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Home My WebLink About2804 ROOSEVELT ST; B; CBC2018-0532; Permit{city of Carlsbad Print Date: 01/16/2019 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2804 Roosevelt St, B BLDG-Commercial 2031820400 $167,436.00 Commercial Permit Work Class: Tenant Improvement Lot#: Reference#: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Description: ALLIANCE BRAZILIAN JUI JITSU: 3,600 SF T.I. URGENT CARE TO GYM Applicant: Owner: Status: Applied: Issued: Permit Fina led: Inspector: Final Inspection: Contractor: Permit No: CBC2018-0532 Closed -Finaled 09/19/2018 11/19/2018 MColl 1/16/2019 10:23:06AM JACK CARTER ROOSEVELTTAMARACK INVESTMENTS PROPERTY HOLDING LLC SP WHITE CONSTRUCTION INC BUILDING PERMIT FEE ($2000+) BUILOING PLAN CHECK FEE (BLDG) 3161 Michelson Dr Irvine, CA 92612-4400 760-487-8751 ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $1,672.46 Total Payments To Date: $1,672.46 2524 Gateway Rd Carlsbad, CA 92009-1742 760-931-1130 Balance Due: 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. $0.00 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov $867.40 $607.18 $89.D0 $55.00 $7.00 $46.88 ·(cicyof Carlsbad JobAddress Jto1 Rd04::tve\:\: COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check tfoCJt}J~ ... ~5~ Est. Value l !{o1,4 _,(k) j PC Deposit --q-z~,'i~Z.,_/8~ Date ----'-.L--'--..L.J,'----'-...,-'-- Suite: _...,fz"----APN: __________ _ CT/Project#: _________ Lot#: ___ _ Tenant Name: f1r,r\.: V dr~ If-z Fire Sprinklers: @I no Air Conditioni g: @s I no ;.- B IEF DESCRI TION OF WORK: -'-''...!!...!....:.lµ..:.,,.::+, _ _._,.i:tr<:,_'.!...(...1.....!\.:...l'-"----1-__L..l.!--l--':....__-1....L..:_.!c,ll..!..!....JL:.._...!.' (,:..:":....__(_1'_"----4--- D Addition/New: ___________ New SF and Use, ___________ New SF and Use, ____ Deck SF, Patio Cover SF (not including flatwork) Tenant Improvement: 3,t,.([0 SF, _____ SF, Existing Use \Jt~"'~ (ai-e., Proposed Use f1~11LS5 · G3""'- Existing Use ______ Proposed Use _____ _ □ Pool/Spa: _____ SF Additional Gas or Electrical Features? ___________ _ D Solar: ___ KW, __ Modules, ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No D Plumbing/Mechanical/Electrical Only: _________________________ _ D Other: ------------------------------------- PROPERTY ER Name: ---'~d~'-'-r--s,d---=-1--1':.....;:..;:....-,,.,,~------ Addr City: -b-L--'-1-'::.L=:J..._~-~ ''kL..l-~ • ----'-1-"-"'-"-...IL-- Phone: :/ Lf ~4 ~ s,4-i) Email: j;li"r yi~hVG f--\:ov-A9t -lo1 CONTRACT R USI M Name:_-'::'::c.!-=---¥'-'-::lf".--'L.:...:.J.c-1-~:::------- Email: --J£~~'.1.!..l..!!..,~.ltJ~¥,1.~1l1/.~:2..!.jL Architect State License:' __________ _ Phone:~~i-"'--:--'-"-+---:-"7--'-----.------ Email: 'h1\t'.Co bi1 \ State License: ';> Bus. License:_,/'-"o-=;;,~3r~--- Bl.-tv i(.6 ~ ~o-i.-2-o11 (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 8-2 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: D 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. £i have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the war My workers' compensation insurance carrier and policy number are: Insurance Company Name: _ _1~{£.'.r]e.<;:'.:ft__l\&/,i_W,l'.1,[l...L_/p_~'_ ____ _ Policy No. 7 '2000 /':I( S')s'l 'b{ Expiration Date: I ftft') -~-,., ....,,~------- 0 Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, t 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 the Labor Code, ::::::;::•:l~::TURE: (}djp~ ~AGENT DATE: / I /19 /2~ ~ J J { OPTION B ): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for 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 himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). □ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The 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. 0 Yes □ 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. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name/ address/ phone/ type of work): OWNER SIGNATURE: □AGENT ---------------------------DATE: _____ _ CONSTRUCTION LENDING AGENCY, IF ANY: 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 registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes O No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 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. 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 Cityofcarlsbad to enter upon th bo e mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARlSBAD AGAINST ALL LIABILITIES, JUDGMENT , C TS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required fore cav tions over 5'0'. and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the su· · fficial under the p · · by such permit is not commenced within 1 rom the date of ire by limitation and become null and void if the building or work authorized rwor~_authorized by such permit is suspended or abandoned at anytime after the work is commenced for a period s (Section 106. -~~'--'-"-+'t+---~---DATE: _0_1,__/1_11.+-,/~~J_ APPLICANT SIGNATURE· 1635 Faraday Ave Carlsbad, B-2 Page 2 of 2 Email: Building@carlsbadca.gov Rev. 06/18 PERMIT INSPECTION HISTORY REPORT (CBC2018-0532) Pormit Type' BLDG-Commercial Application Dato: 09/19/2018 Owner: Work Class: Tenant Improvement Issue Date: 11/19/2018 Subdivision: Status: Closed -Finaled Expiration Dato: 07/15/2019 Address: IVR Number: 14018 Scheduled Date Actual Start Date Inspection Type Inspection No. Inspection Status Primary Inspector 01116/2019 01/16(2019 BLDG-Final Inspection Checklist ltern BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final 081426-2019 Checklist Item BLDG-Building Deficiency BLDG-Building Deficiency BLDG-Plumbing Final BLOG-Plumbing Final BLDG-Mechanical Final BLDG-Mechanical Final BLDG-Structural Final BLOG-Electrical Final BLOG-Electrical Final BLDG-Fire Final 080892-2019 Checklist Item FIRE-Building Final COMMENTS See card Passed COMMENTS Accessibility ok See card GFCI protection ok Scheduled COMMENTS Michael Collins Dominic Fleri ROOSEVELT TAMARACK INVESTMENTS PROPERTY HOLDING LLC SEASIDE LANDS 2804 Roosevelt St, B Carlsbad, CA 92008-1619 Reinspection Complete Passed No No No No No Complete Passed Yes No No Yes Yes No No No Yes Incomplete Passed No ·----·•··------------------------------------------ January 16, 2019 Page 2 of 2 '' PERMIT INSPECTION HISTORY REPORT (CBC2018-0532) Permit Type: BLDG-Commercial Application Dato: 09/19/2018 Owner: ROOSEVELT TAMARACK INVESTMENTS PROPERTY HOLDING LLC Work Class: Tenant Improvement Issue Date: 11/19/2018 Subdivision: SEASIDE LANDS Status: Closed -Finaled Expiration Date: 07/15/2019 Address; 2804 Roosevelt St, B Carlsbad, CA 92008-1619 IVR Number: 14018 Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete 11/2112018 11/21/2018 BLDG-14 076789-2018 Partial Pass Michael Collins Reinspection Incomplete Frame/Steel/Bolting/ Weldlng (Decks) Checklist Item COMMENTS Passed BLDG-Building Deficiency Demising wall only Yes BLDG-21 076790-2018 Passed Michael Colllns Complete Underground/Underf loor Plumbing Checklist Item COMMENTS Passed BLDG-Building Deficiency Showers/ floor drains only Yes BLDG-34 Rough 076796-2018 Partial Pass Michael Collins Reinspection Incomplete Electrical Checklist Item COMMENTS Passed BLDG-Building Deficiency Demising wall only only Yes 12/12/2018 12/1212018 BLDG-84 Rough 078532-2018 Partial Pass Mlchael Collins Reinspection Incomplete Combo(14,24,34,44) Checklist Item COMMENTS Passed BLDG-Building Deficiency Restroom walls only Yes BLDG-14 Yes Frame-Steel-Bolting-Welding (Decks) BLOG-24 Rough-Topout Yes BLDG-34 Rough Electrical Yes 12/17/2018 12/17/2018 BLDG-17 Interior 079015-2018 Passed Michael Collins Complete Lath/Drywall Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 01/11/2019 0111112019 BLDG-85 T-Bar, 081137-2019 Passed Paul Burnette Complete Ceiling Grids, Overhead Checklist ltnm COMMENTS Passed BLDG-Building Deficiency No BLDG-14 No Frame-Steel-Bolting-Welding (Decks} BLDG-24 Rough-Topout No BLDG-34 Rough Electrical No BLDG-44 No Rough-Ducts-Dampers 01115/2019 01/15/2019 BLDG-Final 081298-2019 Failed Michael Collins Reinspection Complete Inspection January 16, 2019 Page 1 of 2 DATE: 11/13/2018 JURISDICTION: Carlsbad PLAN CHECK#.: CBC2018-0532 ✓• EsG1I A SMfbutit Company SET II PROJECT ADDRESS: 2804 Roosevelt St. ste. B □ APPLICANT □ JURIS. PROJECT NAME: Alliance Brazilian Jiu Jitsu Tenant Improvement ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D 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. D EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Telephone#: Date contacted: (b~) Email: Mail Telephone Fax In Person 0 REMARKS: By: Jason Pasiut EsGil 11/6/2018 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 DATE: 9/27/2018 JURISDICTION: Carlsbad PLAN CHECK#.: CBC2018-0532 ✓• EsG1I A SAFEbuilfCompany SETI PROJECT ADDRESS: 2804 Roosevelt St. ste. B □ APPLICANT ,...er JURIS. PROJECT NAME: Alliance Brazilian Jiu Jitsu Tenant Improvement D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. [gj The check list transmitted herewith is for your information. The plans are being held at EsGil until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. [gj The applicant's copy of the check list has been sent to: Mark Virgeas D EsGil staff did not advise the applicant that the plan check has been completed. [gj EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Mark Virgeas Date contacted: 'IIZ:7 liM' (b~ Email: Telephone#: 760-917-2664 mark@yahoo.com C;6Mail TelephM~X In Person 0 REMARKS: By: Jason Pasiut EsGil 9/20/2018 Enclosures: z, :so PM: t'\'lAA"'JI/ 0 ll&'?l.f~·""" CC.' l)~fl-l"t@'I ~ -tllo 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 Car]Jlbad CBC2018-0532 9/27/2018 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK#.: CBC2018-0532 OCCUPANCY: B, S-1 TYPE OF CONSTRUCTION: V-B ALLOWABLE FLOOR AREA: within SPRINKLERS?: YES REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 9/19/2018 DATE INITIAL PLAN REVIEW COMPLETED: 9/27/2018 FOREWORD (PLEASE READ): JURISDICTION: Carlsbad USE: Martial Arts Studio ACTUAL AREA: 3,538sf STORIES: 1 HEIGHT: unchanged OCCUPANT LOAD: 137 DATE PLANS RECEIVED BY ESGIL CORPORATION: 9/20/2018 PLAN REVIEWER: Jason Pasiut This plan review is limited to the technical requirements contained in the California version of the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 2016 CBC, which adopts the 2015 IBC. The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of the 2015 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list when you submit the revised plans. Carlabad CBC2018-0532 9/27/2018 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Jason Pasiut BUILDING ADDRESS: 2804 Roosevelt St. ate. B BUILDING OCCUPANCY: B, S-1 BUILDING AREA Valuation PORTION ( Sq. Ft.) Multiplier Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb -.. -~·-, 1997 UBC Buildin Permit Fee • I g ----~' ------- 1997 USC Plan Check Fee Type of Review: 0 Repetitive Fee •, Repeats Comments: 0 Complete Review □ Other 0 Hourly EsGII F- Reg. Mod. PLAN CHECK#.: CBC2018-0532 DATE: 9/27/2018 VALUE ($) 167,436 167,436 0 Structural Only $529.151 Sheet 1 of 1 .Carlsbad CBC2018-0532 9/27/2018 Please make all corrections, as requested in the correction list. Submit FOUR new complete sets of plans for commercial/industrial projects (THREE sets of plans for residential projects). For expeditious processing, corrected sets can be submitted in one of two ways: 1. Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760) 602- 2700. The City will route the plans to EsGil and the Carlsbad Planning, Engineering and Fire Departments. 2. Bring TWO corrected set of plans and calculations/reports to EsGil, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil is complete. • PLANS 1. Provide a Building Code Data Legend on the Title Sheet. Include the following code information for each building proposed: ♦ Provide an allowable area calculation for this proposed space showing that the Assembly use does not exceed the allowable floor area of CBC Table 506.2. (A-3, sprinklered one story V-B construction = 24,000sf.) • The space requires drinking fountains in compliance with CPC Table 422.1 and CBC 11 B 602. Show 2 complaint drinking fountains. (high -low) ♦ Roof mounted equipment must be screened and roof penetrations should be minimized (City Policy 80-6). • ACCESSIBILITY 2. Provide details for the showers showing compliance with CBC 11 B 608 for standard roll-in showers. 3. Note on the plans that no fewer than one of each locker shall comply with the reach ranges of 11 B-308 and operable parts per 11 B-309. • PARTITIONS 4. Provide a section view of all new interior partitions. Show: a) Manufacturer and approval number of metal studs or indicate "to be ICC approved". .Carlsbad CBC2018-0532 9/27/2018 b) Method of attaching top and bottom plates to structure. (NOTE: Top of partition must be laterally braced to roof or floor framing above, unless suspended ceiling has been designed for partition lateral load). c) Show height of partition and suspended ceiling, and height from the floor to the underside of the floor/ceiling above. • MECHANICAL/ ELECTRICAL / PLUMBING 5. Show on the plans how the installation of new mechanical equipment on the roof will meet the seismic design requirements of ASCE 13.2.1 general design, 13.4 anchorage, and applicable section of 13.6 unless exempted by 13.1.4. 6. Show on the plans that the existing structural framing is sufficient to support the weight of the new RTU being installed. CMC 303.8. 7. A GFCI protected receptacle outlet is required within 25 feet and on the same level as the mechanical equipment (heating, air-conditioning, and refrigeration equipment). Please include on the plans. NEC 210.63. • END OF REVIEW To speed up the review process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. Please indicate here if any changes have been made to the plans that are not a result of corrections from this list. If there are other changes. please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate: □ Yes □ No The jurisdiction has contracted with EsGil, located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review for your project. If you have any questions regarding these plan review items, please contact Jason Pasiut at Esgil. Thank you. OFFICE USE ONLY SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE RECORD ID# __________________ I PLAN CHECK # __________________ I BP DATE p APN# Plan File# following questions represent the facility acti ities, 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: Facility's Square Footage (including proposed project): 13. Corrosives 1. Explosive or Blasting Agents 2. Compressed Gases 5. Organic Peroxides 9. Water Reactives 6. Oxidizers 10. Cryogenics 14. Other Health Hazards 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMDl: 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: YES N9---(for new construction or remodeling projects) 1. D ..f:] _Js...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? 3. D a--wm your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 _ _eounds and/or 200 cubic feet? 4. D ~ Will your business store or handle carcinogens/reproductive toxins in any quantity? 5. D 8-W'ill your business use an existing or install an underground storage tank? 6. D ~our business store or handle Regulated Substances (CalARP)? 7. D ~Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 8. D .g---\iVill your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or reater than 1,320 allons? California's Above round Petroleum Stora e Act . □ CalARP Exempt I Date Initials 0 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 ~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. [+Excludes garages & small outbuildings.] 1. 2. 3. 4. 5. 6. YES NO D CWill the project disturb 160 square feet or more of existing building materials? D [J-Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition. D [3-""lANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance □ □ □ Technician? [a--"(ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification ___.--lllaY be required 1 O working days prior to commencing asbestos removal. D Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet www.sda eel.or /info/facts/ ermits. d for typical equipment requiring an APCD permit. (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bounda Br' fly A'w.:,:4--,,L..1,,::....l..<:::__-J.l~{l,J£..l..!.-,'--------l---~...!.G-1!<.+;__--J.~.!.....•~=-------r\1 :~-~=uitP~~---- 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 m this box only exempts businesses from completing or updatmg a Hazardous Materials Business Plan. Other permitting requirements may still apply. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division