Phone: -ZlP◊·-W~ -f;$9<Z Phone: 94'0, -1,).1 -b,J.,i'-\
Email: au:fvmec--£.eN ~cL::S 0 ,!> ,.\-cl,~J-'rM mail: j2h "'1 i.)·:p:Md,, be\:f S~e . Gum.
DESIGN PROFESSIONAL CONTRACTOR BUSINESS
Name: _________________ _ Name: ·]3'214 ,S l.0'.fu Y-W I &
Address: ________________ _ Address: __________________ _
City: ________ State:. ___ Zip: ___ _ City: _______ State:. ___ Zip: _____ _
Phone: ________________ _ Phone: ,Lso 21L\:-D :S_go
Email: _________________ _
Architect State License: ___________ _
Email: fu\.lLe-6 .. ,._.A-;:> 'ft.l.V\.,U\;, • C-t,.--yy'\
State License: q,q ?n ~ Bus. License:. ______ _
(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
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, commending with Section 7000 of Division 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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)).
1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov
8-1 Page 1 of 2 Rev. 03/20
{ OPTION A): WORKERS'COMPENSATION DECLARATION:
I hearby affirm under penalty of perjury one of the following declarations:
DI 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.
DI have and will maintain 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 carrier and policy number are: Insurance Company Name: ______________________ _
Policy No. _______________ Expiration Date: __________ _
D 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 coverage is unlawful, and shall subject an employer to
criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of t he Labor Code,
interest and attorney's fees.
CONTRACTOR SIGNATURE: □AGENT DATE: -----------------------------------
{ OPTION B ): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
DI, 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
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).
~ 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. QYES Q NO
2. I (have/ have not) signed an application fo(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. I will provide some of the work, bu d (hir d) the following persons to provide the work indicated (include name/ address/ phone/ type of work):
OWNER SIGNATURE: DATE:
I hereby affirm that there is a construction lending 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 registr~ti _ form or risk mana. gement and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? I Yes · No
Is the applicant or future building occupant required to obtain a permit from the air pollution co~tr district or air qua ity management district? Ye~
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes O
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED LESS THE APPLICANT HAS MET OR IS M EETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL 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 City of carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP
HARMLESS THE CITY 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 issued by the Building 1cial under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized
by such permit is not commenced within 360 days ram the d ermit or if the building or work authorized by such permit is suspended or abandoned at any time after
the work is commenced for a period of 180 days ( B 13 .
APPLICANT SIGNATURE: ---+_.e,:_;"'lv'~~<-='1--,-~"'"----------DATE: __ °Si_(_c,_(...__/1)_;,.-o __ _
1635 Faraday Ave Carlsbad, CA 92008
8-1 Page 2 of2
Email: Building@carlsbadca.gov
Rev. 03/20
( City of
Carlsbad
PURPOSE
CLIMATE ACTION PLAN
CONSISTENCY CHECKLIST
B-50
Development Services
Building Division
1635 Faraday Avenue
(760) 602-2719
www.carlsbadca.gov
This checklist is intended to assist building permit applicants identify which Climate Action Plan (CAP) ordinance
requirements apply to their projects. The completed checklist must be included in the building permit application. It may be
necessary to supplement the completed checklist with supporting materials, calculations or certifications, to demonstrate
full compliance with CAP ordinance requirements. For example, projects that propose or require a performance approach
to comply with energy-related measures will need to attach to this checklist separate calculations and documentation as
specified by the ordinances.
NOTE: The following type of permits are not required to fill out this form
❖ Patio I ❖ Decks I ❖ PME (w/o panel upgrade) I •·· Pool
A If an item in the checklist is deemed to be not applicable to a project, or is less than the minimum required by ordinance,
an explanation must be provided to the satisfaction of the Building Official.
A Details on CAP ordinance requirements are available on the city's website.
A A CAP Building Plan template (form B-55) shall be added to the title page all building plans. This template shall be
completed to demonstrate project compliance with the CAP ordinances. Refer to the building application webpage and
download the latest form.
Project Name/Building
Permit No.:
Property Address/APN:
Applicant Name/Co.:
Applicant Address:
Contact Phone:
Application Information
C.l.\-1r-J1-f $2..ECl-tWAN CA-12L.SP.;;.% ~: No.:
} -----------
:::i. ~ :i.v 12-oo'E:,C.~ \:\-:: Sa\-, G&r{S,6~ 1 CA q'>-VD )I'.
Contact information of person completing this checklist (if different than above):
Name:
Company
name/address:
8-50
Contact Phone:
Contact Email:
Page 1 of 6 Revised 08/19
City of Carlsbad Climate Action Plan Consistency Checklist
Use the table below to determine which sections of the Ordinance Compliance checklist are applicable to your project.
For alterations and additions to existing buildings, attach Building Permit Valuation worksheet.
Building Permit Valuation (BPV) from worksheet: $ ______ _
Construction Type I Complete Section(s) I Notes:
D Residential
□ New construction
□ Additions and alterations:
□ BPV < $60,000
□ BPV ~ $60,000
□ Electrical service panel upgrade only
□ BPV ~ $200,000
,,
0 Nonresidential
A high-rise residential building is 4 or more stories, including a
Low-rise High-rise mixed-use building in which at least 20% of its conditioned floor
area is residential use
2A, 3A, 1B, 2B,
4A 3B, 4A
NIA NIA All residential additions and alterations
1A, 4A 4A 1-2 family dwellings and townhouses with attached garages
only
*Multi-family dwellings only where interior finishes are removed
1A, 4A* 1B, 4A* and significant site work and upgrades to structural and
mechanical, electrical, and/or plumbing systems are proposed
□ New construction I 1 B, 2B, 3B, 4B and 5 I
tit!" Alterations: f?-P \} Uh<>~ fl~~
□ BPV ~ $200,000 or additions ~ 1,000 1B,5 square feet
□ BPV ~ $1 ,000,000 1B,2B,5 Building alterations of~ 75% existing gross floor area
□ ~ 2,000 sq. ft. new roof addition 2B, 5 1 B also applies if BPV ~ $200,000
CAP Ordinance Compliance
Checklist Item
Check the appropriate boxes, explain all not applicable and exception items, and provide supporting calculations and documentation as necessary.
1. Energy Efficiency
Please refer to Carlsbad Municipal Code (CMC) sections 18.21.155 and 18.30.190, and the California Green Building Standards Code (CAL Green) for
more information when completing this section.
A D Residential addition or alteration 2!: $60,000 building permit valuation. D NIA -----------See CMC section 18.30.190. □ Exception: Home energy score~ 7
(attach certification)
Year Built Single-family Requirements Multi-family Requirements
D Before 1978 Select one:
D Duct sealing D Attic insulation □Cool roof D Attic insulation
D 1978 and later Select one:
D Lighting package D Water heating Package
D Between 1978 and 1991 Select one:
D Duct sealing D Attic insulation □Cool roof
D 1992 and later Select one:
D Lighting package D Water heating package ,
B. ~ Nonresidential* new construction or alterations :! $200,000 building permit valuation,
or additions 2!: 1,000 square feet D NIA
Updated 8/15/201 9 2
City of Carlsbad Climate Action Plan Consistency Checklist
See CMC 18.21.155 and CAL Green Appendix AS, Division AS.2 -Energy Efficiency.
A5.203.1.1 Choose one: □ .1 Outdoor lighting □ .2 Warehouse dock seal doors
□ .3 Restaurant service water heating (comply with California Energy Code section 140.5, as amended) □ N/A -----------□ .4 Daylight design PAFs □ .5 Exhaust air heat recovery
A5.203.1.2.1
Choose one as applicable: □ .95 Energy budget □ .90 Energy budget □ N/A
A5.211.1 ..
□ On-site renewable energy □ N/A
A5.211.3 ..
□ Green power (if offered by local utility provider, 50% minimum renewable sources) □ N/A
A5.212.1
□ Elevators and escalators □ N/A
A5.213.1
□ Steel framing □ N/A
* Includes hotels/motels and high-rise residential buildings
.. For alterations ?! $1 ,000,000 BPV and affecting > 75% existing gross floor area, or alterations that add 2,000 square feet of new roof addition: comply
with CMC 18.30.130 instead.
2. Photovoltaic Systems
A. D Residential new construction (for low-rise residential building permit applications submitted after 1/1/20). Refer to 2019 California
Energy Code section 150.1(c)14 for requirements. Notes: 1) High-rise residential buildings are subject to nonresidential photovoltaic
requirement (28 below) instead. 2) If project includes installation of an electric heat pump water heater pursuant to CMC 18.30.150(8)
(high-rise residential) or 18.30.170(8) (low-rise residential), increase system size by .3kWdc if PV offset option is selected.
Floor Plan ID (use additional CFA #d.u. Calculated kWdc*
sheets if necessary)
Total System Size:
kWdc = (CFAx.572) / 1,000 + (1.15 x #d.u.)
*Fonnula calculation where CFA = conditional floor area, #du= number of dwellings per plan type
If proposed system size is less than calculated size, please explain.
Exception
□
□
D
D
kWdc
8. D Nonresidential new construction or alterations ~$1,000,000 8PV and affecting ~75% existing floor area, or addition that increases roof
area by ~,000 square feel Please refer to CMC section 18.30.130 when completing this section. Note: This section also applies to
high-rise residential and hotel/motel buildings.
Choose one of the following methods:
□ Gross Floor Area (GF A) Method
GFA:
□If < 10,000s.f. Enter: 5 kWdc
Min. System Size:
□ If?!: 1 O,OOOs.f. calculate: 15 kWdc x (GFA/10,000) ...,
___ kWdc
**Round building size factor to nearest tenth, and round system size to nearest whole number.
□Time-Dependent Valuation Method
Updated 8/1 5/2019 3
City of Carlsbad Climate Action Plan Consistency Checklist
Annual TDV Energy use:*,... ______ x .80= Min. system size: _____ kWdc
*,...Attach calculation documentation using modeling software approved by the California Energy Commission.
3. Water Heating
A D Residential and hotel/motel new construction
Please refer to CMC sections 18.30.150 and 18.30.170 when completing this section.
□For systems serving individual dwelling units choose one:
D Heat pump water heater AND Compact hot water distribution AND Drain water heat recovery (low-rise
residential only)
D Heat pump water heater AND PV system .3 kWdc larger than required in CMC section 18.30.130 (high rise
residential hotel/motel) or CA Energy Code section 150.1 (c) 14 (low-rise residential)
D Heat pump water heater meeting NEEA Advanced Water Heating Specification Tier 3 or higher
D Solar water heating system that is either .60 solar savings fraction or 40 s.f. solar collectors
D Exception:
D For systems serving multiple dwelling units, install a central water-heating system with all of the following:
D Gas or propane water heating system
D Recirculation system per CMC 18.30.150(8) (high-rise residential, hotel/motel) or CMC 18.30.170(8) (low-
rise residential)
D Solar water heating system that is either:
D .20 solar savings fraction
D .15 solar savings fraction, plus drain water heat recovery
□Exception:
B. D Nonresidential new construction
Please refer to Carlsbad Ordinance CMC section 18.30.150 when completing this section.
D Water heating system derives at least 40% of its energy from one of the following (attach documentation):
D Solar-thermal D Photovoltaics D Recovered energy
□Water heating system is (choose one):
D Heat pump water heater
D Electric resistance water heater(s)
□Solar water heating system with .40 solar savings fraction
□Exception:
Updated 8/15/2019 4
City of Carlsbad Climate Action Plan Consistency Checklist
4. Electric Vehicle Charging
A D Residential New construction and major alterations*
Please refer to Carlsbad Ordinance CMC section 18.21 .140 when completin this section.
One and two-family residential dwelling or townhouse with attached garage:
Done EVSE Ready parking space required O Exception :
D Multi-family residential· 0 Exception ·
Total Parking Spaces EVSE Spaces
Proposed Capable Ready
Calculations: Total EVSE spaces = .10 x Total parking (rounded up to nearest whole number)
EVSE Installed = Total EVSE Spaces x .50 (rounded up to nearest whole number)
EVSE other= Total EVSE spaces -EVSE Installed
(EVSE other may be "Capable," "Ready" or "Installed.")
Installed Total
•Major alterations are: (1) for one and two-family dwellings and townhouses with attached garages, alterations have a building permit valuation ;,: $60,000
or include an electrical service panel upgrade; (2) for multifamily dwellings (three units or more without attached garages), alterations have a building permit
valuation ;,: $200,000, interior finishes are removed and significant site work and upgrades to structural and mechanical, electrical, and/or plumbing
systems are proposed.
B D Nonresidential new construction (includes hotels/motels) 0 Exception ·
Total Parking Spaces EVSE Spaces
Proposed Capable I Ready I Installed I Total
10 2 I 5 I 1 I 8
Calculation: Refer to the table below:
Total Number of Parking Spaces provided Number of required EV Spaces Number of required EVSE Installed Spaces
□ 0-9 1 1
□ 10-25 2 1
□ 26-50 4 2
□ 51 -75 6 3
□ 76-100 9 5
□ 101-150 12 6
□ 151-200 17 9
□ 201 and over 10 percent of total 50 percent of Required EV Spaces
Updated 8/15/20 19 5
City of Carlsbad Climate Action Plan Consistency Checklist
5. D Transportation Demand Management (TOM): Nonresidential ONLY
An approved Transportation Demand Management (TOM) Plan is required for all nonresidential projects that meet a threshold of employee-generated ADT.
City staff will use the table below based on your submitted plans to determine whether or nor your permit requires a TOM plan. If TOM is applicable to your
permit, staff will contact the applicant to develop a site-specific TOM plan based on the permit details.
Acknowledgment:
Employee ADT Estimation for Various Commercial Uses
EmpADTfor
. _ first 1,000 _s,f.
EmpADT/
1000 s.f.1
Office (all)2 20
Restaurant 11
Retai'3 8
Industrial 4
Manufacturing 4
Warehousin 4
1 Unless otherwise noted, rates estimated from /TE Trip
Generation Manual, 10th Edition
13
11
4.5
3.5
3
1
2 For all office uses, use SANDAG rate of 20 ADT/1,000 sf to
calculate employee ADT
3 Retail uses include shopping center, variety store, supermarket,
gyms, pharmacy, etc.
Other commercial uses may be subject to special
consideration
Sample calculations:
Office: 20,450 sf
1. 20,450 sf/ 1000 x 20 = 409 Employee ADT
Retail: 9,334 sf
1. First 1,000 sf= 8 ADT
2. 9,334 sf -1,000 sf= 8,334 sf
3. 8,334 sf/ 1,000 x 4.5 + 8 = 46 Em lo ee ADT
I acknowledge that the plans submitted may be subject to the City of Carlsbad's Transportation Demand Management Ordinance. I agree to be contacted should
my permit require a TOM plan and understand that an approved TOM plan is a condition of permit issuance.
Applicant Signature: __________________ _ Date: ______ _
Person other than Applicant to be contacted for TDM compliance (if applicable):
Name (Printed): _________________ _ Phone Number: ------
Email Address: --------------------
Updated 8/15/201 9 6
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MA TE RIALS
QUESTIONNAIRE
RECORD ID # __________________
1
PLAN CHECK# _________________ _
BP DATE
C Business Contact
Ot.C ~ ba...R.. ~r-e -
Telephone#
t/tO-~-t?PL<g
Project Address
$?;)0 i<o--os-eve l+s+--. State APN#
Mailing Address State Zip Code Plan File#
\ 3 2Cl,() \J\ew D~,uv Q). q---:>o~ 4-
The following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects within the City of San
Diego): 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.
Occupancy Rating: ( 1-e> Facility's Square Footage (including proposed project): :l 7 00
1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives
2. Compressed Gases 6. Oxidizers 10. Cryogenics
3. Flammable/Combustible Liquids 7. Pyrophorics 11 . Highly Toxic or Toxic Materials
~~ther Health Hazards
JU.Mone of These.
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMD): If the answer to any of the
questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building permit.
FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy:
1.
2.
3.
4.
5.
6.
7.
8.
YES NO (for new construction or remodeling projects)
D ~ Is your business listed on the reverse side of this form? (check all that apply).
D ~ Will your business dispose of Hazardous Substances or Medical Waste in any amount?
D 5?" Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
pounds and/or 200 cubic feet?
D ~ Will your business store or handle carcinogens/reproductive toxins in any quantity?
D ~ Will your business use an existing or install an underground storage tank?
D !CY. Will your business store or handle Regulated Substances (CalARP)?
D i;J/ Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
D IQ" Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to
or realer than 1,320 allons? California's Above round Petroleum Stora e Act .
□ CalARP Exempt
I
Date Initials
□ CalARP Required
I
Date Initials
□ CalARP Complete
I
Date Initials
PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): Any YES* answer requires a stamp from APCD 10124 Old Grove Road, San
Diego, CA 92131 apcdcomp@sdcounty.ca.gov (858) 586-2650). (*No stamp required if Q1 Yes and Q3 Yes and Q4-Q6 No]. The following questions are intended
to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive
requirements contact APCD. Residences are typically exempt, except -those with more than one building• on the property; single buildings with more than four
dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. i♦Excludes garages & small outbuildings.]
YES NO
1. D ~Will the project disturb 160 square feet or more of existing building materials?
2. D ~ Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition.
3. D O (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 D (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 working days prior to commencing asbestos removal.
5. D iii(' Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.sdapcd.org/info/facts/permits.pd0 for typical equipment requiring an APCD permit.
6. D D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
bounda
de her~nd correct. g / ii\ I >6~
Date
FOR OFFICAL USE ONL . 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* APCD COUNTY-HMO APCD COUNTY-HMO APCD
.. *A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEALTH-HAZARDOUS MATERIALS DIVISION
Check all that apply:
AUTOMOTIVE
D Battery Manufacturing/Recycling
D Boat Yard
D CarWash
D Dealership Maintenance/Painting
D Machine Shop
D Painting
D Radiator Shop
D Rental Yard Equipment
D Repair/Preventive Maintenance
D Spray Booth
D Transportation Services
D Wrecking/Recycling
CHEMICAL HANDLING
D Agricultural supplier/distributor
D Chemical Manufacturer
D Chemical Supplier/Distributor
D Coatings/Adhesive
D Compressed Gas Supplier/Distributor
D Dry Cleaning
D Fiberglass/Resin Application
D Gas Station
D Industrial Laundry
D Laboratory
D Laboratory Supplier/Distributor
0 Oil and Fuel Bulk Supply
0 Pesticide Operator/Distributor
CHEMICAL HANDLING
0 Photographic Processing
D Pool Supplies/Maintenance
D Printing/Blue Printing
D Road Coatings
D Swimming Pool
D Toxic Gas Handler
D Toxic Gas Manufacturer
METAL WORKING
D Anodizing
D Chemical Milling/Etching
D Finish-Coating/Painting
D Flame Spraying
D Foundry
D Machine Shop-Drilling/Lathes/Mills
D Metal Plating
D Metal Prepping/Chemical Coating
0 Precious Metal Recovery
D Sand Blasting/Grinding
D Steel Fabricator
D Wrought Iron Manufacturing
AEROSPACE
D Aerospace Industry
D Aircraft Maintenance
D Aircraft Manufacturing
OTHERS AND MISCELLANEOUS
D Asphalt Plant
D Biotechnology/Research
D Chiropractic Office
D Co-Generation Plant
D Dental Clinic/Office
D Dialysis Center
D Emergency Generator
D Frozen Food Processing Facility
D Hazardous Waste Hauler
D Hospital/Convalescent Home
D Laboratory/Biological Lab
0 Medical Clinic/Office
0 Nitrous Oxide (NOx) Control System
D Pharmaceuticals
0 Public Utility
D Refrigeration System
D Rock Quarry
D Ship Repair/Construction
0 Telecommunications Cell Site
0 Veterinary Clinic/Hospital
D Wood/Furniture Manufacturing/Refinishing
ELECTRONICS
D Electronic Assembly/Sub-Assembly
0 Electronic Components Manufacturing
0 Printed Circuit Board Manufacturing
NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES.
ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE
HAZARDOUS MATERIALS DIVISION (HMO) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (858) 505-6880.
LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES
Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District.
CHEMICAL
47 -Organic Gas Sterilizers
32 -Acid Chemical Milling
33 -Can & Coil Manufacturing
44 -Evaporators, Dryers & Stills Processing
Organic Materials
24 -Dry Chemical Mixing & Detergent Spray
Towers
35 -Bulk Dry Chemicals Storage
55-Chrome Electroplating Tanks
COATINGS & ORGANIC SOLVENTS
27 -Coating & Painting
37 -Plasma Arc & Ceramic Deposition Spray
Booths
38 -Paint, Stain & Ink Mfg
27 -Printing
27-Polyester Resin/Fiberglass Operations
METALS
18 -Metal Melting Devices
19 -Oil Quenching & Salt Baths
32 -Hot Dip Galvanizing
39 -Precious Metals Refining
ORGANIC COMPOUND MARKETING
(GASOLINE, ETC)
25-Gasoline & Alcohol Bulk Plants & Tenninals
25 -lntennediate Refuelers
26 -Gasoline & Alcohol Fuel Dispensing
COMBUSTION ROCK AND MINERAL
34 -Piston Internal -Combustion Engines 04 -Hot Asphalt Batch Plants
13 -Boilers & Heaters (1 million BTU/hr or larger) 05 -Rock Drills
14-Incinerators & Crematories 06-Screening Operations
15 -Bum Out Ovens 07 -Sand Rock & Aggregate Plants
16 -Core Ovens 08 -Concrete Batch, CTB, Concrete Mixers, Mixers
20-Gas Turbines, and Turbine Test Cells & Stands & Silos
48 -Landfill and/or Digester Gas Flares 1 O -Brick Manufacturing
ELECTRONICS
29 -Automated Soldering
42 -Electronic Component Mfg
FOOD
12 -Fish Canneries
12 -Smoke Houses
50 -Coffee Roasters
35 -Bulk Flour & Powered Sugar Storage
SOLVENT USE
28 -Vapor & Cold Degreasing
30 -Solvent & Extrad Driers
31 -Dry Cleaning
OTHER
01 -Abrasive Blasting Equipment
03 -Asphalt Roofing Kettles & Tankers
46 -Reverse Osmosis Membrane Mfg
51 -Aqueous Waste Neutralization
11 -Tire Buffers
17 -Brake Debonders
23 -Bulk Grain & Dry Chemical Transfer & Storage
45 -Rubber Mixers
21 -Waste Disposal & Reclamation Units
36 -Grinding Booths & Rooms
40 -Asphalt Pavement Heaters
43 -Ceramic Slip Casting
41 -Perlita Processing
40 -Cooling Towers -Registration Only
91 -Fumigation Operations
56 -WWTP (1 million gal/day or larger) & Pump
Station
NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION
CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
ENCINA WASTEWATER AUTHORITY
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
SCREENING SURVEY
6200 Avenida Encinas, Carlsbad, CA 92011
Phone: 760-438-3941 Fax: 760-476-9852
SourceControl@encinajpa.com
Date: D ) l \ I 2:o·.:2-0
Business Name: C..h\V\\.'.) $u:~w?/Y\ (?p.c \<S>b~ 1 -~,
Street Address: o\~D j2.cpSC\J'€.\± 9--. Cbc\s\o~ JC:, q'>Ov~
Email Address: c.usdvmoJ-Se/\.J ~L<l'?:>-J ~s iW\/·1J\ $ . 0ryV\
PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) 0
Check all below that are present at your facility:
o Acid Cleaning
o Assemb ly
o Automotive Repair
o Battery Manufacturing
o Biofuel Manufacturing
o Biotech Laboratory
o Bulk Chemical Storage
o Car Wash
o Chemical Manufacturing
o Chemica l Purification
o Dental Offices
• Dental Schools
• Dental Clinics
o Dry Cleaning
o Electrical Component
Manufacturing
o Fertilizer Manufacturing
o Fi lm/X-ray Processing
o Food Processing
o Glass Manufacturing
o Industrial Laundry
o Ink Manufacturing
o Laboratory
o Machining/Milling
o Membrane manufacturing
(i.e. water filter membranes)
o Metal Casting/Forming
o Metal Fabrication
o Metal Finish ing
0 Electroplating
• Electroless Plating
• Anodizing
• Coating (i.e. phosphating)
• Chemical Etching/Milling
a Printed Circuit Board
Manufacturing
o Metal Powders Forming
o Nutritional Supplement/Vitamin
Manufacturing
o Painting/Finishing
o Paint Manufacturing
o Personal Care Products
Manufacturing
o Pesticide Manufacturing/ Packaging
o Pharmaceutical Manufacturing
(including precursors)
o Porcelain Enameli ng
o Power Generation
o Print Shop
o Resea rch and Development
o Rubber Manufacturing
o Semiconductor Manufacturing
o Soa p/Detergent Manufactu ring
o Waste Treatment/Storage
New Business? YesO NoD SIC Code(s) if known: ______ Date operation began/will begin: ______ _
Tenant Improvement? Yes O NoO If yes, briefly describe improvement: _________________ _
Description of operations generating wastewater (discharged to sewer, hauled or evaporated): __________ _
Estimated volume of industrial wastewater to be discharged (gal/ day): __________________ _
List hazardous wastes ge nerated (type/volume}: __________________________ _
Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? YesO Date: ____ No□
Page 1 of 2
ENCINA WASTEWATER AUTHORITY
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
SCREENING SURVEY
6200 Avenida Encinas, Carlsbad, CA 92011
Phone: 760-438-3941 Fax: 760-476-9852
SourceControl@encinajpa.com
The commercial enterprises listed below are a partial listing of businesses that are exempt from indust rial wastewater
discharge permitting under normal operating condit ions. They are exempt because (a) they discharge no process wastewater
(i.e., they only discharge sanitary wastewater with no pollutants exceeding any local limits), and (b) they have no potential to
negatively impact the EWPCF or other wastewater treatment plants in the ESS. Any questions regarding exemptions
should be referred to EWA Source Control staff.
o Automobile Detailers o Hotels/Motels (no laundry)
o Barber/Beauty Shops o Laundromats
o Business/Sales Offices o Libraries
o Cleaning Services o Medical Offices (no x-ray developing)
o Carpet/Upholstery o Mortuaries
o Childcare Facilities o Museums
o Churches o Nail Salons
o Community Centers o Nu rsing Homes
o Consulting Services o Office Buildings (no process flow)
o Contractors o Optica l Services
o Counseling Services o Pest Control Services (no pesticide repackaging for sale)
o Educational Services (no auto repair/film developing) o Pet Boarding/Grooming Facilities
o Financial Institutions/Services
o Fi tness Centers
o Gas Stations (no car wash/auto repair)
o Grocery Stores (no film developing)
o Resident ial based Businesses
CERTIFICATION STATEMENT
o Posta l Services (no car wash/auto repair)
o Public Storage Facilities
w/ Resta ura nts/Bars
o Retail/Wholesale Stores (no auto repair/film developing)
o Theaters (Movie/Live)
rrnotion above is true and correct to the best of my knowledge.
P,int Name, V\J\c.c3 Gk~ DATE :
Facility Contact: MwjSt~vl Title: bfu
ENCINA WASTEWATER AUTHORITY
6200 AVEN IDA ENCINAS, CARLSBAD, CA Phone: 760-438-3941 Fax: 760-476-9852
Sou rceControl@encinaj pa .com
Page 2 of 2
DISABILITY ACCESS REQUIREMENTS AND RESOURCES
NOTICE TO APPLICANTS FOR BUSINESS LICENSES AND
COMMERCIAL BUILDING PERMITS:
Under federal and state law, compliance with disability access laws is a serious and
significant responsibility that applies to all California building owners and tenants with
buildings open to the public. You may obtain information about your legal obligations and
how to comply with disability access laws at the following agencies:
DEPARTMENT OF
GENERALSERVICES,
Division of the State
Architect, CASp Program
www.dgs.ca .gov /dsa
www.dgs.ca .gov /casp
DEPARTMENT OF
REHABILITATION
Disability Access Services
www.dor.ca.gov
www.rehab.cahwnet.gov/
disabilityaccessinfo
CERTIFIED ACCESS SPECIALIST INSPECTION SERVICES
DEPARTMENT OF
GENERALSERVICES,
California Commission on
Disability Access
www.ccda.ca.gov
www. ccda. ca.gov /resourc
es-menu/
Compliance with state and federal construction-related accessibility standards ensures
that public places are accessible and available to individuals with disabilities. Whether
your business is moving into a newly constructed facility or you are planning an alteration
to your current facility, by engaging the services of a Certified Access Specialist (CASp) early
in this process you will benefit from the advantages of compliance and under the
Construction-Related Accessibility Standards Compliance Act (CRASCA, Civil Code 55.51-
55.545), also benefit from legal protections.
Although your new facility may have already been permitted and approved by the building
department, it is important to obtain CASp inspection services after your move-in because
unintended access barriers and violations can be created, for example, placing your
furniture and equipment in areas required to be maintained clear of obstructions. For
planned alterations, a CASp can provide plan review of your improvement plans and an
access compliance evaluation of the public accommodation areas of your facility that may
not be part of the alteration.
A CASp is a professional who has been certified by the State of California to have
specialized knowledge regarding the applicability of accessibility standards. CASp
inspection reports prepared according to CRASCA entitle business and facility owners to
specific legal benefits, in the event that a construction-related accessibility claim is filed
against them.
To find a CASp, visit www.apps2.dgs.ca.gov/DSA/casp/casp certified list.aspx.
(Issued 12-28-18)
DISABILITY ACCESS REQUIREMENTS AND RESOURCES
GOVERNMENT TAX CREDITS, TAX DEDUCTIONS AND FINANCING
State and federal programs to assist businesses with access compliance and access
expenditures are available:
Disabled Access Credit for Eligible Small Businesses
FEDERAL TAX CREDIT-Internal Revenue Code Section 44 provides a federal tax credit for
small businesses that incur expenditures for the purpose of providing access to persons
with disabilities. For more information, refer to Internal Revenue Service (IRS) Form 8826:
Disabled Access Credit at www.irs.gov.
STATE TAX CREDIT-Revenue and Taxation Code Sections 17053.42 and 23642 provide a
state tax credit similar to the federal Disabled Access Credit, with exceptions. For more
informat ion, refer to Franchise Tax Board (FTB) Form 3548: Disabled Access Credit for
Eligible Small Businesses at www.ftb.ca.gov.
Architectural and Transportation Barrier Removal Deduction
FEDERAL TAX DEDUCTION-Internal Revenue Code Section 190 allows businesses of all
sizes to claim an annual deduction for qualified expenses incurred to remove physical,
structural and transportation barriers for persons with disabilities. For more information,
refer to IRS Publication 535: Business Expenses at www.irs.gov.
California Capital Access Rnancing Program
STATE FINANCE OPTION-The California Capital Access Program (CalCAP) Americans with
Disabilities Act (CalCAP/ADA) financing program assists small businesses with financing
the costs to alter or retrofit existing small business facilities to comply with t he
requirements of the federal ADA. Learn more at www.treasurer.ca.gov/cpcfa/calcap/.
FEDERAL AND STATE LEGAL REQUIREMENTS ON ACCESSIBILITY
FOR INDIVIDUALS WITH DISABILITIES
AMERICANS WITH DISABILITIES ACT OF 1990 (ADA)-The ADA is a federal civil rights law
that prohibits discrimination against individuals with disabilities, and requires all public
accommodations and commercial facilities to be accessible to individuals with disabilities.
Learn more at www.ada.gov.
CALIFORNIA BUILDING CODE (CBC)-The CBC contains the construction-related accessibility
provisions that are the standards for compliant construction. A facility's compliance is
based on the version of the CBC in place at the time of construction or alteration. Lea rn
more at www.bsc.ca.gov.
(Issued 12-28-18)
Building Permit Inspection History Finaled
PERMIT INSPECTION HISTORY for (CBC2020-0378)
BLDG-Commercial 09/28/2020Application Date:Permit Type:Owner:ROOSEVELT TAMARACK
INVESTMENTS PROPERTY HOLDING
LLC
Tenant Improvement 10/07/2020Work Class:Issue Date:Subdivision:SEASIDE LANDS
04/19/2021Expiration Date:Status:
IVR Number: 28992
Closed - Finaled 2820 ROOSEVELT ST
CARLSBAD, CA 92008-1619
Address:
Scheduled
Date
Inspection Type Inspection No. Inspection
Status
Primary Inspector Reinspection InspectionActual
Start Date
10/19/2020 10/19/2020 BLDG-84 Rough
Combo(14,24,34,44)
141337-2020 Passed Chris Renfro Complete
COMMENTS PassedChecklist Item
BLDG-Building Deficiency No
BLDG-14
Frame-Steel-Bolting-Welding
(Decks)
No inspection completed of rough framing
prior to drywall. Viewed pictures of rough
appears ok from pictures
Yes
BLDG-24 Rough-Topout No
BLDG-34 Rough Electrical Yes
BLDG-44
Rough-Ducts-Dampers
No
12/01/2020 12/01/2020 BLDG-Final Inspection 144960-2020 Passed Chris Renfro Complete
COMMENTS PassedChecklist Item
BLDG-Building Deficiency Yes
BLDG-Plumbing Final Yes
BLDG-Mechanical Final Yes
BLDG-Structural Final Yes
BLDG-Electrical Final Yes
Tuesday, December 1, 2020 Page 1 of 1
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Carlsbad