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Home My WebLink About1301 PINE AVE; ; CB120797; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 04-30-2012 Permit No: CB 120797 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: 1301 PINE AV CBAD PME 2050521500 Lot#: Status: 0 Applied: Entered By: Reference #: Plan Approved: ISSUED 04/30/2012 JMA 04/30/2012 04/30/2012 PC#: Project Title: Applicant: GRIFFIN JERRIE L GRIFFIN: REPAIR GAS LEAK TO HOUSE 1301 PINE AVE CARLSBAD CA 92008 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Owner: GRIFFIN JERRIE L 1301 PINE AVE CARLSBAD CA 92008 Issued: Inspect Area: $150.00 $0.00 $0.00 $0.00 $150.00 Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due: Inspector: FINAL APPROVAL Date: S-3-f? Clearance: $ -l,,-\ l-c $0.00 NOTICE: Please take NOTICE that approval of your project includes the ~Imposition" of fees, dedications, reseivations, or other exactions hereafter collectively referred to as "fees/exactions.ff You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any 'h h imilr hi fllmi h I <<1") Building Permit Application Plan Check No. Ce:, I 2/i, '17 I 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value ~-CITY OF 760-602-2717 / 2718 / 2719 CARLSBAD Fax: 760-602-8558 Plan Ck. Deposit www.carl§:badca.gov Date '+ /~of 17-lswPP JOB ADDRESS • / ,:. SUITE#/SPACE#/UNIT# IAPN \~t? . n, O\v-'-C0.1'\St)i,.c\ C,UJcJ'o --- CT/PROJECT# LOT# I PHASE# I# OF UNITS I# BEDROOMS # BATHROOMS I TENANT BUSINESS NAME I CONS TR. I YPE I occ. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) '()-. f', ('.h~L {l_ t f.Le PLiJ«-.e__ GJ<S L,..£ -er.,_ ft I " '$ tk'UJ I c..e... 't"l> I , 1 ~ \+cz ,..,_ 1:7:,:.-n.......__ ~ 'PR.,.,.~tL- EXISTING USE I PROPOSED USE 'GARAGE (SF) PATIOS (SF) I DECKS (SF) I FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS YES0 #_ NOD YES D NOD YES D NOD APPLICANT NAME (Primary Contact) APPLICANT NAME (Secondary Contact) ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE IFAX PHONE I FAX E1viA1L '""""" PROPERTY OWNER NAME 'H.Wc. ..t~ C! R)~C µ CONTRACTOR BUS. NAME ADDRESS ?, \..)/£ ADDRESS \"'3, ... , A \{.e_ CITY STATE ZIP CITY STATE ZIP C Alt.(..S 'i3A. b c..~. C,z..._oo ~ PHONE 71.Pc -l&,'!:, 7 -S (.p I<.( IFAX PHONE [FAX 1 ._..,AIL \It~" A. ,_.) A ):) t-) ~ r. F" f-, P eJ ~ 1-lA ~ L_ '"'""" ARCH/DESIGNER NAME & ADDRESS \ STATE LIC. # STATE LIC.# I CLASS I CITY BUS. UC.# (Sec. 7031.5 Business and P.rofess1ons Code: Any City or Coun.ty 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 1s licensed pursuant to the provisions of the Contractor's license Law JChapter 9, commending with Section 70.00 of Division 3 of the Business and Professions Code} or that he is exemP.t therefrom, and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subJects the applicant to a civil penalty of not more than five hundred dollars {$5001). Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following dec/araflbns: 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. 0 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 workers' compensation insurance carrier 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. 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. Jf5 CONTRACTOR SIGNATURE 0AGENT DATE I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: 'l' D 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). 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). [] 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. wY es D No 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (finn) to provide the proposed construction (include name address I phone I 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 m~or work (include name I address I phone I 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 I address I phone I type of work): /ES PROPERTY OWNER SIGNATURE fll;1;t f-' ~;;t7"-0AGENT DATE 9' /so /1 ,-. • 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 bOlmdary 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 1 EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the above lnfonnation is correct and that the lnfonnation on the plans is accurate. I agree to comply with all Clly ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned properfy 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 PERfl!T. OSHA: An OSHA peITTlit is required for excavations over 5'0' deep and demolition or construction of strucilJres over 3 stories in hevJhL EXPIRATION: Eveiy permit issued by the Building Official under the provisions of this Code shall expire by fimitation and become nul and void if the building orwor1( authorized by such permit is not commenced within 180 days from the date of such pennit or if the building orwor1( authorized by such peITTlit is spended or abandoned at any ~me after the worit is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code) . ..@S' APPLICANT'S SIGNATURE /JJiA DATE ~ j'3 l7 ,/)~ . ~ ··'---·--------~ 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 wv.w.building@cartsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CONTACT NAME ADDRESS CITY ZIP PHONE FAX EMAIL DELIVERY OPTIONS D PICK UP: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) D MAIL TO: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) 0 MAIL/ FAX TO OTHER:--------------- A$APPLICANT'S SIGNATURE OCCUPANT NAME BUILDING ADDRESS CITY- Carlsbad OCCUPANT'S BUS. LIC. No. o ASSOCIATED CB#--. CO#: (Office Use Only) STATE CA o NO CHANGE IN USE/ NO CONSTRUCTION o CHANGE OF USE / NO CONSTRUCTION DATE ZIP ' ' City of Carlsbad Bldg Inspection Request For: 05/02/2012 Permit# CB120797 Title: GRIFFIN: REPAIR GAS LEAK TO Description: HOUSE Type:PME Job Address: 1301 PINEAV Suite: Location: APPLICANT GRIFFIN JERRIE L Owner: GRIFFIN JERRIE L Remarks: pm please Total Time: CD Description Sub Type: Lot: 0 Act Comments Inspector Assignment: PD --- Phone: 7605049052 Inspector: -~/._7$~- Requested By: MEAGAN Entered By: JANEAN 23 Gas/Test/Repairs .fJL 1.£1-< J7;-1U-utuil2 m lfm0 Comments/Notices/Holds Associated PCRs/CVs/SWPPPs Original PC# Inspection History Date Description 05/01/2012 23 Gas/TesURepairs Act lnsp Comments CA PD