HomeMy WebLinkAbout2804 VIA CLAREZ; ; CB951259; Permit~ 09/12/95 16:30
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B U I L D I N G
Job Address: 2804 VIA CLAREZ
Permit Type: PLUMBING
P E R M I T
Suite:
Lot#:
Permit No: CB95125~
Project No: A9501861
Development No :
"3642 09/12/9'-0001 1
Construction Type: VN
Parcel No: 167-310-10-00
Valuation: O
Occupancy Group: Reference#: Status: ISSUED
09/12/95
09/12/95
MDP
Description: REPAIR GAS LINE
Appl/Ownr : KENNEDY, SCOTT
2804 VIA CLAREZ
CARLSBAD, CA. 92008
* * le Fees Required ***
Fees:
Adjustments:
Total Fees:
27 .00
.0 0
27 .00
***
Applied:
Apr/Issue:
619
Entered By:
434-3255
Fees Collected & Credits
Total Credits:
Total Payments:
Balance Due:
.00
.00
27.00
***
Fee description Units Fe e/Unit Ext fee Data
Enter "Y" for Plumbing Issue Fee >
Gas Piping System >
* PLUMBING TOTAL
7.00
FINAL APPROVAL
20.00 Y
7.00
27 .00
·•,o --1-t:b-=--DATE 't· I~-~ s
~L.EARAN CE ~zJJ,d....a:0--L.t~s--~_
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
-
PERMIT .APPLICATION PLAN CHECK NO.
City of Carlsbad Buildire Departaent
2075 Las Palaas Dr., Carlsbad, CA 92D09 (619) 438-1161 EST.VAL. __________ _
PLAN CK DEPOSIT, _______ _
t. PERMl"I' lYPE VALID.BY __________ _
DATE
From List 1 (see back) give code of Permit-Type: ____________ _
For Residential Projects Only: From List 2 (see back) give
Code of Structure-Type: _____________________ _
Net Loss/Gain of Dwelling Units __________________ _
2. PRWECf INFORMATION FOR OFFICE USE ONLY
Address Z.f'.'50 / I/; C/
Nearest Cross Street
mt o.
CHECK BElbW IP sOBMII IED:
□ 2 Energy Cales D 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
ASSESSOR'S PARCEL PROPOSED USE
~e_p~(.n-. ~45, L'!:-A-tc
EXISTING USE
DESCRJPTION OF WORK
SQ. FT. # OF STORIES # OF BEDROOMS
3. WN I ACI PERSON (1f diflerent from applicant)
NAME (last name first)
# OF BA TIIROOMS
ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
LI OWN EH LI AGEN I FOR OWNER 4. APPUCAN 1 LI CON I RAc I OR LI AG£N I FOR CON I RACIOR
ADDRESS NAME (last name first)
CITY STATE ZIP CODE DAY TELEPHONE
s. PROPER'IY OWNER
NAME (last name first) C...C-' ~ ADDRESS 7 ~ -( (/q
ZIP CODE
NAME (last name first)
CITY
0 uJ ;V <t-0--.,,
STATE ZIP CODE
ADDRESS
DAY TELEPHONE
STATE UC.#
DESIGNER NAME (last name first)
LICENSE CIASS CITY BUSINESS UC. #
ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE STATE UC. #
1. WORKERS' 00MPENsA'i1oN
Workers' Compensauon beclarauon: I hereby affirm that I have a certificate of consent to sell-insure issued by the Director ol lndustnal
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY POLICY NO. EXPIRATION DATE
Ceru!Jcate of Exemption: I certify that in the performance of the work for which this permit 1s issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. oWNEk-BOIIDEk 0£Cl.ARA'nON
Owner-Butlder Declaration: I hereby alhrm that I am exempt from the Confracfor's License 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 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.).
□ 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 under Section _______ Business and Professions Code for this reason:
(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, commencing 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 [$500]).
SIGNATIJRE DATE
COMPLETE 'I His SECTION FOR NaN-RESIDENTIAL BUILDING PERMITS ONLY:
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 required to obtain a pennit from the air pollution control district or air quality management district?
□ 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 TI-IE ANSWERS ARE YES, A FINAL CERTIFlCATE OF ocx:lJPANCY MAY Nar BE~ AFfER JULY 1, 1989 UNLFSS nm APPUCANT
HAS MET OR IS MEETING nm RF.QumEMENTS OF nm OFFICE OF EMERGENCY SERVICF.S AND nm Am POU.UTION OONTROL DISl1UCT.
9. OONS'lltoCnON LENDING AGENCY
I hereby affirm that there 1s a construcuon lending agency for the performance of the work for which this permit 1s issued (Sec 3097(1) ClVII Code).
LENDER'S NAME LENDER'S ADDRESS
Io. APP□CANI CERliFICAIION
I ceruly that I have read the apphcauon and stale that the above information 1s correct. I agree to comply with all City ordinances and Stale 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 AL50 AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS 1lfE Cl1Y OF CARLSBAD AGAINST AU. UABILITIES, JUDGMENTS, CDSTS
AND EXPENSES WlllOI MAY IN ANY WAY Acx::RUE AGAINST SAID Cl1Y IN CDNSEQUENCE OF 1lfE GRANTING OF nus 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 Buildin "rficial 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 commenced wtJ;hin 365 days from the date of such permit or if the building or work authorized by
such permit is suspended or abandoned at ·me after the ork is commenced for a period of 180 days (Section 303(d) Uniform Building Code).
APPLICANTS SIGNATURE r,,_;,.....,..,,..--/ DATE: ___ _
(