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HomeMy WebLinkAbout1857 PENTAS CT; ; CB122615; Permit• City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 01-16-2013 Residential' Permit Permit No: CB122615 Building Inspection Request Line (760) 602-2725 Job Address: 1857 PENTAS CT CBAD Permit Type: RESDNTL Sub Type: RAD Status: ISSUED Parcel No: 2155210500 Lot #: 0 Applied: 12/06/2012 Valuation: $72,056.00 Constuction Type: 5B Entered By: MDP Occupancy Group: Reference #: Plan Approved: 01/16/2013 # Dwelling Units: 0 Structure Type: Issued: 01/16/2013 Bedrooms: 0 . Bathrooms: 0 Inspect Area: Orig PC #: Plan Check #: Project Title: STEVENS RESIDENCE 547 SF GAMEROOM Applicant: Owner: WORTHING INC, B. A. STEVENS SPENCE L&SUE J STEG C '- 640 GRAND AV CC C 181PENTAS CARLSBAD CA 92008 AS BAD C -92011 760-729-3965 Building Permit $563.32-Mete Size.- .-$0.00 ©\( '-...-' Meter Fee Li U Add'I Building Permit Fee Add'I Red. Water Con. Fee $0.00 Add'I Plan Check Fee $0.00 SDCWA Fee $0.00 Plan Check $394.32 $0.00 Plan Check Discount $0.00 CFD Payoff Fee $0.00 Strong Motion Fee $7.21 PFF (3105540) $0.00 Park in Lieu Fee $0.00 PFF (4305540) $0.00 Park Fee $0.00 License Tax (3104193) ' \ '7) $0.00 LFM Fee $O:OO License Tax (4304193) $0.00 Add'I Renewal Fee $0.00Traffic Impt Fee (3105541) - $0.00 Other Bridge Fee ?,-/ Bridge Fee $0.00 Traffic Impact Fee(4305541) $0.00 $0.00 SidvaIk Fee/ A BTD #2 Fee $0.00 BTD #3 Fee $0.00 PLUMBING TOTAL .j J $45.00 $o.00'\ ELECTRICALTOTA Renewal Fee L . $41.00 j$o.00 MECHANICALirOTAL $40.25 Other Building Fee /$0.00 \HàuingI atFê / $0.00 HMP Fee $0.00 Housing lñLieu Fee.. i I $0.00 Pot. Water Con. Fee $0.00 Housing CréditFèé,.,)-' $0.00 Meter Size , Master Drainie Fee $0.00 Add'I Pot. Water Con Fee $0.00 Sewè Fee $0.00 Red. Water Con. Fee \ $0.00;O Additional Fees $0.00 Green Bldg Stands (SB1473) Fee $1.00 Fiè'SrinkIer Fees $0.00 Green Bldg Stands Plan Chk Fee $0.00 j) TOTAL PERMIT FEES $1,092.10 if,, F'I..-._J Total Fees: $1,092.10 Total Payments to Date:-.1 Due: $0.00 S - •SJ I I HNAL-APPROVAL- InsDector: E. Date: VZ 3 Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition of fees, dedications, reservations, or other exactions hereafter collectively referred to as 'fees/exactions. You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. 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 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Storm Water Pollution Prevention Plan (SWPPP) Permit 01-16-2013 Permit No:SW120530 Job Address: 1857 PENTAS CT CBAD Permit Type: SWPPP Status: ISSUED Parcel No: 2155210500 Lot #: 16 Applied: 12/06/2012 Reference #: Entered By: MOP CB#: CB122615 . Issued: 01/16/2013, Inspect Area: Project Title: STEVENS RESIDENCE Tier: I 547 SF GAMEROOM Priority: M Applicant: Owner: WORTHING INC, B. A. STEVENS SPENCE L&SUE J STEG 640 GRAND AV ,¼',1857PENTASCT CARLSBAD CA 92008 CARLSBAD CA 92011 760-729-3965 Emergency Contact: .5 . BROOKS WORTHING 760 729-3967 5 SWPPP Plan Check $51.00 SWPPP Inspections . / ' " ,• $216.00 Additional Fees $000 TOTAL PERMIT FEES S $26700 ¼ 1 CO DR AlE / Total Fees: $267.00 jotal Payments To Date: $267.00 >Balance Due: / $0.00 S\ S / -' . -- - FINAL APPROVAL DATE i'-Z?-iRA _____ 10L LL U Plan Check No.()B(L Building Permit Application CITY OF 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value 760-602-2717/2718/2719 CARLSBAD Fax: 760-602-8558 Plan Ck. Deposit ___________________________ Date www.carlsbadca.ov 77~S 1 7 (F;°J'.4cI1.trsc, C <1- SUITE#/SPACE#/UNIT# APN ST/PROJECT 7 LOT IS I Include PHASE 55 55 OF UNITS IS BEDROOMS N BATHROOMS I TENANT BUSINESS NAME CONSTR. TYPE 0CC. GROUP DESCRIPTION OF WORK: Square Feet of Affected Area(s) i 647. f 24v rooh- (1)oy EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) I FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS YES 0 #_ NOD YES 0 NOD f YES 0 NOD APPIIr.ANT NAME (Primary Contactf Broocs lovi-hi fl APPLICANT NAME (Secondary Contact) 0._3ox__IO4 DDRESS ADDRESS __________________________________ CITY CLIr'Ltb(l ci STATE ZIP CA. C1 2.0 I e) CITY STATE ZIP _______________________________________________ PHONE i'7ZCi 3C5 IFAX I7(0 -7 7-9- 74 PHONE IFAX I EMAIL bwori-hrclnc-D yahoo. coryl EMAIL PROPERTY OWNER NAME CONTRACTOR BUS. NAM \j.Jor-h1n3 tfl(.... ADDRESS es-i 'c7'@r Cf ADDRESS P0. Box 1041 CITY kep V CA- STATE ZIP CITY STATE ZIP Cor(5bCci A. C1201 I PHONE l(oO72'1 —"2I FAX 707(97 - PHONE 1o•12• 3c 5 1FAX io- '7z.o78Li.. EMAIL_ -7. EMAIL baw't-Vin3trL (j.yahoo .ccni ARCH/DESIGNER NAME & ADDRESS I -O'tro ? _I STATE UC. IS STATE LIC.# 3B7(o Im_I_ I CITY BUS. LIC.# Zc (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 70315 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: thereby aftkin under penalty of perjury one of the following declarations: 0 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. I have and will maintain workers' compensation, as required by Section 370001 the Labor Code, for the performance of the work for which thifi,permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. Catte_Poi+N..ttiora_r't€._(f). Policy No. \PJCP_)(_.t Z"D _12.. Expiration Date C)l/ C) I I 3 This section need not be completed it the permit is for one hundred dollars (8100) or less. 0 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, tar9ges asptffideg for, lj(ectiOl13706 of the Labor code, Interest and attorney's fees. AK CONTRACTOR SIGNATURE []AGENT DATE I "/(o/ Z.. thereby affirm that lam exempt from Contractor's License Lawtor the following reason: CI I, as owner of the property or my employees with wages aktheir sole comensation, 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 b)tlQs or improv thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within oni'year.oLcdmpletion, 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 loan owner of property who builds 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: I personally plan to provide the major labor and materials for construction of the proposed property improvement 0 Yes 0 No I (have! have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name address! phone! contractors' license number): 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! contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name! address! phone !type of work): 'PROPERTY OWNER SIGNATURE OACNT DATE 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? 0 Yes 0 No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYes 0 No Is the facility to be constructed within 1,000 feet of theouter boundary of a school site? I] Yes 0 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 0F EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lenders Name Lenders Address I certify that I have read the application and state thatthe above inlomiatlon ts correct and thatthe information on the plans is accurate. l agree to complywlthall City ordinances and State laws retatingto building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. IALSO 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 51)' deep and demolition or construction of structures over 3 stories in height EXPIRATION: Every permit issued by the Building OfficialundertheprovisionsofthisCodeshallexpirebyllrnitationand become null and void if the building or work authorized by such permit is not commenced within 180 days horn the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time alter the work is commenced bra period of 180 days (Section 106.4.4 Uniform Building Code). ..APPLICANT'S SIGNATURE DATE I 2_/41/I 2— Inspection List Permit#: CB122615 Type: RESDNTL RAD Date Inspection Item 04/23/2013 89 Final Combo 04/23/2013 89 Final Combo 03/18/2013 17 Interior Lath/Drywall 03/18/2013 18 Exterior Lath/Drywall 03/11/2013 84 Rough Combo 03/04/2013 13 Shear Panels/HD's 03/04/2013 23 Gas/Test/Repairs 03/04/2013 59 Final Pool 02/14/2013 15 Roof/Reroof 02/01/2013 11 Ftg/Foundation/Piers Inspector Act - RI PB AP PB AP PB AP PD AP PB •AP PB AP PB WC PB AP PB AP STEVENS RESIDENCE 547. SF GAMEROOMI/MOVE POOL EQUIP CommentS Wednesday, April 24, 2013 Page 1 of 1 Inspection List . . Permit#: 5W120530 Type: SWPPP . STEVENS RESIDENCE 547 SF GAMEROOM Date Inspection Item Inspector Act Comments 06/12/2013 602 Routine Inspection - RI 04/11/2013 602 Routine Inspection - RI 04/11/2013 602 Routine Inspection PB AP 03/12/2013 602 Routine Inspection PD AP 02/19/2013 600 Pre-con PB AP 02/19/2013 601 NPDES PB AP 01/22/2013600 Pre-con PB AP 01/22/2013 601 NPDES . PB AP Wednesday, April 24. 2013 . Page 1 of 1 Carlsbad 12-2615 1/11/13 EsGil Corporation In (Partners/lip wit/i government for (Building Safety DATE: 1/11/13 JURISDICTION: Carlsbad PLAN CHECK NO.: 12-2615 PROJECT ADDRESS: 1857 Pentas Ct. SET: II U APPLICANT U RIS. U PLAN REVIEWER U FILE PROJECT NAME: Game Room and Patio Addition to SFD The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: EsGil Corporation staff did not advise the applicant that the plan check has been completed. EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Email: Fax #: REMARKS: The notes clouded in red on sheet 4 of the approved plans from EsGil must be made to the city set of plans to make additional set of approved plans. By: Chuck Mendenhall Enclosures: EsGil Corporation DGA DEJ 0PC 1/8/13 llCORD co n EsGil Corporation Partnersllip wit/i government for(Building Safety DATE: 12/17/12 JURISDICTION: Carlsbad PLAN CHECK NO.: 12-2615 SET: I PROJECT ADDRESS: 1857 Pentas Ct. PROJECT NAME: Game Room and Patio Addition to SFD U APPt.-ICANT JURIS. U PREVIEWER U FILE The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. LI The applicant's copy of the check list is enclosed for the jurisdiction to-forward to the applicant contact person. The applicant's copy of the check list has been sent to: B. A. Worthing Inc, Att'n: Brooks Worthing P.O. Box 1041, Carlsbad, CA 92018 LI EsGil Corporation staff did not advise the applicant that the plan check has been completed. EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Brooks Worthing Telephone #: (760) 729-3965 Date contacted: I0,3,2.(by: ) Email: baworthinginc@yahoo.com Fax #: (760) 729-0784 Mail —TeIephone Fax- In Person LI REMARKS: By: Chuck Mendenhall EsGil Corporation [:1 GA DEJ EPC 12/10/12 Enclosures: 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax (858) 560-1576 Carlsbad 12-2615 12/17/12 PLAN REVIEW CORRECTION LIST SINGLE FAMILY DWELLINGS AND DUPLEXES PLAN CHECK NO.: 12-2615 PROJECT ADDRESS: 1857 Pentas Ct. FLOOR AREA: Game Rm= 540 sq ft Patio = 300 sq ft REMARKS: DATE PLANS RECEIVED BY JURISDICTION: DATE INITIAL PLAN REVIEW COMPLETED: 12/17/12 JURISDICTION: Carlsbad STORIES: existing two HEIGHT: no change DATE PLANS RECEIVED BY ESGIL CORPORATION: 12/10/12 PLAN REVIEWER: Chuck Mendenhall FOREWORD (PLEASE READ): This plan review is limited to the technical requirements contained in the California version of the International Residential Code, International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinance by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Present California law mandates that construction comply with the 2010 edition of the California Code of Regulations (Title 24), which adopts the following model codes: 2009 IRC, 2009 IBC, 2009 UPC, 2009 UMC and 2008 NEC. The above regulations apply, regardless of the code editions adopted by ordinance. The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of the 2009 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section. etc. Be sure to enclose the marked up list when you submit the revised plans. Carlsbad 12-2615 12/17/12 Please make all corrections, as requested in the correction list. Submit FOUR new complete sets of plans for commercial/industrial projects (THREE sets of plans for residential projects). For expeditious processing, corrected sets can be submitted in one of two ways: Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760) 602-2700. The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments. Bring one corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil Corporation is complete. Expand the notes found on sheet 2 under" Revised Floor Plan" to also indicate that Carbon Monoxide detectors are required on each floor level. 2. The South elevation on sheet 3 shows one 5050 sliding window in the existing Bed Rm #2. The floor plan on sheet 2 shows you are proposing 2- 34040 casement window. Provide consistent plans. Specify on sheet 4 the size of the new patio footings and specify the connection of the patio posts to the footings. The revised roof framing plan on sheet 4 references construction details E/3, G/3 and F/3. This is not correct. These details are found on sheet 4 of the plans not sheet 3. Specify on sheet 4 of the plans the size and spacing of the patio rafters. The proposed does not comply with conventional construction outlined in the CRC. Braced wall panels are required the following: A. mm. braced walls must be 25ft OC in both longitudinal and transverse directions. CRC R602.10.1.4. In the longitudinal direction the plans comply but in the transverse direction the braced walls are 36ft apart. B. Braced walls must be no more than 12.5 ft from the end.. The braced wall at the South end is shown 19ft from the end of the wall. C. Braced walls must be continuous to the roof diaphragms The braced walls between the addition and the existing where the high roof occurs do not extend to the roof sheathing. D. the new headers over the I Oft arched opening do not qualify as conventional. Submit structural design for the addition that will include a vertical and lateral code analysis of the addition. The energy design form CF-1R ADD page 3 of 5 is incorrect. Column 'E#' for the allowed glazing area should be the sum of columns C + D. and column F should be the area of the installed glazing. Every habitable space within a dwelling shall be provided with heating facilities capable of maintaining a room temperature of 68 degrees F at a location 3 feet above the floor and 2 feet from exterior walls in all habitable rooms. Show basis for compliance. CRC 303.8. Show how you intend to provide heating to the addition. Note on the plans that receptacle outlet locations will comply with CEC Article 210.52(A). Carlsbad 12-2615 12/17/12 10. Include on the plans the following specifications for electrical devices installed in dwellings: CEC Article 210 & 406. Tamper resistant receptacles for all locations described in 210.52 (i.e., all receptacles in a dwelling). Weather resistant type for receptacles installed in damp or wet locations (outside). Arc-fault protection for all outlets (not just receptacles) located in rooms described in NEC 210.12(B): Family, living, bedrooms, dining, halls, etc. 11. For a single-family dwelling unit (and for each unit of a duplex), show that at least one• receptacle outlet accessible at grade level will be installed outdoors at the front and back of the dwelling. CEC Article 210.52(E). This receptacle must be GFCI protected. 12. Show at least one wall switch-controlled lighting outlet to be installed the exterior side of outdoor entrances or exits. CEC Article 210.70(A). END OF CODE REVIEW To speed up the review process, note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review for your project. If you have any questions regarding these plan review items, please contact Chuck Mendenhall at Esgil Corporation. Thank you. Jurisdiction Code Icb IBy0rdinance Bldg. Permit Fee by Ordinance IV Plan Check Fee by Ordinance V Type of Review: l Complete Review ERepeuive Fee El Other , Repeats Hourly EsGil Fee $563.321 I $366.161 El Structural Only Hr. © * I $315.461 Carlsbad 12-2615 12/17/12 (DO NOT PAY— THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: 12-2615 PREPARED BY: Chuck Mendenhall DATE: 12/17/12 BUILDING ADDRESS: 1857 Pentas Ct. BUILDING OCCUPANCY: R3 TYPE OF CONSTRUCTION: VB BUILDING PORTION AREA (Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE ($) Rm Add 540 City Est patio 300 City est Air Conditioning Fire Sprinklers TOTAL VALUE 72,056 Comments: Sheet I of I macvalue.doc + CITY OF CARLSBAD CERTIFICATION OF SCHOOL FEES PAID B-34. Development Services Building Department 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov This form must be completed by the City, the applicant, and the appropriate school districts and returned to the City prior to issuing a building permit. The City will not issue any building permit without a completed school fee form. Project Name: Stevens Residence Prolect ID: CT/MS: Building Permit Plan Check Number: CB122615 Project Address: 1857 Pentas Ct. A.P.N 21542105-Oo Project Applicant (Owner Name): Sence & Sue Stevens Project Description: Game Room Building Type: Residential Residential: NEW DWELLING UNIT(S) - Square Feet of Living Area in New Dwelling/s• Second Dwelling Unit: Square Feet of Living Area in SDU Residential Additions: 547 Net Square Feet New Area . Commercial/Industrial: Net Square Feet New Area City Certification of Applicant Information: Carlsbad Unified School District 0 Vista Unified School District 0 San Marcos Unified School District 6225 El Camino Real 1234 Arcadia Drive 255 Pico Ave Ste. 100 Carlsbad CA 92009(760-331-5000) Vista CA 92083 (760-726-2170) San Marcos, CA 92069 (760-290-2649) ________________________________ • Contact: Nancy Dolce (By Appt. Only) 0 .Encinitas Unign School District 0 San Diegulto Union High School District-By Appointment Only 101 South Rancho Santa Fe Rd 710 Encinitas Blvd. Encinitas, CA 92024 Encinitas, CA 92024 - (760944-4300 xl 166) (760-753-6491) Certification of Applicant/Owners. The person executing this declaration ("Owner") certifies under penalty of perjury that (I) the information provided above is correct and true to the best of the Owner's knowledge, and that the Owner will file an amended certification of payment and pay the additional fee if Owner requests an increase in the number of dwelling units or square footage after the building permit is issued or if the initial determination of units or square footage is found to be incorrect,. and that (2) the Owner is the owner/developer ofthe above described project(s), or that the person executing this declaration is authorized to sign on behalf of the Owner. Signature: Date: B-34 • • Page 1 of 2 • Rev. 03/09 SCHOOL DISTRICT SCHOOL FEE CERTIFICATION (To be completed by the school district(s)). THIS FORM INDICATES THAT THE SCHOOL DISTRICT REQUIREMENTS FOR THE PROJECT HAVE BEEN OR WILL BE SATISFIED. SCHOOL DISTRICT: . . The undersigned, being duly authorized by the applicable School District, certifies that the developer, builder, or owner has satisfied the obligation..for school facilities. This is to certify that the applicant listed on page 1 has paid all amounts or completed other applicable school mitigation determined by the School District. The City may issue building permits for this project. • . . . .. SIGNATURE OF AUTHORIZED SCHOOL . . DISTRICT OFFICIAL. . • TITLE D-ey-\' 4t e4q aJ •• D - NAME OF SCHOOL DISTRICT CARLSBAD UNIFIED SCHOOL DISTRICT 6225 EL CAPAINO REAL . . . CARLSBAD1 CA 92009 . DATE . : • . •. • PHONE NUMBER • . . • . . . . . 71 -33t-coOO B-34 Page 2 of 2 Rev. 03109