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Home My WebLink About2912 CORTE JARDIN; ; CBR2022-1293; PermitBuilding Permit Finaled Residential Permit Print Date: 11/17/2022 Job Address: 2912 CORTE JARDIN, CARLSBAD, CA 92009-9253 Permit Type: BLDG-Residential Work Class: Parcel#: 2551445800 Track#: Valuation: $0.00 Lot #: Occupancy Group: #of Dwelling Units: Bedrooms: Bathrooms: Occupant Load: Code Edition: Sprinkled: Project Title: Project#: Plan#: Construction Type: Orig. Plan Check #: Plan Check #: Description: 2912 CORTE JARDIN; NEW POOL/SPA (565 SF) FEE BUILDING PLAN REVIEW -MINOR PROJECTS (LDE) BUILDING PLAN REVIEW -MINOR PROJECTS (PLN) SB1473 -GREEN BUILDING STATE STANDARDS FEE SWIMMING POOL -RESIDENTIAL SWPPP INSPECTION FEE TIER 1 -Medium BLDG SWPPP PLAN REVIEW FEE TIER 1 -Medium Pool Tot al Fees: $856.00 Total Payments To Date: $856.00 {cityof Carlsbad Permit No: CBR2022-1293 Status: Closed -Finaled Applied: 04/14/2022 Issued: 05/18/2022 Fina led Close Out: 11/17/2022 Final Inspection: 11/09/2022 INSPECTOR: Dreibelbis, Pet er Balance Due: Kersch, Tim Alvarado, Tony AMOUNT $194.00 $98.00 $1.00 $228.00 $271.00 $64.00 $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 fi le the protest and any other required information with the City Manager for processing in accordance wit h Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action t o attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to prot est 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 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov ,; RESIDENTIAL (_ Cicy Of BUILDING PERMIT Plan CheckC»llL D-Z!-12'23 Est. Value b7 ~ 0~0 a£ Carlstiad APPL1cAT10N RECf=I IE B-1 PC Deposit .!:-==::::~:__ ___ _ Date BRIEF DESCRIPTION OF WORK: Swimming Pool, Spa, Landscaping □ New SF : Living SF, ____ Deck SF,. ___ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? O Y O N New Fireplace? O YON, if yes how many? ___ _ D Remodel: _____ SF of affected area Is the area a conversion or change of use? O YO N [iD Pool/Spa:._5_6_5 ___ SF Additional Gas or Electrical Features? BBQ ------------ □ Solar: ___ KW,. ___ Modules, Mounted:ORoof OGround, Tilt: 0 YON, RMA: 0 YO N, Battery:OYC N, Panel Upgrade: Ov ON Other: PRIMARY APPLICANT Name: Stephen Redford Address: 941 Pearl Dr City: San Marcos State:._C_A __ Zip: 92078 Phone: 760-613-4171 Email: stephen@pelicanoutdoordesign.com DESIGN PROFESSIONAL PROPERTY OWNER Name: Daniel Reitz Address:2912 Corte Jardin City: Carlsbad Phone: 562-895-5871 Email: kumu.reitz@gmail.com :§~~R\~~~ State: CA Zip: 92009 ·--- Name:. _________________ Business Name: _______________ _ Address: Address: ________________ _ City: Clty: ______ State:. __ __ Phone: Phone: ______ --:::::_.,..:;;;.. ________ _ Email: Email=---~~--------------- ______ Class:. ______ _ Carlsb uslness License# (Required): _______ _ APPLICANT CERT/RCA TION: I certify that I have read the application and state that the above Information Is correct and that the information of the plans is accurate. I agree to comply with all City ordinances and State laws relating to bullding construction. NAME(PRINT): Stephen Redford SIGN:~ DATE: 04/11/2022 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442•339-2719 Email: Buildlng@carlsbadca.gov REV. 04122 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. IF THE PERSON SIGNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: I herebyaf firm under penalty of perjury that I am licensedunder provisions of Chapter9 (commencingwith Section 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations {CHOOSE ONE): 01 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 penmit is Issued. Policy No. _________________________________________ _ -OR- DI have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this penmit is issued. My workers' compensation insurance carrier and policy number are: Insurance Company Name:-----------------------• Polley No. __________________________ Expiration Date:----------------• -OR- D 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. WARNING: Failure to secure workers compensation covera1e Is unlawful and shall subject an employer to criminal penalties 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. 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: _____________________ _ CONTRACTOR CERTIFICATION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and utllltles/utlllty easements. All proposed modifications and/or additions are clearly labeled on the site plan. Any potentially existing detail within these plans Inconsistent with the ~te plan are not approved for construction and may be required to be altered or removed. The city's approval of the application Is based on the premise that the submitted documents and plans show the correct dimensions of; the property, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities. The existing and proposed use of each building as stated Is true and correct; all easements and other encumbrances to development have been accurately shown and labeled as well as all on-site grading/site preparation. All Improvements existing on the property were completed In accordance with all regulations in existence at the time of their construction, unless otherwise noted. NAME (PRINT): _________ SIGNATURE: __________ DATE: ______ _ Note: If the person sl9ntn1 above Is an authori1ed asent for the contract Id tter of authorl1atlon on contractor letterhead. -OR- (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: D 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. 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). -OR-'VI 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The ~tractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) lice nsed pursuant to the Contractor's License Law). -OR- DI am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, 0 FORM B-61 "OWner Bullder Acknowledgement and Verification Form" is required for any permit issued to a property owner. By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the Improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder If it has not been constructed In Its entirety by licensed contractors./ understand that a copy af the applicable law, Section 7044 of the Business and Prof esslons Code, Is avail ab/ e upon request when this application Is submitted or at the fol/owing Web site: http:I!www.leglnfo.ca.gov/ca/aw.html. OWNER CERTIFICATION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and utilities/utility easements. All proposed modifications and/or additions are clearly labeled on the site plan. Any potentially existing detail within these plans inconsistent with the site plan are not approved for construction and may be required to be altered or removed. The city's approval of the application Is based on the premise that the submitted documents and plans show the correct dimensions of; the property, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities. The existing and proposed use of each building as stated Is true and correct; all easements and other encumbrances to development have been accurately shown and labeled as well as all on-site grading/site preparation. All Improvements existing on the property were completed In accordance with all regulations in existence at the time of their constr. tion, unless otherwise noted. NAME (PRINT): SIGN: DATE: __ '(_/, .... , l_-i-_1..-__ Note: If the erson sl nin above Is an authorized a ent for the ro ner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov 2 REV. 04/22 PERMIT INSPECTION HISTORY for (CBR2022-1293) Permit Type: BLDG-Residential Work Class: Pool Status: Closed -Finaled Scheduled Actual Inspection Type Date Start Date BLDG-Final Inspection Checklist Item Application Date: 04/14/2022 Owner: CO-OWNERS REITZ DANIEL AND CLARISSA REITZ Issue Date: 05/18/2022 Subdivision: CARLSBAD TCT#83-16 UNIT#02 AMENDED MAP Expiration Date: 04/25/2023 Address: 2912 CORTE JARDIN CARLSBAD, CA 92009-9253 IVR Number: 39993 Inspection No. Inspection Primary Inspector Reinspection Inspection Status 195051-2022 Cancelled Tim Kersch Reinspection Incomplete COMMENTS Passed BLDG-Building Deficiency No BLDG-Plumbing Final No BLDG-Mechanical Final No BLDG-Structural Final No BLDG-Electrical Final No 11/09/2022 11/09/2022 BLDG-Final Inspection 196233-2022 Passed Tony Alvarado Complete Checklist Item COMMENTS Passed BLDG-Plumbing Final Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes Thursday, November 17, 2022 Page 2 of 2 Building Permit Inspection History Finaled {city of Carlsbad PERMIT INSPECTION HISTORY for (CBR2022-1293) Permit Type: BLDG-Residential Application Date: 04/14/2022 Owner: CO-OWNERS REITZ DANIEL AND CLARISSA REITZ Work Class : Pool Issue Date: 05/18/2022 Subdivision: CARLSBAD TCT#83-16 UNIT#02 AMENDED MAP Status: Closed -Finaled Expiration Date: 04/25/2023 Address: 2912 CORTE JARDIN IVR Number: 39993 CARLSBAD, CA 92009-9253 Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection Date Start Date Status 05/19/2022 05/19/2022 BLDG-SW-Pre-Con 183102-2022 Passed Tony Alvarado Complete Checklist Item COMMENTS Passed BLDG-Building Deficiency May 19, 2022: Yes 1. Discussed with Pool Contractor Stephen-preconstruction meeting requirements, SWPPPs erosion control measures, in-place and intact at all times. 06/06/2022 06/06/2022 BLDG-51 184181-2022 Passed Tim Kersch Complete Excav/Steel(Pools) Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes BLDG-54 Equipotential 184180-2022 Passed Tim Kersch Complete Bond(Pools) 07/28/2022 07/28/2022 BLDG-23 187943-2022 Passed Peter Dreibelbis Complete Gas/Test/Repairs Checklist Item COMMENTS Passed BLDG-Building Deficiency No BLDG-31 187999-2022 Passed Peter Dreibelbis Complete Underground/Conduit - Wiring Checklist Item COMMENTS Passed BLDG-Building Deficiency No 09/09/2022 09/09/2022 BLDG-54 Equipotential 191288-2022 Passed Tony Alvarado Complete Bond(Pools) Checklist Item COMMENTS Passed BLDG-Building Deficiency Rear yard slab concrete decking steel Yes reinforcement rebar bonded to new equipotential pool bond wiring, also at all perimeter locations at pool and spa areas-approved. 10/27/2022 10/27/2022 BLDG-55 195052-2022 Passed Tim Kersch Complete Fence/Preplaster Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes Thursday, November 17, 2022 Page 1 of 2 { City of Carlsbad OWNER-BUILDER ACKNOWLEDGEMENT FORM B-61 Development Services Building Division 1635 Faraday Avenue 442-339-2719 www.carlsbadca.gov OWNER-BUILDER ACKNOWLEDGMENT FORM Pursuant to State of California Health and Safety Code Section 19825-19829 To: Property Owner An application for construction permit(s) has been submitted in your name listing you as the owner-builder of the property located at: Site Address _ _.;...'Vlf ____ -'-Z.. _ _..,C"-'.oaa....;_/1..--'1"1::'""",......~-'':fi.~A:?..__.0'-'l....,.N....,._ _____________ _ The City of Carlsbad ("City") is providing you with this Owner-Builder Acknowledgment and Verification form to inform you of the responsibilities and the possible risks associated with typical construction activities issued in your name as the Owner-Builder. The City will not Issue a construction permit until you have read and initialed your understanding of each provision in the Property Owner Acknowledgment section below and sign the form. An agent of the owner cannot execute this notice unless you, the property owner, complete the Owner's Authorized Agent form and It Is accepted by the City of Carlsbad. INSTRUCTIONS: Please read and initial each statement below to acknowledge your understanding and verification of this information by signature at the bottom of the form. These are very important construction related acknowledgments designed to Inform the property owner of his/her obligations related to the requested permit activities. I. (1/)__ I understand a frequent practice of unlicensed contractors is to have the property owner obtain an "Owner· ~r" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed contractor and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of th rmits of my insurance coverage for injuries to workers on my property. II. I understand building permits are not required to be signed by property owners unless they are responsible e construction and are not hiring a licensed contractor to assume this responsibility. 111. {Y.L_understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I ~rotect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his ~er name instead of my own. IV. ~I understand contractors are required by law to be licensed and bonded in California and to list their license ('o/?'bers on permits and contracts. V. '~I understand if I employ or otherwise engage any persons, other than California licensed contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 1 REV. 08/20 Owner-Builder Acknowledgement Continued VI. ~I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. VII.~ i understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building contractor. VIII.~ understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable ~~ financial or personal injuries sustained by any subsequent owner(s) which result from any latent t uction defects in the workmanship or materials. IX. I understand I may obtain more information regarding my obligations as an "employer" from the Internal e e ue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. X. ~I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: XI. ~I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. XII. ~ agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ~atlon I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractor's State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner- Builder and wish to hire contractors, you will be responsible for verifying whether or not those contractors are properly licensed and the status of their workers' compensation coverage. Before a building permit can be issued, this form must be completed, signed by the property owner and returned to the City of Carlsbad Building Division. I declare under penalty of perjury that I hove read and understand all of the information provided on this form and that my responses, including my authority to sign this form, is true and correct. I am aware that I have the option to consult with legal counsel prior to signing this form, and I have either (1) consulted with legal counsel prior to signing this form or (2) hove waived this right in signing this form without the advice of legal counsel. DA:t.J, ~ U:-,Tc Property Owner Name (PRINT) 2 REV. 08/20 {'Cityof Carlsbad OWNERS AUTHORIZED AGENT FORM 8-62 Development Services Building Division 1635 Faraday Avenue 442-339-2719 www.carlsbadca.gov OWNER'SAUTHORIZED AGENT FORM Only a property owner, contractor or their authorized agent may submit plans and applications for building permits. To authorize a third-party agent to sign for a building permit, the owner's third party agent must bring this signed form, which Identifies the agent and the owner who s/he is representing, and for what Jobs s/he may obtain permits. The form must be completed in its entirety to be accepted by the City for each separate permit application. Note: The following Owner's Authorized Agent form Is required to be completed by the property owner only when designating an agent to apply for a construction permit on his/her behalf. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Property Owner Acknowledgement, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Poot..., 5?A-1 L-A-ND ~C-~P INfu Project Location or Address: 24' l 2-: C..0/2."'i't;:,.. TA-ga>JtJ Name of Authorized Agent: 5~PH~N ~Pofl.i:) TelNo. 7t-cJ-u,(J-41Jf Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above Information and certify Its accuracy. Property Owner's Signature: _..,.)--t.,,_,,.._...._· ___ --=rt---·-----------Date: '{ / H / ,i, "1..- 1 STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FACILITATE RAPID INSTAUATION OF EROSION AND SEDIMENT CONlROL BMPs VlttEN RAIN IS EMINENT. 2. THE O'MiER/CONlRACTOR SHALL RESTORE ALL EROSION CONTROL DE\1CES TO YIURKING ORDER TO THE SATISFACTION OF THE CITY INSPECTOR AFTER EAOi RUN-OFF PROOUCINC RAINFALL 3. THE OWNER/CONlRACTOR SHALL INSTAil. ADDlllONAL EROSION CONlROL MEASURES AS MAY BE REQUIRED BY THE CITY INSPECTOR DUE TO INCOMPI.ETE GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES VlttlCH MAY ARISE. 4. AIJ. REMOVABLE PROTECTI\£ DEVICES SHALL BE IN PLACE AT THE END OF EAOi WORKING DAY \IIHEN THE A\£ (5) DAY RAIN PROBABRJTY FORECAST EXCEEDS FORTY PECENT ( 40~. SILT AND OTHER DEBRIS SHALL BE REM0\£0 AFTER EACH RAINFALL 5. ALL GRAVEL BAGS SHAU. CONTAIN 3/4 INCH MINIMUM AGGREGATE. 6. ADEQUATE EROSION ANO SEDIMENT CONlROL ANO PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. 7. THE CITY INSPECTOR SHAU. HA\£ THE AUTHORITY TO ALTER THIS PLAN DURING OR BEFORE CONSlRUCTION AS NEEDED TO ENSURE COMPLIANCE 'MlH CITY STORM WATER QUALITY REGULATIONS. OWNER'S CERTIFICATE: I UNDERSTAND Al«l ACKND\UDGE lHAT I MUST: (1) IMPUMENT !EST MAIIAGEMOO PRACTICES (BMPS) DtRNG CONSlRIJCllON AC11\111ES TO 1liE MAXIMUM ElITTNT PRACTICABI£ TO A VOID 1HE MOOIJZATION OF PCllUTANlS SUOi 1'S SEDIMENT AND TO AVOID lHE EXPOSURE OF STORM WATER TO CONSlRUCTI<»I REI..AlID PruJJTANTS; AND (2) ADHERE TO, AND AT AU. 11t,£S, COMPl Y YlllH lHIS aTY APPROVED TIER 1 C<»ISlR\JCllON SYll'PP lHROUQiOUT lHE DURA 110N OF lHE CONS1RUC11al ACll'tTTES UNTIL 1HE CONS1RIJC110N WORK IS COMf'\.£TE AND APPRO\Ul BY 1liE aTY OF CARLSBAD. STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP E-29 CB ___ _ SW BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE ErooionConlrol Sedlrnellt Conlml BMPs Tradllr9 Nm-SlonnWatst Waste Management and t.lal8rials BMPs Contra BMPs ~BMPs Polullon CoMt,I 8MPs ! .§ li i i.., .., ~ .., "l, .,. g, :i 5 ,g t E !i i !i 0 j ~ .5 i "E .Q-i ::s ii 0, i ~ 1 ! j' 0, 0, ! s :S ., ! 8 ; I S :§ Best Management Practice' ,¥ s :ell l 1~ ~~ :?i 31<- I!~ 6 s ..,., i .., ~ ! ., i (BMP) Description ➔ 8 - ., l ~.§ 8§ C :::, ::s -:, ~& ~ 0 ~ l "i ~ Si; o.,, ii Ii ii ~ ::s i i ~~ ii ~= ~~ .,,;; . .g~ 0 & ct:g ~ 8 ts .. ... .f l ~ l .!~ -g; Ii ii I jg .., 0 ti 8' ~ ~ l ~ j 2g :c i t; .g 1.§ -5 ::: a ~ 3< ..,,;; Ill ~ ;;ic 3<ct ~o o-J!::s <n> V,Q. ""'' ::s"' ::s "' ::r::::s CASQA Deslgnalon ➔ ,... "" "' ~ -,., ... "' 10 ,... .., 0 "' .., .... "" t N n ... "' <O I I I I I I I I I I t t I ;j; J, J, J, I I I I I ::cl ~ ~ 0 ljj ljj ljj ljj ljj ljj ljj ljj I!: I!: i j j i j j Cons1ruclon Achtty w z z % % Gnidina/Sol Disturbance w ., Trenchina/Excawtlon ,,. st-nma Drtf11a/llcrina Cona-ete/ Aaoholt Sawaittina 'Ill Cona-ete Flatworl< .... - Paw,a , Con<klit ""-Installation J stucco/Marter Wor1c Waste Di!lo090I Staaina II av Down /.Tea E~ •"'"'on! Maintonmce and Fuelinn Hazardous Sli>stance Usetstor~ Dewatema Site Access Aaoss Dirt other /tistl: lnotructlans: 1. Clleck the box to the left of al cpplicable canstructlan octMty (first coluim) e,q,ected to ocar during construction. 2. Located al<ll!ll the tao of the BMP Table is o list of llilP's with it'• COIT""l)Oncf11g Colifamio Stormwoter Q.iality Association (CASQA) ~otion number. Clloose one ar mare BMPs you lnlond to use dumg construction from the list Clledc the box where the chosen octhity ""' intenects with the BMP column. 3. Refer to the CASQA construction honll>ook far Information and detois of the choson BMPs and how to apply than to the projoct. SHOW THE LOCA T/ONS OF ALL CHOSEN BMPs ABOVE ON THE PROJECTS SITE PLAN/EROSION CONTROL PLAN. SEE THE REVERSE SIDE OF THIS SHEET FOR A SAMPLE EROSION CONTROL PLAN. PROJECT INFORMATION SiteAdchsa: 2'f(Z-C:o~T~ ::TA¥:PciJ Assessor's Parcel Number: Z~S'"•t'f':{-ST-00 Emergency Contact Heme: ~TE.P+i.E-N BJ;oFQJ2.ll i o-31< i ti <u ,0 I i p~ JZ.E..rr1,~ il/ff/$,-J P.'-i>~ct"Li) OWIER S S AGENT NAME PRIN / ~ 1L11/•i:z,.. 2-4 HOU' Phone: 7(,o -"l"J • </ I "'1 \ Construction Threat to Storm Water Q.iality (Clleck Box) O SA<iNfi&i:{SIGHAME) DATE OIDUM □LOW E-29 Page 1 of 1 REV 02/16