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Home My WebLink About2021 Gayle Way; ; CBR2017-1245; PermitPrint Date: 06/19/2018 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2021 Gayle Way BLDG-Residential 2051530400 $ 0.00 Residential Permit Work Class: P/M/E Lot#: Reference#: Construction Type Bathrooms: Orig. Plan Check#: Plan Check#: Description: HARGIS: SEWER REPAIR UNDER HOME (NOT IN RIGHT-OF-WAY) FEE Owner: TRUST HARGIS DEBORAH S REVOCABLE LIVIN~ TRUST 04-19-01 2021 Gayle Way CARLSBAD,CA 92008 PLUMBING, ELECTRICAL, AND MECHANICAL PERMIT Total Fees: $ 166.00 Total Payments To Date : $ 166.00 (city of Carlsbad Permit No: CBR2017-1245 Status: Applied: Issued: Permit Finaled: Inspector: Final Inspection: Closed -Expired 06/09/2017 06/09/2017 AMOUNT $166.00 Balance Due: $0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." 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 limitation has previously otherwise expired. Building Division 1635 Faraday Avenue, Carlsbad CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov t.H..:..r~LL.ow1NG APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0PLANNING D ENGINEERING ,· C City of Carlsbad JOB ADDRESS /j Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov ' SUITE#/SPACE#/UNIT# 0BUILD1NG DFIRE 0HEALTH 0HAZMAT/APCD Plan Check No. Est. Value CT/PROJECT# # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE acc. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) EXISTING USE APPLICANT NAME Primary Contact ADDRESS CITY PHONE EMAIL DESIGN PROFESSIONAL ADDRESS CITY PHONE EMAIL PROPOSED USE STATE FAX STATE FAX <2-- GARAGE (SF) PATIOS (SF) DECKS (SF) PROPERTY OWNER ADDRESS ZIP EMAIL ZIP EMAi STATE LIC. # STATE LIC#G. 5 q ( 5. 0 AIR CONDITIONING NoO vES0No0 CLASS CITY BUS. UC.# FIRE SPRINKLERS YES0N00 (Sec. 7031.5 Business and Professions Code: Any City or Coun.ty which requires a permit to_c_onstruct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such per.mil to file a signed statement that he is licensed pursuant to the prov1s1ons of the Contractor's License Law /Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or fhat he is exemP.t 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)). WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D 1 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 0 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 workers' compensation insurance carrier and policy number are: Insurance Co. __ Policy No Expiration Date __________ _ This section need not be completed if the permit is for one hundred dollars ($100) or less. 0 Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. ,Ji$ CONTRACTOR SIGNATURE 0AGENT DATE OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from 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 himse~ 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). "fi3...1, 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 fr_., 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 C.Ode for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0Yes 0No 2. I (have I have not) signed an applk:ation 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 I phone I 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 I address I phone I contractors' license number) (hired) th follow in persons to provide the work indicated (include name address Ip on,e It pe of work): ,Ji$ PROPERTY OWNER SIGNATURE 0AGENT DATE .S,MPLETE THIS SECTION FOR NON-RESIDENTIAi. BUILDING PERMITS ONLY s 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 management district? D Yes D No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D Yes D No I 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 ANO THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the a bow information isoorrectand 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 representative of the City of Cartsbad 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 LIABIUTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN WI WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required foc excavations over 5'0' deep and demolition or construction of structures over 3 stories in hei;;lht. EXPIRATION: Every pennit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building orwor1<: authorized by such pennit is not commenced within 180 days from the date of such pennit or if the building or wor1<: authorized by such permit is suspend or abandoned al any time after the work is commenced for a pericxl of 180 days (Section 106.4.4 Uniform Building Code}. AS APPLICANT'S SIGNATURE DATE ( ~ I -~-I~~'--~+-~~~~~~~~~~ STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. UC. No. DELNERY OPTIONS D PICK UP: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) tl MAIL TO: o CONTACT (Listed above) o OCCUPANT (Listed above) D ASSOCIATED CB#•------------- o CONTRACTOR (On Pg. 1) o NO CHANGE IN USE/ NO CONSTRUCTION D MAIL/ FAX TO OTHER:~--------~-~----- o CHANGE OF USE/ NO CONSTRUCTION AS APPLICANT'S SIGNATURE DATE