HomeMy WebLinkAbout2717 YORK RD; ; CBR2023-0871; PermitBuilding Permit Finaled
Residential Permit
Print Date: 12/19/2023
Job Address: 2717 YORK RD, CARLSBAD, CA 92010-2148
Permit Type: BLDG-Residential Work Class: Retaining Wall
Parcel#: 1673924300 Track#:
Valuation: $16,797.00 Lot#:
Occupancy Group: Project#:
#of Dwelling Units: Plan#:
Bedrooms: Construction Type:
Bathrooms: Orig. Plan Check#:
Occupant Load: Plan Check#:
Code Edition:
Sprinkled:
Project Title:
Permit No:
Status:
{city of
Carlsbad
CBR2023-0871
Closed -Finaled
Applied: 02/24/2023
Issued: 05/15/2023
Finaled Close Out: 12/19/2023
Final Inspection: 12/13/2023
INSPECTOR: Renfro, Chris
Description: 2717 YORK: DEMO EXISTING (CMU) RETAINING WALL BUILD NEW CITY STANDARD WALL (MAX HEIGHT 5'4")
Applicant: Property Owner:
CO-OWNERS BROWN CHRISTOPHER J AND
ERIN M
CO-OWNERS BROWN CHRISTOPHERJ AND
ERIN M
2717 YORK RD
CARLSBAD, CA 92010-2148
(714) 614-3253
FEE
BUILDING PLAN CHECK FEE (manual)
2717 YORK RD
CARLSBAD, CA 92010-2148
(714) 614-3253
BUILDING PLAN REVIEW -MINOR PROJECTS (LDE)
BUILDING PLAN REVIEW -MINOR PROJECTS (PLN)
RETAINING WALL-NON-ENGINEERED-CITY STANDARD
SB1473 -GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION -RESIDENTIAL (SMIP)
SWPPP INSPECTION TIER 1-Medium BLDG
SWPPP PLAN REVIEW TIER 1-Medium
Total Fees: $834.38 Total Payments To Date:
NOTICE:
$834.38 Balance Due:
AMOUNT
$70.20
$194.00
$98.00
$108.00
$1.00
$2.18
$292.00
$69.00
$0.00
Please take NOTICE that approval of your project includes the "imposition" of fees, dedications, reservations, or other exactions
collectively referred to as "fees.11 You have 90 days from the date this permit was issued to protest the imposition of these fees. To protest
the imposed fees, you must follow the protest procedures set forth in Government Code Section 66020(a) and file the protest with the City
Manager. Failure to timely follow the required procedures will bar any subsequent legal action to attack, review, set aside, void, or annul
the imposition of these fees.
You are FURTHER NOTIFIED of your right to request an audit to review the fees imposed on your project. To request an audit, follow the
procedures provided in Government Code Section 66023(a). Additionally, you may file a written request for mailed notice for the public
meeting to review the fee account or fund information related to certain fees that are imposed as a result of the approved permit.
You are FURTHER NOTIFIED that your right to protest the specified fees 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 of which you have previously been given a NOTICE similar to this, and the statute of limitation has 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
•
c·cicyof
Carlsbad
RESIDENTIAL
BUILDING PERMIT
APPLICATION
B-1
Plan Check~~zoz.g ...-of/7 /
Est. Value A' '", ?q ?-
PC Deposit 41 70 . '2..o
Date .Z~:Z.3 -'Z.~3
Job Address Z 7 17 Y,,C ~ /?.I] Unit: _____ .APN:_-~_,_7_-_~_9_z_-_'1_~_-_0 _o_
CT/Project #: __________________ .Lot #: ____ Year Built:_---al_'t,_7'--"-3 _____ _
BRIEF DESCRIPTION OF WORK: /)t';,., 0 t!x 1 \T/1>1 ,; sb • C,<,, v ,v.f->-<-//Ai/) Co,-,,•;,r.hJ c~ /v f'...:, C,<,,< v
/4r1>1N1Nl1 'V;H/4-ffL ST/IN/J/fii# ;:1,e,,,.,,,,.,,i,5 /,,.,,+)L Hr s-''/ '')
0 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
□ Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _
0 Solar: ___ KW, ___ Modules, Mounted:QRoof OGround, Tilt: 0 YON, RMA: OY O N,
Battery:OYO N, Panel Upgrade:OYON Electric Meter number: ------------
Other:
APPLICANT (PRIMARY CONTACT) PROPERTY OWNER
Name: Uf/!1 S /j,t'.o,,.,,J Name: S11,.,,_tf --------'-------------Address: 2717 Yo/l.;:. ,e,:J Address:. __________________ _
City: (,,i/ltf,v,£1 State: C,4 Zip:_~i_?o_,,_,,_City: __________ .State: ___ .Zip: ____ _
Phone: /7"() /,/<,/-~25"3 Phone:. __________________ _
Email: C/;)ro.,_,1t) 0 ~ & 3,-.,4,t.. ,:.,...._ Email: ___________________ _
DESIGN PROFESSIONAL CONTRACTOR OF RECORD
Name: __________________ Business Name: ________________ _
Address: Address: _________________ _
City: ________ .State: __ ~Zip:. ____ _ City: _______ state: ___ Zip: ______ _
Phone: _________________ _ Phone: __________________ _
Email:. _________________ _ Email: __________________ _
Architect State License: ___________ _ CSLB License #: _______ Class:. ______ _
Carlsbad Business License # (Required): _______ _
APPLICANT CERTIFICATION: 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
ogcee to comply w;th all Oty ord;nonces and State low, re/oUng to bu;/d;ng construcUon.~~
NAME (PRINT): c·1-1~1~ g,e.,,v,J SIGN~~-DATE: Z/ 2 't) 1 5
1635 Faraday Ave Carlsbad,CA 92008 Ph: 442-339-2719 Email: Building@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 herebyaff irm under penal tyof perjury that I am I icensed under provisionsof 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(CHOOSE ONE):
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 permit is issued. PolicyNo. ___________________________________________ _
-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 permit is issued.
My workers' compensation insurance carrier and policy number are: lnsuranceCompany Name: ________________________ ,
Policy No. ____________________________ Expiration Date: _________________ 1 -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 coverage is unlawful and shall subject an employer to
criminal penaltles 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:
l 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 CERT/FICA TION: 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 potentfally 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; a\l 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 signing above is an authorized agent for the contra t o Id I tt r of authorization 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:
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. If, however, the building or improvement is sold
within one year of completion, the owner-builder wfll have the burden of proving that he did not build or improve for the purpose of sale).
-OR-
DI, 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).
-OR-
DI am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason:
AND,
0 FORM B-61 "Owner Builder 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, I understand that a copy of the applicable law, Section 7044of the Business and Professions Code, is available upon request when this application is
submitted or at the following Web site: http:!/www./eginfo.ca.gov/calaw.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 construction, unless otherwise noted.
NAME (PRINT): SIGN:~,----DATE: __ z/_"_'f,.;./_z_> __
Note: If the erson si nin above is an authorized a ent for the ro ert owner include form 8-62 si ned b ro ert owner.
1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov
2
REV. 04/22
(cicyof
Carlsbad
OWNER-BUILDER
ACKNOWLEDGEMENT
FORM
8-61
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 2-7 1 7 yo~/C-e~ ?'.1-.??I AH, CA CJ Z ~ 1 o
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.,_1 understand a frequent practice of unlicensed contractors is to have the property owner obtain an "Owner-
-Builder" 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 tor 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
the limits of my insurance coverage for injuries to workers on my property.
11. _fLI understand building permits are not required to be signed by property owners unless they are responsible
for the construction and are not hiring a licensed contractor to assume this responsibility.
111. ~I 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. l'b I understand contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
V. ___02_,1 understand if I employ or otherwise engage any persons, _othert'1a.n California licensed contractors, and
the total value of my construction is at least five hundred dollars ($500),' induding labor and materials, I may be
considered an "employer" under state and federal law.
1 REV. 05/22
',
Owner-Builder Acknowledgement Continued
VI. CIJ 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. ~ l 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. C & 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(s) which result from any latent
construction defects in the workmanship or materials.
IX. ~ I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue 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..!!,_1 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:
2717 'jo,l.,{. /!.tJ ~~I,-;,<>;<?, CA-';!Z-o/o
XI. C,~ 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. ~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 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 have 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 om aware that I hove the option to consult with /ego/ counsel prior to signing this form, and I hove
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.
Property owner Name (PRINT) Property Owner Signature
3
2/z 'f/23
Date
REV. 05/22
Building Permit Inspection History Finaled
{city of
Carlsbad
PERMIT INSPECTION HISTORY for (CBR2023-0871)
Permit Type: BLDG-Residential Application Date: 02/24/2023 Owner: CO-OWNERS BROWN CHRISTOPHER
J AND ERIN M
Work Class: Retaining Wall Issue Date: 05/15/2023 Subdivision: CARLSBAD TCT#74-14 A UNIT#01
Status: Closed -Finaled Expiration Date: 12/04/2023 Address: 2717 YORK RD
IVR Number: 46906 CARLSBAD, CA 92010-2148
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Date Status
05118/2023 05118/2023 BLDG-SW-Pre-Con 211451-2023 Passed Chris Renfro Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
NOTES Created By TEXT Created Date
Angie T eanio 714-614-3253 Chris 0511712023
05130/2023 05130/2023 BLDG-11 212527-2023 Passed Chris Renfro Complete
Foundatlon/Ftg/Plers
(Robar)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
06/06/2023 06/06/2023 BLDG-66 Grout 213520-2023 Passed Chris Renfro Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency 1st and only lift on CMU wall, OK to grout Yes
12/13/2023 12/13/2023 BLDG-Final Inspection 233651-2023 Passed Chris Renfro Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-Structural Final Yes
Tuesday, December 19, 2023 Page 1 of 1
'lrue Nortl1
COMPLIANCE SERVICES
March 28, 2023
City of Carlsbad
Community Development Department -Building Division
1635 Faraday Ave.
City of Carlsbad -FINAL REVIEW
City Permit No: CBR2023-0871
True North No.: 23-018-146
Carlsbad, CA 92008
Plan Review: Residential-Retaining Wall
Address: 2717 York Rd
Applicant Name: Chris Brown
Applicant Email: cbrownj06@gmail.com
OCCUPANCY AND BUILDING SUMMARY:
Occupancy Groups: R-3/U
Occupant Load: NIA
Type of Construction: V-B
Sprinklers: NI A
Stories: 1
Area of Work (sq. ft.): 154 sq. ft.
The plans have been reviewed for coordination with the permit application.
Valuation: Confirmed
Scope of Work: Confirmed
Floor Area: Confirmed
Attn: Building & Safety Department,
True North Compliance Services, Inc. has completed the final review of the following documents for the project
referenced above on behalf of the City of Carlsbad:
Drawings: One (I) copy dated March 16, 2023, by James A. Chinn.
The 2022 California Building, Mechanical, Plum bing, and Electrical Codes (i.e., 2021 !BC, UMC, UPC, and 2020
NEC, as amended by the State of California), 2022 California Green Building Standards Code, 2022 California
Existing Building Code, and 2022 California Energy Code, as applicable, were used as the basis of our review.
Please note that our review has been completed and we have no further comments.
We have enclosed the above noted documents bearing our review stamps for your use. Please call if you have any
questions or ifwe can be of further assistance.
Sincerely,
True North Compliance Services
Review By: Bryan Montes -Plan Review Engineer
True North Compliance Services, Inc.
15375 Barranca Pkwy, Suite A202, Irvine, CA 92618
T / 562. 733.8030
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 SA Tl SF ACTION
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 CONSTRUCTION
ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO AVOID
THE 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 CITY OF CARLSBAD.
C lf,e,r 6,e.,.,.v
OWNER(S)/PWN_ER'S AGENT NAME (PRINT
SIGNATURE
E-29
2/£'( / 2. 3
DATE
STORM WATER COMPLIANCE FORM
TIER 1 CONSTRUCTION SWPPP C ,a R ·2..0'l... ~ og7/
BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE
Erosion Control Sediment Control BMPs Tracking Non-Stonn Water Waste Management and Materials
BMPs Control BMPs Management BMPs Pollution Control BMPs
C -C C 0 -0 0 :;, C C ""C :;, :;, O'> 0 ., ""C ., ""C "' C 0 0 C _!; O'> E C E C -0 -::, ::, 0 ·c: C. 0 0 0 E L L ""C .,
:::;; ""C "' O'> L ., --:;, C L '3 >. O'> C <I> L C ., c "'"' "' !,! ·c: '-CT L 0 C O'> Co C. ., ·c: -C <Jl C L w !;? 0 Best Management Practice• ~ C 0 a, 'a. L 0 ., 0 L (.') ., C :;, :c "' " "' ,= ., 0 C UL u ., -~ ., 0 -"' ., en C E O'> ., O'> a, "i5 C O'> "' ""C "' ~ ""C "' :::;; C <I> C
(BMP) Description ➔ 0 ·e ., "' C C 0 ::::, !;? -., ~ "3 ~ Cl) 0 -0 0 0 ,= C LO ~~ ""C >. 0"' Cc 0 ., :3 E :;, C 0 a, en·-O'> Cl:;:; u., Co O'> .,
X :::;; 0 O'> 0 C ., "" _E 0 N <Jl i!l 0 0 en:;:; ., a, C ~~ ci = L-;,: ., ., 0 ., E -"' -.; ..c E :;J =-= V, :=3 L'-:0 o·c ·c: ~ ~_g O'> -""C ..C C ., LL 0 L ., ::, ""C :o~ --""C ~b cO LO ., ""C 0 -·-C. > ., ::, L-..c 0 •-L .B <I) L 0 0 0 'o ., ., C e; g ·-0 -o -= C := C LO -0 L 0 00 0 O'> .B 0 00 ..c ., 0 ., 0 CL 0 en ., ..c ..c L -o 0 -L U, C ;,: cl: 0 ~u o_ 0 -C. 0 oo
(.') ;,: WO vi en u G: (.') en> en en a. en"" a.a a. :::;; en :::;; en enu en:::;;
CASQA Designation ➔ r--IX) a, ~ ,,, .... "' r--IX) 0 N ,,, r--IX) N ,,, .... "' i" i" <D i" i" i" I I I I I I I I I I I I I I I I I I u u u u w w w w w w w w f"c f"c en en en en i i i i i Construction Activity w w w w en en en en en en en en z z z z
Gradinn 'Soil Disturbance " Trench inn /Excavation
Stockoilina
Drillin~ /Borina
Concrete/Asohalt Sawcuttina
Concrete Flatwork
Pavina
Conduit/Pioe Installation
Stucco/Mortar Work
Waste Disoosal
Staainn /Lav Down Area
Eauioment Maintenance and Fuelinn
Hazardous Substance Use /Storaae
Dewaterina
Site Access Across Dirt
Other !list\:
Instructions:
1. Check the box to the left of all applicable construction 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 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.
.-.. <'= •• \
' :;,~:~. ?_,,_,1
F'"--~ n ~ r -1 :____:) ~ ~ i:_.,_.)
ci: . , _:-_J
....., ,_,
PROJECT INFORMATION
Site Address: 2 7 17 yoc.l'-/¼ c,,,..e_t. ,;g.'1-17
Assessor's Parcel Number: //, 7 -~ '! 2 -Y 3 -oo
Emergency Contact:
Name: ('lfi!tS /!,lh,.....,,J
24 Hour Phone: /71--t) /,1'(-32,3;,
Construction Threat to Storm Water Quality
(Check Box) □ MEDIUM ~W
., -"' 0
;,: -C "' ., ::, E 0 ., l:' O'> oO
NC co ::c :::;;
<D
I
i
., -"' o-3= C .,
" E -., ~ O'> uo
CC
oo
u"'
IX)
I
i
✓
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Page 1 of 1 REV 11/17