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Home My WebLink About2611 JACARANDA AVE; ; CB043215; PermitCity of Carlsbad l/ 10(;?~ 08-1~6J~) 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB043215 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: Applicant: 2611 JACARANDA AV CBAD MISC Subtype: REROOF 2551140700 Lot#: 0 $8,120.00 BROLEY /GOLTZ RESIDENCE 28 SQUARES OF EAGLE LITE ICBO 4660 Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 08/13/2004 MOP 08/13/2004 08/13/2004 HARBOR ROOFING BROLEY RYAN&GOLTZ WENDY A 962 AL YSSUM RD 92009 760 931-9108 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES Total Fees: $154.00 PERMIT 2611 JACARANDA AVE CARLSBAD CA 92009 Total Payments To Date: $0.00 $154.00 $0.00 $0.00 $154.00 Balance Due: $154.00 FINA.l APPROVAi DAT~CiEA.F!ANCE __ _ SIGNATURE .Jkl' PERMIT APPLICATION CITY OF.CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO. ____ _ EST. VAL. _________ _ Plan Ck. Deposit ________ _ Validated By __________ _ Date. _______________ _ Address (include Bldg/Suite II Business Name tat this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total I of units Assessor's Parcel I Existing Use Proposed Use #of Stories :2-- I of Bedrooms II of Bathrooms Name te•¢§ilfMO.t<Oiifffl:O.NIMftl'tiiNM11iil(:~~~.:.~:~~;!,:"'''·:"''•~:h.1-":$f.\1.d~~~"':'~'-"/':;!'.~';''l1;1t./.'tc'::"'r,. ,'.L-:':'"'t~.'r~,,~·.::. 'i ··.-f.Ai!'~,,Z<:::"'.'"·· ";'!7•:r.·,,~.,-,j;~,'.!,.'),":.~ City State/Zip Te~ephon II City Business License II 12 \ {pl.{k \ Designer Name Address City State/Zip Telephone State License I _________ _ ~P8.l<(8$!lCPMe(NSATI0~1.,_, ;;;;_;~J,:;±;~:,,.;,;.,;'.\;,'.;,,~i .... ,.,i :.,;.. :::: .. ·. ~--,~-. ' '.-+·t ·.!-::'•.>~t, .• ,?.;: Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: .. , O I hav 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 rk for which this permit is issued. 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 issued. My worker's com n n ins ranc carrier and policy number are: \//~z.)2 2 Insurance Company -.:.,Q~.!.!111,.<--.J-JLDJ4,,L----------Policy No._.._ _ _,,±_'-'1_ J'7..;_-'-';;;;....=-------Expiration Date 6 \ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) OD~ 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 W rs' Compensation Laws alifornia. WARNING: Failure to cur thousand dollar• ($1 ,000) SIGNATURE '/~~rv? tzS Q)!ffl_gffiE!Jm ' _H ~ !--.~·•~:,~~~~:'.\~~l~ri::~~~Y;t,t±~~~,½:r~•i.:¥ ~3:1~~!h..;~~A~r·?.:f:f:/l'tT!,~~!~~:1{;-1·~fi~~-·,~ exempt from the Contractor's License Law for the following reason: I hereby affirm that I 0 I, as owner o t property or my employees with wages as their sole compensation, will do the work end the structure is not intended or offered for sale s and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does 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 r of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale) . . 0 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(sl licensed pursuant to the Contractor's License Lawt. 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. 0 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 linclude name / address / phone number / 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 / address / phone number / type of work):, ____________________________________________________________ _ DATE _________ _ PROPERTY OWNER SIGNATURE ______________________ _ ~QMPi~«Ft1$tS(C.TI.PttlFPff'l(Q,v'.,C,~OEl(~fl,IJLQ,iff..Qlf'~.RMIUlQNliY,,~~~;~iu~.ll!htl1:'n'J.i:::L • ...,\e1;,!W:,k,::uL.:'"-'-''.;:i:::L .;:i~ii,,;> ,i,:i:.;t:::l •·· .: .. -..!,:.i.c? 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 26605, 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. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS. ________________________ _ [iv~CANriCE8ttf~_NJf\~[~~~~H~~-~;iia~~~1~~'i~~";ff{i~~}i:i~;.:~;_.<~t.~~ ·~~-:-~.:.,;!~:;-;,~ · ·-~~~J;..,,-tl i~,.i-:::~!~~-~ .. ,.. 't,~··"•t:~ ,.--:-·~-"/r~~ .. r 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 Cltt 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 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 shell expire by limitation end become null and void if the building or work authorized by such permit Is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned et any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE ________________________ _ DATE _____________ _ WHITE: File YELLOW: Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS: 1:(pl\ -JAlARAN~~ 2. TYPE OF BUILDING: R4SIDENTIAL 'A COMMERCIAL 3. ROOF SLOPE: RISE inches in 12 inches · 4. NUMBER OF EXISTING ROOF COVERING (circle one) 0 3 ,. TYPE OF EXISTING ROO:'.[~~·••G M\Ml€sHEATHING II\£!;, . *6. NEW ROOF MATERIAL CLAss_A_wEIGHT PER SQUARE 7. -NUMBER OF Sl3UARJS 'l. . / 8. TRADE NAME kA½Wt\1~ MANUFACTURER ~ff 9. ROOF SYSTEM LISTING UL No. . ICBO N:= ii b 10. IS THE EXISTING STRUCTURAL DESIGN~IENT 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: -,-, ,-·, 1. Tear Off/Pre-inspection prior to instalinew roof covering. 2. Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for inspection. Contractor-+1----_____ Contractor Narre l:W.1w~ . Qootlf ~ *6 -Rolled R ofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. City of Carlsbad Bldg Inspection Request For: 08/31/2004 Permit# CB043215 Title: BROLEY /GOLTZ RESIDENCE Description: 28 SQUARES OF EAGLE LITE ICBO 4660 Type: MISC Sub Type: REROOF Job Address: 2611 JACARANDA AV Suite: Lot 0 Location: APPLICANT HARBOR ROOFING Owner: BRO LEY RY AN&GOL TZ WENDY A Remarks: Total Time: CD Description Act Comment Inspector Assignment: JM --- Phone: Inspector: J y..}\, Requested By: NA Entered By: CHRISTINE 19 Final Structural _a, ________ _ Associated PCRs/CVs Inspection History Date Description Act lnsp Comments 08/19/2004 15 Roof/Reroof AP JM OK TO COVER