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Home My WebLink About1005 CARLSBAD VILLAGE DR; G; CB153632; Permit10-26-2015 City of Carisbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CBI 53632 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 1005 CARLSBAD VILLAGE DR CBAD St: G PME 2033202900 Lot #: 0 CARLSBAD VILLAGE CLEAN:REPLACE 250 LF OF 2" GAS LINE TO LIKE MATERIALS Status: ISSUED Applied: Entered By: Plan Approved: Issued: Inspect Area: 10/26/2015 SLE 10/26/2015 10/26/2015 Applicant: M A RODRIGUEZ CONSTRUCTION 1826 FOREST AVE CARLSBADCA 92008-1016 808-651-3789 Owner: CARROLL GLENN S&E GLORIA TRUST A 06-29-81 ET AL C/O E W DAWSON CORP, LTD P 0 BOX 555 INGLEWOOD CA 90307 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees $163.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $163.00 Total Fees: $163.00 Total Payments To Date: $163.00 Balance Due: $0.00 Inspector: FINAL APPROVAL Date: Clearance: NOTICE Rease take NOTICE that approval of your prpject includes the "InTDosition" of fees, dedications, reservations, or other exactions hereafter collectively refened to as "fees'exactions." You have 90 days from the date this penrit v\as issued to pnotest irrposition d these fees/exactions. If you pretest them, you nust follcw the protest procedures set forth in GoverTment Code Section 66020(a), and file the protest and any other requined InfonrHtion vwth the Qty Manager for prewessing in acoofdanoe wth (Cartsbad Mridpal Oode Section 3.32.030. Failure to tirTEly fdlcwthat pnxedure will har any subsequent legal adion to attack, review, s^ aside, void, a annul their imposition. You are hereby FUTfHER NOTIRED that yor right to protest the spedfied fees/exadions DOES NOT AFI^^ dianges, nor planning, zoning, grading or cither sinrilar application pnxessing a servioe fees in oonnection v«th this prqjed. NOR DOES IT /VPPLY to any fees/exacCons of vvhich vou have Dreviouslv been dven a NOflCE sinilar to this, a as to wliich the statute of linnitations fas previouslv othetwise exared. /]THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMITISSUANCE: DPLANNING •ENGINEERING •BUILDING DFIRE IZIHEALTH • HAZMAT/APCD Ccityof Carlsbad Building Permit Appiication 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax:760-602-8558 email: buildlng(gcarlsbadca.gov www.carlsbadca.gov Plan Check NcCfc 1^3>U)5Z Est. Value Plan Ck. Deposit Date jc^ SWPPP JOB ADDRESS SUITE#/SPACE#/UNIT* ,5 -^2D -2^ -CfO T^NTBUSINESS AniE j , I VCON CT/PROJECT # # OF LINITS # BEDROOMS tt BATHROOMS CONSTR. TYPE DESCRIPTION OF WORK: Include Square l^et of A/IMtedAi-ea/s; / !• ' J I,'!/ I f] ft EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YES|~|# NOj I CITY — f\ SW/E ZIP _ AIR CONDITIONING YES I INO I I FIRESPRINKLERS YES I |NO| I APPLICANT NAME Primary Contact_ PROPERTYOWNER Ol ADDRESS 2 CITY PHONE FAX PHONE 3/D (;^77 Zl^( EMAIL EMAIL DESIGN PROFESSIONAL CONTRACTOR BUS. NAME ADDRESS ADDRESS l^li^ h>nj: 'i'liM CITY STATE CITY STAIE, ZIP PHONE FAX PHONE, EMAIL i^(ifc^'nsf{(AcJ^((^p me. COM in.# NTSIASS ICITYF E LIC.# CITY BUS. L1C.# (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct alter, iniprove, demolish or repair any structure, prior to its issuance, also requires the applicant for such permii to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Criapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) ortnat he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). WORKERS' COMPEMSATION Workers' Compensation Declaration: / h&eby affimi under penalty of perjury one ofthe following declarations: I have and will maintain a certificate of consent to seif-insure for woriteis' compensation as piovided by Section 3700 of the Labor Code, for the performance of the woiit for whicli this permit is issued. I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance earner and policy number are: Insurance Co. Policy No. Expiration Date This seatlOT need not be completed if the permit Is for one hundred dollars ($100) or less. U^fCeitificate of Exemption: I certify that In the perfomiance of the work for wtlbh this pemiit 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' corimeneatloircovefage is iHilSwful^andjlialLsubject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages as prided for in Section 3a06jiUtiaCaCorcode, interest and attomey's fees. / / CONTRACTOR SIGNATURE ^.-'^'''^''^^^ QAGENT DATE f2^/'/ OMfNER-BUILOER i>ECl.AR«>. TION / hereby affirm that I am exempt from Contractor's License Law for the following reason: I I I, as owner of the property or my employees with wages as their sole compensation, will do the work and the stnicture 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-bullder will have the buiden of pioving that he did not build or Improve for the purpose of sale). I I I, as owner of the property, am exclusively contracting with licensed contractors to constnjct 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). • I am exempt under Section _ eBusiness and Professions Code for this reason: •Yes I INO 1.1 personally plan to provide the major labor and materials for construction of the proposed property Improvement. 2.1 (have / have not) signed an application for a building perniit for the proposed work. 3.1 have contracted with the following peison (finn) to provide the proposed construction (include name address / phone / contractors' license number): 4.1 pian to provide portions of the wortt, but I have hired the following person to coordinate, supervise and provide the major worit (include name / address / phone / contractors' license number): 5.1 will pravide some of the work, but I have contracted (hired) the following persons to provide the work Indicated (Indude name / address / phone / type of virorit): PROPERTY OWNER SIGNATURE •AGENT DATE COMPtETE THIS SECTION FOR N O N - R E S t O E N T I A L BUItOlNG PERMITS ONLY Is the applicant or future bulMIng occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention pragram under Sections 25505,25533 or 25534 of the Presley-Tanner HazanJous Substance Account Act? Yes No Is the applicant or future building occupant required to obtain a pennit fram the air pollution control district or air quality management district? Yes No Is the facility to be constnicted within 1,000 feet of the outer boundaiy 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. CONSTRUCTION tENDING AGENCY I tiereby affirm that there is a construction lending agency for the perfonmance of the work this perniit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lenders Address APPtlCANT CERTIFICATION ' I certif that I have read the applkatnn and state that the above informaiion is conect and thatthe infbrmation on the plans is aocuiate. I agree to comply wHh all City ordinances and State laws relating to building constmction. I heieby authorize representative ofthe City of Carisbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL UABILmES, JUDGMENTS, COSTS AND EXPENSES WHICH MWjNAff^^^ ACCRUE AGAINST SAID CfTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMff. OSHA: An OSHA pennit is required for excavations over 5'0' deep and^emelitiQn'or constr |btlon.<)f stmctures over 3 stories in height. EXPIFtATION: Every pemiit issued by the Building Ofiiciai underjbefrovisions ofthis (M shall exfte by limitefai3Pd*ec!JfII?nijirind void if the building or vwriaauthorized by such pennit is not commenced within 180 days from the dale of such pemiit or if the building or vw^faithorized by such pemiit is suspendeapwbafiSoned at any time after the writ is commenced for /period of 180 days {Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY If a Certificate of Occupancy will be requested at final Inspection. Fax (760) 602-8560, Email buildlnqlSicarlsbadca.QOV or Mall the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, Califomia 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAILTO: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL / FAX TO OTHER: ASSOCIATED CB#- NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION ^APPLICANT'S SIGNATURE DATE Inspection List Permit*: CB153632 Type: PME Date Inspection Item 11/02/2015 23 Gas/Test/Repairs 11/02/2015 23 Gas/Test/Repairs 11/02/2015 29 Final Plumbing Inspector PB PB Act Rl AP AP CARLSBAD VILLAGE CLEAN:REPLACE 250 LF OF 2" GAS LINE TO LIKE MATERI Comments AM PLEASE IVionday, November 02, 2015 Page 1 of 1