HomeMy WebLinkAbout2569 DOGWOOD RD; ; CB120843; Permit05-07-2012
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Patio/Deck Pernnit Permit No: CB120843
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Reference #:
Project Title:
2569 DOGWOOD RD CBAD
PATIO
2131701500 Lot#: (
$2,452.00 Construction Type: 5A
AIREY RESIDENCE
256 SF PATIO COVER W/ SHADE CLOTH.
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
Plan Check#:
ISSUED
05/07/2012
MDP
05/07/2012
05/07/2012
Applicant:
SUMMIT SERVICES
P 0 BOX 270392
SDCA
92198
944-9615
Owner:
AIREY BRYAN&REBEKAH L
2569 DOGWOOD RD
CARLSBAD CA 92009
Building Pemnit
Addl Building Pemilt Fee
Plan Check
Add'l Plan Check Fee
strong Motion Fee
Green BIdg Standards (SB1473) Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
Additional Fees
TOTAL PERMIT FEES
$58.27
$0.00
$40.79
$0.00
$1.00
$1.00
$0.00
$0.00
$0.00
$0.00
$101.06
Total Fees: $101.06 Total Payments To Date: $101.06 Balance Due: $0.00
Inspectorf
FINAL APPROVAL
Date: 7-?^-iZ^ Clearance:
NOTICE: Please take NOTICE ttiat approval of your project includes ttie "Imposition" of fees, dedications, reseivations, or ottier exactions tiereafter collectively
referred to as "tees/exactions." You have 90 days from ttie date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follovii the protest procedures set forth in Govemment 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 seivice fees in connection with this project. NOR DOES IT APPLY to any
fe^s/exactions of which vou have oreviouslv been given a NOTICE similar to this, or as to which the statute of limitations has oreviouslv othenvise expired.
^ CITY OF
CARLSBAD
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-2717 / 2718 / 2719
Fax: 760-602-8558
www.carlsbadca.gov
Plan Check No.yT^ ^ "\
Est. Value
Plan Ck. Deposit
Date SWPP
JOB ADDRESS SUITE#/SPACE#/UNIT#
CT/PROJECT#
3SI
# OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP
DESCRIPTION OF WORK: Include Square Feet of Affected Areafs)
EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE
YES • # NOD
AIR CONDITIONING
YES • NO •
FIRE SPRINKLERS
YES • NO •
APPUCANT NAME (Primary Contaet) y liomaci) .« ^ -APPUCANT NAME (Secondary Contact)
ADDRESS
P.O. Ji«> ^7o3«)^.
ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE FAX PHONE
EMAIL
FAX
EMAIL
PROPERTY OWNER NAIVIE
ADDRESS
CONTRACTOR BUS. NAME
'- ' STATE ~
ADDRESS
BUS. NAME ,
' ' STATE zip CITY ZIP CITY STATE
EMAIL
FAX PHONE
EMAIL
fe# I o I 1 ^ 1 I CLASS I CITY BUS. LIC.# ARCH/DESIGNER NAME & ADDRESS STATE LIC. # 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 any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuantto the provisions ofthe 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 {$500}).
WORKfRS' COM^INSATION
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one ofthe foiiowing declaratbns:
n >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 I fiave and will maintain workers' compens^on, as required by Section 3700 of the Labor Code, for the performance of the work fbr ^ch this pennit Is Issued. My workers' compensation Insurance carr^r and policy
/dumber are: Insurance Co |pl'0>^"ST' Vyiy/TVic.] Policy No. \\/CK) '^^kO'f// Expiration Date I ^ / S] /)
This section need not be completed ifthe permit Is ibr one hundred dollars ($100) or less.
O 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 employerto criminal penalties and civil fines up to one hundred thousand dollars (&100,000), In
addition to the cost of compensation, damages as provided fbr In Section 3706 of the Labor code. Interest and attomey's fees.
CONTRACTOR SIGNATURE •AGENT DATE
O W N E iff - B U 11 D E R DECtARATION
1 hereby affirm that I am exempt from Contractor's License Law for the foiiowing reason:
O I, as owner of Ihe property or my employees wi(h 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).
• 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:
1.1 personally plan to provide the major labor and materials for construction of the proposed property improvemeni • Yes • No
2.1 (have / have not) signed an application tor a building pemiit for the proposed work.
3.1 have contracted with the following person (fimi) to provide the proposed construction (include name address / phone / co ntractors' license number):
4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the m^or work (Include name / address / phone / contractors' license number):
5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work):
vefpROPERTY OWNER SIGNATURE •AGENT DATE
'jCOMPLBTie'THIS' S i CT I O H'^ F O n\^:UO H'^:a £$ I O e HM •<» W„I. Y'":'
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 pemiit from the air pollution control district or air quality management district? OYes d No
Is the facility to be constructed within 1,000 feet of the outer boundary 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 hereby affinn that there is a constmction lending agency for the perfomiance of the work this permit is issued (Sec. 3097 (i) Civil Code).
Lender's Name fJ ^ fi^ Lender's Address I rf
APPLICANT CERTIFICAT lOH
I certify that I have read the application and state that the above Infonnation Is conectand that the Information on the plans
I hereby authorize representative of the City of Cailsbad to enter upon the above mentioned property fbr inspedran purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HAIRLESS THE CfTY OF CARLSBAD
AGAINST ALL UABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CfTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit is required fbr excavations over 5'0' deep and demoTitkxi or constmction of structures over 3 stories in height
EXPIRATION: Every pemiit issued by the Building OflKlal under the proviskxis of this Code shaH expire by imitatton and become nul and void if the buiMing or woik authorized by such permit is not commenced within
180 days from the date of such peimit or if the buikiing or woik authorized by such pemiit is suspended or abandoned at any time after the woric is commenced fbr a period of 180 days (Sectton 106.4.4 Unifbim Buikiing Code).
>gS'APPLICANT'S SIGNATURE |^ C^^Jlj^ DATE
STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final Inspection.
Fax (760) 602-8560, Email www.buildinataicarlsbadca.aov or Mail the completed fomi to City of Carlsbad, Buikiing Division 1635 Faraday Avenue, Carlsbad, Califomia 92008.
C0#: (Office Use Only)
CONTACT NAME OCCUPANT NAME
ADDRESS BUILDING ADDRESS
CITY STATE ZIP CITY STATE ZIP
Carlsbad CA
PHONE FAX
EMAIL OCCUPANT'S BUS. LIC. No.
DEUVERY OPTIONS
a PICK UP: • CONTACT (Listed above) • OCCUPANT (Listed above)
• CONTRACTOR (On Pg. 1)
• MAIL TO: • CONTACT (Listed above) • OCCUPANT (Listed above)
• CONTRACTOR (On Pg. 1)
• MAIL/FAX TO OTHER:
• ASSOCIATED CB#
• NO CHANGE IN USE / NO CONSTRUCTION
• CHANGE OF USE / NO CONSTRUCTiON
• ASSOCIATED CB#
• NO CHANGE IN USE / NO CONSTRUCTION
• CHANGE OF USE / NO CONSTRUCTiON
VETAPPLICANT'S SIGNATURE DATE
Inspection List
Permit^: CB120843 Type: PATIO AIREY RESIDENCE
256 SF PATIO COVER W/ SHADE CLOTH.
Date Inspection Item Inspector Act Comments
07/19/2012 19 Final Structural - Rl
07/19/2012 19 Final Structural PB AP
05/09/2012 11 Ftg/Foundation/Piers PB AP
Thursday, July 19, 2012 Page 1 of 1