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Home My WebLink About1110 BUENA VISTA WAY; ; CB121919; Permit09-28-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No:CB121919 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 1110 BUENA VISTA WY CBAD PME 1551603700 Lot#: MONTANEZ RES - REPAIR GAS PIPE 1/2" PIPE, 3' UNDERGROUND, OK PER MP Applicant: ROBERT MONTANEZ 3240 MADISON ST CARLSBAD CA 92008 760-644-1462 Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 09/25/2012 SKS 09/25/2012 09/25/2012 Owner: MONTANEZ ALBERTO l&JULIA D LIVING TRUST 09-10-10 1110 BUENA VISTA WY CARLSBAD CA 92008 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees $31.00 $0.00 $0.00 $34.00 TOTAL PERMIT FEES $65.00 Total Fees: $65.00 Total Paynnents To Date: $65.00 Balance Due: $0.00 Inspector: FINAL APPROVAL Date: Clearance: NOTICE: Please take NOTICE tliat approval of your project Includes the 'Imposition' of fees, dedications, resereations, 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 pnitest and any other required infonnation 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 fees/exactions of which vou have previouslv been given a NOTICE similar to this, or as to which the statute of limitations has previously othenwise expired. jrtiE FOLLOWING APPROVALS REQUIRED PRIORTOPERMITISSUANCE: DPLANNING DENGINEERIHG DBUILPIWG DFIRE DHEALTH DHAZMAT/APCD CITY OF CZAR LSBAiD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: buldllng@carlsbadca.gov v^v^vt'.carlsbadca.gov 2^ Plan Check No. Est. Value Plan Ck. Deposit Date SWPP JOB ADDRESS lOT? I PHASE» I # OF UNITS UJ SUITE#/SPACE#/UNIT# a/PROJECT # # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: /nc/ude Square Feet of Affected Area(s) EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YES O # NO • AIR CONDITIONING YES •NOD FIRE SPRINKLERS YES •NOD APPUCANT NAME (Primary Contact) APPLICANT NAME (Seconi/ary Contact) ADDRESS ADDRESS PHONE TFAX ZIP CITY STATE ZIP PHONE FAX EMAIL EMAIL PROPERTY OWNER NAME CONTRACTOR BUS. NAME ADDRESS I CITY _ ]f / /O STATE ^ ' ZIP / PHONE ' [FAX ADDRESS CITY STATE ZIP PHONE EMAIU EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC.# CITY BUS. LIC.# (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 ($500)). W O R K E I? $ ' C.Pv:W P IB W S A T.IO N • : Workers' Compensation Declaration: / hereby affirm under penalty of peijury one of the following declarattons: a 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 perfonnance of the work for which this pemiit is issued. C3 I have and will maintain workers' compensation, as required by Section 3700 of the Lpbor Code, for the perfonnance of the work for which this permit Is issued. My workers' compensation insurance earner and policy number are: Insurance Co. Policy No. Expiration Date This section need not be completed if the permit is for one hundred dollars ($100) or less. Certificate of Exemption: I certify that in the performance ofthe work forwhich this pennit is issued, 1 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, damages as provided for In Section 3706 of the Labor code. Interest and attorney's fees. JS^ CONTRACTOR SIGNATURE •AGENT DATE O W N E R - B U I L £> e R Pj: C IR A Tip H I hereby affirra that 1 am exempt from Contractor's Ucense Law for the following reason: O I, as owner of the property or my employees with wages as their sole compensation, will do the woi1< 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 vrork 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 Ucense 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 Contrxtor'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 pennit for the proposed work. 3.1 have contracted with the following person (finn) 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 piovkie the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have contracted Jjiired) the following persons to provide the wot1( indicated (include name / address / phone / type of work): PROPERTY OWNER SIGNATURE ^Ik^ENT DATE COMPtETE THIS SECTION FOR WON ING 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? • Yes • No Is the applicant or future building oaupant 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 • 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 1(« R UC TIO N LE N O I N G AG INC I hereby affirm that there is a construction lending agency for the perfonnance of the work this pennit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address A;!-P LI CANT C IE RTI FlC^Jf^X} ON I cetti^ that I have read the applkation and state that the above infonnation is conect and that the infbimation on the plans Is accurate. I agiee to comply with all City ordinances and State laws relating ID building constmction. I hereby authorize representative ofthe City of Carlsbad to enter upon the above mentbned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CfTY 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 constiuctton of sinjctures over 3 stories in height. EXPIRATION: Every pemnit issued by the Building Oflicial under flwprovisions of this Code shall expire by limitation and become null and void if the building or vrori< authorized by such permit is not commenced within 180 days from the date of such permit or if the buildingjir \AOrt< aimorized by such permit is suspended or abandoned at any time after the is commenced for a period of 180 days (Sectton 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.buildinq(5)carlsbadc3.qov or Mall the completed forni to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS • PICK UP: • CONTACT (Listed above) • OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) • MAIL TO: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) • MAIL / FAX TO OTHER: • ASSOCIATED CB#- • NO CHANGE IN USE / NO CONSTRUCTION • CHANGE OF USE / NO CONSTRUCTION JSSAPPLICANT'S SIGNATURE DATE Inspection List Pemim: CB121919 Type: PME MONTANEZ RES - REPAIR GAS PIPE 1/2" PIPE, 3' UNDERGROUND, OK PER M Date Inspection Item Inspector Act Comments 09/28/2012 23 Gas/Test/Repairs PD AP 09/28/2012 29 Final Plumbing PD AP Tuesday, October 02,2012 Page 1 of 1