HomeMy WebLinkAbout2345 MICA RD; ; CBR2020-1447; PermitBuilding Permit Finaled
Residential Permit
Print Date: 12/02/2020
Job Address: 2345 MICA RD, CARLSBAD, CA 92009-1739
Permit Type: BLDG-Residential Work Class:
Parcel#: 2132821200 Track#:
Valuation: $27,766.70 Lot#:
Occupancy Group:
#of Dwelling Units:
Bedrooms:
Bathrooms:
Project Title:
Project#:
Plan#:
Construction Type:
Orig. Plan Check#:
Plan Check#:
Description: 530 SF POOL AND SPA// GAS FOR BBQ AND FIRE PIT
FEE
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
Property Owner:
NOVAK TIBOR AND LAURA
2345 MICA RD
CARLSBAD, CA 92009
ELECTRICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL
PLUMBING BLDG RESIDENTIAL NEW/ADDITION/REMODEL
581473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-RESIDENTIAL
SWPPP INSPECTION FEE TIER 1-Medium BLDG
SWPPP PLAN REVIEW FEE TIER 1-MEDIUM
Pool
Total Fees: $860.45 Total Payments To Date: $860.45
Ccityof
Carlsbad
Permit No: CBR2020-1447
Status:
Applied:
Issued:
Finaled Close Out:
Inspector:
Final Inspection:
Contractor:
PRP AQUATICS INC
Closed -Fina led
07/01/2020
07/28/2020
TAlva
12/02/2020
5431 AVENIDA ENCINAS, # STE B
CARLSBAD, CA 92008-4411
(916) 743-2290
Balance Due:
AMOUNT
$265.20
$185.64
$41.00
$62.00
$2.00
$3.61
$246.00
$55.00
$0.00
Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter
collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these
fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the
protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section
3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their
imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection
fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this
project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the
statute of limitation has previously otherwise expired.
Building Division Page 1 of 1
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov
...
{city of
Carlsbad
Job Address d~4S t-,\ 1CC. 'i}..A.
RESIDENTIAL
BUILDING PERMIT
APPLICATION
8-1
Plan Chee~,. JL/L/ T
Est. Value
PC Deposit ---------
Date ---------
Suite: APN: 'd-13-~'t'>.)..-\'2..--00 ----
CT/Project#: __________________ Lot#: ___ _
Fire Sprinklers: 0 YES O NO Air Conditioning: 0 YES O NO Electrical Panel Upgrade: 0 YES O NO
BRIEF DESCRIPTION OF WORK:
\k, ~ s.e:, 5?o Si ~
0 Addition/New: _____ Living SF, ____ Deck SF, ___ Patio SF, ____ Garage SF
Is this to create an Accessory Dwelling Unit? 0 Y ON New Fireplace? 0 Y O N , if yes how many? __
□Remodel: ____ SF of affected area Is the area a conversion or change of use ?OY ON
~Pool/Spa: J3.) SF Additional Gas or Electrical Features? ~CJ C t/·J ~r ~!?,&-H---'1P\ ~
OSolar: ___ KW, __ Modules, Mounted:ORoof OGround, Tilt:O YO N, RMA: 0 YON,
Battery:OY ON, Panel Upgrade: OY ON
0 Reroof: ______________________________ _
D Plumbing/Mechanical/Electrical Only: ________________________ _
D Other: ________________________________ _
APPLICANT (PRIMARY CONTACT)
Name: ~ r'# a~~
Address: $76 •~11:l" le/\ter Q--(
City: $~ State: Cl\ Zip: g::>.105
Phone: l 1 ~ ~43,5~06
Email: CP-rrie t'\Y'G.)G h1r, \-MA I\ · Cll'V\.
PROPERTY OWNER
Name: ~ 1< Lc.uu:. j-rDvC t,,
Address:7JM"Mt e,t. ~
City: C.,, fl i\t!&>i.-l State: (}'\ Zip: 9 'l.. 'g)~
Phone: ]b~ -~~-b ).~ \
Email: ___________________ _
DESIGN PROFESSIONAL CONTRA~OR BUSINf,$,5 < ~ ~=~~,~~~~
Address: Address: S~ ~• ;( &i ~ l'\hJ
City: ______ State: __ .Zip: ____ City: C&,-f Ulld StateU Zip: ~?-cl$
Phone: Phone: 7bo• 4')b---c,~0£;.
Email: Email:--~~---------------
Architect State License: State License: qqg. I \ ':\ Bus. License: C-W'.:r U\1:
(Sec. 7031.S 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.S 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
3-1 Page 1 of 2 Rev. 06/18
( OPTION A): WORKERS'COMPENSATION DECLARATION:
I hearby affirm under penalty of perjury one of the following declarations: DI 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.
~I have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for e performance of the work for which this permit is issued.
My workers' compensation insurance -;arrier and policy number are: lnsurancfJ CqmJ?i!,!IY Name: "-'""'\-..,,V"-"G'-''""--f--------------
Policy No. Cbb?,Q;] l':)fo ExpiratlonDate:_9"'--'_!..,_l..,_lt_,,.~=----
~rtificate of Exemption: I certify that in the performance of the work for which this permit is issued, t 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 penaftles and civil fines up to $100,000.00, In addition the to the cost of compensation, dama1es as provided for In Section 3706 of the Labor Code,
Interest and attorney's fees.
CONTRACTOR SIGNATURE: _tJ--....__ ___ =----------T~GENT DATE: b\» \ <;:.,
( OPTION B ): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
0 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
himself or through his own employees, provided that such improvements are not intended or offered for sale. 1f, 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).
0 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).
0 I am exempt under Section _______ Business and Professions Code for this reason:
1. l personally plan to provide the major labor and materials for construction of the proposed property improvement. QvES Q 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 propased construction (include name address/ phone/ contractors' license number):
4. l plan to provide portions of the work, but I have hired the following person to coordinate, supeivise and provide the major work (include name/ address/ phone/
contractors' license number):
S. I 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? I Yes / No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Yes / No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes/ No
lF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POUUTION CONTIIOL DISTRICf.
APPLICANT CERTIFICATION:
1 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 CllY OF CARLSBAD AGAINST AU LIABILITIES, JUDGMENTS. COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF
THE GRANTING OFlHIS PERMrT.OSHA: An OSHA permtt is required for excavations over S'O' 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 c.ode 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 180~-CBC section 105.5.
APPLICANT SIGNATURE: --=c..,,,,---:_ ________________ DATE: LI '3~/:io
1635 Faraday Ave Carlsbad, CA 92008
B-1
Ph: 760-602-2719 Fax: 760-602-8558
Page2 of2
Email: Building@carlsbadca.gov
Rev. 06/18
PERMIT INSPECTION HISTORY for {CBR2020-1447)
Permit Type: BLDG-Residential
Work Class: Pool
Application Date: 07/01/2020 Owner: COOWNER NOVAK TIBOR AND LAURA
Issue Date: 07/28/2020 Subdivision:
Status: Closed -Finaled Expiration Date: 05/17/2021 Address: 2345 MICA RD
IVR Number: 27219 CARLSBAD, CA 92009-1739
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Relnspectlon Inspection
Date Start Date Status
12/02/2020 12/02/2020 BLDG-Final Inspection 145135-2020 Passed Tony Alvarado
Checklist Item
BLDG-Plumbing Final
BLDG-Mechanical Final
BLDG-Structural Final
BLDG-Electrical Final
Wednesday, December 2, 2020
COMMENTS
December 2, 2020:
1. lnground shotcrete pool and spa
completed per pool engineer's plans and
detail specifications-approved.
December 2, 2020:
1. lnground shotcrete pool and spa
completed per pool engineer's plans and
detail specifications-approved.
December 2, 2020:
1. lnground shotcrete pool and spa
completed per pool engineer's plans and
detail specifications-approved.
December 2, 2020:
1. lnground shotcrete pool and spa
completed per pool engineer's plans and
detail specifications-approved.
Complete
Passed
Yes
Yes
Yes
Yes
Page 3 of 3
PERMIT INSPECTION HISTORY for (CBR2020-1447)
Permit Type: BLDG-Residential Application Date: 07/01/2020 Owner: COOWNER NOVAK TIBOR AND LAURA
Work Class: Pool Issue Date: 07/28/2020 Subdivision:
Status: Closed -Finaled Expiration Date: 05/17/2021 Address: 2345 MICA RD
IVR Number: 27219 CARLSBAD, CA 92009-1739
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Date
Checklist Item
BLDG-Building Deficiency
Status
COMMENTS
August 27, 2020:
1. Pool reinforcement steel rebar per
engineers plans-Approved.
2. Underground pool plumbing under
test-approved.
3. Underground electrical pool conduit
wiring scope of work-approved.
4. Partial pass for Equipotential Pool bond
wire bonded at four points at Pool
perimeter --approved
BLDG-54 Equipotential 136782-2020 Passed Tony Alvarado
Bond(Pools)
Checklist Item
BLDG-Building Deficiency
BLDG-Building Deficiency
COMMENTS
August 24, 2020:
1. Customer called and cancelled
inspection.
August 27. 2020:
1. Equipotential Pool bond wire at four
points around pool bonded to steel pool
deck-approved.
09/11/2020 09/1112020 BLDG-21 137950-2020 Passed Tim Kersch
Underground/Underflo
or Plumbing
Checklist Item
BLDG-Building Deficiency
COMMENTS
09/3012020 09130/2020 BLDG-54 Equipotential 139621-2020 Passed Tony Alvarado
Bond(Pools)
Checklist Item
BLDG-Building Deficiency
COMMENTS
September 30, 2020: (virtual inspection).
1. Equipotential Pool bond wire below 6
inches finish grade and the new decking at
perimeter of entire pool.
2. Equlpotential Poor bond wire will be
bonded to wrought iron fence which is
less than 5' feet from pool water edge-
approved.
11/18/2020 11118/2020 BLDG-55 144025-2020 Passed Tony Alvarado
Fence/Preplaster
Checklist Item
BLDG-Building Deficiency
Wednesday, December 2, 2020
COMMENTS
November 18. 2020: (Virtual inspection).
1. Inspection for equipotential pool bond
wire, bonded/affixed at four locations at
perimeter pool area-Approved.
Passed
Yes
Complete
Passed
No
Yes
Complete
Passed
Yes
Complete
Passed
Yes
Complete
Passed
Yes
Page 2 of 3
Building Permit Inspection History Finaled
{city of
Carlsbad
PERMIT INSPECTION HISTORY for (CBR2020-1447)
Permit Type: BLDG-Residential
Work Class: Pool
Application Date: 07/01/2020 Owner: COOWNER NOVAK TIBOR AND LAURA
Issue Date: 07/28/2020 Subdivision:
Status: Closed -Finaled Expiration Date: 05/17/2021 Address: 2345 MICA RD
27219 CARLSBAD, CA 92009-1739
Scheduled
Date
0810312020
Actual Inspection Type
Start Date
08103/2020 BLDG-SW-Pre-Con
Checklist Item
IVR Number:
Inspection No.
134459-2020
COMMENTS
Inspection
Status
Passed
Primary Inspector
Tony Alvarado
BLDG-Building Deficiency August 3, 2020:
1. SWPPS/BMPs, all erosion control
measures Intact and in place at all times of
pool construction from beginning to final
pool inspection completed and approved.
2. Inform contractor representative Connor.
08124/2020 08124/2020 BLDG-54 Equlpotentlal 136406-2020 Cancelled Tony Alvarado
08/27/2020
Bond(Poots)
Checklist Item
BLDG-Building Deficiency
COMMENTS
August 24, 2020:
1. Customer called and cancelled
inspection.
08/27/2020 BLDG-51 136957-2020 Passed Tony AIVarado
Excav/Steel(Pools)
Checklist Item
BLDG-Building Deficiency
COMMENTS
August 27, 2020:
1. Pool reinforcement steel rebar per
engineers plans-Approved.
2. Underground pool plumbing under
test-approved,
3. Underground electrical pool conduit
wiring scope of work -approved.
4. Partial pass for Equipotential Pool bond
wire bonded at four points at Pool
perimeter -approved
BLDG-52 Poot Plumbing 136959-2020 Passed Tony Alvarado
Checklist Item
BLDG-Building Deficiency
COMMENTS
August 27, 2020:
1. Pool reinforcement steel rebar per
engineers plans-Approved.
2. Underground pool plumbing under
test-approved.
3. Underground electrical pool conduit
wiring scope of work -approved.
4. Partial pass for Equipotential Pool bond
wire bonded at four points at Pool
perimeter -approved
BLDG-53 136958-2020 Passed Tony Alvaredo
Elec/Condult/Wlring(Po
ols)
Wednesday, December 2, 2020
Reinspection Inspection
Complete
Passed
Yes
Relnspeetlon Incomplete
Passed
No
Complete
Passed
Yes
Complete
Passed
Yes
Complete
Page 1 of 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 SATISFACTION
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 CONS1RUCTION
ACTIVITIES TO THE MAXIMUM EXlENT PRACTICABLE TO AVOID
THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO
AVOID THE EXPOSURE OF STORM WA lER TO CONS1RUCTION
RELAlED POLLUTANTS; ANO (2) ADHERE TO, AND AT ALL TIMES,
COMPLY WITH THIS CITY APPROVED TIER 1 CONS1RUCTION SWPPP
THROUGHOUT THE DURATION OF THE CONS1RUCTION ACTIVITIES
UNTI~E CO. NS1RUCTION WORK IS COMPLElE AND APPROVED
BY E ITY OF CARLSBAD. ,·/;~~-e)
-------······---OWNER(S)/o~'~NT-NllME (PRINT)
OWNER(S
E-29
101"/q
DAlE
. ,.!~
STORfvlWATER c'oMPLIANCE FORM
TIER 1-CONSTRUCTION SWPPP I C;6S~D IL.jLfJ-
' BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE
Erosion Contrpl Sediment Control BMPs Tracking Non-Storm Water Waste Management and Materials BMPs i Control BMPs Management BMPs Pollution Control BMPs
' ,, C: · 6 6 .Q~ ......
• "'O •-•-...., Cl> "'O C o, c: ...., ...., CJ) o E c: Cl) -o 15 o _,.... g g 5 .5 .g, a. o E 6
:::E "'O m i E CJ) L. .!! J::; ~ :.:; -g ..!::: ·5 >. 8, 2
cn c11> ; o. ti; c: .~ c ~rn ~ ~ ·c ~ er hi o § rn 2 Best Management Practice* ~ _..c:c O ~ Cl), _g m "g-~ ~ R ~... ..'? a, {!) 2 w ~ a, a +i -~ _, fg -• • CIJ C/Jv, C: .-E G> ·-_.. _.. a, "'O O "'O Cl> a, :E C: G> c: c 3: c (BMP) Descnpbon ➔ .!! -:::,0 . ~ • ... o ~ ...... 0 ~ g 3: g' CD e co "'O .$ "'O ---5 rn cc ~ 3: 6 Cl :::> Q) ~ 1ii Q)E :::,°' "'E "'E ·-·-a> , ..., c o o m C/l ·-en o •-CD......._ a> _, u Cl> o c, _ _ Q) o cu )C :::E O c,, 0 C Cl) 0:::: E O +' No, NO O ·-G> Q) C O Cl) O ~ L-3C Q) ..g Cl) +' Q) ., " ., E .!it:. -..... ::::, .c Eu :=:rn =3: L:;::::; C1'11:j ::0 -·-,::C1'1 ·c a..e en .,_en Ecn
+' "'O .c,5 Q) Lt..•-0 ._ ~ CD::, "'O ._2 :Ca> ::0-0 G>o .5i... O ,gc we Cl) ti_...., ,:,0 oO oo o 00 tc ~ ...., -o Q) .oG> o Eo c oo els, CJCJ 150 >!?...., .c~ +-'o...., o =c =c: NC cc Cl) 0 '-_, = Cl) .C •-1,.. +-' CJ O +' L +' ...,_, 0 ~ I,.. CJ~ 0 Q)_ O_,.... 0 +-' 0.0 0 0 0 CJ Q 0
(!) 3: wo (I) en en u LL. (!) C/l> u, cna... r.n c ·(/)O:::: ~a.. a..o n.. >O ::EV> :::E en cno cn:::E ::c:::E U:::E
CASQA Designation ➔ ,-.. co o, -;;J-~ ..., v "' ID ,.._ co ~ ~ c-i ~ ..., ,-.. co ~ c-i .., v "' ID co I I I II I I I I I I I I I I I I J, I I I I I I I I UU O Ul WLLJWLLJLLJ WW LLJ Cl) (I) U') ~ :::E ::::!: _,,.-Construction Activity w w w u.Ji en en en en en en en en ~ ~ z z z z ;;:: ;;:: j j -;;:: j j
V Grndinn /Soil Disturbance i 'i.:! < r
~ Tranchinn 'Fxcavation : 1--l, "
~tockoilino ' "
llrilllnn lllorinn 1
' Concrete/ Asohalt Sowcuttina i v
· -t:encrete Flatworl< i • ~
< Pavina , ; -
Conduit/Pioe Installation i
J1:tucco/Mortar Work '
,_, Waste Disoosal v·
Staolnn/Lav Down Area I· '
Eauioment Maintenance and Fuelina l
Hazardous Substance Use/Storaae !
Dewaterina i
Site Access Across Dirt !
Other Wstl: '
Instructions: ,
1. Check the box to the left of all applicable construc~on 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 you intend to use during constructiorj from the list. Check the box where the chosen activity row intersects with the BMP column.
3. Refer to the CASQA construction handbook for info+ation and details of the chosen BMPs and how to apply them to the project.
I
I
Page 1 pf 1
I
PROJECT INFORMATION
Site Address: '()J '-i S" M \ ( Lt Q_ •(
Assessor's Parcel Number: a,·~~ 'd,b1-L)--<i2.>
Emergency Contact:
Name; ____________ _
24 Hour Phone: _________ _
Construction Threat to Storm Water Quality
(Check Box)
0 MEDIUM O LOW .
REV 11/17