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Home My WebLink About1387 SAPPHIRE DR; ; CBR2021-1504; PermitBuilding Permit Finaled Residential Permit Print Date: 02/14/2024 Job Address: Permit Type: Parcel#: Valuation: Occupancy Group: #of Dwelling Units: Bedrooms: Bathrooms: Occupant Load: Code Edition: Sprinkled: 1387 SAPPHIRE DR, BLDG-Residential 2122500300 $23,575.50 Project Title: , Description: 450 SF POOL & SPA CARLSBAD, CA 92011-4215 Work Class: Track#: Lot#: Project#: Plan#: Construction Type: Orig. Plan Check#: Plan Check#: Property Owner: Pool CO-OWNERS ALLEN WILLIAM MICHAEL AND ALLEN NATALIE J FEE BUILDING PERMIT FEE ($2000+) BUILDING PLAN CHECK FEE (BLDG) 1387 SAPPHIRE DR CARLSBAD, CA 92011 ELECTRICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL PLUMBING BLDG RESIDENTIAL NEW/ADDITION/REMODEL SB1473 -GREEN BUILDING STATE STANDARDS FEE STRONG MOTION -RESIDENTIAL (SMIP) SWPPP INSPECTION FEE TIER 1 -Medium BLDG SWPPP PLAN REVIEW FEE TIER 1 -Medium Total Fees: $801.60 Total Payments To Date: $801.60 Ccity of Carlsbad Permit No: CBR2021-1504 Status: Closed -Finaled Applied: 05/25/2021 Issued: 08/03/2021 Finaled Close Out: 02/14/2024 Final Inspection: 12/28/2023 INSPECTOR: Kersch, Tim Balance Due: Alvarado, Tony AMOUNT $239.14 $167.40 $41.00 $49.00 $1.00 $3.06 $246.00 $55.00 $0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Building Division Page 1 of 1 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov {cicyof Carlstiad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 plan Cheek _c_~_B_R_2_02_1_-_1 _5_04 __ Est. Value 23,575 PC Deposit Date 5/25/2 l ___ a..;.p_h_ire_D_r _____________ Suite: _____ APN: __________ _ CT/Project #: __________________ Lot #: ____ Year Built: _________ _ Fire Sprinklers: ~ES O NO Air Conditioning:(O]YES O NO BRIEF DESCRIPTION OF WORK: Electrical Panel Upgrade: ~YES O NO New Pool and Spa 0 Addition/New: _____ Living SF, ____ Deck SF, ____ Pat io SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? [JY O N New Fireplace? r:J v ON, if yes how many? __ □Remodel : SF of affected area -----Is the area a conversion or change of use ? []y ON [!] Pool/Spa:_4_50 ____ SF Additional Gas or Elect rical Features? New gas and electric for pool EQ o solar: ___ KW, ___ M odules, M ounted:r;)Roof 0Ground, Tilt:□ vO N, RMA: □v O N, Battery:r:JY O N, Panel Upgrade: av 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 OWNER APPLICANT O PROPERTY OWNERS AUTHORIZED AGENT APPLICANT [!} Name: Allen Residence Name: SAVANNA RAY (OC PERMIT SERVICES) Address: 1387 Sapphire Dr Address: __________________ _ City: Carlsbad State:_C_a __ Zip: ____ City: __________ State: ___ Zip: ____ _ Phone: Phone: 949-412-0595 Email: Email: OCPERMITSERVICES@GMAIL.COM DESIGN PROFESSIONAL APPLICANT O CONTRACTOR OF RECORD APPLICANT 0 Name: SAVANNA RAY (OC PERMIT SERVICES) Address: _______________ _ City:. ________ State: ___ .Zip: ___ _ Phone: ________________ _ Email: ________________ _ Architect State License: __________ _ Name: Capistrano Pools Address: PO box: 3145 City: Dana Point, State:_C_A __ Zip: 92629 Phone: (949) 498-7533 Email: __________________ _ State License/class: 71 2408 C-53 Bus. License : APPLIED 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 permit 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 which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Company Name: _____________________ _ Policy No. ____________________________ Expiration Date: _______________ _ I!] 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: Savanna Ray SIGN:rfc DATE: 5/17/21 (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 will have the burden of proving that he did not build or improve for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: D•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 this application 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/calaw.html. OWNER PRINT: ___________ s1GN: I loATE: ______ _ 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 on the property owner or contractor's behalf I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SA VE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, 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 for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. APPLICANT PRINT:_S_a_v_a_n_na_R_a_y _____ SIGN:~ DATE: 5/17/21 1635 Faraday Ave carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 2 REV. 08/20 Building Permit Inspection History Finaled Ccityof Carlsbad PERMIT INSPECTION HISTORY for (CBR2021-1504) Permit Type: BLDG-Residential Work Class: Pool Status: Closed -Finaled Scheduled Actual Inspection Type Date Start Date 08/05/2021 08/05/2021 BLDG-SW-Pre-Con Checklist Item Application Date: 05/25/2021 Issue Date: 08/03/2021 Expiration Date: 03/28/2022 IVR Number: 33560 Owner: CO-OWNERS ALLEN WILLIAM MICHAEi AND ALLEN NATALIE J Subdivision: Address: 1387 SAPPHIRE DR CARLSBAD, CA 92011-4215 Inspection No. Inspection Primary Inspector Reinspection Inspection 163632-2021 COMMENTS Status Passed Tony Alvarado Complete Passed BLDG-Building Deficiency August 5, 2021 : (Virtual inspections). Yes 08/06/2021 08/06/2021 BLDG-23 Gas/Test/Repairs Checklist Item 1. No stormwater preconstruction/Building Deficiencies. 2. Informed Greg, pool contractor representative, preconstruction meeting guidelines to be observed, city of Carlsbad Pre-Construction-policies and procedures-approved. 163809-2021 Passed Tony Alvarado COMMENTS BLDG-Building Deficiency August 6, 2021: Pass. BLDG-51 Excav/Steel(Pools) Wednesday, February 14, 2024 1. No Swimming pool deficiencies. 2. In ground, Gunite, swimming pool and spa, special engineering reinforcement steel rebar, freestanding pool design and swimming pool detail specifications per pool engineer Todd locker, scope of swimming pool/spa work-approved. 3. Equipotential pool bond wire's tails stubbed-out, located at four points at perimeter of pool-partial pass. 4. Underground electrical and underground swimming pool spa plumbing, underwater leak pressure test-approved. 5. permit inspection record card and approved stamp and sign plans-ok. 6. Gas line under air pressure leak test with gauge, and tracer wire, correct depth, scope of work-approved. 163752-2021 Passed Tony Alvarado Complete Passed Yes Complete Page 1 of 4 PERMIT INSPECTION HISTORY for (CBR2021-1504) Permit Type: BLDG-Residential Application Date: 05/25/2021 Owner: CO-OWNERS ALLEN WILLIAM MICHAEi AND ALLEN NATALIE J Work Class: Pool Issue Date: 08/03/2021 Subdivision: Status: Closed -Finaled Expiration Date: 03/28/2022 IVR Number: 33560 Address: 1387 SAPPHIRE DR CARLSBAD, CA 92011-4215 Scheduled Date Actual Inspection Type Start Date Inspection No. Inspection Status Primary Inspector Checklist Item BLDG-Building Deficiency COMMENTS August 6, 2021: Pass. 1. No Swimming pool deficiencies. 2. In ground, Gunite, swimming pool and spa, special engineering reinforcement steel rebar, freestanding pool design and swimming pool detail specifications per pool engineer Todd locker, scope of swimming pool/spa work-approved. 3. Equipotential pool bond wire's tails stubbed-out, located at four points at perimeter of pool-partial pass. 4. Underground electrical and underground swimming pool spa plumbing, underwater leak pressure test-approved. 5. permit inspection record card and approved stamp and sign plans-ok. 6. Gas line under air pressure leak test with gauge, and tracer wire, correct depth, scope of work-approved. BLDG-52 Pool Plumbing 163754-2021 Passed Tony Alvarado Checklist Item BLDG-Building Deficiency COMMENTS August 6, 2021: Pass. 1. No Swimming pool deficiencies. 2. In ground, Gunite, swimming pool and spa, special engineering reinforcement steel rebar, freestanding pool design and swimming pool detail specifications per pool engineer Todd locker, scope of swimming pool/spa work-approved. 3. Equipotential pool bond wire's tails stubbed-out, located at four points at perimeter of pool-partial pass. 4. Underground electrical and underground swimming pool spa plumbing, underwater leak pressure test-approved. 5. permit inspection record card and approved stamp and sign plans-ok. 6. Gas line under air pressure leak test with gauge, and tracer wire, correct depth, scope of work-approved. BLDG-53 Elec/Conduit/Wiring(Po ols) 163753-2021 Passed Tony Alvarado Wednesday, February 14, 2024 Reinspection Inspection Passed Yes Complete Passed Yes Complete Page 2 of 4 PERMIT INSPECTION HISTORY for (CBR2021-1504) Permit Type: BLDG-Residential Application Date: 05/25/2021 Owner: CO-OWNERS ALLEN WILLIAM MICHAEi AND ALLEN NATALIE J Work Class: Pool Status: Closed -Finaled Issue Date: 08/03/2021 Expiration Date: 03/28/2022 IVR Number: 33560 Subdivision: Address: 1387 SAPPHIRE DR CARLSBAD, CA 92011-4215 Scheduled Date Actual Inspection Type Start Date Inspection No. Inspection Status Primary Inspector Reinspectlon Inspection 08/31/2021 09/10/2021 09/29/2021 12/28/2023 Checklist Item BLDG-Building Deficiency COMMENTS August 6, 2021 : Pass. 1. No Swimming pool deficiencies. 2. In ground, Gunite, swimming pool and spa, special engineering reinforcement steel rebar, freestanding pool design and swimming pool detail specifications per pool engineer Todd locker, scope of swimming pool/spa work-approved. 3. Equipotential pool bond wire's tails stubbed-out, located at four points at perimeter of pool-partial pass. 4. Underground electrical and underground swimming pool spa plumbing, underwater leak pressure test-approved. 5. permit inspection record card and approved stamp and sign plans-ok. 6. Gas line under air pressure leak test with gauge, and tracer wire, correct depth, scope of work-approved. 08/31/2021 BLDG-55 165427-2021 Passed Tim Kersch Fence/Preplaster Checklist Item COMMENTS BLDG-Building Deficiency Bond wire. 09/10/2021 BLDG-27 Shower Pan/Tubs 166248-2021 Passed Tony Alvarado Checklist Item BLDG-Building Deficiency COMMENTS September 10, 2021: (virtual inspection). 1. No new exterior shower plumbing Deficiencies. 2. Installation of new exterior rear yard-shower, rough plumbing under 1 0' feet high of water leak head pressure test, with installation of New clean out installed, scope of work-approved. 3. Special circumstances: a) contractor very sick with the flu on-site, Inspector did not want to complete inspection in person due to infection reason, entire scope of work is small shower located exterior backyard area, rough plumbing, under water leak test. b) Inspection was completed Virtual and Approved. 09/29/2021 BLDG-54 Equipotential 167592-2021 Passed Tim Kersch Bond(Pools) 12/28/2023 BLDG-Final Inspection 235116-2023 Passed Tony Alvarado Wednesday, February 14, 2024 Passed Yes Complete Passed Yes Complete Passed Yes Complete Complete Page 3 of 4 PERMIT INSPECTION HISTORY for (CBR2021-1504) Permit Type: BLDG-Residential Application Date: 05/25/2021 Owner: CO-OWNERS ALLEN WILLIAM MICHAEi AND ALLEN NATALIE J Work Class: Pool Status: Closed -Finaled Issue Date: 08/03/2021 Expiration Date: 03/28/2022 IVR Number: 33560 Subdivision: Address: 1387 SAPPHIRE DR CARLSBAD, CA 92011-4215 Scheduled Date Actual Inspection Type Start Date Inspection No. Inspection Primary Inspector Reinspection Inspection Status Checklist Item COMMENTS Passed BLDG-Plumbing Final Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes BLDG-SW-Inspection 235117-2023 Passed Tony Alvarado Wednesday, February 14, 2024 Checklist Item COMMENTS Are inactives slopes properly stabilized? Are areas flatter than 3:1 covered or protected? Are sediment controls properly maintained? Are natural areas protected from erosion? Is the entrance stabilized to prevent tracking? Have sediments been tracked on to the street? Have materials collected around the storm drains? Has sediment accumulated on impervious surfaces? Are dumpsters and trash receptacles covered? Has trash/debris accumulated throughout the site? Are all storage areas clean and maintained? Were spills/leaks observed during the inspection? Were there any discharges during the inspection? Passed Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Complete Page 4 of 4 STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FACILITATE RAPID INSTALLATION OF EROSION AND SEDIMENT CONTROL BMPs WHEN RAIN IS EMINENT. 2. THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSION CONTROL DEVICES TO WORKING ORDER TO THE SATISFACTION OF THE CITY INSPECTOR AFTER EACH RUN-OFF PRODUCING RAINFALL. 3. THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY INSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES WHICH MAY ARISE. 4. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE AT THE END OF EACH WORKING DAY WHEN THE FIVE (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT ( 40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER EACH RAINFALL. 5. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM AGGREGATE. 6. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. 7. THE CITY INSPECTOR SHALL HAVE THE AUTHORITY TO ALTER THIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDED TO ENSURE COMPLIANCE WITH CITY STORM WATER QUALITY REGULATIONS. OWNER'S CERTIFICATE: I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT BEST MANAGEMENT PRACTICES (BMPS) DURING 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. Gr--@°' SF, °' -~ \.o U~Nt.1~)/GWlER. 's AGENT. NA.ME .(PRINT) J-"~ ' )'-. . . ...... .'.. ', 'j >._r,.,,, -" OWNER(S)/OWNER'S AGENT NAME (SIGNATURE) I 3 l Jt, 1 / ',..., ,,,., V DATE E-29 STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP ~-z-oc:~ tSD.rf> 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 --0 0 :;::; C: C: "O :;::; :;::; 0, 0 Q) "O Q) E C: "O en C: u u C: C: 0, E C: ...... 0 ::::, ::::, 0 'o ·;:: CL 0 0 0 E ...... .... .... :;::; .... Q) ::;: "O en 0, .... Q) ...... ...... C: "-::::, >, 0, C: Q) .... C: Q) c en en en ~ ·;:: O" .... 0 C: 0, CL Q) C: .... Q) 0 Best Management Practice* ~ C: Oc, ·;:: -c: en .... (!) w > C: 0 ID CL .... 0 Q) 0 Q) Q) 0 :;::; .c en 3:: en ~ Q) 0 C: (.) .... u ...... Q) Q) --C E en ~ "O en ::;: C: Q) C: (BMP) Description ➔ en u Q) (/) en 0, Q) 0, ID '6 C: 0, C: "O en C: Q) ...... Q) '6 Q) 0 ::, Q) :5 ~ ...... 0 0 3:: C: .... 0 al~ "O >, o en C: C: 0 > ~ E :;::; •-Q) .... u C: 0 0 ID (/) ·-0, 0--u Q) Oo 0, Q) Q) X ::;: C) 0, 0 C: Q) 0::: E 0 ...... N en ~ 0 u C')+J Q) ~-~ 0 Q) 0 'ci. .__ ~ Q) 0 Q) E ~ Q) ..., ::::, .D E ~ := en := 3:: ._•-·-0, ·;:: a... e 0, Q) "O .c C: (I) I.J... .... Q) ::::, ·-Q) ·--u Q) u C: 0 ..0 u C: .... 0 ~ "O 0 ..., ...,,_ Cl. 'o u > "O .... ..., ..0 .... .D 0 ·-.... 0 ·-0 Q) .... Q) u ..., 0 0 '-0 ..., Q) Q) 0 Q) u C: 0 0 0 0, +-' 0 ~~ ..., .c Q) ..., 0 ...., 0 ;:: C: ·-C: Q) 0 0 '-0 Q) .c .D '-~o 0 .......... en c: .Bo 0 '-0 Q) -o...., 0 ..., CL 0 oo (!) :s: WO u5 en (/) (.) i.i: (.!) (/)> (/) (/) a... (/) 0::: :s: a... a...o a... >U ::;: (/) ::;: (/) (/)(.) (/) ::::!!: CASQA Designation ➔ r--co O'> ..-I") '<t l[") c.o r--co 0 N ..-I") r--co ' N I") '<t l[") ' ..-..-..-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 0::: ~ (/) (/) (/) (/) :::;;; :::;;; :::;;; ::;: ::;: Construction Activity w w w w (/) (/) (/) (/) (/) (/) (/') (/') f-z z z z :s: :s: :s: :s: :s: Grading/Soil Disturbance / I? Trench inq /Excavation ~ Stockoilina Drillinq/Borina Concrete/ Asphalt Sawcuttinq lo{ Concrete Flatwork ~ Paving I')( Conduit/Pipe Installation Iv Stucco/Mortar Work Waste Disoosal Staqinq/Lay Down Area Eauioment Maintenance and Fuelinq Hazardous Substance Use/Storaqe Dewatering 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 Californ ia Stormwater Quality Association (CASQA) designation number. Choose one or more BMPs you intend to use during constructio11 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: /'!J fi::l ~it>ff'h•N.. C,o.sr V Assessor's Parcel Number: --------- Emergency Contact: Name: Co~ Gc..&-wk>\e_ 24 Hour Ph one: C34Q,. £B-l<./,8/ Construction Threat to Storm Water Quality (Check Box) □ MEDIUM □ LOW Q) ...... en 0 :s:...., C: en Q> ::::, E 0 Q) ~ 0, O 0 N C: 0 0 ::r: ::::!!: c.o I ::;: :s: Q) ...... en O +-' :s: C: Q) a, E ...... Q) Q) 0, b o C: C: o o u:::;;; co I :::;;; :s: Page 1 of 1 REV 11/17