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Home My WebLink About2620 ROOSEVELT ST; 5; CB142052; Permit' City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 08-19-2014 Permit No: CB142052 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2620 ROOSEVELT ST CBAD St: 5 PME Status: Parcel No: 2031022800 Lot#: 0 Applied: Entered By: Reference #: Plan Approved: PC#: Issued: Inspect Area: Project Title: APARTMENT UNIT #5-GAS LINE REPAIR FROM METER TO HOME-SHOT OFF BY SDG&E DUE TO LEAK Applicant: TELFORD JONES INC STE 13A-400 25920 IRIS AV MORENO VALLEY CA 92551 951 486-0337 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Owner: SEVILLE HOLDINGS LL C 8080 LA JOLLA SCENIC DR N LA JOLLA CA 92037 ISSUED 08/19/2014 RMA 08/19/2014 08/19/2014 $158.00 $0.00 $0.00 $0.00 $158.00 Total Fees: $158.00 Total Payments To Date: $158.00 Balance Due: Inspector: Date: Clearance: $0.00 NOTICE: Please take NOTIC pproval of your project includes the "Imposition" of ees, 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/exac r as to whi h he statu e f limitation has revi I ire . .. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING D ENGINEERING Ccicyof Carlsbad JOB ADDRIE;U,, ?Co'Zo CT/PROJECT# Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov # OF UNITS # BEDROOMS # BATHROOMS □BUILDING □FIRE □HEALTH D HAZMAT/APCD Plan Check No. Est. Value SWPPP CONSTR. TYPE OCC. GROUP Uo~ EXISTING USE APPLICANT NAME Prtn• Con• ADDRESS CITY PHONE )"o EMAIL ADDRESS CITY EMAIL PROPOSED USE --- STATE LIC. # GARAGE {SF) PATIOS (SF) DECKS (SF) PROPERTY OWNER NAME CITY PHONE EMAIL TATEL'# :S\, 'l ::, f- STATE FAX CLASS c_ 11o ZIP FIRE SPRINKLERS YES0N00 • (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to.construct, alter, improve, demolish or repair an)'. structure, prior to its issu c 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 fChapter 9, commending with Secti 7 00 of Division 3 of the B_usiness 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 dollars {$500)). WORKERS' COMPENSATION Workers' Com ensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: I h and will maintain a certificate of consent to self-Insure for workers' compensation as provided by Section 3700 of the Labor Code, for the pelformance of the work for which !his permit is issued. ave and wlll maintain workers' compensation, as required by Section 3700 of the Labor Code, for the perfonnance of the work for which this pennit is issued. My workers' compensation insur ce carrier and policy number are: Insurance Co. ~ ~ ~ C:: Policy No. Xi~ \ ¢ :1> Ca9,\ 0~ Q Expiration Date Z... l t..c - This section need not be completed if the permit is for one hundred dollars ($100) or less. D Certificate of Exemption: I certify that in the perfonnance 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: Failure to secure workers' compens · n coverage Is uni I, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), In addition to the cost of compensation, damages as provid r in Se of the Labor code, lntarest and attorney's feea, ,..S CONTRACTOR SIGNATURE I hereby affirm that I am exempt from Contractor's License Law for the following reason: □ □ □ I, as owner of the property or my employees witt1 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). I, as owner of the property, am exclusively contracting with licensed co fl tractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does ROI 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). I am exempt under Section _____ Bllslness and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0Yes 0No 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted witti the following person {firm) to provide the proposed construction (include name address/ phone/ contractors' license number): 4. I plan to provide portions of ttie work, but I have hired the following person to coordinate, supervise and provide the major work (inciude name/ address I phone I contractors' license number)· 5. I will provk:ie some of the work, but I have contracted (hired) the following persons to provide the work indicated {include name I address/ phone I type ofworll): ,..S PROPERTY OWNER SIGNATURE □AGENT DATE 1 ci ~ ~ 11 ~ 1 ~ ~ ~ , ¢0MIH£1'1 ,HUI' J,ll!il'EION FOR 1\101\1-R!IUl;!llilD.A.1; BQUlllll\lG l!,IIMl'lfl Ql!U,'f ' ~ ~ j 1 j Is the applicant or Mure building occupant required to submit a business plan, acutely hazardous materials registration form or risk mancgement and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No Is the facility to be col\Structed within 1,000 feet of the outer boundary of a school site? □ Yes □ No IF P-MY 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. I certify that I have read the application and state that the above lnfonnatlon is conectand that the lnfonnatlon on the plans Is accurate. I agree 1D c:omply'Mth all CHy ordinances and State laws 181atlng 1D building construction. I hereby authorize representative of the City of Carlsbad to enter UJXln the alx>ve mentioned property tir inspectkln pu~. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AG'\INST ALL LIABILITIES, JUOOMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGftJNST SAID CITY IN CONSEQUENCE CT' THE GRANTING CT' THIS PERMIT. OSHA: M OSHA permit is required br excavations over 5'0' deep and demolltOO or oonstruction of structures over 3 sbries in hei;;lht. EXPIRATION: Every permit issued by the Building Official under the ~visk:lns of this Code shall expire by limitaoon and beo:lme null and void Wthe building or'M:lrk authorized by such pem,it is notoommenc:ed 'Mlhin 180days from the dale of such permit or if the lx.Jilding orViOrk authorized by sudl permit is suspended or abandoned at any time after the 'Mlrk is oommenced for a rioo of 180days (Secoon 100.4.4 Unibrm Buik!ing Code). ,i!S APPLICANT'S SIGNATURE ~ DATE Inspection List Penni!#: CB142052 Type: PME Date lnspecUon Item 08/19/2014 23 Gas/T esURepairs Thursday, August 21, 2014 Inspector Act PY AP APARTMENT UNIT #5-GAS LINE REPAIR FROM METER TO HOME-SHOT Comments Page 1 of 1