HomeMy WebLinkAbout1048 Carlsbad Village Dr; ; CBC2019-0129; Permit(city of
Carlsbad
Commercial Permit
Print Date: 06/17/2019 Permit No: CBC2019-0129
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
1048 Carlsbad Village Dr
BLDG-Commercial
2033203900
$36,960.00
CARLSBAD VILLAGE LOFTS
Work C!ass: Demo
Lot#:
Reference#: DEV16014
Construction Type:
Bathrooms:
Orig. Plan Check#:
Plan Check#:
Description: DEMO: 6,000 SF DEMO OF EXISTING STRUCTURE AND POLE SIGN
Applicant:
RENEE POWELL
858-560-1141
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
5B1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-COMMERCIAL
SWPPP INSPECTION FEE TIER 2 -Medium BLDG
SWPPP PLAN REVIEW FEE TIER 2 -MEDIUM
Total Fees: $1,877.11
Owner:
CARLSBAD VILLAGE PARTNERS LP
1044 Carlsbad Village Dr
CARLSBAD, CA 92008
Total Payments To Date: $1,877.11
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
03/19/2019
05/09/2019
PBurn
6/17/2019 2:0l:51PM
$0.00
$322.80
$225.96
$2.00
$10.35
$933.00
$383.00
163S Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8S60 f I www.carlsbadca.gov
Ccicyof
Carlsbad
CoMVY\eRC r 4 L
RESIDl!NT•At::
BUILDING PERMIT
APPLICATION
B-1
Qo..c\wet:i \Ii II~ LOf s
Plan CheckCJ3:':,?ol't-OJ(;)?
Est. Value 1J,3"'1 't6Q.()()
PC Deposit ----,-----
Date 3//q ll<f
CT/Project #:. _________ Lot#: ____ Fire Sprinklers: yes t{!j) Air Conditioning: yes@
BRIEF DESCRIPTION OF WORK: 12i,)\U)\NC, 'S) V,/1\'\0\J\::s] ON
0 Addition/New: _____ ,Living SF, ___ Deck SF, ___ Patio SF, ___ Garage SF
Is this to create an Accessory Dwelling Unit? Yes/ No New Fireplace? Yes/ No, if yes how many? __
D Remodel: ____ SF of affected area Is the area a conversion or change of use? Yes/ No
0 Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _
□ Solar: ___ KW, __ Modules, Mounted: Roof/ Ground, Tilt: Yes/ No, RMA: Yes/ No, Battery: Yes/ No
Panel Upgrade: Yes/ No
D Reroof: __________________ _.::'·---------------
D Plumbing/Mechanlcal/Electrical Only: ______________________ _
~ther: Q t-"" 0 <. , .,., o .,.J
Phone:
Email: ..,..l~lli:!.l.S~U.t::d.l~!C!..!.!:!..l.!~!....l.-~ Email:
~ DE!IC!N l'l'tOP~55191QJ'\L A f'PllOJ.-NT CONTRACTOR BUSINESS
Name: ~-en-e-e £0\.ueJ I Name: _______________ _
Address:3:)'.70 iifB·C'\ 42d. $£i \20 Address: _______________ _
Clty:$:Jo Qir'cp State:Cf\ Zip: 92,)Z,:;, City: ______ State:. __ Zlp: _____ _
Phone: BS8 %9 I \4 ( Phone: ______________ _
Email: r-y0.;e\ \ r2? '3toi()C-COr--<"'\ Email:
Architect State License: __________ c_Sfate Lice~ <',zl;,XS:/ I (Eis. Llcens,:.'..,5ec3=..3.:..:2=-----
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, Improve, demollsh or repair any structure, prior to Its
issuance, also requires the applicant for such permit to file a signed statement that he/she is llcensed 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 violatlon of Section 7031.S by any applicant for a permit subjects the applicant to a civll 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 of2 Rev. 06/18
( OPTION A): WORKERS'COMPENSATION DECLARATION:
I hearby affirm under penalty of perjury QM. of the following declarations:
□ I have and wlll maintain a certlflcate 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 wlll maintain worker's compensation, as required by Section 3700 of the Labor Code, for he perfor
My workers' compensation Insurance carrier and policy number are: Insurance Company Name:
Polley No. \0~.)C~DO/e~ ~\'€) Expiration Date: )~\ I \lq
□ Certificate of Exemption: I certify that In the performance of the work forwhlch this permit Is issued, l 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 worker1 compensation coverage Is unlawful, and shall subject an employer to
crlmlnal penalties and civil flnes up to $100,000.00, I dltlon the to the cost of compensation, damages as provided for In Section 3706 of the Labor Code,
Interest and attorney's fees.
CONTRACTOR SIGNATUR AGENT DATE: ~,, y hci I
( 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 emplcyees 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
hlmself or through his own employees, provided that such Improvements are not Intended or offered for sale. If, however, the buildlng 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).
0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044;Buslness and Professions Code: The
Contractor's License Law does not apply to an owner of property who bullds 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 applfcatlon for a bullding permit for the proposed work.
3. I have contracted with the 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):
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work Indicated (1nclude name/ address/ phone/ type of work):
OWNER SIGNATURE: _________________ □AGENT DATE: _____ _
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'sName: ___________________ lender'sAddress: __________________ _
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 preventlon
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 DISTRlcr.
APPLICANT CERTIFICATION:
I certify that I have read the appllcatlon and state that the above Information is correct and that the Information on the plans ls 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 lnspectlon 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 Cm' IN CONSEQUENCE OF
THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit Is required for excavations over 5'0' 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 limltation and become null and void If the buildlng or work authorized
by such permit ls not commenced within 180 days the date of such permit or if the building or work authorized by such permit Is suspended or abandoned at any time
after the work is commenced for a period of 1 Sectio nifor Building Code).
APPLICANT SIGNATUR .
B-1
uohV\
h: 760-602-2719 Fax: 760-602-8558
Page 2 of 2
DATE: :o}1~ )A
Email: Building@carlsbadca.gov
Rev. 06/18
PERMIT INSPECTION HISTORY REPORT (CBC2019-0129)
Permit Type: BLDG-Commercial Application Date: 03/19/2019 Owner:
Work Class: Demo Issue Date: 05/09/2019 Subdivision:
Status: Closed -Finaled Expiration Date: 12/09/2019 Address:
IVR Number: 17762
Scheduled
Date
Actual
Start Date Inspection Type Inspection No. Inspection Status Primary Inspector
06/17/2019 06/17/2019
June 17, 2019
BLDG-Final
Inspection
Checklist Item
BLDG-Building Deficiency
BLDG-Plumbing Final
BLDG-Mechanical Final
BLDG-Structural Final
BLDG-Electrical Final
094741-2019
Checklist Item
BLOG-Building Deficiency
BLDG-Plumbing Final
BLDG-Mechanical Final
BLDG-Structural Final
BLDG-Electrical Final
COMMENTS
Passed Paul Burnette
COMMENTS
CARLSBAD VILLAGE PARTNERS
LP
CARLSBAD LANDS
1048 Carlsbad Village Dr
Carlsbad, CA 92008-1803
Re Inspection Complete
Passed
No
No
No
No
No
Complete
Passed
Yes
Yes
Yes
Yes
Yes
Page 2 of 2
PERMIT INSPECTION HISTORY REPORT (CBC2019-0129)
Permit Type: BLDG-Commercial Application Date: 03/19/2019 Owner: CARLSBAD VILLAGE PARTNERS
LP
Work Class: Demo Issue Date: 05/09/2019 Subdivision: CARLSBAD LANDS
Status: Closed -Finaled Expiration Date: 12/09/2019 Address: 1048 Carlsbad Village Dr
Carlsbad, CA 92008-1803
IVR Number: 17762
Scheduled Actual
Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Re Inspection Complete
05/16/2019 06/1612019 BLDG-SW-Pre-Con 092013-2019 Passed Paul Burnette Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
06/24/2019 06124/2019 BLOG-11 092860-2019 Cancelled Andy Krogh Reinspection Complete
Foundation/Ftg/Pier
s (Rebar)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-Flnal 092861-2019 Cancelled Andy Krogh Reinspection Complete
Inspection
Checklist Item COMMENTS Passed
BLDG•Building Deficiency No
BLDG·Plumbing Final No
BLDG•Mechanical Final No
BLDG-Structural Final No
BLDG-Electrical Final No
06/30/2019 05/3012019 BLDG-11 093281-2019 Failed Paul Burnette Reinspection Complete
Foundatlon/Ftg/Pier
s (Rebar)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-Final 093282-2019 Falled Paul Burnette Reinspectlon Complete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-Plumbing Final No
BLDG-Mechanical Final No
BLDG-Structural Final No
BLDG-Electrical Final No
06/11/2019 06/11/2019 BLDG-11 094108-2019 Cancelled Paul Burnette Reinspectlon Complete
Foundation/Ftg/Pier
s (Rebar)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-Flnal 094109-2019 Cancetled Paul Burnette Reinspection Complete
Inspection
June 17, 2019 Page1 of2
OFFICE USE ONLY SAN DIEGO REGIONAL
HAZARDOUS MATERIALS
QUESTIONNAIRE
RECORDID# ________________ I
PLAN CHECK# ________________ 1
Occupancy Rating: Faclllty'a Square Footage Qncluding proposed project):
1. Explosive or Blasting Agents 13. Corrosives 2. Compressed Gases
3. Flammable/Combustible Liquids
5, Organic Peroxides 9. Water Reactlves
6. Oxidizers 10. Cryogenics
7. Pyrophoncs 11. Highly Toxic or Toxic Matenals
14. OtherHeantl!W(,.» 7 2019
15. None of These.
4. Flammable Solids 8. Unstable Reactives 12. Radioactives
questions s yes, app Icant must contact t e ounty o an D ego
Call (658) 505-6700 pnor to the lssuanca of a building parmlt.
FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy:
YES f (for new construction or remodeling projects) 1. D Is your business listed on the reverse side of this form? (check all that appty).
2. D Will your busJness dispose of Hazardous Substances or Medlcal Waste In any amount?
3. D Will your business store or handle Hazardous Substances In quantltles greater than or equal to 55 gallons, 500
unds and/or 200 cubic faal?
4. D B your business store or handle carcinogens/reproductive toxins In any quantity?
5. D II your business use an existing or install an underground storage tank?
6. D II your business stora or handle Regulated Substances (CalARP)?
7. D J!!'ftill your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? I.
8. D X Will your business store petroleum In tanks or containers at your faclllly with a total facility storage capacity 'equal to
or rester than 1,320 allons? California's Above round Petroleum Stora e Act .
0 C&IARP Exempt
Dato lnltJala
0 CalARP Required
I
Dato lnlUals
0 CalARP Complete
Dato Initials
: Any YES' answer requires a stamp froni APCD 10124 Old Grove Road, San
ego, A 1 •~P!,~Y~lv.ca,ggr 5 6-. ( No stomp required If 01 Yes Ill!! Q3 Yes i!!l! 04-06 No]. The following questions are Intended
to Identify the majo ~r pciJOn Ysues a the p annlng stage. Projects may require addltlonal measures not identified by these questions. For comprehensive
requirements contact APCD. Residences are typlC8lly exempt, except -those with more than one bulldlng• on the property; single buildings with more than four
dwelling units; townhomes; condos; mlxed--commerclal use; deliberate bums; residences forming part of a larger project. rExcludes garages & small outbuildings.}
IS N□8o 1. Will the project disturb 160 square feet or more of existing building matenals?
2. WIii any load supporting structural members be removed? Notification may be required 10 working days prior to commencing demolition.
3. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos suivey been perfonned by a Certified Aabestos Consultant or Sita Suivelllance
Technician?
4. ~ D (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the prQJect disturb any asbestos containing material? Notification
may be required 10 working days prior to commencing asbestos removal. '/(JO~
5. D J( Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet
(www.ldapcd on,/Jnfollacts/pennlts pd() for typical equipment requlnng an APCD pennlt.
6. D 1\1,-(ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school
;o<\ boonda
roject: :i, 1..._ .r-.. :O\\no,, , '
'b tl'1
Date
,13,
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION :
BY: DATE: I I
EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEAIED FOR BUILDING PEAMrT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY
COUNTY-HMO• APCD COUNTY-HMO APCD COUNTY-HMO APCD
~,on co,,t, ~u "o ,,_o "
~r}J/Jf~i 'ci Date/lnittals #,
"-, <'J"'
rJ, Of $~<'
•A stamp m this box~ exempts businesses from completing or updating a Hazardous Matenals Business Plan. Other permitting requirements may still apply.
?t>l"I ~tljQ~ ~~
~(J'Y-
HM-9171 (08/15) County of San Diego-OEH -Hazardous Materials Division
soqf
A~ Sempra Energy ulillty~
Notice of Service Discontinuance
PERMIT DEPARTMENT, CITY OR COUNTY OF: Carlsbad
SERVICE WILL BE DISCONTINUED TO:
ADDRESS: 1048 Carlsbad Village Drive, Carlsbad
BY: (Date) April 25, 2019
[8J ELECTRIC METER NO. --=0=-=6-=-57~4--=-39'-'0'----------
[8] GAS METER NO. 00992841 ~~~'----------
ALL SERVICE LINES WILL BE REMOVED. THIS BUILDING CAN BE MOVED OR
RAZED AFTER THE ABOVE DATE.
SAN DIEGO GA~TRIC
BY: f}JJJA__
Doug Pearce
PHONE: (858) 654-0236 __________ _
DATE: April 26, 2019
APR 2 9 2019
c1-1·-.,, c·1--(.:i'\: ';._,:-;;::,1\0
BUIL~:::/·<<~ LJ!·-/;.SiC'N
{cityof
Carlsbad
DEMOLITION
REQUIREMENTS
B-9
Qevelopment Services
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
A permit for demolition of a structure can be Issued after approval and Issuance of a grading permit.
Please contact the bulldlng division with questions on the demolition process.
The following items must be completed prior to issuance of a demolition permit.
~ Completed Building Permit Application (Form B-1): A demolition permit may only be issued to the , (L,
___/ owner of the property or the State Licensed Contractor that is doing the work. QCJ~-, O
~ Four (4) sets of plans: Building, Planning, Engineering and Fire division will review an~~><-\
mment/approve the submittal. • , e,
etter from Property Owner: The contractor must provide a letter, signed and dated by the property \)'?I
owner, giving permission for the building to be demolished. ~ l
¥ Demolition Asbestos Certification: This certification must be completed, signed and have the correct
square footage of the structure being demolished, as well as its use.
~ San Diego Regional Hazardous Materials Questionnaire: For .ALL dernoll•loa proJec~, proof of ~
· application to County of San Diego Air Pollution Control District must also be provided. Asbestos _
or lead paint remediation must occur prior to issuance of a demolition permit by the City -0
that the utilities have been disconnected. .,,.
·v ✓waste Management Plan (Form B-59): Comply with California Green Code waste disposal and -,,J"',:,. recycling management program (65%). Section 4.408.1 and Section 5.408.1. Complete the attached
B-59, Waste Management Plan which estimates the waste to be recycled.
Public Property: If applicable provide plans and details demonstrating measures to protect public
property and walkways.
Additional Items that may be required:
1. Water Agency: Arrange for appropriate Water Agency to remove water meter unless construction
of replacement structure is to begin shortly.
2. The Planning Division will determine if the structure is in the Village Review area, the South
Carlsbad Review area, the Coastal Zone or If discretionary mitigation conditions apply. (760) 602-
4610
3. The Land Development & Engineering Division will determine If a Haul Route, Right-of-Way Permit
or Storm Water Permit is required. (760) 602-2750.
4. Fire Department may need the use of the building for training purposes. (760) 602-4665.
Rev. 11112118
CARLSBAD VILLAGE PARTNERS, L.P.
3444 Camino Del Rio N #202
San Diego, CA 92108
March 20, 2019
City of Carlsbad Development Services, Building Division
Attn: Building Division
1635 Faraday Avenue
Carlsbad, CA 92008
RE: Demolition Permit Application -1048 Carlsbad Village Drive
Dear City of Carlsbad Development Services, Building Division:
As the legal property owner of 1048 Carlsbad Village Drive, Carlsbad, CA 92008, APN: 203-
320-48, I grant authorization for Unlimited Environmental Inc. to obtain a Demolition Permit
from the City of Carlsbad, CA. They will be obtaining the permit on my behalf for the
demolition of the building located at 1048 Carlsbad Village Drive.
If you should have any questions, please do not hesitate to contact Austin Wermers at (858)
922-0443.
Regards,
Carlsbad Village Partners, L.P.
a California limited partnership
By: Carlsbad Village Genpar, LLC,
a California limited liability company,
its General Partner
By: R&V Management Corporation,
a California corporation
its Manager
By: Dennis Szuberla
619.285.5500
dszuberla@rvmsd.com
3444 CAMINO DEL RION #202, SAN DIEGO, CA 92108
DEMOLITION ASBESTOS CERTIFICATION
ADDRESS: \D½€> C0:-t~Wct \),\\Off,1)Q,.,
USE OF BUILDING TO BE DEMOLISHED: WQ..~ l):uNN~ 'S ¼~
SQUAREFEET,v_.""'-l~()DO"'r""-7"~--lr-7"7""rr
PROPERTY OWNER: ~ 0
ADDRESS:
APPLICANT: ~~'-'-'-!.~~~~...:...;;~~':-:=:.w.;i:::.:::..4-~,'t:;~-------.:-:-~~-=
ADDRESS: ~:1.!....f;:21.'E..~~~~fil..!Ill1.IJ:Lf:1Q.JSZ:d .J _,;;.u,t, g) -Co<'o00
Section 19827.5 of Callfornla Health and Safety Code states In part:
"A demolition permit shall not be issued by any city .•• as to any building or other
structure except upon receipt from the permit applicant of a copy of each written
asbestos notification regarding the building that has been required to be submitted
to the United States Envlronmental Protection Agency or to a designated state
agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations,
or the successor to that part. The permit may be issued without the applicant
submitting a copy of the written notification If the applicant declares that the
notification Is not applicable to the scheduled demolitlon project."
As applicant for a demolitlon permit In the City of Carlsbad, I certify that; I have
read the excerpt from Section 19827.5 of the Health and Safety Code provided
above; the Information I have provided on this form Is true and correct; and I further
certify the followlng:
'>-. ,_.,..... _j_ CJn_, ~~Ncmi-\c,~. ~ On the attached page.rare copies of all written asbestos notifications
regarding the above referenced building that are required to be submitted to
the United States Environmental Protection Agency or to Part 61 of Title 40
of the Code of Federal Regulatlons, or successor to that part.
notification Is not appllcable to the
Rev. 11/12118
SA Recycling LLC 901 New Dock St Sar, Podro. CA 90731
(3 10) 221-4900
11111 11111111 1111111111 11111
Ti cket tt TCLC99
H f!CKET REPR!Nf on 06/07/19 t1
PURCHASE f!CKET
WEfGHMASTER CERTIF ICAfF. Tt!IS JS TO CERT JFY that the following dest:ribed commod ity
was weighed, measured. m· counti'id by u w.;:i9~;1nas1er, whose
si gnature is on this certificate, who is a reco911i zed
authority of accuracy, as prescribed by Chapter 7 {co:nmoncing wl th Sac:tion 12700) of Di·1is i0n 5 cf the Cal dornia
Bi1sirt1!ss ;,nd Prc:fossions God1:1. adm:ni::;tenid by the Divisi on ot
Measurement Standards of the California Depar t111ent of food <l!ld Agriculture BILL OF SALE: I warrant lhitl I am the owner (or owner's
repr ei;entative) of the material dtiscribed hereon and have the right tc sell same. that it contains no H,m1rdour; Materials as defined
by any federal or stcte law and that for payment hereby received, I sell and convey ti tle to SA Recycling.
NOT REFUNDABLE MORE fHAN 90 DAYS FROM DAIE ABOVE
Truck Cnt rl -51: 51 822498
Ticket tt TCLC99 Vehicle ID: 9G02664 Shir• Date: 05/22/ 19
Vehicle No: TKCAAl58914
Purchased From: UNLl02
UNLIM[TED ENVIRONMENTAL. INC . License/II) No: A13 14797 {CA)
1390 32ND ST.
SIGNAL HILL. CA 90755
Order ~ lJNLl 02030S-03
Suppl;er Shipmen t " l '11 Ciirr i er : MAH 170 -MAP TRUCK I NG
... -····--·······-·· Pounds -------·--·-·· ----
Itm Shprnnt Material Gr'O$S Tare Ne t Adj Pd Wt
----·-·•-'---~ ..... <I_.._ ... __ ...... ___ .... _, •..... -... ,.. __ ................... ----·--··-~ ........ _ .,. ______ ._ .... ________ ..,_
1. 758200 E -Grade 51020a 36500c 14520 0 14520
Totals
Gross Wght Date/Time 05/22/19 10:28
Tare Wght Date/Time 05/22/19 10:44
Ticket Comment: A158914/ 3711/ CARLSBAD/ NEf[lS PO
14520 0 14520
METRIC
6.5862
Deputy Signature ·-~~--,,..·---.--s------.. --~-~--·-~~----~~--1., teve u,mza I ez 1
Cus torner Signature ___ , ___ ~ ·--··------------··--·-·· .. ----
Driver __________________ !Date ..
(Al I weights are reported ir; Pc,uncfa ;Jnless c:therwise indicated)
("nt" Hepresents a weight that wa$ manual ly entered)
For any i ssu1'/!; ur concern,~ pl&a:;u eont.:1r, t o,ir cus tomcr ~erv lee dept .
(800) GOT-SCRAP
SYCAMORE LANDFILL -4530
PO BOX 31001-2265
PASADENA, CA 91110-2265
(858) 576-5741
UNLIMITED ENVIRONMENTAL, INC.
1390 E. 32ND ST
SIGNALL HILL, CA 90755-5201
tR~ a,\\
REPUBLIC
SERVICES
INVOICE
Invoice Date 05/31/2019
Invoice No 4530-000026947
Customer No 4-4530-0333400
Page No
Due Date
Cun-ent Charges
1 s21.s10.22 1
Page 1 of 3
UPON RECEIPT
Total Amount Due I s21,s10.22 I
Please pay total amount due
Billing Questions? cau (858) 576-5741
Thank you for your business! Please be sure to remit payments to our loc:kbox
address shown on the bollDm of the invoice.
Date Code Description Reference Rate
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 }1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 }1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 }1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 }1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 }1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 )-1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
5/21 }1
5/21 }1
5/21 AA
5/21 AA
5/21 {1
5/21 {1
MSW
Contract: COMMERCIAL-GATE-04
Y9-1676818
ENVIRONMENTAL FEE 1 SC619481
($16.25 / Ticket )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619482
(7.06% I Ticket )FUEL RECOVERY FEE
MSW Y9-1676899
contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619537
($16.25 / Tldcet )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619538
(7.06% I Ticket )FUEL RECOVERY FEE
MSW Y9-1676901
contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619541
($16.25 / Ticket )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619542
(7.06% I Ticket )FUEL RECOVERY FEE
MSW Y9-1676923
Contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619555
($16.25 / Ticket )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619556
(7 .06% I Ticket )FUEL RECOVERY FEE
MSW Y9-1676952
contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619573
($16.25 I Ticket )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619574
(7.06% I Ticket )FUEL RECOVERY FEE
MSW Y9-1676992
contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619609
($16.25 / Ticket )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619610
(7 .06% I Ticket )FUEL RECOVERY FEE
MSW Y9-1677010
Contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619623
($16.25 / Tldcet )ENVIRONMENTAL FEE 1 $1
FUEL RECOVERY FEE SC619624
(7.06% I Ticket )FUEL RECOVERY FEE
MSW Y9-16n019
Contract: COMMERCIAL-GATE-04
ENVIRONMENTAL FEE 1 SC619633
($16.25 / Ticket )ENVIRONMENTAL FEE 1 $1
90.30
16.25
7.06
90.30
16.25
7.06
90.30
16.25
7.06
90.30
16.25
7.06
90.30
16.25
7.06
90.30
16.25
7.06
90.30
16.25
7.06
90.30
16.25
Quantity
11.30 TN
1.00
1.00
16.26 TN
1.00
1.00
13.65 TN
1.00
1.00
13.39 TN
1.00
1.00
12.96 TN
1.00
1.00
20.13 TN
1.00
1.00
8.30 TN
1.00
1.00
12.59 TN
1.00
Amount
$1,020.39
$16.25
$72.04
$1,468.28
$16.25
$103.66
$1,232.60
$16.25
$87.02
$1,209.12
$16.25
$85.36
$1,170.29
$16.25
$82.62
$1,817.74
$16.25
$128.33
$749.49
$16.25
$52.91
$1,136.88
$16.25
UNLIMITED ENVIRONMENTAL, Ir 4-4530-0333400 Page 2 of 3
Date Code Description Reference Rate Quantity Amount
5/21 }1 FUEL RECOVERY FEE SC619634 7.06 1.00 $80.26
5/21 }1 (7.06% I Ticket )FUEL RECOVERY FEE
5/21 AA MSW Y9-1677062 90.30 13.39 TN $1,209.12
5/21 AA Contract: COMMEROAL-GAlE-04
5/21 {1 ENVIRONMENTAL FEE 1 SC619679 16.25 1.00 $16.25
5/21 {1 ($16.25 I Ticket )ENVIRONMENTAL FEE 1 $1
5/21 }1 FUEL RECOVERY FEE SC619680 7.06 1.00 $85.36
5/21 }1 (7 .06% I Ticket )FUEL RECOVERY FEE
5/21 AA MSW Y9-1677114 90.30 19.17 TN $1,731.05
5/21 AA Contract: COMMEROAL-GAlE-04
5/21 {1 ENVIRONMENTAL FEE 1 SC619729 16.25 1.00 $16.25
5/21 {1 ($16.25 I Ticket )ENVIRONMENTAL FEE 1 $1
5/21 }1 FUEL RECOVERY FEE SC619730 7.06 1.00 $122.21
5/21 }1 (7.06% I Ticket )FUEL RECOVERY FEE
5/22 AA MSW Y9-1677234 90.30 15.66 TN $1,414.10
5/22 AA Contract: COMMERCIAL-GAlE-04
5/22 {1 ENVIRONMENTAL FEE 1 SC619783 16.25 1.00 $16.25
5/22 {1 ($16.25 I Ticket )ENVIRONMENTAL FEE 1 $1
5/22 }1 FUEL RECOVERY FEE SC619784 7.06 1.00 $99.84
5/22 }1 (7.06% / llcket )FUEL RECOVERY FEE
5/22 AA MSW Y9-1677259 90.30 17.47 TN $1,577.54
5/22 AA Contract: COMMERCIAL-GAlE-04
5/22 {1 ENVIRONMENTAL FEE 1 SC619787 16.25 1.00 $16.25
5/22 {1 ($16.25 I Ticket )ENVIRONMENTAL FEE 1 $1
5/22 }1 FUEL RECOVERY FEE SC619788 7.06 1.00 $111.37
5/22 }1 (7.06% I Ticket )FUEL RECOVERY FEE
5/22 AA MSW Y9-16m36 90.30 24.60 TN $2,221.38
5/22 AA Contract: COMMERCIAL-GAlE-04
5/22 {1 ENVIRONMENTAL FEE 1 SC619831 16.25 1.00 $16.25
5/22 {1 ($16.25 I Ticket )ENVIRONMENTAL FEE 1 $1
5/22 }1 FUEL RECOVERY FEE SC619832 7.06 1.00 $156.83
5/22 }1 (7.06% I Ticket )FUEL RECOVERY FEE
5/24 AA MSW Y9-1677880 90.30 25.36 TN $2,290.01
5/24 AA Reference: driver/iuan evraud
5/24 AA Contract: COMMERCIAL-GAlE-04
5/24 {1 ENVIRONMENTAL FEE 1 SC620145 16.25 1.00 $16.25
5/24 {1 ($16.25 / Ticket )ENVIRONMENTAL FEE 1 $1
5/24 }1 FUEL RECOVERY FEE SC620146 7.06 1.00 $161.67
5/24 }1 (7 .06% I Ticket )FUEL RECOVERY FEE
5/31 Z8 ADMINISTRATION FEE SC622695 5.25 1.00 $5.25
······ ·······--······-·-·········· ············------······ ...... ·-·······························-···· ···················-······-··
Material / Fee Summary
{1 ENVIRONMENTAL FEE 1 14.00 $227.50
}1 FUEL RECOVERY FEE 14.00 $1,429.48
AA MSW 224.23 TN $20,247.99
28 ADMINISTRATION FEE 1.00 $5.25
Current
$21,910.22
31-60 Days
$0.00
61-90 Days
$0.00
4-4530-0333400
Refermce Rate
Over 90 Days Total Amount Du
$0.00 $21,910.22
Page 3 of 3
Amount
____ please retum thi!J)Oytion below w~yo~r _e_clr!!lent. Do not attach check stub. _____ _
SYCAMORE LANDFILL -4530 Invoice Date 05/31/2019
PO BOX 31001-2265 Invoice No 4530-000026947
PASADENA, CA 91110-2265 Customer No 4-4530-0333400 (858) 576-5741 REPUBLIC
SERVICES
Please write your account number on your check and make payable to:
Please SYCAMORE LANDFILL -4530
Return PO BOX 31001-2265
Payment to: PASADENA, CA 91110-2265
" TIie Administrative Fee has Increased, Visit www.republlcsel fll:el,c:om
for more Information."
Current Charges
Total Amount Due
Amount Paid:
$21,910.22
$21,910.22
UNLIMITED ENVIRONMENTAL, INC.
1390 E. 32ND Sf
SIGNALL HILL, CA 90755-5201
KELLY & ASSOC., INC.
P.O. BOX 1212
LA MESA CA 91944-1212
Office: 619 462-7772 Fax: 619 462-7774
Lie#: CA #24515
UNITED ENVIRONMENT AL INC
1390 32NDST
SIGNAL HILL CA 90755
Job Location
J1044 CB VILLAGE DR
Date Ft Bill Truck Description
05/21/19 4269339 106 1044 CB VILLAGE DR
05/21/19 4269594 01 1044 CB VILLAGE DR
05/21/19 4784274 K519 1044 CB VILLAGE DR
05/21/19 98133 K8000 1044 CB VILLAGE DR
05/22/19 4269340 106 1044 CB VILLAGE DR
05/22/19 97764 48 1044 CB VILLAGE DR
05/23/19 4269597 01 1044 CB VILLAGE DR
Totals:
INVOICE: 201905-74
Date: 05123/19
Cust.# UEI
Amount
5,837.otj
Total: 5,837. '--------
Qty Rate Fees Gross
8.75 130.00 1,137.5(
6.75 130.00 877.5(
6.90 130.00 897.0(
9.00 130.00 1,170.0(
4.00 130.00 520.0(
5.50 130.00 715.0(
4.00 130.00 520.0(
44.90 5,837.00
Grand Total Qty: 44.90
*,... WE APPRECIATE YOUR BUSINESS!,._
Page 1 of 1
Gross:
Broker Fee:
Subsistance:
Net:
5,837.00
0.00
5,837.00
Ccityof
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT PLAN
B-59
De11elop,ngnt~g1v_ices
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
Section 4.408.1 and Section 5.408.1 of the 2016 California Green Building Standards requires at least 65% of non-hazardous
construction debris is recycled and/or salvaged for reuse.
With the submitting of your application for a Building Permit or permit issuance, you must have completed a Construction Waste
Management Plan (CWMP) demonstrating how you will recycle a minimum of 65% of the construction waste generated from
your project.
NOTICE: Applicant (contractor and subcontractors) shall comply with the project's CWMP. It is the Applicant's responsibility to
collect all receipts from the facilities that recycle their materials AND all project waste/landfill disposal receipts. When working
with the City's franchised hauler, Waste Management, one cumulative project receipt is acceptable. However, it is the
Applicant's responsibility to confirm that the bins are collected for C&D Recycling.
1. This project shall generate the least amount of waste possible by planning and ordering carefully, following all proper
storage and handling procedures to reduce broken and damaged materials, and reusing materials whenever possible.
2. Waste Management Services can provide 2 roll-off bins, one for commingled construction debris and one for trash. The
commingled construction roll-off bin will be taken to a Certified Mixed C&D Processing Facility to sort the material and
create receipt(s), to demonstrate the project has met a 65% diversion rate or greater.
3. Applicants with a goal of recycling greater than 65% of the project's total waste should work with, the City's exclusive
franchised waste hauler, to develop a more specific CWMP. This plan may include using additional roll-off bins for
particular phases of construction (e.g., concrete and wood waste) to ensure the highest waste diversion rate possible.
4. Contractors/subcontractors hauling their own waste as part of their scope of work (e.g., construction clean up
companies, etc.) SHALL NOT be excluded from complying with the CWMP and shall provide weight and waste diversion
receipts from a Certified Source Separated Recycling Facility. For a current list of Certified Recycling Facilities go to
http://www.sandiego.gov/environmental-services/recycling/cd/index.shtml.
5. If contractors/subcontractors furnish their own debris boxes as part of their scope of work, they SHALL NOT be excluded
from complying with the CWMP and shall provide weight and waste diversion receipts from a Certified Source
Separated Recycling Facility.
Part 1 -Before the Project Begins
Prior to issuance of a Building Permit, Applicant must submit PART 1 of the Construction Waste Management Pian (CWMP) Table.
a. Submit completed and signed form to City with Building Permit application.
Part 2 -During and After the Project
Prior to receiving inspection for final sign off of the Building Permit or Certificate of Occupancy, Applicant must submit the fully
completed and approved PART 2 of the Construction Waste Management Plan (CWMP) Table.
a. Save all receipts and/or documents from reuse facilities, recycling centers, processing facilities, and landfills where
materials were taken.
b. Complete the Debris Recycling Report (DRR) as your project progresses. Recycling/diversion goals are (at a minimum)
65% of the waste generated by your project.
c. Return completed form to: City of Carlsbad Building Division -1635 Faraday Ave, Carlsbad, CA 92008 or your inspector
prior to requesting final inspection.
Rev. 1111211 B
Ccityof
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT PLAN
8-59
Development Servifgs
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
Many of the materials generated from your project can be recycled. You are required to list materials that will be
reused, recycled or disposed from your project. If you have questions about the recycling requirement or completing
this form, please contact Waste Management at (760) 929-9400, a certified C&D recycler, or the Carlsbad Building
Division at (760) 602-2700. Please note: Unless you are self-hauling, Waste Management or approved haulers must be
used for all construction projects within the City of Carlsbad.
PART 1 Complete and submit this form when applying for a Building Permit. Note: Permits will _n_~ be issued
without a completed Construction Waste Management Plan.
Applicant Information
Permit No. 113~2-0t q-o I Z '1 Project Title ~.......,..,~-r;;p._,._e,
1
Project Address /o<l8_ CNUr.8At:!_ ll IL '-AC.. f: ~ APN
Owner Contractor Architect Other
Applicant Name ~t..~l'b't • ti-1tifZI< 0 ® 0 0 Last First
Applicant Address 1:r-,0 ?2 ,,,p c-uz.&£:..,, s,e, ,,...._ I./,,._, CA t(47ST
Phone ( s c, 7... l 9 l!J I-I.if,. oo
Applicant Mailing Address
E-mail Address L";Zt z 4: . A;:, uu tA.A e u£r7rM,t, C.C,'1,t
(if different than project address)
Project Type
(check all that apply):
Brief Description
Residential □
Please check the appropriate box:
Public Building □ Industrial □ ..
0 I plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction.
ltl I plan on self-hauling to a certified recycling facility and will provide all receipts after construction.
0 This is a proposed LEED certified project and I plan on separating materials on site in conjunction with WASTE
MANAGEMENT.
Acknowledgement: I certify under penalty of perjury under the laws of the State of California that the information
provided in and with this form pertains to construction and demolition debris generated only from the project listed
in PART 1, that I have reviewed the accuracy of the information, and that the information is true and correct to the
best of my knowledge and belief. /:J §
Print Name~zA:.. /4u,t<,eM Signature ~,~ Date o~p'I
Page 1 of4 Rev. 11/12/18
PART 1 Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Permits will
(cont'd) not be issued without a completed Construction Waste Management Plan.
DEBRIS RECYCLING ESTIMATE:
SECTION A Permit No. _.(i.....,_ff,L....&..t:,~7ot.........__.q_-...... t2'--'l'-'v::t"--'-__ Project Title
APN
Applicant Name_,,_/4__.,,,""/JCL.L../..,L-cc;f;_,,_~~.__ ______ ..,,.clc.......,"'"'.,4H,oc._;::"""'--=------Phone
Last First
SECTION B Complete the following table with estimated waste tonnage to be generated by your project.
This is your plan for construction waste management. Changes can be made on the final recycle report.
Material Type
Complete this line of the table only if
only using WASTE MANAGEMENT
roll-off bins.
Mixed C&D Debris
Asphalt & Concrete
Brick/ Masonry/ Tile
Mixed Inert Debris
Cabinets, Doors, Fixtures,
Windows (circle all that apply)
Car et
Carpet Padding/ Foam
Cardboard
Ceiling Tile (acoustic)
Drywall (used, new, scrap)
Landscape Debris (brush, trees,
stumps, etc.) No dirt.
Unpainted Wood & Pallets
Roofing Mate ria Is
Sera Metal
Stucco
Other:
TOTAL
SECTION C
Goal: the diversion rate shall be 65% by weights of debris.
Estimated
Waste Quantity
(tons)
A B C
Place a ( ✓) check
next to items to be
reused or salvaged
Place a ( ✓) check next Place a ( ✓) check next
to items to be to items to be
recycled disposed at landfill
To meet 65% Diversion Requirement (estimate) ________ x 0.65 = ___________ tons
Total Estimated Waste from above Minimum Required Diversion
Contractor/Owner Signature _________________ ,Date
Page 2 of 4 Rev. 11112/18
PART 2 Complete before final inspection, obtain WASTE MANAGEMENT signature, and return with receipts prior to final
building approval.
DEBRIS RECYCLING REPORT (ACTUAL):
SECTION A Acknowledgement
I certify under penalty of perjury under the laws of the State of California that the information provided in and with
this form pertains to construction and demolition debris generated only from the project listed in PART 1, that I have
reviewed the accuracy of the information, and that the information is true and correct to the best of my knowledge
and belief.
Permit No. ---z:??/9-017.-9 Print Name
Address
SECTION B Use this Final Log below to track loads of materials as they leave the job site.
@@SAVE RECEIPTS@@
Indicate FINAL quantities in tons for each material and save receipts and documents from facilities where material is taken.
Additional Project Log pages are available if necessary. Use City Conversion Table to convert volume to tons.
A B C
Date
Example:
01/05/2018
SECTION C
Material Type
Concrete (broken)
~l)I C· D
@TOTAL
Diversion Rate Achieved
Actual Amt
Reused or
Salvaged
Actual Amt Actual Amt
Recycled Disposed in
Landfill
5 tons
Destination Facility
(Name, Address, Phone)
Palomar Transfer Station, 5960 El
"' 21~-7 ~ =--~~$"_%
~65%
s 6s%0
of columns A + B + C DIVERSION
Date ~u /e,c / ?o-l&j --=----'-'66'""'---=-+--=--+------
Attach the following documentation to this R port:
• Original recycling weight tickets, landfill weight tickets
• Original donation receipts with photos and/or itemized descriptions
• Any other relevant information to support Recycling Report
Return completed form and documentation to:
City of Carlsbad
Building Division (1st Floor)
1635 Faraday Avenue
Carlsbad, CA 92008
(
Page 3 of4 Rev. 11/12/18
'
Conversion Table for Common Construction Waste
This document is informational onlv. It is here to helo vou convert truckload auantities to tons. if necessarv,
Column A Column B Column C
Category Material Volume Tons[Unit Tons
Mixed Debris Construction cy X 0.18 =
Demolition cy X 1.19 =
Asphalt/Concrete Asphalt (broken) cy X 0.70 =
Concrete (broken) cy X 1.20 =
Concrete (solid slab) cy X 1.30 =
Brick/Masonry/Tile Brick (broken) cy X 0.70 =
Brick (whole, palletized) cy X 1.51 =
Masonry brick (broken) cy X 0.60 =
Tile sq ft X 0.00175 =
Building Materials (cabinets, doors, windows, etc.) cy X 0.15 =
Cardboard (flat) cy X a.as =
Carpet By square foot sq ft X 0.0005 =
By cubic yard cy X 0.30 =
Carpet Padding/Foam sq ft X 0.000125 =
Ceiling Tiles Whole (palletized) cy X 0.0003 =
Loose cy X 0.09 =
Drywall (new or used) 1/2" (by square foot) sq ft X 0.0008 =
5/8" (by square foot) sq ft X 0.00105 =
Demo/used (by cu. yd.) cy X 0.25 =
Landscape Debris (brush, trees, etc.) cy X 0.15 =
Asphalt Composition
Shingles, asphalt Shingle cy X 0.22 =
Unpainted Wood/Pallets By board foot bd ft X 0.001375 =
By cubic yard cy X o_.1s =
Trash/Garbage cy X 0.18 =
Other (estimated weight) cy X estimate =
cy X estimate =
cy X estimate =
cy X estimate =
Total all =
Page 4 of4
Rev. 11/12118
{cityof
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT PLAN
8-59
Pevelopment Services
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
Many of the materials generated from your project can be recycled. You are required to list materials that will be
reused, recycled or disposed from your project. If you have questions about the recycling requirement or completing
this form, please contact Waste Management at {760) 929-9400, a certified C&D recycler, or the Carlsbad Building
Division at (760) 602-2700. Please note: Unless you are self-hauling, Waste Management or approved haulers must be
used for all construction projects within the City of Carlsbad.
PART 1 Complete and submit this form when applying for a Building Permit. Note: Permits will not be issued
without a completed Construction Waste Management Plan.
--------dMliiiii•ful•I-
PermitNo. _ . _ ProjectTitle ~'Irv,.~~
Proje~~~,.~~a~°-ru\G~~1X-Cru\s~.(1\ APN
'.)ll\}~c~~~----m-'-'¥~'""kc...::....~--1.-+\_\},.,_~""--I-~----O ~ ·o O ----
La,t '@,~t ~
ApplicantAddress \YID{)~ . ~'Pi~ \1\\. c~ 9.0JSb
Phone 1<juq-1qf;\,(otg_CO E-mailAddress ~b\--.V'~~ ,Cti)(V'
Applicant Mailing Address ______________________________ _
{if different than project address)
Project Type ''""□"'"'' i•~'•' '""\tlWI'""• {check all that apply/: LJ
BriefDescription \"OC'()'¥.X'~~'91!,~ ~
Project Size (\,; (o(O() ~ Estimated Cost of Project$ n'.di ,~ :::V
(squarefootoge)
Please check the appropriate box:
~~an on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction.
-,""7, plan on self-hauling to a certified recycling facility and will provide all receipts after construction. ·-· D This is a proposed LEED certified project and I plan on separating materials on site in conjunction with WASTE
MANAGEMENT.
Acknowledgement: I certify under penalty of perjury under the laws of the State of California that the information
provided in and with this form pertains to construction and demolitio debris generated only from the project listed
in PART 1, that I have reviewed the accuracy of the Information, a hat the information is true and correct to the
best of my kn\\)~~~~tv~¥,
Print Name ..js.}otcl~ _,,, Slgnatur·f-.J-¥-tftV/~:-l,,;..-..t::.::::... b] 111h°l.
Page 1 of4 Rev. 11112118
PART 1 Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Permits will
(cont'd nq! be issued without a com feted Construction Waste Management Plan.
DEBRIS RECYCLING ESTIMATE:
CompJete the following tabluvith estimated waste tonnage to be generated by. your project.
J.hls Is ¥Our plan for construction waste manc1.1,ment. (:hanges e.an be made OJ') the final recycle report.
Material Type
Complete this line of the table only If
only using WASTE MANAGEMENT
roll-off bins.
Mixed C&O Debris
Asphalt & Concrete
Brick/ Masonry /Tile
Mixed Inert Debris
Cabinets, Doors, Fixtures,
Windows (circle all that apply)
Car et
Carpet Padding/ Foam
Cardboard
Ceiling Tile (acoustic)
Drywall (used, new, scrap)
Landscape Debris (brush, trees,
stumps, etc.) No dirt.
Unpainted Wood & Pallets
Roofing Materials
Sera Metal
Stucco
Other:
Goal: the diversion rate shall be 65~ by welgtits of debris.
=
Estimated
Waste Quantity
(tons)
\\d-
A B C
Place a (✓) check
next to Items to be
reused or salvaged
Place a (✓) check next
to items to be
recycled
Place a(✓) check next
to items to be
disposed at landfill
To meet 65% Diversion Requirement (est'
Page 2 of4 Rev. 11112118
PART 2 Complete before final inspection, obtain WASTE MANAGEMENT signature, and return with receipts prior to final
building approval.
DEBRIS RECYCLING REPORT (ACTUAL):
SECTION A Acknowledgement
I certify under penalty of perjury under the laws of the State of California that the information provided in and with
this form pertains to construction and demolition debris generated only from the project listed in PART 1, that I have
reviewed the accuracy of the information, and that the information is true and correct to the best of my knowledge
and belief.
Permit No. _______________ Print Name
Address _________________________ Date
Use this Final Log below to track Joads ·of materials as they leave the Job site.
@@SAVE RECEIPl'.$«>)@
Indicate FINAL quantltles In !Q!!! for each material and save receipts ahd docoments fl'om faijlities where material is taken.
Additional Project log pages are available If necessary. Ose City Conversion Table to convert volume to tons.
Date
Example:
01/05/2018
Material Type
Concrete (broken)
@TOTAL
A B C
Actual Amt
Reused or
Salvaged
Actual Amt Actual Amt
Recycled Disposed in
Landfill
5 tons
Destination Facility
(Name, Address, Phone)
Palomar Transfer Station, 5950 El
Camino Real
-750 503-0153
Diversion Rate Achieved _______ __, __________ = ____ %
<!:65%
S65%0
Total of columns A + B Total of columns A + 8 + C DIVERSION
Contractor/Owner Signature ______________ Date
Attach the following documentation to this Report: Return completed form and documentation to:
• Original recycling weight tickets, landfill weight tickets City of Carlsbad
• Original donation receipts with photos and/or itemized descriptions Building Division (1st Floor)
• Any other relevant information to support Recycling Report 1635 Faraday Avenue
Carlsbad, CA 92008
Page 3 of 4 Rev. 11/12118
Ccityof
Carlsbad
DETERMINATION OF PROJECT'S
SWPPP TIER LEVEL AND
CONSTRUCTION THREAT LEVEL
E-32
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
I'm applying for: □ Grading Permit
Project Name: Carlsbad Village Lofts
Address· 1044 Carlsbad Village Drive
~ullding Permit D Right-of-way permit Ill Other
Project ID: ____ DWG #/CB# CBC2019-0JIVIZ~
APN 203-320-48 Disturbed Area· 0 11 Ac
Section 1: Determination of Project's SWPPP Tier Level SWPPP
(Check applicable criteria and check the corresponding SWPPP Tier Level, then go to section 2) Tier
Level
Exemr2t No Threat Project Assessment Criteria
My project Is in a category of permit types exempt from City Construction SWPPP requirements. Provided no
significant grading proposed, pursuant to Table1, section 3.2.2 of Storm ~ater Standards, the following permits
are exempt from SWPPP requirements: □ Exempt
□ Electrical □ Patio D Mobile Home D Plumbing D Spa (Factory-Made)
D Fire Sprinkler D Mechanical D Re-Roofing □Sign D Roof-Mounted Solar Array
Tier 3 Significant Threat Assessment Criteria -(See Construction General Permit (CGP) Section 1.B)*
□ My project Includes construction or demolition activity that results in a land disturbance of equal to or greater
than one acre including but not limited to clearing, grading, grubbing or excavation; or,
□ My project includes construction activity that results in land disturbance of less than one acre but the
construction activity is part of a larger common plan of development or the sale of one or more acres of
disturbed land surface; or,
D My Project is associated with construction activity related to residential, commercial, or industrial D Tier3
development on lands currently used for agriculture; or
□ My project is associated with construction activity associated with Linear Underground/Overhead Projects
(LUP) including but not limited to those activities necessary for installation of underground and overhead
linear facilities (e.g. conduits, substructures, pipelines, towers, poles, cables, wire, towers, poles, cables,
wires, connectors, switching, regulating and transforming equipment and associated ancillary facilities) and
include but not limited to underground utility mark out, potholing, concrete and asphalt cutting and removal,
trenching, excavation, boring and drilling, access road, tower footings/foundation, pavement repair or
replacement, stockpile/borrow locations.
D other per CGP
Tier 2 Moderate Threat Assessment Criteria: My project does not meet any of the Significant Threat
Assessment Criteria described above and meets one or more of the following criteria:
D Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 of the Carlsbad
Municipal Code); or,
lill Project will result in 2,500 sq. ft. or more of soils disturbance Including any associated construction staging,
stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one
or more of the additional following criteria: lill Tier 2
• located within 200 ft. of an environmentally sensitive area or the Pacific Ocean; and/or,
• disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical; and/or
• disturbed area is located along or within 30 ft. of a storm drain inlet, an open drainage channel or
watercourse; and/or
• construction will be initiated during the rainy season or will extend into the rainy season
{Oct. 1 -Apr. 30\
Tier 1 Low Threat Assessment Criteria
D My project does not meet any of the Significant or Moderate Threat criteria above, is not an exempt permit
type per above and the project meets one or more of the following criteria: D Tier 1 • results in some soil disturbance; and/or
• includes outdoor construction activities (such as roof framing, saw cutting, equipment washing, material
stockoilina, vehicle fuelina, waste stockoilinn\
* Items listed are excerpt from CGP. CGP governs cntena for triggers for Tier 3 SWPPP. Developer/owner shall confirm coverage under the current CGP
and any amendments, revisions and reissuance thereof.
E-32 Paae 1 of2 REV. 02116