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Home My WebLink About1885 CHESTNUT AVE; ; CB050695; Permit03-08-2005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB050695 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 1885 CHESTNUT AV CBAD MISC 2052302500 $2,928.00 Subtype: REROOF Lot #: 0 HJELT RES- 24 S BUILDUP REROOF Status: ISSUED Applied: 03/08/2005 Entered By: LSM Plan Approved: 03/08/2005 Issued: 03/08/2005 Inspect Area: Applicant: KNOX ROOFING 4008 WOOSTER DR 92056 760726-6120 Owner: HJELT JEANNE M TRUST 04-19-04 1885 CHESTNUT AVE CARLSBAD CA 92008 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees $77.00 $0.00 $0.00 TOTAL PERMIT FEES $77.00 Total Fees:$77.00 Total Payments To Date:$0.00 Balance Due:$77.00 3276 03/08/05 0002 01 02 CGP 77. Inspector: FINAL APPROVA Date: ROVAL v >^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 fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. PERMIT APPLICATION CITY'OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposi, Validated By Dan Address (include Bldg/Suite #) Legal Description Assessor's Parcel tt Description of Work Business Name (at this address) Lot No. Subdivision Name/Number Unit No. Phase No. Existing Use SQ. FT. Proposed Use #of Stories # of Bedrooms Total tt of units «2 # of Bathrooms 2. CONTACT PERSON (if different from applicant) Name Address City 3. APPLICANT CS'Contractor ' Q Agent for Contractor fj Owner " Q Agent for Owner State/Zip Telephone #Faxff itV ^»S€^*'State/ZipName 4. PROPE Address Telephone # OWNER 'JT'JS V Address City State/Zip Telephone #Name 5. CONTRACTOR*-COMPANY NAME ", ' f (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 [$500]). Name State License # O&> Address License Class City &&yfo/f/*U State/Zi^ ^J^lephone citV Business License tt / 2. f) (> */ 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: 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. O1' 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 S'paT'f^ ^C>Sl/S? _ Policy ^o. (•)£)()/ J^? p -.xtyPj"" Expiration Date Q / ~ C>S - (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) CJ 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 ($1QO,pOO), in addition. to the-'^ost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE /C&j&A&f Jgf/^^^P* _ _ DATE g—ffJ^OS' 7. ,- , OWNER-BIDDER DECLARATION : 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: D 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). PI 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). f~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 f~lNO 2. I (have / have not) signed 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-RESIDENimmuitolNGiPERtMTS ONLY 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? C] YES O 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 O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? [3 YES Q 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. 8. CONSTRUCTION LENDING AGENCY 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 9. Y-APPLICANT CERTIFICATION 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 from the 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 commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE /^^fjA >!?X!g^ DATE J?« WHITE: File YELLOW: Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS:. 2. TYPE OF BUILDING: RESIDENTIAL i^ COMMERCIAL 3. ROOF SLOPE: RISE ^//^ inches in 12 inches 4. NUMBER OF EXISTING ROOF COVERING (circle one) Q 2 3 5. TYPE OF EXISTING ROOF CQVERINO^/T^SHEATHING *6. NEW ROOF MATERIAL ^/^ C L AS S^f_ WEIGHT PER SQUARE 7. "NUMBER OF SQUARES 8. TRADE NAME frs? /- _ MANUFACTURER 9. ROOF SYSTEM LISTING UL No^f<?//V^ ICBO No.^ _ . 10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? YES 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 £>6£xs*/ ^f/A^^^ Date_w — T^^_—L --X '"'«'»'>' ^ Contractor ?^ Owner Contractor Name /fafiYS[ *6 - Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. City of Carlsbad Bldg Inspection Request For: 06/02/2005 Permit* CB050695 Title: HJELT RES- 24 S BUILDUP REROOF Description: Type:MISC Sub Type: REROOF Job Address: 1885 CHESTNUT AV Suite: Lot 0 Location: APPLICANT KNOX ROOFING Owner: HJELT JEANNE M TRUST 04-19-04 Remarks: CARD WILL BE OUTSIDE Inspector Assignment: TP Phone: 7607292724 Inspector^ Total Time: CD Description 19 Final Structural Act Comment AlL Requested By: JEAN Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments 03/11/2005 15 Roof/Reroof AP PY 03/09/2005 15 Roof/Reroof PA TP VERF. T & G INSL. FOR SHTNG SD COMPENSATION INSURANCEFUND POLICYHOLDER COPY P.O. BOX 807, SAN FRANCISOXCA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-2005 \ CONTRACTORS STATE LICENSE BOARD ATTN: WORKERS' COMP. UN IT BOX 26000 SACRAMENTO CA 95826 :'" '" • ^ SD GROUP: OO0285 POLICY NUMBER: 0001830-2005 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 01-01-20O6 01-01-2005/01-01-2006 LICENSE NUMBER: LIC #424063 INCEPTION DATE: 01-01-2005 D;o. • - ;: so .' ;•"-••.,. 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 39 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 hernia Notwithstanding ?ny requirement, term, or condition of any contract or other document with respect to which this certificate of insurance .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'? LIABILITY LIMIT: INCLUDING DEFENSE COSTS? $i,obo;ooO;OO PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE IFOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. V \ ^ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2OQ5 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. "•,-. EMPLOYER LEGAL NAME KNOX ROOFING COMPANY 4008 WOOSTER DR :i OCEANS IDE CA 92Q56 KNOX, IILYSSES GRANT (III) AND KNOX. SALLY ! * ; (REV.3-03)PRINTED:P0409 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND