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HomeMy WebLinkAbout1923 CALLE BARCELONA; 136; CBC2021-0286; PermitPERMIT REPORT Ccityof Carlsbad Commercial Permit Print Date: 03/29/2022 Permit No: CBC2021-0286 Job Address: 1923 CALLE BARCELONA, # 136, CARLSBAD, CA 92009-8457 Status: Closed -Fina led Permit Type: BLDG-Commercial Work Class: Tenant Improvement Parcel#: 2550120400 Track#: Valuation: $130,228.00 Lot#: Occupancy Group: M Project#: #of Dwelling Units: Plan#: Bedrooms: Bathrooms: Construction Type:V-B Orig. Plan Check#: Plan Check #: Project Title: Description: ALLBIRDS: Tl (2800SF) (RETAIL TO RETAIL) Applicant: Property Owner: GORING AND STRAJA ARCHITECTS JIM GORING 729 HEINZ AVE, # STE 1 BERKELEY, CA 94710 T-C FORUM AT CARLSBAD LLC 4675 MACARTHUR CT, # 110 NEWPORT BEACH, CA 92660 FEE COMM RES & MULTI RES REMODELS -NON-STRUCTURAL BUILDING PLAN CHECK FEE (manual) BUILDING PLAN REVIEW-MINOR PROJECTS (LOE) BUILDING PLAN REVI EW -MINOR PROJECTS (PLN) CERTIFICATE OF OCCUPANCY SB1473 -GREEN BUILDING ST.ATE STANDARDS FEE STRONG MOTION -COMMERCIAL (SMIP) Total Fees: $2,166.62 Total Payments To Date: $2,166.62 Applied: 08/05/2021 Issued: 11/24/2021 Fina led Close Out: 03/29/2022 Inspector: Final Inspection: Contractor: TAlva 01/26/2022 MANAGEMENT RESOURCE SYSTEMS INC 1907 BAKER RD HIGH POINT, NC 27263-2007-GUILFORD (336) 861-1960 Balance Due: AMOUNT $1,341.00 $476.16 $194.00 $98.00 $15.00 $6.00 $36.46 $0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Sect ion 66020(a), and file the protest and any other required information with the City Manager for processing in accorda nce 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 sew er connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. 1635 Faraday Ave.nue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca .gov { City of Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 OSv P Ian Che<I< £e-028(,p Est. Value 0 PC De posit ---+---:;I;-+---,----· Date ---=-.'6/,____5/.....,....jj-_/ __ Suite: 136 APN: 255-012-04-00 ----Job Address 1923 Calle Barcelona Tenant Name: Allbirds ----------------Lot ti: Vear Built: _2_oo_4 ___ Occupancy:_M ___ _ mo rnc:1 Construction Type ... • v_-B ____ Fire Sprinklers: ves no A/C: yes no: BRIEF DESCRIPTION OF WORI<: D Addltlon/New: __________ New SF and Use, __________ New SF and Use, ___ Deck SF, Patio Cover SF (not including flatwork) ~ Tenant lmprovement:_2_,a_o_o ___ SF, Existing Use_M _____ Proposed Use _M _____ _ _____ SF, Existing Use Proposed Use _____ _ D Pool/Spa: _____ SF Additional Gas or Electrical Features? ___________ _ □ □n □□ □□ Solar: ___ KW, ___ Modules, ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No D Plumbing/Mechanical/Electrical Only: ------------------------- 0 Other: This permit is to be Issued In the name of the Property Owner as Owner-Builder, licensed contractor or Authorized Agent of the owner or contractor. TURN IN PAGE ONE OF THIS APPLICATION UPON SUBMITTING PLANS. PAGE TWO IS REQUIRED AT PERMtT ISSUANCE. PROPERTY OWNER APPLICANT O PROPERTY OWNERS AUTHORIZED AGENT Name: T-C Forum At Carlsbad, LLC Address: 730 Third Avenue MS: 730/12/02 Name: Jones Lang LaSalle Americas, Inc. Address: 1905 Calle Barcelona, Suite 200 APPLICANT 0 City: New Yori< State: NY Zip: 10017 City: Carlsbad State: CA Zlp:_9_2_00_9 __ _ Phone: Phone: 678-226-5301 ----------------Em a ii: Email: ann.nance@am.jll.com DESIGN PROFESSIONAL APPLICANT l!J CONTRACTOR BUSINESS APPLICANT 0 Name: Jim Goring I Goring & Straja Architects Name Ma~en+:R◄SCPif<=CcSi.d£ieme,) nc.,. Address: 729 Heinz Ave, Suite 1 Address: 1c;=,D1 84t;« p,J1. City: Berkeley State: CA Zip: 94710 City~ Ebiot: State: Ul, Zip: ;,.,,:;u,a, Phone: 510-848-0895 Phone:..aaJQ~~J,,..?2_ Email: jgoring@gasarchitects.com Email: hlAJa~.,-z'?. '4:)r'J Architect State License: _C_1_9_27_a ________ State Licens;_. _ __,,.....,.-=-_Bus.l.lcense:'13 20-2D24 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph : 760-602-2719 Fax: 760-602-8558 Page 1 of 2 Email: Building@carlsbadca.gov Rev. 08/20 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECI< NUMBER: C1&'::, 2(12/-(J2.'8/J:, A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. IF THE PERSON ~l(iNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: /herebyaf{irmunderpenaltyofperjwythatlam/icensedunderprovisionsofChapter9(commencingwithSection7000)ofDivision3 of the Business and Professions Code, and my license is in full force and ef feet. I alsoaffirm under penalty of pe1ju1yo11e of the following declarations (CHOOSE ONE): ,DI have anµ wlll maintain a certificate of consent to sell•lnsute for workers' compensation provided by Section 3700 or the Labor Code, for the performance of the work which this permit Is Issued. PolicyNo •. ____________________________________ _ •OR- ~I have and will maintain worker's compe11sat1on, as required by section 3700 of the Labor Code, for the performance or the work for which this permit Is Issued. My workers' compensation Insurance carrier and policy number are: lnsuranceCompany Name: I .AWN I~~ Policy No. 3tt\, &:z8 2, Expiration Da'fe: ~ 26 2,,2,. -OR- OcertlOcate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subJect to the workers' compensation Laws of Callfornla. WARNING: Failure to secure workers compensation coverage Is unlawful and shall subject an employer to crlmlrial penalties and clvll fines up to $100,000.00, In addition the to the cost of c01n11ensation, damages as provided for In Section 3706 of the Labor Code, l11terest and ~ttorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there Is a construction lending agency for the performance or the work this permit Is Issued (Sec. 3097 (I) Civil Code). lender'sNamo: ___________________ lender'sAddre5S: ___________________ _ CONTRACTOR CERT/FICA T/ON: I certify that I have read the application and state that the above information is correct and that the Information on the pf ans is accurate. I agree to comply with all City ordinances an State laws relating to building construction. -OR • (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: q I, as owner ol the property or my employees with wages as their sole compensation, will do th~ work and the structure is not Intended or offered for sale (Sec. 44, Business and Professions Code: The contractor's License Law does not apply to ,m owner of property who builds or Improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not Intended or offered for sale. If. however, the building or Improvement is sold Within one year of complellon, the owner-builder wlll have the burden of proving that he did not build or Improve for the purpose of sale). -OR-□~ as owner of the property, am excluslvely contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The t ontr.ictor's lJconS<! 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). -OR-□, am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 lor lhls reason: AND, D FORM 8-61 •owner Bullder Aclmowledgement and Verification Form" Is required for any permit issued to a property owner. ~y mv, 5lgnature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the lmJ>rovemenls covered by thls permit, I cannot legally sell a structure that I have built as an owner-builder If It has not been construtted in its entirety by licensed coil.tractors,/ understand that a copy of the applicable law; Section 7044 of the Buslnessand Prof ess/ons Code, Is available upon requestwllen this application Is submitted or at the following Web site: http: I /www.leginfo.ca. gov I ca/aw. html. OWNER CERTIFICATION: /certify that I have read the application and state that theaboveinformatlon 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. NAME (PRINT): ________ _ SIGN: _________ DATE: _____ _ Note: If the penon signing above Is en authorl1ed ogent for the property owner Include form B-62 signed by property owner. 1635 Faraday Ave Carlsbad,CA 92008 Ph: 760-602-2719 Fax: 760-602-85S8 2 REV. 07/21 PERMIT INSPECTION HISTORY for (CBC2021-0286) Permit Type: BLDG-Commercial Work Class: Tenant Improvement Status: Scheduled Date Closed -Finaled Actual Inspection Type Start Date BLDG-Electrical Final Tuesday, March 29, 2022 Application Date: 08/05/2021 Issue Date: 11 /24/2021 Owner: T-C FORUM AT CARLSBAD LLC Subdivision: CARLSBAD TCT#92-08 GREEN VALLEY Expiration Date: 06/13/2022 IVR Number: 35013 Address: 1923 CALLE BARCELONA, # 136 CARLSBAD, CA 92009-8457 Inspection No. Inspection Primary Inspector Status January 17, 2022: 1. (1 )-qty. additional front door entry universal ADA symbol/Label-Approved. 2. (2)-qty. required ADA restrooms square placard symbol on watt latch side-Approved. 3. Air balance report verified, filed, and Approved. 4. ADA dressing room height of bench seat verified Per architect of record-Approved. 5. Rest of work OK. 6. Final Inspection for structural framing, electrical, plumbing, and mechanical scope of interior tenant improvement work, per engineer's plans and detail specifications-Approved. Reinspection Inspection Yes Page 4 of 4 PERMIT INSPECTION HISTORY for (CBC2021-0286) Permit Type: BLDG-Commercial Work Class: Tenant Improvement Status: Scheduled Date Closed -Finaled Actual Inspection Type Start Date Checklist Item BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final Tuesday, March 29, 2022 Application Date: 08/05/2021 Issue Date: 11/24/2021 Owner: T-C FORUM AT CARLSBAD LLC Subdivision: CARLSBAD TCT#92-08 GREEN VALLEY Expiration Date: 06/13/2022 IVR Number: 35013 Address: 1923 CALLE BARCELONA, # 136 CARLSBAD, CA 92009-8457 Inspection No. COMMENTS Inspection Status January 17, 2022: Primary Inspector 1 . ( 1 )-qty. additional front door entry universal ADA symbol/Label-Approved. 2. (2)-qty. required ADA restrooms square placard symbol on wall latch side-Approved. 3. Air balance report verified, filed, and Approved. 4. ADA dressing room height of bench seat verified Per architect of record-Approved. 5. Rest of work OK. 6. Final Inspection for structural framing, electrical, plumbing, and mechanical scope of interior tenant improvement work, per engineer's plans and detail specifications-Approved. January 17, 2022: 1. (1 )-qty. additional front door entry universal ADA symbol/Label-Approved. 2. (2)-qty. required ADA restrooms square placard symbol on wall latch side-Approved. 3. Air balance report verified, filed, and Approved. 4. ADA dressing room height of bench seat verified Per architect of record-Approved. 5. Rest of work OK. 6. Final Inspection for structural framing, electrical, plumbing, and mechanical scope of interior tenant improvement work, per engineer's plans and detail specifications-Approved. January 17, 2022: 1. (1 )-qty. additional front door entry universal ADA symbol/Label-Approved. 2. (2)-qty. required ADA restrooms square placard symbol on wall latch side-Approved. 3. Air balance report verified, filed, and Approved. 4. ADA dressing room height of bench seat verified Per architect of record-Approved. 5. Rest of work OK. 6. Final Inspection for struciural framing, electrical, plumbing, and mechanical scope of interior tenant improvement work, per engineer's plans and detail specifications-Approved. Reinspection Inspection Passed Yes Yes Yes Page 3 of 4 PERMIT INSPECTION HISTORY for {CBC2021-0286) Permit Type: BLDG-Commercial Work Class: Tenant Improvement Application Date: 08/05/2021 Issue Date: 11/24/2021 Owner: T-C FORUM AT CARLSBAD LLC Subdivision: CARLSBAD TCT#92-08 GREEN VALLEY Status: Scheduled Date 01/14/2022 01/26/2022 Closed -Finaled Expiration Date: 06/13/2022 IVR Number: 35013 Address: 1923 CALLE BARCELONA, # 136 CARLSBAD, CA 92009-8457 Actual Inspection Type Start Date Inspection No. Inspection Status Primary Inspector Checklist Item COMMENTS BLDG-Building Deficiency December 13, 2021: drywall anchoring, Gypsum Board attachment -approved. BLDG-85 T-Bar, Ceiling 172458-2021 Passed Tony Alvarado Grids, Overhead Checklist Item COMMENTS BLDG-14 December 13, 2021: drywall anchoring, Frame-Steel-Bolting-Welding Gypsum Board attachment -approved. (Decks) 01/14/2022 BLDG-Final Inspection 174632-2022 Partial Pass Tony Alvarado Checklist Item COMMENTS BLDG-Building Deficiency 1. One front door entry ADA symbol. 2. ADA Square placard symbol on wall latch side-required. 3. Air balance report to be verified. 4. ADA dressing room height of bench seat need to be verified, not on plans, and architect needs to research and provide height of dressing room bench seat. 5. Rest of work OK. TCO approved for stocking shelves employee training, and furniture installation-approved. BLDG-Plumbing Final BLDG-Mechanical Final 1. One front door entry ADA symbol. 2. ADA Square placard symbol on wall latch side-required. 3. Air balance report to be verified. 4. ADA dressing room height of bench seat need to be verified, not on plans, and architect needs to research and provide height of dressing room bench seat. 5. Rest of work OK. TCO approved for stocking shelves employee training, and furniture installation-approved. BLDG-Structural Final BLDG-Electrical Final 01/26/2022 BLDG-Final Inspection 175376-2022 Passed Tony Alvarado Reinspection Inspection Passed Yes Complete Passed Yes Reinspectlon Incomplete Passed Yes Yes Yes Yes Yes Complete Tuesday, March 29, 2022 Page 2 of 4 Building Permit Inspection History Finaled {city of Carlsbad Permit Type: Work Class: Status: Scheduled Date 12/01/2021 12/09/2021 12/10/2021 12/13/2021 PERMIT INSPECTION HISTORY for (CBC2021-0286) BLDG-Commercial Application Date: 08/05/2021 Owner: T-C FORUM AT CARLSBAD LLC Subdivision: CARLSBAD TCT#92-08 GREEN VALLEY Tenant Improvement Issue Date: 11/24/2021 Closed -Finaled Expiration Date: IVR Number: 06/13/2022 35013 Address: 1923 CALLE BARCELONA, # 136 CARLSBAD, CA 92009-8457 Actual Start Date 12/01/2021 12/09/2021 12/10/2021 12/13/2021 Inspection Type Inspection No. Inspection Primary Inspector Status BLDG-84 Rough 171630-2021 Passed Tony Alvarado Combo(14,24,34,44) Checklist Item BLDG-14 Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-44 Rough-Ducts-Dampers COMMENTS December 1, 2021: 1. Interior tenant improvement, rough frame combination inspection (MEPS), for walls (only) -Partial pass. 2. OK to cover walls. December 1, 2021: 1. Interior tenant improvement, rough frame combination inspection (MEPS), for walls (only} -Partial pass. 2. OK to cover walls. December 1, 2021: 1. Interior tenant improvement, rough frame combination inspection (MEPS), for walls (only) -Partial pass. 2. OK to cover walls. December 1, 2021: 1. Interior tenant improvement, rough frame combination inspection (MEPS), for walls (only) -Partial pass. 2. OK to cover walls. BLDG-85 T-Bar, Ceiling 172337-2021 Failed Jason Paslut Grids, Overhead Checklist Item COMMENTS BLDG-Building Deficiency BLDG-14 Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout BLDG-34 Rough Electrical BLDG-44 Rough-Ducts-Dampers BLDG-14 172457-2021 Partial Pass Tim Kersch Frame/Steel/Bolting/We lding (Decks) Checklist Item COMMENTS BLDG-Building Deficiency In progress. BLDG-17 Interior 172562-2021 Passed Tony Alvarado Lath/Drywall Reinspection Inspection Complete Passed Yes Yes Yes Yes Reinspection Incomplete Passed No No No No No Reinspection Incomplete Passed Yes Complete Tuesday, March 29, 2022 Page 1 of 4 ..1.-+----=r-ct,C,:ZO ZJ-01.-~{f 1_..------,· 1123 CA-U.-E:. ~ . ~~ AIR-SOUND-HYDRONIC PROFESSIONAL-5 HVAC Test and Balance Report PROJECT: CONTRACTOR: ARCHITECT: ENGINEER: Allbirds The Forum at Carlsbad Carlsbad, CA Prospec Goring & Straja Beldin Consulting REPORT CERTIFICATION NO: 41241 REPORT CERTIFICATION DATE: January 18, 2022 REVIEWED AND APPROVED BY: Michael Conboy ICB / TABB Certified Contractor 457 E. Arrow Hwy, Ste. D, Azusa, CA 91702 TEL: 626-915-8117 FAX: 626-915-8112 E-MAIL: associatcdaLrbalance@gmail.com Anoclated Air Bal:ince \l,c~"'I>. ,~ #0728 TESTING, ADJUSTING ANO BAU .. CING BUREAU THE PROFESSIONAL!S CHOICI:,. 1S0/IEC 17024 Personnel Certification P~ogran tionaC Certificatto -. e y11 a rz 210 l 'Ylt · Qrq~ Sheet :Metal and ..'Air Conditioning Jn ditstry Tfns certifies tliat )lssociated .}lir <Ba[ance Jfas successfu{{y comp fetea tfie requirements for 'T)ICWB Contractor . ; ,'-i(I" J' :' f! \I f.'ct tWhi. ~\,1(,i/llhi't ,'CJ, 't1;1) 'Novem6er 19, 2020 _p.,-A~ .. di.·-:-~,,.._ 7 r. -;,,,; •. ----~;,- I ~:-h .t ~ \ ••\., I r::,,;..•._, ,, ,-------~ ,~· ... \;~~ j-" r.--·: ·._---~ ' .. ,· .... ~ ~ ~ . ~-. ~: -t '! .. :;.·.' f._;:· , ·:(.-. • • :.,>'!.' ~.,:.-,,.) .. ~-• ..:.u.at• 1H.' ... I Tu,_ --2-k ~(2-. G '-..__ - Allbirds -The Forum at Carlsbad Table of Contents System Project Summary RTU-1 Supply Diffuser_Sheet RTU-2 Supply Diffuser_Sheet Exhaust (diffusers) Page Number 1 2 3 4 Project Summary Job Name: Allbirds -Carlsbad (A) EF-2 deleted from project 03+032 Page 1 Date: 1/14/2022 Technician: W. Scrimmager Diffuser And Grille Test Data Job Name: Allbirds -Carlsbad System: RTU-1 Room Number Size :SUPPIY Sales 1 48X3 Sales 2 48X3 Sales 3 48X3 Sales 4 48X3 Sales 5 48X3 Sales 6 48X3 Sales 7 48X3 Sales 8 48X3 Sales 9 48X3 Sales 10 48X3 Return Sales R-1 48X3 Sales R-2 48X3 Sales R-3 48X3 Sales R-4 24X3 Sales R-5 24X3 Sales R-6 24X24 Sales R-7 48X3 Remarks: 03+032 Type LD LD LO LO LO LO LD LO LO LO LO LD LO LO LO RG LO Ak 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Page 2 Date: 1/14/2022 Technician: W. Scrimmager Design Actual FPM CFM FPM CFM • 220 * 210 • 220 • 211 * 220 • 200 • 220 * 210 • 220 • 211 • 220 • 209 • 220 . 214 • 220 • 214 . 220 • 219 . 220 • 214 Total 2,200 2,112 * 220 * 206 • 220 * 200 • 220 * 209 • 120 • 110 . 120 • 113 • 810 * 781 • 220 * 211 Total 1,930 1,830 OSA 270 -282 Total 270 282 Diffuser And Grille Test Data Job Name: Allbirds -Carlsbad System: RTU-2 Room Number Size supply Sales 1 48X3 Sales 2 48X3 Sales 3 48X3 Sales 4 48X3 Office 5 10X10 Back 6 18XB Back 7 18XB Back 8 18X8 Back 9 18X8 Return Sales R-1 48X3 Sales R-2 48X3 Sales R-3 48X3 Sales R-4 24X3 Sales R-5 24X3 Office R-6 24X24 Back R-7 48X3 Remarks: 03+032 Type LD LO LD LD CD SW SW SW SW LO LO LO LO LO CD LO Ak 1.00 1.00 1.00 1.00 1.00 0.75 0.75 0.75 0.75 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Page 3 Date: 1/14/2022 Technician: W . Scrimmager Design Actual FPM CFM FPM CFM * 220 * 214 * 220 * 212 * 220 * 203 * 220 ., 211 * 80 * 77 413 310 411 308 413 310 404 303 413 310 399 299 413 310 391 293 Total 2,200 2,121 * 220 * 209 .. 220 * 204 * 220 * 212 * 220 * 204 * 220 * 209 * 80 * 75 * 750 * 736 Total 1,930 1,849 OSA 270 -272 Total 270 272 Diffuser And Grille Test Data Job Name: Allbirds -Carlsbad System: Exhaust Room Number Size Exhaust EF-1 Restroom 1 8X8 Remarks: (A) Direct drive unit no access to motor. 03+032 Type Ak CEF 1.00 Date: 1/14/2022 Technician: W. Scrimmager Design Actual FPM CFM FPM CFM * 100 * 101 Total 100 (A) 101 Page 4 + + ------a ;:: ~ ~ .. ~ 01 ~ EID c'i ~0 '{!:. ~t "'I) E!) s;: z e G) EID ;o 0 e c:: z 0 ~ ·I .,, e i § E!)~ ef ® ;fl EID : ~ E!) J EID EID , ~ ~ ~ @ID l'1 ,0 ' ~E!> ~ m E!) + ~ , It) + ~ ~ ~ EID @) . @) EID•!!~ @) + ~ + ( ~' ~ + -0------+ 0000% f ;; !n1; 1u; ii ~ u ~ nm 11 Pi 0 • ;i• • J • 1f Ji 1U} 1!! !! l ai 11 1eq I i ~ ~ <,) If d rUtf •.iM ii r II m ·» • I l z -< m 11 ;~I ,! H m ,, A• •• i l • 11 0 ~ i X' •x• I 'ff' •• 1 ~ t 11a et ~ , ~· I ·U . • I• I z 11 i ii :a1• hsl .1 ., 0 z 1 lh 9 1 --i I ' 1 ·1 II ~ ( 'I 0 m rri I 1:s ~ (/) 1 : n1, ii~: 1i : !1 (f) , d ~ i 1:j!= i!• 11 I J • I i D' I· 'ii I , 1 · •' ~I "' HH! 1: aJibwb, •p N ' i €).! 0 -. 1r-() Id ~!; •c THE FORUM AT CARLSBAD ~-; " ' !111 SPACE #136. BLDG-3 ·r i '. 1923 CALLE BARCELONA !z CARLSBADO, CA 92037 SAN DIEGO REGJONA1 HAZARDOUS MATERtALS QUESTIONNAIRE l'll!Jl~]lll'~'ICYCLl,$$~f.,..• 11"1; Ofmf IJ$t; l)lfl;Y ~'°·-----------~---! "V-NC:Wf:<:1<11 ______________ , ~TE J I OCotMPe-... ..,_. I a~,.., .. &iii {.... ClCIIIAAP~• -, --tiO-~-______ "" ___ ,.., ....... ~--~-..-Coum'._ -CDIJltr¥.+M) »(;I) ,p'..,..,., ¾4- ~ 11,:m;_T.'r.,% o.,..,,,,,. .... ~,, L>,ego/ A--.ll'lilCICIOl!ll:{ ___ ,,,_~,_~• aa P'WI vo•it""'""""IINIII,_ -l'lllll'MIINe!Y □ □ □ □ □ □ □ □ □ □ ENCi NA WASTEWATER AUTHORITY INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY 7/26/2021 Date: 6200 Avenida Encinas, Carlsbad, CA 92011 Phone: 760-438-3941 Fax: 760-476-9852 SourceControl@encinajpa.com ------. Allbirds Business Name: -------------------- Street Address: 1923 Calle Barcelona, Space #136 Email Address: tkurnadi@gasarchitects.com PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT : (ON REVERSE SIDE CHECK TYPE OF BUSINESS) Iv' I Check all below that are present at your facility: Acid Cleaning D Food Processing D Metal Powders Forming Assembly D Glass Manufacturing D Nutritional SupplementNitamin Automotive Repair D Industrial Laundry D Manufacturing Battery Manufacturing D Ink Manufacturing D Painting/Finishing Biofuel Manufacturing D Laboratory D Paint Manufacturing Biotech Laboratory D Machining/Milling D Personal Care Products Bulk Chemical Storage D Membrane manufacturing D Manufacturing Car Wash D (i.e. waterfilter membranes) D Pesticide Manufacturing/ Packaging Chemical Manufacturing D Metal Casting/Forming D Pharmaceutical Manufacturing Chemical Purification D Metal Fabrication D (including precursors) D Dental Offices D Metal Finishing D Porcelain Enameling D Dental Schools D Electroplating D Power Generation D Dental Clinics D Electroless Plating D Print Shop D Dry Cleaning D Anodizing D Research and Development □ Electrical Component D Coating (i.e. phosphating) D Rubber Manufacturing □ Manufacturing D Chemical Etching/Milling D Semiconductor Manufacturing □ Fertilizer Manufacturing D Printed Circuit Board D Soap/Detergent Manufacturing □ Film/ X-ra y Processing D Manufacturing D Waste TreatmenUStorage New Business? Yes[:]NoO SIC Code(s) if known: 5661 Date operation began/will begin: 211712022 Tenant Improvement? Yes [:]No□ If yes, briefly describe improvement : non-structural interior remodeling, apply exterior cladding to existing exterior finishes. Description of operations generating wastewater (discharged to sewer, hauled or evaporated): _________ _ Estimated volume of industrial wastewater to be discharged (gal/ day) : ____________________ _ List hazardous wastes generated (type/volume): ___________________________ _ Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? YesODate: _____ No~ Page 1 of 2 ENCINA WASTEWATER AUTHORITY INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY 6200 Avenida Encinas, Carlsbad, CA 92011 Phone: 760-438-3941 Fax: 760-476-9852 SourceControl@encinajpa.com The commercial enterprises listed below are a partial listing of businesses that are exempt from 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. □ Automobile Detailer s □ Barber/Beauty Shops □ Business/Sales Offices □ Cleaning Services □ CarpeUUpholstery □ Childcare Facilities □ Churches □ Community Centers □ Consulting Services □ Contractors □ Counseling Services □ Educational Services (no auto repair/film □ Financial Institutions/Services □ Fitness Centers □ Gas Stations (no car wash/auto repair) □ Grocery Stores (no film developing) □ Residential based Businesses developing) □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ [!] □ Hotels/ Motels (no laundry) Laundromats Libraries Medical Offices (no x-ray developing) Mortuaries Museums Nail Salons Nursing Homes Office Buildings (no process flow) Optical Services Pest Control Services (no pesticide repackaging for sale) Pet Boarding/Grooming Facilities Postal Services (no car wash/auto repair) Public Storage Facilities Restaurants/Bars Retail/Wholesale Stores (no autorepair/film developing) Theaters (Movie/Live) CERTIFICATION STATEMENT I certify that the iriformation above is true and correct to the best of my knowledge. Theresia Kurnadi 7/26/2021 Signature :. _____________ _ Print Name: ____________ _ Date: ____ _ Elias Abu Shanab Project Manager Facility Contact: __________ _ Title: ______________ _ ENCINA WASTEWATER AUTHORITY 6200AVENIDAENCINAS,CARLSBAD,CA Phone: 760-438-3941 Fax:760-476-9852 SourceControl@encinajpa.com Page 2 of 2