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Home My WebLink About2005 COSTA DEL MAR RD; 639; CB052851; Permit08-12-2Q05 Job Address Permit Type Parcel No Valuation Occupancy Group # Dwelling Units Bedrooms Project Title Applicant SYDNEY NICKELL City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Residential Permit Permit No CB052851 Building Inspection Request Line (760) 602-2725 2005 COSTA DEL MAR RD CBAD St 639 RESDNTL Sub Type 2162100101 Lot# $1,000 00 Construction Type Reference # 0 Structure Type 0 Bathrooms NICKELL RES ADD CASED OPENINGS STUDIO RAD 0 NEW Status Applied Entered By Plan Approved Issued Inspect Area Ong PC# Plan Check* PENDING 08/02/2005 KG Owner STE639 92009 858-442-7677 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park in Lieu Fee Park Fee LFM Fee Bridge Fee Other Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot Water Con Fee Meter Size Add'l Pot Water Con Fee Reel Water Con Fee $21 33 Meter Size $0 00 Add'l Reel Water Con Fee $1386 Meter Fee $0 00 SDCWA Fee $0 00 CFD Payoff Fee $100 PFF (3105540) $0 00 PFF (4305540) $0 00 License Tax (3104193) $0 00 License Tax (4304193) $0 00 Traffic Impact Fee (3105541) $0 00 Traffic Impact Fee (4305541) $0 00 Sidewalk Fee $0 00 PLUMBING TOTAL $0 00 ELECTRICAL TOTAL $0 00 MECHANICAL TOTAL $0 00 Housing Impact Fee $0 00 Housing InLieu Fee Housing Credit Fee $0 00 Master Drainage Fee $0 00 Sewer Fee Additional Fees TOTAL PERMIT FEES $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $2000 $000 $000 $000 $000 $000 $000 $000 $5619 Total Fees $56 19 Total Payments To Date $25 00 Balance Due $31 19 /I . 4631 08/12/05 0002 01 02 CGR 31.19 Inspector FINALAPPROVAL Date 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 PROJECTNINFORMATION FOR OFFICE USE ONLY PLAN CHECK EST VAL Plan Ck Deposit :2<T, 0 Q Validated By jCtJ_O- "-> ^^ ' is*Date <C~-*- MIWZ. Address (include Bldg/Suite #)Business Name (A this address) Legal Description Assessor s Parcel # Description of Work 2 CONTACT PERSON Lot (if different from applicant) No Subdivision Name/Number Existing Use •S-fofVt^ SO. FT #of Stories ,""?£?£> ^4^lo*t|/S Unit No Phase No Total # of units .Proposed Use3860}^/0&gJ> 0002 01 02 I . # of Bedrooms U! 13 J'S'f Bathrooms 25 > (/V?1Tt/U^"T"v*'i?lO /ifelS I lf"2. Name Address City 3 APPLICANT "Q Cbltrac1bw:i; D Agent for Contractor D Owner Q Agent for Owner State/Zip Telephone tt Fax* Name Address City PROPERTY OWNER State/Zip Telephone # Name Address City State/Zip Telephone # CONTRACTOR - COMPANY NAME (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 tt Address License Class City State/Zip City Business License # Telephone # Designer Name Address City State/Zip Telephone State License # _ 6 WORKERS' COMPENSAtlON :,.. ..... 'l.:w' ' " *" :•«&,•. Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations l~l 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 O I have and Wl11 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] 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 damages as provided for in Section 3706 of the Labor code interest and attorney s fees SIGNATURE ___ DATE _ '7 OWNER-BUILDER DECLARATION"" • • :-IS; ' ..::¥•• M; •iii'i '"'•;• 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason EK 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) l~l 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 fj YES [UNO 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) OWNER SIGNATURE __^_^ _ ___ COMPLETE THfS SECTION FOH'mW^SH^TM^UILDING 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? l~l YES l~l NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' l~l YES l~l NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site' Q 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 s ^CONSTRUCTION LENDING AGENCY ::""'. '^ ' ' ..::::'-;- ' ^..IJ\ '• - Z: * "^ ';:- ' 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 APPLICANT CERTIFICATION • -?fR: ,.j:S::'-:- 'I,., ...... ; ;: ' :' : ':'\ ; .— : '" ;;.,?;,;,. :,,- ^n* '" 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 foLgjDerioj qMQO da^ys (SecJipnX06 4 4 Uniform Building Code) 8PLICANT S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK N EST VAL Plan Ck Deposit ^2*5", tf Q Validated By iC/J Date P-^ Business Name (at this address)Address (include Bldg/Suite #) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total 9 of units Assessor s Parcel #Existing Use JJroDpsed Use38%P§y/D&g5 pOC2_Ql .2 tt of Bedrooms l_- »_3#-6'f Bathrooms 25Description of Work 2 CONTACT PERSON (if different from applicant) SQ FT #of Stories '/Z Name Address City 3 .APPLICANT- Q Contractor " Q Agent for Contractor D Owner CD Agent for'Owner State/Zip Telephone tt Fax # Name Address City State/Zip Telephone PROPERTY OWNER Address City State/Zip TelephoneName 5 CONTRACTOR..- COMPANY NAME (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 tt Address License Class City State/Zip City Business License tt Telephone tt Designer Name State License tt Address City State/Zip Telephone 6 WORKERS' COMPENSATION '• , " • Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations Q 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 Q 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] OR LESS) C] 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, damages as provided for in Section 3706 of the Labor code interest and attorney s fees .SIGNATURE _ DATE _ 17 OWNER-BUILDER DECLARATION • " - , ' I I hereby affirm that I am exempt from the Contractor s License Law for the following reason / Er 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) £] 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) 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 l~l YES 2 I (nave / 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) TMVilUILDING PERMITS ONLYCOMPLETE THIS SECTION FOR NON-1 Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention nronror« . r*Anr Cn^+»«» ICC^C 1CGQQ „, T T K Q A -.* *hn D nflo • T^.nr*« Ur»-Fi ^/* f C iKi-+^nnd Ao^rtllnt A o+7 I I VCC I I MO City of Carlsbad Bldg Inspection Request For 11/10/2005 Permit* CB052851 Title NICKELL RES ADD CASED OPENINGS Description STUDIO Type RESDNTL Sub Type RAD Job Address 2005 COSTA DEL MAR RD Suite 639 Lot 0 Location APPLICANT SYDNEY NICKELL Owner GRABOWSKI MARILYN Remarks AM 8-10 Inspector Assignment PD Phone 8584427677 Inspector Total Time CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Act Comment Requested By SIDNEY Entered By CHRISTINE Comments/Notices/Hold Associated PCRs/CVs Inspection History Date Description Act Insp Comments 08/22/2005 24 Rough/Topout 08/22/2005 34 Rough Electric 08/19/2005 14 Frame/Steel/Bolting/Weldmg 08/19/2005 24 Rough/Topout 08/19/2005 34 Rough Electric AP PD KITCHEN AP PD PA PD PA PD PA PD PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB ADDRESS DATE DENTI RESIDENTIAL ADDITION MINOR « $10,000.00) TENANT IMPROVEMENT PLAZA CAMINO REAL CARLSBAD COMPANY STORES VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER a PLANNER DATE ENGINEER DATE Oocs/MISf omu/POnninn Fnainccrlna ABnrnuaK