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Home My WebLink About2873 ANDOVER AVE; ; CB071111; PermitO£b2-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No: CB071111 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC#: Project Title: 2873 ANDOVER AV CBAD MISC Subtype: 1674801836 Lot#: $0.00 PC070029 VILLAS OF CALAVERA HILLS 2ND FLR ENTRY DECK REPAIR-2873&2875 REPAIR Status: ISSUED 0 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: DULAK KARIN L 2873 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 APPROVAL Date: —J 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 92668 FOR OFFICE USE ONLY, PLAN CHECK NO./ EST. VAL." Plan Ck. Deposits; •; Validated B; Date Address (include Bldg/Suite #)Business Name (at this address! Legal Description Subdivision Name/Number Phase No. Total # of units , Assessor's Parcel #Existing Use Proposed Use Description o , 5 "i ' "">*9 FT- . Q^SontrWatT, ..'... . City Q'Owner " Q Agent for Owner^, i State/Zip-Telephone # State/Zip Telephone # -^.^ Name City State/Zip Telephone,Address (Sec. 7031.5 Business and Prof ess jqns_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 :- [Chapters, 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 penaltyof not more than five hundred dollars [$5001). ,-. ^T^*. f f\ *-i .. .*f » - •'' • /"*•• -•' • 11 „-•':. '^-l^ ".•. f. ''••> 1*'-^!' ' /"V;i ?< i »••'» :' .'.!>.'- r. ' ,*_•:.^*~- -j1,, —»*•**'a*-SOeJleptfV^crrvr- --Ctou^vr V Name- '• -Lr^' 3-StiUod 1*^1^ > State License'* •i'SS*t'''"^-C>Vli-'r - JOT i-4 WOT— OC?0~U*>* . Address: *>•- •., >-... License Class - - V£* City City Busines r tfxLfTj L/ •-. State/dp*. ... ;s License * $rP V- V2Wfc» ^(V- H\tlA: , •. 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-insure1! for workers' compensation as provided by Section 3700 of the Labor Code, forlthe performance , of the^work for which this permit is issued. . . , ; Cffl 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 / ^ ' ' Insurance Company "oTyYOfT *T^t?|^j^ Policy No. '" o I Q O^ST'"' 2-&&(j? Expiration Date ^( * ( "^-cJO I (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, .I shall not employ any personjn any manner so as to become subject to the Workers' Compensation Laws of California. . " I WARNING: Failure to secure workers' compensation coverage la unlawful, and shall subject an employer to criminal penaKle» and civil fines up to one hundred;! thousand dollaGa~tt 100,000), in addition to theicost of compensation, damages as provided for In Section 3706 of the Labor code, interest and attorney's fees.,/ \C\_l.l,. f^. „__ _ R iL—— " - - ... SIGNATURE 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 sale (Sec. 7044, Business and Professions Code:,The Contractors 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 buildJng^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 ol sale).'- -'-• i ..--'_;- .1 . *-l 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 pVojects with contractor(s) licensed, pursuant to the Contractor's License Law). '• • '• D I am exempt under Section Business and Professions Code for this reason: , .. ; .t , 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Q YES QNQ . f ^. .. ;- ( : 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. ('plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major'work1'(include*nameV address / phone number / contractors license number): :-^.. fe;c ^A'-^^yH;} j • ;. 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): - - ••<•>": -in* -f .-?..•..,..'. ; PROPERTY OWNER SIGNATURE , 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? Q YES ' C9^*flO Is the applicant or future building occupant required to obtain a permit from trie1 air pollution control district^oriair 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.;, Q IF ANY OF THE ANSWERS ARE YES, / REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. jlllllip^^ ILJV _™_»»-i * ^IL^ k "* 1 lw '*~_*^ * £ -.*! ^ ^ 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 NAME1; ' ' LENDER'S ADDRESSm%m&swmfi&ffiir± ^n ^"*z^' _ ^^^r^^i, ~ ± JIT " v^*^ *z ^r,r ^r^^ i M I certify that I have reed 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. 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 sto'ries 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 commenca} for a period jjf 180 days jSeftion_106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE ( ' yUJ|P 73WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 08/15/2007 Permit# CB071111 Title: VILLAS OF CALAVERA HILLS 2ND Description: FLR ENTRY DECK REPAIR-2873&2875 2873 AN DOVER AV Lot Type:MISC Sub Type: REPAIR Job Address: Suite: Location: APPLICANT DEGROODT CONSTRUCTION CO. Owner: DULAK FAMILY 2007 TRUST 04-28-07 Remarks: Inspector Assignment: PY 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 06/07/2007 18 Exterior Lath/Drywall AP PY 05/14/2007 14 Frame/Steel/Bolting/Welding AP PY 05/10/2007 14 Frame/Steel/Bolting/Welding NR PY MIT:—ico—iing CERTHOLDER COPY SG COMPENSATION INS UR ANCE FUND P.O. BOX. 420807, SAN FRAMClSCO.CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE; 04-05-2007 WESTERN NATIONAL CONTRACTORS, THE IRVINE CO. LLC. THE IRVINE LAND CO. LUC 8 EXECUTIVE CIR IRVINE CA 82914-6746 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 KORTHSIDE 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 tor the policy period indicated This Policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. We will also give you 3Od»ys 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 lo which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED 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 WIPE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. Ml EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,OOO,OOO PER OCCURRENCE. ENDORSEMENT 12065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE OO-O1-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. "ENDORSEMENT #2570 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 21602 SURVEYOR CIR HUNTINOTON BEACH CA 92846 SG PRINTED [B10.SC] O4-05-20O7 TOTflL, P.01