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Home My WebLink About1340 OAK AVE; ; CB022257; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 08-16-2002 Residential Permit Permit No: CB022257 Building Inspection Request Line (760) 602-2725 J \,~o~ Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: Applicant: 1340 OAK AV CBAD RESDNTL 1561906100 $54,008.00 Sub Type: Lot#: Construction Type: Reference #: 0 Structure Type: O Bathrooms: LOOSEN RES-ADD 314 SF BEDROOMS REMODEL 336 SF LIVING RM RAD 0 VN 0 Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Orig PC#: Plan Check#: 4)END1NG 08/05/2002 RMA WORTHING INC, B. A. NATHAN JACK A&LOOSEN ANDREA K 690 CARLSBAD VILLAGE DR CARLSBAD, CA 92008 619-729-3965 Total Fees: $665.36 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Plan Check Discount Strong Motion Fee Park in Lieu Fee Park Fee LFM Fee Bridge Fee Other Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'I Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'I Pot. Water Con. Fee Reel. Water Con. Fee Inspector: 1340 OAK AVE CARLSBAD CA 92008 Total Payments To Date: $242.65 $373.31 $0.00 $242.65 $0.00 $0.00 $5.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Meter Size Add'I Reel. Water Con. Fee Meter Fee SDCWAFee CFO Payoff Fee PFF PFF (CFO Fund) License Tax License Tax (CFO Fund) Traffic Impact Fee Traffic Impact (CFO Fund) Sidewalk Fee PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Housing Impact Fee Housing lnlieu Fee Master Drainage Fee Sewer Fee Additional Fees TOTAL PERMIT FEES FINAL APPROVAL Date: Clearance: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $665.36 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 vou have oreviouslv been niven a NOTICE similar to this or as to which the statute of limitations has oreviouslv otherwise exnired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 Validated By __ -+....,.-1,::........~::::....,,4=11=::=-- Date._~~~-X--l-~./--I--,(;-~=<-~~- 1. PROJECT INFORMATION Address (include BG* #) /!Jv 1::;10 e. Business Name (at this address) legal Description Lot No. Subdivision Name/Number Phase No, Total # of units # of Bedrooms t2-~~~--~~-- 1.io, e State/ e ep one 71,0 •7':J'I· 39 Telephone# 4. ~RTY OWNER ~ret<t ~ Name Address City State/Zip 5. 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 he is exempt therefrom, and the basis for the alleged ewption. Any viol ion of SectionJ7031.5 by any applicant for a permit subjects the app ·canJ to a cjvil penalty of not more than five hundred dollars ($500]). Pi r , t1 n.c. 6 o o '{, LA,.r ~IJ a ~o ~<1 .39~o City Telephone 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. ~ 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 5 f lt-1f'-Pu1vD PolicyNo.;l~q-18 u11.,t ~S3=t'ExpirationDate J -t)J-t/3 (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 secur workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100 , 'n addi · t the cost of compensation, damages as provided for in Section 3706 of the lab r co , interest and attorney's fees. SIGNATURE DA TE _.._.+..c...,-=::::....,,-=:::......- 7. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the ontra or's license law for the following reason: 0 I, as owner of the property or my e Joye 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: e 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(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 I 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 I address I phone number 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 major work (include name I address I phone number 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 number I type of work): __________________________________________________________ _ PROPERTY OWNER SIGNATURE----------------------- COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY DATE _________ _ 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---------------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 Cit\r 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 comme ed within 180 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 the work is comm e for a l'.l I d of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE YELLOW: Applicant PINK: Finance