Form Ds-164 - High-Piled Combustible Storage - City Of San Diego Development Services
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City of San Diego
High-Piled
Development Services
DS-164
1222 First Ave., MS-401
Combustible Storage
San Diego, CA 92101
(619) 446-5000
January 2014
This form is required to be submitted for all new or existing High-Piled Combustible Storage as defined in the California Fire
Code. All applicants must fill out Section I.
SECTION I: GENERAL INFORMATION
Project Name:
Project Number:
For City Use Only
Tenant Name:
Permit Number:
For City Use Only
Job Address:
Building/Unit/Suite Number:
Phone Number:
❏
No high-piled combustible storage. If this facility will NOT contain storage of high hazard commodities (including Group A
plastics) over 6 feet in height to the top of storage or over 12 feet in height of storage of all other commodities, check this box.
❏
High-piled combustible storage. If this facility will contain storage of high hazard commodities over 6 feet in height to the top
of storage or over 12 feet in height of storage of all other commodities, check this box and complete Sections II and III below.
I declare under penalty of perjury that, to the best of my knowledge, the responses made herein are true and correct.
____________________________________________________
______________________________________ ______________________
Name of Owner/Occupant/Authorized Agent (circle one)
Signature
Date
SECTION II: COMMODITIES
Total Combustible High-Piled Storage Area ____________________ft
Ceiling/Roof Height: ________ ft
2
List all products containing plastics over 6 feet in height in the table below. List all products stored over 12 feet in height. List
all aerosol products and all flammable/combustible liquids stored over 1 container high.
Single-, Double-,
Max.
Cartoned or
Palletized
Solid
Material(s) - Include Description of
Aisle
Encap-
Multiple-Row
Storage
Open Top
Floor or
Shelv-
Product, Packaging, & Type of Pallet
Width
sulated
Racks, Shelf,
Height
Containers or
Solid Piled
ing
(Plastic or Wood)
(ft)
(Y/N)
Automated or
(ft)
Bin box?
Storage?
(Y/N)
Carousel?
1.
2.
3.
4.
5.
6.
7.
8.
9.
❏
❏
❏
❏
❏
For City Use Only
COMMODITY CLASSIFICATION
I
II
III
IV
N/A
❏
High Hazard/Expanded Group A
❏
City Employee: _______________________________
Date: _____________________
High Hazard/Unexpanded Group A
Printed on recycled paper. Visit our web site at
Clear Page 1
Upon request, this information is available in alternative formats for persons with disabilities.
DS-164 (01-14)
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