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Home My WebLink About2780 BERKELEY AVE; ; CB070911; Permit04-05-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No CB070911 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 2780 BERKELEY AV CBAD PLUM 1675630800 Lot# 0 Construction Type NEW MEDINA RES REPLACE WTR HTR Status Applied Entered By Plan Approved Issued Inspect Area ISSUED 04/05/2007 KG Applicant CALIFORNIA DELTA MECHANICAL SUITE #27 12440 OAK KNOLL RD 92064 866-898-0008 Owner MEDINA STEVEN R&MARY M H 2780 BERKELEY AVE CARLSBAD CA 92010 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees 0 0 0 0 1 0 0 $2000 $000 $000 $000 $000 $700 $000 $000 $000 $000 $000 $000 TOTAL PERMIT FEES $2700 Total Fees $27 00 Total Payments To Date $27 00 Balance Due $000 PER«an HAS EXPIRED % ACCOrOAHCE WITH 0 8 C SECTION 10b 4 4 A& A'iEWFD BY C U G 18 04 030 DATE Inspector FINAL APPROVAL Date 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 nght 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 T'^"PROJECT INFORMATION ? i™"" 2780 Berkeley ave FOR OFFICE USE ON PLAN CHECK NO EST \ Plan Ck Deposit. Validated By Date /7--: Address (include Bldg/Suite #) Legal Description Lot No Assessor s Parcel # Replace standard water heater like for like Description of Work Business Name (at this addres,>) Subdivision Name/Number Unit No Existing Use SO FT # of Stories Phase No Proposed Use # of Bedrooms Total # of units # of Bathrooms 2 ipjONTACT PERSON (if different frblntapplicant).;.^ California Delta mechanical Inc 2500 S Power Rd Suite #120 Mesa AZ 85209 {480) 898 0007 (480) 898 0005 Name Address City 3 APPLICANT EI,Ctfhfractor D Agent for Contractor " Q Owrfer Galma Pavlova 2500 S POWER RD # 120 MESA State/Zip Telephone # D Agent for Owner .„'"' ».y.: AZ 85209 480-898 0007 Fax# Name Address 4 PROHBRmOWNER " Steven Medina 2780 Berkeley ave City Carlsbad State/Zip CA92010 Telephone # 7607209218 Name 5 CONTRACTOR Address City State/Zip Telephone # COMPANY NAME •:• '• ::"' __. r^P*"5"' . a.^'"'" "*" ,:i: •"'' ^M'-- (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 provision'- 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 [$500]) Cahfqmia_Dclta Mechanical, Inc 2500 S Power Rd Suite # 120 Mesa 85209 (480)898-0007 Name Address City State/Zip Telephone* State License # 811114 License Class C-36 Citv Business License # 1 2 1428 1 Designer Name Address State License # City State/Zip Telephone # 6nV;"WORKERJjCpMPENSATION "*lpk. """illfe -^IIL _^ "'";' '-it 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 13 I have and will maintain worker's 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 State Compensation Insurance Fund Policy No 1697823 Expiration Date 07/01 /07 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] 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 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 damagesare,prpj)8ed for in Section 3706 of the Labor Code interest and attorney's fees SIGNATURE Galma Pavlova jjn^l DATE 04/03/07 7 OWNER BUILDER DECLARATION'" J^^ / ~" -"iff^ '"" -*f &** -f; I hereby affirm that I am exempt from the Contractor's License Law for the following reason P I as owner of the property or my employees with wages as their sole compensation will d 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 s-ale) n 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 contractors) licensed pursuant to the Contractor s License Law) n 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 D NO 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 / /ontractors 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 WHITE File YELLOW Applicant PINK Finance PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad CA 92008 Page 2 of 2 COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY v.-«y- --sif"'" K*£ ••; <, .*; Is the applicant or future building occupant required to submit a business plan acutely hazardous materials registration for or risk management and prevention program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act' D 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? D YES D NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? D 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 J8^ CONSTRUCTION LENDING AGENCY2 ' ;~ ^T^^f- ' ™|||f; "1;^- ^ 2JJI. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(1) Civii Code) LENDER S NAME _ LENDER S ADDRESS __ SiJfAPPLlCANT 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 City 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 JUDGEMENTS 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 of 5 0 deep and demolition or construction of structures ovei 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 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 of 180 days (Section 106 4 4 Uniform Building Code) APPLICANT s SIGNATURE Galma Pavlova ^Zs^-7 DATE 04/03/07~ WHITE File YELLOW Applicant PINK Finance PQUCTHOLOBR COPY «* form W-MT <»TF 100 43>0ftn?' SAN PBAWCISCOCA OP WORKERS' COMPENSATION INSURANCE GROUP- POLICY NUMBER CERTIPICA76 ID B CEKTWCAT6 EXPIRES 07-01-3007 O7~m -JJOOB/07 -01 -JK»7 li t'T furtlfy «h»t pulley Is tifit nr)n nl«in rfhr« rnrtiflrstm o< Mfy \\ «rt hv tli \ » vrtfd w<vfc«f*' Comp*m»«lon Insurmwi palloy In a form apnrnwM* <tin nfflplnywr nmnad t)«!ow Cor Sus poilry pwlort indicated. tfl \n onnc!»IWInn. hy «Hi» Funri «xr»« iiprm ^ rf»iw advMftH wrUt/jfi notff* to thn di notion should thin policy h» wmrBllwt prior to jts normsl «xpfrfltiesa l» not «n li«urant» policy »r«t rtow not «m«JBt. axtwnd or alter »h» fltwIthntKidlfia wiy Mjqulremant, »rm or eandRlon oi any eantmer « Aid corflflcwr Pt mmirnnoB m»y h« luiwiorf ot t» wtiW it ">•» PwWn, (h d*«onh»d hfjrnln )•? -wihjijct to all !tt» tflrrns, «?telu!»lon*, ind eOBdltlonii, of mch pulley »,T«TT CO«T< $1,000,000 PER occuiw«»icfi "'t)