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Home My WebLink About2895 CAMINO SERBAL; ; CB010034; Permit01/05/2001 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Patio/Deck Permit Permit No:CB010034 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 2895 CAMINO SERBAL CBAD PATIO 2552832100 Lot#: 0 $1,488.00 Construction Type: NEW MOSELLE - COV PATIO 192 SF GAS LINE TO FIRE PIT Applicant: PARKER, DAVID 4911 REFUGIOAV CARLSBAD, CA Status: ISSUED Applied: 01/05/2001 Entered By: JM Plan Approved: 01/05/2001 Issued: 01/05/2001 Inspect Area: Owner: LACOSTA VALLEY-CARLSBAD L P C/O HEARTHSTONE „„ n< , 16133 VENTURA BLVD#14(lfj9 "1/05/01 0002 01 ENCINO CA 91436 L,bP Total Fees:$77.05 Total Payments To Date:$0.00 Balance Due:$77.05 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Strong Motion Fee Renewal Fee Add'l Renewal Fee Other Building Fee TOTAL PERMIT FEES $29.73 $0.00 $19.32 $0.00 $1.00 $0.00 $0.00 $27.00 $77.05 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 capactiy 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 1. PROJECT TION FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Dep Validated By\ Date Address (include Bldg/Suite #)Business Name (et this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel #Existing Use Proposed Use Description of Work SO. FT.*of Stofles # of Bedrooms * of Bathrooms iCT PERSON Of different from appicantV Name APPlilCANT Address City O Agent for Contractor Q Owner O Agent for Owner State/Zip Telephone #Fax* Name i4. PRO Address City State/Zip Telephone * OWNER //'/fe Name v Address City State/Zip Telephone * IS, CONTRACTOR • COMPANY NAME . , (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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred i Name State License # Address License Class City State/Zip City Business License * Telephone # Designer Name State License # 6, WORKERS' COMPENSATION Address City State/Zip Telephone ^Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0^1 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. Q 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: .—^/o Insurance Company cJV/P"7ZT x*~^/vXj Policy No. C7 t**7 f-3 ' Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*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 person in any manner so as to become subjegrfo^the Wodc£»' Compensation Laws of California. WARNING: Faiiure/n *yya^iottm*' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollarsUnioMI&^yiyl&tian to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interesj_and attorney's fee*. SIGNATUBJ&XX L/^^L- DATE /^ ^ " @ & 7. OWNER-BUILDER DECLARATION „ -; '--.... "v ". 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 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 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 end Professions Code: The Contractor's License Lew 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). l~l 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. l~l YES l~lNO 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 we 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 COMPETE THIS SECTION FOR WOWJ^S/OBVTMIBUILDINQ PERMITS ONLY ....... 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 2S50S, 25S33 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? O YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES 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 OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8. CONSTRUCTION LENDING AGENCY ..:..' : 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 m APPLICANT CERTIFICATION . , ", . . % . . I certify that I have read the application and state that the ebove 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 purpose*^ 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 EXPIRATION: Every permit/issued 0y the I authorized by such permit is not at any time after the work islco/rtrrje'ncei APPLICANT'S SIGNATUrl • 5'0" deep and demolition or construction of structures over 3 stories in height. Official under the provisions of this Code shall expire by limitation and become null and void if the building or work ) days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned (of 180 days (Section 106.4.4 Uniform Building Code). -, LS/ _DATE WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 03/15/2001 Permit# CB010034 Title: MOSELLE -COV PATIO 192 SF Description: GAS LINE TO FIRE PIT Inspector Assignment: SR 2895 CAMINO SERBAL Lot 0 Type: PATIO Sub Type: Job Address: Suite: Location: APPLICANT PARKER, DAVID Owner: Remarks: CELL 518 7944 Phone: 7607207944 Inspector: Total Time: CD Description 19 Final Structural Act Comments Requested By: DAVE PARKER Entered By: CHRISTINE .C Associated PCRs Inspection History Date Description Act Insp Comments 01/08/2001 11 Ftg/Foundation/Piers AP SR 01/08/2001 21 Underground/Under Floor WC SR 01/08/2001 23 Gas/Test/Repairs AP SR 9 SD P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE COMPENSATION INSURANCE ISSUE DATE: 01-01-01 POLICY NUMBER: 229-01 UNIT 0017449 CERTIFICATE EXPIRES: 01*01-02 CONTRACTORS STATE LICENSE BOARD ATTN: WORKERS' COMP. UNIT BOX 26000 SACRAMENTO CA 95826 JOB: * 709S01 INCEPTION DATE: O1-O1-O1 0.0.: SAN DIEGO 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 1O days' advance written notice to the employer. We will also give you 10 days' 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 policies 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 may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,OOO,OOO.OO PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. EMPLOYER LEGAL NAME DAVID L. PARKER LANDSCAPE 4911 REFUGIO AVE CARLSBAD CA 92008 PARKER, DAVID L PRINTED: 12-16-OO P0409 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF I0265 (REV. 2-'