HomeMy WebLinkAbout2780 JAMES DR; ; CBR2022-3301; PermitBuilding Permit Finaled
Residential Permit
Print Date: 08/13/2024
Job Address: 2780 JAMES DR, CARLSBAD, CA 92008-1953
Permit Type:
Parcel#:
Valuation:
Occupancy Group:
#of Dwelling Units:
Bedrooms:
Bathrooms:
Occupant Load:
Code Edition:
Sprinkled:
Project Title:
BLDG-Residential
1561425100
$25,448.64
Description: VECK INVESTMENTS: 392 SF POOL & SPA
Work Class:
Track#:
Lot#:
Project#:
Plan#:
Construction Type:
Orig. Plan Check#:
Plan Check #:
Applicant: Property Owner:
Pool
CARRIE JONES VECK INVESTMENT PROPERTIES LLC
9921 CARMEL MOUNTAIN RD, # STE 189
SAN DIEGO, CA 92129-2898
(619) 343-5908
FEE
3276 HIGHLAND DR
CARLSBAD, CA 92008-1918
(760) 753-5543
BUILDING PLAN REVIEW -MINOR PROJECTS (LOE)
BUILDING PLAN REVIEW -MINOR PROJECTS (PLN)
SB1473 -GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION -RESIDENTIAL (SM IP)
SWIMMING POOL-RESIDENTIAL
SWPPP INSPECTION FEE TIER 1-Medium BLDG
SWPPP PLAN REVIEW FEE TIER 1 -Medium
Total Fees: $904.31 Total Payments To Date: $904.31
Permit No:
Status:
( City of
Carlsbad
CBR2022-3301
Closed -Fina led
Applied: 09/12/2022
Issued: 09/28/2022
Finaled Close Out: 08/13/2024
Final Inspection: 07/25/2024
INSPECTOR: Kersch, Tim
Balance Due:
Alvarado, Tony
Renfro, Chris
AMOUNT
$194.00
$98.00
$2.00
$3.31
$246.00
$292.00
$69.00
$0.00
Please take NOTICE that approval of your project includes the "Impositi on" 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
( City of
Carlsbad
RESIDENTIAL
BUILDING PERMIT
APPLICATION
8-1
Plan Check ~;;;G ,3;Z) I
Est. Value @&5-,L/LI-J -vt./
PC Deposit _______ _
Date q -f ';;2-o?[)
JobAddress ct700 ""Ja~ Dr , Suite: APN : \ S° 6 ,... l '-\o -~ \ ·----
CT/Project #:. _________________ Lot #: ____ Year Built: ________ _
Fire Sprinklers: OvEsQ NO Air Conditioning:Q YES O NO
BRIEF DESCRIPTION OF WORK:
f'/\f P oo \ ~-~e. 3 qd e'
Electrical Panel Upgrade: OvEsO NO
0 Addition/New: _____ Living SF, ___ Deck SF, ___ Patio SF, ____ Garage SF __
Is this to create an Accessory Dwelling Unit? Ov O N New Fireplace? Ov O N , if yes how many? __
D Remodel: SF of affected area -----Is the area a conversion or change of use? Ov O N
~ Pool/Spa: "3 0,) SF Additional Gas or Electrica l Features? ___________ _
o solar: ___ KW, ___ Modules, M ounted:ORoof OGround, Tilt: 0 vO N, RMA: Ov O N,
Battery:Ov O N, Panel Upgrade: Ov O N
D Reroof: ----------------------------------□ Plumbing/Mechanical/Electrical
D 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 0WN~R . ·: ,f PPLICANT □ PROPERTY OWNERS AUTHORIZED AGENT APPLICANT lN
Name: V-e'-~ .J:/\ve~ ~.-'\. ~ Name: cP,rl' ,e..-CS"AQ..r
Address: 1 g:, W .. So~ t ()-r-.----Address: 5 '7g; '3 M \SI) 1-'~ LJ§1\:+cr fZ.J...
City: c;;:::;:k \c:.,\ State: c~ Zip: q?o:2f, City: 6P State: Cl<\ Zip: % \ .::::f?
Phone: Phone: 0,s -3Y3 --f c::J O ~
Email: Email: Co-r r I e. J'4""\e'.J e:.~ \'f\x;) I .C'c:t::':-l
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
af the Business and Professions Code, and my license is in full farce 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 ahd..will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the perfor1mance of the w6rk for whic~ this 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: '1/ I
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 my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Seel
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).
~s owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
~actor'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 this application giving the agent authority to obtain the permit on the owner's behalf.
By !71Y 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
ir1Jprovements 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 applica~le law, Section 7044 of the Business nd Professions Code, is available upon request when this appficatian is
submitted or at the following M.:~://-z;jn~:·c:gov/calaw.
5
.hltGmlN. ·. ...._,t.,_.d:!;.....;~------"1'1-.1 A } O \ ·'\ :)_
OWNER P~INT: ________ ...,....... __ l _ -~--------TE:_""1__,__ J _O-__ _
;\ <$'C-v\ \-J
APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT.THE TIME OF SUBMITTAL
I • ' By my signature be/aw, 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 propeny for inspection purposes. I ALSO AGREE TO SAVE,
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: SIGN: t4-DATE:
1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov
2 REV. 08/20
I.
II.
( City of
Carlsbad
OWNER-BUILDER
ACKNOWLEDGEMENT
FORM
8 -61
De vel o m e nt Services
Building Division
1635 Farad a/ /\v.,nu<>
760 602 2719
www cMlsbadca go,
OWNER-BUILDER ACKNOWLEDGM ENT 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 2780 James Dr., Carlsbad, CA, 92008
The City of Carlsbad ("City") is providing you with this Owner-Builder Acknowledgment and Ver1f1catron form
to inform you of the responsibilities and the possible risks associated with typical construction act1v,t1es rs sued
in your name as the Owner-Builder.
The City will not issue a construction permit until you have read and initialed your understand,ng 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 construct,on
related acknowledgments designed to inform the property owner of his/her obligations related to the requested
I understand a frequent practice of unlicensed contractors is to have the property owner obtarn an 'Owner
ilder" building permit that erroneously implies that the property owner rs providing hrs or her own labor and
material personally. I, as an Owner-Builder, may be held liable and sub1ect to serious financial r sk for any 1niuries
sustained by an unlicensed contractor and his or her employees while working on my property My horneowner's
insurance may not provide coverage for those in1uries. I am willfully acting as an Owner Builder and am aware of
th Ii its of my insurance coverage for injuries to workers on my property.
I understand building permits are not required to be srgnecl by property owners unles~ chey MP responsible
h construction and are not hiring a licensed contractor to assume thrs responsibility
Ill. I understand as an ·•owner Builder" I am the responsible party of record on the pe1 m1t I unde,~tJnri that I
y protect myself from potential financial risk by h1nn g a licensed contractor and havrng the permit filed m hrs
ame instead of my own.
IV. I understand contractors are required by ldw to be licensed and bonded in California and to list their licem~
V. understand if I employ or otherwise engage any persons, other than California lrcen~ed co1Hr<H tor~ . .ind
th total value of my construction rs at least five hundred dollars ($500), 1nclud1ng labor and materials, I may ue
considered an "employer" under state and federal law.
REV 08/20
Owner-Builder AcknowlPcigement Conttnucd
VI. I underst,rnd ,f I .irn co,1\1cJerecl c111 "ernployc," unrlPr •.t,lt" .J1HI f,-,,t '' ,I l,h'I I rr111 r ,, F .,,.r 1,,•r tt,•· ,t,,•,.
,11 d feder,,I govc1 nmcnt. w1thholrl pJyroll ta.<e,, nrov1rlP workr•r; rnn>p,., ·, ,t, ,n d1 1b , I tr.,,, 1r "', H1cJ
c r tribute to unem ployment compensation for e,1c h ",_,mplnyf'P 'I ,1·,o ur,dr•r ,t.1 nd rn-, f.i ur•· ,r; .If rJc, b·1 n ".,,
ay subiect m e to seriou~ f1n;inc1<1l 11sk.
VII I understand under Californ1;i Contractors' State l1cenv• l ,1.v, ,i n O 111,,., B11 1rlr•r :11'0 b1J1'r.J, , '•R. ,. f im 1
VIII
re> 1dPnt1al structures c;innot legally build them with thP intent to offc·r ttwm for ',"IP. unlr•~, ,111 w;,., , µ,,,,, ,,.,,.,1
b licensed subcontractors ilnd the number of str uctures does not l::'~C(•nd four w,th,n ,,n,' i1.,,.,,i,lf ,,.,.. 0r i I '.)I
work 1s performed under contract with a licensed general budd,nr, contr,1ctor
I understand J S an Owner-Builder 1f I sell the propcrtv for 111h1ch th s p~rrr 1 •~ ·,•,1J"iJ rr.11 r;,, r c 'J i .. n ''
any fi nancial or personal injurtes sustained by any su bsequr•nt ovm"r(•,i n t ' r•· ,,, • :•orr 1n 1 11'"".
struct1on defects 111 the workmanship or material,.
IX. I understand I may obtain more information regarding my o bl1ga t1ons as an '••tf'D '1 1 •r '",,.,. ·, ·' • ·~rrtJ
X.
XI.
venue Service, the United States Small Business Adm1n1 strat1on. the C.il1fr1 rn1 1 u,,p 1r·r-n:1· o· ~,-, 0 • •
yment s, and the California Di111s1on of Industrial Accidents. I also underst.ind I n ,, ,,;r' t ·-•• (.) ·,, 1
Co tract ors' State License Board (CSLB) at 1 800·321 CSLB (2752) or v,wv,.cslb c,1 ~,.,, ·,r ,.,.. J'• ~· ,,., ,·-,,
I am aware of and consent to an Owner Builder bu1ld1r1g permit applied for •" m, r,,.,.~· l"'J ~-c··-~·1-l
t I am the pa rty legnlly and financia lly responsible for proposed construction ;ict1>11 / ;it tre 'a, o .'I -g y; J-.·· ,
I agree that, as the party legally nnd financially responsible for this proposed cons tr ur; or J,: . • 1
.ill applicable laws and requirements that govern Owner Burlders as well as ernp over,
XII. I agree to notify the issuer of this form 1mmed1ately of any add1t1ons, deletions, o· cr-1"'c{-'S :o 1r , '.)r :· ~
In ormation 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 f1nanc1JI loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors m.iy be in c1,11I court.
It is also important for you to understand that if an unlicensed Contractor or employee of that 1nd1v1dual or firm
is injured while working on your property, you may be held liable for damages. If you obtain a perm,~ a) 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 con be issued, this form must be completed, signed by the property owner and returned
to the City of Carlsbad Building Division.
I dee/ore under penolcy of per11.1ry 1h01 I hove reod ond 1.111derscond o/1 of the 1nformor,on provided on th,s 10,m and chat my ,;,sponses, ,nc/1.10,no my
ovchorrt)I co s,gn ch,s form, ,s cr1.1e ond correct. I om aware rhot I hove thr opc,on to cons1.1lc w,!/1 leqol counselµ, or co s•qnmg cn,s form, ond I hov~
either (l) conwlled v1<1h legal covnsel pr,or 10 s,gnmg th,s form or /2) hove wo,ved th,s r,ght Ill s,gnmg Ch,s torm MIi-our ere odv,ce of leqol counse
~M ~ c5?~
J/~»r~~ ~
Property Owner Name (PRINT)
0911412022
Date
REV 08/10
~ City of
Carlsbad
OWNERS
AUTHORIZED
AGENT FORM
8-62
Deve/QP_men t Ser vices
Building Division
1£,3) F ,Ir,1d,I 1 A 1r•nt.<>
760 602 2719
•111111 ~arl',O.Jdc,1 go ,
OWNER'SAUTHORIZED AGENT FORM
Only a property owner, contractor or their authonzed agent may submit plans and appl1cot,ons for bu,ld,ng
permits. To authorize a third party agent to sign for a building permit, the owner's th,rd party agen must bring
this signed form, which identifies the agent and the owner who s/he 1s representing, and for 11ha 100s s/he
m ay obtain permits. The form must be completed in its entirety to be accepted by the C,ty for each seoara:e
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 ,s my personal respon::.Ib1 Icv
I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents nece-,r;ary
to obtain an Owner-Builder Permit for my project.
f . . ( 0 . . f w kl pool and spa Scope o Construction ProJect or escription o or : ___________________ _
Project Location or Address:
Carrie Jones/Mike Condon 619-343-5908 Name of Authorized Agent: __________________ Tel No ________ _
Address of Authorized Agent: 9921 Carmel mtn rd, #189
sd, ca 92129
I declare under penalty of perjury that I am the property owner for the address listed above and I personallv filled
out the above information and certify its accuracy.
Property Owner s Signature: ___
7
--. ...... f2~..,.,.~~----------Date: _0_9_1_1_4_l2_0_2_2_
Building Permit Inspection History Finaled
(city of
Carlsbad
PERMIT INSPECTION HISTORY for (CBR2022-3301)
Permit Type: BLDG-Residential Application Date: 09/12/2022 Owner: VECK INVESTMENT PROPERTIES LLC
Work Class: Pool Issue Date: 09/28/2022 Subdivision: CARLSBAD TCT#98-16
Status: Closed -Finaled Expiration Date: 01/08/2025 Address: 2780 JAMES DR
IVR Number: 43219 CARLSBAD, CA 92008-1953
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Re inspection Inspection
Date Start Date Status
09/08/2023 09/08/2023 BLDG-SW-Pre-Con 223227-2023 Passed Tim Kersch Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
10/19/2023 10/19/2023 BLDG-51 227562-2023 Passed Tim Kersch Complete
Excav/Steel(Pools)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-52 Pool Plumbing 227561-2023 Passed Tim Kersch Complete
05/10/2024 05/10/2024 BLDG-54 Equipotential 247962-2024 Passed Chris Renfro Complete
Bond(Pools)
07/12/2024 07/12/2024 BLDG-55 254516-2024 Passed Tony Alvarado Complete
Fence/Preplaster
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-SW-Inspection 254758-2024 Partial Pass Tony Alvarado Reinspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
07/25/2024 07/25/2024 BLDG-Final Inspection 255890-2024 Passed Tony Alvarado Complete
Checklist Item COMMENTS Passed
BLDG-Plumbing Final Yes
BLDG-Mechanical Final Yes
BLDG-Structural Final Yes
BLDG-Electrical Final Yes
Tuesday,August13,2024 Page 1 of 2
PERMIT INSPECTION HISTORY for (CBR2022-3301)
Permit Type: BLDG-Residential
Work Class: Pool
Application Date: 09/12/2022 Owner: VECK INVESTMENT PROPERTIES LLC
Issue Date: 09/28/2022 Subdivision: CARLSBAD TCT#98-16
Status: Closed -Finaled Expiration Date: 01/08/2025 Address: 2780 JAMES DR
CARLSBAD, CA 92008-1953 IVR Number:
Scheduled Actual Inspection Type Inspection No.
Date Start Date
Tuesday,August13, 2024
BLDG-SW-Inspection
Checklist Item
255951-2024
COMMENTS
Are erosion control BMPs
functioning properly?
Are perimeter control BMPs
maintained?
Is the entrance stabilized to
prevent tracking?
Have sediments been tracked
on to the street?
Has trash/debris accumulated
throughout the site?
Are portable restrooms
properly positioned?
Do portable restrooms have
secondary containment?
43219
Inspection Primary Inspector Reinspection Inspection
Status
Passed Tony Alvarado Complete
Passed
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Page 2 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 SAT1SFACT10N
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 PROTECTlVE 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.
~\~u~
OWNER,(S)/OV(NER'S t\GENT NAME (PRINT) qlci l dd
DATE
E-29
STORM WATER COMPLIANCE FORM
TIER 1 CONSTRUCTION SWPPP CYo(Z~{') d, PS -3 ,30 I
BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE
Erosion Control Sediment Control BMPs Tracking Non-Storm Water Wast.e Management and Materials
BMPs Control BMPs Management BMPs Pollution Control BMPs
C:
C: C: 0 ...... ...... 0 0 :;:; C: C: -:, :;:; :;:; C7' 0 (I) -:, Q) -:, (/) C: u u C: C: C7' E C: E C: .... 0 ...... ::, ::, 0 'o ·;:: c.. 0 0 0 E (I) .... .... :;:; .... ·5 Q)
::::::!: -:, (/) C7' .... .... ...... C: '->, C7'
C7' C: (I) .... C: (I) C: (/) (/) (/) ~ ·;:: O'" .... 0 C:
Cc, c.. Q) ·;:: -C: (/) C: .... w (I) 0
Best Management Practice* .;; C: 0 CD c.. .... 0 (I) 0 .... <.!) (I) > C: :;:; (/) 3: (/) ~ (I) 0 C: (I) ...... (I) 0 ...... ..c: C: E u ... u (/) ~ -:, v (/) ::::::!: C: (I) C:
(BMP) Description (/) u (I) (/1 C7' (I) C7' CD ·o c: C7' -:, (/) ➔ ·e (I) (/) C: C: a ::::::> (I) ...... (I) (I) :5 ~(I) u ...... 0 0 3: C: .... 0 ~~ -:, >, 0 (/) C: C: 0 > ~E 0 CD (/1 ·-Co (I) :;:; ::::::!: a c,, a C: C: a E C7' a·-~o U(I) C7' c (I) c (I)
(I) a::: 0 ...... N CJ) CTI:;:; (I) 0.. .__ 3: Q) X (I) E ~ u (I) C: ·-C7' a. 0 Q) 0 E ~ v ...... ::, ..a == "' == 3: ... --::0 0 ·c: ·;:: C7' .... -:, ..c: C: (I) LL u ... (I)::, -:, :0 (I) ·--:, Q) ...... C: 0 ... 0 (I) ~ .... -:, 0
0 ....,,_ c.. '6 (I) > .bg ......... ..a 0 ...... u -~ ~ 0 ·-0 (I) ... u _ ......
0 ... 0 0 ...... Q) 0 C: 00 0 ... .Eo 00 ...... ..c: (I) ...... 0 ...... 0 = C: ·-C:
(I) 0 0 ... (I) ..c: ,Q .... 0 ...... .... ...... C7' 0 Q) -o...., 0 ...... C..0 oo
<.!) 3: WO vi vi (/1 u LL <.!) en> (/1 (/1 a. (/1 C: (/1 a::: 3:ct 0.0 a. >u ::::::!: (/1 ::::::!: (/1 cnu (/1 ::::::!:
CASQA Designation ➔ " co O'l ~ I"') -.t-LO " co 0 N I"') " co N I"') -.t-LO
'T ~ c:D ~ ~
I 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 g: g: (/1 (/1 (/1 (/1 ::::!!: ::::!!: ::::!!: ::::!!: ::::!!:
Const.ruction Activity w w w w (/1 (/1 (/1 (/1 (/1 (/1 (/1 (/1 z z z z 3: 3: 3: 3: 3:
I✓ Gradinq/Soil Disturbance N llljg )<:.
V T ren china /Excavation ..,.. ~ """"' \ Stockoilina . ">4
Drillina /Borina
J Concrete/ Asphalt Sawcuttina
" Concrete Flatwork
\J Pavinq
Conduit/Pioe Installation
Stucco/Mortar Work " Waste Disposal )cl
Staaina/Lav Down Area
Eauioment Maintenance and Fuelina
Hazardous Substance Use/Storaae
Dewaterina
Site Access Across Dirt
Other (I ist ):
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.
PROJECT INFORMATION
Site Address: ~12,0 ~J. ~/'.
Assessor's Parcel Number: J) (;, -1'10 -S \
Emergency Contact:
Name: 1'fV\.c.. r--'\q1-o ~
24 Hour Phone:/ b\) ~ bb b ... O~<t.,b
Construction Threat to Storm Water Quality
(Check Box)
)tJ MEDIUM □ LOW
(I) ...... (/) 0 3:...., C: (/) Q)
::i E 0 (I) ~ C7' oO N C: co
I::::!:
c:D I i
Q) ...... (/)
0-+-' 3: C: Q)
Q) E ...... Q) ~ C7' uo C: C:
0 C
U::::::!:
co I ::::!!: 3:
~
)o
VJ.
Page 1 of 1 REV 11/17