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HomeMy WebLinkAbout1291 CARLSBAD VILLAGE DR; ; CB090870; Permit05-28-2009 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB090870 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # PC# Project Title 1291 CARLSBAD VILLAGE DR CBAD MISC Subtype 1561907005 Lot# $000 CB090600 OTHER 0 Status ISSUED Applied 05/28/2009 JMA 05/28/2009 05/28/2009 CARLSBAD VILLAGE ORTHODONTICS DEMO PARTS OF FOUNDATION FOR PLUMBING FOR WASTE & Entered By Plan Approved Issued Inspect Area Applicant SUMMIT DEVELOPMENT 7574 TRADE ST 92121 858-549-4885 Owner CARLSBAD MEDICAL VILLAGE L P C/0 RUSS RIES 9225 DOWDY DR #106 SAN DIEGO CA 92126 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees $6500 $000 $000 TOTAL PERMIT FEES $6500 Total Fees $65 00 Total Payments To Date $6500 Balance Due $000 BUILDING PLANS IN STORAGE ATTACHED Inspector 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 Section 66020(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 NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired City of Carlsbad 1635 Faraday Ave Carlsbad, CA 92008 760 602 2.717 / 2718 / 2719 Fax 7606028558 www carlsbadca gov Building Permit Application Plan Check No Est Value Plan Ck Deposit Date t JOBADWESS . -. | v ft l//f> I? <\ \ C0/U^ vfl CT/PROJ'.Cl # 'LOT*PHASE ## OF UNITS W « BEDROOMS SUITEft/SPACE»/UNIT# # BATHROOMS APN TENANT BUSINESS NAME 1 CONSTR TYPE OCC GROUP DESCR'PMON OF WORK Include Square Feet of Affected Area(s)•^ r^ /\ *r j , A-o r\ o A^~ .^~^ ~7 . i.,, a_'*-AP£ EXISTING USE PROPOSED USE GARAGE (SF) CONTACT NAME (If Different Fom Applicant) ADL RESS CITY STATE ZIP PHO\E FAX EMAIL PROPERTY OWNER NAME ADDRESS CITY STATE ZIP PHONE FAX EMAIL ARCh'DtSIGCER NAME & ADDRESS STATE LIC # PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES D # NO D YES D NO D YES D NO D APPLICANT NAME ADDRESS CITY STATE ZIP PHONE FAX EMAIL CONTRACTOR BUS NAME ^ <\ (T)- . 1 ^ aJST~ Tf. ADDRESS .^ . CITY . STATF ZIP G&fci~/-#- Gft~" f\'LSR}*\ PHONE , ~ FAX . _ EMAIL STATE LIC # CLASS CITY BUS LICK s {$500}) ' .Workers Compensation Declaration / hereby affirm under penalty of penury one of the following declarations I ha *nd 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 lhau ind will maintain workers corapeneation as required by Secton 3700 of the Labor Code for the performance of thaw^k for which this permit is issued My workers compensationjnsuran^e carrier and policy num'j'i are Insurance Co sj"1* lt*J\v^ "Td^Q Policy No fO ' < VCg / Expiration Date _ on insurance ca / ~ / — This sec'i need not be completed if the permit is for one hundred dollars (S100) or less CD Cer1 mcate of Exemption I certify that in tlie 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 w(f kajs compensation coverage is unlayrfufand shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in /addition t i the cost of compensation darmraesjas m ovided for in SectionlzeeTof the Labor code interest and attorney s fees CONTRACTOR SIGNATURE DATE I hereby &' TI that I am exempt from Contractor s License Law for the following reason Q 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 Lice *. 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) O ! ac> owner of the property am exclusively contracting with licensed contractors to construct the proiect (Sec 7044 Business and Professions Code The Contractor s License Law does not apply to an owner of prr-pert; who builds or improves thereon and contracts for such proiecls with contrador(s) licensed pursuant to the Contractor s License Law) O i am exenpt under Section Business and Professions Code for this reason 1 I peisonally plan to provide the major labor and materials for construction of the proposed property improvement O Yes O No 2 I (ha^e / 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 / contractors license number) 4 I pldii to provide portions of the work but I have hired the following person to coordinate supervise and provide the mapr work (include name / address / phone / 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 / type of work) ^"PROPEPTY OWNER SIGNATURE DATE J'>iisrj« • -«: '.'t•'•• ^* r~J —i ' *«Jf -J v-'^- Is the appl cant 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 Tr.nrer Hazardous Substance Account Act? d Yes n No Is the appear t or future building occupant required to obtain a permit from the air pollution control district or air quality management district' n Yes a No Is the fac Hty o be constructed within 1 000 feet of the outer boundary of a school site7 O Yes O No IF ANY OF THE ANSWERS ARE YES EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT I ^ereby a* irm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (\) Civil Code) Lender a Nane Lender s Address I certify thst 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 aiJih >nze representative of the City 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 AJ_ 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 excavatiopfe over 5 0 deep and demolition or construction of structures over 3 stones in height EXPIRATICM Every permit issued by the BuildjWJ Offoal under the provisions of this Code shalljxpifetiy limitation and become null and void if the building or work authonzed by such permit is not commenced within •UBO days (• DTI the date ot such permit or if the/w!ldinc«>r work authonzed by such permitjs^aSpended or abandoned at any time after the work is commenced for a period;rf 180 days (Section 106 4 4 Uniform Building Code) ^APPLICANT S SIGNATURE DATE City of Carlsbad Bldg Inspection Request For 08/26/2009 Permit# CB090870 Title CARLSBAD VILLAGE ORTHODONTICS Inspector Assignment PC Description DEMO PARTS OF FOUNDATION FOR PLUMBING FOR WASTE & VENT Sub Type OTHERType MISC Job Address 1291 CARLSBAD VILLAGE DR Suite Lot 0 Location APPLICANT SUMMIT DEVELOPMENT Owner GREEN COASTLINE L L C Remarks CAN YOU FINAL? Phone Inspector Total Time CD Description 19 Final Structural 29 Final Plumbing omments Requested By CHRISTINE Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat Page 1 of 1 Department of Consumer Affairs - > , GOV Contractors State License Board Contractor's License Detail - License # 568818 £1.} DISCLAIMER A license status check provides information taken from the CSLB license database Before relying on this information you should be aware of the following limitations >> CSLB complaint disclosure is restricted by law (B&.P 712,4_6) If this entity is subject to public complaint disclosure a link for complaint disclosure will appear below Click on the link or button to obtain complaint and/or legal action information ' Per BSP 7071.1.7 only construction related civil judgments reported to the CSLB are disclosed Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration Due to workload there may be relevant information that has not yet been entered onto the Board s license database License Number Business Information Entity Issue Date Expire Date License Status Classifications 568818 Extract Date 05/28/2009 Bonding SUMMIT DEVELOPMENT & BROKERAGE INC PO BOX 1131 CARDIFF CA 92007 Business Phone Number (760)634 1888 Corporation 05/23/1989 05/31/2011 This license is current and active All information below should be reviewed CLASS DESCRIPTION GENERAL BUILDING CONTRACTOR CONTRACTOR'S BOND This license filed Contractors Bond number 100021213 in the amount of $12,500 with the bonding company AM..ERICAN_CQNTRACJ_QRS INDEMNITY COMPANY Effective Date 04/04/2007 Contractors Bonding History BOND OF QUALIFYING INDIVIDUAL 1 The Responsible Managing Officer (RMO) STEVEN MERRILL MURRAY certified that he/she owns 10 percent or more of the voting stock/equity of the corporation A bond of qualifying individual is not required Effective Date 05/23/1989 This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND ^Policy Number 1814467 Workers Compensation \ ., . „.. ,„.. ,„,-„>,-\Effective Date 01/01/2005 Expire Date 01/01/2010 Workers Compensation History Personnel listed on this license (current or disassociated) are listed on other licenses Conditions of Use | Privacy Policy Copyright © 2009 State of California https //www2 cslb ca gov/OnhneServices/CheckLicense/LicenseDetail asp 05/28/2009