HomeMy WebLinkAboutPE 2.86.11; LA COSTA ESTATES NORTH LOT 42; Engineering ApplicationPW67 110, 29- / .
Application for Grading Permit
CITY OF CARLSBAD
ENGINEERING DEPARTMENT
1200 Elm Avenue
438-5541
PE NO. 2:,'II
Validation by Finance
Department
Building Permit Plan Check No. 85-71 9
FOR APPLICANT TO FILL IN
Site Address s Bond No. pay
7323 BOLERO DRIVE (/"J
Legal Description Map No.
LOT 42 CARLSBAD, TRACT 75-4 8302
Surety Address
Subdivision Name .
LA COSTA ESTATE NORTH
Date Iile UUILJ IiO± U?/iy .LIU.UIJ
f9/a6
Owner Phone
Mr. & Mrs. B.T.LEE 722-0573
Csheposit Rec'd by Date filed
Owner's Address
2 103 El Camino Real, #102, Cc 5. 92054
The following documents are required and shall become a part
of the grading permit when they ar roved.
P Specifications V" Grading plans
Soil report Geologic Report
Drainage structures Other
Plans by Civil Engineer R.C.E.
WAYNE DAVIS, I C6795
Address Phone
2625 GARNET AVE. S.D. 270-0512
Soil Engineer . R.C.E. Phone Compaction report
LD ALLIED GEOTECHNICAL S 449-5900
Grading Contractor Phone SPECIAL CONDITIONS WHICH ARE MADE
R.E.C. INC . 942-2900 A PART OF THIS PERMIT
Address
2103 El Camino Real, #102, OCS. 92054 Authorized hours of operation:
7:00 AM to Sunset, Monday - Friday. Party responsible for overall supervision
Haul routes are to be approved by City Engineer. C INC.
Proposed use of grade site
Adequate provisions shall be made for erosion and siltation
control.
STNGTE RESIDENCE
Number of -cubic yards
Cut Fill Import Waste
All slopes shall be planted per City Code.
610 610 0 0
Proposed Schedule of Start Finish
Operations (dates) FEB . 86 MARCH. 86
All fills to be compacted to at least 90% of optimum
density unless noted otherwise.
I hereby acknowledge that I have read the application and state that
the information I have provided is correct and agree to comply with
211 Cit, nrdin,nrac nd State 1- ran, I+nn ns,rrn,+nn ....,.1 n.-... J•• Under City Code Sec. 11.06 170 this grading is: and the provisions and conditions of any permit issued pursuant to E REGULAR GRADING - City inspector will make inspections this application. sted below.
Signature of Permittee ()-it -2._ _ CONTROLLED GRADING - Private grading engineer shall
observe work, coordinate tests, make reports.
Owner or authorized agent INSPECTION DATE INSP. SIGNATURE
Initial - site prep.
ENVIRONMENTALCLEARANCE -
Date o Rough . prior to drains
El A Log No. ,2
By Final - slopes planted
Grading ermit fee $ Plan check fee $ Compaction reports rec'd.
Perm Is , 86.
Private engr. cert. rec'd.
by
Ilow-Inspector'; Pink-Permittee; Goldenrod-Finance
Date ______________________________ White-Office; Green-Building;
Permi xpiration Date _________________________________________________
THIS FORM WHEN PROPERLY VALIDATED ISA PERMIT TO DO THE WORK DESCRIBED
THIS PERMIT IS VALID FOR A SIX (6) MONTH PERIOD
0C4 S
1200 ELM AVENUE TELEPHONE
CARLSBAD, CA 92008-1989 (619) 438-5541
Office of the City Engineer• /F 09k
Citp at tartbab
TO: BUILDING DEPARTMENT 72P5 I
FROM: ENGINEERING DEPARTMENT
DATE:
ROUGH GRADING APPROVAL FOR PROJECT NO.
(TRACT or P.E. #)
e.
(PROJECT NAME AND ADDRESS)
,2A7t Je - a iM 4e4/ 92e'fl'
(DEVELOPER'S NAME AND ADDRESS)
We have inspected the grading for lot. -9.2 or phase
of the above mentioned project. In addition, we have received rough
grading certification from /4iJ,/ 774j/ç...'i,t— , the Soils
Engineer, dated , and from
the Supervising Grading Engineer, dated , and are satis-
fied that the rough grading has been completed in accordance with City
standards.
Based on these certifications and our observation, we take no exception to
the issuance of a building permit for lots or phase
of project 7 - ( from a grading
standpoint. This release, however, is not intended to certify the project
from other engineering concerns including site development, water or sewer
availability, or final grading.
Prior to the issuance of a certificate of occupancy, we need to be advised
so that we can verify that final grading and landscaping has been complet-
ed in accordance with the approved plans for the project.
APPROVED:
Proj&ct Grading Inspector / r. Constructi' Inspector
cc: Developer
COUTY OF SAN D1
DEPARTMENT OF PLANNING AND LAND USE
CODES DIVISION
SAN DIEGO OFFICE NORTH COUNTY OFFICE
RETURN TO: 5201 Rullin Road, Suite B3 334 Via Vera Cruz
San Diego. CA 92123 San Marcos, CA 92069
565-5920 741-4236
Project Location Name of Permittee WP
LI Ccri-\ (irading Permit No.
This report form for a "minor" grading project is to be completed and signed by the Registered Civil Engineer (or Architect) who
has been designated on the Grading Plan and Permit as the Engineer who will furnish the compaction report for work authorized
by a grading permit issued by the Department of Planning and Land Use.
The intent of the format is to provide inforriiation to the Department of Planning and Land Use as to grading compliance with the
approved Grading Plan and Permit. Where the questions below refer to location, configuration or quantity of cut and/or fill
areas, it is understood that your response will not normally he based on an actual land survey or detailed earthwork quantity
calculations. It should be noted, however, that the Department is particularly concerned where there are possible infractions with
respect to over-steepened slopes, encroachments of required setbacks, uncompacted fills placed, or where the quantity of fill
placed differs substantially from that authorized.
The Department ofPlanning and Land Use requires-that all fills authorized by a Grading Permit becompacted to a minimum of
90% of maximum density with the exception that not mOre than 12" of uncompacted and untested fills may be dispersed over the
land parcel. The need tocompact all fills that are beyond the present limits of the present proposed construction is to insure that
future proposed construction of room additions or swimniiri1,gp6ols or similar structures will not require that uncompacted fills
be removed or recompacted, or that extensive loundatio ill' 'ô+k&e installed.
Compaction reports will not be accepted unless this form is completed and signed by the registered person.
A. COMPATIBILITY WITH GRADING PLAN AND PERMIT
"l. Was tliècompacted IllI placed only in the approximate locations designated on the grading plan
as areas to be filled?
Did the quantity of fill material placed approximately conform to the grading plan?
Did the toe of fill or the top of cut appear to meet the prescribed property line setback
(1.5' for fill; 3.0' for cuts)? T -
Were the finished fill slopes equal 'to or'less than 2 horizontal to I vertical?
5 If the fill material was obtained by cuts on the site were the cuts maie in the proper location and
to the proper slope approximately as shown on the approved grading plan?
6. Were brow ditches' constructed aiproxiniatly a shown oii theading plan?
WLOCATION AND AMOUNT OF COMPACTION lESTS .,
I. Have-you attached a sketch and data showing the location and relative elevation 1o!- all
compaction tests?
2. Was a compaction test made so that there is at least one test in-each 2' thick lens of compacted
material?
Yes _____ No
Yes _____ No _____
Yes _____ No -
Yes _____ No
Yes _____ No
Yes ____ No -
Yes ± No
Yes '" No
3. As indicated by inspections, observations and compaction test results, was the fill, excluding the
top 1.0', compacted to at least 90% of maximum-dry density? . Yes No
C. QUALITY OF FILL COMPACTION OPERATION
I. Was the area to-receive fill properly prepared in terms of brushremoval, benching, wetting,
removal of noncompacted fill or debris and related items? Yes No
Was all detrimelntally expansive soil placed in the fill at 3' or mörc below finish grade? Yes No
Have you attached a copy of your curve liowing the relationship, between optimum moisture
content and maximum density? Yes _____ No
Was all material used as fill (earth, rocks, giavel) smaller than 12" in size? Yes ____ No
Are all areas of the fill ci:ila He for support of ci riiçl Ii Yes _____ No
- -6- Were all cxistingf111s on the site reconipactcd in accordance with the provisions of the grading
S I M
STATISTICAL DATA
I. Dates the grading work was performed:
2. Dates your representative was on Site and number of hours On site for each date, and name of representative:
9-T---S-€ L.t~E, /HR EACH
E. AS-BUILT DATA
I. If the fill placement was not in accordance with the approved grading plan; did you notify the
permittee to obtain approval for deviation frofn the plan before proceeding with additional
fill placement? Yes ______ No
2. If the approved grading. plan does not reflect (licactual location, depth and type of till, have you
submitted for review and approval an as-built plan? Yes ______ No
REMARKSLE'N5IVE ou_ tIVE °tL— co'NtAVtcLS A
pa (\ Vz c), TW 0 sro#g /9"e4iM.
CO C.T(Ot'I TESTS WILL Wt tJ ¶.A tIiNC WAI4.s
ULS 'AF/LL IS USED..
CER11F1CArior1
I hereby certify, under penalty of perjury that the information provided in this certification is
true to the best of my knowledge and belief.
I1i 1535 S. E.sc'ondido Blvd.
1 (619) 741-0533
i4 Il9 -'
II.!
i.
BY:
1)11.
Rev. 5-7-79 S
County of San Diego
DEPARTMENT OF PLANNING AND LA'b USE
San Diego Offico North County Office
5201 Puffin Road, Suite 63 334 via Vera Cruz
San Diego. CA 92123 San Marcot, CA 92069
565-5920 7414236
SINGLE STORY CLAY SOIL FOUNDATION DESIGN (FOR CONCRETE FOOTINGS AND SLAB)
MAJOR PROBLEMS COMMON TO CLAY SOILS C. THE REASON FOR EACH SPECIFIED ITEM IN THE DESIGN
1. Clay soils shrink when allowed to lose lh,ir moisturU, thereby SHOWN BELOW
causing withdrawal of support and allowing a concrete slab or I. Thoroughly Wet Soil
foundation to move downward. Wetting places the clay toil in an exconded condition to as to pre-
clude future expansion of the soil.
2. Clay soils expand when allowed to gain moisture. Soil expansion - 2. Footings to be 24" Deep
causes an upward pressure upon and an upward movement of a
concrete slab or foundation. Places footings at a dept;whee major changes in the moisture con-
tent of the toil will not occur as seasonal and ground surface water
3. Clay soils may be non-uniformly subjected to moisture changes that
conditions vary.
will cause soil shrinkage in some areas and toil expansion in others. Continuous Reinforcing Steal
resulting in withdrawal of support along some portions of the con- Continuous bars provide a beam action for the concrete footings to .
crete slab or loundation, combined with an upward thrust on other . allow those footings to bridgi across the underlaying clay soils that
portions of the slab or foundation, causing tilting or cracking of the may not have uniform bearing ability or may not be subjected to
concrete slab or foundation or complete structural failure with uniform changes in moisture.
attendant cracking and other structural damage to the structure
resting upon the concrate slab or foundation. Slab to be 4" Thick (Nominal)
A 4" thick slab (nominal) provides whet is deemed to be a minimum
4. Capillary action in clay soil allows moisture to move through the thickness to effectively serve as a reinforced concrete slab.
soil. The upward migration through the toll to the under side of the S. Mesh: 6x6/.l0xlO Welded Wire Mesh
concrete slab or foundation can cause a decrease in the bearing cop- Wire mesh reinforcement in mid-slab prevents the slab frqm showing
aclty of the soil. distress in the event non-uniform soil support or non-uniform soil
expaqsivs pressures develop.
Capillary action can result In moisture migration to the-under side
of the concrse"slab. Moisture movement through the concrete slab
Layer of 114" Mm. Rock or Gravel (4" deep)
Provides a cepHlárlty breaker ty#&Qfmaterial.'&1oisture will not rise
can result lndemage, to tile,, carpeting, or other materials installed
oil the upper sideof the concrete slab,
through the materiel as It would-in the original clay or In a tejs
coarse material, such as fine sand-or (me granite.
Visqueen Moisture Barrier IS mill
AUTHOAIZATJION FOR USE OF CLAY SOIL FOUNDATION DE- Properly lapped it provides avapor seal atop and along the vertical
SIGN sides of any exposed clay soil to seal oft the moisture within the soil
so as to reduce variations in the volume of the soil due to changes in
1 he design showil is nuthoii,ed IC be usr'd for single-stony strlJcturs moisture and to also reduce the risk of moisture migrating Into th
i loc;.tions wlin,i lunodenately ':x)ansive soil conditions exist Use area between the under side of the slab and the top of the clay toil.
01 the design may 'but denied by the Building Official when site con- nn. n;Finished (. .4. in Cl from Cm,.',. - Finished
A '
safeguard against structural damage.
1%riinirnum grade for at least adist;ncaof 5' makes provision ditions indicate that use of the design may not be adequate to .... '
for witef to travel sway from she structure so as to preclude surface
2. This design may not suparcede any foundation design prepared by
water wetting the clay soil Immediately adjacent to the exterior
a California Registered Civil Engineer for this site,
footings that would cause lostof soil bearing value and changes in
soil volume.
-4This design is not applicable to all sites. In instances where an
unusual toil problem eitts. the applicant will be required to retaiul
- a California Registered Civil Engineer in the private sector and have
that engineer make recomiendations, for our review, designed to
resolve the problem-that exists as the site.
. -, -'NOTE: 'Thoroughly wet do' soil for 24hóuri using Relnbird or. ' iwi!I instalt..the foundation, and
z. .e-:iIrrJar method until all cracks In the clay are closed. ulab,exactiy in accordence wIth' the
requirements contained on this
sheet or, elternately, I will exercis'
4' of Coarse I 1/4''mIn.l. Rock or Oral
- ,-.
my option to retain a Calilornt,
Registered Civil Engineer in the
6 Mil VIsou.etsVepor Barrier or, -. "\
private sector to submit an 015cm-
ate design, prior to the placing 01
't All Clay Surfn'cei..L.o at Joints. - - 6" x 6" 10 X tO W.W. Mesh
Mid an -Slab any concrete, for your review an'd
ihall be pi3Cad approval.
Signed
Permitt"it or Psrmtste.s Agent
. •., •_,___'\, '\ ,".
00
- •
F ,,,
'Slope Data:
No. 5 Bs,s. Position beicife pour Exterior B. DEPT. AUTHORVATION
Let) 24" end tin splices. Footing 0 It
R 17652 C.E.
6' IG'- I • 1 SINGLE STORY DESIGN
I e-' 6•' I' I .Plan Chick No.
Sheet_ of
lNo Scald Job Location—.
0. COMPLIANCE'WITHtDESlGN REQUIREMENTS PRIOR,TO PLAC-
ING CONCRETE
No concreeslselI,be placid In the footing or slab areas until aut-
horized bythe Building Inspector.
I A. PEPMITIE'CONCURRENCE
OPt. No. 6519 (fluvlidd 1.23.8 1) - -- 1_P.!mI'.. -- I
1% slope
No. 5 bars. Position
24"
before pour, lap 24"
and tie splices.
-
110
Ili
Continuous grade
beam foundation,
SINGLE STORY DESIGN
- - (No Scale)
24"
CO! OF SAN DI3O
DEPARENT OF PLANNING AND LAND
CODES DIVISION
San Diego Office. North County Office
5201 Ruffin Road. Suite 53 334 Via Vera Cruz
San Diego, CA 92123 San Marcos, CA 92069
565.5920 741-4236
SINGLE STORY CLAY SOIL FOUNDATION DESIGN (RAISED _WOOD FLOOR, GRADE BEAM)
-
A. MAJOR'PROBLEMS COMMON TO CLAY SOILS C. THE REASON FOR 'EACH SPECIFIED ITEM IN THE DESIGN
I SHOWN BELOW
Clay soils shrink when allowed to lose their moisture, thereby
causing withdrawal of support and allowing a concrete slab or
foundation to move downward.
Clay soils expand when allowed to gain moisture. Soil expansion
causes an upward pressure upon and an upward movement of a
concrete slab or foundation.
Clay soils may be non-uniformly subjected to moisture changes that
will cause soil shrinkage in some areas and soil expansion in others,
resulting in withdrawal of support along some portions of the con-
Crete slab or foundation, combined with an upward thrust on other
portions of the slab or foundation, causing tilting or cracking of the
concrete slab or foundation or complete structural failure with
attendant cracking and other structural damage to the structure
resting upon the concrete slab or foundation.'
Capillary action in clay soil allows moisture to move through the
soil. The upward migration through the Soil TO the under side of the
concrete slab or foundation can cause a decrease in the bearing cap-
acity of the soil.
.5,mapillary action can result in moisture migration to the under side
6f (he concrete slab. Moisture movement through the concrete slab
' aflrésuIt in damage to tiles, carpeting, or oth-r materials installed
—on the upper side of the concrete slab.
B. AUTHORIZATION FOR USE OF CLAY SOIL FOUNDATION DE
SIGN
I. The, design shown is authorized to be used for single-story structures
at locations where moderately expansive soil conditions exist. Use
of the design may be denied by the Building Official when site con-
ditions indicate that use of the design may not be adequate to
safeguard against structural damage.
This design may not supercede any foundation design prepared by
a California Registered Civil-Engineer for this site.
This design is not applicable to all sites. In instances where an
unusual Soil problem exists, the applicant will be required to retain
a California Registered Civil Engineer in the private sector and have
tfat'enginéér make recommendations, for our review, designed to
resolve the problem that exists at the site.
Thoroughly Wet Soil
Wetting places the clay toil in an expanded condition so as to pre-
clude future expansion of the soil.
Footings to be 24" Deep
Place footings at a depth where major changes in the moisture con-
tent of the soil will not occur as seasonal and ground surface water
conditions vary,
Continuous Reinforcing Steel
Continuous bars provide a beam action for the concrete footings to
allow those footings to bridge across the underlaying clay soils that
may not have uniform bearing ability or may not be subjected to
uniform changes in moisture.
Girder sizes and post spacing depend upon the design of the build-
ing. All sizes must'comply with the current U.B.C.
5, All footings must be constructed with 3 Continuous concrete pour.
Drainage must be directed away from all footings.
In order to pr,et'dep seated slope failure. the maximum slope of
the building sitemtst be limited to 10%.
S. Finished Grade tqSlope Away from Structure
A 1% minimum grade for at least a distance of 5' makes provision
for water to travel away from the structure so as to preclude surface
water wetting the clay soil immediately adjacent to the exterior
footings that would cause loss of soil bearing value and changes
soil volume,
9. Masonry or concrete fireplaces may be used subject to the fàllowing
criteria:
Footings must be 15" thick & extend 24 below the adjacent grade
The overall fire place height is limited to 17'
Reinforce the footing with # 4 horizontal bars at 6" 0/C each
direction & extending 6" into the foundation stem well.
D. COMPLIANCE WITH DESIGN REQUIREMENTS PRIOR TO PLAC-
IN G• CONCRETE
concrete shall be placed in the footing or slab areas until author-
ized by the Building Inspector.
A. PERMITTEE CONCURRENCE'
6
1%sIoe JE1,
- II
if
AX 10" A.B. r'
typical -
lilt
fll
liii
12"
OPL No. 65A (Revised 1.23.811
NOTE: Thoroughly wet clay Soil for 24 hours using Rainbird . -, . .....S
or similar method until all cracks in the clay are closed. I will install the foundation and
slab exactly in accordance with the
- requirements contained on this
sheet or, alternately. I will exercise
my option to retain a California
SeeFrm DPL No. 888 for Framing Details N . Registered Civil Engineer in the
s., private sector to submit an altern.
ate design, prior to the placing of
'I." Tj Note C-4 steel dowel ____________ any concrete, for your review and
1%
18" approval.
slope mm. 1
Signed
jr Permittee or Permittees Agent
iti IrS lIU'lW, Date:
Note C-S ôip - AUTHORIZATION
R.C.E. 17652
Plan Check No. __________
Sheet — of
Job Location
Permittee
•
- FEE: $175'.00
RECEIPT NO: i74/3/
ENVIRONMENTAL IMPACT ASSESSMENT FORM - Part I
(To Be Completed by APPLICANT)
CASE NO: •1. /1
DATE -3'-d
Applicant: MR. &M,RS. B.T.LEE .' •
Address of Applicant: 2103' El Camino Real, #102, Oceaiside,' Ca. 9.2054
PhoneNumber: (619') 942-2900
Name, address and phone number -of person to be contacted (if other than
Applicant): WARD KAO '
GENERAL INFORMATION:
•
S
Description 'of Project: ONE SINGLE RESIDENCE
Project Location/Address: '7323 Bolero Drive, Carlsbad, Ca. 92008
Assessor Parcel Number: 215 -493 • - 1700
5
Zone of Subject Property:PC
Proposed Use 'of Site: ONE SINGLE RESIDENCE
'List all other applicable applications related to this project:
GRADING PERMITS, BUILDING PERMITS
._
2.' Describe the activity area, including distiguishing natural and man-
.,.made characteristics; also provide precise slope analysis when
appropriate.
.. . . . :
CUT IN THE REAR AREA FOR LANDSCAPING, FILL AROUND THE BASEMEN'iET AREA
3. Describe energy conservation measures incorporated into the design
and/or operation of the project.
kf
. .
N/A
A. If residential, include:the number of units, schedule of unit sizes,*
range of sale prices or rents, and type of, household. size expected.
ONE SINGLE RESIDENCE, ± 6000 SF. . . . .
I'f'commercial, indicate the type, whether neighborhood, city'.or
regionally oriented, square footage' of sales area, and. loading -
facilities.
. N/A-.,
6'. If industrial, indicate type, estimated 'employment per shift, and
loading facilities
N/A
7. If institutional, indicate the major function, estimated employment per
shift, estimated occupancy, loading facilities, and -community benefits'
- . to be derived from the project.
N/A
-2-
• I. ENVIRONMENTAL IMPACT ANALYSIS .
Answer the following questions by placing a check in the appropriate
space. (Discuss all items checked "yes". Attach additional sheets as
necessary.)
YES NO
Could the project significantly change present
land uses in the vicinity of the .activity?
Could the activity affect the use of a recreational
area,' or area of important aesthetic value? X
Could the activity affect the functioning of an
established community or neighborhood? X
Could the activity result in the displacement of
community residents?
Could the activity increase the number of low and:
modest cost housing units in the city? '
ix
Could the activity decrease the number of low and
modest cost housing units in-the city? ..
Are any of the natural or man-made features in the
activity area unique, that is, not found in other
'parts of the county, state or nation? ' ' '
8)' Could the activity significantly affect an
historical or archaeological site or it,s settings?
Could the'activity significantly affect the
potential use., extraction, or conservation of a
scarce natural resource? . '
' Does the activity significantly affect th,e
'potential use, extraction, or conservation of a
scarce natural resource?
Could the activity significantly affect fish,
wildlife or plant life? . '
Are there any rare or endangered plant species
in the activity area?' " ' ' ' '
Could the activity change existing features.of .any of the, city's lagoons, bays, or' tidelands?' '
Could the activity change existing features of x any of the city's beaches?
15).' Could the activity result in the erosion or
elimination of agricultural lands?
16) Could the activity serve to encourage development '
of presently undeveloped areas or intensify develop- .' x
- ment of already developed areas?'-
-3-
X
X
x
X
X
x
x
X.
X
IM
17) Will, the activity require a variance from
established environmental standards (air, water,
noise, etc.)?
YES NO
x
Will the activity require certification, authoriza-
tion or issuance of a permit by any local, state or
federal environmental control agency?
Will the activity require issuance of a variance
or conditional use permit by the City?
Will the activity involve 'the application, use, or
disposal of potentially hazardous materials?
21)'. Will the activity involve construction of
facilities in a flood plain?
22) Will the activity involve construction of
facilities in, the area of an active fault?.
23) ' Will the activity involve construction of
facilities on a slope of 25percent or greater?
24) Could the activity result in the generation of
significant amounts of noise?
25) Could the activity result in the generation of
significant amounts Of dust?
26) Will'-the activity involve the burning of brush,
trees, or other materials?
27) Could the activity result in a significant change
in the quality of any portion of the region's air
or water resources? (Should note surface,' ground
water, off-shore.)
28) Will the project substantially increase fuel
consumption (electricity, oil,, natural gas, etc.)?
29) Will there bea significant change to existing
land form?
Indicate estimated grading to be done in
cubic yards: 610 , • . ' Percentage of alteration to the present
land form: 5 ' •
Maximum height of cut or fill slopes:.
'5 ft.
''
• .
30) Will the activity result in substantial increases.
•
- in the use of 'utilities, sewers, drains or streets? X
31) Is the activity carried out as part of a larger '
project or series of projects? ' • . • ' X
-4-
•
ENVIRONMENTAL IMPACT ASSESSMENT FORM - PART II
(To Be Completed by the LAND USE PLANNING OFFICE)
CASE, NO.
0
DATE:
BACKGROUND
1.. APPLICANT: IB.t LQE,.
ADDRESS AND PHONE NUMBER OF APPLICANT: 9O ç Cotèr °\
Ocea-., cA gos
DATE CHECK LIST SUBMITTED:__________________________________
ENVIRONMENTAL IMPACTS
(Explanations of all Affirmative Answers are to b Written Under
Section III - Discussion of Environmental Evaluation)
YES MAYBE NO
1. Earth - Will the proposal have • •
significant results in: • •
a. Unstable earth conditions or in
changes in geologic substructures?
Disruptions, displacements, corn- • •
paction or overcovering of the soil? 0
Change in topography or ground
surface relief features?
0 0
The destruction, covering or 0
• •
-
modification of any unique geologic or physical features? ______ ••• _____ ______
Any increase in wind or water • 0
erosion of soils, either onor off
the site? •
0
0 • _____ ______
Changes in deposition or.erosion
of beach sands, or changes in
siltation, deposition or erosion • •
which may modify the channel or a. 0 •
river or stream orthe bed of the
ocean or any bay, inlet or lake?
•
0
0 1 --------•
0
•
YES MAYBE NO
2. Air - Will the proposal have
sin ificant results in:
a. Air emissions, or deterioration
of ambient air quality?
b. The creation of objectionable S
odors?
c. Alteration of air movement,
• moisture or temperature, or any
• .• change in climate, either locally • '1 j • or regionally?
3. Water '- Will the proposal have
significant'results in:,
Changes in currents, or the course '
"or direction of water movements,
in either marine or 'fresh waters?
Changes in absorption rates,
drainage patterns, or the rate and
- amount of surface water' runoff? -
- Alterations-'to'the course or flow' S •
• -
-
of flood waters?-
d. Change in the amount of surface' S
water in any water body
- e.' Discharge-into surface waters, S ' S .• • or in any alteration of surface S
•
S S water quality, including but not S S
- limited to, temperature, dissolved S
oxygen or turbidity?. S
S
•
• - S
f. Alteration' of the direction or - S - •
-
-
-
-
: rate of flow of ground waters?
I g. Change in the quantity of ground , S ',
S ' • '
waters, either through direct • S , • S
'additions or withdrawals, or through
S - ' interception of an aquifer by cuts ' S
S • • S
- :
• or excavations.?
h. Reduction in the amount 'of-ater • S • -
5 • •
otherwise available for public , • S
.5 5
• •
water supplies
-2- • - S
o
YES
4. Plant Life.'will the, proposal have
significant results in:
a.'' Change,in the diversity of species,
or nurnbers.of any species of plants
(inäluding. trees, shrubs, grass,
crops, microflora and aquatic plants)?
Reduction of the numbers of any
unique, rare or endangered species
of plants?
Introduction of new species of plants V
into an area, or in a 'barrier to the
normal replenishment of existing
, species?
d. Reduction in acreage of any,
agricultural crop?
Animal Life'- Will the proposal have
significant results in:
a. Changes in the diversity of species,
.or numbers of any species ,of animals
V V V (birds, land animals including reptiles, V
fish and shellfish, benthic organisms,
V insects or microfauna)?
V •
• V
b V Reduction of the numberá of any' unique,
rare or endangered species of animals?' V V
C.. Introduction of new species of animals
into an area, or result in a barrier
V to the migration or movement of
animals? V
d. DeteriOratiOn to existing fish or V
V
wildlife habitat?
Noise - Will the proposal significantly V
increase existing noise levels? V • •
Light and Glare - Will the proposal sig-
nificantly produce new light or glare?
Land' Use .- Will the proposal have V
V significant results in the alteration of, ' V V
V the present or planned land use of an
area?
MAYBE No
V
-3-
MON
YES MAYBE' NO
Natural Resources - Will the proposal
have significant results in:
a.' Increase'in the -rate of use of any
natural resources?
b. Depletion of any nonrenewable
natural resource? . .
Risk of'Upset - Does the proposal
involve a significant risk of an
explosion or the release of hazardous
substances (including, but riot limited
to, oil,, pesticides, chemicals or
radiation) 'in the' 'event of an accident
'or upset conditions?
11. , Population - Will the proposal signif-
icantly alter the location, dIstribu-
tion, density, or growth rate of. the
human population of an area?
Housing - Will the. proposal signif-
icantly affect existing housing, or '
create 'a demand for additional housing?
Transportation/Circulation - Will the
proposal have significant results in:
a. Generation of additional vehicular'
movement? .
b,. Effects on existing parking facilit-
ies, or demand for new parking?
c. Impact upori existing transporation.
systems?
d. Alterations to 'present patterns of •
' circulation or movement of people
and/or good's?.
Alterations to waterborne, rail or
air traffic?
'Increase •th traffic hazards to
motor vehicles, bicyclists or
pedestrians?
YES MAYBE NO
14. Public Services -.Will the proposal have S
a significant effect upon, or have signif-.
icant results in the need for new or
altered governmental services in any of •.
the followijig areas:
a. Fire protection?
b. Police protection? • ______ _____ ______
c Schools'
d. Parks or other recreational I
facilities?
'e. Maintenance of public facilities, •fl
including roads?
f. Other governmental services?
15. Energy - Will the• proposal have signif- :
icant results in:
•
S • • '•
Use of substantial amounts of fuel. • ••
5
or energy? S ______ •
• _____ S
Demand upon existing sources of - 5
energy, or require the development S
of new sources of energy? • • ______ _55
16. • Utilities. - Will the proposal have • ••
•
significant results in the needfor new S
S systems, or alterations to the following S •
utilities: 5
Power or natural gas? S • ____ 'k
Communications systems? S
•
S •
Water? S
Sewer or septic tanks?
Storm water drainage?,
f. Solid waste and disposal?
S S
t S;
17. Human Health - Will-the proposal have S
S significant results in. the creation of S • 55
any health hazard or potential health S •,
hazard (excluding mental health)'
-5-
YES MAYBE NO
18. Aesthetics -'Will the proposal have
significant results in the obstruction
of any-. scenic vista or view open to the
public, or will the proposal result in -
creation of an aesthetically offensive
public view?.
I.
19. Recreation - Will the proposal have • •
significant result in'-the impact upon •
the quality -or quantity of existing • • • -
recreational opportunities? • •• •
-.
20. Archeological/Historical - Will the
proposal have significant results in
the alteration of a significant •
archeological or historical site, • • •
structure, object or building?
21. Analyzeviable alternatives to the proposed project such as:
a) Phased development of the project, b) alternate site designs, •.
c) alternate scale of development, d) alternate uses for the site, •
e) development at some future time rather than now, f) alternate • sites for the proposed, and g) no project alternative. •
• _e•••_5 ci \c
: 0 -6- •
0 •
.
: YES MAYBE NO
22. Mandatory Findings of Significance
Does the project have the potential
to. degrade the quality of the . S
environment, or curtail the diversity . .
in the environment?
Does the project have the potential . . .
to achieve short-term, to the dis-
advantage of long-term, environmental . . .
goals?. . (A. short-term impact. on• the . . .
environment is one which occurs in a
relatively brief, definitive period of
. . time while long-term impacts will . . . . . •
.endure well into the future.) . . . . . . .
C. Does the project have impacts which . . .
are individually limited, but .
cumulatively considerable? (A . . .
project may 'impact on two or more . . . .
separate. resources where the. impact
on each resource is relatively small, S.
but where the effect of the total of . . .. .
those impacts on the environment is
significant )
d.' Does .the project have environmental .. .. . •
effects which will cause substantial .
adverse effects on human beings, • . . . . . .
either directly or indirectly?
III. DISCUSSION OF ENVIRONMENTAL EVALUATION A I 4J
.,& nk a
QO cibc
*oc -
40
-7-
. .
Iv. DETERMINATION (ToBeCompleted by the -Land Use Planning Office)
On the basis of' this initial, evaluation:
find the proposed project COULD NOT have a significant effect on....
the environment, and a NEGATIVE.DECLARATION will be prepared. .
.1 find that although the proposed' project could have a significant
effect on the environment, there will not be a significant 'effect in ;
this case because the mitigation measures described on an attached
sheet have been added to the project. A Conditional Negative -
Declaration will be proposed. •
•
•
I find the proposed project MAY, have a significant, effect on the
environment, and an ENVIRONMENTAL IMPACT REPORT is required.
/Date/ . ,
.•
Si n ture , • • , •
V. MITIGATING MEASURES (If Applicable) • • '. . • '•. .'