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Home My WebLink About2847 CAMINO SERBAL; ; CB052628; Permit07-18-2005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB052628 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: 2847 CAMINO SERBAL CBAD MISC 2552812000 $0.00 Subtype: OTHER Lot #: 0 O'GRADY RES- BACKYARD FIREPLAC PER SPECS Status: ISSUED Applied: 07/18/2005 Entered By: LSM Plan Approved: 07/18/2005 Issued: 07/18/2005 Inspect Area: 395-SUNSETDR ENCINITASCA 92024 760 942-2796 Owner: OQRADY TIMOTHY J 3847 CAMINO SERBAL CARLSBAD CA 92009 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT FEE $89.00 $0.00 $0.00 $89.00 Total Fees:$89.00 Total Payments To Date:$0.00 Balance Due:$89.00 2746 07/18/05 BUILDING PLANS STORAGE ATTACHED 02 89.00 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 lees/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 Address (include Bldg/Suite #) FOR OFFICE USE ONLY PLAN CHECK NO.J EST. VAL. Plan Ck. Deposit Validated By Date Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No. Phase No. Total ft of units Assessor's Parcel #Existing Use Proposed Use Description of Work SQ. FT.#of Stories # of Bedrooms # of Bathrooms Name APPLICANT Address City ntractor Q Agent for Contractor Q Owner P Agent for Owner State/Zip Telephone #Fax # Name Address City State/Zip Telephone tt Address City/State/Zip Telephone #Name G. CONTRACTOR • 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 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]). Name State License # Address License Class , "7 City State/Zip City Business License # \ Telephone # Designer Name Address City State/Zip Telephone State License # 6. WORKERS'COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: C] 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 thB'work for which this permit is issued. uB 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: x Insurance Company •^fftTlE. ^UMP Policy No. (~J£-£"?l^ - "Z.&O^ Expiration Date **"*/*)/ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) ' f~| CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure wooers'compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars l$ 1OQyCCffi LKjdytSnto the cost of compensation, damages as provided for in Section 3706 of the Labof codaji interest and attorney's fees. SIGNATURE ^> X£-"T* //*f^-' DATE 7. '• OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: Q 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). Q 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). C] 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. l~l YES l~lNO 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 A **• **'QNloT NO 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 Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? l~l YES Is the facility to be constructed within 1 ,000 feet of the outer boundary of a school site? Q 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. 8. CONSTRUCTION LENDING 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 _ 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, 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 buijcilng Officialunder 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 copMTfifi^feo>wj}ffinJ£0-tfays^m 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 coj?1rn§»jp«<J)rfpafiod 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: 08/22/2005 Permit* CB052628 Title: O'GRADY RES- BACKYARD FIREPLAC Description: PER SPECS Inspector Assignment: PC Sub Type: OTHERType: MISC Job Address: 2847 CAMINO SERBAL Suite: Lot 0 Location: APPLICANT THE PALM CO Owner: OGRADY TIMOTHY J Remarks: Phone: 7607178358 Inspector: Total Time: CD Description 49 Final Mechanical Act Comment Requested By: PAUL Entered By: JANEAN Associated PCRs/CVs Inspection History Date Description Act Insp Comments 08/02/2005 62 Steel/Bond Beam AP PC 07/20/2005 11 Ftg/Foundation/Piers AP PC so COMPENSATION I NSUKANCB POUCYHOLDER COPY P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01 -ZOOS GROUP: POLICY NUMBER: 1733719-2003 CERTIFICATE ID: 2 CERTIFICATE EXPIRES: 07-01-2000 07-O1-2005/07-01-2008 CONTRACTORS STATE LICENSE BOARD WORKERS' COMPENSATION UNIT P 0 BOX 26000 SACRAMENTO CA 95826 SD LICENSE NUMBER: #650724INCEPTION DATE: 07-01-2005 D.O.: SO This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon todays' advance written notice to the employer We will also give you 10 days' advance notice should this poliey be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed1 herein. Notwithstanding any requirement, term, or condition of any contract or ether document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the - policies described herein is subject to all the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,OOO,OOO.OO PER OCCURRENCE. EMPLOYER LEGAL NAME THE PALM COMPANY 395 SUNSET OR ENCINITAS CA 92024 TWO TOGETHER, LLC AND/OR COOMES. CARL DOUGLAS AND COOKIES, JOANNE EV.3-03)PRINTED: <*/17'*X* P0409 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND BB83-3VB £1 Cajon Blvd. La Mesa Ca 91941 (619)697-3363 Fax (619) 697-3790 LIC * S02181 CLASS B-l C-S3 to have wit alarm* on all door* leading from houte diretftf to pool fard area or self-dosing self-latching door hardware with a rebate mechaniam located no lower then 54 incheft above the floor. (05. O»