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Home My WebLink About2853 ANDOVER AVE; ; CB071109; Permit05-02-2007' City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB071109 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC#: Project Title: 2853 ANDOVER AV CBAD MISC 1674801854 $0.00 PC070029 VILLAS OF CALAVERA HILLS 2ND FLR ENTRY DECK REPAIR-2853&2855 Subtype: REPAIR Lot #: 0 Applicant: DEGROODT CONSTRUCTION CO. 21602 SURVEYOR CIRCLE HUNTINGTON BEACH CA 92646 714-375-1325 Status: ISSUED Applied: 04/18/2007 Entered By: KG Plan Approved: 05/02/2007 Issued: 05/02/2007 Inspect Area: Owner: DARLING GALE 322 7TH ST DEL MAR CA 92014 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT FEE $120.00 $0.00 $0.00 $120.00 Total Fees:$120.00 Total Payments To Date:$120.00 Balance Due:$0.00 Inspector: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 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 FOR OFFICE USE QJS PLAN CHECK NO./ EST. VAL. . Plan Ck. Deposit Validated Date Address (include Bldg/Suite #)Business Name (at this address) Legal Description Subdivision Name/Number Total # of units i Assessor's Parcel #Existing Use Proposed Use — '" """" " x®9 FT ~" • tfoiStorbes^j, ' # of Bedrooms # of Bathrooms ?PA-.ftK,/b-!^p^6 3^ oLblc, er) f.rw 4 f %S_,,,-,,„appUrantl^teJtoa.i'xJ.te,'' j v > »" > i*-««>* ' ,»-a, TV tJttl«a 9 f5(,i," » ,. ^ Description of Woric^c<ANi^ Name 3 City Q Agent for Owner ' State/Zip-Telephone » JT> ? City ' > ^ \ A" State/Zip Telephone *i* ** a ••- *r 1 • r r-\£LL - v± v. City State/Zip Telephone, (Sec. 7031.5 Business and Prpfessiqns^Code: Any_City or County which requires a permit to construct, alter, improve; demolish or repair anystructure, 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..wmXSection.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 civjl penartvjrf not more trjgn five hundred dollars IS5001I. , Name- •• .{' •-.-' :%£,uufi WJi : State License # ' -^Vi*^ *^O*-f , ; Address. ''-•• r License Class ;•%City ..< State/Zip •„ City Business License # #Vl ,•'..; Telephone # : •-,.' '/ • = • . - Designer Name - ., / .^. State License,*; • > *!.i'.ii ''A*:! ;;n . Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: ' Q.I have and will maintain.a.certificate.of consent to self-insure'for workers' compensation as provided by Section 3700 of the Labor Code, forithe performance . jrk for which this permit is issued. '.-.., i. 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: . '- > • /I :/i J ' Insurance Company ^jI^TVc^ "vt^f"^^ Policy No. *jv^ I Q u'S *" 3-6C>t^ Expiration Date O\ ^ I ^"^^^ ** (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100| OR LESS) *'"' -' - ' - f-— O 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. . , . I . WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to ona hundred' thousand dotlata-f£ 100,000), Inaddrtlon to thetcost of compensation damages as provided for In Section 3706 of the Labor code, interest and attorney s fees SIGNATURE C S^AA^V^XL^Ol^T^" ^_^^_^_____ DATE Hi iU •jTt&J* iTi f-^'CJp** *v* *& — *?%»_-*» .^.^ V^_ B * «n s* Js**. i * " B, ai. '' I hereby affirm that I am exempt from the Contractor's License Law for the following reason: O 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 wilt have the burden of proving that he did not build or improve for.the purpose of sale). ~ • i ,?'.--?.-• :'M . -•'•_ 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 cbntfactor(s) licensed pursuant to the Contractor's License Law). ' ' ' i ''. .-•• - ... . , . . [J 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. Q YES QNO ,r ,v v : . 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): ^ i , ' -' 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work |includeH~hame"/ address / phone number / contractors license number): . • • :\ - • ry-T., ,J[r--^i v.;i.ri-'i \ ^v 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): : -•• - . .-^ . '.'..J^..';L.J,.'..tL—f'.' ';: .'".J^ j.. ' PROPERTY OWNER SIGNATURE _ 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^fla: '*••-' - ' J Is the applicant or future building occupant required to obtain a permit ffom-the air pollution control district'or air quality management district? Q YES Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 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 ) 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, 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 .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 commencejj for a period of 180 daysJSection-106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE. WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION DATE » AS-V*7 INSPECTOR (^" *** t /\ ~) i IA ^ 'PLAN CHECK^ DESCRIPTION CODE DESCRIPTION ACT COMMENTS no •1 ing CERTHOLOER COPY SG P.O. BOX 420807, SAN FRAJMClSCO.CA 94142.-0807 COMPENSATION I N SURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE; 04-05-2007 WESTERN NATIONAL CONTRACTORS. THE IRVINE CO. LLC, THE IRVINE LAND CO. LLC 8 EXECUTIVE CIR IRVINE CA S2Q14-8746 SG GROUP: POLICY NUMBER: 1481888-2006 CERTIFICATE ID: 85 CERTIFICATE EXPIRES: 06-01-2007 06-01-2008/08-01-2007 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE * 64 DATCO Q4-O3-2007 JOB:VILLA DORADO 25O7 NORTHSIDE DRIVESAN DIEGO CA 921O8 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 30 days advance written notice to the employer. Wg will also give you SOdays advance notice should this policy 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 policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. 'THORI2ED REPRESENTATI PRESIDENT UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: tl.QOO.OOO PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE OO-O1-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. "ENDORSEMENT #2970 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2007-04-05 is ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: -WESTERN NATIONAL CONTRACTORS. THE IRVINE . EMPLOYER DE GROODT, CHUCK 216O2 SURVEYOR CIR HUNTINSTON BEACH CA 92848 SG PRINTED [B10.SC] O4-O5-2OO7 TOTftL P.01