HomeMy WebLinkAbout1564 CORMORANT DR; ; CB120276; Permit02-15-2012
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Plumblng/Mechanical/Electrical (PME) Permit
Permit No: CBl 20276
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Reference #:
PC #:
Project Title:
1564 CORMORANT DR CBAD
PME
2156500205
VOSS/MORGANS RES-
REPLACE FAU
Lot#:
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
02/15/2012
LSM
02/15/2012
02/15/2012
Applicant:
ASI HASTINGS
1250 GREENFIELD DR
EL CAJON, CA 92167
619-223-9016
Owner:
VOSS MICHAEL P&DONNA P
5471 GERMAN VILLAGE RD
WEST BEND Wl 53095
Plumbing Fees
Electrical Fees
Mechanical Fees
Other PME Fees
$0.00
$0.00
$150.00
$0.00
TOTAL PERMIT FEES $150.00
Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due: $0.00
Inspectoi
FINAL APPROVAL
Date: ^'Z/^/l^ Clearance:
NOTICE: Please take NOTICE ttiat approval of your project includes the "Imposition" of fees, dedications, resen/ations, or other exactions hereafter collectively
referred to as "fees/exactions." You have 90 days from the date this penmit 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 information with the City Manager for
processing in accordance with Carlsl)ad Municipal Code Section 3.32.030. Failure to timely follow that procedure will tar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereljy 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 sen/ice fees in connection with this project. NOR DOES IT APPLY to any
feea'exactions of which vou have previously t)een given a NOTICE similar to this, or as to which the statute of limitations has previously othenwise expired.
<m>
^ CITY
CARLSBAD
O F
Building Perniit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-2717/2718/2719
Fax 760-602-8558
www.carlsbadca.gov
Plan Check No.
Est. Value
Pian Ck. Deposit
Date ^iCji'l^
D
SUITE#/SPACE»/UNIT» APN
CT/PROJECT » LOT* PHASE* » OF UNITS t BEDROOMS » BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP
DESCRIPTION OF WORK: (ncfude Square feet of Affected Araa(s)
EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS
YEs|~|# Noj 1 YESQNOQ YES| |NO| 1
CONTACT NAME (liOitterent fom Applicant) APPLICANT NAME r . /)
ADDRESS
CIW STATE ZIP CmL STATE* ZIP
PHONE FAX FAX
EMAIL "SMAIL "
PROPERTVOWNERNAME^^^^;^ CONTRACTOR BUS. NAME |^^-
ADDRESS * . 1 U ADDRESS , , . ^ A ^
CITY , , 1 STATE ZIP CITX-, -..^ r STATE D ZIP
PHONE FAX 9H0NE ^ FAX
EMAIL •SMAIL '
ARCH/DESIGNER NAME & ADDRESS STATE LIC. # STATE 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 applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Cliapter 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
s
Workers' Compensation Decliration: / fiereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self-insure for writers' compensation as provided by Section 3700 of the Latxir Code, for the performance of lie worit for which this pennit is issued,
t have and will maintain wm^re'compensation. asJ%|uiied bv Section 3700 of the Labor Code, for the perfonnance of the worl( for whicti this pemiit is issued. My workers' compensation insiirance canier and policy
number are: insurance Co (^^iUYn'€^ f DXyW Policy NoVO (JT-fe^ .[ C>>--t \ Expiration Date _lJiiXU-X-L^
This section need not be completed if the permit is for one hundred dollars ($100) or less.
I I Certificate of Exemption: I certify that in the perfbnnance of the worit fbrwhichthispennitis issued, I shall not employ any person in any manner so as to become subject to the Woriters' Compensation Laws of
Califomia. WARNING: Failure to secure worktn' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,IX)0), in
addition to the cost of compensation, danjkges as aravUM for in Section 3706 of the LabeiYode, interest and attomey's fees. t
.^eS* CONTRACTOR SIGNATURE V^^^C^j^N,!^ (QA^-^XV ^ N ^^^NT DATE ^ j * ^ j )
OWNER-BUILDER DECLARATION
/ fiereby affi/m that I am exempt from Ckntracta's Ucense Law for the foiiowing mason:
I I I, as owner of the property or my employees with wages as their sole compensation, wiil do Uie work and the stmcture is not intended or offered for sale (Sec. 7044, Business and Professkms Code: The Contractor's
License Law does not apply to an owner of property who buikls or improves thereon, and who does such work himself or through his own empkiyees, provided that such improvements are not intended or oflered for
sale. If, hovtever, the buikiing or improvement is sokl within one year of compietkin, the owner-bulkier will have the burden of proving that he dkl not buikl or improve for the purpose of sale).
I I I, as owner of the property, am exclusively contracting with Ifcensed contractors to constmct the project (Sec. 7044, Business and Professions Code: The Contractor's Lcense Law does not apply to an owner of
property who buikls or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law),
• am exempt under Section _ .Business and Professions Code fbr this reason:
1 I personally plan to provide the major labor and materials for oonstnx:tx)n of the proposed property improvement. Qves I No
2 I (have / have not) signed an applk;alxin fbr a buikiing pemiit for the proposed work.
3.1 have contracted with the foltowing person (fimi) to provkle the proposed constmction (include name address / phone / contractors' lfcense number);
4 I plan to provide porttons of the work, but I have hired the following person to coordinate, supenrise and provide the major worit (include name / address / phone / contractors' lfcense number):
5.1 will provide some of the worit. but I have contracted (hired) the tollowing persons to provkle the worit indicated (include name' address I phone / type of worit):
^PROPERTY OWNER SIGNA' \^<Q<T DATE
COMPLETE THIS SECTION FOR N O N - R E S I D E N T I A L BUILDING PERMITS ONLY
Is the appikiant or futuie buikiing occupant requited to submit a business plaii. acutely hazardous materials registration fbrni or risk management and preventton program under Secttons 25505,25533 or 25534 of the
Presley-Tanner Hazardous Substance Account Act? j I Yes I iNo
Is the applicant or future buiWing occupant required to obtain a pemiit from the air pollution control district or airaualitv management district? I Ives I I No
Is the facility to be constmcted within 1,000 feet of the outer boundary of a school site? ClYes I I 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
I hereby affirm that there is a constmction lending agency for the perlmnance of the work this perniit Is issued (Sec. 3097 (i) Civil Code).
Lender's Name Lender's Address
APPLICANT CERTIFICATION
I ceitl^ that I have read the applicafion and state that the abate infonnation is conect and that tlie inlbmiati
I hereby authorize representative of the Oty of Carlsbad to enter upon the above mentioned property Ibr inspection puiposes. 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 pemiit is fet^uired for excavatbns over S'O' deep and denxilition or constrtJcSon of structures over 3 stories in height
EXPIRATION: Every pemit issued by the Buikiing OfSdal under the pnovisions of this Code shall expire by Watkin and become null and void if the bulWing or worit authorized by such pernt is not commenced within
180 days liDm the date of such penmit or if the buikiing or work authorized by such pemiit is suspended or abandoned at any time after the worit is commenced for a period of 180 days (Section 106.4.4 Unifomi Buikiing Code).
jgS"APPLICANT'S SIGNATURE OATE
City of Carlsbad BIdg Inspection Request
For: 04/23/2012
Permits CB120276 Inspector Assignment: PB
Title: VOSS/MORGANS RES-
Description: REPLACE FAU
Type: PME Sub Type:
Phone: 7604589379
Job Address: 1564 CORMORANT DR
Suite: Lot: 0
Location: Inspector:
APPLICANT ASI HASTINGS
Owner: VOSS MICHAEL P&DONNA P
Remarks: PM PLEASE GATE CODE 4317 CALL 15 MINS PR
Total Time: Requested By: JULIE
Entered By: JANEAN
CD Description Act Comments
44 Rougli/Ducts/Dampers
49 Final Mechanical
Comments/Notices/Holds
Associated PCRs/CVs/SWPPPs Original PC#
Inspection Historv
Date Description Act Insp Comments
03/27/2012 43 AirCond/Furnace Set NR PB