HomeMy WebLinkAboutCDP 2023-0041; 4080 SUNNYHILL DRIVE ADU; Coastal Development Permit (CDP){ Cicyof
Carlsbad
AUTHORIATION, CONSENT, AND
DISCLOSURE STATEMENT
P-1(A)
A PU
Development Services
Planning Division
1635 Faraday Avenue
442-339-2600
www.carlsbadca.gov
~ APPLICATION AND ACKNOWLEDGEMENT INFORMATION
This submittal form {Part A through Part F) must be completed as part of your application with the City
of Carlsbad. Your project cannot be reviewed until this information is completed.
PART A. Owner Authorization and Consent
NOTE: This Consent and Disclosure Form must list the name of the principal owners {10% or greater) and
attach a copy of the current corporate articles, partnership agreement, or trust document, as applicable.
Provide name(s) of the person(s) authorized to sign on behalf of the organization. (A separate page may
be attached if necessary.) IF NO INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE INDICATE
NOT-APPLICABLE {N/A) IN THE SPACE BELOW.
This is to certify under penalty of perjury that the undersigned is/are the record owner(s) of the
property known as:
Assessor's Map Book, Page and Parcel (APN/APNs): ~O 1 -0' ?,_ --1... I -O 0
______________________________ ;and
Street Address (if applicable): 4C> 't> D S vA.JA1'1 H ll.-\.,, Dt2-I ~/ CArl. L.~SAD, cA 4'2..008
that I/we (full legal name of all record owners) consent to the filing of the Land Use Review Application
on our property for processing by the City of Carlsbad Planning Division. I/We declare under penalty of
perjury that I/we have reviewed this Affidavit and the information is true and correct.
Name: CAM€~~ \to~~~~
Signature: C -+ n. _ -
Name: s~()~ ~~~A-cJ
Signature: ---~___,;;i:::,,,.,.....----=--~-------------
Name: ________________________ _
Signature: _______________________ _
(For additional names, please use a separate sheet of paper)
Page 1 of6
P-1(A) Form Rev 6/2023
PART C. Project Team Information (complete all applicable fields)
Applicant: □ Same as Owner IB'Different from Owner
Name (if different from Owner): JC>~~ ~e,p..,,uo
Company or Firm: J()~ ~Jl,,.fZ...~/JO -t-l rte~
Contact Address: .Z.. ~ 1(&, CAM1tJo $'€~
City: C;,.~.SAP State: CP-Zip Code: 4 200'l
Agent or Representative: IB'Same as Applicant □ Different from Applicant □N/A
Name (if different from Applicant): ______________________ _
Company or Firm: ____________________________ _
Contact Address: ____________________________ _
City: ___________ State: ___________ Zip Code: ____ _
Other (specify Architect, Engineer, CEQA Consultant, etc.): ______________ _
Name: _______________________________ _
Company or Firm: ____________________________ _
Contact Address: ____________________________ _
City: ___________ State: ___________ Zip Code: ____ _
NOTE: A Letter of Authorization (LOA) from the Property Owner empowering a person or persons to act
on the behalf of the Property, is required if anyone other than the Property Owner signs the Land Use
Review Application as the Applicant or Agent. The authorized person (Applicant or Agent) on the LOA
must correspond with the name and signature, above.
PART D. Single "Point of Contact" Designation
A single "point of contact" is an individual that handles all communications with the city and its review
team for the purposes of sending and receiving application materials, information, reports, etc. The
point of contact is to be the single individual elected on the Land Use Review Application form for all
communications and to remain as the primary contact for all status updates relating to the Land Use
Review Application.
Single Point of Contact: ~ppiicant □ Property Owner □ Agent □ Other _______ _
Page 3 of6
P-1 (A) Form Rev 6/2023
PART E. Contribution Disclosure
Has the Property Owner, Applicant, or Agent had more than $900 worth of business transacted with any
member of city staff, Boards, Commissions, Committees and/or Council within the past 12 months?
D Yes ~o If yes, indicate person(s): ___________________ _
NOTE: Attach additional sheets if necessary.
PART F. Applicant Declarations (to be signed by Applicant)
I hereby certify under penalty of perjury that I have read the information below and that:
'
1. I have carefully reviewed and prepared the application and plans in accordance with the
instructions.
2. I understand that the specific information needed to initiate planning case processing
corresponds to those items listed in the application form's "Minimum Submittal Intake
Requirements Checklist." I also understand that even if the application is duly filed and
accepted for intake processing, each application submitted to the Planning Division is
required to have specified information included in the application packet before it is
determined to be complete. The specific information to determine completeness is in
"Completeness Determination Requirements Checklist."
3. The Planning Division has developed policies to help ensure that discretionary permit
applications are timely processed. The Permit Streamlining Act shot clock starts on the intake
date the Planning staff accepts a duly filed application.
4. I understand that once an application is determined to be complete, project or design changes
that will increase the number of units, add uses that were not previously listed, substantially
change the site plan, or other changes that trigger the need for additional discretionary
approvals will require a new application, or the filing of other application permit types, which
would restart the review "clock" and extend processing timelines.
5. I understand that upon city review, additional information, documents, reports, entitlements
and fees might be required, including any referral fees. I understand that all fees and deposits
submitted with this application will be refunded only as provided for by the ordinances,
regulations, or policies in effect at the time of the application submittal.
6. I understand that it is my responsibility to ensure that statements are true, that discrepancies do
not exist between the project's description on the application, the architectural plans and the
structural plans. If discrepancies exist between the architectural plans and the structural plans,
the architectural plans shall take precedence. Ultimately, the scope of work, as described on the
permit that auth6rizes construction, takes precedence over the plans. If there is a discrepancy
between the plans and the description on the permit, the permit governs.
Page4 of6
P-1 (A) Form Rev 6/2023
7. I understand that all materials submitted in connection with this application might become
public record subject to inspection and copying by the public. I acknowledge and understand
that the public might inspect and copy these materials and that some or all of the materials
might be posted on the city website or elsewhere online, outside of the city's control.
8. I understand there are no assurances at any time, implicitly or otherwise, whether provided to
me in writing or by oral communications regarding final staff recommendations to the decision-
making body about this application or the determination of any decision-making body.
9. If the project is approved or conditionally approved, the approved plan set of project drawings,
civil plans/grading, sections, site plans, floor plans, architectural elevations, and landscape plans
shall not be altered without express authorization by the City Planner. Once a permit has been
issued, the Applicant may request permit modifications. "Minor" modifications might be granted
if found by the City Planner to be in substantial conformity with the approved plan set, including
all exhibits and permit conditions. Modifications beyond the scope described in the approved
plan set might require submittal of an amendment to the permit and approval by the authorized
review body.
10. Should any proponent of the project fail to file a timely and valid appeal of the permit within the
applicable appeal period, such inaction shall be deemed to constitute acceptance of the permit
by the Applicant; and agreement by the Applicant to be bound by, to comply with, and to do all
things required of or by the Applicant pursuant to all of the terms, provisions, and conditions of
the issued permit or other approval.
11. As part of this application, the Applicant hereby agrees to defend, indemnify, and hold harmless
the City of Carlsbad, its Council, boards and commissions, officers, employees, volunteers, and
agents from any claim, action, or proceeding against the City of Carlsbad, its Council, boards and
commissions, officers, employees, volunteers and agents, to attack, set aside, void or annul an
approval of the application or related decision, including environmental documents, or to
challenge a denial of the application or related decisions. This indemnification shall include, but
not be limited to, damages awarded against the city, if any, costs of suit, attorneys' fees, and
other expenses incurred in connection with such claim, action, causes of action, suit or
proceeding whether incurred by Applicant, city, and/or the parties initiating or bringing such
proceeding. The Applicant shall indemnify the city for all of the city's costs, attorneys' fees, and
damages that the city incurs in enforcing the indemnification provisions set forth herein. The
Applicant shall pay to the city upon demand any amount owed to the city pursuant to the
indemnification requirements prescribed.
Page 5 of 6
P-1 (A) Form Rev 6/2023
PART B. Supplemental Information
Denote whether the following items are applicable to the project or if any portion of the property located within any of the
following? Use an addendum sheet to further describe all items marked "yes" in this list (attach additional sheets as
necessary).
1. A very high fire hazard severity zone, as determined by the Department of Forestry
and Fire Protection pursuant to Government Code§ 51178 for State Responsibility
Areas; or any official local maps published pursuant to Government Code§ 51178
for Local Responsibility Areas.
2. Wetlands, as defined in the United States Fish and Wildlife Service Manual, Part
660 FW 2 (June 21, 1993).
3. A hazardous waste site that is listed pursuant to Government Code§ 65962.5 or a
hazardous waste site designated by the Department of Toxic Substances Control
pursuant to Health and Safety Code§ 25356 of the Health and Safety Code.
NOTE: Certification of compliance required on Form P-l(CJ.
4. A special flood hazard area subject to inundation by the 1 percent annual chance
flood (100-year flood) as determined by the Federal Emergency Management
Agency in any official maps published by the Federal Emergency Management
Agency.
5. A delineated earthquake fault zone as determined by the State Geologist in any
official maps published by the State Geologist.
6. Any historic or cultural resources known to exist on the property.
7. The project requires any approvals under the Subdivision Map Act, such as a parcel
map, a tentative map, or a condominium map.
NOTE: If "yes," you may need to complete Form P-l(EJ and Form P-l(FJ.
8. The project require a Density Bonus Approval.
NOTE: If "yes," you must complete Forms P-l(H).
Yes No
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9. The project site located within the Coastal Zone. [E( □
NOTE: If "yes," you may need to complete Form P-6 and/or Form P-7.
a. If "yes," does any portion of the property contain wetlands, as defined in Title 0
14 of the California Code of Regulations § 13577.
Page 3 of4
P-l(B) Fonn Rev 6/2023
Yes No
b. If "yes," does any portion of the property contain environmentally sensitive
habitat areas, as defined in Public Resources Code§ 30240.
NOTE: If "yes," you may need to complete Form P-17 or Form P-18.
□
c. tf "yes," does any portion of the property contain a tsunami run-up zone or D
mapped inundation area.
d. If "yes," does any portion of the property contain any public access to or along D
the coast.
10. The project impacts a stream or other resource that may be subject to a stream bed D
alteration agreement pursuant to Chapter 6 (commencing with Fish and Game
Code§ 1600.
11. Any portion of the property is subject to any recorded public easement, such as D
easements for storm drains, water lines, and other public rights of way.
0'
I/We declare under penalty of perjury that I/we have reviewed this Affidavit and the information furnished is true
and correct.
Name: J O>~Pl-f ~P-tz.~
S~n~--
This form must be stapled/attached to the application and shall be effective until replaced or revoked in writing.
NOTE: The Applicant, Property Owner, or Agent should use this form when submitting project revisions to update
the information provided in response to issues raised by during the course of the city's review.
Page 4 of 4
P-1(8) Form Rev 6/2023
PART A. Requested Environmental Clearance (All Projects)
✓ DON'T KNOW/ UNKOWN. It is unknown how CEQA applies to this project.
D CEQA APPLICABILITY -NOT A PROJECT. The requested activity associated with the application
package is NOT a "project'' as defined by CEQA (Public Resources Code§ 21065; CEQA Guidelines
§ 15378.
Applicable Public Resource Code or CEQA Guidelines Sec.: _____________ _
D EXEMPT FROM ENVIRONMENTAL REVIEW. An Applicant, Property Owner, or Agent
contemplating using a CEQA exemption should carefully review both the Public Resources Code
and the State CEQA Guidelines to determine whether specific criteria apply that may or may not
be applicable to their proposed project. To assist the city in assessing whether t~e proposed
project is exempt from further review, the Applicant, Property Owner, or Agent may be asked to
provide written explanation and substantiate the requested exemption (see below).
□ Ministerial. The requested activity is exempt from further CEQA review because
it is specifically excluded from CEQA consideration as defined by the State
Legislature. These exemptions are delineated in Public Resource Code §§ 21080
et seq. and CEQA Guidelines.
Applicable section: ____________________ _
□ Categorical. The requested activity is exempt from further CEQA review because
it belongs to a list of classes of projects that generally are considered not to have
potential impacts on the environment. Categorical exemptions are identified by
the State Resources Agency and are defined in the CEQA Guidelines §§ 15300-
15333. ADDITIONAL DOCUMENTATION MUST BE ATTACHED. Written evidence
must include why the quested exemption is not negated by some sort of an
exception to the exemption, pursuant to CEQA Guidelines §15300.2 and Chapter
19.04 of the Carlsbad Municipal Code.
D Other type of exemption, such as Agricultural Housing, Affordable Housing, and
exemption for residential projects in a specific plan, etc. (Article 12.5 of the CEQA
Guidelines; § 15182; § 15183; Public Resources Code§ 21155.1; etc.) ADDITIONAL
DOCUMENTATION AND/OR CHECKLIST MUST BE ATTACHED.
□ ENVIRONMENTAL DOCUMENTATION REQUIRED. Environmental review is required under CEQA
because the project does not qualify for an exemption. This Environmental Information Form will
be used to assist staff in determining what type of environmental documentation (i.e.,
Environmental Impact Report, Mitigated Negative Declaration, or Negative Declaration) will be
required to be prepared, per CEQA and Chapter 19.04 of Carlsbad's Municipal Code. The city will
typically complete its initial environmental study thirty days after an application is determined
complete, consistent with Public Resources Code§ 21080.2; CEQA Guidelines§ 15102, unless the
timeframe is extended.
Page 2 of 5
DRAFT P-l(D) Fotm Rev 6/2023
PART B. Property and Project Screening Information (If Applicable)
This section is to be completed only if further environmental review and documentation is required (such
as an Environmental Impact Report, Mitigated Negative Declaration, or Negative Declaration. After your
land Use Review Application is complete, the City Planner will request the preparation of an Initial Study,
whi_ch will rely, in part, on the information provided in this form. If you believe that a previously' completed
CEQA document adequately addresses the environmental impacts of the proposed project, a Petition for
Use of Prior CEQA Document or tiering checklist (as required by CEQA) may be filed which will be reviewed
and considered. It is important to note that the details of the request must be carefully evaluated and
Planning staff's recommendation or decision for environmental review may change.
NOTE: If you have any questions regarding what constitutes an environmental resource of concern,
Planning staff may be contacted for further information. The clarity and accuracy of the information you
provide is critical for purposes of quickly determining the specific environmental effects of your project.
1. Describe each item as it relates to the PROJECT SITE:
a. Existing land uses/ structures: -----------------------
b. Topography/ slope: _________________________ _
c. Vegetation: _____________________________ _
d. Wildlife: ___________________________ _
e. Surface waters: ___________________________ _
f. Cultural/ historical resources: ______________________ _
g. Other: ______________________________ _
2. Describe each item as it relates to the SURROUNDING AREA:
a. Existing land uses/ structures: -----------------------
b. Topography/ slope: ________________________ _
c. Vegetation: _____________________________ _
d. Wildlife: ___________________________ _
e. Surface waters: ___________________________ _
f. Cultural/ historical resources: ______________________ _
g. Other: _____________________________ _
Page 3 of 5
DRAFT P-I(D) Form Rev 6/2023
·3. Describe the whole action involved, including but not limited to later phases of the project, and any
secondary, support, or off-site features necessary for its implementation.
4. What steps can be taken to mitigate any adverse effects that may result from this project? List the
adverse effect first, then the mitigation measure(s) to reduce that effect.
· Are the following items applicable to the project or its effects? Discuss all items checked "yes" (attach
additional sheets as necessary).
5. Change in existing features of any bays, tidelands, beaches, or hills, or substantial
alteration of ground contours.
6. Change in scenic views or vistas from existing residential areas or public lands or
roads.
7. Change in pattern, scale or character of general area of project.
8. Significant amounts of solid waste or litter.
9. Change in dust, ash, smoke, fumes or odors in vicinity.
10. Change in ocean, bay, lake, stream or ground water quality or quantity, or
alteration of existing drainage patterns.
10. Substantial change in existing noise or vibration levels in the vicinity.
11. Site on filled land or on slope of 10 percent or more.
12. Use of disposal of potentially hazardous materials, such as toxic substances,
flammables or explosives.
13. Substantial change in demand for municipal services (police, fire, water, sewage,
etc.).
14. Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.).
15. Relationship to a larger project or series of projects of the same type in the same
general area.
Yes No
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Page 4 of 5
DRAFT P-1 (D) Form Rev 6/2023
Yes No
16. Site with tree groves, rock outcroppings, or similar resources. □ □
17. Site with ~ensitive plant or animal habitats, defined by the California Endangered □ □
Special Act (Fish and Game Code §§ 2050 et. seq.) or the Federal Endangered
Species Act (16 U.S.C. §§ et. seq.); or sensitive, rare, candidate species of special
concern; endangered or threatened biological specials or their habitat (specifically
including sage scrub habitat for the California Gnatcatcher}; or the site is
immediately adjacent to a corridor or larger area which has wildlife movement.
18. Site has known archaeological or cultural resources from either historic or □ □
prehistoric periods.
19. Site has buildings or structures, including houses, garages, barns, commercial □ □
structures, etc. with extant architecture that are usually more than 45 years old.
NOTE: The city requires completion of this form for informational purposes. An affirmative response to any
of the items does not necessarily trigger special or additional CEQA review. Any environmental studies (i.e.,
biological, cultural resource, traffic, noise) that are necessary to substantiate a "no impact" or "yes impact"
determination should be submitted as an attachment to this Environmental Information Form to help
expedite the city's environmental review but IS NOT required to complete your application. Formal
environmental review does not begin the Land Use Review Application is determined to be complete.
A few statutes or ordinances require agencies to make decisions on permits within time limits that are so
short that review of the project under CEQA time limits would be difficult. To enable the city to comply
with the Permit Streamlining Act and CEQA, the case planner will deem an application for a project not
received for filing under the statute or ordinance until such time that progress toward completing the
environmental documentation required by CEQA is sufficient to enable the city to finish the CEQA process
within the shorter permit time limit.
This form must be stapled/attached to the application and shall be effective until replaced or revoked
in writing.
Page 5 of 5
DRAFT P-l(D) Fonn Rev 6/2023
______ r,_'IZ_c_J_£""! .. c,T : AD LI_ w ,--!ti 6 a. r ~17 . ~ c J, or C D f>
{ a_dt,,t,,, :111..n .l+ir(__ Cd-7 ?l~/11 -le.tGI
( Cicyof
Carlsbad
MINOR d~~t'ft'o,.,)
COASTAL DEVELOPMENT PERMIT/ Development Services
SINGLE FAMILY RESIDENCE Planning Division 1635 Faraday Avenue
APPLICATION (442) 339-2610
P-6 www.carlsbadca.gov
J\UG Z S 2823
{-~ C,t,vo JI. fs,
A proposed project requiring application submittal must be submitted by appointment*.
Please call 442-339-2600 to make an appointment
*SAME DAY APPOINTMENTS ARE NOT AVAILABLE
All joint application exhibits, i.e. Tentative Map and Planned Development Site Plan should be prepared
at the same scale. (Use a scale no smaller than 1" = 40'.)
I. GENERAL BACKGROUND
A. Estimated Cost of Development:
Development costing $60,000 or more does not qualify as a Minor Coastal Development Permit.
The City Planner shall make the final determination regarding a project's cost of development.
The primary basis for determining cost of development will be the application of dollar costs per
square foot for different types of residential construction. These costs are set by the
International Conference of Building Officials (ICBO) and are applied throughout San Diego
County.
Please complete the following information to assist in the determination of this project's cost of
development (Contractor proposals may also be submitted for consideration by the City
Planner). Please refer to the current fee schedule for the appropriate $/square foot fee rate.
⇒ New Residential Square Footage: A-vv'
⇒
⇒
⇒
⇒
I i 18 square feet x $ ____ ./sq. ft. = $. ________ _
Residential Addition Square Footage: IJ/ ,t,...
______ square feet x $ ____ ./sq. ft.=$ __ ...;..._ _____ _
Any Gara~e Square Footage:
( ( :13.. square feet x $ ___ ./sq. ft. = $. ________ _
Residential Conversion Square Footage: rJ ~
______ squarefeetx$. ____ /sq.ft.=$. __ .;../_I-_____ _
Please contact the City of Carlsbad Building Division for current fee rate for Non-
Residential uses (i.e. Retail/Store; Restaurants; Office; and Manufacturing/Warehouse
uses.) , 1 ______ square feet x $ __ /sq. ft. = $ _ ____;,g __ 1/J'-'-A ______ _
COST OF DEVELOPMENT ESTIMATE: $ __ ....,rJ~/Js~.,---------
B. Do you wish to apply for:
1. A Minor Coastal Development Permit (Under $60,000 cost estimate)'¢,kt:l\._
2. A Coastal Development Permit ($60,000 or more cost estimate) D
C. Street address of proposed development 4 O ~ 6 <;; vAJtJ '( H, c..-1..,-Pt2--1 I.A-1 C.A-~(....> ~ ,c,.9, CA q 'Z O O 8
P-6 Page 1 of 7 Revised 3/22
D. Assessor's Parcel Number of proposed development
W 1 -o 7 7--D f&, -o 6
E. Development Description:
Briefly describe project: P ~ yl..-'I o L-{ ~ f::{ !~)Cf >-r I '-.J{,,-bA a~ >~12. Jc..-,-...,.~
f\,£,W p~1 AC .l.-l ~D '2 C All-{-,p. fl>.~ {,J l TI-{ \ I 9 8 s-Cl. r'"t;
~I,,-) APU .Al?o~ 6At1-..A-6f2 l,J(-r1-{ / l ~ 8 SQ Pl" o/ 1-(1 S"~ Pl
o P !7Uic-A ,L ~A, & , %UD~/kA1JP-'"<:..A-Pr~G::=:
F. Describe the present land uses (I.e. vacant land, single family homes, apartments, offices,
etc.) that surround the proposed development to the:
North: ;;; / Nbl..,c -r AM IL--( Ho I-"'-~~
South: ______ , ..... c ___________________ _
East: _______ ,_, ___________________ _
West: _______ ,t ___________________ _
G. Is project located within a 100-year flood plain? D Yes Cia""No
II. PRESENT USE OF PROPERTY
A. Are there existing structures on the property? [B'Yes D No
If yes, please describe.
&& s---rt>~I ~f6.J6\&-'pAhlt...-/ :g_£S"r-pa;u -t-n J?~ p€f-A-OL.,U-l-{~p
o~-~~t--f ;t?el:AG::J ?P 6.A:~ .g;r--12-v(::tv1-l.~-=rn ee::oe,....,__oL-l5H61>
B. Will any existing structure be removed/demolished? G1Yes D No
If yes to either question, describe the extent of the demolition or removal, including the relocation
site, if applicable (also show on plans). p u... 126 M OL.-(1""( o,u op ~--rr2uc..-rLILeS
Ill. LOT COVERAGE / ~Db4 1001 /5'004
A. Existing and Proposed
Existing Progosed Total
Building Coverage ,z 884 sq. ft. ~ I I/ 1,1,,, sq. ft. :f JD~ sq. ft. ~,.4 %
Landscaped Area ~03{ sq. ft. -7 0 5" sq. ft. 11'1-~ sq. ft. 21..-. 1-, %
Hardscape Area 8_o 8 er sq. ft. 'f 17 sq. ft. 7(1'l sq. ft. SD.f-%
Unimproved Area (Left Natural) 0 sq. ft. a sq. ft. 0 sq. ft. !) %
P-6 Page 2 of 7 Revised 3/22
P-6
B. Parking: Number of existing spaces
Number of new spaces proposed _Z---____ _
Existing/Proposed TOTAL: 1,_
Number of total spaces required __ 'l-____ _
Number of covered spaces 1_,,
Number of uncovered spaces __ 0....,,.... ___ _
Number of standard spaces i,
Number of compact spaces 0
Is tandem parking existing? D Yes# (B"No
Is tandem parking proposed? D Yes# __ B"No
C. Grade Alteration:
Is any grading proposed? [0Yes □No
If yes, please complete the following:
1. Amount of cut z3 7-/ cu. yds.
2. Amount of fill ______________ __._.......,..___cu. yds.
3. Maximum height of fill slope feet
4.
5.
6.
Maximum height of cut slope------------=--/ ..... 6 __ feet
Amount of import or@ _________ <g_q_t __ cu. yds.
Location of borrow or disposal site L..<o '? -4 Ca.viy o1.c: Cr-a+ Dr,
t;.~ C..a-,.& i J_ 0 I Cf,.. 17-07.-t
Page 3 of7 Revised 3/22
City of Carlsbad Climate Action Plan Consistency Checklist
STEP 1: LAND USE CONSISTENCY
The first step in determining CAP consistency for discretionary development is to assess the project's consistency
with the growth projections used in the development of the CAP. This section allows the city to determine a
project's consistency with the land use assumptions used in the CAP. Projects found not to be consistent with the
CAP's land use assumptions and that are projected to emit at or above t he CAP screening threshold of 900 metric
tons of CO2 equivalent (MTCO2e) GHG will be subject to a project-specific analysis of GHG emissions' impact on the
environment in accordance with the requirements of the California Environmental Quality Act (CEQA). This may
result in GHG-reducing mitigation measures applied as a condition of project approval in addition to compliance
with the CAP ordinance requirements identified in Step 2 of this checklist.
=· --:-·.· -------- - - . . . - -~ -71
,i . -
.._ . -----------A
Checklist Item
(Check the appropriate box and provide an explanation and supporting documentation for your answer)
A. ls the proposed project consistent with the existing General Plan land use and specific/master plan or zoning designations?
OR,
If the proposed project is not consistent with the existing land use plan and zoning designations, does the project indude a
land use plan and/or specific plan, master plan or zoning designation amendment that would result in an equivalent or less
GHG~ntensive project when compared to the existing designations?
Yes No
□
If "Yer', proceed to Step 2 of the checklist For the second option under Question A above, provide estimated project-related GHG emissions under both existing and
proposed designation(s) for comparison. GHG emissions must be estimated in accordance with the City of carlsbad Guidance to Demonstrating Consistency with the
Oimate Action Plan.
If "No•, proceed to Question B.
The CAP established a screening threshold of 900 MTCOze/year for new development projects to assist in determining
consistency with the CAP. The types and sizes of typical projects listed below have been determined to correspond to the CAP
screening threshold. Will the proposed land use change result in the construction of less than any one of the following?
• Single-Family Housing: 50 dwelling units
• Multi-Family Housing: 70 dwelling units
• Office: 35,000 square feet
• Retail Store: 11,000 square feet
• Grocery Store: 6,300 square feet
• Other: If the proposed project is not one of the above types, provide a project-specific GHG emissions analysis to
determine whether it is below the 900 MTCOze/year screening threshold.
If "Yer', proceed to Step 2 of the checklist.
□ □
If NNo•, the project's GHG impact is potentially significant and must be analyzed in accordance with CEQA. Applicant must prepare a Self-developed GHG emissions
reduction program in accordance with the City of cartsbad Guidance to Demonstrating Consistency with the Climate Action Plan to demonstrate how it would offset
the Increase in emissions over the existing designations. The project must incorporate each of the applicable measures identified in ,$!ml to mitigate cumulative
GHG emissions impacts unless the decision maker finds that a measure is infeasible in accordance with California Environmental Quality Act Guidelines Section
15091. Mitigation in lieu of or in addition to the measures in~ may be required, depending on the results of the project-specific GHG impact analysis. Proceed
and complete a project-specific Self-developed GHG emissions reduction program and~ of the Checklist.
P-30 Page 2 of 8 Revised 06/22
STEP1
TO BE COMPLETED FOR ALL PROJECTS
To determine if your project is a "development project", please answer the following question:
YES NO
Is your project LIMITED TO routine maintenance activity and/or repair/improvements to an existing building □ ~ or structure that do not alter the size (See Section 1.3 of the BMP Design Manual for guidance)?
If you answered "yes" to the above question, provide justification below then go to Step 6, mark the box stating "my project
is not a 'development project' and not subject to the requirements of the BMP manual" and complete applicant information.
Justification/discussion: (e.g. the project includes only interior remodels within an existing building):
If you answered "no" to the above question, the project is a 'development project', go to Step 2.
STEP2
TO BE COMPLETED FOR ALL DEVELOPMENT PROJECTS
To determine if your project is exempt from PDP requirements pursuant to MS4 Permit Provision E.3.b.(3), please answer
the following questions:
Is your project LIMITED to one or more of the following:
YES NO
1. Constructing new or retrofitting paved sidewalks, bicycle lanes or trails that meet the following criteria:
a) Designed and constructed to direct storm water runoff to adjacent vegetated areas, or other non-
erodible permeable areas; OR □ I!! b) Designed and constructed to be hydraulically disconnected from paved streets or roads; OR
c) Designed and constructed with permeable pavements or surfaces in accordance with USEPA
Green Streets auidance?
2. Retrofitting or redeveloping existing paved alleys, streets, or roads that are designed and constructed in □ Iii accordance with the USEPA Green Streets guidance?
3. Ground Mounted Solar Array that meets the criteria provided in section 1.4.2 of the BMP manual? □ Ii]
If you answered "yes" to one or more of the above questions, provide discussion~ustification below, then go to Step 6, mark
the second box stating "my project is EXEMPT from PDP ... • and complete applicant information.
Discussion to justify exemption (e.g. the project redeveloping existing road designed and constructed in accordance with
the USEPA Green Street guidance):
If you answered "no" to the above questions, your project is not exempt from PDP, go to Step 3.
E-34 Page2 of 4 REV 08/22
STEP3
TO BE COMPLETED FOR ALL NEW OR REDEVELOPMENT PROJECTS
To determine if your project is a PDP, please answer the following questions (MS4 Permit Provision E.3.b.(1 ));
YES NO
1. Is your project a new development that creates 10,000 square feet or more of impervious surfaces □ I!] collectively over the entire project site? This includes commercial, industrial, residential, mixed-use,
and public development projects on public or private land.
2. Is your project a redevelopment project creating and/or replacing 5,000 square feet or more of impervious
surface collectively over the entire project site on an existing site of 10,000 square feet or more of □ 00 impervious surface? This includes commercial, industrial, residential, mixed-use, and public
development projects on public or private land.
3. Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of
impervious surface collectively over the entire project site and supports a restaurant? A restaurant is a □ ~ facility that sells prepared foods and drinks for consumption, including stationary lunch counters and
refreshment stands selling prepared foods and drinks for immediate consumption (Standard Industrial
Classification {SIC) code 5812).
4. Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious □ !!I surface collectively over the entire project site and supports a hillside development project? A hillside
development proiect includes development on any natural slooe that is twenty-five percent or areater.
5. Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of
impervious surface collectively over the entire project site and supports a parking lot? A parking lot is a □ 00 land area or facility for the temporary parking or storage of motor vehicles used personally for
business or for commerce.
6. Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more
of impervious street, road, highway, freeway or driveway surface collectively over the entire project □ 00 site? A street, road, highway, freeway or driveway is any paved impervious surface used for the
transportation of automobiles, trucks, motorcycles, and other vehicles.
7. Is your project a new or redevelopment project that creates and/or replaces 2,500 square feet or more of
impervious surface collectively over the entire site, and discharges directly to an Environmentally □ 00 Sensitive Area (ESA)? "Discharging Directly to" includes flow that is conveyed overland a distance of 200
feet or less from the project to the ESA, or conveyed in a pipe or open channel any distance as an
isolated flow from the project to the ESA (i.e. not commingled with flows from adjacent lands).*
8. Is your project a new development or redevelopment project that creates and/or replaces 5,000 square
feet or more of impervious surface that supports an automotive repair shop? An automotive repair □ 00 shop is a facility that is categorized in any one of the following Standard Industrial Classification (SIC)
codes: 5013, 5014, 5541, 7532-7534, or7536-7539.
9. Is your project a new development or redevelopment project that creates and/or replaces 5,000 square
feet or more of impervious area that supports a retail gasoline outlet (RGO)? This category includes □ ~
RGO's that meet the following criteria: (a) 5,000 square feet or more or (b) a project Average Daily
Traffic (ADT) of 100 or more vehicles per day.
10. Is your project a new or redevelopment project that results in the disturbance of one or more acres of land □ ~ and are expected to generate pollutants post construction?
11 . Is your project located within 200 feet of the Pacific Ocean and (1) creates 2,500 square feet or more of
impervious surface or (2) increases impervious surface on the property by more than 10%? (CMC □ IKI
21.203.040)
If you answered "yes" to one or more of the above questions, your project is a PDP. If your project is a redevelopment
project, go to step 4. If your project is a new project, go to step 5, complete the trash capture question.
If you answered "no" to all of the above questions, your project is a 'STANDARD PROJECT'. Go to step 5, complete the
trash capture question.
• Environmentally Sensitive Areas Include but are not limited to all Clean Water Ad 5ectiOn 303(d) impaired water bodies; areas designated as Areas of Special
Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); water bodies
designated with the RARE beneficial use by the State water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments);
areas designated as preserves or their equivalent under the Multi Species Conservation Program within the Cities and County of San Diego; Habitat Management
Plan; and any other equivalent en111ronmentally sensitlve areas which have been identified by the City.
E-34 Page 3 of 4 REV08/22
STEP4
TO BE COMPLETED FOR REDEVELOPMENT PROJECTS THAT ARE PRIORITY DEVELOPMENT PROJECTS (PDP)
ONLY
Complete the questions below regarding your redevelopment project (MS4 Permit Provision E.3.b.(2)):
YES NO
Does the redevelopment project result in the creation or replacement of impervious surface in an amount of
less than 50% of the surface area of the previously existing development? Complete the percent impervious
calculation below:
Existing impervious area (A) = sq. ft. □ □
Total proposed newly created or replaced impervious area (B) = sq. ft.
Percent impervious area created or replaced (B/A)*100 = %
If you answered "yes·, the structural BMPs required for PDP apply only to the creation or replacement of impervious surface
and not the entire development. Go to step 5, complete the trash capture question.
If you answered "no," the structural BM P's required for PDP apply to the entire development. Go to step 5, complete the
trash capture question.
STEPS
TO BE COMPLETED FOR ALL DEVELOPMENT PROJECTS
Complete the question below regarding your Project (SDRWQCB Order No. 2017-0077):
YES NO
Is the Project within any of the following Priority Land Use (PLU) categories and not exempt from trash
!Capture requirements per section 4.4.2.2 of the BMP Manual?
R-23 (15-23 du/ac), R-30 (23-30 du/ac), Pl (Planned Industrial), CF (Community Facilities), GC (General □ J!1 Commercial), L (Local Shopping Center), R (Regional Commercial), V-B (Village-Barrio), VC (Visitor
Commercial), 0 (Office), VC/OS (Visitor Commercial/Open Space), Pl/O (Planned Industrial/Office), or
Public Transportation Station
If you answered "yes", the 'PROJECT' is subject to TRASH CAPTURE REQUIREMENTS. Go to step 6, check the first
box stating, "My project is subject to TRASH CAPTURE REQUIREMENTS ... " and the second or third box as
determined in step 3.
If you answered "no", Go to step 6, check the second or third box as determined in step 3. List exemption if applicable
for 'no' answer here:
STEPS
CHECK THE APPROPRIATE BOX(ES) AND COMPLETE APPLICANT INFORMATION
0 My project is subject to TRASH CAPTURE REQUIREMENTS and must comply with TRASH CAPTURE
REQUIREMENTS of the BMP Manual. I understand I must prepare a Storm Water Quality Management Plan (SWQMP).
~
My project is a 'STANDARD PROJECT' OR EXEMPT from PDP and must only comply with 'STANDARD PROJECT'
stormwater requirements of the BMP Manual. l will submit a" Standard Project Requirement Checklist Form E-36'. If my
project is subject to TRASH CAPTURE REQUIREMENTS, I will submit a TRASH CAPTURE Storm Water Quality
Management Plan (TCSWQMP) per E-35A.
□ My project is a PDP and must comply with PDP stormwater requirements of the BMP Manual. I understand l must
prepare a Storm Water Quality Management Plan (SWQMP) per E-35 template for submittal at time of application.
Note: For projects that are close to meeting the PDP threshold, staff may require detailed impervious area calculations
and exhibits to verify if 'STANDARD PROJECT' stormwater requirements apply.
□ My project is NOT a 'development project' and is not subject to the requirements of the BMP Manual.
Applicant Information and Signature Box
Applicant Name: J O sepi,,l ~~toPc-tJC> Applicant Title: Ar'LW~v--r-
I ~ B -'2.-S ..... 'ZLYZ.-~
Applicant Sign-• -~ ~----== ::;;.-::: --vc:ne:
,,,;:---------/ -
Page4 of 4 REV 08/22
'
□ Other: □ □ infeasible to do so.
C. □ BMPs for Rooftop Areas: Check this box if rooftop areas are proposed and select at least one BMP (see Fact
below. Sheet BL-3)
If no BMPs are selected, explain why they are infeasible in the area below.
KJ SD-B oso..c OSD-E
Direct runoff to pervious areas Install green roofs Install rain barrels
D. 6a BMPs for Landscaped Areas: Check this box if landscaping is proposed and select the BMP below (see Fact
Ii:) SD-K Sustainable Landscaping SheetBL-4)
If SD-K is not selected, explain why it is infeasible in the area below.
Provide discussion/justification for site design BMPs that will not be implemented (either partially or fully):
Baseline BMPa for Pollutant-generating Sources
All development projects must complete Table 2 -Source Control Requirement to identify applicable requirements for
documenting pollutant-generating sources/ features and source control BMPs.
BMPs must be implemented for source control features where feasible. Leaving the box for a BMP unchecked means it
will not be implemented (either partially or fully) either because it is inapplicable or infeasible. Explanations must be
provided in the area below. The table provides specific instructions on when explanations are required.
Table 2 -Source Control Requirement
A. Management of Storm Water Discharges
1. Identify all proposed outdoor 2. Which BMPs will be used to prevent 3. Where will runoff from the
work areas below materials from contacting rainfall or work area be routed?
runoff?
□ Check here if none are proposed (See Fact Sheet BL-5) (See Fact Sheet BL-6)
Select all feasible BMPs for each work area Select one or more option for each
work area
SC-A SC-8 SC-C SC-O SC-E Other
Overhead Separation Wind Sanitary Containment
covering flows from protection sewer system
adjacent
areas
□ Trash & Refuse Storaae □ D D D □ □
IKl Materials & Eauioment Storaae □ D D D □ □
E-36 Page 2 of 4 Revised 02/22
D Loadina & Unloadina D D □ D D D
D Fuelina D D □ D □ D
D Maintenance & Repair D D D D D D
D Vehicle & Equipment Cleanina D D D D □ D
D Other: Trash Bins D D (29 D D 1K)
B. Management of Storm Water Discharges (see Fact Sheet BL-7)
Select one or,tion for each feature below:
• Storm drain inlets and catch basins ... Kl are not proposed D will be labeled with stenciling or signage to
discouraae dumoina lSC-F\
• Interior work surfaces, floor drains & D are not proposed m will not discharge directly or indirectly to the MS4
sumps ... or receiving waters
• Drain lines (e.g. air conditioning, boiler, D are not proposed Ix:) will not discharge directly or indirectly to the MS4
etc.) ... or receiving waters
• Fire sprinkler test water ... D are not proposed IKJ will not discharge directly or indirectly to the MS4
or receivina waters
Provide discussion/justification for source control BMPs that will not be implemented (either partially or fully):
E-36 Page 3 of 4 Revised 02/22
Form Certification
This E-36 Form is intended to comply with applicable requirements of the city's BMP Design Manual. I certify that it has
been completed to the best of my ability and accurately reflects the project being proposed and the applicable BMPs
proposed to minimize the potentially negative impacts of this project's land development activities on water quality. I
understand and acknowledge that the review of this form by City staff is confined to a review and does not relieve me as
the person in charge of overseeing the selection and design of storm water BMPs for this project, of my responsibilities for
project design.
Preparer Signature: J-..<.. J/,/~ l Date: 7-27-23
Print oreoarer name: Joel Valdovinos, P.E.
X
E-36 Page 4 of 4 Revised 02/22