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Home My WebLink About1475 MCCAULEY LN; ; CBC2023-0157; PermitBuilding Permit Finaled Commercial Permit Print Date: 10/18/2023 Job Address: Permit Type: Parcel#: Valuation: Occupancy Group: #of Dwelling Units: Bedrooms: Bathrooms: Occupant Load: Code Edition: Sprinkled: Project Title: 1475 MCCAULEY LN, CARLSBAD, CA 92008 BLDG-Commercial Work Class: Tenant Improvement Track#: $5,000.00 lot#: Project#: Plan#: Construction Type: Orig. Plan Check#: Plan Check#: Description: BOZER: REMOVE AND REPLACE PARKING LOT LIGHTING (3 POLES & 6 LUMINARIES) Applicant: JIM BOZER 2790 FOOTHILL DR VISTA, CA 92084-6506 (760) 518-3473 FEE BUILDING PLAN CHECK Property Owner: H ANDA JEREMY HART 265 VENETIA WAY OCEANSIDE, CA 92057-7656 (760) 450-4781 BUILDING PLAN REVIEW-MINOR PROJECTS (LOE) BUILDING PLAN REVIEW-MINOR PROJECTS (PLN) CERTIFICATE OF OCCUPANCY ELEC: OTHER COMPLEX ELECTRICAL SB1473 -GREEN BUILDING STATE STANDARDS FEE STRONG MOTION -COMMERCIAL (SMIP) Total Fees: $1,042.10 Total Payments To Date: $1,042.10 Permit No: Status: Ccityof Carlsbad CBC2023-0157 Closed -Finaled Applied: 06/02/2023 Issued: 09/08/2023 Finaled Close Out: 10/18/2023 Final Inspection: 09/19/2023 INSPECTOR: Alvarado, Tony Balance Due: AMOUNT $288.60 $194.00 $98.00 $16.00 $444.00 $1.00 $0.50 $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 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 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov / \._ City of Carlsbad Job Address 14 75 McCauley Lane COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check CRC 20Z3 -D\S 7 Est. Value .5 000 PC Deposit Date 268,bO Suite:. ____ _.APN: ___________ _ Tenant Name#: Lot#: Year Built: 1988 ·------------------------------- Year Built: 1988 Occupancy:_A_-3 __ Construction Type:5-B Fire sprinklersOEs(!)No A/C:0YESQNo BRIEF DESCRIPTION OF WORK: Remove and replace parking lot lighting (3 poles and 6 luminaires). 0 Addition/New: ____________ New SF and Use, __________ New SF and Use _______ SF Deck, SF Patio Cover, SF Other (Specify) ___ _ OTenant Improvement: _____ SF, _____ SF, Existing Use: _______ Proposed Use: ______ _ Existing Use: Proposed Use: ______ _ D Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _ 0 Solar: KW, ___ Modules, Mounted: 0Roof 0Ground 0 Reroof: ____________________________________ _ ~ Plumbing/Mechanical/Electrical Replace existing parking lot light poles and luminaires). Oother: ____________________________________ _ PRIMARY APPLICANT Name:Jim Bozer Address:2790 Foothill Drive City:Vista Phone: 760-518-34 73 Email}m.bozer@cox.net DESIGN PROFESSIONAL Name: Mario Perez State:_C_A __ .Zip: 92084 PROPERTY OWNER Name:Jeremy Hart Address:265 Venetia Way City:Oceanside Phone: 760-450-4 781 Email: jahart1@gmail,com CONTRACTOR OF RECORD State: CA Zip:._9_2_05_7 __ _ Business Name: N/A (Owner Builder) Address: 784 Barker Avenue Address: -------------------City: Hayward State: CA Zip:_9_45_4_1 ___ City: ________ State: ___ .Zip: ______ _ Phone:619-213-4739 Phone: ___________________ _ Email:Perez.Mario.a.1982@gmail.com Email: --------------------Architect State License: E22246 CSLB License#: Class: -------------- Carlsbad Business License# (Required): _______ _ APPLICANT CERT/FICA TION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. /agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT}: Jim Bazer SIGN: Jim Bazer DATE: ------- 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Fax: 760-602-8558 Email: Build1ng@carlsbadca.gov REV. 07/21 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMIT CAN BE ISSUlD TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. lf-THl. PU:· SIGNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR yo PERMIT ISSUANCE. (OPTION A):_LICE_NSEDCONTRACTOR DECLARATION. I hereby affirm under penalty of perjury that I om licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ef feet. I also affirm under penalty of perjury one of the following declarations(CHOOSE ONE): D1 have and will maintain 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 this permit is issued. PolicyNo. ________________________________________ _ -OR- D1 have and will maintain worker's compensation, as required by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: lnsuranceCompany Name: _____________________ _ Policy No. ____________________________ Expiration Date: ________________ _ -OR- Ocertificate of Exemption: I certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. WARNING: Failure to secure workers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. CON_SIRUCTIONLtNDINC, AG_EN~C'I, If ANY I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). lender's Name: _____________________ l.ender's Address: _____________________ _ CONTRACTOR CERT/FICA T/ON: I certify that I have read the application and state that the above information is correct and that theinformationon the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT}: _________ SIGNATURE: _________ DATE: _____ _ Note: If the person signing above Is an authorized agent for the contractor provide a letter of authorization on contractor letterhead. -OR (OPTION B): O\N_NER-BUILDfRDECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: r.1 I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. ~44, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work 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 completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). -OR- D1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). -OR-01 am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, [!]FORM B-6.1 "OWner Builder Acknowledgement and Verification Form" is rC'quired for any permit issued to a property owner By my signature below I acknowledge thnt, except for my personal residence in which I must have re,;ided for at lec1st one year prior to completion of the improvements covered by this permit, I cannot leg;:illy sell a structure that l h.:ive built ;:is an owner-builder if It ha.-, not been constructed in 1ts f'ntirety by licensed contractors./ understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submftted orat the following Web site: http:/ lwww.leginfo.ca.gov/calaw.html. OWNER CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on theplansisaccurate. /agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT}: _J_er_e_m_y_H_a_rt _____ _ SIGN: Jeremy Hart DATE: ______ _ Note: If the person signing above is an authorized agent for the property owner include form 8-62 signed by property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Fax: 760-602-8558 2 REV. 07/21 Ccityof Carlsbad OWNERS AUTHORIZED AGENT FORM 8-62 Development Services Building Division 1635 Faraday Avenue 442-339-2719 www.carlsbadca.gov OWNER'SAUTHORIZED AGENT FORM Only a property owner~ contractor or their authorized agent may submit plans and applications for building permits. To authorize a third-party agent to sign for a building permit, the owner's third party agent must bring this signed form, which identifies the agent and the owner who s/he is representing, and for what jobs s/he may obtain permits. The form must be completed in its entirety to be accepted by the City for each separate permit application. Note: The following Owner's Authorized Agent form is required to be completed by the property owner only when designating an agent to apply far a construction permit on his/her behalf. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Property Owner Acknowledgement, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Replace parking lot light poles and luminaires. Scope of Construction Project (or Description of Work): ___________________ _ 1735 McCauley Lane, Carlsbad, CA 92008 Project Location or Address: _____________________________ _ Jim Bazer 760-518-3473 Name of Authorized Agent: __________________ Tel No. _________ _ AddressofAuthorizedAgent:279O Foothill Drive, Vista, CA 92084 I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. I Property Owner's Signature: _"'-_;;;J.sL::;.=..::~~L_/.:..!:::::lo'.'. ________ Date: _,_(_z_,_(_z_? __ 1 Building Permit Inspection History Finaled {city of Carlsbad Permit Type: Work Class: Status: Scheduled Date 09/14/2023 PERMIT INSPECTION HISTORY for (CBC2023-0157) BLDG-Commercial Application Date: 06/02/2023 Owner: HAND A Tenant Improvement Issue Date: 09/08/2023 Subdivision: Closed -Finaled Expiration Date: 03/18/2024 Address: 1475 MCCAULEY LN IVR Number: 49696 CARLSBAD, CA 92008 Actual Inspection Type Start Date Inspection No. Inspection Status Primary Inspector Reinspection Inspection 09/14/2023 BLDG-11 Foundation/FtgfPlers (Rebar) Checklist Item 224065-2023 Partial Pass Tony Alvarado COMMENTS BLDG-Building Deficiency September 14, 2023: (partial pass). BLDG-12 Steel/Bond Beam Checklist Item 1. Footing foundation, steel reinforcement per structural engineer, plans and detail specifications: as-built parking lot lighting pole bases-site conditions "do not reflect" structural engineers, vertical steel, rebar reinforcement. Construction As-built site conditions, installed #4 steel reinforcement rebar, structural engineered plans specifications require #5 steel reinforcement rebar. 2. The rest of footing/parking lot lighting bases. horizontal, steel, rebar, reinforcement, grounding, copper, wire, specifications, and electrical conduit, scope of work-OK. 224120-2023 Passed Tony Alvarado COMMENTS BLDG-Building Deficiency September 14, 2023: 2nd. inspection-approved. BLDG-31 Underground/Conduit. Wiring 1. Footing foundation, steel reinforcement per structural engineer's, plans and detail specifications: as-built parking lot lighting pole bases-site conditions "NOW reflect" structural engineers, vertical steel, rebar reinforcement. Construction As-built site conditions, installed New #5 steel reinforcement rebar, per structural engineered plans specifications-Approved. 2. The rest of footing/parking lot lighting bases, horizontal, steel, rebar, reinforcement, grounding, copper. wire, specifications, and electrical conduit, scope of work per plan-OK. 224122-2023 Passed Tony Alvarado Relnspectlon Incomplete Passed Yes Complete Passed Yes Complete Wednesday, October 18, 2023 Page 1 of 5 PERMIT INSPECTION HISTORY for (CBC2023-0157) Permit Type: BLDG-Commercial Work Class: Tenant Improvement Status: Closed -Finaled Application Date: 06/02/2023 Issue Date: 09/08/2023 Expiration Date: 03/18/2024 IVR Number: 49696 Owner: H AND A Subdivision: Address: 1475 MCCAULEY LN CARLSBAD, CA 92008 Scheduled Date Actual Inspection Type Start Date Inspection No. Inspection Status Primary Inspector Reinspection Inspection Checklist Item BLDG-Building Deficiency COMMENTS September 14, 2023: 2nd. inspection-approved. 1. Footing foundation, steel reinforcement per structural engineer's, plans and detail specifications: as-built parking lot lighting pole bases-site conditions "NOW reflect" structural engineers, vertical steel, rebar reinforcement. Construction As-built site conditions, installed New #5 steel reinforcement rebar, per structural engineered plans specifications-Approved. 2. The rest of footing/parking lot lighting bases, horizontal, steel, rebar, reinforcement, grounding, copper, wire, specifications, and electrical conduit, scope of work per plan-OK. BLDG-81 Underground 223884-2023 Partial Pass Tony Alvarado Combo(11, 12,21,31) Checklist Item BLDG-11 Foundation-Ftg-Piers (Rebar) BLDG-12 Steel-Bond Beam BLDG-21 Underground-Underfloor Plumbing BLDG-31 Underground-Conduit Wiring COMMENTS BLDG-SW-Inspection 224121-2023 Wednesday, October 18, 2023 Partial Pass Tony Alvarado Passed Yes Reinspection Incomplete Passed Yes Yes Yes Yes Reinspection Incomplete Page 2 of 5 Permit Type: Work Class: Status: Scheduled Date 09/18/2023 PERMIT INSPECTION HISTORY for (CBC2023-0157) BLDG-Commercial Application Date: 06/02/2023 Owner: HAND A Tenant Improvement Issue Date: 09/08/2023 Subdivision: Closed -Finaled Expiration Date: 03/18/2024 Address: 1475 MCCAULEY LN Actual Start Date 09/18/2023 49696 CARLSBAD, CA 92008 IVR Number: Inspection Type Inspection No. Inspection Primary Inspector Status Checklist Item COMMENTS Are inactives slopes properly stabilized? Are areas flatter than 3:1 covered or protected? Are sediment controls properly maintained? Are erosion control BMPs functioning properly? Are natural areas protected from erosion? Is the entrance stabilized to prevent tracking? Have sediments been tracked on to the street? Have materials collected around the storm drains? Has sediment accumulated on impervious surfaces? Are dumpsters and trash receptacles covered? Has trash/debris accumulated throughout the site? Are stockpiles and spoils protected from runoff? Are all storage areas clean and maintained? Were spills/leaks observed during the inspection? Were there any discharges during the inspection? Are BMPs stockpiled for emergency deployment? BLDG-11 224091-2023 Passed Tony Alvarado Foundation/Ftg/Piers (Rebar) Checklist Item BLDG-Building Deficiency COMMENTS September 18, 2023: (3)-footings pass). 1. Footing foundation, steel reinforcement per structural engineer's plans and detail specifications: as-built parking lot lighting (3) qty., pole bases-site conditions "NOW reflect" structural engineer's vertical steel, rebar reinforcement. 2. The rest of footing/parking lot lighting bases, horizontal, steel, rebar, reinforcement, grounding, copper, wire, specifications, and electrical conduit, scope of work-OK. Reinspection Passed Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Passed Yes Wednesday, October 18, 2023 Inspection Complete Page 3 of 5 PERMIT INSPECTION HISTORY for (CBC2023-0157) Permit Type: BLDG-Commercial Work Class: Tenant Improvement Status: Closed -Finaled Application Date: 06/02/2023 Owner: H AND A Issue Date: 09/08/2023 Subdivision: Expiration Date: 03/18/2024 Address: 1475 MCCAULEY LN CARLSBAD, CA 92008 IVR Number: 49696 Scheduled Actual Inspection Type Inspection No. Date Start Date Inspection Primary Inspector Reinspection Inspection BLDG-81 Underground 224092-2023 Combo(11, 12,21,31) Checklist Item BLDG-11 Foundation-Ftg-Piers (Rebar) BLDG-31 Underground-Conduit Wiring COMMENTS Status Passed Tony Alvarado 09/19/2023 09/19/2023 BLDG-Final Inspection 224346-2023 Passed Tony Alvarado Checklist Item BLDG-Structural Final BLDG-Electrical Final BLDG-SW-Inspection Wednesday, October 18, 2023 COMMENTS September 18, 2023: (3)-footings pass). 1. Footing foundation, steel reinforcement per structural engineer's plans and detail specifications: as-built parking lot lighting (3) qty., pole bases-site conditions "NOW reflect" structural engineer's vertical steel, rebar reinforcement. 2. The rest of footing/parking lot lighting bases, horizontal, steel, rebar, reinforcement, grounding, copper, wire, specifications, and dedicated electrical conduit, electrical timer and identification breaker labeled at main panel, scope of work-OK. 224467-2023 Passed Tony Alvarado Complete Passed Yes Yes Complete Passed Yes Yes Complete Page 4 of 5 PERMIT INSPECTION HISTORY for {CBC2023-0157) Permit Type: Work Class: Status: Scheduled Date BLDG-Commercial Application Date: 06/02/2023 Tenant Improvement Issue Date: Closed -Finaled Expiration Date: IVR Number: Actual Inspection Type Start Date Inspection No. Checklist Item Are inactives slopes properly stabilized? Are areas flatter than 3:1 covered or protected? Are sediment controls properly maintained? Are erosion control BMPs functioning properly? Are natural areas protected from erosion? ls the entrance stabilized to prevent tracking? Have sediments been tracked on to the street? Have materials collected around the storm drains? Has sediment accumulated on impervious surtaces? Are dumpsters and trash receptacles covered? Has trash/debris accumulated throughout the site? Are all storage areas clean and maintained? Were spills/leaks observed during the inspection? Were there any discharges during the inspection? Are BMPs stockpiled for emergency deployment? COMMENTS 09/08/2023 03/18/2024 49696 Inspection Status Wednesday, October 18, 2023 Owner: HAND A Subdivision: Address: 1475 MCCAULEY LN CARLSBAD, CA 92008 Primary Inspector Reinspection Inspection Passed Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Page 5of5 Business Name Hazardous Materials Questionnaire County of San Diego, Department of Environmental Health and Quality PO Box 129261, San Diego, CA 92112-9261 (858) 505-6700 (800) 253-9933 WWW •.cir ,1.,1,q urg Pacific View Cong. of JWs Business Contact Jim Bozer Project Address 1735 McCauley Lane Applicant Jim Bazer City Applicant E-Mail jim.bozer@cox.net State Record ID #: Not in System Plan Check#: DEH2023-HHMBP--013015 Balance Due. $87.00 Telephone# Zip Code 92008 Applicant Telephone# Plan File# APN# 156 220 35 00 The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT-HAZARDOUS METERIALS DIYISIQN: OCCUPANCY CLASSlflCATIQN: (Not required for projects within the City of San Diego.) Indicate by selecting the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are selected, Applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: A-3 Facility's Square Footage (including proposed project): 3872 □ Explosive or Blasting Agents □ Organic Peroxides □ Water Reactives □ Corrosives □ Compressed Gases □ Oxidizers □ Cryogenics □ Other Health Hazards □ Flammable/Combustible Liquids □ Pyrophorics □ Highly Toxic or Toxic Materials □ None of These □ Flammable Solids □ Unstable Reactives □ Radioactives PART 11; SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION (HMO): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, in person at 5500 Overland Ave., Suite 110, San Diego, CA 92123, or by phone at (858) 505-6700 prior to issuance of a building permit. FEES ARE REQUIRED. Project Completion Date: 9/1812023 YES 1. □ 2. □ 3. □ 4. □ 5. □ 6. □ 7. □ 8. □ NO " " " □ " " " " Is your business listed on the reverse side of this form? (check all that apply). Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business store or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet? Will your business handle carcinogens or reproductive toxins in any quantity? Will your business use an existing, or install an underground storage tank? Will your business store or handle Regulated Substances (CalARP)? Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? Will your business store petroleum in tanks or containers at your facility with a total storage capacity equal to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). □ □ □ CalARP Exempt CalARP Required CalARP Complete Review Date: PART 111· SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): If the answer to Question #1 is 'Yes' and the answer to Question #2 is 'No', the applicant must contact the APCD prior to the issuance of a building or demolition permit. If any answer to Questions #3, #4, or #5 is 'Yes', the applicant must contact the APCD prior to the issuance of a building or demolition permit. If the answer to Question #3 or #4 is 'Yes', the applicant may need to submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation (some residential projects may be exempt from the notification requirements). Contact the APCD at 10124 Old Grove Road, San Diego, CA 92131 or telephone (858) 586-2600 for more information. YES NO 1. □ [8l 2. □ □ 3. □ □ 4. □ ~ Will any existing building materials be disturbed as part of this project? (If the answer is 'Yes', an asbestos survey may be required.) Has a survey been performed to determine the presence of asbestos containing materials? Will the project involve handling or disturbance of any asbestos containing materials? 5. 6. □ □ " □ Will the project involve the removal of any load supporting structural member? Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet al http l/www.sdapcd org/lnfo/t;icts/perm1ts pdf (ANSWER ONLY IF QUESTION 5 IS 'YES') Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)? Search the California School Directory at http·//'=w.cde ca.gov/re/sci/ for public and private schools or contact the appropriate school district. Briefly describe business activities Meetings for worship Briefly describe proposed project: Replace parking lot light poles and luminaires. I declare under penalty of perjury that to the best of my knowledge and belief, the responses made herein are true and correct. ~; Fees Acknowledged: ~ Jim Bazer Name of Owner or Authorized Agent FIRE DEPARTMENT OCCUPANCY CLASSIFICATION· EXEMPT OR NO FURTHER INFORMATION REQUIRED COUNTY-HMO* M. Marll'lez SIG~lf.TL;~E 2 '28/2023 c.lloH APCD FOR OFFICIAL USE ONLY RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY COUNTY-HMO APCD 2/23/2023 Date DATE· _________ _ RELEASED FOR OCCUPANCY COUNTY-HMO APCD *A stamp in this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply. OEHQ_HMD_HMBP _Questionnaire v 2.0 (812021) Printed on: 2128/2023 @ 2:00 PM