HomeMy WebLinkAbout1834 Marron Rd; ; CBC2018-0297; Permit(City of
Carlsbad
Commercial Permit
Print Date: 07/26/2018 Permit No: CBC2018-0297
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
1834 Marron Rd
BLDG-Commercial
1563011600
$35,000.00
Work Class: Tenant Improvement
Lot#:
Reference#:
Construction Type:
Bathrooms:
Orig. Plan Check#:
Plan Check#:
Description: MARSHALLS: T.I. (WIDEN ENTRY WAY TO FITTING ROOMS)
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
SB1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-COMMERCIAL
Total Fees: $538.80
Owner:
PK I NORTH COUNTY PLAZA LP
3333 New Hyde Park Rd Kimco Realty Corp,
100
NEW HYDE PARK, NY 11042
Total Payments To Date: $538.80
Status:
Applied:
Issued:
Permit
Finaled:
Inspector:
Final
Inspection:
Contractor:
DEL MAR BUILDERS INC
13025 Calicott Way
San Diego, CA 92130-1329
858-792-6855
Balance Due:
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.
Closed -Finaled
05/29/2018
06/12/2018
7/26/2018 1:50:38PM
$0.00
$310.DO
$217.00
$2.DO
$9.80
1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0PLANNING 0ENGINEERING
(city of
Carlsbad
JOB ADDRESS
CT/PROJECT# LOT#
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
Ph: 760-602-2719 Fax: 760-602-8558
email: building@carlsbadca.gov
www.carlsbadca.gov
SUITEI/SPACEf/UNITf
PHASE# # BATHROOMS
DESCRIPTION OF WORK: Include Square Feet of Affected Area(s)
0BU1LD1NG OFIRE DHEALTH
Est. Value
Plan Ck. Deposit
Date
IJ l'lV\ "J+(ll'-->-4vm I
°'ffl (O '1-, 7...5'f:> dJ
'~-~'°' ~"'~ "'\'\.tu~M<J'\, { --Io ez<,<:,{,~ .(',1+,~
\N , le.n -e..-,< I '?'.j. l'J -0\,-\-., Ct.li'LL.. i-il ·K\-\-1~ 1/'0 01M..7 .
EXISTING USE GARAGE (Sf) PATIOS (SF) DECKS (SF)
M
PROPERTY OWNER NAME
ADDRESS
ZIP CITY fi'a.
PHONE
DESIGN PROFESSIONAL 5'-t>-li &,\,~Ol\. A.Jt....
ADDRESS
CITY
PHONE
EMAIL
0HAZMAT/APCD
(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 permit to file a signed statement that he 1s licensed pursuant to the provisions of the Contractor's License LawJChapter 9, comme.nd1ngwith Section 7000 of D1v1s1on 3 of the Business 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 subJects the applicant to a
c1v1I penalty of not more than five hundred dollars {$500}).
WORKERS' COMPENSATION
Worilers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D I h.Jl't and will maintain a certificate of consent to self-Insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
~ve and will maintain work.Jnsation, as re!ired 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 polk:y
number are: Insurance Co. ~ ftA,tl\, . Policy No. 'f 131 3(J Z Expiration Date t..( -30 ...._ 1 ?
J!]§.seclion need not be completed if the permit is for one hundred dollars ($100) or less LJ Certificate of Exemption: I certfy that in the perfonnance of the work for which this permit is issued, I shall not employ any person in any marmer so as to become subject to the Workers' Compensation Laws of
California WARNING: Failure to secure workers' comp satlo overage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), In
addition to the cost of compensation, damages a 6 of the Labor code, interest and attorney's fees.
8$ CONTRACTOR SIGNATURE
I hereby affirm that I am exempt from Contractors License Law for the following reason:
D
D
D
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 iniprovement. 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 I contractors' license number):
4. I plan to provide portions of the worll, but I have hired the following person to coordinate, supervise and provide the major work (include name I address I phone I contractors' license number):
5. I will provide some of the work, but I have contracted (hired} the following persons to provide the worll indicated (include name I address I phone I type of work):
RS PROPERTY OWNER SIGNATURE 0AGENT 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 Acr? Yes V'"No ../
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quaranagement district? Yes VNo
Is the facility to be constructed within 1,000 feel of the outer boundary of a school site? Yes ._.,...flo 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.
I certify that I have mad the application and state that the above information Is correct and that the lnfonnation on the plans is accura1B. I agree to romply 'Mth all City ordinances and State laws relating to building construction.
I hereby authorize representative of the City of Car1sbad to enter urxm the atxive mentioned pro~rty br inspeciion purposes. I ALSO AGREE TO SAVE, INDEMNIFY .AND KEEP HARMLESS THE CITY OF CAALSMD
AGAINST All LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT
OSHA: Ari OSHA permit is required br excavations oYer 5'0' deep and demolitOn oc ronstrudion of strucb.Jres over 3 stories in height.
EXPIRATION: Every ~rrnit issued by the Building Offcial under the · (Ins of this Code shall expjre by limitation and become null and void if the building or w:irk authorized by such permit is notrommenced within
180 days from the date of suet, permit or if the building or uth by permit is sus~nded or abandoned at any time after the 'Mlrk is commenred for a period of 100 days (SectKJ<l 100.4.4 Uniform Building Code)
Af5 APPLICANT'S SIGNATURE 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, Carlsbad, 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.
DELIVERY 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:---------------~
A$ APPLICANT'S SIGNATURE
ASSOCIATED CB#-------------
NO CHANGE IN USE/ NO CONSTRUCTION
CHANGE OF USE/ NO CONSTRUCTION
DATE
ZIP
f t" ' d}' #. '0 "> '
: :. .. · ·. · · · ;. PERMIT INSPJ:CTION t,tlSTOf:tY RE~RT (ce;2.01 s-0297)
,.,,, , 0' R »' ', , .-,;j 1 t
Permit Type: BLOG-Commercial Application Date: 05/29/2018 Owner: P K I NORTH COUNTY PLAZA LP
Work Class: Tenant Improvement lssuc Date: 06/12/2018 Subdivision: PARCEL MAP NO 15975
Status: Closed -Finaled Expiration Date: 01/21/2019 Address: 1834 Marron Rd
Carlsbad. CA 92008-1172
IVR Nurnber: 11612
Scheduled Actual
Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete
"·-·----w----------··" ___
07/13/2018 07/13/2018 BLDG-14 063986-2018 Passed Paul Burnette Complete
Frame/Steel/Bolting/
Welding (Decks)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
07/16/2018 07/16/2018 BLDG-14 064083-2018 Passed Paul Burnette Complete
Frame/Steel/Bolting/
Welding {Decks)
Checklist !ten, COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-17 Interior 064084-2018 Passed Paul Burnette Complete
Lath/Drywall
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
07/24/2018 07/24/2018 BLOG-85 T-Bar, 064803-2018 Partial Pass Chris Renfro Reinspection Incomplete
Ceiling Grids,
Overhead
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Inspected T bars, ceiling grids in overhead. No
Contractor said they spoke with fire
inspection about one sprinkler head being
capped, and no fire inspection was needed.
Partial pass until verification
BLDG-14 Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topout Yes
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
07/26/2018 07/26/2018 BLDG-Final 064979-2018 Passed Michael Collins Complete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Dressing room entry only Yes
July 26, 2018 Page 1 of 1
DATE: 6/7/2018
JURISDICTION: Carlsbad
PLAN CHECK#.: CBC2018-0297
PROJECT ADDRESS: 1834 Marron Rd.
~ EsG1I
A SAFEbu1lfCornpany
SET: I
PROJECT NAME: TJX Company Dressing Room remodel
IJ APPLICANT
~RIS
~ 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.
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-. --rn Telephone#:
Date contacted: (~ ) Email:
Mail Telephone Fax In Person
D REMARKS:
By: Morteza Beheshti
EsGil
5/29
Enclosures:
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576
Carlsbad CBC2018-0297
6 (7,,./ 2'918
[DO NOT PAY -THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad PLAN CHECK#.: CBC2018-0297
PREPARED BY: Morteza Beheshti
BUILDING ADDRESS: 1834 Marron Rd.
BUILDING OCCUPANCY: M
BUILDING
PORTION
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code
1997 UBC Plan Check Fee
----
Type of Review:
0 Repetitive fee
-~--• I Repeats
Comments:
AREA Valuation
(Sq.Ft.) Multiplier
Cb By Ordinance
-~
0 Complete Review
D Other
D Hourly
EsGII Fee
DATE: 6/7/2018
Reg. VALUE ($)
Mod.
35,000
35,000
$310.49/
$201.82!
D Structural Only
I Hrs.@•
=====$=1 o=s=.o:o $176.981
Sheet 1 of 1
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MATERIALS
QUESTIONNAIRE
RECORD ID# ___________________ ,
PLAN CHECK #------------------I
Business Name
Project Ac1Cf1:ss
"b 7 L-t /\{.A,;-o (\.
Mailing Address
Pro~ct yontac
{IA 1 c..iM.L.-
BP DATE
Business Contact Telephone#
APN#
( 1 1c1ty Co..r ~ l)<t-d
City State Plan File#
The following questions represent the facility's a th,lties, NOT the specific project description.
PART I: FIRE DEPARTMENT-HAZARDOUS MATERIALS DMSION: OCCUPANCY CLASSIFICATION: (not required for projects within tho City of San
Diego}: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled,
applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal.
Occupancy Rating: Facllity'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
PART II: 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 pennit.
FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: 0 CalARP Exempt
YES NO/ (for new construction or remodeling projects) ---~'~---
1. D @'" /fs your business listed on the reverse side of this fonn? (check all that apply). Date Initials
2. D [SY ,,Will your business dispose of Hazardous Substances or Medical Waste in any amount?
3. D ty"' Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
_ /pounds and/or 200 cubic feet?
4. D ~/Will your business store or handle carcinogens/reproductive toxins in any quantity?
5. D U:r ,;Will your business use an existing or install an underground storage tank?
6. D ~Will your business store or handle Regulated Substances (Ca1ARP)?
7. D ~ ~ill your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?
8. D BY 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 .
0 CalARP Required
I
Date Initials
0 CalARP Complete
Date Initials
PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD\: Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San
Diego, CA 92131 apcdcomp@sdcoynty.ca.gov (858) 586-2650). [*No stamp required if Q1 Yes and Q3 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. [•Excludes garages & small outbuildings.]
YES No/
1. D ~Will the project disturb 160 square feet or more of existing building materials?
2. D ~ Will any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition.
3. D D (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 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. D D Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.sdapcd.org/jnfo/facts/permits.pd0 for typical equipment requiring an APCD pennit.
6. D D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
bound a
Briefly describe proposed project:
true and correct. 0 ?'l /{~
Date
FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: _______________________________ _
BY: DATE: I I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANcY RELEASED FOR OCCUPANCY
COUNTY-HMO• APCD COUNTY-HMO APCO COUNTY-HMO APCO
*A stamp 1n this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other perm1tt1ng requirements may still apply.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION
Check all that apply:
AUTOMOTIVE
0 Battery Manufacturing/Recycling
D Boat Yard
D Car Wash
0 Dealership Maintenance/Painting
0 Machine Shop
D Painting
D Radiator Shop
D Rental Yard Equipment
D Repair/Preventive Maintenance
D Spray Booth
D Transportation Services
0 Wrecking/Recycling
CHEMICAL HANDLING
D Agricultural supplier/distributor
D Chemical Manufacturer
0 Chemical Supplier/Distributor
0 Coatings/Adhesive
D Compressed Gas Supplier/Distributor
D Dry Cleaning
D Fiberglass/Resin Application
D Gas Station
D Industrial Laundry
D Laboratory
D Laboratory Supplier/Distributor
D Oil and Fuel Bulk Supply
0 Pesticide Operator/Distributor
CHEMICAL HANDLING
D Photographic Processing
0 Pool Supplies/Maintenance
D Printing/Blue Printing
D Road Coatings
D SWimming Pool
0 Toxic Gas Handler
D Toxic Gas Manufacturer
METAL WORKING
D Anodizing
D Chemical Milling/Etching
D Finish-Coatlng/Painting
D Flame Spraying
D Foundry
D Machine Shop-Drilling/Lathes/Mills
D Metal Plating
D Metal Prepping/Chemical Coating
D Precious Metal Recovery
D Sand Blasting/Grinding
D Steel Fabricator
D Wrought Iron Manufacturing
AEROSPACE
D Aerospace Industry
D Aircraft Maintenance
D Aircraft Manufacturing
OTHERS AND MISCELLANEOUS
D Asphalt Plant
D Biotechnology/Research
D Chiropractic Office D Co-Generation Plant
D Dental Clinic/Office
D Dialysis Center
D Emergency Generator
D Frozen Food Processing Facility
D Hazardous Waste Hauler
D Hospital/Convalescent Home
D Laboratory/Biological Lab
D Medical Clinic/Office
D Nitrous Oxide (NOK) Control System
D Pharmaceuticals
D Public Utility
D Refrigeration System
D Rock Quarry
D Ship Repair/Construction
D Telecommunications Cell Site
D Veterinary Clinic/Hospital
D Wood/Furniture Manufacturing/Refinishing
ELECTRONICS
D Electronic Assembly/Sub-Assembly
D Electronic Components Manufacturing
D Printed Circuit Board Manufacturing
NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES.
ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE
HAZARDOUS MATERIALS DIVISION (HMO) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (858) 505-6880.
LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES
Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District.
CHEMICAL
47 -Organic Gas Sterilizers
32 -Acid Chemical Milling
33 -Can & Coil Manufacturing
44 -Evaporators, Dryers & Stills Processing
Organic Materials
24 -Dry Chemical Mixing & Detergent Spray
Towers
35 -Bulk Ory Chemicals Storage
55 -Chrome Electroplating Tanks
COATINGS & ORGANIC SOLVENTS
27 -Coating & Painting
37 -Plasma Arc & Ceramic Deposition Spray
Booths
38 -Paint, Stain & Ink Mfg
27 -Printing
27 -Polyester Resin/Fiberglass Operations
METALS
18 -Metal Melting Devices
19-0il Quenching & Salt Baths
32 -Hot Dip Galvanizing
39 -Precious Metals Refining
ORGANIC COMPOUND MARKETING
/GASOLINE. ETC)
25 -Gasoline & Alcohol Bulk Plants & Terminals
25 -Intermediate Refuelers
26 -Gasoline & Alcohol Fuel Dispensing
COMBUSTION ROCK AND MINERAL
34 -Piston Internal -Combustion Engines 04 -Hot Asphalt Batch Plants
13-Boilers & Heaters (1 million BTU/hr or larger) 05-Rock Drills
14 -Incinerators & Crematories 06 -Screening Operations
15 -Bum Out Ovens 07 -Sand Rock & Aggregate Plants
16 -Core Ovens 08-Concrete Batch, CTB, Concrete Mixers, Mixers
20 -Gas Turbines, and Turbine Test Cells & Stands & Silos
48 -Landfill and/or Digester Gas Flares 10 -Brick Manufacturing
ELECTRONICS
29 -Automated Soldering
42 -Electronic Component Mfg
FOOD
12 -Fish Canneries
12 -Smoke Houses
50 -Coffee Roasters
35 -Bulk Flour & Powered Sugar Storage
SOLVENT USE
28 -Vapor & Cold Degreasing
30 -Solvent & Extract Driers
31 -Dry Cleaning
OTHER
01 -Abrasive Blasting Equipment
03 -Asphalt Roofing Kettles & Tankers
46 -Reverse Osmosis Membrane Mfg
51 -Aqueous Waste Neutralization
11 -Tire Buffers
17 -Brake Debonders
23 -Bulk Grain & Ory Chemical Transfer & Storage
45 -Rubber Mixers
21 -Waste Disposal & Reclamation Units
36 -Grinding Booths & Rooms
40 -Asphalt Pavement Heaters
43 -Ceramic Slip Casting
41 -Perlite Processing
40 -Cooling Towers -Registration Only
91 -Fumigation Operations
56 -VVWTP (1 million gal/day or larger) & Pump
Station
NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION
CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
! .
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
SCREENING SURVEY
Date 5"-Z-q-1~
Business Name MAs2\...9.\\. S
Street Address l'U7:{ ,L{ a,xl)V\ e.J (c ... ,dsl?M cA 9 200"6'
Email Address·--------------------------~-
PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS)
Check all below that are present at your facility:
Acid Cleaning Ink Manufacturing Nutritional Supplement/
Assembly Laboratory Vitamin Manufacturing
Automotive Repair Machining I Milling Painting I Finishing
Battery Manufacturing Manufacturing Paint Manufacturing
Blofuel Manufacturing Membrane Manufacturing Personal Care Products
Blotech Laboratory (i.e. water filter membranes) Manufacturing
Bulk Chemical Storage Metal Casting I Forming Pesticide Manufacturing I
Car Wash Metal Fabrication Packaging
Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing
Chemical Purification Electroplating (including precursors)
Dry Cleaning Electroless plating Porcelain Enameling
Electrical Component Anodizing Power Generation
Manufacturing Coating (i.e. phosphating) Print Shop
Fertilizer Manufacturing Chemical Etching I Milling Research and Development
Film I X-ray Processing Printed Circuit Board Rubber Manufacturing
Food Processing Manufacturing Semiconductor Manufacturing
Glass Manufacturing Metal Powders Forming Soap I Detergent Manufacturing
Industrial Laundry Waste Treatment/ Storage
SIC Code(s) (if known):----------------------
Brief description of busines -\._
facturing Operations): _____ _
Description of operations generating wastewater (discharged to sewer, hauled or evaporated):
Estimated volume of industrial wastewater to be discharged (gal I day): --------
List hazardous wastes generated (type I volume): -~A~~~*=...L-.------------
Date operation began/or will begin at this location: ----------------
Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority?
Yes No If yes, when:---------------------
Site Contact~A 7-{o..VL'\ Title /3..,.,_;cJcY\ {.
Signature~ Phone No. "i!St-L/D(-20?;0
ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941
FAX: (760) 476-9852
DISCHARGE PERMIT EXEMPT LIST
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 Detailers
Barber/Beauty Shops
Business/Sales Offices
Carpet/Upholstery Cleaning Services
Childcare Facilities
Churches
Community Centers
Consulting Services
Contractors
Counseling Services
Educational Services (no auto repair/film developing)
Financial Institutions/Services
Fitness Centers
Gas Stations (no car wash/auto repair)
Grocery Stores (no film developing)
Home-based Businesses
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
Public Storage Facilities
Restaurants/Bars
~holesale Stores (no auto repair/film developing)
l'l'ieafers (Movie/Live)
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