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HomeMy WebLinkAbout2864 CAMINO SERBAL; ; CB053847; PermitCity of Carlsbad * •; ' 1635 Faraday Av Carlsbad, CA 92008 11 -02-2005 Plumbing Permit Permit No: CB053847 Building Inspection Request Line (760) 602-2725 Job Address: 2864 CAMINO SERBAL CBAD Permit Type: PLUM Status: ISSUED Parcel No: 2552812800 Lot#: 0 Applied: 11/02/2005 Construction Type: NEW Entered By: KG Reference #: Plan Approved: 11/02/2005 Issued: 11/02/2005 Project Title: SUTTON RES ELEC TO PORTABLE Inspect Area: SPA Applicant: Owner: WILLOW LANE GROWERS SUTTON TIMOTHY G TRUST 01 -31-97 753 REQUEZA 2864 CAMINO SERBAL ENCINITAS CA 92024 CARLSBAD CA 92009 760-753-4595 \ 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 0 0 0 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $40.00 Total Fees: $40.00 Total Payments To Date: $40.00 Balance Due: $0.00 FINAL APPROVAL Inspectok^ " ~ % - Date:^f ""/i ' &(? 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 civen 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 n ft CA FOR OFFICE USE O PLAN CHECK N EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Suite *)Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total * of units Assessor's Parcel *Existing Use Proposed Use SQ.FT.#of Stories f of Bedrooms * of Bathrooms 2. •-•••' CONTACT dHJannt from :• j^' •..-••• O Name Address City State/Zip Telephone I EjJCJAS f. Fax* Name Address''City State/Zip Telephone # Name Address City State/Zip Telephone # (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^gpplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 14500]). Name State License # Addss License Class City State/Zip City Business Licenser/a/fSS* Designer Name Address City State/Zip Telephone State License * Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: O 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. O^lhave 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: Insurance Company /fa/ffaaJ-A&r^J&tSltS'Si Policy No. ff/l/SffO // TYrSt?/ Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED.* THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100] OR LESS) n 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: Fatture to secure workers' compensation coverage is unlawful, and she! subject an employer to criminal penalties and chrfl fines up to one hundred •KMisand dollars 1*100,000), hvaddWon to the cost of compensation, damages as provided for hi Section 3706 of the Labor code. Interest and attorney's fees. C^BIGNATURE^ /^l £f ~d&&7lf- *~ DATE / f~ ?~-~0 ^ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 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 Lew 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 ha did not build or improve for the purpose of sale). O I, es 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). 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. Q YES QNO 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 *EC^^ 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? O YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q NO Is the facility to be constructed within 1 ,000 feet of the outer boundary of a school site? D VES 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 OFRCE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. ;-:;::;. .;;,;. :'::v:3'::;:/.-:;:; ; ..••;-::".--, : -! •--.;. : :-: \^\ . f :.;> •:.,;•:;-.: :?-: ;-;. v. -: :;;: -- -::•••-., -. ••• -; 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 iftJiiieK^^ •-;^::.;:;:;:x ••:•.•• • . :,x^ I certify that I have read the application and state thet 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 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 commencedjor a period of 180 days (Sectional 06.4.4 Uniform Building Code). APPLICANT'S SIGNATURE ommencedjor t WH DATE // YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 04/10/2006 Permit* CB053847 Title: SUTTON RES ELEC TO PORTABLE Description: SPA Inspector Assignment: JM 2864 CAMINO SERBAL Lot 0 Type: PLUM Sub Type: Job Address: Suite: Location: OWNER SUTTON TIMOTHY G TRUST 01-31-97 Owner: SUTTON TIMOTHY G TRUST 01-31-97 Remarks: Phone: 7606855576 Total Time: CD Description 29 Final Plumbing ~ Act Comment Comments/Notices/Hold Requested By: HENRY Entered By: KAREN Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 11/15/2005 31 Underground/Conduit-Wiring PA JM CONDUIT ONLY 11/15/2005 34 Rough Electric WC JM WILLLAN-04 MADA ACORDn CERTIFICATE OF LIABILITY INSURANCE "5S5ST PRODUCER ' . ' ' (530) 668-2777 Armstrong & Associates Insurance Services George Petersen Ins. Agcy. License # OB50501 P.O. Box 1270 Woodland, CA 95776 INSURED Willow Lane Growers 753 Requeza St. Encinitas, CA 92024- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER* Virginia Surety Company, Inc. INSURER B: INSURER C: INSURER D: INSURER E: NAIC# COVERAGES ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A ADD'LNSRC TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ] CLAIMS MADE [ | OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY I |?ER& I I LOG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY | OCCUR | | CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe underSPECIAL PROVISIONS below OTHER POLICY NUMBER WVS0011 74301 POLICY EFFECTIVEDATE (MM/DD/YYt 9/9/2005 POLICY EXPIRATIONDATE rMM/DD/YY) 9/9/2006 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Eaoccurence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT(Ea accident) BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EAACC AUTO ONLY: AGG EACH OCCURRENCE AGGREGATE Y WCSTATU- I OTH-A TORY LIMITS I ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ , 1,000,OOC $ 1,000,000 , 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS App#200501 03442 CERTIFICATE HOLDER CANCELLATION Contractors State License Board Attn: Workers' Compensation Unit P.O. Box 26000 Sacramento, CA 95826- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE f—AA „ ^-ni , . ^*TK\ <X>\Z\xv^\ v-JL^VT' ~O n^Aiivj mcA ACORD 25 (2001/08)© ACORD CORPORATION 1988