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HomeMy WebLinkAbout2726 MORNING GLORY LN; ; CB042642; Permitpie kcOGi I City of Carlsbad 1635FaradayAv Carlsbad,CA 92008 07-o2004 Miscellaneous Permit Permit No: CB042642 a0ding 'Inspection Request Line (760) 602-2725 Job Address: 2726 MORNING GLORY LN CBAD Permit Type: MISC Subtype: OTHER Parcel No: 1561203400 Lot #: 0 Valuation: $0.00 Reference #: Project Title: FUKUDA RES REPLACE SGD © FAMRM, DIN RM & MSTR BDRM Status: ISSUED * -Applied: 07/06/2004 Entered By: i SB. Plan Approved: 07/06/2004 Issued: 07/06/2004 lnspectArea: - Applicant: Owner: . FUKUDA LANE -FUKUDALANE,.. • - 2726 MORNING GLORY LN 2726 MORNING GLORY LN CARLSBAD CA 92008 CARLSBAD CA 92008 / c) -/\ /O) • Miscelaneous Fee #1 / \PERMIT FEE -$120.00 Miscelaneous Fee 2 Additional e / TOTAL PERMIT Total Fees: EES /7 \2000 \\\ I 7 ) Lm / \ 1Z $120.00 Total Payments To Date: .-'$0.00 Balance Due:--- $120.00 I (( Al k ¶rfl. H&',./1 \ •.•.r4fJ / . / I , / INCORPORATED / 1952 \ . -•- '- tA ••-- •. \' ( ID 5935 . , .- •- \ \ / / C• \ \ • ANAL APPROVAL. . DATE I±CLEARANCE SIGNATURE______________________ 120 07/06/04 0002 01 02 PERMIT APPLICATION CITY OFCARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE.ONLY PLAN CHECK NO.__________ EST. VAL. Plan Ck. De Validated B Address (include Bldg/Suite #) Business Name (at this address) .' Pma0004 .- Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units 390O . (E ,Lp# ..47 Assessor's Parcel # Existing Use Proposed Use .eEL4-Ce- SLo'AF€. &OS 2ob' c' 4/ Description of Work . . SQ. FT. #of Stories . # of Bedrooms # of Bathrooms Name . Address - - City State/Zip Telephone /1 Fax # - - 'Name Address - - City State/Zip Telephone # .TT . ..... .. .. ..-.., . Name - Address City - State/Zip Telephone # on --CON - ,..• .... . (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, 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 ($50011. -State Address City State/Zip Telephone # State License # ' License Class City Business License # ,Designer Name Address . City . State/Zip Telephone State License # EWORKERS'COMPENAT1ON.. - _,-- Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations - I have and will maintain a certificate of consenta 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 have 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 issued. My worker's compensation insurance carrier and policy number are: Insurance Company - Policy No. Expiration Date - (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) 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 employer to 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 attorney's fees. SIGNATURE - _' DATE Wby affirm that I am exempt from the Contractor's License 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). - 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contràctor's License Law does not apply to an owner of prdperty 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: I personally plan to provide the major labor and materials for construction of the proposed property improvement. IcES ONO lhave not) signed an application for a building iermit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number. / contractors license number): I plan to provide portionsof the work, but have hired the following person to coordinate, supervise and provide the major work (include name / address _/ phone number / contractors license number): 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 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 thi Presley-Tanner Hazardous Substance Account Act? 0 YES I!"N0 - - 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 I"NO Is the facility to be constructed within 1.000 feet of the outer boundary of a school Site? 0 YES I "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. 30970) Civil Code). LENDER'S NAME LENDER'S ADDRESS . . t APPLLCANTC FICATON ,.-,, T.- . . •.. ... .. ..'•- I certify that I have read the application and state that the above information is correct and that the information an 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 Citi 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 shall expire by limitation and became null and void if the building or work authorized by such permit is not commen ed within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commen for a per f 180 days (Section 106.4.4 Uniform Building Code). - APPLICANT'S SIGNATURE -- • DATE __________________________ WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request L For 08/06/2004 Permit# CB042642 Inspector Assignment: Title: FUKUDA RES REPLACE SGD @ Description: FAM RM, DIN RM & MSTR BDRM Type: MISC Sub Type: OTHER Phone: 7607309990 Job Address: 2726 MORNING GLORY LN Suite: . Lot 0 Location: Inspector: APPLICANT, FUKUDA LANE Owner: FLUHARTY KELLY • • Remarks: HEADER INSPECTION • Total Time: Requested By: LANE . • • Entered B.: CHRISTINE CD Description • • Act Comment 14 Frame/Steel/BóltinglWelding _____ • Associated PCRs/CVs Inspection History • Date • Description • Act Insp Comments •.