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HomeMy WebLinkAbout2284 CAMINO ROBLEDO; ; CB090125; Permit01-22-2009 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No: CB090125 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: 2284 CAMINO ROBLEDO CBAD PLUM 2552704200 Lot#: 0 Construction Type: NEW BOUGHNER RES REPLACE WTR HTR Status: ISSUED Applied: 01/22/2009 Entered By: KG Plan Approved: 01/22/2009 Issued: 01/22/2009 Inspect Area: Applicant: AFFORDABLE WATER HEATER 24707 SAN FRANANDO RD SANTA CLARITA, CA 91321 661 259-7131 Owner: BOUGHNER GAIL B 2284 CAMINO ROBLEDO CARLSBAD CA 92009 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees 0 0 0 0 1 0 0 $20.00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $27.00 Total Fees:$27.00 Total Payments To Date:$27.00 Balance Due:$0.00 Inspector: FINAL APRROVAL 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. City of Carlsbad 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 - Fax: 760-602-8558 Building Permit Application Plan Check No. Est. Value Plan Ck. Deposit JOB ADDRESS . , , , A - .} , I . 1 CT/PROJECT* LOT# PHASE # # OF UNITS # BEDROOMS DESCRIPTION OF WORK: fceflaee f>0 fliAllors ^t\s OJAteij j EXISTING USE PROPOSED USE GARAGE (SF) CONTACT NAME (If Different Fom Applicant) ADDRESS CITY STATE ZIP PHONE FAX EMAIL PROPERTY OWNER NAME ~ ADDRESS ^ J CITY STATE ZIP PHONE FAX ~"l (00 \H^- " OCC ^ EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC. # SUITE#/SPACE#/UNIT# J APN SV # BATHROOMS TENANT BUSINESS NAME 1 CONSTR. TYPE 1 OCC. GROUP ' Hecxter »4-j PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES P # NO D YES D NO D YES D NO D APPLICANT NAME . . . J ADDRESS CITY STATE ZIP PHONE FAX EMAIL -. CONTRACTOR BUS. NAME ill ADDRESS CITY STATE ZIP JL 1 fi 1 1\ w JL 1 t fl f\ Ok / *9 % 1/^W ^ WW f| £l 1 / t- ^r T f 1<Sd^ I PHONE I FAX (jjjf -^5"^" 05^-0 1 EMAIL STATE LIC.# CLASS CITY BUS. LIC.# :. 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 isnsed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 ol Division 3 of the Business and Professions Code} or that he is e<empt therefrom, and the basis lor the alleged eiemption. Anv violation oflion 7031.S by any applicant for a permit subjects die applicant to a civil penalty of not more than five hundred dollars {$500}). WORKERS' COMPENSATION Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: CJ I have and will maintain a certificate of consent to self-Insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Ml have and will maintain workers'compensation as required by Section 3700 of the Labor Code, for the performance of the work for which thispermit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. f C. F>l T K ' Policy No. "$.Qb*1f*f')t)$ Expiration Date I * / " 10 This section need not be completed if the permit is for one hundred dollars ($100) or less. O 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, damage*as provided for In Section 3706 of the Labor code, interest and attorney's fees. >6!f CONTRACTOR SIGNATURE AdOt^L . DATE OWNER-BUILDEI. DECLARATION / hereby affirm that I am exempt from Contractor's License Law for the following reason: O I, as owner of the properly 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). O 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: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. D Yes D No 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number): 4.1 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 / contractors' license nurr her): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): ^PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING f*,«It M I TS O N i ¥ 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? Cl 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? D Yes O No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? CJ Yes O No IF ANY OF THE ANSWERS ARE YES, t EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address APPLICANT CERTIFICATION I certify that I have read the application and state that the above information Is arredand mat the Infomiaflon on me plans Is acairateJagreetooompK/with all City odinances and I hereby authorize representative of the City of Cartebad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE Cm OF CARLSBAD OSHA: An OSHA permit is required for excavations over 5'G" deep and demolition or construction of slmctures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of (his Code shall expire by limitation and become null and void if the building or work aulhorized by such permit is not commenced within 1«) days trom tr« date of such pern* or If (r« buWIm « wnX mitr«xtzed ^APPLICANT'S SIGNATURE DATE - ! If ~ C City of Carlsbad Bldg Inspection Request For: 07/01/2009 Permit* CB090125 Title: BOUGHNER RES REPLACE WTR HTR Description: Inspector Assignment: Type: PLUM Sub Type: Job Address: 2284 CAMINO ROBLEDO Suite: Lot: 0 Location: OWNER BOUGHNER GAIL B Owner: BOUGHNER GAIL B Remarks: Phone: 7609420006 Inspector: Total Time:Requested By: NA Entered By: CHRISTINE CD Description 25 Water Heater/Vents Act Comment Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 16619481533 WMI 02:31.-40 p.m. 01-06-2009 2/3 AQQR& CERTIFICATE OF LIABILITY INSURANCE •£%£* PRODUCER (661)948-1003 FAX (661)948-1533 Walter Kortensen Insurance License JOD44424 1113 West Ave M-4 *c Palmdale, CA 93551 INSURED Affordable Water Heaters & Plumbing, Inc. 24663 Railroad Avenue Newhall, CA 91321 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE! HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Zenith Insurance Conpany INSURER B: INSURER C: IN SURER ft INSURER E NAIC# COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR JJJ5. A tornMSBI TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY J CLAIMS MADE [ | OCCUR GEN'L AGGREGATE LIMIT APPLIES PERn^cYpi^ n«* AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY [ ANY AUTO EXCESSWMBRELlA LIABILITY | OCCUR | | CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ' yes. describe underSPECIAL PROVISIONS below OTHER POLICY NUMBER Z067898703 POLICY EFFECTIVEDATE fMU/OtUYYl 01/01/2009 POLICY EXPIRATIONn^TF OlM/DDfVY) 01/01/2010 UMTS EACH OCCURRENCE DAMAGE TO RENTEDPBFUISFS Iff rrair«««ri MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPA3P AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY(Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EAACC AGG EACH OCCURRENCE AGGREGATE 1 WCSTATU-1 TORY IJMITS OTH-ER E.L. EACH ACCIDENT EL DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ S $ t * $ S t % s *$ $ t $ s f s l.OOO.OOC $ 1,000,000 t l.OOO.OOC DESCRIPTION OF OPERATIONS ' LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONSertificate of Insurance CERTIFICATE HOLDER CANCELLATION Affordable Water Heaters & Plumbing Inc 24707 Railroad Avenue Santa Clarita, CA 91321 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Of}/ Mark Heyne/MJN ^^^ ACORD 25 (200*08)©ACORD CORPORATION 1988