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HomeMy WebLinkAbout2124 SALIENTE WAY; ; 86-212; PermitCl) z 0 ;:: < IC < ~ (.) "' 0 II: I[ 0 (.) II: "' 0 ~ 5 • ii "' z 3, 0 i[ O I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. J3, ) lie No /"3{/-~ Closs - I hereby a1fnm that I am e1temp1 lrom tne Contrac- tor's L,cense Law lo< the lollowmg reason (Sec 7031 5 Busmess and Proless,oos Code· Any c,ty or county whten re-quires a permit 10 consuuct. alter, improve. demolish or repair any struclure. pnor to_ 1ts issuance also requues !heap- plaeant kif such perm11 lo hie a signed stalement that he 1s licensed pursuant 10 lhe prov1SKK1S ol the Conuac101 s license Law (Chapter 9 commencing with sec-1,on 7000 of Ow1s1on 3 of the Business and Professions COde) or !hat ls ex- empt therefrom and 1he basis lor !he allegea exemp110n Any v1olat10n of Sec.hon 7031 5 by an apphc.anl for a permit sub-1ec1s the applicant 10 a c1v1I penalty of nol more than hve hun- dred dollars ($500). r 1. as owner of the propeny, or my employees w11h wages as their sole compensation will do the work and the struc- ture 1s not mlended or ollered IOf sale (Sec 7044 Business and Profession!» Code The Contractor's license Law does not apply to an owner ot properly who builds Of' improves thereon and who does such work hImsell or through his own employees. provided that such Improvements are ncl mtend· ed or ollerecl lor sale If. however !he building or 1mprove- menl ,s sold wIlhm one year ol compithon the owner-builder will hav-e the burden of proving lhat he did nor build or 1m· prove for the purpose of sale) [' 1. as owner of lhe property, am exclus1v-ely c0n1rac11ng w11t1 hcense<l contractors to construct the pro,ec1 (Sec 7044, Business and Professions Code The Contractor's License Law does not apply to an owner of property who bullds 01 im· proves thereon. and who conlracts for each proiects w11h a conlractor(s) hcense pursuant to the Contrac1o<'s license Law) □ As a hon,eowner I am ImprovIng my home. and the follow mg cond11tons exist. t. The work ,s bemg pe~..-med pnor lo sale 2 I hav-e hved m my home !or twelve months prK>r to completion o1 lh1s work 3 I have nol claimed thts exempllon during lhe las! three years □ lamexemptunderSec ______ ,B&PC lor this reason ____________ _ 0 I hereby affirm that I have a cert,hcate ot consent to self-insure. or a certificate ol Workers· Compensation In• surance. or a cert11ied copy thereof (Sec. 3800. Lat>Or Code) POLICY NO. COM P A.N Y 0 Copy IS hied with the city NOTICE TO APPU~: l( after making this Certificate of Exemption. you uld become subJec:t to the Workers· Compensation pr 1sions of the Labor Code. you must lorthw1th comply with such provisions or this permit shall be deemed cevoked. D I hereby affirm that there is a construc11on lending agency tor the performance of the work for which this per- mit is issued (Sec. 3097, Civil Code) Lender's Name ____________ _ Lender's Addrus ___________ _ USE BALL POINT PEN ONLY & PRESS HARO --.... -·-····· . APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS .. CARLSBAD BUILDING DEPARTMENT APPLICf' TION ~ERMIT Carlsbad, California 92008-1989 (619) 438-5525 , ;oe ADDRESS 5ALIJ=IVTA AV ST.RO. NEAREST CROSS ST. I Os; 0~7;;N1 ts, r lCENSE r, VALUATION PERMIT NUMBER :21?. 'I ~A)/ -Ii lno 11o-~, 7--LOT BLOCK f sueo1v1s,0N I ASSESSOR PARCEL;.,~ t/ b CONTRACTOR . C°'I',. TORS,ONE • ZONE .;,.-11--4 1-4,ep..e.,~ G-1--'S,~~7JZ rJ -~-nwKi? 'J /VI 1 1 /-;I OWNER"S PHONE .,~222 CONTRACTOR'S ADDRESS LIC~_O PLAN 1,0. # BUILDING SO. FOOTAGE 0 :Z/; ~7 A5;L I BAJ ,-:e t.;"9P' A4 ~,4/.. ~ ,UL) P~£ i;.,;J / 35~~! -./, "'2.--Y--o k/,<ty' DESIGNER 5 ~.t:_ . J!S~,4d-,,lj ~~~ DESIGNER'S PHONE DESCRIPTION OF W0Ri< ~"-,vc;~p-$ E 2=)1..1 ~r / .u.6 ~,t?P"~ 0ESIGNER'S ADDRESS LICENSE NO . I p~,P ,I pee/<' .;I~~!:;~ ,Up.V,#A)lf.b 5/0B/666465 ~Cl~SJ I _ F p F LR ELEV NO EDU □00IBt.66 51001 es 30~5 J E;l/CLv'SV ~E., _;p.x,, ~ "rtJ OCC GP I STORIES I v□ NO I CENSUS TRACl I GP LAND USE I PARK ING SPACE RES UN ITS I I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE 0CC LOAD FIRE SPP A REA CONST I y O N 0 vO NO vO NO Not Valid Unless Machine Cerrtfied I I ~t!!-QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER 1 ,PTY. PLUMBING PERMIT -ISSUE ~- I EACH Fl XT URE TRAP , INSTALL FURN. DUCTS UP TO 100,000 BTU BUILDING PERMIT 001·810-00·00·8220 ,i',i - EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 001-810·00·00-8221 ., EACH WA TEA HEA TEA ANO OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 001 ·810-00-00-8806 1/f-- EACH GAS SYSTEM 1 TO 4 OUTLETS BO I LEA /COMPRESSOR 3 15 HP TOTAL PLUMBING 001·810·00-00-8222 I , EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 001-810-00·00-8223 EACH INSTAl . ALTER. REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 001-810·00·00-8224 -~ --- EACH VACUUM BREAKER MECH EXHAUST H000'0UCTS MOBILEHOME 001-810-00-00·8225 WA TER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP EACH ROOF DRAIN (,NSIDE) SOLAR 001-810-00-00-8226 TOH,L MECHANICAL STR0~ 1 0N 880-519-92·33 ,.JO l I --- I TOTAL PLUMBING FIRE ' ERS 001-810-00-00-8227 I 5'- Pu.iLW CIUTIES FEE 332-810-00-00-8930 I QTY. ELECTRICAL PERMIT · ISSUE QTY. SOLAR · ISSUE .....~· \ I I NEW CONST EA AMP SWl BKR COLLECTORS L , ~SCHOOL F~i~ DISTR1r,,.,.V ,..:,'"'' I I PH 3 PH STORAGE TANKS A L Ca_r~bad ~i~....... ·.-{, I 1( . • I EXIST BLOG EA AMP/SWT BKR ROCK STORAGE ( .)"' En°cinitas. ~:..· • • ..::_~• I 1 PH 3 PH PUMP San rn~,'\i i..;". I I REMODEL AL HR PER CIRCUIT PLAN CHECK FEE Sa~arc~-,--· I TEMP POLE 200 AMPS . ·'~\_' . I OVER 200 AMPS \J L!~SETAX 001·810-00-00-8162 I . I TEMP OCCUPANCY 130 DAYS) -~F 880-519-92-5 7 . -~ I '-' CREDIT DEPOSIT < f '1 -) I I TOTAL ELECTRICAL I TOTAL SOLAR I ' TOTAL FEES PAYABLE ~t),~ I I I I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT" AND DO HEREBY Expirallon Every permit issued by the Building 011tc1al under the provos1ons of this * AN OSHA PERMlT IS REOU"'ED FOR EXCAVATIONS OVER I CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by ltmllallon and become null and vo,d II the bu,lding or work S' O" DEEP AND DEMOLITION OR CONSTRUCTION OF DECLARATIONS ARE TRUE ANO CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS aulhor,zea by such permil 15 not commenced wilhin l80 days from the dale Of such S RUCTI.IAES OVER 3 STOAIES IN HEIGHT / I permit. or 1t the bulld1nff or \Nork autnonzed by such permit 1s suspe~ ~ ; ISSUED TO COMPLY WITH ALL CITY. COUNlY AND STATE LAWS GOVERNING BUILDING CON• abandonea at anv lime a ter the work ,s commenced for a nRrtod of 180 o s I STRUCTION WHETHER SPECIFIED HEREIN OR NOT, I ALSO AGREE TO SAVE INDEMNIFY A~ 1~ t APPRO'J D BY 01 &,Ii I KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND PLI S ~RE ~ ~ OWNER ~CT~ I EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OFT ~ ~ • -BY O E Q ~o...--J_• ' ~ t I GRANTING OF THIS PERMIT ~ , _ ~t. P1"I N I 'f L I I I J I I ~ u: >-~ 0 C. E (I) t- i -0 0 0 c co I BP ~TL. I .:,c C: a:: 0 (/) (/) (I) (/) (/) ~ I ~ 0 ai >- r,j (/) (I) CJ 0 a: co <ii 0 ~ (I) CJ C: co C: u: s C: (I) ~ 0 0 u (I) C. er, C: ~ .c 3: TYPE ' DATE INSPECTOR I .. (; BUILDING I FOUNDATION I REINFORCED STEEL I I MASONRY I , 8-~ -;;).,/;;).,_ , \ . \ , l -J ~ FIELD INSPECTION RECORD . REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES GUNITE OR GROUT I SUB FRAME □ FLOOR □ CEIL;ING SHEATHING □ ROOF D SHEAR ' INSPECTION REQ IF INSPECTORS DATE ..... , . CHECKED APPROVAL -- / ' . ·--~ -. SOILS COMPLIANCE , PRIOR TO FRAME ·' I FOUNDATION INSP IC EXTERIOR LATH I I STRUCTURAL CONCRETE ' - OVER 2000 PSI . INSULATION I INTERIOR LATH & DRYWALL I I I PRESTRESSED ~~ . CONCRETE POST TENSIONED i , ..... .,,_ .. CONCRETE ~. PLUMBING I . . ' FIELD WELDING -; ' □ SEWER AND BUCO D PVCO UNDERGROUND D WASTE D WATER , HIGH STRENGTH BOLTS ., TOP OUT D WASTE D WATER SPECIAL MASONRY y ., ~· TUB AND SHOWER PAN ' I . GAS TEST I l D WATER HEATER D SOLAR WATER PILES CAISSONS I ELECTRICAL ' I D ELECTRIC UNDERGROUND □, UFFER I . ' ROUGH ELECTRIC ' · .. ~ - D ELECTRIC SERVICE D TEMPQRARY D BONDING D POOL I • ·, --. • •. I MECHANICAL I D DUCT & PLEM., D REF. Pl PING HEAT -AIR COND. SYSTEMS ' ' I , . VENTILATING SYSTEMS I --. I :-~ . ,,.~ ... -' ' ' . r--. -' k-- ITEMS A-Bi:iVE HA-JE BEEN APPROVEb: FINAL PLUMBING . ' . . , ' ' ELECTRICAL MECHANICAL ' f- GAS . ,,, .. .. --. .0 ' / -, ) \ ~ -:--- BUILDING ~.:1 .. -·-. SPECIAL CONDITIONS \ '--..... Cl) z 0 ~ C oc C .., 0 "' 0 C I[ 0 0 oc "' 0 .., 5 • ii: "' z 3t 0 i[ O I hereby affirm that I am licensed under provlalona of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is In full force ~yff~. p-/ Loe No / ~ Z~m I I hereby alllrm that I am exempt lrom the Contrac· tor's Ltcense law lor the lollowmg reason (Sec 7031 5 Business and Pro1ess1ons Code. Any c11y or counly which re· quires a perm11 to construct, alter. ,mprove, demohsh, or repa1r any structure. prior to 11s issuance also ,equires !heap· r~:~~'"p~~~:r~11 ,1::e1i1~,~~~~~~ :?'~~~~~! ': License Law (Chapter 9 commencing with Section 7000 of 0w1s1on 3 ol the Business and ProfesSlons Code} or that ,s u-empl therefrom and the basis !or the allege<I exemphon Any violation of Sect,on 7031.5 by an applicant lor a permil sub· Jecls the apphcanl to a c1V1l penalty of llOt more than five hun· dred dollars ($500) rJ I. as owner ol lhe property, or my employees with wages as their sole compensat10n, will do the work. and rhe s1ruc· ture 1s nol m1ended or ollered !or sale (Sec 7044. Business and Professions Code The Contractors Lteense Law does :r:gfrn!i0 :;o ~oe~,s~~t="~1::, ~~,:~~~~~r;:~ employees, provided !hat such improvements are not ,ntend• ed or offered lor sale If. however. the bu1kJrng or ,mprove- menl 1s sold within one year of completion. the owner·bu11der will have the burden of provir-.g lhat he dKf nol bu1ki or im- prove fo, lhe purpose of sale) □ I, as owner of the property. am e:11:clus,vely contract109 with hcensed contractors 10 construct the pro1ec11sec. 70-44, Business and Professions Code The Contraclor's lteense Law does not appty to an owner of prQperty who builds Of 1m· proves thereon, and who contracts lor each proiecls wllh a contractor(s) lieense pursuanl 10 !he Contractor's license law). D As a homeowner I am 1mprovmg my home, and lhe follow· 1ng conditions ex,st I The work 1s bemg pertormed pnor to sale 2. I have lived m my home for twetve monlhs prlOf to completion of lh,s wOfk I have no1 claimed this exemphon dunng the last three years. D l amexemptunderSec ______ ,B&PC for !his reason ____________ _ 0 I nereby aftum thal I have a cert1tica1e ol consent to sell-msure. or a cert,hcate ol Workers Compensation In- surance. or a cer11hed copy thereof (Sec 3800. Labor Code} POLICY NO COMPANY :J Copy 1s tiled with the city D Cer11l1ed copy ,s hereby furnished CERTIFICATE OF EXEMPTION fROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the perm1t is for one hundred dollars ($100) or less) lh1s \:r%1,11~s1~s3~~:.;~~s:~o~;a:o,~l~~l:~t:~s!: ~h~~ manner so as lo become sub1ec::t to the Workers Compen• sat,on Laws ol Cahforn,a. D I hereby affi~s a construction lending agency for the performance of the wor'K for which this per- mit 1s issued (Sec. 3097. C1v1I Code) Lender's Name ____________ _ Lender's Address ___________ _ r ... ~c DIILL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. I CARLSBAD BUILDING DEPARTMENT Carlsbad, California 92008-1989 (619) 438-5525 APPLICATl~N ~AMIT jo:JZ76( c}. ~L / e U ;v.8Ro. h:+s\7oss sr. !DATE OF APPLICATION! BUSI E CENSE :i V A LUATION PERMIT NUMBER LOT IBLOCI( /.tJ .,. I '""°'"'"'o" I m"'°""'""-'D ~• ...'.'""'-'' '°" 3 / (a OWNER'S NAME _ I OWNER"SPHONF p~ c:;;a_/~ • ..;:?.5 '<:7-022...:. DESCRIPTION OF WORo< -c-p ,,c,c= DESIGNER'S ADDRESS LICENSE NO. !'>r-e>~,Y F/P F LR ELEV. .P~ ji! ~..z,,~ ~ . ~"''9 I I NO I ' OCC GP EDU r CENSUS TRACT I GP LAND USE I PARl(ING SPACE I RES UNITS I GRADING PERMIT ISSUED YO N 0 vO NO REDEVELOPMENT AREA vO NO STORIES TYPE CONST OCC LOAD FIRE SPP vO NO PLAN 1.0 . ./t BUILDING SO. FOOTAGE Nor Valid Unless Machine Cerrified QTY. PLUMBING PERMIT -ISSUE QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER ~ EACH FIXTURE TRAP INSTALL FURN DUCTS iJP TO 100,000 BTU EACH BUILDING SEWER EACH WATER HEATER ANO OR VENT OVER 100,000 BTU I I -·-·· ._ ....... BOILER/COMPRESSOR UP TO 3 HP BUILDING PERMIT 001-810-00-00-8220 l /(t) Slr.N PFAMIT 001-810-00·00·8221 I PLAN CHECK 001·810-00-00-8806 EACH GAS SYSTEM I TO 4 OUTLETS BOILER/COMPRESSOR 3 15 HP TOTAL PLUMBING 001-810-00-00-8222 EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 001-810-00-00-8223 I I EACH INSTAl . ALTER, REPAIR WATER PIPE __ EACH VACUUM BREAKER VENT FAN SINGLE DUCT MECH EXHAUST HOOOtOUCTS MECHANICAL 001-810-00-00-8224 MOBILEHOME 001-810-00-00-8225 WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP EACH ROOF DRAIN (l'ISIDE) SOLAR 001-810-00-00-8226 TOT ;;.L MECHANICAL STRONG MOTION 880·519-92-33 TOIAL PLUMBING l FIRE SPRINKLERS 001 ·810-00-00-8227 QTY. I ELECTRICAL PERMIT -ISSUE QTY. I SOLAR -ISSUE PUBLIC FACILITIES FEE 332-810-00-00-8930 NEW CONST EA AMP SWT BKR COLLECTORS SCHOOL FEE • DISTRICT ) PH 3 PH STORAGE TANKS Carlsbad EXIST BLOG EA AMPISWT BKR ROCK STORAGE Encinitas I PH 3 PH PUMP San Oie_g_ullo REMODEL AL HR PER CIRCUll PLAN CHECK FEE San Marcos TEMP PO LE 200 AMPS OVER 200 AMPS LICENSE TAX 001 ·810·00-00-8162 TEMP OCCUPANCY 130 DAYSI MFF 880-519-92·5 7 CREDIT DEPOSIT A TOTAL ELELlRICAL 1 TOTAL SOLAR TOTAL FEES PAYABLE l /CJ~ -, I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT • ANO DO HEREBY Expiration Every permit issued by the Bu,ldong Off1c1al under theprov1soonsofth1s CERT;FY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall e,pore by lom,1at1on and become null and vo,d If the buoldong or wo,. DECLARATIONS ARE TRUE ANO CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS aulhorized by such perm111s not commenced w11hon t80days from the date of such ISSUED TO °COMPLY WITH ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CON• permit. or of the building or work aulhorized by such permlf os suspended or * AN 05HA PERMIT IS REQUIRED FOR EXCAVATIONS OVER 5 O" DEEP AND DEMOLITION OR CONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT STRUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND abandoned al an lome after th ork 15 commenced for a riOd of 180 cla KEEP HARMLESS THE CITY OF CARLSBAD AuAINSl ALL LIABILIT,ES. JUDGMENTS, COSTS AND APPL! NT·s SIG~ATURI:' OWNFR 0 EXPENSES WHICH MAY IN ANY WAY ACGRUE AGAINST SAID CITY IN CONSEQUENCE OF E GRANTING OF THIS PERMIT ~ ~ IDA~-w~- J ~ u:: >-;;; 0 a. E Q) I- I 'O ~p C ro 0 a. a. <( I X C a: 0 (/) (/) Q) (/) (/) <( I ,; .2 <ii >- r/) (/) Q) 0 0 a: ro iii 0 fl Q) 0 C ro C u:: :s C Q) ~ c., 0 u Q) a. "' C ~ r:. ~ TYPE I DATE INSPECTOR r L -BUILDING I o.~ FOUNDATION ' ~Z7-~ ll Vff" / FIELD INSPECTION RECORD I REINFORCED STEEL : I I REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES MASONRY ' I REO IF INSPECTORS GUNITE OR GROUT I INSPECTION CHECKED APPROVAL DATE I SUB FRAME □ FLOOR □ CEIUING SHEATHING □ ROOF □ SHEAR SOILS COMPLIANCE PRIOR TO FOUNDATION INSP FRAME I I STRUCTURAL CONCRETE EXTERIOR LATH I OVER 2000 PSI INSULATION l PRESTRESSED CONCRETE INTERIOR LATH & DRYWALL I POST TENSIONED I I CONCRETE PLUMBING I FIELD WELDING I □ SEWER AND BUCO □ P~/CO HIGH STRENGTH BOLTS UNDERGROUND □ WASTE □ !WATER TOP OUT □ WASTE D \-VATER SPECIAL MASONRY TUB AND SHOWER PAN I GAS TEST I PILES CAISSO!I.S □ WATER HEATER □ SOLAR W.a,TER I ELECTRICAL I □ ELECTRIC UNDERGROUND □;UFFER ROUGH ELECTRIC I □ ELECTRIC SERVICE □ TEMPG>RARY □ BONDING □ POOL ' I MECHANICAL I □ DUCT & PLEM., □ REF. PIP11'!G HEAT -AIR COND. SYSTEMS I VENTILATING SYSTEMS I ., . . --. ::: .... ·-.,;,. -_, ....... . . ""--.•.4~ I ' I . .,._ ... -~ ~ -CALL FOR FINAL INSPECTTON WHEN ALL APPROPRIATE . . ... -. . . ITEMS ABOVE HA '/E BEEN AP PROVED. \' '., ......... -'"" \. f . ,, FINAL .. ' . \ .. . ·,. -. -·-. ·-.. I , _,._,r1,_ • ~, ~ -·-. ,:-r-PLUMBING I . . ' I . C 0, . ELECTRICAL I . ,._ ..... <-. . --. -~· MECHANICAL I .;: ... • ' . . , . . GAS ' .. .. . . ---I . ,._._ " -' . V • BUILDING I SPECIAL CONDITIONS I I llt-~ ""• •. .. Of, Y \-/ ' Jr/ . · !.<./4- PLAN CHECK NO. ~ ADDRESS ~ c<-( ;2. ~~ ;t-DA TE S-: b --;l>-6 PLANNING ~~~ Cl w ex: ::::> --o __ w ex: (/) z o __ ZONE: ----TYPE Of PROJECT: -------------------- SCHOOL DISTRICT: SAN OIEGUITO ENCINITAS CARLSBAD SAN t-\l\RCOS -- SETBACKS: FRONT SIDE REAR DISCRETIONARY ACTIONS: ________________________ _ REDEVELOPMENT PERMIT REQUIRED: ---------------------- LANDSCAPE PLAN CO .... ENTS: ------------------------- 1-:, L ~ ; ENVIRONMENTAL REQUIRED: ______ .,_ __ .._~+--------------- t: -~ ~· .~ > ~ 0 QI IQ U CX: Cl ADDITIONAL COMMENTS: -------------------------- OK TO ISSUE: DATE: ----------------- ENGINEERING LEGAL DESCRIPTION VERIFIED? APN CHECKED? ----------------- P.F.F.: PARK-IN-LIEU QUADRANT:_ , FEE PER UNIT: ----------------- RIGHT-OF-WAY: TRAFFIC IMPACT FEE PER UNIT: ------------------ EASEMENTS: DRIVEWAY: ------------------------- Cl IMPROVEMENTS: -----------------------------w ex: ::::> 0 w FIELD CHECK DATE: !NIT IALS: ex: ----------------------- (/) z E.D.U.: --------------SEWER: --------------0 I-L u QI w 3 0:: QI LATERAL: -----------+----INDUSTRIAL WASTE PERMIT: ------- GRADING PERMIT: -----------------------------ex: > QI 0 ..., QI IQ u ex: Cl CERTIFIED: ADDITIONAL COMMENTS: ------+--...+-.'-+------------------ \ OK TO ISSUE: _____________ DATE: _____________ _ DPD2:DPD6:04/15/86