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Home My WebLink About2520 LA COSTA AVE; ; CB122611; Permitr ., . ~27-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Residential Permit Permit No: CB122611 Building Inspection Request Line (760) 602-2725 Job Address: . Permit Type: 2520 LA COSTA AV CBAD RESDNTL Sub Type: RAD Lot#: 0 Constuction Type; 58 Reference #: Status: ISSUED Applied: 12/06/2012 Entered By: LSM Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: 2163600200 . $34,833.00 0 0 Structure Type: Bathrooms: O Orig PC#: Plan Approved: 12/27/2012 Issued: 12/27/2012 Inspect Area: Plan Check #: Project Title: CHRISTIAN RES-289 SF BASEMENT REMODEL TO ADD NEW BEDROOM AND BATH, 317 SF REMODEL OF 1ST FLOOR KITCHEN Applicant: TERRY MONTELLO 4715 60TH ST SAN DIEGO CA 92115 619-994-5557 . Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Plan Check Discount Strong Motion Fee Park in Lieu Fee Park Fee LFM Fee Bridge Fee Other Brrdge Fee STD #2 Fee BTD #3 Fee Renewal Fee Add'I Renewal Fee Other Building Fee HMP Fee Pot. Water Con. Fee Meter Size Add'I Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Green Bldg Stands Plan Chk Fee $344.57 $0.00 $241.20 $0.00 $0.00 $3.48 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $0.00 Total Fees: $720.61 Total Payments to Date: Owner: CHRISTIAN CARRIE & KELLIS 2520 LA COSTA AVE CARLSBAD CA 92009 760-445-4789 MeterSize . Add'I Reel. Water Con. Fee Meter Fee SDCWA Fee CFO Payoff Fee PFF (3105540) PFF (4305540) License Tax (3104193) License Tax (4304193) Traffic. Impact Fee (3105541) Traffic Impact Fee (4305541) Sidewalk Fee PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAt. TOTAL Housing Impact Fe:ie Housing lnLieu Fee Housing Credit Fee Master Drainage Fee Sewer Fee Additional Fees Fire Sprinkler Fees TOTALPERMIT FEES $720.61 Balance Due: F. NAL APPROVAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.00 $41.00 $44.36 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $720.61 $0.00 Inspector: 7·12--13 Clearance: _____ _ NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." 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. ___ ___J /). THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: ENGINEERING OFIRE DHEALTH 0HAZMAT/APCD «~ Building Permit Applicatiofl 1635 Faraday Ave., Garlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: billldlng@carlsbadca.gov www.carlsbadca.gov Plan Check No. ~ l ~ ?<a l I '¥ CITY OF Est. Value S CARLSBAD JOB ADDRESS SUITE#/SPACE#/UNIT# CT/PROJECT# OCC. GROUP EXISTINQ USE PATIOS,(SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES D #_ NO D YES D NO D YES D NO D APPLICANT NAME (Primary Contact) A_l'PLICANT NAME (Secondary Contact) STATE ZIP FAX EMAIL (Sec. 7031.5 Business and·Prc>fessions Code: Any City or County which requires a permit to construct, alter, improve, demolish oi repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement ttiat 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} or that he 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)). · Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following dec/arafons: Cl I have and will maintain a certificate of consentto self.insure for workers' compensation as pro viced by Section 3700 of the Labor Code, for-the performance of the work for which this perm it is issued. I ve and will maintain wo . rs' c pensa io as required by S t~n 3700 of the bor Code, for the performance of the work for which thiS,P_ei"]~t~~Aue~yt:".orkers' compensati ins nee carrier and policy number are: insurance Co,;_.,...--'-'--=4-"-----1'--'"""--'-'-'-"'~~.-----Policy No. '"1 t;,OOC;itl) ~ :J f ~piralion Date_-.._..--.--+----,-.,---- This section need not be completed if the permit is for one hundred dollars ($100) or less. . CJ Certificate of Exemption: I certify thatin lhll,l'lellifflTTIIIN"'-Of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to workers' compens coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compens 1On, • provided f in Section 3706 of the Labor code, interest and attorney's fees. ,,I$ CONTRACTORSIGNATUR I hereby affirm that I am-exempt from Contractor's Ucense Law for the following reason:' 1:1 i, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himseff or through his own employees, provided that such improvements are not intended or offered for sale. I( 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). Cl 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 pu~uant to the Contractor's License Law), Cl I am exempt under Section ____ Business and Professions Code for tlils reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Cl Yes Cl No 2. I (have I have not) signed an application for a l,luilding permit for the proposed work. -3.1 have contracted with the following person (firm) to provide the proposed construction (include name address I phone/ contractors' license number): 4. I plan to provide portions of the work, bull have hired the following person to coordinate, supervise and provide the major work (include name I 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 (include name I address I phone I type of work): ,,I$ f'ROPERTY OWNER SIGNATURE C:JAGENT DATE 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? CJ Yes CJ No · Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? CJ Yes CJ No Is the facility to lie constructed wlthin 1,000 feet of the outer boundary of a school site? CJ Yes CJ No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED lfNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT, I certify that! have read the application and state th.jtthe above Information Is correct and that the Information on the plans is accurate. I agree to comply with all City orclim!nces and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property kJr, inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE Cl1Y OF CARLSBAD AGAINST ALL LIABILITIES, JUDGME , EXPENSES WHICH MAY IN ANY WAYACCRUEAGAINST SAID Cl1Y IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is · xcavations over D' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every pe · ISSUed b ui ing Officia nder the provisions of this CQde shall expire by imitation and become null and void if the building or oolk authorized by such permit is not commenced v.ithin 180 days from the date o uch permit if uilding o 1k authorized by such permit is suspended or abandoned at any time after the oolk is commenced fo a period of days (Section 106.4.4 Uniform Building Code). DATE t· Inspection List Permit#: CB122611 Type: RESDNTL RAD Dat~ Inspection Item !nspector 07/10/2013 89 Final Combo 07110/2013 89 Final Combo PB 07/02/2013 19 Final Structural 07i02/2013 19 Final Structural PY 05/17/2013 17 Interior L.athlDrywall PB 04/29/2013 18 Exterior Lath/Drywall PB 04/23/2013 17 Interior Lath/Drywall PB 04/16/2013 16 Insulation PB 04711/2013 84 Rough Combo PB 04/08/2013 84 Rough Combo PB 04/05/2013 13 Shear Panels/HD's PB 02/12/2013 11 Ftg/Foundation/Piers PB 02/12/2013 21 Underground/Under Floor PB Thursday, July 11, 2013 Act RI AP RI CA AP AP· AP CA AP co AP AP AP CHRISTIAN RES-289 SF BASEMENT REMODEi-TO ADD NEW B!=DROOM AND Comments. Page 1 of 1 RJS Inspection & Material Testing P.O. Box 2450, Alpine, CA 91903 Ph. 619-540-0612 FAX 619-445-5889 SPECIAL INSPECTION REPORT Project: Christian residence Address: .2520 La Costa Ave City: Carlsbad,. CA Permit Number: CB122611 ----------------------------- Plan File Number: ---------"----~-~-------------- TYPE OF OBSERVATIONS: Reinforcini Steel __ Reinforced Concrete __ Structural Masonry __ Field Welding __ Epoxy_!_ Prestressed Concrete-._ Shop Welding __ Boltin_g __ Wedge Anchors __ Number of Samples___ Type:~· _____________________ _ Materials/DesignMix/Psi., Simpson Set XP ICC ER-2508 ( exp. 08/13) . Date: 4-2-13 REPORT Epo:xy Procedure: Verified holes are clean, dry, right size & depth. At north basement wall, inspected (18) 5/8" threaded rod anchors in 3/4" holes, embedded 5", with Simpson Set XP ICC ER-2508. Work is per . dytail 2/SDI & Shear wall schedule, note #10, of approved plans. WORK INSPECTED CONFORMS WITH APPROVED PLANS AND SPECIFICATIONS UNLESS OTHERWISE NOTED Clayton A. Jongetjes 815 TIME lN 1:30 TIME OUT ----- Inspector (Print) Certification# General Contractor: Marrokal Const. -·~~~ Address: ---------------Inspector's Signature City-. _______________ _ Phone: 760-535-8805 DATE: DEC. 21, 2012 JURISDICTION: CARLSBAD PLAN CHECK NO.: 12-2611 EsGil Corporation In Q'artnersli.ip witli. government for (}Jui(aing Safety SET: III PROJECT ADDRESS: 2520 tA COSTA AVENUE PROJECT NAME: SFR REMODEL FOR CHRISTIAN D _>PPLICANT 12f"JURIS. D PLAN REVIEWER D FILE ~ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: Terry Montello 4715 60th St., S.D., CA 92115 ~ EsGil Corporation staff did not advise the applicant that the plan check has been completed. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Terry Telephone#: 760-445-4789 Date contacted: (by: ) Email: permits@cox.net Fax #: Mail Telephone Fax In Person D REMARKS: By: ALI SADRE EsGil Corporation D GA D EJ D PC 12/19 Enclosures: 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 '' DATE.: DEC. 17, 2012 JURISDICTION: CARLSBAD PLAN CHECK NO,: 12-2611 EsGH C-orporation In (l'artner~liip witli government for 0ui{aing Safety SET: II . PROJECT ADDRESS: 2520 LA COSTA AVENUE PROJECT NAME: SFR REMODEL FOR CHRISTIAN l:l APPLICANT _)YJURIS. l:l PLAN REVIEWER Q Fl~E D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. · D. The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies 'identified on the enclosed check list .and should be corrected and resubmitted for a complete recheck. [Zl The check list transmitted herewith is for your information. The plans are being held at Esgil· Corporation until corrected plans are submitted for recheck. PLEASE SEE BELOW · D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check. list has ·been sent to: Terry Montello 4715 60t~ St, S.D., CA 92115 EsGil Corporation staff did not advise the applicant that the plan check has been completed. EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Terry Telephone#: 760-445-4789 Date contacted: (by: ) Email: permits@cox.net Fax #: Mail Telephon~ 'Fax In Person [Zl REMARKS: £1}: Submit struo.tural oalo's; tm: On Sht. A-9, revise plumbing note #1, to state 1.28 gal/flush for W/C; ttID: On A-5, show kitchen outlets @4'o.c.; tt.41:. On Sht. S-2, identify Pad A. [Submit 2-sets of revised, stamped & signed plans to the city for review & approval]. Structural calc's. were provided under this submittal. By: ALl SADRE EsGil Corporation tJ GA O EJ O PC Enclosures: 12/14 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 DATE: DEC. 13,2012 JURISDICTION: CARLSBAD PLAN CHECK NO.: 12-2611 EsGil Corporation In <Partnersliip witli government for (JJuiCaing Safety SET:I PROJECT ADDRESS; 2520 LA COSTA AVENUE PROJECT NAME: SFR REMODEL FOR CHRISTIAN 1:1 APPLICANT )tf JURIS. 1:1 PLAN REVIEWER 1:1 FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitte·d herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. ~ The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. PLEASE SEE BELOW D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. ~ The applicant's copy of the check list has been sent to: Terry Montello 4715 60th St., S.D., CA 92115 D EsGil Corporation staff did not advise the applicant that the plan check has been completed. lZ] EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Terry Telephone#: 760-445-4789 Date contacted: (by: ) Email: permits@cox.net Fax #: Mail Telephone Fax In Person ~ REMARKS: 1tl}: Submit structural calc's; tm: On Sht. A-6, revise plumbing note #1, to state 1.28 gal/flush for W/C; rn: .on A-5, show kitchen outlets @ 4'o.c.; tM}: On Sht. S-2, identify Pad A. [Submit 2-sets of revised, stamped & signed plans to the city for review & approval]. By: ALI SADRE EsGil Corporation D GA D EJ D PC Enclosures: 12/10 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 ' T [DO NOT PAY -THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: CARLSBAD PREPARED BY: ALI SADRE PLAN CHECK NO.: 12-2611 DATE: DEC. 13, 2012 BUILDING ADDRESS: 2520 LA COSTA AVENUE BUILDING OCCUPANCY: R3/U BUILDING PORTION remodel -- Air Conditioning Fire Sprinklers '. TOTAL VALUE Jurisdi.ction Code cb Bldg. Permit Fee by Ordinance Plan Check Fee by Ordinance Type of Review: D Repetitive Fee -,..] Rep~ats Comments: 0 AREA Valuation ( Sq. Ft.) Multiplier 606 By Ordinan·ce Complete Review D Other 0 Hourly EsGil Fee TYPE OF CONSTRUCTION: V-B Reg. VALUE Mod. D Structural Only ----IHr.@• ($) 34,833. $344.571 $223.971 $192.961 Sheet 1 of 1 macvalue.doc + ~ «--~~ . ¥ CITY OF CARLSBAD PLAN C·HECK REVIEW TRANS MITT AL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www.carlsbadca.gov DATE: 12/11 /12 PROJECT .NAME:Christian· Residence PROJECT ID: PLAN CHECK NO: CB12-2611 SET#: I ADDRESS: 2520 La Costa Av APN: 216-360-02 VALUATION: $34,833 .-You may have corrections from one or more of the divisions listed in the table below This plan check review tra_nsmittal is to notify you of clearance by: . LAND DEVELOPMENT ENGINEERING DIVISION Final Inspection by the Construction & Inspection DivisiQn is required: Yes n No ~ D ~ For status from a division not marked below, please call 760-602-2719 This plan check review is NOT COMPLETE. Items-missing or :incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check Comments have been sent to: I,· 0 ., n~·· ,.PLANNING r . JIJ LAND DEVELOPMENT ·EN<i;: _ ~·-~--. _:. ·_7,6~02-4610_ .. ,, . . . :~ . . _____ ?~~-~~~:~~~!~~;,,,_ .. _:::_; ; -Fl~E :PR;EVENTl'()f;J' · ·, 1 . · . . >1-so':G.02-.4665 . . . ': ·. I r--, Chris Sexton I . l_j 760-602-4624 Chris.Sexton@car!sbadc~.gov n Gina Ruiz ,.__; 760-602-4675 Gina.Ruiz@carlsbadca.gov · \ f-j Kathleen Lawrence JI_; 760-602-~7 41 I , Kathleen.Lawrence@carlsbadca.gov i IXI Linda Ontiveros i 760-602-2773 1 Linda.Ontiveros@carlsbadca.gov ,' ', 1, --·-,•' .. r--i Greg Ryan . L_ 760-602-4663 Gregory. Ryan@cerlsbadca.gov ; .--, . I ! -· -Cindy Wong 760-602-4662 Cynthia.Wong@carlsbadca.gov Remarks: interior only --no expansion of footprint/soil disturbance i ~ ~ CITY OF CARLSBAD BUILDING PLANCHECK CHECKLIST QUICK-CHECK/APPROVAL Development Services Land Development Engineering 1635 Faraday Avenue 760-602~2750 www.carlsbadca.gov ENGINEERING Plan Check for CB12-2611 Date: 12/11/12 P . t Add 2520 La Costa Av .APN·. 216-360-02 roJec ress: Project Description: 289 sf basement floor remodel and Valuation: $34,833 317 sf first floor remodel in existing kitchen ENGINEERING contact: Linda Ontiveros Phone: 760-602-2773 GZ] RESIDENTIAL 0 RESIDENTIAL ADDITION MINOR ( <$20,000.00) 0 CARLSBAD PREMIER OUTLETS OOTHER: Email: linda.ontiveros@carlsbadca.gov Fax: 760-602-1052 OTENANTIMPROVEMENT 0 PLAZA CAMINO REAL 0 COMPLETE OFFICE BUILDING r .. -··-· ~ .. .,.._. ··-.. -.. --.. -.. -.. -.. -.. -... -.. -.. -.. -.. -.. -... -;··· ,, . . OFFICIAL l,ISE ONl Y .. · ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT · I . . I . I . .. I . . I I .. I BY: DATE;: 12/11,/12 REMARKS: interior cmly --no .expansion of footprint/so.ii djsturbance . I , . ·I .I . . I -I I -I I -I I -I I --1 I _,1 I~ l'I ---I 1,_ I I -I I'•-I I~ I I ...... I I -1'1 _, I jj -I I"-I.,,...:... I ---I I E-36 Page 1 of 1 REV 4/30/11 .«,~ ~:CITY OF CARLSBAD PLANNING DIVISION BUILDING PLAN CHECK APPROVAL P-29 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.e:ov . DATE: 12/6/12 PROJECT NAME: KITCHEN/BEDROOM/BATHROOM REMODEL PROJECT ID: Pt.AN CHECK NO: CB122611 SET#: ADDRESS: 2520 LA COSTA AV APN: lZ] This plan check review is complete and has been APPROVED by the PLANNING Division. By: GINA RUIZ A Final Inspection by the PLANNING Division i~ required D Yes !ZI No You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. D This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check APPROVAL has been sent to: PERMITS@COX.NET For questions or clarifications on the ·attached checklist please contact the following reviewer as marked: "" ' " -.FIRE :PREVENTtON. ., · Pl.ANN.ING ENGINEERING-" 760•602-4610 760-602-2750 760°602-4665 ,, . D i D D Chris Sexton Kathleen Lawrence G~eg Ryan 760-602-4624 760-602-27 41 760-602-4663 Chris.Sexton@carl~badca.gov Kathleen.Lawrence@carlsbadca.gov Gregory.Ryan@carlsbadca.gov " 0 Gina Ruiz D Linda Ontiveros D Cindy Wong 760-602-4675 760-602-2773 760-602-4662 · Gina.Ruiz@carlsbadca.gov Linda.Ontiveros@carlsbadca.gov Cynthia.Wong@carlsbadca.gov \ D D D Dominic Fieri 760-602-4664 Dominic.Fieri@carlsbadca.gov Remarks: CB122611 2520 LA COST"AV CHRISTIAN RFS-?f\!=l SF RASFMFNT ,~, (p I l""L ib ~ c...A-u / tS;\&-I {SSc.,.-\ L wt!:.~ c.~c:....:', \L[~ !12.., ~ -f:v ~ CJCV Flnallnsp. Approved Date By BUILDING 12--I 2--t lf7_ AS PLANNING J1_Jr~/ I Z.. ;,..,,, ( 1-{ \\ I I l.. ~@., A:.--. l ~,,,,,f fY . , 2/ i <+ 1 , z_ ~ P(tu-o @ r-e,, fl-ri / 10 w JP E~1n L21 d-., I J"Z.-,~~u.lM) ENGINEERING 1'7.... I 11 //-z.,, l-10 FIRE Expedite? y N ' AFS Checked by: HazMat APCD Health Forms/Fees Sent Rec'd Due? By Encina y N Fire y N HazHealthAPCD y N PE&M IZ..I tt, I l'Z .... y N School • . y N Sewer • y N Stormwater y N Special Inspection y N CFD: y N LandUse: Density: lmpArea: FY: Annex: Factor: -PFF: y' ( N) Comments Date Date Date Date Building \ 21 I'~ IL-ft,/ 1711~ Planning Engineering Fire Need? a Done aoone - l;JDone - aoone t> .:,.. aoone SW a Issued -