HomeMy WebLinkAbout2173 SALK AVE; 135 | 145; PC2017-0047; PermitPlan Check Permit
Print Date: 06/21/2018
Job Address: 2173 Salk Ave, 145 & 135
Permit Type: BLDG-Plan Check Work Class: Commercial
Parcel No: 2120210700 Lot#:
Valuation: $ 0.00 Reference #:
Occupancy Group: Construction Type
# Dwelling Units: Bathrooms:
Bedrooms: Orig. Plan Check#:
Plan Check#:
Project Title:
(city of
Carlsbad
Permit No: PC2017-0047
Status:
Applied:
Issued:
Permit
Finaled:
Inspector:
Final
Inspection:
Closed -Finaled
12/11/2017
02/27/2018
06/21/2018
Description: SPEC SUITES: 3,596 SF OFFICE TO OFFICE -SPLIT EXISTING SUITE 145 INTO 135 & 145 (135; 1,608 SF// 145 SF; 1,988
SF) & CORE RESTROOM UPGRADES
Applicant:
GREGG HARTNESS
2524 Gateway Rd
Carlsbad, CA 92009-1742
858-829-5997
FEE
MANUAL BUILDING PLAN CHECK FEE
Total Fees: $ 500.00
Building Division
Owner:
BROOKWOOD C B I LLC
138 Conant St
Beverly, MA 01915-1665
978-720-7500
Total Payments To Date : $ 500.00
Contractor:
SP WHITE CONSTRUCTION INC
2524 Gateway Rd
Carlsbad, CA 92009-1742
760-931-1130
Balance Due:
AMOUNT
$500.00
$0.00
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
C_cicyof
Carlsbad
CllY
CITY
\00
STATE
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
Ph: 760-602-2719 Fax: 760-602-8558
email: building@cartsbadca.gov
www .carlsbadca.gov
ZIP
PHONE
l 7<c0
EMAIL
Off'\
STATE UC.#
Plan Check No.
Est. Value I~'°" lO '2.'5 -
SWPPP
-02-.\
~-STATE ZIP
FAX
C. C,yV'\
ZIP
CL.ASS CITY BUS. UC.#
FIRE SPRINKLERS
YESQs}No□
\0
B BLNR000431-02-201
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair an~ structure, prior to itS issuance, also requires the applicant for such permit to file a signed 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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)).
WORKERS ' COMPENSATION
Workers' Compensation Declaration: / hereby affirm under penalty of peryury one of the following declarations: D I have and will maintain a certificate of consent to self-Insure for wori<ers' compensation as provided by Secllon 3700 of lhe Labor Code, for the performance of the work for which this perm~ is issued. 0 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of lhe wori< for which this permit is issued. My wori<ers' compensation Insurance carrier and policy
numberare:lnsuranceCo Everest Natio nal Insurance Com PolicyNo. 7600014158171 ExpirationDate 01 /01/2018
~section need not be completed tt the permit is for one hundred dollars ($100) or less. LJ Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall nol employ any person In any manner so as lo become subject to the Workers' Compensation Laws of
Calttomia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penatties and civil fines up to one hundred thousand dollars (&100,000), In
addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
/6 CONTRACTOR SIGNATURE r-□AGENT DATE 1 2 / 11 / 2 0 1 7
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from Contractor's License Law for the lo/towing reason:
□
□
□
t, 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 lo an owner of property who builds or improves thereon, and who does such wori< himself or through his own employees, provided that such improvements are not intended or offered for
sale. ff, however, the building or lmprovemenl 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 projecls 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. O Yes O No
2. I (have/ have not) signed an application for a building permit for the proposed won<.
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 wori< (include name / address I phone / contractors' license number):
5. 1 will provide some of the wori<, but I have contracted (hired) the following persons to provide the work indicated (include name / address/ phone / type of work):
/6 PROPERTY OWNER SIGNATURE □AGENT DATE
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 No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes No
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF
EMERGENCY SERVICES ANO THE AIR POLLUTION CONTROL DISTRICT.
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
I certify that I have read the appHcation 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 aulhorize represenlative of lhe City of Carlsbad to enter upon lhe above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD
AGAINST ALL LIABILrTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN /WYWAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA An OSHA permit is requred for excavations ove< 5'0' deep and demolition or construction of structures over 3 stones in height.
EXPIRATION: Every permit issued by lhe Building Official unde provisions of lhis Code shall expire by imitation and become nul and void W the building or work authorized by such permit is not commenced within
180 days from lhe date of such permit or Wlhe building or a · ed by such permit is suspended or abandoned at any tine after the work is commenced for a period of 180 days (Section 106.4.4 Unifoon Build119 Code).
,I$ APPLICANT'S SIGNATURE DATE I~ II /jZ
• STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection.
Fax (760) 602--8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008.
CO#: (Office Use Only)
CONTACT NAME OCCUPANT NAME
ADDRESS BUILDING ADDRESS
CrTY STATE ZIP CrTY STATE ZIP
Carlsbad CA
PHONE I FAX
EMAIL OCCUPANT'S BUS. LIC. No.
DELIVERY OPTIONS
PICK UP: CONTACT (Listed above) OCCUPANT (Listed above)
CONTRACTOR (On Pg. 1)
ASSOCIATED CB# MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above)
CONTRACTOR (On Pg. 1) NO CHANGE IN USE/ NO CONSTRUCTION
MAIL/ FAX TO OTHER:
CHANGE OF USE/ NO CONSTRUCTION
~APPLICANT'S SIGNATURE DATE
DATE: 2/16/18
JURISDICTION: City of Carlsbad
PLAN CHECK#.: PC2017-0047
✓• EsG1I
1\ '.)ME:ln;1lt C:irnp,,nv
SET II
PROJECT ADDRESS: 2173 Salk Ave Suites 135 & 145
PROJECT NAME: Spec Suites 135 & 145 -TI
DftPLICANT
/JURIS.
D The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's codes.
~ The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department
staff.
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 rson
~ REMARKS: The set II replacement sheets must be incorporat into plan set I form Esgil
to make a complete set of approved plans. This must lso b,&-ti.r~ with the city set of
plans to make a second set of complete approved city p ..... ,,~-..
By: Jason Pasiut by CM
EsGil
2/15/18
Enclosures:
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
DATE: 12/20/17
JURISDICTION: City of Carlsbad
PLAN CHECK#.: PC2017-0047
✓• EsG1I
A SAFl-bu1lt Company
SET: I
PROJECT ADDRESS: 2173 Salk Ave Suites 135 & 145
PROJECT NAME: Spec Suites 135 & 145 -TI
□ ~PLICANT
_.,0"'JURIS.
•
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.
~ 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:
D EsGil staff did not advise the applicant that the plan check has been completed.
~ EsGil staff did advise the applicant that the plan check has been completed.
Person contacted: Gregg Hartness Telephone#: 760-931-1130
Date ~cted: 0/('l<l
.r6ail Telephone Fax
0 REMARKS:
By: Doug Moody
EsGil
(byf'l..--r Email: gregg@whiteconstructioninc.com
In Person
Enclosures:
12/12/17
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
City of Carlsbad PC2017-0047
12/20/17
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK#.: PC2017-0047
OCCUPANCY: B
TYPE OF CONSTRUCTION: VB
ALLOWABLE FLOOR AREA:
SPRINKLERS?: YES
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 12/11/17
DATE INITIAL PLAN REVIEW
COMPLETED: 12/20/ 17
FOREWORD (PLEASE READ):
JURISDICTION: City of Carlsbad
USE: Office
ACTUAL AREA: 3596sf
STORIES: 1
HEIGHT:
OCCUPANT LOAD: 81
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 12/12/17
PLAN REVIEWER: Doug Moody
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.
···----·
City of Carlsbad PC2017-0047
12/20/17
Please make all corrections on the original tracings, as requested in the correction
list. Submit four 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 Corporation and the Carlsbad
Planning, Engineering and Fire Departments.
2. Bring two corrected sets of plans and calculations/reports to EsGil Corporation,
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 Corporation only will not be
reviewed by the City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
1. Please provide plans and calculations signed by the California State licensed
engineer or architect for the structural support and lateral bracing of the ceiling
mounted transformer. Include all calculations and finding on the plans. Please
include the California license number, seal, date of license expiration and date
plans are signed. Business and Professions Code.
2. Please revise the single line diagram to show the grounding of the new
transformer to be per section 250-30 A (4) of the NEC.
3. Please clarify the mechanical plans they indicate the scope of work to be on the
second floor?
4. Please revise the mechanical plans to show the outside air connection to HP10.
Advisory Note : When alterations, structural repairs or additions are made to an
existing building, that building, or portion of the building affected, is required to
comply with all of the following requirements, per Section 11 B-202.4:
• Existing toilet and bathing facilities that serve the remodeled area must be
shown to comply with all accessibility features.
• Please address the following comments that are the result of the alterations.
5. It is unclear from the plans if the restrooms servicing the tenant improvement are
disabled accessible, please provide a dimensioned restroom plan showing the
restroom to be accessible compliant.
6. Where toilet rooms are provided, each toilet room shall comply with Section 11 B-
213. Where bathing facilities are provided, each bathing room shall comply with
Section 11B-603. Section 11B-213.2.
City of Carlsbad PC2017-0047
12/20/17
7. Show that at least one water closet fixture, located in a compartment, shall provide
the following, per Section 11 B-604:
a) One side of the water closet shall provide 17" -18" from the centerline of
the water closet to the adjacent compartment wall.
b) For water closet compartments having side-opening doors, compliance with
the following figure must be shown on the plans. The door shall be in the
partition farthest from the water closet and shall be 4" maximum from the
front partition. Please address the following specific concerns:
i) Both the men's and women's restrooms
8. At least one side partition at the accessible water closet(s) must have a toe
clearance of at least 9" (unless the stall width is increased to 66"). Section 11 B-
604.8.1.4.
9. If showers are proposed, show or note compliance with the following requirements,
per Section 11 B-608:
a) Size and Clearance. Accessible showers shall comply with one of the
following:
i) Roll-in shower 60 inches minimum in width between wall surfaces
and 30 inches in depth with a full opening width on the long side.
Shower compartment size and clear floor space shall comply with
Figure 11 B-608.2.2.
ii) Alternate roll-in shower 60 inches minimum in width between the wall
surfaces and 36 inches in depth with an entrance opening width of
36 inches minimum. Shower compartment size and clear floor space
shall comply with Figure 11 B-608.2.3.
b) Threshold in roll-in type showers shall be½ inch in high maximum.
c) Where within the same functional area, two or more accessible showers are
provided, there shall be at least one shower constructed opposite hand
from the other or others (i.e., one left-hand control versus right-hand
control). Section 11 B-213.3.6.
d) Water controls shall be of a single-lever design, operable with one hand,
and shall not require grasping, pinching or twisting of the wrist. The controls
shall be on the back wall, adjacent to the seat, and the center line of the
controls shall be located 39" -41" above the shower floor.
e) A flexible hand-held shower unit is required with at least a hose 59 inches
long that can be both used as a fixed shower head and hand held. This unit
shall be mounted such that the top of the mounting bracket is a maximum
of 48 inches above the shower floor.
f) Two wall-mounted heads may be installed in lieu of the hand-held unit in
areas subject to excessive vandalism. (Except within guest room and suites
of hotels, motels and similar transient lodging establishments) Each shower
head shall be installed so that it can be operated independently of the other
City of Carlsbad PC2017-0047
12/20/17
and shall have swivel angle adjustments both vertically and horizontally.
One head shall be located at a height of 48 inches above the floor.
g) The floor slope shall be a maximum of 1 :48 in any direction. Where drains
are provided, the grate shall have openings ¼ inch maximum and located
flush with the floor surface.
h) Indicate on the plans a folding seat, located on the wall adjacent to the
controls, 18" above the floor and shall not extend more than 6 inches from
the wall.
i) Grab bars shall be located, per Section 608.3:
i) On the back wall and the side wall opposite the seat.
ii) Mounted ~33" but 536" above the shower floor.
iii) Grab bars shall not extend into that portion of the wall over the seat.
To speed up the review process, 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 Corporation 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 Doug Moody at
Esgil Corporation. Thank you.
City of Carlsbad PC2017-0047
12/20/17
[DO NOT PAY -THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad
PREPARED BY: Doug Moody
PLAN CHECK#.: PC2017-0047
DATE: 12/20/17
BUILDING ADDRESS: 2173 Salk Ave Suites 135 & 145
BUILDING OCCUPANCY: B
BUILDING AREA Valuation Reg.
PORTION (Sq.Ft.) Multiplier Mod.
Tl 135 1608 46.51
Tl 145 1988 46.51
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code cb By Ordinance
Bldg. P~-r~it Fee by Ordinance ------;7 --------------------~--:J
Plan Check Fee by Ordinance ~ -_ --~
VALUE
Type of Review: 0 Complete Review D Structural Only
D Repetitive Fee ·---..;.] Repeats
Comments:
□ Other
D Hourly
EsGil Fee
,__ __ __,, Hr. @ *
($)
74,788
92,462
167,250
$867.461
$563.ssl
$494.45/
Sheet 1 of 1
..,'""' ... .,, .. .....,""' ., .. .....,,.....,, ~,.,, ..
HAZARDOUS MATERIALS RECORD ID #
PLAN CHECK#
QUESTIONNAIRE BP DATE
Business Name Business Contact Telephone#
)eL ~,\e \--1\u~c \\ -~cA 7 (.J..J) il'o-1 ':)~ 0
Project Address City State Zip Code APN#
2 7 "'t \t.\S CCA-<\s\J 'A a, 2 -
City
,~ lo<A6
State Zip Code Plan File#
C p.,_ Q.200
Applicant E-mail Telephone#
c:::,~ -lv-1 vc..h ·, n .1.. ::7 C\?:,\ -\
The following questions repre en e 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: Facility's Square Footage (including proposed project):
1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives
2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards
3. Flammable/Combustible Liquids 7. Pyrophorics 11. 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 IHMD): 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: 0 CalARP Exempt
I
1.
2.
3.
4.
5.
6.
7.
8.
YES NO (for new construction or remodeling projects)
Is your business listed on the reverse side of this form? (check all that apply). D IE
D I!! Will your business dispose of Hazardous Substances or Medical Waste in any amount?
D lhl 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
D D D
D
~ Will your business store or handle carcinogens/reproductive toxins in any quantity? 00 Will your business use an existing or install an underground storage tank?
Ii] Will your business store or handle Regulated Substances (CalARP)? Iii Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
ffi 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 .
Date Initials
0 CalARP Required
I
Date Initials
0 CalARP Complete
I
Date Initials
PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT IAPCD): 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. [•Excludes garages & small outbuildings.]
1.
2.
3.
4.
5.
6.
YES NO
B ~ □ □
□
□
□
□
~
□
Will the project disturb 160 square feet or more of existing building materials?
Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition.
(ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance
Technician?
(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.
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.pdD 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
Briefly describe business activities: Briefly describe proposed project:
-f e,,
I declare under penalty of pe~ury that to the best of my knowledge and beli
":::x:2:h VI. \.-\ec c:c.iaoe. :c \2. I OCo / 1.D\3
Name of Owner or Authorized A ent Date
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ________________________________ _
BY· DATE· I I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMrT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMO• APCD COUNTY-HMO APCD COUNTY-HMO APCD
. . *A stamp 1n this box only exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other perm1tt1ng requirements may still apply .
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division