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Home My WebLink About1040 BUENA PL; ; CB080045; Permit01-04-2008 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Mechanical Permit Permit No CB080045 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 1040BUENAPLCBAD MECH 1552512400 $000 CUSHMAN RES-REPLACE FAU Lot# Status ISSUED Applied 01/04/2008 LSM 01/04/2008 01/04/2008 Entered By Plan Approved Issued Inspect Area Applicant ACTION AIR COND & HEATING-S D 2517 BS SANTA FE VISTA CA 92083 619-727-4152 Owner CUSHMAN DANIEL C&JENNIFER S 6209 54TH AVE NE SEATTLE WA 98115 Mechanical Issue Fee Install/Furn/Ducts/Heat Pumps Fee Fireplace Installation Fee Exhaust Fan Fee Installation/Relocation Vent Fee Hood Fee Boiler/Compressor to 15HP Fee Other Additional Fees TOTAL PERMIT FEES 1 0 0 0 0 0 $1500 $900 $000 $000 $000 $000 $000 $000 $000 $2400 Total Fees $24 00 Total Payments To Date $24 00 Balance Due $000 Inspector Date Clearance 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 nght 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 limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave Carlsbad CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date / Address (include Bldg/Surte #)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units Assessor's Parcel Existing Use Proposed Use Descnption of Work SQ FT # of Stories # of Bedrooms # of Bathrooms ft/&K Name Telephone #Fax# Telephone # (Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construct alter improve demolish or repair any structure prior to its issuance 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 1$500]) Name State License # _/Address License Class L. City State/Zip City Business License # Telephone # Designer Name State License # Address City State/Zip Telephone # r r t / 3 // Qg> Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations D I have 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 Q""^ I have and will maintain worker's 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 earner and policy number are . /? / i /I I / * / / / x\/ *7~ fl£^/\.? S~\ / "C\Insurance Company fa/ff- L^Trjf/TJL^TOrS AJg^jUCTf~ Policy No Ota '_/ ' tr2l/O ~ (-/I O Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) 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 one hundred thousand dollars($100 000) lnjaddfljOTtb>He)cost of compensation damages are provided for in Section 3706 of the Labor Code interest and attorney s fees^. _ ..^ DATE •x>-...vt=._>^-.^s:. .cj_iiz - - , I hereby affirm that I am exempt from the Contractor's License Law for the following reason D I as owner of the property or my employees with wages as their sole compensation will d 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 trie 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 contractors) licensed pursuant to the Contractor's License Law) D I am exempt under Section Business and Professions Code for this reasoh 1 I personally plan to provide the major labor and matenals for construction of the proposed property improvement D YES D NO 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 (include name / address / phone number / contractors license number) 4 I plan to provide portions of the work but I have hired the following person to coordinate supervise and provide the major work (include name / address / phone number / /ontractors 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 number / type of work) PROPERTY OWNER SIGNATURE.DATE WHITE File YELLOW Applicant PINK Finance PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad CA 92008 Page 2 of 2 \ ~ *~~--- . Is the applicant or future building occupant required to submit a business plan acutely hazardous matenals registration for or risk management and prevention program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act? D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control distnct or air quality management distnct? D YES D NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? D YES D 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 for which this permit is issued (Sec 3097(1) Civil Code) LENDER S NAME LENDER S ADDRESS 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 representatives 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 CARLSBAD AGAINST ALL LIABILITIES JUDGEMENTS 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 of 5 0 deep and demolition or construction of structures over 3 stones in height •* •* "* \ / by such permit is not commenced within 180 days from the date of such permit or if the building or work authonzed by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 daya-(Section 106 4 4 Uniform Building Code) APPLICANT S SIGNATURE DATE 4- WHITE File YELLOW Aoohcant PINK Finance City of Carlsbad Bldg Inspection Request For 01/24/2008 Permit* CB080045 Title CUSHMAN RES-REPLACE FAU Description Inspector Assignment Type MECH Sub Type Job Address 1040 BUENA PL Suite Lot 0 Location OWNER CUSHMAN DANIEL C&JENNIFER S Owner CUSHMAN DANIEL C&JENNIFER S Remarks Phone 7604381234 Inspector op Total Time CD Description 43 AirCond/Furnace Set Act Comments Requested By DAN Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments ACORDm CERTIFICATE OF LIABILITY INSURANCE OP IDACCUR-: DATE (MM/DD/YYYY) 11/07/06 PRODUCER California Contractors Network^ Inc 2151 Convention Center Wy #203 Ontario CA 91764 Phone 800-592-0047 Fax 800-592-2541 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A California Contractors Network Accurate Comfort Systems, Inc dba Action Air Conditioning & Heating 2750 S Santa Fe Ave San Marcos CA 92069 INSURERS INSURER C INSURER D INSURERS COVERAGES MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS [NSfT LTR A ADEFE NSRD TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY | CLAIMS MADE j [ OCCUR GEN L AGGREGATE LIMIT APPLIES PER ^l POLICY nJPERC°T flLOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY [ OCCUR | | CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' If yes describe under SPECIAL PROVISIONS below OTHER POLICY NUMBER 06-1-4503-018 POLICY EFFECTIVE DATE (MM/DDfiTY) 11/01/06 POLICY EXPIRATION DATE (MM/DD/YY) 12/31/08 LIMITS EACH OCCURRENCE UAMAtib 1 U KtN 1 fcU PREMISES (Ea occurence) MED EXP (Any one person) PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY EA ACCIDENT OTHFR THAN ^ ACC AUTO ONLY AGQ EACH OCCURRENCE AGGREGATE v WC STATU OTH X TORY LIMITS ER EL EACH ACCIDENT EL DISEASE EA EMPLOYEE EL DISEASE POLICY LIMIT t $ $ S $ S $ $ 5 S $ $ $ S $ $ $ $ $1,000,000 $1,000,000 $1,000,000 *10 days in the event of cancellation due to non payment of premium Authorized by State of California -Department of Industrial Relations -Office of the Director Certificate to Self Insure #4503 CERTIFICATE HOLDER CANCELLATION PROOFIN For Information Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE ^f^^ \ / l/),^^ Thomas J Wheelef^Z/fc^^S^ O fx JlAJlMS ACORD 25 (2001/08)CORPORATION 1988