HomeMy WebLinkAboutPD 16-22; WORTHING RESIDENCES; Engineering ApplicationDevelopment Services ccity of APPLICATION
ENGINEERING Land Development Engineering
Cdrlsbad PLANCHECK 1635 Faraday Avenue
760-602-2750 E23 www.carlsbadca.gov
Complete all appropriate information. Write N/A when not applicable.
Project Name: Madison and Worthing Residences Date:9-8-16
Project Description: Demolish existing house and build two new residences with second dwelling units.
Project Address: 3443 Madison Street, Carlsbad CA 92008
Lot No(s).:Lots 24 and 25 Map No.: 775 APN(s): 204-172-04,05
Number of Lots:2 Number of Acres:0.16 Miles of Trails: N/A
Owner: Brooks A.Worthing Applicant: Brooks A.Worthing
Mailing Address: P.O.Box1041 Mailing Address: P.O.Box1041
Carlsbad,CA92018 Carlsbad,CA92018
Phone Number: 7607293965 Phone Number: 760-729-3965
Fax Number: 760-729-0784 Fax Number: 760-729-0784
E-mail: baworthinginc@yahoo.com E-mail: baworthinqinccyahoo.com
I certify that I am the legal owner and that all the above
informati n i rue a orrect to the of my k wle e.
Signat_ Date: '1'_7/&2 Signatur_. _Date: __
Civil Engineer: tev nJones Soils Engineer: car ?fF,q5 f'6. I)
Firm: Coa_tal Land Solutions, Inc. Firm: Ez_CooJSôJCsj/,4Jrr
Mailing Address: 2ndStreet Mailing Address: Jo_a<//ár7'/zc/
Encinitas, CA 92024 aihe.,C4
Phone Number: 760-230-6025 Phone Number: 41t?-_2!5i-7f,1 /
Fax Number: 760-230-6026 Fax Number: 4/g_.2SS-7'O 2-
E-mail: Steve Jones <snowbrdl@hotmail.com> E-mail: (V)dpru4111_€Adme,1.
StateRegistrationNumber:RCE65124 State Registration Number: ICE_...2o5/
Additional Comments:
IMPROVEMENT VALUATION
What water district is the proposed project located in? (check one)
Carlsbad Municipal Water District LI Olivenhain LI Vallecitos
If in the Carlsbad Municipal Water District, what is the total cost estimate, including the 15% contingency fee, for
water and reclaimed water improvements, sewer (for Carlsbad Municipal Water District only), street, public
(median) landscape and irrigation, and drainage improvements (if applicable)? $
GRADING QUANTITIES
cut I ,Z0 cy fill cy remedial ZO cy import cy export cy
E-23 Page 1 of 2 REV 07/14
APPLICATION Development Services c i3of ENGINEERING Land Development Engineering
CarIb d PLANCHECK 1635 Faraday Avenue
IJ LL 760-602-2750
E23 www.carlsbadca.gov
ComDlete all anoroDriate information. Write N/A when not aoolicable.
APPLICATION FOR
(check all that apply)
FOR CITY USE ONLY
Project
I.D.
Drawing
Number
Deposit /Fees
Paid
Comments
El Adjustment Plat (ADJ)
j .. L
El Certificate of Compliance (CE)
El Dedication of Easement (PR)
Type:
Type:
El Encroachment Permit (PR)
El Final Map (FM)
L1 Grading Plancheck(DWG) J
El Improvement Plancheck (DWG)
El Parcel Map (PM)
El Quitclaim of Easement (PR)
Type:
El Reversion to Acreage (RA)
El Street Vacation (STV)
El Tentative Parcel Map (MS)
El Certificate of Correction (CCOR)
El Covenant of Easement (PR)
El Substantial Conformance
Exhibit (SCE)
El Trails El <mile El > mile
M'Other cappç
PIED
E-23 Page 2 of 2
DATE STAMP
APPLICATION RECEIVED
SEP 272016
.LUV1V1fNT
ENGINEERING
REV 07/14
APPLICATION
SVERADING PERMIT
Car1sb43zo7
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
ENGNEKIIN
- LPERMIT NUMBER: GR2016-0014
Project Name: WORTHING RESIDENCE Project Number: PD 16-22
Project Location: 3443-3447 MADISON STREET Drawing Number: 498-3A
Assessor Parcel Number(s): 204-172-04 & 204-172-05
Project Description: DEMO OF EXISTING HOME; GRADING FOR 2 SINGLE FAMILY HOMES
Owner: ç I,()c4Lj 'rc ( no Ls -L)Ot*h 4G
Address: 3' C) '2>o5( j pg / Suite: 9201
City: ('- ç J State: ('f Zip:
Phone Number: '7(O. 7?l- Fax Number:
I certify that I am the legal owner of this property and I authorize the grading associated with this permit.
OWNER SIGNATURE: DATE:
Civil Engineer: j-j-fr. (1paç-1 ( Lqj-d S1cd-iô-iç
Address: '2' c;2re( 1-reA-- Suite:
City: State: Zip:
Phone Number: Fax Number:
Soils Engineer: C (' (_ S- I C,
Address: )gQ5 Suite: ' 7
City: sa 4e-c- State: (JA Zip:
Phone Number: (, 1'- L2S -7ft3 f Fax Number:
Grading Contractor: 'S i.— 3y State License No.: 5J 7
— City Business License No.:R-
Addres.J (:3 \ Suite:
City: rç'j State: ( .- Zipq O (
Grading Quantities: cut cy fill cy import cy
remedial cy export cy
Qualified contact person trained in NPDES requirements: 7'5
Phone Number: -%S i
Basis of Permit Fees: j 2.0 cy Total Permit Fees: $ 1115-170
Verified By: C-Vw1. Balance Due: $ I g I . 00
I hereby acknowledge that I have read the application and information provided is correct. I agree to comply with all
federal, state, and city laws, ordinances, regulations and policies relating to excavation and grading including, but not
limited to, the Federal Endangered Species Act of 1973 and any amendments thereto. I will also comply with OSHA
Permit requirements for trenches over five feet deep and the provisions and conditions of any permit issued pursuant to
this application. _-
Applicant Name: OOL L'.jor4L-t
Address: T. 0. Sox 104 l Suite:
City: ( 0_r- ç 3 State: (j- Zip: 9.20/
Phone Number: "7 (gp -2.2. -3 -ax Number:
APPLICANT'S SIGNATURE: AJ)d I t-,( DATE: 411,3/1. 7
-..-
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