The URL can be used to link to this page

Home My WebLink About2380 CAMINO VIDA ROBLE; ; CB972470; PermitBUILDING PERMIT09/03/97 12:06 Page 1 of 1 Job Address: 2380 CAMINO VIDA ROBLE Permit Type: MISCELLANEOUS Parcel No: Valuation: 25,152 Occupancy Group: Reference*: Description: RE-ROOF,26,200 SF-BUILT-UP Suite: Lot#: Permit No: CB972470 Project No: A9703130 Development No: Appl/Ownr : PREMIER ROOFING 9054 OLIVE DR SPRING VALLEY CA 91977 *** Fees Required *** Fees : Adjustments: Total Fees: Fee description Ai*/*: P31 Of/08/W QQtt. 01 02 Mam 431-00 Construction Type: NEW Status: ISSUED Applied: 09/03/97 Apr/Issue: 09/03/97 Entered By: RMA 619 667-4565 Collected & Credits Miscellaneous Fee * MISCELLANEOUS T *** .00 .00 431.00 Ext fee Data •— ^—«•• *— — — _ mm* ^ _ •«*<»• — 431.00 PERMIT FE 431.00 APPnOVAL CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 P-.no FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Suite #1 Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel #Existing Use Proposed Use Description of SO. FT. ^ ft of Bedrooms ^ of Bathn Name Address City 13," AJ>PlJCANt ^Contractor O Agent for Contractor ; " :DBwneP":T] ;AgMfer!G%ier State/Zip Telephone # Fax # Name %i -!, : PRC-PERTY OWNBrT Address S r> s~*\ 1 ' • ' '-••'• City ' . • " •';" • ' f •' ' •'-' 'fi State/Zip '"•>•*•• . '"-'•• •• -vT" ''•'••*"$' ' •'••-"'••• •- / Telephone 9 Name Address *. cbHtnActbrt i COMPANY NAME ' ^ ; City State/Zip mt; l^^(^,^.*^.^^J«^!S^:^^JJ«|9f[-J>^;*J^f,»!!^1^™|SJ^JJ- Telephone* (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 faction 7031.5 by any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars [$5001). OR ^/Vr^SO' CA ^£? Name State License # ,- -. , fc^r ' d G» Address License Class . ^C_ "~ 3 7 State/Zip City Business License # Telephone # Address City State/Zip TelephoneDesigner Name State License # 6. WORKERS' COMPENSATION " "'' "" """ "'" ' " ' ^'•-.^••:--- -v--v-•.,••,-• ^-^^ Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0T 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. •Q_l 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: ^/\ -.. . _^ Cv\S^lTl/ Policy No. /Q6 3 ?7' ^6 / Exoiration Date S V~'Insurance Company (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS IS100] OR LESS) CJ^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 Lews 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 cost of compensation, damages as provided for hi Section 3706 of the Latter code, Intonst and attorney's fees. DATE ' 5~ / * thousand dollars ($100,000), In addfflota SIGNATURE _ (£\^>/ 7, OWNER-BUILDER DECLARATttiN (hereby affirm that I am exempt from the Contractor's License Law for the following reason: ^3 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 (See. 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). [3=i-f; 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 improvemen^QYES QNO 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. 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 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 DATE M£M«JitttH«*teftb»^ 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? Q YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O<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 OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. |8. CbNST^UCtibni LENbliNd AGENCY ; "•--"-<:-;--"- ;y; -yv'".!.'^^.™"1-'1"'"""' •'•"" '"• '•':' -f •T^--^r!:- ;?;r.•' Yr?-" "^ " -- :":; .J£j.,:'-f < 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 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 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 authorized by such permit is not c^wrfmenced Vith«H>65 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 APPLICANT'S SIGNATURE a period of 180 days (Section 106.4.4 Uniform Building Code). DATE 9 - >9 WHITE: File YELLOW: Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB972470 FOR 09/08/97 DESCRIPTION: RE-ROOF,26,200 SF-BUILT-UP TYPE: MISC JOB ADDRESS: 2380 CAMINO VIDA ROBLE APPLICANT: PREMIER ROOFING PHONE: CONTRACTOR: PHONE: OWNER: PHONE: INSPECTOR AREA PLANCK* CB972470 OCC GRP CONSTR. TYPE NEW STE: LOT: 619 667-4565 REMARKS: C/DAVE/667-4565(9) AFTER 11AM INSPECTOR SPECIAL INSTRUCT: TOTAL TIME: —RELATED PERMITS — PERMIT* TYPE STATUS CD 15 890577E CTI EXPIRED LVL DESCRIPTION ACT COMMENTS ST Roof /Reroof flA £0t->r* 7&AfL £&-& 4~ /?£-/?.& of- /tJ SG& DATE DESCRIPTION ***** INSPECTION HISTORY ***** ACT INSP COMMENTS CITY OF CARLSBAD SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS <25frQ Cft^ I*Q l/(Qf\ 2. TYPE OF BUILDING: RESIDENTIAL _ COMMERCIAL 3. ROOF SLOPE: RISE V inches in 12 inches 4. TYPE OF EXISTING ROOF COVERING R, J. (L. SHEATHING r' 5. NUMBER OF EXISTING ROOF COVERINGS (circle one) (T) 2 3 *6. NEW ROOF MATERIAL \O'U<$^ _ CLASS & WEIGHT PER SQUARE 7. NUMBER OF SQUARES 8. TRADE NAME ^/t*- MANUFACTURER 9. ROOF SYSTEM APPROVAL UL No. 0/Ass ft Other 10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN TH£ WEIGHT OF THE PROPOSED ROOF YES >^ NO If the answer is no, a roof plan must be provided with this application. 11. Fire rating of roof: Class A cx^ Class B _ I understand the following inspections are required: 1. Tear Of f/Pre- inspect! on prior to installing new roof covering. 2. Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for inspection, SIGN DATE Contractor CX Owner Contractor Name *6 - Rolled Roofing, Tile, Shake, Shingle, Asphalt/Comp Fiberglass, Built up [ACORD r CERTIFICATE OF LIABILITY INSURANCE - ^™ 1 TODUCER (Q lA. Pearsc Insurance 6' Lusk Sa.. Jiego, Attn: Karin 19)642-0010 FAX (619)642-0888 3n and Associates Brokers, Inc. Blvd. Ste. B CA 92121 Cramer Ext: INSURED Premier Roofing, Inc. 9054 Olive Drive Spring Valley, CA 91977-2301 THIS UtK r IMUA 1 t IS ISSUtU A5 A MA 1 1 tK Uh INfUKMA 1 IUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY CNA - Transportation insurance Co. A COMPANY CNA - Valley Forge insurance Co. B COMPANY CNA - American Casualty Co. of Reading, PA C COMPANY D ::£QVERA§E5S» - . , . INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR A B C TYPE OF INSURANCE GEI...... ISPJimX X AU "x v GA EXC NERAL LIABILITY COMMERCIAL GENERAL LIABILITY ; CLAIMS MADE \ X ! OCCUR OWNER'S & CONTRACTOR'S PROT $5,000 Property Damage Deductible IMMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS RAGE LIABILITY ANYAUTO ESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ ' ,NCL PARTNERS/EXECUTIVE OFFICERS ARE: X EXCL ; OTHER POLICY NUMBER C1055398208 BUA1055398211 1063791361 POLICY EFFECTIVE \ POLICY EXPIRATION DATE (MM/DD/YY) : DATE (M M/D D/YY) 05/01/1997 ; 05/01/1998 05/01/1997 05/01/1998 05/01/1997 ; 05/01/1998 LIMITS GENERAL AGGREGATE PRODUCTS - COMP/OP AGO PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any orw fire) MED EXP (Any on* parson) COMBINED SINGLE LIMIT BODILY INJURY (P«r pmon) BODILY INJURY(Pw accident) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE X : vmxoimu- • :vin-• TORY LIMITS | • ER EL EACH ACCIDENT EL DISEASE - POLICY LIMIT * 2,000,000 * 1,000,000 * 1,000,000 * 1,000,000 * 50,000 * 5,000 1,000,000 • $ $ 3 * s $ s s jiii\ - \ » 1,000,000 s 1,000,000 EL DISEASE - EA EMPLOYEE S 1 , QOO , 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS £: Contractors State License Number - 689726. ny and All Operations of the above named insured, CONTRACTORS STATE LICENSE BOARD P.O. Box 26000 Sacramento, CA 95826 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 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 COMPANY, ITS AGENTS OR REPRESENTATIVES. AUJUOROED REPRESENTATIVE , // ' /I /•^•CH ,— - ,r> > -^ - •• <y — ;, >,"?* '--iSACORDCQRPQRATioKISSB