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Home My WebLink About158 CHESTNUT AVE; ; CB980130; PermitBUILDING PERMIT 01/20/98 09:19 Page 1 of 1 Job Address: 158 CHESTNUT AV Suite: Permit Type: MISCELLANEOUS Parcel No: 204-122-10-00 Lot#: Valua t i on : 1,920 Occupancy Group: Reference*: Description: RE-ROOF, 2000 SF , COMPOSITION Permit No: CB980130 Project No: A9800190 Development No: Applied: 01/20/98 Apr/Issue: 01/20/98 Entered By: RMA Appl/Ownr : HOFFMAN ROOFING P.O. BOX 442 ESCONDIDO CA 92033 *** Fees Required *** *** 760 741-7363 Fees Collected & Credits *** Fees : Adjustments : Total Fees: Fee description 75.00 .00 .'•: -; ,-75.00 /- - '\ l\ -'.Total Credits: Total Payments : Balance, -'Due : Units Fee/Unit . 00 . 00 75.00 Ext fee Data Miscellaneous Fee #1 ; * MISCELLANEOUS TOTAL 75.00 75.00 PERMIT FE 75. 00 FINAL APPROAL INSP. CLEARANCE. DATE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 1. PROJECT INFORMATION -/S'&e&es, FOR OFFICE USE PLAN CHECK NO EST. VAL. Plan Ck. Deposit Validated Bv Date \ \0, J1 \ JL^ ONLYfllvf) /"> A i P+- /7R \l Address (include Bldg/Suite t»Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel #Existing Use Proposed Use Description of Work SQ. FT.#of Stories # of Bedrooms # of Bathrooms 2. CONTACT PERSON (if different from applicant) 3. -APPLICANT ^Contractor Address j^e> Q Agentifor Contractor City ,"Q Owner _ Q Agem for Owns? State/Zip Telephone Fi>x * Name Address City State/Zip Telephone # 4. PROPERTY OWNER^_ Address City State/Zip Telephone #Name E. CONTRACTOR - COMPANY NAME . - - _ - " '"" " „ - - /,*",.:; '.," ;~r " . ; ,."".. (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 exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a,fivul penalty of not more than five hundred dollars ($500)). Name State License tt &STjLe7^L/ Address License Class ^—3*5 City State/Zip ' City Business License # /^2 Telephone # /^/W^r /**** ~~ ~~^ Designer Name Address City State/Zip Telephone State License # fi. WORKERS'COMPENSATION . . .."".". ; ~_ 17JI,7,r7'' '""•" -."7 • " - -- .- ^ Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: l~l 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. >SLj 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 insuranceVarrier and policy number are: Insurance Company ..Sf/ff- /ff, f~tS&J<y ' Policy No. (*&&f j'y Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR^LESS) l~) CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($ 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. SIGNATURE *^?^?Ci»<%iy^ DATE //3&/fff 7. OWNER-BUILDER DECLARATION ".— • - - r~~~~ '• ~- • - " - • 7 - '•'' -.. l¥-. " "-^ "',: '• .' • "'ri ;1 I hereby affirm that I am exempt from the Contractor's License 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 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). Q 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). O 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. 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, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE tiolptEtt:THIS SECTION FOR NON-RESIDENTIAL 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 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? O YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? LH 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 _ ___ ___ _ a. APPLICANT CERTIFICATION , , . " : ' ,/' . 7. ,.----,- I certify that I have read the application and state that the above information is correct and that the information on jthe plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the CitV 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 commenced within 365 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 commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). ^ - ..^APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS: 2. TYPE OF BUILDING: RESIDENTIAL ^~- COMMERCIAL 3. ROOF SLOPE: RISE */ inches in 12 inches/ 4. NUMBER OF EXISTING ROOF COVERING (circle one) \(^) 3 5. TYPE OF EXISTING ROOF COVERING 6e>py> SHEATHING *6. NEW ROOF MATERIAL &>**)" CLASS/? WEIGHT PER SQUARE 7. NUMBER OF SQUARES 2& 8. TRADE NAME E/-k tf^^t^ MANUFACTURER 9. ROOF SYSTEM LISTING ULNo. ICBONo.. 10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? ^ESJ NO AH roof coverings are required to be CLASS A. Combustible roof coverings of any type or classification are prohibited. I understand the following inspections are required: 1. Tear Off/Pre-inspection prior to install new roof covering. 2. Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for inspection. Signature <^t *~— _ Date7^? _ Contractor >^- Owner "* Contractor Name *6 - Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB980130 FOR 02/03/98 INSPECTOR AREA PY DESCRIPTION: RE-ROOF,2000 SF,COMPOSITION PLANCK# CB980130 OCC GRP TYPE: MISC CONSTR. TYPE NEW JOB ADDRESS: 158 CHESTNUT AV STE: LOT: APPLICANT: HOFFMAN ROOFING PHONE: 760 741-7363 CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: C/MIKE/741-7363 INSPECTOR SPECIAL INSTRUCT: TOTAL TIME: CD LVL DESCRIPTION ACT COMMENTS 19 ST Final Structural ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP COMMENTS 012198 Roof/Reroof AP PY OK TO COVER COMPENSATION IN S UR ANCE P.O. BOX 807, SAN FRANCISOXCA 94101-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-01-97 POLICY NUMBER: 1236134 - 97 CERTIFICATE EXPIRES: 03-01-98 STATE CONTRACTORS LICENSE BOARD-WORKER'S COMP. BOX 26000 SACRAMENTO CA 95826 JOB: LIC #352921 EXP 1 31 94 INCEP 3-1-93 3-1-94 SO This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. s™ We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an" insurance policy and does not amend, extend or alter the coverage afforded, by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is 'subject to all the terms, exclusions and conditions of such policies. 1 PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.OO PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. , ENDORSEMENT #2O65 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03/O1/97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. , EMPLOYER LEGAL NAME HOFFMAN ROOFING P.O. BOX kk2 ESCONDIDO CA 92033 HOFFMAN, MIKE PRINTED: 02-19-97 P0409 THIS DOCUMENT HAS A BLUE'PATTERNED BACKGROUND