HomeMy WebLinkAbout1733 CATALPA RD; ; CB982611; PermitP, U T I D I N C PER 11 1 T Permit No" LB9B/61I
08/I7/9H 1E;-n Pi oject No- 09PO-
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CITY OF CARLSBAD
2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr, Carlsbad CA 92009
(760)438-1161
1 PROJECT INFORMATION7*7*3
FOR OFFICE USE
PLAN CHECK NO.
EST VAL "j
Plan Ck Deposit
Validated By/
Date (/
Address (include Bldg/Suitfe #)Business Name {at this address)
Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units
Assessor's Parcel #
T/e frttc:
Existing Use
300/3
Proposed Use
2
Description of Work
2-lr CONTACT PERSON {ifdifferant from applicant),
SO FT #of Stones tt of Bedrooms * Of Bathrooms
S.\S IJjLt
Name S
3 /APPLICANT/
f r^vw*
-;[SifComractor.
-^
"OAg*
y?y/ /'i^*u.*jt i-mrts v t<*~ xj<v*i /'x-c^
Address City
wit for Contractor^ Q Owner^f Q Agent for 6wner_ „**,„„
C-l 'C
State/Zip
" •> 5
-// ' f of u *j a
Telephone ff
' ^/ /'//wJC
Fax #
Name
4 v PROPERTY OWNER
Address City State/Zip Telephone #
Name Address ' City State/Zip Telephone #
5'.i. CONTRACTOR^- COMPANY NAME ./^"^'"i i|r."'" L •"-„•,"". "T-7 w " f"1, . T '' '"" *,4 " . 7"'" "",", ""I?*"-ll*1 P /" * " " ' " ! « ,
(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 applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
[Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt theiefrom, 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 ihan five hundred dollars [S500]}
Name Address
State License # 'j / u l-^-O License Class C ~ -
Designer Name Address
State License ff
City ' State/Zip Telephone ff
^ 7 Citv Business License # I ^D v ( W — ^~
^
Cfty StateVZip Telephone
Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
!j3 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
C3 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for tha performance of the work for which this permit is
issued My worker's compensation insurance carrier and policy number are ,
\jf * / f* /« i ^ O /* *? /\ *~/ ^^~/'*\ 'Insurance Company **^L&A~tr-^ CAn*-0 Cl> Policy No [Ayl^/ OJCJ '-3 *-/ Expiration Date
(THIS SECTION NEED NOT st COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
F~l 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 eny 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 (^00,000), intadditrOn^gJIw-colit of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees
SIGNATURE .A\»-— f - •="ff"-'"^^ DATE &// 11 IP
7 ' OWNER-BUILDER DECLARATION » - ''"I? >< * I - '-> - • ^ > ' ' ' ' ,- -„ ; "»l ^ • - -
I hereby affirm that I am exempt from the Contractor's License Law for the following reason
D 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 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)
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)
[~1 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 O YES QNO
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 / address / phonti 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 (includa name / address / phone number / type
of work)
PROPERTV OWNER SIGNATURE DATE
.COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY '. -, "* ,"""< „.', '\ '^ i-"Y " J, < '<
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration torn or risk management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES Q NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES n NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES C] 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 CENDIN&AGENCY-.V "i~* ,„!, U«V *" -J^" '- "^ ' . . -«.,/* T ; _ ( >'-] t«, ; -1 ,
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097{i) Civil Code)
LENDER'S NAME LENDER'S ADDRESS
9 ~j! APPLICANT CERTIFICATION f^r * u * '"1^ ,'~ "« ' , „ "-!»-„ - r 'T' J !% !L, ' ,J" •* ' , „„ ' * , , , ' ' ",
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 CitV 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 within 365 days Uom the date of such permit or if the building or work authorized by such permit is suspended
or abandoned at any time after tr^work is cwn/neneg33c^lTpengfi'C:f 180 days (Section 106 4 4 Uniform Building Code} /
APPLICANT'S SIGNATURE DATE /nhe
WHITE File YELLOW Applicant PINK Finance
I
City Of Carlsbad
SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING
1. JOB ADDRESS: HW
2. TYPE OF BUILDING: RESIDENTIAL !/ COMMERCIAL
3. ROOF SLOPE: RISE_/6__inches in 12 inches
4. NUMBER OF EXISTING ROOF COVERING (circle one) (& 2 3
5. TYPE OF EXISTING ROOF COVERING foot ^AtefSHEATHING
{?•"* a r r*-u-> /%*6. NEW ROOF MATERIAL vfawn CLASS ft _ WEIGHT PER SQUARE
7. NUMBER OF SQUARES
8. TRADE NAME ^^J^Jj^ MANUFACTURER _ GflF
9. ROOF SYSTEM LISTING UL No. 9?f7 ICBO No.
10. IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE
WEIGHT OF THE PROPOSED ROOF? ^YE^> NO
All roof coverings are required to be CLASS A. Combustible roof coverings
of any type or classification are prohibited.
I understand the following inspections are required:
1. Tear Off/Pre-inspection prior to install new roof covering.
2. Final Inspection
I agree to provide a ladder extending at least 2 rungs above the roof for
inspection.
Signature / V\ ^ A <&^ Date~
Contractor \/ Owner Contractor Name
*6 - Rolled Roofing, Standard/Lite Tile,(Asphalt/Comp Fiberglass] Built up,
Other.
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT! CB982611 FOR 08/27/98
DESCRIPTION: RE-ROOF,3000 SF COMPOSITION
TYPE: MISC
JOB ADDRESS: 1733 CATALPA RD
APPLICANT: A-l ALL AMERICAN ROOFING
CONTRACTOR:
OWNER:
REMARKS: R/JOHN/619-581-5177
SPECIAL INSTRUCT:
TOTAL TIME:
PHONE:
PHONE:
PHONE:
INSPECTOR AREA
PLANCK# CB982611
OCC GRP
CONSTR. TYPE NEW
STE: LOT:
619 581-5L77
INSPECTOR
CD LVL DESCRIPTION
19 ST Final Structural
ACT COMMENTS
***** INSPECTION HISTORY *****
DATE DESCRIPTION
082198 Roof/Reroof
ACT INSP
AP PY
COMMENTS'
SHEATHING
08/17/1398 14 52 6195059521 Al ALL AMERICAN ROOF PAGE 01
ASQBD. CERTIFICATE OF LIABILITY INSURANCE
DuBarrow Group, Ltd.
63ff Exctungv Pl««
Suite 300
Ulbum, OA 30247
MStlRIB
A-1 AH Afrwrican Roofing Co., San Diego, Inc.
4901 Mocwn» Btvd , Suit* 912
SanDI«go,CA 92117
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER A American SatMy Casualty Inaurance Company
INSURER P Ldflion Insurance Company
INSURER C
INSURER D.
INSURER E
COVERAGES
THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWfTHSTANDlNS
ANY REQUIHMENT. TERM Qfl CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WtTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. TH6 INSURANCE AFFORDCD BY THE POLICIES DESCRIBED HEREIN (S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
ManUB,TYMOFIMBMHANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION
EACti OCCURRENCE
CLMUSMAOe OCCUR ELP 97-546-001
ORE C>AMAQE (Any on* Nra|
7/1/97 7/1/99 MED EXP (Any tntfntyDn)
PERSONAL ft AOV(KJUH-f
QENIAGGRKATEUUITAPPUES PER-PHOWX:TS • COMP/OP AGO
i 1,000,000
50,000
*___6,Wt
COMB NED SINGLE UMIT
ANY AUTO
All, OWNED AUTOS
SCHEDULED AUTOS
HtfWB AUTOS
BOOILf INJURY
(Parptnon)
BODlLf INJURV
PBOPCHTV DAMAGE
OAMUttUAMLfTY AUTO ONLY - 6A ACCIDENT
ANY AUTO EAAGC
AI/TOONLY
D
EACH OCCUPRENCfi
CLAIMS MADE
WOWBM COVPENaAtlOH ANO OTH-_ea
B WC2-030460 11/11/97 11/11/98
1,000,000
EL DISEASE EA EMPLOYE!1.000,000
E L DISEASE - POLICY.LIMIT.looo.ood"
omen SPECIAL ITEM
ayUHnM taunt tir »• enwiMM |i»HiPH|
owewmoH OF o*wuTKMiaA.ocATWHwveHKLea«itcuj!MO»B AOOEO BY ENOOfraiiiorrapEciAL PROVISIONS
MrtBcM
NONE-
CEFrnfTCATE HOLDER INSURER LETTER'CANCELLATION
SHOULt) ANY OF THE ABOVE OCSCHiatO POUCK9 BE CAHCCLLRQ BePORETOB UtPUtATKHt
DATE THEHEOP, THH B»UWO INSURER WIUl fiMDCAVOR TO MAIL 30_ DAys WATTTEN
NOTICE TO THE CERTIFICATE HOLDER NAMBD TO THE LEFT, BUT FAILURE To pO SO SMALL
IMPOSE NO OBLIGATION OR LUetUTY OP ANY KIND UPON THE INSURER, TO AGENT* OR
REPRESENTATIVES.