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Home My WebLink About1022 IRIS CT; ; VARIOUS; Permit• I hereby affirm 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. Lie No Class I Iiereby affirm that I am exempt from the Contrac- tor s License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or couniy whicf-i re-quires a permit to construct, alter, improve demolish or repair any structure, prior To its issuance also requires the'ap- plicanl for such permit to file a signed statement lhat he is licensed pursuant to the provisions of the Contraclor's License Law (Chapter 9 commencing with Sechon 7000 of Division 3 of the Business and Professions Code) or that is ex- empt therefrom and the basis for the allegea exemption. Any violation of Section 7031.5 by an applicant for a permit suD- jecls tbe applicant to a civil penalty of not more than five hun- dred dollars ($500). 11 I, as owner of Ihe property, or my employees with wages as Iheir sole compensation, will do the work, and the struc- ture is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law does not appiy to an owner of properly who builds or improves Ihereon and who does such work himself or through his own employees, provided that such improvemenls are nol intend- ed or oftered for sale. If, however, the building or improve- ment (S sold wilhin one year of completion, the owner-builder will have Ihe burden ot provmg that he did not build or im- prove for the purpose of sale). I, as owner of lhe property, am exclusively conlracling with licensed contractors lo construct the pro|ecI (Sec, 7044, Business and Professions Code, The Contractor's License Law does not apply to an owner of properly who builds or im- proves Ihereon, and who coniracts for each projects with a contractor(s) license pursuant to the Contractor's License Law), L: As a homeowner I am improving my home, and the follow mg conditions exist: 1. The work is being performed prior to sale 2. I have lived in my home for twelve months prior lo completion of this work. 3. I have not claimed this exemption durmg the lasl three years - . I am exempt under Sec, for this reason i P C • i hereby afdfm that I have a certificate o' consent to self insure, or a ceriificate ol Workers Compensation Insurance, or a certified copy thereof (Sec 38C», Labor Codei POLiCY NO COMPANY • Copy IS filed with the city Q Cenitied copy is hereby furnished CERTIFICATE. OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed it the permit IS tof one hundred dollars ($100) or lessi Q I certify that in the performance ot the worK tor which this pennit is issued, I shall not employ any person in any manner so as to become subiect to the Workers Compensation Laws of California NOTICE TO APPLICANT If, after making this Cerii ficate of Exemption, you should become subject t-:) the Workers' Compensation provisions of the Lat>or Code, you must forthwith comply with such provisions Of this permit shall be deemed revoked Q I hereby attirm that there is a construction lending agency 'o' the pertofmance o' the work fof which this permit is issued iSec ,3097, Civil Codei Lendef s Name _ Lender s Address . USE BALL POINT PEN ONLY & PRESS HARD HAVE GAREFUILLY EXAMINED THE COMPLtTEO S'APPLICATION AND PERMIT" AND DO HEftEBY CERTIFY UNDER PENALTY OF PERJURY THAT AtJ. INFORMATION HEREON INGLUBINQ THE DECLAfiATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, COUNTY ANO STATE LAWS GOVERNING BUILDING CON- STRUCTION, WHETHER SPECIFIED HEHEIN QR NOT, I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF GARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. Exwratron. Every permit Issued by the Building Official under the provisions ofthis >^°^SMS*^P*'P W Mmitmm^^ null snd void, If lhB-buiWitwor»orli ..nmnomm bjiWW permit is riotcornlrienced Mttim 180daysfTOni*ff£l«teo(Such ^ pWmrt, or If tfie building or work aulhorized by such permit is suspended or abandjomKl at an^aiiw after the work is commertced lor a period, of rao days. " APPOCA"ST*» SISttATfiil .OWNEI CONTHACTOR O BY PHONED * AN OSHA PERMIT IS REeWIRED FOB iXCAVATlONS OVER ' 'S- 0"6EeP.«f«S' 0tiilOt#l6« OR 'GOHSTiiUtlTION W'-'- ^ STRUCTURES OVER 3 STORIES IN HEIGHT I .E TYPE BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT FLOOR & CEILING SUB FRAME SHEATHING • ROOF • SHfiAR FRAME EXTERIOR LATH INSULATION INTERIOR LATH & DRYWALL PLUMBING SEWER AND BUCO •jPUGO UNDERGROUND • WASTE • WATER TOP OUT • WASTE • WATER TUB AND SHOWER PAN GAS TEST • WATER HEATER • SOLAR WATER ELECTRICAL • ELECTRIC UNDERGROUND • UFFER ROUGH ELECTRIC • ELECTRIC SERVICE • TEMPORARY • BONDING • POOL MECHANICAL • DUCT & PLEM., • REF. PIPINiG HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS DATE INSPECTOR CALL FOfl FINAL INSPECTIQN WHEN ALL A ffPROPRIA] ITEMS ABOVE HAVE BEEN APPROVED. FINAL ' PLUMBING I ELECTRICAL ' tr 1 1 r MECHANICAL , GAS ; . V A BUILDING ; \W /i SPECIAL CONDITIONS ' W ' \ 1 FIELD INSPECTION RECORD REOUIRED SPECIAL INSPECTIONS INSPECTION REO IF CHECKED INSPECTOR S APPROVAL DATE SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOL fs SPECIAL MASONRY PILES CAISSONS t il INSPECTOR'S NOTES J . . . €itp of Carlfl^bab REQUEST FOR INSPECTION RECORD BUILDING DEPARTMENT INSPECTOR OWNER ADDRE] PERMITNO. TIME: .DATE: REQUESTED BY PHONE NO. PERSON TAKING REPORT. BUILDING ELECTRICAL No work for six months. Permit expired Work continues slowly date Work not started, permit expired date initial initial date initial The inspector will return the permit to the Permit Clerk who will either replace the permit in the file as active or send the owner/ contractor written notice that the permit has expired. Ready For Inspection: n Monday • A.M. n P.M. n Tuesday 1 Wednesday r ! Thursday Friday PLAN CHECK NUMBER ADDRESS OATE PLANNING: TYPE OF STRUCTURE SCHOOL FEES: SAN DIEGUITO CARLSBAD % COVERAGE BUILDING HEIGHT FENCES/WALLS TWO CAR GARAGE Ul ac o COf^ENTS: ZONE: ENCINITAS SAN MARCOS REQUIRED SETBACKS FRONT SIDE REAR a: o I I REDEVELOPMENT APPROVAL REQUIRED: |\J JD n LANDSCAPE PLAN COMMENTS: [V /V ac Z3 Csi - o ENVIRC^;MENTAL REQUIRED: ADDITIOriAL COMMENTS: OK TO ISSUE: DATE OK TO FINAL: DATE: ENGINEERING P.F.F. R.O.W: LEGAL OESCRIPTION VERIFIED?. _ PARK IN LIEU IMPROVEMENTS: A.P.N. CHECKED?. E.D.U: SEWER: LATERAL: DRIVEWAY: ac LU < OC o l/l z 2o oc Z3 CC cr O UJ (-> oc • ID • GRADING PERMIT: DRAINAGE: EASEMENTS: ADDITIONAL COMMENTS: OK TO ISSUE: DATE; ENGINEERING INSPECTION REQUIRED:, PUBLIC WORKS INSPECTOR:__ FINAL OK: DATE: IF THIS ITEM IS NOT CHECKED, BUILDING DEPARTMENT WILL MAKE ALL INSPECTIONS (DRIVEWAYS, CURB CUT, DRAINAGE, ETC.) BUILDING 1U47 30 11:57 Paae 1 of i Job Addi-eaa: 1022 IBIS CT P-srmit Typei MISCELLANEOUS Parcel No: ai4-4i:»2-16--00 Valuation: 8,745 Occup^cy Grn^upt Reference*; OescripCloni 3300 SF REROOF TO LITE TILE Appl/Ownr I BETYAR CONSTRUCTION 2265 VIEW ST OCEANSIDE CA 92054 Fees Required *»• P E I* H I T Suite: Permit No: CB9S4214 Development Mo: tottti Constructltjn Type: NEW Status: ISSUED Applied: 12/04/98 Apr/Insue: 12/04/98 Entered By: BT 967-5988 Collected 6 Credits Fees: Adjustments: Total Fees: Fee description Miscellaneous Fee * MISCELLANEOUS T V « * 12/W/W 11 f>!f ee ^174-00 r>ata 174.00 PERMIT 174.00 CITY OF CARLSBAD 2075 Lss Palmas Dr., Carisbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 1. PROJECTINFORMATION FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Validated By. Date Address (include BIdg/Suite #) Business Name lat this address) Legal Oescription Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # , QUiP $if90H^^ Us» / Proposed Use _ f ^ Description of Work SQ. FT. fof Stories # of bedrooms t of Bathrooms 2. CONTACt PERSON (H dlHwaiit from appiicant) ' : ' Nama Address iij. -.APPLICANT ^Contractor • Agent for Contractoir ^ D Owner City D Agerrt for Owner State/Zip Telephone # Fax It Name Addrsss 4. PROPERTY OWNER . , ............^ k/iu>t mt^^ I^C City 73. if;^^ State/Zip Telephone # State/Zip Telephone f Name Address City S. CONTRACTOR • COMPANY I4AME""' "•"^'^J.'''^'"'^''''^""'v (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, altar, improve, demolish or repair any 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 IChapter 9, commending with Section 7000 of Division 3 of the Business end Professions Code! or that he Is exempt therefrom, and the basis for the alleged exemotion. Any violation of Section 7031.5 I Bmotion. Anv vi 5 by any applicant far a permit aubjacts the applicant to a civil penalty of not more than five hundred dollars i>5QQl). ^^'C YiioP <^ awg(7:£ CPr ^ 7' '^m Address ^ City State/Zip. Telephone # Name State License f Address Licanse Class City Business License # X ^ Designer Name Address City State/Zip Telephone State License * 6. WORKERS'COMPENSATION ' • .....y...^.,^..^.:....^ Workers' Coinpensation Declaration: I hereby affirm under penalty of perjury one of the fallowing declaratiorts: O I l<sve and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I hava 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 worker's compensation insurance Mfrier and policy number are: ^. - / I oo Insurance Company C^TPT^TTZ fi}fjC> Policy No. /\C>i^*'^''l% Expiration Date o /^ / (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100) OR LESS) Q CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ eny person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation covaraga is unlawful, and thaU tubfact an amployar to criminal penalties and civil finas up to one hundred thousand dollars (SKKLOOOI, in aORion ta tha cost of compensation, damages as providad for in Saction 3706 of tha Laborycody jntaraat and attorney's fees. SIGNATURE 7. OWNER-BUILI DATE jy-Hm DECLARATIO I hereby affirm that I em exempt from the Contrector'a License Law for the following reason: • I, as owner of the property or my employees with wages as their sole compensation, will do the work and ths structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law doas not apply to an ownar of property who builds or Improves thereon, and who doas such work himself or through his own employees, provided that tuch 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 heve the burden of proving that he did not build or Improve for tiM purpose of sale). • I, as owner of the property, em exclusivsly contrecting with licensed contrectors to construct the project (Sec. 7044, Business and Professions Code; The Contractor's License Lew does not spply to an owner of property who builds or improves thereon, end contracts for such projects with eontractorls) liceiwed pursuant to the Contractor's License Lsw). • I am exempt under Section Business snd Professions Code for this reeson; 1. I personally pien to provide the major labor and materials for construction of the proposed property Improvement. Q YES QNO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction linclude name / addrass / phona number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provida the major work (Includa name / addrass / phone number / contrsctors license number); ^ 5. I will provide some of the work, but I heve contracted (hired) the following persons to provide the work Indicated (include nama / address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECtiON FOR AiOAWieSBe^^ Is the applicant or future building oceupent required to submit a business plan, acirtely hexardous materials registration form or risk msnagement and prevention progrem under Sections 2S505, 25533 or 25534 of the Presley-Tenner Hazardoua Substance Account Act? Q YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES • NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O YES Q NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL OISTRICT. «. CONSTRUCTION LimDWG AGEMciV .-'r.^,.::.,-.'-;:..-,^--,,:^!,^ _ . I hereby atfirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME LENDER'S ADDRESS a.APPLICANT CERTIFICATION:'"'^' . = I certify that I have read the application and state that the above Information is correct and that tha Information on tha plans is accurate. I agree to comply with all Citv ordinances and State laws relating to building construction. I hereby authorize representativas of the CitV ot Carlsbad to amer upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CPTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMrr. OSHA: An OSHA permit is required for excavations over S'O' deep end demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned »t any time after the worlTisi^coi^encedfo^peFjpd of 180 days (Section 106.4.4 Uniform Building Code). / / APPLICANT'S SIGNATURE commencea witnin a irKiStCOinmenced toc^ DATE WHITE: File YELLOW; Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOBADDRESS: 2. TYPE OF BUILDING: RESJDENTIAL VC COMMERCIAL , 3. ROOF SLOPE: RISE ^ inches in 12 inches 4. NUMBER OF EXISTING ROOF COVERING (circle one) (^2 3 5. TYPE OF EXISTING ROOF COVERING <)Mc SHEATHING 9>6^tp . *6. NEW ROOF MATERIAL CLASS rf WEIGHT PER SQUARE 7. NUMBER OF SQUARES 8. TRADE NAME (pje^un^ MANUFACTURER P^^H^^ 9. ROOF SYSTEM LISTING ULNo. ICBO No. 10. IS THE EXISTING STRUCTURAL DESIGN SljEEICIENT TO SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? /"YES J) NO All roof coverings are required to be CLASS A. Combustible roof coverings of any type or classification are prohibited. I understand the following inspections are required: 1. Tear Off/Pre-inspection prior to install new roof covering. 2. Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for inspection. Sianature / / Date M^, Contractor )<-- Owner Contractor Name *6 - Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up. Other. CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB984214 FOR 12/22/98 DESCRIPTION: 3300 SF REROOF TO LITE TILE TYPE: MISC JOB ADDRESS: 1022 IRIS CT APPLICANT: BETYAR CONSTRUCTION CONTRACTOR: OWNER: REMARKS: C/BAYLA/967-5988 SPECIAL INSTRUCT: PHONE: PHONE: PHONE: STE: 967-5988 INSPECTOR AREA DH PLANCK# CB984214 OCC GRP CONSTR. TYPE NEW LOT: INSPECTOR TOTAL TIME: CD LVL DESCRIPTION 19 ST Final Structural ACT COMMENTS ***** INSPECTION HISTORY ***** DATE DESCRIPTION 121098 Roof/Reroof 120998 Roof/Reroof ACT INSP AP DH AP DH COMMENTS INSPECTED ON 12/9 11-22-2011 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Residential Permit Pernnit No: CB112335 Building Inspection Request Line (760) 602-2725 1022 IRIS CT CBAD RESDNTL 2144021600 $68,803.56 Sub Type: RAD Lot #: 0 Construction Type: NEW Reference #: 0 Structure Type: 0 Bathrooms: 0 SATTERFIELD: REMODEL 1197 SF INCLU. ADDITION OF NEW MASTER BATH Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Orig PC#: Plan Check # ISSUED 10/31/2011 JMA 11/22/2011 11/22/2011 Applicant: WARREN SCOTT 765 2ND ST. STE. 200 ENCINITAS 92024 760-943-8180 Owner: VALLEJO MYRNA FAMILY TRUST 05-04-98 C/O DIANE FOLEY 16 VICTORIA CIR ROCHESTER NH 03867 Building Pennit $543.72 Meter Size Add1 Building Permit Fee $0.00 Add'l Reel. Water Con. Fee $0.00 Plan Check $380.60 Meter Fee $0.00 Add1 Plan Check Fee $131.03 SDCWA Fee $0.00 Plan Check Discount $0.00 CFD Payoff Fee $0.00 Strong Motion Fee $6.88 PFF (3105540) $0.00 Park in Lieu Fee $0.00 PFF (4305540) $0.00 Park Fee $0.00 License Tax (3104193) $0.00 LFM Fee $0.00 License Tax (4304193) $0.00 Bridge Fee $0.00 Traffic Impact Fee (3105541) $0.00 Other Bridge Fee $0.00 Traffic Impact Fee (4305541) $0.00 BTD #2 Fee $0.00 Sidewalk Fee $0.00 BTD #3 Fee $0.00 PLUMBING TOTAL $150.00 Renewal Fee $0.00 ELECTRICAL TOTAL $30.00 Addl Renewal Fee $0.00 MECHANICAL TOTAL $30.00 Other Building Fee $0.00 Housing Impact Fee $0.00 HMP Fee $0.00 Housing lnl.ieu Fee $0.00 Pot. Water Con. Fee $0.00 Housing Credit Fee $0.00 Meter Size Master Drainage Fee $0.00 Add1 Pot. Water Con. Fee $0.00 Sewer Fee $0.00 Reel. Water Con. Fee $0.00 Additional Fees $0.00 Green Bldg Stands (SBl473) Fee $1.00 Fire Sprinkler Fees $0.00 Green Bldg Stands Plan Chk Fee $0.00 TOTAL PERMIT FEES $1,273.23 Total Fees: $1,273.23 Total Payments To Date: $536.33 Balance Due: $736.90 Inspector: CeM^*, FINAL AP, Date: ^ !\PPRp VAL Clearance: NOTICE: Please take NOTICE that approval of your project Includes the Imposition" of fees, dedications, reseivations, or other exactions hereafter collectively refen-ed to as lees/exactlons." You have 90 days from the date this pemiit was issued to protest imposition of these fees/exactlons. 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 attacl<, 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 sen/ice fees in connection with this project. NOR DOES IT APPLY to any tees/exactions ot which vou have previousiv been given a NOTICE similar to this, or as to which the statute of iimitations has oreviouslv othera/ise expired. CITY OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 wvt'w.carlsbacica.gov Plan Check No. CJE> { \ - 'ZS'^ ^ Est Value ^fn^ g-'^f^ Plan Ck. Deposit Date SWPP JOB ADDRESS SUITE#/SPACE#/UNIT# CT/PROJECT # L0T# PHASE # # OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet ofAtfected Area(s) Willi IIWI1 VI Vf ma liiwiuu^ Vlf MR* »* • r-mi 11 EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPUVCE YESD # NOD AIR CONDITIONING YES D NOD FIRESPRINKLERS YES D NO • i. APPLICANT NAME (Primary Contac iSL APPLICANTNAME (Secondary Contact) ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX 7eo- ^^-^-^{-^o I '^^o 1-^3 ^111 PHONE FAX EMAIL EMAIL PROPERTY OWNER NAME CONTRACTOR ADDRESS i^T-Z ADDRESS I^IAP5/I, CJI qn^ft TY ^ , .STATE . ^ ZIP CITY STATE ZIP PHONE ~ I TFAX PHONE FAX EMAIL EMAIL ARCH/DESIGNER NAME & ADDRESS "7 \ I STATE LIC. # ~ inty wlfji C.# _ r I CLASS/ I CITY BUS, UCJ (Sec. 7031.5 Business and Professions Code: Any City or County wnich requires a permit to construct, alter, improve, demolish or repair any 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 fCnapter 9, commenaing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500)). tf.orkas' Compensation Declaration: //lerefjy affim under penalty of peijury one of the followingdeclarations: nave and will maintain a certificate of consent to self-insure for woricers' compensation as provided bySection 3700 oftiie Labor Code, forthe performance of the wori( for wiiich ttiis permitis issued. '\ have and will maintain workers' compensation^ as requjred by Sjfiljpn 3700 of lliaLabor Code, for the performance of the work fgr wiiich thjs pemtjs isayed. My worl<ers' compensationjiaumnce carrieBrand policy numberare: Insurance Co. as reqiured by Policy No.. of the work for which this permitjs issued. My workers' compensation iflsumnce carrieBand t 7^ - 5 >C!^^^;^Fxni.linnnI j^S :^^f This section need not be completed ifthe permit is for one hundred dollars ($100) or less, n 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 Worliers' Compensafion 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 one hundred thousand dollars (&100,000), in addition to the cost of compensation, damaoes as Djpyjiled for in,f ectyfi 3706 of the Labor code, interest and attorney's fees. JS^ CONTRACTOR SIGNATURE .^Mr^^utj.^m,.,^^^^ — •AGENT I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: n 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). • 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 Contractor's License Law). O I am exempt under Section .Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. • Yes O No 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firni) to provide the proposed construction (include name address / phone / contractors' license number): 4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the maj or work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): PROPERTY OWNER SIGNATURE •AGENT DATE Isthe applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505,25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? • Yes • No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? • Yes • No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? • Yes CD 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 affrm 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 certily that I have mad the application and state thatthe above infbimation is conect and thatthe infbmiation on the plans is accurate. I agree to comply witti all City onlinances and State laws relating to building constmction. I hereby authorize repnesentative of the City of Carisbad to enter upon the above mentioned property for inspection puiposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITiES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CFTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA pemiit is required for excavations over 5'0' deep and demolitbn or construction of structures over 3 stories in height. EXPIRATION: Every pemiit issued by the Buikfing Official under the provisions of this Code shall expire by limitation and become null and void if the building or woii< authorized by such permit is not commenced within 180 days from the date of such permit or if the buildingrar wnk authorized by such pemiit is suspended or abandoned at any time after lhe vrork is commenced for a period of 180 days (Seclion 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE I VAYIW/ DATE Inspection List Permit*: CB112335 Type: RESDNTL RAD SATTERFIELD: REMODEL 1197 SF INCLU. ADDITION OF NEW MASTER BAT Date Inspection Item Inspector Act Comments 04/16/2012 89 Final Combo MC Fl SMOKE AND C02 DETECTOR OK, NO JOB CARD. GFI AND T-24 OK. 04/16/2012 89 Final Combo -Rl AFTER 3:00 PLEASE 03/05/2012 89 Final Combo MC PA MINOR PICK UP 12/12/2011 17 Interior Lath/Drywall TP AP 12/08/2011 16 Insulation TP AP 12/07/2011 13 Shear Panels/HD's TP AP SHR PANEL 12/07/2011 14 Frame/Steel/BoltingA/Veldin TP AP 12/07/2011 24 Rough/Topout TP AP 12/07/2011 34 Rough Electnc TP AP 12/02/2011 13 Shear Panels/HD's TP AP STITCH NAIL STUDS TO GABLE END TRUSS FLR SHEAR PANELS 12/02/2011 15 Roof/Reroof TP WC 12/02/2011 84 Rough Combo TP NR N/COMP. 11/28/2011 11 Ftg/Foundation/Piers PD AP 1 PAD FTG 11/28/2011 12 Steel/Bond Beam PD AP 1 PAD FTG 11/23/2011 11 Ftg/Foundation/Piers JM AP (2) INTERIOR POST FTGS 11/23/2011 22 Sewer/Water Service JM AP MSTR BATH Tuesday, April 17, 2012 Page 1 of 1 CB112335 1022 IRISCT SATTERFIELD: REMODEL 1197 SF ir\ini 11 AnniTif-iM nc MC\A/ JJACTCO D»-I ?f/h^j(^^C. /^//'^>W io^roc-^ k/tez I • cv Approved ^' BUILDING .^ijZ^' ///ifT. PLANNING ENGINEERING FIRE Expedite? Y N By //////// cf>y/t llllll AFS Checked by: HazMat APCD Health Forms/Fees Sent Rec'd Due? By Encina Fire HazHealthAPCD PE&M School Sewer Stormwater CFD: Y LandUse: UL Y N /o/ii/n 7^ Density: ImpArea: FY: Annex: Factor: PFF: Y Comments Date Date Date Date Building Planning Engineering Fire Need? sw JJjfbone a Done • Done a Done • Issued