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Home My WebLink About1211 WIND STAR WAY; ; CB131249; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 05-15-2013 Permit No: CB131249 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: 1211 WIND STAR WY CBAD PME 2122121100 VANDENBREE RES-GAS LINE REPAIR @ KITCHEN ISLAND SPECTRUM RENOVATIONS STE E 7283 ENGINEER RD SAN DIEGO CA 92111 585-279-7800 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Status: Lot #: 0 Applied: Entered By: Plan Approved: Issued: Inspect Area: Owner: VANDENBREE JAY & LINDA 1211 WIND STAR WAY CARLSBAD CA 9201 1 ISSUED 05/15/2013 LSM 05/15/2013 05/15/2013 $154.00 $0.00 $0.00 $0.00 $154.00 Total Fees: $154.00 Total Payments To Date: $154.00 Balance Due: (}r7 ~ FI NALAPP ROVAL Inspector: ~ Date: ,5 'l'w-/ $ Clearance: $0.00 NOTICE: Please take NOTICE that approval of your project includes the 'Imposition· of fees, dedications, reservations, or other exactions hereafter collectively referred to as 'fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any f THE FOLLOWING APPRifVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0 PLANNING ~ «'-~ ~ CITY OF D ENGINEERING Oeu1LD1NG OARE □HEALTH D HAZMAT/APCD Plan Check No. Est. Value CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: buldllng@carlsbadca.gov www.carlsbadca.gov Plan Ck. Deposit SWPP JOB ADDRESS \2 vJ,t'{ SUITE#/SPACE#/UNIT# CT/PROJECT# LOT# PHASE# # or UNIT # BATHROOMS TENANTS IN CONSTR. TYPE OCC. ROUP DESCRIPTION OF WORK: Include Square Feet of Atrected Area(s) l>R.f-S$v .e c -r 6'51°' O "1 N -lt'TV M"l-lti-1'5 UN t- L-~k ~ R~P,A) [2.. <;' 0 6c g_c~ 1)1 R.tS FOL,,/.P/,1JIIIJ6 crry 5J6N dFF pR.,oR 1D R~~o R./Nb '5~\) I'-€ GARAGE [SF) PATIOS [SF) DECKS [SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES D #_ NO D YES D NO □ YES D NO D APPLICANT NAME (Secondary Contact) ADDRESS 3 ~N6lNcElc ADDRESS STATE C,.,A,. ZIP 'l~l ll CITY STATE ZIP PHONE FAX PROPERTY OWNER NAME ADDRESS CITY STATE ZIP ZIP ~I\ l PHONE FAX ARCH/DESIGNER NAME & ADDRESS STATE UC.# (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct. alter. improve. demolish or repair ant structure, prior to Its issuance, also 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 [Cha'fter 9. commending with Section 7000 of Division 3 of the Business and Professions Code) or !hat he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 703 .5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001). Workers' Compensation Declaration: I hereby affirm under penalty of perjixy one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for WOl1<ers' compensation as provided by Section 3700 of the Labo< Code, for the performance of the WOl1< for which this permit is issued. CX,1 have and will maintain workers~•lie~.~ (Wred by S891lon 3700 of the Labor Code, for the pertormance of the work for which this permit is issued. My workers' compensation insurance ~er and policy { number are: Insurance Co. ~~ ~ tJWtt{ i: ~. Policy No. C,fa(.; A \ ~ $''22. Expiration Date 1-1-\~ This section need not be completed ff the permit is for one hundred dollars ($100) or less. 0 Certificate of Exemption: I certily !hat in the performance of the work for which this pem,it is issued, I shall not employ any person in any manner so as lo become subject to the Workers' Compensation Laws of CaJijomia WARNING: Failure to secure worbrs' compensation covera e Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, dam~provi~ 1Jj in Sect' 706 ofth .£$ CONTRACTOR SIGNATURE /c,t/~ I hereby affirm fhaf f am exempt from Contractor's Ucense Law for the following reason: D I, as owner of lhe property or my employees wilh wages as their sole compensation, will do the WOl1< and the structura is not inlended 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 WOl1< himsett or through his own employees, provided !hat such improvements are not intended or offered lor 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). D 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 to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contraclor's License Law). D I am exempt under Section ____ Business and Prolessions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. D Yes □ No 2. I (have/ have not) signed an application for a building permit for lhe proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address/ phone I contractors' license number): 4. I plan to provide portions of the WOl1<, but I have hired the following person lo coordinate, supervise and provide the major work Ondude name I address / phone / contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone I type of work): _£S PROPERTY OWNER SIGNATURE □AGENT DATE ·-.,. • Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and p,evention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Acri □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management districr? □ Yes □ No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ 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. 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 }...) { I certify that I ha'J8 read the application and stale that the aboYe infonnation is correct and that the infonnation on the plans is accurate. I agree to comply with all City ordinances and Stale laws relating tD building construction. I hereby auroize rep-esentaM of lhe City of Cattsbad kl enter upon lhe alxlve menoooed property br nspecoon ixirposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARI.SB.AD AGAINST ALL U/>BIUTIES, JUDSMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN Cet-JSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: AA OSHA perml is requred b-excavations over 5'0' deep and demolioon or construction of structures over 3 sl:>ries in height. EXPIRATION: El/ery permrt issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void ~ the building or v.()fk authorized by sudl permit is not commenced within 1jl)days from the date of sl.dl permrt or· i1g or a thorized permrt is sus at any time after the v.()fk is OOllV1lenC8d b" a period of 100days (Sedion 100.4.4 Unitxm Buikjjng Code). ~PLICANT'S SIGNATURE DATE -_ .,2_C) Jl STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. CERTIFICATE OF OCCUPANCY fCommerc1.tl Proiects On I y I Fax (760) 602--8560, Email www.building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. I CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE I FAX EMAIL OCCUPANT"S BUS. LIC. No. DELIVERY OPTIONS D PICK UP: o CO NT ACT (listed above) o OCCUPANT (Listed above) o CONTRACTOR {On Pg. 1) □ MAIL TO: o CONTACT (Listed above) o OCCUPANT (Listed above) o ASSOCIATED CB# o CONTRACTOR (On Pg. 1) o NO CHANGE IN USE / NO CONSTRUCTION □ MAIL/ FAX TO OTlfER: o CHANGE OF USE / NO CONSTRUCTION -- ,l!S APPLICANT'S SIGNATURE DATE -. ' .... Inspection List Permit#: CB131249 Type: PME Date Inspection Item 05/15/2013 23 Gas/T esURepairs Thursday, May 16, 2013 Inspector Act PB AP VANDENBREE RES-GAS LINE REPAIR@ KITCHEN ISLAND Comments Page 1 of 1