HomeMy WebLinkAbout1375 CYNTHIA LN; ; CB043665; Permit11-12-20
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Residential Permit Permit No: CB043665
Building Inspection Request Line (760) 602-2725
1375CYNTHIALNCBAD
RESDNTL Sub Type:
1562315000 Lot#:
$31,200.00 Construction Type:
Reference #:
0 Structure Type:
0 Bathrooms:
SMITH RES-CONVERT 1040 SF
BASEMENT TO HABITABLE SPACE
RAD
0
VN
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
Orig PC#:
Plan Check#:
ISSUED
09/22/2004
RMA
11/12/2004
11/12/2004
Applicant:
JOHN BEERY ARCHITECT
760 438-2563
Owner:
SMITH DON ALLAN&MICHELE CHRISTINE
214 WOODLAND DR
VISTA CA 92083
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l 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'l Renewal Fee
Other Building Fee
Pot. Water Con. Fee
Meter Size
Add'l Pot. Water Con. Fee
Reel. Water Con. Fee
$254.11 Meter Size
$0.00 Add'l Reel. Water Con. Fee
$165.17 Meter Fee
$0.00 SDCWAFee
$0.00 CFD Payoff Fee
$3.12 PFF
$0.00 PFF (CFD Fund)
$0.00 License Tax
$0.00 License Tax (CFD Fund)
$0.00 Traffic Impact Fee
$0.00 Traffic Impact (CFD Fund)
$0.00 Sidewalk Fee
$0.00 PLUMBING TOTAL
$0.00 ELECTRICAL TOTAL
$0.00 MECHANICAL TOTAL
$0.00 Housing Impact Fee
$0.00 Housing InLieu Fee
Housing Credit Fee
$0.00 Master Drainage Fee
$0.00 Sewer Fee
Additional Fees
TOTAL PERMIT FEES
$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
$0.00
$466.40
Total Fees:$466.40 Total Payments To Date:$0.00 Balance Due:$466.40
BUILDING PLANS
IN STORAGE 5335 11/12/04
ATTACHED
Inspector:
FIN
Date:
APPROVA
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 beensiven a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired.
02 466-40
PERMIT APPLICATION
CITY pF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
FOR OFFICE USE ONLY
PLAN CHECK NO.
EST. VAL.
Plan Ck. Deposit
Validated By
Date
Address (include Bldg/Suite *)Business Name (at this address)
Legal Description Lot No.Subdivision Name/Number Unit No.Phase No. Total * of units
# of Bedrooms
^p5^E=u
Hfttf^
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair^aSV sttuatufc, p*rtortokta&
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
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 ($5001).
Name Address
State License * Ucense Class
Designer Name Address
State Ucense *
City State/Zip Telephone #
City Business License *
City State/Zip Telephone
Workers' Compensation Declaration: I hereby affirm under penalty of perjury 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 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 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 [S100J OR LESS)
Q 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 Lews of California.
WARNING: Failure to secure worker*' compensation coverage ts unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars (4100,000), In addition to the cost of compensation, damages aa provided for In Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE „ DATE
1 hereby affirm that I am exempt from the Contractor's Ucense 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 Ucense 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 wjjhin 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).
D*"!, 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 epply to an owner of property who builds or improves thereon, and contracts for such projects with contractor^) licensed
pursuant to the Contractor's License Law).
n I •"> 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 QNO
2. I (have / 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 number / 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 / address / phone
number / contractors license number): ,
5. I will provide some of the work,
of work):
ive contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
PROPERTY OWNER SIGNATURE
NO
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? - Q YES Q NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES D 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 the work for which this permit is issued (Sec. 3097(i) 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 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 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 it the building or work
authorized by such permit is not commenced 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 comrrjejiced/for a period of 180 days (Section 106.4.4 Uniform Building Code).
APPLICANT'S SIGNATURE
WHITE: File YELLOW: Applicant PINK: Finance,
DATE
City of Carlsbad Bldg Inspection Request
For: 07/22/2005
Permit# CB 043665
Title: SMITH RES-CONVERT 1040 SF
Description: BASEMENT TO HABITABLE SPACE
Sub Type: RAD
1375 CYNTHIA UN
Lot
Type: RESDNTL
Job Address:
Suite:
Location:
APPLICANT JOHN BEERY ARCHITECT
Owner: SMITH DON ALLAN&MICHELE CHRISTINE
Remarks:
Inspector Assignment: PY
Phone: 7602243480
Inspector:
Total Time:
CD Description
19 Final Structural
29 Final Plumbing
39 Final Electrical
49 Final Mechanical
Act/i Comment
Requested By: BRUCE
Entered By: CHRISTINE
Associated PCRs/CVs
PCR05017 ISSUED SMITH RES-TRUSS CALC REV;
Inspection History
Date Description Act Insp Comments
07/20/2005 89 Final Combo CO PY
01/27/2005 13 Shear Panels/HD's WC PY
7895 Convoy Court, Suite 18
San Diego, California 92111
(858)715-5800 Fax:(858)715-5810
DSA FILE NUMBER
DSA APPLIC
Project No.
Construction Inspection Report
Project Name
Project Location
Contractor %«jf g. tal
Reviewed by
Bldg. Permit No.
ate Reviewed <y*27'"0
Time Arrived__2L
Time Departed.
Travel Time r
TYPE OF INSPECTION
Masonry D Batch plant Q Foundations D Concrete D Welding D Bolting D Soil D Fireproofing Q Reinforcement Steel
n Pre-Post Tensioned Tendon ED Metal Decking Q*Other
Documents Referenced
Summary
<&>&*;<? /**r -
THE WORK: D WAS D WAS NOT
INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS
OF THE MA APPROVED DOCUMENTS
THE WORK INSPECTED: Q MET 0" DID NOT MEET
-#*THE REQUIREMENTS OF THE*« APPROVED DOCUMENTS
Cc: Project Architect
Structural Engineer .
Inspector-of- Record _
DSA Regional Office.
School District
Print Name
if
T^^ fc» 1
EsGil Corporation
In Partnership witA government for Quitting Safety
DATE: 10/28/04 Q
Q
JURISDICTION: City of Carlsbad Q PLAN REVIEWER
Q FILE
PLAN CHECK NO.: 04-3665* SET: III
PROJECT ADDRESS: 1375 Cynthia Lane
PROJECT NAME: Smith Residence Revision to Unfinished Basement
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
The applicant's copy of the check list has been sent to:
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: . Telephone #:
Date contacted: (by: ) Fax #:
Mail Telephone Fax In Person
X] REMARKS: Revision to 04-815
By: David Yao Enclosures: original approved plan (04-815)
Esgil Corporation
D GA D MB D EJ Q PC 10/21 trnsmtl.dot
9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 4 (858)560-1468 + Fax (858) 560-1576
EsGil Corporation
In <PannersHip witfi government for (Bui&fing Safety
DATE: 1O/15/O4
JURISDICTION: Carlsbad a PLAN REVIEWERa FILE
PLAN CHECK NO.: O4-3665 * SET: II
PROJECT ADDRESS: 1375 Cynthia Lane
PROJECT NAME: Smith Residence Revision to Unfinished Basement
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
The applicant's copy of the check list has been sent to:
Roark Redwood
5751 Palmer Way, Suite G-3 Carlsbad CA 92013
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
X] Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Roark Redwood Telephone #: (760)438-2963
e contac
^^^il ^-^Tele
Date contacted: Ab:- Fax #:
Mail ^-^Telephone *^ Faxr-*^ln Person
X REMARKS: Revision to 04-815.
By: David Yao Enclosures:
Esgil Corporation -.
D GA D MB D EJ n PC 10/11 tmsmtldot
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 * (858)560-1468 * Fax (858) 560-1576
Carlsbad 04-3665 *
10/15/04
RECHECK PLAN CORRECTION LIST
JURISDICTION: Carlsbad ' PLAN CHECK NO.: 04-3665 *
PROJECT ADDRESS: 1375 Cynthia Lane SET: II
DATE PLAN RECEIVED BY DATE RECHECK COMPLETED:
ESGIL CORPORATION: 10/11 10/15/O4
REVIEWED BY: David Yao
FOREWORD (PLEASE READ):
This plan review is limited to the technical requirements contained in the Uniform Building Code,
Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws
regulating energy conservation, noise attenuation and disabled access. This plan review is
based on regulations enforced by the Building Department. You may have other corrections
based on laws and ordinances enforced by the Planning Department, Engineering Department
or other departments.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 106.4.3,
1997 Uniform Building Code, the approval of the plans does not permit the violation of any
state, county or city law.
A. Please make all corrections on the original tracings and submit two new sets of prints to:
ESGIL CORPORATION.
B. To facilitate rechecking, please identify, next to each item, the sheet of the plans upon
which each correction on this sheet has been made and return this sheet with the
revised plans.
C. The following items have not been resolved from the previous plan reviews. The original
correction number has been given for your reference. In case you did not keep a copy of
the prior correction list, we have enclosed those pages containing the outstanding
corrections. Please contact me if you have any questions regarding these items.
D. Please indicate here if any changes have been made to the plans that are not a result of
corrections from this list. If there are other changes, please briefly describe them and where
they are located on the plans. Have changes been made not resulting from this list?
QYes Q No
Carlsbad 04-3665 *
10/15/04
1. Specify on the Title Sheet of the plans the gross floor area of each element of this project,
including dwelling, garage, carport, patio, deck and balcony. Section 106.3.3.
2. Window area must be at least 1/10 of the floor area and a minimum of 10 square feet per
Section 1203.3.(aame room and shop) The window schedule shows the window MM at shop
is 5046 slider. The floor plan appears to not show 50 window for MM. Please check.
3. Openable window area in habitable rooms must be 1/20 of the floor area and a minimum of
5 square feet. In bathrooms and water closet compartments, 1/20 of area is required and
minimum is 1.5 sq. ft. Section 1203.3.(game room}
4. Show that ceiling height for habitable rooms is a minimum of 7-6". Section 310.6.1.
5. Note on the plans that receptacle outlet locations will comply with NEC Art. 210-52(a).
6. All bedroom branch circuits now require arc fault protection. Note clearly on the plans that
"Bedroom branch circuits will be arc fault circuit protected." NEC Art, 210-12(b).
7. The regulations require a properly completed and properly signed Form CF-1R to be either
imprinted on the plans, taped to the plans or "sticky backed" on the plans, to allow the
building inspector to readily compare the actual construction with the requirements of the
approved energy design.
8. The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive,
Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the
plan review for your project. If you have any questions regarding these plan review items,
please contact David Yao at Esgil Corporation. Thank you.
EsGil Corporation
In fffrtntrsfup with government for WuiCtCing Safety
DATE: October 1, 2004
JURISDICTION: Carlsbad a PLAN REVIEWER
Q FILE
PLAN CHECK NO.: 04-3665 * SET: I
PROJECT ADDRESS: 1375 Cynttiia Lane
PROJECT NAME: Smith Residence Revision to Unfinished Basement
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck.
The check list transmitted herewith is for your information. The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck.
The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person.
The applicant's copy of the check list has been sent to:
Roark Redwood
5751 Palmer Way, Suite G-3 Carlsbad 92013
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Roark Redwood Telephone #: (760) 438-2963
Date contacted: PH/tH* (by:tf£x) Pax #: : itf^
Mail *xTelephone^x Fax.^\n Person
REMARKS: Revision to 04-815.
By: David Yao (by KG) Enclosures:
Esgil Corporation
D GA D MB D EJ n PC 9/23/04 tmsmtl.dot
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858)560-1468 4 Fax (858) 560-1576
Carlsbad 04-3665 *
October 1, 2004
GENERAL PLAN CORRECTION LIST
JURISDICTION: Carlsbad PLAN CHECK NO.: 04-3665*
PROJECT ADDRESS: 1375 Cynthia Lane
DATE PLAN RECEIVED BY DATE REVIEW COMPLETED:
ESGIL CORPORATION: 9/23/04 October 1, 2004
REVIEWED BY: David Yao 0>y KC)
FOREWORD (PLEASE READ):
This plan review is limited to the technical requirements contained in the Uniform Building Code,
Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws
regulating energy conservation, noise attenuation and disabled access. This plan review is
based on regulations enforced by the Building Department. You may have other corrections
based on laws and ordinances enforced by the Planning Department, Engineering Department
or other departments.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 106.4.3,
1997 Uniform Building Code, the approval of the plans does not permit the violation of any
state, county or city law.
• Please make all corrections on the originals and submit two new complete sets of prints to:
ESGIL CORPORATION.
• To facilitate rechecking, please identify, next to each item, the sheet of the plans upon
which each correction on this sheet has been made and return this sheet with the
revised plans.
• Please indicate here if any changes have been made to the plans that are not a result of
corrections from this list. If there are other changes, please briefly describe them and where
they are located on the plans. Have changes been made not resulting from this list?
Q Yes Q No
Carlsbad 04-3665 *
October 1, 2004
1. The only thing we received was a copy of the Title 24 energy calculations. Please
provide [revised] architectural plans, specify room uses, insulation, etc. There may be
significant code issues with habitable space in the basement.
2. The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive,
Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform
the plan review for your project. If you have any questions regarding these plan review
items, please contact David Yao Cby KC) at Esgil Corporation. Thank you.
Carlsbad 04-3665 *
October 1, 2004
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad PLAN CHECK NO.: 04-3665 *
DATE: October 1, 2004PREPARED BY: David Yao (by KC)
BUILDING ADDRESS: 1375 Cynthia Lane
BUILDING OCCUPANCY: TYPE OF CONSTRUCTION:
BUILDING
PORTION
Create habitable
space
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code
AREA
(Sq.Ft.)
cb
Valuation
Multiplier
By Ordinance
Reg.
Mod.
VALUE ($)
35,100
35,100
$276.35
Flan Check Fee by Ordinance
Type of Review:
D Repetitive FeeRepeats
Complete Review
D Other
,- Hourly
D Structural Only
Hour*
Esgll Plan Review Fee
$179.63
$154.76
Comments:
Sheet 1 of 1
macvalue.doc
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB DATE '
ADDRESS A375 (Lyn+h'ta. Ln
RESIDENTIAL ADDITION MINOR
« $10,000.00)
TENANT IMPROVEMENT
PLAZA CAMINO REAL
CARLSBAD COMPANY STORES
VILLAGE FAIRE
COMPLETE OFRCE BUILDING
OTHER
PLANNER DATE
ENGINEER
DoctfMbfMn&Plannfng Ensrtneef Ing Approvals
DATE /P//ftfr)
7
TITLE 24 REPORT
Title 24 Report for:
The Smith Residence
Cynthia Lane
Carlsbad, CA
Project Designer:
John S. Beery, Architect
PO Box 130684
Carlsbad, CA
Report Prepared By:
Julie A. Gustine
GMS / Murphy Mechanical
140 Vallecitos de Oro
San Marcos, CA 92069
(760)591-9172
Job Number:
03-12-1508*
Date:
9/21/2004
The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2001 Building Energy Efficiency Standards.
This program developed by EnergySoft, LLC (415) 883-5900.
EnergyPro 3.1 By EnergySoft Job Number: 03-12-1508r2 User Number: 1536
LI6MT < VENTILATION/CALCULATIONS
Per Section 1203.2 and Section 12033 (attached;
the calculations below are based on the more
restrictive requirment of light, and therefore satisfy
ventilation requfrments as well.
Area
fat
Provided
FtJ
Required
(Bq. FU
Area Size
Door 40 4 Hindoos LL 4
= 40 + 15 + IB = bb.0 5F > 44.4 6F ok
> 22.2 5F ok
444 6F / 10
44.4 6F
Game
Room
Door 34 + Window MM = 40
IB = 415 6F > 20.0 6F ok
> 10.0 6F ok
200 5F / 10
20.0 6F
City of Carlsbad
CSOH08IS~
Building Department
CERTIFICATE OF COMPLIANCE
PAYMENT OF SCHOOL FEES OR OTHER MITIGATION
This form must be completed by the City, the applicant, and the appropriate school districts and returned to the City
prior to issuing a building permit. The City will not issue any building permit without a completed school fee form,.
Project Name:
Building Permit
Plan Check Number;
Project Address:
A.P.N.:
Project Applicant
(Owner Name):
Project Description:
Building Type:
Residential:Number of New Dwelling Units I
Square Feet of Living Area in New Dwelling
Second Dwelling Unit: Square Feet of Living Area in SOU
Residential Additions: Net Square Feet New Area
Commercial/Industrial: Square Feet Floor Area
City Certification of ~~
Applicant Information:Date: S-25-QH
LOL DISTRICTS WITHIN THE GITY OF CARLSBAD
Carlsbad Unified School District
6225 El Camino Real
Carlsbad CA 92009 (331 -5000)
San Marcos Unified School District
215 Mata Way
San Marcos, CA 92069 (736-2200)
Encinitas Union School District
101 South Rancho Santa Fe Rd
Encinitas, CA 92024 (944-4300 ext 166)
San Dieguito Union High School District
710 Encinitas Blvd.
Encinitas, CA 92024 (753-6491)
Certification of Applicant/Owners. The person executing this declaration ("Owner") certifies under penalty of perjury that (1) the
information provided above is correct and true to the best of the Owner's knowledge, and that the Owner will file an amended
certification of payment and pay the additional fee if Owner requests an increase in the number of dwelling units or square
footage after the building permit is issued or if the initial determination of units or square footage is found to be incorrect, and
that (2) the Owner i^Jto-^wner/developer of the abqtfe~^scfibed project(s), or that the person executing this declaration is
authorized to sign on behalfV the Owner.
Signature:Date:
1635 Faraday Avenue • Carlsbad, pA 92OO8-7314 • <76O) 6O2-27OO
Revised 4/20/00 BuildinQ Counter • (76O) 602-2719 • FAX (76O) 6O2-8558
SCHOOL DISTRICT SCHOOL FEE CERTIFICATION
(To be completed by the school district(s))
IT**********
THIS FORM INDICATES THAT THE SCHOOL DISTRICT REQUIREMENTS FOR THE
PROJECT HAVE BEEN OR WILL BE SATISFIED.
SCHOOL DISTRICT:
The undersigned, being duly authorized by the applicable School District, certifies that the
developer, builder, or owner has satisfied the obligation for school facilities. This is to certify that
the applicant listed on page 1 has paid all amounts or completed other applicable school
mitigation determined by the School District. The City may issue building permits for this project.
SIGNATURE OF AUTHORIZED SCHOOL
DISTRICT OFFICIAL
TITLE GAVtEN FREEMAN
DEPUTY SUPERINTENDENT
CARLS8ADUN1FOSCHOOLDISTR1CT
NAME OF SCHOOL DISTRICT 6225aCWWOHE«L
—CARLSBAD, CA920M
DATE
PHONE NUMBER
Revised 4/20/00
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