HomeMy WebLinkAbout1525 FARADAY AVE; 350; CBC2020-0093; PermitBuilding Permit Finaled
Commercial Permit
Print Date: 07/30/2020
Job Address:
Permit Type:
Parcel#:
Valuation:
Occupancy Group:
#of Dwelling Units:
Bedrooms:
Bathrooms:
Project Title:
1525 FARADAY AVE, # 350, CARLSBAD, CA 92008-7372
BLDG-Commercial Work Class:
2121302700 Track#:
$5,348.65 Lot#:
Project#:
Plan#:
Construction Type:
Orig. Plan Check #:
Plan Check#:
Tenant Improvement
{'city of
Carlsbad
Permit No: CBC2020-0093
Status:
Applied:
Issued:
Finaled Close Out:
Inspector:
Final Inspection:
Closed -Finaled
03/05/2020
03/28/2020
CRenf
07/30/2020
Description: BRIXMOR REALTY GROUP: 115 SF TENANT IMPROVEMENT, OFFICE TO OFFICE (ADD 1 INTERIOR OFFICE)
Applicant:
JENNIFER KNOTT
4631 VIEWRIDGE AVE
SAN DIEGO, CA 92123-1689
(858) 794-3222 x311
FEE
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
Property Owner:
OWNER EMERALD LAKE CORPORATE CENTRE
LP
1525 FARADAY AVE, # 100
CARLSBAD, CA 92008
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
SB1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-COMMERCIAL
Total Fees: $178.62 Total Payments To Date: $178.62 Balance Due:
AMOUNT
$79.48
$55.64
$41.00
$1.00
$1.50
$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 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
{cicyof
Carlsbad
Job Address 1525 Faraday Ave.
Tenant Name: Brixmor Realty Group
COMMERCIAL
BUILDING PERMIT
APPLICATION
B-2
Suite:
Plan Check (\;;( ·2o LO -()093
Est. Value 1J~3if€. (£-
PC Deposit --•~._)'-=5-~_b_,l-'/:_-_ -_
Date _5.,___-...::S::...,--_-_2_0_2_:o:....· -
5'>c, APN: 212-130-27-00
CT/Project#:, _________ Lot #:,...:.:10"'2'-----
Occupancy: ____ Be.,_ ____ Construction Type: _V,_,B"---Fire Sprinklers:® no Air Conditioning:@ no
BRIEF DESCRIPTION OF WORK: Tenant Improvement in existing Suite. Adding (1) additional office
D Addition/New: ___________ New SF and Use, ___________ New SF and Use,
____ Deck SF, Patio Cover SF (not including flatwork)
D Tenant Improvement: __ 1'-1"'5'----__ SF, Existing Use O(t, le Proposed Use -=-O_N_{.'--'--,,·.c.c_e __ _
______ SF, Existing Use _______ Proposed Use ______ _
□ Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _
D Solar: ___ KW, __ Modules, ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No
D Plumbing/Mechanical/Electrical Only: _________________________ _
D Other: -----------------------------------------
APPLICANT (PRIMARY)
Name: Jennifer Knott
Address: 4631 Viewridge Ave.
City: San Diego State: CA Zip: 92123
Phone: 858-794-3222 x 311
Email: jknott@designcorpsd.com
DESIGN PROFESSIONAL
Name: Designcorp
Address: 4631 Viewridge Ave.
City: San Diego State: CA Zip: 92123
Phone: 858-794-3222
Email: cjordan@designcorpsd.com
Architect State License: ___________ _
PROPERTY OWNER
Name: Jeff Brusseau
Address: 1525 Faraday Ave. Ste. 100
City: Carlsbad State: CA Zip: ..,9 .. 2.,.0.,.09._ __
Phone: 760-607-4282
Email: jbrusseau@newportnational.biz
CONTRACTOR BUSINESS
Name: _______ ~--\------------
Address: _____ _J'-''-+~-~~-------
City: ______ _
Phone: ___________ ~-------
Email: ___________________ _
State License: ______ Bus. License: ______ _
(Sec. 7031.S Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law
{Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he/she is exempt therefrom, and the basis for the alleged
exemption. Any violation of Section 7031.S by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}).
1635 Faraday Ave Carlsbad, CA 92008
B-2
Ph: 760-602-2719 Fax: 760-602-8558
Page 1 of2
Email: Building@carlsbadca.gov
Rev. 06/18
( OPTION A): WORKERS'COMPENSATION DECLARATION:
I hearby affirm under penalty of perjury one of the following declarations:
□ t 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.
□ I have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation insurance carrier and policy number are: Insurance Company Name: ______________________ _
Polley No. ______________ Expiration Date: _________ _
□ Certificate 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 be come
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.
CONTRACTOR SIGNATURE: □AGENT DATE: ------------------------------
( OPTION B ): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
□ 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.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work
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).
□ I, 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).
□ I am exempt under Section ________ ,Business and Professions Code for this reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. □ Yes □ No
2. I (have/ have not) signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction (include name address/ phone/ contractors' license number):
4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name/ address/ phone/
contractors' license number):
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name/ address/ phone/ type of work):
OWNER SIGNATURE: __________________ □AGENT DATE: _____ _
CONSTRUCTION LENDING AGENCY, IF ANY:
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: _____________________ _ Lender's Address: _____________________ _
ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ Yes □ No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ Yes □ No
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
APPLICANT CERTIFICATION:
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction.
I hereby authorize representative of the City of carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP
HARMLESS THE CllY OF CARl5BADAGAINST ALL UABILmES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CllY IN CONSEQUENCE OF
THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized
by such permit is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time
after the work is commenced for a period of 180 day (Section 106.4.4 Uniform Bl7~
APPLICANT SIGNATURE: --~~=-Jb,---~-_;_ ________ DATE: 01/21/2020
1635 Faraday Ave Carlsbad, CA 9
B-2
8 Ph: 760-602-2719 Fax: 760-602-8558
Page 2 of 2
Email: Building@carlsbadca,gov
Rev. 06/18
Building Permit Inspection History Finaled
(Cityof
Carlsbad
PERMIT INSPECTION HISTORY for (CBC2O2O-OO93)
Permit Type: BLDG-Commercial Application Date: 03/05/2020 Owner: OWNER EMERALD LAKE CORPORATE
CENTRE LP
Work Class: Tenant Improvement Issue Date: 03/28/2020 Subdivision: CARLSBAD TCT#85-24 UNIT#05
Status: Closed -Finaled Expiration Date: 01/05/2021 Address: 1525 FARADAY AVE, # 350
IVR Number: 25226 CARLSBAD, CA 92008-7372
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Re inspection Inspection
Date Start Date Status
07/09/2020 07/0912020 BLDG-84 Rough 132284-2020 Passed Chris Renfro Complete
Combo(14,24,34,44)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-14 Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topoul No
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
0713012020 0713012020 BLDG-Final Inspection 134273-2020 Passed Chris Renfro Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-Plumbing Final No
BLDG-Mechanical Final Yes
BLDG-Structural Final Yes
BLDG-Electrical Final Yes
Thursday, July 30, 2020 Page 1 of 1
DATE: 3/20/2020
JURISDICTION: City of Carlsbad
PLAN CHECK#.: CBC2020-0093
✓• EsG1I
A Sl\~Ebuilt Com;,,wy
SET: I
PROJECT ADDRESS: 1525 Faraday Ave.
PROJECT NAME: Brixmor Reality Group Suite 350 Office T. I.
~ The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
D The plans transmitted herewith will substantially comply with the jurisdiction's codes
when minor deficiencies identified below are resolved and checked by building department staff.
D The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
D The check list transmitted herewith is for your information. The plans are being held at EsGil
until corrected plans are submitted for recheck.
D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
D The applicant's copy of the check list has been sent to:
~ EsGil staff did not advise the applicant that the plan check has been completed.
D EsGil staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone#:
Date contacted:.3/r-,Jzo (by~ Email:
Mail Telephone
0 REMARKS:
By: David Yao
EsGil
Fax In Person
Enclosures:
3/9/20
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
City of Carlsbad CBC2020-0093
3/20/2020
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad
PREPARED BY: David Yao
BUILDING ADDRESS: 1525 Faraday Ave.
BUILDING OCCUPANCY: B
BUILDING AREA Valuation
PORTION (Sq.Ft.) Multiplier
T, I, 115
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code cb By Ordinance
---..,, Bldg. Permit Fee by Ordinance _ -~
~~an Check F_~_~Y ~~~!nan<:_~_ -----~j
Type of Review: 0 Complete Review
D Repetitive Fee
~I Repeats
-~-_j
Comments:
□ Other
0 Hourly
EsGil Fee
PLAN CHECK#.: CBC2020-0093
DATE: 3/20/2020
Reg. VALUE ($)
Mod.
per city 5,439
5,439
□ Structural Only
$51.421
Sheet of
-SAN DIEGO REGIONAL OFFICE USE ONLY
HAZARDOUS MATERIALS RECORD ID# .
n
PLAN CHECK# (1~(2020-aoz13 .
BPDATE ) 12 iLO 21 ! QUESTIONNAIRE
Business Name Business Contact Telephone#
Brixmor Realty Group Matthew Berger 858 -202 -1107
Project Address 1525 Faraday Ave.
City Carlsbad State CA Zip Code 92009 APN# 202-130-27-00
Mailing Address City State Zip Code Plan File#
Project Contact . . Jknott@des1gncorpsd.com Applicant E-mail Telephone# 858.794.3222 X 314
.. . . The following questions represent the facility's actlv1t1es, NOT the specific proJect descnpt1on .
PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: not re ulred for ro·ects within the Cit of San
Die o : Indicate by circling the item, whether your business will use, process, or store any o the llowing hazardous materials. I any o the items are circled,
applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal.
Occupancy Rating: Facility's Square Footage (including proposed project):
1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives
2. Compressed Gases 6. Oxidizers 10. Cryogenics 14. Other Health Hazards
3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These.
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
questions is yes, applicant must contact the unty o an Diego Hazardous
Call (858) 505-6700 prior to the issuance of a building pennit.
FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: 0 CalARP Exempt
I
1.
2.
3.
4.
5.
6.
7.
8.
YES NO (for new construction or remodeling projects)
Is your business listed on the reverse side of this form? (check all that apply). D IXI D IXI Will your business dispose of Hazardous Substances or Medical Waste in any amount?
D IXI Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
pounds and/or 200 cubic feet?
D
D D D D
!RI Will your business store or handle carcinogens/reproductive toxins in any quantity?
f(I Will your business use an existing or install an underground storage tank?
(XI Will your business store or handle Regulated Substances (CalARP)? lXI Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 5cl Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to
or realer than 1,320 allons? California's Above round Petroleum Stora e Act .
Date Initials
0 CalARP Required
I
Date Initials
0 CalARP Complete
I
Date Initials
PART Ill: AN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT APCD: Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San
Diego, CA 92131 apcdcomp@sdcounty.ca.gov 858 5 -2650 . [ No stamp required if 01 Yes and 03 Yes and 04-06 No]. The following questions are intended
to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive
requirements contact APCD. Residences are typically exempt, except -those with more than one building• on the property; single buildings with more than four
dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. rExcludes garages & small outbuildings.]
1.
2.
3.
4.
5.
6.
YES NO
D IXI Will the project disturb 160 square feet or more of existing building materials?
D IKI Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition.
(ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been perfonned by a Certified Asbestos Consultant or Site Surveillance
Technician?
D liCI
D
D
D
!RI (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification
may be required 10 working days prior to commencing asbestos removal. !RI Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.sdapcd.org/info/facts/permits.pdf) for typical equipment requiring an APCD permit.
1K) (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
boundary
Briefly describe business activities: Briefly describe proposed project:
Commercial Real Estate Facility Office Addition
I decta;:1~n f~ of Pt\Wo the best of my knowledge and belief t e f!spon~ade ~e and correct. 01 / 21 , 2020
Date Name of Owner or Authorized Aaent Sianatrlre of O\Uuk or Authorized Aaent
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION·
FOR OFFi.s,~ USE'ONLY:
BY: DATE: I I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMO• APCO COUNTY-HMO APCD COUNTY-HMO APCO
*A stamp 1n this box 2!Jb: exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other permitting requirements may still apply.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
ENCINA WASTEWATER AUTHORITY
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
SCREENING SURVEY
6200 Avenlda Encinas, Carlsbad, CA 92011
Phone: 760-438-3941 Fax: 760-476-9852
SourceControl@encinajpa.com
Date: 01/21/2020
Business Name: Brixmor Realty Group
Street Address: 1525 Faraday Ave. San Diego, CA 92109
Email Address: jknott@designcorpsd.com
PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINES~
Check all below that are present at your facility:
o Acid Cleaning
o Assembly
o Automotive Repair
o Battery Manufacturing
o Biofuel Manufacturing
o 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 Man ufactu ring
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
New Business? Yes D No D SIC Code(s) if known: _____ _ Date operation began/will begin: ______ _
Tenant Improvement? Yes JlJ No □ If yes, briefly describe improvement: Addjna (1) new offjce to a
commercial real estate business.
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? Yes D Date: ____ No D
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.
o Automobile Detailers
o Barber/Beauty Shops
)( Business/Sales Offices
o Cleaning Services
o Carpet/Upholstery
o Childcare Facilities
o Churches
o Community Centers
o Consulting Services
o Contractors
o Counseling Services
o Educational Services (no auto repair/film developing)
o Financial Institutions/Services
o Fitness Centers
o Gas Stations (no car wash/auto repair)
o Grocery Stores (no film developing)
o Residential based Businesses
CERTIFICATION STATEMENT
o Hotels/Motels (no laundry)
o Laundromats
o Libraries
o Medical Offices (no x-ray developing)
o Mortuaries
o Museums
o Nail Salons
o Nursing Homes
o Office Buildings (no process flow)
o Optical Services
o Pest Control Services (no pesticide repackaging for sale)
o Pet Boarding/Grooming Facilities
o Postal Services (no car wash/auto repair)
o Public Storage Facilities
o Restaurants/Bars
o Retail/Wholesale Stores (no auto repair/film developing)
o Theaters (Movie/Live)
I certify that the information above is true and correct to the best of my knowledge.
Signature:_0..-,=ff~+I----~---DATE: 01/21/2020
Facility Contact: ___________ _ Title: ______________ _
ENCINA WASTEWATER AUTHORITY
6200 AVENIDA ENCINAS, CARLSBAD, CA Phone: 760-438-3941 Fax: 760-476-9852
SourceControl@encinajpa.com
Page 2 of 2