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Home My WebLink About2410 BURGOS CT; ; CB152452; Permit08-03-2015 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Demolition Permit Permit No: CB152452 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Occupancy Group: PC #: # Dwelling Units: Bedrooms: Project Title: 2410 BURGOS CT CBAD DEMO 2162404000 Full Demo: Lot #: Reference #: Status Applied Entered By: Plan Approved 0 Structure Type: Issued: 0 Bathrooms: 0 Inspect Area: BROWN RES - DEMO POOL NO GRADING PERMIT OR SOILS REPORT ASSOCIATED. NOT ISSUED 08/03/2015 SLE 08/03/2015 08/03/2015 Applicant: HOWE CONSTRUCTION Owner: BROWN RICHARD E&SHARON D 1525 CALLE PENSAMIENTOS ENCINITAS CA 92024-4720 760-685-2457 2410 BURGOS CT CARLSBAD CA 92009 Building Permit Plumbing Fee Other Fee Additional Fees TOTAL PERMIT FEES $0.00 $0.00 $65.00 $0.00 $65.00 Total Fees: $65.00 Total Payments To Date: $65.00 Balance Due: $0.00 Inspector: FINAL APR Date: . ^PROy AL Clearance: NOTICE: Please take NOTICEthat approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively reten-ed to as "fees/exactions." You have 90 days from the date this pemiit was issued to protest imposition of these fees/exactions. Ifyou protest them, you must follow the protest procedures set forth in Govemment 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 vou have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously othenwise expired. 08-03-2015 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Storm Water Pollution Prevention Plan (SWPPP) Permit Permit No:SW150295 Job Address: Permit Type: Parcel No: Reference #: CB#: Project Title: 2410 BURGOS CT CBAD SWPPP 2162404000 SWPPP FOR POOL DEMO Applicant: HOWE CONSTRUCTION 1525 CALLE PENSAMIENTOS ENCINITAS CA 92024-4720 760-685-2457 Emergency Contact: KEREK HOWE Status: ISSUED Lot#: 0 Applied: 08/03/2015 Entered By: SLE Issued: 08/03/2015 Inspect Area: Tier: 1 Priority: L Owner: BROWN RICHARD E&SHARON D 2410 BURGOS CT CARLSBAD CA 92009 760-685-2457 SWPPP Plan Check SWPPP Inspections Additional Fees $48.00 $58.00 $0.00 TOTAL PERMIT FEES $106.00 Total Fees: $106.00 Total Payments To Date: $106.00 Balance Due: $0.00 FINAL APPROVAL DArE_^^'//W4EARANpE S!GNArURE_^ THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: • PLANNING •ENGINEERING •BUILDING DFIRE • HEALTH nHAZMAT/APCD C City of Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax:760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Plan Check No. Qj^ |^ Q.'4S^2- Est. Value Plan Ck. Deposit Datet^- S> K |SWPPP15025\ JOBADDRKS _ SUITE</SPACE«/UNIT« CT/PROJECT » It OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME DESCRIPTION OF WORK: Inctude Square Feet or Affected Area(s; T^^VWO P ^^O^ .^'O (^A<—|C *~/.iO/Ll\ (^fl&^\.^ SC^b^ bou-JKj CONSTR. TYPE OCC. GROUP EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YES[~|* N0| I AIR CONDITIONING YES I I NO I I FIRESPRINKLERS YES I |NO| I APPLICANT NAME Prhiafv Contact PROPERTYOWNER NAMI ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX PHONE ^ FAX EMAIL EMAIL DESIGN PROFESSIONAL CONTRACTOR BUS. NAME ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP £N&kt A ^ _ [FAX PHONE EMAIL EMAIL iTELIC.# , , > f. CITY BUS. Lie*. , (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 fite a signed statement that he 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) ortnat he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfor a permit subjects the applicant to a Civil penalty of not more than five hundred dollars ($500)). WORKERS' COMPENSATION Workers' Compensation Declaration: / hereby affirm under penalty of perjury one ofthe foiiomng deciarations: Bl have and will maintain a certificate of consent to selMnsure for workers' compensation as pravided by Section 3700 of the Labor Code, for ttie perfomiance of the work for which this pemiit is issued. 1 have and will maintain workers' compensation, as required bv Section 3700 of the Labor Code, for the perfonnance of the work for which this permit is issued. My workers' compensation insurance canier and policy number are: Insurance Co. Policy No. Expiration Date TJis section need not be completed ifthe permit is for one hundred dollars ($100) or less. Certificate of Exemption: 1 certify that in the perfonnance of the wort< for which this pennit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of C^fomia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damagra as providad for In Section 3706 of the Labor code, interest and attomey's fees. ^gT CONTRACTOR SIGNATURE /r^^'r/i ^'*"*-^V.__^ QAGENT DATE OWNER-BUILOER DECLARATION / hereby affimi t/iat / am exempt from Contractor's Ucense Law for the foiiowing reason: I I I, as owner of the praperty or my employees with wages as their sole compensation, will do the work and the stmcture 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 impraves 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 bunJen of proving that he did not build or improve for the purpose of sale). I I 1, as owner of the property, am exclusively contracting with licensed contractors to constmct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an ovmer 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 Prafessions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. I lYes I iNo 2.1 (have / have not) signed an application for a building pemiit tor the proposed work. 3.1 have contracted with the following person (firni) to pravide the proposed constmction (include name address / phone / contractors' license number): 4.1 plan to pravide ponions of the work, but 1 have hired the following person to coordinate, supen/ise and provide the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the wori( indicated (include name / address / phone / type of work): ^efpROPERTY OWNER SIGNATURE •AGENT DATE COM}>|.sre THIS SECTION rOR NON«l$&SIDEN[TIAI. VUILOINQ PERMITS ONLY Is the applicant or future building occupant requiied to submit a business plan, acutely hazardous materials registration fonn 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 constmcted within 1,000 feet of the outer boundary of a school site? • Yes DUo 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 CONSTRUCTION LENOING AGENCY 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 APPLICANT CERTIFICATION I certif ttiat I have lead the appikatkin and state that the above infbimation is conectand that the Infbimation on the plans Is accuiate. I agree to comply vMi all City oidinances and Stale laws relating to building constniction. I hereby authorize representative ofthe City of Carlsbad to enter upon the above mentioned property for inspectbn puiposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HAIRLESS THE CITY OF CAF!LSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEOUENCE OF THE GRANTING OF THIS PERMIT, OSHA: An OSHA pemiit Is required for excavations over 5'0' deep and demolitbn or constructkjn of stmctures over 3 stories in height, EXPIRATION: Every pennit issued by the Bulkiing Official under the provisbns of this Code shall expire by limitation and become null and void if the building or work authorized by such pennit is not commenced within 180 days from the date of such pennit or If thg^iljJIng or ^ au|)erized by such pennit is suspencied or abandoned at any time after the va\<. is commenced fbr a period of 180 days (Sectbn 106.4.4 Unifonn BuikJing Code). APPLICANT'S SIGNATURE DATE Inspection List Permit* CB152452 Type: DEMO BROWN RES - DEMO POOL NO GRADING PERMIT OR SOILS REPORT Date Inspection Item Inspector Act Comments 08/10/2015 19 Final Structural PY AP 08/10/2015 59 Final Pool - Rl POOL DEMO 08/04/2015 11 Ftg/Foundation/Piers PY AP 08/04/2015 54 Pre-Site - Rl PRE-CON INSPECTION Tuesday, August 11, 2015 Page 1 of 1 Ax CITY OF CARLSBAD STORM WATER COMPLIANCE ASSESSMENT B-24 Development Services Building Division 1635 FaradayAvenue 760-602-2719 www.carlsbadca.sov I am applying to the City of Carlsbad for the following type{s) of construction permit: • Building Permit • Right-of-Way Permit • My project is categorically EXEMPT from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it only requires issuance of one or more of the following permit types: Electrical Fire Additional Fire Alarm Fixed Systems Mechanical Mobile Home Plumbing Patio/Deck Photo Voltaic Re-Roofmg Sign Spa-Factory Sprinkler Water Discharge Project Storm Water Threat Assessment Criteria'' No Threat Assessment Criteria • My project qualifies as NO THREAT and Is exempt from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it meets the "no threaf assessment criteria on the City's Project Threat Assessment Worksheet for Determination of Construction SWPPP Tier Level. My project does not meet any of the High, Moderate or Low Threat criteria described below. Tierl • Low Threat Assessment Criteria My project does not meet any of the Significant or Moderate Threat criteria, is not an exempt pennit type (See list above) and the project meets one or more of the following criteria: • Results in some soil disturbance: and/or • Includes outdoor construction activities (such as saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling). r/er 2 - Moderate Threat Assessment Criteria • My project does not meet any of the Significant Threat assessment Criteria described below and meets one or more of the following criteria: • Project requires a grading plan pursuantto the Carlsbad Grading Ordinance (Chapter 15.16 ofthe Carlsbad Municipal Code); or, • Project will result in 2,500 square feet 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: • Located within 200 feet 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 feet 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 through April 30). Tier 3 • Significant Threat Assessment Criteria • My project includes clearing, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas: and/or • My project is part of a phased development plan that will cumulatively result in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, refueling and maintenance areas: or, • My project is located inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant potential for contributing pollutants to nearby receiving waters by way ot storm water runoff or non-storm water discharge(s). / certify to the best of my knowledge that the above checked statements are true and correct. I understand and acknowledge that even though this project does not require preparation of a construction SWPP, I must still adhere to, and at all times during construction activities for the permit type(s) check above comply with the storm water best management practices pursuant to Title 15 ofthe Carlsbad Municipal Code and to City Standards. •The City Engineer may authorize minor variances from the Storni Water Threat Assessment Criteria in special circumstances where it can be shown that a lesser or higher Constmction SWPPP Tier Level is wan'anted. Project Address: Assessor Parcel No. Owner/Owner's Authorized Agent Name: Title: OwrierlOm^r'^i^^^i Agent Signature: Date: City Concurrence: By: Date: • YES DNO Project ID: B-24 Page 1 of 1 Rev.03/09 CITY OF CARLSBAD CONSTRUCTION THREAT ASSESSMENT WORKSHEET FOR DETERMINATION OF PROJECT'S PERCEIVED THREAT TO STORM WATER QUALITY E-33 Development Services Land Development Engineering 1635 FaradayAvenue 760-602-2750 www.carlsbadca.gov Construction SWPPP Tier Level Construction Threat Assessment Criteria* Perceived Threat to Storm Water Quality Tiers Tier 3 - Hiati Construction Ttireat Assessment Criteria O Project site is 50 acres or more and grading will occur during the rainy season • Project site is 1 acre or more in size and is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA • Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kf greater than or equal to 0.4) • Site slope is 5 to 1 or steeper • Construction is initiated during the rainy season or will extend into the rainy season (Oct 1 through April 30). • Owner/contractor received a Storm Water Notice of Violation within past two years High Tiers Tier 3 - Medium Construction Threat Assessment Criteria Medium Tiers • All projects not meeting Tier 3 High Construction Threat Assessment Criteria Medium Tier 2 Tier 2 Hiah Construction Threat Assessment Criteria • Project is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA • Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kf greater than or equal to 0.4) • Site slope is 5 to 1 or steeper • Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). • Owner/contractor received a Storm Water Notice of Violation within past two years • Site results in one half acre or more of soil disturbance High Tier 2 Tier 2 - Medium Construction Threat Assessment Criteria Medium Tier 2 • All projects not meeting Tier 2 High Construction Threat Assessment Criteria Medium Tierl Tier 1 - Medium Inspection Threat Assessment Criteria Medium Tierl • Project is located within the Buena Vista or Agua Hedionda Lagoon watershed, within or directly adjacent to an environmentally sensitive area (ESA) or discharges directly to an ESA • Soil at site is moderately to highly erosive (defined as having a predominance of soils with USDA-NRCS Erosion factors kf greater than or equal to 0.4) • Site slope is 5 to 1 or steeper • Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 through April 30). • Owner/contractor received a Storm Water Notice of Violation within past two years • Site results in one half acre or more of soil disturbance Medium Tierl Tier 1 - Low Insoection Threat Assessment Criteria 8^ All projects not meeting Tier 1 Medium Construction Threat Assessment Criteria Low Exempt - Not Applicable -Exempt *The city engineer may authorize minor variances from the construction threat assessment criteria in special circumstances where it can be shown that a lesser or higher amount of stomi water compliance inspection is warranted in the opinion of the city engineer E-33 Page 1 of 1 REV 4/30/10 CITY OF CARLSBAD STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Land Development Engineering 1635 FaradayAvenue 760-602-2750 www.carlsbadca.gov INSTRUCTIONS: To address post-development pollutants that may be generated from development projects, the City requires that new development and significant redevelopment priority projects incorporate Permanent Storm Water Best Management Practices (BMP's) into the project design per the City's Standard Urban Stormwater Management Plan (SUSMP). To view the SUSMP, refer to the Engineering Standards (Volume 4, Chapter 2) at www.carisbadca.aov/standards. Initially this questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary pennits and/or construction permits). The results of the questionnaire determine the level of stonn water standards that must be applied to a proposed development or redevelopment project. Depending on the outcome, your project will either be subject to 'Standard Stomiwater Requirements' or be subject to additional criteria called 'Priority Development Project Requirements'. Many aspects of project site design are dependent upon the storni water standards applied to a project. Your responses to the questionnaire represent an initial assessment of the proposed project conditions and impacts. City staff has responsibility for making the final assessment after submission of the development application. If staff determines that the questionnaire was incorrectly filled out and is subject to more stringent stonn water standards than initially assessed by you, this will result in the return ofthe development application as incomplete. In this case, please make the changes to the questionnaire and resubmit to the City. If you are unsure about the meaning of a question or need help in detennining how to respond to one or more of the questions, please seek assistance from Land Development Engineering staff. A separate completed and signed questionnaire must be submitted for each new development application submission. Only one completed and signed questionnaire is required when multiple development applications for the same project are submitted concurrently. In addition to this questionnaire, you must also complete, sign and submit a Project Threat Assessment Form with construction permits for the project. Please start by completing Step 1 and follow/ the instructions. When completed, sign the form at the end and submit this with your application to the city, STEP1 TO BE COMPLETED FOR ALL PROJECTS To determine if your project is a priority development project, please answer the following questions: YES NO 1. Is your project LIMITED TO constructing new or retrofitting paved sidewalks, bicycle lanes or trails that meet the following criteria: (1) Designed and constructed to direct storm water runoff to adjacent vegetated areas, or other non-erodible permeable areas; OR (2) designed and constructed to be hydraulically disconnected from paved streets or roads; OR (3) designed and constructed with permeable pavements or surfaces in accordance with USEPA Green Streets guidance? y 2. Is your project LIMITED TO retrofitting or redeveloping existing paved alleys, streets, or roads that are designed and constructed in accordance with the USEPA Green Streets guidance? y If you answered "yes" to one or more of the above questions, then your project is NOT a priority development project and therefore is NOT subject to the storm water criteria required for priority development projects. Go to step 4, mark the last box stating "my project does not meet PDP requirements" and complete applicant information. If you answered "no" to both questions, then go to Step 2. E-34 Page 1 of 3 Effective 6/27/13 STORM WATER Development Services Land Development Engineering STANDARDS Development Services Land Development Engineering ^ CITY OF CARLSBAD QUESTIONNAIRE E-34 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov To determine if your project is a priority development project, please answer the following questions: YES NO 1. Is your project a new development that creates 10,000 square feet or more of impervious surfaces collectively over the entire project site? This includes commercial, industrial, residential, mixed-use, and public development projects on public or private land. K 2. Is your project creating or replacing 5,000 square feet or more of impervious surface collectively over the entire project site on an existing site of 10,000 square feet or more of impervious surface? This includes commerciai, industrial, residential, mixed-use, and public development projects on public or private land. 3. Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious surface collectively over the entire project site and supports a restaurant? A restaurant is a facility that sells prepared foods and drinks for consumption, including stationary lunch counters and refreshment stands selling prepared foods and drinks for immediate consumption. Y 4. Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious surface collectively over the entire project site and supports a hillside development project? A hillside development project includes development on any natural slope that is twenty-five percent or greater 5. Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious surface collectively over the entire project site and supports a parking lot. A parking lot is a land area or facility for the temporary pari<ing or storage of motor vehicles used personally for business or for commerce. V 6. Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious surface collectively over the entire project site and supports a street, road, highway freeway or driveway? A street, road, highway, freeway or driveway is any paved impen/ious surface used for the transportation of automobiles, trucks, motorcycles, and other vehicles. y 7. Is your project a new or redevelopment project that creates or replaces 2,500 square feet or more of impervious surface collectively over the entire site, and discharges directly to an Environmentally Sensitive Area (ESA)? "Discharging Directly to" includes flow that is conveyed overiand a distance of 200 feet or less from the project to the ESA, or conveyed in a pipe or open channel any distance as an isolated flow from the project to the ESA (i.e. not commingles with flows from adjacent lands).* V 8. Is your project a new development that supports an automotive repair shop? An automotive repair shop is a facility that is categorized in any one of the following Standard Industrial Classification (SIC) codes: 5013, 5014, 5541, 7532-7534, or 7536-7539. 9. Is your project a new development that supports a retail gasoline outlet (RGO)? This category includes RGO's that meet the foliowing criteria: (a) 5,000 square feet or more or (b) a project Average Daily Traffic (ADT) of 100 or more vehicles per day. 10. Is your project a new or redevelopment project that results in the disturbance of one or more acres of land and are expected to generate pollutants post construction? Y 11.1s your project located within 200 feet of the Pacific Ocean and (1) creates 2,500 square feet or more of impervious surface or (2) increases impervious surface on the property by more than 10%? If you answered "yes" to one or more of the above questions, you ARE a priority development project and are therefore subject to implementing structural Best Management Practices (BMP's) in addition to implementing Standard Stomi Water Requirements such as source control and low impact development BMP's. A Storni Water Management Plan (SWMP) must be submitted with your application(s) for development. Go to step 3 for redevelopment projects. For new projects, go to step 4 at the end of this questionnaire, check the "my project meets PDP requirements" box and complete applicant information. If you answered "no" to all of the above questions, you ARE NOT a priority development project and are therefore subject to implementing only Standard Storm Water Requirements such as source control and low impact development BMP's required for all development projects. A Stonn Water Management Plan (SWMP) is not required with your application(s) for development Go to step 4 at the end of this questionnaire, check the "my project does not meet PDP requirements" box and complete applicant information. E-34 Page 2 of 3 Effective 6/27/13 CITY OF CARLSBAD STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Land Development Engineering 1635 FaradayAvenue 760-602-2750 www.carlsbadca.gov TO BE COMPLETED FOR REDEVELOPMENT PROJECTS THAT ARE PRIORITY DEVELOPEMENT PROJECTS ONLY Complete the questions below regarding your redevelopment project: YES NO Does the redevelopment project result in the creation or replacement of impervious surface in an amount of less than 50% ofthe surface area ofthe previously existing development? Ifyou answered "yes," the structural BMP's required for Priority Development Projects apply only to the creation or replacement of impervious surface and not the entire development. Go to step 4, check the "my project meets PDP requirements" box and complete applicant information. If you answered "no," the structural BMP's required for Priority Development Projects apply to the entire development. Go to step 4, check the "my project meets PDP requirements" box and complete applicant information. CHECK THE APPROPRIATE BOX AND COMPLETE APPLICANT INFORMATION • My project meets PRIORITY DEVELOPMENT PROJECT (PDP) requirements and must comply with additional stonnwater criteria per the SUSMP and I understand I must prepare a Storm Water Management Plan for submittal at time of application. I understand flow control (hydromodification) requirements may apply to my project Refer to SUSMP for details. 3 My project does not meet PDP requirements and must only comply with STANDARD STORMWATER REQUIREMENTS per the SUSMP. As part of these requirements, I will incorporate low impact development strategies throughout my project. Applicant Information and Signature Box Address: Applicant Name: Applicant Signature: Accessor's Parcel Number(s): Applicant Title: Date: This Box for City Use Only City Concurrence: YES NO By: Date: Project ID: * Environmentally Sensitive Areas include but are not limited to all Clean Water Act Section 303(d) impaired water bodies; areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); water bodies designated with the RARE beneficial use by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); areas designated as preserves or their quivalent under the Multi Species Conservation Program within the Cities and County of San Diego; and any other equivalent environmentally sensitive areas which have been identified by the Copermittees. E-34 Page 3 of 3 Effective 6/27/13 CITY OF CARLSBAD STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP E-29 Development Services Land Development Engineering 1635 FaradayAvenue 760-602-2750 www.carlsbadca.gov STORM WATER COMPLIANCE CERTIFICATE 1^ My project is not in a category of permit types exempt from fhe Construction SWPPP requirements My project is not located inside or within 200 feet of an environmentally sensitive area with a significant potential for contributing poiiutants to nearby receiving waters by way of storm water runoff or non-storm water disGharge(s). My project does not require a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 ofthe Carlsbad Municipal Code) My project will not result in 2,500 square feet or more of soils disturbance including any associated constmction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas that meets one or more ofthe additional following criteria: • located within 200 feet 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 feef 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 through April 30). I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT ALL OF THE ABOVE CHECKED STATEMENTS ARE TRUE AND CORRECT. I AM SUBMITTING FOR CITY APPROVAL A TIER 1 CONSTRUCTION SWPPP PREPARED IN ACCORDANCE WITH THE REQUIREMENTS OF CITY STANDARDS. I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO MINIMIZE THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO MINIMIZE 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. O^NER(S)/OWNER'SflAGENT NAME (PRINT) 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 SATISFACTION OF THE CITY ENGINEER AFTER EACH RUN-OFF PRODUCING RAINFALL 3. THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY ENGINEERING OR BUILDING INSPECTOR DUE TO UNCOMPLETED GRADING OPEFIATIONS 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 PERCENT (40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER EACH RAINFALL. 5. ALL GRAVEL BAGS SHALL BE BURLAP TYPE WITH 3/4 INCH MINIMUM AGGREGATE. 6. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. SPECIAL NOTES PROJECT INFORMATION Site Address:PV(0 <gaR.(aQS Assessor's Parcel Number: Project ID: Constmction Permit No.: Estimated Construction Start Date Project Duration Months Emergency Contact: Name: 145^6 HOAJ^T 24 hour Phone: Perceived Threat to Stonrn Water Quality Q Medium H^Low If medium box is checked, must attach a site plan sheet showing proposed wodc area and location of proposed structural BMPs For City Use Only CITY OF CARLSBAD STANDARD TIER 1 SWPPP Approved By: _ Date: E-29 Page 1 of 3 REV 4/30/10 Erosion Control BMPs Sediment Control BMPs Tracking Control BMPs Non-Storm Water Management BMPs Waste Management and Materials Pollution Control BMPs Best Management Practice (BMP) Description -> Geotextiles & Mats Wood Mulching Earth Dikes and Drainage Swales Slope Drains Silt Fence Sediment Trap Check Dam Fiber Rolls Gravel Bag Berm street Sweeping and Vacuuming Sandbag Barrier Storm Drain Inlet Protection Stabilized Construction Ingress/Egress Stabilized Construction Roadway Water Conservation Practices Paving and Grinding Ooerations Potable Water/Irrigation Vehicle and Equipment Cleanina Material Delivery and Stnrane Material Use Stockpile Management Spill Prevention and Cnntrnl Solid Waste Manaaement Hazardous Waste Mananement Concrete Waste Manaaement CASQA Designation -> Construction Activity EC-7 EC-8 EC-9 EC-11 SE-1 SE-3 SE-4 SE-5 SE-6 SE-7 SE-8 SE-10 TR-1 TR-2 NS-1 NS-3 NS-7 NS-8 WM-1 WM-2 WM-3 WM-4 WM-5 WM-6 WM-8 Grading/Soil Disturbance X Trenching/Excavation Stockpiling Drilling/Boring Concrete/Asphalt Saw cutting Concrete flatworic Paving Conduit/Pipe Installation Stucco/Mortar Woric Waste Disposal Staging/Lay Down Area Equipment Maintenance and Fueling Hazardous Substance Use/Storage Dewatering Site Access Across Dirt Other (list): Instructions: Begin by reviewing the list of constmction activities and checking the box to the left of any activity that will occur during the proposed construction. Add any other activity descriptions in the blank activity description boxes provided for that purpose and place a check in the box immediately to the left of the added activity description. For each activity descmbed, pick one or more best management practices (BMPs) from the list located along the fop of the fonn. Then place an X in fhe box af fhe place where the activity row intersects with the BMP column. Do this for each activity thaf was checked off and for each ofthe selected BMPs selected from the lisf. For Example - Ifthe projecf includes sife access across dirt, then check fhe box to the left of "Sife Access Across Dirt". Then review fhe list for something that applies such as "Stabilized Constmction Ingress/Egress" under Tracking Control. Follow along the "Site Access Across Dirt" row until you get fo the "Stabilized Constmcfion Ingress/Egress" column and place an X in the box where the two meet. As another example say the project included a stockpile thaf you intend to cover with a plasfic sheet. Since plasfic sheeting is nof on fhe list of BMPs, then write in "Cover wifh Plastic" in fhe blank column under fhe heading Erosion Confrol BMPs. Then place an X in the box where fhe "Stockpiling" row intersects the new "Cover with Plastic" column. To leam more about what each BMP descripfion means, you may vwsh fo review fhe BMP Reference Handout prepared to assist applicants in fhe selection of appropriate Best Management Practice measures. The reference also explains fhe Califomia Stomiwater Quality Association (CASQA) designafion and how fo apply the various selected BMPs fo a projecf. E-29 Page 2 of 3 REV 4/30/10 PRINT ON 11X17 Carlsbad Comrnunity & Economic Development Site Plan for Pools & Retaining Walls 1\8 inch scale shown A.P.N SiteAddress: 2H (O -^^OGCS CT. CJ^^f^^, OA. StateLic.#: /^V27^ Phone: ^(^O ^QS'2'<X^ Phone: ^^Q HIZ-^^^'^'^O Legal Description: Contractor's Name ^OtOfc Owner's Name 4-^f<ArtON> \^/ZO^t^ Address: ^cf^p ^M^CoS CT rMCSG^^ CvA Site Plan Checklist • Dimensioned & to scale Shown: • North Arrow • All existing and proposed structures • Legal description • Property lines dimensions • Drainage patterns • Existing & proposed slopes • Slope cross section • Distance from pool to property lines and all structures • Distance- house to water's edge • Distance- pool heater to P/L and any operable window • Length, width & sq. ft. of pool • Existing topography and pool's distance from toe/top of slopi • Easements • Pool fencing w/height & gate compliance noted 6 • Will a ROW permit be required? -S-4ndicate what will happen w/ soil excavated For Retair)ing Walls Add: • Wall heights at ends of walls or at any change in height. TW=top of wall, BW=bottom of wall. • Cross-section of wall stating wall height above and below grade • Grading quantities: Cut Fill_ Import/Export The discharge of pollutants to any storm drainage system is prohibited. No solid waste, petroleum byproducts, soil particulate, construction waste materials, or waste water generated on construction site or by construction activities shall be placed, conveyed or disctiarged into the street, gutter or storm drain system. This project shall comply with the 2013 CA Building Code, 2013 CA Mechanical Code, 2013CAglumbina Code, 2013 CA Electrical laJLc/tyf