HomeMy WebLinkAbout2400 ALTISMA WAY; ; CB043267; Permit08-19-2004
Job Address:
Permit Type: Parcel No: Valuation:
Reference #:
Project Title:
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Building Inspection Request Line (760) 602-2725
Miscellaneous Permit Permit No: CB043267
2400 ALTISMA WY CBAD
MlSC Subtype: REROOF Status: ISSUED 23szm#+ Lot #: 0 Applied: 0811 912004
$23,200.00 Entered By: RMA
Plan Approved: 0811 912004
Issued: 0811 912004 ARROYO VILLAS-8000 SF STD WT CONCRETE Inspect Area:
Applicant:
J P WITHEROW ROOFING
1001 MORENA BLVD 921 10
6192974701
Owner: PRINCE ROBERT D&HENRY MICHELLE A
2400 ALTISMA WAY #A CARLSBAD CA 92009
Miscelaneous Fee #I
Miscelaneous Fee #2
Additional Fees
TOTAL PERMIT FEES
PERMIT FEE $345.00
$0.00
$0.00
$345.00
Total Fees: $345.00 Total Payments To Date: $0.00 Balance Due: $345.00
Inspector: Clearance:
NOTICE: Please take NOTICE that approval of your project includes the “Imbosition’of fees, dedications, reservations, or other exactions hereafter collectively
referred to as “feeslexactions.“ You have 90 days from the date this permit was issued to protest imposition of these feeslexactions. 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
feeslexactions of which vou have Dreviouslv been aiven a NOTICE similar to this. or as to which the statute o flimiai t to n s h as D r ev i ous I v ot h e Iwi se e x D ired.
PERMIT APPLICATION PLAN CHECK NO.
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
Assessor's Parcel X Existing Use Proposed Use
X of Bedrooms t of Bathrooms
7a Y
Name Address City Statelzip Telephone I
(Sec. 7031.6 Business and Professions Code: Any City or County which requires a permit to construct, altar, 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 Lew
IChanter 9. commendina with Section 7000 of bivision 3 of the Business and Professions Codel or that he is exempt therefrom, and the basis for the alleged
City StateKip Telephone I
City Business License x /a I I 938 Nama Address
License Cless
Designer Name Address City StateZip Telephone
State License I
Workers' Compensation Declaration: I hereby affirm under penalty of pejury one of the following declarations:
0 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.
g/;have end 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
Insurance Company Policy No. c% 9 Expiration Date / f '
-
[THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS I$1001 OR LESS)
0 to become subject to the Workers' Compensation Laws of Celifomia.
WARNINQ Fdhm thowand dollars ((11
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 es
covomga b unl.wtul, nd atuN e n onrpkyw to aimhd p.n.ltiea urd dvR Rno up to one hundnd cornpen8ation. datnqpa as provided for in Saction 3706 o
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
0 1, as owner of the property or my employees with wages as their sola compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Busineu and Professions Code: The Contrnctor's License Law does not apply to an owner of property who builds or improves thereon, and who does
such work himself or through Ms own employees, provided that such improvements are not intended 01 offered for sale. if, however, the building of Improvement is
mid 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'a License Law does not epply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(8) licensed
pursuant to the Comnctor's License Law).
0
1.
2.
3.
I am exempt under Section
I personally plan to provide the major labor and matarials for construction of the proposed property improvammt. 0 YES ON0
i (hava I have not1 signed an rpplication for a building permit for the proposad work.
I have contracted,wlth the following person (firm) to provlde the proposed construction (include name I address I phone number I contractors license number):
Budnoas and Professions Code for this reason:
4.
number I contrecton licenaa number):
6.
of work):
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 I address I phone
I will provide some of the work, but I have contracted (hired) the following parsons to provide the work indicated (include name I address I phone number I type
PROPERTY OWNER SIGNATURE DATE
Is the applicant or future building occupant required to submit a businass plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 26506,26633 or 26534 of the Presley-Tanner Hazardous Substance Account Act? c 0 YES
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air qualiy management district? 0 YES 0 NO
la 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 METING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
0 NO
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30971i) 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 Cit). 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 la required for excavations over 6'0' deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit Issued by ttie building Offlcial under the pmvisions of this Code shall explre by limitation and become null and void If the building or work authorized by such permit is the date of such permit or if the building or work authorized by such permit 18 suspended or abandoned
at any time after the work is mmm
APPLICANT'S SIGNATURE DATE
ion 106.4.4 Uniform Building Code).
WHITE: File YELLOW: Applicant PINK: Finance
I
'.
City Of Carlsbad
SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING
2. TYPE OF BUILDING: RESIDENTIAL 6/ COMMERCIAL
3. ROOF SLOPE: RISE 1 inches in 12 inches
4. NUMBER OF ExisTi~G ROOF COVERING (circle one) @J 2 3
5. TYPE OF EXISTING
*6. NEW ROOF
7.
mer SHEATHING ppm~ .
CLASB WEIGHT PER SQUARE
9. ROOF SYSTEM LISTJNG UL No. IC60 No. 37H .
10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE
WEIGHT OF THE PROPOSED ROOF? @ NO
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: -,
4,
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. A
Signature Date $* 19-4
Owner Contractor Name Contractor /-
*6 - Rolled Roofing, StandardlLite Tile, AsphalVComp Fiberglass, Built up,
Other.
City of Carlsbad Bldg Inspection Request
For: 0 1 /05/2005
Permit# CB043267 Inspector Assignment: JM
Title: ARROYO VILLAS-8000 SF STD WT
Description: CONCRETE
Type: MlSC Sub Type: REROOF
Job Address: 2400 ALTISMA WY
Suite: Lot 0
Location:
OWNER PRINCE ROBERT D&HENRY MICHELLE A
Owner:
Remarks:
Total Time:
Phone: 61 92974702
Inspector:
Requested By: BOB BYRD
Entered By: CHRISTINE
CD Description Act Comment
19 Final Structural
Associated PCRs/CVs
InsDection History
Date Description Act lnsp Comments
09/20/2004 13 Shear Panels/HD's WC JM
09/20/2004 13 Shear PaneWHD's WC JM
09/20/2004 13 Shear PaneldHDs WC JM
09/20/2004 15 RooWReroof AP JM NORECORDCARD
P-04
4 01:4€3P
.yi<?&-,;* ~ -** -- .;. &-+5! . ., ...
State Of California
QRS STATE LICENSE B~ARI-I
'-V Entity bUKr
BIF~~I- Nirw J P WITHEROW ROOFING COMPANY
,.
.L .. .. ..
..._ -. ... ^_ -__ . .
Any change of business addresslname must be reported to the Registrar within 90 days.
This license is not transferrable, and shall be returned to the Registrar upon demand when suspended, revoked, or invalidated for any reason. ,
This pocket card is valid through the expiration date only.
Postage guaranteed by:
Contractors State License Board
P.O. Box 26000
Sacramento, CA 95826
If f9und, drop in any mailbox.
Licensee Signature
65JPWITH
--Ir Client#: 14986 -
ACORD, CERTIFICATE OF LIAgILlfY INSURANCE DATE (MMIDM
01106/04
HRH of Colorado
720 S. Colorado Blvd. Ste. PH N
P.O. Box 469025 I
INSURER E: I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFoR~T,~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIF~ATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
I I Denver, GO 80246-9025
INSURED J.P. Witherow Roofing Company, Inc.
1001 Morena Boulevard
San Diego, CA 92110
AUTO ONLY - EA ACCIDENT I $ I ~GEUABIUN I I I I
INSURERS AFFORDING COVERAGE NAlC# '
INSURER A: Valley Forge Insurance Company
INSURER 8: Transcontinental Insurance Companies
INSURERC: State Comp. Ins. Fund
INSURER D t.
I HANYAUTO
B
CLAIMS MADE
ANY PROPRlETORlPARTNERECUTIVE OFFlCERlMEMBER EXCLUDED?
KSCRlPTlON OF OPERATIONS I LOCATlONS I VEHICLES I EXCLUSIONS ADMD BY ENDORSEMENT I SPECIAL PROVISIONS
"IO DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM
GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPfOP AGG $2,~~~,~~~ ipoLlCy~~gf n LOC
-? ~1,000,000 AUTOMOBILE LIABILITY BUA2067535304 12/31/03 12/31/04 COMBINED SINGLE LIMIT (Ea stdent) ANY AUTO
ALL OWNED AUTOS BODILY INJURY
- - s (Per penm x SCHEDULED AUTOS -
BODILY INJURY
CERTIFICATE HOLDER CANCELLATION
lSIiOUl0 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ME O[PI-nON I
REPRESENTATIVES.
-
- Proof of lnsurance- DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 OnYs WRI~N
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE To Do SO SHAU
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE-INSURER. lis OR