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Home My WebLink About2640 HIGHLAND DR; ; CBR2022-3300; PermitBuilding Permit Finaled Residential Permit Print Date: 08/23/2023 Job Address: Permit Type: 2640 HIGHLAND DR, BLDG-Residential 1561300900 $29,084.16 CARLSBAD, CA 92008-1027 Work Class: Parcel#: Valuation: Occupancy Group: #of Dwelling Units: Bedrooms: Bathrooms: Occupant Load: Code Edition: Sprinkled: Project Title: Description: FEGRELL; 448 SF POOL & SPA Applicant: CARRIE JONES 9921 CARMEL MOUNTAIN RD, # STE 189 SAN DIEGO, CA 92129-2898 (619) 343-5908 FEE BUILDING PLAN REVIEW-MINOR PROJECTS (LOE) BUILDING PLAN REVIEW-MINOR PROJECTS (PLN) 5B1473 -GREEN BUILDING STATE STANDARDS FEE STRONG MOTION -RESIDENTIAL (SMIP) SWIMMING POOL-RESIDENTIAL SWPPP INSPECTION TIER 1-Medium BLDG SWPPP PLAN REVIEW TIER 1-Medium Track#: Lot#: Project#: Plan#: Construction Type: Orig. Plan Check#: Plan Check#: Pool Total Fees: $904.78 Total Payments To Date: $904.78 Permit No: Status: (city of Carlsbad CBR2022-3300 Closed -Finaled Applied: 09/12/2022 Issued: 01/09/2023 Finaled Close Out: 08/23/2023 Final Inspection: 06/09/2023 INSPECTOR: Kersch, Tim Balance Due: Renfro, Chris AMOUNT $194.00 $98.00 $2.00 $3.78 $246.00 $292.00 $69.00 $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 FURTH ER NOTI Fl ED 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 lT 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 {_ City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check(/:R;x:).J..-v-33?() JobAddress ?Wo t\19½\rvd Dr, Est. Value PC Deposit Date Suite: APN: \ ~6 -l 'S u--0 I --6<) _____ , CT/Project #:, _________________ Lot #: ____ Year Built: ________ _ Fire Sprinklers: OYESO NO Air Conditioning:Q YES ONO BRIEF DESCRIPTION OF WORK: Electrical Panel Upgrade: QvEsO NO f\'\f Po.?\ ~ 5?, 0 Addition/New: _____ Living SF, ___ Deck SF, ____ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? OY ON New Fireplace? Ov ON, if yes how many? __ ORemodel:~~-~~SF of affected area Is the area a conversion or change of use 7 OY ON ~Pool/Spa: \...,,\ '-1,~ SF Additional Gas or Electrical Features? _;J __ /_li\. _________ _ osolar: ___ KW, ___ Modules, Mounted:0Roof 0Ground, Tilt:0 YON, RMA: Ov ON, Batterv:OY ON, Panel Upgrade: Ov ON D Reroof: -----------------------------------□ Plumbing/Mechanical/Electrical 0 Only: Other: This permit is to be issued in the name of the Property Owner as Owner-Builder, licensed contractor or Authorized Agent of the owner or contractor. The person listed as the Applicant below will be the main point of contact throughout the permit process, PROPERTY 0\/$NER_ APPLICANT O PROPERT,Y_ OWNERS AUTHORIZED AGENT Name: U 11k \-'c ..1re, \\ Name: Lori'•~ <'J Cne..-_s Address: 76¼.o \1Lqe{\:::;i. D.r ( ' Address: s 1 b) (v\1 $\0:) C'?\,.t V ¢=? City: Ccr\ '> '-':-d\ State:~ Zip:9:fG\)2-City: :"$/) State: Cv\ Zip: 9?c)o9 Phone: ______________ Phone: '21t'.i'~'}4'3-S-4 08 Email: Email: (y(r,e,~J@hof"::':-:}, I.~ APPLICANT fad DESIGN PROFESSIONAL APPLICANT O CONTRACTOR OF RECORD APPLICANT 0 Name: ________________ _ Name: __________________ _ Address: _______________ _ Address: _________________ _ City: _______ State: ___ Zip: ___ _ City:. _______ .State: ___ .Zip: _____ _ Phone: _______________ _ Phone: __________________ _ Email: ________________ _ Email: __________________ _ Architect State License: __________ _ State License/class: _____ Bus. License:, ___ _ 1635 Faraday Ave Carlsbad, CA 92008 Ph; 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov REV. 08/20 IDENTIFY WHO Will PERFORM THE WORK BY COMPLETING (OPTION A) OR {OPTION B) BELOW: (OPTION A): LICENSED CONTRACTOR DECLARATION: I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with 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: 0 I 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 perm·tt is issued. Policy No. _______________________________________ _ 0 I have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for whch ~his permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Company Name: ____________________ _ Policy No. ____________________________ .Expiration Date: _______________ _ 0 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 coverage 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, damages 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 PRINT: _________ SIGN: _________ DATE: (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 rny employees with wages ~s their sole compensatlOn, 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). ~ as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The mJiractor'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 Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: O"owner Builder acknowledgement and verification form" has been filled out, signed and attached to this application. 0 Owners "Authorized Agent Form• has been filled out, signed and attached to thls appJication giving the agent authority to obtain the permit on the owner's behalf. 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. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: http://www.leginfo.ca.gov/colaw.html. ,.\ ~ ; DATE: Q I C'l l OWNERPRINT: lV\\k Qy,t!~ SIGN: __ OJ_~-----( 1 d-~ kb~ APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL By my signature below, I certify that: I am the property owner or State of California Licensed Contractor or authorized to act an the property owner or contractor's behalf I certify that I have read the application and state that the above information is correct ond that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating ta 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 CITY OF CARLSBAD AGAINST ALL UAB/Lff/ES, 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 far excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. APPLICANT PRINT: SIGN: DATE: 1635 Faraday Ave Carlsbad, CA 92008 Ph; 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 2 REV. 08/20 f> l_ City of Carlsbad OWNER-BUILDER ACKNOWLEDGEMENT FORM 8-61 Deve/opmen t Services Building Division 1635 Faraday Avenue 760·602·2719 www.carlsbadca.gov OWNER-BUILDER ACKNOWLEDGMENT FORM Pursuant to State of Californio Health and Safety Code Section 1.9825-19829 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: SiteAddress z.~~o \! .. ,~\/Jr-.~ })( .. The City of Carlsbad ("City"l 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 obi igations re lated to the requested permit activities. I. A,p' I understand a frequent practice of unlicensed contractors isto 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. ram willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. II. t~I understand building permits are not required to be signed by property owners unless they are responsible for ~e construction and are not hiring a licensed contractor to assume this responsibility. 111. t...r.,_1 understand as an "Owner-Builder'' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own. IV. 41 understand contracto;s are required by law to be licensed and bonded in California and to list their license "':~~rs on permits and contracts. • V. .li_l 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. R[V. 08/10 Owner-Builder Acknowledgement Continued VI. ~I understand if I am con1,idered an "employerll 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 mv failure to abide by thes(' laws may subject me to serious financial dsk. VII. 1A-1 understand under California Contractors· State License Law, an Owner· Builder who builds single-family residential structures cannot legally bulld them with the intent to offer them for sale, unless all work is performed by licensed subconlractors and the number of structures does not exceed four within any calendar year, or all of ~ork is performed under contract with a licensed general building contractor. Vil!. I understand .as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(sJ which result from anv latent construction defects in the workmanship or materials. IX. * l understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Sm.all 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 X. a_!>~t licensed contractors. ~I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legall and inancially responsible for proposed construction activity at the following address: 1,. r.,. XI. ~I agree that, as tHe party legally and financially responsible for this proposed construction activity, I will abide by a~pplicable laws and requirements that govern Owner-Builders as well as employers. XII. ~I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 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 finandal 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 Ownet- 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 con be issued, this form must be completed, signed by the property owner and returned to tht> City of Carlsbad Building Division. I declare under penalty of jMrjury that I havt! tead ond underltar,d oJ/ of the ir,Jormatian provided on lllis Jatm and that my trspanscs, includ,'nq my ctulh<lr,rv ro iign lhiS form, ,s true and correct. I om aware rnar I /rave o,e apllon lo coma(/ w,rh tcgaf cou115c/ prior (O signing thi$ fo1m, cmd t have eit/li,, (1) co.n,.,!red wit/> ll'gc,J roun<el p1ior to signing this form or (l) ha~c waiiled !h,s ft9ht In j/qning this faun wittioot ttie advice oJ le90/ rounsct Property Owner Si R{V. 08/20 {_ City of Carlsbad OWNERS AUTHORIZED AGENT FORM 8~62 Deve/opmen t Services Building Division 163!> Faraday Avenue 760-602·2719 www.carlsbadca.gov OWNER'SAUTHORIZED AGENT FORM Only a property owner, contractor or their authorized agent may submit plom and applications for building permits. To authorize a rhird-party agent to sign for a building permit, the owner's third party ogenr 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 robe accepted by the City for each separate permit opp/icatfon. Note: The fol/owing Owners Authorlred 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 per~onal 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·Sullder Permit for my project. Scope of Construction Project (or Description of Work): _p_o_o_l_a~n_d __ s_p_a __ ~----~--- Project Location or Address: __ ;l-_~_~.._0 _ __,y\o.-c...,~71-\_\'iJ.......,,.,..., _\)--'\-"C_.,, ____________ _ Name of Authorized Agent: Carrie Jones/Mike Condon Tel No. 619-343-5908 Address of Authorized Agent: 9921 Carmel mtn rd, #189 sd, ca 92129 1 declare under penalty of perjury that I am the property owner for the address listed above and I persomilly filled out the above information and certify its accuracy. Property Owner's Signature: __ ~ __ "'---r-~---· ________ Date: __ 9 ....... (\_1-J __ l _'11_V_· PERMIT INSPECTION HISTORY for (CBR2022-3300) Permit Type: BLDG-Residential Work Class: Pool Status: Closed -Finaled Application Date: 09/12/2022 Owner: CO-OWNERS F AGRELL PETER AND LINDA Issue Date: 01/09/2023 Subdivision: Expiration Date: 10/23/2023 IVR Number: 43217 Address: 2640 HIGHLAND DR CARLSBAD, CA 92008-1027 Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection Date Start Date Wednesday,August23,2023 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final NOTES Created By Angie Teanio Status COMMENTS TEXT 760-310-7261 Linda Passed Yes Yes Yes Yes Yes Created Date 06/08/2023 Page 2 of2 Building Permit Inspection History Finaled {cityof Carlsbad PERMIT INSPECTION HISTORY for (CBR2022-3300) Permit Type: BLDG-Residential Application Date: 09/12/2022 Owner: CO-OWNERS FAGRELL PETER AND LINDA Work Class: Pool Issue Date: 01/09/2023 Subdivision: Status: Closed -Finaled Expiration Date: 10/23/2023 Address: 2640 HIGHLAND DR IVR Number: 43217 CARLSBAD, CA 92008-1027 Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Re inspection Inspection Date Start Date Status 01/10/2023 01/10/2023 BLDG-SW-Pre-Con 200411-2023 Passed Tim Kersch Complete Checklist Item COMMENTS Passed BLDG-Building Deficiency Virtual pre con Yes 01/12/2023 01/12/2023 BLDG-51 200546-2023 Passed Chris Renfro Complete Excav/Steel(Pools) Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes BLDG-52 Pool Plumbing 200545-2023 Partial Pass Chris Renfro Reinspection Incomplete 03/08/2023 03/08/2023 BLDG-52 Pool Plumbing 204804-2023 Passed Chris Renfro Complete NOTES Created By TEXT Created Date Angie Teanio 760-310-7261 Linda 03/06/2023 BLDG-53 204805-2023 Passed Chris Renfro Complete Elec/Conduit/Wiring(Po els) NOTES Created By TEXT Created Date Angie Teanio 760-310-7261 Linda 03/06/2023 BLDG-54 Equipotential 204806-2023 Partial Pass Chris Renfro Reinspect ion Incomplete Bond(Pools) NOTES Created By TEXT Created Date Angie Teanio 760-310-7261 Linda 03/06/2023 04/26/2023 04/26/2023 BLDG-55 209164-2023 Passed Chris Renfro Complete Fence/Preplaster Checklist Item COMMENTS Passed BLDG-Building Deficiency Yes NOTES Created By TEXT Created Date Angie Teanio 760-310-7261 Linda 04/2512023 06/09/2023 06/09/2023 BLDG-Final Inspection 213734-2023 Passed Chris Renfro Complete Wednesday,August23,2023 Page 1 of 2 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 ALTIER THIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDED TO ENSURE COMPLIANCE WITH CITY STORM WA TIER QUALITY REGULA TlONS. OWNER'S CERTIFICATE: I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO AVOID lHE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO AVOID THE EXPOSURE OF STORM WATER TO CONSTRUCTION RELATED POLLUTANTS; AND (2) ADHERE TO, AND AT ALL TIMES, COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED BY THE CllY OF CARLSBAD. N.t\L.e G)~~~ PRINT E-29 STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE Erosion Control Sediment Control BMPs Tracking Non-Storm Water Waste Management and Materials BMPs Control BMPs Management BMPs Pollution Control BMPs C: ...... C C: 0 -.Q .2 :;:; C C: "C Q) 'O C ..... -C'> 0 E C: Q) "C ti) 0 u u C C: C'> 0 E C: ..... :::, :::, 0 'o ·.::: .9-0 0 E ...... L. .... :;:; Q) ~ L. >.. ::E "C ti) a, L. ..... --C "-:::, C'> C: Q) .... (I) .£ ti) {t) (I) 0 ·;:: O" ,.__ 0 C: C'> a. Q) .~ ·c C u, C: > .... Q.) 0 O"'i5 L. c., w C: Best Management Practice* ad C: 0 (D C. '--0 Q) 0 Q.) -~ :;:; :c (I) 3: rn L Q.) 0 C: u Q) _, QJ 0 -C I-E u ,.__ rn 0 "C v [I) ::: C (I) C (BMP) Description ➔ fl) u Q) (/) ·a Q) .!!!. O'> Q) C'> CD •5 C a, C: -0 Cl) 3::: C Cl ::::> ~ _, Q) Q) :5 ~ Q) 0 ...... 0 0 0 3 C .... 0 -g~ "C >, o rn C: C 0 Cl) §E :;:; .... C: a ID C/) ·-O'I Cl·-uw Co C'> Q) ::E Cl er, a C: c::: E 0 ..... N oo ~ 0 c:n:;::; ~ :-§ :g, 0 = ...,_ 3::: Q) X w Cl) u ~.£ Q. a.. e Q.) 0 LL. E ~ v ..., :::, -Cl E g = ti) :.::: 3: ... --C: 0 -Cl '--0 ·;;: .:£ C'> .... "C ..c C: w u .... Q) :::, -0 :o~ ·--.::, (I)-0 u C: Q) ... Q) +-' "C 0 '6 > .__. -Cl 0 ..... u ·~t ·-0 u 0 0 ...... _ Q, Q) Q) ~g C: 00 -..c: Q) -o +-' 0 = C: ·-C: Q) i L. 0 0 ... Q) .c: .0 0 0 Ol l:!o oO 0 o...., 0 a. 0 oo CL in .._ 0 _, .._ -C: :3: a:: ~u ..... (!I LL.JO V5 C/) u G: Cl en> (/) U') a.. U}_ (/) c::: a.a 0... :I!; (/) ::it U} cnu (/) ::: CASQA Designation ➔ r---co -I") -.I-LO co r---co 0 N I") r---ro 'T N n v LO 0) .--'T --I I I I I I I I I I I J I I I I I I I I I u 0 u (J w Lu LLJ LLJ Lu w w w ~ ~ (/) (/) C/) (/) ::.::;;; I i ::: :::!: Construction Activity LLJ w LLJ I.LI (/) (/) (/) U') C/) (f) (/) (f) z z :z :z 3::: 3::: 3::: µ Gradinq/Soil Disturbance N lC.. •✓ Trenchinq/Excovation ')o )C .., Stockpilinq M Drillinq/Borinq \. Concrete/Asphalt Sawcutting 'v Concrete Flatwork ....... Paving Conduit/Pipe Installation Stucco/Mortar Work 1, Waste Disposal )Q Staging/Loy Down Area I Eauioment Maintenance and Fuelina Hazardous Substance Use/Storaqe Dewaterinq Site Access Across Dirt Other (list): Instructions: 1. Check the box to the left of all appricable constructi,)n 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 Storm water Quality Association (CASQA) designation number. Choose one or more BMPs you intend to use during construction from the list. Check the box where the chosen activity row intersects with the BMP column. 3. Refer to the CASQA construction handbook for information and details of the chosen BMPs and how to apply them to the project. PROJECT INFORMATION Site Address: ;)b\.tO t\\4h \c,,,J 't> r. Assessor's Parcel Number: \ \ b -l"":) b ·-Oq Emergency Contact: ,L Name: ~"-.,.._"'" i,rv\c.."lO~ 24 Hour Phone: J bC)--6p\i •' ()5'66 Construction Threat to Storm Water Quality (Check Box) '18 MEDIUM □ LOW Q) ..... ti) 0 3::_.., C: 1/) Q) :::i E Ow ~ C'> oO NC: 00 :r: ::!: tO I i (I) ..... Cl) 0-+-' 3:: C: Q) ai E ..... Q) Q) C'> no C: C: 0 0 u::z: to I ::z: 3:: ·xi 'x.a '),, Page 1 of 1 REV 11 /17