HomeMy WebLinkAbout2220 SARA WAY; ; CB962008; Permit6 1 :
f
B U l L
SA A WY P Irr1t Type: -~~~--~ AD[ AL'
Pirc l Nu: 167-540-2l-O
N p E R M I
Suite:
Valuation: 1~,
~up ncy Grou~: Referenc #:
Description: ADD 1 S SF,EXTtND K TCH & FMLY
: ROM UNDER EXIST DECK
L, t#:
I Pt=-rm t N : Pr Ject N : A9bl DF-velopment N{.,:
0779 11105 96 00◊1 01 o:;, C i:'RMT
C nc-+-ruct1 >n Typ t S5U€'D
Statu5
Appl1e
Api:/Issue: Appl; wnx : HENEGAR H MES
161 JERRILYNN PL
ENC?NITA~. CA 92024
Ente:re3 By· RMA 19 4 4-1611
Foe Req,.nred -------------------F es:
A1Justments:
Total Fee ... :
Fee description --------------------Bu1.ld1ng Permit
Plan Check
St1ong Mot1 n Fee
,., BUILr ING TOTAL
94. 01.,
14':l.oo
Ext fee Dat ------------:,44. 00
94.00
1.00
2.39.00
PPROVAL
!NS ?~--11--F-DATE 2-CJ
CL th
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
rf7&J CL APPLICATION PLAN CHECK NO.
City of Carlsbad Building Department
2075 Las Palaas Dr •• Carlsbad., CA 92009 (619) 438-1161
I. PERMII hPR
DATE
From List 1 (see back) give code of Permit-Type: -~R"-"A"D"---------
For Residential Projects Only: From list 2 (see back) give
Code of Structure-Type: ____________________ _
Net Loss/Gain of Dwelling Units __ +~~1~3-S~S~,~f~----------
2. PRCllECT INFORMATION FOR omra tlSJ;:.ONLY
"fflo Sara Way, Carlsbad BuiJdmg or Suite No.
Nearest Cross Street Ce 1 in da Drive
LEGAL DESCRIPIION Lot No. Subd1V1s10.11 r,lall},e/.]'-lumber Lot 30 of Carlsbad Tract ~l-lY no. 1 [MAR Y MONTA°§'i§"] Map 1flil'l'fs'0 "filed 8-20-86
CHECK BEWW IF S0BMII IED:
0 2 Energy Cales Ii 2 Structural Cales □ 2 Soils Report □ l Addressed Envelope
DESCRIPTION OF WORK X en room un . .
to the living space. SQ. Ff. # OF STORIES 1 # OF BEDROOMS / A . # OF BATHROOMS N/ A
3. WN IACI PERSJN (lf daferent from apphcanO
NAME (last name first)
Marvin Henegar,
CI1Y
ADDRESS
1615 Jerrilynn PL.c3 Encinitas 92024 434-1611
STATE ZIP C DE DAY TELEPHONE
or 633-1421
4. APPUU\Nl gfCON IRACIOR OAGENI FORWNIRACIOR DOWNER UAGENI FOR OWNER
NAME (last name first) ADDRESS
~egar Homes, 1615 Jerrilynn P1 1., Enfinitas, CA 92024 434-1611 STATE -Z Y CODI DAY TELEPHONE
Or 633-1421
NAME (last name first) Sokol, Gerald Jr. ADDRESS 2220 Sara Way, Carlsbad, CA 92008
DAY TELEPHONE 930-3010 CI1Y STATE ZIP CODE
NAME (last name first) Henegar Homes
CI1Y Encinitas, STATE CA
STATE IJC. # 187761
ADDRESS 1615 Jerrilynn Pl.
ZIP CODE 92024 DAY TELEPHONE 434-1611 or 633-1421
IJCENSE CLASS B CI1Y BUSINESS IJC. #
DESIGNER ~nE (last name hrst) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE STATE IJC. #
7. Wultk£RS' WMPMSAIION
Workers' Compensation Declaration: I hereby aftlrm that I have a certificate of consent to seif-msure issued by the Director of lndustnal
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY State Fund POIJCY NO. 229-96 EXPIRATION DATE Continuous
Certificate of Exemptmn: I certify that m the performance of the work for which this permit 1s issued, I shall not employ any person m any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. OWNrut-B0llDrut Df!CLAkAIION
□
□
□
Owner-Builder Declaration: I hereby afnrm ilia[ I am exempt from the Confradofs License Law for the iollowmg reason:
I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractor's Llcense Law does not apply to an owner of property who builds
or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended
or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden
of proving that he did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects
with contractor(s) licensed pursuant to the Contractor's License Law).
I am exempt under Section _______ Business and Professions Code for this reason:
(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 Llcense Law (Chapter 9, commencing 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]).
SIGNATIJRE DATE
COMPLEIE IHIS SECIION FOR NON-RESIDEN I !AL BOILblNG PERMIIS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
□YES ONO
ls the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□YES ONO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES ONO
IF ANY OF 1lIB ANSWERS ARE YES, A FINAL CERTIFICATE OF oa:tJPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 IJNUlSS 1lIB APPIJCANT
HAS MET OR IS MEETING 1lIB REQUIREMENTS OF 1lIB OFFICE OF EMERGENCY SERVICES AND 1lIB AIR PO!LlfTION CONTROL DISI1UCT.
9. wNSIROCltuN LHNDING AGENCY
I hereby aihrm that there is a construction lendmg agency for the performance of the work for whtch thts permit 1s ISSUed (Sec 3097(1) C1vH Code).
LENDER'S NAME None LENDER'S ADDRESS
10. APPIJCANI C£ltlfi2ICAIION
I certify that I have read the apphcat1on and state that the aOOve mfonnat1on 1s correct. I agree to comply with ail City ordmances and Stare laws
relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection
purposes. 1 AI.50 AGREE ID SAVE INDEMNIFY AND KEEP HARMLESS 1lIB CTIY OF CARISBAD AGAINST AIL IJABIIITIES, JUDGMENTS, CX>SfS
AND EXPENSES WlDCH MAY IN ANY WAY AaJlUE AGAINST SAID CITY IN CONSEQUENCE OF 1lIB GRANTING OF TIIlS PERMIT.
OSHA: An OSHA permit 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 Ccxle shall expire by limitation and become null and void if the
building or work authorized by such permit is not commenc~ within 365 days from the date of such permit or if the building or work authorized by
such permit is suspended or aban ned at any time afte~ rJ.e work is commenced for a period of 180 days (Section 303(d) Uniform Building Code
APPIJCANT'S SIGNATURE • ,cf.,; DATE: It>~ -
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB962008 FOR 04/30/97
DESCRIPTION: ADD 135 SF,EXTEND KITCH & FMLY
ROOM UNDER EXIST DECK
TYPE: RAD
STE:
INSPECTOR AREA PY
PLANCK# CB962008
OCC GRP
CONSTR. TYPE VN
LOT: JOB ADDRESS: 2220 SARA WY
APPLICANT: HENEGAR HOMES
CONTRACTOR:
PHONE: 619 434-1611
PHONE:
OWNER:
REMARKS: RS/MARVIN/
SPECIAL INSTRUCT:
TOTAL TIME:
CD LVL DESCRIPTION
19 ST Final structural
29 PL Final Plumbing
39 EL Final Electrical
49 ME Final Mechanical
--------------------
--------------------
--------------------
PHONE:
INSPECT
ACT COMMENTS
***** INSPECTION HISTORY*****
DATE
042497
112796
112796
112796
112096
112096
110796
110796
DESCRIPTION
Final Combo
Interior Lath/Drywall
Exterior Lath/Drywall
Gas/Test/Repairs
Frame/Steel/Bolting/Welding
Rough Electric
Ftg/Foundation/Piers
Rough/Topout
ACT INSP
CO PY
AP PY
AP PY
AP PY
AP PY
AP PY
AP PY
AP PY
COMMENTS
ND GFI@ISLND/SMK ALRM PR CODE
OK TO INSULATE & DW
EsGil Corporation
Professional Plan rJ/,!view 'E.ngineers
DATE: 11/5/96
JURISDICTION: Carlsbad
PLAN CHECK NO.: 96-2008 SET: II
PROJECT ADDRESS: 2220 Sara Way
PROJECT NAME: Sokol Residential Addition
□ APPLICANT
□ JURIS. □ FIRE
□ PLAN REVIEWER
□ 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:
D 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: Marvin Henegar
Date contacted: 11/5/96 (by: CM) Telephone#: in person
■ REMARKS: Applicant to hand carry plans to the city.
By: CHUCK MENDENHALL
Esgil Corporation
0 GA O CM O EJ O PC walk in
Enclosures:
trnsmtl.dot
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (619) 560-1468 ♦ Fax (619) 560-1576
""
EsGil Corporation
Professiona{ Pfan ~view 'Engine,rs
DATE: 10/29/96
JURISDICTION: Carlsbad
PLAN CHECK NO.: 96-2008 SET:I
PROJECT ADDRESS: 2220 Sara Way
PROJECT NAME: Sokol Residential Addition
~ 0 .Q.....!.UBIS._ □ FIRE
□ PLAN REVIEWER
□ FILE
D The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's ••••••••••• codes.
■ The remarks below are transmitted herewith 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.
■ The applicant's copy of the remarks has been sent to:
Marvin Henegar
1615 Jerrilynn Pl., Encinitas, CA 92024
■ Esgil Corporation staff did not advise the applicant (except by mail) that the plan check has
been completed.
D Esgil Corporation staff did advise the applicant that the plan check has been completed.
■ REMARKS: 1. Note on the plans that smoke detectors will be provided inside all existing bed
rms, in the corridor providing access to the bed rms and at the top and bottom of the stairs. 2.
The design shows the bending moment in the new GLB is 14.42 K-Ft. Assuming the existing
floor and roof are supported by this beam the load is 960 #/ft. The moment should be 23.5K-Ft.
for a 14' span. Revise the calc's to include all loads on this beam. 3. Show on the plans the
shear walls as indicated in the design calc's. 4. Provide a foundation plan that shows all new
and existing footings and the location of the hold downs as required by the calc's. 5. Submit
complete energy design calc's to show compliance with the state energy stds. 6. Imprint on the
plans the signed energy form CF-1 R
By: CHUCK MENDENHALL
Esgil Corporation
0 GA O CM O EJ O PC 10/21/96
Enclosures:
trnsmtl.dot
9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (619) 560-1468 ♦ Fax (619) 560-1576
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad
PREPARED BY: CM
BUILDING ADDRESS: 2220 Sara Way
PLAN CHECK NO.: 96-2008
DATE: 10/29/96
BUILDING OCCUPANCY: R3 TYPE OF CONSTRUCTION: VN
BUILDING PORTION BUILDING AREA VALUATION VALUE
(ft. 2) MULTIPLIER ($)
Addition 138 94 12,972
Air Conditioning
Fire Sprinklers
TOTAL VALUE 12,972
■ 1991 UBC Building Permit Fee □ Bldg. Permit Fee by ordinance: $ 144.00
■ 1994 UBC Plan Check Fee □ Plan Check Fee by ordinance: $ 93.60
Type of Review: ■ Complete Review □ Structural Only □ Hourly
□ Repetitive Fee Applicable □ Other:
Esgil Plan Review Fee: $ 74.88
Comments:
Fire Services Review:
□ FireAlarm
□ Complete Review
□ Other:
Esgil Fire Services Review Fee:
Comments:
□ Suppression System
$
Sheet 1 of 1
macvalue.doc 5196
City of Carlsbad
■ #el· 11,144 41,1· 1·24·61 I; ,,14 ,Ii
I I BUILDING PLANCHECK CHECKLIST
DATE: 11 'i 19 I:, PLANCHECK NO.:
BUILDING Ao'DRfss: :2} 2. 0 Sar0,, i.Jy
PROJECT DESCRIPTION: _ _._R'""'e,_.5'--'-."""'a=M=~..___7 _____________ _
ASSESSOR'S PARCEL NUMBER: I(, 7-'0/0 ~ 2Z.. EST. VALUE: 1-Z , 61 o
CTS"I • '' J,;,-L ut JO ,-.,.,,_P '01IS'fi-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.
D A Right-of-Way permit is required prior to
construction of the following improvements:
ATTACHMENTS
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
D Right-of-Way Permit Submittal Checklist
and Information Sheet
D Sewer Fee Information Sheet
' Please ~ee he attached report of deficiencies
marked h . ake necessary corrections to plans
or speci , ,ons for compliance with applicable
codes and standards. Submit corrected plans and/or
specifications to this office for review.
DENIAL pw6' z_>,f-"I
By: Q.J<_,, Date: -'='----=--
By: Date: --------
By: ________ Date:
ENGINEERING DEPT. CONTACT PERSON
Name: David Rick
City of Carlsbad
Address: 2075 Las Palmas Dr .. Carlsbad, CA 92009
Phone: (619) 438-1161, ext. 4324
A-4
\\LASPAt.M,\S\SYS\LIBAARY\ENG\WOllO\DOC5'CHKLST\IMlllng PIMchack Cllllt Bl"0001 F-DR.doc ftev.8121189
2075 Las Palmas Dr. • Carlsbad, CA 92009-1576 • (619) 438-1161 • FAX (619) 438-0894
□
BUILDING PLANCHECK CHECKLIST
SITE PLAN
1. Provide a fully dimensioned site plan drawn to scale. Show:
Q North Arrow / <---6. Property Lines Ea110R10Rls
VS Existing & Proposed Structures ,.4. Easements f,J,, 1 e J ~.,_.,,,.
lf:i\ Existing Street lmprovements✓O-. Right-of-Way Width & Adjacent Streets v ~~
2. Show on site plan:
Drainage Patterns U5 e w,o . ..J 1
Existing & Proposed Slopes 51-io,,.I
Existing Topography
t<:> ,,cf;c,,te d,'re<-1'~"
Sloft..S •~ pr-/f'rlJ.
3. Include note: "Surface water to be directed away from the building foundation at
a 2% gradient for no less than 5' or 2/3 the distance to the property line
(whichever is less)." [Per 1985 UBC 2907(d)5]
On graded sites, the top of any exterior foundation shall extend above the
elevation of the street gutter at point of discharge or the inlet of an approved
drainage device a minimum of 12 inches plus two percent." [Per 1990 UBC
2907(d)5]
4. Include on title sheet:
./;._ Site address
B. Assessor's Parcel Number
✓C. 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
Page 1 of 4
H:\WORO\OOCS\CHKLS'T\Buikfng ~ C1dlt BP0001 Form OR.doc RIIV. 81211118
□
□? □
BUILDING PLANCHECK CHECKLIST
DISCRETIONARY APPROVAL COMPLIANCE
5. Project does not comply with the following Engineering Conditions of approval
for Project No .. ______________________ _
Conditions were complied with by: ________ _ Date: ___ _
DEDICATION REQUIREMENTS
6. 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 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 ½" 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. Provide the
completed application form and the requirements on the checklist at the time of
resubmittal.
Dedication completed by: ___________ _ Date: ____ _
IMPROVEMENT REQUIREMENTS
7a. 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 Code Section 18.40.040.
Public improvements required as follows: _____________ _
Please have a registered Civil Engineer prepare appropriate improvement plans
and submit them together with the requirements on the attached checklist for a
separate plancheck process through the Engineering Department. Improvement
plans must be approved, appropriate securities posted and fees paid prior to
issuance of permit.
Attached please find an application form and submittal checklist for the public
improvement requirements. Provide the completed application form and the
requirements on the checklist at the time of resubmittal.
Improvement Plans signed by: _________ _ Date: ___ _
Page 2 of 4
H:\WORD\DOCS\CHKLS'T\Blilcing ~ Cld9I: Bfl0001 Form OR.doc ...... 8121I08
□ □ □
□ □ □
□ □
□ □ □
□ □
BUILDING PLANCHECK CHECKLIST
7b. Construction of the public improvements may be deferred pursuant to 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:
Improvement Plans signed by: Date: ----------
7c. Enclosed please find your Future Improvement Agreement. Please return
agreement signed and notarized to the Engineering Department.
Future Improvement Agreement completed by:
Date:
7d. 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.
GRADING PERMIT REQUIREMENTS
The conditions that invoke the need for a grading permit are found in Section
11.06.030 of the Municipal Code.
Ba. Inadequate information
grading requirements.
export).
available on Site Plan to make a determination on
Include accurate grading quantities (cut, fill import,
Sb. 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:
Be. No Grading Permit required.
Page 3 of 4
H:\WORD\DOCS'laiKLST\Buiklng P11ncMc11 Cldll 8P0001 Form DR.doc Rev. 8121/N
□
□
□
BUILDING PLANCHECK CHECKLIST
MISCELLANEOUS PERMITS
9. 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, trees, driveways, tieing into public storm
drain, sewer and water utilities.
Right-of-Way permit required for:
A separate Right-of-Way permit issued by the Engineering Department is
required for the following:
10. A SEWER PERMIT is required concurrent with the building permit issuance. The
fee is noted in the fees section on the following page.
11. INDUSTRIAL WASTE PERMIT is required. Applicant must complete Industrial
Waste Permit Application Form and submit for City approval prior to issuance of
a Permit.
Industrial Waste permit accepted by:
Date:
12. 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.
Page 4 of 4
H:\WORO\DOCS\CHKLST\Buiking Pllncl-.ck Cldlt BP0001 Form OR.doc Rav.1121118
~ ~ ~ D D D
; N ~ " " ,! ,! ,! • • • ~ ~ ~ u u u
C C C m .. IE a: "-
F{J_ □ □
PLANNING DEPARTMENT
BUILDING PLAN CHECK REVIEW CHECKLIST
Plan Check No. CB C/6-J-008 Address M~ JARA WAy
Planner Jd. p; 5 heJL Phone (61 9) 438-1161, extension ___ _
APN: /61-'S°L/0-~;L
Type of Project and Use: -~M~~_;+,_o~;</~/~..s:~'b~;e:: _____________ _
Zone: R,.-A-fO,(J)rJ-@_ Facilities Management Zone: _..::. ____________ _
CFD lin/,wt)#
Circ(Q;/. (If property in, complete SPECIAL TAX CALCULATION WORKSHEET provided by Building
Department.)
Legend
~ Item Complete
D Item Incomplete -Needs your action
Environmental Review Required: YES __ NO J_ TYPE ___ _
DATF_.£F COMPLETION:-~.------
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval
Discretionary Action Required: YES __ NO 2 TYPE ____ _
APPROVAL/RESO. NO. _____ DATE ___ _
PROJECT NO. _______ _
OTHER RELATED CASES: ___________________ _
Compliance with conditions or approval? If not, state conditions which require action.
Conditions of Approval
Coastal Zone Assessment/Compliance
Project site located in Coastal Zone? YES
If NO, proceed with checklist; if YES, proceed below.
NO ✓
Determine status (Exempt or Coastal Permit Required):
If Exempt, proceed with checklist; if Coastal Permit required, hold building permit until Coastal
Permit issued.
Coastal Permit Determination Form already completed? YES NO
If NO, complete Coastal Permit Determination Form now.
Coastal Permit Determination Log #:
Follow-Up Actions:
1) Stamp Building Plans as "Exempt" or "Coastal Permit Required" (at minimum
Floor Plans).
2) Attach completed Coastal Permit Determination Form to this Checklist.
3) Complete Coastal Permit Determination Log as needed.
$□□
~□□ (]' □ □ Cf D □
□□□
lnclusionary Housing Fee required: YES __ NO ~
(Effective date of lnclusionary Housing Ordinance -May 21, 1993.)
.Site Plan:
1. Provide a fully dimensional site plan drawn to scale. Show: North arrow,
property lines, easements, existing and proposed structures, streets, existing
street improvements, right-of-way width, dimensional setbacks and existing
topographical lines.
2. Provide legal description of property and assessor's parcel number.
Zoning:
1 . Setbacks:
Front: Required 2--z,o' Shown 60'
Int. Side: Required Shown /c..-'
Street Side: Required -Shown
Rear: Required rv· Shown Jr,,,
• .?-'/Cl% 2. Lot Coverage: Required = !; <10¾ Shown
3. Height: Required L.. '30' Shown .± ;J..I
4. Parking: Spaces Required L Shown J
Guest Spaces Required Shown
Additional Comments J,/r!N ( ----~--~-----------------