The URL can be used to link to this page

Home My WebLink About2569 DOGWOOD RD; ; CB120847; Permit05-08-2012 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB120847 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 2569 DOGWOOD RD CBAD PME 2131701500 AIREY: GAS TO FIREPIT Lot#: Status: ISSUED Applied: 05/07/2012 Entered By: Plan Approved: Issued: Inspect Area: JMA 05/08/2012 05/08/2012 Applicant: SUMMIT SERVICES P O BOX 270392 SDCA 92198 944-9615 Owner: AIREY BRYAN&REBEKAH L 2569 DOGWOOD RD CARLSBAD CA 92009 Plumbing Fees Electrical Fees Mectianical Fees Other PME Fees $150.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $150.00 Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due: $0.00 Inspector: FINAL APPROVAL Date: '^^^^/p Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, resenrations, or other exactions hereafter collectively refened to as lees/exactlons." You have 90 days from the date this pemiit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Sectton 66020(a), and file the protest and any other required infomiation 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 sen/ice fees in connectton with this project. NOR DOES IT APPLY to any fees/exactions of which vou have orevioush/ been oiven a NOTICE similar to this, or as to which the statute of limitations has previously 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. ("Z O 7 Est. Value Plan Ck. Deposit Date SWPP JOB ADDRESS CT/PROJECT# |L0T# I SUITE#/SPACE#/UNIT# 1/3 -]no -/r- 3^/ # OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: /nc/ude Square Feet of Affected Area(s) EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YES • # NOD AIR CONDITIONING YES • NOD FIRE SPRINKLERS YES •NOD APPUCANT NAME (Primary Contact) APPLICANf NAME (Secondary Contact) ADDRESI Po. Bv^ 1-70 ^'i^ ADDRESS CITY 'Ceo STATE ZIP CITY ZiP PHONE EMAIT" FAX l(oO PHONE FAX EMAIL PROPERTY OWNER NAME CONTRACTOR BUS. NAME , i ADDRESS ADDRESS P.O. 3oy LICKS') Z- CITY STATE ZIP CITY STATE ZIP 9^/'7<P PHONE EMAi?^^ FAX PHONE EMAIL IE FAX , "7feD |74o jrS'SU T~ ZZ~~i !Z ^ I cuss I CITY BUS. LIC.# ARCH/DESIGNER NAME & ADDRESS cuss /2r^2-/<f^7 (Sec. 7031.5 Business and Professions Code: Any City or County whicti requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the appllcantfor 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 appllcantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: / hereby afTirni under penalty of perjury one olthe foiiowing deciarattons: n I have and will maintain a certificate of consent to self-insure for workers'compensation as pmvided by Section 3700 ofthe Labor Code, for the performance of the work for which this permit Is issued. ^^1^ I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, fbr the performance of the work for which this permit is Issued. My worl<ers' compensation Insij^nce ^rrier and policy number are: Insurance Co., PolicyNo. ance of the work tor which this permit Expiration Date. latlpn insuiance earner a This section need not be completed If the pemiit is for 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 for in Section 3706 of the Labor code. Interest and attomey's fees. S^/7// CONTRACTOR SIGNATURE LA ^GENT DATE S>/7/i «5r / hereby affirm that I am exempt from Contractor's Ucense Law for the foltowing 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 oifered 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). O 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 properly improvement. • Yes D No 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (Include name address / phone / contractors' license number): 4.1 plan to provide portions of the work but I have hired the following person to coordinate, supen/ise and provide the major 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): veTpROPERTY OWNER SIGNATURE •AGENT DATE f QMP L B T'« T HI S'^^' S g C TI O N.: OVk Ji O H-Vi^ii'ti^^m I AX. B;*! I \..Vlt\HM,f^ 't^mi't^.O, NLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous matenals 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 fxility to be constructed within 1,000 feet of the outer boundary of a school site? • Yes O No IF ANY OF THE ANSWERS ARE YES. A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CON S;tft U'C^rtl H H D i U13, A,G 1 N C Y I hereby affinn that there is a constmction landing agency for the perfonnance of the work this permit is issued (Sec. 30j)7 (i) Civil Code). Lender's Name IT'''^ 11^ Lender's Address f\J APPLICANT CERTIFI C A T I «|iNI i I certlly that I have read the application and state that the above Infbmiation Is conect and that the infonnatkin on the plans is accurate. I agree to comply with all City onjinances and State laws relating to building consbuction. I hereby authorize representative of the 01^ of Cailsbad to enter upon the above menttoned property fbr inspectton puiposes. I ALSO AGREE TO SAVE, INDEIVNIFY AND KEEP HARIVILESS THE Gfrv OF CARLSBAD AGAINST ALL LIABILfTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA pemiit is required for excavations over S'C deep and demoiition or constructton of structures over 3 stories in heighL EXPIRATION: Every peimit issued by the Buikiing Ofliciai under the provistons of this Code shafl expire by imitatton and become nul and vokJ if the buikiing or worit aulhorized by such pemiit is not commenced within 180 days from the date of such pemnit or if Ihe buiMing or worit aulhorized by such petmit is suspended or abandoned at any time after the woik is commenced for a period oM'to days (^edion 106.4.4 Uniform Buikiing Code). >eS'APPLICANT'S SIGNATURE Qjtj^^^^^t^ 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.buildina@carlsbadca.aov or Mail the completed forni to City of Carlsbad, Building 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. UC. No. DELIVERY OPTIONS a PICK UP: • CONTACT (Listed above) • OCCUPANT (Usted above) • CONTRACTOR (On Pg. 1) • MAIL TO: • CONTACT (Listed above) • OCCUPANT (Listed above) • CONTRACTOR (On Pg. 1) n MAIL / FAX TO OTHER: • ASSOCIATED CB#~ • NO CHANGE IN USE / NO CONSTRUCTION • CHANGE OF USE / NO CONSTRUCTION ^APPLICANT'S SIGNATURE DATE Inspection List Permittli: CB120847 Type: PME AIREY: GAS TO FIREPIT Date Inspection Item 07/19/2012 29 Final Plumbing 07/19/2012 29 Final Plumbing 05/09/2012 23 Gas/Test/Repairs Inspector Act Comments Rl PB AP PB AP Monday, July 23, 2012 Page 1 of 1