HomeMy WebLinkAbout2867 CAMINO SERBAL; ; CB000253; PermitV
02/23/2000
City of Carlsbad
Mobile Home Building Permit Permit No: CB000253
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
2867 CAMINO SERBAL CBAD
MOHO
2552811500
$0.00
0
0
Sub Type:
Lot#:
Construction Type:
Reference #:
Structure Type:
Bathrooms:
LA COSTA VLLY-SHELBOURNE
INSTALL Status: ISSUED
544 Applied: 01/27/2000
NEW Entered By: JM
Plan Approved: 02/23/2000
Issued: 02/23/2000
0 Inspect Area:
Applicant:
DAVIDSON BUILDERS
1302 CAMINO DEL MAR
DEL MAR CA92014
858 259-8500
Total Fees: $140.00
tWfFUFU&LyDfeMOO
^mtWSr '
RLSW4L<l2/23/00 OOOi 01 02
$0.00 BHnke Due: $140.00
*."'
Mobile Home Issuance F
Earthquake Bracing Fee
Coach Setup Fee
Cabana/Ranada Fee
Private Garage Fee
Awning/Carport Fee
Porch Fee
Fence Over 6ft
Other Building Fee
Building Permit
Plan Check
Park in Lieu Fee
Bridge Fee
Pot. Water Con. Fee
Meter Size
Add'l Pot. Water Con. Fee
Heel. Water Gift.
WfeterSiz* -*•- - "
Add'l Red; Water Con. Fee
CFD Payoff Fee
Fund)
$0.00
$0.00
$0.00
$0.00
Fee
Mechanical Fee
Housing Impact Fee
Housing InLieu Fee
TOTAL PERMIT FEES
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$20.00
$0.00
$0.00
$0.00
$140.00
Inspecto
FINAL APPROVAL
Date: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.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection tees and capactiy
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 qiven a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired.
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
1. PROJECT INFORMATION
FOR OFFICE USE ONLY
PLAN CHECK NO.
Plan Ck. Deposit
Validated By
Date
Name
*. PROPERTY OWNER
U
Name 7 Address City State/Zip Telephone #
6, CfflWimftCTOR• COMPANYNftMi , . •,, ',, , ->, ' -:-' : ; .' •." ' ' . ', '.''"' ""' . ., /.,.,,
(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 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 applicarjlto a civil penalty of not more than five hundred dpllarsj$50_0])._
City Stati
City Business License
Telephone"*
Designer Name
State License tt
Address City State/Zip Telephone
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
[pt 1 have and will maintain a certificate of consent to self-insure for workers^compensation as provided by Section 3700 of the Labor Code, for the performance
of theSwork for which this permit is issued. ^t^E^^O ILZpB^^lLJ^
IJ3, I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My worker's compensation insurance carrier and policy number are: nffouafe.l^. policy NO. R<3°( ll£>4D? yInsurance Company Expiration
(THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
l~l CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as
to become subject to the Workers' Compensation Laws of California. M[r^
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars ($ 1 00,000], inaddltion to the cost of compensation, damages as provided for in Section 3706 of the Laborcode. interest and attorney's fees.
SIGNATURE /X^!^/ja^I> [/ f 'f * (f^/^^- _ DATE
7,
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
n I, as owner of the property or my employees with wages as their^ole compensation, will do the work and the structure is not intended or offered for sale
(Sec. 7044, Business and Professions Code: The Contractor's License^Law does not apply to an owner of property who builds or improves thereon, and who does
such work himself or through his own employees, provided that sucfi 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 tjw burden of proving that he did not build or improve for the purpose of sale).
O 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 or property who builds or improves thereon, and contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License Law).
0 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. f~l YES
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 number / contractors license number):
CffJ 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
'"'number / contractors license number): _ _ ___
5f I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
of work):
DATEPROPERTY OWNER SIGNATURE
COMPLETE THIS SECTION FOR N^N-RESlDENTTAL^ftlCOiNG 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? O YES ''M NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? l~l YES Ql NO
* / 'Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES ofl^ 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.
8, CONSTRUCTION LENDING AGENCY
I hereby affirm that there \i a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
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 representatives of the CitV 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 days from 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 80 days (Section 1 06.4.4 Uniform Building Code).
APPLICANT'S SIGNATURE Y
WHITE: File YELLOW: Applicant PINK: Finance
DATE
City of Carlsbad Bldg Inspection Request
For: 3/17/2000
Permit# CB000253
Title: LA COSTA VLLY-SHELBOURNE
Description:
Inspector Assignment: PD
2867 CAMINO SERBAL
Lot 544
Type: MOHO
Job Address:
Suite:
Location:
APPLICANT DAVIDSON BUILDERS
Owner:
Remarks:
Sub Type: INSTALL
Phone: 7609424330
Inspected
Total Time:
CD Description
79 Final Mobile Home
Act Comments
Requested By: ROBERT
Entered By: CHRISTINE
Associated PCRs
Inspection History
Date Description Act Insp Comments
3/3/2000 22 Sewer/Water Service AP PD
City of Carlsbad
Engineering Department
DATE:
BUILDING A^DR^SS:
BUILDING PLANCHECK CHECKLIST
PLANCHECK NO.:
PROJECT DESCRIPTION:
ASSESSOR'S PARCEL NUMBER:
ENGINEERING DEPARTMENT
APPROVAL
The item you have submitted for review has been
approved. The approval is based on plans,
information and/or specifications provided in your
submittal; therefore any changes to these items after
this date, including field modifications, must be
reviewed by this office to insure continued
conformance with applicable codes. Please review
carefully all comments attached, as failure to comply
with instructions in this report can result in
suspension of permit to build.
Ok Right-of-Way permit is required prior to
construction of the following improvements:
DENIAL
Please se&thex- attached report of deficiencies
marked witJ££Q Make necessary corrections to plans
or specifications for compliance with applicable
codes and standards. Submit corrected plans and/or
specifications to this office for review.
By:
Date:
Date:
FOR OFFICIAL USE ONLY
ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT:
Date:
^-A&JTACHME NTS
D Dedication Application
D Dedication Checklist
D Improvement Application
D Improvement Checklist
D Future Improvement Agreement
D Grading Permit Application
D Grading Submittal Checklist
D Right-of-Way Permit Application
[] Right-of-Way Permit Submittal Checklist
and Information Sheet
D Sewer Fee Information Sheet
ENGINEERING DEPT. CONTACT PERSON
Name: JOANNE JUCHNIEWICZ
City of Carlsbad
CFD INFORMATION
Parcel Map No:
Lots:
Recordation:
Carlsbad Tract:
A-4
, CA 92OO9-^576 • (76O) 438-1161 • FAX (760)
3 A-
BUILDING PLANCHECK CHECKLIST
SITE PLAN
1 . Provide a fully dimensioned site plan drawn to scale. Show:
A. North Arrow
B. Existing & Proposed Structures
C. Existing Street Improvements
2. Show on site plan:
D. Property Lines
E. Easements
Right-of-Way Width & Adjacent Streets
Driveway widths
oerp
'
) Drainage Patterns /^O Cor^ Co^-«_ «Jttc3vA>edf - UA~ 5^ou U
1. Building pad surface drainage must maintain a minimum
percent towards an adjoining street or an approved drainage course.'
2. ADD THE FOLLOWING NOTE: "Finish grade will provide a minimum positive
drainage of 2% to swale 5' away from building." <ZLPpw-eJ)
Existing & Proposed Slopes and Topography Q-Y-Ljifl^* o]cVvS.
3. Include on title sheet:
Site address
Assessor's Parcel Number
. )Legal Description
For commercial/industrial buildings and tenant improvement projects, include:
total building square footage with the square footage for each different use,
existing sewer permits showing square footage of different uses (manufacturing,
warehouse, office, etc.) previously approved.
EXISTING PERMIT NUMBER DESCRIPTION
DISCRETIONARY APPROVAL COMPLIANCE
Q Q Q 4a. Project does not comply with the following Engineering Conditions of approval for
Project No.
Q Q Q 4b. All conditions are in compliance. Date:
H:\WORD\DOCSVCHKlSt\BulHlng PlanehedtCUst BP0001 Form JJ.Soc
BUILDING PLANCHECK CHECKLIST
DEDICATION REQUIREMENTS
5. Dedication for all street Rights-of-Way adjacent to the building site and any storm
drain or utility easements on the building site is required for all new buildings and
for remodels with a value at or exceeding $ , pursuant to Carlsbad
Municipal Code Section 18.40.030.
Dedication required as follows:
Dedication required. Please have a registered Civil Engineer or Land Surveyor
prepare the appropriate legal description together with an 8 Vz" x 11" plat map
and submit with a title report. All easement documents must be approved and
signed by owner(s) prior to issuance of Building Permit. Attached please find an
application form and submittal checklist for the dedication process. Submit the
completed application form with the required checklist items and fees to the
Engineering Department in person. Applications will not be accept by mail or fax.
Dedication completed by: Date:
IMPROVEMENT REQUIREMENTS
6a. All needed public improvements upon and adjacent to the building site must be
constructed at time of building construction whenever the value of the
construction exceeds $_ , pursuant to Carlsbad Municipal Code
Section 18.40.040.
Public improvements required as follows:
Attached please find an application form and submittal checklist for the public
improvement requirements. A registered Civil Engineer must prepare the
appropriate improvement plans and submit them together with the requirements
on the attached checklist to the Engineering Department through a separate plan
check process. The completed application form and the requirements on the
checklist must be submitted in person. Applications by mail or fax are not
accepted. Improvement plans must be approved, appropriate securities posted
and fees paid prior to issuance of building permit.
Improvement Plans signed by: Date:
6b. Construction of the public improvements may be deferred pursuant to Carlsbad
Municipal Code Section 18.40. Please submit a recent property title report or
current grant deed on the property and processing fee of $ so
we may prepare the necessary Future Improvement Agreement. This agreement
must be signed, notarized and approved by the City prior to issuance of a
Building permit.
Future public improvements required as follows:
H:\WORD\DOCS\CHKLST\8ulldlng Plandnck Cklst BP0001 Form JJ.doc
BUILDING PLANCHECK CHECKLIST
0 Q Q
Q Q Q
6c. Enclosed please find your Future Improvement Agreement,
agreement signed and notarized to the Engineering Department.
Future Improvement Agreement completed by:
Date:
Please return
6d. No Public Improvements required. SPECIAL NOTE: Damaged or defective
improvements found adjacent to building site must be repaired to the satisfaction
of the City Inspector prior to occupancy.
Q Q Q
Q Q Q
GRADING PERMIT REQUIREMENTS
The conditions that invoke the need for a grading permit are found in Section
11.06.030 of the Municipal Code.
7a. Inadequate information available on Site Plan to make a determination on grading
requirements. Include accurate grading quantities (cut, fill import, export).
7b. Grading Permit required. A separate grading plan prepared by a registered Civil
Engineer must be submitted together with the completed application form
attached. NOTE: The Grading Permit must be issued and rough grading
approval obtained prior to issuance of a Building Permit.
Grading Inspector sign off by:Date:
7c. Graded Pad Certification required. (Note: Pad certification may be required even
if a grading permit is not required.)
7d.No Grading Permit required.
7e.lf grading is not required, write "No Grading" on plot plan.
MISCELLANEOUS PERMITS
8. A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or
private work adjacent to the public Right-of-Way. Types of work include, but are
not limited to: street improvements, tree trimming, driveway construction, tieing
into public storm drain, sewer and water utilities.
Right-of-Way permit required for: _
BUILDING PLANCHECK CHECKLIST
H:\WORD\DOCS\CHKLST\8uMin8 PUnctwck CUst BP0001 Form JJ.doc A
A SEWER PERMIT is required concurrent with the building permit issuance. The
fee is noted in the fees section on the following page.
10. INDUSTRIAL WASTE PERMIT If your facility is located in the City of Carlsbad
sewer service area, you need to contact the Carlsbad Municipal Water District,
located at 5950 El Camino Real, Carlsbad, CA 92008. District personnel can
provide forms and assistance, and will check to see if your business enterprise is
on the EWA Exempt List. You may telephone (760) 438-2722, extension 153, for
assistance.
Industrial Waste permit accepted by:
Date:
Q Q 11.NPDES PERMIT
Complies with the City's requirements of the National Pollutant Discharge
Elimination System (NPDES) permit. The applicant shall provide best
management practices to reduce surface pollutants to an acceptable level prior to
discharge to sensitive areas. Plans for such improvements shall be approved by
the City Engineer prior to issuance of grading or building permit, whichever
occurs first.
12.uired fees are attached
No fees required
13. Additional Comments:
H:\WORD\DOCS\CHKLSTOuWng Pbncheck CUM BP0001 Form JJ.doc
PLANNING/ENGINEERING APPROVALS
PEPMIT NUMBER CB QQ Q 9 6 3
ADDRESS QS£~7
PATE 3ll/flfl
TENANT IMPROVEMENT
RESIDENTIAL ADDITION MINOR
«$10rOOO.OO)
PLAZA CAMINO REAL
CARLSBAD COMPANY STORES
VILLAGE FAIRE
COMPLETE OFFICE BUILDING
OTHER \Crnp
MANNER DATE \\0o
ENGINEER DATE
GARRETT ENGINEERING ASSOCIATES7612 Bestel Avenue
WESTMINSTER. CALIFORNIA 92683
(714) 893-2979
Project No..
Project:
J&
Designed Bv: L6
Reviewed By:
Dale
Client:
TABLE OF CONTENTS
Page Subject
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Governing Building Code: / / ?/
Design Live Loads:
Construction Materials:£00 <?
Soils & Foundation:/'S /^
NOTICE: Calculations are valid only
whh an authorized signature in i
Thoso calculations contain infornation propriotnry to
Garrott Znginooring Acsociatoo. Thin docuaont or ito
contonto nay not bo reproduced or diocloeod to othoro
without tha prior written consent of Carrott Englnoorlng
Associates. All righto rosorvod.Date:
GARRETT ENGINEERING ASSOCIATES
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9 * ANCHOA FOtlNO^T I
LEUCADIA COUNTY WATER DISTRICT E N T E R E °
APPLICATION FOR SEWER SERVICE DEC 2 7 1999
The application must be signed by the owner (or his representative) of the property ta be. .seeed TheJ
charges must be paid to the District at the time the application is submitted D ' •
APPLICANT MUST SUBMIT EVIDENCE OF BUILDING PERMIT WITHIN 60 DAYS. FAILURE TO MAKE SUCH
SUBMITTAL WILL RESULT IN AUTOMATIC CANCELLATION OF THE SEWER PERMIT. THE SEWER
CONNECTION FEE LESS A $50 ADMINISTRATIVE FEE WILL BE REFUNDED.
A six-month construction period shall be provided and sewer service charges for the balance of the fiscal
year shall be collected at the time of application for sewer permits. Sewer service charges for subsequent fiscal
years shall be collected on the tax roll in same manner as property taxes. If the six-month construction period
extends into the subsequent fiscal year, a prorated sewerservice charge forthat fiscal yearshall be collected on
the tax roll in thesamemanneras property taxes. Thefullsewerservice charges for all subsequent years shall be
collected on the tax roll in the same manner as property taxes. There will be no additional fee or refund if service
actually commences on a different date.
The prorated sewer service charge shall not be required in those application for sewer permits for
subdivisions. Such applicants shall be required to notify the District, on forms provided by the District, of escrow
closing on individual properties within the subdivision. Sewerservice charges shalLeommence upon close of
escrow and will be the responsibility of the buyer.
If a service lateral is required, it must be installed by the owner/applicant in conformance with
the specifications, rules and regulations of the District and subject to inspection by the District
A DISTRICT INSPECTOR MUST BE ON THE SCENE ATTHE TIME OF CONNECTION.
The service lateral is that part of the sewer system that extends from the main collection line in the street
(or easement) to the point in the street (at or near the applicant's property line) where the service lateral is
connected to the applicant* s building sewer. The applicant is also responsible for the construction, at the
applicant's expense, of the building of sewer from the applicant's plumbing to the point in the street (or
easement) where a connection is made to the service lateral and for construction, maintenance and connection
of the service lateral to the main line.
IT MUST BE INSPECTED AND APPROVED BY THE DISTRICT BEFORE THE SEWER SYSTEM MAY BE
USED BY THE APPLICANT. THE APPLICANT, OR HIS AUTHORIZED REPRESENTATIVE MUST NOTIFY THE
DISTRICT AT THE TIME INSPECTION IS DESIRED. ANY CONNECTION MADE TO THE SERVICE LATERAL
OR COLLECTION LINE WITHOUT PRIOR APPROVAL AND INSPECTION BY THE DISTRICT WILL BE CON-
SIDERED INVALID AND WILL NOT BE ACKNOWLEDGED. ALL SUCH CONNECTIONS MUST BE MADE
WITH AN LCWD INSPECTOR ATTHE SCENE ATTHETIMEOFCONNECTION. IF, FOR ANY REASON, ACON-
NECTION IS IMPROPERLY MADE, IT SHALL BE THE RESPONSIBILITY OF THE APPLICANT, AT THE
APPLICANTS EXPENSE, TO DIG UP OR OTHERWISE RE-EXPOSE THE CONNECTION SO THAT AN
INSPECTION MAY BE MADE AND THE APPLICANT AT THE APPLICANTS EXPENSE SHALL MAKE ANY
CORRECTIONS OR ALTERATIONS REQUIRED BY LCWD. IN THE EVENT THAT THE APPLICANT, FOR ANY
REASON, FAILS TO TAKE APPROPRIATE ACTION, THE DISTRICT RESERVES THE RIGHT TO DIG UP AND
INSPECT THE CONNECTION AND MAKE ANY CORRECTIONS NECESSARY, AT THE APPLICANTS
EXPENSE: OR IN THE ALTERNATIVE, TO DISCONNECT SERVICE ANY COSTS INCURRED BY LCWD IN
TAKING SUCH CORRECTIVE ACTION SHALL BE BILLEDTO THE APPLICANT AND MAY BE RECORDED AS
A LIEN AGAINST THE APPLICANTS PROPERTY EQUAL IN PRIORITY TO A TAX LIEN.
OWNER'S NAMF DAVIDSON BUILDERS _ MAILING Anr>RFSSl6133 VENTURA BLVD #1400
PHONE NiJMRFR 818 385 0005 _ _ ENCINO CA 91436 _
SERVICE ADDRFRR PHASE 7 CAMINO SERBAL ARROYO UNIT 3 _ _
TRACT NAMF/NO Village E LOT*various CONNECTION FEE: S 32.560.00 _
ASSESSOR'S PARCEL NO. various _ PRORATED SEWER SERV. FEE: $ _
_ TOTAL S ^?
TYPE/BUILDING __SZD _ #/UNITS J_£L__ PAID BY: D CASH £1 CHECK*
The undersigned hereby agrees that the above information given is correct and agrees to the
conditions as stated
12/22/99 TLM 21833-21842
mer Signature Date Rec'd by Account No.
Ref:15BS.PERMIT1
DAVIDSON
NEIGHBORHOOD "E"
PHASE 7
Lot No.Street No. Street Name
1 043
3 546
H 551
*" 552
b 553
, 554
? 555
t, 556
<» 557
4BR
3AR
3C
1C
3A
2B
4C
3B
4A
255-281-16
255-281-17
255-281-22
255-281-23
255-281-24
255-281-25
255-281-26
255-281-27
255-281-28
2863 —
2859
2839
2844
2848
2852
2856
2860
2864
uammo SerBa^
Camino Serbal
Camino Serbal
Camino Serbal
Camino Serbal
Camino Serbal
Camino Serbal
Camino Serbal
Camino Serbal
.,dLIUENHflIN MUD
9.2000
^
Fax:1-760-753-1578
DEVELOPMENT
Feb 9 '00 9 = 10
NO.941
P. 02
P. 2/2
1S66 Olivenhain Road, Encinitas, CA92Q24-56S9
(780) 753-5466 (760) 753-1578 Fgx No.
Municipal Water District
rcperty Address:camino Serial
WATER METER APPLICATION
For District Use Only;
Carlsbad, CA 92009
255-281-IS
ustomer information:
WrterName: Davidson Builders, Inc.
usineaa Namer _
Address:
Account*
om* Pnone*
wrtc Phone *
ailular/Pager*:
SX35 (855> 259-4644
ir Permanent Metef Installation only:
xial Security *
ivers License #:i :
Fire
Type of 3arvi<. IRRIG. TCM, TIM
5/a \ 11/2
21/2
Fire Meter Size: 1" or 11/2"
No. of Metare;
Meter Access,Chaige:
Fire Meter Access Cfiarga;
Lottfs:
Pressure Zane:Zone of
EDU's /.
Application Taken Sy:
A '
PR1CSS QUOTED ARE SUBJECT TO CHANGS WITHOUT NOTICE
•TER INSTALLATION CHARGE
IS METER INSTALLATION
WD CAPACITY F5E Traated/Radaimed)
J6:PRE-PA1D OMWD CAPACHTY FSES
XS O S
xs
s
X5 '111- '
•Al DISTOCT CAPACITY FEE. J_
* CAPACJTY F5E # XS S_
3JNE EXTENSION REIMBURSEMENT FEE , ^_
I/TIM., ,Size:.
30XJMATE CUBIC YARDS OF EARTH TO BE MOVED? $_
SR,, , i
TOTAL: $ 3 O C> • £> £)
HBY AGREE TO ABIDE BY THE RUUHS AND REGULATIONS OF THE OUVENHAJN MUNICIPAL WATER DISTRICT AND i
RECEIPT OF A COPY OF THESE RULES AND RgGULATlCNS." INSTALLATION OF MET5RS ARE SCHEDULED ACCORDfNG
i DISTRICTS CURRENT WORKLOAD. TGMPaRARV COMSTRUcnaN WETERS Ape FOP. CONSTRUCTION U£C ONLY.
SIGNATUR!
ISO A: WSw
QOOTg3AlN
Municipal Water District
1966 Olivenhain Road, Encinitas, CA 92024-5699
(760) 753-6466 (760) 753-1578 Fax No.
WATER METER APPLICATION
Property Address:6<2e.b^.l
Date:
APN:
Customer Informatio
Owner Name:
Business Name:
Mailing Address:
Account #:
21/2
Home Phone*:
Work Phone #:
Cellular/Pager*:
Fax*:1 "£eW~'6.
For Permanent Meter Installation only:
Social Security #:
Drivers License #:
For District Use Only:
Work Order*
Fire Meter*:
Type of Service
Meter Size: S/8 3/4///T/T1/2
Fh~e Meter Size: t 'or 11/2"
). of Meters:
Meter Access Charge:
Fire Meter Access Charge:
Lot #s:
Pressure Zone:Zone of Benefit:
EDU's
Application Taken By:
A-
PRICES QUOTED ARE SUBJECT TO CHANGE WITHOUT NOTICE
METER INSTALLATION CHARGE #_
FIRE METER INSTALLATION J_
OMWD CAPACITY FEE Treated/Reclaimed) #_
LESS:PRE-PAID OMWD CAPACITY FEES £_
TOTAL DISTRICT CAPACITY FEE
CWA CAPACITY FEE #
X$$
X$
x$
x$$ (
X$$
PIPELINE EXTENSION REIMBURSEMENT FEE _$_
TCM^TIM Size:.../ $
APPROXIMATE CUBIC YARDS OF EARTH TO BE MOVED? $
OTHER $
TOTAL: $
• I HEREBY AGREE TO ABIDE BY THE RULES AND REGULATIONS OF THE OLIVENHAIN MUNICIPAL WATER DISTRICT AND I
AM IN RECEIPT OF A COPY OF THESE RULES AND REGULATIONS." INSTALLATION OF METERS ARE SCHEDULED ACCORDING
TO THE DISTRICTS CURRENT WORKLOAD. TEMPORARY CONSTRUCTION METERS ARE FOR CONSTRUCTION
DATE:oo CHECK*:SIGNATURE:
Revised 3/98 A: Water Meter Application