HomeMy WebLinkAbout2808 ROOSEVELT ST; 102; CBC2017-0638; Permit(city of
Carlsbad
Print Date: 02/27/2018
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
2808 Roosevelt St, 102
BLDG-Commercial
2031820400
$56,556.16
Commercial Permit
Work Class: Tenant Improvement
Lot#:
Reference#:
Construction Type:
Bathrooms:
Orig. Plan Check#:
Plan Check#:
Description: CARLSBAD CHIROPRACTIC: 1,216 SF CHIROPRACTOR OFFICE
Owner:
Status:
Applied:
Issued:
Permit
Finaled:
Inspector:
Final
Inspection:
Contractor:
Permit No: CBC2017-0638
Closed -Finaled
12/08/2017
01/16/2018
MColl
2/27/2018 1:46:0lPM
ROOSEVELT OF TAMARACK INVESTMENT 5 P WHITE CONSTRUCTION INC
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
6 Venture, Unit 215
IRVINE, CA 92618-7364
ELECTRICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
MECHANICAL BLDG COMMERCIAL NEW/ADDITION/REMODEL
SB1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-COMMERCIAL
Total Fees: $866.76 Total Payments To Date: $866.76
2524 Gateway Rd
Carlsbad, CA 92009-1742
760-931-1130
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.
$0.00
1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
$437.01
$305.91
$60.00
$45.00
$3.00
$15.84
THE FOLL\)WING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH OHAZMAT/APCD
( City of Building Permit Application Plan Check No.('1),(1 J"Ol7'-QU 3«?,
1635 Faraday Ave., Carlsbad, CA 92008 Est. Value !::-1 f\ , 5 9 r, -
Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Deposit email: building@carlsbadca.gov
www.carlsbadca.gov Date 12. -9\ -I , ISWPPP
JOB ADDRESS SUITH/SPACE#/UNITJ rPN 2808 Roosevelt St., Carlsbad, CA 92008 102 ---
CT/PROJECT# ILOT# I PHASE# I# OF UNITS I# BEDROOMS # BATHROOMS I TENANT BUSINESS NAME I CONS;sTYPE I acc. ~OUP
Carlsbad Chiropractic
DESCRIPTION OF WORK: Include Square Feet of Affected Area(s)
Tenant Improvement -Minor interior wall demolition, New interior wall construction, including light fixture, mechanical
diffuser relocations, flooring and paint.
l"2-! C,R -sF -±-
EXISTING USE I PROPOSED USE I GARAGE (SF) PATIOS (SF) I DECKS (SF) FIREPLACE IAIR CONDITIONING I FIRE SPR!NKLERS
Commercial Office Same YES[], NOIZ) YES[Z]No □ YES □NolZ)
APPLICANT NAME Jack Carter Architect/ White Construction PROPERTY OWNER NAME Yelland Properties, inc. Prlmarv Contact
ADDRESS ADDRESS
6828 Richard St. 6 Venture, Suite 215
CITY STATE ZIP CITY STATE ZIP
San Dieqo CA 92115 Irvine CA 92618
PHONE PHONE I FAX IFAX 760-310-2439 949-727-0283 949-234-1946
EMAIL EMAIL
jackcarteraia@,yahoo.com johny@,pouch.com
DESIGN PROFESSIONAL Jack Carter, Architect CONTRACTOR BUS. NAME White Construction
ADDRESS ADDRESS
6828 Richard St.
CITY STATE ZIP CITY STATE ZIP
San Dieqo CA 92115 Carlsbad CA 92008
PHONE IFAX PHONE l'AX 760-310-2439 760-931-1130
EMAIL EMAIL
jackcarteraia@.yahoo.com www.whiteconstructioninc.com
Architect 1 STATE "'c-21021 STATELICB IO ;;i 3 ~ 5 ~ l"LAS13 I CITY BUS. LIC.#
(Sec, 7031.5 Business and P_rofessions 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_m1t to file a signed statement that he 1s licensed pursuant to the provisions of the Contractor's License Law {Chapter 9, comme_ndmg with Section 7.000 of Div1s1on 3 of the
Business and Professions Code} or that he Is exempt therefrom, and the basis for the alleged exemption. Any vio\at1on of Section 7031.5 by any apphcant for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars {$500)).
WORKERS' COMPENSATION
Worken' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q I have and will maintain a certificate of consent to self-Insure for workers' compensation as providei:J by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
){J I have and will maintain workers' compensatio , as reQuired by Se~bon 3700 oft Labor Code, for the _performance of the work for which this permit is issued. My workers' compensatiozr1srnce carrier and policy
aombe,a~, los,raoce Co_ ::V S Pol,cy No. J lo QD{) I Y. I S '8 L]l__ E,p;rauon Date / / « 0 I 1
~section need not be completed if the permit is for one hundred dollars ($100) or less. I 1
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 to become subject to the Workers' Compensation Laws of
California WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and clvll fines up to one hundred thousand dollars (&100,000), in
addition to the cost of compensation, dama es as provided for IR Section 3706 of the Labor code, interest and attorney's fees.
NS CONTRACTOR SIGNATURE
I hereby affirm that I am exempt from Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do the work and the stwcture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's
License Law does not apply to an owr1er of property who builds or improves thereor1, and who does such work himseif or through his own employees, provided that such improvemer1ts are not intended or offered for
sale. If, however, the buildir1g or improvement is sold within one year of completion, the owner-builder will have the burder1 of proving that he did r1ot build or improve for the purpose of sale).
□
□
I, as owner of the property, am exclusively contractir1g with licensed cor1tractors to construct the project (Sec. 7044, Business and Professions Code: The Cor1tractor'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 Contracto(s Ucense Law),
I am exempt ur1der 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/ have not) signed ar1 application for a building permit for the proposed work,
3. I have contracted with the following person (firm) to provide the proposed cor1struction (include name address I phor1e / cor1tractors' 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 (ir1clude name I address I phone I contractors· license number)·
5, l will provide some of the work, but I have cor1tracted (hired) the followir1g persons to provide the work indicated (include name I address I phone I type of work):
NS 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 registratioo 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 ouality 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.
I c:ert!fy that I have read the appUcatlon and state that the above lnfonnation Is correct and that the lnfonnatlon on the plans Is accurate. I agree to comply with all Cltyordlnances and State laws relating to building construction.
I hereby au~orize repre,enlative of lhe Cify of Carlsbad ID enter upon lhe-., mentioned property for ilSj)OCtion purposes. I ALSO AGREE TO SAVE. INDEMNIFY AND KEEP HARM.ESS THE CITY OF CARLSBAD
AGAINST ALL LLIIIJILITIES. JUDGt.ENTS. COSTS SES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA j)EMTTlit is requred for excavation aod demolition or construction of strucb.Jres wer 3 stories in height
EXPIRATION: Every j)EMTTlit i.5sued by the . I u der provisions of lhis Code shall expire by limitation and become null and void if lhe building or WOik authorized by such pennitis notcorrmenc:ecl within
180 days from~• dale of such pem,t or l~e , a ~orized by such perml is suspended or abandooed at any time after~•"'"' is commenced for a period of 180 days (Section 106.4.4 Unloml Bui~l"!I Code).
__ D_ATE----+'-/v/p_r; I')--() 17 -~-···-··~··· k5 APPLICANT"S SIGNATURE ,
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 ttJe completed fom, to Cify of Cansbad, Bui~ing Division 1635 Faraday Avenue, Cansbad, Califom~ 92008.
CONTACT NAME
ADDRESS
CITY STATE
PHONE
EMAIL
DELIVERY OPTIONS
PICKUP:
MAIL TO:
CONTACT (Listed above)
CONTRACTOR (On Pg. 1)
CONTACT (Listed above)
CONTRACTOR (On Pg. 1)
ZIP
FAX
OCCUPANT (Listed above)
OCCUPANT (Listed above)
MAIL/ FAX TO OTHER: ________________ _
A$ APPLICANT'S SIGNATURE
CO#: (Office Use Only)
OCCUPANT NAME
BUILDING ADDRESS
CITY STATE
Carlsbad CA
OCCUPANT'S BUS. UC. No.
ASSOCIATED CB#
NO CHANGE IN USE/ NO CONSTRUCTION
CHANGE OF USE/ NO CONSTRUCTION
DATE
ZIP
PERMIT INSPECTION HISTORY REPOl~T (CBC2017-0638)
Permit Type: BLDG-Commercial Application Date: 12/08/2017 Owner: ROOSEVELT OF TAMARACK
INVESTMENT
Work Class: Tenant Improvement Issue Date: 01/16/2018 Subdivision: SEASIDE LANDS
Status: Closed -Finaled Expiration Date: 08/20/2018 Address: 2808 Roosevelt St, 102
Carlsbad, CA 92008-1688
IVR Number: 8232
Scheduled Actual
Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Re inspection Complete
01/17/2018 01/17/2018 BLDG-84 Rough 046049-2018 Passed Michael Collins Complete
Combo(14,24,34,44)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Wall frame & electrical only Yes
BLDG-14 Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-34 Rough Electrical Yes
01/19/2018 01/19/2018 BLDG-17 Interior 046273-2018 Passed Michael Collins Complete
LathfDrywall
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Walls only Yes
02/20/2018 02/20/2018 BLDG--43 Air 049179-2018 Failed Michael Colllns Reinspection Complete
Cond./Fumace Set
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
02/21/2018 02/21/2018 BLDG-85 T-Bar, 049405-2018 Passed Michael Collins Complete
Celling Grids,
Overhead
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-14 Yes
Frame-Steel·Bolting-Welding
(Decks)
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
02/27/2018 02/27(2018 BLDG-Flnal 049984-2018 Passed Michael Collins Complete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-Electrical Final Yes
February 27, 2018 Page 1 of 1
DATE: 1/11/2018
JURISDICTION: Carlsbad
PLAN CHECK#.: CBC2017-0638
✓• EsG1I
A s.i.H=.bllllt Coinp,ir1y
SET: II
PROJECT ADDRESS: 2808 Roosevelt St. #102
PROJECT NAME: Carlsbad Chiropractic Tenant Improvement
□ APPLICANT fl' JURIS.
~ 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
Date contacted:
Mail Telephone
0 REMARKS:
By: Jason Pasiut
EsGil
Telephone#:
(by~ Email:
Fax In Person
Enclosures:
1/9/2018
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
DATE: 12/19/2017
JURISDICTION: Carlsbad
PLAN CHECK#.: CBC2017-0638
✓• EsG1I
A SAFEbuilt Compar,y
SETI
PROJECT ADDRESS: 2808 Roosevelt St. #102
PROJECT NAME: Carlsbad Chiropractic Tenant Improvement
~PLICANT
/ JuRIS.
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.
r:gj 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.
r:gj The applicant's copy of the check list has been sent to:
Jack Carter
D EsGil staff did not advise the applicant that the plan check has been completed.
r:gj EsGil staff did advise the applicant that the plan check has been completed.
Person contacted: Jack Carter Telephone#: 760-310-2439
I Date co')t'acted:\'117-0 (by:r-u Email: jackcarteraia@yahoo.com
J~ail Wt~~n-e) Fax In Person
0 REMAR~
By: Jason Pasiut
EsGil
Enclosures:
12/12/2017
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576
Carlsbad CBC2017-0638
12/19/2017
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK#.: CBC2017-0638
OCCUPANCY: B
TYPE OF CONSTRUCTION: V-A
ALLOWABLE FLOOR AREA: within
SPRINKLERS?: YES
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 12/8/2017
DATE INITIAL PLAN REVIEW
COMPLETED: 12/19/2017
FOREWORD (PLEASE READ):
JURISDICTION: Carlsbad
USE: Chiroproactor
ACTUAL AREA: 1,216s.f.
STORIES: 1
HEIGHT: unchanged
OCCUPANT LOAD: 19
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 12/12/2017
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 CBC2017-0638
12/19/2017
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 Corporation and the Carlsbad Planning,
Engineering and Fire Departments.
2. Bring TWO corrected set of plans and calculations/reports to EsGil Corporation, 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 Corporation only will not be reviewed by
the City Planning, Engineering and Fire Departments until review by EsGil Corporation is
complete.
PLANS
1. Provide the correct address and suite number of tenant space on the plans.
Section 107.2.
2. Provide a statement on the Title Sheet of the plans, stating that this project shall
comply with the 2016 California Building Code, which adopts the 2015 IBC, 2015
UMC, 2015 UPC and the 2014 NEC. Remove the "applicable building codes"
section from sheet A0.3.
3. Please revise the scale shown on sheet A0.4 to ¼" per foot. Also revise the
occupant load on sheet A0.4 to reflect 19 total.
a) Please update sheet A0.1 Building Data "usage" section to show
occupant load factor of 15 s.f. per occupant for the lobby area.
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. The path
of travel shall include the following five elements.
Detail on the plans the following elements of the existing path of travel that are required
to comply with the 2016 accessibility standards:
Carlsbad CBC2017-0638
12/19/2017
4. Existing signage at parking stall, building entrance, route to accessible features
and the accessible features themselves.
a) Update site plan specific note 3 on sheet A 1.1 to show existing parking
signs in compliance with 11B-216.5, 11B-502.6, and 11B-502.8.
b) Update site plan specific note 1 on sheet A 1.1 to show that the existing
entrance sign is in compliance with 11 B-216.6, with an International Symbol
of Accessibility per 11 B-703.7.2.1.
c) Update plan specific notes 2 and 3 on sheet A0.4 to show the restroom
signs in compliance with 11B-703.7.2.6.3.
d) Sheet A0.2 shows code sections that relate to residential projects per CBC
11A. Please update all code references to relate to 11 B for commercial
projects.
5. Please show the required 44" clear width at the hallway for the accessible route to
the accessible toilet room. 11 B-403.5.1 (5).
INTERIOR BEARING/NON-BEARING PARTITIONS
6. Indicate on the plans the wall type, based on the legend on sheet A0.4, with
reference to the appropriate construction details. The rated walls are not shown
on the occupancy and exit plan. Please clarify the location of these rated walls.
7. Provide a section view of all new interior partitions. Show:
a) Show rating for fire rated walls on the floor plan, sheet A2.1, and method
of achieving or maintaining the rating if applicable, per CBC Table
721.1(1). (Steel stud minimum 25 gauge in rated wall)
b) Please show the wall stud size and gauge being proposed for each wall
height based on the table provided on sheet A9.1.
EGRESS
8. Please update "door and window" note 5 to 34" to 44" per 11 B-404.2.7.
9. Please update "door and window" note 13 to code section 1010.1.9 and 13b to
34" to 44" per 11 B-404
10. Please clarify what type of door hardware is on the main exit and state whether
this hardware will need to be changed in order to meet CBC 1010.1.9 and 11 B-
404.
Carlsbad CBC2017-0638
12/19/2017
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: □ Yes □ No
The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake
Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to
perform the plan review for your project. If you have any questions regarding these plan
review items, please contact Jason Pasiut at Esgil Corporation. Thank you.
, Carlsbad CBC2017-0638
12/19/2017
[DO NOT PAY -THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad
PREPARED BY: Jason Pasiut
PLAN CHECK#.: CBC2017-0638
DATE: 12/19/2017
BUILDING ADDRESS: 2808 Roosevelt St. #102
BUILDING OCCUPANCY: B
BUILDING AREA Valuation
PORTION ( Sq. Ft.) Multiplier
1216 46.51
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code cb By Ordinance
Bldg. Permit Fee by Ordinance -_,.,.1
Plan Check Fee by Ordinance --~~---~J
Type of Review: 0 Complete Review
D Repetitive Fee
···•··.·· ~ .... J Repeats
Comments:
□ Other
D Hourly
EsGil Fee
Reg.
Mod.
VALUE ($)
56,556
56,556
$432.11 I
$280.871
D Structural Only
$246.301
Sheet 1 of 1
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MATERIALS
QUESTIONNAIRE
RECORD ID# _________________ I
PLAN CHECK # __________________ I
Business Name
CARLSBAD CIIIROPRACTOR
Project Address
2808 ROOSEVELT. STE. 102
Mailing Address
SAME
Project Contact
JACK CARTER, ARCHITECT
Business Contact
DR. DESI GAMBOA
City
CARLSBAD,
Cily
State
CA
State
Telephone#
760-
Zip Code
92008
Zip Code
Applicant E-mail Telephone#
JACKCARTERAIA@YAHOO.COM
BP DATE
APN#
Plan File#
760-310-2439
The following questions represent the facility's activities, NOT the specific project description.
PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: lnot required for projects within the 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: Facility's Square Footage (including proposed project):
1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives
~ther Health Hazards
0 .. one of These.
2. Compressed Gases 6. Oxidizers 10. Cryogenics
3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
PART 11: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH -HAZARDOUS MATERIALS DIVISION IHMDI: 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. 0 CalARP Exempt
I FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy:
1.
2.
3.
4.
5.
6.
7.
8.
YES NO (for new construction or remodeling projects)
Is your business listed on the reverse side of this form? (check all that apply). D rn
B ~ 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?
D
D
D
D D
(21 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
X or reater than 1,320 allons? California's Above round Petroleum Stora e Act .
Date Initials
0 CalARP Required
I
Date Initials
0 CalARP Complete
I
Date Initials
PART Ill: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCDI: Any YES• answer requires a stamp from APCD 10124 Old Grove Road, San
Diego, CA 92131 apcdcomp@sdcounty.ca.gov (858) 586-2650). [•No stamp required if Q1 Yes i!!l!! 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; town.homes; condos; mixed-commercial use; deliberate burns; residences fonning part of a larger project. [*Excludes garages & small outbuildings.]
1.
2.
3.
4.
5.
6.
YES NO
D ~
D lxl D D
D
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?
D
D
D
(ANSWER ONLY IF QUESTION 3 IS YES) Based on the swvey results, will the project disturb any asbestos containing material? Notification
may be required 10 working days prior to commencing asbestos removal. IX! Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.sdapctj.org/info/facts/penniJs.pdf) 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
bounds
Briefly describe business activities:
CHIROPRACTIC SERVICES/ MESSAGE
Briefly describe proposed project:
TENANT IMPROVEMENT OF EXISTING SPACE ONLY
I declare under penalty of perjury that to the best of my knowledge and belief t e responses made herein are true and correct.
. JACK E. CARTER I I
Name of Owner or Authorized Agent Signature of Owner or Authorized Agent Date
FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ______________________________ _
BY· I I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMO* APCD COUNTY-HMO APCD COUNTY-HMO APCD
*A stamp m th,s box 2Dh'.. exempts busmesses from completing or updating a Hazardous Materials Business Plan. other pennittmg requirements may still apply.
HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division
INDUSTRIAL WASTEWATER DISCHARGE PERMIT
-SCREENING SURVEY
Date 12/98/2017
Business Name CARLSBAD CHIROPRACTIC
Street Address
-,2°"80"'8"RTT("'lC"">S""E"'V""ET'L''l""l "'ST"".', S""'T.,,E~. "10"'2 ________________ _
-----------------------------
Em a i I 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: Ni A
Acid Cleaning Ink Manufacturing Nutritional Supplement/
Assembly Laboratory Vitamin Manufacturing
Automotive Repair Machining/ Milling Painting / Finishing
Battery Manufacturing Manufacturing Paint Manufacturing
Biofuel Manufacturing Membrane Manufacturing Personal Care Products
Biotech Laboratory (i.e. water filter membranes) Manufacturing
Bulk Chemical Storage Metal Casting/ Forming Pesticide Manufacturing /
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 / Milling Research and Development
Film / X-ray Processing Printed Circuit Board Rubber Manufacturing
Food Processing Manufacturing Semiconductor Manufacturing
Glass Manufacturing Metal Powders Forming Soap / Detergent Manufacturing
Industrial Laundry Waste Treatment I Storage
SIC Code(s) (if known): ______________________ _
Brief description of business activities (Production/ Manufacturing Operations): _____ _
Description of operations generating wastewater (discharged to sewer, hauled or evaporated):
Estimated volume of industrial wastewater to be discharged (gal/ day): ________ _
List hazardous wastes generated (type/ volume): _______________ _
Date operation began/or will begin at this location: _______________ _
Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority?
Yes NoX If yes, when: _____________________ _
Site Contact Title -----------------------------
Signature _______________ Phone No. ___________ _
ENCi NA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941
FAX: (760) 476-9852