Loading...
HomeMy WebLinkAbout1902 WRIGHT PL; ; PC2020-0053; PermitPERMIT REPORT Plan Check Permit Print Date: 07/21/2021 Job Address: 1902 WRIGHT Pl, CARLSBAD, CA 92008-6583 Permit Type: BLDG-Plan Check Work Class: Commercial Parcel#: 2120912600 Track#: Valuation: $19,000.00 Lot#: Occupancy Group: Project#: #of Dwelling Units: Plan#: Bedrooms: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Project Title: Description: CORNERSTONE: SITE LIGHTING IMPROVEMENTS// ELECTRICAL WORK FEE Total Fees: Building Division Property Owner: CORNERSTONE CORPORATE LLC 200 PINE AVE, # 502 LONG BEACH, CA 90802-3040 Total Payments To Date: {city of Carlsbad Permit No: PC2020-0053 Status: Closed -Fina led Applied: 12/28/2020 Issued: 02/10/2021 Finaled Close Out: 07/21/2021 Inspector: Final Inspection: AMOUNT Balance Due: Page 1 of 1 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov (cicyof Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 pc_iozc-0053 Plan Check C&CZVZV • - Est. Value :mi ,, , ,. " PC Deposit _____ _ Date I L-2 s-202..0 0 Addltlon/Naw: ________ .. e,w SF and Use, ________ ,New SF and Use, ___ Deck SF, Patio Cover SF (not lncludl111 flatwork) D T-nt lmp,-mant: SF, Extstlna Use, _____ ,Proposed Use----- ____ SF, Exlstlnc Use Proposed Use----- □ Pool/Spa: ____ .SF Additional Gas or Electrtcal Features?_---==-=----= 0 Solar: KW,, __ ,Modules,, ___ Mounted, Tilt:~/ rro! RMA: ~ Ro, Panel Upv,1de: ~ Ro D Plumbln,JMIK:h1nlcal/ElactrlcalOnly: __________________ _ '11 Otter. 5 !'re 1,Vo,I k ~f '1ti1~ol'5 'frJ ~,s n~l '{Yc.,c, l -:,..7 1,u1t.flr;I ,, re l,7~1ri4 "<-t~ltul,s. This permit II to be t......i In the -of th• Pnlperty OWn■r II OWn■r-lullder, 1--■d contni;IIOt ar Authortud A1■nt of th■ -at COl•b-. TIHI person /lsfed as the AP,,llcant below w/11 be the main paint of r:ontact mrou,haut the pmnlt process. Architect State UcellN: 5 I,,, 0 S:: 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph: 760-602-2719 Fax: 760-602-85S8 Page1 af2 Email: Bulldlng@carlsbadca.gov Rev.08/20 JI-, '1 • IDENTIFY WHO Will PERFORM THE WORK BY COMPLETING (OPTION AJ OR (OPTION BJ BELOW: (OPTION Al: UCENSEQ CONTRACTOR DECLARATION; I hereby affirm under penafty of perjury that I om llcensed under provisions of Chapter 9 (commencing with Section 7000} of Division 3 of the Business and Professions Code, and my 1/cense 15 In full force and effect. I also affirm under penalty of perjury one of the followtno declarations: 0 .:..":"wb-::::~.~-=:-r:i~;1tt'x:'°"7J'"~PW~f ,,'r~"'"~ ;gj,-ondwll molnllln_.,co.......-, 11,.qultod bySoctlon 3700dthl Laor Cade, le>< lhepe,formence oflhe_for_lllls ponmttls lUUed. Mvwc><lclrl' ~ lnsuron,;,tcont.,end pollcynomblro,., -~nyN1m1: -,--.-,--T,..--,--------- l'Gllcy No. \.Vs._ u S:O:S Pif!COS::: .-----'''"'"Lli'-1'--+1..,2.......,1 _______ _ ..... I f □ C-tao/Eamplfon: 1 COfllt-,thotln the~ aflhe-11 for-thlo permltls luuod.1-not 1tnplarony-l• 111Y-IO aso, HCIIIMtub/lCtO>lhe__.compon-nl.awsofClllfomll. __ ,_.to...,.._,._.,. __ 11_,..,._..,liltctan .......,IO_ll...,_1 .. clWl-•IOllDO,GOCl.lll,ln-1helOtho_of_-6..,...,_u,.-i...1n-S7Glaflha ia.Cado, __ _,,.,. ..... CONSTRUCTION LENDING AGENCY. IF ANY; 1 hor1141y 1111m that..,_ Is a -Ian -no-for tho ............. ollhe wort this ponmtt Is lstUld (Sec. !!097 (ij CMI Cade). CONTRACTOR PRM': X, IC .b~y €(l SIGN: : -·-landof•~ (OPTION BJ: OWNER-BUILDER DECLARATION: I ,,.,.,,,of/Inn lhat I am_,,,_-•_ I_,.,, the,._.,_, DATE: ,~, l '-f /20 l Or,u owneroltho pn,pertyor myomPDl'"S--11---... -• wll dOtha-k sndthlstructure Is not-orolflnd fornlo (Sec. 7044, _,.,, and p,_Qxhi:The con~•lke-1.aw.,_ not apply to on ownarol pn,porty-bulldtorl-thoroon, and--- workhlmldor_....,, hlr"""'"""""'"" p,ovldldthotwch lmprcMlmaftll-not-or""-dforsalo. If, -.tholuldln■0<lmp,ow■11•ntb IOld wfthln ono -ol con,pletlon, tht-bui1dorwll hlvo tho bunion of flNIYlne thot ho did not bulk! or lm-lo•tht po-of toll). Ht. a awn.-of the praperty, am exclullVIII\,• contnctlnl with llctMld contrlctorl to construd: thl prcjlct: cs«-1044. Business 1nd Peof I t: ff Code: The c...,._, Uce-Law dNI not1pply0> an...,., olpropartywllobuldl«lmpnM/11-and contracts for such projlcb-con~) llolnsod punuanttQthl Contra<IOr's llconH Law). 01 am txlfflPI undtr luSlneH.ancJ Plofnat01111 Code OMslan 3. Chlpte,9, Ankle 3 b'thls reason: 0 '"Ownlr Bullder ada.owl1dpmenl and verlflcatlDn farm" has been flled out, llped and ltbched to thls 1ppllcat1on. Proof af ltlantifkallon atladled. ll:J °""""' •-IIN Jllont Fonm" his been &hd ou~ lilNd and attached to 1h11 sppllaollon ,,.,.,. 11w .....,, aurhorfty to obtol!I 11w ,,.,,,,,, on th<_,-/Jeholf. Proof of Identification_ By my slintture below 1· acknowltdl• that. except fot my per1an1I Nlidlnc1 In Which I must have resided for at Inst ona vnr prll)rto completlon of the Improvements ~ovend by this permit, I cennot leply sell 1 1tructur1 that,..,. built as an owner-buitder If It has not belln constructed-. Its endnny by lfcensed contractan-1...--thotaco,,,o/lN,,,,,,._ ,.,.,s«f/On mMof tM-andProfoulons;'J; tr IIVOllabl,UJIOli_,_ .,.,, oppbllon Ir ===:1d~;~;;--SIGf~ DATE: !¥'¢a APPLICANT CERTIRCATI0N: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL lq my ,lgnatu,,r bd!w, I~ that: I om the /IIDPfflY OWMr., Star. a/ Callfom/0 lkMsed ConbucCOI ., author/ad ... Oct an the property awrwr a,a,nlnl<IOl'1 bd,olf. I Cll'ta!l that I how rtOd ""1 opp/l<otlan ond shlte that the above lnjbnnotlan 15 comer and that the Inform-on the plans 15 acant•. I Olllff ID-'Vwitll all Qty ordlnan<u ond SttM lowl rtlotlnQ ID bu/ldlng ...,,IIVCtlan. t ltmby-,.,,,.,..IDIM of the City a/ OJrlslJadlD miff-ti. obcw. nWtltb .... (JIOfJfflyfor/tup«l;/an '"""°'"'"/ALSO AG/IEE TO SAIIE INDEMNIFYANDKEEPIWIMl.6STHEarf01CARI.SMDAGNNSTALLIWJIU11ES.JUDGMEN1S,cosnNiDEXl'fNSESWHIOIMAYINANYWAY Aam/E AGA/NSTSAIO cr,y INCONSEQUl!NCf 01 THE GIIANTIHG 01 THIS PERMIT. OSHA: An OSHA potmlt 15 fWIU/ted {araQIWJllans _, 5'0' dnp ond demo/ltfon or c:onstntctfon a/ ,tructurn o..,. 3 •-In height APPLICANT PRINT: __________ SIGN: ________ o,An: _____ _ 1635 Faraday Ave carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Bulldlng@carlsbadca.goy B-2 Page 2 ol 2 Rov.08120 { City of Carlsbad OWNERS AUTHORIZED AGENT FORM B-62 Development Services Buftdlng Division 1635 Faraday Avenue 760-602-2719 www.carlSbadca.gov OWNER'S AUTHORIZED AGENT FORM Only a property owner, contractor or tMlr outhorlttd agent may submit plans and oppl/aJtlons for bulldfng permits. To ourhorln a third-party agent to sign for a but/ding permit, the owner's third potly agent mud.,,,,, fhls .,.,,. fotrn, which /dent/jiu the agent and the owner who s/he Is reprnentlno, and for what Jobs s/lle l1IO)I obtain permits. The form must be completed In Its entlmy to be a«epted by the City for each s.porote permit opplkotlon. Nola: ni. followlng Owner'• Autllodzed Ao-nt form Is required to be conrp/efff by the pl'OIIIIJ'fy -only when deslfnotlng an agent to opplv ftw a consttudlon permit on his/hr lleholf, AUTHORiZAJION Pf MINI JO ACT QN PRQPERJY OWNQ'S HtW.F Eltcludlna the Property owner AcknQwtedgement, the execution of which I understand Is my personal responsibility, I hereby authorize the folloWlng person(s) to act as rnv apnt(s) to apply for, sign, and file the documenu necessary to obtain an awner-Bullder Permit for my project. Scope of Construction Project (or Description of Work): 2!7f /Joo b.f'jMe. J(,scel:es::r~/ I . Project Location or Address: / 2 (2 '3 [ °{ 0 '$ Lu IV Colt [ Pl.c: I Name of Authorized Agent: Br, c;,,1 L,e;,~mc?b' Address of Authorized Apnt: P& i'zO )c S:::CZ 3 7 '( 3 Sa k1 /2, "fj o t-& 9 f)..r >TJ I declare under penalty of perjury that I am the property owner for the address Msted above and I penonally filled out the abow Information and certify Its accuracy. ----~✓ -,wu, 1 ' DATE: 1-11-21 JURISDICTION: Carlsbad PLAN CHECK#.: CBPC2020-0053 ✓• EsG1I A SAFEbuilfCompany SET: I PROJECT ADDRESS: 1902-1903 Wright Place □ APPLICANT □ JURIS. PROJECT NAME: Cornerstone Corporate Exterior Landscape Lighting 1:8:J 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: 1:8:J 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: (by: Email: Mail Telephone I Telephone#: Fax In n 0 REMARKS: By: Scott Humphrey EsGil Enclosures: 1-6-21 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Scott Humphrey PLAN CHECK#.: CBPC2020-0053 DATE: 1-11-21 BUILDING ADDRESS: 1902-1903 Wright Place BUILDING OCCUPANCY: BUILDING AREA Valuation Reg. PORTION ( Sq. Ft.) Multiplier Mod. Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code 1997 UBC Buildin Permit Fee g ... I 1997 UBC Plan Check Fee Type of Review: r Complete Review VALUE r Structural Only r r Repetitive Fee .iJ Repeats r ~ Other 1 Hourly EsGII Fee r ~Hrs.@* Comments: In addition to the above fee, an additional fee of$ $ /hr.) for the CalGreen review. ($) $13s.ooJ is due ( hour@ Sheet of C Cicyof Carlsbad PURPOSE CLIMATE ACTION PLAN CONSISTENCY CHECKLIST B-50 Development Services Building Division 1635 Faraday Avenue (760) 602-2719 www.carlsbadca.gov This checklist is intended to assist building permit applicants identify which Climate Action Plan (CAP) ordinance requirements apply to their projects. The completed checklist must be included in the building permit application. It may be necessary to supplement the completed checklist with supporting materials, calculations or certifications, to demonstrate full compliance with CAP ordinance requirements. For example, projects that propose or require a performance approach to comply with energy-related measures will need to attach to this checklist separate calculations and documentation as specified by the ordinances. NOTE: The following type of permits are not required to fill out this form ❖ Patio I ❖ Decks I ❖ PME (w/o panel upgrade) I ❖ Pool ..i11 If an item in the checklist is deemed to be not applicable to a project, or is less than the minimum required by ordinance, an explanation must be provided to the satisfaction of the Building Official. ..i11 Details on CAP ordinance requirements are available on the city's website . ..i11 A CAP Building Plan template (form 8-55) shall be added to the title page all building plans. This template shall be completed to demonstrate project compliance with the CAP ordinances. Refer to the building application webpage and download the latest form. [ Project Name/Building Permit No.: Property Address/APN: Applicant Name/Co.: Applicant Address: Contact Phone: Appllcat:lon lnfonnatlon U?(fle/e;'fc2l1R //vi} 5, re Yrflfhvt:ff!t,{Q /"'JO i,. / 90?; WA5 "1, fl Contact Email: BP No.: Contact information of person completing this checklist (if different than above): Name: Company name/address: Contact Phone: Contact Email: Applicant Signature:~ ~ Date: ttlyi~qlO) ~/ /✓ - d'J B-50 Page 1 of6 : I Revised 06/18 City of Carlsbad Climate Action Plan Consistency Checklist Use the table below to determine which sections of the Ordinance Compliance checklist are applicable to your project. For alterations and additions to existing buildings, attach Building Permit Valuation worksheet. Building Permit Valuation (BPV) from worksheet:$ Cb,rtr(d,fo( 155,,,-J { 6 f)I soe r COlllbuction Type 1 ~ Section(I) 1 Natll= A high-rise residential building is 4 or more stories, including a 0 Residential Low-rise High-rise mixed-use building in which at least 20% of its conditioned floor area is residential use □ New construction 2A, 3A, 18, 28, 4A 38,4A 0 Additions and alterations: □ BPV < $60,000 N/A N/A All residential additions and alterations □ BPV ~ $60,000 1A,4A 4A 1-2 family dwellings and townhouses with attached garages □ Electrical service panel upgrade only only *Multi-family dwellings only where interior finishes are removed □ BPV ~ $200,000 1A, 4A* 18, 4A* and significant site work and upgrades to structural and mechanical, electrical, and/or plumbing systems are proposed f;Y Nonresidential D New construction 1 B, 28, 38, 48 and 5 D Alterations: D BPV ~ $200,000 or additions ~ 1,000 18,5 square feet □ BPV ~ $1,000,000 18, 28, 5 Building alterations of~ 75% existing gross floor area □ ~ 2,000 sq. fl. new roof addition 28, 5 1 B also applies if BPV ~ $200,000 Checklat Nam Check the appropriam boxes, explai1 al nm applcalE aid exception ilems, 111d pnMde fqlpOr1ing cabMoos 111d doCllnertallm as necessay. 1. Energy Efficiency Please refer to Ca~sbad Municipal Code (CMC) sections 18.21.155 and 18.30.190, and the California Green Building Standards Code (CALGreen) for more information when completing this section. A D Residential addition or alteration ~ $60,000 building permit valuation. See CMC section 18.30.190. Year Built Single-family Requirements □ Before 1978 Select one: □ Duct sealinq □ Attic insulation □ Cool roof □ 1978 and later Select one: □ Lighting package □ Water heating Package □ Between 1978 and 1991 □ 1992 and later □ NIA _________ _ □ Exception: Home energy score ~ 7 (attach certification) Multi.family Requirements □ Attic insulation Select one: □ Duct sealing □ Attic insulation □ Cool roof Select one: □ Lighting package □ Water heating package B. D Nonresidentiar new construction or alterations ~ $200,000 building permit valuation, or additions~ 1,000 square feet. Updated 8/15/2019 2 N City of Carlsbad Climate Action Plan Consistency Checklist See CMC 18.21.155 and CALGreen Appendix AS, Division AS.2 -Energy Efficiency. A5.203.1.1 Choose one: ~1 Outdoor lighting □ .2 Warehouse dock seal doors D .3 Restaurant service water heating (comply v.ith California Energy Code section 140.5, as amended) □ NIA ----------□ .4 Da~ight design PAFs □ .5 Exhaust air heat recovery A5.203.1.2.1 Choose one as applicable: ~95 Energy budget D .90 Energy budget 0 NIA A5.211.1 .. D On-stte renewable energy A5.211.3 .. D Green power Of offered by local utiltty provider, 50% minimum renewable sources) ~IA A5.212.1 D Elevators and escalators }? NIA A5.213.1 D Steel framing • lndudes hotels/motels and high-rise residential buildings ~ NIA .. For alterations~ $1,000,000 BPV and affecting > 75% existing gross floor area, or alterations that add 2,000 square feet of new roof addition: comply v.1th CMC 18.30.130 instead. 2. Photovoltaic Systems □ r~ Residential new construction (for low-rise residential building permit applications submitted after 1/1/20). Refer to 2019 California Energy Code section 150.1 (c)14 for requirements. Notes: 1) High-rise residential buildings are subject to nonresidential photovoltaic requirement (2B below) instead. 2) If project includes instaUation of an electric heat pump water heater pursuant to CMC 18.30.1 S0(B) (high-rise residential) or 18.30.170(8) (low-rise residential), increase system size by .3kWdc if PV offset option is selected. f Floor Plan ID (use additional CFA #d.u. Calculated kWdc* Exception I sheets if necessary) Total System Size: k'Ndc = (CFAx.572) / 1,000 + (1.15 x #d.u.) *Fomiula calculation 'Mlere CFA = conditional floor area, #du= number of dwelMngs per plan type If proposed system size is less than calculated size, please explain. □ D D D kWdc B. D Nonresidential new construction or alterations 2:$1,000,000 BPVand affecting 2:75% existing floor area, or addition that increases roof area by 2:2,000 square feet Please refer to CMC section 18.30.130 when completing this section. Note: This section also applies to high-rise residential and hotel/motel buildings. Choose one of the following methods: □ Gross Floor Area (GFA) Method GFA: Olf < 10,000s.f. Enter: 5 kWdc Min. System Size: 0 If~ 1 O,OOOs.f. calculate: 15 kWdc x (GF A/10,000) .. kWdc -Round building size factor to nearest tenth, and round system size to nearest whole number. D Time-Dependent Valuation Method Updated 8/15/20 I 9 3 City of Carlsbad Climate Action Plan Consistency Checklist Annual TDV Energy use:,... ______ x .80= Min. system size: _____ kWdc ***Attach calculation documentation using modeling software approved by the California Energy Commission. 3. Water Heating A. D Residential and hotel/motel new construction Please refer to CMC section's 18.30.150 and 18.30.170 when completing this section. D For systems serving individual dwelling units choose one: □ Heat pump water heater AND Compact hot water distribution AND Drain water heat recovery (low-rise residential only) □ Heat pump water heater AND PV system .3 kWdc larger than required in CMC section 18.30.130 (high rise residential hotel/motel) or CA Energy Code section 150.1 (c) 14 (low-rise residential) □ Heat pump water heater meeting NEEA Advanced Water Heating Specification Tier 3 or higher □ Solar water heating system that is either .60 solar savings fraction or 40 s.f. solar collectors D Exception: D For systems serving multiple dwelling units, install a central water-heating system with all of the following: D Gas or propane water heating system D Recirculation system per CMC 18.30.150(8) (high-rise residential, hotel/motel) or CMC 18.30.170(8) (low- rise residential) D Solar water heating system that is either: □ .20 solar savings fraction □ .15 solar savings fraction, plus drain water heat recovery □Exception: B. D Nonresidential new construction Please refer to Carlsbad Ordinance CMC section 18.30.150 when completing this section. D Water heating system derives at least 40% of its energy from one of the following (attach documentation): □ Solar-thermal D Photovoltaics D Recovered energy □Water heating system is (choose one): □ Heat pump water heater □ Electric resistance water heater(s) □Solar water heating system with .40 solar savings fraction D Exception: Updated 8/15/2019 4 City of Carlsbad Climate Action Plan Consistency Checklist 4. Electric Vehicle Charging A D Residential New construction and major alterations* Please refer to Cartsbad Ordinance CMC section 18.21.140 when com One and two-family residential dwelling or townhouse with attached garage: D One EVSE Ready parking space required D Exception : D Multi-family residential· D Exception · Total Parking Spaces EVSE Spaces Proposed Capable I Ready I Installed I I Calculations: Total EVSE spaces = .10 x Total parking (rounded up to nearest whole number) EVSE Installed = Total EVSE Spaces x .50 (rounded up to nearest whole number) EVSE other= Total EVSE spaces -EVSE Installed (EVSE other may be "Capable," "Ready" or "lnstalled.j I Total I *Major alterations are: (1) for one and two-family dwellings and townhouses with attached garages, alterations have a building permtt valuation 2: $60,000 or indude an electrical service panel upgrade; (2) for mtitifamily dwellings (three units or more without attached garages), alterations have a building permit valuation 2: $200,000, interior finishes are removed and significant site work and upgrades to structural and mechanical, electrical, and/or plumbing systems are proposed. B D Nonresidential new construction (includes hotels/motels) D Exception · Total Parking Spaces EVSE Spaces Proposed Capable I Ready I Installed I Total I I I Calculation: Refer to the table below: Total Number of ParkinQ Spaces provided Number of reauired EV Spaces Number of reQuired EVSE Installed Spaces □ 0-9 1 1 □ 10-25 2 1 □ 2~50 4 2 □ 51-75 6 3 □ 7~100 9 5 101-150 12 6 151-200 17 9 201 and over 1 0 percent of total 50 percent of Required EV Spaces Updated 8/15/2019 5 City of Carlsbad Climate Action Plan Consistency Checklist 5. D Transportation Demand Management (TOM): Nonresidential ONLY An approved Transportation Demand Management (TOM) Plan is required for all nonresidential projects that meet a threshold of employee-generated ADT. City staff will use the table below based on your submitted plans to detemiine whether or nor your pennit requires a TOM plan. If TOM is applicable to your ~ tt, staff will contact the applicant to develop a site-specific TOM plan based on the penntt details. Acknowledgment: Emp ADT for Emp ADTI Use first 1,000 s.f. 1000 s.f.1 Office (all)2 20 Restaurant 11 Retaib 8 Industrial 4 Manufacturing 4 Warehousina 4 1 Unless otherwise noted, rates estimated from /TE Trip Generation Manual, 1CJhEdition 13 11 4.5 3.5 3 1 2 For all office uses, use SANDAG rate of 20 ADT/1 ,000 sf to calculate employee ADT 3 Retail uses include shopping center, variety store, supermarket, gyms, pharmacy, etc. Other commercial uses may be subject to special consideration Sample calculations: Office: 20,450 sf 1. 20,450 sf/ 1000 x 20 = 409 Employee ADT Retail: 9,334 sf 1. First 1,000 sf = 8 ADT 2. 9,334 sf -1,000 sf= 8,334 sf 3. (8,334 sf/ 1 000 x 4.5) + 8 = 46 Employee ADT I acknowledge that the plans submitted may be subject to the City of Carlsbad's Transportation Demand Management Ordinance. I agree to be contacted should my permit require a TOM plan and understand that an approved TOM plan is a condition of pennit issuance. Applicant Signature: _________________ _ Date: _____ _ Person other than Applicant to be contacted for TDM compliance (if applicable): Name (Printed): _________________ _ Phone Number: ____ _ Email Address: __________________ _ Updated 8/15/2019 6 B □ □ □ □ □ □ □ □ ENCINA WASTEWATER AUTHORITY INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY 6200 Avenlda Encinas, Carlsbad, CA 92011 Phone: 760-438-3941 Fax: 760-476-9852 SourceControl@enclnaJpa.com Date: I ?j.rr('Jc>h) Business Name: Lo f r{f{5irJfl-.f StreetAddress: t 9@ ('30;, IA/jl(Cftr: Pk I Email Address: fe(,ti1~/IS{?MtzOt1c..f, ¢0'W'l PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT : (ON REVERSE SIOE CHECK TYPE OF BUSINESS~ Check all below that are present at your facility: Acid Cleaning Assembly Automotive Repair Battery Manufacturing Biofuel Manufacturing Biotech Laboratory Bulk Chemical Storage Car Wash Chemical Manufacturing Chemical Purification B Food Processing Glass Manufacturing D Industrial Laundry D Ink Manufacturing D Laboratory D Machining/Milling D Membrane manufacturing D (i.e. waterfilter membranes) D Metal Casting/Forming D Metal Fabrication D Metal Powders Forming D Nutritional SupplemenWitamin D Manufacturing D Painting/Finishing D Paint Manufacturing D Personal Care Products D Manufacturing D Pesticide Manufacturing/ Packaging D Pharmaceutical Manufacturing D (including precursors) D Dental Offices D Metal Finishing D Porcelain Enameling D Dental Schools D Dental Clinics D Dry Cleaning D Electrical Component □ Manufacturing □ Fertilizer Manufacturing □ Film/ X-ray Processing D Electroplating D Electroless Plating D Anodizing D Coating (i.e. phosphating) □chemical Etching/Milling D Printed Circuit Board D Manufacturing D Power Generation □ Print Shop D Research and Development D Rubber Manufacturing D Semiconductor Manufacturing D Soap/Detergent Manufacturing D Waste Treatment/Storage NewBusiness?YesONo~ICCode(s)ifknown: ______ Date operation began/will begin: ______ _ Tenant Improvement? YesON~f yes, briefly describe improvement=------------------ Description of operations generatingwastewater(discharged to sewer, hauled or evaporated): __________ _ Estimated volume of industrial wastewater to be discharged (gal/ day) : ____________________ _ List hazardous wastes generated (type/volume): ___________________________ _ Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? YesODate: _____ ,NoO Page 1 of 2 EN CINA WASTEWATER AUTHORITY INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY 6200 Avenlda Encinas, Carlsbad, CA 92011 Phone: 760-438-3941 Fax: 760-476-9852 SourceControl@encinaJpa.com 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 Detailer s □ Hotels/ Motels (no laundry) □ Barber/Beauty Shops □ Laundromats □ Business/Sales Offices □ Libraries □ Cleaning Services □ Medical Offices (no x-ray developing) □ CarpeVUpholstery □ Mortuaries □ Childcare Facilities □ Museums □ Churches □ Nail Salons □ Community Centers □ Nursing Homes □ Consulting Services ~ Office Buildings (no process flow) □ Contractors Optical Services □ Counseling Services □ Pest Control Services (no pesticide repackaging for sale) □ Educational Services (no auto repair/film developing) □ Pet Boarding/Grooming Facilities □ Financial Institutions/Services □ Postal Services (no car wash/auto repair) □ Fitness Centers □ Public Storage Facilities □ Gas Stations (no car wash/auto repair) □ Restaurants/Bars □ Grocery Stores (no film developing) □ Retail/Wholesale Stores (no autorepair/film □ Residential based Businesses developing) □ Theaters (Movie/Live) CERTIFICATION STATEMENT I certify that the information above is true and correct to the best of my knowledge. ~~ Signatu✓-~ Print Name: & t.Cir/~l#J/e Date:L~AI)) Facility Contact: __________ _ Title: _____________ _ ENCINA WASTEWATER AUTHORITY 6200AVENIDAENCINAS, CARLSBAD, CA Phone: 760-438-3941 Fax:760-476-9852 SourceControl@encinajpa.com Page 2 of2