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Home My WebLink About2271 COSMOS CT; ; CB070656; Permit03-08-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB070656 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 2271 COSMOS CT CBAD MISC 2130504100 $000 Subtype OTHER Lot# 0 RESPIRONICS-DEMO NON BEARING WALLS@1ST&2ND FLOOR-ELECT TO NEW SYSTEMS Status Applied Entered By Plan Approved Issued Inspect Area Applicant ADVANCED DRYWALL SYSTEMS INC STE 101 5735 KEARNY VILLA RD SAN DIEGO CA 92123 858 576-7480 Owner KOCH INVESTMENTS L P 12 CHURCHILL LN RANCHO MIRAGE CA 92270 ISSUED 03/08/2007 RMA 03/08/2007 03/08/2007 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees $8000 $000 $000 TOTAL PERMIT FEES $8000 Total Fees $80 00 Total Payments To Date $80 00 Balance Due $000 \nspector{ FINAL APPROVAL 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 ''1 ilRQJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit. Validated By_ Date^ / (/ ' Address (include Bldg/Suite tt)Business Name (at this address) Legal Description Assessor s Parcel tt Description of Work Lot No Subdivision Existing Use II //} SQ FT Name/Number S7 / #of Stories A* Unit No ' Phase No Total tt of units Proposed Use / , /c> UP i c /-*y •)# of SaScooys// # of Bathrooms Name - IV~ ' Address; / " £T ' ' *"" City 3 ^yVP^t'CANT D Contractor Q AgengfofContractoriR; Q Owner D Agent for Owner tate/Zip Telephone # Fax # Name 4"'- 'PROPERTY OWNER Address City State/Zip Telephone it rName Address City State/Zip Telephone tt 6!F CONTRACTOR - COMPANY NAME ., ,,..;.v > ..^i- " {^, " ' is,ii:. :".. ;^:-ii"T : '"'™' '"' •••**&• ,:^r- (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]) "" " -/ i/,/k Cld 3/e fof " ~ Name State License # Address License Class /City State/Zi City Business License tt Designer Name State License # 6 ^WORKERS' COMPENSATION Address City State/Zip Telephone Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations f~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 l~l 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 £"<. /^ ^ / f^ Policy No C-O^-X-S O ^ — •"•' A.. Expiration Date_ . "p\. P HUND if ~f (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) l~1 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^foysecure workers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred A thousand dollars/? 100 000) in addition to tharcost of compensation damages as provided for in Section|3706 of the Labor code interest and attorney s fees\/ / / ir/) / „ /f I -s r-> ^ r\j\ SIGNATURE / SU~-^1 /^/ *-~^*<-<r£~-^/\ ^J DATE _< - V ~Cl ') 7 :..:i OWNER'BUILDER DECLARATION .tfy; ;:"'r" V .:..C.;,: " ~J* ^ "'.';. ",..: • . I hereby affirm that I am exempt from the Contractor s License Law for the following reason n 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) D 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 CD NO 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) ^PROPERTY OWNER SIGNATURE / i DATE BUILDING PERMITS ONLY h " : M ; 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? d YES O 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 l~l NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? Q YES O 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 CONSTRUCTION LENDING AGENCY '••*•*"'': "j^^ :: '_ "" 9f-! '" 'fVC ,:/' -i , . 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 Sim APPLICANT CERTIFICATION" ::. : ,:.N • •': f ""'_ . . . ;- .;; -^ /:B:I:' ' ' : 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 demolitiopior construction of structures over 3 stories in height EXPIRATION Every permit issued by the building Official under the provisions^jfy/his Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commptyed within 180 days from the date of s^h/permit or if the building or work authorized by such permit is suspended or abandoned ,t any time after the work is commepicecirfor a period of 180 days (Section 10(y4/( Uniform Building Code) APPLICANT S SIGNATURE //{s-^ /// I ^ _^>L, ^f A.DATE WHITE File YELliDW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 04/11/2007 Permit* CB070656 Title RESPIRONICS-DEMO NON BEARING Inspector Assignment TP Description WALLS@1ST&2ND FLOOR-ELECT TO NEW SYSTEMS FURNITURE-5 FT HIGH Type MISC Sub Type OTHER Job Address 2271 COSMOS CT Suite Lot 0 Location OWNER KOCH INVESTMENTS L P Owner KOCH GREGORY G TRUST 02-20-03 Remarks Phone 7609187309 Inspecto Total Time CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Act Comments Requested By RICK Entered By JANEAN Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 03/13/2007 14 Frame/Steel/Bolting/Weldmg CA TP WILL INSP @ SYSTEM FURN 03/13/2007 19 Final Structural WC TP Qiifilimtr \ffulra Slate Of California BS. CONTRACTORS STATE LICENSE BOARD ACTIVE LICENSE _ ,_, 478027 im, CORP . „«. ADVANCED DRYWALL SYSTEMS INC 11 .......-.(i BC 9 08/31/2008 B3/8.V2007 20 10/1B/S006 18535970503 3E5I bAN DIEGO PAGE: ai Advaiced Drywall Systems Inc S-'as Kearny v^lla Ed Ste A San D-<?go, CA 323 -.1 PWfewf, Oregon 9723$ 503 220 0988Re Barrett Business, Services Inc Letter of self-Insurance for Workers' Compensation Plan Dear Customei The purpose of this letter is fo provide documentation regarding FBESMS Barrett Bus-ness services' Self-Insured workers' rompenaation Plan Barrett has been a qualified esl£-iraured employer for Workers' Compensation continuously -n Oregon since 1987, in Washington, Maryland and Delaware since 1994 and in California since 1955 0 ir claim? are ri&naged by oui third- party administrators, Pinnacle Risk Management Services o^ STSCO, depending on your location As the nstnea addressee of this, letter, your company's required workers compensation coverage as provided through Barrett's Self-Insured Plan Our covered California custctiers can. also verify our state certification at rfwu dir cagpv /sxp/sip html, tien, in tre middle of the page undei Hesters", cltcJc on Piiyate...sel£ insured^emglcyers. then scroll cown to Barrett (the list IE alpha by company name ) MdiEio-i&l information is as follows Self-Insurance Ceitificataon Number Oregon Washingtor Delaware Maryland 706,116 ' 11365 Advanced Drywall Systems Inc workers' compensatacn coverage thrsugn Barrett Business Services as effeiti\e for Advancea Drywall Systems Inc services performed for RaBpironicg, 2271 Co8iBo_egtj_Cai.le_b»d, CA 92009-1517 and at Our Excess Workers' Compensation Insurance Carrier and policy Number Are as follows National Union/American International Group (AIGj Polity No 450-0723 and ^ggoc-iatsd insurance Conpany (AICE) , Policy No WCXS07-5 Ad\auce<3 Prywall Syatgais lac WC Coverage is jEron _ i through S/9/ SCO? Foi additional infoimatiou, please contact your locil Barrett, oftice a? (838} S.917 0522 crulv yours, Mu3nolland Vice President -S1 inane a Or, -'2(307 59 3EST bAH Dlt'aO Jb. IV CERTIFICATE OF INSURANCE -) 1,2307 PRODUCER Uil Wh'Mloaev TTK'«> CPRTIFICVF iS ISSUfcO AS A WHt-t OF iNCQRMATiCK ONLY A*U < N3 RISHTS I POM ThC CEBTl=!CArB HOi OE'« 1 rl!3 CEWnrlCAI'C DOES MOT 220 NW 2no Avenue Suite BOO Barrett BuKln=s§ SsiMcss he fi 00 NE ParlWf.y Ddvs Suite 290 Vanwuvw, WA 6CB62 L5TTER e C&VMMT LtTTER C COMPW L.I»TTER D COVIPAM'1 i COVERAGE 'MSUfWNCB COMPANV POR EXCESS iAIC;!} NATIONAL UNION > IRC. NSURAMCE QPWF"»\Y (Afi'i fHAt THE courts 3r WS'JR/XMS iSiEii Bf xw< «-\vS u&M i».EO ro THF iNfi^jsre tif«o ^EO'.r TOR n<F nouiv WRBD iNacftTr"WY TfiOJVt'tef «RU On COW TOfl C*M-t COITMITOH OTrtSS flCOJME»,T WITH ?iE9re(,T TO WHiiS I 'KB rCRfplSA IB Mf / tfiwSi nt»i#ui*.w,sc ATIWWM isv THE POLICIUS oeecmttfn ^t^aN ,s suast t? 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