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Home My WebLink About2325 CAMINO VIDA ROBLE; ; CB961723; PermitSuite 09/11/96 14:12 BU I LD ! NG P ERM I Page l of 1 Job Address: 2325 CAMINO VIDA ROBLE Permit Type: MISCELLANEOUS Parcel No: 213-050-27-00 Lot* • Valuation: 0 Occupancy Group: Reference*: Description: DEMO FOR ONTOGEN / REMOVE : NON-BEARING WALLS AND CEILING/NO NEW Appl/Ownr : RUDOLPH SLETTEN P.O. 4637 FOSTER CITY, CA. 94404 *** Fees Required *** 415 T Permit No: CB961723 Project No: A9602448 Development. No : 9632 09/11/9/i 0001 01 02 C-PHMT 30. Construction Type: VN Status: ISSUED Applied: 09/11/96 CON Apr/Issue: 09/11/96 Entered By: MDP 450-1919 Fees ; Adjustments: Total Fees: Fee description Miscellaneous Fee # * MISCELLANEOUS TOT ected & Credits * * , 00 . 00 30.00 Ext fee Data 30.00 PERMIT 30. 00 APPROVAL DATE U/J3/U CLEARANCE CITY OF CARLSBAD 2075 Las Pabnas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Palsas Dr., Carlsbad, CA 92009 (619) 438-1161 1. FEKMil TYPE From List 1 (see back) give code of Permit-Type: For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: PLAN CHECK NO. EST.VAL PLAN CX DEPOSIT. VALID. BY ~_ DATE Ne 2. t Loss/Gain of Dwelling Units PROJECT INFORMATION Address -? :z —3 c~ f <• Nearest Cross Street *^[ Oc^ LEGAL DESCRIPTION Lot NO. . 1 - ( building or Suite No.*.o Nsdtv, KoM«. **"-vLi_(* K_^»^\ Subdivision Name/Number FOR OFFICE USE ONLY Unit No. Phase No. CHECK BELOW IF SUBMITTED: D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK SQ.FT.# OF STORIES # OF BEDROOMS # OF BATHROOMS 3. (JUNTAirr reKbUN {,11 auterent irom appiicantj NAME (last name first) CITY STATE ADDRESS ZIP CODE DAY TELEPHONE 4. APPLICANT U CONTRACTOR. NAME (last name first) «^ ^ LJAGhNl frUK UJNIKAL.1UK ^ s ^ ADDRESS LJUWNtK LJAUtNl hUK UWNtK i>. 6. CITY PROPERTY UWNEK NAME (last name first) CITY UJN1KAL.IUK NAME (last name first) STATE STATE \^-y STATE ^ STATE UC. # ZIP CODE ZIP CODE ZIP CODE ^H LICENSE CLASS DAY TELEPHONE ADDRESS DAY TELEPHONE ADDRESS \^ O -^ «=>K H ^ -^ < <4 * <f DAY TELEPHONE <-{ v 5~ U, 5~° CITY BUSINESS LIC. # 1 • <• "M 1 ZOOCC(^ NAME uast name first) CITY STATE ZIP CODE DRLS5 DAY TELEPHONE STATE LIC. # 7. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm that T nave a certincate or consent to self-insure issued by the Director ol Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY POLICY NO.EXPIRATION DATE Ceruhcate of Exemption: I certify that in the performance ot 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. SIGNATURE DATE 8. OWNER-BUILDER DECLARATION uwner-Buiider Declaration: l nereoy atnrm that l am exempt rrom tne (Contractors License Law tor the lonowmg reason: O 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: (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, commencing 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 [$SOO]). SIGNATURE DATE CQMFLk~it 1 HIS SECTION FOR NCJN-RESIDENTIAL BUILDING PERMITS UNLY: 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 D 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? D YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 9. CONSTRUCTION^ LANDING AGENCY I hereby allirm that there Is a construcuon lending agency tor the pertormance ot the work tor which this permit is issued (.sec 3097UJ Civil uodej. LENDER'S NAME LENDER'S ADDRESS 10. APFLJCANl T certify that I have read the application and state that the above information is correct. T agree to comply with all City ordinances and Mate 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 AGATNST All. UABDJTIES, 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 ot this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work i&,commenced for a period of 180 days (Section 303(d) Uniform Building Code). APPLICANT'S SIGNATURE S^fcg^S j? s^~) DATE: WHITTL: File YELLOW:^Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB961723 FOR 11/13/96 DESCRIPTION: DEMO FOR ONTOGEN / REMOVE NON-BEARING WALLS AND CEILING/NO NEW CON TYPE: MISC JOB ADDRESS:2325 CAMINO VIDA ROBLE APPLICANT: CONTRACTOR: OWNER: RUDOLPH SLETTEN PHONE: PHONE: PHONE: STE INSPECTOR AREA PLANCK* CB961723 OCC GRP CONSTR. TYPE VN LOT: 415 450-1919 REMARKS: MW/MIKE/942-7812 SPECIAL INSTRUCT: INSPECTOR TOTAL TIME: —RELATED PERMITS—PERMIT* SE930071 AS930064 FA930024 CB961421 AS960066 FA960010 CB961992 TYPE SWOW ASC FALARM ITI ASC FALARM ELEC STATUS ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED CD LVL DESCRIPTION 13 ST Shear Panels/HD's ACT COMMENTS DATE DESCRIPTION ***** INSPECTION HISTORY ***** ACT INSP COMMENTS 07/02/96 16:03 345 4689 RUDOLPH&SLETTEN SAN DIEGO OFFICE ACOKD CERTIFICATE OF LIABILITY INSURANCE ISSUE DATE (07/01/96) nwouceir *RKER. SMITH & PEEK. INC. .. JO First Interstate Ce Tier 999 3rd Avenue Seattle. Washington 9* 104 WSORED' ~ ~ ~ " RUDOLPH AND SLETTEN P.O. Box 4637 Foster City, California 944 04 NC. THS cernincATE is issue? AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS WON THE CBTTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER me COVERAGE AFFORDED BY TVF Pl COMPANIES AFFORDING COVERAGE COMPANY A I COMPANY B COMPANY" c COMPANY" D INDUSTRIAL INDEMNITY COMPANY IIS IS TO CERTIFY THAT THE POU IESOF (NSURANCe LISTED BELOW HAVE"BEEN"ISSUED' TOi'THE; INSURED N^«EO AecVE FCfl THE POUCY PERKX) INDICATED. NOTWrTHSTANDING AN1 REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WFTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR M' Y PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN rS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH FTDUCIE: . LIMFTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. Co LIT A Type of Insurance General Liability ^Commercial Goneral Li' aifity _Claim3 Made Occur. _jDwn«ra & Contractors '« rot Automobile Liability _Any Auto _. AH Owned Autos _Scheduled Autos Hired Autos Non-Owned Autos Garage Liability Any Auto Excess Liability _UmbtBlIa Form __OtherThan Umbreila F rm Workers' Compensatlor and Employers' Liability The Proprietor/Partners/ _ (net Executive Officers are: _ Exd. Other Policy Number CR 962-6432 Policy Effective Date (MM/DD/YY) 06/30/96 Policy Expiration Date (MM/DD/YY) 06/30/97 Limits General Aggregate $ Products/Comp Ops Agg. S Pars. & Adv. Injury $ Each Occurrence S Fife Damage («ny on* fir*) $ Mod. Expense <»ny owpman} $ Combined Single Umit S Bodily Injury (per person) S Boddy Injury (per accident) J Property Damage $ Auto Only - Each Accident $ Other Than Auto Only: Each Accident $ Aggregate S Each Occurrence $ Aggregate $ X WC STATUTORY LIMITS OTHER EL Each Accident $ 1,OOO,OOQ EL Disease-Policy Umit S 1,000,000 EL Disease-Each Employee £ 1,OOO,OOO Description of operations/locations/' ehicfes/speciaj items SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPtflATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL W_ DAYS WHITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. HUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AMY KJhHJllPnM THF COMPANY ITS AQFMTS QH HFPRFSFMT*Tft/FR AUTHORIZED REPftESENTATlVE- RUDOLPH\SAMPL£4