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Home My WebLink About2396 APPIAN RD; ; CB033123; Permit1 1 -i7-2063 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: Applicant: A V ROOFING INC 390 OAK AV 92008 760 730-0273 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Building Inspection Request Line (760) 602-2725 Miscellaneous Permit Permit No: CB033123 2396 APPIAN RD CBAD MlSC Subtype: REROOF Status: ISSUED 1673700700 Lot#: 0 Applied: 11/17/2003 $0.00 Entered By: KMT Plan Approved: 1 111 7/2003 Issued: 11/17/2003 YARUSSI RES- REROOF, 28 SQRS Inspect Area: Owner: YARUSSI DORIS TR 15441 WEBSTER ST WESTMINSTER CA 92683 Miscelaneous Fee #I Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT FEE $89.00 $0.00 $0.00 $89.00 Total Fees: $89.00 Total Payments To Date: $0.00 Balance Due: $89.00 FIN E PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO. flfi 0 33/23 EST. VAL. Plan Ck. Deposit Validated By Date Legal Description Lot No. Subdivision NamelNurnber Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Desqiption of Work SO. FT. #of Stories # of Bedrooms # of Bathrooms Fax # Name Address City Statelzip Telephone # (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provlsions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code1 or that he is exempt therefrom, and the basis for the alleged . Name Address City Statelzip Telephone # State License I 8%' &# License Class /- z5 City Business License I /!,/$/<&,r Designer Name Address city State/Zip Telephone 0 of the work for which this permit is issued. 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 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 Insurance Company Policy No. /7 .ir/YH -a3 Expiration Date 01 -2w (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS I51001 OR LESS) 0 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 employar to criminal penalties and civil fines up to one hundred Eued. My worker's policy number are: attorney's fees. 0 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). 0 1, 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 contractorls) licensed pursuant to the Contractor's License Law). 0 1. 2. 3. 4. I am exempt under Section I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES I (have I have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): Business end Professions Code for this reason: ON0 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. of work): I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone number /type PROPERTY OWNER SIGNATURE DATE 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? 0 YES 0 NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 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. 0 YES 0 NO LENDER'S NAME 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 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 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 k authorized by such permit is suspended or abandoned at any time after the work is APPLICANT'S SIGNATURE DATE /</<A? WHITE: File YELLOW: Applicant PINK: Finance .' 1 City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOBADDRESS: 2'3% p/& M 2. TYPE OF BUILDING: RESIDENTIAL 3c' COMMERCIAL 3. ROOF SLOPE: RISE 4 inches in 12 inches 4. NUMBER OF EXISTING ROOF COVERING (circle one) /32 3 5. TYPE OF EXISTING ROOF COVERING~G&&SHEATHING *6. NEW ROOF MATERIAL &?,U CLASS A WEIGHT PER SQUARE 7. NUMBER OF SQUARES 8. TRADENAME 77 *5ry hf MANUFACTURER AF 9. ROOF SYSTEM LISTING UL No. IC60 No. 10. IS THE EXISTING STRUCTURAL DESIGN &JNTit SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? All roof coverings are required to be CLASS A. Combustible roof coverings of any type or classification are prohibited. I understand the following inspections are required: I, -,-, 1. Tear OfflPre-inspection prior to install'new roof covering. 2. Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for inspection. Contractor Owner Contractor Name *6 - Rolled Roofing, StandardlLite Tile, AsphaltlComp Fiberglass, Built up, Other. City of Carlsbad Bldg Inspection Request For: 03/17/2004 Permit# CB033123 Inspector Assignment: PD Title: YARUSSI RES- REROOF, 28 SQRS Description: Type: MlSC Sub Type: REROOF Job Address: 2396 APPIAN RD Suite: Lot 0 Location: APPLICANT A V ROOFING INC Owner: YARUSSI DORIS TR Remarks: CAN YOU FINAL? Total Time: Inspect phodK r: Requested By: CHRISTINE Entered By: CHRISTINE CD Description Act Comment !E 19 Final Structural Associated PCRsKVs InsDection History Date Description Act lnsp Comments 1 111 912003 15 RooflReroof AP PD ,. 4. STATE P.0. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE Fu N D CERTIFICATE OF WORKERS COMPENSATION INSURANCE JUNE 6, 2003 GROUP: POLICY NUMBER: 1741449-2003 CERTIFICATE ID: 2 CERTIFICATE EXPIRES: 05-01 -2004 05-01-2003/05-01-2004 CONTRACTORS STATE LICENSE BOARD WORKERS' COMPENSATION UNIT ~- #I804868 05 01 03 P 0 BOX 26000 SACRAMENTO CA 95826 SCDO This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance pdicy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with resped to which this certificate of insurance 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. AUTHORIZED REPRESENTATIVE AL e.& PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE EMPLOYER AV ROOFING INC P 0 BOX 1892 CARLSBAD CA 92018 SClF 10262E ' IEPF-UI: N5 1