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Home My WebLink About1677 BUENA VISTA WAY; A; CB120829; Permit05-04-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/MeGhanical/Electrical (PME) Permit Permit No: CB120829 Building Inspection Request Line (760) 602-2725 Job Address: Pennit Type: Parcel No: Reference #: PC #: Project Title: 1677 BUENA VISTA WY CBAD St: A PME 1562001500 Lot#: MEDINA PROPERTY- EMERGENCY GAS LINE REPAIR FROM METER TO UNIT Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 05/04/2012 LSM 05/04/2012 05/04/2012 Applicant: K DRURY AND SONS CONSTRUCTION 399 ESCONDIDO AVE VISTA 92084 760 822-2508 Owner: MEDINA CONSTANTINO JR FAMILY TRUST 05-14-01 2448 FLAMETREE RD VISTA CA 92084 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees $150.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $150.00 Total Fees: $150.00 Total Payments To Date: $150.00 BalanceDue: $0.00 Inspector: FINAL APPROVAL Date: Clearance: NOTICE: Please take NOTICE that approval of your project Includes the "Imposition' of fees, dedications, reservations, or other exactions hereafter collectively refen-ed to as lees/exactions." You have 90 days from the date this penmit was Issued to protest imposition of these fees/exaotions. 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 Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set askJe, void, or annul their Imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactlons DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or sen/tee fees In connection with this project. NOR DOES IT APPLY to any fees/exactlons of which vou have oreviouslv been oiven a NOTICE similar to this, or as to which the statute of limitations has oreviouslv othenvise expired. ^ CiTY OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 www.carlsbadca.gov JOB ADDRESS I LOT/ ' ' I PHASE # I# OF UNITS # BEDROOMS Plan Check No. C6> | 5Q^Q9' Est. Value Plan Ck. Deposit Date SWPP CT/PR0JECT# TENANT BUSINESS NAME DESCRIPTION OF WORK: /nclude Square Feet of Affected Area(s; , ^ppcj^rj; ui/0iif5/L C-rj^uyp ^AS l^fjje /^c?/n /neT^fi-S / o iLAJnS CONSTR. TYPE OCC. GROUP EXISnNG USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YESa # NOD AIR CONDITIONING YES n NOD FIRESPRINKLERS YES • NO • APPUCANT NAME (Primary Contact) APPLICANT NAME {Secondary Contaet) ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE EMAIL FAX PHONE FAX EMAIL PROPERTY OWNER NAME CONTRACTOR BUS. NAME ADDRESS ADDRESS ESS ^ "Sff C///C de^/r&i' O/L-CITY STATE ZIP CITY PHONE FAX PHONE .T^in^ispy y/y)-tOL^y)^^^ EMAIL ICLASS T' I CITV BUS. LIC.# _ ' ARCH/DESIGNER NAME & ADDRESS Mt i.i\..Tr ' (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct alter, improve, demolish or repair any structure, rffior to its issuance, also requires the applicantfor such permit to file a signed statement that he is licensed pursuantto the provisions ofthe Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom, and the basis forthe alleged exemption. Any violation of Section 7031.5 by any applicantfor a permit subjects the applicant to a civil penalty of not more than five hundred doiiars ($500)). t'W O RKERS' C O M P E N Si^ TJ O'N Workers' Compensation Declaration: / hereby affm under penalty of perjury one of the following declarations: C\ I liave 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. 1^ I have and will maintain workers' campensation, as required by Section 3700 of the Labor Code, fbr the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. Policy No. Expiration Date This sectian need not be completed ifthe permit is for one hundred dollars ($100) or iess. Certificate of Exemption: I certify that ih 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 Califomia WARNING: Failure to secure workers' compensation coverage is unlawful, and shaii subject an employer to criminai penalties and civil fines up to one hundred thousand doiiars (&100,000), in addition to the cost of compensation, dggl^e^ providedbrj^ Settio»4706 of the Labor code, interest and attomey's fees. ^CONTRACTORSIGNATURE -'^T^^f^^^^^^^^^^^^^y^ nAGENT ^''^^"/l^ 5S5Si<^ O W'i'tR ^. B ,U I L D ^ R O'i C .1. ARA Ti O H t hereby affinn that I am exempt from Contractor's Ucense Law for the foitowing reason: • 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). n 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: 1.1 personally plan to provide the major labor and materials for construction of the praposed property improvement • Yes • No 2.1 (have / have not) signed an application for a building permit for the proposed work 3.1 have contracted with the following person (fimi) to provide the proposed construction (include name address / phone / co ntractors' license number): 4.1 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 / contractors' license number): 5.1 will provide some ot the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): ^eTpROPERTY OWNER SIGNATURE •AGENT DATE COMPLETE THIS SEiCTI0N F O If •* O N - R E $ I O E N T iK^^ PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, xutely hazardous materials registration form or risk management and prevention program under Sections 25505,25533 or 25534 of the Presiey-Tanner Hazardous Substance Account Act? OYes nNo Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? • Yes • No Isthefacilitytobeconstructedwithin LOOOfeetoftheouterboundaryof aschoolsite? DYes aNo 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. CONSTR OCT ION IB NO 1 HG A Ci 1 N C Y I hereby affimn that there Is a construction lending agency for the perfomnance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address I certhy that I have read the application and state thatthe above Infbmiation Is conect and that the inforniation on the plans Is accuiate. I agree to comply with all City ordinances and State laws relating to building constniction. I hereby authorize representative of the City of Cailsbad to enter upon Ihe above mentkmed property fbr Inspectkm puiposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CfTY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CfTr IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSIHA: /V\ OSHA perniit Is required fbr excavatkms over S'O' deep and demolition or constmctkin of structure over 3 stories in heighL EXPIRATION: Eveiy permit Issued by the Buikling Oflicial under ttie provisbns of this Code shall expire by imitatkm and become nui and voki if the buikiing or woik auttxxized by such permit Is not commenced wittiin 180 days from ttie date of such perniit or If ttie buMpa^ woik autt)|X^ed4i5Scich perniit is suspended or abandoned at any time after ttie wodc is commenced fbr a period of 180 days (Sectkm 106.4.4 Uniform BuMng Code). vg^APPLICANT'S SIGNATURE "^^^'^^/ST^^i^::?*^ 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.bulldina(a)carlsbadca.gov or Mail the completed forni to City of Carlsbad, Building Division 1635 Faraday Avenue, Carisbad, Califomia 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP cmr STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LiC. No. DELIVERY OPTIONS • PICK UP: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) • MAILTO: • 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 ^APPLICANT'S SIGNATURE DATE Inspection List Permit#: CBl 20829 Type: PME MEDINA PROPERTY- EMERGENCY GAS LINE REPAIR FROM METER TO UNIT Date Inspection Item 05/08/2012 23 05/04/2012 23 05/04/2012 29 Gas/Test/Repairs Gas/Test/Repairs Final Plumbing Inspector Act Comments Rl PB AP PB AP Wednesday, May 09, 2012 Page 1 of 1