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HomeMy WebLinkAbout2021 CIMA CT; ; CB973203; PermitBUILDING\PERMIT\p 10/24/97 16 25 ~ Page 1 of 1 Job Address 2021 CIMA CT Permit Type MISCELLANEOUS Parcel No 216-491-10-00 Valuation 7,491 Occupancy Group Reference* Description REROOF 3300 SF, NATUREGAURD ICBO 5121 Appl/Ownr SAN DIEGO ROOFING 625 NORHT AVENUE VISTA, CA 92083 •*** Fees Required *** *** Permit No Project No Development No CB973203 A9704115 Suite Lot#0667 10/24/97 0001 01 02 Construction TCsHSRHT NEW 163.00 Status ISSUED Applied 10/24/97 Apr/Issue 10/24/97 Entered By JM 760 758-1800 Fees Collected & Credits *** Fees 163 Adjustments Total Fees 163 Fee description Miscellaneous Fee #1 * MISCELLANEOUS TOTAL 00 00 00 Total" Credits Total Payments Balance Due Units Fee/Unit > 163 0,0 00 00 163 00 Ext fee 163 163 00 00 Data PERMIT FE! CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr Carlsbad CA 92009 (760) 438 1161 1 PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By ( Date Addro (includo BIdg/Suito ft) onil Doscnptf Business Namo (at this address) Log Lot No Subdivision Nnmo/Numbor Unit No Phase No Totol It of units Assessor s ParcoL*Existing Uso Proposed Us Description of Vvork 2 CONTACT PERSON (If different Irom applicant) SO. FT Sol Storios It of Bedrooms ' "t # of Bathrooms Namo Addross 3 APPLICANT D Contraotor 0 Agent lor Contractor Q Owner City I Agont lor Owner State/Zip I 1 i Telephone ff Fax /> Namo 4 PROPERTY OWNER Addross ,1 "- - r I City State/Zip Tolophono i ,-ir " r f , ' Namo Address City State/Zip Tolophono # E CONTRACTOR COMPANY NAME " (Soc 7031 j Busmos.. ond Profession., Codo Any City or County which requires a permit to construct altor improve demolish or repair any structure prior to Its i juonco aljO requires the applicant (or such permit to (ilo o signed statement that he ts licensed pursuant to the provisions of the Contractor s License Law (Chapter 9 commending with Section 7000 ol Division 3 of the Business and Professions Codol or that ho is oxompt therefrom and the basis for the alleged exemption Any violation ol Section 7031 5 by any applicant for a permit subjects the applicant to a civil penalty of not moro than five hundred dollar^ ($500)} Us Name State Licence ft & lfrl& j \ J Addross X Liconso Closs C_^ ~ *^ ' City State/Zip City Business Licenso If / 2,1 Tolophono /f Designer Namo Snto LiconjC f Addross City Stato/Zip Tolophono G WORKERS COMPENSATION \ 'orkors Compensation Doclarntion I hereby oflirm under penalty o! perjury one of the following declarations 0 I have and will maintain a comlicato of consent to self insure for workers compensation as provided by Section 3700 of the Labor Codo for tho performance 01 tho work for which this permit is is.,uod [jf I have and will mainfim workers compensation as required by Section 3700 of tho Labor Codo for tho performance of tho work for which this permit is i ucd My worker s compensation insurance carrier and policy number arc Insurance Company f\~tp£-'fy Policy No W (j / Lf£3-$ ~^3lj0l~] Expiration Palo j (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*1001 OR LESS) Q CERTIFICATE OF EXEMPTION I certify that in tho performance of tho work for which this permit is issued I shall not employ any person in any manner so as to become subject to tho Workers Compensation Lows of California WARNING Failure to socuro workers compensation coverage is unlawful and ahnll subject an employer to criminal penalties and civil fines up to one hundred thousand dollars fChoo 000) in addition to tho cost of compensation damages as provided (or In Section 3706 of the Labor code Interest and attorney s foes SIGNATURE \ffilfrfjL Afil/U-. . DATE fo(^lh~] 7 OVYNCR BUILDER DECLAfmTION ' I horoby affirm that I am oxompt from tho Contractor s Liconso Law for tho following reason Q I a owner of tho property or my employees with wages os their solo compensation will do tho work and tho structure is not intended or offered for solo (Soc 7044 Business and Professions Codo Tho Contractor s License Law doos not apply to an owner of property who builds or improves thoraon and who does such work himsolf or through his own employees provided that such improvements ore not intended or offered for sale If however tho building or improvement is sold wuhin ono yoar of completion tho owner builder will hovo tho burden of proving that ho did not build or improve for tho purpose of solo) Q I a owner ol tho property am exclusively contracting with licensed contractors to construct tho project ISoc 7044 Business and Professions Codo Tho Con rjctor o Licence Law doos not apply to an owner of property who builds or improves thereon and contracts tor such projects with contractorls) licensed pur uant to the Contractor s Licence Law) Q I am oxompt under Section Business and Professions Codo for thij reason 1 I por onally plon to provido tho major labor and materials for construction of tho proposod property improvement O YES Q]NO 2 I (have / have not) signed an application for a building permit for tho proposod work 3 I havo contracted with tho following person (firm) to provido tho proposed construction (include namo / address / phono number / contractors license number) H I plan to provido portions of tho work but I havo hired tho following porson to coordinate suporvisa and provido tho major work (includo namo / address / phono number / contractors licoiuo number) j I will provido some of tho work but I hovo contracted (hired) tho following persons to provido tho work indicated (include namo / address / phono number / typo of work) PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NON-ff£SlDENTJAL BUILDING PERMITS ONLY i vv .II ""*" r, n f I tho applicant or future building occupant required to submit a business plan ocutely hazardous materials registration form or risk management and prevention program undor Soctions 25505 25533 or 25534 of tho Prosloy Tanner Hazardous Substance Account Act? Q YES C] NO the applicant or future bulbing occupant required to obtain a permit from tho air pollution control district or air quality management district? [3 YES f~l NO s thu facility to bo constructed within 1 000 foot of tho outor boundary of a school sito? Q YES O NO F ANY OF THE ANSWERS ARE YES A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE ACQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT i CONSTRUCTION LENDING AGENCY " v ""* " * T -»~"~ horoby affirm that there is a construction lending agoncy for tho parformonco of tho work for which this permit is issued (Sec 3097(0 Civil Cods) ENDER S NAME LENDER S ADDRESS i APPLICANT CERTIFICATION ' ~ "Jf " cortily that I havo rood the application and state that tho above Information is correct and that the information on the plans Is accurate I agroo to comply with ill ity ordinance., ond State lows relating to building construction I horoby authorize representatives of the City of Carlsbad to enter upon tho above mentioned roporty for in poction purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES UDGf/lENTS COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT SNA An OSHA permit is required for excavations over 5 0 deep and demolition or construction of structures over 3 stories in height XPIRATION Every permit usuod by tho Building Official under tho provisions of this Codo shall expire by limitation and become null and void if the building or orV authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended abandoned nt ony time oftor-jho work is commenced for a period of 180 days (Section 106 4 4 Uniform Building Codo) =PL'CANT S SIGNATURE BUILDING PERMIT APPLICATION FOR RE-ROOFTNG The following information shall be provided for city review and approval prior to issuing a budding permit for re-roofing , 1 C. 2 Building Occupancy 4/U r^A>) 3 Roof slope Rise - — ----- 1 - inches in 12 inches 4 New Roof Classification 5 New Roof Type -5K*JU .4 IA ^5 t 6 New Roof Trade Name & Manufacturer 7 New Roof Weight per Square S5"O # of Squares 8 Description of New Roof Application 9 Basis For Roof System Approval ICBO#_JLL«LJ UL #. 10 Type of Existing Konf kW>J 11 Will existing roof be removed1? \£&^ No 12 Is there more than one existing roof? Yes ^2-^ 13 Is the existing structural design sufficient to sustain the weight of the proposed new roof? No 14 Re-roofing requires a pre-roofing inspection prior to the application of new roof (UBC Appendix Chapter 15 ) The pre-roofing inspection may be accomplished by a special inspector in heu of the City inspector The Budding Official has determined that a state licensed general contractor or roofing contractor is qualified to act as the special inspector B^ I certify that all information on this form is true and correct W I agree to perform all work in accordance with City building requirements ^ I am a licensed general contractor or roofing contractor and will act as the pre- roofing special inspector I will certify in writing prior to final City approval that the pre-roofing inspection was made that the substrate and/or existing roof complied with UBC Appendix Chapter 15 prior to application of the new roof 0 Signature Contractor's Firm Name State License Number CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB973203 FOR 11/17/97 INSPECTOR AREA NF DESCRIPTION. REROOF 3300 SF, NATUREGAURD PLANCK* CB973203 ICBO 5121 OCC GRP TYPE: MISC CONSTR. TYPE NEW JOB ADDRESS: 2021 CIMA CT STE: LOT: APPLICANT- SAN DIEGO ROOFING PHONE: 760 758-1800 CONTRACTOR: ^ ~ ^ PHONE: OWNER: fcf ( > ©L PHONE: REMARKS: C/DON/942-1963 INSPECTOR SPECIAL INSTRUCT: HOME OWNER WILL CALL IN THE AM TO FIND OUT WHAT TIME INSPECTOR IS COMING SO HE CAN PUT UP LADDER TOTAL TIME. CD LVL DESCRIPTION 19 ST Final Structural ACT COMMENTS DATE DESCRIPTION 102897 Roof/Reroof INSPECTION HISTORY ***** ACT INSP COMMENTS AP NF AC_ t-3 IUC -i Q/l£>,•% j •*v., L_RT1F»/•"» r \ — -*uA \ i / -\ i—Or ..K\ti!i '-» V)_ i t THI" o\t 1 j\] 3 ^ CEprnrvAMD no jRAiMCt c T: IS ISSLTD / S A f FCPS f<O RIGHTS UP !>O^-3 ATTcK O^ r O TH- CFTT D-T c VII OS/2?/9/ cOTi TIO ~ir.f TP I'lirin f r^ici Jisuiince. "ScO Sue CM c Av E. , first Floor C« 920/5 HOi DEft THIS CERTI ICATF DOES f OT A Ei* D EXTEND OR ALTER THE COVERrtGI Ac ORDED FY Tn: FOJCI..S ! ELO 1 CO' PA IES /FFORuNC COVERAGE Cuss p 619-259-5300 F < t , C 19-259-S069 Western Specialty Insurat ce Co CO CO A S 'r D ego Poo^ rcj CO =„ < i E State Compensation Ins Func1 CO =M IllC C £">5 JiO^. th Pveiue co = v ^'_&ta CA 92083 D" T 'S Ij TO CERTI'Y TH^T TnE POLICiCS O" 1 iSLR^ Cl LlbTEO EZLO /ri^VZEEEl ISSUED TO THE 1 SURED f MCD ABOVE FOR TH" POLICY PCPiOD i i C~T;D NOT^/ITI-ST ODI GA v P:QUIR: i T TET i Ori co DITID o= «i v co. TRACT OR OTH:R oocu I:^T\ ITH RZS^^CT TO \ HIGH TH s C:^T "IC^TE f UY EE ISSUZD OJ f \Y P:^TA' Tri. 1 SUFU CE A FORDCO BY TH: POLICIES DESCHIBZO H;R: IS SUBJECT TO ALL THZ TERMa E/ CLUSIO. SAO COisDITIO iS 0" SUCH PO ICIES LI UTS SHI f U> H^v: B'tfl REDUCED BY PA D CLAI '3 | TYPE Or 1NSUR,, C G _-„ u—iurr X | CO 1 =1CIA C H^ LU i "Y 1 I 1 CLAI liM-,3 [^X 1 0000=% \ \ O I =» S 1 CO JT^ACTOS 3 P OT AJ-0 10- IE UAi UTY | A Y AJTO ^ O1. D AJ'OS j SCri DL. 0 ^^~Os H R D AUTOS 1 , j 0 O S D Aj"O5 1 GA ^S U^_ILTY ,- Y AJ'O | EXC ^o L^2 UTY ' 1 L lo=i I A 0- 1 ' OTH HTHA 1 L I3S i I A FC=; B \ OS^^S COM?- (SATION A 0 EMPLOYEES UA3 UTY TH = O=FI -Oi [ | -i PA=T =13 x. cu-u i 1 0 C T3 AH | 1 EXC POUCYfU ^ POUCYET CT!VEr-JU^-TTU ,_n OAT (s ,DDTY| 1 ViGL005254 04/28/97 i i 1 i i i i f/C1452S3497 01/01/97 POUCV E^r-S«-|ON D^T ( 1DOVYI U 1TS G N ^ ACC^ .ATc > 2 , 000 , 000 0<*/28/98 Fr,oDbCTb co i o?«o $1,000,000 P ,»ON« 4A3yiMJL^ $1,000,000 c^c-' occts- c $1,000,000 n=l DA ^o IA , cr f ) S 50,000 M 3 cX=> (A / cr« jrl S 5 , 000 CO 3! 1 D SI G L M" S oOOl Y 1 1 IUnv (S p r) 4 ! cODM Yl J S< , 1 1° i d nt, PRO= STY DA ^3 S A TO ON s A ^.CCQ ~ » O~« ^ T IA AJ"O O Y =A:H A-CID - s A"i -A" S «C-, ocr^, z s A 3S 3,,- 1 S i C S"A" ' 1 0"- i ITCR L TS 1 -, \ E *CH ^ccio -.- sl, 000 ,000 01/01/98 DIS AS BOI -T LI - sl,000,000 013 Aa LA QV > 1,000,000 1 0 SCSPTONO OPERATIONS LO3AT10 IS V hIC1 E» S? CIAL IT^'S Operations of naned insured in tbe State of California HOC is 10 dav s for i o i-paynient of premium CE"TRCrtTE HOLDER <; > < t\ < /Y / o v o YX XX / X»X'- < < X wivy, > ^ XXY^ XXXX"" > XX ACOTD 25 S (1/93) CA* CELLATION j^v f\ j. SUO_ 3«N|-OrTH A-0^ 0 SC=^_ DPOJCI S E C C OEr"0=? "i EX 1=«TION D^T Ti-CT 0 Ti- losJ G CO IPAN'r \ I E D „ 0=1 TO i '< /^X>>' <Y 10 C~YS =5ITT 1 N3TIC TO Th C3TirC-,* 1-0 03 N^ 0 TO TI- L~T " ''^, EJ* ^ UR_ TO ^ SL.i~ri 0"IC SHA 1 IX)S NO OsLG-TIO N OT U~ -' >\^ / Y Tr \ <. ^ YX^ YC i-\\I.>vY"ii'y1i'X> Cr ANY K ° U?ON TH c:i ?" Y rs "^ Ti O1! F "^ S STAT i TYOY XX ^X^^.XAX1' ^OTriO"l7cOR^nS TAT/ Hark Guss ^ / (fo *~J ^ s - ^/ /- feACOrliLCORPORATION 1988