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Home My WebLink About2409 JACARANDA AVE; ; CB020201; Permit·•------ City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 01-17-2002 Mechanical Permit Permit No: CB020201 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2409 JACARANDA AV CBAD MECH Status: Parcel No: 2550703100 Lot#: 0 Applied: ISSUED 01/17/2002 RMA 01/17/2002 01/17/2002 Valuation: $0.00 Reference #: Project Title: BROCK RES-REPLACE FAU Applicant: ADVANCED MECHANICAL SERVICES STE E 10707 MEADOW GLEN WY 92026 760 751-3075 Entered By: Plan Approved: Issued: Inspect Area: Owner: BROCK KARIN S TRUST 05-03-99 9050 01/17 /02 2409 JACARANDA AVE CARLSBAD CA 92009 Total Fees: $24.00 Total Payments To Date: $0.00 Balance Due: Mechanical Issue Fee Install/Furn/Ducts/Heat Pumps Fee Fireplace Installation Fee Exhaust Fan Fee Installation/Relocation Vent Fee Hood Fee Boiler/Compressor to 15HP Fee Other Additional Fees TOTAL PERMIT FEES 1 0 0 0 0 0 $15.00 $9.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $24.00 0002 01 CGP $24.00 Inspector: _lJ _ _,,C,,::;_ __ FINA~ZROVAL Date: / olo~ Clearance: _____ _ NOTICE: Please take NOTICE that approval of your project includes the ~1mpositionff of fees, dedications, reservations, or other exactions hereafter collectively referred to as '1ees/exactions.ff 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 capactiy 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 vou have oreviouslv been aiven a NOTICE similar to this or as to which the statute of limitations has nreviouslv otherwise exr ired. 02 24-00 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave .. Carlsbad. CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO. <:ta 2,{),l.._o J EST. VAL. _________ _ Plan Ck. Deposit --------- Validated By k:. Date JI I z4z ¾.. IT• .,, Address (include Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Existing Use Proposed Use SQ. FT. #of Stories # of Bedrooms # of Bathrooms ~2-~C~:~N~TA~C~T~P~ER~S~O-N-llf_d_lff_•~_•L=:,:l.!,,Ll__.,;i.!!.l(:..l,lcCJl~l:>a.S:~=--.!.....IUl~oc!.l-:,___~C~4a!....,,;:J<:a£:::::;.,..L-~~~~0~·-"J'5.l.>!.sl..::',J:a5q Name Address City Telephone II Fax II -~ROPERTY OWNER f'OC, \2., Name 0 Agent for Contractor O Owner O Agent for Owner 10 Address 5. CONTRACTOR ~ CDMPAN.Y· NAME c ,4. q,Qooct '::J(a(?-1~3.-,';l ~~ State/Zip 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 tor such permit to file a signed statement thet 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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$50011. l/41L\\l4\X:i5lt> \WJ'D::M &b::V'/1~-S 1&1 o, Mp,l.'ll&<,..>G,\:,:u 1,,7 iz::. pSccJ c~"l..?o.;l-C. Jr.o-'7,Sl-a'D]-S Name Address City State/Zip Telephone# State License# ~ ~:;)/Jq°== License Class C..-;J O City Business License# \ ~ \~'J \"7 Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D 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. D 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 issued. My worker's compensation insurance carrier and policy number are: Insurance Company_____________________ Policy No. ____________ _ Expiration Date. _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$100) OR LESS) ~ 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 worker■' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars I ) · Ion to the cost of compensation, damages a• provided for in Section 3706 of the L bo, co , lnte,est and attorney'• fees. SIGNATUREe_"'"_-',.(..,..~~,.li~~----------------- 7. OWNER-BUILDER DECLARATION I hei'eby affirm that I am exempt from the Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do the work and the st,ucture 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 th,ough his own employees, provided that such improvements are not intended or offered to, 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). 0 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 improvement. D YES ONO 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. 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. J 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 _________ _ COMPLETE 'THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS 'ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materisls registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 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? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O 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. CONSTRUCTION LENDING AGENCY 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 ________________________ _ 9. APPLICANT CERTIFICATION I certify that r have read the application and state that the above information is correct and that the information on the plans is accurate. t agree to comply with all City ordinances and State laws relating to building construction, I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO ~AVE, INDEMNIFY ANO 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 shalt expire by limitation and become null and void if the building or work authorized by such permit is not com · hin 180 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. is enced for a · s (Section 106.4.4 Uniform Building Code). j J APPLICANT'S SIGNATURE ~~====~~f:;~~Sd::¥\::::====--------OATE \7 0 ,Q WHITE: File YELLOW: Applicant PINK: Finance • Inspection List Permit#: CB020201 Type: MECH Date Inspection Item 01/29/2002 43 AirCond/Furnace Set 01/29/2002 43 AirCond/Furnace Set Wednesday, January 30, 2002 BROCK RES-REPLACE FAU Inspector Act Comments RI JC AP FINAL Page 1 of 1