HomeMy WebLinkAbout2100 COSTA DEL MAR RD; ; CB023129; Permit-1-Y-20t)2
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Miscellaneous Permit Permit No CB023129
Building Inspection Request Line (760) 602-2725
Job Address
Permit Type
Parcel No
Valuation
Reference #
Project Title
2100 COSTA DEL MAR RD CBAD
MISC Subtype
Lot#
$000
LA COSTA RESORT & SPA
DEMO PARKING LOT & POND
OTHER
0
Applicant
CUSIKMIKE
2100 COSTA DEL MAR RD
CARLSBAD 92008
Status
Applied
Entered By
Plan Approved
Issued
Inspect Area
ISSUED
10/17/2002
MDP
10/17/2002
10/17/2002
PD
Owner
CUSIKMIKE
2100 COSTA DEL MAR RD
CARLSBAD 92008
8952 10/17/02 0002 01 02
CGP 60 = 00
Total Fees $6000 Total Payments To Date $000 Balance Due $6000
Miscelaneous Fee #1
Miscelaneous Fee #2
Additional Fees
TOTAL PERMIT FEES
PERMIT $6000
$000
$000
$6000
/L
Inspector^
FINAL APPROVAL
Date Clearance
NOTICE Please take NOTICE that 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 for
processing in accordance with 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 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
fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired
PERMIT APPLICATION
CITY OF"CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave , Carlsbad, CA 92008
1 PROJECT INFORMATION
FOR OFFICE USE ONLY
PLAN CHECK NO
EST VAL
Plan Ck Deposit
Validated By
Date
Address (include Bldg/Suite it)Business Name (at this address)
Legal Lot No Subdivision Name/Number Unit No Phase No Total ft of units
Assessor s Parcel #Existing Use /Proposed Use
Description of Work
2 , CpNTApTLPERibN (if different from applicant)
SO. FT ffof Stones of Bedrooms # of Bathrooms
Name AWZT/t^T OAJ^FZ-P^ Address 2./00
W- ,,APPLICAN|E , ^ contractor. jjS^glllSjpontractor -II
'i&tity
I Owner SfSgentJpr Owner.,,,.,._
^telephone
State/Z|P Bphone #
Name P^//^-~ Address City State/Zip Telephone #
1 "Cbm iactORtSCCiMPANY NAME 7 " """ "' "..., .-,....-....,...„ -: ; ^ ....,,,..._
(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 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 1$5001)
Name
State License #
Address
License Class
City State/Zip
City Business License #
Telephone #
Designer Name
State License #
Address City State/Zip Telephone
;6 WORKERS COMPENSATION ;
Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
Q 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
n I have and will maintain workers compensation as required by Section 3700 of the Labor Code for the performance of the work for which this permit is
issued My worker s compensation insurance carrier and policy number are
Insurance Company Policy No Expiration Date
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
l~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 any 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 ($100 000) in addition to the cost of compensation damages as provided for in Section 3706 of the Labor code interest and attorney s fees
SIGNATURE DATE
7 ;v|pWNER BUILDER DECFSRAtlbN -vysiir-" ,..::L " Jjf, ^ ^ "- , - j
I hereby affirm that I am exempt from the Contractor s License Law for the following reason
f~l 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 vrfithm 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)
IC-t 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 |~l 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 / 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 / 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 (include name / address / phone number / type
of work) . /
PROPERTY OWNER SIGNATURE DATE
COMPLETE THIS SECTION FOR NONfffS/D£/V7/XliLBUILplNiG]PERMITS ONLY . i/ SJ ,„....,.**."' jl . ifi
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? Q YES 0^NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? O YES QNO
Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? Q YES Q'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 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 A/tVA>tS LENDER S ADDRESS
:9'" APJPLICANfCERTIFICATONU:i:,-:::: -^n.,™ •-.,-, • •••••&VFT ': »P^; -'< f ^ ^ -^
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 City 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 180 days from the date of such permit or if the building or work authorized by such permjt is suspended or abandoned
at any time after the work is commenced for a period otJ 80 days (Sedtjon 106 4 4 Uniform Building Code)
APPLICANT S SIGNATURE DATE
WHITE File YELLOW Applicant PINK Finance 7
City of Carlsbad Bldg Inspection Request
For 12/12/2002
Permit# CB023129
Title LA COSTA RESORT & SPA
Description DEMO PARKING LOT & POND
Sub Type OTHER
2100 COSTA DEL MAR RD
Lot 0
Type MISC
Job Address
Suite
Location
APPLICANT CUSIKMIKE
Owner
Remarks DEMO OF POND INSPECTION
Inspector Assignment PD
Phone 7608995628
Inspector*
Total Time
CD Description
21 Underground/Under Floor
Act Comment
4
Associated PCRs/CVs
Requested By KEN
Entered By CHRISTINE
Inspection History
Date Description Act Insp Comments