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Home My WebLink About2850 Andover Ave; ; CBR2017-1090; PermitPrint Date: 06/21/2017 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 2850 Andover Ave BLDG-Residential 1674801842 $0.00 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Residential Permit www.carlsbadca.gov Work Class: P/M/E Lot#: Reference #: Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Description: BERGEN: WATER HEATER REPLACEMENT Owner: TRUST BERGEN DARCY J TRUST PLUMBING, ELECTRICAL, AND MECHANICAL PERMIT Total Fees: $98.00 Total Payments To Date: $98.00 Status: Applied: Issued: Fina led: Inspector: Contractor: THA HEATING AND AIR 3240 F St San Diego, CA 92102-3395 858-571-8865 Balance Due: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." 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 limitation has previously otherwise expired. Permit No: CBR2017-1090 Closed -Finaled 05/23/2017 05/23/2017 $0.00 $98.00 ,1 •• THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0PLANNING 0ENGINEERING 0BUILDING OFIRE {'city of Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Plan Check No. Cft> t'( Est. Value Plan Ck. Deposit SUITEt/SPACE#/UNIT# JOB ADDRESS."'} '9 ·o--o S"'O APN CT/PROJECT# LOT# # OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) (;J {) f-(,,J,( J/ ~_;(- EXISTING USE GARAGE (SF) PATIOS (SF) DECKS (SF) APPLICANT NAME PROPERTY OWNER l ADDRESS CITY STATE ZIP PHONE FAX EMAIL STATE UC.# 0 SWPPP CONSTR TYPE OCC. GROUP ZIP FIRE SPRINKLERS YESONoD CITY BUS. UC.# r 2-3 (/2..j (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to constru , alter, improve, demolish or repair an~ 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)). WORKERS' COMPENSATION 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. Ii] I have and will maintain workers' compensation, as reQuired by Section 3700 of the Labor Code, for the performance the work for which this rmit is issued. My workers' compensati n ins nee carrier and policy number are: Insurance Co. '!'\' U W/ ':> 1 tl\..S ~-'i.(..,V'l.'1-l(l ~ Policy No. 0 q Cl L Expiration Date ~-'-'--'~oJ----- This section need not be completed if the permit is for one hundred dollars ($100) or less. O 0 Certificate of Exemption: I certify that in the performance of the wo · · · · · ed, 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' on coverage Is unlawful, and shall subJ employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of com pen~ rovfcft--• rJn Section'3706'iii'lne Lali'oreode; inte.".!,Si an· omey's fees. . -··,··--·--- ,/15 CONTRACTOR SIGNATURE ----... ..• ,____ 0AGENT ........ · I hereby affinn that I am exempt from Contractor's Ucense Law for the following reason: D D 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 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}. 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). I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and matertals for construction of the proposed property improvement. 0Yes 0No 2. I (have I 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 I phone I 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 I address I phone I 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 I address I phone I type of work): .fl5 PROPERTY OWNER SIGNATURE 0AGENT DATE - 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? Yes No • Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air Quality management district? Yes No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUEO UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the above infonnation is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State law.; relating to building construction. I hereby aulhorize representative of the City of Carlsbad to enter upon the aoove mentioned property br 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 requred br excavations over 50' deep and demolioon or coostruction of structures over 3 stories n height. EXPIRATION: Every permit issued by the B.Jilding Olfcial under the provisions of this Code shall expire by rrn~oon and become null and voo if the building or v.ork autholized by such permit is not commenred \\ithin 100days from the date of such permit or if the buildrig oroortaulhorized such permit is suspended or abandoned at any time after the v.ork is commenred bra period of 100days (Sedbn 100.4.4 Unibrm B.Jilding Code). Ji$ APPLICANT'S STGNATUR~ DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. .--i ~ 1 : ;-I C ,.~, ~ [ 0 F 0 C C U f' ,, !I! C Y / C o rn n~ e : ~ r , l i 1 r o ! e _ ~ , 0 1}; \' j Fax (760) 602~560, Email buildinq@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. I CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE I FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) ASSOCIATED CB# CONTRACTOR (On Pg. 1) NO CHANGE IN USE / NO CONSTRUCTION MAIL/ FAX TO OTHER: CHANGE OF USE / NO CONSTRUCTION A5 APPLICANT'S SIGNATURE DATE PERMIT INSPECTION HISTORY REPORT (CBR2017-1090) Permit Type: BLDG-Residential Application Date: 05/23/2017 Owner: TRUST BERGEN DARCY J TRUST Work Class: P/M/E Issue Date: 05/23/2017 Subdivision: CARLSBAD TCT#82-16 Status: Closed -Finaled Expiration Date: 11/19/2017 Address: 2850 Andover Ave Carlsbad, CA 92010-7002 IVR Number: 3887 Scheduled Actual Inspection No. Inspection Status Primary Inspector Reinspection Complete Date Start Date Inspection Type 06/21/2017 BLDG-25 Water 026949-2017 Passed Andy Krogh Complete HeaterNents BLDG-Final 026950-2017 Passed Andy Krogh Complete Inspection Checklist Item COMMENTS Passed BLDG-Plumbing Final Yes June 21, 2017 Page 1 of 1