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Home My WebLink About1069 LIGHTHOUSE RD; ; CB120734; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 04-20-2012 Permit No: CB120734 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 1069 LIGHTHOUSE RD CBAD PME Status: Parcel No: 2145312200 Lot#: 0 Applied: Reference #: PC#: Project Title: Applicant: KEREKFFY RES-RUN GAS LINE TO EXISTING FIRERING & BBQ REEF CONCRETE, INC 2877 WOODRIDGE CR CARLSBAD CA 92008 760-809-9428 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Entered By: Plan Approved: Issued: Inspect Area: Owner: KEREKFFY FAMILY TRUST 03-22-04 1069 LIGHTHOUSE RD CARLSBAD CA 92011 ISSUED 04/20/2012 LSM 04/20/2012 04/20/2012 $150.00 $0.00 $0.00 $0.00 $150.00 Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due: Inspector: INAL APPROVAL l-!;"-13 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 penTiil 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 . h h Tl 'mil r hi f lim' i I , <<~ . Plan Check No. C-6t~734 . Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value ~ CITY OF 760-602-2717 / 2718/ 2719 CARLSBAD Fax: 760-602-8558 Plan Ck. Deposit www.carlsbadca.gov Date ~::>-D/12, lswPP JOB ADDRESS SUITE#/SPACE#/UNIT# IAPN I 0'-"' L.;"11.,\-"-ous"'tlJ, (1..,/ \ 5~ ~z.o I l --- CT/PROJc.vT # rOT# I PHASE# I* OF UNITS I# BEDROOMS # BATHROOMS I TENANT BUSINESS NAME I CONSTR. lYPE I DCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) y'\e.., ~""~ l \._AC... +., e..ic , ,; t •'-ill. .f: tf. < 1 "'") ~,.,J__ B~O.. . I ' EXISTING USE I PROPOSED USE I GARAGE (SF) PATIOS (SF) I DECKS (SF) I FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS YES □#_ NO □ YES □ NO □ YES O NOD APPLICANT NAME (Primary Contact) (2.'C2."2zf' r~~~ T ---<?. APPLICANT NAME {Secondary Contact) ADDRESS I~) eDJ... v-~..le:,, ADDRESS °?~T+ C!,v CITY C ... ,. k i, .. .t... STATE M ZIP '17__.t, CITY STATE ZIP o<l, PHONE IFAX PHONE I FAX -=i'f>O 'S O"j -C\ l.o\ '2. "iJ I c"'c.lv.J.. (2. -ru..-f ~<MC. ,re.. +.e. It.MAIL . ao..,. PROPERlY OWNER NAME IG,. le.. ~e.re..~.CC .... C0NTRACT0~US. NAME(' .-L.t, , D.0 i,: """'~ r"C -r-(\.,., ADDRESS /...,c-,M-~ I ADDRESS Ir-, o<"f ~J... CITY STATE ZIP CITY STATE ZIP e_.,. ✓ l .-, t, -'-CA "'lzo \ I PHONE I FAX PHONE 1 FAX 1-',o 'Z-"'1-\-"'I~\~ EMAIL t.MAIL ARCH/DESIGNER NAME & ADDRESS I STATE UC.# STA~ 8'i0~(;q I CLASS lc'¥B "Ai¥L-<f (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, also requires the applicant for such permit to file a signed statement tliat he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of D1v1sion 3 of the Business and Professions Code] or fhat he is exempt therefrom, and the basis for the alleged exemption. Any v1olat1on 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)). Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: □ 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. "fl., I have and will maintain worke,:.compensa!i~ ~ r~d by, Section 3700 .2!.!.,he LabOJi,Code, for the performance oi_the work for which this permit is issued. My workers' compens~n i surance arrier and policy number are: Insurance Co. :)P<b ,r \ ~ +,WI.Al J.-.""~ \:.o. Policy No. f"\ A. I 02:c,-Z.'S'" '3r>l> Expiration Date .S I Z 111/ _ 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), In addition to the cost of compensation, da provided for In Section 3706 of Labor code, interest and attorney's fees. ~ CONTRACTOR SIGNATURE {.,.,e.. ..... ~~, ~ I hereby affirm that I am exempt from Contractor's 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 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 contractoi(s) licensed pursuant to the Contractor's License Law). □ I am exempt under Section ~-----Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. □ Yes □ No 2. I (have I 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 I phone I 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 I address I phone I 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 I address I phone I type of work): ,#6 PROPERTY OWNER SIGNATURE □AGENT DATE lilO,MPLlt1"'11111 111:ru:>111 ran' !\lor,i-1un,1aif111r1:li:E'/B'i:i'u.1{iiu1 '12111f'MIT$ aNtv * * ~ "1~ * = 1 X C H -i ----~ L'""'1 '~ j c * * "=** µ_,~, C] ,~-' ~ H X 1 :J Is the 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 manar;iement district? □ Yes □ No Is the facility to be constructed within 1,000 feel 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 ANO THE AIR POLLUTION CONTROL DISTRICT. I certify th at I have read the appllcatlon 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 representative 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, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA pennlt is required for excavatioos over 5'0' deep and demolition or construction of structures over 3 stories in height EXPIRATION: Every pennlt issued by the Building Official under the provisions of this Code shall expire by Imitation and become nul and void if the building orwor1<. authorized by such pennit is not commenced within 180 days from the date of such pennit or if the building or WOO. authorized by such pennlt is suspended or abandoned at any time after the wor1<. is commenced for a 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 www.building@ca~sbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CONTACT NAME ADDRESS CITY STATE ZIP PHONE FAX EMAIL DELIVERY OPTIONS □ PICK UP: o CONTACT (Listed above) □ OCCUPANT (Listed above) □ CONTRACTOR (Oa Pg. 1) O MAIL TO: o CONTACT (Listed above) o OCCUPANT (Listed above) □ CONTRACTOR (On Pg. 1) □MAIL/FAX TO OTHER: ______ _ ..f!i'APPLICANT'S SIGNATURE CO#: (Office Use Only) OCCUPANT NAME BUILDING ADDRESS CITY STATE Carlsbad CA OCCUPANT'S BUS. UC. No. □ ASSOCIATED CB#-------- □ NO CHANGE IN USE/ NO CONSTRUCTION o CHANGE OF USE/ NO CONSTRUCTION DATE ZIP Inspection List Permit#: CB120734 Type: PME Date Inspection Item 09/13/2012 29 Final Plumbing 04/23/2012 21 Underground/Under Floor 04/23/2012 23 Gas/TesVRepairs Tuesday, February 05, 2013 Inspector Act PB AP PB PB WC AP KEREKFFY RES-RUN GAS LINE TO EXISTING FIRERING & BBQ Comments Page 1 of 1