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~
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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
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~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
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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~
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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
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