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Home My WebLink About1604 CORTE ORCHIDIA; ; CB121794; Permit09-12-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No:CB121794 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 1604 CORTE ORCHIDIA CBAD PME 2159500100 DONNELLY RES- ADD A/C PRE PLUMBED Lot#: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 09/12/2012 LSM 09/12/2012 09/12/2012 Applicant: GREEN BUILDING TECHNOLOGIES DBA GREEN MECHANICAL CONTRACTORS 930 S ANDERSON DR #A ESCONDIDO CA 92029 858-909-0719 Owner: DONNELLY RICHARD V&REBA D TRUST 07-05-11 1604 CORTE ORCHIDIA CARLSBADCA 92011 Plumbing Fees Electrical Fees Mectianical Fees Other PME Fees $0.00 $0.00 $154.00 $0.00 TOTAL PERMIT FEES $154.00 Total Fees: $154.00 Total Payments To Date: $154.00 Balance Due: $0.00 Inspector: FINAL APPROVAL Date: f-///2^ Clearance: NOTICE: Please take NOTICE that approval of your project Includes the "Imposition' of fees, dedications, resen/ations, or other exactions hereafter collectively refened to as lees/exactlons." You have 90 days from the date this penult was Issued to protest imposition of these fees/exactions. If you protest them, you must follovir the protest procedures set forth In Govemment Code Secfion 66020(a), and file the protest and any other required Infomiatlon with the City Manager for processing In accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will t>ar any sut)sequent 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 senrlce fees In connection with 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 othenivise expired. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: • PUNNING nENGINEERING • BUILDING DoRE • HEALTH • HAZMAT/APCD ^ CITY OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Pti: 760-602-2719 Fax: 760-602-8558 email: buldllng@carlsbadca.gov wvvw.carlsbadca.gov Plan Check No. (l6fa.p9^ Est. Value Pian Ck. Deposit SWPP JOB ADDRESS LOT! I PHASE # I # OF UNITS |#BEDR0(5M SUnES/SPACEt/UNIT* CONSTR. TYPE I OCC GROUP CT/PROJECT # # BATHROOMS TENANT BUSINESS NAME DESCRIPTION OF WORK: fncfude Square Feet of Affected Aiea(s; EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YESD # NOD AIR CONDITIONING YES • NOD FIRE SPRINKLERS YES • NOO APPLICANT NAME (Primary Qontact) . APPLICANT NAME (Secondary Contact) ADDRESS yap 6. AAj/)>zg^^<^ soi/€ /\ ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE EMAir '%SS' L,ZS' PHONE EMAIL FAX PROPERTY OWNER NAME CONTRACTOR BUS. NAME ADDRESS ADDRESS CITY STATE . ZIP CITY STATE PHONE FAX PHONE FAX EMAIL EMAIL ARCH/DESIGNER NAME & ADDRESS , :. 7031.5 Business and Profes^ns Code: Any City fe^County which requires a permit to i iiMic L.iv^.rr -CUSS CITY BUS. UC.# (Sec. 7031.5 Business and ProfessSons Code: Any City w 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 byany applicantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). COMPENSATION Workers' Compensation Declaration: / hereby afBnn under penalty ofpeijwy one of the following declarations: a 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 pennit is issued. X I have and will maintain workers' compensation, as requiied by Section 3700 ot the Labor Code, for the perfomiance of Ihe work for wIM this pennit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co._ Policy No. lAJ^P (^^/ifvCa/ "Z— Expiration Date "f ~ ^.3 This section need not be completed if the permit is ibr one hundred dollars ($100) or less. • Certificate of Exemption: I certify that in the perfomiance of the work for which this pennit is issued, I shall not employ any person in any manner so as to become subject to the Wori(ers' Compensation Laws of Califomia. WARNING: Failure to secure workers' compensajipn coverage is unlawh||<4nd 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, damagesas provlded^in Section 3706^^il«Labor code, interest ud attomey's fees. >e CONTRACTOR SIGNATURE / AXL, V <— ' OAGENT DATE OWNER-BUttDIER OgCLARA i I O N ; hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: O I, as owner of the property or my employees with wages as their sole compensation, will do the work and the stmcture is not intended or offered for sale (Sec. 7044, Business and Professkins Code: The Contractor's License Law does not apply to an owner of property who bulkts or improves thereon, and who does such work himself or through his own employees, provided that such impmvements 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 dkl not build or improve for the puipose of sale). • I, as owner of the property, am exclusively contracting with licensed contractors to constmct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who buikis or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). • I am exempt under Sectton Business and Professions Code for this reason: 1.1 personally plan to provkle the major labor and materials for construction of the proposed property improvement • Yes l!J No 2.1 (have / have not) signed an application for a building permit for the proposed worit. 3.1 have contracted with the following peison (fimi) to provide the proposed construction (include name address / phone / contractors' Iteense number): 4.1 plan to provkJe portions of the worit, but I have hired the Ibllowing person to coordinate, supenrise and provkle the major worit (include name / address / phone / contractors' license number): 5.1 will provkle some of the worit, but I have contracted (hired) the following persons to provide the worit indteated (Include name / address / phone / type of worit): >CS'PR0PERTY OWNER SIGNATURE •AGENT DATE COMPteTE THIS SECTION FOB N O N - R E S I D E N T i A L 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? • Yes • No Is the applicant or future building occupant required to obtain a pennit from the air pollution control district or air quality management district? • Yes O No Is the facility to be constmcted within 1,000 feet of the outer boundary of a school site? OYes • 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. CONSTRUCTION LENDING AGENCY I hereby affinn that there Is a construction lending agency for the perfomiance of the work this pemilt Is Issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address APPLICANT CERTIFICATION I cetti^ tliat I have read tlie applicatian and state that tlie above infomiation Is conect and that ttie inlbimaton on I hereby authorize representative of the Qty of Cartsbad to enter upon the above mentbned property for Inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CfTY OF CARLSBAD AGAINST ALL UABIUTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CffY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An 0^t^^ permit is required for excavatkms over S'O' deep and demolitbn or constnx;tbn of stmctures over 3 stories In height EXPIRATION: Every pemiit issued by the Buikling Oflfcial under the provisbns of this Code shall expire by llmitatbn and become nul and vokl if the bulMing or vwrit authorized by such pemiit is not commenced within 180 days fiom the date of such permit or if the buikling or vwrit authorized by such permit is suspended or abandoned at any fme alter Sie writ is commenced for a period of 180 days (Sectbn 106.4.4 Unifomi Building Code). vfifAPPUCANT'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.buildlno@cartsbadca.oov or Mail the completed fbmi to City of Carlsbad, Building Division 1635 Faraday Avenue, Cartsbad, Cailfbmia 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CrrY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DEUVERVOPnONS • PICK UP: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) • 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 • ASSOCIATED CB# • NO CHANGE IN USE/NO CONSTRUCTION • CHANGE OF USE / NO CONSTRUCTION >e$'APPLICANT'S SIGNATURE DATE Inspection List Permlt#: CB121794 Type: PME DONNELLY RES-ADD A/C PRE PLUMBED Date Inspection Item Inspector Act Comments 09/17/2012 43 AirCond/Furnace Set - RI 09/17/2012 43 AirCond/Furnace Set PB AP 09/17/2012 49 Final Meclianical PB AP Tuesday, September 18,2012 Page 1 of 1