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HomeMy WebLinkAbout2752 CARLSBAD BLVD; 103; CB044664; Permit12-27-2004 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Mechanical Permit Permit No: CB044664 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 2756 CARLSBAD BL CBAD MECH 0000000000 $0.00 WILKINSEN RES-NEW A/C UNIT WITH ELECTRIC Lot#: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: pplicant: LEGEND SERVICE 1JE15 2588 PROGRESS ST VISTA CA 92083 760-631-8397 Owner: ISSUED 12/27/2004 LSM 12/27/2004 12/27/2004 Mechanical Issue Fee Install/Furn/Ducts/Heat Pumps Fee Fireplace Installation Fee Exhaust Fan Fee Installation/Relocation Vent Fee Hood Fee Boiler/Compressor to 15HP Fee Other Additional Fees TOTAL PERMIT FEES $15.00 $9.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $0.00 $44.00 Total Fees:$44.00 Total Payments To Date:$0.00 Balance Due:$44.00 8372 12/27/04 0002 Inspector: FINAL APPROVAL Date: 7- S 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 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. 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 fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1. PROJECT INFORMATION FOR OFFICE USE PLAN CHECK N EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Suite #)Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel,*Existing USB Proposed Use escription of Wo SQ. FT.#of Stories # of Bedrooms # of Bathrooms 2; GJJNTAGTPERSONJIfdHfMeht-fronvlippllcsntlM (If differ*£_k , **tfLName APPLICANT Q Cdntfaqtor Address City for Contractor D Owner Q Agent for Owner State/Zip Telephone # Fax # Name •* Address ty State/Zip Telephone # Name Address City State/Zip Telephone # fi' ; CON^RAGTdR- COMPANY NAME (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 B)«mption. 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 I$5001). Ir*. *£> o 4 y\ f\ Sri1* C. C/|> c r / o I? tf A3 fOt£* Name i/ Address State License # / D ^j & ^T / License Class {_ oi f H ff *>CM f\O. t £Xff"C_ *•- *7 7-*fi<* i* (^ *>/""/* J^y ' City State/Zip Telephone # O City Business License # /DS/Ov V*J Designer Name Address State License # City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D 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 thewfwk for which this permit is issued. H""! 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 gLM^]o<gr*£ C"p»-\C> _ Policy No. fj \ Q^Cl $&•&)Expiration Date (THIS SECTION NEED NOT BE COMPLTED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS) ' / 0 CERTIFICATE OF EXEMPTION: 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($U>0,000), ta additlonip the_po«t of comaensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE [AjQsAjU*, ^5. ?VL&X7 _ DATE / 2-7 7J7/ &P 7/ OWNER-BUILDER DECLARATION /^ '/ ~^~ 1 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 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). D 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). Q 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. fj YES QNO 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 (include 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): _ _ PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY . 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 the Presley-Tanner Hazardous Substance Account Act? Q YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES C3 NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES Q 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. iScv:<?)rtNSTBUCTION;iENDING AGENCY 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 LENDER'S ADDRESS 3^ ^PUCANT CERTIFICATION 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 CitV 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 become null and void if the building or work authorized by such permit is not commenced within 1 80 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 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 Bldg Inspection Request For: 02/04/2005 Permit# CB044664 Title: WILKINSEN RES-NEW A/C UNIT Description: WITH ELECTRIC Sub Type: 2756 CARLSBAD BL Lot 0 Type: MECH Job Address: Suite: Location: *^ •£ APPLICANT LEGEND SERVICE Owner: Remarks: Inspector Assignment: Phone: 7605220344 Inspector: Total Time: CD Description 43 AirCond/Furnace Set Act Comment Requested By: ELAINA Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments AGSBBL CERTIFICATE ur- UIMDILI 11 TVflS CEJmnCATE IS IS3UEU AS A IftAllkH V± INHJHttAlION ONLY AND CONFERS MO RIGHTS UPON THE ceRTWCATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (WO) 524 7024 FAX (SOO)524-4023 Automatic Data Process-ing Insurance Agency, Inc » Entii/w Parsippam S*rvic« c«nt«r 1384 Broken Hitch Rd Oeeanslde, CA INSURERS AFFORDING COVERAGE Employer* Compensation Insurance Co INSURCTC: f^INSURER E: COVCRAOE3 TH? POLK38S OF fctSURANCE UStiD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OH CONDITION OF ANY CONTRACT OB OTHER OOCU^NTWiTHRSSPECT TO WMJCH THIS CERTIFICATE MAY BE BSUEO OR MAY PERTAIN, TH6 N3URANOE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMTS SHOWN MAY HAVfi BEEN REDUCED BY PAID CLAIMS. ?Sf A TVPEDPM5UUMCE GBNCWLilAWUnr ^^ •^~ coMMincw.oe«Mtii*wurf GENT. AaqnggATg umr APPLIES PCS. 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