HomeMy WebLinkAbout1175 HARBOR VIEW LN; ; CB981177; Permit.. 6 U • L D I N G P E R M I T fPIWlt N : CB~d~l77
Pru~ert No: A9H, :c4t
Development No:
,rn /u 8 I ':I b :. 7 : L 0
Patft-1 o t 1
;\b A<idress: 11?5 HARBOR Vlr.W LN Suite:
P~rmit Tyre: RESIDEN-AL ADD/ALT
Par< el No: 2tJ6-140 10 00 Lot#:
VulUdt1on: 1/,lS0
Occupan, y Group: ReferencP#:
::)escription: 1 75 SF ADDIT!:CJN TO BEDROOM
AppllOwnr : fC>:?E-NS, TOM
11?"> HARBORVIEW LN
CARLSBAD CA 920(8
Feus Rcqu. u ed
Fee£:
AdJu£t111Lnt£:
Total. Fees:
Fee de~cript1.on
Bu1. ldir.q PE:,rm1. t
Plan Check
Strong Mot10n Fee
* BUILDING TOTAL
E::n"'<:>r "Y for
Enter Y' for
£-.ute>r 11y1 f0r
Ent-er 'Y' for
C0r.struct1on Type: V~
Status: 1::-fllED
App:ied: t4/22/Y~
Apr/Issue: Ob/0~/9R
Ente>red By: RMA
? 2 0-4 783. 9 06/08/98 0001 01 02
C-PRHT
Credit_
.oo
120. (J')
206.00
206-00
Ext fpe Data
184.00
120,')0
2.00
J06.0(
N
10.0t Y.
10.00 V
N
APPROVAL
DATE i-J~ -4 t --11---t~---
, __ -
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-116 1
FOR OFFICE USE ONL V °/L
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
PLAN CHECK NO ._qt-11~-' (a......o7'---17f--
EST. VAL. / 7, ( "{li
Plan Ck. Deposit
y __ r---,,,o,.....--c:,,,-----f"cr-A-"---
1. PROJECT~ATl9N •
//7.S r'bd'Y'V,~
Address (include Bldg/Suite #) Business Name (at this address)
L~al Description Lot No. Subdivision Nam~Number Unit No. Phase No. Total # of units
,< (!) ~ -/~(!)-/I!) -()(!) rc.,c,~h~
Assessor's Parcel # Existing Use
/ 7.S Proposed Use C-PRHT 120.00
Description of Work SO. FT. #of Stories # of #o
2. CONTACT PERSON (If different from appllcent)
Address City State/Zip Telephone# Fax# Name
3.~CANT
-/Or.,-,
Cl Contractor D Agent for Contractor ~er ·o Agent for Owner /... //1 ~ z__c.,../...r // 7 J ffe✓b~v1e,,,..; c.-,...,~ a .,.,<.i ~ C 4-z 2.t:J-3/7'? <--..
Name Address City State/Zip Telephone #
Name Address City
q~ 7"6,<:7 -,2,(!) -1/ 7V -z_
S.tate/Zip Telephone #
6. CONTRACTOR • COMPA~Y 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
~ption. fu~t~ of S ction ~~plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ]$500)).
Name Address City State/Zip Telephone #
L3 State License # ---==S"'--7-<--Z~.c./_,,_2"--'2'--License Class ----------City Business License # _______ _
Designer Name Address City State/Zip Telephone
State License # _________ _
6. WORKERS' COMPENSATION
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
0 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.
f;I 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 nu ber are:
Insurance Company ..s'~ 1 Policy No. / :J ~ / I 7 ~ -7'1" Expiration Date 2 -/ -? 9
(THIS SECTION NEED NOT BE COMPLETED I THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS)
0 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, damages as provided for In Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE-------------------------------------===-DATE--:::::=:::;;:;::::::::::;;:::;;::===:;;:_-,
7. OWNER-BUILDER DECJ.ARATION
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 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 ~hin 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 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 / 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)::~==::=~~~--=;_;;;;~f~f~?~]r__Z(.Ji-~f-i~-i,i;;.;.;.;-;,,,-=----_-_-_-_-_-_-_-_-_-_-_-~-::-:--~r =-~;,:=3~C::-:;;--------PROPERTY OWNER SIGNATUR _ DATE S -3/-7 ;::--
-=....:••.,-RMIT~ 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? 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? 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
9. APPLICANT;;_C:;;E;;;;RT:;l:;Fl::;CA:;T:;l::;O;;N=:--------
LENDER'S ADDRESS ---------------------------~
1 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 365 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 mmenced for a P. · d of 180 days (Section 106.4.4 Uniform Building Code).
DATE ~ -r-7<::P-
YELLOW: Applicant PINK: Finance
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB981177 FOR 08/24/98
DESCRIPTION: 175 SF ADDITION TO BEDROOM
TYPE: RAD
JOB ADDRESS: 1175 HARBOR VIEW LN
APPLICANT: COZENS, TOM
CONTRACTOR:
OWNER:
REMARKS: C/TOM/720-4792
SPECIAL INSTRUCT:
TOTAL TIME:
PHONE:
PHONE:
PHONE:
INSPECTOR AREA PY
PLANCK# CB981177
OCC GRP
CONSTR. TYPE VN
STE: LOT:
760 720-4792
CD LVL DESCRIPTION ACT COMMENTS
ST Final Structural
PL Final Plumbing
EL Final Electrical
ME Final Mechanical
---
*****
DATE DESCRIPTION
081398 Exterior Lath/Drywall
081398 Interior Lath/Drywall
081298 Exterior Lath/Drywall
081298 Interior Lath/Drywall
071698 Rough/Ducts/Dampers
071698 Rough Electric
INSPECTION
ACT
AP
AP
CA
CA
AP
AP
071698 Frame/Steel/Bolting/Welding AP
071698 Roof/Reroof AP
071698 Shear Panels/HD's AP
061098 Ftg/Foundation/Piers AP
HISTORY *****
INSP COMMENTS
PY
PY
PY
PY
PY
PY
PY
PY
PY
PY
EsGil Corporation
1n Pannersliip Witli {jov,mm,;nt for 'BuiUirrg Safety
DATE: 6/5/98
JURISDICTION: Carlsbad
PLAN CHECK NO.: 98-1177
PROJECT ADDRESS: 1175 Harborview Lane
PROJECT NAME: Tom Cozens Room Extension
SET: II
~ANT
~ • PLAN REVIEWER • FILE
D The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
• The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified in Remarks below are resolved and checked by building
department staff.
D The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
D The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
D The applicant's copy of the check list has been sent to:
• Esgil Corporation staff did not advise the applicant that the plan check has been completed.
D Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone#:
Date contacted: (by: ) Fax#:
Mail Telephone Fax In Person
• REMARKS: Please make the notes as circled in red on sheet 2 of the Owner Set II to the
City Set II.
By: Mike Puckett
Esgil Corporation
0 GA O CM O EJ O PC
Enclosures:
5/26/98 trnsmtl.dot
9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (619) 560-1468 • Fax (619) 560-1576
EsGil Corporation
2n Partnusliip witli {jovunnu:nt for 'lJuiUing Saf,ty
DATE: 5/ 13/98
JURISDICTION: Carlsbad
PLAN CHECK NO.: 98-1177
PROJECT ADDRESS: 1175 Harborview Lane
PROJECT NAME: Tom Cozens Room Extension
SET: I
• APPLICANT
~VIEWER • FILE
D The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
D The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department
staff.
D The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
• The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
• The applicant's copy of the check list has been sent to:
Tom Cozens
1175 Harborview Lane
• Esgil Corporation staff did not advise the applicant, except by mail, that the plan check has
been completed.
D Esgil Corporation staff did adv'ise the applicant that the plan check has been completed.
Person contacted:
Date contacted: (by:
Mail Telephone Fax In Person
0 REMARKS:
By: Mike Puckett
Esgil Corporation
D GA D CM D EJ D PC
Telephone#:
Fax#:
Enclosures:
5/5/98 trnsmtl.dot
9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (619) 560-1468 • Fax (619) 560-1576
•
Carlsbad 98-11 77
5/13/98
PLAN REVIEW CORRECTION LIST
SINGLE FAMILY DWELLINGS AND DUPLEXES
PLAN CHECK NO.: 98-1177 JURISDICTION: Carlsbad
PROJECT ADDRESS: 1175 Harborview Lane
FLOOR AREA: 175sf Room Ext.
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 4/22/98
DATE INITIAL PLAN REVIEW
COMPLETED: 5/ 13/98
FOREWORD (PLEASE READ):
STORIES: 1
HEIGHT:
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 5/5/98
PLAN REVIEWER: Mike Puckett
This plan review is limited to the technical requirements contained in the Uniform Building
Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state
laws regulating energy conservation, noise attenuation and access for the disabled. This plan
review is based on regulations enforced by the Building Department. You may have other
corrections based on laws and ordinance by the Planning Department, Engineering
Department, Fire Department or other departments. Clearance from those departments may be
required prior to the issuance of a building permit.
Present California law mandates that residential construction comply with Title 24 and the
following model codes: 1994 UBC ( effective 12/28/95), 1994 UPC ( effective 12/28/95), 1994
UMC (effective 2/23/96) and 1993 NEC (effective 12/28/95).
The above regulations apply to residential construction, regardless of the code editions
adopted by ordinance.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 106.4.3,
1994 Uniform Building Code, the approval of the plans does not permit the violation of any
state, county or city law.
To speed up the recheck process, please note on this list (or a copy) where each
correction item has been addressed, i.e., plan sheet number, specification section, etc.
Be sure to enclose the marked up list when you submit the revised plans.
LIST NO. 1, GENERAL SINGLE FAMILY DWELLINGS AND DUPLEXES WITHOUT SUPPLEMENTS (1994 UBC) r3forw.dot
Carlsbad 98-1177
5/13/98
1. Please make all corrections on the original tracings, as requested in the correction
list.
Submit three sets of plans for commercial/industrial projects (two sets of plans for
residential projects). For expeditious processing, corrected sets can be submitted
in one of two ways:
1. Deliver all corrected sets of plans and calculations/reports directly to the City
of Carlsbad Building Department, 2075 Las Palmas Drive, Carlsbad, CA 92009,
(619) 438-1161. The City will route the plans to EsGil Corporation and the
Carlsbad Planning, Engineering and Fire Departments.
2. Bring one corrected set of plans and calculations/reports to EsGil
Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (619) 560-
1468. Deliver all remaining sets of plans and calculations/reports directly to the City
of Carlsbad Building Department for routing to their Planning, Engineering and Fire
Departments.
NOTE: Plans that are submitted directly to EsGil Corporation only will not be
reviewed by the City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
2. When the valuation of a room addition or repair exceeds $1,000, or when sleeping
rooms are created, smoke detectors shall be provided, except that smoke detectors
added at existing construction need only be battery powered. Section 310.9.1.2.
Please note on the plans that smoke detectors will be installed in all existing
bedrooms and in the hallways leading to the bedrooms.
3. Glazing in the following locations should be of safety glazing material in accordance
with Section 2406.4 (see exceptions):
4. Fixed and sliding panels of sliding door assemblies and panels in swinging doors other
than wardrobe doors. Please show the sliding glass door to be tempered.
5. An interior door may open at a landing that is not more than 8" lower than the floor
level, provided the door does not swing over the landing. Section 1004.9. Please
show a full concrete landing at the exterior of the sliding glass door as wide
as the openable part of the door and a minimum of 36" in length.
ROOFING
6. Specify on the plans the following information for the roof materials, per Section
106.3.3:
• Manufacturer's name.
• Product name/number.
• ICBO approval number, or equal.
Carlsbad 98-1177
5/13/98
FRAMING
7. Please show the length of the proposed ridge beam on the floor plan.
8. If the 4x12 ridge beam is to be continuous and supported above the 4x8 on the one
end and the existing 4x10 shown on the other, then the 4x12 beam and both the
support headers are undersized for the loads shown. Please provide calculations
and design from a licensed Engineer or Architect for the ridge beam and the
supporting headers and foundation.
9. Plans, specifications and calculations shall be signed and sealed by the California
state licensed engineer or architect responsible for their preparation, for plans
deviating from conventional wood frame construction. Specify expiration date of
license. (California Business and Professions Code).
10. Please detail the flashing and counterflashing at the existing wall and the new roof
of the room extension per Section 1509 UBC.
To speed up the review process, note on this list (or a copy) where each correction
item has been addressed, i.e., plan sheet, note or detail number, calculation page,
etc.
Please indicate here if any changes have been made to the plans that are not a
result of corrections from this list. If there are other changes, please briefly describe
them and where they are located in the plans.
Have changes been made to the plans not resulting from this correction list? Please
indicate:
Yes • No •
The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake
Drive, Suite 208, San Diego, California 92123; telephone number of 619/560-1468,
to perform the plan review for your project. If you have any questions regarding
these plan review items, please contact Mike Puckett at Esgil Corporation.
Thank you.
Carlsbad 98-1177
5/13/98
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad PLAN CHECK NO.: 98-1177
PREPARED BY: Mike Puckett DATE: 5/13/98
BUILDING ADDRESS: 1175 Harborview Lane
BUILDING OCCUPANCY: R3 TYPE OF CONSTRUCTION: VN
BUILDING PORTION BUILDING AREA VALUATION VALUE
(ft. 2) MULTIPLIER ($)
Room Extension 175 98.00 17,150.00
Air Conditioning
Fire Sprinklers
TOTAL VALUE 17,150.00
D 1994 UBC Building Permit Fee • Bldg. Permit Fee by ordinance: $ 183.58
D 1994 UBC Plan Check Fee • Plan Check Fee by ordinance: $ 119.33
Type of Review: D Complete Review D Structural Only D Hourly
D Repetitive Fee Applicable D Other:
. '
Esgil Plan Review Fee: $ 95.46
Comments:
Sheet 1 of 1
macvalue.doc 5196
City of Carlsbad • 9 ,1·1 I ,14411,1· I .. g4.p; 4 I ,,14,11
. j BUILDING PLANCHECK CHECKLIST
DATE: 5LB/'lc8 PLANCHECKNO.: CB qSf/77
BUILDING ADDRE'ss: 1 1 7 ';;Z_ t-\c._.r-ho .-v, Q.,w
PROJECT DESCRIPTION: -~'-'-~ ;.\_,_1).,,.1 .,__ ______________ _
ASSESSOR'S PARCEL NUMBER: QQ ( o -140 -IC) EST. VALUE: \---J IS-b
ENGINEERING DEPARTMENT
APPROVAL DENIAL
The item you have submitted for review has been
approved, The approval is based on plans,
information and/or specifications provided in your
submittal; therefore any changes to these items after
this date, including field modifications, must be
reviewed by . this office to insure continued
conformance with applicable codes. Please review
carefully all comments attached, as failure to comply
with instructions in this report can result in
suspension of permit to build.
A Right-of-Way permit is required prior to
construction of the following improvements:
:eii:::jjjiPaanached report of deficiencies
marke Make ecessary corrections to plans
or spe tio compliance with applicable
codes and standards. Submit corrected plans and/or
specifications to this office for review.
By: ________ Date:
By: ________ Date:
FOR OFFICIAL USE ONLY
ENGIN~UTHORIZATION TO ISSUE BUILDING PERMIT:
~ Date: fz.. CZB
ATTACHMENTS
Dedication Application
Dedication Checklist
Improvement Application
Improvement Checklist
Future Improvement Agreement
Grading Permit Application
Grading Submittal Checklist
Right-of-Way Permit Application
Right-of-Way Permit Submittal Checklist
and Information Sheet
Sewer Fee Information Sheet
ENGINEERING DEPT, CONTACT PERSON
Name: Danna Trigs
City of Carlsbad
Address: 2075 Las Pa/mas Dr., Carlsbad, CA 92009
Phone: (619)438-1161,ext.4374
CFO INFORMATION
Parcel Map No:
Lots:
Recordation:
Carlsbad Tract:
A-4
Hiwo,o"~a'1'!!;"\"',i'~"l"l1i'rm~"",3";_'::"~i:."i'1sbad, CA 92009-1576 • (760) 438-1161 • FAX (760) l!H"!/!;"759
0
0
BUILDING PLANCHECK CHECKLIST
SITE PLAN
1. Provide a fully dimensioned site plan dra? scale. Show:
A. ,.MSith Arrow V°Property Lines
IV' pciSting & Proposed Structures~asements
·V,Existing Street Improvements Vffe9ht-of-Way Width & Adjacent Streets
G/"Driveway widths
2. Show on site plan:
A. Drainage Patterns
1. Building pad surface drainage must maintain a minimum slope of one
percent towards an adjoining street or an approved drainage course.
2. ADD THE FOLLOWING NOTE: "Finish grade will provide a minimum positive
drainage of 2% to swale 5' away from building."
/ ~xisting & Proposed Slopes and Topography
✓ 0 3 Include on title sheet:
0 0
0 0
Site address
Assessor's Parcel Number
Legal Description
For commercial/industrial buildings and tenant improvement projects, include:
total building square footage with the square footage for each different use,
existing sewer permits showing square footage of different uses (manufacturing,
warehouse, office, etc.) previously approved.
EXISTING PERMIT NUMBER DESCRIPTION
DISCRETIONARY APPROVAL COMPLIANCE
4a. Project does not comply with the following Engineering Conditions of approval for Project No. ________________________ _
4b. All conditions are in compliance. Date: __________ _
H:IWORDIDOCSICHKLSnBulldlog Plancheck Clllst BP0001 Form OT.doc Rev. 1'212&196
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BUILDING PLANCHECK CHECKLIST
DEDICATION REQUIREMENTS
5. Dedication for all street Rights-of-Way adjacent to the building site and any storm
drain or utility easements on the building site is required for all new buildings and
for remodels with a value at or exceeding $ ______ , pursuant to Carlsbad
Municipal Code Section 18.40.030.
Dedication required as follows: _________________ _
Dedication required. Please have a registered Civil Engineer or Land Surveyor
prepare the appropriate legal description together with an 8 ½" x 11" plat map
and submit with a title report. All easement documents must be approved and
signed by owner(s) prior to issuance of Building Permit. Attached please find an
application form and submittal checklist for the dedication process. Submit the
completed application form with the required checklist items and fees to the
Engineering Department in person. Applications will not be accept by mail or fax.
Dedication completed by: ___________ _ Date: ____ _
IMPROVEMENT REQUIREMENTS
6a. All needed public improvements upon and adjacent to the building site must be
constructed at time of building construction whenever the value of the
construction exceeds $ ______ ~ pursuant to Carlsbad Municipal Code
Section 18.40.040.
Public improvements required as follows: _____________ _
Attached please find an application form and submittal checklist for the public
improvement requirements. A registered Civil Engineer must prepare the
appropriate improvement plans and submit them together with the requirements
on the attached checklist to the Engineering Department through a separate plan
check process. The completed application form and the requirements on the
checklist must be submitted in person. Applications by mail or fax are not
accepted. Improvement plans must be approved, appropriate securities posted
and fees paid prior to issuance of building permit.
Improvement Plans signed by: __________ _ Date: ____ _
6b. Construction of the public improvements may be deferred pursuant to Carlsbad
Municipal Code Section 18.40. Please submit a recent property title report or
current grant deed on the property and processing fee of $ _______ so
we may prepare the necessary Future Improvement Agreement. This agreement
must be signed, notarized and approved by the City prior to issuance of a
Building permit.
Future public improvements required as follows:
H:\WORDIDOCSICHKLST\Building Plancheck Cklst BPOOOt F0rTTI OT.doc 3 Rev. 12/26196
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BUILDING PLANCHECK CHECKLIST
6c. Enclosed please find your Future Improvement Agreement. Please return
agreement signed and notarized to the Engineering Department.
Future Improvement Agreement completed by:
Date:
6d. No Public Improvements required. SPECIAL NOTE: Damaged or defective
improvements found adjacent to building site must be repaired to the satisfaction
of the City Inspector prior to occupancy.
GRADING PERMIT REQUIREMENTS
The conditions that invoke the need for a grading permit are found in Section
11.06.030 of the Municipal Code.
?a. Inadequate information available on Site Plan to make a determination on grading
requirements. Include accurate grading quantities (cut, fill import, export). Write
"No Grading" on plot plan if none is required.
7b. Grading Permit required. A separate grading plan prepared by a registered Civil
Engineer must be submitted together with the completed application form
attached. NOTE: The Grading Permit must be issued and rough grading
approval obtained prior to issuance of a Building Permit.
Grading Inspector sign off by: -----------Date:
7c. Graded Pad Certification required. (Note: Pad certification may be required even
if a grading permit is not required.)
?d.No Grading Permit required.
7e.lf grading is not required, write "No Grading" on plot plan.
MISCELLANEOUS PERMITS
8. A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or
private work adjacent to the public Right-of-Way. Types of work include, but are
not limited to: street improvements, tree trimming, driveway construction, tieing
into public storm drain, sewer and water utilities.
Right-of-Way permit required for:
H:IWORD\DOCSICHKLST\B~ikhng Planchec:k C~1 BP0001 Fonn OT.doc 4 Rev. 12126196
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BUILDING PLANCHECK CHECKLIST
9. A SEWER PERMIT is required concurrent with the building permit issuance. The
fee is noted in the fees section on the following page.
10. INDUSTRIAL WASTE PERMIT If your facility is located in the City of Carlsbad
sewer service area, you need to contact the Carlsbad Municipal Water District,
located at 5950 El Camino Real, Carlsbad, CA 92008. District personnel can
provide forms and assistance, and will check to see if your business enterprise is
on the EWA Exempt List. You may telephone (760) 438-2722, extension 153, for
assistance.
Industrial Waste permit accepted by:
Date:
11. NPDES PERMIT
Complies with the City's requirements of the National Pollutant Discharge
Elimination System (NPDES) permit. The applicant shall provide best
management practices to reduce surface pollutants to an acceptable level prior to
discharge to sensitive areas. Plans for such improvements shall be approved by
the City Engineer prior to issuance of grading or building permit, whichever
occurs first.
12. • Required fees are attached • No fees required
13. Additional Comments:
H:IWOROIOOCS\CHKLST\Building Pl&ncheck Cklst BPOOOl Form OT.doc 5 Rttv. 12126/96
~ ~ ~ * Cl Cl
PLANNING DEPARTMENT
BUILDING PLAN CHECK REVIEW CHECKLIST
Plan Check No. CB qg; 1 7 7 Address II J 'J 1-/4 rfu.1 v1 e"'1(/J,,U f
Planner Greg Fisher Phone (619) 438-1161, extension 4328
APN: 'µJ(o -I l(t/ -I U
Type of Project and Use: __ __.,.c:;""-f/1-'-"-~-------------------
Zone: f!_-\ Facilities M;iagement Zone: ----+----------
CFO (in/out) #
Circle One (If property in, complete SPECIAL TAX CALCULATION WORKSHEET provided by Building
Department.) ~ i.! ; ~ _ u~ Legend u u
£ £ £ ~ Item Complete
(D Item Incomplete -Needs your action
~ D D Environmental Review Required: YES_ NO):,__ TYPE ___ _
DATE OF COMPLETION: ______ _
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval
~ D D Discretionary Action Required: YES NO TYPE -----
[fl)D •
APPROVAL/RESO. NO. _____ DATE ___ _
PROJECT NO. _______ _
OTHER RELATED CASES: __________________ _
Compliance with conditions or approval? If not, state conditions which require action.
Conditions of Approval
Coastal Zone Assessment/Compliance
Project site located in Coastal Zone? YES __l_ NO
CA Coastal Commission Authority? YES __ NO~
If California Coastal Commission Authority:. Contact them at -3111 Camino Del Rio North, Suite
200, San Diego CA 92108-1725; (619) 521-8036
Determine status (Coastal Permit Required or Exempt):
Coastal Permit Determination Form already completed?
If NO, complete Coastal Permit Determination Form now.
Coastal Permit Determination Log #: o//J " 27
Follow-Up Actions:
1) Stamp Building Plans as "Exempt" or "Coastal Permit Required" (at minimum
Floor Plans).
2) Complete Coastal Permit Determination Log as needed.
M O O lnclusionary Housing Fee required: YES NO ~ '"'t" (Effective date of lnclusionary Housing Ordinance -May 21, 1993.)
qo ••
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NO
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1. Provide a fully dimensional site plan drawn to scale. Show: North arrow,
property lines, easements, existing and proposed structures, streets, ex1st1ng
street improvements, right-of-way width, dimensional setbacks and existing
topographical lines.
2. Provide legal description of property and assessor's parcel number.
Zoning:
1 . Setbacks: d3 cJO Front: Required Shown
Int. Side: Required b Shown L6.1 -f /0'
Street Side: Required ~ Shown -
Rear: Required L~ I Shown Zb
2. Accessory Structure Setbacks:
Front: Required ~ I Shown 7c3d'
Int. Side: Required b' Shown /0'
Street Side: Required ~ Shown -
Rear: Required Shown
3. Lot Coverage: Required _!:. 'f U % Shown t-<;tJ/
I '
4. Height: Required !::: 301
Shown LJO
5. Parking: Spaces Required -z__ Shown -z ----Guest Spaces Required Shown
Additional Comments
OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER ~ i
DATE
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INSP. _____ o,· i:: _____ _
CLEARANCE _________ _
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
FOR OFFICE USE f ~ f (
PLAN CHECK NO . ~C] l \
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
1. PROJECT INFOR~ / 1 , • //7 -L ,!:Jfht "'I~
Address (include Bldg/Suite I) Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number Unit No.
~~../' ~n~r /2 ~
Description of Work SQ. FT. #of Stories ¼ / ·
Phase No. Total # of units
Name Address
(J!tcontractor O Agent for Contractor
City
0 Agent for Owner
State/Zip elephone I ~ Fax II
760 · 72t:J -,~ P "< 3. APPLICANT 0 Owner
Name Address City State/Zip Telephone#
4. PROPERTY OWNER
Name Address City State/Zip Telephone I
6. CONTRACTOR -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 ha 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).
Name Address City State/Zip Telephone#
State License I _________ _ License Class _________ _ City Business License # _______ _
Designer Name Address City State/Zip Telephone
State License # _________ _
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.
O 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 _____________________ Policy No._____________ Expiration Date _______ _
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 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 aecure workera' compenaatlon coverage la unlawful, end ahan subject an employer to crtmlnel peneltlea and civil fines up to one hundred
thouaand dollars ($100,000), In addition to the coat of compensation, damages as provided for in Section 3706 of the labor code, Interest end attorney's fees.
SIGNATURE ______________________________ DATE _________ _
7. OWNER•BUILDER DECLARATION
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 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).
0 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(&) licensed
pursuant to the Contractor's License Law).
0 I am exempt under Section ______ Business end 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 / 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 w ill 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 workl: _________________________________________________________ _
PROPERTY OWNER SIGNATURE DATE -------------------------------------COMPLETE THIS SECTION FOR NON-RESIDENTIAL 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? 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 sita7 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. 3097Ii) 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 ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES,
JUDGMENTS, COSTS ANO 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 36 5 days from the data of such permit or if the building or work authorized by such permit is suspended
or abandoned at any time after k is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). ,
DATE ~e, -2 .G-YcP-APPLICANT'S SIGNA TUR
YELLOW: Applicant PINK: Finance
....... /?t!~ .. ?g>-1/ f
--~-----------,----. -·---------· -. . ---
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---·---
/05-f-.,f, . ~h0 QD,v~
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB ftp.. '1~\I /
ADDRESS lM~ ~\-tw V\.
7-<t-~<l DATE __ '----------
RESIDENTIAL TENANT IMPROVEMENT
RESIDENTIAL ADDITION MINOR PLAZA CAMINO REAL
( < $10,000.001
VIUAGE FAIRE
COMPLETE OFFICE BUILDING
PLANNER 12·. ~ c ~ .
)
. DATE _1...:._-_8'_-_"\_v";:__ __
ENGINEE~zrr /4 ... ;,;, DATE_..._7 ....... -fw0~-L.,;L8...:; __
C:\WP51 \FILES\BLDG.FRM Rev 11 /15/90