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HomeMy WebLinkAbout1780 MAGNOLIA AVE; ; CB112624; Permit.• City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 12-14-2011 Permit No: CB112624 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: 1780 MAGNOLIA AV CBAD PME 2052301700 DILLARD; CHANGE OUT FAU MACLEOD HEATING &A/C 401 DURIAN ST VISTA CA 92083 760-945-6621 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Status: Lot#: 0 Applied: Entered By: Plan Approved: Issued: Inspect Area: Owner: DILLARD HENRY J&JUDITH A 1780 MAGNOLIA AVE CARLSBAD CA 92008 ISSUED 12/14/2011 JMA 12/14/2011 12/14/2011 $0.00 $0.00 $150.00 $0.00 $150.00 Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due: Inspector: Clearance: $0.00 at 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 tor processing in accordance with Ca;!sbad 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 f x in fw i h h 1 Tl i ii hi I w i h h i t <<~> Building Permit Application 1635 Faraday Ave .• Carlsbad, CA 92008 760-602-2717 / 2718/ 2719 Plan Check No. CB( I • 2~ Z ~ CITY OF CARLSBAD EXISTING USE vi. I , STATE CA tt_,IL FAX ARCH/DESIGNER NAME & ADDRESS Fax: 760-602-8558 www.carlsbadca.gov SUITE#/SPACE#/UNIT# Est. Value Plan Ck. Deposit Date 1-z,/ ltf I APN # BATHROOMS TENANT BUSINESS NAME ZIP C ,- I GARAGE (SF) PATIOS {SF) DECKS (SF) ADDRESS ~3' CITY PHONE ZIP 'z1' STATE FAX ( SWPP CONSTR. TYPE OC . GROUP AIR CONDITIONING FIRE SPRINKLERS YES □ NO □ YES □ NO □ ZIP (Sec. 7031.5 Business and Professions Code: Any C!ty or County which requires a permit to.construct, alter, improve, demolish or repair any structure, prior to its issuan , a o 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 00 of D1Vision 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 {$500)). WORKliRS" C0MPll!N$ATION Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: □ I have and wlll maintain a certificate of consent to self-insure for workers' compensation as provided b)' Section 3700 of the Labor Code, for the performance of the work for wtlich this pennit is issued. □ I have and will maintain workers' compensation, as required b)' 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: Insurance Co. Policy No. ______________ Expiration Date _________ _ section need not be completed 11 the permit Is for one hundred dollars ($100) or less Certificate of Exemption: I certify that In the performance of the work for which this pennil Is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of mIa WARNING Failure to secure w 'compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in on to the cost of compensation, da ~ s pro~o/ fo~~on 3706 of a de, Interest and attorney's fees. ,ws CONTRACTOR SIGNATURE " 71/C,(irl ,a~//'47"'~ □AGENT DATE r 11 I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: □ I, as owner of the property or my employees With wages as their sole compensation, will do the work and the structure is not il1tended 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 WIii have the burden of proving that he did not build or improve for the purpose of sale) □ 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). □ I am exempt ur.der 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. □ Yes □ No 2. I (have I 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/ phone/ contractOfs' license number): 4. I plan to provide JX)rtions of the work, but I have hired the following person to coordinate, supeNise and provide the major work (Include name I address I phone/ 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 I address I phone I type of work): _.15 PROPERTY OWNER SIGNATURE □AGENT DATE • ~ V O ' -- COMPLliTI! THU SECTION FOR NON·ftl!UDliN'l'IAL IUUUUNG Pl!RMITJ ONtY 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? □ Yes □ No Is the applicant or future building occupant reqllired to obtain a permit from the air pollution control disbict or air quality management dislrk:t? □ 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. I hereby affirm that there 1s a construction lending agency for the performance of the work this permit Is issued (Sec 3097 (1) C1v1I Code) Lender's Name Lender's Address I certify that I have read the application and state that the above lnfonnatlon Is correct and that the lnfonnatlon on the plans is !KX:llrate. I agree ID comply with all City ordinances and State laws relating ID building construclion. I hereby authorize representative of the Qty of Carlsbad to enter uJX)n the aoove mentbned property fi:lr inspecoon pulJXlses. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY CF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AG.AJNST SAIO CITY IN cm SEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA AA OSHA permit is required br excavaOOns over 5'0' deep and demolition or construction of structures~ 3 stories in height. EXPIRATION: Every permit 6Sued by the Buik:ling Offcial under the provisions of this Code shall e · by limitatKln and become nul and void ~ the buikling or '.\Ofk authorized by such p:irmlt is not commenced 'Mthin 180 days from the dale of such permit or if th ing oroork authorized by such J):!rmlt is sus r abandoned at anytime after the v.ork is commenced for a perbd of 180 days (Secoon 100.4.4 Unilonn Building Code) _,g APPLICANT'S SIGNATURE DATE l:l--If -ff City of Carlsbad Bldg Inspection Request For: 12/21/2011 Permit# CB112624 Title: DILLARD: CHANGE OUT FAU Description: Type:PME Sub Type: Job Address: Suite: 1780 MAGNOLIAAV Lot: 0 Inspector Assignment: Phone: 7606963856 Location: Inspector: OWNER DILLARD HENRY J&JUDITH A Owner: DILLARD HENRY J&JUDITH A Remarks: PM PLEASE -:;r Total Time: CD Description Associated PCRs/CVs/SWPPPs Original PC# Inspection History Date Description Act lnsp Comments ---- Requested By: H.O. Entered By: JANEAN