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Home My WebLink About1075 MAGNOLIA AVE; ; CB042259; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 -07-2'7-2004 Miscellaneous Permit Permit No: CB042259 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: 1075 MAGNOLIA AV CBAD MISC 2052702400 $5,356.00 Subtype: OTHER Status: Lot#: 0 Applied: Entered By: Reference#: Plan Approved: ISSUED 06/07/2004 MDP 06/10/2004 06/10/2004 PD Project Title: WELCH RESIDENCE-52 SF SOLID ROOF COVER-OPEN PATIO Applicant: WELCH FLORENCE W 1075 MAGNOLIA AVE CARLSBAD CA 92008 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES ELEC PERMIT Owner: WELCH FLORENCE W 1075 MAGNOLIA AVE CARLSBAD CA 92008 Total Fees: $28.00 Total Payments To Date: $28.00 Inspector. FINA Date: PPROVAL -2-1---~ Issued: Inspect Area: $20.00 $115.00 ($107.00) $28.00 Balance Due: 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. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1. PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO. :;Y,-2,J~. EST. VAL. ~ ?,~ (,CJ Plan Ck. Deposit ________ _ Validated By __________ _ Date. _______________ _ Business Name (at this address) Assessor's Parcel # Description of~o;z_cp 2. CONTACT PERSON (If dlf 5~ Name 3. ~ontrac:tor Subdivision Name/Number Existing Use Address 0 Agent for Contractor P.o. Box Unit No. Phase No. Total # of units Proposed Use # of Bathrooms State/Zip Address Telephone# 4. Name State/Zip Te ephone # 6. CONTRACTOR • COMPANY NAMJ: ~sg--~ 7 3'-.3 (,C() (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 that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending 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 [$5001). O O I 0 Designer Name State License # .39 .;;) 8 °I ~ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: O 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. g/ 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 worker's compensation insurance carrier and policy number are: Insurance Company Q:tZ<, k :Fu.kl d._ Policy No.Oq)t) l] '( .., ;). Qcfr Expiration Date I -I -0 ( (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS) O 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 cove ge is uni thousand dollars ($100.000), in addition to the cost ensatio I, and shall subject an employer to criminal penalties and civil fines up to one hundred a es as provided for In Section 3706 of the La r co e i terest and attorney's fees. SIGNATURE·------------:::a!::::aiiP.S£.......J<:.!e!:::........=:....!.~__:;~------- 7. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ~ I, as owner of the property or my employees with wages as their s le com ensation, 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 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). O 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). 0 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. 0 YES ONO 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 I 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 I phone number/ contractors license number):. ______________________________________________ _ 5. I will provide some of the work, ut I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type ~(°'work): A PROPERTY OWNER SIGNATUR~~~~s~-:t-~~~====-----------~1 DATE ---=-,_,_,..,_,_ ...... _,_ __ _ COMPLETE THIS SECTION FOR N 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? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 0 YES O 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. 8. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS ________________________ _ 9. APPLICANT CERTIFICATION 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 Citt 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 permit is required for excavations over 5'0" deep and 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 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commence raper' o 180 days (Section 106.4.4 Uniform Building Code). ~ /. ~ APPLICANT'S SIGNATURE ~ ...... ..6,,V:,~oE....:....:..:....>',,f'----------------DATE __,,I_ ~Z--~~--+-------- YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 07/26/2004 Permit# CB042259 Title: WELCH RESIDENCE-52 SF SOLID Description: ROOF COVER-OPEN PATIO Type: MISC Sub Type: OTHER Job Address: Suite: Location: 1075 MAGNOLIA AV Lot APPLICANT WELCH FLORENCE W Owner: WELCH FLORENCE W Remarks: Total Time: 0 CD Description Act Comment 19 _F_i_na_1_s_t_ru_c_1_u_ra_, ____ ~ i Associated PCRs/CVs Inspection History Date Description Act lnsp Comments 07/23/2004 17 Interior Lath/Drywall AP JM Inspector Assignment: PD --- Phone: :;!}770 Inspect/~ Requested By: ART Entered By: ROBIN 06/17/2004 14 Frame/Steel/Bolting/Welding NR PD WANTS TO CHANGE WORK ON PERMIT CITY OF CARLSBAD REQUEST FOR REFUND Account No. {J(j /JC/ 9 'f 1 J,P Vendor No. _____ _ Amount of Refunci JI· /OZ {20 Fee Paid For: ff;J.Jn, t'T # {:./J C2L/ d :L.fc; Date Fee Paid: 6 /!IJ/() '( Fee Paid By: ....,,lti~4t-T1--"_j(14'1)'--'[.____,..,L...,C.,""' H,a__ ______ ~_ Facts Supporting Request: 'J]tr_ ®W[IJ., f<. fAJuCCdJ f1+L ft'~,JIL o:I' W 121/..tc & om ,ti-;1/0C>K d-M1r1t74J m .d /J#rto {}J111:4 Name of Applicant: M ·r u J LL Cd+: . Address: {07 5 /Yk?wat--dt,/HI {)¾L-t&#l o4--f/ ?.Pr>f: ~t) &V -~ Street City State Zip Telephone Signature of Applicant: -----------------------Date Dept. Justification: Rec: D Approve D Disapprove Date Finance Investigation: Rec: D Approve D Disapprove . Dept. Head Signature Date City Manager's Action: D Approve D Disapprove City Manager Signature Date * • . . • City of Carlsbad 1635 Faraday Avenue Applicant: WELCH FLORENCE W Description CB042259 Receipt Number: R0043466 Transaction Date: 06/10/2004 Pay Type Method Description Payment Other Carlsbad CA 92008 Amount -107.00 Amount -107.00 Transaction Amount: -107.00 G{7l6 '-f CB042259 1075 MAGNOLIA AV CBAD WELCH RESIDENCE-52 SF SOLID ROOF COVER-OPEN PATIO MISC OTHER Lot#· WELCH FLORENCE W f ,rJ:, i lol.!:{" 1 ,,.. h "t\..-o .,._ "'"" fh~, l .l f"--_ f='~ l l" v t--N ' @-(c_ ()ro /oy f JJf/tJ? I ( ) c...r IC l/ , r} · I / I · . , . ! · t , l I i/' /. . f l e,,.ry, (, . -t (' , I---.. C<, ·_« l! . ft C ',J<✓' • ~Vt ,y; ·•. 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