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Home My WebLink About1200 CARLSBAD VILLAGE DR; ; CB044396; Permit12-07-2004 fe£ City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB044396 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 1200 CARLSBAD VILLAGE DR CBAD MISC Subtype OTHER 1561803400 Lot# 0 $000 CITY OF CARLSBAD COUNCIL CHAMBERS REMODEL W/ ELEC Applicant CITY OF CARLSBAD Status ISSUED Applied 12/07/2004 Entered By SB Plan Approved 12/07/2004 Issued 12/07/2004 Inspect Area Owner CITY OF CARLSBAD PUBLIC AGENCY 00000 PUBLIC AGENCY 00000 / ' Miscelaneous Pee #1 ' , / Miscelaneous Fee #2 ' x- / Additional Fees ' ' t TOTAL PERMIT FEES i f ^ ,. t s- ^ -, ** , Total Fees $0 00 J Total Payments To Date • t ^ \ ' ' \ - \ $0 00 -, ' ,^ $000 ^ - ' $0'00J 1 ^'; 5°°0, * ' ^^ ~ f "•/ ' . ' . " •' /- ' ' ' S -, , " $000 Balance Due • $000/ j ; ( - / '-/',. Inspector FINAL APPROVAL Date 3- 2 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 prates! procedures set forth in Government Code Section S6020(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 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 you have previously been given a NQTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION•>> -.* CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 1 >l PROJECTJNFORMATIQN FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deport). Validated ~ Date Address (include Bldg/Suite ft)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total ft of units Assessor's Parcel ft Existing Use Proposed Use Description of Work Na'me Address City '; J APPLICANT, i! Q Contractor^ j"H!Agent"f or'Contractor, Q Owner t Q Agent for Owner # of Bathrooms liCONTACT, PERSON (if different,fromapplicant) Slate/Zip Telephone tt Fax # Name Address City Slate/Zip Telephone tt OWNER me is,' j,;fCOPrTRACTOR~ J^ Name Address City State/Zip Telephone # 'COMPANY NAMEVU^'^V' J: '. ~ ~ ' „ "" $ "'"-, >!' * /. _ < _ ' - * ' "{• ? ^ ' *, r' I? ' - * ~ ' k (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 thdt 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 155001) Name State License f/ Address License Class City State/Zip City Business License tt Telephone tt Designer Name State License tt Address City State/Zip Telephone Workers Compensation Declaration I hereby affirm under penalty of penury 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 fof which this permit is issued [H 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 [S100] OR LESS) 0 CERTIFICATE OF EXEMPTION I certify that in the performance o( the work for which this permit is issued I shall not employ any person in any manner so as to become sub|ect 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 DECLARATION / ^ ^ ',," ", ,<„' '..,. *' '' < , U . "< ' ' ' T M '' ' ' ' "'^ '" H'V N -, * '<"( ' ''\l 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason CJ 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) Q 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 Q YES Q^O 2 I (have / have not) signed an application foi 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) 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~win f O f__t/\ , i~ I &number / contractors license number) 5 I will provide some of the work but I have ".ontracted (hired) the following persons to provide the work indicated (include name / address / phone number / type work) PROPERTY OWNER SIGNATURE DATE .COMP.LETEsTHIS SECTION FOR NOfJ-RESID&tT/AL.BUtLDlNG PERMITS|ONLY^ E« , ; ^" „" >-„- _ ,„ ^_ ,_, ~ > ?~ _' 's » ^ Is the applicant 01 future building occupant required to submit a business plan, acutely hazardous materidls registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act7 Q YES n NO Is the applicant or future building occupant required to obtain a permit from the air pollution control distr/ct or air qudlity management district' Q YES O NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? [3 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 I hereby affirm that there is a construction lending agency for the performance of thu work for which this permit is issued (Sec 3097d) 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 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 permil is not commejjced within 1 80 days from the date of such permit or it the building or work authorized by such permit is suspended or abandoned at any time after the work is commericep/for scnify^oi/&Q days (Section 106 4 4 Uniform Building Code) APPLICANT'S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 03/01/2005 Permit* CB044396 Title CITY OF CARLSBAD Description COUNCIL CHAMBERS REMODEL W/ ELEC Inspector Assignment RB 1200 CARLSBAD VILLAGE DR Lot 0 Type MISC Sub Typo OTHER Job Address Suite Location APPLICANT CITY OF CARLSBAD Owner Remarks am please Phone Inspector Total Time CD Description 19 Final Structural Act Comment Requested By BOB Entered By CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments 02/08/2005 34 Rough Electric AP RB