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Home My WebLink About2199 AVENIDA TORONJA; ; CB032686; Permit09-30-2003 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Building Inspection Request Line (760) 602-2725 Mechanical Permit Permit No: CB032686 Job Address: Permit Type: MECH Status: ISSUED Parcel No: 2552615700 Lot#: 0 Applied: 09/30/2003 Valuation: $0.00 Entered By: RMA Reference #: Plan Approved: 09/30/2003 Issued: 09/30/2003 Project Title: HULTGREN RES-NEW A/C W/ELECTRI Inspect Area: 2199 AVENIDA TORONJA CBAD Applicant: LEGEND SERVICE SUITE 15 2588 PROGRESS ST VISTA CA 92083 760-631 -8397 Owner: HULTGREN DOUGLAS L&HEATHER M 2199 AVENIDA TORONJA CARLSBAD CA 92009 Mechanical Issue Fee InstalI/Furn/Ducts/Heat Pumps Fee Fireplace Installation Fee Exhaust Fan Fee InstaIIation/Relocation Vent Fee Hood Fee Boiler/Compressor to 15HP Fee Other Additional Fees TOTAL PERMIT FEES $1 5.00 $9.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $0.00 $44.00 Total Fees: $44.00 Total Payments To Date: $0.00 Balance Due: $44.00 5280 09/3/03 0002 01 02 CGF 44.09 T PERMIT APPLICATION CITY 6F CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 I FOR OFFICE USE ONLY EST. VAL. Plan Ck. Deposit Validated By Date this address) Legal Description Lot No. Subdivision NamelNumber Unit No. Phase No. Total # of units Assessor's Parcel # Proposed Use Description of W6rk SQ. FT. #of Stories # of Bedrooms MCk.S// . # of Bathrooms (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he IS exempt therefrom, and the basis for the alleged City Statelzip cad City Business License # /J Name 1 Address State License # 7 D License Class Designer Name Address City State/Zip Telephone State License # 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance I have and will maintain workers' compensation, es required by Section 3700 of the Labor Code, for the performance of the work for which this permit is rk for which this permit is issued. issued. My worker's compensation Insurance Company a fho Policy NO. AD PO? o$ Et? -@ Expiration Date $/dy/Ad@ (THIS SECTION NEED NOT BE COMPLET~D IF THE PERM^ IS FOR ONE HUNDRED DOLLARS [c1001 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 I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 (Sec such 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 . 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 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 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 property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Section Business and Professions Code for this reason: 1. 2. 3. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ON0 I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the fallowing person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. number 1 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 / 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 / phone number /type of work): PROPERTY OWNER SIGNATURE DATE 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? 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 REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 0 YES 0 NO 0 YES LENDER'S NAME LENDERS 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, 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 authonzed bv such oermit is not commenced within 180 davs from the date of such oermit or if the buildtno or work authorized bv such oermit is suswnded or abandoned at any the after the work is APPLICI T'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance //