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HomeMy WebLinkAbout1925 CALLE BARCELONA; 161; CB070565; PermitV,• , 03-29-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB070565 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 1925 CALLE BARCELONA CBADSt 161 MISC Subtype 2550120400 Lot # $000 THE FORUM @ CARLSBAD DEMO FOR FUTURE Tl OTHER 0 Applicant RUSSELL FILAND BUILDERS STEC-56 18001 NORTH 79TH STREET GLENDALEAZ 85308 Status ISSUED Applied Entered By Plan Approved Issued Inspect Area 03/01/2007 MDP 03/01/2007 03/01/2007 PY Owner BORDERS INC <LF> FOURTH QUARTER PROPERTIES XXX L C/ODELOITTETAXLLP POBOX 131071 CARLSBAD CA 92013 Miscelaneous Fee#1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT $6000 $000 $000 $6000 Total Fees $60 00 Total Payments To Date $6000 Balance Due $000 PLANS IN STORAGE " ATTACHED Inspector Date Clearance NOTICE Please take NOTICE/nat approval of your project includes the Imposition" of fees, dedications, reservations or other exactions hereafter collectively referred to as "fees/enactions 'YOU have 90 days from ihe dale !his 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 DCES IT APPLY to any fees/fexaclions 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 ONLX-. PLAN CHECK NO O / EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite #)Business Name (at this address) Legal Description Assessor's Parcel # Vie.\vvQ ^\U7, \~w-ijvrj. Description of Work Lot No Subdivision Name/Number \AA/v-C_£AjvvV-ta, Existing Use SQ FT # of Stones Unit Mo PhrfseNo WX-fcv- C CXvv>>-A* Proposed Use 0 ft of Bedrooms Total # of unite # of Bathrooms Address Fax* "I\VL' i^i Address City State/Zip Telephone # City State/Zip Telephone ftName Address (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 thai he is licensed pursuant to the provisions of the Contractors 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 [$500])v\ Name State License # "~l ^U CP *A Designer Name State License # Address License Class S-~i Address City City State/Zip Cilv Business License # State/Zip Tetephonep A C-i £1^ Cj"""- ***•/ ^"^1 C/ yC Telephone # (. 6'f f i WORKERS COM^t^ATJONlJ, ,"[j$f!J %$$£*> '' ^WL , I! ^ !«P!IJ[ !V!! Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations D 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 (his permit is issued QJ I have and will maintain worker's 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 compensationirisurancjfjamer and policy number are *»/ a k^i ' / i Insurance Company 'T^/ffft^^Jfflf^^ /*££, C& Policy No Q/\JQrfr(Q jCCs Expiration Date trr 1£ ^~7 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) D CERTIFICATE OF EXEMPTION I certify that in the performance of the work for which this permit is issued I shall not e mploy any person in any manner so as to become subject to the Workers Compensation Laws of California WARNING Failure to securfuttadurs' compensation coverage is unlawful, and shall subject an employer to criminal penalties amd civil lines up to one hundred thousand dollars($100,OOQ}, in adjIffTon to^i cjst o^prifapan^ation, damages are provided for in Section 3706 of the Labor Code, interest and attorney's fee .-^ ^ DATE: 3/1 |;£|!sOWNE^ILDERDECUVRA|lpNB^ IP'-^^ll *>? ? WC611 <f J I 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 d 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-butlder will have the burden of proving that he did not build or improve for the purpose of sale) D I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec 7044 Business and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon and contracts for such projects with contrador(s) licensed pursuant to the Contractor's License Law) D 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 D YES D NO 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 / addiess / ptione 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 / /ontractors 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 WHITE File YELLOW Applicant PINK Finance PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad CA 92008 Page 2 of 2 CPMPIELEJHIS SE^ Is Ihe applicant or future building occupant required to submit a business plan acutely hazardous matenals registration (or or risk management and prevention program under Sections 25505 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' D YES D NO Is Ihe facility to be constructed within 1 000 feet of the outer boundary of a school site'' D 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(1) 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 all City ordinances and State laws relating to building construction I hereby authorize representatives of the City 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 JUDGEMENTS, 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 of 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 autnonzed by such permit is not commenced within ISOJaifS-ttom 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 o^TSSdays ^Ejtion 10^14 Uniform Building Code) APPLICANTS SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 03/28/2007 Permit# CB070565 Title THE FORUM @ CARLSBAD Description DEMO FOR FUTURE Tl Inspector Assignment Type MISC Sub Type OTHER Job Address 1925 CALLE BARCELONA Suite 161 Lot 0 Location APPLICANT RUSSELL FILAND BUILDERS Owner Remarks DEMO Phone 5804918767 Inspector Total Time CD Description 19 Final Structural Act Comme Requested By TERRI Entered By BINSPECT Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description - Act Insp Comments Project Info Project Chico's/Soma The Forums 1925 Calle Barcelona, Bldg #5 Ste # 161 & 162 Carlsbad, CA 92009 General Contractor Russell - Filand Builders, Inc Contact Kyle Sheehan or Tiffany Russell 1800 IN 79th Ave Ste , #C-56 Glendale, AZ 85308 Phone 623-412-8999 Description of Demo work Remove all existing sales area fixtures, displays, doors and flooring Disconnect and remove all existing electrical stub ups All above floor conduits, j-boxes and outlets shall be cut off at floor level Remove existing mezzanine, stairs and all associated framing members Remove existing air supply, difrusers, ceilings, light fixtures and soffits Remove all existing rest room plumbing fixtures From Patty Daminguez At Minard-Ames Insurance FaxlD Mmard-Ames Insuranc To Knstien Lash Date 2/27/2007 0343PM Page 2 of 5 .ACORD,, CERTIFICATE OF LIABILITY INSURANCE wffiiW1 PRODUCER Minard-Ames Insurance Group 4646 E van Buren 3t , #200 Phoenix AS 85008 Ehone- 602-273-1625 INSURED Russell-ffiland Builders lac 18001 North 79th Ave Sto c-56Glendale AZ 85308 DATE (MM/DD/mY) 02/27/07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES! NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE USURER A Valley Forge Insurance Co NSURP38 QontliMnt«l Caaualty Conpiny NSURETC West Chester Surplus Lines NSI.RF^n PEaneportation In»ui«lo» Co USURER E NAICtf 2Q508 20443 20494 COVERAGES THF =lil iriF^OFINSURANTF! ISTPDHFIOtt -IAVF R=FN SSI JFD TO ThF NS1 IRF") NAVFT) AROVF FORTHF PTI trf R-FRiOn INDtnATFT \OTW1~HST ANTING AN" REQUIREMENT TERM Dfi CONDITION OF «NY CONTRACT OR OTHER DOCUVENT A'lTH RESPECT TO WHICH THIS CERTIFICA-E MAV BE ISSUED Of! MAY PEfTTAW THE INSURANCE AFFORDED B/ THE POLICIES DESCUBED HEREIN IE SUBJECT TO «L_ THE TrHMS EXCLUSION AND CONDIT ONS OF EUCH POLICIES AGGREGATE LIMITS SHOWN MAC HAVE BEEN REDUCED 3Y PAID CLAIVS LTR A B B D C NSR TYPE OF INSURANCE GENERAL LIABILITY X COMME^CliU CEtJER^. Ll^aLfTY _bhVL A*Pbfa«b U Wl *M^Vb^ AUTDMoaiLE LIABILITY X .\WY /WJTO ALL OVWsED AUTOS SCHEDULED AITOS X NUN-OWNtJAUILfo GAfeACE LIABILITY 1 ANY AUTO ~1 EXCE9SAJMBRELLA LIABILITY X_] UJLL1H | CLAIMS VAUb n=ri *~~ IH F X [RETENTION tO WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP^lE~OR.'PARTNE:VEXEa.TIVE If /w irtstrttw uxerSPECIAL PROVISIONS ix>kw OTHER Pollution Iiiab POLICY NUMBER 2084946931 2092205042 2092205073 ' 2084946900 S22067667-002 DATE (MWDD/YY) 12/01/06 12/01/06 12/01/06 12/01/06 04/07/06 POLICE EXPIRATIONDATE (MWDD/YY) 12/01/07 12/01/07 12/01/07 12/01/07 04/07/07 LIMITS EACH y. CURREtvCE DAMAGE TO RENTED PREMISE S ,Ea «_,-uiwiuu) VEDEXF1 Ally JIM uwbU } PEKSOfil 4 ADV MURV GENERAI /»GGRE3*TE HWCXXK- 1 !s - CUMH/Jh fliaL, COMBINED SIN3LE LIMITiCaaicidsrr) BCDLi'lUJRY DCDI_/ I'UJRYiPsr sccio'ent) PROPEFTY DAMAGE iP«raccid«nt) AUTCO^i-Y EA ACCIDENT cm-FBTW4N ^*CC NJTC 0-i.Y ,„A5G EACH OCl-URRfNCE AbUfebAls X EL EL £L TORY LIMITS ER EACH ACCIDENT DISEASE -EAEMPLOi-rE DISEASE -POL ICY. MFT s 1,000,000 £300,000 s5,000 51,000,000 ^2, 000, 000 '.2,000,000 si, 000, 000 s G s G s £ s 10,000,000 blO, 000, 000 s s e s 1,000,000 sl,000,000 si, 000,000 Claim 1,000,000 Atjgregate 1,000/000 DESCRIPTION Op OPERATIONS/ LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL P KUWISIUNS A07-014 & A07-015, Chico's & Soma,Tne Forum 8 Carlsbad, 1925 Calle Barcelona, Carlsbad, CA; Additional insured for general liability: Fourth Quarter Properties 30 LLC s Thomas Enterprises Inc, Chi GO'S FAS Inc fi its subsidiaries & Arc vision * Except 10 days for nonpayment of premium CERTIFICATE HOLDER CANCELLATION CHIF001 Chico ' s FAS , Inc . and Subsidiaries 11215 Metro Parfcway Ft Meyers FL 33912 SHOULD ANY OF THE ABOVE DESCRIBED POLICE!* BE CANCELLED BEFORE THE EXPIRATION OATETHSREOF Uffi ISSUKG INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 9O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KWCI UPON THE INSURER' ITS AGENTS OR REPRESENTATIVBl ALnHo^^e^™^^^^** ^ ACORD 25 (2001/08)© ACORD CORPORATION 1938