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HomeMy WebLinkAbout1285 CARLSBAD VILLAGE DR; ; CB073192; Permit01-29-2008 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No Building Inspection Request Line (760) 602-2725 CB073192 Job Address Permit Type Parcel No Valuation Occupancy Group Project Title 1285 CARLSBAD VILLAGE DR CBAD St Tl Sub Type 1561905400 Lot# $85,540 00 Construction Type Reference # DR TSAI 1820SF SHELL TO OFF 100 COMM 0 VN Applicant UTGARD CONSTRUCTION STEL 12225 WORLD TRADE DR SAN DIEGO CA 92108 619293-0234 Status Applied Entered By Plan Approved Issued Inspect Area Plan Check# Owner CARLSBAD MEDICAL VILLAGE L P C/O RUSS RIES 9225 DOWDY DR #106 SAN DIEGO CA 92126 ISSUED 12/26/2007 JMA 01/29/2008 01/29/2008 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot Water Con Fee Meter Size Add'l Pot Water Con Fee Reel Water Con Fee $537 46 Meter Size $0 00 Add'l Reel Water Con Fee $349 35 Meter Fee $0 00 SDCWA Fee $0 00 CFD Payoff Fee $1796 PFF (3105540) $0 00 PFF (4305540) $0 00 License Tax (3104193) $0 00 License Tax (4304193) $0 00 Traffic Impact Fee (3105541) $000 Traffic Impact Fee (4305541) $0 00 PLUMBING TOTAL $0 00 ELECTRICAL TOTAL $0 00 MECHANICAL TOTAL $4,878 00 Master Drainage Fee D3/4 Sewer Fee $0 00 Redev Parking Fee $0 00 Additional Fees HMP Fee TOTAL PERMIT FEES $000 $19000 $4,492 00 $000 $1,55683 $1,43707 $000 $000 $000 $000 $41 00 $2000 $6550 $000 $000 $000 $000 79 $13,585 17 Total Fees $13,58517 Total Payments To Date $13,585 17 Balance Due $000 BUILDING PLANS ^^L IN STORAGE ATTACHED FINAL APPROVAL Inspector Clearance NOTICE Please take NOTICE that approval of your project includes the' Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions" You have 90 days from the date this permit was issued to protest imposition of "hese 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 othei 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 limitations has previously otherwise exoired City of Carlsbad 1635 Faraday Ave, Carlsbad CA 92008 760-602-2717 / 2718 / 2719 / 2721 Fax 760-602-6558 Building Permit Application P.an Check No Est Value (Set 7031S UusmuwMJ Prafeuions Codt Any Oty or County wfidi rcqinru a permit to comma ilttf. imdivrt, dtmobib x repair any itruoon. pnor to m nuince iho requtrei the appficant for inch ptrtmt to file a signed tmemtnt that ht a(tamed ounuant to the provision) of die Contractor*! Uen» Uw {Qtuttr 9 commendiiM with Setnon 7000 of Dntswn 3 o( tht BuJintu and Profeuioiu Codt) or that ht is exempt thertfrom, nd the bau for tht iHeeed uemption Any violation ofSection 70313 (17 an? applicant for a penmt mbjttti tnt ippheam to T cml ptnaltr of iw more than five biuutred doOan {(500}} S Workers Compensation Declaration thereby affirm under penalty of perjury one of the following (focian&ons (have and will maintain a certificate of conwnt to self-insure forwotkers compensation as provided by Section 3700 of Ihe Labor Code for the performance of the work for when this permit is issued j^n have and will maintain workers compensation as required by Section 3700 of Ihe Labor Code for the perfotrnance oHhewnrk JQT whii;h this permit is issued My workers compensation iisurance * number arc Insurance Co ^^^f^t^lKlC^ PollcyNo CU&~\5&)O Expralcn Date \ \'Z& ThissectMnneodnotbecompleledifthepermitisforonfthundreddollars($100)orless ' and policy Certificate of Exemption I certify that in the performance of the work for which this permit is issued I shall not employ any person in any nanner so as to become subject to the Woftera Compensation Laws of Califoma WARNING Failure to secure workers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100 000) in addition to the cost of compensation damages ap providedior in Section 3708 of the Labor code interest and attorney's fees JS$ CONTRACTOR 3SNATURE ^tj/ IWI/^ DA1E ( I I &J24? /V[ '(nereby affirm that I am exempt from Contractor's Lvense Law /brine foUovimg reason ovmer of the property or my employees with wages as their sole compensation will do the work and Ihe structure is not intended or oBered for sale (Sec. 7044 Business and Professions Code The Contractor's i not apply to an owner of property who bufcls or improves thereon and who does such work himself or through his own e mployees provided that such improvements are not intended or offered for sale If howeveT*tns4ujldjrvj or improvement is sold wthm one year of completion Ihe owner-builder will have the burden of proving that re did not buDd or improve for the purpose of sate) I as owner of the property ameTaiwweJxcontradjng 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 arKTCDntfacls^forsuch projects with contractors) licensed pursuant to Ihe Contractor's License L nv) I am exempt under Section Business and ProfessTSr&^odeJorthis reason 1 I personally plan to provide the major labor and materials for coristnjctJC^rlrleiwjp^ed property improvement Yes Mo 2 I (have / have not) signed an application for a buidmg permit for [he proposed work 3 I have contracted with Ihe following person (firm) to provide the proposed construction (indude name addres^7ptwafj,/contractors I cense number) 4 I plan lo provide portions of the work but I have hired the following person to coordinate supervise and provide the majoTwolk-fwdude name / address / phone / contractors license number) 5 I wdl provKJe some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / addressTpUfflwUwgof work) ^PROPERTY OWNER SIGNATURE DAT! C'COOS OOQOrl©OO<3 (PSBGBOlfS Is the applicant or future buading occupant required to submit abusiness plan acutely hazardous matenals registration form or nsk management ind prevenlon program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act? S Yes No s Is Ihe applicant or future building occupant requited lo obtain a permit from the air pollulnn control district or air quality management distnct? •y' Yes No Is Ihe facility to be constructed wilhm I 000 feel of the outer boundary of a school site? Yes /No EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT I hereby affirm that there ts a constructjon lending agency for the performance of the work this permit B issued (Sec. 3097 (i) Civil Code) Lender's Name Lender's Address Icr^ttiatl haw read tj» application and state tliat me abrminfomat Ihen^authorizererjBsantatlwdtte INDEMNIFY AND KEFJ> HARMLESS THE CITY OF CARLSBAD OSHA. An OSHA permit is requred for excavations over 5'ff deep and demofton or oonslruton of structures over 3 stones in heightEXPIRATION Every petrrfl issued by Ite Bulking Official urKjatterxovKKtEd 180 days torn the data of such permit or if (he buiBng or mt auttnrr^bysuriipariritissuspenlad vabandoiedatar^ .^APPLICANTSSIGNATURE liA/^ IV(/V\- DATI City of Carlsbad Bldg Inspection Request For 05/12/2008 Permit* CB073192 Title DR TSAI 1820SF SHELL TO OFF Description Inspector Assignment PY 1285 CARLSBAD VILLAGE DR 100 Lot 0 Type Tl Sub Type COMM Job Address Suite Location OWNER CARLSBAD MEDICAL VILLAGE L P Owner Remarks Phone 6198403409 Inspector Total Time CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Requested By BILL Entered By KGIRV Act Comment Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp 05/08/2008 89 Final Combo CO PY 03/26/2008 84 Rough Combo AP PY 03/04/2008 17 Interior Lath/Drywall PA PY 02/21/2008 14 Frame/Steel/Boltmg/Welding AP PY 02/21/2008 24 Rough/Topout AP PY 02/21/2008 34 Rough Electric AP PY 02/08/2008 21 Underground/Under Floor AP PY 02/08/2008 31 Underground/Conduit-Wiring PA PY 02/04/2008 32 Const Service/Agricultural PA PY 02/04/2008 34 Rough Electric WC PY Comments DRYWALL BOTH SIDES OF' DEMISING WALL PER PLAN T-BAR DRYWALL IN SUITE OK NEED DRYWALL ON UNOCCUPIED SIDE OF DEMISING WALL WASTE LINE CONDUIT ONLY EMR FOR HOUSE METER HPD EsGil Corporation In Partnership with government for (Building Safety DATE January 15, 2O08 a APPLICANT a JURIS JURISDICTION Carlsbad a PLAN REVIEWER a FILE PLAN CHECK NO 07-3192 SET II PROJECT ADDRESS 1285 Carlsbad Village Drive, Suite #100 PROJECT NAME Tsai TI XI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes The plans transmitted herewith will substantially comply wilh the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person I | The applicant's copy of the check list has been sent to XI Esgil Corporation staff did not advise the applicant that the plan check has been completed Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Telephone # Date contacted (by ) Fa<# Mail Telephone Fax In Person XI REMARKS Applicant is carrying perforated plans to the Cily By Bryan Zuppiger Enclosures Esgil Corporation GA D MB D EJ D PC LOG trnsmtl dot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 4 (858)560-1468 + Fax (858) 560-1576 EsGil Corporation In <PannersHip with government for <Buififmg Safety DATE January 8, 20O8 JURISDICTION Carlsbad a PLAN REVIEWER Q FILE PLAN CHECK NO 07-3192 SET I PROJECT ADDRESS 1285 Carlsbad Village Drive, Suite #1OO PROJECT NAME Tsai TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person 2<] The applicant's copy of the check list has been sent to Kui 7540 Metropolitan Drive, Suite #101 San Diego, CA92108 Esgil Corporation staff did not advise the applicant that the plan check has been completed Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Kuy «/ Telephone* 6192930234 Date contacted ///w ^ (b^/fef)) Fax # 619 293 0484 Mail Telephone y"' Fax \/ 'n Person REMARKS By Bryan Zuppiger Enclosures Esgil Corporation D GA D MB D EJ D PC 12/28/2007 trnsmtl dot 9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 * (858)560-1468 * Fax (858) 560-1576 Carlsbad O7-3192 January 8, 2008 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO 07-3192 OCCUPANCY B TYPE OF CONSTRUCTION VN SPRINKLERS'? yes DATE PLANS RECEIVED BY JURISDICTION DATE INITIAL PLAN REVIEW COMPLETED January 8, 2O08 JURISDICTION Carlsbad USE dentist ACTUAL AREA 1820ft2 OCCUPANT LOAD 18 DATE PLANS RECEIVED BY ESGIL CORPORATION 12/28/2007 PLAN REVIEWER Bryan Zuppiger FOREWORD (PLEASE READ): This plan review is limited to the technical requirements contained in the Uniform 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 2001 CBC that adopts the 1997 UBC 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 106 4 3, 1997 Uniform 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. TENANT IMPROVEMENTS WITHOUT SPECIFIC ENERGY DATA OR POLICY SUPPLEMENTS (1997UBC) tifotw dot Carlsbad O7-3192 January 8, 2008 • PLANS 1 Please make all corrections on the original tracings, as requested in the correction list Submit three sets of plans for commercial/industrial projects (two sets of plans for residential projects) For expeditious processing, corrected sets can be submitted in one of two ways a) Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Avenue, Carlsbad, CA 92008, and (760) 602-2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments b) Bring one corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, and (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 2 Roof mounted equipment must be screened and roof penetrations should be minimized City Policy 80-6 Please imprint the attached. 3 The City requires the following notes on the plans • WIRING METHODS AC Cable is not allowed in A, B, E, H, and I occupancies NM cable is restricted (without City approval) to one and two family dwellings Note on plans that an equipment ground conductor is to be installed in all flexible conduits • The use of flexible metal conduit as a grounding means must comply with City Policy 84-36 • No wiring is permitted on the roof of a building and wiring on the exterior of a building requires approval by the Building Official. City Policy 4 Provide complete plumbing plans, including a) Show water heater size, type and location on plans UPC Section 501 0 b) Show that water heater is adequately braced to resist seismic forces Provide two straps (one strap at top 1/3 of the tank and one strap at bottom 1/3 of the tank) UPC, Section 5105 c) Show P & T valve on water heater and detail dram line route from P & T valve to the exterior UPC Section 608 4 5 Please show all fixtures in the isometric see the sinks at the upper end of the Office 6 Please revise the plans to show the new doors to the room or enclosure shall be self-closing smoke and draft seal assemblies with a fire resistive rating not less than 1 hour 7 Rooms shall have an exterior wall in which there shall not be less than two vents not less than 36 square inches The vents shall be located within 6" of the floor and 6" of the ceiling 8 Please provide a note on the plans stating that the medical gas system shall be installed by a certified installer and shall be certified prior to service by an independent third party certification agency approved with the City per Section 1323 of the UPC Carlsbad O7-3192 January 8, 2OO8 9 Revise plans, or door schedules, to show that every required passage door has >32" clear width, per CBC Section 1133B 2 See pocket doors. 10 Show or note that all hand-activated door opening hardware meets the following requirements, per CBC Section 1133B 252 See pocket doors. a) Latching, or locking, doors in a path of travel are operated with a single effort by lever type hardware, by panic bars, push-pull activating bars, or other hardware designed to provide passage without requiring the ability to grasp the opening hardware b) Is to be centered >30" but <44" above floor 11 Please revise the plans to show a disabled accessible transaction counter located at a section of counter that is at least 36" long and no more than 28" to 34" high CBC Section 1122B 4 The person responsible for their preparation must sign all final sheets of plans (California Business and Professions Code) To speed up the review process, 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 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 Bryan Zuppiger at Esgil Corporation Thank you Carlsbad 07-3192 January 8, 2008 APR 15 2C31 17 26 CITY OF CARLSBAD POLICIES AND PROCEDURE #5820 P 001 /001 •IUMBER EFFECTIVE 80-6 5/1/92 SUPERSEDES 80-6(9/10/80) 80-6(5/01/81) SUBJECT ROOF MOUNTED EQUIPMENT SECTION BUILDING DEPARTMENT PURPOSE INTENT PROVIDE INSTALLATION STANDARDS FOR ALL ROOF MOUNTED EQUIPMENT AND PENETRATIONS ON COMMERCIAL AND INDUSTRIAL BUILDINGS A Maintain roof integrity B Prevent hazardous condition to firemen who must fight fire on the roof C Provide an installation that is aesthetically sensitive to the building and the adjoining properties POLICY 1 All equipment shall be concealed from view and the design* shall meet the approval of the Planning Department 2 All equipment shall be specifically designed and approved for exterior use and shall be approved by the City of Carlsbad Building Department 3 All roof mounted equipment shall be on a platform which shall be an integral part of the roof—flashed and waterproofed When a screen is approved, it shall have as few roof connections as possible and be structurally adequate 4 All electrical, plumbing, mechanical duct wotk and related piping shall be inside the building and not on the roof All connections related to equipment shall be made in the same roof opening on the platform or have the prior approval from the building official 5 Sewer vents shall be brought to one mam vent below the roof and have one penetration where restrooms or other plumbing fixtures are back to back or in the general proximity Air exhaust fans and other equipment shall be within the building and use the same roof opening where restrooms and other equipment are back to back or in general proximity 6 Existing buildings and equipment, remodel or replacement, shall meet the above regulations or shall have the prior approval from the building official 7 Where new equipment is installed, unused or abandoned equipment, including all roof mounted piping, electrical, mechanical, duct, and other related appurtenances shall be removed from roof and unused openings properly sealed to maintain roof integrity. *The architect should, through design, conceal the heating/AC unit and other equipment whether they are on the roof or elsewhere initiated By Approved B Carlsbad 07-3192 January 8, 2O08 JURISDICTION Carlsbad VALUATION AND PLAN CHECK FEE PLAN CHECK NO 07-3192 PREPARED BY Bryan Zuppiger DATE January 8, 2008 BUILDING ADDRESS 1285 Carlsbad Village Drive, Suite #100 BUILDING OCCUPANCY B TYPE OF CONSTRUCTION VN BUILDING PORTION tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code AREA (Sq Ft) 1820 cb Rlrla Pprmrt FPP hv Orrlmanrp ^P Valuation Multiplier \ ^37 X \X\GP By Ordinance Reg Mod VALUE ($) 62,553 -i — " I—I \ Oi$b(5UO ^&2jttS $440 85 Plan Check Fee by Ordinance Type of Review I I Repetitive Fee r^Tj Repeats Complete Review D Other i—I Hourly Structural Only Hour * Esgil Plan Review Fee $286 55 $246 88 Comments macvalue doc City of Car Is bad Wo^ksl||fi&n gl nee ring BUILDING PLANCHECK CHECKLIST DATE BUILDING ADRESS" /^ 05 PLANCHECK NO \ff\A PROJECT DESCRIPTION ASSESSOR'S PARCEL NUMBER / D - &3> G£> /'ft '6$ ', /<j ENGINEERING DEPARTMENT APPROVAL The item you have submitted for review has been approved The approval is based on plans, information and/or specifications provided in your submittal therefore any changes to these items after this date, including field modifications, must be reviewed by this office to insure continued conformance with applicable codes Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to build D A Right-of-Way permit is required prior to construction of the following improvements EST VALUE DENIAL Please see the attached report of deficiencies marked with D Make necessary corrections to plans or specifications for compliance with applicable codes and standards Submit corrected plans and/or specifications to this office for review By By By Date Date Date By FOR OFFICIAL USE ONLY NGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT Date /ATTACHMENTS Q Dedication Application Q Dedication Checklist Cl Improvement Application Q Improvement Checklist D Neighborhood Improvement Agreement D Grading Permit Application Q Grading Submittal Checklist D Right-of-Way Permit Application Q Right-of-Way Permit Submittal Checklist and Information Sheet D Storm water Applicability Checklist ENGINEERING DEPT CONTACT PERSON Name JOANNE JUCHNIEWICZ City of Carlsbad Address 1635 Faraday Avenue Carlsbad CA 92008 Phone (760) 602-2775 CFD INFORMATION Parcel Map No Lots Recordation Carlsbad Tract Carlsbad CA 9200^-7314 • (76O) 6O2-272O • FAX (76O) 602^3*02 BUILDING PLANCHECK CHECKLIST D SITE PLAN 1 Provide a fully dimensioned site plan drawn to scale Show A North Arrow B Existing & Proposed Structures C Existing Street Improvements D Property Lines E Easements 2 Show on site plan F Right-of-Way Width & Adjacent Streets G Driveway widths H Existing or proposed sewer lateral I Existing or proposed water service J Existing or proposed irrigation service A Drainage Patterns 1 Building pad surface drainage must maintain a minimum slope of one percent towards an adjoining street or an approved drainage course 2 ADD THE FOLLOWING NOTE "Finish grade will provide a minimum positive drainage of 2% to swale 5' away from building " B Existing & Proposed Slopes and Topography C Size, type, location, alignment of existing or proposed sewer and water service (s) that serves the project Each unit requires a separate service, however, second dwelling units and apartment complexes are an exception D Sewer and water laterals should not be located within proposed driveways, per standards 3 Include on title sheet A Site address B Assessor's Parcel Number C Legal Description For commercial/industrial buildings and tenant improvement projects, include total building square footage with the square footage for each different use, existing sewer permits showing square footage of different uses (manufacturing, warehouse, office, etc ) previously approved EXISTING PERMIT NUMBER DESCRIPTION F \BUILDING PLANCHECK CKLST FORM doc iST BUILDING PLANCHECK CHECKLIST 3RD DISCRETIONARY APPROVAL COMPLIANCE ID 4a Project does not comply with the following Engineering Conditions of approval for Project No [U O 4b All conditions are in compliance Date -11 DEDICATION REQUIREMENTS 5 Dedication for all street Rights-of-Way adjacent to the building site and any storm dram or utility easements on the building site is required for all new buildings and for remodels with a value at or exceeding $ 17,000 . pursuant to Carlsbad Municipal Code Section 18 40 030 Dedication required as follows Dedication required Please have a registered Civil Engineer or Land Surveyor prepare the appropriate legal description together with an 8 Vz x 11" plat map and submit with a title report All easement documents must be approved and signed by owner(s) prior to issuance of Building Permit Attached please find an application form and submittal checklist for the dedication process Submit the completed application form with the required checklist items and fees to the Engineering Department in person Applications will not be accept by mail or fax Dedication completed by Date D IMPROVEMENT REQUIREMENTS 6a All needed public improvements upon and adjacent to the building site must be constructed at time of building construction whenever the value of the construction exceeds $ 82,000 . pursuant to Carlsbad Municipal Code Section 1840040 Public improvements required as follows Attached please find an application form and submittal checklist for the public improvement requirements A registered Civil Engineer must prepare the appropriate improvement plans and submit them together with the requirements on the attached checklist to the Engineering Department through a separate plan check process The completed application form and the requirements on the F BUILDING PLANCHECK CKLST FORM doc BUILDING PLANCHECK CHECKLIST pND gRD checklist must be submitted in person Applications by mail or fax are not accepted Improvement plans must be approved, appropriate securities posted and fees paid prior to issuance of building permit Improvement Plans signed by Date CH CH d 6b Construction of the public improvements may be deferred pursuant to Carlsbad Municipal Code Section 1840 Please submit a recent property title report or current grant deed on the property and processing fee of $430 so we may prepare the necessary Neighborhood Improvement Agreement This agreement must be signed, notarized and approved by the City prior to issuance of a Building permit Future public improvements required as follows D D D 6c Enclosed please find your Neighborhood Improvement Agreement Please return agreement signed and notarized to the Engineering Department Neighborhood Improvement Agreement completed by Date D D D 6d No Public Improvements required SPECIAL NOTE Damaged or defective improvements found adiacent to building site must be repaired to the satisfaction of the City Inspector prior to occupancy GRADING PERMIT REQUIREMENTS The conditions that invoke the need for a grading permit are found in Section 15 16 010 of the Municipal Code D [Zf D 7a Inadequate information available on Site Plan to make a determination on grading requirements Include accurate grading quantities in cubic yards (cut, fill, import, export and remedial) This information must be included on the plans 7b Grading Permit required A separate grading plan prepared by a registered Civil Engineer must be submitted together with the completed application form attached NOTE The Grading Permit must be issued and rough grading approval obtained prior to issuance of a Building Permit Grading Inspector sign off by Date D D 7c Graded Pad Certification required (Note Pad certification may be required even if a grading permit is not required ) F \BUILDING PLANCHECK CKLST FORM doc BUILDING PLANCHECK CHECKLIST ,ST ND2 D 5RD D D 7d No Grading Permit required 7e If grading is not required, write "No Grading" on plot plan D n n MISCELLANEOUS PERMITS 8 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or private work adjacent to the public Right-of-Way Types of work include, but are not limited to street improvements, tree trimming, driveway construction, tying into public storm drain, sewer and water utilities Right-of-Way permit required for 9 INDUSTRIAL WASTE PERMIT If your facility is located in the City of Carlsbad sewer service area, you need to contact the Carlsbad Municipal Water District, located at 5950 El Cammo Real, Carlsbad, CA 92008 District personnel can provide forms and assistance, and will check to see if your business enterprise is on the EWA Exempt List You may telephone (760) 438-2722, extension 7138, for assistance Industrial Waste permit accepted by Date 10 NPDES PERMIT Complies with the City's requirements of the National Pollutant Discharge Elimination System (NPDES) permit The applicant shall provide best management practices to reduce surface pollutants to an acceptable level prior to discharge to sensitive areas Plans for such improvements shall be approved by the City Engineer prior to issuance of giadmg or building permit, whichever occurs first 10 a STORM WATER APPLICABILITY CHECKLIST Q Requires PSWP (project storm water permit) # JfNot required Required fees are attached 0 No fees required F \BUILDING PLANCHECK CKLST FORM doc ,ST NO ,RD D D D BUILDING PLANCHECK CHECKLIST WATER METER REVIEW 12a Domestic (potable) Use Ensure that the meter proposed by the owner/developer is not oversized Oversized meters are inaccurate during low-flow conditions If it is oversized, for the life of the meter, the City will not accurately bill the owner for the water used • All single family dwelling units received "standard" 1" service with 5/8" service • If owner/developer proposes a size other than the "standard", then owner/developer must provide potable water demand calculations, which include total fixture counts and maximum water demand in gallons per minute (gpm) A typical fixture count and water demand worksheet is attached Once the gpm is provided, check against the "meter sizing schedule" to verify the anticipated meter size for the unit • Maximum service and meter size is a 2" service with a 2" meter • If a developer is proposing a meter greater than 2", suggest the installation of multiple 2" services as needed to provide the anticipated demand (manifolds are considered on case by case basis to limit multiple trenching into the street) 12b Irrigation Use (where recycled water is not available) • All irrigation meters must be sized via irrigation calculations (in gpm) prior to approval The developer must provide these calculations Please follow these guidelines 1 If the project is a newer development (newer than 1998), check the recent improvement plans and observe if the new irrigation service is reflected on the improvement sheets If so, at the water meter station, the demand in gpm may be listed there Irrigation services are listed with a circled "I", and potable water is typically a circled "W" The irrigation service should look like STA 1+00 Install 2" service and 5 meter (estimated 100 gpm) 2 If the improvement plans do not list the irrigation meter and the service/meter will be installed via another instrument such as the building plans or grading plans (w/ a right of way permit of course), then the applicant must provide irrigation calculations for estimated worst-case irrigation demand (largest zone with the farthest reach) Typically, Larry Black has already reviewed this if landscape plans have been prepared, but the applicant must provide the calculations to you for your use Once you have received a good example of irrigation calculations, keep a set for your reference In general the calculations will include • Hydraulic grade line • Elevation at point of connection (POC) • Pressure at POC in pounds per square inch (PSI) • Worse case zone (largest, farthest away from valve • Total Sprinkler heads listed (with gpm use per head) • Include a 10% residual pressure at point of connection F BUILDING PLANCHECK CKLST FORM doc .ST BUILDING PLANCHECK CHECKLIST 3 In general, all major sloped areas, of a subdivision/project are to be irrigated via separate irrigation meters (unless the project is only SFD with no HOA) As long as the project is located within the City recycled water service boundary, the City intends on switching these irrigation services/meters to a new recycled water line in the future D 12c Irrigation Use (where recycled water is available) 1 Recycled water meters are sized the same as the irrigation meter above 2 If a project fronts a street with recycled water, then they should be connecting to this line to irrigate slopes within the development For subdivisions, this should have been identified, and implemented on the improvement plans Installing recycled water meters is a benefit for the applicant since they are exempt from paying the San Diego County Water Capacity fees However, if they front a street which the recycled water is there, but is not live (sometimes they are charged with potable water until recycled water is available), then the applicant must pay the San Diego Water Capacity Charge If within three years, the recycled water line is charged with recycled water by CMWD, then the applicant can apply for a refund to the San Diego County Water Authority (SDCWA) for a refund However, let the applicant know that we cannot guarantee the refund, and they must deal with the SDCWA for this D D D 13 Additional Comments F \BUILOING PLANCHECK CKLST FORM doc ENGINEERING DEPARTMENT FEE CALCULATION WORKSHEET itimate based on unconfirmed information from applicant Calculation based on building plancheck plan submittal 0/0Address Prepared by.Date //{2/O6^Checked by .Date EDU CALCULATIONS List types and square footages for all uses Types of Use Sq Ft /Units Types of Use Sq Ft/Units APT CALCULATIONS List types and square footages for all uses Types of Use Sq Ft /Units Types of Use Sq Ft/Units EDU's EDU's ADT's . ADT's FEES REQUIRED WITHIN CFD D YES (no bridge & thoroughfare fee in District #1, reduced Traffic Impact Fee) D 1 PARK-IN-LIEU FEE FEE/UNIT PARK AREA & # X NO UNITS =$_ DNO D D D D D D 2 TRAFFIC IMPACT FEE ADT's/UNITS 3 BRIDGE AND THOROUGHFARE FEE ADT's/UNITS 4 FACILITIES MANAGEMENT FEE UNIT/SQ FT 5 SEWER FEE EDU's BENEFIT AREA EDU'S 6 SEWER LATERAL ($2,500) 7 DRAINAGE FEES PLDA / ACRES X FEE/ADT fDIST #1 DIST #2 DIST X FEE/ADT ZONE X FEE/SO FT /UNIT X FEE/EDU X FEE/EDU HIGH /LOW X FEE/AC ,0 8 POTABLE WATER FEES UNITS CODE CONNECTION FEE METER FEE SDCWA FEE =$ #3 ) =$ =$ =$ =$ =$ =$ SDCWA FEE F \FEE CALCULATION WORKSHEET doc 1 of 2 Rev 7/14/00 Q Q Q (Q to tOa. Q. a ETD D PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No CB Planner Chris Sexton Type of Project & Use taSSearhloAdOfAddress Phone (760) 602-4624 £r Zoning./^" fi-^fceneral Plan O Net Project Density DU/AC CFD (in/out) #_Date of participation Facilities Management Zone J Remaining net dev acres Circle One (For non-residential development Type of land used created by this permit ) Legend Item Complete Environmental Review Required DATE OF COMPLETION Item Incomplete - Needs your action YES NO / TYPE Compliance with conditions of approval7 If not, state conditions which require action Conditions of Approval Discretionary Action Required APPROVAL/RESO NO PROJECT NO YES NO TYPE DATE OTHER RELATED CASES Compliance with conditions or approval9 If not, state conditions which require action Conditions of Approval a S/fa D D D Coastal Zone Assessment/Compliance Project site located in Coastal Zone? YES_ CA Coastal Commission Authority7 YES_NO If California Coastal Commission Authority Contact them at - 7575 Metropolitan Drive, Suite 103, San Diego CA 92108-4402, (619) 767-2370 Determine status (Coastal Permit Required or Exempt) Habitat Management Plan Data Entry Completed7 YES NO \// If property has Habitat Type identified in Table 11 of HMP, complete HMP Permit application and assess fees in Permits Plus (A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, HMP Fees, Enter Acres of Habitat Type impacted/taken, UPDATE!) Inclusionary Housing Fee required YES NO \f (Effective date of Inclusionary Housing Ordinance May 21, 1993 ) Data Entry Completed7 YES NO (A/P/Ds, Activity Maintenance, enter CB#. toolbar. Screens, Housing Fees, Construct Housing Y/N, Enter Fee, UPDATE') H \ADMIN\COUNTER\BldgPlnchkRevChklst Rev 3/06 n n Site Plan Provide a fully dimensional site plan drawn to scale Show North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements, right-of-way width, dimensional setbacks and existing topographical lines (including all side and rear yard slopes) Provide legal description of property and assessor's parcel number H'D n n n n Policy 44 - Neighborhood Architectural Design Guidelines 1 Applicability YES _ NO 2 Project complies YES _ NO efb n Zoning 1 Setbacks Front Interior Side Street Side Rear Top of slope Required _ Required Required Required Required S_ 2 Accessory structure setbacks Front Interior Side Street Side Rear Structure separation 3 Lot Coverage Required Required Required Required Required Required ___ Shown _ Shown Shown Shown Shown Shown Shown Shown Shown Shown Shown 4 Height Required Shown ta n 5 Parking Spaces Required Shown (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required Shown t Additional Commentsj /IJLflKVf J OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE H \ADMIN\COUNTER\BldgPlnchkRevChklst Rev 3/06 Carlsbad Fire Department Plan Review Requirements Category TI, COMM Date of Report 01-25-2008 Reviewed by BLDG-DBPTCOPY Name UTGARD CONSTRUCTION Address STE L 12225 WORLD TRADE DR SAN DIEGO CA 92108 Permit # CB073192 Job Name DR TSAI 1820SF SHELL TO OFF Job Address 1285 CARLSBAD VILLAGE DR CBAD St 100 INCOMPLETE The item you have submitted for review is incomplete At this time, this office cannot adequately conduct a review to determine compliance with the applicable codes and/or standards Please review carefully all comments attached Please resubmit the necessary plans and/or specifications, with changes "clouded", to this office for review and approval Conditions^ Cond CON0002564 [MET] Sheet TS - Occupancy classification shall reflect use If 1-1 2, building construction shall meet code requirements CBC 308 2 Sheet A-l Expand details on detail "Vent to Outside" to include requirements for medical gas systems CFC 7404 2 1 2 Entry 01/17/2008 By cwong Action CO Entry 01/25/2008 By cwong Action AP Cond CON0002568 [MET] ***Note*** Door to gas enclosure shall have self-closure Top vent (mm 36 sq in) shall be within 6 inches of ceiling Bottom vent (mm 36 sq in) shall be within 6 inches of of floor Entry 01/25/2008 By cwong Action AP Carlsbad Fire Department Plan Review Requirements Category TI, COMM Date of Report 01-17-2008 Reviewed by Name UTGARD CONSTRUCTION Address STE L 12225 WORLD TRADE DR SAN DIEGO CA 92108 Permit # CB073192 Job Name DR TSAI 1820SF SHELL TO OFF Job Address 1285 CARLSBAD VILLAGE DR CBAD St 100 INCOMPLETE The item you have submitted for review is incomplete At this time, this office cannot adequately conduct a review to determine compliance with the applicable codes and/or standards Please review carefully all comments attached Please resubrmt the necessary plans and/or specifications, with changes "clouded", to this office for review and approval Conditions Cond CON0002564 [NOT MET] Sheet TS - Occupancy classification shall reflect use If 1-1 2, building construction shall meet code requirements CBC 308 2 Sheet A-l Expand details on detail "Vent to Outside" to include requirements for medical gas systems CFC 7404 2 1 2 Entry 01/17/2008 By cwong Action CO Dec 18 07 07 29p Rague Rssociates 6192930484 P 2 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFPff. BP DATE / Business Name Business Contact Project Acidross ^ City State Telephone #_^, .fo»sg-)7£/ • Project Contact Slate Zip Code=L._2.Zip Code APNft Plan Filetf The following questions represent the facility & activities NOT Iho specific project description PARTI FIR^PEPARTMENT-HAZARDOUS MATERIALS DIVISION OCCUPANCY CLASSIFICATION Indicate by circling the item whether your business will use process or slore any of the following hazardous materials If any of the items are circled applicant must contact thy Fire Protection Agency with jurisdiction prior to plan submittal 1 Explosive or BMsting Agents G Organic Peroxides 9 W ilar Roactives 13 2 3 4 Compressed Gases Flammable/Combustible flammable Solids Liquids 6 7 8 Oxidizers Pyrophoncs Unstable Roactives 10 11 12 Cryogenics Highly Toxic or Toxic Radioactlvos Materials •M Other Health Hazard ^tp None of These o PART II. SAN DIEGO COUNTY PEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD) It the answer to any ol the quQstions is yes applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue 3 lloor San Dlcgo CA 92101 FEES ARE YES 1 J3"" 2 1^3 n 4 D 5 LU 6 D REQUIRFD Expected Dalo of OccuDdncv / / NO D Is your business Hated on the reverse sldo of this form? (check all that apply) D Will your business dispose of Hazardous Substances or Medical Wdslc In any amount? 0" Will your business store or handle Hazardous Substances in quantities equal to or greater than GO gallons 300 pounds, 200 cubic foot or carcinogen's/reproductive toxins In any qu intity? J!a Will your business use an existing or install an underground stongo tank? JE^. Will your business store or handle Regulated Substances (CalARP)? iC3^ Will your business use or Install a Hazardous Waste Tank System (Titl$ 22, Article 10)7 Q CalARP Exempt Date Initials D CalARP Required Date Initials D CalARP Complete Date Initials PART III SAHOIEGO COUNTY AIR POLLUTION CONTROL DISTRICT If the answer to any of the questions below ib yes, applicant must contact the Air Pollution Control District (APCD) 20124 Old Grove Road San Dieqo CA 92131 1649 telephone (85B) 586 2GOO prior to the issuance of a building or demolition permit Note If the answer 10 questions 3 or 54 Is yes applicant must nlso submit an asbestos notification form to the APCD at least 10 working days prior to commimclrig demolition or renovation, except demolitipn or ronovahon of residential structures of four units or less Contact the APCD for more Information YES NO,1 D Id Will the subject facility or construction activities Include operations or equipment that emit or are capable of emitting an air contaminant? (Soe the APCD factsheel dt litlo //www sdapcd orp/mfo/facts/permits DOT . and the list of typical equipment requiring an APCD permit on the rtjversa side / of [his from Contact APCD If you have any questions) 2 D iQ (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1 000 feet of the outer boundary of a school (K through 12)7 (Public and prlvaio schools may be found after search of the California School Directory at hftp./ywww.crto ca gov/re/sd/ or contact the - appropriate school district) l thorc be renovation that Involves handling of any friable asbestos materials or disturbing any material that contains non friable asbestos? Will ihorc be demolition involving the removal of d load supporting structural membci?[D Briefly describe business, activities Briefly describe proposed project I declare under penalty of ryjrjury that to the best of my knowledge and belief the res|e herein are truo and correct Name of owrier or Authorize;Signaturn of Owner 01 Authorised Agent Date FOR OFFICAL USE ONLY FIRE DEPARTMENT OCCUPANCY CLASSIFICATION . BY DATE: CXEMPT OR NO FURTHER INI-OKMATION REQUIRED RELEASES FOR DUILDING PERMIT BUT NOT t-OR OCI UPANCY HfLEoSCD FOR OCCUPANCY COUNTY HMD ^^sjs STlBBB^ APCD COUNTY HMD APCD COUNTY-HMD APCD HM <Cuunlynl Sin Oiepn-131 II - Hazardous Materials llivisiun COUNTY OF SAN IE KIVA# Department of Environmental Health Radiological Health Program 9325 Hazard Way San Diego, CA 92m Tel (858) 694-3621 Fax (858) 694-3629 PLAN CHECK # Ol'O ACTIVITY # FEE AMOUNTS PAYMENT TYPE DCASH DCHEC.K Check Number Plans submitted by RADIATION SHIELDING PLAN CHECK APPLICATION £> /t SSOC/A TE$ Phone # Facility Name/ Owner's Name UK *- * ™ n Job Site Address / 3. 8 5 CAfeLSMD T5A / ,Phone Mailing Address, if different # of Rooms ftd JZip _Zip X-RAY MACHINE INFORMATION Manufacturer Model/Type OWNER/REPRESENTATIVE DECLARATION I understand that the fee paid is based on my declaration of the radiation shielding classification If the declaration is incorrect, I understand that this application will not be appiovcd until the appropriate fee is paid ,)atc This space for Office Use Only A CSij^TY 0? C.V rOEPARTWEM OF ENVIRONED":- HEALTH _JADIAT!ON^na6j^G Based on the elate submrttel the tnstalietion is approved for This iac,!,?y \«ili meat the structural shielwnj requirements of ttiy C*iiforrfc«Radiation Control." By. CLASSIFICATION NO OF ROOMS TOTAL DENTAL, MEDICAL or INDUSTRIAL I-IRST TWO ROOMS (6CRAD -O) 80 °°£000 EAC1IADDTLROOMUI'T06(6CRAD O)42 00 EACH nb oo MORE THAN 6 ROOMS (6CRADI IR 0)IN ADDITION TO $248 BASE 1;EE HOURLY FEE BASED ON REVIEW TIME HM-9901 (10-07) Maa 12 08 01•13p Rague Rssociates 6132330484 RASUE + ASSOCIATES 7540 Metropolitan bnve, Suite 101 San biego, CA 92108 P 6192930234 F 6192930484 Email kui@ragueassoc com PROJECT' DR LINH TSAI 1285 CARLSBAD VILLAGE DRIVE, CARLSBAD MEDICAL VILLAGE ADDEMDL/M TO DEMISING WALL Date 5/8/08 ROOF STRUG ABOVE ^ 1 3/S" TECH SCREOI —/ ATTACH TO TRAC TO CJ OR PURLIN « 4&" OC DO NOT PENETRATE SHEATHING <5»" 20 <jtA STEEL 5TlJn^i « 16" OC "4182 ^- =,/A" TYPE X ^>IE 1 SIDES INSULATE HILTI PINS « 3'"' Of~ PV|$T-|NCI SLAB ^ ^ -^ S- ° 1 vO ^) ^ 1 DEMISING LUALL PLEASE CONTACT ME IF YOU HAVE QUESTIONS THANKS, KUI TAN \ TITLE 24 REPORT Title 24 Report for: DR LINH ISA) 1285 CARLSBAD DR CARLSBAD, CA 92008 Project Designer- Report Prepared By HADI MAHZARI ENERGY CONSULTING GROUP 8015 BALBOA AVENUE. SAN DIEGO, CA 92111 (858) 268-0660 Job Number. Date: 12/21/2007 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2005 Building Energy Efficiency Standards This program developed by EnergySoft LLC www energysoft com EnergyPro 4 4 by EnergySoft Job Number User Number 2984 REM MEDICAL RADIATION PHYSICS P 0 Box 460490 Escondido, CA 92046-0490 Tel/fax (888) 736-7497 remdeh@aol com October 12, 2007 Dr Lmh Tsai, D D S 858-761-5992 C/o kui@ragueassoc com Fax 619-293-0484 4915 Riding Ridge Road San Diego, CA 92130 RE Dental X-ray Suite, Dr Lmh Tsai, D D S , Carlsbad, CA The following recommendations for radiation shielding have been made in accordance with recommendations of NCRP #147 and the California Radiation Control Regulations, Title 17 Recommendations for the facility were made from information supplied by Lee Palmer of Burkhart Dental in the form of a facility plan and equipment information The assumptions below are consistent with the information supplied If any changes are made in the site layout or equipment, then please notify this office so that appropriate modifications in these recommendations can be made Assumptions 1 Workload (W) The Workload (W) factor in units of milliamperes-minutes per week or milliroentgen per week is supplied from customer, or is assumed that which represents a common value for the specified use (for example, see NCRP Report No 145, Table F 3) 2 Use (U) The Use (U) factor indicates the fraction of exposure to Primary beam (U = an assigned value) or the Scattered beam (U = I for a dental facility) 3 Occupancy (T) The occupancy (T) factor indicates the fraction of time of exposure at a specific location NCRP Report No 145, Table F 1 is generally followed for non-controlled areas \ 4 Weekly Exposure Limit (P) The Weekly Exposure Limit (P) is 2 mrem per week (0 002 factors) for non-radiation workers and is 100 mrem per week (0 1 factors) for occupational radiation workers RE Dental X-ray Suite -2- 10/12/07 5 KiloVoltage Potential (kVp) The KiloVoltage potential (kVp) is assumed to be an average of 70 for scattered dental X-rays. 6 Distance (d) The Distance (d) used in shielding calculations is the distance from the scattering object to the position of occupancy 7 Walls The walls of the rooms, unless otherwise noted are assumed to consist of one 5/8" layer of sheetrock on each side of a 3 inch or greater wall stud This is approximately equivalent to 0 08 mm lead 8 Doors The doors of the rooms are assumed to be solid core doors 9 Windows The windows of the room are assumed to be generally of minor shielding significance 10 Floor/Ceiling The Floor and Ceiling occupancies must be specified 11 Height of Shielding The height of shielding must be 80 inches (or more if specified) as per California Radiation Control Regulations, Title 17 12 Primary Barrier The primary barrier is not utilized in a dental facility (secondary scatter shielding only) 13 Half-Value-Layer (HVL) These values at specific kVp values are taken from NCRP Report No 145, Table F 11 14 Shielding Value Minimum The values of shielding are minimum values Larger values can be used if cost effective RE Dental X-ray Suite -3- 10/12/07 FACILITY INFORMATION Name Dr Lmh Tsai, D D S Address 1285 Carlsbad Village Drive, Ste #8, Carlsbad, CA 92008 Level single story on grade Ceiling roof Floor on grade Walls, interior 2 layers of 5/8" gypsum board (assumed) Workload, X-ray 30 mA-min/week @70 kVp each X-ray room Equipment, X-ray 4 wall mount units, 1 panoramic unit RECOMMENDATIONS FOR SHIELDING BARRIER A Use scattered X-ray barrier (U = 1) Adjacent space exterior Occupancy 3% Distance 5' Shielding Recommendation Use common construction materials in wall Read x-ray operator's instructions at the end of this report Read dental X-ray assistant's instructions at the end of this report BARRIER B Use scattered X-ray barrier (U = 1) Adjacent space game area Occupancy 12% Distance 5' Shielding Recommendation Use 1 extra layer of sheetrock for a total of 3 layers in wall BARRIER C Use scattered X-ray barrier (U = 1) Adjacent space business office Occupancy 85% Distance 6' Shielding Recommendation Use 1 extra layer of sheetrock for a total of 3 layers in wall RE Dental X-ray Suite -4- 10/12/07 BARRIER D Use scattered X-ray barrier (U = 1) Adjacent space hallway and control area Occupancy 20% Distance 5' Shielding Recommendation Use common construction materials No persons should be in this area except the X-ray operator BARRIER E Use scattered X-ray barrier (U = 1) Adjacent space sedation room Occupancy 12% Distance 51 Shielding Recommendation Use common construction materials BARRIER F Use scattered X-ray barrier (U = 1) Adjacent space storage holding area Occupancy 3% Distance 5' Shielding Recommendation Use common construction materials BARRIER G Use scattered X-ray barrier (U = 1) Adjacent space operator/ Occupancy 75% Distance 6' Shielding Recommendation Use common construction materials BARRIER H Use scattered X-ray barrier (U = 1) Adjacent space reception area Occupancy 85% Distance 4' Shielding Recommendation Since the panoramic X-ray unit is essentially self-shielded, then radiation scatter from the patient is the only concern Use 1 extra layer of sheetrock for a total of 3 layers in wall The area around the panoramic x-ray unit may be an open area, therefore, the X-ray operator should be aware of persons in that area so that they might caution such persons not to be in the area during the taking of X-rays RE Dental X-ray Suite -5- 10/12/07 BARRIER I Use scattered X-ray barrier (U = 1) Adjacent space X-ray room and panoramic room Occupancy 50% Distance 4' Shielding Recommendation Use 1 extra layer of sheetrock for a total of 3 layers in wall BARRIER I* Use scattered-ray barrier (U = 1) Adjacent space occupied area Occupancy 90% Distance 4' Shielding Recommendation Use 1 extra layer of sheetrock for a total of 3 layers in wall BARRIER J Use scattered-ray barrier (U = 1) Adjacent space hand washing area Occupancy 6% Distance 4' Shielding Recommendation Use common construction materials BARRIER K Use scattered X-ray barrier (U = 1) Adjacent space ceiling/roof Occupancy 3% Distance 8' Shielding Recommendation Use common construction materials BARRIER L Use scattered X-ray barrier (U = 1) Adjacent space on grade floor Occupancy 0% Distance 4' Shielding Recommendation Use common construction materials RE Dental X-ray Suite -6- 10/12/07 X-Ray Operators It is important that the control units for each x-ray machine be mounted in such a manner that the x-ray dental X-ray operators are protected by at least two layers of 5/8" sheetrock or equivalent at a distance of at least 5', or at least one layer of 5/8" sheetrock or equivalent at a distance of 6', or if no shielding is present, they must stand at a distance of at least 10' from the source of scattered x-rays Those operators should be cautioned that their standing position must be such that the x-ray tube is not pointing in their direction Note that the patient must be observed during the taking of radiographs Dental X-ray Assistants: Since the doorways into the x-ray rooms may be open doorways, then the x-ray assistants should be aware of persons in those doorway areas so that they might caution such persons not to be in the doorway areas during the taking of radiographs If I might be of further assistance on the above project, then please contact me CERTIFICATION FOR RADIATION PROTECTION NAME OF FACILITY Dr Lmh Tsai, D D S ADDRESS Carlsbad, CA DESCRIPTION OF PROPOSED PROJECT Dental X-ray Rooms Based on my assumptions and calculations, I declare under penalty of perjury, that the radiation protection design for the above project** will conform to the applicable provisions of Title 17, California Administrative Code, relating to radiation protections I further declare that I am a certified radiation physicist, health physicist and medical physicist See NOTE 1 NAME DONALD E HOLMES, Ph D TITLE Professor Emeritus of Medical Physics SIGNATURE **as per my radiation shielding report of October 12, 2007 and any following addenda NOTE 1 My responsibility is for the design of the radiation shielding and not for the installation of the shielding Enclosures Floor plan with shielded areas marked CONSTRUCTION COMPANY INC 12225 World Trade Drive Suife "L San Diego, CA 92128 • CA ?563379 AZ if 103885 • (858)674-8040 FAX (858) 673 1064 December 26, 2007 Rague & Associates 7540 Metropolitan Drive #101 San Diego, CA 92108 RE Job #08001 -Dr Tsai 1285 Carisbad Village Drive Carlsbad, CA 92008 To Whom It May Concern Utgard Construction Company, Inc hereby gives permission to Architects, Rague and Associates to pull permits on behalf of UCC, Inc for the above referenced project Also attached please find Evidence of Worker s Compensation Insurance Any questions or concerns please phone our office at (858) 674-8040 Thank you Yours truly, Utgard Construction Company, tnc BJ Utgard' VP President BJdd Mailing Address PO Box 501047 » San Diego, CA 92150 1047 CERTHOLDER COPY SD COMPENSATION INSURANCE PO BOX 420807 SAN FRANCISCO CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 01-01-2007 GROUP 000046 POL CY NUMBER 0009500-2007 CERTIFICATE ID 79 CERTIFICATE EXPIRES 01-01-2008 01-01-2007/01-01-2008 UTGARD CONSTRUCTION CO INC 12?25 WORLD TRADE DRIVE Hi, SAN DIEGO CA 92128 SD JOB EVIDENCE OF INSURANCE This is to certif/ that we have issued a walid Workers Compensation insurance policy in a form approved by the California Insurance Commissions' to the employer named below for the policy period indicated This policy is not sjbject to cancellation by the Fund except upon 3(j days advance written notire to the errplo^er We will a'so tj'.ve you gg days advance notice should his ooli'v be cancelled prior to ts norms' expiration This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded b\ the policy listed herein Notwithstanding any requirement term or condition of any contract or other document with resoert to which this certificate of insurance may be issued or to which it may pertain the insurance afforded by the policy described herein is subject to all the terms exclusions and condition-; of surh policy AjWvnfi/t- ^//S^yt^-,/- \$UTHORIZED REPRESENTATIVE) PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS $1,000 OOO PER OCCURRENCE ENDORSEMENT //1600 - STEPHEN C UTGARO, PRES - EXCLUDED ENDORSEMENT f/1SOO - BARBARA JO UTGARD SEC TR - EXCLUDED ENDORSEMENT #2035 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2O02 IS ATTACHED TO AND FORMS A PART OF THIS POLICY FWIPuOYER UTGARD CONSTRUCTION COMPANY INC PO BOX 501O47 SAN DICGO CA 92150 SD !R5V 2 OSl PRINTED 12-15-2006 M0408