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Home My WebLink About2634 GALICIA WAY; ; CB044360; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 ' . 12-06-2004 Miscellaneous Permit Permit No: CB044360 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: 2634 GALICIA WY CBAD MISC 2161802000 $2,736.00 Subtype: REROOF Status: Lot#: 0 Applied: Entered By: Reference #: Plan Approved: Issued: Project Title: BRASSINGTON RES-2400 SF COMPOS Inspect Area: Applicant: PATRIOT ROOFING 1042 EL CAMINO REAL ENCINITAS, CA 92064 760-577-2935 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES Total Fees: $77.00 Owner: BRASSINGTON THERESA A PERMIT FEE 2634 GALICIA WAY CARLSBAD CA 92009 Total Payments To Date: $0.00 Balance Due: ISSUED 12/06/2004 RMA 12/06/2004 12/06/2004 $77.00 $0.00 $0.00 $77.00 $77.00 6830 12/06/04 0002 01 CGF• Inspector: FINAL APPROVAL D , /_ J.S' ,C, V ate: .,.. ~ Clearance: NOTICE: Please take NOTICE that approval of your project includes the 'Imposition" of fees, dedications, reservations, 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 ln 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. 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 service fees in connection with this project. NOR DOES IT APPLY to any fee~1"x::1rtions nf which vou h::iv., nreviouslv been niv.,n ::i NOTICE similar to this or as tn which the stat'·~" "f limitations ha<: nr.,viou"\·· otheiwic:"' "'Xnired. 02 T/,00 FOR OFFICE USE ONLY PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT '1635 Faraday Ave., Carlsbad, CA 92008 PLAN CHECK NO.a O L{lfJh 0 EST. VAL. d 7J( Plan Ck. Deposit {c Validated By :~ 4::.. Date ,Q/t/, 3/ ~· .~ '(,6\ .. _., ..... Business Name (at this address) Subdivision Name/Number Unit No. Phase No·. Total # of units Assessor's Parcel # Existing Use Proposed Use # of Bathrooms 2.. City State/Zip Telephone# Fax# le~9'.NJBA<rf'Q8 iCQM~AN~M~).,/.~~;~l.'m ~?P-·::"h'!:r:T.'.:":"Uf~,i:fir..s,l ,41",,:i*t .. ~"f-Wit.~r-,•.;<..;-;""".~'.;';,:·.~; ·; (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 pursuant to the provisions of the 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, end the basis for the alleged exam ·on. Any,violar of tion 7 3,1 .5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500)). dress License Class f _,, 6 67 City State/Zip Telephone II City Business License # /;)/ Ye,) ? ~ Designer Name Address City State/Zip Telephone State License # _________ _ (8~&""-W.QR.KJ;BS.LCOM~fll.JATI.P~.v~A'.i:.: •. ~,..,'.\.;.' ~:.,i..ioe. ,,,i .~ ''-•. ,,L' i' -o.· · ~-,, · •;: .;;, :'~,, ,-,1•: Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 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. 0 r I l)a'fe and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issulra'.' My worker's compe ation i surance carrier a~ policy number are: ./ _ Insurance Company Fi U Policy No. } /.t 7 7 '.d: / d:: Expiration Date J )L~ 5 (THIS SECTION NEED NOT E COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARi ($1001 OR LESS) v / 0 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 10 Hcure workers' companHtlon coverage Is unlawful, and ahaM aubjact an employer to criminal panalties and civil fines up to one hundred thousand dollars ($10 ,000), In addltl to the coat of companHtlon, damages aa provided for In Section 3706 of the Labor cod , Interest nd at rnay'a feaa. SIGNATURE·--.,Jl!~A,4A~U...t.Li...lo!:.i.c~~::------------------DATE __ L..J~.J.-J.L...l.t~~'-,,1 fimai.QW~:' :· ~ .-~~-~~~~;~ ;rj:,f~;~tt•~if::·.t·~~~.1~ 0~\J.~~~~~·S.A N.:~·;,;;;,•~~,~~<~~G:~•1i~;r. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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 Coda: 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). 0 I, as owner of the property, am axclusively 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). 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 I 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 I address / phone number I contractors license number): 4. I plan to provide portions of the work, but I have hired the following parson to coordinate, supervise and provide the major work (include name / address / phone number 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 / address / phone number / type of work):. ________________________________________________________ _ PROPERTY OWNER SIGNATURE ______________________ _ DATE __________ _ tc6MP,~!9'1:11$t,$(~n.okifQll!N<JN'.rfl~DEl{,77A~-~J~J~QffRMl1"1QJ~l;Y,.'!li.lir:1if.6~.,\~$1t.4&~2:.:;,iz..!~~..:.l,::.,.,. .. :,.1t . .J::ii •:•. :•1v/.t ..it'.: .. ; ,,: -ifi:.;t:,: r. 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 constn.:cted within 1,000 f~'lt of thl' 9uter ~~und~,Y of r..~9hoof sit11? 0 Y~S 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(i) Civil Code). LENDER'S NAME ______________ _ ftp'•" ~ ~e,acANTl<;Elltffi•~no~~~~~~~""~~~.,..~~•~~~~.:~~~;~i~~i~~tt~~-!;~i,.:?~~,/:: .;.~:. .. g ~ ~-~:.. ~~--~~~·~· " A 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 Cit'° 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 lhe building Official under the provisions of this Code shell expire by limitation end become null end void if the building or work authorized by such permit is not co menced within 180 days from lhe date of such permit or ii lhe building or work authorized by sue permit is suspended or abandoned at any lime after the work is comm ce for !_Perio I 180 days (Seclion 106.4.4 Uniform Building Code). DATE WHITE: File YELLOW: Applicant PINK: Finance City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS: 2J.a 3 L/ (.o 0r /1 c 10-'-12 r,1 2. TYPE OF BUILDING: RESIDENTIAL V:: COMMERCIAL. __ _. 3. ROOF SLOPE: RISE Lf inches in 12 inches 4. NUMBER OF EXISTING ROOF COVERING (circle one) (j/ 2 3 s. TYPE OF EXISTING ROOF COVERING$rJUC( SHEATHING Vj/JVj f . •s. NEW ROOF MATERIA-CLASS~WEIGHT PER SQUARE 7. -NUMBER OF SQUARES----2:1,_ • 8. TRADE NAME 212 ✓eCl/1 MANUFACTURER GA-r - 9. ROOF SYSTEM LISTl~G UL No. f 1,, f . ICBO No. ____ __, IO. IS THE EXISTING STRUCTURAL DESIGN ~CIENT TO SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? ~ NO All roof coverings are required to be CLASS A. CombU"Stible roof coverings of any type or classification are prohibited. I understand the following inspections are required: •.-, ( .. 1. Tear Off/Pre-inspection prior to instalfnew roof covering. 2. Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for inspection. Signature_..,,1'"'~+.~~-=->-"'~'-1'-e-----Date t&/~f; Contractor-¥0wner ____ Contractor Naf!1e {1 Jrr'u t /loo-h' fo/ *6 -Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, Other. City of Carlsbad Bldg Inspection Request For: 12/27/2004 Permit# CB044360 Title: BRASSINGTON RES-2400 SF COMPOS Description: Type: MISC Sub Type: REROOF Job Address: 2634 GALICIA WY t 141 I:,/ 0 Suite: Lot Inspector Assignment: BN --- Phone: 7605222285 Location: Inspector: OWNER BRASSINGTON THERESA A Owner: BRASSINGTON THERESA A Remarks: Total Time: CD Description Act Comment ---- Requested By: AILEEN Entered By: KAREN 19 Final Structural ¥------ Associated PCRs/CVs Inspection History Date Description 12/20/2004 15 Roof/Reroof Act lnsp Comments AP BN POLICYHOLDER COPY STATE: P.O. BOX 807, SAN P:RANCISCO,CA 94142~0807 .OOMP&N $Anb ti! IN SU F'I A.N•(:I!! Fu ND CERTlFIC~TE C>F ,WORKERS' . COMPENSATION. INSURANCE ISSUE DATE: 12~01-2004 CO~TRACTO_RS. STATE. ~I CENS~ (IOARD WORKERS COMP.ENSATI ON~UN It P.O. BO~ 26000 SACRAMENTO~·~A _95826 SD GROUP: POLICY NUMBER: 1877212-2004 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 12-01-2005 12-01-2004/12-01-2005 LICENSt NIJM6ER: INCEPTION DATE: D.o.: LICENSE #716994 12-01-2004 SD This is to certify that-we ha~.e isslled a valid We>rk.ers' Comp•n·satic,n insurance policy In a fprm approved by the California lnsuranc·e .CQmmi_$sioner. to. the em.Plover named b&fow for the polity period indicated. This policy is '.not ~ubjElct to cane:e11atiotl ·by' the Fund ··ex·cept upon 30 dayS' advance writte~ notice to the employer. . . We will· also give you 3~-dji1/S' ·ad~ ... ~ notice should this p~licy be cancelled prior to its_ normal expiration. ' '' . ' '·,' ' . ' . ' This certifi~te o-i _,ihsuf.ince,, iS_ ··(1P'f 1in inSUrf!nce policy' ·and ddes not amend; ext.end·· or alter the coverage_ af_forded by the POiicies -fisted her'ein..; 1gotWJtnsta!i,~in9 any f-11;!:Q\Ji.r.em.eht, term, or cdndition of any contract or other document wit~ respect to. Which t!iis ce'i-tlflcate of,:insuran¢e may i),e'-lssued or may pertain. the insurance afforded .by the policies d&$fribed herein is sul:1ject to al, tt,e term,. exc_l~sions and conditions of such policies. AUTHORIZeo ~PRESEN11\TIVE PRESIDENt EMPLD'(ER'S LIABILITY LIMIT I,:,C:LUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ' " ,,< • ' f!'IDORSEMENT #2'()85,ENTI'l'U.i).CE)!TI'i'tc;ATE HOLDERS' NOTICE EFFECTIVE 12-01-2004 IS ATTACHED TO AND FORMS A PART OF TtiIS Poqov.' (REV.3•03) EMPLOYER P.ATR.IOT ROOF I NG, ; I Nt; 2131 LAS PALMA~ QR STE E CAl'lLSBAD CA 92009 LEGAL NAME PATRIOT ROOFING, INC l!if..1•l•ItHi1,1@~lilt·Y...1·1=1•1112·iili;t¢ta•l=t·t+r3fl;HJf't1i• PRINTFl"l· 11/17/2004 Pnerq SD