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Home My WebLink About1870 BIENVENIDA CIR; ; CB041011; Permit* City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Building Inspection Request Line (760) 602-2725 03-26-2004 Miscellaneous Permit Permit No: CB041011 Job Address: Permit Type: MlSC Subtype: OTHER Status: ISSUED Parcel No: 2072504700 Lot #: 0 Applied: 03/26/2004 Valuation: $0.00 Entered By: SB Reference #: Plan Approved: 03/26/2004 Issued: 03/26/2004 Project Title: FORMANEK RES DEMO FIREPLACE Inspect Area: ADD WINDOW W16X8 HEADER REPLACE WINDOWS 1870 BIENVENIDA CR CBAD Applicant: FORMANEK SHEILA TR 1870 BIENVENIDA CIR CARLSBAD CA 92008 Owner: FORMANEK SHEILA TR 1870 BIENVENIDA CIR CARLSBAD CA 92008 Miscelaneous Fee #I Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT FEE $60.00 $0.00 $0.00 $60.00 Total Fees: $60.00 Total Payments To Date: $0.00 Balance Due: $60.00 L PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT dress) FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Unit No. Phase No. Total Y of units Assessor's Parcel X Existing Use Proposed Use Name Address City Statelzip Telephone I Fax I (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 [$5001). Name Address city Statelzip Telephone # State License X License Class City Business License # Designer Name Address City State/Zip Telephone State License Y of the work for which this permit is issued. 0 issued. My worker's compensation insurance carrier and policy number are: Insurance Company Policy No. Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$lo01 OR LESS1 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 secwe workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,00OL in addition to the cost of compensation, damages as provided for In Section 3706 of the Labor code. interest and attorney's fees. 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 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 and the structure is not intended or offered for sale perty who builds or improves thereon, and who does 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). 0 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/l am exempt under Section Business and Professions Code for this reason: 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone number I type 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 e permit from the air pollution control district or air quality management district? 0 YES 0 NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 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 YES 0 NO 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 NAME LENDER'S ADDRESS 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 ell City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit). 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 from the date of such permit or if the buildinrr or work authorized by such Dermit is suswnded or abandoned at any time after the work i Uniform Building Code). APPLICANT'S SIGNATU DATE - 8J - WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 09/08/2004 Permit# CB041011 Inspector Assignment: PY Title: FORMANEK RES DEMO FIREPLACE Description: ADD WINDOW W/6X8 HEADER REPLACE WINDOWS Type: MlSC Sub Type: OTHER Job Address: 1870 BIENVENIDA CR Suite: Lot 0 Location: OWNER FORMANEK SHEILATR Owner: FORMANEK SHEILA TR Remarks: DID NOT SAY WHAT TYPE OF INSPECTION Phone: 7609087706 Inspector: Total Time: CD Description Act Comment Requested By: CARL LEROY Entered By: CHRISTINE 14 Frame/SteeVBoltingMlelding 19 Final Structural Associated PCRsKVs Inspection History Date Description Act lnsp Comments 05/21/2004 11 FtgEoundatiodPiers AP PS 05/21/2004 14 Frame/Steel/Bolting/Welding AP PS -M-