HomeMy WebLinkAbout2509 VIA SORBETE; ; CB951893; PermitB U I L D I N G P E R M I T
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Pro7ect N,,: P.-1<;11:,7c,1,
Development N<
Jnb A<1•l:!'."ess: 2509 VIA SORBETE Suite:
Permit ~ype : PLUMBING
L=ircr::l Nv : 1o7-4UU-29-(1U
Valuat1,.Jt1 : IJ
Lvt#:
uccup,:incy Gr 01tp : Reference#:
Const1~ct1on Type: NEW
3tatus: ISSUED
Applie ]: 12/2H/Yr;
Apr/Issue: 12/28;qs
Entel•?<) Bv: RMA
619-729-U9bl
Description: REPLA(E GAS LINE
Appl/Ownr CHUt_'K' S PLUMBING
J8UU WESTHAVEN DR
CARLSBAD , CA 92008
Fees Required
Fees :
Ad7ustments:
Total Fees :
Enter "Y" foi Plumbing
Gas Piping System
* PLUMBING TOTAL
> >
Fees Collected & Credits
TJ its:
Tota _ ntc :
Balance Due:
e/Unit
.uu
.LO
27 .0U
Ext fee Data
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7. U fl
27, l)lJ
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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION PI.AN OIBCI< NO.
City of Carlsbad Building Departaent
2075'Las Pal-Dr., Carlsbad, CA 92009 (619) 438·1161
i. PERMJ'i IYPE
From Lise I (see back) give code of Pennie-Type: ____________ _
---------------------------------· ................................. .
For Residential Projects Only: From List 2 (see back) give
Code of Structure-Type: _____________________ _
Nee l.Dss/Gain of Dwelling Units __________________ _
2. PROJECT fNFORMATION
Address
FOR OFFICE USE ONLY
Building or Sune No.
nt[ o.
CHECK BEWW IF S0BMI I i Eb:
□ 2 Energy Cales □ 2 Strucrural Cales □ 2 Soils Repon □ I Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROPOSED USE
# OF BEDROOMS # OF BATIIROOMS 1 1 eren rom app 1can
NAME (last name first) /3 .A-/{ 0 f.) C O £11/ [1(JRESS
CITY STATE ZIP CODE DAY TELEPHONE
4. APPUCANI OcONIRACIOR DAGEN! FORcONIRAclOR D OWNER OAC£NI FOROWN£R
NAME (last name first) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE s. PROPER'IY dWNER
NAME (last name first) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
6. CiJN"l'RAC'ioR /) / ,.. r?J -I
NAME (las[ name first) vn r..) C KJ r l vvY'l 6, 'i./c ADDRESS 3? {;) 0 t..v.e.5:>rs,, trt/4-..,./ P-e'.
C1TYC,19-/ll<56',9-J:? STATE~ ZIPCODE '.7..200.P DAY TELEPHONE &19 7,29_ot7 t;
ucENsE cIASst'.1-i:k: ... c1TY Bus1NEss uc. # .:Y?t/oD STATE UC.#
asc name 1rsc
CITY STATE ZIP CODE DAY TELEPHONE STATE UC. # 1. WORICERS' CiJMPENSAliON
Workers' Compensation Oeclarauon: I hereby allinn that I have a ceruhcate of consent to sell-insure issued by the Director of lndustnal
Relations, or a cenificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplica_!!i tl);~f cenified
by the Director of the insurer thereof filed with the Building Inspection Depanment (Section 3800, Lab. C). M/'r~ ve__p
.,-
so as to become subject to the Workers' Compensation laws of California.
SIGNATURE DATE
A. dWNEk-80llDER OfilXRAl1bN
Owner-Builder Declaration: I hereby afhnn that I am exempt from the Contracfo?s License Law for the following reason:
□ I, as owner of the propeny or my employees with wages as their sole compensation, will do the work and the strucrure 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 propeny 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.).
□ 1, as owner of the propeny, 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 propeny who builds or improves thereon, and contracts for such projects
with contractor(s) licensed pur..uant 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 pennit to construct, alter, improve, demolish, or repair
any strucrure, prior to its issuance, also requires the applicant for such pennit 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 DAIB
COMPLETE tAIS SECTION FOR NoN-RESIDEN liAt BuitblNC PERM! IS oNLV:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn or risk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Accounc Act? □ YES □ NO
Is the applicant or future building occupant required to obtain a permit 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 TIIE ANSWERS ARE YES, A FINAL CERTIFICAIB OF CXDJPANCY MAY NOT BE~ AYl'ER JULY I, 1989 UNLESS THE APPLICANT
HAS MET OR IS MEETING THE RF.QUIR.EMENiS OF nm ornCE OF EMERGENCY SERVICES AND THE AIR POLLUTION OONTROL DISTRICT.
9. CDNS 11t0Ci1ON LENDING AGENCY
I hereby alhnn that there 1s a construcuon lending agency tor the performance of the work tor which this penn1c ts ISSued (Sec 3097(1) C1VJI Code).
LENDER'S NAME LENDER'S ADDRESS
lo. APPUCAN l CERl1FICAl10N
I cen1fy that I have read the apphcauon a nd state that the above inlonnauon 1s correct. 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 propeny for inspection
purposes. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLF.SS TIIE CTIY OF CARLSBAD AGAINST All. LIABILITIES, JUDGMENTS, CDSTS
AND EXPENSES WlllOI MAY IN ANY WAY MX:RUE AGAINST SAID crrv IN OONSF.QUENCE OF THE GRANTING OF nns PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
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TIKI AJUlIVS: _____ TIXI t.ZAVS: ____ _
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PDIIJ:fl
t/15/19
OUatIPrION
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ACT C:ONNEMTS 107: zf L a--J------
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