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Home My WebLink About1854 LILAC CT; ; CB011162; Permit03/26/2001 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: Applicant: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No:CB011162 Building Inspection Request Line (760) 602-2725 1854 LILAC CT CBAD MISC 2155211100 $2,997.00 Subtype: REROOF Lot#: 0 SZYMANSHI RES/ 27 SF OF FIBER COMPOSITION SHINGLE, RESHEATAING Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 03/26/2001 CB 03/26/2001 03/26/2001 5142 03/26/,)1 0002 )1. •);: SAN DIEGO ROOFING SZYMANSKI DONNA M CGP ··7,!)C 615 NORTH AVE VISTA, CA 92083 760-758-1800 Total Fees: $77.00 Miscelaneous Fee #1 Miscelaneous Fee #2 TOTAL PERMIT FEES Inspector: 1854 LILAC CT CARLSBAD CA 92009 Total Payments To Date: $0.00 Balance Due: $77.00 PERMIT FEE $77.00 $0.00 $77.00 EXPIRED PERMIT r-· . ; .. r.:(PIRED !\'\I IIC'CORDAN(Y ,r-, ~ q s.c . • C:-.4 ' . 0.-?tvii -p\ SIGNATURE_..LW __ _ FINAL APPROVAL Date: _____ _ Clearance: NOTICE: Please take NOTICE that approval of your project includes the "lmposi~on" 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 wtth 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 capactiy 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 oiven a NOTICE similar to this or as to which the statute of limitations has oreviouslv otherwise exoired. ,J FOR OFFICE USE ONL V PERMIT APPLICATION PLAN CHECK No(&:/ 11 l(a1-, CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Plan Ck. Deposit ________ _ 1. PRO.iECT1NFOl!MATION L, L'1-C. Validated By C ~ Date 3h {/j__Q f ' Address (include Bldg/Suite #) Legat Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel I Existing Us~ D r elk Description of Work SO. FT. #of Stories .i. .::OIIITACTPEIISOlll llhllf.,ent from ..,.,ncantl Name Address :j, "Al'PtlCANT a· Contractor; 0 ·AB•nt 10r'.Co'ntiectot City Qciwner ·'0".<lilonflorOwner Name 4. l!IIOPlim:Y OWNER Address . s z:y11.,,_i1ttvth.; Name Address City 5, CONTRACTOR• COMPANY NAME State/Zip Telephone# Fax# State/Zip Telephone# (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 fer 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 'vision 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption~~~,,l action 70 .5 ny appljcant f2;; ~ subj;t_t}-a~t to ivil pe~~f):fore than f ~r d rs 17~ 7 5'8 /P. Name City State/Zip ,.i{'~-".:) State license # --=-~~~~--license Class C.. J } City Business license II _ _,_J_,i'-_tV'--_7.,__' > r Designer Name Address City State/Zip Telephone State License # _________ _ 8. 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 °!_~ work for which this permit is issued. J;;;ir~ t have and will maintain workers' crprmpen ation, as required by Section 3700 of the Labor Cod~, for the performance of the work for whic thi permit is issued. My worker's compens~ rrier and policy number are~ . ,//: CJ{ 7'-{f ( . . (. / O;). Insurance Company----~--""----'-------------Policy No. Q'l ~ f Exprrat1on Date~c...c_. ____ _ (THIS SECTION NEED NOT BE COMPlETEO IF THE PERMIT IS FOR ONE HUNDREO DOLLARS [$1001 OR LESS) 0 CERTIACATE 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 -■cure workers' compen1atlon coverage la unlawful, and shall subject an employer to criminal penalties end civil fine• up to one hundred thouaand dollart 1$100,000), in ■ddhlon to the co1t of compensation, damegn u provided tor In Section 3706 of the Labor code, intareat and ■ttom■y'1 tees. SIGNATURE______________________________ DATE _________ _ 7. OWI\IER'8UILDER D£ClARATJON I hereby affirm that I am exempt from the Contractor's License law for the following reason: 0 I, as owner of the property or my employees with wages as their aole compensation, will do the work and the structure is not intended or offered for sale ISec. 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 ownet•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(sl 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 I have not) signed an application for a building permit tor the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / 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 I address I phone number I comractors 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-RESIDEN71AL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit e 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? D 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 ts 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(i) Civil Code). LENDER'S NAME _____________ _ LENDER'S ADDRESS ________________________ _ $. APPUCANTCERTIFICATION 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. l agree to comply with all City ordinances and State laws relating tp building construction. I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned proparty tor 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. YELLOW: Applicant PINK: Finance