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Home My WebLink About2775 CARLSBAD BLVD; ; CBC2021-0406; PermitPrint Date: 08/11/2022 Permit No: CBC2021-0406 Building Permit Finaled Commercial Permit Job Address: Permit Type: Parcel #: Valuation: Occupancy Group: 2775 CARLSBAD BLVD, CARLSBAD, CA 92008-2210 BLDG-Commercial 2031430700 $0.00 Work Class: Lot #: Project #: P/M/E Status: Applied: Issued: 10/21/2021 10/24/2021 Finaled Close Out:10/26/2021 #of Dwelling Units: Track #: Plan #: Closed - Finaled Plan Check #: Orig. Plan Check #:Bathrooms: Final Inspection:10/26/2021Bedrooms:Construction Type: Occupant Load: Code Edition: Sprinkled: INSPECTOR:Dreibelbis, Peter ST MICHAELS BY THE SEA: GAS LEAK REPAIR (E-REVIEW)Description: Project Title: Property Owner: ST MICHAELS-BY-THE-SEA EPISCOPAL CHURCH PO BOX 127 CARLSBAD, CA 92018 AMOUNTFEE PLUMBING, MECHANICAL & ELECTRICAL PERMITS $193.00 Total Fees:$193.00 Total Payments To Date:$193.00 Balance Due:$0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." 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 limitation has previously otherwise expired. 1635 Faraday Avenue, Carlsbad CA 92008-7314 ï 442-339-2719 ï 760-602-8560 f ï www.carlsbadca.gov Building Division Page 1 of 1 {"Cityof Carlsbad CBC2021-0406 10/21/21 { City of Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check ________ _ Est. Value PC Deposit Date Job Address2775 Carlsbad Blvd. Carlsbad, CA 92008 Tenant Name#: St. Michael's by-the-Sea Suite: APN: 203-143-07-00 ----- Lot#: Year Built: Chapel 1894, Church 1959 ·---- Year Built: 189411959 Occupancy:_O __ Construction Type: wood Fire sprinklersQ'ESC!)NO A/C:0YES0No BRIEF DESCRIPTION OF WORK: a gas pipe located outdoors approx 1 foot from the chapel was replaced A picture of the pipe is attached. D Addition/New: ____________ New SF and Use, __________ New SF and Use ______ SF Deck, _______ SF Patio Cover, ________ SF Other (Specify) ___ _ 0Tenant Improvement: _____ SF, _____ SF, Existing Use: _______ Proposed Use: ______ _ Existing Use: Proposed Use: ______ _ D Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _ D Solar: KW, ___ Modules, Mount ed: 0 Roof 0 Ground D Re roof: ___________________________________ _ ~ Plumbing/Mechanical/Electrical Plumbers replaced a leaking outdoor gas pipe. O other: ------------------------------------- PRIMARY APPLICANT Name: Linda Mumford Address: 2775 Carlsbad Blvd. City: Carlsbad State:_C_A __ Zip: 92008 Phone: 760.729.8381 Email: linda@stmbts.org PROPERTY OWNER Name: Rev. Doran Stambaugh Address: 2775 Carlsbad Blvd. City: Carlsbad Phone: 760.729.8901 Email: frdoran@stmbts.org DESIGN PROFESSIONAL CONTRACTOR OF RECORD State: CA Zip:_9_20_0_8 __ _ Name:_n_on_e ________________ Business Name:_n_on_e ______________ _ Address: Address: __________________ _ City: ________ State: ___ .Zip: _____ City: ________ State: ___ Zip: ______ _ Phone: Phone: __________________ _ Email: Email: ___________________ _ Architect State License: CSLB License #: _______ Class: ______ _ Carlsbad Business License# (Required): _______ _ APPLICANT CERT/FICA TION: 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. c:;--i / NAME {PRINT): Fr. Doran Stambaugh SIGN: J{f :f-:: DATE: 10/20/2021 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov REV. 07/21 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. IF THE PERSON SIGNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: lherebyaffirmunderpenaltyofperjurythatlamlicensedunderprovisionsofChapter9(commencingwithSection7000)ofDivision3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations (CHOOSE ONE): DI have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. Policy No. ______________________________________ _ -OR-D1 have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: lnsuranceCompany Name: ____________________ _ Policy No. ___________________________ Expiration Date: _______________ _ -OR- Ocertificate 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: Failure to secure workers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name: ____________________ Lender's Address: ____________________ _ CONTRACTOR CERT/FICA TION: 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. NAME (PRINT): _________ SIGNATURE: _________ OATE: _____ _ Note: If the person signing above is an authorized agent for the contractor provide a letter of authorization on contractor letterhead. -OR - (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: n 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. '--rcf44, 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). -OR-01, 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). -OR-□1 am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, ~ FORM B-61 "Owner Builder Acknowledgement and Verification Form" is required for any permit issued to a property owner. By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: http: I I www.leginfo.ca.gov/ cal aw. html. OWNER CERTIFICATION: 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 al I City~ord·nances and State laws relating to building construction. NAME (PRINT): Fr. Doran Stambaugh SIGN: r DATE: 10/20/2021 Note: If the person signing above is an authorized agent for the property owner include form B-62 signed by property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 2 REV. 07/21 I. {'cityof Carlsbad OWNER-BUILDER ACKNOWLEDGEMENT FORM 8-61 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov OWNER-BUILDER ACKNOWLEDGMENT FORM Pursuant to State of California Health and Safety Code Section 19825-19829 To: Property Owner An application for construction permit(s) has been submitted in your name listing you as the owner--builder of the property located at: Site Address 2775 Carlsbad Blvd, Carlsbad CA 92008 The City of Carlsbad ("City") is providing you with this Owner--Builder Acknowledgment and Verification form to inform you of the responsibilities and the possible risks associated with typical construction activities issued in your name as the Owner-Builder. The City will not issue a construction permit until you have read and initialed your understanding of each provision in the Property Owner Acknowledgment section below and sign the form. An agent of the owner cannot execute this notice unless you, the property owner, complete the Owner's Authorized Agent form and it is accepted by the City of Carlsbad. INSTRUCTIONS: Please read and initial each statement below to acknowledge your understanding and verification of this information by signature at the bottom of the form. These are very important construction related acknowledgments designed to inform the property owner of his/her obligations related to the requested permit activities. ~I understand a frequent practice of unlicensed contractors is to have the property owner obtain an "Owner- Bu~er" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed contractor and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 11. lli_1 understand building permits are not required to be signed by property owners unless they are responsible furlhe construction and are not hiring a licensed contractor to assume this responsibility. <...., 111. ~I understand as an "Owner--Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own. IV. ~I understand contractors are required by law to be licensed and bonded in California and to list their license ers on permits and contracts. V. Sll_1 understand if I employ or otherwise engage any persons, other than California licensed contractors, and ~tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. REV. 08/20 Owner-Builder Acknowledgement Continued VI. ~ I understand if I am considered an "employer" under state and federal law, I must register with the state ~ederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. VII. VIII. IX. X. XI. ~'-, I understand under California Contractors' State License Law, an Owner--Builder who builds single--family ~ntial structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building contractor. ~ I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable f~y financial or personal injuries sustained by any subsequent owner(s) which result from any latent construction defects in the workmanship or materials. ~ I understand I may obtain more information regarding my obligations as an "employer" from the Internal R~nue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors . .lliS._1 am aware of and consent to an Owner--Builder building permit applied for in my name, and understand th;t' I am the party legally and financially responsible for proposed construction activity at the following address: 2775 Carlsbad Blvd, Carlsbad CA 92008 ~I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. XII. ~I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the i;;"i~/mation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractor's State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured w hile working on your property, you may be held liable for damages. If you obtain a permit as Owner-- Builder and wish to hire contractors, you will be responsible for verifying whether or not those contractors are properly licensed and the status of their workers' compensation coverage. Before a building permit can be issued, this form must be completed, signed by the property owner and returned to the City of Carlsbad Building Division. I declare under penalty of perjury that I hove read and understand all of the information provided on this form and that my responses, including my authority to sign this form, is true and correct. I am aware that I hove the option to consult with legal counsel prior to signing this form, and I have either (1) consulted with legal counsel prior to signing this form or (2) have waived this right in signing this form without the advice of legal counsel. Fr. Doran Stambaugh (o/ ~ r (J,o Property Owner Name (PRINT) Property Owner Signature Date 2 REV. 08/20 Building Permit Inspection History Finaled PERMIT INSPECTION HISTORY for (CBC2021-0406) BLDG-Commercial 10/21/2021Application Date:Permit Type:Owner:ST MICHAELS-BY-THE-SEA EPISCOPAL CHURCH P/M/E 10/24/2021Work Class:Issue Date:Subdivision:TOWN OF CARLSBAD AMENDED 04/25/2022Expiration Date:Status: IVR Number: 36597 Closed - Finaled 2775 CARLSBAD BLVD CARLSBAD, CA 92008-2210 Address: Scheduled Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection InspectionActual Start Date 10/26/2021 10/26/2021 BLDG-23 Gas/Test/Repairs 169255-2021 Passed Peter Dreibelbis Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency No BLDG-Final Inspection 169450-2021 Passed Peter Dreibelbis Complete COMMENTS PassedChecklist Item BLDG-Plumbing Final Yes Tuesday, October 26, 2021 Page 1 of 1 {cityof Carlsbad