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HomeMy WebLinkAbout2762 OLYMPIA DR; ; CB161308; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 04-18-2016 Miscellaneous Permit Permit No: CB 161308 Building Inspection Request Line (760) 602-2725 2762 OLYMPIA DR CBAD MISC Subtype: REPAIR 1674315100 Lot #: 0 $35,000.00 COLLINS RES-FOUNDATION REPAIR CITY DOES NOT GUARANTEE FIX Status: ISSUED Applied: 04/05/2016 Entered By: RMA Plan Approved: 04/18/2016 Issued: 04/18/2016 Inspect Area: Job Address: Permit Type: Parcel No: Valuation: Reference #: PC#: Project Title: Applicant: Owner: DAKINI ENGINEERING COLLINS FAMILY TRUST 01-26-93 6616 CRABTREE ST 2762 OLYMPIA DR SAN DIEGO CA 92114 CARLSBAD CA 92010 619 697-9000 Miscelaneous Fee #1 PERMIT FEE $527.00 Miscelaneous Fee #2 $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $527.00 Total Fees: $527.00 Total Payments To Date: $527.00 Balance Due: $0.00 /1 -f FINAL APPROVAL Inspector: Date: '7 dY Clearance: NO110E Reese take 110E that açxc,aI doir prqeci irLxJes ile "Irrtiori' cf fees, dedcaba, isaatias, ad1tia,s hereafte aAIediy rerred toes fee ors' You hae 90 days fmthe date ills pemit ves issued to protest irrpticn d these fee iims Ifyouprotestthemyourrust fdloN the protest procedures set forth in Gm iud Code Sedicn 66(2)(a), and file the protest and anyetha required infaietiamth the City NlaraW for ptcessing in amordarioeith Caisbal Mmildpei Code Sedicn 3.30. Failure tohrryfdIawtt'et pdureWilber aiysubsequant legal action to attack review set aside, void, or arrd their irrpcetion You am hereby RJThER NOTIFIED that your right to protest the spedfied feesfea,s DOES MYtAPR.Ytoeta- aJ seer ccrr,edon fees and capaity denges ru pnrg, zairg, gracrig or other enlist apçic2ba1 pressing or serwe fees in axwedon wth this xqed. NCR DOES IT AFFLY to any eore4aislv been ae,a KICTICE siryilw to this. cresto Widi the statute cf linitalaisles orwvdlieniseaemci CB161308 COLLINS FOUNDATION REPAIR 2762 OLYMPIA DR CBAD SWPPP 1674315100 Job Address: Permit Type: Parcel No: Reference #: CB#: Project Title: Applicant: DAKINI ENGINEERING 6616 CRABTREE ST SAN DIEGO CA 92114 619 697-9000 Emergency Contact: BILL PUZZO Status: ISSUED Lot #: 0 Applied: 04/05/2016 Entered By: RMA Issued: 04/18/2016 Inspect Area: Tier: I Priority: M Owner: COLLINS FAMILY TRUST 01 -26-93 2762 OLYMPIA DR CARLSBAD CA 92010 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Storm Water Pollution Prevention Plan (SWPPP) Permit 04-18-2016 Permit No:SW160161 619 247-9296 SWPPP Plan Check $54.00 SWPPP Inspections $228.00 Additional Fees $0.00 TOTAL PERMIT FEES $282.00 Total Fees: $282.00 Total Payments To Date: $282.00 Balance Due: $0.00 FINAL APPROVAL ITHE FOLLOWIN'G APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: DPLANNING DENGINEERING DBUILDING DFIRE DHEALTH DHAZMATIAPCD Building Permit Application Plan Check No. (?/ Um Est. Value '5 ,,p 4r City of 1635 Faraday Ave., Carlsbad, CA 92008 Ccefrisbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Deposit email: building©carlsbadca.gov Date Lj /I ( Iswppp I A_... www.carlsbadca.gov jfl JOB ADDRESS ISUIss#/SPACE#/UN APN PHASES U OF UNITS 15 BEDROOMS S BATHROOMS I 43!ICONSTFrTYP V TENANT BUSINESS NAM E E I dTI,5H DESCRIPTION OF WORK: Include Square Feet of ected Area(s) EXISTING USE I PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) -1 FIREPLACE I AIR CONDITIONING' I FIRE SPRINKLERS ,s c' I IYEsIP_NoII YES 'NO t:i I YESNoII APPLICANT NAME 'b _AP) ;j4ç. d4J'" PROPERTY OWNER Primary Contact '4 AJL,L/L ADDRESS ADDRESS '6 L,1P1i CITY STATE ZIP £ 4- '3.0 / 4 CIL STATE ZIP k (4- PHONE FAX I . PHONE (9..gzJ-z - IFAX I EMML &4fr1C, EMAIL ltt ,; A)) ,i 1 4C £,v.c — Ore' 6I,4'i, ,Jcr PROCESSIONAL COAcTOR BUS. NAME "7 A A Mi £) ADDRS - '4 4k Iwa ADDSS :--- \E r CITY ZIP CITY STATE ZIP C PHONE IFAX t 1q)I PHONE cfg-61-'1,00 I FAX EMAI TI ,1)OMiL,I(? ,4o7#I IIIZ. Cr MAL E I t A-ka 91 I STATE LI C. S STATE LIC.# ??Z1ff I C 2 7 693 1 1 IA- (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issrjRé,lso requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law fChapter 9, commending with Sec(ØnpOOO of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a perrMit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). 90003005 G0G1390O®11 Workers' Compensation Declaration: I hereby affirm under penalty of pe4uiy one of the following declarations: I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' ompensation, as Ui by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation I urae carrier and policy number are: Insurance Co. ¶' IlFI A Policy No. C~'2 J.~'ic Expiration Date S 12 ___________ is section need not be completed if the permit is for one hundred dollars ($100) or less. Certificate of Exemption: I certify, that 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 secu work rn compensation coy n fut, and s ubject an employer to criminal penalties and civil fines up to one hundred thOusand dollars (&100,000), In addition to the cost of compensation, da a as provided fort ection 3 o e Lab de, interest and attorney's fees, CONTRACTOR SIGNATURE AGENT DATE ®@(oOWO)GO OUGGaMIZ9000 thereby affirm that lam exempt from Contrac!or's License Law for the following reason: [] I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply loan 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). [J I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply loan owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). [J I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. DYes [—]No 2.l(have I have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name address! phone! contractors' license number): I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name! address! phone Icontractors' license number): I will provide some of the work, butt have contracted (hired) the following persons to provide the work indicated (include name! address! phone! type of work): .PROPERTY OWNER SIGNATURE []AGENT DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 Yes ti4o Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air qugfty management district? Ci Yes Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? CI Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CONSTRUCTION ifcW A G ENCY II I hereby affirm that there is a constructi le/ding agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address A PPLICANT 4 loerlifythatl have read the application and state thatthe above InlOimation iscornectand thatthe information on the plans Is accurate. I agree to complywith allCtyordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO 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 tor lions over 50'deep and demolition orconstiuclion of structures over stories in height EXPIRATION: Every permit issued by 0Bui ingOttldalundertheprovisio of this CodshaIl expire by limitation and become null and void if the budding orwork authorized by such permit is not commenced within 180 days from the dateofsuth permit rifthe uiiding orworkau y dili% suspendedor abandoned at any time after the work iscommencodlora i,itdof 1 days (Sedion 106.4.4 Unitomi Building Code). ,."APPLICANT'S SIGNATURE ,,I1V' DATE ',#/( /2 7/ STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. CE RTIFICATE P rojects Onlyl Fax (760) 602-8560, Email building(&)Carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICK UP: ci CONTACT (Listed above) o OCCUPANT (Listed above) ci CONTRACTOR (On Pg. 1) ASSOCIATED CB# MAIL TO: a CONTACT (Listed above) ci OCCUPANT (Listed above) CONTRACTOR (On Pg. 0 NO CHANGE IN USE / NO CONSTRUCTION MAIL! FAX TO OTHER: CHANGE OF USE / NO CONSTRUCTION ..'APPLICANT'S SIGNATURE DATE Inspection List Permit#: CB161308 Type: MISC REPAIR COLLINS RES-FOUNDATION REPAIR 07/28/2016 19 Final Structural 07/28/2016 19 Final Structural 06122/2016 11 Ftg/Foundation/Piers f Friday, July 29, 2016 Page lofi Date Inspection Item CITY DOES NOT GUARANTEE FIX Inspector Act Comments - RI PD AP PD AP Geotechnical Engineer 4962 Cresita Drive, San Diego, CA 92115 Tel: 619-813-8462, Fax: 619-542-9046 Email: martinowen@geotechengineer.com Job No. 151119 July 28, 2016 To: Mr Neill Collins Subject: Report of Inspection of Pipe Pile Foundation Repairs 2762 Olympia Drive Carlsbad, CA 92010 References: Geotechnical Investigation for Pipe Pile Foundation Repairs, 2762 Olympia Drive, Carlsbad, CA 92010, by Martin R. Owen PE, GE, dated January 31, 2016 Supplemental Report for Proposed Pipe Pile Foundation Repairs, 2762 Olympia Drive, Carlsbad, CA 92010, by Martin R. Owen PE; GE, dated March 30, 2016 Dear Mr. Collins: This report summarizes my inspection of the pipe pile foundation repairs recently undertaken at the subject residence by Dakini Engineering General Contracting, Inc. I inspected the pipe pile repairs on June 21, 2016. PIPE PILE REPAIRS The pipe pile repairs consisted of driving a total of 38, 2-inch diameter, Schedule 80, steel pipe piles beneath all exterior and interior load bearing walls of the house and garage, with the exception of the front, exterior walls. The pipe piles were driven to refusal in the underlying bedrock at depths of 11 to 49 feet below the ground surface. The shallower piles were located at the front of the house. The deeper piles were located at the rear of the house Reinforced concrete grade beams, approximately 1-foot deep, were also constructed between the pipe piles. New grade beams were also constructed at the front of the house and garage. The grade beam reinforcing conformed to the plan requirements. The grade beams were doweled to the existing footings with epoxy rebar dowels (chemical anchors) in accordance Report of Inspection of Pipe Pile Foundation Repairs Page 2 2762 Olympia Drive Job No. 151119 Carlsbad, CA 92010 July 28, 2016 with the plan requirements. Rebar dowels were installed using Simpson Set-XP Epoxy Adhesive. Dowels extended at least 6 inches into the footing concrete. Based on my inspection, the pipe pile repairs were performed satisfactorily, in accordance with my recommendations. The house was partially releveled (up to about 4 inches at the southeast corner) by jacking the existing footings against the tops of the pipe piles. The gap beneath the floor slab was filled with pressure injected polyurethane. Cracks in the floor slab were also repaired. Please note, I did not inspect the polyurethane injection or the floor slab crack repairs. As stated in my previous reports, referenced above, this report provides no warranty, either expressed or implied, concerning future building performance. Future damage from geotechnical or other causes is a possibility, especially in areas of the building not underpinned with pipe piles. This opportunity to be of service is appreciated. If you have any questions, please do not hesitate to call or contact me. Very truly yours, A"Xact.." Martin R. Owen PE, GE Geotechnical Engineer Martin R. Owen PE, GE Geotechnical Engineer Martin R. Owen PE, GE Geotechnical Engineer Tel: 619-813-8462, Fax: 619-542-9046 Email: martinowengeotechengineer.com FIELD INSPECTION REPORT PIPE PILE FOUNDATIONS rpeC/,sL f,/ree71w'S ADDRESS 2iz- 01-y 41ftrn 19/4IVe / cw4yop DATE _VP- CONTRACTOR !)k//'/ Locations of Pipe Piles *LL- 7/O/ .4,4 j9M /I7/ D/4 L04 jJ4jLf Y.'&t)0f n',4- #Dlere ot.4 o*#-o No. of Pipe Piles 3 Depth of Pipe Piles (Below Ground Surface) // To Concrete Pile Cap Dimensions f fr 4',4AD)G. )C - p - pe' Concrete Grade Beams /2" W/,3t- Q /2." ?)P Pipe piles are approved as installed. Pile cap and grade beam excavations are approved and ready for pouring concrete. Notes If you have any questions, please call. Martin R. Owen PE, GE Geotechnical Engineer EsGil Corporation In (Partners/lip wit/i government for (Building Safety DATE: 04/15/16 JURISDICTION:, Carlsbad, PLAN CHECK NO.: 16-1308 PROJECT ADDRESS: 2762 Olympia Drive SET:I P APPLICANT -JtJRIS. U PLAN REVIEWER U FILE PROJECT NAME: Foundation Repair for Collins Residence The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. EsGil Corporation staff did not advise the applicant that the plan check has been completed. REMARKS: All sheets of plans must be signed by the person responsible for their preparation. (California Business and Professions Code). Transmitted herewith are plans for proposed foundation repairs, to attempt to mitigate continued settlement of the existing foundation and to further prevent resulting structural damage. Esgil Corporation cannot offer any guarantees that the proposed system will resolve the present problems, nor should the City offer such representation. However, acceptance of the proposed remedies may result in an enhanced foundation support system from the current situation. At the time of permit issuance, the following should be noted on the plans: "Prior to the City building inspector approving final inspection, the responsible design professional shall notify the building official, in writing, that the proposed foundation repairs have been installed in accordance with the design". Sincerely, ESGIL CORPORATION By: Ray Fuller EsGil Corporation E] GA DEJLJMB EJPc (P) 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax(858)560-1576 [DO NOT PAY— THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: 16-1308 PREPARED BY: Ray Fuller DATE: 04/15/16 BUILDING ADDRESS: 2762 Olympia Drive BUILDING OCCUPANCY: R3 U TYPE OF CONSTRUCTION VB BUILDING PORTION AREA (Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE ($) Fnd Repair Per City Est 35,000 Air Conditioning Fire Sprinklers TOTAL VALUE 35,000 Jurisdiction Code ICB IBY Ordinance I Bldg. Permit Fee by Ordinance Plan Check Fee by Ordinance V Type of Review: El Complete Review J Structural Only I $310.491 I $201 .821 El Repetitive Fee 1W I Repeats El Other El Hourly Hr. @ * EsGil Fee I $132.081 Comments: Sheet 1 of 1 - macvalue.doc + C17city of Carlsbad STANDARD PROJECT REQUIREMENT CHECKLIST E-36 Development Services Land Development Engineering 1635 Faraday Avenue (760) 602-2750 www.carlsbadca.góv Project Information Project Name: Collins Foundation Repair Project ID: DWG No. or Building Permit No.: Source Control BMPs All development projects must implement source control BMPs SC-I through SC-6 where applicable and feasible. See Chapter 4 and Appendix E.I 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 will 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. Please add attachments if more space is needed. "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). Discussion/justification may be provided. Source Control Requirement Applied? SC-I Prevention of Illicit Discharges into the MS4 J Yes 0 No D N/A Discussion/justification if SC-I not implemented: - SC-2 Storm Drain Stenciling or Signage 0 Yes 0 No JZ N/A Discussion/justification if SC-2 not implemented: SC-3 Protect Outdoor Materials Storage Areas from Rainfall, Run-On, Runoff, and Wind Ei Yes 0 No IZI N/A Dispersal Discussion/justification if SC-3 not implemented: - E-36 Page 1 of 4 Revised 03/16 • Aliëi1? SC-4 Protect Materials Stored in Outdoor Work Areas from Rainfall, Run-On, Runoff, and Wind Dispersal I Yes 0 No 0 N/A Discussion/justification if SC-4 not implemented: SC-5 Protect Trash Storage Areas from Rainfall, Run-On, Runoff, and Wind Dispersal —71:1 Yes 0 No 0 N/A Discussion/justification if SC-5 not implemented: 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). On-site storm drain inlets 0 Yes 0 No 0 N/A Interior floor drains and elevator shaft sump pumps 0 Yes El-No J N/A Interior parking garages 0 Yes 0 No 0 N/A Need for future indoor & structural pest control 0 Yes 0 No 0 N/A 0 Landscape/Outdoor Pesticide Use 0 Yes 0 No 0 N/A D Pools, spas, ponds, decorative fountains, and other water features 0 Yes 0 No 0 N/A Food service 0 Yes 0 No IZI N/A Refuse areas 0 Yes 0 No 0 N/A Industrial processes .• 0 Yes 0 No 0 N/A Outdoor storage equipment or materials _of 0 Yes 0 No 0 N/A Vehicle and Equipment Cleaning 0 Yes 0 No 0 N/A 0 Vehicle/Equipment Repair and Maintenance 0 Yes 0 No 0 N/A 0 Fuel Dispensing Areas 0 Yes 0 No 0 N/A 0 Loading Docks 0 Yes 014o IZI N/A Fire Sprinkler Test Water 0 Yes 0 No, 0 N/A Miscellaneous Drain or Wash Water ' 0 Yes 0 No 0 N/A 0 Plazas, sidewalks, and parking lots 0 Yes 0 No IZI N/A For "Yes" answers, identify the additional BMP per Appendix E. 1. Provide justification for "No' answers. E-36 Page 2 of 4 Revised 03/16 Site Design BMPs All development projects must implement site design BMPs SD-i 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. Please add attachments if more space is: needed. "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. SourceControl Requirement Applied? SD-I Maintain Natural Drainage Pathways and Hydrologic Features 0 Yes I 0 No 1 0 N/A Discussion/justification if SD-I not implemented: SD-2 Conserve Natural Areas, Soils, and Vegetation I i Yes I 0 No I D N/A Discussion/justification if SD-2 not implemented- SD-3 Minimize Impervious Area I IZl Yes I 0 No Discussion/justification if SD-3 not implemented: SD-4 Minimize Soil Compaction ' I o Yes I 0 No I 0 N/A Discussion/justification if SD-4 not implemented: SD-5 Impervious Area Dispersion I izi Yes I 0 No I D N/A Discussion/justification if SD-5 not implemented: E-36 Page 3 of 4 Revised 03/16 Source Control Requirement (continued) Applied? SD-6 Runoff Collection 0 Yes 0 No 0 N/A Discussion/justification if SD-6 not implemented: SD-7 Landscaping with Native or Drought Tolerant Species I 0 Yes I 0 No I J N/A Discussion/justification if SD-7 not implemented: SD-8 Harvesting and Using Precipitation I 0 Yes I 0 No I izi N/A Discussion/justification if SD-8 not implemented: ¼ LI E-36 Page 4 of 4 Revised 03/16 (City of Carlsbad STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Land Development Engineering 1635 Faraday Avenue (760) 602-2750 www.carlsbadca.gov INSTRUCTIONS: • -. 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 (BMPs) 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. V 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. V V - PROJECTINFORMATION PROJECT NAME: Collins Foundation Repair - PROJECT ID: ADDRESS: 2762 Olympia Drive APN: 167-431-51 The project is (check one): IZ New Development 0 Redevelopment • V The total proposed disturbed area is: 681 2 ( ) acres The total proposed newly created and/or replaced impervious area is: 681 2 ( ) 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: 5f,&J/ 1 6'[.( • Then, go to Step 1. and follow the instructions. When completed, sign theV form at the end and submit this with your application to the city. V E-34 Page 1 of 4 REV 02/16 - STEP I- - 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 El 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): Project is a foundation repair to an existing single family residence. New pipe pilings and grade beams to existing foundation. If you answered "no" to the above question, the project is a deveIopmeit project', go to Step 2. STEP 2 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: Designed and constructed to direct storm water runoff to adjacent vegetated areas, or other non- erodible permeable areas; El El Designed and constructed to be hydraulically disconnected from paved streets or roads; Designed and constructed with permeable pavements or surfaces in accordance with USEPA Green Streets guidance? - 2. Retrofitting or redeveloping existing paved alleys, streets, or roads that are designed and constructed in o 0 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? .0 0 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 S41jEPj3 E" PL TEI JE EQE-VELIOOP16MENTiP.R!OJEC--TMS To determine if your project is POP, please answer the following questions (MS4 Permit Provision E.3.b.(1)): 1 YES NO 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, El IlJ and public development projects on public or private land. 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 El 0 more of impervious surface? This includes commercial, industrial, residential, mixed-use, and public development projects on public or private land. 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 IJ refreshment stands selling prepared foods and drinks for immediate consumption (Standard Industrial Classification (SIC) code 5812). 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 0 IJ development project includes development on any natural slope that is twenty-five percent or greater. 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. 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 usedfor the automobiles, other vehicles. _transportation _of _trucks, _motorcycles, _and 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 0 Z 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 commingled with flows fromadjacent 1and5).* _ESA _(Le._not 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 of the following Standard Industrial Classification (SIC) codes: 5013, 5014, 5541, 7532-7534, or 7536-7539. 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 Daily Traffic (AD 7) of 100 or more vehicles per day. 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? 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 0 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 second box stating "My project is a 'STANDARD PROJECT'..." and complete applicant information. E-34 Page 3 of 4 REV 02/16 :STEP4 TO BE COMPLETED FOR REDEVELOPMENT PROJECTSTHATARE PRIORITY DEVELOPMENT.PROJECTS(PbP) - .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 existing development? Complete the percent impervious calculation below: Existing impervious area (A) sq. ft. 0 0 Total proposed newly created or replaced impervious area (B) = sq. ft. Percent impervious area created or replaced (B/A)*100 = % If you answered "yes", the structural BMPs 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 El 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 (SWQMP) for submittal at time of application. IZ 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. El My Project is NOT a 'development project and is not subject to the requirements of the BMP Manual. Applicant Information and Signature Box Applicant Name: Da sell, Dakini . nera ontracting Applicant Title: Contractor, Agent for owner Applicant Signature:%.- (i2' Date: 41-rlza Environmentally Sensitive Areas include but are not limited to all Glean Water Act Section 303(d) impaired water bodies; areas designated as Areas 0? 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 On/v City Concurrence: YES NO By: Date: Project ID: E-34 Page 4 of 4 REV 02/16 BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE. Erosion Control Sediment Control BMPs Tracking Non-Storm Water Waste Management and Materials BMPs Control BMPs Management BMPs Pollution Control BMPs C C C .2 ' . CL 3C C 0 5 LiJ ° Best Management Practice* E M 0- . , .a) a .., (BMP) Description —3 . 75 A . >, . o Q) 0 0 D i_ .2 = Q .0 2 L.. 0 C 0 00 -..' i_ 0 -..' 0 .. 0 D 0 i... >Q) 0 C -' 0 .C° q) . 'o 0 - '-' 0 o — =C 0 0 =C 0 0 NC 0 0 CC 0 0 LiJ U) U) U) C) L C) U)> U) U) o Cn .E cn a. a. 0 a. > c n U) C) U) C) CASQA Designation - N 00 0) t') ' U) to N 00 ') N. I I "U) I . I U) I to I 00 I I o I o I o I 0 I W I LU I W I LU I W I LU I Li I W I I I U) M I U) I U) I U) Construction Activity LU LU LU LU, in in (I) U) in in Cl) U) Z / Grading/Soil Disturbance '4 Trenching/Excavation - - - - - - - - -- Stockpiling - - - - - Drilling/Boring Concrete/Asphalt Sawcutting Concrete Flatwork Paving Conduit/Pipe Installation I Stucco/Mortar Work - Waste Disposal - - - - - - - - - - - -- - - - Staging/Lay Down Area - Equipment Maintenance and Fueling - - - - -. - - - - - - - - - - Substance Use/Storage _Hazardous Dewatering -- Site Access Across Dirt - Other (list): - - --- - - - - -- - - - - - Instructions: Check the box to the left of all applicable construction activity (first column) expected to occur during construction. 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. Refer to the CASQA construction handbook for information and details of the chosen BMPs and how to apply them to the project. STORM WATER COMPLIANCE FORM TIER I CONSTRUCTION SWPPP E-29 STORM WATER POLLUTION PREVENTION NOTES ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FACILITATE RAPID INSTALLATION OF EROSION AND SEDIMENT CONTROL BMPs WHEN RAIN IS EMINENT. THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSION CONTROL DEVICES TO WORKING ORDER TO THE SATISFACTION OF THE CITY INSPECTOR AFTER EACH RUN—OFF PRODUCING RAINFALL. 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. ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACE AT THE END OF EACH WORKING DAY WHEN THE FIVE (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT (40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER EACH RAINFALL. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM AGGREGATE. ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST BE INSTALLED AND MAINTAINED. 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 NTH THIS CITY APPROVED TIER 1 CONSTRUC11ON SWPPP THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED BY THE CITY OF CARLSBAD. I:,'llvdr- AAllf-0, NER( /OWNER'S AGEN](gR1NT) 021 / I OWN /OWNER'S ANTNME (SIGNATURE) / 7A'FE E-29 PROJECT INFORMATION Site Address:_ O/-'('/4' '& Assessor's Parcel Number: /t - .T/ .-._c'/ Emergency Con)ct: Name: 1.:ii.— PU2_v_0 24 Hour Phone:_________ '4vIq !4—'j.1Tf Construction Threat to Storm Water Quality (Check Box) 0 MEDIUM E 'LOW Page 1 of 1 REV 02/16