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HomeMy WebLinkAbout2087 WESTWOOD DR; ; CBR2018-3484; PermitC cityof Carlsbad Residential Permit Print Date: 10/03/2019 Permit No: CBR2018-3484 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: II Dwelling Units: Bedrooms: Project Title: 2087 Westwood Dr BLDG-Residential 1671800700 $10,772.65 Work Class: Addition Lot II: Reference II: Construction Type: Bathrooms: Orig. Plan Check II: Plan Check II: Description: MUNDAY: 32 SF ADDITION / 115 SF REMODEL (UPSTAIRS BATHROOMS) Applicant: ALISA EICHELBERGER 760-889-8931 BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) Owner: WILLIAM R MUNDAY 2087 Westwood Dr CARLSBAD, CA 92008 ELECTRICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL GREEN BUILDING STANDARDS PLAN CHECK & INSPECTION MECHANICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL PLUMBING BLDG RESIDENTIAL NEW/ADDITION/REMODEL SB1473 GREEN BUILDING STATE STANDARDS FEE STRONG MOTION-RESIDENTIAL SWPPP INSPECTION FEE TIER 1-Medium BLDG SWPPP PLAN REVIEW FEE TIER 1 • MEDIUM Total Fees: $820.91 Total Payments To Date: $820.91 Status: Applied: Issued: Permit Finaled: Inspector: Final Inspection: Balance Due: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Closed -Finaled 12/19/2018 01/07/2019 CRenf 10/3/2019 4:03:59PM $0.00 $123.83 $86.68 $41.00 $175.00 $39.00 $49.00 $1.00 $1.40 $246.00 $58.00 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check C/jtf;t)J/•3'1rc/ Est. Value PC Deposit --------- Date +/.10:l_-...,/._9.L---.L../=¥ __ _ Suite: ___ APN: I ~J-j 2,0-0J-00 CT /Project#: _________ lot#: '2-I Fire Sprinklers: yes~ Air Conditioning: yes ;rfi) 2 '2-Living SF, ___ Deck SF, ___ Patio SF, Garage SF [\:=.) Is this to create an Accessory Dwelling Unit? Yes~ New Fireplace? Yes No if yes how many? ✓.emodel: 11 s SF of affected area Is the are;-~c( change of use ? Yes ,G> □ Pool/Spa: ____ SF Additional Gas or Electrical Features?__,__N__i_,o"---' --------- □ Solar: ___ KW, ___ Modules, Mounted: Roof / Ground, Tilt: Yes/ No, RMA: Yes/ No, Battery: Yes/ No Panel Upgrade: Yes/ No D Reroof: ------------------------------------ □ Plumbing/Mechanical/Electrical Only: ------------------------- □ Other: ------------------------------------- APPLICANT (PRIMARY) Name: A; \·1 Sa.. bl c,he_.j k, e;r-<3 lf: Address: 3>~os T (Teste,. 1)nw_ PROPERTY OWNER Name: -SV-t-j ~ ~ 0 t\. f\r\. C\__ ~ lA...¥\til.t\. ¥ Address: es±wc O a 1:>ny-{__, City:Ctvr' '> bt7u7l State: CA-Zip: 92-0 l 0 Phone: 7~0 ~8°\ -8 3 City: --==~~....'6-~--tate: Ci\-: Zip: °{'2--0 0 8 Email: q \I.SC\.©~ e~tp-~V\Of • COyy\_ DESIGN PROFESSIONAL /yee._ ';\ CONTRACTOR BUSINESS Name: A;\1 ~t\ &'cbe,\~ \..._~y\lC0.1'.ti:j Name: _______________ _ Address:________________ Address: _________________ _ City: _______ State: ____ Zip: ___ _ City: _______ State:. ___ Zip: _____ _ Phone: ________________ _ Phone: __________________ _ Email: ________________ _ Email: __________________ _ Architect State license: __________ _ State License:. ______ Bus. license:. _____ _ (Sec. 7031.S Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law {Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he/she is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}). 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov B-1 Page 1 of 2 Rev. 06/18 ( OPTION A): WORKERS'COMPENSATION DECLARATION: I hearby affirm under penalty of perjury one of the following declarations: □ I have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. □ I have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Company Name: ______________________ _ Policy No. ______________ Expiration Date: __________ _ □ Certificate of Exemption: I certify that in the performance of t he work for which this permit is issued, I shall not employ any person in any manner so as to be come subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to $100,000.00, In addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. □AGENT DATE: CONTRACTOR SIGNATURE: -------------------------------- ( OPTION B ): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License law for the following reason: □ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). di, as owner of the property, am exclusively contracting 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, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). □ I am exempt under Section ________ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. □ Yes □ No 2. I (have/ have not) signed an application for a building permit for the proposed work. 3. I have contracted with t he following person (firm) to provide the proposed construction (include name address / phone/ contractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name/ address / phone/ contractors' license number): S. I will provide some of the work, but I have contract hired) the following persons to provide the work indicated (include name/ address / phone/ type of work): DATE: /d -It -I f CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name: ______________________ Lender's Address: _____________________ _ ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ Yes □ No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. APPLICANT CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required for excavations over S'O' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time ::~::::: :G::~o~:~~;ld;ogCode) DATE, } 2--( { 6 I} g' 1 i 1635 Faraday Ave Carlsbad, CA 92008 B-1 Ph: 760-602-2719 Fax: 760-602-8558 Page 2 of 2 Email: Building@carlsbadca.gov Rev. 06/18 Permit Type: Work Class: Status: Scheduled Date October 03, 2019 BLDG-Residential Application Date: 12/19/2018 Owner: Addition Issue Date: 01/07/2019 Subdivision: Closed -Finaled . Expiration Date: 11/04/2019 Address: IVR Number: 16116 Actual Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final COMMENTS NEW FRONT ENTRY ADDITION COMPLETE AND FINAL ONLY; MASTER BATH AND BATH #2 (115SF) REMODEL, HOMEOWNER ADVISED DECIDED NOT TO DO AND TO REMOVE FROM PERMIT WILLIAM MUNDAY FALCON HILL UNIT#3 2087 Westwood Dr Carlsbad, CA 92008-1143 Relnspection Passed Yes Yes Yes Yes Yes Complete Page 2 of 2 ' PERMIT INSPECTION HISTORY REPORT (CBR2018-3484) Permit Type: BLDG-Residential Application Date: 12/19/2018 Owner: WILLIAM MUNDAY Work Class: Addition Issue Date: 01/07/2019 Subdivision: FALCON HILL UNIT# 3 Status: Closed -Finaled Expiration Date: 11/04/2019 Address: 2087 Westwood Dr Carlsbad, CA 92008-1143 IVR Number: 16116 Scheduled Actual Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete 02/20/2019 02/20/2019 BLDG-SW-Pre-Con 084261-2019 Passed Chris Renfro Complete Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 02/26/2019 02/26/2019 BLDG-11 084649-2019 Passed Chris Renfro Complete Foundation/Fig/Pier s (Rebar) Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 03/28/2019 03/28/2019 BLDG-ll4 Rough 087241-2019 Partial Pass Chris Renfro Relnspectlon Incomplete Combo(14,24,34,44) Checklist Item COMMENTS Passed BLDG-Building Deficiency Front entry way Yes BLDG-14 Yes Frame-Steel-Bolting-Welding (Decks) BLDG-24 Rough-Topout Yes BLDG-34 Rough Electrical Yes BLDG-44 Yes Rough-Ducts-Dampers 04/02/2019 04/02/2019 BLDG-13 Shear 087773-2019 Passed Chris Renfro Complete Panels/HD (ok to wrap) Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 04/04/2019 04/04/2019 BLDG-17 Interior 087946-2019 Passed Chris Renfro Complete Lath/Drywall Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 05/08/2019 06/08/2019 BLDG-14 091216-2019 Cancelled Chris Renfro Reinspectlon Complete Frame/Steel/Bolting/ Welding (Decks) Checklist Item COMMENTS Passed BLDG-Building Deficiency No BLDG-18 Exterior 091217-2019 Passed Chris Renfro Complete Lath/Drywall Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 10/03/2019 10/03/2019 BLDG-Final 106622-2019 Passed Chris Renfro Complete Inspection October 03, 2019 Page 1 of 2 C I J -J H C PROJECT NO. City of Carlsbad INSPECTION 0 ... TE 7/</., $/6'1"-71//..? DAIL y INSPECTION REPORT CONR1~1Hl.'a'.E MAR ! 8 '2019 FOR llliEEK ENOING I~ AUTHORIZED BY THE INOICATEO AGalCY TO PERFORM SPECIAL INSPEcn<)N INTHE CATEGORY CHECKED. ~City of San Diogo 0 CAI.TRANS .0 OSHP.0 0 Other ...a..~ltjf~CEO COtlCnETE '-f:1-l'kY-lialQNcoNCRm 0 REINFORCED MAS_QNR.Y SOURCE OF MFGR. ARCHITECT . □ smucrufW. STEEL ASSEMBLY 0 DEEP FOUNOATIOH 0 SPRAY-APPLIED FIREPROOFING Pl.AN FflE NUMBER DESCRIBE MATERIAL (MIX DESIGN, RE-eAR GRADE & MANUFACTURER, WELD-ROD, ETC.) .T ARRIVAL TIMS/ OETAIU:OREPORTOP _ DEPARTURE WORK INSPECTED TIME TIMEON SITE .TIME AM lnspeetiori based on lo addltlon.over 8 t:irs a SIGNATURE ~ GENERAi. COITTRACTOR LOCATION Of WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. CERTIFICATE Of COMPLIANCE TO• THE BEST OF MY KNOWLEDGE, THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, IS IN CONFORMAHCE WITH THE.APPROVED PLANS ANO SPECIFICA1'.10NS, • ANO THE APPLICABLE WORKMANSHIP PROVISIONS OF THE GOVERNING ST.QIDAROS JOB J18438 -MUNDAY RESIDENCE SHEET NO. _____ 1:...._0F _1 ____ _ CALCULATED ev ___ s::..,;_.G=-~s . DATE _31_13_11_9 __ _ Digttally signed by Miles Lovelace CHECKEDBY _____ D.._TE ____ _ phone858.535.9111 • fax858.535.1989 • www.lovelaceeng.com SC ... LE N.T.S. ' (() ' LL "-w '-......., <E) F.B . ' J ' LL "-w '-......., ' (() ' LL ~ X ~ "-w '-......., ,......__ I co lL '-...., <E) F.J. <FB-3) FLUSH RIM BEAM 1t-1uc1 4 xb FLUSH ~-............ --~----□- HDR. "-w '-......., C·ty of ~r -~-, I , l • ·-·-...... lo.I MA.R 2 8 '2019 BUILDING DIVISION I Of?oco ' LL ~< "-w '-......., Job Number 28156 Munday NRG Wall Insulation Ceiling Insulation Window SHGC R-13 D 1" Exterior Foam R-30 D Radient Barrier Req'd See Notes Window U Value See Notes Furnace Efficiency _N_/_A ___ _ Heat Pump E fficie n cy__;.N_;..;./.;._A;.___ __ Air Conditioning Efficiency N/A ----- Water Heater Efficiency _N_/_A ___ _ HERS Measures for Compliance □Tankless D Verified Refrigerant Charge Other Notes □Quality Insulation Inspection (Qll ~ECEr✓·-­ DAII Hot Water Pipes Insulated ·-t-) DEC 1 9 2018 CITY OF CARLSJAC BUILDING 0, .1;:,01-. Vinyl Windows to have SHGC 0.25 and U-Value of 0.32 Aluminum Windows to have SHGC 0.57 and U-Value of 0.55 DATE: 12/31/2018 JURISDICTION: City of Carlsbad PLAN CHECK#.: cbR2018-~ ✓. EsG1I A SAFEbu1lt Company SET: I 3-4'o+ PROJECT ADDRESS: 2087 Westwood Dr. □ APPLICANT ~URIS. PROJECT NAME: Addition and Remodel for Munday Residence D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. 1:8] 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. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: 1:8] EsGil staff did not advise the applicant that the plan check has been completed. D EsGil staff did advise the applicant that the plan check has been completed. Person contacted: ---.~ Telephone#: Date contacted: (b : ) Email: Mail Telephone Fax erson 1:8] REMARKS: Person responsible for plan preparation to add note cloude and E-1 to the set of plans held at the city to match the plan set being ' By: Rich Moreno EsGil 12/20/2018 Enclosures: 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-I 468 ♦ Fax (858) 560-1576 • City of Carlsbad cbR2018-3483 1~/~/_2018 1 • [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: Rich Moreno BUILDING ADDRESS: 2087 Westwood Dr. BUILDING OCCUPANCY: R-3/U BUILDING PORTION Remodel Addition Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb 1997 UBC Building Permit Fee 1997 UBC Plan Check Fee Type of Review: D Repetitive Fee 3 Repeats Comments: AREA Valuation ( Sq. Ft.) Multiplier 115 45.51 32 169.50 By Ordinance Complete Review D Other □ Hourly EsGil Fee PLAN CHECK#.: cbR2018-3483 DATE: 12/31/2018 Reg . VALUE ($) Mod. 5,234 5,424 10,658 D Structu ral Only $75.31 I Sheet 1 of 1 STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FAOLITATE RAPID INSTALLATION Of' EROSION AND SEDIMENT CONTROL BMPs 'M-IEN RAIN IS EMINENT. 2. THE Ov.tJER/CONTRACTOR SHAU. RESTORE All EROSION CONTROL DEVICES TO WORKING ORDER TD THE SATISFACTION OF THE OTY INSPECTOR AFTER EACH RUN-OFF PROOUONG RAINFALL 3. THE Ov.tJER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE OTY INSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES 'M-IICH MAY ARISE. 4. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE AT THE END OF EACH WORKING DAY v.HEN THE FlVE (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT ( 40,:). SILT AND OTHER DEBRIS SHAU. BE REMOVED AFTER EACH RAINFALL 5. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM AGGREGATE. 6. ADEOUA TE EROSION ANO SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTAll.ED AND MAINTAINED. 7. THE CITY INSPECTOR SHAU HAVE THE AUTHORITY TO ALTER THIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDED TO ENSURE COMPLIANCE WITH CITY STORM WATER QUALITY REGULATIONS. OWNER'S CERTIFICATE: I UNDERSTAND ANO ACKNO'M..EOGE THAT I MUST: (1) U,lPI.DIENT BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABl.E TO AVOID THE MOBILIZATION Of' POllUTANTS SUCH AS SEOll.!ENT ANO TO AVOID THE EXPOSURE Of STORM WATER TO CONSTRUCTION RELATED POlLUTANTS; ANO (2) ADHERE TO, ANO AT All TIMES, COMPI. Y '111TH THIS QTY APPROVED TIER 1 CONSTRUCTION SIWPP THROUGHOUT THE DURATION Of' THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION ~ IS COMPLETE ANO APPRO'IEO BY THE QTY Of' CARLSBAD. STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE Erosion Ccntn:11 Sediment Ccntn:11 BMPs Traclcing Non-&rmWater Was!e Management end Materials Pclulion Ccntn:11 BMPI BMPs Control BMPs Manogement BMPs " .§ ~ 2 ii " ij ., !s u u "' " E Ii " ~ .Ii .g ~ 6 " l .; .5 .5 .., -~ 2 -g II "' -~ l s <;;. & ._ "' "' Q. .Ii £ ., I! ] ~ w l " 2 Best Management Practice' ~ .!. o ll .. " t"' j ,§ ;. :,: Ii Jl6 ~ ii ~~ .Ii ,= E .. .!. ]j j " 'i 2 i (BMP) Description ➔ "5 df; C) ~ !l i " 15 g •.i. ~2 Ill:!. 1~ ,§ :: 6 0 :::, .. 'i 0 CD Vl E "' "' .. ; 2 o.,. J "' ~ ~~ "., ~~ goj;, i ~-~ i~ ? -t cl:~ :5 -~ ,!; ii l -" ,. II "8 8-~ 18 Jg 0 ~" ~ .., " " ] ~~ -8 ·s 0 ii " -ll 0 vi l~ ::2 C: J i ~~ .,: 0 ~ <3 en a: i rr. ~ "-3!~ 111 Vl> "'"' Q. >0 ::,av, 2 CASQAOeslgl8llon ➔ ,._ "' "' ,,, ... "' "' ,._ "' 0 N ,,, ,._ "' 'j N ,,, ... "' I I I 'j 'j I I I I I I 'j 'j I 'j J, I I I I I I 0 0 0 0 l)j w w l)j l)j l)j l)j l)j l!c l!c Vl V, Vl i i i i i Conolructlon ........ w w w w V, Vl z z z z Grodi no /Soi Disturbance Trencl,in• ~xC<Jvotlon \/ St"""•iinn Or!iin• ll>orino Ca,cretelAsoholt SowcuttitlQ Concrete Flotwork ,/ 1 • ....- Povino Conduit/Pioe lnstollotion StucC<J/Mortor Work 1,/ v' Waste Olaoosol ., Stooina II ov Down Area Eouioment Maintenance ond Fuellno Hazardous Sub st once Use /Storone Oewoterino Site Access Across Dirt Other 7nstl: Instructions: 1. Check the box to the left of oil oppllcoble construction activity (frst column) expected to occur during construction. 2. Located along the top of the Bt.lP Tobie Is o list of Bt.lP's with it's corresponding Colifomlo Stoonwoter Quality Assoclotlon (CASOA) designation number. Choose a,e or more B~P-s you intend to use during construction from the list. Check the box where the ci,osen activity row intersects with the Blo!P column. 3. Refer to the CASOA construction handbook for information ond details of the chosen 81.!Ps ond how to apply them to the project. ~ " ~-.. I ~"' "" >< C "" :,:2 "' I i PROJECT INFORMATION Site Address: ZOfi,1 w~S-\::tvoO J. 'Dr~ Assessor's Parcel Number) (p 7-/8O-07-O0 Emergency Contact: . LJ . ! ~ Nom•· ;fo~VW\~_ L!IA~Y, 24 Hour Phon•{11.a o') ~ gq -02)~] Con~ctlon Threat to Storm Water Quouty (Ch Bo UM O LOW ~ i] ii 81 "' I i ✓ 'V PQge 1 of 1 REV 11/17