HomeMy WebLinkAbout2236 Rutherford Rd; 115; CBC2018-0489; PermitPrint Date: 08/19/2019
Job Address:
Commercial Permit
(City of
Carlsbad
Permit No: CBC2018-0489
PermitType:
2236 Rutherford Rd, 115
BLDG-Commercial
2120612600
Work Class: Tenant Improvement Status: Closed -Expired
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
Description:
Applicant:
TRIVISTA INC
JOSH GIBBS
116 Market Pl
$ 334,872.00
SYN ERG EYES
SYNERGEYES: 7,200 SF T.I.
Escondido, CA 92029-1352
760-294-0277
FEE
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
Lot#:
Reference #:
Construction Type
Bathrooms:
Orig. Plan Check#:
Plan Check#:
Owner:
A AND M CAP RE RC P LLC
2236 Rutherford Rd
CARLSBAD,CA 92008
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
GREEN BUILDING STANDARDS PLAN CHECK & INSPECTION
MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
PLUMBING BLDG COMMERCIAL NEW/ADDITION/REMODEL
SB1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-COMMERCIAL
DEV2017-0243
Total Fees: $ 2,990.19 Total Payments To Date : $ 2,990.19
Applied: 08/27/2018
Issued: 09/28/2018
Permit
Finaled:
Inspector: MColl
Final
Inspection:
Contractor:
TRI VISTA INC
116 Market Pl
Escondido, CA 92029-1352
760-294-0277
Ba la nee Due:
AMOUNT
$1,460.25
$1,022.18
$89.00
$170.00
$55.00
$86.00
$14.00
$93.76
$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 changes1 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
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
1'1'iE FOLL1'NING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE, □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH OHAZMAT/APCD I
{city of Building Permit Application Plan Check Noao/~'1/"\f Jr-()<..fJ{9
1635 Faraday Ave., Carlsbad, CA 92008 Est. Value ,fJ ';l,?J-1, q 1---i... -
Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. D!!poslt -
email: building@carlsbadca.gov
www.carlsbadca.gov Date Y J ;;;i_ ";J, //)(
JOB ADDRESS SUITE#/SPACEt/UNIT# l"N 212 2236 Rutherford Rd 115 -061 -26 -00
CT/PRvJECT# I LOT# I PHASE# 1#oFu
1
N11:, l*seo~;s #SA1HROOMS I TENANT BUSIN-NAME I CON~~;" I -" ;ou, 4 SynergEyes
DESCRIPTION OF WORK: Include Square FHt of Affr,cted Area(s)
Commercial Tenant Improvement for new business office in existing vacant office space. New interior partition walls, new
MEPs, and new rooftop Skylights proposed, ± 7,200 SF scope of work
EXISTING USE I PROPOSED USE I GARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE IAIR CONDITIONING I FIRE SPRINKLERS
B • Office (vacant) B • No Change NA NA NA YESQ No(I] YESIZ]No □ YESIZ]No□
APPLICANT NAME Josh Gibbs PROPERTY OWNER NAME Alvarez & Marshal Capital RE, LLC Primary Contact
ADDRESS ADDRESS
116 Market Place 2276 East Maple Ave
CITY STATE ZIP CITY STATE ZIP
Escondido CA 92029 EISeaundo CA 90245
PHONE I FAX PHONE I FAX 760,294.0277 760,294.0278 310.975.2661
EMAIL EMAIL josh@trivistacorp.com mvelarde@amcapitalre.com
DESIGN PROFESSIONAL ( same as above ) CONTRACTOR BUS. NAME TriVista. Inc
ADDRESS ADDRESS 116 Market Place
CITY STATE ZIP CITY STATE ZIP
Escondido CA 92029
PHONE PHONE I FAX 760.294.0277 !FAX 760,294.0278
EMAIL EMAIL
jessica@trivistacorp.com I STATE UC.# STATE LIC.# ICLASS B I CITY BUSBLOS1226286 68561
(Sec. 7031.5 Busmess and Professions Code: Any City or County which requires a permit to.construct, alter, improve. demohsh or repair any structure, pnorto 1ts issuance, alSo requires the
applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending w1th Section 7000 of D1vis1on 3 of the B_usmess and Professions Code! or Olathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any apphcant for a permit subJects the applicant to a
civil penalty of not more than five hundred dollars {$5001).
" WQRtKl!!RS' COMPEl\l'.SAT'EON
Worken' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: 0 I 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 performance of the work for which this permit is lssued. 0 I have and wtll maintain workers' 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 Co. Zenith Insurance Company Policy No. Z127364803 Expiration Date 9111118
~section need not be completed if the permit is for one hundred dollars {$100) or less. LJ 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 lo 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 one hundred thousand dollars (&100,000), in
addition to the cost of compensation, damages as for In Section 3706 of the labor code, interest and attorney's fees.
2S CONTRACTOR SIGNATU
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
□
□
□
\, as owner of the property or my employees wth 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 exctusive!y 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 thls reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Oves Oo
2. I (have I have not) s~ned an application for a building perm1l 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 work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address/ phone I contr~ors' license number):
5. I will provide some of the work, butt have contracted (hired) the following persons to pro~ide the work indicated (include name/ address I phone I type of work):
2S PROPERTY OWNER SIGNATURE □AGENT DATE
,,,, ~ '*""'"'" -1 ~, ~ -., ,~ ~ ,~, ~" w.-_,, me;w:;=•~""" 'e -~ "'"'~"!"!n" 0 "" -"'"="' ", -"'~"" ~1 '""',, ,,,,~--~ ~ r""'<W COMPLETE THU $ECTIOl!l FOR: l!il'C:U.l•RES:IDENTF.IU. 81.ULIHlll'G l>ERIIIUTS Ol!llY' '1
~ 1 ~ a , ~ 1" 1 ~ ~ ~/4 _ c,<£
Is the applicoot or future buildirg 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
ls 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.
I hereby affirm that there IS a construction lending agency for the performance of the work this permit 1s ISSUed (Sec. 3097 (i) Civil Code).
lender's Name lender's Address
I certify that I haw read the application and state lhatthe abow lnfoonatlon lsconectancl that the Information on the plans Is aa:urate. I agree to comply with all Chy ordinances and State laws relating to building oonstructlon.
I hereby aulhollze represe,Jlaive cithe Cily ci Calsbad to enlerupoo the-., rnenlioned property for inspeclon puiposes. I ALSO AGREE TO SAVE, INIJEM'llFY AND KEEP HARM.ESS THE CITY OF CARLSBAD
AGAINST ALL LIABILITIES, JUDGt.ENTS, COSTS AND EXPENSES v'MICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA An OSHA pemit ii l8qlftd forexcMlioos Mf 5U' deep and delrdiion or oonslrudion ci studures Mf 3 stories in height.
EXPIRATION: EY81Y pemit osued by the Buidng Official ender lhe pro,isions ci lho Code shal expre by IITTilalion and become rd and void I the bulking or 1Mll1< aulhorized by such permit is not comr,nced wilhr,
180 days from the date cisuch pemit orWlhe bu · or1Mll1< aulhorized by such perrri1 osuspended or -ed at any tirre ater the 1Mll1< is comr,nced for a period ci 180 days (Section 106.4.4 Lnlam Buldng Code)
LS APPLICANT'S SIGNATU DATE
PERMIT INSPECTION HISTORY REPORT (CBC2018-0489)
Permit Type: BLDG-Commercial Application Date: 08/27/2018 Owner: AAND M CAPRE RC P LLC
Work Class: Tenant Improvement Issue Date: 09/28/2018 Subdivision: CARLSBAD TCT#81-10 UNIT#01
Status: Closed -Expired Expiration Date: 06/10/2019 Address: 2236 Rutherford Rd , 115
Carlsbad, CA 92008
IVR Number: 13475
Scheduled Actual Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete Date Start Date
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Not ready, check clearances & lighting No
attachment
BLDG-14 Minor pick up Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
11/20/2018 11/20/2018 BLDG-85 T-Bar, 076679-2018 Passed Michael Collins Complete
Ceiling Grids,
Overhead
Checklist Item COMMENTS Passed
BLDG-Building Deficiency 2nd floor. Yes
BLDG-14 Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topout Yes
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
12/10/2018 12/10/2018 BLDG-Final 078172-2018 Failed Michael Collins Reinspection Complete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Not ready No
BLDG-Plumbing Final No
BLDG-Mechanical Final No
BLDG-Structural Final No
BLDG-Electrical Final No
August 19, 2019 Page 3 of 3
, PERMIT INSPECTION HISTORY REPORT (CBC2018-0489)
Permit Type: BLDG-Commercial Application Date: 08/27/2018 Owner: AAND M CAPRE RC P LLC
Work Class: Tenant Improvement Issue Date: 09/28/2018 Subdivision: CARLSBAD TCT#81-10 UNIT#01
Status: Closed -Expired Expiration Date: 06/10/2019 Address: 2236 Rutheliord Rd , 115
IVR Number: 13475 Carlsbad, CA 92008
Scheduled Actual Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete Date Start Date
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Lower walls at Restroom, server, shower Yes
and Upper walls at Office 5-10 & Exect. Off.
BLDG-Building Deficiency Open office #2 Yes
BLDG-24 075177-2018 Passed Michael Collins Complete
Rough/Topout
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Walls only at Lower level shower, server & Yes
restroom, upper level restrooms
BLDG-34 Rough 075331-2018 Partial Pass Michael Collins Reinspection Incomplete
Electrical
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Walls only at Lower restroom, server, Yes
shower room and upper restrooms.
BLDG-Building Deficiency Partial wall receptacles only, at Office 5-10 Yes
& Executive only.
11/13/2018 11/13/2018 BLDG-17 Interior 075925-2018 Passed Michael Collins Complete
Lath/Drywall
Checklist Item COMMENTS Passed
BLDG-Building Deficiency restroom, server, shower and west offices Yes
BLDG-Building Deficiency Lower walls at Restroom, server, shower Yes
and Upper walls at Office 5-10 & Exect. Off.
BLDG-Building Deficiency Open office #2 Yes
11/15/2018 11/15/2018 BLDG-85 T-Bar, 076206-2018 Failed Michael Collins Reinspection Complete
Celling Grids,
Overhead
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Not ready, check clearances & lighting No
attachment
11/16/2018 11/16/2018 BLDG-85 T-Bar, 076313-2018 Cancelled System Administrator Reinspection Complete
Ceiling Grids,
Overhead
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Not ready, check clearances & lighting No
attachment
11/19/2018 11/19/2018 BLDG-85 T-Bar, 076397-2018 Passed Michael Collins Complete
Ceiling Grids,
Overhead
--------------------------------------------------August 19, 2019 Page 2 of 3
PERMIT INSPECTION HISTORY REPORT (CBC2018-0489)
Permit Type: BLDG-Commercial Application Date: 08/27/2018 Owner: AAND M CAPRE RC P LLC
Work Class: Tenant Improvement Issue Date: 09/28/2018 Subdivision: CARLSBAD TCT#81-10 UNIT#01
Status: Closed -Expired Expiration Date: 06/10/2019 Address: 2236 Rutherford Rd , 115
IVR Number: 13475
Carlsbad, CA 92008
Scheduled Actual Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete Date Start Date
10/10/2018 10/10/2018 BLDG-21 072492-2018 Partial Pass Michael Collins Reinspection Incomplete
Underground/Underf
Joor Plumbing
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Partial waste at Mop, Restroom & Shower. Yes
Leak at POC.
BLDG-34 Rough 072733-2018 Partial Pass Michael Collins Reinspection Incomplete
Electrical
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Partial wait receptacles only, at Office 5-10 Yes
& Executive only.
10/15/2018 10/15/2018 BLDG-21 072876-2018 Passed Michael Collins Complete
Underground/Underf
loor Plumbing
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Waste POC ok Yes
BLDG-Building Deficiency Partial waste at Mop, Restroom & Shower. Yes
Leak at POC.
10/17/2018 10/17/2018 BLDG-84 Rough 073268-2018 Passed Paul Burnette Complete
Combo(14,24,34,44)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-14 No
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topout No
BLDG-34 Rough Electrical No
BLDG-44 No
Rough-Ducts-Dampers
10/25/2018 10/25/2018 BLDG-14 07 4306-2018 Partial Pass Michael Collins Re inspection Incomplete
Frame/Steel/Bolting/
Welding (Decks)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Lower floor, Open Office #2 wall only. Yes
BLDG-17 Interior 074210-2018 Partial Pass Michael Collins Reinspection Incomplete
Lath/Drywall
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Lower walls at Restroom, server, shower Yes
and Upper walls at Office 5-1 O & Exec!. Off.
11/05/2018 11/05/2018 BLDG-17 Interior 075176-2018 Partial Pass Michael Collins Reinspection Incomplete
Lath/Drywall
August 19, 2019 Page 1 of 3
PROJECT NAME Synergy Eyes T.I.
ADDRESS 2236 Rutherford Rd.
Carlsbad, Ca.
ARCHITECT
ENGINEER
CONTRACTOR
Trivista, Inc.
Trivista, Inc.
Trivista, Inc.
INSPECTION REPORT
INSPECTION
□
□
□
□
□
CONCRETE
REINF. STEEL
MASONRY
P.T. CONCRETE
FIELD WELDING
MATERIAL IDENTIFICATION
CONC. MIX NO. & lb/in2
GROUT MIX NO. & lb/in2
MORTAR TYPE & lb/in2
REINF. STEEL GR./SIZE
STRUCTURAL STEEL
OTHER Mark Norry Const. 0 SHOP WELDING HIGH-STRENGTH BOLT
INSPECTION DATE 10·18•2018 0 BATCH PLANT MASONRY BLOCK ------------
PLAN FILE/OTHER 0 EXP. ANCHOR OTHER
BLDG. PERMIT/OTHER CBC2018-0489 OTHER Epoxy all thread rods
MATERIAL SAMPLING
0 CONCRETE O MORTAR O GROUT 0 FIREPROOFING O MASONRY BLOCK
0 REINFORCING STEEL O STRUCTURAL STEEL 0 BOLTS O OTHER
INSPECTIONS PERFORMED, MATERIAL IDENTIFICATION, PROGRESS, WORK REJECTED, REMARKS
PLEASE NOTE ANY RE-INSPECTION, TESTING, OR OTHER PROJECT ISSUES.
I observed the epoxy process of 1-1/8" all thread rods into the (E) concrete as noted below.
Epoxy product: Simpson SET XP, #N1000020797, exp. 08/20.
Locations: (2) all thread rods at each of (6) proposed HFX 24x12 Hardy Frames.
Hole diameters: 1-1/4".
Effective embedment: 24" per det. B/S1 .2.
Note: All holes were drilled with a rotary hammer drill and carbide tipped bit, then brushed with a nylon brush and blown out with
compressed air until dust free prior to injecting the epoxy. The entire procedure meets or exceeds plan details and ESR-2508
requirements.
No discrepancies were observed or noted.
All work is subject to City of Carlsbad approval.
Certification of Compliance: All work, unless otherwise noted, complies with applicable codes and the approved plans and specifications.
PRINTED NAME Craig Bechtel --------------
CERTIFICATION NO. ICC 5265295 -------------SIGNATURE_~~-----
April 16, 2019
TRJVISTA INC
ATTN: JOSH GIBBS
116 MARKET PL
ESCONDIDO, CA 92029-1352
RE: BUILDING PERMIT EXPIRATION
PERMIT TYPE: BLOG-Commercial, Tenant Improvement
Ccityof
Carlsbad
PERMIT NUMBER: CBC2018-0489
ISSUE DATE: 09/28/2018
ADDRESS: 2236 Rutherford Rd, Suite 115
Carlsbad, Ca 92008-8836
Our records Indicate that your building permit will expire by limitation of time on 05/20/2019.
18-04-030 Section 105-5 amended -Expiration:
Every permit issued by the Building Official under the provisions of this code shall expire by
limitation and berom e null and void if the building or work authorized by such permit is not
commenced within 180 calendar days from the date of such perm it, or if the building or work
authorized by such permit is stopped at any time after the work is commenced for a period of 180
calendar days, or if the building or work authorized by such permit exceeds three calendar years
from the issuance date of the permit. Work shall be presumed to have commenced if the permittee
has obtained a required inspection approval of work authorized by the permit by the Building
Official within 180 calendar days of the date of permit issuance. Work shall be presumed to be
stopped if the permittee has not obtained a required inspection approval of work by the Building
official within each 180 day period upon the initial commencement of work authorized by such
permit.
Before such work can be recommenced, a new permit shall be obtained to do so, and the fee
therefore shall be one half the amount required for a new permit for such work, and provided that
no changes have been made or will be made in the original plans and specifications for such work,
and provided further that such suspension or abandonment has not exceeded one year. In order to
renew action on a permit after expiration, the permittee shall pay a new permit fee.
Any permittee holding an unexpired permit may apply for an extension of time within which work
may commence under that permit when the permittee is unable to commence work within the time
period required by this section fur good and satisfactory reasons.
Please check below indicating your intentions and return this letter to us.
D PrOject abandoned. A new permit will be obtained prior to commencing work.
D Permit 180 day extension request, with written explanation including phone number and email address.
Request will not be considered without explanation
D Renewa I permit requested.
If the project has been completed and only a final inspection is needed, please call the
inspection request line at (760) 602-2725-
If you have any questions, please contact the Building Inspection Division at 760-602-2700.
Community & Economic Development
Building Division I 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
February 28, 2019
TRIVISTA INC
ATTN: JOSH GIBBS
116 MARKET PL
ESCONDIDO, CA 92029-1352
RE: BUILDING PERMIT EXPIRATION
PERMIT TYPE: BLDG-Commercial, Tenant Improvement
{cityof
Carlsbad
PERMIT NUMBER: CBC2018-0489
ISSUE DATE: 09/28/2018
ADDRESS: 2236 Rutherford Rd, Suite 115
Carlsbad, Ca 92008-8836
Our records indicate that your building permit will expire by limitation of time on 05/20/2019.
18-04.030 Section 105.5 amended -Fxpir.,.tion:
Every permit issued by the Building Official under the proV1sions of this code shall expire by
limitation and become null and void if the building or wor1c authorized by such permit is not
commenced wilhin 180 calendar days from the dam of such permit, or if the building or wortc
authorized by such permit is stopped at any lime aftef' the wor1c is commenced for a period of 180
calendar days, or if the building or wortc authorized by such permit exceeds three calendar years
from the issuance date of the permit. Work shall be presumed ID have commenced if the pennittee
has obtained a required inspection approval of work authorized by the permit by the Building
Official within 180 calendar days of lhe dam of permit issuance. Worlc shall be presumed ID be
stopped if the permil:IBe has not obtained a required inspection approval of wortc by the Building
Official within each 180 day period upon the initial commencement of work authorized by such
permit.
Before such work can be recommenced, a new pennit shall be obtained ID do so, and the lee
therefore shall be one half the amount required for a new permit for such work, and provided that
no changes have been made or will be made in the original plans and specifications fur such wortc,
and provided further that such suspension or abandonment has not exmeded one year. In order ID
renew action on a permit after expiration, the permil:IBe shall pay a new permit fee.
Any permitme holding an unexpired permit may apply fur an extension of lime within which work
may commenm under that permit when the permil:IBe is unable to commence wor1c within the time
period required by this section fur good and satisfactx>ry reasons.
Please check below indicating your intentions and ret .. n this letter to us.
D Project abandoned. A new permit will be obtained prior to commencing work.
D Permit 180 day extension request, with written explanation including phone number and email address.
Request will not be considered without explanation
D Renewal permit requested.
If the project has been completed and only ii final inspection is needed, please call the
inspection request line at (760) 602-2725.
If you have any questions, please contact the Building Inspection Division at 760-602-2700.
Community & Economic Development
Building Division I 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
DATE: 9/26/2018
JURISDICTION: Carlsbad
PLAN CHECK#.: CBC2018-0489
✓• EsG1I
A SAFEbuilt"Company
SET: II
PROJECT ADDRESS: 2236 Rutherford Rd. #115
PROJECT NAME: SynergEyes Tenant Improvement
0 APPLICANT
0 JURIS.
~ The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
0 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.
0 The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
0 The check list transmitted herewith is for your information. The plans are being held at EsGil
until corrected plans are submitted for recheck.
0 The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
0 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.
0 EsGil staff did advise the aQ licant that the plan check has been completed.
Person contacted:
Date contacted:
Mail Telepho
0 REMARKS:
By: Jason Pasiut
EsGil
Telephone#:
(b ) Email:
Fax son
Enclosures:
9/20/2018
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
IMEIIIIN£EBS
Consulting structural engineers
325 W. 3rd Ave., Suite 205 ♦ Escondido, CA. 92025
Phone (760) 7 41-7306 ♦ Fax (760) 738-8364
STRUCTURAL CALCULATIONS
PROJECT NAME
PROJECT NO.
CLIENT
This signature is to be a wet
signature not a copy
APPROVED
DATE SIGNED
2236 Rutherford Skylight
2018023
Trivista Inc.
A,r1
4-/~j7J/-&
l
I
I DESIGNED
I
I
I BY
I
DATE:
CBC2018-0489
2236 RUTHERFORD RD
SYNERGEYES 7,200 SF T.I.
DEV2017-0243
A.M.
April, 2018
#115
2120612600
8/27/2018
CBC2018-0489
11-ERIUERS
Consulting Structural Engineers
325 W. 3rd Ave., Suite 205. Escondido, CA. 92025
Phone (760) 741-7306 Fax (760) 738-8364
DESIGN CRITERIA
(F«Jof Loadln9)
Roofing
Plywood
Sub-purlins
Purlins
Beams
Misc.
DL=
LL=
Seismic:
Wind:
sons:
1.0psf
1.5 psf
1.0 psf
2.0 psf
2.0 psf
2.5 psf
10 psf
20 psf
Seismic Design Category: D
Exp. "C"
Brg =1500 psf
Concrete: f'c=2500 psi
fc=3000 psi
for footings and slab
for structural slab
Reinforc.: Fy=60000 psi for#5 and grater
Fy=40000 psi for #4 and smaller
Lumber:
Steel:
Masonry:
Weld:
Code:
DF/L #1
DF/L#2
24F-V4
24F-V8
for 2x rafters, 2x joists, beams and posts.
for 2x studs.
for simple span glue-laminated beams
for continuous glue-laminated beams
ASTM A500, grade B for tubular sections
ASTM A501, -OJ ASTM A.53, 4'p.e E gr.ad.e 8 fOT •clrc~lar sectiGr;s
ASTM A572 grade 50 for all other sections.
fm=1500 psi
Welding should conform to AWS D1-1. All welding shall be done by electric
ar.c.pro;;_ess .using alclllroved . .rods anct . .perfor.mad .by .ce.rti.!ied. welders .. All
fabricatlDtc and wetdfng shall be performed tn the strop of arr apptovecl
fabricator. The approved fabricator must submit a certificate of compliance in
accordance with C.B.C. All field welding requires continuous
special inspection and all shop welding requires periodic special inspection.
C.B.C. 2016 edition
L~.d
A M ENGINEERS
Consulting Structural Engineers
(760) 741-7306
WP!, ,;.£L ,_ {j o + 2,3) 13/ ~ -.. \ 2u ,t,/p )-
\X-o,,tt,t ..,. 4,1.c..l ,fr,
f10\,t(,( ,:... '/ t () I~
c;r,J.d" <?.'J.. 1t1J !.f..1,1>'-i -:..\3 72, 11 o'k
SHEET NO,----;,.-~----OF ____ _
ft
CALCULATED BY ______ DATE __ --'-_•_•,_
j),,-113 sr:-yLt?-H ( /fA"F-T8LS
~,wt,
.~ -(tJJ ~t 11i1~J;efr
a'l.4 r,,, Gj<,\ r. -z,e&.
J ~ 'ir&-f'lfl<WAJ
. ---"--i ----·---. ---.-
·--------i--
-------·. --. -··----t
----_, -
i --·---7 --. -• . .. ---1 ·
-.. ·-~ :~r=:Fl-=~:
t-·------~----.---
_________ ---~~~ -~ ___ l>Rf -: _---·: ~-~
+ ---+-·
t ____ . .__ -___ ..,__
' i --I----·---. ,. ···-·-· --·--~ ----··
:_ ---. -·;,,,:,i ;1-Jrti· -p.t ·t· -----·_· .. 1 ----.. ,_ /f'1_$,IL[r+7 V---1 __ ----+. -
,, I !
-· i· ---
.. --··' ,. ------------. ---------.. --t·-. ------!------
. --i· ------·-.,. ··+---. --.. ->----
+ -
l -
···-~-----
-· -----
-------·-.
t ----,··--·----·---------,--
---,------··-· .. + --·------·--' ------.. ·----r-----t--
' -. ---; -----r---.. --.. --1-----· -···--·· :· -,,._ ----t--------1---
,t
I c;, I
Suite 113
PROPOSED NEW SKYLIGHT PLAN ,r-,-~
~TI\IVISTA·INC SP!:;.C ~LUT~ 0:IMMUCW.<"OOIIIN:l(II$ -----·-,,,_,,._ 22Xl'l~l'ld ":=,. ""'-"...,"':,!:" CWIIDaG,CA82008
,,_,:1en __ ~.,.. ........... .__ .. __ , ____ ""'""""''"'''"111• ........... _>'¥1_T_, __ :,,,i>n""mi<"1 _ _,_~lfYll•"<""QM~!J<--,d ..... --~~ ..... --...,.,..,_,.._,., .. --~,-~ ... ,..,.,,~
-· _, ----
J?GI...., 3130/2(118 (M PROP PlAN I I ....., 1/8'• 1'..(I"
2236111.JlHERFOl[l llD t113
2236RUTHE!lfOIIOFc0.DWG
]
A M Engineers
325 W. 3Rd. Ave., Suite 205
Escondido, CA 92025
(760) 741-7306
Title Block Line 6
project Title:
Engineer:
Project Descr:
iij6 Rutherford Skylihgt
Skylight opening
Project ID: 2018023
Prmled: 30 APR 2018, 4.25PM
i ASCE .. Seismic Base Shear File '? Ci\Usersv\dmin\OOCUME--1\ENERCA"'1\2236RlH _,EC6
ENERCALC,JNC:·193:3-,2()1.7, Bu111fl0.17.1.2.·10, Ver:10:17.12.10
I, II; I,
Sin_gle story concrete tilt-up bldg
Risk Category
Risk Gategory of Building or Other Structure :
Seismic Importance Factor =
Gridded Ss & S1values ASCE-7-10 standard
"II'' All Buildings and other structures except those listed as Category I, 111, and IV
Calculations per ASCE 7-10
ASC£ 7-10, Page 2, Table 1.5-1
ASCE 7-10, Page 5, Table1.5-2
ASCE 7-10 11.4.1
Max. Ground Motions, 5% Damping :
i>s • 1.1ee4 s,0.2...,,..,,..,..
latitude =
\.ungi'roOe, ""
33.158 deg North
11 i .'321l \leg 'fdesl
S 1 = 0.4469 g, 1.0 sec response Location : Carlsbad, CA 92008
Site Class, Site Coeff. and Design Category
Site Classfficatioo ·o· : Shear Wave Velocity 600 to 1,200 fl/sec
Site Coefficients Fa & Fv Fa
Fv
=
=
D
1.03
ASCE 7-10 Table 20.3-1
ASC£ 7-10 Tabla 11.4-1 & 11.4-2
(using straight-Nne interpolation from table values) = 1.55
Maximum Consldered Earthquake Acceleration
Design Spectral Acceleration
Seismic Design Category
Resisting System
Basic Seismic Force Resisting System ...
Response Modilcatlon Coefficient • R •
System OVerstrenglh Factor "Wo •
Deflectioo Ampf~cation Factor • Cd •
S =Fa'Ss s·~s · Fv'S1 N-, -
Bearing Wall Systems
=
=
=
=
Ordinary reinforced concrete shear,waUs.
1.205
0.694
0.804
0.463
D
= 4.00 Bulldmg height limits:
= 2.50 Category "A & 8" Lim~
Category "C" Limit =
NOTE! See ASCE 7-10 for an app/ieab/a footnotes
4.00 Category ·o· Limit
Category 'E' Limit:
Category "F' Limit
L~eral Force Procedure
S1 >= 0.75
No Limit
No Limit
Not Permitted
Not Permitted
Not Permitted
Equivalent Lateral Fonoe Procedure
Ibe ·eauivatent 1,,ateral Force Proced11re· is being 11sed according to the nrovisions of ASCE 7-1-0 12 8
l>etennine "Building l'erloll
Strucwre Type for Bul~ing Penod Calculation : All Olhar Strucwral Systems
·Ct· value 0.020 • hn ·: Height from base to highest level = 25.0 ft
0.224 sec
8.000 sec
M x • value 0.75
•Ta• Approximate fundamental p!fiod using Eq. 12.8-7 : Ta= Ct• (hn 'x) =
"TL": Long-period transition period par ASCE 7-10 Maps 22-12-> 22-16
S 0~ Short Penod Des~n Spectral Response =
• R • : Response Modification Factor =
• l • : Seismic Importance Factor =
Seismic Base Shear
Cs• 0.2009 from 12.B.1.1
Building Penod ·Ta· Calailated from Approximate Method sele~ed
0.804 From Eq. 12.8-2, Preliminary Cs
4.00 From Eq. 12.8-3 & 12.8-4, Cs need n01 exoeed
From Eq. 12.6-5 & 12.6-6, Cs n01 be less than
Cs : Seismic Response Coefficient =
WI see Sum Wi b~ow I =
Seismic Base Sttesr V =-Cs • W -=
0.00 k
0.00 k
ASCE 7-10 Eq. 11.4-1
ASCE 1-10 Eq. 11.4-<
ASC£ 7-10 Eq. 11.4-3
ASCE 7-10 Eq. 11.4-4
~SCE 7-10 Table 11.6-1 &-2
ASCEl-10 Tab/a 12.2-1
ASCE 7-10 Section 12.8.2
Usa ASCE 12.8-7
= 0.224 sec
ASCE 7-10 S&o/ioll 12:8. t.1
= 0.201
= 0.517
= 0.035
= 0.2009
ASCE 7-10 Section 12.8.1
4
AM Engineers
325 W. 3Rd. Ave., Suite 205
Escondido, CA. 92025
(760) 741-7306
Title Block Line 6
ASCE Seismic Base Shear
,.,1: ,.
• k ·: hx exponent based on Ta:: 1.00
Table ol buiding Weights by Floor Level ...
Lev~# Wi: Weight
Sum Wi = 0.00 k
Hi: Height
Diaphragm Forces : Seismic Design Category "B" to "F"
Level# Wl Fi Sum Fi Sum Wi
Pro1,0ct Title:
Engineer:
Project Descr:
(Wi •Hi'k) Cvx
0.00 k-ft
2~6 Rutherford Skylihgt AM
Skylight opening
Project ID 2018023
Pril'lfflll: 30 APR 2018. ~:25PM
File ,. C:\1Jseis~_dmln\OOCUME-1\ENERCA-1_\2236RLJ-1 £C6
_ENSRCALC,JNC. 1983-2017, BuikM0.17.12 .. 10, Ver,:10.17-12.10
f!SCET-10 Section 12.8.3
Fx=Cvx •v Sum Story Shear Sum Story Moment
Total Base Shear= 0.00 k
Base Moment= 0.0 k-ft
ASCE7-10 12.10.1.1
Wpx . . Weight at level of diaphragm and other structure elements attached to it.
Fi . Design Lateral Force applied at the level.
Sum Fi . . . Sum of 'Lat. Force' of current level plus all levels above
MIN Req'd Force@ Level . 0.20' S 05 I 'Wpx
MAX Req'd Force@ Level. .. ... 0.40 • S osl 'Wpx
Fpx: Design Force@ Level . . . . . Wpx • SUM(x->n) Fi I SUM(x->n) wi, x = Current level, n = Top Level
5
Jos -::# Zvl b c/l 5
A M ENGINEERS SHEET NO. ,e_ _____ OF ____ _
Consulting Structural Engineers CALCULATED BY _____ DATE ____ _
(760) 741-7306
fZw-F-UJM ==-I o X G 2-
WA-U tOAn --=-/orU/z.,y! L
0,-:::rJ,'JvxfJ:,?v = 1713/f,f
{? :::: /-J 4~ Se./ ,z_ y;:.o, 7 -::.-qt;, 7i 6
V ~ ---4B> 12-I {::2---=-7 fo 3/µ
""" f,Z:,J #/,1
-::....-2-5 ,I -tP/tJ
67tl -3//1
r.~ "' 4e,,72--t1<h< lGz -X, 7 = 3 34/ #
<Vtf.,,11~, ~ --~s 4 I · .,__._ ,~ l:1J <4'2,5 ¾ta&-
&2.-i5xi,
/151,4 ze( A r
Offi,.J/w (,if.,~
E
David Thomas
Engineering, A.P.C.
Structural Engineering Services
Structural Calculations
(Shearwall Retrofit)
Project
Rutherford -Suite 115 / 18158
2236 Rutherford Rd.
Carlsbad, California 92008
Prepared For
Philip Williamson
TRIVISTA, INC.
116 Market Place
Escondido, California 92029
9-6-18
RECEIVED
SEP 1 8 2018
CITY OF CARLSBAD
BUILDING DIVISION
Mailing: 3525 Del Mar Heights Road, #331, San Diego, California 92130
Physical: 12625 High Bluff Drive, Suite 106, San Diego, California 92130
Office Phone: (858) 201-3072 Cell Phone: (858) 336-9902
Website: www.dtengsd.com Email: david@dtengsd.com
C6C. 20\ 'o-04t>9
)-
t
c..
'
Job Rutherford Suite 115 18158
Sheet No. ______ of _____ _
Calculated by DT Date ____ _
David Thomas Engineering
LATERAL DESIGN (Sheet 1)
Wind Design
Method Used -Main Wind-Force Resisting System (MWFRS) -Method 2
Maximum Buildt feet ·ng Height (z) = 30
Design mph Wind Speed= 110
ure Category = Expos
lmporta nee Factor (I) =
C
1.00
(110 mph for California)
(per ASCE-7, 6.5.6.3)
(per ASCE-7, Table 1.5-2)
(per ASCE-7, 26.8.2)
(per ASCE-7, Figure 28.6-1)
(per ASCE-7, Figure 28.6-1)
K,, =
Jc=
Ps30 =
0.6 x Ps =!
(reduced for ASD load combos)
1.00
1.40
17.70 psf
14.87!psf P5 =Ax K,,x Ix Ps30 (per ASCE-7, 6.4.2.1, Equation 6-1)
Adjust Factor A Table
Mean Roof Exposure
Height (ft) B C D
15 1.00 1.21 1.47
20 1.00 1.29 1.55
25 1.00 1.35 1.61
30 1.00 1.40 1.66
35 1.05 1.45 1.70
40 1.09 1.49 1.74
45 1.12 1.53 1.78
so 1.16 1.56 1.81
55 1.19 1.59 1.84
60 1.22 1.62 1.87
Seismic Design
Method used -Equivalent Lateral Force Procedure
Occupancy Category= 2 (per ASCE-7, Table 1-1) (Residential = 2.0)
6.5 R = (per ASCE-7, Table 12.2-1) (Wood Shearwalls = 6.5)
1.00 I= (per ASCE-7, Table 11.5-1) (Residential= 1.0)
Site Class= (per ASCE-7, 11.4.2) (Assume Site Class= "D" w /o Soils Report)
Ss = g (0.2 sec) F, = ~ Sos= 0.764 g
D
1.068
0.413 S1 = g (1 sec) F.= ~ S01 = 0.437 g
Seismic Design Category (SOS) =
Seismic Design Category (SDl) =
D
D
T, = 0.256
Cs= 0.118
Csma, = 0.262
Cs min = 0.010
Cs,ct-0.118
p = 1.3
V = 0.109
(Use the worst case seismic design category)
sec C,h: (per ASCE-7, Equation 12.8-7)
S0s/(R/1) (per ASCE-7, Equation 12.8-2)
S0i/T,(R/I (per ASCE-7, Equation 12.8-3)
Csm1n > 0.01 or O.SStf(R/1) (per ASCE-7, Eq. 12.8-5 / 12.8-6)
Assumed
W, (Cs,ct*P)*W,/1.4 (ASD)
··----------···----
Job Rutherford Suite 115 18158
Sheet No. ______ of _____ _
David Thomas Engineering Calculated by DT Date ____ _
LATERAL DESIGN (Sheet 2)
BUILDING WEIGHTS
Total Installed Floor Weight
Total Installed Interior Wall Weight
Total Installed Exterior Wall Weight
Commercial Partition Loads?
=I
=apsf = 16 psf
= Y Y or N
Mezzanine Floor Loads
Diaphragm Area
Exterior Wall Length
Interior Wall Length
Roof= 4284 sq. ft.
Minimum Diaphragm Dimension
TOTAL BUILDING DEAD LOAD, WT.
C,(adjusted)
BASE SHEAR, V
LATERAL LOAD DISTRIBUTION
Story Area (A)
Story Unit Shear (vx)
WIND VS. SEISMIC COMPARISON
Wind Pressure (Pl
Story Linear Forces
NORTH-SOUTH
NORTH-SOUTH
EAST-WEST
EAST-WEST
Wind
Seismic
Wind
Seismic
0 ft.
300 ft.
N-S = 34 ft.
= 224,700.00
= 0.109
= 24,523.63
=
4284 sq. ft.
5.72 psf
14.87 psf
= Mezz.
14.87 psf X
= 5.72 psf X
14.87 psf X
5.72 psf X
Mezz.
LBS.
LBS.
Roof Project Height
Plate Height
• Alternate Ext. Wall =
Deck =1
Alt= I~:· ft.
E-W=I 1001ft.
TOTAL= 224700 LBS.
.__ __ __.!psf
See Lateral Design Loads Spreadsheet
See Lateral Design Loads Spreadsheet
5 ft.
34 ft.
5 ft.
100 ft.
74 plf
195 plf
74 plf
572 plf
SEISMIC GOVERNS
SEISMIC GOVERNS
D_r-r; .. D>l:E'
Job _=R-ut=b~e~c~~o~c-ct~S-u=it~e~1~1~5 __ ~1-6-1-58~
Sheet No. ______ of _____ _
Calculated by __ ~D~T~Date ____ _ David Thomas Engineering
Shearwall Design
Mezzanine Story Shearwalls North-South Direction Unit Lateral Load, v = 5.72 psf
Gridline Interior Shearwall
Tributary Area (This Level): (73'-0" + 53'-0") / 2 x 34'-0" = 2.142 sq. ft.
Lateral Load (This Level): = 12 252 Lbs
Lateral Load (Level Above): ________________________ Lbs
Total Load (All Levels), Fx = = 12 252 Lbs
Install (6)-Six HFX 12 x 12 Hardy Panels W/ 1-1/8" Dia. Std. Anchors epoxied into Existing Foundation
Allowable Load = 6 x 2.515 lbs= 15,090 lbs
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MATERIALS
QUESTIONNAIRE
RECORD ID# _________________ I
PLAN CHECK# __________________ ,
BP DATE
Business Name Business Contact
t-/ 14£. lp(Z..DW ~ Telephone#
11,0, "!,'!,(. ~1\f
Project Address ?:I,?~ rz-vnt~JZO 12-0. -IL(r~
State
CK
Zip Code_ / APN# Zcio'6 2 l'Z • OCo \ -z_r,,
Mailing Address ,, City State Zip Code Plan File#
Project Contact j Applicant E-mail Telephone# • L
O',lf-t:,, ,,...s (l~/IB,r,t1v,,;rµ,.,(LP, 0.M ?r-<>. 2."1--r, <>'l-17
The following questions represent the facility's activities, NOT the specific project description.
ART I: FIR DEPARTMENT-HAZARDO S MATERIALS DIVISIO : OCCUPA CY CLASSIFICATION: not re uired for ro·ec within the Cl of San
.Q!!ggl: Indicate by circling the item, whether your business will use, process, or store any of the following 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 (inctuding 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
NTY EPARTM NT OF ENVIRON ENT L HEALTH -HAZARDOUS M TERIALS DIVISION HMO: If the answer to any of the
questions is yes, applicant must contact the ounty o an iego Hazardous aterials Division, 5500 Overland Avenue, uite 110, an Diego, CA 92123.
Call (858) 505-6700 prior to the issuance of a building permit.
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) 0 ~ Is your business listed on the reverse side of this form? (check all that apply).
0 ~ Will your business dispose of Hazardous Substances or Medical Waste in any amount?
D E§/" Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500
.,/1)ounds and/or 200 cubic feet?
0 ~ Wm your business store or handle carcinogens/reproductive toxins in any quantity? 0 l.!:f. Will your business use an existing or install an underground storage tank? D g° Will your business store or handle Regulated Substances (CalARP)? 0 a Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? 0 §"' Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to
or reaterthan 1,320 allons? California's Above round Petroleum Stora eAd.
Date Initials
0 CalARP Required
I
Date Initials
□ CalARP Complete
I
Date Initials
ART Ill: SAN DIEGO C UNTY AIR OLLUTION CONTROL DISTRICT A CD: Any YES" answer requires a stamp from APCD 10124 Old Grove Road, Sar
Diego, A 92131 a cdcom s coun .ca. ov (8 8) 586-650). ["No stamp required if Q1 Yes and Q3 Yes~ Q4-Q6 No]. The following questions are intendec
to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensiv1
requirements contact APCD. Residences are typically exempt, except -those with more than one building• on the property; single buildings with more than fou
dwelling units; town homes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. r♦Excludes garages & small outbuildings.]
YES 1'1__0/
1. 0 [!f., Will the project disturb 160 square feet or more of existing building materials?
2. 0 ~ 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 sucvey been performed by a Certified Asbestos Consultant or Site Surveillance
4. □
5. □
6. □
Technician?
0 (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.
~ Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(v{ww.sdaocd.9rg/inf9/facts/permjts.pdfl for typical equipment requiring an APCD permit. D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
bounda
Briefly describe busine~Vctivities:
~6"'~ o\Hvif'
Briefly describe proposed project:
OM/A~t/l't.-/1,N'I I lllf'{UN,:M,,ts,Jf'"
I decla~~der penalty of perjury that to the best of my knowledge and belie
{_09f: b,,,a .....
Name of ner or Authorized A ent Si ature of
erein are true and correct.
<t, I Vf Ir</
Date
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 In this box .2!J.Jl exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permIttmg requirements may still apply.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division