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Home My WebLink About1845 CHESTNUT AVE; ; CB042386; Permit06-J 5-20*04 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB042386 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 1845 CHESTNUT AV CBAD MISC 2052303100 $2,664.00 Subtype: REROOF Lot #: 0 MEJIA RES 24SF COMP SHINGLE Status: ISSUED Applied: 06/15/2004 Entered By: FM Plan Approved: 06/15/2004 Issued: 06/15/2004 Inspect Area: Applicant: KNOX ROOFING 4008 WOOSTER DR 92056 760726-6120 TOTAL PERMIT FEES Owner: MEJIA FAMILY TRUST 12/21/89 1845 CHESTNUT AVE CARLSBAD CA 92008 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees $77.00 $0.00 $0.00 $77.00 Total Fees:$77.00 Total Payments To Date:$0.00 Balance Due:$77.00 4480 06/15/04 0002 01 02 CC3F-77 = 00 DATE SIGNATURE PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 ft;,, -;CT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Validated By Date C-IS Address (include Bldg/Suite tt) Legal Description Assessor's Parcel # £?lFl/—1 Description of Work " Business Lot No. Subdivision Name/Number Existing Use SO. FT. .f #of Stories Name (at this address) Unit No. Phase No. Proposed Use # of Bedrooms Total tt of units » of Bathrooms Name Address City ICANT Sf Contractor •'' D Agent for Contractor Q Owner - Q Agent for Owner State/Zip Telephone tt Fax » Name Address City State/Zip Telephone tt 5. 'CONTRACTOR-COMPANY NAME ?,. v . -* • • - •-, '. (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 civil penalty of not more than five hundred dollars [$5001). LA Name State License # Address License Class City State/Zip City Business License tt Telephone tt Designer Name Address City State/Zip Telephone State License # 6. WORKERS'COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the 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, for the performance of the work for which this permit is issued. 0 I 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 insurance carrier and policy number are: Insurance Company ?T%?rf /^J/i/-^? Policy No. OnQj%'J(}-^(?ne-/ Expiration Date fl J - QJ-^fPC? (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) f~) 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 additionjto the cpstof_compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE ^>^^^^ DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason: f~] 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). 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 builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). l~l 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) sighed 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 COMPLETE THIS SECTION, FOR NON-RESIDENTIAL BUILDING PERMITS ONIYi , ,, -„,.',,,,., 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? - D 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? Q YES CH NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? CD YES d 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. 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 ADDRESSLENDER'S NAME .3"... APPLICANT CERTIFICATION »,* •,T,..,, .. , , ,„ ,...;-. .-_.•",„.,.,. ., ,,,',, I certify that I have read the application and state that the above information is correct and that the information on the 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 180 days frornthe 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 comrrjenc,edjor a period of^BO^dayMSection 106.4.4 Uniform Building Code). _&^7^. DATE WHITE: File YELLOW: Applicant PINK: Finance APPLICANT'S SIGNATURE City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS: X^^T <^<P?tt/f/r S?^ (sf^M^M£? G^ 2. TYPE OF BUILDING: RESIDENTIAL ^^ COMMERCIAL 3. ROOF SLOPE: RISE^7^ inches in 12 inches 4. NUMBER OF EXISTING ROOF COVERING (circle one) 1 (?) 3 5. TYPE OF EXISTING ROOF COVERINGx^^^SHEATHING f *6. NEW ROOF MATERIAL ir^/' CLASS^xQVEIGHT PER SQUARE 7. DUMBER OF SQUARES 8. TRADE NAME (rrf/?' MANUFACTURER 9. ROOF SYSTEM LISTING UL No. _JCBO 10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE /^^, WEIGHT OF THE PROPOSED ROOF? (_YJS^ NO All 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 .^ - y^^____ _ Date Contractor \ Owner Contractor Name *6 - Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. City of Carlsbad Bldg Inspection Request For: 07/20/2004 Permit* CB042386 Title: MEJIA RES 24SF COMP SHINGLE Description: Inspector Assignment: JM 1845 CHESTNUT AV Lot 0 Type:MISC Sub Type: REROOF Job Address: Suite: Location: APPLICANT KNOX ROOFING Owner: MEJIA FAMILY TRUST 12/21/89 Remarks: Phone: 7604734545 Inspector: Total Time: CD Description 19 Final Structural Act Comment Requested By: NA Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments 06/17/2004 15 Roof/Reroof AP JM OK TO COVER EXISTING PLY so POLICYHOLDER COPY COMPENSATION i N S U R A N C E P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 FUND ISSUE DATE: CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 01-01-2004 ! CONTRACTORS STvATE LICENSE BOARD ATTN: WORKERS' ;COMP. UNIT BOX 26000 ; SACRAMENTO CA i 95826 SD GROUP: OOO285 ! POLICY NUMBER: 000183O-2O04 CERTIFICATE IDv 1 CERTIFICATE EXPIRES: 01-01-20O5 01-O1^2004/01-01-20O5 LICENSE NUMBER: LIC #424063 INCEPTION DATE: 01-01^2004 D.O.: SD 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. 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 msuranbe 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. ; ! AUTHORIZED REPRESENTATIVE: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 EMPLO¥E|S UNDER THIS POLICY. i ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-20O4 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.; EMPLOYER LEGAL NAME KNOX ROOFING COMPANY i»008 WOOSTER DR:: I OCEANS IDE CA 92656 KNOX, ULYSSES(GRANT (III) AND KNOX, SALLY (REV.3-03)12-17-2003 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND