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Home My WebLink About1677 BUENA VISTA WAY; B; CB120830; Permit05-04-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB120830 Building Inspection Request Line (760) 602-2725 Job Address: Perinit Type: Parcel No: Reference #: PC #: Project Title: 1677 BUENA VISTA WY CBAD St: B PME 1562001500 Lot#: MEDINA PROPERTY- EMERGENCY GAS LINE REPAIR FROM METER TO UNIT & RE ROUTE 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 Ovvner: MEDINA CONSTANTINO JR FAMILY TRUST 05-14-01 399 ESCONDIDO AVE VISTA 92084 760 822-2508 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, reseivations, or other exactions hereafter collectively referred to as "fees/exactlons." You have 90 days from the date this permit was issued to protest imposition of these fees/exactlons. 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/exactlons of which vou have previously been qiven a NOJICE similar to this, or as to which the statute of limitations has oreviouslv otherorlse expired. ^ CITY OF CARLSBAD Building Permit Appiication 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717/2718/2719 Fax: 760-602-8558 www.carlsbadca.gov Plan Check No. Est. Value Plan Ck. Deposit Date SWPP JOBADDRESS y^7 7ABC BuB/^^ y/^T/i Moy I LOT/ r ' I PHASE# I#OF UNITS # BEDROOMS SUITE#/S^ei!IIWJNIT# # BATflESlo^' CT/PR0JECT# TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIFnON OF WORK: /ncfud* Squara Faat of Atftctad Araafs) EXISnNG USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YESO # NOO AIRCONDITIONING YES • No n FIRE SPRINKLERS YES • NOD APPUCANT NAME (Primary Contaet) APPUCANTNAME (Sacondary Contact) ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE EMAIL FAX PHONE EMAIL FAX PROPERTY OWNER NAME CONTRACTOR BUS. NAME ADDRESS ADDRESS Iff CI//C Ce/yr&L. dn. CITY STATE ZIP CITY / PHONE FAX PHONE wmr ICLASS ' I CITY BUS. LIC.# _ . ARCH/DESIGNER NAME & ADORESS (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct alter, Improve, demolish or repair any structure, rfFlor 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 mat 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' CQMPENSATION Woihers' Compensation Declaration: //lerety affimi uncier penalty af perjury one cS9ie 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, fbr the perfonnance of the work for which this permit is Issued. G I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, fbr the peribrmance of the work Ibr which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. Policy No. . Expiration Date This section need not be completed If the pemilt is fbr one hundred dollars ($100) or less. "if Certificate of Exemption: I certify that in the performance of the work for whk;h this permit is issued, I shall not empkiy any person In any manner so as to become subject to the Workers' Compensation Laws of Califbrnla. WARNING: Failure to secure workers' compensation coverage It unlawful, and shall subject an employer to criminal penalties and civil flnes up to one hundred thousand dollars (fttOO ,000), in addition to the cost of compensation, 6ggSfl0k providedbr^ Se{tjaii-H06 of the Labor code. Interest and attomey's fees. .^CONTRACTORSIGNATURE DAGENT DA'{^//--/2^ OWNER-BUILD'^R OBCLARATION I hereby affinn that I am exempt from Contractor's Ucense IJIW for the foliowing reason: O 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 pioperty who bulkls or Improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offeied fbr sale. If, however, the building or impiovement is sold within one year of completion, the owner^uilder will have the burden of proving that he did not build or Improve for the purpose of sale). O 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 bulkts or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). • 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 improvemenL O Yes a No 2.1 (have / have not) signed an applk:ation for a building permit for the proposed work. 3.1 have contracted witli Ihe following person (firm) to provide the proposed constructkin (include name address / phone / contractors' license nuinber): 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. i will provide some of the work, but I have contracted (hired) the foilowing persons to provide the work Indicated (Include name / address / phone / type of work): >ef PROPERTY OWNER SIGNATURE •AGENT DATE 71 # L ETl THIS SECTION FOR NON-RESIDENTIAL BUILOING PERMITS ONLY 1^ applicant or future buikling oaupant required to submit a business plan, acutely hazanlous materials registration form or risk management and prevention program under Sections 25505,25533 or 25534 of the '^sley-Tanner Hazardous Substance Aaount Act? 13 Yes ONo Is the applicant or future building oaupant required to obtain a permit from the air pollutkin control district or air quality management district? O Yes • No Is the facility to be constnjcted within 1,000 feet of the outer boundary of a school site? • Yes • 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 POLLUnON CONTROL DISTRICT. CON ST RUCTION LENDING ACENCY I hereby affimi that there is a construction lending agency for the perfbrmance of the work this permit is issued (Sec. 3097 (I) Civil Code). Lender's Name Lender's Address APPLICANT CERTIFICATION I certif that I have lead the applkatlon and state that the above infonnatton Is conect and that the lnfbnnatk)n on I hereby aulhorize representative of the 01^ of Cailsbad to enter upon the above mentkml ^ AGAINST ALL UABILTTIES, JUDGMENTS, COSTS AND DCPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CtTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA pennit Is lequired for excavattons over 5'0'deep and deiiiolllion or constructkm of sln^ B(PIRATION: Eveiy pemt issued by the BuiUing Oflicial under the praviswns 0f this Code s^ 180 days fiiirn Ihe date (tf such pemiit or if the byUrig or vwrk a^^ ^^i^^ DATEjT-^-/^ ^e^APPUCANT'S SIGNATURE 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 vww.buildina(a.cai1sbadca.qov or Mail the completed fbrm to City of Carlsbad, Building Diviston 1635 Faraday Avenue, Carlsbad, Cdifomia 92008. C0#: (Offlce Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. UC. No. DEUVERY OPTIONS a PICK UP: a CONTACT (Usted above) • OCCUPANT (Usted above) • CONTRACTOR (On Pg. 1) • MAILTO: • CONTACT (Usted above) • OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) • MAIL/FAX TO OTHER: • ASSOCIATED CB# • NO CHANGE IN USE/NO CONSTRUCTION • CHANGE OF USE/NO CONSTRUCTION 4l$'APPUCANrS SIGNATURE DATE Inspection List Permit*: CB120830 Type: PME Date Inspection Item 05/08/2012 23 Gas/Test/Repairs 05/08/2012 29 Final Plumbing 05/04/2012 23 Gas/Test/Repairs Inspector Act Rl PB AP PB AP IVIEDINA PROPERTY- ElVIERGENCY GAS LINE REPAIR FROM METER TO UNIT Comments Wednesday, IVlay 09, 2012 Page 1 of 1