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Home My WebLink About2822 STATE ST; ; CBC2019-0106; PermitBuilding Permit Finaled Print Date: 05/05/2020 Job Address: PermitType: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: ProjectTitle: 2822 State St BLDG-Commercial 2031810500 $7,953.21 Commercial Permit Work Class: Tenant Improvement Lot#: Reference #: Construction Type Bathrooms: Orig. Plan Check#: Plan Check#: {'cityof Carlsbad Permit No: CBC2019-0106 Status: Closed -Finaled Applied: 03/06/2019 Issued: 03/05/2020 PermitFinal Close Out: Inspector: PBurn Final Inspection: 05/05/2020 Description: CARLSBAD THEATER: 171 SF T.I. (CONVERTING AN EXISTING RESTROOM INTO 2 UNISEX/HANDICAP RESTROOMS)) Applicant: Owner: AVENT DESIGN 2822 STATE STREET LLC LISA AVENT 28720 Sandhurst ESCONDIDO, CA 92026-680S 619-889-9481 2808-2822 State St CARLSBAD, CA 92008-1630 FEE BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL FIRE A-1 Occupancies -Tl MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL PLUMBING BLDG COMMERCIAL NEW/ADDITION/REMODEL SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $1,205.50 Total Payments To Date: $1,205.50 Contractor: REX CLARK HOME IMPROVEMENTS 1158 Avenida Frontera Oceanside, CA 92057-7733 760-390-4012 Balance Due: AMOUNT $97.22 $68.05 $41.00 $908.00 $39.00 $49.00 $1.00 $2.23 $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 11fees/exaction.11 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. Buildin Division 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov Page 1 of 1 -,., ...... ,,, ( City of Carlsbad Job Address 2822 State Street Tenant Name: Carlsbad Theater COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check Cf;(<fg9 f ~ -Q//l Est. Value _J~_ 3 · ;;?/ PC Deposit #?,: £-6 '>- Date 3-0 -i q Sulte: ___ APN:2c6-I~ --Ds-OO CT /Project#: Lot#: -3 2- Fire Sprinklers: yes/ no Air Con~tloning: yes/ no • n BRIEF DESCRPTIONOFWORK:1,icJ &Uk ffiU) b.CWA£~ Cc.errw r~~-1illv1r\ $, . l " I D Addition/New: _____ 1....:.... _____ New SF and Use, ___________ New SF and Use, ___ Deck SF, ___ Patio Cover SF (not including flatwork) l I'! I SF, Existing us-;rhtv½'.:\ D Tenant Improvement: Proposed Use'::\:h{W::{ _____ SF, Existing Use ______ Proposed Use _____ _ 0 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: _______________________ _ □ Other: ------------------------------------ PROPERTY OWNER +-"'--"--.=:,,--L.-'-"-''+,"---++e---:,;-+.--,--Name: K t?c, ...::..:r.w~:::r,<-,-::=====~~~+ Address: _________________ _ City: _________ State: ___ Zip: ____ _ --"=~.z,..:Of+J..:w'-1....J\,,:---::--::cr--r--Phone: _________________ _ Email: Email: __________________ _ (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 Ltcense 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 B-2 Ph: 760-602-2719 Fax: 760-602-8558 Page 1 of2 Email: Bullding@carlsbadca.gov Rev. 06/16 -,) ..... ( OPTION A): WORKERS'COMPENSATION DECLARATION: I hearby affirm under penalty of perjury i1!1f. of the following declarations: □ I have and will maintain a certificate of consent to self-Insure for workers' compensation provlded by Section 3700 of the Labor Code, for the performance of the work which this permit ls Issued. IJ'I 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 \nsurance carrier and policy number are: Insurance Company Name:_ Policy No. _______ Expiration Date:_ ~ Certificate of Exemption: I certify tl1at in the performance of the work for whlcl1 th!s permit is Issued, I shall not employ any person in any manner so as to be come ~Ject 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 clvll 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, Interest and attorney's fees. ~ / /7, CONTRACTOR SIGNATURE: -~..L.......-4.o-"'-=-b""""~==---"-----------~AGENT DATE: ' 3 l,s-_/2 0 ( OPTION B ): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's license Law for the following reason: O 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 to an owner of property who builds or improves thereon, and who does such work hlmself or through his own employees, provided that such improvements are not lntended or offered for sale. If, however, the bulldlng or improvement Is sold within one year of completlon, the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sa1e). □ I, as owner of the property, am excluslvely contracting with licensed contractors to construct the project (Sec. 7044, Buslness 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. □ Yes □ No 2. r {have/ have not) signed an application for a buildlna permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction {include name address/ phone/ contractors' license number): 4. I p1an to provide portions of the work, butt have hired the followlng person to coordinate, supervise and provide the major work (include name/ address/ phone/ contractors' llcense number): 5. I wlll provide some of the work, butt 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: r hereby affirm that there is a construction lending agency for the performance of the work this permit ls Issued jSec. 3097 (I) Clvil Code). Lender's Name: ___________________ _ Lender's Address: ___________________ _ ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future bulldlna occupant required to submit a business plan, acutely hazardous materials registration form or r!sk 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 A.NY OF THE ANSWERS ARE YES, A FINALCERTIACATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR 15 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 City of Carlsbad to enter upon the above mentioned property for Inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLES.S THE CITY OF CARLSBAD AGA!NST All LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WH1CH 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 S'(j deep and demol!tion or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Bui by such permit Is not commenced within 1 after the work Is commenced for a rlod Official under the provisions of this Code shall expire by limitation and become null and void If the budding or work authorized s from the date such permit or if the building or work authorized by such permit ls suspended or abandoned at any time days (Section 1 .4 Uniform BuKdlng Code). APPLICANT SIGNATURE: ~-,L.i..U.......6:::::L~=========--..,.---DATE: -'-?,,+/1,1,-w ti-/ 1-,/ r<--- 1635 Faraday Ave Carlsbad, CA 92008 8-2 Ph: 760-602-2719 Fax: 760-602-8558 Page 2 of 2 Email: Building@carlsbadca.gov Rev. 06/18 PERMIT INSPECTION HISTORY for (CBC2019-0106) Permit Type: BLDG-Commercial Application Date: 03/06/2019 Owner: 2822 STATE STREET LLC Work Class: Tenant Improvement Issue Date: 03/05/2020 Subdivision: SEASIDE LANDS Status: Closed -Finaled Expiration Date: 09/08/2020 Address: 2822 STATE ST IVR Number: 17488 CARLSBAD, CA 92008-1630 Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspectlon Inspection Date Start Date Tuesday, May 5, 2020 Checklist Item BLOG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final COMMENTS Status Passed Yes Yes Yes Yes Yes Page 2 of 2 Building Permit Inspection History Finaled {'city of Carlsbad PERMIT INSPECTION HISTORY for (CBC2019-0106) Permit Type: BLDG-Commercial Application Date: 03/06/2019 Owner: 2822 STATE STREET LLC Work Class: Tenant Improvement Issue Date: 03/05/2020 Subdivision: SEASIDE LANDS Status: Closed -Finaled Expiration Date: 09/08/2020 Address: 2822 STATE ST IVR Number: 17488 CARLSBAD, CA 92008-1630 Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Re Inspection Inspection Date Start Date Status 03105/2020 03/05/2020 BLDG-84 Rough 121353-2020 Failed Paul Burnette Relnspectlon Incomplete Combo(14,24,34,44) Checklist Item 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 03106/2020 03106/2020 BLDG-21 121699-2020 Passed Chris Renfro Complete Underground/Underflo or Plumbing Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 03110/2020 03110/2020 BLDG-84 Rough 121809-2020 Passed Peter Dreibelbis Complete Combo(14,24,34,44) Checklist Item COMMENTS Passed BLDG-14 Yes Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout Yes BLDG-34 Rough Electrical Yes 03/12/2020 03/12/2020 BLDG-17 Interior 122067-2020 Passed Peter Orelbelbls Complete Lath/Drywall Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 05/04/2020 05/04/2020 BLDG-Final Inspection 126395-2020 Failed Paul Burnette Relnspectlon Incomplete Checklist Item COMMENTS Passed BLDG-Building Deficiency No BLDG-Plumbing Final No BLDG-Mechanical Final No BLDG-Structural Final No BLDG-Electrical Final No 05/05/2020 05/05/2020 BLDG-Flnal Inspection 126551-2020 Passed Paul Burnette Complete Tuesday, May 5, 2020 Page 1 of 2 DATE: 4/26/2019 JURISDICTION: Carlsbad PLAN CHECK#.: CBC2019-0106 PROJECT ADDRESS: 2822 State St. ✓• EsG1I A SAFEbu1lt Co1T1pany SET II PROJECT NAME: Carlsbad Theatre Tenant Improvement □ APPLICANT □ JURIS. D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. ~ The plans transmitted herewith will substantially comply 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: (by~) Email: Mail Telephone Fax In Person ~ REMARKS: Applicant to slip sheet the set II sheets into the approved set I plans prior to permit issuance. By: Jason Pasiut EsGil 4/19/2019 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 DATE: 3/18/2019 JURISDICTION: Carlsbad PLAN CHECK#.: CBC2019-0106 PROJECT ADDRESS: 2822 State St. ✓• EsG1I A SAFEbuilt Company SET: I PROJECT NAME: Carlsbad Theatre Tenant Improvement □ APPLICANT M 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. IZ] 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. IZ] The applicant's copy of the check list has been sent to: Lisa Avent D EsGil staff did not advise the applicant that the plan check has been completed. IZ] EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Lisa Avent Telephone#: 619-889-9487 Date contacted:3/lfllt:\ (by:~) Email: aventdesign@outlook.com t, Mail ✓ Telephone1,wi Fax In Person 0 REMARKS: By: Jason Pasiut EsGil 3/11/2019 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 Carlsbad CBC2019-0106 3/18/2019 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK#.: CBC2019-0106 OCCUPANCY: A-1 TYPE OF CONSTRUCTION: ALLOWABLE FLOOR AREA: complies SPRINKLERS?: REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 3/6/2019 DATE INITIAL PLAN REVIEW COMPLETED: 3/18/2019 FOREWORD (PLEASE READ): JURISDICTION: Carlsbad USE: Theatre ACTUAL AREA: 1 71 sf STORIES: 2 HEIGHT: unchanged OCCUPANT LOAD: DATE PLANS RECEIVED BY ESGIL CORPORATION: 3/11/2019 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. Carlsbad CBC2019-0106 3/18/2019 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 3. Provide a Building Code Data Legend on the Title Sheet. Include the following code information for each building proposed: ♦ Occupancy Classification(s) ♦ For Mixed Occupancy Buildings, state whether the "nonseparated" or "separated" option was chosen from Sections 508.3/508.4. ♦ Type of Construction ♦ Sprinklers: Yes or No ♦ Floor Area ♦ Occupant Load 4. Please provide a minimum plumbing facilities calculation based on occupant load of facility. a) Update the restroom design and plumbing plans if applicable. b) This A-1 facility appears to be large enough to require more facilities than are shown, including separate facilities for each gender, urinal(s) and drinking fountains. Refer to CPC Table A and Table 422.1. 5. Please update the unisex restroom sign detail on sheet A-1 to be compliant with 11B-703.7.2.6.3. There are no images on the approved signs. • END OF REVIEW Carlsbad CBC2019-0106 3/18/2019 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. Carlsbad CBC2019-0106 3/18/2019 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Jason Pasiut BUILDING ADDRESS: 2822 State St. BUILDING OCCUPANCY: A-1 BUILDING AREA Valuation PORTION ( Sq. Ft.) Multiplier Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code #N/A -- P rmi Fee ... 1997 UBC Building e t ---~ 1997 UBC Plan-C_he_ck_F_;~_----•~I Type of Review: 0 Complete Review D Repetitive Fee ;;-] Repeats Comments: D Other D Hourly EsGil Fee PLAN CHECK#.: CBC2019-0106 DATE: 3/18/2019 Reg. VALUE ($) Mod. D Structural Only ,------ilHr.@ * #NIAi Sheet 1 of 1 Carlsbad CBC2019-0106 3/18/2019 /DO NOT PAY-1111S IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Jason Pasiut BUILDING ADDRESS: 2822 State St. BUILDING OCCUPANCY: A-1 BUILDING AREA PORTION ( Sq. Ft.) Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Gode cb .. 1 f 1997 UBC Bur1dmg Permit Fee L_J I 1997 UBC Pran Check Fee '. '.!.i Valuation Multiplier By Ordinance Type of Review: P' Complete Review r Repetitive Fee j :..,.i Repeats .. Comments: r Other r Hourly EsGII Fee .. Reg. Mod. PLAN CHECK#.: CBC2019-0106 DATE: 3/18/2019 VALUE ($) 7,953 7,963 , r Structural Only 1-------11 Hr. @ • $59.0Bl Sheet 1 of 1 SAN DIEGO REGIONAL OFFICE USE ONLY 0 ~ HAZARDOUS MATERIALS .,. < ,, .• QUESTIONNAIRE Busi7• N_,;'j'e k -6 /1 ,i LM1 .., M rr, . Business Contact Pro)ecr,,.ddress ' Mailing Address Project Contact City City Applicant E-mail Organic Peroxides Oxidizers Pyrophorlcs Unstable Reactives questions s yes. app ,cant must contact the ounty o an ego Call (858) 505•6700 prior to the issuance of a building permit. RECORD ID# PLAN CHECK# Telephone# State Zip Code State Zip Code Telephone# Water Reactives BP DATE I APN# Plan FIie# 13. Corrosives 14. Other Health Hazards e:; None of These. I : If the answer to any of the an Diego, CA 92123. FEES ARE REQUIRED Project Completion Date: Expected Date of Oc<::upancy: YES 1 (for new construction or remodeling projects) 1. D Is your business listed on the reverse side of this form? (check all that apply}. 2. D Win your business dispose of Hazardous Substances or Medical Waste In any amount? 3. D WiU your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? 0 CaiARP Exempt I Date Initials 0 CalARP Required I 4. 5. 6. 7. 8. D Will your business use an existing or install an underground storage tank? D Will your business store or handle Regulated Substances (CalARP)? D l Will your business store or handle carcinogens/reproductive toxins In any quantity? D Will your business use or Install a Hazardous Waste Tank System (ntle 22, Artlde 10)? D Will your business store petroleum in tanks or containers at your facility with a total faclllty storage capacity equal to or realer than 1,320 eUons? California's Abov round Petroleum Sto e Act . Date Initials 0 CalARP Complete Date Initials ART Ill· I O RP L CONTR I T APCD • Any YES• answer requires a stamp from APCO 10124 Old Grove Road, San o. A 2131 3PcdC~P@sdc0UDIY-C8·90V ( ) 0). rNo stamp required If Q1 Yes l!lit 03 Yes insl 04-06 No). The following questions are intended to i entity the majority o 7 r pollution Issues at the planning stage. Projects may require additional measures not Identified by these questions. For comprehensive requirements contact APCO. Residences are typically exempt, except -those With more lhan one building* on lhe property; single buildings Wilh more than folK iwe~~i un~~;;~~;;;~;~;:;~;;,~;;;{;.;;be;;;;;•~;;;;~;~~g:::,: •1:::::::~·:,::::•:0::::n: ::~:~::ull~ngs.J 3, O ~ (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certlfted Asbestos Consultant or Site Surveillance Technician? 4. D □ (ANSWER ONLY IF QUESTION 31S YES) Based on the survey results, wfll the project disturb any asbestos containing material? Notification may be required 10 working days prior to commencing asbestos removal. 5. 0 Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCO factsheet OWW-sdaocd org1tnfg(fags1permits.pdf) 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 bound• Briefly t to the best of my knowledge a 3 I ff I /1 Name Date FIRE DE CY CLASSIFICATION· BY: DATE: I I 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 1n this box 2.ll!i. exempts busmesses from completing or updating a Hazardous Materials Busmess Plan. Other permitting requrrements may still apply. I-IM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division . "----·-···· ----