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Home My WebLink About2066 AVENUE OF THE TREES; ; CB030475; Permit-n -n rn rn 8 v, 00~0000 b T 2. =! h E 9 z! rn rn n n N v, z R 2 6 2 0 I rn n L rn 4 R s -I I -I rn rn v, D 0 z 0 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT Legal Description Lot No.5&bdivision NamelNumber Unit No. Phase No. Total # of units FOR OFFICE USE ONLY PLAN CHECK NO.Cs 0 3ac/75- EST. VAL. -. . . Existing Use Proposed Use sa. FT. #of Stories t of Bedrooms # of Bathrooms Name Address City Statelzip Telephone # Fax # 6. CONTRACTOR - COMPA (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any strycture. 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 Codel or that he is exempt therefrom, and the basis for the alleged hu red dollars 155001) 867 7 6%- Name Addred City Statelzip Telephone # State License # 7cI I fj.m Designer Name Address City Statelzip Telephone License Class C L7-9 C5b City Business License X I'Di%7a State License # 6. WORKkRS' COMPENSATldN Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: of the work for which this permit is issued. issued. My worker's compensation insurance carrier and policy number are: insurance Company mcc4A Policy No. 24aW -01 Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 181001 OR LESS) 0 WARNING: Fail thousand dollars 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 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 1/1 la6 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 mannar so as 0 1, 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). 0 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 contractorls) licensed pursuant to the Contractor's License Law). 0 1. 2. 3. I am exempt under Section I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES I (have I have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name I address I phone number / contractors license number): Business and Professlons Code for this reason: UNO ~~~ 4. number I contractors license number): 5. 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 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address I phone number / type of work): PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR MON-RE$IDEN Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES 0 NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES 0 NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE AEDUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8, CONSTRUCTION LENDING AGENC I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Codel YES LENDER'S NAME LENDERS ADDRESS 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. 1 agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representetives of the Cit). of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSEAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations ovar 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit iss authorized by such permit is n al any time alter the work is co APPLICANT'S SIGNATURE - -DATE 1 I' CERTIFICATE HUMSER 1oDUCER ~~~~~cs~laster MARSH USA , C ,emficate . Team 500 w My' &"$ ChlC?P IL 60661 NO RIGHTS UPON THE CERTIFCATE HOLDER OTHER THW THOSE PROVIDED 111 THE POLICY THE CERTFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE lYFORDED LW THE POLICES DESCRIED HEREIN - COMPANIES AFFORDING COVERAGE Am Fax 877-732-7399 cOV=IKv 8112 A ZURICH AMERICAN INSURANCE COMPANY -__- _____~_______ __ _-- co TYPE OF INWRIU(CE POLlCY NUMBER -'TR I GENERAL LIARlLlN GLO 2938645-01 X COMMERRaK GENERN LlLELlLlTy 1 QHMSMA2E =CUR Ab ,I Ti( S IS TO OZTIFY TRAT iCliCES Or- INSLRANCE JESGRl@EJ nEMh PIAL€ @€EN ISXJ TO THE INSRE3 NMED nREIN FOR THE ?&Iff JERlOD INDICATED VOTWTHSFANOING ANY QE(YIIREWNNT TERM OR CONDlTlOV OF ANV C(xrTRACT OR OTHW JoCi'MENT WTh RESECTTOMIW kE CERTIFICATE MAV BE ISSLED OR MAV LiMTS WOW MAY HAVE BEEN REDUCED 3V PAD CLAMS =GRT+JN THE ~NSJRANCE KFOSEO QY THE mLiaE.sD~~tam IERBN ISSU~JECTTO .L THE TERMS comnms NVO EXCLUSONS 5 SIJCH POLICES AGGREGATE POLICY EFFECTIVE DATE @lMtDDWf) 01 101103 - MER'S 6CUVTi?.AOWSPRUl - I ti I I I I I GARPOE LIbBILIN mv AUTO b 01 101 Io6 I I H I 1 GENWM MGREGATE I s,aoo,ooc PRODUCTS- CoHPMp AGG $ 1 ,ooo,ooc 9R93NLL a ADVINJURV ' f 1 ,000,ooc EACH OCCURRENCE $ 1 ,000,Ooc ilRE DAMAGE (hymnellre) $ 1 ,ooo,ooc I# I (04/01101 UMWELLAFCRM LYKS Pam EXPIRATTIOW DATE plrroom) /I WSTATU- O'h' 01101106 x TmYI tMlTS I I ER 1 .ooo,oo(l 1% EL EAW ACODEVT I MARSH USA WC. BY ChristyN Phoebus %?- Permit# City of Carlsbad Bldg Inspection Request For: 02/28/2003 CB030475 Inspector Assignment: Title: GUTIERREZ RES NEW H20 HEATER Description: Type: PLUM Sub Type: Job Address: Location: 2066 AVENUE OF THE TREES Suite: Lot 0 APPLICANT ARS Owner: HENIS DAVID M&GUTIERREZ ANGELA M Remarks: Total Time: CD Description 25 Water HeaterNents Phone: 7607294185 Inspector: h Requested By: ANGELIA Entered By: CHRISTINE e-4 Comment ___ Associated PCRsICVs Inspection History Date Description Act lnsp Comments