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Home My WebLink About1330 CHUPAROSA WAY; ; CB121252; Permit07-03-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB121252 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC#: Project Title: 1330 CHUPAROSA WY CBAD MISC 1561107300 $0.00 RAMSEY HOUSE GAS TEST TO SET METER Subtype: OTHER Lot #: 0 Status: Applied: Entered By: Plan Approved: ISSUED 07/03/2012 MDP 07/03/2012 Issued: 07/03/2012 Inspect Area: Applicant: JOHNSON EDMOND D&KATHLEEN M Owner: JOHNSON EDMOND D&KATHLEEN M 3211 IBSEN ST SAN DIEGOCA 92106 3211 IBSEN ST SAN DIEGOCA 92106 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES TEST $27.00 $0.00 $0.00 $27.00 Total Fees: $27.00 Total Payments To Date: $27.00 Balance Due: $0.00 Inspector: FINAL Date: .ARPRpVAL Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposltton" of fees, dedications, resen/ations, or other exactions hereafter collectively refened to as "fees/exactions." You have 90 days from the date this perniit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth In Govemment Code Section 66020(a), and file the protest and any other required infomiation witti the City Manager for processing in accordance with Carisbad 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 ottier similar applicatton processing or sen/ice fees in connection witti this project. NOR DOES IT APPLY to any fees/exactions of which vou have previously been given a NOTICE similar to this, or as to which the statute of limitations has oreviouslv ottienivise expired. THEFOLLOWINGAPPROVALSREQUIREDPRIORTOPERMITISSUANCE: DPIANNING nENGINEERING • BUILDING DFIRE DHEALTH DHAZMAT/APCD ^ CITY CARLSBAD O F Building Permit Application 1635 Faraday Ave., Carlsbad, OA 92008 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 www.carlsbadca.gov Plan Check No. Est. Value Plan Ck. Deposit Date SWPP JOBADDR CT/PROJECT # I LOT # T PHASE* # OF UNITS 1 rBS|?( SUITE#/SPACE#/UNIT# # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: /ncfude Square Feet ofiWected Araa(s; EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YESD # NOD AIR CONDITIONING YES D NOD FIRE SPRINKLERS YES D NOD APPUCANT NAME (Primary Contact) APPUCANT NAME (Seconilary Contact) ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX PHONE FAX EMAIL EMAIL \J PRO ( A5B PROPERTY OWNER NAME ADDRESS CONTRACTOR BUS. NAME ADDRESS r " ' STATE ^ PHONE ZIP CITY STATE PHONE FAX tad IE\^D^SI^^ 04^ EMAIL ARCH/DESIGNER NAME CLASS CITY BUS. LIC.# (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 appllcantfor such permit to file a signed statement that he is licensed pursuant to the provisions ofthe 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 ($500)). WORKERS' COMPENSATION Workers' Compsniitton Declaration: / hereby aflinn under penalty ol perjury one ofthe following deciarations: n 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 permitis 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 pemiit is issued. My workers' compensation insurance canier and policy number are: Insurance Co. Policy No. Explratton Date This section need not be completed ifthe pemiit is for one hundred dollars ($100) or less. O Certificate of Exemption: I certify that in the perfonnance of the wort< for whch this pemiit is issued, I shall not employ any person in any manner so as to become subject to the Wori<ers' Compensation Laws of Callfbmia. 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 dollart (&100,000), In addition to the cost of compensation, damages as provided for In Section 3706 of the Labor code. Interest and attomey's fees. VKT CONTRACTOR SIGNATURE •AGENT DATE O W N E 17 - B U I L D E R DECLARATION / h&eby afUrm that I am exempt from Contractor's Ucense Law for the foiiowing reason: • I, as owner of the property or my employees with wages as their sole compensatton, will do the work and the stracture 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 wori< 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 completton, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). a I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professtons 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 Professtons Code for this reason: 1.1 personally plan to provide the major labor and materials for constructton of the proposed property improvement • Yes • No 2.1 (have / have not) signed an application for a building pemiit for the proposed wori<. 3.1 have contracted with the following person (fimi) to provide the proposed constraction (include name address / phone / contractors' license number): 4.1 plan to provide porttons of the wori<, but I have hired the follovflng person to coordinate, supenrise and provide the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have coniratted (hired) the following peisons to provide the work indicated (include name / address / phone / type of wori(): COMPLETE THIS SECTION FOR NON-RESIOENTIAL 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 Hazanlous Substance Account Act? • Yes • No Is the appltoant or future building occupant required to obtain a pemiit from the air pollution control district or air quality management district? • Yes • No Is the facility to be constracted within 1,000 feet of the outer boundary of a school site? • Yes • No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CONSTRUCTION LENDING AGENCY 1 hereby affimi Uiat ttiere is a constmction lending agency for the performance of ttie work this perniit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address APPLICANT CERTIFICATION I certify that I have read the appHcation and state that the above Information Is conect and that the Infomiation on the plan^ I hereby authorize representative of the Qty of C^arbbad to enter upon Ihe above menttoned property fbr inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND l€EP 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 pennit is required fbr excavations over SV deep and demolitton or constmctton of stractures over 3 stories in height EXPIRATION: Every pemiit issued by the Building Official under the provistons of this Code shall expire by limitatton and become nul and void if Ihe building orwari( authorized by such pennit is not commenced wilhin 180 days from the date of such pemiit or if the buiHing or woik authorized by such pemiit is suspended or abandoned at any time after the wori( is commenced fbr a period of 180 days (Section 106.4.4 Unifomi Buikiing Code). APPUCANT'S SIGNATURE DATE 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 www.buildinq(5)carlsbadca.qov or Mall ttie completed fomi to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, Califomia 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. UC. No. DELIVERY OPTIONS a PICK UP: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) a MAIL TO: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) • MAIL / FAX TO OTHER: • ASSOCIATED CB#- • NO CHANGE IN USE / NO CONSTRUCTION • CHANGE OF USE / NO CONSTRUCTION .ef APPUCANT'S SIGNATURE DATE Inspection List Permlt#: CB121252 Type: MISC OTHER RAMSEY HOUSE GAS TEST TO SET METER Date Inspection Item Inspector Act Comments 07/09/2012 23 Gas/Test/RepaIrs MP AP 07/09/2012 29 Final Plumbing MP AP REL MTR Monday, July 09, 2012 Page 1 of 1