HomeMy WebLinkAbout1032 IRIS CT; ; VARIOUS; PermitUSE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
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VI I heraby affirm that I am licensed under
^previsions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
•nd Professions Code, and my Iicense is in
fuli force and effect. , . /
Lie No Class C - (c I
I hereby affirm that I am exempt from the Con-tractor's License Law for the following reason (Sec. 7031 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 fiie a signed statement that he is
licensed pursuant to the provisions of the Con-
tractor's License Law (Chapter 9 commencing with
Section 7000 of Division 3 of the Business and Pro-
fessions Code) or that is exempt therefrom and the
basis for the alleged exemption. Any violation of
Section 7031.5 by an applicant for a permit subjects
tne applicant to a civit penalty of not more than five
hundred dollars (SSOO).
Q I, as owrwr 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 Professiofis Code:
The Contractor's License Law does not apply to an
owner of property who builds or improves thereon
arKl who does such worV himself or through his own
employees, provided that such improvements are
not intended or offered for sale If, however, the
tnjilding or improvement is sold within one year of
completion, ttw 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 properly, am exclusively
contracting with hcensed contractors to construct
ttw project (Sec, 7044, Business and Professtons
Code: The Contractor's License Law does not apply
to an owner ot properly who builds or improves
ttwreon, and who contracts for each projects with a
contractor(s) license pursuant to the Contractor's
License Law).
O I am exempt under Sec __ _ , B & P C
for this reason
• \ hereby affirm that t have a certificate of consent
to self-insure, or a certificate of Workers'
Compensation Insurance, or a certified copy thereof
(Sec 3800. Ubor Code)
POLICY NO
COMPANY ^X^iyiMkS l=-kMD
"y^CoQi is filed with the city
Q Certified copy is hereby furnished
CERTIFICATt OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit
IS for one hundred dollars ($100) or less)
D I certity 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
NOTICE TO APPLICANT If, after making this Certi
ficate of Exemption, you should twcome subject to
the Workers' Compensation provisions of the Laixir
Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked
• I hereby atttrm that there is a construction
lending agency for the performance ot the wofV tor
which this permit is issued (Sec 3097. Civd Code)
Lender s Name
Lender s Address ,
CARLSBAD BUILDING DEPARTMENT
1200 Elm, Carlsbacl, California 92008 (714) 438-5525 APPLICATION & PERMIT /^J
OWNER'S NAME
^ /C^3Z IRIS CL-T
AViST. RD.
wNER's MAILING ADDRESS
OWNER'S PHONE
^3^- Of n
(0 3X /I^LS C^J
SL^BOI VISION ASSESSOR PARCEL NO.
DATE Of APPLICATION ^SKlNeSS LICENise #:
PRIME CONTRACTOR
CONTRACTOR'S AODRESS
peSCRfPTION OF WORK
^^^'^•THf-'^ ..y\Ji-<.^^Z^ ^-f^ .„'fj^£,.AJ^^
^SUS TRACT*' GP LAND USE PARK^JG SPACE RES UNI
DESIGNER'S ADDRESS
F/P FLR ELEV.
GRADING PERMIT ISSUED
Y • N •
REDEVELOPMENT
AREA
NO
STORIES
TYPE
CONST
CONTRACTORS PHONE »
UCENSE NO.
STATE LICENSE #
DESIGNER'S PHONE
OCC LOAD
EDU
FIRE SPR
YD ND
VALUATION
ZONE
PLAN l.D. #
STANDARD PLAN #
PERMIT NUMBEB
BLDG USE CODE
BUILDING SO. F(X>TAGE
Not Valid Unless Machine Certified
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATIOH HEREON INCLUDING THE
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS
ISSUED: TO COMPLY WITH ALL CITY, COUNTY ANO STATE LAWS GOVERNING BUILDING CON-
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND irAkiT'C oir-M^xi .oc n
KEEP HARMLESS THE CITY OF CARLSBAD AQAINST ALL LIABILITIES, JUDGMENTS, COSTS AND '^^'i'""' BltiNArURE *
EXPENSES WHICH MAY IN ANY WAY ACCRUE AQAINST SAID CITY IN CONSEOUENCE OF THE ^ -=-s/
GRANTING OF THIS PERMIT. Q{^lAAM/li^'ft.<.£> /^ iA^ {
Expiration. Every permit issued by Ihe Building Official under the provisions ofthis
Code shall expire by limitation and become null and void. If the building or work
auttiorized t>y such permtt Is not commainced within 180 days from the date of such
permit, or if the buUding or VMxlt authoriied by such permit rs suspended or
abandoned at any time alter ttie work is commenced for a period of T80 days.
0WNE^3r CONTRACTOR
BY PHONE •
* AN OSHA PERMIT IS REQUHED FOR EXCAVATIONS OVER
5' 0" DEEP ANO DEMOCmON OR CONSTRUCTION OF .
STRUCTURES OVER 3 STOKES IN HEIGHT /
APPROVED
QTY. PLUMBING PERMIT - ISSUE 7.50 QTY. MECHANICAL PERMIT - ISSUE 3.00 SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU BUILDINGPERMIT
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT
EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3 15 HP TOTAL PLUMBING
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL
EACH INSTAt, ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL /
EACH VACUUM BREAKER MECH EXHAUST - HOOD/DUCTS MOBILEHOME
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) SOLAR
TOTAL MECHANICAL STRONG MOTION
TOTAL PLUMBING FIRE SPRINKLERS
QTY. ELECTRICAL PERMIT - ISSUE 2.00 QTY. SOLAR - ISSUE PUBLIC FACILITIES FEE QTY. ELECTRICAL PERMIT - ISSUE 2.00 QTY. SOLAR - ISSUE BRIDGE FEE
NEW CONST EA AMP/SWT,/BKR COLLECTORS SCHOOL FEE - DISTRICT
1 PH 3 PH STORAGE TANKS Carlsbad
EXIST BLDG EA AMP/SWT/BKR ROCK STORAGE Encinitas
1 PH 3 PH PUMP San Dieguito
REMODEL/ALTER PER CIRCUIT PLAN CHECK FEE San Marcos
TEMP POLE 200 AMPS •
OVER 200 AMPS
TEMP OCCUPANCY (30 DAYS)
TOTAL ELECTRICAL ysc TOTAL SOLAR TOTAL FEES PAYABLE 4
INSPECTION TYPE DATE INSPECTOR
BUILDING
FOUNDATION
•
REINFORCED STEEL
MASONRY 1
GUNITE OR GROUT '
FLOOR & CEILING SUB FRAME
SHEATHING j
FRAME j
EXTERIOR LATH INSULATION i
INTERIOR LATH & DRYWALL !
PLUMBING
SEWER AND BL/CO i
PLUMBING UNDERGROUND {
PLUMBING TOP OUT {
TUB AND SHOWER PAN 1
GAS TEST
ELECTRICAL
TEMPORARY POWER 1
ELECTRIC UNDERGROUND ]
ROUGH ELECTRIC [
ELECTRIC SERVICE 1
BONDING l\. \
G. F. 1. - SMOKE DETECTOR- , [
MECHANICAL 1
DUCT & PLEM., REF. PIPING 1
HEAT - AIR COND. - SOLAR SYSTEfjlS
VENTILATING SYSTEMS 1
' 1
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE pEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
—. . _—. . « . . —— 1
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REQ IF
CHECKED
INSPECTORS
APPROVAL DATE
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PS:
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES'CAISSONS
-.t
08-30-2013
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Miscellaneous Permit Permit No: CB132101
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Reference #:
PC#:
Project Title:
1032 IRIS CTCBAD
MISC
2144021100
$0.00
Subtype:
Lot #:
OTHER
0
MOORE RES- REMOVE WOOD
SIDING ON FRONT AND PARTIAL LEFT SIDE OF HOME AND
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
08/30/2013
LSM
08/30/2013
08/30/2013
Applicant:
MOORE KATHLEEN E TRUST 05-17-00
1032 IRIS CT
CARLSBAD CA 92011
760-438-0911
Owner:
MOORE KATHLEEN E TRUST 05-17-00
1032 IRIS CT
CARLSBADCA 92011
Miscelaneous Fee #1
Miscelaneous Fee #2
Additional Fees
TOTAL PERMIT FEES
INSPECTION FEE $130.00
$0.00
$0.00
$130.00
Total Fees: $130.00 Total Payments To Date: $130.00 Balance Due: $0.00
FINAL ARPR
Inspector: Date:
ARPRO<^AL r
Clearance:
NOTICE: Please take NOflCE mat 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 pemiit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Govemment 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 vou have oreviouslv been given a NOTICE similar to this, or as to which the statute of limitations has oreviouslv othenvise expired.
THE F«5LL0WING>;PPR0VALS REQUIRED PRIOR TO PERMIT ISSUANCE: nPLANNING nENGINEERING nBUILDING OFIRE •HEALTH •HAZMAT/APCD
^ CITY OF
CARLSBAD
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
Ph: 760-602-2719 Fax:760-602-8558
email: building@carlsbadca.gov
www.carlsbadca.gov
Plan Check No. | SQ-l O /
Est. Value
Plan Ck. Deposit
Pate SOTO SWPPP
JOB ADDRESS SUITE*/SPACE*/UNIT*
CT/PROJECT # L0T# PHASE # # OF UNITS # BEDROOMS tt BATHROOMS I TENANT BUSINESS NAME CONSTR. TVPE OCC. GROUP
DESCRIPTION OF WORK: Inc/ude Square Feet of Affected Area(s)
EXISTING USE PROPOSEO USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE
YESr~|#, NOj ]
AIR CONDITIONING
YES QNC •
FIRE SPRINKLERS
YES I |NO| I
APPLICANTNAME fPr/mary Contact; », ^ APPLICANTNAME (Secondary Contact;
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE
-M^n A2,<k \^A\ -1^^ Q^lC^2^h
PHONE FAX
EMAIL EMAIL
PROPERTY OWNER NAME
ADDRESS
CONTRACTOR BUS. NAME
ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE FAX PHONE FAX
EMAIL EMAIL
ARCH/DESIGNER NAME & ADDRESS STATE LIC.# CITY BUS. LIC.#
(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 applicantfor such permitto file a signed statement that he is licensed pursuantto the provisions ofthe Contractor's License Law (Chapter 9, commending VKith 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 dollars {$500)).
WORKERS' COMPENSATION
Workers' Compensation Declaration: / fters&y affinn under penalty of perjury one of the foltowing declarations:
Bl have and will maintain a certificate of consent to selMnsure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain workers' compensation, as required bv Seclion 3700 of the Labor Code, for the perfomiance of Ihe work for which this permit is issued. My workers' compensation insurance earner and policy
numberare: Insurance Co. PolicyNo. Expiration Date
This section need not be compieted if the permit is for one hundred doiiars ($100) or iess.
I I Ceitificate of Exemption: I certify that in the perfonnance of the worl< for which this pemiit is issued, I shaii not employ any person in any manner so as to become subject to the Wori<ers' Compensation Laws of
Califomia. WARNING: Failure to secure workers' compensatian coverage is unlawful, 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 provided for In Section 3706 of the Labor code, interest and attomey's fees.
JS^ CONTRACTOR SIGNATURE • AGENT DATE
OWNER-BUILOER OECLARATION
J hereby affinn ttmt I am exempt from Contractor's License Law for the following reason:
h, as owner of the property or my empioyees with wages as their sole compensation, wiil do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's
l.icense 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
^ale. If, however, the buiiding 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).
1^ 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 impraves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
I I lam exempt under Section, .Business and Professions Code for this reason:
1.1 personally pian to provide the major iabor and materiais for construction of the proposed property improvemenL •Yes I |NO
2.1 (have / have not) signed an application for a building pemiit for the proposed work.
3.1 have contrxted with the foltowing person (fimi) to provide the proposed constmction (include name address / phone / contractors' license number):
4.1 plan to pravide portions of the worii, but I have hired the following person to coordinate, supervise and provide the major wori( (include name / address / phone / contractors' license number):
5.1 will provide some of the wortc, but I have contracted (hired) the following persons to provide the worit Indicated (include name / address / phone / type of worit):
PROPERTY OWNER SIGNATURE •AGENT DATE
COMPLETE THiS SECTION FOR NON-RESIOENTIAL BUiLDING PERMITS ONLY
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registretion form or risk management and prevention program under Sections 25505,25533 or 25534 of the
Presiey-Tanner Hazardous Substance Account Act? Yes No
Is the applicant or future building occupant required to obtain a pemnit from the air pollution control district or air quality management district? Yes No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes 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,
CONSTRUCTION LENOINC AGENCY
I hereby affimi 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
APPLICANT CERTIFICATiON
I certif Itiat I have lead tlie applk»tk>n and statethatthe above Inforniation Is cone(A and thatthe Inlbima
I hereby auihorize representative of the City of Cartebad to enter upon the above mentkined property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CPIY OF CARLSBAD
AGAINST ALL LIABILrTIES, JUDGMENTS, COSTS AND EXF^NSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT
OSHA: An OSHA permit is required fbr excavations over 5'0' deep and demolition or constiucton of structures over 3 stories in height.
EXPIRATION; Every pennit issued by the Building Oflicial under the provisbns of this Code shall expire by limitatton and become nuH and void if the building or woik authorized by suoh permit is not oommenced within
180 days from the date of such pemnit or if the buikiing or wort< authorized by such peimit is suspended or abandoned at any time after the vwk is commenced for a period of 180 days (Secton 106,4.4 Unifomi Buikiing Code).
^APPLICANT'SSIGNATURE ZCC^/L, /V^-DATE
STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection.
Fax (760) 602-8560, Email buildina(S)carlsbadca,aov or Mail the completed fbmi to City of Carlsbad, Building Division 1635 Faiaday Avenue, Carisbad, Califomia 92008.
C0#: (Office Use Only)
CONTACT NAME OCCUPANT NAME
ADDRESS BUILDINQ AODRESS
CITY STATE ZIP CITY STATE ZIP
Carlsbad CA
PHONE FAX
EMAIL OCCUPANT'S BUS. LIC. No.
DELIVERY OPTIONS
PICKUP: CONTACT (Listed above) OCCUPANT (Listed above)
CONTRACTOR (On Pg. 1)
MAILTO: CONTACT (Listed above) OCCUPANT (Listed above)
CONTRACrrOR (On Pg 1)
MAIL/FAX TO OTHER:
1
ASSOCIATED CB#
NO CHANGE IN USE / NO CONSTRUCTION
CHANGE OF USE / NO CONSTRUCTION
ASSOCIATED CB#
NO CHANGE IN USE / NO CONSTRUCTION
CHANGE OF USE / NO CONSTRUCTION
jef APPUCANT'S SIGNATURE DATE
Inspection List
Permit*: CB132101 Type: MISC OTHER MOORE RES-REMOVE WOOD
SIDING ON FRONT AND PARTIAL LEFT SI
Date Inspection Item Inspector Act Comments
01/23/2014 19 Final Structural - Rl FINAL STUCCO
01/23/2014 19 Final Structural PY AP
10/25/2013 19 Final Structural PY NR
09/25/2013 18 Exterior Lath/Drywall PY AP
Friday, January 24,2014 Page 1 of 1
10-20-2014
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Plumbing/Mechanical/Electrical (PME) Permit
Permit No:CB142789
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Reference #:
PC#:
Project Title:
1032 IRIS CTCBAD
PME
2144021100 Lot#:
MOORE RES - REPLACE FURNACE
AND A/C UNIT - SAME LOCATIONS
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
10/20/2014
SKS
10/20/2014
10/20/2014
Applicant:
LOMACK SERVICE CORPORATION
STEB
2259 S SANTA FE AV
VISTA CA 92083
760-727-3607
Owner:
MOORE KATHLEEN E TRUST 05-17-00
1032 IRISCT
CARLSBADCA 92011
Plumbing Fees
Electrical Fees
Mechanical Fees
Other PME Fees
$0.00
$0.00
$160.00
$0.00
TOTAL PERMIT FEES $160.00
Total Fees: $160.00 Total Payments To Date: $160.00 Balance Due: $0.00
Inspector:
FINAL APPROVAL
X7 Date: /Ci'/Y Clearance:
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
refen-ed to as "fees/exactions." You have 90 days from the date this pemiit was issued to protest imposition of these tees/exactions. If you protest them, you must
follow the protest procedures set forth in Govemment 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 lo 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 vou have oreviouslv been given a NOTICE similar to this, or as to which the statute of limitations has previously othenvise expired.
To: c Page 1 of 2 2014-10-20 14:49:59 (GMT) From: Jennifer Cole
THE FOLLOWING/ipPROVAtS REQUIRED PRIOR TO PERMIT ISSUANCE: • PUMNING • ENGINEERINO nBUILDING QFIRE • HEALTH •HAZMATIAPCD
^ CITV OF
CARLSBAD
Building Permit Application
1635 Faraday Ave.. Carlsbad, CA 92008
Ph: 760-602-2719 Fax: 760-602-8558
email: bullding@carisbadca.gov
>www.cartel)adca.gov
3
Est Vaiue
Plan Ck. Deposit.
Date lOT^C^lN SWPPP
JOBADDRESS 1032 Iris Court SUITE*/SPACE4/UWT» Am 1
CT/PROJECT If LOT» PHASE# # OF UNITS » BEDROOMS » BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE occ. CROUP
DESCRiniON OF WORK: fncliKto Square Feet of M<»eted/IraafsJ
Replace Furnace arid AC Unit
EXISTiNQ USE PROPOSED USE GARACE (SF) PATIOS (SF) DECKS (SF) FIREPLACE
YEsQl NOn
AIR CONDrriONING
YES I INQ I I
FIRESPRINKLERS
YESj |NO| I
APPUCANTNAME (Primary Cenfvot; Lomack Service APPUCANTNAME (S»»oiid*ry Conftt) Jennifer/Randy Cole
ADDRESS
2259 S SANTA FE AVENUE SUITE B
ADDRESS
9880 Magnolia Ave #119
VISTA,
STATE ZIP
CA 92083
CITY Santee STATE . ZIP
CA 92071
PHONE
760-727'3607
PHONE
619^05-2648 619-330-4796
EMAIL EMAIL
PROPERTVOWNERNAME kathy Moore CONTRACTOR BUS. NAME Lomack Service
ADDRESS
1032 Iris Court
ADDRESS 2259 S SANTA FE AVENUE SUITE B
Carisbad CA
ZIP
92011
CITY
VISTA,
STATE
CA
ZIP
92083
PHONE
(760)845-8426
FAX PHONE
760-727-3607
FAX
EMAIL
ARCH/DESIGNER NAME & ADDRESS Sn'ATE LIC.#
415709
CLA^
C20
CITY BUS. UC.#
568700
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permitto construct alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permitto file a signed statement that he is licensed pursuantto the provisions of the Contractor's License Law ICnapter 9, commendine with Section TOOOof Division 3 of the Business and Profisssions Code) or that he is exemot therefrom, snd the t>a5ts for the alleged exempMon. Any vioiation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars (»500)). =- r , ^ r-
WORK ERS COIMPENSATION
Workers' Compenntion Declaration: / henby aflhn underpenelly of perjury one ofthe Mowing deciamtions:
S I have and will maintain a certificate of consent to ttlMnsure for workers' compansation as pravided lly Seclion 3700 of the L^r Code, for Ihe perfonnance Of the vKnk tor which this perniit Is Issued.
I have and will maintain worlnrs' conipensation, as rSQuiied bv Seclion 3700 of the Labor C^, lor the perfomiance of Ihe work fbr which this pennit is issued My workers' compsnsation insirance carrier and poicy
number are: Insurance Co Markel InS Poiicv No. MWC005958201 Expiratbn Dale 1/1/15
This seclion need not be completed if the pernA is for one hundied doBars ($101$ or less.
I I CertHlcat* of Exemption: f certify that In 8ie peifonnance of Ihe work lor wNch this pemM is issued, I ShaB not arrpoi any person In any manner so as lo become subject to the Workers' Compensalion Laws of
Carifomia. WARNING: Fsikir* to lacure worksfa' canipenHtion<pvenge ia unlawful, md ahall lubjiel in employer to criminal panaltiaa and dvil finis up to one burabed Siouiaml dollan (&1(I0,000kl
ad<8tion to the coat of compentation, dama«as« providediIMn Stetion 3706 of the Labor code, Interesl and attomey't feet.
CONTRACTOR SiatATOWE /•'jj/LfiJ'j4Sl^U^ QAGENT DATE 10/20/14
O WM £ R - B U I L O £ R O E C L A R A T 1 O W
/ hereby Mim lhat I am exempt tom Contactors Ucense Law hrthe blowing reason:
I I I, as owner ot the property or my amptoyees w«h wages as their sole compensation, wiH do the work aid the structuie is not inlended or ofifered lors* (Sec. 7044, Susrieu and Professions Code: Tlie Contrector's
Ucense Law does nol apfil to an owner ol property who builds or impraves Ihereon, aid who does such wortt hknself or through his own empioyees, provided that such bnprovemenis »» not inlended or offered for
sale. If, however, the buking or improvement is soM within one year of completion, the owner.buikjer wilt hsve Ihe buiden of provkig that he dkl not buki or improve lor the purpose of sale).
I I I. as owner of the property, am exclusively contracting with Icensed contradors to construct the project (Sec. 7044, Business and Prolejskjnj Code: The ContraeWs license Law does not apply to an owner of
property who buikis or improves theieon, and contiacts Ibr such projecis vtith canlractor(s) icensed pursuant to fhe Contractoi's Lnense Law)
I I 1 am exen^ under Sectton eBusiness and Professtons for this reason:
1.1 personally plan to provWe the major labor and materiais for conslructa of the proposed property improvenienL DYes I INO
2.1 (have / have not) signed an apfritoatkin tor a buikSng permit for the proposed Mvk.
3.1 have ojntistad with the foMng person (linn) to provkle the proposed constnK:fian (nckjde nan^
4.1 plan to provkle porttons of the wortt, bul 1 have hked Ihe fotowkig peison to coordinate, si^Jeivise and provkte the major woric (ixdude name / address / phone / conlroctorj' Scense nun*er|:
5.1 wn provkle some of the wortc, bul I have contracted (Nied) the folkmng peisons to provkle the work kidtoated (kKlude name / addiess I phone / type of wortc):
yfiS'pROPERTY OWNER SIGNATURE •AGENT DATE
To: c Page 2 of 2 2014-10-20 14:49:59 (GMT) From: Jennifer Cole
COMPLETE THIS SECTION FOI? N O N - R E S I D E N T I A t B U > >-» • N G P E R MJ T S O N t Y
Is the appltoant or fuiure buiding occupant lequked to submit a buskiess plan, acutely hazadous materials registratton forni or nsk managemenl and prevenSon program under Sedtons 25505,25533 or 25534 of the
Presley-Tanner Hazaidous Substance Account Ad? OYes ONo
Is the appScant or future bulding occupant required to obtain a pemgl from the air pollutton control distrtot or air qualify managenient distrid? • Yes • No
Is the fadBty to be consiiucted withki 1,(00 feet ollhe outer boundaiy of a school site? 13 Yes nNo
IF ANY OF T)£ ANSWERS ARE YES, A FWAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS TKE APPUCANT HAS IKT OR IS KKEHNG TME REQUIREMENTS OF TIC OFFICE OF
EMERGENCY SERVICES AND VK AIR POLLUTION CONTROL DISTRICT.
CONSTRUCTION LENDING AGENCY
I hereby affirm that theie Is a constitx^ lending agency for the perfomnance of the vwik INs permi is Issued (Sec. 3097 (1) CM Code).
Lender'sName Lender's Address
A P PLICANT CER TIF ICATION
I cettiy thati have lead Ihe applicatim and statethatthe alxiw inldiTiialion B oc(M
1 hereby aithorlzB representalive of Ihe City of Carlsbad to enter upon Ihe al^
AGAINST ALL LIABILITIES, JUDCSMENTS, COSTS AND BTOISES WHICH MAY IN ANY WAY ACCRl« AGAINST SAID CrtY IN CONSEIXtENCE OF THE Gf?ANTIN(3 OF THIS PERMIT.
OSHA: An OSHA perniit is requied for excavollons overS'O' deep and demcHon cr constuclion of stiuctiies over 3 sicries in heighL
EXPIRATiCW: Bery peril* issued tv the Building Olftjal under the provs^
180 days fiom the dale of siich pemA or if the buikling or wok aulhop^jii'V
JCTAPPLICANT'S SIGNATURE DATE 10/20/14
Inspection List
Permit#: CB142789 Type: PME MOORE RES - REPLACE FURNACE
AND A/C UNIT - SAME LOCATIONS
Date Inspection Item Inspector Act Comments
10/31/2014 43 AirCond/Furnace Set - Rl
10/31/2014 43 AirCond/Furnace Set PB AP
10/31/2014 49 FinallVlechanical - Rl
10/31/2014 49 FinalMechanical PB AP
Monday, November 03, 2014 Page 1 of 1