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Home My WebLink About1097 CHESTNUT AVE; ; CB032803; Permit10-09-2003 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB032803 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 1097 CHESTNUT AV CBAD MISC 2051900700 $1,665.00 Subtype: REROOF Lot #: 0 CUSHMAN RES-15 SQRS-COMPOSITIO Status: ISSUED Applied: 10/09/2003 Entered By: RMA Plan Approved: 10/09/2003 Issued: 10/09/2003 Inspect Area: Applicant: SECURE ROOF INC 7356 TRADE ST SAN DIEGO CA 92121 800 338-6868 Owner: CUSHMAN CHARLES W 2469 OCEAN ST CARLSBAD CA 92008 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES $56.00 $0.00 $0.00 $56.00 Total Fees:$56.00 Total Payments To Date:$0.00 Balance Due:$56.00 6158 10/09/03 0002 01 02 CGP 56. FINAL APPROVAL CLEARANCE. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1. PROJE FOR OFFICE USE ONLY PLAN CHECK NO. EST, VAL./ Plan Ck. Deposit Validated By Date Business Name (at this address)92.00 g Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel #Existing Use Proposed Use Description of Wgjk 2, CONTACT PERSOM^ilf different from applicant), SQ. FT._#of Stories ft of Bedrooms # of Bathrooms Name Address City 3. , APPLICANT:, ^Contractor , Q^gontiorContractor ...,Q Owner, \ Q"Agent for Ownar State/Zip Telephone # Fax # Address City State/Zip Telephone > Address City State/Zip Telephone #Name B. CONTRACTORS COMPANY NAME-" • ","- '.,., .- -," . "'" , . > •< '-•• • . • "•>,'-.;>,' (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 fopa permit subjects the applicant to a cu/il pshalty of not more than five hundred dollars |$500l). Name State License Addres% License Class City State/Zip Telephone # City Business License # /2./<5' £&3 Designer Name Address City State/Zip Telephone State License # _ el .WORKERS.' COMPENSATION.^ ,....„ '-,„•• i* ' [ • • Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: [~| | have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. S I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: / S fft f£ R/f *J t? _ ' Policy No. 2-8£ /^c?4 O3 . Expiration Date <9f-<3( ~ &7Insurance Company (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$TOO] OR LESS) [~| 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 additlrtt to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE -*&& eX^X^g^? _ _ _ ; _ DATE /O ^ S " 7. -". OWNER'BUltDER DECLARATION ' , "*'..".' . " . . I hereby affirm that I am exempt from the Contractor's License Law for the following reason: l~] 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). |~l |, 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). n 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. D 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 (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 / 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 / address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE COMPtETETTHIS SECTION FOR NON<HE$IDENTIAL BUILDING PERMITS ONLY , 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? O 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? Q YES d NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O 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. 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 CitV 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 daysJfotrUhe 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 commenceo>fof a period oH£Cula^8/(Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE /£> - g WHITE: File YELLOW: Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS: //)97 2. TYPE OF BUILDING: RESIDENTIAL &P COMMERCIAL/ # /f&f s/rctf _____ ,— • ? . . ~ 3. ROOF SLOPE: RISE ^ \nu\\m \.\ m&SZBSSto - 3 I/A 4. NUMBER OF EXISTING ROOF COVERING (circle one) 0) 2 5. TYPE OF EXISTING ROOF COVERING^^ SHEATHING *6. NEW ROOF MATERIAL /4 CLASS jggWEIGHT PER SQUARE 7. -NUMBER OF SQUARES 8. TRADE NAME 697*? /> ^tf^/^ MANUFACTURER 9. ROOF SYSTEM LISTING UL No. _ ICBO No. 10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? (YES) 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. Signature ^1&ss /<fa%es<f. _ Date W -$-o3-,1 . /iContractor^ Owner _ Contractor Name *6 - Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. City of Carlsbad Bldg Inspection Request For: 10/31/2003 Permit* CB032803 Title: CUSHMAN RES-15 SQRS-COMPOSITIO Description: Inspector Assignment: JM 1097 CHESTNUT AV Lot 0 Type: MISC Job Address: Suite: Location: APPLICANT SECURE ROOF INC Owner: CUSHMAN CHARLES W Remarks: Sub Type: REROOF Phone: 7605460254 Inspector: V Total Time: CD Description 19 Final Structural Act Comment Requested By: RUTH Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments 10/16/2003 15 Roof/Reroof AP JM OK TO COVER CERTIFICATE OF INSURANCE Date 01/10/2003 PRODUCER v Michael Ehrenfeld Company 2910 Jefferson Street, Suite 103 Carlsbad, CA 92008 J60) 730-2939 Fax (760) 730-2936 License #0537922 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 COMPANY COMPANIES AFFORDING COVERAGE A Admiral Insurance Company INSURED Secure Roof, Inc. 2255 Barham Drive Escondido, CA 92025 COMPANY B State Compensation Fund COMPANY c COMPANY o COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WtTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE(MMTOD/YY) POUCY EXPIRATION DATE (MM/DD/YY)UMTS GENERAL UABIUTY COMMERCIAL GENERAL UABIUTY [CLAIMS MAOe f^JOCCUH OWNERS & CONTRACTOR'S PROT SS.OOO. DEO Per Claim GENERAL AGGREGATE A02AG14454 8/7/02 8/7/03 PRODUCTS - COMP/OP AGO PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MEDEXP (Any one person) 2.000.000. 2.000.000. 1.000.000. 1.000.000. 50.000. Excluded AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NOM43WNED AUTOS COMBINED SINGLE LIMIT BODILY INJURY [Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE GARAGE UABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EXCESS UABIUTY UMBRELLA FORM OTHER THAN UMBRELLA EACH ACCIDENT AGGREGATE B WORKERS COMPENSATION EMPLOYERS' UABIUTY THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE: WCSTATU- I TORY LIMrTS I OTH- ER 285 1486 03 01/01/2003 01/01/2004 EL EACH ACCIDENT $1.000.000 EL DISEASE - POLICY UMIT EXCL S1.000.000 EL OISEASE-EA EMPLOYEE $1.000.000 OTHER 3ESCRIPT10N OF OPERATTONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ; Proof of insurance only EfcffFJCATE«OLDER 2322 CANCELLATION 149 Insurance Verification SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ...10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABIUTY IY, ITS AGENTS OR REPRESENTATIVE