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Home My WebLink About1960 LA COSTA AVE; MULTI-PERMIT FILE; CB030849; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-24-2003 .• Misce-llaneous Permit Permit No: CB030849 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 1960 LA COSTA AV CBAD MISC Subtype: OTHER Parcel No: Lot#: 0 Valuation: $0.00 Reference #: Project Title: LEUCADIA WATER DIST-DEMO EXIST CONCRETE TANKS,CAP OFF PIPES&UTILITIES Applicant: LEUCADIA SEWER DISTRICT Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES Total Fees: $60.00 Inspector: , Owner: PERMIT FEE Total Payments To Date: $0.00 Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: PENDING 03/24/2003 RMA 1057 03/24/03 0002 01 02 $60.00 $0.00 $0.00 $60.00 Balance Due: CGP 60°00 $60.00 Clearance: ------ NOTICE: Please take at approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." ou have 90 daysfrom 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/exa 'oils f which o h v r vi I n iv n N Tl E imil r. hi or a o which the statute oflimitati n has reviousl otherwise ex ired. P~FIMIT APPLICATION . } FOR OFFICE USE ONLY PLANCHECK No.C/Jlf.5tJ$4f ~ CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA92008 EST. VAL. _________ _ Plan Ck. Deposit-----=------ Validated)?¥ k Date :¥/j '=f(./4- Legal Description Lot No. Subdivision Name/Numbe'r Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use ·Name Address .City State/Zip Telephone # Fax # ~~~:::ZGil~~~gw_t;~:[;J~JiJ;ig~jft?!4Jr~v-:'fJf@T~~~1f~~f~f~~~~~~.7~~5'i:;;:~E1i4li~£~Kr~~t~;~ Name Address City State/Zip. Telephone# Name Address City State/Zip Telephone# ~ ~~l:Q'PJliM~i~13;!:Qq}yl_ftl\ftl~~'-'~GA~:~:f:1F:~;E~,~,?~:'~ l~,3StZ:::,§:.r:,~~ill~1~~~0~Z-~;~~~~\,J:;~'q~'T~E;~~~~~~m'\!1 (Sec. 7031,5 Business and Professions Code: Any City or County which requires a permit to construct, alt.er, improve, demolish or repair any structure, prior to its issuanc!!, 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]), J Name Address City State/Zip Telephone# State License #-~---~~---License Class~·---------City Business License # _______ _ Designer Name Address ·city State/Zip Telephone State License # -~----~--- ~~k~W<>'.aKr;I~!Q._Q"4ffiN.l}'*fQNAL~(~'ii;S~~7]7:::;::;;[f:i~,~-i~i;r~;{U~~J;~~~~_Z;~~:t~~:1@2J£:~r;-f~:~7,;~Z+::~*~-::~}~,~F~~%?:/J;f ~?~~¥,;9}31\~:;;~ Workers' Compensation Declaration: I hereby· affirm under penalty of perjury one of the following declarations: · O: I have and will· maintain a certificate of con~ent 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 •. o· 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 ______ ~~--~-~-------Policy No.____________ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED·DOLLARS ($100].0R LESS) D 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 C!!lifornia. 'WARNING: Failur_e to secure workers' compensation coverage is unlawful, and shall subject a11· employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as·provided for lri Section 3706 of the labor code, interest l!nd attorney's fees. SIGNATURE. _____ -'---,-------------,-----,.----;--,---~ DATE_-'---------=-f~~=;.:::,::~:=-::f ::::~:¥.l~;~:JJ¼:::*:~ (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 offere.d for-sale. If, however, the building or improvement is sold within one yea·r of completion, the owner-builder will have the burden of'j)roving that he did not build or improve for the purpos.e of sale). ~ I, as owner of ·the property, am exclusively contracting with licensed contraqtors 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(sl licensed pursuant to tiie Contractor's l:icense Law). D I am exempt under Section--~--~ Business and·Professions Code for this.reason: 1. ~lly plan to provide the major labor and materials for constructiqn of the proposed-property improvement. D YES ~O 2. '~ave not) signed an ~pplication 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 d the following· person to coordinate, supervise and provide the major work (include name / address / phone number/ qon~ractors license number):-l,-"''---4..q;...a...y.,4;;:;i...-'--L1.L:;.J<LL!:<:.s.c:.t;.:=e::.----'-'-------------------------- / 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include na e / address / phone number / type ·. ~ ofwork): ,,;:;r.,...---. . ~ ~~~::,:e;;~;;~i~~;~;oa'.iffiN•0 .:s1f>"~jJ,;;;~1«i~N'~~;1~··1;:-,ft:~""·/;};f:;\i ~!~~~~ti;! .. · ~~~;::.01<?ltf~;·:i.~~'l~",?;~~:i.r,11• ....,.,..,~,~·,.,.. --~.;.""'~"""""7"........_....J.,~,..,.,,,. -~"'"'"'~~l~_.,,j,~=,>""""_,.,._,,,,.,,,..,....,,,............,~,~ _J!!!,.~,--~-~----~......W:«-"""""-~~ .... ~,v.~W,,v>i;'V<,,..._~~-<,,........,n,,{4,_">'{:;~i,.n;:;F~i:-.,;:~~'Y-,,.~<>!<;;i,.:f.({, 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 D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality managem~nt district? D YES D NO ls the facility to be constructed within 1,000 feet of the.outer bo.undary of a school site? D YES D NO IF ANY OF THE ANSWERS ARE YEi;, A FINAL CERTIFICATE OF OCCUPANCV MAY NOT.BE ISSUED UNLESS THE APPLICANT HAS MET OR JS MEETING THE REQUIREMENTS OF THE OFFICE .OF EMERGENCY·SERVICES. AND THE AIR POLLUTION CONTROL DISTRICT. ~oz;;!.tr9JJffi;liI!lT&~fflf:l¢~~ueM::ii"::,·:"::"..;~:F:11½~~;r~,,'-: ;;-J:~~·:rirzr;;)Jli?;?l~~1~~~ ~; ~}i{fl\1E':i1 .. -,.·.-.c:,,· ., ...... ....,,,,. ,_ .. I hereby affirm that there is a construction lending agency for the performance of the work fo'r which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______ '---------LENDER'S ADDRESS---------------,----------~ ~~i'0V~QA,l\l.itJt1;,11~i~ttQ~fIY~:&~:~·~~?=:·~::-f:S"J:i1~.t:\IS?ilff~~~~¾t;1-~~t~1f1itii!;:i~1it~~~~~~~!~t:,~~~~,Ni~ft~~~gr?1~~tJZ!1~~;t I certify that I have ,read the application and state that the above information is correct an!:fthat 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 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, COST~ 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 th!;! provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is n<;>t commence · in 180 days from the date of such permit or if tne building or work allthori~ed by such rmit is uspended or abandoned at any time after the work is comm rio eci days action 106A.4 Uniform Building Code). •. 0 City of Carlsbad Bldg Inspection Req·uest For: 03/10/2004 Permit# CB030849 Inspector Assignment: ,,__+-r- Title: LEUCADIAWATER DIST-DEMO EXIST Description: CONCRETE T ANKS,CAP OFF PIPES&UTILITIES Type: MISC Sub Type: OTHER Job Address: 1960 LA COSTA AV Suite: Lot 0 Location: APPLICANT LEUCADIA SEWER DISTRICT Owner: LEUCADIA WATER DISTRICT Remarks: WILL MEET THE INSPECTOR AT SITE Total Time: CD 19 29 39 Description Final Structural Final Plumbing Final Electrical 49 Final Mechanical Associated PCRs/CVs Inspection History Date Description Act lnsp Comments Phone: Inspector: ---- (; (.,0 )52-s--'61:,5 3 · Rlct-,~ Requested By: NA Entered !3y: CHRISTINE MAR.2.4.2003 2:21PM NO. 4326 P. 2/2 LOIS HUMPHREYS l'ttllllttll DAVID KULOIIN 'Dillclor ELAINE-SUlUVAN Plre1Ior JUDY HANSON Dlr,d11r AWN JUUUSSEH Dil'flllt MICHAELJ. BARDIN minlMtnqvr February 14, 2003 ?v.[r. Ken O'Connor Dudek & Associates 605 Third Street Encinitas, CA 92024 Re: Notice to Proceed for Bngtneertng and Construction Management $ervices of the Demolition of Gafn.er Treatment Plant I>earMr. O'Coxmor: This lc,tter SerVes as tb,e formal notice to proceed (NTP) for Engineering and Constructioil Management services of the Deimolition of Gafher Treatment Plant. The ofiicfa.l NTP is February 14, 2003. Please proceed with the aforementioned project as directed by the District Manager. Sincerely, Leucadia Collllty Water bistrict cc: Leo Schempp, LCWD Steve Deenni, Dudek Steve Jepsen, Dudek· --- DisfrictOlfice: 1960 Lu CoilllAvenue, Catl~d, California 92009-6810 • (760) 7S3,0155 • FAX (760) 753-3094 ' PrinlH en NMlld OIIW, < - JJUDEK & ASSOCIATES, INC. Professional Tuams for Complex Projects March 24, 2003 Engineering, Planning, Environmental Sciences and Management Services City of Carlsbad Building Department 1635 Faraday Ave. Carlsbad CA 92008 Corporate Office: 605 Third Street Encinitas, California 92024 Re: Gafner Demolition Project-"-Submittal for Demolition Permit 760.942.5147 Fax 760.632.0164 Dudek & Associates is currently providing engineering and construction management services to coordinate and manage the demolition of the Gafuer wastewater treatment plant located at: Leucadia County Water District 1960 La Costa Ave. Carlsbad CA 92009 The demolition will include the following: • Primary and Secondary Clarifiers • Digester • Trickling Filter • Soil Filter. Bed • Trees and Shrubs • ACremoval (Please refer to attached Site Plan) This demolition project will elimi_nate several safety hazards and unattractive facilities. The demolition will consist of hauling concrete and debris from the site the recycling plant. The above noted structures will be demolished and removed to 3' below grade and backfilled with Class II Base to 90% relative compaction. All piping and utilities associated with facilities to be demolished are abandoned. No piping or utilizes will be removed. Associated piping will be cut and plugged below grade and left in place. The future use of the site is as yet undetermined, however the site will be left in a clean and acceptable condition for building purposes. .,._ -.... Dudek and Associates requests a Demolition Permit for the above referenced facility. Three (3) copies of this submittal are provided herein. If there are any questions please call or email me at (760) 942-0366 xl56 or sfisher@dudek.com Very truly yours, Dudek & Associates, fuc. ~0-,__-- Project Engineer Attachments . CC: Ken O'Connor, Dudek & Associates Karen Rabner, Dudek & Associates Steve Jepsen, Dudek & Associates J:..;-.• ~·:·r-. ., . ~cit . ~I I > ·:L,_L 1e '\ \ ' a J! ', \ J __ "i ·1\: Ii Ir II ·11 Ti . It 0 0 MAIHlEHANCE BLDG I DEMOLITldN;..,LEGEND .. \ £) REMO~ AND DISPOSE OF E)(ISTING SOil FILTER BED AND APPURTENANCES. ;. SEE DETAIL 1, DWG D-2 \ ~ REMOVE AND DISPOSE OF E)(ISTING lREE OR VEGETAllON. ~I-=~~~:~~A~~~ ~~~IDIANCES. , i· SEE DETAIL 1 &: 2. DWG 0...:3.. \ ~ . t• REMOVE .AND DISPOSE OF E)(ISTING lRICl<UNG RLlER, AND ASSOCIA1ED \ j APPUR'JENAN~ SEE DETAIL 1, OWG D-5. ~ R&.OVE AND DISPOSE OF ~STING SECONDARY PUMP STA110N _! AND AP.PUR1ENANCES. SEE DETAIL 1, DV.C 0-:.-6. i'9 ! ~ IS. REMOVE AND DISPOSE CF EXISllNG FRP BLOWERS AND APPUR'JENANCES. \ ' '.; SEE DETAIL 2, DWG 0-2. 7. REMOVE AND DISPOSE OF E)(ISTING RECIRCULA110N PUMP 'i STA110N AND APPURTENANCES. SEE DETAIL 2, DWG D-5. 8. REMOVE AND DISPOSE OF EXISTING SECONDARY Cl.ARIAER AND APPURTENANCES. f SEE DETAIL 1, OWG 0-4-. I , f· . REMOVE AND DISPOSE OF EXISllNG INLET S1RUC1URE. SEE DETAIL 3, 0~ D-6. JO. REMOVE ANO DISPOSE ·OF E)(ISTING CARBON ADSORPTION UNIT AND CONCRETE PAD } Wl1H ALL RENFORCING. j1. CUT, REMOVE, AND· ~ OF 80'• OF 4-INCH WS PIPING AND FmlNGS ,l f GRAPHlc SCALE iZO O 20 U-..-.J ; I ~ {INFEET) ; 1 INCH ~ 20 FT. i ASSOCIATES, INC. js lNrd Sino! Fncini1as, CA 9202-4 ~147 fllX 760.632.0164 i -40 I -=;;:;;;;;;;;;;;iiiiiif'z-Z:_-PLAN SCALE: 1·=20' RE\JISIONS , NO. ' 8Y r DA1E , REMARKS 'DESIGNED: AL/Jr/EB r----t---t---+-------------JDRA»t RR/PAC t--t--+---+--------------IQl£CKED: __J!!_,q ----------------~- AOMNS1RA110N BLDG LEUCADIA CGU.NTY WATER DISTRICT 1960 LA COSTA AVE. CARLSBAD, CA-92009 PHONE:' (760) 753-0155 FAX: (760} 753-3094 ""' ',. -~.,..,_.,_.,,, ~ ~ . --· ....,..,,.__ ~----CCC-,--=. ---· _:__ ____ oeMoui-10N-1:EGENo~eeN:t;· -.:;.-~ .. -=---:.1 __ ·~ · •12. REMOVE AND RELOCA,:E EXJS1JNG SlUDGE BLOW D_OWN (2~1NCH AIR RELEASE; VALVF. AND 3-INCH MOTOR AC'TUAiED PLUG VALVE). SEE SHEET C;-2. CUT, REMOVE, AND DISPOSE OF 55'* OF 12-INCH SE PIPING AND FlTIJNGS. CUT, REMOVE, AND DISPOSE OF 30'•. OF 6.:_INCH -SCUM PIPING ~D FITTINGS. CUT, REMOVE, AND DISPOSE OF 30"*. OF 6-INCH SLUDGE PIPING AND RTIINGS. ~ '.r.lll~CUT, REMOVE, AND DISPOSE OF 1;30'• OF GROUND SUMP DRAIN LINE PIPING, ATTINGS ~ _ANO APPURlENANCES. GROUNDWAlER PUMP TO REMAIN IN. PLACE. CAP UNE AT PUMP. . ' . ,:" REMOVE ANO DISPOSE OF 80'* OF +-INCH HS PIPING, FITTING, AND APPURTENANCES. REMOVE AND DISPOSE OF 55'*· OF 12-INCH CI..ARIFIER INFLUENT -PIPING, FITTINGS, AND . APPURTENANCES. . · CUT, REMOVE, AND DISPOSE OF 7({• OF 6-INCH RWL PIPE, FITIINGS, ANO .APPURTENANCES. • CUT, REMOVE, AND .DISPOSE OF 2'4(t• OF '4-INCH SLUDGE PIPING, FlTnNGS, AND . APPURTENANCES. . CUT, REMOVE. AND DISPOSE OF 80'• OF 24-INCH ABANDONED SEWER LINE PIPING AND RTIINGS. CONlRACTOR TO Fl£l.O VERIFY SIZE AND MA1ERIAL . CUT, REMOVE, AND DISPOSE OF 33({* OF 6-INQ¾ SLUDGE: LINE PIP.ING AND FlT11NGS. BEGIN REMOVAL AT 1HE 'PRIMARY SLi.JDGE PUMP STA110N. . · CUT, REMOVE, AND DISPOSE OF 65'* OF B"tPASS PIPING. CONTRACTOR TO FIElD VERIFY SIZE AND MATERIAL. CUT, REMOVE, AND DISPOSE OF 160'* OF 8-INQ¾ iECHl1E AIR PIPING AND FITllNGS. CUT, REMOVE. AND DISPOSE OF 25'• OF 12-INCH PRIMARY a.ARIAER INFLUENT l;'IPING, AND APPUR'JENANCES. · . CUT, REMOVE, AND DISPOSE OF 100'* OF DIGES'TER SUPERNATANT PIPING AND .FITTINGS. BEGIN REMOVAL AT 1HE PRIMARY SLUDGE PUMP ~~ ~wf~~~ Pl~~ STORAGE: WILDING. .• ·• SECONDARY CLARIAER, TRICKLING FILTER, PRIMARY CI.ARlflER, AND ANCILLARY P.IJMP . STA110NS SHALL BE REMOVED. ALL OlHER l;'lNff. WAlER SHALL REMAIN IN_SER\'ICE. CUT, REMOVE, AND DISPOSE OF -40"-OF 1+-INCH PRIMARY CLARIFIER EFFUJENT PIPING AND FJTIINGS. CUT, REMOVE, AND DISPOSE OF -40', OF 12 a: 14--INCH RECIRCIJLAllON PIPING ANO FITllNGS. 12-CAST'IRON ltfl.lJENT 'PPE lO BE ABANDONED ti PLACE.· . ciJT, REMOVE, A,ND DISPOSE OF 380:!:'* CF. El.EClRICAL DUCT BANK. PULL BOXES. . ~ AND CONDUIT IN LOCATIONS SHOWN. DISCONNECT AND REMOVE AU. POWER AND· CQNlR(L 'MRING lO JiREJtS TO BE DEMOLISHED. POWER SOURCE IS IN lHE ADMINISl'RAllON ANNEX BUILDING (CONTRa. ROOM}~ CON'JRACTOR SHAU. FJELD VERIFY AU. WIRINGS PRIOR 10 DISCONNEC110N AND REMOVAL PRIOR TO DISCONNECTION OF POWER. CON~ SHAU. CIH'ER 'M1H LCWD TO ENSURE 'THAT POER AND CON1ROL 'MRING REMAINS INTACT FOR AU. Pl.ANT El.EClRICAL SERVICE NOT ASS0CIA1ED VIITH ll£ DEMOLISHED s,lRUClURES. •· REMOVE AND DISPOSE OF EXISTING RW FLOW EQUALIZATION VAULT. SEE DETAR.2, OWG 0-8. CUT, REMOVE, AND DISPOSE OF 1-40'* OF 8-INCli RWB PIPING AND. RTTINGS. BEGIN REMOVAL AT ill£ RW FLOW EQUAUZA110N VAULT. CAP ENDS QF PIPE lO BE ABANDONED. REMOVE AND DISPOSE OF EJ<l'.STING MASONRY BLOCK WALL., REINFORCED ~ AND STEEl... . . CUT, REMOVE AND DISPOSE OF 1 1 /2 a: 2-INa¾ Cl l:'IPING AND FlT11NGS. 2 1/2" POJ"ABLE WA'lm LINE lO ~ 'IN SER\1CE. . REMOVE AND SALVAGE CONCRElE DECORA11VE PANEL =i~ =·~ ~ ~~:~~~AU(. REMOVE AND DISPOSE OF EXISTING STORM ORAIN.. CONlRACTOR 10 FJELD VERIFY SIZE ~ ~~~ AND DISPOSE OF 70'* . OF· SlU~ PIPING. CONlRACTOR 10 FIELD VERIFY SIZE AND MAlERIAL . ~~ D=~~~ ~1:~~ TO REMAIN IN Pt.ACE. CUT, REMOVE AND DISPOSE OF DRAIN PIPE. CON1RACTOR :ro REI.D VERIFY SIZE AND MAlERI CUT, REMOVE AND DISPOSE OF 50'* OF SLUDGE LINE. CON1RACTOR lO FIELD VERIFY SIZE AND MAlERIAL. CUT, REMOVE ANO DISPOSE Of 110'* OF ABANDONED 12-CAST IRQN I CUT, REMOVE, AND DISPOSE OF DRAIN AND B"tPASS PIPING. CON111U,C'1 PIPE. ELD VERIFY SIZE AND MAlERIAL ~p EXISTING 18.EPHONE UNES AND TEI..EPHONE PEDESTAL TO REll~N/,WFffA_g....,,-- ,12• C.l. FORCEMAIN (ABANDONED) TO REMAIN IN PI.Acg,._1 ' 53.. REMOVE AND DISPOSE OF EXISTING AC BERM. AS REQUIRED. 54., POR110N OF EXISTING CONCRElE SIDEWALK TO REMAIN. •<' A. 1\\\)J '1 ~W-.\<-% - --:eP.0 ',... p..~\..:~ .. ~ c,w o1 v ~\G o~J' . &lIES.. \j\\..0\'"' . 1. • INDICATES QUAN11TY IS APPROXIMAlE AND SHALL BE FIELD ~ED BY CONlRAcnlR. 2. PIPE LENGlHS ARE PR0\1DED FOR CONlRACTOR'S CONVENIENCE. 'THE . ENGINEER DOES DOES NOT GUARANlEE lHE ACCURACY OF lHESE LENGlHS. IT IS il-lE RESPONSIBIUTY OF lHE CON1RAC1UR TO REMOVE 1HE AC1lJAI. LENGlHS OF PIPES ENCOUNTERED. GAFNER WATER RECLAMATION FACILITY RECYCLED WATER FACILITIES IMPROVEMENTS-PHASE A SITE DEMOLITION PLAN OAlE 2/16/01 I 90% SUBMITTAL I DWG 0-1 SHEET.J_ Of"_.rr_ CAD REF: NO. 1493--70 d1.0WG G!j o 76 ?Lt 1 )- -~ ~ CJ . . 4 --~ .J \Q,:J1 BU IL.DING PERM ':t T Permit No: CB982355 Project No: A9803114 Development No: '07/24/98 '.!-0:12 Page_ ;I. of 1 Job Address£ 1960 LA COSTA Permit Type: MISCELLANEOUS ParGel No: Valuation: · Occupancy Group: AV Suite: Lot#: Reference#: De~cription: 51 SQUARES OF EAGLE LITE Appl/Ownr ! PREMIER ROOFING 9·054 OLIVE DRIVE SPRING VALLEY CA Fees Required * .u . ' --,-,---------------------- Fees: Adjustn1ents: Total Fees: . Fee _description Miscellaneous Fee# * MISCELLANEOUS TO 760 ~onstruction Type: Status: Applied: Apr/Issue: Entered By: 753~0155 VN ISSVED '07 /24/98 07/24/98 MDP 02 CLEARANCE-----==----===== i ____ 1.,_,....,.,_, "'""'"' •-· ._,w.....,......,.·=-----• -=::tm..~·~--,. ,. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 f PERMIT APPLICATION ·FOR OFFICE USE ONL 'f? · c S- PLAN CHECK NO. f O --7.,?):)- EST. VAL . 2, l.-( J , CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-11'61 Plan Ck. Deposit ________ _ Validated By _______________ _ Date ___ ......, _________ _ Address (include Bl!lg/Suite #) Business Name (at this address) Legal Description Lot No.· Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # · Existing Us_e Proposed Use # of Bathrooms Name . Address · pty · State/ iP. Telephone# ;·-., ..... R ..... .,,,r··w· .. ·----~---··,",""·~·------.--..,,.~,.~-.. ,,. ··'"·' ... , ···.·.,·,.· .. -,-~, ... , .. ,.,,--.. -.... , .. ,-· .,,.,., .......... .,cAR.,f-s.-;40, ... ··. -. ··-.. . l4,,/'[·lti~i);~'u·,zs~4-~"ii'·,: . fj·~ld',ii''::;•,_;::·-,:·.,,·~~-'i4l6' ·t~-C~s1A'; ·-11 •. ~i_' _.·c.iA.:-~·: . '·'1=1 )$'7/;0~75'3-0IS"J Name Address -City S.tate/Zip Telephone# ~lf,,1J';,e_Qfi!1'-itAJ:m)~;~;-coM_p,~l\!'(_\ijA"1E::::: ~"""'::ti~" ... ~-xz _j ~'-~~-':·,: ': • ... . ••. (Sec. 7031.5 Business and Professions Code: Any City or Co!Jnty which requires a permit to construct, alter, improve, demolish or repai.r 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 se·ction 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged ex~ti~l'.l· Any violation of Section 7031.5 by any applicant for a ermit subj!!Cts the ~plicant to a civil penalty of not morezthan five hundred p,ollip:,s I $500)) . . M&\"\,\e.\L -' ooFv\ l NC..., 05 Olfve. QR.., s~,11. -vvy/ ey Cl'{ ,(1)) ~{,, ?~l/rls Name 6 f-Q 7 '\ b Address City . State/Zip -Telephone # State License# .0 T <7" License Class C 39-City Business License# /J..Ol/ $0 _Designer Name Address City State/Zip Telephone State License # ___ --"-~----- [6:.:,,~,.)V,Ql:l~.ER$LClQf,'lf'E~~ATI.Q!'<l'::};'.L;,-1.";\~~~ .. .::.....--~.::.._~.;.,::.:.: .. ~·;...,_:.:::.,~,--,.;_;.:::, -: • .' _:':': .'f.:;.·-::_-->;'";;,"'::!:.'":.:: :·?.'.' '-::·:, Workers' Compensation Declaration: I-hereby affirm under penalty of perjury one of the following declarations: qzf-ni;~e and will mainta.in a certificate-of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for tl)e performance of the w_ork for Which this permit is issued. 0 J ·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 .com ensation insurance ca~ and policy number are: . 9 ()_ Insurance Company efl.1,(..1\-1'\ 1.._,A-Svft IT Policy No. / 06 3) CJ-/ 56 f Expiration Date S-/ -/ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FO ONE HUNDRED DOLLARS [$100) 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 Californja. WARNING: ·Failure to workers' c;:ompenaatlon coverage la unlawful, end shall subject an employer to criminal penalties and civil fines up to one hundred thousand dolhira / o,oo..or.~1tlon to the cost of compensation, damages B!I provided for in Section 370-6 of the :8bor code, ~erest and attorney's fees. SIGNATURE R' '---.. _ _ DATE 7 ) y-9 ~,J',~f]Q 1 , 'E}l{l(U:l~Q~_ij{j;>Ep~~tfO,-.~",,-~-:~=~~/.;::::_;,;:t,;/:;::f:{~,:i:,-.,.:,.;,,:"~. '...~~:-~l)t:?;::.~:·f:.:;-: / ··< ,;_-; 'v,· ':: ~\:·~:;:~:~:-·;--_: ~,,··\> ·. ;:/_;, P,: .,' !'_,, -:~> _:} ;~,!:-,~~ ',,. ·.--·~:; I here affirm that I. am exempt from the Contractor's License Law for the following reason: _' as oiwer r~tl).e prgperty or my employees with-wages as their sole compensation, will do the· work and .the structure is not intended or offered for sale c, 70<14, si 8@.S<at,,c("professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does h work hi for through his own employees, provided that such-improvements ·are not intended or offered for sale. If, however, the b1.1ilding or improvement is ol within-a e year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). R as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contr,ac 's License La'!" 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). I am exempt undef Section~--------Business and Professions Code for this-reason: .J personally plan to provide the major labor and materials for construction of the propose~ property improvemen,,-.c.1,.---~ I· (have / ~ave,notl signed an application for a building permit for the proposed work. 0 1. 2. 3. I have contracted _with the following person (firm) to provide the proposed construction (include name / address / phone ber / 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 11umber I 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 I address / phone number / type of work):. ___ -'----------------'--------------------------------------- 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 H'azardous Substance Account Act? 0 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? O YES O NO Is the facility to be constructed within-1,000 feet of the outer bC>undar.y of a school site? 0 , YES O , 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. lf!;I'.JL@ff~fRQCUQ'f,~P.tN.G.1A<if~~;;::;::;:s:::'.:t~;;_gi?',;;Y:;;"K:~ ;-,·. ,, ·, .-;-.. _;--.'.; _:::,:·.; .-... _, .', .. 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). ~ •, . ~ ' ' ·. :,. _:,. 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 Citt 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 ANYWAY ACCRUE AGAINST SAID CITY IN C,ONSEOUENCE 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 limltation and become null and void if the building or work authorized by such pi,rmit is not commence · · 365 days from the date of such permit or if the ~uilding or work authorized by such permit is suspended or abandoned at any time after the work is co for period of 180 days (Section 106.4.4 Uniform Building Code). 7,...)e-1-1 fJ DATE WHITE: File YELLOW: Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1~ JOB ADDRESS: 1919 0 lA CosfA Ave, 2. TYPE OF BUILDING: RESIDENTIAL . COMMERCIAL ~ 3. ROOF SLOPE: RISE L/ inches in 12 inches <:::. 4. NUMBER OF EXISTING ROOF COVERING (circle one) Cf) 2 3 5. -TYPE OF EXISTING ROOF COVERINGS/./tt-~e.. SHEATHING . *6. NEW ROOF MATERIAL TrLtL_ CLASS .&-.WEIGHT PER SQUARE 500 7. NUMBER OF SQUARES ~ / 8 .. TRA_DE NAME /JA'f fe.. LtfL · MANUFACTURER. _____ ____ 9. ROOF SYSTEM LISTING .UL No. .-ICBO No. ____ _ 10.1$ THE EXISTING STRUCTURAL DESI&. . . CIENT TO SUSTAIN THE W'=IGHT OF THE PROPOSED ROOF? Y~S NO ' . -. AH 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 __ ....,#L-,.__.,.....__._-_____ ._.----~-·-------Date Contractor ~er Contractor Name f.:ker,,•"-,£,d/7 *6 -Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB982355 FOR 08/19/98 DESCRIPTION: pl SQUARES OF EAGLE LITE TYPE: MISC STE: INSPECTOR AREA DH PLANCK# CB982355 OCC GRP CONSTR. TYPE VN LOT: JOB ADDRESS: 1960 LA COSTA AV APPLICANT: PREMIER ROOFING CONTRACTOR: PHONE: 760 753-0155 PHONE: OWNER: PHONE: REMARKS: C/DAVID/619/667-4565 AM PLEASE INSPECTOR (}fi~ ---=--'---------SPECIAL J;:NSTRUCT: PLEASE INSPECT AS CLOSE TO ldAM AS POSSIBLE TOTAL TIME: --RELATED PERMITS-- CD LVL DESCRIPTION PERMIT# TYPE CUP00130 CUP 19 ST Final Structural ----------------------------------------------~------------ STATUS EXPIRED ACT COMMENTS ·f A_-------- ***** INSPECTION HISTORY***** DATE 072898 072798 DESCRIPTION Roof/Reroof Roof/Reroof ACT INSP AP DH PA DH COMMENTS SHEATHING STRIPPED NORTY/SOUTH & WS ROO BU IL· DING P E R M I T Permit No: CB930780 Project No: A9301131 Development No: 08/09/93 15:31 Page 1 of 1 Job Address: 1960 LA COSTA AV Permit Type: MISCELLA~EOUS Parcel No: Val.uation: 0 Construction Type: NEW Suite: Lot#: Occupancy Group: Reference#: Description: ELEC CIR FOR REFUELING STATION : PER MIKE PETERSON CITY OF CARLSBAD 3440 08/09/93 0001 01 C-PRtlT Status: Applied: Apr/Issue: Entered By: 753-0155 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 02 ISSUE:) 08/09/93 08/09/93 DC PERMIT APPIJCATION PLAN CHECK NO. City of Carlsbad Building Departllll!f'lt / 2075 Las Palmas Dr •• Carlsbad, CA 92009 (619) 438-1161 • . ~-VAL:..,_..,_ _________ _ . PLAN CK DEPOSIT _______ _ VAIID.BY ___________ _ 1. PERMII IYPR DATE ... · ____________ _ A -0 Commerc1a! D New Butldmg O Tenant Improvement B -D Industrial D New Building D Tenant Improvement -C -a Residential D Apartment D Condo D Single Family Dwelling D Addition/ ~eration D Duplex D Demolition D Relocation D Mobile Home 0.Electrical ~lu!llbing D Mechanical D Pool D Spa D Retaining Wall D Solar D Other ____ _ 2. PRQJECf INFORMATION FOR OFFICE USE ONLY mt o. CHECK BEWW IF sOBMl'l'l'ED: __ tJ 2 Energy Cales a 2 Structural Cales D 2 Soils Report D 1 Addressed Envelope s # OF STORIES "/i(e/1 ~y/.:Jer/-/ S'Uf~ ADDRESS<f;itlG eb,fu7 /4.tburt;q:'f hS-¢-/1~9 CITY ~ j,11. O STATE t!,4-ZIP CODE o/~l;E-/a'/.!§)AY TELEPHONE "QIC/} ~ .,~ : NAMEJ.:uu~tZdk ~jah4-.b,s-/1\DDRESS /~~ Lr:i ~-.s-lk /kre; . ' CITY "r /~-d, STATE M, ZIP coDEd,91109 DAY TELEPHONE Bl.er) 7tr"3-q-s-c -15-ni:S-rl,l~i:._ NAME CITY DESIGNER NAME STATE STATE UC.# ADDRESS ZIP CODE UCENSECIASS ADDRESS DAY TELEPHONE CITY BUSINESS LIC. # CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # 1. WoltkfiltS' OOMPRNSA11dN Workers' compensation beclarat1on: I hereby affirm that I have a cert1hcate of consent to se!f-msure issued by the-b1rector of Industnal Relations, or ·a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspec_tion Department (Section 3800, Lab. C). INSURANCE COMPANY POUCY NO. EXPIRATION DATE Cert1hcate of Exemption: I certify that m the performance of the work for which this permit 1s issued, i shall not employ any person m any manner so as to become subject to the Workers' Compensation Laws of California. SIGNATURE DATE 8. o\vNEll-BOn.bmt DECI.ARA.TION Owner-Butlder beclaratlon: I hereby afhrm that I am exempt from the Contractor's Llcense law for the fol!owmg reason: D I, as owner of the property or my employees with wages as their sole compen,sation, 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.). D 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 wi~ contractor(s) licensed pursuant to the Contractor's license Law). D I am exempt under Section _______ Business and Professions Code for this reason: (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 statemei:it that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9, commencing with ~tion 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). SIGNATIJRE DATE COMPLETE THIS s£c116N FOR NON-RESIDENTIAL BOIIDING PERMITS 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? . 0~ D00 . Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0~ 000 . Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES D NO IF ANY OF TIIE ANSWERS ARE YES, A FINAL CERTIFICATE OF CXDJPANCY MAYNOf BE ISSUED AFfER. JULY 1, 1989 UNLESS TIIE APPUCANT HAS MET OR IS MEETING TIIE REQUIREMENTS OF TI-IB OFBCE OF EMERGENCY SERVICES AND TIIE AIR POillJTION CDNlROL DISTIUCT. 9. OONSIRUC11oN mNDING AGENCY I hereby afhrm that there 1s a construction iendmg agency for the performance of the work for which this permit 1s issued (Se_c 3097(1) Civil Code). LENDER'S NAME LENDER'S ADDRESS Io. APPlltAN'r CEllffiic!AnON I certify that I have read the apphcatton and state that the above mformatton 1s correct. I agree to comply with all City ordmances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the apove mentioned property for inspection purposes. I AISO AGREE TO SAVE INDEMNIFY AND KEEP HARMIJ?.SS TIIE CITY OF CARLSBAD AGAINST AIL IJABIIJTIFS, JUDGMENTS, CDSTS AND EXPENSES WlilCH MAY IN ANY WAY MXJUJE AGAINST SAID CITY IN CDNSEQUENCE OF TIIE GRANTING OF 11IlS 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 365 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 pt!riod of 180 days (Section 303(d) Uniform Building Code). DATE: -, ltjfa._:g ' -:.APPLlcANT.S SiGNATURE .. . }2y} tu -~il W Ap ;. PINK: p· : e YELLO : p 1cant · mance CITY OF CARLSBAD INSPECTION lIBQUEST PERMIT.# CB930780 FOR 10/14/93 DESCRIPTION: ELEC CIR FOR REFUELING STATION PER MIKE PETERSON TYPE: MISC JOB ADDRESS: 1960. LA COSTA AV STE: INSPECTOR AREA PY PLANCK# CB930780 OCC GRP CONSTR. TYPE NEW LOT: APPLICANT: LEUCADIA·COUNTY WATER DISTRICT PHONE: 619 753-0155 CONTRACTOR: PHONE: OWNER: , PHONE: f!-1 REMARKS: MH/NEIL/654-1109 INSPECTOR -----+--,f------- SPECIAL INSTRUCT: TOTAL TIME; --RELATED PERMITS-- . . CD LVL DESCRIPTION PERMIT# TYPE CUP00130 CUP 3·9 EL Final Electrical ---· _ ......... _______________ _ ----------------------------------------· --. -------------------------- STATUS EXPIRED ACT COMMENTS Pf_ ----------- ***** INSPECTION HISTORY***** DATE D~SCRIPTION 100193 Rough Electric ACT INSP AP PY COMMENTS Leucadia Water District 1960 _La Costa 81-vd. · Electrical· Room _ ___.I,. .... Gas Meter Driveway I I ........ i La Costa Blvd~ N s E LIPE.NS,1,:Q CONTRACTOR'S,DECLARATION I lieiepy ·aftlmi .that •.I. am licensed un(!!)r provi- sions of :chapter 9 (commencing·· with "Section 7000) of. ,Division· 3, .of the ,Buiiln,e)js ·;ind Profes- slons ,Code,.and my-license ls,in.fu,11 force and ef- fect.. · · · I l > .1 .OWNER-BUIL:DER >DECLARATION . ·. ·.o !. hereby ~!firm that I am·exempt-from the Co_n-1: · .tr?lclor'f! Llc,eiii;e Law for:the fqll_owlflg reason : (S11c. 7031.5 ,Business and Profes.slons Gode), Ariy city or-. county .which-req1l'ires a iiermjt ·to -con-. struci, ·a\ter,: imprc;>ve,, .. demoilsh, .or repair any structure, .prio~ to iis issuance also req1.1lres the ap_pilcant ·for such. permit to. file a signe.d state- merit that he is licensed p1.1rsuant to t_he prov!· sions QI the Contractor's License law· (Chapter·9· cbrrilJlllncing -with-Section 7.090 of, Divfsfon ·3 of the Busir.iess and Professions Code) or that is ex- empt. therefrom and,the basis-for the-alleged ex- ·emptlon:. ·Any violation of Secti9n 7031,S;by_ ii" ap- plica11t ·fqr a petrpit. Sl/1:)Jects the appllc!lnt tq · a • · .;cil(]bpenalty of, riot "1ore than·five hu.niJred dollars .• ($500);_ ' ,.-··.-. ," ••• . • ,. •. » ·, ,·\.f. as 9wnet of 'the .property, or my e_mployees /~h wages as'their sole compensation, wlll do the work, lil)d the·stru9t,ure is riot ln,iende~ or 61-1 · · fered· for sale (S~.c. 7044, Business. and Profe·s-· ; sions Cc:>d.~: The· Cohtractor'i; ~i9ens!! Law. ~bes : · 1 not.apply to an owner of property·wtto-builds or improves .thereon and who does such ·work .. himself or throllgh" his' own employe11s, provided that such impro.vements are not.Intended .or of' .ff!red·for-saie: if, hqivever, the building or,improye- me.nt»i~-sold within one Ye!lr of compl_et.lon, the owner-buildei-wlll.have the-burden of proving that he did ·1101· build' ·or improve tor the purpose of . ~ sale). ;(.~)Un > • . · ~:2r-A J so,.or" DI, as o· n o he pr~~ ex9luslveiyl'con-· tractlng with ilcense'd contractors to construct the project (Sec. 7044; Business and .Professions Code:· The Contractor's License Law does riqt :ap- ply to an owner of :property \•no J:iuilds or Im, proves thereon, and who contract~ for i;uch pro- jects with ~ contractor(s) license-pur~uant -to the C0fltractor's License Law). I, am exempt under Sec.,~---• B. & P.C. for this reaso,,__~--·----~---~ Date Owner WORKERS' COMPENS~TION DECLARATION I .hereby affirm that-I have a certificate of con, sent• to self-Insure, or. a certificate of Workers' Compensat19n Insurance, or. a certified copy thereof (Sec. 3800, Labor Code) . . POLICY No_-__________ _ COMPANY--------~--- OCopy is filed with the city. ·ocertlfled copy is hereby furnished . CERTIFICAT!c QF E)(EMPTION FRO"1 WORKERS' COMPENSATIQN.INSI./RANCE · !This St!Cl,lon need· not be completed if th!! pef- mlt Is for one hundr!!d. dollars ($109). or le~~):, I certify that. In the. pe'rforma,nce of the work tor .,,which' this permit. Is ls~µ~l!.,.Lshail not emploY..s'"Y peri,on In ;my mann,er so as to·becom~,subject·to . the Workers' Compensaiion Laws of California, NOTICE TO APPLICANT: ·11,. afte; making' thls,Cer- tiflcal!) of.Ex.emptlon,:you'sh9uld becom·e s4bject to the Worliers'·Oompensailon provlslons.of·th~ Labor Codil, 'you.must forthwith comply-with such wovlsions or this p~rl'(lll'·shall be·c:Jeeme(I revoked. CONSTR~CTION LEND!NG.AG'ENC)'• ,, ': !·hereby aftlrrri thai-there•ls:a,co!)struct!on,len- \:ling age.ncy for th·e· perforJ11ance of the v,,ork .for. ~hlch. thls.permjt Is Issued (Sec .. 30\)7.1 Cfv,11 Code),, •.. -. USE -!3Al,.L POINT Pf;:N ONL, y. . 'CITY.OF'C'Af{LSBAD..:BUIL.DING DEPA,RT-MENT· > • ·-APPLICATiON & PERMir . , . -1200 !;:-LM AVENUE (714}. 438-5~25 . -\ AP·PL'l~ANT TO FILL ll'i lNFOR:-- MA!,ION · WITHIN-RE~ LINES., .i AV, •. sT-, !DATE Of' -\P~-I:.'icA1'10N1Ii'us. LICENSE 0 RD ·, , ' • . -_.._ .. PERMIT NUMBER ·-sa.--·o/s-£ PRIME ·i:oi-i:i:k~c;r!J~'. /9,;AILI~/~-~ ·-LOTs-1 BLOCK .. • I SUBD(YISION' DESlliJIER ·• DESCRIPTION OF. WO~K I / , .. · l 'DESI,!;NER'? AJ?D~Ess· A.-1"' =.L:., -............ :..A I"··· -.. - BLDG 'SQ •. FT. BLOG USE '-0.TY:I'· ·,'PLIJMBfNG PE,RMIT· . EA:CH•F!XTURE_"fJ!.~(. EAC'i-t BU,1t1;1iNG SEW_ER. .EACH WATER HEATER ANDii ~~ .-1,-, -~MT.·· ,, RES. ,UNJ·TS, ,PLAN"Y· ._Pi.-~N 'ID II fYPE <;QNST :. QTY. MECHANICAL PERMJT 1~$TALL FURN. DU,CT~ UP TO l0Q,0liiJ BTU OVER 100;09p 0 :BOILER/COM!'R.ESSOR UP'TO 3 He/ 'ST'i,TE LIC'ENSE -CONTRACJ:OR'S i>iic:>NE ''. ST"'T.E; Ll~ENSE, ,DESI,GN,!,f !; Pfi'oNE, 00 ,'N~M~-~1(0'.F STOR1E'S o·cc;, LOj.:Q·. AMT. Not Yaliir iltiless M11cliini:C,rtifi,II!(. / -~~ 't ~ .,. '~ ~ e: 'UJ' .. .I- <( e . .. ~ VALUATION·: . < ?' ~ .. -:_:_-' ~-~~~:_:_:~··----.. ,.,.,..-... :_ __ ~-·-·· _ _: __ --'---···--;: ____ "'_ B~ILDING,PERMIT .. , ~- SIGN PERMiT , i+' TOTAL PLUMBING NEW CONST EA l\f!IP/SWT/BK ,AWNING 1 PH___.,25 PORCH EXIST BLDG EA AMP/SWT/BKR SET-UP 1 PH .25 3 PH REMOPEL/ALTER PER CIR_ClJIT . TEMPPO L~ 200 ~M.PS OVER 2~0 AMPS. TEMP,OCCUPANCY'(30 DAYS) I HA\iE,CAREF\JLLY EXAMINED THE COMPLETI;J? "APPLICATION-A.ND PERMJ:r, AND qo· HEREBY CERTIF-Y 'THAT ALL iNFORMAl'.ION HEREON IS TRUE AND.CORRECT AND I , FURTHER CER:fJFY ANC5-AGREE JF A PERMIT IS ISSUED!TO·COMPL:V W!TH ·ALL CITY, COUNTY.AND Sl'.ATE I:.AWS .GO.VERNI NG BUILDING CONSTR,UCTION, WHETHE.R 'SP,ECIFIED'HEREIN OR·NOT. ,J,·ALSO AGREE TO SAVE INDEMNiFY ANDKEEP,HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITfES,JUOGMENTS, COSTS AND ,EXP,ENSES WHICH M'i\:v IN ANY WAY,ACCRUE,AGAiNST SAID CITY IN CONSEQU.ENCE O.F THE GRANT-ING OFT-HIS PERMIT •• : , • . . -:t: .· AMT, . . u W(N CHECK' , :f .ALL iNi:~tiSIVE PERMIT ~ TOTAL PLUM.BING "ELECTRiCAl .. . MECHANICAL r,10BILE HOME SOLAR MiCO'-FI LM .s·y PHONE. D ....... ;; \ .• '. SITE ADDRESS: . ·-'<--!::-'·-. ,. ; ~, .. ' ~> ; ~?f:~· •j. .r;;/ .·':: INSF?E:CTIOf.:.i_;.';.~ ~ ... = ~ __ "'!"!!_!{ DATE vioob FLO_~R -·' ,· : t' ;. ~ l FO!-JNDJ>io/im~;··t0RriS • SET !3ACK • toU.,ET' ~~==~:~t~!',:~i::t· .' j ... ot<"to· !NSf.fiLL sus_Fi,,CJ0'5-.' ·v: '· • • ~;!:_.~-=---~ "'· <: '-,----,..1;1.,r, 11;1'~-,fo, • SLAB FLOOR: :_J.,~t_:..•,,. UNDER SLAB PLUMBING FOOTING. FbRMS. SETS.A.CK. TOll,.'.ET OK TO POU~ CONCRETE FRAME ROUGH ELECTRiCAL -'! R<;)UGH PLUMBING· . ROUGH HEATINGIVENTILJ):TING FRAME OK• PLACE INSULATION INStJLATlON OK • PL.ACE WALl:..B~ARt> WALLBOARD 9K~ PLACE T~PE EXTERIOR LATH qK_• P!-A<;:E STUCCO FIREPLACE DAMPER 8:STEEL Pt:.ATE TIEs/HEiGHT OF CHIMl'IEY, .... _ •. ~ 1~, OTHER • i,- . TEMP. POWER (POLE) SEWER GAS TEST SWIM .POOL-• . STEEL E\30IIIDING •· PRE DECK · •· FENCE f'-REPLASTER. SHOWN • FRAME • PAN F!NAL lNSP EfY B!JDG 'DEPT . -OTHER ,Ql;:Pir§ ~Eq CO~PLl;;T_ED ELE:C METER-;PEJ,M-,--TEtw!P GA'S.~TEq~.;.Pf;.RM-,,TEfdP;,,; .:: .,,. ·, -~\~_ ~ ,,,..;(·_ ...... ; .... ~·-~r,,..,_ot-~, .;. -~"'-,;,f_~~ .. \ ,;. -:r, · -,1. :~ERY OF OCCUPANCY -ISSU!;:;D_; _ '·-'-1'. ~--\_ ..• ~' '. ':· ·-:..~..:.;;. --~ _..;,-7' :. ~ -~ :1 ... , ~-....... .-.:!,(. , W: t,. ·~ • ·owNER: PERfvtlT NO: _go-~~- FIELD fNSPECTION RECORD ~ - IN~PE:CT()R .. JNSPECTOR'S NOTES· .. . .,, __ . --·-· ····~- ·-· -. < '• , "· •i,I ~;,.·~ -..... ~-.. r .... ~y .~. -~.