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Home My WebLink About2770 MADISON ST; 5; CB030860; PermitCity of Carlsbad tl3-25-2003 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB030860 Building Inspection Request Line (760) 602-2725 Job Address: 2770 MADISON ST CBAD St: 5 Permit Type: MISC Subtype: REPAIR Status: Parcel No: 2031102600 Lot#: O Applied: Valuation: $6,458.00 Entered By: Reference #: Plan Approved: ISSUED 03/25/2003 SB 03/25/2003 03/25/2003 Project Title: PHILLIPS RES FIRE DAMAGE DRYWALL,MINOR ELEC ,INSULATION, 2 WINDOWS Applicant: BUILDING RESTORATION INC 6975 NORTH AVENUE #D LEMON GROVE, CA 92045 619-464-6213 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES Total Fees: $120.00 Inspector: PERMIT FEE Owner: PHILLIPS JACK D 2667 OCEAN ST CARLSBAD CA 92008 Total Payments To Date: $0.00 Date: o.3 Issued: Inspect Area: il01 03/25/03 0002 01 02 $120.00 $0.00 $0.00 $120.00 Balance Due: Clearance: CGP 120-00 $120.00 at approval of your project includes the "Imposition" of tees, 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 tor processing in accordance with Carlsbad Municipal Code Saction 3.32.030. Failure ID 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 lees/exactions DOES NOT APPLY to water and sewer connaction 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 fwhi h v r i 1 n n I ii r hi r . h h Ii r . x. FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NOC ~30~0 • CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. "· 'z'.S-S i Plan Ck. Deposit--.~------- Validated By_5_-:....,..0.c;_ ______ _ Date '3 -.z.,--01 Address (include Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use I I Description of Work SQ. FT. -#of Stories # of Bedrooms # of Bathrooms ,[1', ;-e_ [:b~.,<.;-~a~ t'C ,l;;~~~;;; ,g~f'~,,;::;,;,~m~:;;;~"'~"f!: .b~~;i,.";;,J,,.~~~-i;:,i;:;,, ,,..,l¼li'.,\':i~,~, ~ \~,':! ~ ,,_, 9 ;.N®-u~GP.~~fil!Tu;rs:,ZP.J1'J;,~1;;1ai1Mww:Zfil1,l! N%P.1,w;,v,"+m~;;@fll'it1i•£""'.!"mw'sl~,1&\~%illif4,_~1:11r~•sNt.tiP~J&i;t; . ....-<a_,-'-'"' 7 S-o~ ""'"'"' <JS r;.11-a'-i ~--o 1 .. 1 "'' --. c;-n., n Name Address City State/Zip Telephone # Fax # ~~1~~~~~~t~~=~j76,~~~~l(Lr;:ii~:ll5~!:;':fr1:,;~:;~,.'.~· Name Address City State/Zip Telephone # Wlilll""""'~ • -·~*"" • .. ,,,,ms•,;,awr '""'"'"'•ll>"il''"' .. ~-·, •, -,· -,,.,~..&r,.,""""'" • ·,,,. "' --im·, l'ii"+ii>' --•,"'•;n··, .. ,., .. , • • r , .. , · •" -• •· • · 0L~f\:· \ \L ~ ·e·!~"TI'.:~~~;~~&Qili~~5;;~=7k1b~·rSh~:·:(0~16':,;:0w,,Y1?t~!~.s+YQ,iA~Ylq:~0~?~~%2;Yffe¥£:¢~~;::.::.;;~::, ;•~,:~;-·,•~;-'· Name Address City State/Zip Telephone II ---i'.';llii.i:g,J!!<li-,MW,iil!'i,_Y.;i.,...,_,i.1iilllillMll" .. ill!Ml,fiiii-,iliii""6,i: (Sac. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demollsh 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 applic~t for a permit su~ects the applicant to a civil penalty of not more than .!!_ve hundred dollars ($5001). bu,ld;~s &,,,hwd1<2"khc_ G'f7<:, /Vo..--i:<.,-_,'1-,H.---. µ,"'<),--, 0n--o--,e__ CA--91q'/, (,,!1-'i~v-r,,,C?-13 Name Address City State/Zip Telephone # State License # '-/ 31 b 3 ~ License Class ~~-------City Business License # B \<? ~i 4 0 0 Designer Name Address City State/Zip Telephone State License # _________ _ ~':ir~PMD'M~IM~-::1•t1;1¼1~;;J1~~~Jmirl!.lilf:"Jilf!~~$ll1l ,'x:ilt,;2t·~vstr!:;t:-,j\\i}11f.(r_::;,?Jt" ·-,:-01+R{/\;, 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 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 Compan~+-e...Cg, ........... ~ Fu1o--...dl Policy No. / S-f33? / ~ i1 +-Expiration Date S:--( ~o j (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) D 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 worker■' compensation coverage la unlawful, and ahaU subject an employer to criminal penalties end clvll fines up to one hundred thousand dollars $1 0,00 In addition to e coat of compensation, damages u provided for in Section 3708 of the Labor code, Interest and attorney's fees. SIGNATU DATE 3 -p ~ _c, "';; I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D 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 improve,ents 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 ot,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). · _, ~~ "·- 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. D YES ONO 2. I (have / have not) signed en 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):. ___________________________________________________________ _ 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 26505, 26533 or 25534 of the Presley-Tanner HazardoiJs Substance Account Act? D 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? D YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES D 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. ·j-~IIIQfjJl:l~j-D:J ..... Oli:i~~t-~;~r1~,~;i'J:Pfl:;;1£~t;:Jii.i_1~/h~~~?~i~!"\~~?1;;.~:.;,~;•~{;~~ 1{;:,l,)~-;et~~f_,.]i.:i/11:-:•::·;:~-,;:,~;-.;,.:., ·;.::,:•.,i 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 ________________________ _ t~-~-NIIGMi#illWd' ____ tltlll8lft!::~!i1;;.;ts;;i~,-~~i!IIIQifr1 ... ;!r,JX~:!f.;(.,"1;:l~!,~~\fiiiir{iJ,1;~,~~~~r.~~t~:,: ,~;,,M:t!;.,:D'i ;;•::~:,~::~;,;_;;:~•~;;~:-;:.;.~;.~:,t, 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. l agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt 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 ol this Code shall expire by limitation and become null and void 11 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 at any time after the work is commenced for a period o~f 180 da s (Section 106.4 4 Uniform Building Code). APPLICANT'S SIGNATURE ~ 1'),v-..~~ DATE ,3----;J 5'-03 ~ WHITE: e YELLOW: Applicant PINK: Finance • City of Carlsbad Bldg Inspection Request For: 06/10/2003 Permit# CB030860 Inspector Assignment: PY --- Title: PHILLIPS RES FIRE DAMAGE Description: DRYWALL,MINOR ELEC ,INSULATION, 2 WINDOWS Type: MISC Sub Type: REPAIR Job Address: 2770 MADISON ST Suite: 5 Lot 0 Location: APPLICANT BUILDING RESTORATION INC Owner: PHILLIPS JACK D Remarks: Total Time: CD Description Act Comment 19 Final Structural -It{) 29 Final Plumbing 39 Final Electrical Associated PCRs/CVs Inspection History Date Description 04/07/2003 17 Interior Lath/Drywall Act lnsp Comments AP PY Phone: 6198430761 Inspector: ---- Requested By: JERRY Entered By: CHRISTINE 03/31/2003 16 Insulation AP PY NO STRUCTURAL DAMAGE