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Home My WebLink About1810 Oak Ave; ; CBR2019-1481; PermitPrint Date: 11/08/2019 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 1810 Oak Ave BLDG-Residential 1562202300 $29,024.06 Residential Permit Work Class: Pool Lot#: Reference #: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Description: NERE: 544 SF POOL// GAS LINE TO BBQ AND FIRE PIT {city of Carlsbad Permit No: CBR2019-1481 Status: Applied: Issued: Permit Finaled: Inspector: Final Closed -Finaled 06/10/2019 06/18/2019 Inspection: 11/8/2019 2:00:30PM Owner: Contractor: COOWNER NERE ANDREWS & NERE NORA I WATERLINE POOLS AND SPAS INC 1810 Oak Ave BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) CARLSBAD, CA 92008 ELECTRICAL 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: $885.37 Total Payments To Date: $885.37 Po Box 605 CARDIFF, CA 92007-0605 760-815-6733 Balance Due: $0.00 $278.00 $194.60 $41.00 $62.00 $2.00 $3.77 $246.00 $58.00 Please take NOTICE that approval of your project includes the "lmposition11 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 aside1 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. 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov Ccityof Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check C'fsR2o1y-J'lf/ Est. Value /Z'f,02..f. C\6 ,...._ PC Deposit --------- Date C//o ILr Job Address _...,~'--8_/_() ___ O_Rfi___:(;__.:...ltYld<-.::..~------·Suite: ____ APN: _________ _ CT/Project#: _________ Lot#: ____ Fire Sprinklers: yes/ no Air Conditioning: yes/ no BRIEF DESCRIPTION OF WORK: __ V<""'"'""o'-'-'-"-__ t-_=;;,_·_· f\-A'-'----'-l'-~-"''----":c;_=-:..~.,___,.1....=0:..>-->__.(_s:c/""9""0'-IJ_C_fl.t_· '_IG-"~)'------- /)5 i ·c -!Jff< ah-'5 n Ir 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 D Pool/Spa: 2 ~_l/_ sF Additional Gas or Electrical Features? /J (J ~ r finqlt I □ Solar: ___ KW, ___ Modules, Mounted: Roof/ Ground, Tilt: Yes/ No, RMA: Yes/ No, Battery: Yes/ No Panel Upgrade: Yes/ No D Reroof: ___________________________________ _ D Plumbing/Mechanical/Electrical Only: ________________________ _ D Other: __________________________________ _ APPLICANT (PRIMARY~) PROPERTY OWNER Name: /:"}:n?)e_ ~(.)(.,..J:5 Name: AfvD:'<B,J ~ Address: fo t3 O)( bOS' Address: /~J/O 0/}f<'. /ka.?'. City:C/tt?J)JEf State: CA Zip: 9@2 City: CM<,SB49 State: cA Zip: 9zri? Phone: -2'.'kQ ~-~733 Phone: 700 S{'S -2-7 !f 7 Email:t...,.,..§iaeC/~&S~OJrs@ ~h:i':_Email: ________________ _ DESIGN PROFESSIONAL Name: ________________ _ Address: _______________ _ City: _______ State:. ___ Zip: ___ _ Phone: ________________ _ Email: ________________ _ Architect State License: __________ _ CONTRACTOR BUSINESS Name: ?-JR'f'€12 U'1fE @l--S. Address: Po &;)X hos' City: CfJtW1ff State: C/1 Zip: 9-z.oo'7 Phone: tl;,O ff/5-l.7 33 Email: __ ~,-----------~-~--- State License:9573BD Bus. License: &QSOCX)3-76-01 c.~ i5 '5 -101.- (Sec. 7031.5 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: 0 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. g{ have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of &b.Q work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Company Name: ___ ":)=~==-_./vMD_.,,,,,:,,::..... __________ _ Policy No. C/ZZ2 /$7 Expiration Date: ? ~ / G:, -/ 'j □ Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any 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, tion the to the cost of compensation, damages as provided for In Section 3706 of the Labor Code, interest and attorney's fees. ( 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 safe {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). □ I, 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 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. l will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include 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'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 O 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 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 limitation and become null and void if the building or work authorized by such permit is not commenced within 180 da 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 f 1 days ecti 6.4.4 Uniform Building Code). 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 INSPECTION HISTORY REPORT (CBR2019-1481) Permit Type: BLDG-Residential Application Date: 06/10/2019 Owner: COOWNER NERE ANDREW S & NERE NORA M Work Class: Pool Issue Date: 06/18/2019 Subdivision: PARCEL MAP NO 12182 Status: Closed -Finaled Expiration Date: 05/04/2020 Address: 1810 Oak Ave IVR Number: 19646 Carlsbad, CA 92008-1103 Scheduled Actual Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete Date Start Date 07/12/2019 07/1212019 BLDG-51 097352-2019 Passed Chris Renfro Complete Excav/Steel(Pools) Checklist Item COMMENTS Passed BLOG-Building Deficiency Yes BLDG-52 Pool 097353-2019 Passed Chris Renfro Complete Plumbing BLDG-54 097354-2019 Partial Pass Chris Renfro Reinspection Incomplete Equipotential Bond(Pools) 07/1512019 07/1512019 BLDG-21 097545-2019 Passed Paul York Complete Underground/Underf loor Plumbing Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes BLDG-23 097546-2019 Passed Paul York Complete Gas/Test/Repairs Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 08/1312019 08/1312019 BLDG-54 100645-2019 Passed Chris Renfro Complete Equipotential Bond(Pools) 10/30/2019 10/30/2019 BLDG-55 109205-2019 Passed Chris Renfro Complete Fence/Preplaster Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes 11/06/2019 11/06/2019 BLDG-Final 110044-2019 Failed Tony Alvarado Reinspection Complete Inspection 11/0812019 11/08/2019 BLDG-Final 110282-2019 Passed Tony Alvarado Complete Inspection Checklist Item COMMENTS Passed BLDG-Plumbing Final Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes November 08, 2019 Page 1 of 1 C cicyof Carlsbad PURPOSE CLIMATE ACTION PLAN CONSISTENCY CHECKLIST 8-50 Development Services Building Division 1635 Faraday Avenue (760) 602-2719 www.carlsbadca.gov This checklist is intended to assist building permit applicants identify which Climate Action Plan (CAP) ordinance requirements apply to their projects. Unless none of the requirements apply, the completed checklist must be included in the building permit application. It may be necessary to supplement the completed checklist with supporting materials, calculations or certifications, to demonstrate full compliance with CAP ordinance requirements. For example, projects that propose or require a performance approach to comply with energy- related measures will need to attach to this checklist separate calculations and documentation as specified by the ordinances. ~ If an item in the checklist is deemed to be not applicable to a project, or is less than the minimum required by ordinance, an explanation must be provided to the satisfaction of the Building Official. ~ Details on CAP ordinance requirements are available on the city's website. 5"" ,lA.''''' -I -. •-f \' -• ! ' •-c,, • -"••~•--• .,.;•-;-._,-~-.;I• "l .~,-:i 1.--~ra~ I • I • -•-•.<I • •• ,_.. ' -~ • ---•• • ,-. f)' },-.. · . i'. . ~--. _-. . . . ,, '. ' '.·,. . .· -·_: _;,' Project Name/Building Permit No.: Property Address/APN: Applicant Name/Co.: Applicant Address: Contact Phone: BP No.: ~05 cftr?-D I fT- Contact Email: Contact information of person completing this checklist (if different than above): Name: Company name/address: B-50 Contact Phone: I 1 \ _ _ ~. -==.. Contact Email: ~'IBYlk:l~ \~ ( \)o'B D'>c: f.o [)5 UYlo(Ff; 7ft9u ~ts -to -Z?.3 -s~ Applicant Signature:--~➔-::::.......!..' _Q~~~::.::,,...~_....c..;•::;...~----Date: (o -( 0 r { 2 Page 1 of 3 Revised 04/19 City of Carlsbad Climate Action Plan Consistency Checklist Use the table below to determine which sections of the Ordinance Compliance checklist are applicable to your project. For residential alterations and additions to existing buildings, contact the building counter for the building permit valuation. Building Permit Valuation (BPV) $ ·2.:to 1.. 'f,06 ~Residential □ New construction 1A ;B...Alterations: ~ exempt □ BPV ~ $60,000 □ Electrical service panel upgrade 1A 1A 1-2 family dwellings and townhouses with attached garages only □ BPV ~ $200,000 1A Multi-family dwellings only where interior finishes are removed and significant site work and upgrades to structural and mechanical, electrical, and/or plumbing systems are proposed D Nonresidential □ New construction 1B and 2 □ Alterations 2 1. Electric Vehicle Charging A D Residential New construction and major alterations (or electric panel upgrade)* Please refer to Carlsbad Ordinance CS-349 when completing this section. □ One and two-family residential dwelling or townhouse with attached garage: □ One EVSE ready parking space required □ Exception : D Multi-family residential· □ Exception · Total Parking Spaces EVSE Spaces Proposed Capable I Ready I I I Calculations: Total EVSE spaces= .10 x Total parking (rounded up to nearest whole number) EVSE Installed = Total EVSE Spaces x .50 (rounded up to nearest whole number) EVSE other= Total EVSE spaces -EVSE Installed (EVSE other may be "Capable," "Ready" or "Installed.") Installed I Total I *Major alterations are: (1) for one and two-family dwellings and townhouses with attached garages, alterations have a building permit valuation ~ $60,000 or include an electrical service panel upgrade; (2) for multifamily dwellings (three units or more without attached garages), alterations have a building permit valuation ~ $200,000, interior finishes are removed and significant site work and upgrades to structural and mechanical, electrical, and/or plumbing systems are proposed. B D Nonresidential new construction (includes hotels/motels) □ Exception · Total Parking Spaces EVSE Spaces Proposed Capable I Ready I Installed I Total I I I Calculation· Refer to the table below· Total Number of ParkinQ Spaces provided Number of required EV Spaces Number of required EVSE Installed Soaces □ 0-9 1 1 □ 10-25 2 1 □ 26-50 4 2 □ 51-75 6 3 □ 76-100 9 5 □ 101-150 12 6 □ 151-200 17 9 □ 201 and over 10 percent of total 50 percent of Required EV Spaces Updated 4/12/2019 2 ' City of Carlsbad Climate Action Plan Consistency Checklist 2. D Transportation Demand Management (TDM) A. List each proposed nonresidential use and gross floor area (GFA) allocated to each use. 8. Employee ADT/1,000 square feet is selected from the table below. Use GFA Employee ADT for first Employee ADT for each 1,000 S.F. subsequent 1,000 S.F. Total If total employee ADT is greater than or equal to 110 employee ADT, a TOM plan is required. TOM plan required: Yes D No D Updated 4/12/2019 Employee ADT Estimation for Various Commercial Uses ADT for first 1,000 s.f. EmpADTI 1000 s.f.1 Office (all)2 20 Restaurant 11 Retaib 8 Industrial 4 Manufacturing 4 Warehousin 4 1 Unless otherwise noted, rates estimated from /TE Trip Generation Manual, 1ClhEdition 20 11 4.5 3.5 3 1 2 For all office uses, use SAN DAG rate of 20 ADT/1,000 sf to calculate employee ADT 3 Retail uses include shopping center, variety store, supermarket, gyms, pharmacy, etc. Other commercial uses may be subject to special consideration Sample calculations: Office: 20,450 sf 1. 20,450 sf/ 1000 x 20 = 409 Employee ADT Retail: 9,334 sf 1. First 1,000 sf= 8 ADT 2. 9,334 sf -1,000 sf= 8,334 sf 3. 8,334 sf I 1,000 x 4.5 + 8 = 46 Em lo ee ADT Total Employee ADT 3 STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FACILITATE RAPID INSTALLATION OF EROSION AND SEDIMENT CONTROL BMPs WHEN RAIN IS EMINENT. 2. THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSION CONTROL DEVICES TO WORKING ORDER TO THE SA Tl SF ACTION OF THE CITY INSPECTOR AFTER EACH RUN-OFF PRODUCING RAINFALL. 3. THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY INSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES WHICH MAY ARISE. 4. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE AT THE END OF EACH WORKING DAY WHEN THE FIVE (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT ( 40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER EACH RAINFALL. 5. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM AGGREGATE. 6. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. 7. THE CITY INSPECTOR SHALL 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 AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT BEST MANAGEMENT PRACTICES (BMPS} DURING CONSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO AVOID THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO AVOID THE EXPOSURE OF STORM WATER TO CONSTRUCTION RELATED POLLUTANTS; AND (2) ADHERE TO, AND AT ALL TIMES, COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED BY THE CITY OF CARLSBAD. i}&eJL 7Ya-045 OWNER(S)Jm/tiE~ AGENT NAME (PRINT SIGNATURE E-29 <b-r6•!l DATE STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP CB RZo/9 -__:l__._,'-!zcl....11 __ BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE . Erosion Control Tracking Non-51orm Water Waste Management and Materials Sediment Control BMPs BMPs Control BMPs Management BMPs Pollution Control BMPs C -C C .Q -0 0 -C C -c, :;:; :;:; CJ> 0 ., -c, ., -c, "' C u u C CJ> E C: E C -0 -=> => 0 _,; ·c C. 0 0 0 E ., L L :;:; -c, L ·5 >-., ::,; -c, "' CJ> L --.!; CJ> C Q) L C ., c "'"' "' ~ '-CT L 0 C CJ> C. ., L ., Best Management Practice* <'<! Co ·o. ·c -Ca, C: L (!) L w > C 0 £ ~ CD L 0 ., 0 ., :;:; "' ., " ., 0 C (.) ., -~ ., 0 -.c: C E ., CJ> "i5 C (.) L "' -c, "' i -c, "' ::,; ~ Q) C (BMP) Description ➔ "' u ., V, ·o ., "' CJ> CD CJ> C C: 0 :::, -., Q) 3 ~ Q) -0 '5 0 3' C LO -c, w -c, >-0"' <=c 0 CJ> 13 E :a L u C: 0 CD v, ·-CJ> Cl;, Q)-...... (.) Q) Co Q) Q) ::,; 0 CJ> 0 C Q) "' E 0 Na, ~o u c,+' Cl) 0 Q) 0 = L-;r; Q) X 0 Q) .Y. -.; -=> .0 E~ = (/) =3 L"-:c ~-~ ·-CJ> ·c C. a. e CJ> Q) -c, .C: C ., "--E L Cl) => -c, :0 Q) ·--c, .e 1, C: 0 UC LQ .Y. -c, 0 -a. u > L-.0 0 •-L 0 Q) L Q) u --0 0 t::·a 'o Q) Q) ~ u C CL Ej 8 -·-0 -o -=C •-C 0 -.0 0 00 .s 0 0 0 .c: Q) 0 oo Q) i CL en = Cl) .c: L -o 0 -L -CJ> ;r; ct 0 ~u o_ 0 -C. 0 (!) WO V, V, (.) G: (!) VJ> V, Vl a. Vl C V,"' a.a a. ::,; Vl ::,; V, V, (.) Vl::,; CASOA Designation ➔ r--~ 0 N "' r--IX) N "' ... .,., IX) C, ~-"' ... .,., co ,.._ IX) 'T 'T 'T I I I I I I I I I I I I I I I I I I I I (.) (.) (.) (.) w w w w w w w w ~ ~ V, V, V, V, ::,; ::,; i i i Construction Activity w w w w V, V, V, V, V, V, V, V, z z z z ;r; ;r; Grad inn /Soil Disturbance Trenchina/Excavation -= I><. -Stockoilina Drillina/Borina Concrete/ Asohalt Sawcuttina Concrete Flatwork Pavinq Conduit/Pioe Installation Stucco/Mortar Work Waste Disoosal Staqina /Lay Down Area Eauioment Maintenance and Fuelina Hazardous Substance Use /Storaae Dewaterinq Site Access Across Dirt Other (list): Instructions: 1. Check the box to the left of all applicable construction activity (first column) expected to occur during construction. 2. Located along the top of the BMP Table is a list of BMP's with it's corresponding California Stormwater Quality Association (CASQA) designation number. Choose one or more BMPs yau intend to use during construction from the list. Check the box where the chosen activity row intersects with the BMP column. 3. Refer to the CASQA construction handbook for information and details of the chosen BMPs and how to apply them to the project. Page 1 of 1 PROJECT INFORMATION Site Address: / ~ / {) 04K. 41-6 Assessor's Parcel Number: ________ _ Emergency Con~t: ~ Name: / l'&!lcY-L OfZ.Er U:,-J5 24 Hour Phone: 7" () 'o / ':)-&, 7 ~:;> Construction Threat to Storm Water Quality (Check Box} □ MEDIUM □ LOW ., -"' ., -0 "' ;r; -o-C ,r; C "' ., Q) => E ., E 0 Q) -Q) ~ CJ> ~ CJ> O 0 uo NC C: C 0 0 oo :r: ::,; u:::. co IX) I I i i ">'"'"'- REV 11/17 ... _-,c..,.~,.--· ?r. ,4 ~·,,.:..~