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HomeMy WebLinkAbout165 PINE AVE; MULTI-PERMIT FILE; CB160636; Permit02-18-2016 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB160636 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 165 PINEAVCBAD St: TP PME 2CM1230100 Lot#: PINE AV MF: TEMP POWER POLE POLE TO BE PLACED OUTSIDE OF ROW Status: Applied: Entered By; Plan-Approved: Issued: Inspect Area: ISSUED 02/18/2016 SLE 02/18/2016 02/18/2016 /Applicant: DI/V^OND POWER SERVICES INC Owner RAMMY LLC 807 E MISSION RD S/\N MARCOS CA 92069 760-744-7191 3778 AVENIDA CALLADA CALABASAS CA 91302 Plurnbing Fees Electrical Fees Mechanical Fees Other PME Fees $0.00 $163.00 $0.00 . $0.00 TOTAL PERMIT FEES $163.00 Total Fees:$163.00 Total Payments To Date:$163.00 Balance Due:$0.00 Inspector: FINAL APPR'mDate:Clearance: NOTICE FteasetateNOnCEthBtappraffllcf)arprcjedirc)uclesth0lrnfx»ltkifrffi0e8,decfcaikrB,n08efV8tkrB.orc<heracactionshsreeftercdlediwB)y rBfenedtoasfeesTeBcacbons.' Yciihehe 90 db^fhorri the date tMspem1tv«slaBUBd to protest Irrposition of these fees/aadions. If yaj pretest therr; yoi must fdlcw the pretest preicediJBS set forth h G3*«rrTTBnt Code Sedicn 66Q20(a), arri file ttia pretest and any cither neqiited InfcfrrBtion Wth the Qty Manager far prooesdnginaccodarcevsithCErtstjadMjfdpei Code Section 3.32.030. FaSune to Hmely fdlcwttiat prooedLrewfl! ter any subsequert legal action to attack, review; set aside, void, or arni their trrpoettkri You are herety FLRTl-HR NCTTIR BO that yoLT rigtt to protest ttie spedfled feesTescadiorB DOGS NCfT APPLY to vvBter arid serwr oornectkri fees arri capacity chariges, nor piarririg,2DrTirig,gBclrTg or other sirrilar application prooesslrig or service fees In cornectlonwth this prcjecL NORDCBIT/WLYtDary fiBes'eoactlorsofwHdivojhBNegevioustvbeendv^aNOnCEslrdlartothis.crastovvMchtheststUecfllrrftationshasDratouslvcthervvteeeMAgi THE FOaOWWG APPROVALS REQUREO PRIOR TO paw BSUAHCE: nPLAHNWO □eMGWEBUHG DbIJUJIHG DfRE □HEALTH GHAZMAT/APCO *<«»^ CITY OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, OA 92008 Ph: 760^2-2719 Fax:760-602-8558 email: bulldlng@carj8badca.gov www.caf1sbadca.gov Plan Check No. Q]^ iUOUSCz? Est Value Plan Ck. Deposit SWPPP JOB ADDRESS 165 PINE AVE crypftOJECTi WT" tUnSt/SMCU/UMTt 204 123 01 00 E>GSCIUPTK>N OF WORK: toeMaSgogre AetofAmoMArM(iil PHASE# iOfUNTTS «BEDROOMS # BATHROOMS 1INANT BUSMESS NAME CONSTR.TYPE OCC. GROUP install temporary power pole for construction. Reference Grading Permit GR150036 . U be lo IS^fSiSW PRoPa^W GARAGE (SF)DECKS (SF)FIREPLACE yesQi N(0PATIOS (SF)AIR CONDITIONINGYES □noQ RRE SPRINKLERS |N0| I APPUCANT NAIffi (Primmry Contact)APPUCANTNAME (Soeondory Contact)Jennifer/Randy Cole ADDRESS ADDRESS 9880 Magnolia Ave #119 CITY STATE ZIP criY Santee STATE CA ZIP 92071 PHONE FAX PHONE 619-405-2648 FAX 619-330-4796 EMAIL EMAIL jennifer@permitrunner.net PROPERTY OWNER NAME THE RAMMY LLC / RKR INC CONTRACTOR BUS. NAME Diamond Environmental ADDRESS 23679 CLABASAS RD #362 ADDRESS 807 E MISSION ROAD CRY CALABASAS STATE CA ZIP 91302 CITY SAN MARCOS STATE CA ZIP 92069 PHONE (760) 999-2146 FAX PHONE (760)744-7191 FAX EMAIL EMAIL AROVDESIQNER NAME & ADDRESS 908341 CIO (aTYBUS.UC.# 1229625 Business and PiTifesslonsCode)orniathelsexennottherefrDm,dvH penaltyof not more than five hundned dollars ($500)); WORKERS' COMPENSATION Its Issuance, also r ^ ^ .with Section 7000 of Division 3 of tfiea permit subjects the appOcent to a Vioilm'CoiapenuaaiDacImtetoKlhemtiyaSntiundBrpenallyo/peifityo'iBofSiBlblawiigdBctaratons:BlhaveandwIUnMlnfdnacsrtffliatsofconMnttosslHniiiefcnwiteTcompensallcrasproyldsdbySecdor 3700 of the Labor Cods, for fie perfomiancs of the wrk for vihlch ills permit Is Issued. I have ind wB mintiln wortars'coiBoensatlon, as raqulredbfSecton 3700 of the Labor Code, for the petforniance of foe wotf for which this penrfl Is Issued. My wrfBrt'coihpensalonfuuranca carrier and pcBcy Snumber aie: IhEuencs Co._ECURTTY NATIONAL neURANCE CO , PoBcyNo..SWa06S516 ExpfadonDafo.3/01/3016 tiecllon need not be complstsd V the pema Is for one hundred ddars ($100) or ten.I Certlflcato of E*e«ptlon: I cerltiy tha h IB perfomiflnce of the w*f for»t*fo fofc perirtt Is baled, I SbD not employ any pereon In any mannerso as to become subject to (he Woriws" ComperBaUoti Laws ofCalfomia. tNAIWtNQ; Failure to s«3irewortaiacampenndcacov»a«liuiilisM and (htfwbjed an aoiployw to otatnalpaiiltlas and chriltbiss up to one huidred thousand dolaii(aiO(MnCI), In •ddUcn to the cost of compensitlon, damtgM n/xevldsd for lySydUM ^ of the Labor code, brtsrest and Ntom^ fMs. .CT CONTRACTOR SIGNATURE igai asixevli A/tr □agent DATE 2/11/16. OWNER-BUILDER DFCLARATION I/nreby aflfon MI am aanvX fom CmtrBCfoFt License Law for foe fofMftp reascfc □ I, as owner of the property or my employees i«i waBBi as thef sote aimpentatlon, wi do lie vrak and the stuctuB b not tntsnded or offered for rate (Sec. 7044, Burtiesa and Ptolesdons Code; The ContraclortLliwiae Lav does not apply fo an ovmar (X property vKfo tnids or Improws fereciL and who does auch wort hlrtBalf or ttrough Ws ovm employee!, provWad foal such Improvemenls are not Mended or offered forsale. If, however, tie buOdkie or Impievement la told wthfo one year of conipletlon, foe owner-txiOderwIll have the buiden of prevtng that he did not buld or Impreve for foe purpose of E^).n I, as ovmer of the property, am exdiBlwlyconfBclngellhfcansed contractors to cotBlruct the project (Sec. 7044, Buslnees and Profesafxa Code: The Contractort License Law does not apply to an owner of property who buSds or Improvse thereon, and ccnlracb Ibr such projects w(h conbacforts) Bcensed ptisuani to foe ContrackxY License Law).I I I am axampt under Section Business and Professions Code for INs reason:Lipeisonaly plan to provide the majorlabor and matoitals for contorucllon of foe proposed property Improvemant l~lYes I ko ZI (have / have not) signed an applcagon for a bidding perms for foe proposed wot3.1 h»e contracted wSh the folovdng person (Ifm) to provide foe proposed constnidon (Include name addnses/phone/conlracloiTlcanse number): 4.1 plan to provide portions of foe wtxf, but I have hired the following peraon to coofllInate,supervlsa and prcMde the nu^woif (Include name/addiBSi/phone/contractcni'lcansenuinbeij: 6.1 wS provide some of the wuK but I have contractod (hired) the foSoMing persons to provide the vnif fidlcabd (Include name / address / phone / type of worf): ^eTPROPetTY OWNER SIGNATURE □aqent DATE HA-O NnA- plan, acutely hazaRloul malertis tBgktmlon fcrni or r» management and prawfdon program under Sections 2S05,2S33 or 2®34 d lie □ Yes DNo □ Yes □No Is tn applicant or ftitere bidding occupant reqiiied to submit aPresley-Tanner Hsanious Substance Account Act? Is tn applcait or future btddlng ocotpant required to obtain a permit torn ttie air pohfion oonliDl distlct or dr queCty management (fistitct? ■ ■ — - -Is the (actnty to be constucted wMti 1,000 feet of tie outer boundary of a school stie?F ANY OF THE ANSWERS ARE YES, A FHAL CERTFKtATH OF OIXUPANCY HAY NOT BE ISSUED UNLESS TIE APPUCANT HAS lET OR B HSTWO TtE REaUnBHENTS OF THE OFFICE OF EIIERGEI«:Y raniCES AND THE AR POLLimON CONTROL DISTRKrr. hereby afBnm that there Is a constmctkxi lending agenqr for the performance of the vwrit this perml Is Issued (Sec. 3097 (I) OitlOxle). Lender's AddressLender's Name lceitt^11iatttn)eteedtlieapplcat)onaBjstalatltet1lBabomlnlbrmatloolsconsctandtlnttlBtiiloiinatloaonttBplanslsaocaata.lieDeetocomp)yr«lliallCByontlnancasandSlalelamielaSn{!tDbuiUngcanstnEaDn. I hereby authortzB repreeerialve of toe City of Cartabad to enter upon the abtwe tnenSoned property tbr toepecSon puipoeee I ALSO AGJ^ TO SA\^, KO0#IIFY Al® lO" HAfSAESS THE CITY OF GAfaSBADAGAWST AJ± UABtLITIES JUDCaCNTS, COSTS AhC EXPeiSES VWICH MAY tN ANY WAY ACCFtUE AGAINST SAD CITY W CONSEQieiCE OF THE aWNTWG OF THIS PERMTT. OSHA An 09tA petml Is lequlied tor eptcavaSons over 60* deep and demotnion or constncflon of etntoties over 3 stortee In helgitEXPIRATTOtt Ev^ pemilt issued by toe BUUng Ofldal litter toe provisions of r ■160 days torn the (to of such penrlt or f toe buUng or worlLautoortzBd by spsh vtS'APPUCANrSSIGHATURE de sttel etptie by Irtttaion and become nul and wid r the bufdng or woit( autoortzed by such pennlt Is not ooninenoed witolnIs suspended or abandoned at any ftne alter toe worit Is contnenced tor a period of 180 days (Section 106.4.4 Unttbrm Buldtog Oode). DATE 2/11/16 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY Inspection List Pemilt#; CB160636 Type: PME PINE AV MF: TEMP POWER POLE POLE TO BE PLACED OUTSIDE OF ROW Inspection Item Inspector Act Comments 02/29/2016 32 Const. Service/Agricultural - Rl 02/29/2016 32 Const. Service/Agricultural PD AP 02/29/2016 39 Final Electrical - Rl 02/29/2016 39 Final Electrical PD AP Monday, February 29, 2016 - Page 1 of 1 01-20-2015 City of Carlsbad 1635 Faraday Av Carlsbad, OA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB150177 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC #: Project Title: 165 PINE AVCBAD PME 2041230100 Lot#: RAMMY LLC - REPAIR GAS LEAK Status: Applied: Entered By: Plan Approved: ISSUED 01/20/2015 SKS 01/20/2015 Issued: 01/20/2015 Inspect Area: Applicant: RAMMY LLC 165 PINE AVE CARLSBAD CA 92008-3136 818-438-8800 Owner: RAMMY LLC 165 PINE AVE CARLSBAD CA 92008-3136 818-438-8800 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees $160.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $160.00 Total Fees:$160.00 Total Payments To Date:$160.00 Balance Due:$0.00 Inspector: F NAL Clearance: NOTICE: Please take NOTICE ttiat approval of your pn^ect Includes ttie "l^posltlorrof fees, dedications, reservations, or other exactions hereafter collecfively referred to as fees/exactions.' You have 90 days from the date this permlf 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 Car1st)ad Munldpai Code Section 3.32.030. Failure to timety follow that procedure wl0 tar any sutaequent legal action to attack, review, sat aside, void, or annul their Imposition. You are heretjy FURTHER NGTIRED 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 feea/exaclions of which vou have oreviouslv been olven a NOTICE similar to this, or as to which the statute of limitations has PfevlQUSlY 0tll8fwl89 Btdred, THE FOLLOWING APPROVALS REQUBLEDPRKIR TO PERiarriSSUANCE; □PLANNING □ENGINEERWG □BUIOWG nFRE □HEALTH □HAZHAT/APCD laaitsQBm® PenrouBS i^[pDil€ig0£S@iraCity Oi 1635 Faraday Ave., Carlsbad, OA 92008 llJ J] Ph: 760^2-2719 Fax; 760-602-8558(LairlSOaQ bullding@oarlsbadca.govwvvw.carlsbadca.gov (Jyy) Plan Check Wo. Q) ( Est. Value Plan Gk. DeposDit Date 1 /'Ja M SWPPP hjni#/5PACEi/UNn-p apn^ ' CT/PROJEWi ' 'COT# PftASE##OFUNltS # BEDROOMS # BATHROOMS TQIANT BISINESS NAME CONSTfLTrt^ OCC.QROUP DESCRIPTIOPd OF WORK: inetwk) Foet <ff Affoctoti EXISTING USE PROPOSED USE GARAGE (SF)PATIOS (SF) DECKS (SF)nREPLACE AIR CONDITIONING RRE SPRINKLERSYESr~fef NC| 1 YES[^N0|^ YES| [ N0| | APPtlCAPfT NAME ) \ \ /^ <0 lyPrimary Coataot /"dc ADDRESS ■ CITY STATE ZIP PHONE FAX PHONE , _FAX EMAIL EMAIL DESIGN PROFESSIONAL CONTRACTOR BUS. NAME ADDRESS ADDRESS CfTY STATE ZIP CITY STATE ZIP PHONE FAX PHONE FAX EMAIL EMAIL STATT UC. #STATE UC.#CLASS CITY BUS. UC.# (Sec. 7031.5 Business artd Professions Code: Any City or County which requires a permit to construct alter, improve, demolish or repair any structure, pnorto Its Issuance, also requires theapplKantfor such permrtto file a signed statement that he is licensed pursuant to the provisions of the Ctontractor's License Law {Chapter 9, commending with Section 7(XX) of Division 3 of theBusiness and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any vtolatjon of Sectron 7031^ by any appiicanifor a permit subjects the ap^icantto acivil penalty of not more than five hundred dollars {$500}). (3®EDPBCDa^i'u'Q®C3 Workers' Ccmpensitlon Dedvation: / hawtyafSmi mxlerpenalfyolpeijitYoneofthB loloning dedarations:Bl have and wn maintain a carttflcata of conaant to aslMnaura for workera'compersafion as provided by Section 3700 of the Labor Code, for the performance of the work for which hilspemiH Is Issued. I have and eiDI maintain workara' compenaatlon, as required by Section 3700 of Sia Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carter and polcy numtrer ate: Insiiance Co. Policy No Brpkatlon Dale Thbsecflon need not be completed if the permit Is for one hundred dolats (JiOO) or less.I I Certificate of Exerrrptlon: I certify that In Ore performance of the work for which this permll is Issued, I shal not employ any person In any manner so as to become sut^ect to the Workers' Compensation Laws of Caifomla. WARNI>IG: Falkrre to secure workers' compenaadon coverage It unlawful, and ehaJI aul^ect an employer to crtmlnal peneWM and cfvfl fines up to one hundred thousand doflirs (Si100,0t)0), In addition to the cost of compensation, damages as provided for In Seciiotr 3706 of the Labor code, hrteneat and ittomey'a fees, JS^ CONTRACTOR SIGNATLiRE □ AGENT DATE 'jl'fflBBoBtflljltBBiB ©QSLLfaE'Sli'ii'O®!?} I htmby^PmfhetlmexemplfnmCoidmclor^UcanseLawforthefolanlngwBson: If IXas owner of the property or my employees with wages as their sole compensation, wDl do the work and the structure Is not tetended or offered fcrr sale (Sec. 7044, Business and Professions Code; The Confractorb Llcensa Law does not apply to an owner of property who buBds or improves thereon, and who does such work hkrtsalf or through his own eraployeas, pravldad that such Improvements are not Intended or offered for). If, howjyer, the biiisng or improvement Is sold within one year of completion, the owner-txrikterwil have the burdan of proving that he did not buld or htprove for the purpose of sale). 3r of the property, am enckrstvely contracting wISi Dcansed contractDrs to constnrct the project (Sec. 7044, Bustness and ProfessIonE Code: The Contractor'E License Law does not apply to an owner of^ —^perty whobjjjds-or bnproves thereon, and contracts for such projects with contractorts) Dcen^ prisuant to the Contractor's Licanse Law). f (I LflttyeifSn^ under Section Business and Professions Code for this reason: 1.1 personaJy plan to provide tha major labor and mSerlals for constructlcn of the proposed property Improvement I lYes I [No Z I (have / have not) signed an appScatlon tor a bul(&ig permit for the proposed work. 11 have contracted wito toe fcllowfng person (Ikm) to provide toe proposed constnicflon (include name address / phone / contractors' Icanse numbetj: 4.1 plan to provide porltons of toe work, but I have hired the folowing person to coordinate, supervise and provide toe mt^ work (Include name / address / phone / contractors' Dcansa number): 5.1 wa provide some of the work, but I have contracted (hired) the following persons to provide toe vrotk Indicated (Include name/address/phone/type of work): JS$PflOPERTY OWNER SfGNATDRE^-'|3^gent DATE Cg®raiP(i@C0 'i7[2D0 80(3'u'O®GO 0®© C]®ra°©SOOSB(Zl'u'D(aii. 130DJ10OGII® PBEraDITS ©Cat^ b Ihe appllcart or future buMng occupant required to submH a bushes! plan, acutaly hazadous materiab reglstrato fcrm Of risk management and preverttoi program under Secltons 2K05,25533 or 25534 of (he Presley-Tanner HazanJous Substance Account Act? Yes No Is treappOcarrt or fidure building occupant required to obtain a permit frernttie air pollution control dbtrtct or air quality managernentdstrtct? Yes No Is ttrefarkty to be constructed within 1,000 feet of ttie outer boundary of a Ectiool site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APinjCANT HAS MET OR IS HEETING TtC REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AM) TtC AK POLLimON CONTROL DISTRICT. S®CDB'u'Q(E)S'u'0®[n [t0CI®OC)@ ra@SC]e\5' I hereby affirm fitat there Is a constrtiction lencfing agency for the performance of the wortt this permit is issued (Sec. 3097 (i) Civil (3ode). Lender's Name Lender's Address rappQ.oe/aci'if' esE'O'DPQeta'iFDeca I certify thtai have read the affitotbn and state that the above tnfoiTiHftin Is conect and that the liilutiiijlluji on the ptans Is Bccurata I agree to coniplyvitlhal city oitllnarices and state law relat^ig to buS ding constiuclloa I hereby authoree represeriative of the Gfty of Cffltsbad to enter upon flie atrowB mendoned property br jnspecfion purposes. I ALSO AGRS TO SAVE, lNDa#lR'AND KEff HARMLESS THE CITY OF CARLSBAD AGAINST ALL LtABiJTlES, JUDGMBfTS, COSTS AND EXPBJ^ WHICH MAY N ANY WAY ACCRUE AGAINST SAID CITY IN CONEEQUBlCEOFTHE aWTOIG OFTHS PERMIT. OSHA; An OSHA perm Its requhed for excavalons over 5T7 deep and demoHon or construction of strucUes over 3 stories In heighLEXPSWIOfb E^perrrit isaied by the Building (CISdal under Ire pwarasMlhbliida^gllaxpitB by OmJadon and becorite nul arto void fSte biJdlng Of Milt auttortzed180 days trom tie of such perrnd or jftoehuldtofl or wgtMiuaajBB3iya]diperiTtlsa^>xtad Of abandoned at arytirrB alter tttevic«t(bcofnmenced for a period of 180 days (Section 10S4.4UntfarmBiidlr^ vSS'aPPUCANT'S 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. CERTIFICATE OF OCCUR ANCV fCommerc i .vl I'ro 1 c c t .s Only) Fax (7601602-8560. Email buildinafSfcailsbadca.aov or Matt Bie comoletsd form to Citv of Carlsbad. BuSdino Division 1635 Faraday Avenue, Carlsbad, Cailfomta 92008. CO#: (Office Use Only) CONTACT NAME occupant name ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANTS BUS. LIC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed atxjve) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) MAIL TO: (X)NTACT (Ltetsd above) OCCUPANT (Listed above) CONTRACrrOR (On Pg. 1) MAIL/FAXTOOTRER: ASSOCIATED CB# NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION .efAPPUCAirrs hoiature DATE Inspection List Permit#: CB150177 Type: PME RAMMY LLC - REPAJR GAS LEAK Date Inspection Item lrispwtor_ Act Comments 01/22/2015 23 Gas/Test/Repairs SP AP 01/22/2015 29 Final Plumbing SP Pi Thursday, January 22, 2015 Page 1 of 1 /OSCi.S'] BUILDING PERMIT 10/27/98 14:23 Page 1 of 1 Job Address: 165 PINE AV Permit Type: PLUMBING Parcel No: 204-123-01-00 Valuation: 0 Occupancy Group: Description: GAS LINE REPAIR Suite: Lot#: Reference#: Permit No: CB983697 Project No: A9804824 Development No: Appl/Ownr : SKINNER RUSS 1645 SUPERIOR NORTHRIDGE CA ■kick Fees Required kkk 2724 10/27/98 0001 01 02 Construction VN 27-00 Status: ISSUED Applied: 10/27/98 Apr/Issue: 10/27/98 Entered By: MDP 760 434-3147 Fees : Adjustments: Total Fees: Fee description Fees Collected & Credits * * * ■^Tbyd;^ (^etfvts :Ti>\:;^r P'^yment's :. 00 .00^ C 2 7.00Q-^J^ee^Un^it Ext fee Data Enter "Y" for Pluifibfna Iss/ie Fee Gas Piping Syster 20.00 Y 7 .00 INCORPORATED 1952 ^ppROVAL P —^ • HHb HMhVhN I ION BUHbAU gooo oniorj way, CAniSDAD, CA OPOOO 7000 (MO) 001 P1£1 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad OA 92009 (760) 438-1161 1.PROJECTI A INFORMATION jV-iL FOR OFFICE USE PLAN CHECK NO EST. VAL. Pi en Ck. Deposit VaKdated By Date ' Addrsfs Itndude BldgTSuna tl Buamatt Nam* (at thia addraas) Lagil Datcnptton Lot No.Subdhnaton Nama/Numbar Unit No.Phaaa No.Total * of uniu Aaaaaaor's Parcal #Exlataig Uaa Daacnptnn of Wortc 2. CONTACT PERSbN Pt cBtfarant tnmi appleant} SQ. FT.#of Stonai # of Badroofiu a of Batfuuoiiii Namt Addraif 3. APPLKMNT n Contraotor Q Apant for Contn Addraif CItv )r □ Apant for Contq etor nOwiiar ^^Apant for Ownarh A^cr/ir 7f. Addran Ch StatayZlp Tafapiwna a Fax a Nama 4.,-RROfERTY OWNER Kohfcr /C "" Addraas v Stata/Zfp Tafapftona a Nama E. CONTRACTOR - COMPANY NAIIIE City Stata/Zlp TataptKxia a (Sac. 7031.6 Buainaas and Profaaahma Coda: Any City or Coomy rvtiiefi raquiraa a parmft to construct, attar, fmprova, damoHah or rapair any atnictura prior to Itiiaauinca, also raquraa ttia applicant tor aucfi parmft to fita a alpnad atatament that ha la Ucanaad pursuant to tha proviatona of tha Contractofa Lwsnaa LawIChaptar 9, commandinp with Saction 7000 of Diviaion 3 of tha Buainsas and Profaaalena Coda) or that ha to aaampt tharafrom, and tha baala for tha allapadaxamptlon. Any vlofatlon of Section 7031.5 by any appltcant for a permit aubtoeta the appliaant to a dvR penalty of not mora than ftwa hundred doltora l*5001) Nama State Ucana a f Addraai Licanaa Ctoas City State/Zip City Buainaaa Licanaa f State/Zip I any mannai so aa Desipnar Name Addraas City State Licanaa # 6. WORKERS'COMPENSATION " "• "r" ~ •Workari' Compensation Dadaratfon: I haraby affirm under penalty of parpsy one of tha fobowlnp dactorationa:□ I have and will maintein a cartfficata of consent to aalf-inaure for workara' compensation aa providad by Section 3700 of the Labor Coda, for tha performance of tha work for wfuch thla permit is laauad.□ I have and will maintain workers' compensation, aa requrad by faction 3700 of tha Labor Coda, for tha parformanca of the work for which this permit is Issuad. fily worker's compensation Insurance carrier and pobcy ntimbar are: Inauranca Company Pobcy No. Expiration Data (THIS SECTION NEED NOT BE COMPLETED F THE PERMIT IS FOR ONE HUNDRB) DOUARS 1*1001 OR mSI□ CERTIRCATE OF EXEMPTION: I certify that In tha parfonnance of the work for avhich this permit to toauad, I ahali not employ any parson In i to become subject to tha Workers' Compensation Laws of Callforrka. WARNING: FaBura to seoura workara' companaatiun oovaraga to uniawfui, and shall aebject an amplorar to criminal panatUea and eta* fines up to one hundredthousand dollars 1*100.000), in addWon to tha coat of oompanaation. dan ■pas aa ptoeldad tar In Section 3706 of the labor code, tataiaal and attomay'a fees. SIGNATURE 7. 0WNER4UILDER DECUVRATION • , . - ...• . ..-.rai-rr .•I hereby affirm that I am axempt from ttia Contractor's Ljcanaa Law for tha fobowmg reason:13 I. as owner of the property or my amptoyeea with wapaa aa their sola compensation, will do the work and tha atructura to not intandad or offered for aela(Sec. 70^. and ProfMawna Coda: Tha Contractofa Licanaa Law does not apply to an owner of property who buMda or hnprovaa thereon, and who doessuch work himaatt or through his own emptoysea, providad that such knpruvamanta are not kitartdad or effarad for aaia. If, howavar, tha buUdina or imcrovemerit tosold within one year of compietion, the owner-buildar will have the burden of proving that ha did not build or improve for tha purpose of aatol.□ I, aa owner of tha property, am exdualvely contracting with boanaed contractors to construct tha project ISec. 7044, Buaineaa and Coda: ThaContractor's License Uw does not apply to an owner of property who buHda or Miprovea tharaon, and contraou for auoh projects with oontraetorla) pursuant to tha Contractor's Licanaa Law). Q I am exempt under Saction . Buaineaa and Prolaaaiuna Coda for this reason: 1. 2. 3. I paraonaily plan to provide the major labor and motariala for construction of tha proposed property knprovaiiieiit. □ YES DnO I (have / have not) signed an application for a building permit for tha proposed work.I have comrictad with tha following parson (firm) to provida the proposad conatnretion (Induda nama / addraea / phone number / conbauura Hcanas numbar): E. ^ will provida some of tha work, but^^^^id (hirad) tha^j4o,^ pmaorw to^provida tha work Indlcatad lir«lude nanw / addraas / phorw r«^^ PROPERTY OWNER SIGNATURE DATE 11/COMPLETE THIS SECTION FOR NON-nSMlBrmL BUUDMQ reftjulB oilLt':'Is the appllomrt or future bulMno occupem ramdred to submit buataeaa ptan. acutaly harardoua mamrtoto ragiatration form or risk nwnaganrant and prevmttron program under Sactkma 25805. 25533 or 28534 of tha Praator-Tarmar Haiantooa Substance Aoooum Act? □ YB □ NO la tha appluant or future building occupem required to obtain a permit from the air pobution control dmrict or.Bir qualty manegamant dtotrict? □ YES □ NO Is tha facility to be constructed within 1,CX»faat of tha outer boundary of a school aha? □ YES □ NOANSWERS ARE YES. A FWAL CERTIRCATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MPPTPm THCREQUIREMENTS OF THE OFHCE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DBT^. HAS MET OR IS MffiTINQ THE 6. COffSTRUCTIOflj LEr«DIN(i AQ^CiV --f— — --- - .I hereby affrrm that there Is a construction lenrkng agency for the parformanca of tha work for which this permit to waued (Sec. 30975) Civil Coda). LENDER'S NAME LENDER'S ADDRKS «. APPUCANT CERTTRCATION ^I Mrtlfy that I have nrad the application and state that tha above Information la correct and that the Information on tha plans Is accurate I aqree to comolv with allCity ordmancas and State laws relating to building construction. I hereby authoriza rapraaantabves of the CItt m C^^ OSHA: An OSHA permit Is required for excavations over S'O" deep and demolition or construction of stiucturaa over 3 stones In height. -nd void If tha buildmg or /o^s?-9s'APPLICANT'S SIGNATURE DATE WHIT YELLOW: Applicam PINK: Finance VNSCHFnTTT Kn Brrn nrvr. pvsPpr-poK: DATE PERMIT* JOB ADDRESS INSPECTOR descriptign /a>.. PLAN CHEC3C# TIME ARRIVE:TIME CODE DESCRIPTION ACT CO»MTS ,<7 UJ o CO z o h- 2 3 U UJ o horoby affirm that I am llcenaed ur>dar 8k>na of Chapter 9 (commenclr>g with Section 7000) of CKvlalon 3 of the Business and Profeaslone Code, and my llcenee is In I liereby ttfimi ttut I an exempt from the Contractor's bcense. Law tor the fdowmg reason (Sec. 7031 5 Busmess artd Professions Coda Any city or county which re quires a permit to construct, alter, tmprove, demohsh, or repair any structure, prior to its issuance also requires the applicant tor such perrnt to trie a signed statameni ttial he is Bcersed pursuant to the provisnns of the Contractor's License Law (Chapter 9 cormenong with SectHsn 7000 of Drvtson 3 o( the Business and Profossiorts Code) or that rs exempt therefrom and the tase for the afie^ exemption AnyVToUtion of Section 7031.5 tiy an applcant lor a permit sub- tects the appticant to a civil penalty of not more than five hun dred dollars ($500) □ 1. as owner of ttie property, or my employees with wagesas ther sole compensation, wd do the work, and the structure Is ml sHended or offered tor sale (Sec 7044, Busmessand Professions Code The Contractor's License Law doesnot apply to an owner of property who Ixiids or improvesthereon and who does such work htmseff or through ha ownemployees, provided that such improvements are not intended or ottered lor sale If, however, the butding or vnprove-ment is sokl wrthsi one year of complebon, the owner-buiderwil have the burden of proving tfut he did not buifd or m-prove for the purpose of safe). □ I, as owner ol the property, am wcluswefy contractingwth licensed contractors to construct the protect (Sac 7044,Busmets and Professions Code: The Contractor's LicenseLaw does not apply to an owner of propel who builds or im-prtves ttweon, and who contracts for each prefects with agntractorfs) license pursuant to the Contractor's Licanse □ As a hcgneowner I am inprtwing my home, and the following condihoni oost1 The work a bemg performed pnor to sale2 I have lived in my home for twefve monthspnor to completion of this work3 1 hM not ctaimed this axemptnn durvig thelast three years ■ □ I am exempt under Sec .'tor this reason n I hereby affirm thai I have a ceriificaie of consentto self-insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec 3000, Labor (Code) Zo p3 s oo cUJ oc O POLICY NO COMPANY 19 filed with the city Q Certitied copy is heretry furnished CERTIFICATE. OF EXEMPTION ffOM WORKERS COMPENSATION INSURANCE(This section need not t>e completed if the permit IS tor one hundred dollars ($100) or less) Q I certify that in the performance of the work forwhich this permit is issued. I shall not employ anyperson in any manner so as to become subject to tfie Workers' Compensation Laws of (California NOTICE TO APPLICANT If after making this (Certificato of Exemption, you should become subfect tothe Workers' (Compensation provisions ol the LaborCode, you must lorlhwith compty with such provisions or this permit shall be dwmed revoked O ' hereby affirm triat there is a constructionler>ding aperxiy for the performance of the work for which this permit is issued (Sec 3(397. Civii Code) Lender's Name Lender's Address . USE BALL POINT PEN ONLY S PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. CARLSBAD BUILDING DEPARTMENT1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 APPLICATION & PERMIT JOB ADDR^S AV. ST.RD, NEAREST CROSS ST, 09ylSh/9^ C/9r LOT BLOCK SU^DI VISION ASSESSOR PARCEL NO OWNER'S NAME U/(?ncJ fh'd OWNER'S MAILING ADICRESSOWNER'S MAILING ADICRKS OWNER'S PHONE V. DESCRIPTION OF WORK CENSUS TRACT QTY. GP LAND USE PARK ING SPACE PLUMBING PERMIT - ISSUE EACH FIXTURE TRAP EACH BUILDING SEWER EACH WATER HEATER AND/OR VENT EACH GAS SYSTEM 1 TO 4 OUTLETS EACH GAS SYSTEM 5 OR MORE EACH INSTAL . ALTER, REPAIR WATER PIPE EACH VACUUM BREAKER WATER SOFTNER EACH ROOF DRAIN (INSIDE) TOTAL PLUMBING DATE OF APPLICATION cT-•- Y~ HY BUSINESS LICENSE # CONTRAII^^iQ CONTRACTOR'S ADDRESS ^09 frCn/kti^ DESIGNER DESIGNER'S ADDRESS F/P F LR ELEV. yD nQ RES UNITS GRADING PERMIT ISSUED Y □ N □ 7.S6 4? QTY.ELECTRICAL PERMIT - ISSUE NEW CONST EA AMP/SWT'BKR 1 PH 3 PH EXIST BLOG EA AMP/SWT/BKR 1 PH 3 PH REMQOEL.'ALTER PER CIRCUIT TEMP POLE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) total electrical QTY. REDEVELOPMENT AREA yQ nD MECHANICAL PERMIT - ISSUE INSTALL FURN. DUCTS UP TO 100,000 BTU OVER 100,000 BTU BOILER/COMPRESSOR UP TO 3 HP BOILER/COMPRESSOR 3 15 HP METAL FIREPUCE VENT FAN SINGLE DUCT MECH EXHAUST - HOOO/OUCTS RELOCATION OF EA FURNACE/HEATER TOTAL MECHANICAL QTY. NO STORIES TYPE CONST CONTRACTORS PHONE t 7^9^//7r UCEN8E NO. DESIGNER'S PHONE CX:C LOAD ao VALUATION PLAN I.D. # STANDARD PLAN # PERMIT NUMBER V BLDG USE CODE BUILDING SO. F(X3TAGE FIRE SPR yQ nD . 5/DL/qCs ■ I 1 Ii 1 1? b/Lc/ L /,OOLil lii iy G'j Not VtKd Unkss NUchina Ctrtifiad :v ■'■/ SUMMARY/ACCOUNT NUMBER BUILDING PERMIT 01-00-00-8220 SIGN PERMIT 01-00-00-8221 PLAN CHECK 01-00-00-8806 TOTAL PLUMBING 01-00-00-8222 SOLAR - ISSUE COLLECTORS STORAGE TANKS ROCK STORAGE PUMP PLAN CHECK FEE TOTAL SOLAR ELECTRICAL 01-00-00-8223 MECHANICAL 01-00-00-8224 MOBILEHCME 01-00-00-8225 MOBILEHCME PARK INSP SOLAR 01-Q0-nn-fl??fi STRONG MOTION 80-92-33-0519 FIRE SPRINKLERS 01-00-00-8227 PUBLIC FACILITIES FEE 32-00-00-8933 BRIDGE FEE SCHOOL FEE - DISTRICT Carlsbad 80-92-21-0519 Enclnitas 80-92-22-0519 San Diefluito 80-92-23-0519 San Marcos 80-92-24-0519 UCENSE TAX 01-00-006162 CREDIT DEPOSIT TOTAL FEES PAYABLE 7^ I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY CERTIf^ UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT ISISSUED TO CX3MPLY WITH ALL CITY COUNTY AND STATE LAWS GOVERNING BUILDING CON^ STRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFYKEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COST^ND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE THE GRANTING OFTHIS PERMIT. Expiration Eyiiy ).wnmt ii^ed tjytha Buildir^g Off toCode shall ex^re by iimitattoK-and become nullauthofizedrby aachjjemu^i nonpommgnceri y"<f[inPfht't. df if lh^''6uild»dti Qf-mmt au'liorue^ by r the provisions of thisvoid If the building or work)0 days from the date of such.h permit is suspended or * AN OSHA PtRMfT tS REQUIRED FOR EXCAVATONS OVER5' 0" DEEP AND DEMOLmON OR CONSTRUCTION OF STRUCTUntS (DVER 3 STORIES IN HEKjHT APPL s^^ROVED BYTURE DATECONTRACTO BY PHONE □ o a Eo o (3 < [ So >- CO Q c0)05 0Q. TYPE 1 DATE INSPECTOR BUILDING 1 FOUNDATION i REINFORCED STEEL i MASONRY 1 GUNITE OR GROUT | FLOOR & CEILING SUB FRAME i SHEATHING □ ROOF □ SHEJaR FRAME 1 EXTERIOR LATH 1 . INSULATION 1 INTERIOR LATH & DRYWALL ' IPLUMBING ; SEWER AND BUGO nlPUCO i UNDERGROUND □ WASTE □ WaTER TOP OUT □ WASTE □ WATER TUB AND SHOWER PAN i GAS TEST ; □ WATER HEATER □ SOLAR WATER 1 ELECTRICAL□ ELECTRIC UNDERGROUND □ IjIFFER ROUGH ELECTRIC . i □ ELECTRIC SERVICE □ TEMPOFilARY □ BONDING □ POOL [ 1 MECHANICAL ! □ DUCT & PLEM., □ REF. PIPING HEAT — AIR COND. SYSTEMS i VENTILATING SYSTEMS 1 \ . -•\ " 1 CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATEITEMS ABOVE HAVE BEEN APPROVED. x FINAL !■ PLUMBING 1 ELECTRICAL 1 ^ \•"AMECHANICAL 1 \\W GAS 1 ^j\'V BUILDING 1 V N J ■\ SPECIAL CONDITIONS 1 1 : vzt ^ FIELD INSPECTION RECORD ■ ^ REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES INSPECTION REQ. IF CHECKED INSPECTOR'S APPROVAL DATE - 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 -A . < . ■ -■ - . S ■ J.*' ' \ - V • . 1 \ -