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Home My WebLink About2454 MICA RD; ; CB112658; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 12-19-2011 Permit No: CB112658 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2454 MICA RD CBAD PME Status: Parcel No: 2132700400 Lot#: 0 Applied: Reference #: PC#: Project Title: SIMS RES GAS/ ELEC TO BBQ Applicant: SIMS DAVID M&SHELL Y L 2454 MICA RD CARLSBAD CA 92009 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Entered By: Plan Approved: Issued: Inspect Area: Owner: SIMS DAVID M&SHELLY L 2454 MICA RD CARLSBAD CA 92009 ISSUED 12/19/2011 KG 12/19/2011 12/19/2011 $150.00 $30.00 $0.00 $0.00 $180.00 Total Fees: $180.00 Total Payments To Date: $180.00 Balance Due: Inspector: Date: Clearance: $0.00 t approval of your project includes the "lmpo lion" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "tees/exactions.~ .>u have 90 days from the date this pennlt was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set for~h in Government Code Section 66020(a), and file the protest and any other required information with the City Manager tor processing in accordance with Cai l5bad 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 NOTIF!ED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, gra,jing or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any f x in f hi h h flimi . n h I h i «~"\ Building Permit Application Plan Check No.C B / / Zf.t; $""" 1635 Faraday Ave., Garlsbad, CA 92008 Est. Value ~ CITY OF 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 Plan Ck. Deposit y CARLSBAD www.carlsbadca.gov Date /2-Jq-// \swPJ~ JOB ADDRESS -;,_y ~Li SUITE#/SPACE#/UNIT# IA?\7. -., CH ro /Yllc ... R11Ab -<.L Jr__, - CT/PROJECT# . LOT#' PHASE# I# OF UNITS I # BEDROOMS # BATHROOMS I TENANT BUSINESS NAME . CONSTR. TYPE I vu,. GROUP DESCRIPTION OF WORK: Include Square Feet of Atrected Area(s) 1:.,., ~ ~ \ .. ,, L .. ,,. '.:. ""' (' ~ f~L..<. ,n . ' EXISTING USE I PROPOSED USE tARAGE (SF) PATIOS (SF) I DECKS (SF) I FIREPLACE I AIR CONDITIONING I FIRE SPRINKLERS YES □#~ NOD YES □ NOD YES O NOD APPLICANT NAME (Primary Contact~ I 1'\ 1 C APPLICANT NAME (Secondary Contact) i I ~1/11 <';.J,,S{<..~ ' ...... < ADDRESS ADDRESS 2'-t S ½ tn ICA t-<,Ab Cl1Y STATE ZIP Cl1Y STATE ZIP CA~1,.S{',A,b r '1. q zeicq --\_A~Ac PHONE l'Al(ir"'f ::J--i;;r t 'iror PHONE rAX ~o91f tC,o'i? EMAIL si"ms.. n/11 6Jaol..-.r .. ,n "'""" PROPERTY OWNER NAME CONTRACTOR BUS. NAME .,...,,. ____ ADDRESS .. ~ ADDRESS Cl1Y STATE ZIP Cl1Y STATE ZIP PHONE I FAX PHONE l'AX EMAIL EMAIL ARCH/DESIGNER NAME & ADDRESS I STATE LIC. # STATE UC.# I CLASS I CITY BUS. LIC.# (Sec, 7031.5 Business and Professions Code. Any City or County which requires a permit to construct, alter, improve, demolish or repair ant structure, pnor to its issuance, also requires the applicant for such per_mit 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 a_usiness and Professions Code) or that he 1s 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 cIvII penalty of not more than five hundred dollars {$500}). -wa IU( 11.,. It GMi>II NS ATl~III Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: □ 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. □ I have and will maintain workllf'S' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. _____________________ Policy No. ______________ Expiration Date _________ _ This secbon need not be completed if the permit is for one hundred dollars ($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 workers' compensation coverage Is unlawful, and shall subject an employer to criminal penaltie& and civil fines up to one hundred thousand dollars (&100,000), In addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. ~ CONTRACTOR SIGNATURE □AGENT DATE I hereby affirm that I am exempt from Contractor's License Law for the following reason: ~ 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 f'..... 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 buikl or improve for the purpose of sale). □ 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}. □ I am exempt under Section ---~_Business and Professions Code for this reason: 1. I personaJly plan to provide the major labor and materials for construction of the proposed property improvement. □ Yes □ No 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 constniction (include name address I phone/ 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 I phone/ 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 I address I phone/ type of work) _65 PROPERTY OWNER SIGNATURE □AGENT 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? □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No Is the facility to be constructed within 1,000 feet of the outer bouridary of a school site? □ 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. I certify that I have read the application and state that the above information Is correct and that the infonnation on the plans Is accurate. I agree ID comply with atl Clfy ordinances and S1ate laws mlating ID building construction. I hereby authorize representafive of the City of Carlsbad to enter upon the alxlve mentDned property for inspection purposes, I AL.SO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AG\INST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AG\INST SAID CITY IN CONSEQUENCE CT' THE GRANTING CT' THIS PERMIT. OSHA: M OSHA permit is required brexcavations over 5'0' deep and demolition or construction of structures over 3 stories in he'Jht. EXPIRATION: Every permit issued by the Buik::ling Oflk;ial under the provisk:Jns of this Code shall expire by imitatbn and become null and void n the buik::ling or oork authorized by sudi permtt is not commenced 'Mthin 180 days from the date ofsuct, permit or if the building or oork authorized by sudi permit is suspended or abandoned at anytime after the v.ork is commenced for a perbd of 180 days (Sectk:Jn 100.4.4 Uniform Building Code). AS APPLICANT'S SIGNATURE DATE City of Carlsbad Bldg Inspection Request For: 12/27/2011 Permit# CB112658 Title: SIMS RES GAS/ ELEC TO BBQ Description: Type:PME Sub Type: Job Address: 2454 MICA RD Suite: Lot: Location: APPLICANT SIMS DAVID M&SHELLY L Owner: SIMS DAVID M&SHELL Y L Remarks: Total Time: 0 CD Description Act Comments 23 Gas/Test/Repairs 11 ~~ents/Notic-l!'ec-1s_"1_ :"1"'7- Associated PCRs/CVs/SWPPPs Original PC# Inspection History Date Description Act lnsp Comments Inspector Assignment: PY --- Phone: 7609181908 Inspector: ---- Requested By: DAVID Entered By: CHRISTINE 12/23/2011 23 GasrresVRepairs PA PY NEED PRESSURE TEST 12/23/2011 31 Underground/Conduit-Wiring AP PY OK TO BACKFILL