HomeMy WebLinkAbout2071 LEE CT; ; CBR2021-1113; PermitBuilding Permit Finaled
Residential Permit
Print Date: 09/19/2022
Job Address: 2071 LEE CT, CARLSBAD, CA 92008-2765
Permit Type: BLDG-Residential Work Class: Pool
Parcel#: 2053303500 Track#:
Valuation: $22,265.75 Lot#:
Occupancy Group: Project#:
#of Dwelling Units: Plan#:
Bedrooms: Construction Type:
Bathrooms: Orig. Plan Check#:
Occupant Load: Plan Check#:
Code Edition:
Sprinkled:
Project Title:
Description: KING: 425 SF POOL & SPA// GAS FOR FIRE PIT
Applicant: Property Owner:
CARRIE JONES
5431 AVENI DA ENCINAS, # B
CARLSBAD, CA 92008-4411
(619) 343-5908
CO-OWNERS KING CHARLES AND LEINAIA
2071 LEE CT
FEE
BUILDING PERMIT FEE ($2000+)
BUILDING PLAN CHECK FEE (BLDG)
CARLSBAD, CA 92008
ELECTRICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL
PLUMBING BLDG RESIDENTIAL NEW/ADDITION/REMODEL
SB1473 GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION-RESIDENTIAL
SWPPP INSPECTION FEE TIER 1-Medium BLDG
SWPPP PLAN REVIEW FEE TIER 1-MEDIUM
Total Fees: $786.35 Total Payments To Date: $786.35
(city of
Carlsbad
Permit No: CBR2021-1113
Status: Closed -Finaled
Applied: 04/19/2021
Issued: 05/25/2021
Finaled Close Out: 07/22/2022
Final Inspection: 07/22/2022
INSPECTOR: Alvarado, Tony
Contractor:
LOS CABOS POOLS INC
PO BOX 189
VISTA, CA 92085-0189
(760) 908-3443
Balance Due:
AMOUNT
$230.27
$161.19
$41.00
$49.00
$1.00
$2.89
$246.00
$55.00
$0.00
Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter
collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these
fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the
protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section
3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their
imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection
fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this
project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the
statute of limitation has previously otherwise expired.
Building Division Page 1 of 1
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov
,,.
(cicyof
Carlsbad
RESIDENTIAL
BUILDING PERMIT
APPLICATION
B-1
Job Address (jl)') \ le B:: 6)-.,/ :t:
Plan Check
Est. Value
PC Deposit
Date
CT/Project #: _________________ ,Lot #: ____ Year Built: ________ _
Fire Sprinklers: QvEsQ NO Air Conditioning:Q YES Q NO Electrical Panel Upgrade:QYESQ NO
BRIEF DESCRIPTION OF WORK:
~qi~ 5('A
0 Addition/New: _____ Living SF, ____ Deck SF, ____ Patio SF, ____ G.arage SF __ _
Is this to create an Accessory Dwelling Unit? Ov ON New Fireplace? OY ON, if yes how many? __
0Remodel: ______ .SF of affected area Is the area a conversion or change of use? Ov ON
~ Pool/Spa: 4 0 l SF Additional Gas or Electrical Features? _1-_,_r<, _ _.._p_l_~ _______ _
osolar: ___ .KW, ___ .Modules, Mounted:ORoof OGround, Tilt: 0 vO N, RMA: Ov ON,
Battery:OY ON, Panel Upgrade: Ov ON
D Reroof: --------------------------------□ Plumbing/Mechanical/Electrical
D Only: Other:
This permit Is to be Issued in the name of the Property owner as Owner-Builder, licensed contractor or Authorized Agent of the
owner or contractor. The person listed as the Applicant below will be the main point of contact throughout the permit process.
PROPERTY OWNER APPLICANT O PROPERTY OWNERS AUTHORIZED AGENT
Name: C\.c,,,e, ~'l\t Name: Co.rne.,:J4'.'&:\
Address: (zO) \ Lee cw t-Address: 5 I B 3 M ' I.;. I""' ce..-.ter f. A
City: C,-,r\.slo-cl,, State: C/l Zip: 9oa,€;, City: -SD State: cA Zip: 'i"olv~
Phone: l.?L0 -3't 3·"54 08 Phone: ,, I~ -3 '-'"3 -s---,oe
Email: _______________ ,Email: Cc r ( I C)0 <""':)Ii!~ fM;. L( · COlv'\
APPLICANT~
DESIGN PROFESSIONAL APPLICANT O CONTRACTpR OF RECORD D _ APPLICANT 0
Name: ______________ Name: (.,t,J ~/()ru TC>J,ll .J")r -
Address: Address· fD e;/)1(. (fY!
City: _______ ,State: __ ,Zip: ____ City: V,ifc. State:cA Zip: lj~f
Phone: Phone: ) bu -qoE -'3\l'{]
Email: Email: J_
Architect State License: State License/class: fzfi"3E:',bS]&t;'3 Bus. License: ___ _
1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: 8ullding@car1sbadca.gov
REV. 08/20
r:NTIFY WHO WILL PERFORM THE WORK BY COMPLETING (OPTION A) OR (OPTION B) BELOW:
(OPTION A): LICENSED CONTRACTOR DECLARATION:
I hereby affirm under penalty of perjury 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. I also affirm under penalty of perjury one of the
following declarations:
DI have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the
work which this permit is issued. Policy No. ________________________________________ ~
D Certificate of Exemption: I certify that in the 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 secure workers compensation coverage Is unlawful and shall subject an employer to
criminal penalties and civil fines up to $100,000.00, In addition the to the cost of compensation, damages as provided for In Section 3706 of the Labor Code,
interest and attorney's fees.
CONSTRUCTION LENDING AGENCY, IF ANY:
I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code).
Lender's Name: ______________________ ,Lender's Address:---------------~-----~
CONTRACTOR PRINT:__,,C'-'0_1_r....::,t:....C'..;;;~_..;·::.1 __ s1GN: 0/"\... --DATE: Y/·2)0"1
(OPTION B): OWNER-BUILDER DECLARATION:
I hereby affirm that I am exempt from Contractor's License Law for the following reason:
O 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 to an 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).
DI, 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 to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License law).
0 I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason:
O"Owner Builder acknowledgement and verification form" has been filled out, signed and attached to this application.
0 Owners "Authorized Agent Form" has been filled out, signed and attached to this application giving the agent authority to obtain the permit on the owner's behalf.
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the
improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed
contractors. / understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is
submitted or at the following Web site: http://www.leginfo.ca.gov/colow.html.
OWNER PRINT: SIGN: _________ DATE: _____ _
APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL
By my signature below, I certify that: I am the property owner or State of California Licensed Contractor or authorized to act on the property
owner or contractor's behalf I certify that I have read the application and state that the above information is correct and that the information on
the plans is accurate. I agree to comply with all City ordinances 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 CARl5BAD 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 for excavations over 5'0' deep and
demolition or construction of structures over 3 stories in height.
APPLICANT PRINT: __.C_.c-=:;..a.-._r""ie'--;-};;_~_.;;.';:;_ __ s1GN:
1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov
2 REV. 08120
. PERMIT INSPECTION-HIS. ORY for (CBR2021-1113)
8 -
Permit Type: BLDG-Residential
Work Class: Pool
Status:
Scheduled
Date
Closed -Finaled
Actual Inspection Type
Start Date
Checklist Item
Application Date: 04/19/2021
Issue Date: 05/25/2021
Expiration Date: 08/22/2022
IVR Number: 32859
Owner: CO-OWNERS KING CHARLES AND
LEINAIA
Subdivision: CARLSBAD TCT#85-36
Address: 2071 LEE CT
CARLSBAD. CA 92008-2765
Inspection No. Inspection Primary Inspector Reinspection Inspection
Status
COMMENTS Passed
BLDG-Building Deficiency September 24, 2021: (pass). Yes
02/22/2022 02/22/2022 BLDG-55
Fence/Preplaster
07/22/2022 07/22/2022 BLDG-Final Inspection
Checklist Item
BLDG-Plumbing Final
BLOG-Mechanical Final
BLDG-Structural Final
BLDG-Electrical Final
Monday, September 19, 2022
1. No equipotential bond copper wire
Deficiencies.
2. New copper equipotential swimming pool
and spa bond wire connected at four
points perimeter of swimming pool and spa
areas-approved.
177015-2022 Passed Tony Alvarado
187 494-2022 Passed Tony Alvarado
COMMENTS Passed
Yes
Yes
Yes
Yes
Complete
Complete
Page 4 of 4
C
PERMIT INSPECTION HISTORY for (CBR2021-1113)
Permit Type: BLDG-Residential
Work Class: Pool
Status:
Scheduled
Date
Closed -Finaled
Actual Inspection Type
Start Date
Checklist Item
Application Date: 04/19/2021
Issue Date: 05/25/2021
Expiration Date: 08/22/2022
IVR Number:
Inspection No.
COMMENTS
32859
Inspection
Status
Owner: CO-OWNERS KING CHARLES AND
LEINAIA
Subdivision: CARLSBAD TCT#85-36
Address: 2071 LEE CT
CARLSBAD, CA 92008-2765
Primary Inspector Reinspection Inspection
Passed
BLDG-Building Deficiency June 28, 2021: Yes
BLDG-53
Elec/Conduit/Wiring(Po
ols)
Checklist Item
1. No Building/lnground swimming pool with
spa-Deficiencies.
2. In ground swimming pool/spa plumbing
piping, under water leak pressure
test-approved.
3. Swimming pool and spa steel
reinforcement rebar, scope of work, per
Stapleton pool engineering, approved
engineered swimming pool/spa -approved.
4. Equipotential pool bond ground wire
located at 4-points located at pool
perimeter -partial pass.
5. New gas plumbing line, with tracer wire,
under gas leak air pressure test with test
gauge, scope of gas line work-approved.
6. New electrical conduit type.size, depth,
for inground pool/spa, scope of
work-approved.
160623-2021 Passed Tony Alvarado
COMMENTS
BLDG-Building Deficiency June 28, 2021:
09/24/2021 09/24/2021 BLDG-54-Equipotential
Bond(Pools)
Monday, September 19, 2022
1. No Building/Jnground swimming pool with
spa-Deficiencies.
2. In ground swimming pool/spa plumbing
piping, underwater leak pressure
test-approved.
3. Swimming pool and spa steel
reinforcement rebar, scope of work, per
Stapleton pool engineering, approved
engineered swimming pool/spa -approved.
4. Equipotential pool bond ground wire
located at 4-points located at pool
perimeter -partial pass.
5. New gas plumbing line, with tracer wire,
under gas leak air pressure test with test
gauge, scope of gas line work-approved.
6. New electrical conduit type,size, depth,
for inground pool/spa, scope of
work-approved.
167156-2021 Passed Tony Alvarado
Complete
Passed
Yes
Complete
Page 3 of 4
{ t ,,,"
PEIMIT 1NSPECT::IPN HISTORY for (CBR2021-1113)
Permit Type: BLDG-Residential Application Date: 04/19/2021 Owner: CO-OWNERS KING CHARLES AND
LEINAIA
Work Class: Pool
Status: Closed -Finaled
Issue Date: 05/25/2021
Expiration Date: 08/22/2022
IVR Number: 32859
Subdivision: CARLSBAD TCT#85-36
Address: 2071 LEE CT
CARLSBAD, CA 92008-2765
Scheduled
Date
Actual Inspection Type
Start Date
Inspection No. Inspection
Status
Primary Inspector Reinspection Inspection
Checklist Item
BLDG-Building Deficiency
COMMENTS
June 28, 2021:
1. No Building/lnground swimming pool with
spa-Deficiencies.
2. In ground swimming pool/spa plumbing
piping, under water leak pressure
test-approved.
3. Swimming pool and spa steel
reinforcement rebar, scope of work, per
Stapleton pool engineering, approved
engineered swimming pool/spa -approved.
4. Equipotential pool bond ground wire
located at 4-points located at pool
perimeter-partial pass.
5. New gas plumbing line, with tracer wire,
under gas leak air pressure test with test
gauge, scope of gas line work-approved.
6. New electrical conduit type.size, depth,
for inground pool/spa, scope of
work-approved.
BLDG-51
Excav/Steel(Pools)
160622-2021 Passed Tony Alvarado
Checklist Item
BLDG-Building Deficiency
COMMENTS
June 28, 2021:
1. No Building/lnground swimming pool with
spa-Deficiencies.
2. In ground swimming pool/spa plumbing
piping, under water leak pressure
test-approved.
3. Swimming pool and spa steel
reinforcement rebar, scope of work, per
Stapleton pool engineering, approved
engineered swimming pool/spa -approved.
4. Equipotential pool bond ground wire
located at 4-points located at pool
perimeter -partial pass.
5. New gas plumbing line, with tracer wire,
under gas leak air pressure test with test
gauge, scope of gas line work-approved.
6. New electrical conduit type,size, depth,
for inground pool/spa, scope of
work-approved.
BLDG-52 Pool Plumbing 160624-2021 Passed Tony Alvarado
Monday, September 19, 2022
Passed
Yes
Complete
Passed
Yes
Complete
Page 2 of4
Building Permit Inspection History Finaled
( City of
Carlsbad
PERMIT INSPECTION HISTORY for (CBR2021-1113)
Permit Type: BLDG-Residential
Work Class: Pool
Status:
Scheduled
Date
06/02/2021
Closed -Finaled
Actual Inspection Type
Start Date
06/02/2021 BLDG-SW-Pre-Con
Checklist Item
Application Date: 04/19/2021
Issue Date: 05/25/2021
Expiration Date: 08/22/2022
IVR Number:
Inspection No.
158706-2021
COMMENTS
32859
Inspection
Status
Cancelled
Owner: CO-OWNERS KING CHARLES AND
LEINAIA
Subdivision: CARLSBAD TCT#85-36
Address: 2071 LEE CT
CARLSBAD, CA 92008-2765
Primary Inspector
Tony Alvarado
Reinspection Inspection
Reinspection Incomplete
Passed
BLDG-Building Deficiency No
Checklist Item
BLDG-Building Deficiency
COMMENTS
June 2, 2021: (virtual Inspection).
DryroVtermite wood damage to existing
stairwell-structural beams-(typical).
No building deficiencies.
1. Inform contractor Rep., (Charles),
regarding the following:
2. Temporary toilet facilities require pan
under toilet
Temporary toilet factlities require pan under
toilet I need to be located outside public
right-of-way and on owners property.
3. Dirt spoils/stockpiling, requires be
covered and protected, dust and runoff
containment, with straw waddle or
gravel/sandbags.
4. Contain all soil erosion and sediment
erosion on property, keep any soil or
debris away from storm water inlet,
adjacent property owners, and
public-right-of-way sidewalk areas
(typical).
5. Final as-built plan revisions need to be
approved prior to final inspection, for
historical purposes and city records
management maintaining latest and
greatest current plans on file.
6. Security perimeter fencing and gates
installed at all times during the construction
process till final clearances and sign offs
from all agencies/depts.
7. Hours of construction observed.,
8. Federal holidays observed and no
construction work allowed.
9. Additional preconstruction requirements
may follow.
06/28/2021 06/28/2021 BLDG-23 160811-2021 Passed Tony Alvarado
Gas/TesURepairs
Monday, September 19, 2022
Passed
Yes
Complete
Page 1 of 4
" fORM 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 WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP
THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES
UNTILrThlE CONSTRUCTION WORK IS COMPLETE AND APPROVED
BY nrE 1!1~ OF CA~AD. .
"----Qvf I ,-e_ )D;l-e
-· -------OWNER(S)/OWNER'S BGENT-NAME (PRINT to'1"10
SIGNATIJRt DATE
E-29
s~roRM WATER. C.OMPLIANCE FORM
TIER 1 CONST.RUCTION SWPPP
----··-'"" .. ·------·
t :i:Jfz ?~-~ '
,\ ' ,.......,, i ;\ )
BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE
Erosion Control Sediment Control BMPs Tracking Non-storm Water Waste Management and Materials
BMPs i Control BMPs Management BMPs Pollution Control BMPs
' ' C: .,_, C: C: :8 .,_,
:8 :8 C: C: "O cn 0 " "O Q) "O "' C: u u C: ,5 "' E C: E c:: .,_, 0 2 ::, .2 ·c 0
0 E
.,_, L "O .Q. Q) 0 Q) Q) .,_, L :,; "O "' "' L .., -C: s;::_ ::, c en -C: Q) L .5 " C: "' "' "' !a 'C CT 0 C: "' en c,_ Q) -~ ~ Co ·c -C: "' C: L C!l L w C: :8 0 Best Management Practice* .5 e co a. " u, ;,, "' L 0 Q) 0 " -" C .!B~ ;.: .,_,
.,:: .5 I-E "' 0 .5 UL u "' ~ "O "iii "' ::. ! C:
(BMP) Description ➔ "' u ., (/) u, en "' "' co C C: en § u,
"O ., C: Cl u, "' " e "' 0 C ;,, C ~~ C C :::, "' Q) :5 ~<I,) 0 .., '5 LO "O >, C en Q) cE ::, E :;5 C: Cl 0) en·-en Cl +i '=·~ Co
X :::. Cl c,, Cl C " a< ..,E 0 ~~ l!lo O):;:; Q) ~.5 0 Q) 0 "5. L-"'Q) 0 II)
.!!l 0 ~ ~ .,,_ ] .0 E ~ =;,, :0 ·cg ":i"i :::: _g "' -e "' "O .C C " 0 L " ::, "O :.0 ~ ·-"O ~ t, cC oc i3 "O 0 cc a. "' :, L+' .0 0 •-L C •-C Q) L
0 0 t·o 0 .,_, Q) Q) e LO § 00 0 "' .s 0 o" e; ~ 15 .c Q) .,_, 0 ..., ti = C: ~§ N C:
" ~ QL = Q) .c .0 ..,c +' L UJ C :;:: ct ~u o.,_, 0 c,_O cc
C!l WCl in. (/) en u ti: C!l en> en (/) 0.. en a< 0.0 0. :,; en ::. (/) u VJ~ :c ::.
d CASQA Designation ➔ ,... co a, .... 00 0 N t') ,... 00 N ,.,., .... "' <D ~ ..., It) <D ,... 'T ~ 'T 'T I <', I ,, I I I I I I J, I I I I I I I I I I
u u 0 w w w w w w w ~ ~ en en en en :,; :,; ;:,, ~ :::. ~ .,,--Construction Activity w w w w: en U) en U) en en en en z :z z z .. .. .. ;.:
/ Grndina /Soil Disturbance i '/.-I V '
-Trench inn /Excavation I 1--l, ,,
--5'tackPilina . T . ..
Drillina /Borina ' "
, Concrete/Asphalt SawcuttinQ !
· 'Concrete Flatwork
, Pavinq ' ' Conduit/Pipe Installation '
,Stucco/Mortar Work '
"" Waste Disposal ' v
'
Staainn /Lav Down Areo I
Eauloment Maintenance and Fuelinn I
Hazardous Substance Use/Storaae '
Dewaterina '
Site Access Across Dirt !
Other (list l:
Instructions: . 1. Check the box to the left of all applicable construction activity (first column) expected to occur during construction.
I
2. 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.
3. Refer to the CASQA construction handbook for intorjnation and details of the chosen BMPs and how to apply them to the project.
PROJECT INFORMATION
Site Address: d071 l,e(, Co..Jrt
Assessor's Parcel Number: 00$", 33 v ·· 3\ •CN
Emergency Contact:
Name: Nc,r I~ e \
24 Hour Phone, 76u, °JO[ ,, J'. .. c,{3
Construction Threat to Storm Water Quality
(Check Box)
~EDIUM O LOW.
Q) -"' c-3' C: "' "'E .., Q) f: o> uo CC: oo u:,; -
ro I :::. :;::
)(
. ,,
Page 1 pf 1 REV 11/