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HomeMy WebLinkAbout1712 Drake Way; ; CBC2019-0457; PermitPrint Date: 12/18/2019 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 1712 Drake Way BLDG-Commercial 2111300300 $35,000.00 Commercial Permit Work Class: Tenant Improvement Lot#: Reference#: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: (city of Carlsbad Permit No: CBC2019-0457 Status: Applied: Issued: Permit Fina led: Inspector: Final Closed -Finaled 09/25/2019 10/30/2019 Inspection: 12/18/2019 3:42:14Pr Description: GRAND PACIFIC: ( NEAR VILLA 56) POOL HOUSE COURTYARD GAS AND ELECTRIC FOR FIRE PIT AND BOCCI COURTS Owner: GRAND PACIFIC CARLSBAD LP BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) 5900 Pasteur Ct, 200 CARLSBAD,CA 92008 ELECTRICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL PLUMBING BLDG RESIDENTIAL NEW/ADDITION/REMODEL SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-COMMERCIAL Total Fees: $641.80 Total Payments To Date: $641.80 Balance Due: $0.00 $310.00 $217.00 $41.00 $62.00 $2.00 $9.80 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 tor 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. 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov THE FOLi.OWiNG APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH 0HAZMATIAPCD Building Permit Application Plan Check No. "Pl,JJI 19-()4 ~ 1 Ccityof 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value ·E -,.,.r-:. c1fl 1 _ r ::) Ph: 760-602-2719 Fax: 760-602-8558 Carlsbad Plan Ck. Deposit ' -email: building@carlsbadca.gov www.carlsbadca.gov Date Lf t:l c;;, 11'-I lswPPP JOB ADDRESS l) "It-. u \n .. SUITEf/SPACEf/UNIT# l'PN 211 . -130 -02 -l 11 CT/PROJECT# LOT# PHASE# I# OF UNITS 7BEDROOMS # BATHROOMS -rENANT BUSINESS NAM~PR I CONSTR. TYPE I OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) Proposed recreational area for patrons-bocce and fire pit. Gas connections, and lighting to be implemented. ~w vtil.R s to) PiL -:a-.foa, ooa EXISTING USE I PROPOSED USE GARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE I AIR CONDITIONING FIRE SPRINKLERS landscape bocce court/ fire ID YES!lf, ND□ YES □No[Zj YES □NO[Z] APPLICANT NAME Dan Talant PROPERTY OWNER NAME Grand Pacific Resorts Primary Contact ADDRESS ADDRESS 1220 Rosecrans St. 5900 Pasteur Court Suite 200 CITY STATE ZIP CITY STATE ZIP San Dieao CA 92106 Carlsbad CA 92008 PHONE IFAX PHONE IFAX 619-297-8066 760-431-8500 EMAIL EMAIL dant@noaainc.com hamold@gpresorts.com DESIGN PROFESSIONAL Gary Nogle CONTRACTOR BUS. NAME Grand Pacific Resorts Inc ADDRESS ADDRESS 1220 Rosecrans St. #329 5900 Pasteur Court, Suite 200 CITY STATE ZIP CITY r STATE ZIP San Dieao CA 92106 ... tu.s· . -CA 92008 PHONE l'AX PHONE '. I 'AX 619-297-8066 I "7r..n . ~i;::t 'b • 88-11:f EMAIL EMAIL dant(lilnoaainc.com hamold(lilgpresorts.com I STATELICC11956 STATE UC.# I CLASS CITY BUS. UC.# (Sec. 7031.5 Business and Professions Code: Any City or Coun_ty which requires a permit to. construct, alter, improve, demolish or repair any_ structure, prior to its issuance, also requires the applicant for such per_mIt to file a signed statement that he Is licensed pursuant to the provIsIons of the Contractor's License Law/Chapter 9, commending with Section 7000 of D1vIsIon 3 of the B_usiness and Professions Code) or that he Is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subiects the applicant to a cIvII penalty of not more than five hundred dollars {$500)). WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: B 1 have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the per1ormance of the wor'K for which this permit is issued. I have and will maintain workers' compensation, as reQuired bv Section 3700 of the Labor Code, for the per1ormance of the wor'K for which this permit is issued. My wor'Kers' compensation insurance carrier and policy number are: Insurance Co ____________________ Policy No, _____________ Expiration Date ________ _ This section need not be completed 1f the permit is for one hundred dollars ($100) or less. 0 Certificate of Exemption: I certify that in the per1ormance of the worl< for which this permit is issued, I shall not empjoy any person in any manner so as to become subject to the Workers' Compensation Laws ol California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition 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 OWNER-BUILDER DECLARATION I hereby afflnn 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 worl< 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 wor'K 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 sa\e). I, as owner of the property, am exclusively contracting with licensed contrcr::tors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of ,:r...._==rty 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. 0Yes 0No 2. I (have I 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 I phone/ contractors' license number)· 4. I plan to provide portions of the worl<, but I have hired the following person to coordinate, supervise and provide the major work (include name I address/ phone I contractors' license number) 5. I will provide some of the worl<. but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone I type of work): ·:.7 8$ PROPERTY OWNER SIGNATURE , ,· AGENT DATE \ ' COMPLETE THIS 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there 1s a construction lending agency for the performance of the work this penmt ts issued (Sec 3097 (1) Civil Code} Lender's Name Lender's Address APPLICANT CERTIFICATION \ certify that I have read the application and state that the abtwe infonnation is correct and that the information on the plans is accurate. I agree to oomply ~ all City otdlnances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above menooned property br inspeclioo purl).)Ses. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CllY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSHA: AA OSHA perm rt is required for excavations over 5'0' deep and demolition or construction of structures over 3 stores in height EXPIRATION: Every l):lnnit issued by the Buik:ling Official under the provisKJns of this Cooe shall expire by limitaOOn and become null and void iflhe buik:ling or Mrk authorized by such permit is not commenced .....;lhin 180days from the date of sudl permit or if the buik:11ng orM autho · such perm rt is suspendOO or abandonOO at anytime after the WJrk is commenced for a r;erbd of 100days (Section 100.4.4 Unifonn Buik:ling Code) A$ APPLICANT'S SIONA TURE DATE • STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Car1sbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELNERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1} MAIL TO: CONTACT (Listed above) CONTRACTOR (On Pg. 1) OCCUPANT (Listed above) MAIL/ FAX TO OTHER: __________ _ ,.MS APPLICANT'S SIGNATURE ASSOCIATED CB#------------- NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION DATE ZIP PERMIT INSPECTION HISTORY REPORT (CBC2019-0457) Permit Type: BLDG-Commercial Application Date: 09/25/2019 Owner: Work Class: Tenant Improvement Issue Date: 10/30/2019 Subdivision: Status: Closed -Finaled Expiration Date: 06/15/2020 Address: IVR Number: 22015 Scheduled Date Actual Start Date Inspection Type Inspection No. 10/31/2019 10/31/2019 BLDG-21 109373-2019 Underground/Underf loor Plumbing Checklist Item BLDG-Building Deficiency BLDG-23 Gas/TesURepalrs 10937 4-2019 Checklist Item BLDG-Building Deficiency BLDG-31 Underground/Condu it -Wiring 109372-2019 Checklist Item BLDG-Building Deficiency 12/17/2019 12/17/2019 BLDG-Final 113973-2019 Inspection 12/18/2019 12/18/2019 BLDG-Final Inspection December 18, 2019 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Finat 114152-2019 Checklist Item BLDG•Building Deficiency BLDG·Plumbing Final BLDG~Mechanical Final BLDG~Structural Final BLDG·Electrical Final Inspection Status Primary Inspector Passed Paul Burnette COMMENTS Passed Paul Burnette COMMENTS Passed Paul Burnette COMMENTS Failed Paul Burnette COMMENTS Passed Paul Burnette COMMENTS GRAND PACIFIC CARLSBAD LP 1712 Drake Way Carlsbad, CA 92008 Reinspection Complete Complete Passed Yes Complete Passed Yes Complete Passed Yes Reinspection Complete Passed No No No No No Complete Passed Yes Yes Yes Yes Yes Page 1 of 1 DATE: 10/30/2019 JURISDICTION: Carlsbad PLAN CHECK#.: CBC2019-0457 PROJECT ADDRESS: 1712 Drake Way ✓• EsG1I A SAFEbuilf Company SET: II re. APPLICANT /'-' JURIS. PROJECT NAME: Grand Pacific Resort Outdoor Tenant Improvement ~ 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: /ll[ JOl I/J (by:>lr\ ) Email: Mail Telephone Fax In Person 0 REMARKS: By: Jason Pasiut EsGil 10/28/2019 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 DATE: 10/1/2019 JURISDICTION: Carlsbad PLAN CHECK#.: CBC!I019-04S7, PROJECT ADDRESS: 1712 Drake Way ✓• EsG1I A SAFEbuitfCompany SET: I , □ APPLICANT □ JURIS. PROJECT NAME: Grand Pacific Resort Outdoor Tenant Improvement D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. L8] 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. L8] The applicant's copy of the check list has been sent to: Dan Talant D EsGil staff did not advise the applicant that the plan check has been completed. L8] EsGil staff did advise the applicant that the plan check has been completed. Person contacted: Dan Talant Telephone#: 619-297-8066 1~Getiracte~~-t q (by:7b Email: dany@noaainc.com Telephone Fax In Person By: Jason Pasiut EsGil 9/26/2019 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 Carlsbad CBC2019-0457 10/1/2019 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK#.: CBC2019-0457 OCCUPANCY: R-1 TYPE OF CONSTRUCTION: ALLOWABLE FLOOR AREA: SPRINKLERS?: REMARKS: All work is outside DATE PLANS RECEIVED BY JURISDICTION: 9/25/2019 DATE INITIAL PLAN REVIEW COMPLETED: 10/1/2019 FOREWORD (PLEASE READ): JURISDICTION: Carlsbad USE: Hotel ACTUAL AREA: STORIES: HEIGHT: OCCUPANT LOAD: DATE PLANS RECEIVED BY ESGIL CORPORATION: 9/26/2019 PLAN REVIEWER: Jason Pasiut This plan review is limited to the technical requirements contained in the California version of the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 2016 CBC, which adopts the 2015 IBC. The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of the 2015 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list when you submit the revised plans. Carlsbad CBC2019-0457 10/1/2019 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Jason Pasiut BUILDING ADDRESS: 1712 Drake Way BUILDING OCCUPANCY: R-1 BUILDING AREA Valuation PORTION ( Sq. Ft.) Multiplier Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance 1997 UBC Building Pormit Fee >"" I 1997 UBC Plan Check F•• Type of Review: 17 Complete Review r Repetitive Fee .,, I l:"!H Repeats ,. Comments: r Other r Hourly EsGil Fee ,. Reg. Mod. PLAN CHECK#.: CBC2019-0457 DATE: 10/1/2019 VALUE ($) 35,000 35,000 , , r Structural Only $201.82) Sheet 1 of 1 Carlsbad CBC2019-0457 10/1/2019 Please make all corrections, as requested in the correction list. Submit FOUR new complete sets of plans for commercial/industrial projects (THREE sets of plans for residential projects). For expeditious processing, corrected sets can be submitted in one of two ways: 1. Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760) 602-2700. The City will route the plans to EsGil and the Carlsbad Planning, Engineering and Fire Departments. 2. Bring TWO corrected set of plans and calculations/reports to EsGil, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil is complete. • PLANS 3. Please update the occupancy type to R-1 for this hotel. • ACCESSIBILITY FOR REMODELS, ADDITIONS, AND REPAIRS The following disabled access items are taken from the 2016 edition of California Building Code. Per Section 1.9.1.2, all privately funded public accommodations and commercial facilities shall be accessible to persons with disabilities. Where existing elements or spaces are altered, each altered element or space shall comply with applicable requirements of Division 2, including CBC section 11 B-202.4. CBC section 11 B-202.4 states that when alterations or additions are made to existing buildings, an accessible path of travel to the specific area of alteration shall be provided. See exceptions to 11 B-202.4. Detail on the plans the following elements of the existing path of travel that are required to comply with the 2016 accessibility standards: 4. Existing primary path of travel to the building or facility entrance, including: a) The accessible parking dimensions, slope, and cross-slope in compliance with CBC 11 B-502. b) The access aisle dimensions, slope, and cross slope in compliance with 11 B-502.3. c) The location of detectable warnings at hazardous vehicle areas. 11 B- 705.1.2.5. Carlsbad CBC2019-0457 10/1/2019 d) The curb ramp (if any) 48" minimum width, 48" x 48" turning space at the bottom, landing length of 48" at the top, slope and cross-slope in compliance with CBC 11 B-406. e) The ramp (if any) slope, cross-slope, 48" minimum width, 60" x 60" landing at the top, 72" long landing at the bottom, compliant changes in direction (60" x 72") in compliance with CBC 11 B-405. f) The stair (if any) width, riser and tread dimensions, contrasting stipes, handrail height, gripping surfaces and top/bottom extensions in compliance with CBC 11 B-504 and 505. g) Show that the walking surface from the access aisle to the building entrance complies with slope, cross slope, changes in level and clear width provisions of 11 B-403. h) Show the accessible entrance door threshold, door hardware, door width, and maneuvering clearances on either side of the door in compliance with CBC 11 B-206.4. 5. Existing toilet facilities that serve the remodeled area shall be shown to comply with the accessibility features of CBC, 11 B, Division 6. Provide generic restroom details showing compliance. 6. Existing drinking fountains (if any) shall be shown to comply with the accessibility features of 11 B-602 and 11 B-211.2. 7. Existing accessible parking reflectorized identification including the "van accessible", "250 fine", and "unauthorized vehicle parking" signs per 11 B-502.6, 11 B-502.6.2, 11 B-502.8.2. a) Existing accessible parking surface identification. 11 B-502.6.4.1. b) Existing access isle "NO PARKING" identification per 11 B-502.3.3 c) Provide the address and phone number for the location to reclaim towed vehicles. 11 B-502.8.2. 8. Show that compliant restrooms are marked with signs per 11 B-216.8 with the international symbol of accessibility and geometric symbols per 11 B-703.7.2.6. a. AB 1732 Section 1, Article 5: 118600: All single-user toilet facilities in any business establishment, place of public accommodation, or state or local government agency shall be identified as all-gender toilet facilities by signage that complies with Title 24 of the California Code of Regulations and designated for use by no more than one occupant at a time or for family or assisted use. Carlsbad CBC2019-0457 10/1/2019 b. The location of and directions to compliant restrooms shall be posted in or near the building entrance and shall include the International symbol of accessibility. 11 B-216.8. 9. Show the permanent sign identifying the restroom on the latch side of the doorway, in compliance with 11 B-703.1,2,3, and 5. (raised characters with braille installed 48" from the baseline of the lowest braille and 60" from the baseline of the highest raised characters) 10. There shall be an accessible route from the resort to the new outdoor recreation areas. Please show a complaint accessible path from the resort leading to both fire pit areas and the boche ball area. 11 B-206.2.2, 206.2.17. a) 48" width minimum. b) Provide complete details for the accessible route method chosen. (ramp, lift) 11. Provide details for the directional signs that may be required to direct people to the accessible route. a) Non-glare finish, contrasting with background. b) Upper or lower case, conventional font. c) 40" above the finish floor. d) Tactile directional signs with braille to comply with 11 B-703.2 -4. 12. Provide details or notes for the proposed gas line and electric conduit trench depths and tracer wire for plastic gas lines. • END OF REVIEW To speed up the review process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. Please indicate here if any changes have been made to the plans that are not a result of corrections from this list. If there are other changes, please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate: D Yes D No The jurisdiction has contracted with EsGil, located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the OFFICE USE ONLY SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE RECORD ID # __________________ I PLAN CHECK# ________________ _ BP DATE The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT-H RDOU MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: not re uirod r ro·ects within tho Ci of San Q!!!s.Q}: Indicate by circling the item, whether your business will use, process, or store any o the following hazardous materials. I any of 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): 13. Corrosives 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 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 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, 5500 Overland Avenue, Suite 110, San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. FEES ARE REQUIRED Projecl Completion Dale: Expected Date of Occupancy: □ CalARP Exempl I 1. 2. 3. 4. 5. 6. 7. 8. YES NO □ ~ □ ticl □ Iii! (for new construction or remodeling projects) 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 greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? □ □ □ □ □ II Will your business store or handle carcinogens/reproductive toxins in any quantity? I 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 1 0)? Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or reater than 1,320 allons? California's Above round Petroleum Stora e Act . Date Initials □ CalARP Required I Date Initials □ CalARP Complete I Date Initials PART 111: SAN DIEG COUNTY AIR POLLUTION CONTROL DISTRICT APCD: Any YES" answer requires a stamp from APCD 10124 Old Grove Road. San Diego, 92131 a cdcom sdcount .ca. ov (858) 586-2650). [*No stamp required if Q1 Yes and Q3 Yes and Q4-Q6 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 bums; residences forming part of a larger project. [+Excludes garages & small outbuildings.] 1. 2. 3. YES NO □ 11'11 □ 15 □ □ Will the project disturb 160 square feet or more of existing building materials? 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 performed by a Certified Asbestos Consultant or Site Surveillance Technician? 4. □ D (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. 5. 6. □ □ Kl 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/pennits.pdf) for typical equipment requiring an APCD permit. D (ANSWER ONLY IF QUESTION 5 1S YES) Will the project or associated construction equipment be located within 1,000 feet of a school bounda Briefly describe business activities: -l.>-NoscA.t=>E I declare under penalty of perjury that to the best of my knowledge and belief t e resp n Briefly describe proposed project: bl~e 11£ ;c;..,,_. womc Name of Owner or Authorized A ent 9 /,2<4 119 Date FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ___________________ --,-___________ _ BY DATE / / EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HM□* APCD COUNTY-HM□ APCD COUNTY-HM□ APCD . A stamp In this box only exempts busmesses from completing or updating a Hazardous Matenals Busmess Plan. Other permIttIng requirements may still apply . HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division