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Home My WebLink About1145 CARLSBAD VILLAGE DR; ; CB010878; Permit03/02/2001 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB010878 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 1145 CARLSBAD VILLAGE DR CBAD MISC Subtype 1561802600 Lot# $000 OTHER 0 SHELL STATION - DEMO ONLY DEMO INTERIOR - NO NEW CONSTRUCTION Applicant JAUREGUI& CULVER 959 W MISSION AVE ESCONDIDICA 92025 760-743-0518 Status ISSUED Applied 03/02/2001 JM 03/02/2001 03/02/2001 Entered By Plan Approved Issued Inspect Area SH,CK FAMILY TRUST 09-09299934 °3/02/0i 37550 PINEKNOLL AVE PALM DESERT CA 9221 1 02 CGP 30-00 Total Fees $3000 Total Payments To Date $000 Balance Due $3000 Miscelaneous Fee#1 Miscelaneous Fee #2 TOTAL PERMIT FEES PERMIT $3000 $000 $3000 Inspector FINAL APPROVAL 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 Secton 66020(a) and file the protest and any other required information with the City Manager for processing m accordance with Carlsbad Municipal Code Section 3 32 030 Failure to tmely 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 capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this pro]ect NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which trie statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 [1 "IJPRO JECTJNFO RM AT 10 N~ "," FOR OFFICE USE PLAN CHECK EST VAL Plan Ck Deposit. Validated Date / Address (include Bldg/Suite #)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units Assessor's Parcel H Existing Use Proposed Use Description of Work / SQ FT J-/^T&/2-JfQ tC L)£frf&£,f 77/QA.(_ ^Jt^t' IS^l^CONTACTjPERSON (Indifferent from applicant),. '", #of Stories # of Bedrooms of Bathrooms Name Addiess City State/Zip Telephone #Fax fAP^ Name Address City State/Zip XJuSiSL?! Telephone if 7 r~" irr "^r,. -T^Ti"..JL, i feiiJr-i; j.il j Jii. Name Address Citv State/Zrp Telephone it (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 IChapter 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 iption Any viola^ion^of Section 7031 5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [5500]) f/H^er- A..-eWa,^^ /"^ C?a-.A-<: "7/X3 7 ^3 OS/JT Name ' ' Address State License # /C)o 2-3 / License Class A ft Designer Name Address State License # City State/Zip A Tefephonp'* City Business License # -/^/MiJI f~c-^£J ^ I/ City State/Zip Telephone "p-w—myi,* U—^rfw-————.—J Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations Q 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 [3-*n 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 ^T/ffT^L f"tjd ft Policy No C/7& ~g?/ f/yV/" V^^O Expiration Date / ~/" <0 ~2~— (THIS SECTION NEEtfNOT 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 wpfkers conipensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand-dollars ($100,000)uinadditiO[Kft the cost of compensation damages as provided for in Section 3706 of the Labor code, interest and attorney s fees SIGNATURE DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason 0 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 Coda 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) Q I, as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Professions Coda The Contractor s License Law do&s 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) Q 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 O YES QNO 2 I (have / have not) signed an application for a building permit for the proposed work 3 ! 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) _ _ _ _ _ __ DATEPROPERTY OWNER SIGNATURE [COMPLETE,[THIS SECT™IONjFOR NON-Re$tDENT/AL BUlCotNG PERMITS,ONLY^ IJIidl'l!'l 7*1 * lliU'ST^ ^ISZ^lQ "J JJlIl.7k! 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? Q YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? l~1 YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? L7I 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(0 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 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^HIGH MAY IN ANY WAY ACCRUE AGAINST SAtD CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSHA An OSHA permit is required for excavations ovei>5*P" deep and demolition or construction of structures over 3 stones in height EXPIRATION E/ery permit issued by the b|jild[noJ3ff!ciayur]0er the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by suh permit is not commenc at any time after tr APPLICANT'S SIGNATURE rom the date of such permit or if the building or work authorized by such permit is suspended or abandoned days (Section 106 4 4 Uniform Building Code) / I _ _ DATE J?/2*/n / _ WHITE File YELLOW Applicant PINK Finance /v COMPENSATION INSURANCE JANUARY P O BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 2001 /POLICY NUMBER CERTIFICATE EXPIRES rCONTRACTORS STATE LJCEKSE BOARD WUSKEPS- amp. UNIT SACRAMSSTQ CA JOB: LIC #706231 01/01/01 ' SAM OIEGC L 046-01 UNIT 0009625 1-1-02 This is to certify that we have issued a valid Workers' Qompensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the poJicy period indicated This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer We will also give you TEN days' advance notice shou/d this policy be cancelled prior to its normal expiratfon This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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 ' ^ „* " * AUTHORIZED REPRESENTATIVE - J , *. EMPl-nYER'S LIABILITY LIMIT INCLUDIH5 DEFGMSn C03T& PRESIDENT PER-OCCURRENCE. EMPLOYER r JA^ECiJI & CULVER INC 959 W HTSSIOH AYE E5COHDIDU CA 92025 PS L THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262 (REV. 3-9 POLICYHOLDER'S COi