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Home My WebLink About2630 LEWIS LN; ; CB151665; Permit.. 06-01-2015 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: DIRECT AC INC STE 126 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB151665 Building Inspection Request Line (760) 602-2725 2630 LEWIS LN CBAD PME 1552722100 STALEY RES-REPLACE NC AND FURNACE Lot#: 0 Owner: STALEY ERIK Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 06/01/2015 LSM 06/01/2015 06/01/2015 4199 FLAT ROCK DR RIVERSIDE CA 92505 951-742-8222 2630 LEWIS LN CARLSBAD CA 92008 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Total Fees: $160.00 Total Payments To Date: Inspector: Date: $0.00 $0.00 $160.00 $0.00 $160.00 $160.00 Balance Due: Clearance: $0.00 NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reseivations, or other exactions hereafter collectively referred to as "fees/exactions." 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. THE FOLLOWING APP,ROVALS ~EQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH 0HAZMATIAPCD {'city of Building Permit Application Plan Check No. CE:, I '51 G:. 1,, 5 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Deposit email: building@carlsbadca.gov www.carlsbadca.gov Date IA/, I /C-lswPPP JOB ADDRESS ).63ul,,....,,,'3 L,, SUITH/SPACEI/UNITI IAPN . --- CT/PROJECT# ILOT# I PH.4SE # l # OF UNITS 1 # BEOROOMS # BATHROOMS I TENANT BUSINESS NAME I CONSTR. TYPE I occ. GROUP DESCRIPTION OF WORK: Include Square Feet of Atrected Area(s) ti Ve, C C ~Ci":} C 0£.d" l,[) oo~ /!,r/l-? 'F-i ,,...,.,e0 ( l.( J. ,.;--, 11,1,S 'SEE.If ,Ve EXlSTING USE FIREPLACE I PROPOSED USE I GARAGE (SF) PATIOS (SF} I DECKS (Sf} YES0, !AIR CONDITIONING I FIRE SPRINKLERS No[] YES0No0 YES□No□ APPLICANT NAME PROPERTY OWNER :S tp,,l,e,J Primary Contact ADDRESS ADDRESS __J CITY STATE ZIP CITY STATE ZIP PHONE IFAX PHONE IFAX EMAIL EMAIL DESIGN PROFESSIONAL CONTRACTOR BUS. NAME /J"' -:__'7 -A c... ,l"',::Oc: ADDRESS ADDRESSe Cf I 19 /Ji.rt /Zo Ck_ /J,--:{f 14 CITY STATE ZIP CITY /~ '.. 1Lf<'l_L 2:'.at c:,2~ <()( PHONE IFAX PHONE~.S( 7'·/ . lfA)( . -2-Jlll.. EMAIL EMAIL 0 rQ. ">&\. (iJ J-,✓G'CJ/c,..c , c CY/YI ISTATELIC.# STATELIC#cfu 3 9 2.. l r.: 2u I CITY BUS. UC.# (Sec. 7031.5 Business and P_rofessions Code: Any City or County which requires a permit to.construct, atter, 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 pursuant to the provIsIons of the Contractor's License Law JChapter 9, commending with Section 7000 of Division 3 of the B_usiness and Professions Code} or [hat he is exempt therefrom. and the basis for the alleged exemption. Any violat+on of Section 031.5 by any applicant for a permit subJects the applicant to a cIvII penalty of not more than five hundred dollars {$500)). WOlfJ(ElfS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of petjury 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 per1ormance of the work for which this pemiit is issued. I have and wlll maintain workers' compens~as req4ui d bv Sedon 3700 of the Labor Code, for the per1ormance ICh !~permit is issued. My workers' compensation insurance carrier and !X)licy numberare:lnsuranceCo. {--¾c. f'.ffl/' ~ PolicyNo. -£1 /~6 ExpiratiOnDate °4I t fb(S: l I ~section need not be completed if the permit is for one hur.dred dollars ($100) or less. LJ Certificate of Exemption: I certify that in the performance of the work for which this pemiit 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 penalties and clvll fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages a for In Section 3706 e Interest and attorney's fees. _g CONTRACTOR SIGNATURE I hereby affirm that I am exempt from Contractor's Ucense 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 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 contracUng with licensed contractors lo 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 contraclor(s) licensed pursuant lo the Contractor's License Law), I am exempt under Section _____ ,Business and Professions Code for ttiis reason: 1, I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0Yes 0No 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 pro!X)sed construction (include name address I phone I contractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise al'\d provide the major work (include name I address I phone I 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/ phone/ type of work): ~ PROPERTY OWNER SIGNATURE □AGENT DATE I I -- COMPLETE THIS SECTION FOR NON•REJIDIINTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials regis1ration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substar.ce Account Act? Yes No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air ciuality management district? Yes 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 ANO THE AIR POLLUTION CONTROL DISTRICT. CON$ TR.Ut; T.J ON LEN D.1 NG . .AG.E.N CY I hereby affirm that there 1s a construction lendmg agency for the perfonnance of the work this permit 1s issued (Sec 3097 (i) Civil Code) Lender's Name Lender's Address APPi-iC.ANT CERTIFICATION I certify that I have read the appllcatlon and state that the above infumiatlon Is correct and that the Information on the plans is accurate. I agtee to comply'Mth all City oldlnances allq State lav.s relating 1D building oonstructlon. I hereby authorize representative of the City of Cartsbad b enteru1xm the atove mentioned property Dr insp:lC!ion purl))SeS. 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: All OSHA pennt is requred for excavations over 5'0' deep and demolltDn or construction of structures over 3 stories il hej;;Jht. EXPIRATION: Every permit issued by the Building Offcial under the proviskJns of this Code shall expire by Imitation and beoome null and vok:I ttthe building or'MJrk authorized by such permit is not commenced 'Mthin 180 days from the date ofsl.dl petmlt or tt the · · or 'Mlrk authorized by such permit is suspended or abandoned at any time after the w:Jfk is com mer.red for a period of 180 days (Section 106.4.4 Uniform Building Code). _.@$ APPLICANT'S SIGNATURE DATE C 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 building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. UC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (Listed above) CONTRACTOR (On Pg. 1) OCCUPANT (listed above) MAIL/ FAX TO OTHER: _______________ _ A$ APPLICANT'S SIGNATURE ASSOCIATED ce,, ____________ _ NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE/ NO CONSTRUCTION DATE ZIP Inspection List Permit#: CB151665 Type: PME Date Inspection Item 06/05/2015 43 AirCond/Furnace Set 06/05/2015 43 AirCond/Furnace Set 06/05/2015 49 Final Mechanical 06/05/2015 49 Final Mechanical Friday, June 05, 2015 Inspector Act AEK AEK RI AP RI Fl STALEY RES-REPLACE A/C AND FURNACE Comments AM PLEASE AM PLEASE Page 1 of 1