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Home My WebLink About2864 ANDOVER AVE; ; CB071103; Permit05-02-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB071103 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC#: Project Title: 2864 ANDOVER AV CBAD MISC 1674801845 $0.00 PC070029 VILLAS OF CALAVERA HILLS 2ND FLR ENTRY DECK REPAIR-2864&2866 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: DAQUILA MICHAEL C 2864 ANDOVER AVE CARLSBAD CA 92010 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: FINAL 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 Q PLAN CHECK NO !EST. VAL. ; Plan Ck. Deposit Validated Date Address (include Bldg/Suite #)Business Name (at this address) Legal Description Subdivision Name/Number Unit No.Phase No. •Total # of units . Assessor's Parcel #Existing Use Proposed Use -—~j -- "/*9 FT""" \f~ *^pA-cvii/oc6855\ dltSKSKm^Vwl^SF^I^ f Bedroo # of Bathrooms ..,'>: * - . -3 Name —,—.-,. Address • - - City 3]-^ AfjWJCANT^ D Contractor ^QtAgent for*Contraoioih Q'oWner "T3 Agent forCorner, State/Zip-Telephone #Fax* —- --*— --- Address.City State/Zip Telephone # Name City State/Zip TelephoneAddress V"* ^^v^'f JT^^TTYtr^^ ^J1 (Sec. 7031 .5 Business and. Prof essions^Cqde: 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 violationpf Section 7031.5 by any applicant for a permit subjects the applicant to a civil penaltyof not more than five hundred dollars (S500J). r USjewa-oe Name : State License 0 Designer Name . State License:!' 6"' r: WORKERS rtVF-- t:C«JtrVT V_o ^"fT-oif1 • COMPENSAtlON ~TT >~-~ XlfeOT— r>Jft-U<-^CA^ Address, ''-. ~ •• r..:-- License Class - 'Ky Address •r,~--- -»*« , , ' ^ r- -, . V--M* , tUirr fa£-rT-y- City :••• State/Zip City Business License » City State/Zip iL.~*"v,i"- ' '"" L ^V" T'Z;«'T'kj» A.VT* .yZ\ILT' • ~. .'''.•• Telephone # -' . A-Pfi^J/ •"' .-.. '/ .••;:••. Telephone '^'JTE^^S"."",'. ", t«\ 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-insurejor workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the^ork for which this permit is issued. , , _ ! 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: . <, . . ' > : V I * ' • " t' [Insurance Company Policy No.Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) ....', , ... Q CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this: permit is issued, l-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 one hundred; thousand dollairtt100,OQO). ipaddltlon to theicost_of compensation, damages as provided for In Section 3706 of the Labor code. Interest and attorney's fees. SIGNATURE ( ^^^^^^f _ DATE t.M " (i^**ij|? ^ ig.**m"*sj, j/"^*7^,'" 2 ^^zT* * t 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,propertyVwho builds or improves thereon, and.whb'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).- - -| '-™*-' *'-*-•• ! f~I 1, 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 cbhtractor(s) licensed pursuant to the Contractor's License Law). • ' '• ; \ '• '•'• Q 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 ,K ;;.,„.! = ; 2. {(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*" (ihclude^rVame 7 address / phone number / contractors license number): ^..'.J'li-t >'''> '"-' '^'j'-1'^ I > 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 / typeof work!: • • • - .... ' ..... ...•..=<. *^ L. ,-..(.,, , ^ t PROPERTY OWNER SIGNATURE, .. ,.. : :DATE iPiSliii^^ II!!lv ISJ-iZ^ -J, Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or,nsk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES* Is the applicant or future building occupant required to obtain a" permit from the air pdllutfo'n 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? D ,YES,j . S^flo .. . :J ,, : IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR tS MEETING THE 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 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, f 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 commence^ for a period ^f 180 days^S^ption 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance ! UNSCHEDULED Bl DATE •Q.7"v/*3 "" JOB ADDRESS DESCRIPTION. INSPECTOR PLAN CHECKS, CODE DESCRIPTION '•it ACT COMMENTS NOTE. APPRESSES ing CERTHOLDER COPY SG COMPENSATION INSURANCE FUND P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE; 04-OS-2007 WESTERN NATIONAL CONTRACTORS, THE IRVINE CO. LLC, THE IRVINE LAND CO. LLC 8 EXECUTIVE CIR IRVINE CA 82614-6746 SG GROUP: POUCV NUMBER: 1481888-2006 CERTIFICATE ID: 85 CERTIFICATE EXPIRES: 08-01-2O07 O6-01-2OOB/08-01-2007 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE * 64 DATED 04-03-2007 JOB:VILLA DORADO 2507 NORTHSIDE DRIVESAN DIEGO CA 821O8 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. We will also give you 3Odays 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 of 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. IB EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000.000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE O8-01-2003 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 PE GROODT, CHUCK 216O2 SURVEYOR CIR HUNTINGTON BEACH CA 82646 SG mev.j-06) [B10.SCJ PRINTED : O4-05-2O07 TOTfiL P. 01