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Home My WebLink About2869 ANDOVER AVE; ; CB071110; Permit05-0^-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB071110 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC#: Project Title: 2869 ANDOVER AV CBAD MISC 1674801838 . $0.00 PC070029 VILLAS OF CALAVERA HILLS 2ND FLR ENTRY DECK REPAIR-2869&2871 Subtype: REPAIR Lot #: 0 Status: ISSUED Applied: 04/18/2007 Entered By: KG Plan Approved: 05/02/2007 Issued: 05/02/2007 Inspect Area: Applicant: DEGROODT CONSTRUCTION CO. 21602 SURVEYOR CIRCLE HUNTINGTON BEACH CA 92646 714-375-1325 Owner: GRIFFIN JACQUELINE H 2869 ANDOVER AVE CARLSBAD CA 92010 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees $120.00 $0.00 $0.00 TOTAL PERMIT FEES $120.00 Total Fees:$120.00 Total Payments To Date:$120.00 Balance Due:$0.00 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 "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, CA92Ci08 FOR OFFICE USE Q PLAN CHECK NO. EST. VALV__V_1 Plan Ck. Deposit: Validated B' Date : Address (include Bldg/Suite Business Name {at this address) Legal Description Subdivision Name/Number -Total # of units , Assessor's Parcel #Existing Use Proposed Use Description of # of Bathrooms City State/Zip ' Telephone * fd~ • 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. witruSection 7000 of Division 3 of the. Business and Professions Code! or that he is exempt therefrom, and the basis for the alleged xemption. Any vtolationof Section 7031.5 by any applicant for a permit subjects the applicant to a civil penaltyof not more thn five hundred dollars [$500]). Crooy^ Co; :e/3p •Name .\: State License # • Address. ' . • License Class City' • Stat City Business License !-> Telephone # Designer Name State License.# Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: . " Q I have and will maintain.a certificate of consent to self-insure for Workers' compensation as provided by Section 3700 of the Labor Code, for.the performance of the^work for which this permit is issued. ( ^f I have and will maintain workers'-compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: ..->,; ' '-••••-J "V I /!- Insurance Company ^STVYTir T^K^S* Policy No. '" " ( Q 0*$ "" 2-C)O^ Expiration Date 6\ ^\' **-&'& "\ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) " ' 'i *' - -" •. -'•• CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued,:! shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California... iWARNING: Failure to-secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and •civil fines up to one hundred *; thousand dollata-tt100.000). Inaddltfon to theicost of compensation, damages as provided for In Section 3706 of the Labor code,: Interest and attorney's fees. \ SIGNATURE C ^^AXX^lIJ^r^lMf DATE _ IX^SSIKCI^^iJ 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^salej. (Sec. 7044, Business and Professions Code: The Contractor's License La w'rdoe3 not "apply to an owner'of-property who builds or improves thereon,.and who does j, 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). ' ' J - ' ' ' 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 , f t, ] 2. I (have / have not) signed an application for a building permit for the proposed work. j 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): .'• / ^ >• ^ T. 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 —*•'* _ teOMElFTEstHISWcllb^^ 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, 26533 or 26534 of the Presley-Tanner Hazardous Substance Account Act? Q YES- Q^'tio ' -' - ' «~ 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 Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES ; IF ANY OF THE ANSWERS ARE YES. i 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 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 commenced^for a period ^f 180 days^Se^tion 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 08/15/2007 Permit# CB071110 Title: VILLAS OF CALAVERA HILLS 2ND Description: FLR ENTRY DECK REPAIR-2869&2871 Inspector Assignment: PY Sub Type: REPAIR 2869 AN DOVER AV Lot Type: MISC Job Address: Suite: Location: APPLICANT DEGROODT CONSTRUCTION CO. Owner: GRIFFIN JACQUELINE H Remarks: Phone: 7143885247 Inspector: . Total Time: CD Description 19 Final Structural Act Comment Requested By: CHRIS Entered By: JANEAN Comments/Notices/Holds Associated PCRs/CVs Original PC# PC070029 Inspection History Date Description Act Insp Comments 07/24/2007 18 Exterior Lath/Drywall AP PY 05/21/2007 14 Frame/Steel/Bolting/Welding AP PY DUIL.UIWVJ rvcr i.\o •iing CERTHOLOER COPY SG COMPENSATION IN SUR ANCE FUND P.O. BOX 420807. SAN FRANQSCO.CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE; 04-OS-2007 WESTERN NATIONAL CONTRACTORS. THE IRVINE CO. LLC. THE IRVINE LAND CO. U.C 8 EXECUTIVE CIR IRVINE CA 82614-6746 SG GROUP: POLICY NUMBER: 1481888-2006 CERTIFICATE ID: 85 CERTIFICATE EXPIRES: 08-01-2007 06-01-2008/08-01-2007 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE * 64 DATED 04-03-2007 JOB:VILLA DORADO 2507 NORTHSIDE DRIVE SAN DIEGO CA 82108 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 tor 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 al&o 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 HEPRESENTATI 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 WIPE 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: $1,000.000 PER OCCURRENCE. ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2003 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 HUNTINGTDN BEACH CA 82846 mev.j-06)PRINTED [B10.SC] O4-05-ZOO7 TOTAL P.01