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HomeMy WebLinkAbout1015 DAISY AVE; ; CB162869; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 07-26-2016 Demolition Permit Permit No: CB162869 Building Inspection Request Line (760) 602-2725 Job Address:1015 DAISY AV CBAD Permit Type:DEMO Full Demo:N Status:ISSUED Parcel No:2144221700 Lot #:0 Applied:07/26/2016 Entered By:RMA Occupancy Group:Reference #:Plan Approved:07/26/2016 PC #: # Dwelling Units:0 Structure Type:Issued:07/26/2016 Bedrooms:0 Bathrooms:0 Inspect Area: Project Title:YORK RES-DEMOLISH POOL-PLACE HOLES IN BOTTOM & FILL WITH DIRT. NO FORMAL Applicant:Owner: TOM YORK TOM YORK 1015 DAISY AVE 1015 DAISY AVE CARLSBAD CA 92011 CARLSBAD CA 92011 858 775-4603 858 775-4603 Building Permit $0.00 Plumbing Fee $0.00 Other Fee $65.00 Additional Fees $0.00 TOTAL PERMIT FEES $65.00 Total Fees:$65.00 Total Payments To Date:$65.00 Balance Due:$0.00 -II/6 FINAL APPRI9yAL Inspector:Date:e *(bri-Clearance: NO110E Please take NCITICE that approva of your project includes the "Imposition" cf fees, decicaticns, reservations, or other exactions hereefter collectively referred to as lees/exactions."You have 90 days from the date thispantwas issued to protest irrpositioncf these fees/exactions.If you protest them you rrust fdlani the protest pnxecires set forth in Goverment CrrIP Section 66003(a), and file the protest and any other required irfarration with the City Mmager for processing in clauddrx..with Carlsbad Kridpal Cif Section 3.32.030.Failure to timely fdlchy that procedue will bar mysubsequent legal action to attack, review, set aside, void,aannul their imposition. You ae hereby R.Aill-ERNalRED that you-rip to protest the spedfied fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, ncr planning, zoring,gatingor other sirrila application processinga service fees in connection Wth this project.NCR DOES ITAPPLY tomy fees/exactions of which you have Previously been riven a NOTICE sirrilar to this. or as to wtich the statute of limitations has orevicusly otherwise exoired. City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Storm Water Pollution Prevention Plan (SWPPP) Permit 07-26-2016 Permit No:SW160331 Job Address:1015 DAISY AV CBAD Permit Type:SWPPP Status:ISSUED Parcel No:2144221700 Lot #:0 Applied:07/26/2016 Reference #:Entered By:RMA CB#:CB162869 Issued:07/26/2016 Inspect Area: Project Title:YORK RES-FILL IN POOL W/ DIRT Tier:1 Priority:L Applicant:Owner: TOM YORK TOM YORK 1015 DAISY AVE 1015 DAISY AVE CARLSBAD CA 92011 CARLSBAD CA 92011 858 775-4603 858 775-4603 Emergency Contact: TOM WELLINGTON 619 867-1581 SWPPP Plan Check $0.00 SWPPP Inspections $59.00 Additional Fees $0.00 TOTAL PERMIT FEES $59.00 Total Fees:$59.00 Total Payments To Date:$59.00 Balance Due:$0.00 FINAL APPROVA DATE 7. Y.16 A SCE SIGNATURE _ _......._., Building Permit Application Plan Check No.Cidt/‘jti 7r` .IIV.„ff.' . -.A.Oi 1635 Faraday Ave, Carlsbad, CA 92008 Est. Value .r--1 -.'"' 1.-4 --'Ph: 760-602-2719 Fax: 760-602-8558 oi Plan Ck. Depo7 1,p 4-1 c. riq 0 :email: building@carlsbadca.govi..L.Ji.....P..!_www.carlsbadca.gov - _Date -712 6 /L swppfp --- 1 1mBADDREss tom-- ail5y A ve— SINEVSPACEVIRVIT4 APN CT/PROJECTa LOT 4 PRASE*itof UNITS 4 KORCISMS a UAIII ROOMS TENANT BUSINESS NAME CONSTR. TYPE 000_ GROUP 1 Sfihoilkestillt 18 2.1 3 2.... 1 1.___1 1DESCRIPTION OF WORK:Include Square Feetet Affected Areal's)I`De Astob A opt cgi Po©l i Fill In Ii (r .1-7.0 - 1:-)cep P(Y-)•• EXISTING USE PROPOSEDcUr GARAGE (SF)rPATIOS (Sr)DECKS (SF)FIREPLACE AIR CONDITIONING FIRE SPRINKLERSPool,Ya r YESE34,NOD YES EjNo2 YESD NOQ rPLICANT NAME _...1-"""'PROPERTY OWNER NAMEp.,...c......i oin York (0 in York:4 'lacy 10 (.1 ib..22t)PtADDRESSADDRESS 720 ?1111.3k-i-ta id,72(9 tets/e."1/4 i WcyCITYSTATEZIPCITYaSTE ZIPCarl5 ba ct.CA-f2oil -(s.!._ark_CA-920/iPi'FAX PitiltNE I A)j_ Sitc3 _77 c 1 603 15(i S -)2 if 7ga K5'87751603 _i_si.5-g e241 7 d-jo? EMAIL r EMAILicon.yo lak6-yikla 1 r .COM Do noVoK.K.6...grata /.CO M. DESIGN PROFESSIONAL Am CONTRACTOR BUS. NAME V._________ALL ""riet tz_toElliot, yr/GA)/NC,____.,... ADDRESS ADDRESS CITY STATE •ZIP CITY .STA E ZIP To mu I_Y/936" PHONE FM TRIUNE FAX G 0-i p7-i5kl.1 P?-6 -.‘_).I ((_. EMAIL EMAIL 1 ,l-arc i i •i lo tic 9 Act y at ali evRO II riepitvc 0 in _- ISTATE [AC.*STATE 4 MAS.S CITY BUS.tiC.4 I _g8 6 6 5-.)c -A.1.'.4 Cy 5-1(Sec.7031.5 Business and Professions Code:My City or County which requires a permit to construct, after, improve, demolish or repair any structure, prior to its issuance, also requires theapplicant for such permit to file a srgned statement that he is licensed pursuant to the provisions of the Contractors License Law iChapter 9, commenting with Section 7000 of Division 3 of theBusiness and Professions Code]or that he is exempt therefrom, and the basis for the alleged exemption.My violation of Section 7031.5 by arty applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars [$SOOD- Workers' Compensation Bettaration: I herebyaRtii artierpenalty of perjury o rm&the A:Waving ft/orations: 01 have and will maintain acertificateofconsent to self-insure for workers' conwiSallen as provided by Section 3700 of theLain.Code. for the perfonnanceofthe work for which MSpewitisissued 10Ihave and will maintain workers' compensation, as required be Section 3700 of the Labor Code. for the performance of the work for which this Selma is issued.Mg workers' Compensation insurance carrier end policy . number xe:Insurance Oa Policy Na xpkationDatea ,This need not be completed if the permit isformehundred doltzs ($100) or fess. 1 certificate of Exemption:I cerkfy that in the performance of themork for which this permit is issued,I stall rotemploy any person in any manner so as to become subject to the Workers' Compensation taws of 1Carffornia.WARNING: Failureto secure twitters' compensation coverage is .'subject an employer to aiming) penalties and civil fines UPtoOne hundred Thousand dollars (B100.000), in add Mon to the cost of compensalinrcdomages as provided for in Section 3706mitre Lahti' code! .....e4rietibri and attorney's fees. ..es.CONTRACTOR SIGNATURE k....,..ki IV:Ark_.t.i.....,W 4)4',..-/.'---']AGENT DATE '.".7 ..;d 5 _./1 Ihereby affirm that tam exempt from C.ontractor'snooseLaw for the foiiming reason:In li i I, as owner of the property or my emptifees v.ith wages as their sole compc-mabon,40do the work and the structure is not intended or okered for sale (Sec. 7044, Business and Professions Code The Contractor's 1 ii License Law does not apply to an mimerofproperty who bales or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for isale.If, however, the building or improvement is sold within ose yearofcompletion, the °Inter-Wader will have tieburden of pmuing that hodd not OW or improve for the purposeofsale). i 54 I,as owner of the property, am evasively contracting with licensed contractors lo construct the project (Sec. 7044, Business and Professions Code: The Contractor's license taw does rotapply to an owner of 1property whoMilsor improves thereon, and contracts for suchprOjeCIS with cootvector(s) licensed pursuant to the Contractor's License Law). I0Iam exempt under Section _Business and Professions Code for this reason: 1 1.1 persenany plan to provide the ffialOr labor and materials for constructon ofthe proposed property improvementOYes DM 24 (haveIhave not)s*ied an application forabuilding impish for theproceedwork. 3.I have contracted with the followingWM (firm) to provide the p cOnstrolion (include name Warns I phOneicontractors license number):i i 4.IVan to provide portons of the work, titoI have hired the fordo 'to coordinate. supervise and monde the major. work (include nameIaddress I phone 1 contractors' license nuMber): S.1vial Oftwile sorra?of tiS work, but I have contracte .irerrt s to provide the moth inotated (include name/address / phew ( type of wen): //10 _...------' .--------- 17.2.i..riKPROPERTY OWNER SIGNATURE QAGENT DATE j--- . Inspection List Permit#:CB162869 Type:DEMO YORK RES-DEMOLISH POOL-PLACE HOLES IN BOTTOM & FILL WITH DIRT.N Date Inspection Item Inspector Act Comments 08/03/2016 19 Final Structural RI POOL DEMO 08/03/2016 19 Final Structural PD AP 07/29/2016 54 Pre-Site RI PROGRESS INSPECTION FOR POOL DEMO 07/29/2016 92 Compliance Investigation PD AP Wednesday, August 03, 2016 Page 1 of 1 ••.....•..... ..7'e 0.-- STORM WATER COMPLIANCE FORM LCB6v____ZglTIER1CONSTRUCTION SWPPP •E-29 SWZ42 -- STORM WATER POLLUTION PREVENTION NOTES BEST MANAGEMENT PRACTICES (8A4P) SELECTION TABLE &MsNM SeamOm Mrs NM*Mtufacm Mate %Me Immettmlet meMarls 1.ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE (MNOAPs MouseemOMR memCanedOM AvAILASa ON STE TO FACI iTATE RAP.O INSTALLATION . OF EROSION AND SEDIMENT CONTROL Ws MIEN RAIN 1 tl 1 I 1 -1 1 . IS EMINENT.3 1 1 I 2 3 1 I tt i li 2.THE CYMER/CONTRACTOR SHALL RESTORE ALL EROSION 2 p e *2 CONTROL DEVICES TO WORKING CODER TO DIE SATISFACTION BesthlanagementRadior .2 il a I 1 I I .i1A 1 1 -.F il .--Lii - OF THE CITY INSPECTOR AFTER EACH RUN-OFT PRCOUCING gRARIORKIVIRR ---)I I i g -1i I r gi 1 1 II I at g RAINFALL zi uir.ir il i sit'i -It/1..„IN il3.THE WEER/CONTRACTOR SHALL INSTALL ADOTITONAL EROSION Siigi righ;*...t>1 h at I.it ..g f ii J. i j ati 11 ,_,=TIROL MEASURES AS MAY BE REOUWEO BY ITC CITY WSPECTCO DUE TO INCOMPLETE GRADING OPERATIONS OR 4Daseposios —9 c.7 7 1.7 —.........0 9 —CY F..r.et.•-•....•••.dr 03 UNFORESEEN CIRCUMSTANCES OCR MAY ARISE.8 t.".:a ti i ilii il it i it i i i i i i a i i i i iOxman.Amm•ALL REMOVABLE PROTECTRE DEVICES SHALL BE ITT PLACE OMMatee - AT THE END OF EACH MORIONC DAY MEN THE FILE (5)omarna/Onmatice --Ale - 'p4Acti)!AISNATPROBAB ANOoaJTY FoRccAsTHER DEWEIS1-4EXCEEtALLeeRFORTY PECENT go susciame.. I .ELIOVFD AFTER EACH RAINFALL.ConantrAsquit Smutting - Casa*. yid M !5.ALL CRAWL BAGS SHALL MOM 3/4 INCH MINIMUM ___PIII'.... AGGREGATE Conan satellotion i '' , 6 ADEQUATE EROSION AND SEDIMENT CONTROL.AND PERIMETER %gm Pr tiwk PROTECTION BEST MANAGOIENI PRACTICE MEASURES MEI — 1TN!.. RE INSTALLED AND MATNTAIPRI1 a.Doest Ma Esoloosent INAMenonee entl Fuelina - 7 THE OTT INSPECTOR SHALL HAVE TEE ALITITORIFT'TO ALTER Nazenteue Subaru Use/Siorom .•THIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDED Dmaterina '.TO ENSURE COMPLIANCE WIN OTT STORM WATER OUALITY SiloArms Acme Our .. ..REGULATIONS.Oth ---.•..1..i ..- 1ImmetiontI.Check the bet to the left of eft oppieehle conottuettoo ootkity (WO column) minded to °cox dueno emmbucliork 2 Loomed along the lop of the 974'TOM te .FM of MrP's Mth Ira meopensing Colima Samuel°. (Natty Asseciolica (CASINO)Mamba.samba:Choose oneetmorem's )01I illeUld to use Wang candruction Rom the let.Check the boil ohm the chosen oetiAty roe Mernmets NO the IMP Mans 3.Relic to the CAVA =snuck..nom:Doak la anlonnolion and &tads of he Moser 1311Pa and ho*to goofy than to the project. OWNERS CERTIFICATE 1 uNDERsroNo AND AcKNORIGICE THAT I eloST.(T) IMPIDOTT TER'MANAGEMENT (*Acmes (BMPS)CORM OTINSTAUCTION AciNums TO TIE RAMON EXTENT PRACTICABLE TO AVOD PROJECT INFORMATION TNT tiONLIZATION OF POLLUTANTS RIOT AS SEDIMENT AM)TO Sile Mama 1A IS 444i Sti•_AtC=-___.AD THE DPOSTWE OF STORM MATER TO CONSTRUCT/WI SHOW THE LOCATIONS OE ALL CHOSEN&Ws ABOVE RELATED PCLITIONTS;NO (2) AMIE TO.AND AT ALL MOS.ON THE PROJECTS SITE PLAMEROSION CONTROL PLAN.Assessoei Pomo Nwebu:"")14.1 -Z.111114_717.7I CDcoupty vm.Ns an APPROVED ITER I COISTRUCTICN STEPP SEE THE REVERSE SIDE OF THIS SHEET FORA SAMPLE 1THROUGHOUTTIEDURATIONOrTHEGGNSIRUC1104ACTIVITIESEROSION CONTROL PLAN.Emergency Contact - WA TT*CATHSTRuCTOW WORK 5 COIRICTE ktft)APPROVED .......-re 1 IVzu-/d4 raiBYTHEOTT CF C.ARLETNI. "T'Pr Ph'''. -6/1-A-7--1S49/ OftelkIMDMRIERI AGENT NAME (PANT) Ccenetvetion Threot to Stone Wu Ouolity OmERITSVOISEES AGENT RARE (SOTATURE)---ar—E (Check BM ID MECALai 0 UM E-29 Page I of 1 REV 02/10 • .....I...O.MI. DETERMINATION OF Development ServicesCl0PROJECT'S SWPPP Land Development EngineeringayfTIER LEVEL AND CONSTRUCTION 1635 Faraday Avenue Carlsbad THREAT LEVEL 760-602-2750 E-32 www.carlsbadca.gov I'm applying for:D Grading Permit D Building Permit 0 Right-of-way permit NfaOther Project Name:Project ID:DWG ft-ICB# Address:/0/S 64i Atiellii -C.APN Qi44-44a)-11-e6 Disturbed Area:Ac_JAHENt_ Section 1: Determination of Project's SWPPP Tier Level (Check applicable criteria and circle the corresponding SWPPP Tier Level, then go to section 2) SWPPP Tier Level Exempt -No Threat Project Assessment Criteria My project is in a category of permit types exempt from City Construction SWPPP requirements. Provided no significant grading proposed,pursuant to Tablet,section 3.2.2 of Storm Water Standards,the following permits are exempt from SWPPP requirements:Exempt___..., >Electrical >Patio >Mobile Home j D Plumbing 1 >Spa (Factory-Made)l .1.....--4 --......-1 >Fire Sprinkler D Mechanical D Re-Roofing i >Sign >Roof-Mounted Solar Array........______________.-----------------.........................._ Tier 3-Significant Threat Assessment Criteria —(See Construction General Permit (CGP) Section LB)* O My project includes construction or demolition activity that results in a land disturbance of equal to or greater than one acre including but not limited to clearing, grading, grubbing or excavation; or, Li My project includes construction activity that results in land disturbance of less than one acre but the construction activity is part of a larger common plan of development or the sale of one or more acres of disturbed land surface; or, O My Project is associated with construction activity related to residential, commercial, or industrial Tier 3 development on (ands currently used for agriculture; or O My project is associated with construction activity associated with Linear Underground/overhead Projects (LUP) including but not limited to those activities necessary for installation of underground and overhead linear facilities (e.g. conduits, substructures, pipelines, towers, poles, cables, wire, towers, poles, cables, wires, connectors, switching, regulating and transforming equipment and associated ancillary facilities) and include but not limited to underground utility mark out, potholing, concrete and asphalt cutting and removal, trenching, excavation, boring and drilling, access road, tower footings/foundation, pavement repair or replacement, stockpile/borrow locations. El Other per CGP _,, Tier 2-Moderate Threat Assessment Criteria: My project does not meet any of the Significant Threat Assessment Criteria described above and meets one or more of the following criteria: O Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 15.16 of the Carlsbad Municipal Code); or, Li Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria:Tier 2 •located within 200 feet of an environmentally sensitive area or the Pacific Ocean; and/or, •disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical; and/or •disturbed area is located along or within 30 feet of a storm drain inlet, an open drainage channel or watercourse; and/or •construction will be initiated during the rainy season or will extend into the rainy season (Oct.1 through Apr. 30).— Tier 1 -Low Threat Assessment Criteria My project does not meet any of the Significant or Moderate Threat criteria above, is not an exempt permit type per above and the project meets one or more of the following criteria: •results in some soil disturbance; and/or Tier 1 •includes outdoor construction activities (such as roof framing, saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling) *Items listed are excerpt from COP. CGP governs criteria for triggers for Tier 3 SWPPP.Developer/owner shall confirm coverage under the current CGP and any amendments, revisions and reissuance thereof. E-32 Page 1 of 2 REV. 02116 Ma NM NM I SWPPP Section 2: Determination of Project's Construction Threat Level 0 Tier (Check applicable criteria under the Tier Level as determined in section 1,circle Construction Level the corresponding Construction Threat Level, then complete the Threat Level sirature block belowL Exempt -Not Applicable -Exempt Tier 3 —High Construction Threat Assessment Criteria: My Project meets one or more of the following: 0 Project site is 50 acres or more and grading will occur during the rainy season U Project site is located within the Buena Vista or Agua Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA High U Soil at site is moderately to highly erosive (defined as having a predominance of soilsTier 3 with USDA-NRCS Erosion factors kr greater than or equal to 0.4) LI Site slope is 5 to 1 or steeper El Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 -April 30). GI Owner/contractor received a Storm Water Notice of Violation within past two years Tier 3 —Medium Construction Threat Assessment Criteria.Medium All projects not meeting Tier 3 High Construction Threat Assessment Criteria Tier 2 —High Construction Threat Assessment Criteria: My Project meets one or more of the following: I:3 Project is located within the Buena Vista or Ague Hedionda Lagoon watershed, inside or within 200 feet of an environmentally sensitive area (ESA) or discharges directly to an ESA U Soil at site is moderately to highly erosive (defined as having a predominance of soils High with USDA-NRCS Erosion factors kr greater than or equal to 0.4) Tier 2 LI Site slope is 5 to 1 or steeper L3 Construction is initiated during the rainy season or will extend into the rainy season (Oct. 1 -Apr. 30). U Owner/contractor received a Storm Water Notice of Violation within past two years 1: - .1 Site results in 10,000 sq. ft. or more of soil disturbance Tier 2 —Medium Construction Threat Assessment Criteria Medium My project does not meet Tier 2 High Threat Assessment Criteria listed above Tier 1 —Medium Construction Threat Assessment Criteria: My Project meets one or more of the following: ED Owner/contractor received a Storm Water Notice of Violation within past two years MediumLiSite results in 500 sq. ft. or more of soil disturbanceTier10Construction will be initiated during the rainy season or will extend into the rainy season (Oct.1 -April 30) Tie r 1 -Low Construction Threat Assessment Criteria LowMy project does not meet Tier 1 Medium Threat Assessment Criteria listed above =I certify to the best of my knowledge that the above statements are true and correct I will prepare and submit an appropriate tier level SWPPP as determined above prepared in accordance with the City SWPPP Manual.I understand and acknowledge that I must adhere to and comply with the storm water best management practices pursuant to Title 15 of the Carlsbad Municipal Code and to City Standards at all times during construction activities for the permit type(s) checked above. The City Engineer/Building Official may authorize minor variances from the Construction Threat Assessment Criteria in special circumstances where it can be shown that a lesser or higher SWPPP Tier Level is warranted. ContctName:Telephone No:City Concurrence:Yes No /- (For City Use Only)Owner/Owner's Authorized Agent Namei*---p-Ali(.ee-y+By.Cowner/Owner's1s Authorized Agent Signature:Date:Date: Project ID: E-32 Page 2 of 2 REV. 02/16 STORM WATER Development Services Ar 1/4 • ....CitY Of STANDARDS Land Development Engineering 1635 Faraday Avenue CarlSbad QUESTIONNAIRE 760-602-2750 E-34 www.carlsbadca.gov To address post-development pollutants that may be generated from development projects,the City requires that new development and significant redevelopment priority projects incorporate Permanent Storm Water Best Management Practices (BMP's) into the project design per Carlsbad BMP Design Manual (BMP Manual). To view the BMP Manual, refer to the Engineering Standards (Volume 5). This questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary permits and/or construction permits). The results of the questionnaire determine the level of storm water standards that must be applied to a proposed development or redevelopment project. Depending on the outcome,your project will either be subject to 'STANDARD PROJECT'requirements or be subject to 'PRIORITY DEVELOPMENT PROJECT' (PDP) requirements. Your responses to the questionnaire represent an initial assessment of the proposed project conditions and impacts. City staff has responsibility for making the final assessment after submission of the development application. If staff determines that the questionnaire was incorrectly filled out and is subject to more stringent storm water standards than initially assessed by you, this will result in the return of the development application as incomplete.In this case, please make the changes to the questionnaire and resubmit to the City. If you are unsure about the meaning of a question or need help in determining how to respond to one or more of the questions, please seek assistance from Land Development Engineering staff. A completed and signed questionnaire must be submitted with each development project application. Only one completed and signed questionnaire is required when multiple development applications for the same project are submitted concurrently. PROJECT INFORMATION . PROJECT NAME:Pas,I int Lkk PROJECT ID:16 J -)ItA.Jtj t:4-i.c• ..Ai <NALC..The project is (check one):0 New Development 0 Redevelopment 70(..)FN .The total proposed disturbed area is:-4 2 L.;ft2 )acres The total proposed newly created and/or replaced impervious area is:_ta!ft2 acres If your project is covered by an approved SWQMP as part of a larger development project, provide the project ID and the SWQMP # of the larger development project: Project ID:Ni/4 SWQMP #:'kJ 1.1\ Then, go to Step 1 and follow the instructions. When completed, sign the form at the end and submit this with your application to the City. E-34 Page 1 of 4 REV 02/16 STEP 1' TO BE COMPLETED FOR ALL PROJECTS To determine if your project is a "development project., please answer the following question: YES NO Is your project LIMITED TO routine maintenance activity and/or repair/improvements to an existing building or structure that do not alter the size (See Section 1.3 of the BMP Design Manual for guidance)? If you answered "yes" to the above question, provide justification below then Go to step 5, mark the third box stating "my project is not a 'development project' and not subject to the requirements of the BMP manual" and complete applicant information. Justification/discussion: (e.g. the project includes only interior remodels within an existing building): If ou answered 'no" to the above question, the project is a development project', go to Step 2. -STEP 2 tf.1 -":01\lM**:Ye'-'';''' TO BE COMPLETED FOR ALL DEVELOPMENT PROJECTS '•- To determine if your project is exempt from PDP requirements pursuant to MS4 Permit Provision E.3.b.(3), please answer the following questions: Is your project LIMITED to one or more of the following: YES NO 1.Constructing new or retrofitting paved sidewalks, bicycle lanes or trails that meet the following criteria: a)Designed and constructed to direct storm water runoff to adjacent vegetated areas, or other non- erodible permeable areas; b)Designed and constructed to be hydraulically disconnected from paved streets or roads; c)Designed and constructed with permeable pavements or surfaces in accordance with USEPA Green Streets guidance?Nar 2.Retrofitting or redeveloping existing paved alleys, streets, or roads that are designed and constructed in accordance with the USEPA Green Streets guidance? 3.Ground Mounted Solar Array that meets the criteria provided in section 1.4.2 of the BMP manual? If you answered "yes" to one or more of the above questions, provide discussion/justification below, then Go to step 5, mark the second box stating "my project is EXEMPT from PDP ..." and complete applicant information. Discussion to justify exemption ( e.g. the project redeveloping existing road designed and constructed in accordance with the USEPA Green Street guidance): • If you answered "no" to the above questions, your project is not exempt from PDP, go to Step 3. E-34 Page 2 of 4 REV. 02/16 ;•itti).W.14n.ANW 0 •.9).,;;InE'M •4•MR -*011.-if/ To determine if your project is a PDP, please answer the following questions (MS4 Permit Provision E.3.b.(1)): YES NO 1.Is your project a new development that creates 10,000 square feet or more of impervious surfaces collectively over the entire project site?This includes commercial, industrial, residential, mixed-use,ofand public development projects on public or private land. 2.Is your project a redevelopment project creating and/or replacing 5,000 square feet or more of impervious surface collectively over the entire project site on an existing site of 10,000 square feet or more of impervious surface?This includes commercial, industrial, residential, mixed-use, and public development projects on public or private land. 3.Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface collectively over the entire project site and supports a restaurant?A restaurant is a facility that sells prepared foods and drinks for consumption, including stationary lunch counters and refreshment stands selling prepared foods and drinks for immediate consumption (Standard Industrial Classification (SIC) code 5812). 4.Is your project a new or redevelopment project that creates 5,000 square feet or more of impervious surface collectively over the entire project site and supports a hillside development project? A hillside development project includes development on any natural slope that is twenty-five percent or greater. 5.Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface collectively over the entire project site and supports a parking lot? A parking lot is a land area or facility for the temporary parking or storage of motor vehicles used personally for business or for commerce. 6.Is your project a new or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface collectively over the entire project site and supports a street, road,highway freeway or driveway?A street, road, highway, freeway or driveway is any paved impervious surface used for the transportation ofautomobiles, trucks, motorcycles, and other vehicles. 7.Is your project a new or redevelopment project that creates and/or replaces 2,500 square feet or more of impervious surface collectively over the entire site, and discharges directly to an Environmentally Sensitive Area (ESA)?"Discharging Directly to° includes flow that is conveyed overland a distance • of 200 feet or less from the project to the ESA, or conveyed in a pipe or open channel any distance as an isolated flow from the project to the ESA (i.e. not commingled with flows from adjacent lands).* 8.Is your project a new development or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious surface that supports an automotive repair shop?An automotive repair shop is a facility that is categorized in any one ofthe following Standard Industrial Classification (SIC) codes: 5013, 5014, 5541,7532-7534, or 7536-7539. 9.Is your project a new development or redevelopment project that creates and/or replaces 5,000 square feet or more of impervious area that supports a retail gasoline outlet (RGO)?This category includes RGO's that meet the following criteria: (a) 5,000 square feet or more or (b) a project Average \74 -- Daily Traffic (ADT) of 100 or more vehicles per day. 10.Is your project a new or redevelopment project that results in the disturbance of one or more acres of land and are expected to generate pollutants post construction?1„/" 11.Is your project located within 200 feet of the Pacific Ocean and (1) creates 2,500 square feet or more of impervious surface or (2) increases impervious surface on the property by more than 10%? (CMC 21.203.040) If you answered "yes" to one or more of the above questions, your project is a PDP.If your project is a redevelopment project, Go to step 4. If your project is a new project, Go to step 5, check the first box stating "My project is a PDP ..." and complete applicant information. If you answered "no" to all of the above questions, your project is a 'STANDARD PROJECT', "Go to step 5,check the I second box stating "My project is a 'STANDARD PROJECT'..." and complete applicant information. E-34 Page 3 of 4 REV. 02/16 .,_•-.STEP 4 - •,•-.- TO BE COMPLETED FOR REDPCRE PiiipRireDEVELOPMtNT•pROJEcTS 'EVELOMENTPROJETS THAT A, •.,(PDP) ONLY • Complete the questions below regarding your redevelopment project (MS4 Permit Provision E.3.b.(2)): YES NO Does the redevelopment project result in the creation or replacement of impervious surface in an amount of less than 50% of the surface area of the previously existin de lopment? Complete the percent impervious calculation below: Existing impervious area (A)= scATotal proposed newly created or replaced imperviou a a (sq. ft. Percent impervious area created or replaced (B/A)*100 =4 % If you answered "yes", the structural BMP's required for PDP apply only to the creation or replacement of impervious surface and not the entire development.Go to step 5, check the first box stating "My project is a PDP ..." and complete applicant information. If you answered 'no," the structural BMP's required for PDP apply to the entire development.Go to step 5, check the check the first box stating "My project is a PDP and complete applicant information. STEP 5 -• CHECK THE APPROPRIATE BOX AND COMPLETE APPLICANT INFORMATIoN"*04''-'-',--,k.;s • My project is a PDP and must comply with PDP stormwater requirements of the BMP Manual.I understand I must prepare a Storm Water Quality Management Plan (SWAMP) for submittal at time of application. -My project is a 'STANDARD PROJECT' OR EXEMPT from PDP and must only comply with 'STANDARD PROJECT' stormwater requirements of the BMP Manual.As part of these requirements,I will submit a "Standard Project Requirement Checklist Form E-36' and incorporate low impact development strategies throughout my project. Note: For projects that are close to meeting the PDP threshold, staff may require detailed impervious area calculations and exhibits to verify if `STANDARD PROJECT' stormwater requirements apply. 0 My Project is NOT a 'development project' and is not subject to the requirements of the BMP Manual. Applicant Information and Signature Box Assessor's Parcel Number(s): Applicant Name:Applicant Tit!.wte".:$) I t.) Applicant Signature:_Date: *Environmentally Sensitive Areas include but are not limited to all Clean Water Act Section 303(d) impaired water bodies; areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); water bodies designated with the RARE beneficial use by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); areas designated as preserves or their equivalent under the Multi Species Conservation Program within the Cities and County of San Diego; Habitat Management Plan; and any other equivalent environmentally sensitive areas which have been identified by the City. This Box for City Use Only City Concurrence'YES NO --By: Date: Project ID: E-34 Page 4 of 4 REV. 02/16 STANDARD PROJECT Development Services'r City of.REQUIREMENT Land Development Engineering CHECKLIST 1635 Faraday Avenue Carlsbad E-36 760-602-2750 www.carlsbadca.goy •0610.4.104On0:00 .;;. Project Name:,j ke/ty,j Project ID:6 is 6".- .s4 44/c DWG No. or Building Permit No.: AR development projects must implement source control BMPs SC-1 through SC-6 where applicable and feasible. See Chapter 4 and Appendix E.1 of the BMP Design Manual for information to implement source control BMPs shown in this checklist. Answer each category below pursuant to the following. •"Yes" means the project wilt implement the source control BMP as described in Chapter 4 and/or Appendix E.1 of the Model BMP Design Manual. Discussion/justification is not required. •"No" means the BMP is applicable to the project but it is not feasible to implement. Discussion/justification must be provided. •"N/A" means the BMP is not applicable at the project site because the project does not include the feature that is addressed by the BMP (e.g., the project has no outdoor materials storage areas). Discussionfjustification may be provided. SC-1 Prevention of Illicit Discharges into the MS4 )44•-....1;tikkl/ADiscussion/justification if SC-1 not implemented:rs,, • Wje__-\--.5 -ft c.le.t?rs t +Pe...k./..4.\../ SC-2 Storm Drain Stenciling or Signage 771 Yes Li No J>V1/A Discussion/justification if SC-2 not implemented: SC-3 Protect Outdoor Materials Storage Areas from Rainfall, Run-On,f71 Yes 0 No ›fl/ARunoff, and Wind Dispersal Discussion/justification if SC-3 not implemented:N 44-1-7P41.-N. SC-4 Protect Materials Stored in Outdoor Work Areas from Rainfall, Run-On,Yes El No >"/ARunoff, and Wind Dispersal Discussion/justification if SC-4 not implemented:I\J C 4- 71 - . -c.kso i•Jo c-)LA-ii I 05 SC-5 Protect Trash Storage Areas from Rainfall, Run-On. Runoff, and Wind n Yes 7 No >eV/A Dispersal Discussionfjustification if SC-5 not implemented:A ) E-36 Page 1 of 3 REV 02/16 _.„..„.„.:...aikUitkai*toegt),Otrougeggirement:;.;'.H:..:;..:•-;..!..'......-..3APiglid..7t4.:4V0.:, SC-6 Additional BMPs based on Potential Sources of Runoff Pollutants must answer for each source listed below and identify additional BMPs. (See Table in Appendix E.1 of BMP Manual for guidance). .1 On-site storm drain inlets 0 Yes Noi C N/A 0 Interior floor drains and elevator shaft sump pumps 0 Yes .''o 0 N/A O Interior parking garages 0 Yes L•o 0 N/A 0 Need for future indoor & structural pest control 0 Yes ..,_i_-o 0 N/A 0 Landscape/Outdoor Pesticide Use 0 Yes No C N/A 0 Pools, spas, ponds, decorative fountains, and other water features 0 Yes No 0 N/A 0 Food service 0 Yes 1St No C N/A 0 Refuse areas 0 Yes -.Q•No C N/A O Industrial processes •0 Yes .q\No Li N/A :• - ;Outdoor storage of equipment or materials 0 Yes •:No 0 N/A u Vehicle and Equipment Cleaning 0 Yes xNo Ei N/A 0 Vehicle/Equipment Repair and Maintenance 0 Yes 'N No 0 N/A O Fuel Dispensing Areas 'i Yes klNo 0 N/A 0 Loading Docks :i Yes ...No 0 N/A 0 Fire Sprinkler Test Water 0 Yes No Li N/A O Miscellaneous Drain or Wash Water 0 Yes No El N/A O Plazas, sidewalks, and parking lots 0 Yes WkNo 0 N/A For "Yes° answers, identify the additional BMP per Appendix E.1. Provide justification for "No" answers. . c....k.i„.A...k_4..--) .t ...4--..e._5 1 Lic_"_.4--L.-k L Pig L b:.-Q 1 I-11—*,...,o .o or.-A.)1 A-4errt-it Lix.1..5 ./..'(c L k)o (i--PIA-.k.--e-4-A-a v e-i-c.)... --r4i_..---v t,kr • 1 1 ‘14 -"E- 't\1 tt--t--/)0 .A 04 ENT rt. o x)L.1..141. i'- - -5'. \..4j -6t.p.„....16H"- -; -5 •, ".v-) It -Q_t".)--A\A ..e_e. 4-rAt•-)ct,(.:_- 1-iN -5----.4 5 E-36 Page 2 of 3 REV. 02/16 4.!.0 „Site Design BMPs All development projects must implement site design BMPs SD-1 through SD-8 where applicable and feasible. See Chapter 4 and Appendix E.2 thru E.6 of the BMP Design Manual for information to implement site design BMPs shown in this checklist. Answer each category below pursuant to the following. •"Yes" means the project will implement the site design BMPs as described in Chapter 4 and/or Appendix E.2 thru E.6 of the Model BMP Design Manual. Discussion / justification is not required. •"No" means the BMPs is applicable to the project but it is not feasible to implement. Discussion/justification must be provided. •"N/A" means the BMPs is not applicable at the project site because the project does not include the feature that is addressed by the BMPs (e.g., the project site has no existing natural areas to conserve). Discussion/justification may be provided. Site`„Design Requirement . •" I.: SD-1 Maintain Natural Drainage Pathways and Hydrologic Features I.:Yes MTV 0 N/A Discussion/justification if SD-1 not implemented: SD-2 Conserve Natural Areas, Soils, and Vegetation I No N/A Discussion/justification if SD-2 not implemented: SD-3 Minimize Impervious Area Yes 0 No 0 N/A Discussion/justification if SD-3 not implemented: SD-4 Minimize Soil Compaction ThtisYes P.No 0 N/A Discussion/justification if SD-4 not implemented: SD-5 Impervious Area Dispersion FE Ye—s -- 1Thiskto I 0 N/A Discussion/justification if SD-5 not implemented: SD-6 Runoff Collection 0 Yes J N/A Discussion/justification if SD-6 not implemented: SD-7 Landscaping with Native or Drought Tolerant Species FEY N/A0 Discussion/justification if SD-7 not implemented: SD-8 Harvesting and Using Precipitation lo 1 0 N/A Discussion/justification if SO-8 not implemented: E-36 Page 3 of 3 REV. 02/16 Pate.'evy—ii2.2_/ 700 }for 1416/%5 oyt D ert w.111 be S 4v*kr - d e IAd drIvawaiar and telo GI i r-- 1 -qo be 1ef-f .ci 7P Th dr/VeWay Ci)-/el-e efrwe f eacti c1a4. ii No woiek. du rioq ra'ri.a 0 wow VON 1..iiii.Wili II.110.'.116 gill.Mill mow OW WV - > VIMorIOW iip ill. ..C1 4 _...— % 1 PRI 404'AY % 1015.1..AISY AVEAVE Pop 1\ %-tv. 1 .\‘ 1 n i > , ,, 1 .ei.6 ,1:e•S`1\o' 1 '--.--'C;\\*1 •qOc\Civ el`N IA 0 'e. te ,&O.RS. 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