HomeMy WebLinkAbout1891 RUTHERFORD RD; 100; CBC2019-0603; PermitPERMIT REPORT
{'city of
Carlsbad
Commercial Permit
Print Date: 09/28/2021 Permit No: CBC2019-0603
Job Address: CARLSBAD, CA 92008-7436 Status:
Permit Type:
1891 RUTHERFORD RD, # 100,
BLDG-Commercial Work Class: Tenant Improvement
Closed -
Withdrawn
12/26/2019
03/17/2020
Parcel#:
Valuation:
Occupancy Group:
#of Dwelling Units:
Bedrooms:
Bathrooms:
Project Title:
2121203600
$95,485.03
Track#:
Lot#:
Project#:
Plan#:
Construction Type:
Orig. Plan Check#:
Plan Check#:
Description: DNA ELECTRONICS: 2053 SF Tl, LABORATORY TO LABORATORY
Property Owner:
PDG CARLSBAD 47 AND 48 LP
505 LOMAS SANTA FE DR, # 200
SOLANA BEACH, CA 92075
FEE
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
CERTIFICATE OF OCCUPANCY
(619) 258-2900 x304
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
FIRE Plan Review Per Hour -Office Hours
MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
PLUMBING BLDG COMMERCIAL NEW/ADDITION/REMODEL
581473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-COMMERCIAL
Total Fees: $1,666.37 Total Payments To Date: $1,651.37
Applied:
Issued:
Fina led Close Out:
Inspector:
Final Inspection:
Contractor:
JOHNSON AND JENNINGS INCORPORTAED
3870 MURPHY CANYON RD, # STE 110
SAN DIEGO, CA 92123-4403
(858) 221-5800
Balance Due:
AMOUNT
$609.78
$426.85
$15.00
$60.00
$408.00
$45.00
$71.00
$4.00
$26.74
$15.00
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.
Building Division Page 1 of 1
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
( Cicyof
Carlsbad
COMMERCIAL
BUILDING PERMIT
APPLICATION
B-2
Job Address I 'a"J , 7, u. -11 .. 102.. s;::.__,12...l) ,<.o'?Sl;> Suite: 1o;, APN: _________ _
Tenant Name: _J)....,;1-\"-'f'>='=-=-~-----------CT/Project#: _________ Lot#:, ___ _
Occupancy: ---l~----Construction Type: Iii Fire Sprinklers: yes/ no Air Conditioning: yes/ no
BRIEF DESCRIPTION OF WORK: ~ s; Mo bi:, I o'r t::>< :r S 7 :r ,..J <; l c,., ~" f..1>,; 7 c.,<c , SP'¥:'.,s
D Addition/New: __________ New SF and Use, __________ New SF and Use,
___ Deck SF, Patio Cover SF (not Including flatwork)
l:3-Tenant Improvement: 2q SQ SF,
_____ SF,
Existing Use ·-;z_:;;;:i, L:?--!:, Proposed Use']';.;\.]:, ~~
Existing Use ______ Proposed Use ______ _
□ Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _
D Solar: ___ KW, __ Modules, ___ Mounted, TIit: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No
0 Plumblng/Mechanlcal/Electrlcal Only: _______________________ _
D Other: _______________________________ _
APPLICANT (PRIMARY) PROPERTY OWNER
Name: ]21,,11:t; ii; Name: )?:+, ISf&S+ £::h::;;u ·v~u?<-rf2..-r.:r.e. S
Addreu: I B"l 1 ·3u._ ,>1ef12 .. :£p S-h 'Rb "" , :IT<i< 100 Address: SoS t Df..A.._ s. S,!>.-. 7.,_ R '}lg :,,v...:i.r ..,-Zoo ' City: kt'?-\ ..,a '4:, State: CA. Zip: '1"2<:;dl'. City: $26'"'-"' A. '&;;-,,..c_ H State: c A Zip: ;rl-Q +.5
Phone: 7<.oo · le 3,3 -11 Sf Phone: __,4,.._,_\ '!-'-'---2'=S""8'---2.='t~o"'-"'O'-----------
DESIGN PROFESSIONAL
Name: \!:?, OsN ..n( J?g:;;.:;i t:N c, &w,. f>
Address: L> S 'l..o ,. c,..,-..c-.: ·J? 1-:::. 6'6' ·12 ",,,:s::,
City: >"-"-' t:P""" 9 State: ( fs Zip: "l"LI Z. I
Phone: l<:'.'.J\Jl:':Ss><I L)'. ®,;;.i,.,;.?-4ai::...:,,p:,.;r<,,y
Email: '¢-58 558 -S<l ?.5
Architect State License: C.. 1...<..;-J-8<.e,. Cu M
CONTRACTOR BUSINESS
Name: ::SO·-'•~?R·u Ar~A :Sz?Nt-aJ,4liS, .:r,-.J::'.
Address: 3 SI+? µ.__u,5 Vi+'r l'•"-"'-'ic,,✓ ::B+i~
City: 'S,!~ i::u ~, o State: c: A Zip: 't'2. I~ 3
Phone: g S-:fs 2."L..I -S)~t> D
Email: J,:! t:':::@ :;i:o ....,,.. Sg,J Ac! b S.-2:(•LW, s._ C0M,
State License: 4 3 $9<.,, :i Bus. License: 12,2--Y?n±
(Sec. 7031.S Business and Professions C~e: Any City or County whk:h requires a permit to «>nstruct, alter, Improve, demolish or repair any structure, prior to Its
issuance, also requires the applicant for such permit to file a slsned statement that he/she ls licensed pursuant to the provisions of the Contractor's License Law
{Chapter 9, commending with section 7000 of Dlvlslon 3 of the Business and Professions Code} or that he/she ls exempt therefrom, and the basis for the alleged
exemption. Any violation of Section 7031.S by any applicant for a permit subjects the applicant to a eMI 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: Buildlng@carlsbadca.gov
Rev. 06/18
. ( OPTION A ): WORKERS'COMPENSATION DEQ.ARATION;
I hearby affirm under penalty of perjury QllC of the following declarations:
□ I have and will malntaln 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 th~ permit Is Issued.
□ I have and wUI maintain worker's compensation, as required by 5ectlon 3700 of the Labor Code, for the performance of the work for which this permit Is Issued.
My workers' compensation Insurance carrler and poUcy numb1r'are: Insurance Company Name: Evereat Natlonal Insurance Co.
Polley No. 7800014105191 Expiration Date: 01/01/20
□ Certificate of Exemption: I certify that in the performance of tht work for which this permit Is luued, I shlH not employ any person in any manner so as to be come
subject to the workers' compensation Laws of Calffomll. WAIINING: Fallwe to HCUN Mmlllfl mmpenution COverlll: ii unlawful, and shall lul>ject an employer to
crimlnal penattlet and clvll flnN up ID $100,000.00, In ■dclltlon the to cottof campenutlon, dlfflllfll as provided for In SectiDn l70I of the Labor Code,
lntanstand ■-y'sr.o..
CONTRACTOR SIGNATURE:
( OPTION B ): OWNER-BUILDER DEa.ARATION:
I hl!reby affirm that I am exempt from Contractor's Llcl!nse Law for the following reason:
Cl I, as owner of the property or my employees wtth W11ff as their sole compensation, will do the work and the structure It not Intended or offered for sale (5ec.
7044, BuslneSI and Professions Code: The Contractor's Uc.ense Law does not: IPPlv 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. tf, however, the buildll'II or Improvement is sold within
one year of completion, the owner-bullder will have the burden of provln1 thlt ht did not build or Improve for the purpose of sale).
□ I, as OWfler of the property, am excluslvelv contracting with licensed contractors to construct the project (SK. 7044, Business and Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or Improves thtreon, and contracts for such pro juts with contractorfs) licensed
pursuant to the Contrlctor's Ucense Law,.
0 I am exempt undar S.ctk>tl _______ Business and Professions Code for this reason:
1. I personalty plan to provide th1 major labor and materials for construction of the prapcsed property Improvement. 0 Ves □ No
2. I (have/ have not) lilflad an application for a bullclln& permit for the propo,ed work.
3. I hava contllCtad with tho followlna person (flrm) to provlcla the propOHd conmuelion (lnchldt name addreso / phona / contractors• bnsa number):
4.1 plan to provide portions of the work, but I h■vo hired tho followlna person to coordln.,., supervise and provida tho major work (Include name/ address/ phone/
contractor( llc1nse number):
s. I wlll provk:11 some of the work, but I haw contracted (hired) the following persons to provide the work lncncated (lndude name/ address/ pbone / type of work):
OWNER SIGNATURE: _________________ □AGENT DATE: _____ _
CONSTRUCTION LENDING AGENCV, IF ANY;
I hereby affirm that there Is a construction lendtna aaency for the performance of the work this permit Is Issued (Sec. 3097 Ii) Civil Cade).
Len~• Name: __________________ Lender's AddNK: _________________ _
ONLY COMPLETE THE FOLLOWJNG SECTION FOR NON-RESIDENTIAL BUH.DING PERMITS ONLY;
Is the applicant or future bulldlng occupant required to submit a business plan, acutely hazardous materials rqlstratlon form or risk management and prevention
program under sections 25505, 25533 or 25534 of the Presley-Tanner H111rdous Substance Account Act? QI Yes C No "D e. Hlc:>I t.., -.ff-U .P~7-c 0 iJ.&-~
Is the appllcant or future building occupant required to obtain a permit from the air pollution control district or air quality mana1ement district? □ Yes J{ No
Is the facility to be constructed within 1,000feet of the outer boundary of a school site? 0 Vu ·Git No
IF Alff DF THE ANSWWARE YES, A FINAL CERTIRCATf OF OCCUPANCY MAY NOT BE ISSUED UNl!SS THE APPUCANT HA5 MET DR 15 MEETING THE
REQUIIIEMENTS Of TH! Ol'FICI! 0, EMERGENCY S!RVICfS AND THE Alli POLWTION CONTROL DISTIUc;T,
APPLICANT CERTIRCATIQN;
l certlfy that I hive read the application and state that the above Information Is correct and that the Information on the plans is accurate. 111ree to comply with all
Oty ordinances and State laws relatln1 to bulldlns construction.
I hereby authol1m repmenratt.e of the City of Clrlsbod ta anltl' upon the ■-mentioned property for inspection purpo,es. I AISO AGREE TO SAVE, INDEMNIFY AND KEEP
HARMLESS TH£ 01Y OF CARISSADAGAINST All UASILIT1ES,JUOGMEN1$, C0S1S AND EXPENSES WHICH MAY IN Ntl WAY ACCRUE AGAINST SAID 01Y IN CONSEQUENCE OF
THE GRANTING OF TH IS PERMIT.OSHA: An OSHA permit is required for ucavations owr S'O' deep Ind demafition or construction ohtruaures ovtr 3 stories In hllaht.
EXPIRATION: Ewry pennl Issued by the Sullcllfl& Offlclal under the provisions of this Codt shal e,q,lre by 6mltatlon and become nun and void Wthe buldlna or work authorized
by such permit Is not cornmencod -I• 180 dlys from mt dab! of suet, pennlt or f the bulldln& or wotk authorized by sud\ pormlt Is suspendod or abandoned at any ~me
alter the worl< Is commencod for I period of 180days (Section 106.4A Uniform Bu:: COde),
APPLICANTSIGNATURE: <::...,':::::,, . 2\... ~ ~. _.,---DATE: 1'2..\\'\\ Zu\)
1635 Faraday Ave Carlsbad, CA 92008
B-2
Ph: 760-602-2719 Fax: 760-602-8558
Page 2 of 2
Email: Building@carlsbadca.gov
Rev. 06/18
September 27, 2021
Hollianne Holmes
City of Carlsbad
Permit Technician II
1635 Faraday Avenue
Carlsbad, CA 92008
Ill
JOHNSON & JENNINGS
GENERAL CONTRACTING
Subject: Permit #CBC2019-0603. Issued on 3-15-2020.
Ms. Holmes:
The referenced project has been cancelled due to the impacts that the COVID 19 pandemic has had on
the tenant's business segments. Work will not commence, and we will not need a building permit.
Please cancel the permit application.
Thank you
Dan Dreesen
Senior Project Manager.
CC:
Stuart Schueler
Mike Stout
3870 MURPHY CANYON ROAD • SUITE 110 • SAN DIEGO, CALIFORNIA 92!21 • TEL 858.221.S800 • LIC.#-438867
------·--·-·-· .... " ... ---..
• www.johmonandjennings.com
DATE: MARCH 2, 2020
JURISDICTION: Carlsbad
PLAN CHECK#.: CBC2019-0603
✓• EsG1I
A SAr Ehuiit Conip,1·-,y
SET: II
PROJECT ADDRESS: 1891 Rutherford Rd. #100
PROJECT NAME: DNA Electronics Inc. Tenant Improvement
□ LICANT
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: Stuart Schueler Telephone#: 760-637-1157
Date contacted: o~~ (by<bi ) Email: stuart.scheler@dnae.com
Mail Telephone Fax In Person
REMARKS: Please add the following note to the plans, "~he o Room will be a research
laboratory with minor amounts of adequately diluted che · . erefore, per CPC 811.8,
pretreatment of the sinks will not be required."
By: Jason Pasiut Enclosures:
EsGil
2/14/20
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
DATE: 1/23/2020
JURISDICTION: Carlsbad
PLAN CHECK#,; CBC2019-0603
✓• EsG1I
A SAFEbui!fCompany
SETI
PROJECT ADDRESS: 189_1 Rutherford Rd. #100
PROJECT NAME: DNA Electronics Inc. Tenant Improvement
□ APPLICANT
□ 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 correq~ed and resubmitted for a complete recheck.
1:8] 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.
1:8] EsGil staff did advise the applicant that the plan check has been completed.
Person contacted: Stuart Schueler Telephone#: 760-637-1157
Date contacted:
Mail Telephone
0 REMARKS:
By: Jason Pasiut
EsGil
(by: ) Email: stuart.scheler@dnae.com
Fax In Person
Enclosures:
12/30/2019
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
____ ,, __________ _
Carlsbad CBC2019-0603
1/23/2020
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK#.: CBC2019-0603
OCCUPANCY: B
TYPE OF CONSTRUCTION: III-8
ALLOWABLE FLOOR AREA: complies
SPRINKLERS?: YES
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 12/26/2019
DATE INITIAL PLAN REVIEW
COMPLETED: 1/23/2020
FOREWORD (PLEASE READ):
JURISDICTION: Carlsbad
USE: Office
ACTUAL AREA: 2,053sf
STORIES: 2
HEIGHT: unchanged
OCCUPANT LOAD: 21
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 12/30/2019
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 CBC2019-0603
1/23/2020
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 M.Q 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.
BUILDING AND LIFE SAFETY REQUIREMENTS
1. Sheets Tl-4, M3.1, and P1 .2 are missing from the plans.
2. Detail 1 on sheet A 10.1 makes reference to detail's on sheet A20.1 which is not
in the plans.
3. Provide reference to the details on sheet A 10.2 on the suspended ceiling work
plan on sheet A4.1.
ELECTRICAL REVIEW
1. Approved as submitted.
PLUMBING AND MECHANICAL COMMENTS
PLAN REVIEWER: Connor Reuss SET: I
PLUMBING (2016 CALIFORNIA PLUMBING CODE)
1. The plumbing sheets are required to be signed by a licensed designer before the
plans can be approved.
2. The statement, "Not for Construction," must be removed from the plans before the
plans can be approved.
3. The industrial waste within Core Room #124 should not discharge directly into the
sanitary waste system on sheet P2.1. Please address.
MECHANICAL (2016 CALIFORNIA MECHANICAL CODE)
Mechanical plans approved as is.
Carlsbad CBC2019-0603
1/23/2020
Note: If you have any questions regarding this Plumbing and Mechanical plan
review list please contact Connor Reuss at (858) 560-1468. To speed the
review process, note on this list (or a copy) where the corrected items have been
addressed on the plans.
Carlsbad CBC2019-0603
1/23/2020
[DO NOT PAY-THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad
PREPARED BY: Jason Pasiut
PLAN CHECK#.: CBC2019-0603
DATE: 1/23/2020
BUILDING ADDRESS: 1891 Rutherford Rd. #100
BUILDING OCCUPANCY: B
BULDING AREA
PORTION (Sq.Fl)
Tl 2053
Air Conr:lilioring
Fire Sprinklers
TOTAL VALUE
Jurisdiction COde cb
j 1997 UBC Building Penni! Fct ~
I t".f ?ic~:
j 1997 USC Plan Check Fee
lt\.l!')fl'.
Valuation
~ier
46.51
By Ordinance
Type of Review: r,; Complete Review
Reg.
Mod.
VALUE
r Structural Only
rRepettiveFee -. l ~j Repeats
r Other
r How-ly
EaOilFee ..
f-----i]Hr. @ •
Comments:
($)
95,485
95,485
1 ,
$393.171
Sheet 1 of 1
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS
QUESTIONNAIRE
Business Contact
e, d..
: by rding the m. er your u neu II use. prooea, or store any
nt must contact the Fire Protection Agency with Jurisdiction prior to plan 1ubmlttal.
Telephone# .:r-\\"6+
APN#
2-12.-~ i l-C -:J((>
Plan File#
~0t:: tct 'l ... ol.#o
Occupancy Rating: Facillty'a Squa..-Footage (including proposed project):
1. Exploslve or Blutlng Agenta 5. Organic PeroxldN 9. Water Reactlves
2. ComprHsect Gases 6. Oxidizers 10. Cryogenics
3. Aammable/Combuatibfe Liquids 7. Pyrophorlca 11. Highly Toxlc or Toxic Materials
4. Flammable Solids 8. Unstable Reactfvet 12. Radloactlvel
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
4.
5.
6.
~ □ 8
□
□
□
· If the answer to any of the an Diego, CA 92123.
EJcpected Dati, of Occupancy:
(for new construction or remodeling projects)
I• your bu1lneu lilted on the reverse aide of this form? (checl( all that apply).
WIN your businese dlspo&e of Haiardous Subet.ances or Medical Waste In any amount?
WIii ycur bualne11 1tore or handle Hazardous Substances In quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet?
D WIU your busine11 store or handle carclnogenl/reproductlve toxlns in any quantity? 6a Will your butinese UH an existing or install an underground storage tank? 9 WIP your bualneaa atore or handle Regulated Substances (CalARP)? Gi WIH your bualnHa UH or lnatall a Hazardous Waste Tank System (Title 22, Article 10)?
Iii WIU your business store petroleum In tanks or containers at your facility with a total facility storage capacity equal to
or reater than 1 320 allona? Califomla'a Abov round Petroleum Stora At:.t .
I
0 CalARP Exempt
Data lnlttalt
D CalARP Required
Date lnltlalt
0 C11ARP Complete
Date lnltlall
Will the project disturb 160 1quare feet or more of existing bulldlng materials? · ~ ~ I) .{ ~· ., ')
Will any load supporting structural members be removed? Notification mey be required 10 working days i1or t6 eomrrlenelng dernollti .
(ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site S!;!rvelllance
Technician? ':ASH ~
(ANSWER ONL V IF QUESTION 3 IS YES) Baled on the IUl'IJ8Y reaulta, wlll the project dlstUllf.lily asbestos containing material? Not cation
may be required 10 wor1dng days prior to commencing ubeiatos removal. , r,1r Vl'1/\ 1..•c
Wlll the project or aaaoclated construction equipment emit air contaminants? See the reversnlde d thls fC>rrn'Ol'APe&fleMrelt~ ~ (www.sd1pcd,prg(u,fp/flctaJperm1tHxffi for typical equipment requiring an APCO permit. 0 (ANSWER ONL V IF QUESTION 61S YES) WIii the project or ... ocilted construction equipment be located within 1,000 feet of a school bounds
Briefly de8erlbe bualneu activities: Briefly deacribe proposed project:
·.:r a , eO•t ~ ..... --;:z_ • 'b -
I declare under'fenalty o(perjury that t~ the beat of my knowledge and belief. e respo{IS8S madl\bereln llj1t true and correct. $),.,., • :,..A-Sr y , + '$e \. $ C '":;;,\a.+ h \ ~ ~<-~ ,..,,\ ~
<; ~~
12,, / l;, /2.o(C,
Date Name of OWner or Authorized Agent Slgnatul'9 of Owner or Autho~ AQent
FOR OFFICAL USE ONLY; FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. _____________________________ _
BY: DATE:
IXIMPT OR NO FUR'l'Hllt IIU'OIUIATION IUIQUll'IIO N!l.llAal.O l'OA ■UILOINQ MtllMrr IIUT NOT P'OI\ OOCIJl'ANCY IU!Ll!Alll!D P'OI\ OC::CUP'AHCY
COUNTY-HMO• APCO COUNTY-HMO APCO
•A atamp In this box .Qll.b£ exempta buslnesaes from cornpletl oua Materlalt Business Plan. Other permitting requirements may still apply.
HM-9171 (08/15) County of San Diego -OEH -Hazardous Materlale Division
LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEAL TH -HAZARDOUS MATERIALS DIVISION
Check all that apply:
AUTOMOTIVE
0 Battery Manufacturing/Recycllng
D Boat Yard
OcarWaah
D Dealership Maintenance/Painting
0 Machine Shop
O Painting D Radiator Shop
0 Rental Yard Equipment
D Repair/Preventive Maintenance
0 Spray Booth
D Transportation Services
0 Wrecking/Recycling
CHEMICAL HANDLING D Agricultural auppller/dlstrtbutor
D Cheml<:al Manufacturer
0 Chemk:al SUppller/Dletributor
0 Coalinga/Adhesive
O Compressed Oaa Suppller/Diattlbutor
D Dry Cleaning
0 FlberglaMIRealn Applloallon
0 Gaa Station D Industrial Laundry
□ Laboratory
0 Laboratory Supplier/Distributor
D OIi and Fuel Bulk Supply
D Peetlclde 0perator/Dlatri:Jutor
CHEMICAi, HANDLING
0 Photographic ProceNlng
0 Pool Supplies/Maintenance
D PrlnUni>'Slue Printing D Road CoatJnga
0 Swimming Pool
D Toxic Gas Handler 0 Toxic Gas Manufacturer
METAL WORKING
□Anodizing
0 Chemlcal Ml!Jlng/Etchlng
D Flnlah.Coallng/Palntlng
0 Flame Spraying
0 Foundry
0 Machine Shop-Drlllng,1.athes/Mllla 0 Metal Plating 0 Metal Propplng/Chemloal Coating
0 Predous Metal Recovery
0 Sand Blutlng/Grlnding
0 Steel Fabricator
0 Wrought Iron Manufacturing
AEROSPACE
D Aeroapace Industry
D Aircraft Maintenance D Aircraft Manufacturing
OTHERS ANP MISCELLANEOUS
0 Asphalt Plant
~lotechnolo9y/R~arch 0 Chiropractic Office
D Co-Generation Plant
0 Dental CllnldOfflc.e
D Dlalyals Center
D Emergency Generator D Froxen Food Proeeatlng Facility D Hazardous Waste Hauler
D Hospltal/Convalesoent Home
0 Laboratory/Blologlcat Lab
0 Medical Cllnla/Offlce
D Nltrou, Oxide (NO,.) Control System
0 Pharmaceuticals
0 Public utility
0 Refrigeration Syswim
0 RockQuany 0 Ship Repair/Construction D Telecommunications Cell Site
D Veterinary CHnlc/.,.ospltal
0 Wood/Fumlture Manufacturing/Refinishing
ELECTRONICS
0 Electronic ANembly/Sub-Assembly
D Eledronlc Component• Manufacturing
D Printed Circuit Board Manufacturng
NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPJCALL Y USE, STORE, HANDLE, ANO 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
Buslne8886, whk:h Include any of the following operatlon8 or equipment, will require clearance from the Air Pollution Control District.
CHEMICAL
47 -Organic Gas Steriltzera
32 -Acid Chemical Mllllng
33 -can & Coll Manufactur1ng
44 -Evaporators, Dryers & Stille Procesalng
Organic Materials
24 -Dry Chemical Mixing & Detergent Spray
Towera
35 -Bulk Ory Chemicals Storage
55 -Chrome ElectroplaUng Tanks
COATINGS & ORGANIC SQl,YENU
27 -Coating & Painting
37 -Plaema Arc & Ceramic Deposition Spray
Boothe
38 -Pant, Stain & Ink Mfg
27 -Printing
27 -Polyester Reafn/Flberglass Operations
METALS 18 -Metal Meltlng Devices
18 -011 Quenching & Salt Bath•
32 -Hot Olp Galvanlzlng
39 -Prec::ioua Metai. Refining
ORGANIC COMPOUND MARKETING fGA8QUNE, ETC)
25 -Gaaollne & Alcohol Bulk Plants & Terminals
25 -Intermediate Refuelerl
21:1 -Gasoline & Alcohol Fuel Dispensing
COMBUSTION ROCK AND MINERAL
34 -Piston lntemal -Combustion Englnet 04 -Hot Asphalt Batch Plant.
13 -Bollens & Haatara (1 mlK!on BTU/hr or larger) 06 -Rock Drill•
1-4 -Incinerators & Crematories 06 -Scntenlng Operations
15 -Bum Out OVens 07 -Sand Rock & Agg~ata Planlt
16 -Core OVena 08 -Concr.te Batch, CTB, Concrete Mixers, Mlxert
20-Gas Turbines, and Turbine Teat Cell• & Stands & SIios
48-Landfill and/or Digester Gas Flares 10 -Brick Manufacturing
ELECTRONICS
29 -Automated Soldering
42 -Elactronlo Component Mfg
fggJ2
12-Flsh Cannertea
. 12 -Smoke Houses
50 -Coll'ee Roaster1
35 -Bulk Flour & Powered Sugar Storage
SOLVENT USE 28 -Vapor & Cold Degrea,lng
30 -Solvent & Extract DO.I'$
31 -DryCleanlng
QD:Wi 01 -Abrasive Blasting Equipment
03 -A&phalt Roofing Kettles & Tankers
46 -Reverse Oama.la Membrane Mfg
51 -Aqueous Waste Noutra.Kzatlon
11 -Tire 8uffera
17 -Brake Debondera
23 -Bulk Grain & Dry Chemical Tran,fer & Storage
-46 -Rubber Mixers
21 -Waste Diapotal & Reclamation Units
36 -Grinding Bootha & Rooms
-40 -Asphalt Pavement Heateni
43 -Ceramic Sllp Casting
-41 -Perllle Processing
40 -Cooling Towers -Reglatratlon Only
91 -Fumigation Operations
56 -WNTP (1 million gel/day or larger) & Pump
Stetlon
NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION
CONTROL DIS'J'.RICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLlJTION CONTROL DISTRICT AT (858) 686-2600.
HM-9171 (08/15) County of San Diego -DEH -Haurdoua Matarlal• 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: , 1--) \ -z... \ 2() \ ~
Business Name:_0-=--'-r..\_;,_;_~---'---'s,.,,,, .... .___ ____________ _
Street Address: \ <:o9. \ ~-....,.._ '"TL-\t,~-t.._~~ 'J,oAb Su ::t. 7~ tuo (>~\.~~•('A.
I I
Email Address: ;.\.u.sA .. S~v-:c;,,\._-.e_~ A=ns~-~&?m
PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) □
Check ail below that are present at your faclllty:
o Acid Cleaning
o Assembly
o Automotive Repair
o Battery Manufacturing
o Biofuel Manufacturing
"" Biotech Laboratory
o Bulk Chemical Storage
o Car Wash
o Chemical Manufacturing
o Chemical Purification
o Dental Offices
• Dental Schools
• Dental Clinics
o Dry Cleaning
o Electrical Component
Manufacturing
o Fertilizer Manufacturing
o Film/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 Finishing
• Electroplating
• Electroless Plating
• Anodizing
• Coating (i.e. phosphating)
• Chemical Etching/Milling
• 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 Enameling
o Power Generation
o Print Shop
o Research and Development
o Rubber Manufacturing
o Semiconductor Manufacturing
o Soap/Detergent Manufacturing
o Waste Treatment/Storage
"'S~(v'\....J: + 1 o I = <.o
New Business? Yes O No llJ. SIC Code(s) If known: ______ Date operation began/will begin: ,:s. 6B,.JA; 3120 2-l)
Tenant Improvement? Yes D NoO If yes, briefly describe improvement: '12-.~ 11--'--<..>!l(;.£... e;,<.:r.::. 7 UC,
0 (_~l'2..A'7o'2.\
Description of operations generating wastewater (discharged to sewer, hauled or evaporated}: :F::-I c ~ 'D:t-r:,0 ~/\L
("'4-Lt..o..JS/"'bA4. o~ .i '"'lo \.iYPoc\oiLJ217~ w:t.LL ::B?, ~e-l) -r0-rH~
Estimated volume of industrial wastewater to be discharged (gal/ day): ::::::::, (Q c'.) 11,-Ls[ j)A y
Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes D Date: No R ----
Page 1 of 2
ENCINA WASTEWATER AUTMORITY
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 industrial wastewater
discharge permitting under normal operating conditions. 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 Detallers 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 Nursing Homes
o Consulting Services o Office Buildings (no process flow)
o Contractors o Optical 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 Postal Services (no car wash/auto repair)
o Fitness Centers o Public Storage Facilities
o Gas Stations (no car wash/auto repair) o Restaurants/Bars
o Grocery Stores (no film developing) o Reta il/Wholesale Stores (no auto repair/film developing)
o Residential based Businesses o Theaters (Movie/Live)
CERTIFICATION STATEMENT
I certify that the information above is true and correct to the best of my knowledge.
ENCi NA WASTEWATER AUTHORITY
6200 AVENIDA ENCINAS, CARLSBAD, CA Phone: 760-438-3941 Fax: 760-476-9852
Sou rceControl@encinaipa.com
Page 2 of2
(_ 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
,. 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.
,. Details on CAP ordinance requirements are available on the city's website.
,. 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
_·L>~'t-\~~-e._-_2-_o_,~~-------BPNo.: (1;>(2.011-0603
Contact Email:
Contact information of person completing this checklist (if different than above):
Name:
Company
name/address:
v~t...._t;;..
\ 9) 9' I ~....._ "T L4e:N2. i-o2 ..b ·~o~
~::i,.'"11;:!:. /00
c_ AS'LL ~B~. CA CZ20D'j'
Contact Phone:
Contact Email:
Applicant Signature: s\,.,,__),bs ~b:!::::9,\..-Date: \~-·u~C-""Lo,,
B-50 Page 1 of 6 Revised 08/19
City qf 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 Bui'lding Permit Valuation worksheet.
Building Permit Valuation (BPV) from worksheet: $ 'J 5,~ '-( S--
•
Constructloo 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
□ 8PV c!: $200,000
IB Nonresidential
□ New construction
121-Alterations:
~ BPV cl!: $200,000 or additions cl!: 1,000
square feet
□ BPV c!: $1,000,000
□ cl!: 2,000 sq. ft. new roof addition
Checklist Item
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, 18, 2B,
4A 38,4A
N/A N/A 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
1B, 5
1B, 28, 5 Building alterations of cl!: 75% existing gross floor area
2B,5 1 B also applies if BPV cl!: $200,000
Check the~ boxes, explan al not appicable and exceplioo Isms, Md ~ supporting cak:ulaions llld doctmentation as necessay.
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 (CALGreen) for
more information when completing this section.
A D Residential addition or alteration? $60,000 building pennit valuation.
See CMC section 18.30.190.
Year Built Single-family Requirements
D Before 1978 Select one:
D Duct sealinA D Attic insulation D Cool roof
D 1978 and later Select one:
D Lighting package D Water healing Package
D Between 1978 and 1991
D 1992 and later
□ NIA _________ _
□ Exception: Home energy score ~ 7
(attach certification)
Multi.family Requirements
D Attic insulation
Select one:
D Duct sealinA D Attic insulation D Cool roof
Select one:
D Lighting package □ Water healing package
B. ~ Nonresidential* new construction or alterations:! $200,000 building permit valuatlon,
or additions i? 1,000 square feel D NIA
Updated 8/15/2019 2
City qt 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.
D 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:
8. 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
D 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
D Exception:
Updated 8/15/2019 4
City Qf Carlsbad Climate Action Plan Consistency Checklist
· 4. Electric Vehicle Char in
A O Residential New construction and major alterations*
Please refer to Carlsbad Ordinance CMC section 18.21.140 when completing this section.
D One and two-family residential dwelling or townhouse with attached garage:
D One EVSE Ready parking space required D Exception :
D Multi-family residential· D Exception ·
Total Parking Spaces EVSE Spaces
Proposed Capable I Readv I
I I
Calculations: Total EVSE spaces= .10 xTotal 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 I Total
I
*Major alterations are: (1) for one and two-family dwellings and townhouses with attached garages, alterations have a building permit valuation ~ $60,000
or indude 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) D Exception ·
Total Parking Spaces EVSE Spaces
Proposed Capable I Ready I Installed I Total
I I I
Calculation· Refer to the table below:
Total Number of Parking Spaces provided Number of reauired EV Spaces Number of required EVSE Installed Spaces
□ 0-9 1 1
D 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 oercent of total 50 oercent of Required EV Soaces
Updated 8/15/2019 5
City 9f 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
pennit, staff will contact the applicant to develop a site-specific TOM plan based on the pennit details.
Acknowledgment:
Employee ADT Estimation for Various Commercial Uses
Office (all)2
Restaurant
Retai'3
Industrial
Manufacturing
Warehousin
EmpADTfor
first 1,000 s.f.
20
11
8
4
4
4
EmpADTI
1000 s.f.1
13
11
4.5
3.5
3
1
1 Unless otherwise noted, rates estimated from /TE Trip
Generation Manual, 1 ()th Edition
2 For all office uses, use SAN DAG rate of 20 ADT/1,000 sf to
calculate employee ADT
a 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 I 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 TDM 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 comp/lance (if applicable):
Name (Printed): _________________ _ Phone Number: ____ _
Email Address: __________________ _
Updated 8/ l 5/20 19 6