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Home My WebLink About1080 PALM AVE; ; CB050798; Permit.·Cc City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-15-2005 Miscellaneous Permit Permit No: CB050798 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuaiion: 1080 PALM AV CBAD MISC 2051900900 $2,189.00 Subtype: OTHER Status: Lot#: 0 Applied: Entered By: Reference #: Plan Approved: Project Title: CVETICHAN RES-ADD PRE-FAB -:::::::"-<::-f'IREPLACE W/2 WINDOWS.GAS-MOVE ELECTRIC Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES Total Fees: $124.00 PERMIT FEE Owner: CVETICHAN DIANE 1080 PALM AVE CARLSBAD CA 92008 Total Payments To Date: $0.00 Issued: Inspect Area: Balance Due: ISSUED 03/15/2005 RMA 03/15/2005 03/15/2005 $124.00 $0.00 $0.00 $124.00 $124.00 3896 03/15/05 0002 OJ.. Inspector: FINAL APP~VAL Date: 'l. J 2. i> 5 ' C:GP Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection wtth this project. NOR DOES IT APPLY to any f f wh· h I Tl . ii r i r whi f limi i n h r vi 1 h i 12-4. ,JC, FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. CJJ {25 o ??I CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. __________ _ Validated By • _ _-.'.Lt= Plan Ck. Deposit ~ Date ,] (L$l ) 1 . PROJECT INFORMATION Business Name (at this address) Address (include B~/Suite #) ~ lDBo ~&\ Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use D~ff;ork hve-, {J) l,VINdl~~ sa;~av~t;f,orruv. 2. CONTACT~ON (if diff{rent from applicant) ] ' Name 3. Address City Proposed Use State/Zip Telephone# Fax# -o78't./ 4. ~o 7:Z~ .3~7 Telephone# 5. 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I 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. ~ 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: Insurance Company~~ 1:::1/AJ D PolicyNo.~8: 7'75 -~D5 Expiration Date /-O/-0"' (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS) 0 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 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 one hundred thousand dollars ($100,00 additlo the ost of compensation, damages as provided for in Section 3706 of the L or code, nterest and attorney's fees. SIGNATURE:-:---:::--::-::="'1~&,(,,llf,RJ'fl~l-\lil'J-"T~,c_ __________ ----:==-DATE ......:~~.l--l~.L...JU...L..£... ___ ~---·-- 7. I hereby affirm that I am exempt from the Contractor' L ense Law for the following reason: 0 I, as owner of the property or my employees ith ages 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 Co ct '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, provide 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). 0 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 projects with contractor(s) licensed pursuant to the Contractor's License law). 0 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. 0 YES ONO 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 I address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the 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 __________ _ COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING 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 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O 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(il Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS ________________________ _ 9. APPLICANT 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 all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit\' 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, 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 for excavations over 5'0" deep and demolition or construction of structures over 3 stories 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 wi 180 d rom 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 commenced for p iod of 1 (Sectio 106.4.4 Uniform Building Code). / J APPLICANT'S SIGNATURE ___ __.__l,A~..._,,e_:____:_-hCV-:....____________ DATE 1, -I '21t-tJ, YELLOW: Applicant PINK: Finance ~ • City of Carlsbad Bldg Inspection Request For: 08/01/2005 Permit# CB050798 Inspector Assignment: PY --- Title: CVETICHAN RES-ADD PRE-FAB Description: FIREPLACE W/2 WINDOWS,GAS-MOVE ELECTRIC Type: MISC Sub Type: OTHER Job Address: 1080 PALM AV Suite: Lot Location: APPLICANT WORTHING INC, B. A. Owner: GHEZZI DIANE J Remarks: Total Time: 0 Phone: 7607293965 Inspector: ----- Requested By: TERESA Entered By: CHRISTINE • CD Description Act Comment 19 _F_i_n_a_i_s_tr_u_c_tu_r_a_i _____ ~----------------------- Associated PCRs/CVs lns~ection Histo[I! Date Description Act lnsp Comments 07/28/2005 19 Final Structural co PY SEE NOTICE ATTACHED 06/30/2005 18 Exterior Lath/Drywall AP PD 06/14/2005 17 Interior Lath/Drywall AP PY 06/1312005 17 Interior Lath/Drywall AP PY 06/10/2005 13 Shear Panels/HD's AP PY OK TO WRAP 05/27/2005 14 Frame/Steel/Bolling/Welding AP PD AT FIREPLACE 05/27/2005 15 Roof/Reroof WC PD 05/27/2005 23 Gas/T est'Repairs WC PD 05/05/2005 11 Ftg/Foundation/Piers AP PY ------·---------·-------------·--·----