The URL can be used to link to this page

Home My WebLink AboutPD 2021-0033; 3357 ADAMS ST; Engineering Application E-23 Page 1 of 2 REV 07/14 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov APPLICATION ENGINEERING PLANCHECK E-23 Complete all appropriate information. Write N/A when not applicable. Project Name:________________________________________________ Date:______________________________ Project Description: ________________________________________________________________________________ ________________________________________________________________________________________________ Project Address:___________________________________________________________________________________ Lot No(s).:_______________________ Map No.:__________________ APN(s):____________________________ Number of Lots:___________________ Number of Acres:____________ Miles of Trails:_______________________ Owner: ____________________________ Applicant: ___________________________ Mailing Address: ____________________________ Mailing Address: ___________________________ ____________________________ ___________________________ Phone Number: ____________________________ Phone Number: ___________________________ Fax Number: ____________________________ Fax Number: ___________________________ E-mail: ____________________________ E-mail: ___________________________ I certify that I am the legal owner and that all the above information is true and correct to the best of my knowledge. Signature:________________ Date: ______________ Signature:____________________ Date:_____________ Civil Engineer: ______________________________ Soils Engineer: ______________________________ Firm: ______________________________ Firm: ______________________________ Mailing Address: ______________________________ Mailing Address: ______________________________ ______________________________ ______________________________ Phone Number: ______________________________ Phone Number: ______________________________ Fax Number: ______________________________ Fax Number: ______________________________ E-mail: ______________________________ E-mail: ______________________________ State Registration Number: _____________________ State Registration Number: _______________________ Additional Comments:_______________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ IMPROVEMENT VALUATION 1. What water district is the proposed project located in? (check one) Carlsbad Municipal Water District Olivenhain Vallecitos 2. 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 _______ cy fill _______ cy remedial _______ cy import _______ cy export _______ cy □ □ □ E-23 Page 2 of 2 REV 07/14 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov APPLICATION ENGINEERING PLANCHECK E-23 Complete all appropriate information. Write N/A when not applicable. APPLICATION FOR (check all that apply) FOR CITY USE ONLY Project I.D. Drawing Number Deposit /Fees Paid Comments Adjustment Plat (ADJ) Certificate of Compliance (CE) Dedication of Easement (PR) Type: ___________________ Type: ___________________ Encroachment Permit (PR) Final Map (FM) Grading Plancheck (DWG) Improvement Plancheck (DWG) Parcel Map (PM) Quitclaim of Easement (PR) Type: ___________________ Reversion to Acreage (RA) Street Vacation (STV) Tentative Parcel Map (MS) Certificate of Correction (CCOR) Covenant of Easement (PR) Substantial Conformance Exhibit (SCE) Trails < mile > mile Other APPLICATION ACCEPTED BY: DATE STAMP APPLICATION RECEIVED ____________________________________________________________ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ II 11 E-23 Page 1 of 2 REV 07/14 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov APPLICATION ENGINEERING PLANCHECK E-23 Complete all appropriate information. Write N/A when not applicable. Project Name:________________________________________________ Date:______________________________ Project Description: ________________________________________________________________________________ ________________________________________________________________________________________________ Project Address:___________________________________________________________________________________ Lot No(s).:_______________________ Map No.:__________________ APN(s):____________________________ Number of Lots:___________________ Number of Acres:____________ Miles of Trails:_______________________ Owner: ____________________________ Applicant: ___________________________ Mailing Address: ____________________________ Mailing Address: ___________________________ ____________________________ ___________________________ Phone Number: ____________________________ Phone Number: ___________________________ Fax Number: ____________________________ Fax Number: ___________________________ E-mail: ____________________________ E-mail: ___________________________ I certify that I am the legal owner and that all the above information is true and correct to the best of my knowledge. Signature:________________ Date: ______________ Signature:____________________ Date:_____________ Civil Engineer: ______________________________ Soils Engineer: ______________________________ Firm: ______________________________ Firm: ______________________________ Mailing Address: ______________________________ Mailing Address: ______________________________ ______________________________ ______________________________ Phone Number: ______________________________ Phone Number: ______________________________ Fax Number: ______________________________ Fax Number: ______________________________ E-mail: ______________________________ E-mail: ______________________________ State Registration Number: _____________________ State Registration Number: _______________________ Additional Comments:_______________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ IMPROVEMENT VALUATION 1. What water district is the proposed project located in? (check one) Carlsbad Municipal Water District Olivenhain Vallecitos 2. 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 _______ cy fill _______ cy remedial _______ cy import _______ cy export _______ cy SMS Geotechnical 5931 Sea Lion Place Carlsbad 760- Mehdi Shariat 602-7815 smsgeocontroller@gmail.com GE-2885 Remedial grading to prepare foundation per soils engineer 46 241 ~ □ □ E-23 Page 2 of 2 REV 07/14 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov APPLICATION ENGINEERING PLANCHECK E-23 Complete all appropriate information. Write N/A when not applicable. APPLICATION FOR (check all that apply) FOR CITY USE ONLY Project I.D. Drawing Number Deposit /Fees Paid Comments Adjustment Plat (ADJ) Certificate of Compliance (CE) Dedication of Easement (PR) Type: ___________________ Type: ___________________ Encroachment Permit (PR) Final Map (FM) Grading Plancheck (DWG) Improvement Plancheck (DWG) Parcel Map (PM) Quitclaim of Easement (PR) Type: ___________________ Reversion to Acreage (RA) Street Vacation (STV) Tentative Parcel Map (MS) Certificate of Correction (CCOR) Covenant of Easement (PR) Substantial Conformance Exhibit (SCE) Trails < mile > mile Other APPLICATION ACCEPTED BY: DATE STAMP APPLICATION RECEIVED ____________________________________________________________ PC2021-0029 □ □ □ □ □ ~ □ □ □ □ □ □ □ □ □ □ □ □ □ II 11 E-24 Page 1 of 1 REV 07/14 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov APPLICATION GRADING PERMIT E-24 PERMIT NUMBER: _______________________________ Project Name: ___________ ___________ ___________ ___________ _______ Project Number: Project Location: Drawing Number: Assessor Parcel Number(s): Project Description: Owner: Address: Suite: City: State: Zip: Phone Number: 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: Address: Suite: City: State: Zip: Phone Number: Fax Number: Soils Engineer: Address: Suite: City: State: Zip: Phone Number: Fax Number: Grading Contractor: State License No.: City Business License No.: Address: Suite: City: State: Zip: Grading Quantities: cut cy fill cy import cy remedial cy export cy Qualified contact person trained in NPDES requirements: Phone Number: Basis of Permit Fees: cy Total Permit Fees: $ Verified By: Balance Due: $ 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: Address: Suite: City: State: Zip: Phone Number: Fax Number: APPLICANT’S SIGNATURE: DATE: Rivera Construction Inc 3221 Calle Vallarta Carlsbad CA 92009 857152 01-24-22 01-24-22 BLRE008777-11-2020 II ~~ ~~