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Home My WebLink About2270 CAMINO VIDA ROBLE; M; CB121043; Permit06-05-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No:CB121043 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 2270 CAMINO VIDA ROBLE CBAD St: M PME 2130504700 Lot#: R A MEDICAL - INSTALL NEW DRAIN AND SEWER CONNECTION FROM Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 06/05/2012 LSM 06/05/2012 06/05/2012 Applicant: JOHN STEVENSON PLUMBING STE A108 6351 CORTE DEL ABETO CARLSBADCA 92011 760 918-04456 Owner: 2270 CAMINO VIDA ROBLE LLC 685TUROUOISE ST LA JOLLA CA 92037 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees $150.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $150.00 Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due: $0.00 Inspector: FINAL APPROVAL Date: '^l^/u^'^ Clearance: NOTICE: Please talte NOTICE Ipfat approval of your project includes ttie "Imposition" of fees, dedications, reservations, or other exactions tiereafter collectively referred to as lees/exactions." You tiave 90 days from ttie date this permit was issued lo protest imposition of ttiese fees/exactions. If you protest ttiem, you must follow ttie protest procedures set forlti in Government Code Section 66020(a), and file the protest and any ottier required information with the City Manager for processing in accordance with Carload 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 ttiat 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 tees/exactions of which vou have previouslv been qiven a NOTICE similar to this, or as to which the statute of limitations has previouslv otheiwise expired. 06-05-2012 Job Address: Permit Type: Parcel No: Reference #: CB#: Project Title: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Storm Water Pollution Prevention Plan (SWPPP) Permit Permit No:SW120231 2270 CAMINO VIDA ROBLE CBAD St: M SWPPP 2130504700 Lot#: CB121043 R A MEDICAL - ISOLATE SUITES Status: Applied: Entered By: Issued: Inspect Area: Tier: L & M WITH NEW SEWER CONNECTION TO 6" IN DRIVEWAY Priority: L Applicant: JOHN STEVENSON PLUMBING STE A108 6351 CORTE DEL ABETO CARLSBADCA 92011 760 918-04456 Emergency Contact: JT CALHOUN Owner: 2270 CAMINO VIDA ROBLE LLC 685 TURQUOISE ST LA JOLLA CA 92037 ISSUED 06/05/2012 LSM 06/05/2012 1 760-918-0486 SWPPP Plan Check SWPPP Inspections Additional Fees $45.00 $55.00 $0.00 TOTAL PERMIT FEES $100.00 Total Fees: $100.00 Total Payments To Date: $100.00 Balance Due: $0.00 ltl>l 2^ CLEARANCeL DATE. CITY OF Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 v^ww.carlsbadca.gov Plan Check No. Est. Value Plan Ck. Deposit Date 11^112^ I^WPP /ao^-^) JOB ADDRESS ^010 CAV^IM \/>*AA (U\>[JL su ITE#/SPACE#/UN IT# CT/PROJECT # # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YESO # AIRCONDITIONING YES a NOD FIRE SPRINKLERS YES • NOD APPUCAHT NAME (Primary Contact) APPLICANT NAME (Secondary Contact) ADDRESS 035/ C^-t4.be.U\^'t^ A\(fk ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX 7UV'^I1I'035^ PHOME FAX EMAIL EMAIL PR^ERTY OWNER NAME _Jf\MJL uL^x ADDRESS CONTRACTOR BUS. N^ME ADDRESS "VIE r\. CITY, STATE . ZIP CITY STATE PHORT ~~ ~ FAX PHONE FAX EMAIL EMAIL \J&M CLASS O CITY BUS. LIC.# ARCH/DESIGNER NAME & ADDRESS (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 siened statement that he is hcensed pursuant to the provisions ofthe Contractor's License Law [Cnapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or uiat 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)). Workers' Compensation Declaration: I hereby affirm under penalty of perjury one ot tf\e following declarations: n 1 have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 ot 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 ^(/-fcy^W /Jf%Htt^»l Ciwt^^'V*^ Policy No. JUQooOUi^l^* - Expiration Date ' *1 ~ l*^ This seclion need not t)e completed ifthe permit is for one hundred dollars ($100) or less, • 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 Wori<ers' Compensation Laws of Caiifornia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employerto 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 ofthe Labor code, interest and attorney's fees. ^CONTRACTORSIGNATURE .^/=^Y\ /. QAGENT DATE / hereby affirm that I am exempt from Contactor's Ucense Law for the following reason: • I, as owner of the property or my empioyees 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 properfy 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 wilh licensed contractors to construct the project (Sec, 7044, Business and Professions Code: The Contractor's License Law does no! apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant lo the Contractor's Ucense Law). • I am exempt under Section .. . Business and Professions Code for this reason: 1,1 personally plan to provide Ihe major labor and materials for consiruction of the proposed properfy improvement. O Yes • l^o 2.1 (have/have not) signed an application for a buiiding permil for the proposed work. 3. i have contracted with Ihe following person (firm) lo provide Ihe proposed construction (include name address / phone / contractors' license number): 4.1 plan lo provide portions ofthe work, but 1 have hired the following person to coordinate, supen/ise and provide the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but i have contracted (hired) the following persons to provide Ihe work indicated (include name/address/phone/type of work): >eS'PROPERTY OWNER SIGNATURE nAGENT DATE Is Ihe 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? • Yes • No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? • Yes • No Is the facility to be conslrucled wilhin 1,000 feet ofthe outer boundary of a school site? • Yes • 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 DF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending agency for the perfomiance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address Iceitl^thatlhave iBad the aopHcation and state lhatthe above infomiation isconectand tfiat the infonnation on the plans isaccurate.1 agree to complywith all Cl^ondinancesand State laws relatingto building consbtiction. I hereby authorize r^resentative of the Cify of Cartsbad to enter upon Ifie above mentioned property for inspecfioi 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 CfTY IN CONSEQUENCE OF THE GRANTING OF THIS PERJi4)T. OSHA: An OSHA pemiit is required for excavations over 5'0' deep and demolition or construction of stmctures over 3 stories in height EXPIRATION: Every pennit issued by fhe Building Official under the provisions of this Code shall expire by timitation and become null and void if the building or work authorized by such pemiit is not commenced wilhin 180 days from the date of such pennit or if the building or worit authorized by such pemiit is suspended orabandonedatanytimeafterthevw)ri( is commenced fora period of 180 days (Section 106.4.4 Unifomi Building Code). APPLICANT'S SIGNATURE DATE 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 www.building@carisbadca.gov or Mail the completed forni to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008, C0#: (Office Use Only) CONTACT NAME OCCUPANT NAIVIE ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANTS BUS. LIC. No. DELIVERY OPTIONS • PICKUP: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) • IVIAIL TO: • CONTACT (Listed above) n OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) • MAIL / FAX TO OTHER: • ASSOCIATED CB# • NO CHANGE IN USE / NO CONSTRUCTION • CHANGE OF USE/NO CONSTRUCTION ^APPLICANT'S SIGNATURE DATE Inspection List Permit#: CB121043 Type: PME R A MEDICAL- INSTALL NEW DRAIN AND SEWER CONN Date InspectloMtem Inspector Act Comments 11/07/2012 29 Final Plumbing PY AP 06/08/2012 21 Underground/Under Floor PY AP 06/08/2012 22 Sewer/Water Service PY AP Wednesday, November 07, 2012 Page 1 of 1 p 2 o o •^ 3 C/) 5-O o m X r*" N) O O O < D) o c y o Is a =3 cn ll CD S X O ^ 0) ^ 3. o o- CD Q. o 00 CO 03 < C [XI 0) £0 Q. CD <g P 0) n ^ CD o fl) ^ CO 0) d ^ 9J o ^ 5 > o-e o — 3- Ik if ^1 o 8 CD o tn ll CD (0 CD a> CL CD 3 O ^. (Q CT :r c_ 5' O 3 o i 3 O < CL :c o cr n> o TJ •a —1 o >< cn o «l * *> 4 Tl -n O «l * *> 4 > m « 11 > Z o CO n If 5^ rO-. 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