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Home My WebLink About2258 VISTA LA NISA; ; CB984158; Permit11/3()/98 11:58 Page 1 of 1 B U I L D I N G P E R M I T Job Address: 2258 VISTA LA NISA Suite: Permit Type: PLUMBING Parcel No: 255-270-08-00 Lot#: Valuation: U Occupancy Group: Reference#: Description: GAS LINE TO FIREPIT AND FUTURE : BBG Permit No: CB98415B Project No: A9b05398 Development Nc1: Construction Type: NEW Status: ISSUED Applied: 11/30/98 Apr/Issue: 11/30/98 Entered By: BT Appl/Ownr : LISA HACKMAN 436-7309 2258 VISTA LA NISA CARLSBAD CA 92U09 Fees Required le le}< Collected & Credits Fees: Adjustments: Total Fees: Fee description Enter "Y" for P l.u Gas Piping System FINAL INSP. j CLEARANCE _______ _ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 0001 01 02 C--PRMT • 0 0 27 .oo .uo 27.00 Ext fee Data 20.UO Y 7.00 PERMIT APPLICATION FOR OFFICE USE ONLY ) PLAN CHECK NO. q <Zif; 5 Q CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 EST.VAL·--------~-+/ Plan Ck. Deposit _ __, __ ::.._ __ .....__ (760) 438-1161 Validated By ___ +-6!::--'---,---r--- Date _____ ---1-1--1--.-~-+-.---- 1. PRo.iECT INFORMATION ~ zz s:x: V', sfa la Alisa Address (include Bldg/Suite I) CCYr:h6a d Cli-9rltk22 Busineu Marna let this addreasl Legal Description Lot No. Subdivision N1rne/Number Unit No. Ph■se No. Total I of units Assessor" s Parcel I 6as 1/;1 rMt. -Iv., r,(; Description of Work 2. CONTACT PERSON llf dlffe,ent from aj,pilcantl Name Addres■ City State/Zip Telephone I Fax I ,3. • APPLICANT O Contractor O Agent for Contractor O Own,; -• 0 Agint foi Owner •' ,: Name Addre,s City State/Zip Telephon& I 4. PROPERTY OWNER -'( .5co+t<+-usa,. Name /-ku:im!JM 2-2-~x V,sta ··;·;·;;~a-·· d~-,,-/£/~n~d Addrua City Ctl: StllelZlp 5 .• , CONTRACTOR. COMPANY NA;,U," -· .·-. ,-·.·· --.,, ••• (Sec. 7031.5 Business and Professions Code: Any City or County which requires I permit to construct, alter, irnprova, 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 tha Business and Professions Codel or that he Is exampt therefrom, and the basis for the alleged exemption. Anv violation of Section 7031.5 by 1ny applicant for a permit subjects the applicant to• civil penalty of not more than five hundred dollars ($5001). Name Address City Stata/Zip Telephone I State License , _________ _ License Cle11 _________ _ City Business License I _______ _ D!9aigner Name Address City State/Zip Telephone State License I _________ _ 6. 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' compenaation es provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 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 (t1001 OR LESSI 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is Issued, I ahall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to aecure workera' compenutlon covaflga la unlawful, 811d ahall aubject an employer to criminal penaltlea and clwll fines up to one hundred thousand dollar• (t100,0001, In addition to tha coat of compensation, damagea H provided for In Section 3706 of the labor code, lnter111t and attomey'a fe111. SIGNATURE _______________________________ DATE _________ _ ,,c 7. OWNER-BUILDER DECLARATION '····· •• , .• ,·•r , ••••• .. •• --:~•.,,:··•,v••~, .... ,:• ,,.•.r·-.r:T.r·,-;.;··•• •• •, ••• 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 es their sole compensation, will do the work and the structure la not intended or offered for sale (Sec. 7044, Busine■a and Professions Coda: The Contractor'• License Law does not apply to an owner of property who builds or Improves theraon, alld who does such work himself or through his own employees, provided that such Improvements ere not Intended or offered for Hie. If, however, the buildlng or lmprovemant 11 sold within one year of completion, the owner-build■r wlll hava the burden of proving that he did not build or lmprova for the purpose of aele). l[] I, es owner of the property, arn exclusively contracting with licensed contractors to construct the project (Sac. 7044, Business and Professions Code: The ttihtractor' s License Law does not apply to an ownar of property who builds or improv-■ theraon, and contracts for such projecta with contractor(1) llcanaed pursuant to the Contractor's License Law). • 0 I arn exempt under Section ______ Business and Professions Code for this reason: 1. I personally plen to provide the mejor lebor end materials for construction of the proposed property Improvement. 0 YES ~NO 2. I lhave / ~l signed en application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to rovlde the proposed construction (Include name / addr■ss / phone number / contractors licenH number): • (,I..(!_ - 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise Ind provide the major work (Include name / address / phone number/ contractors license number): _______________________________________________ _ Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials ragistratlon form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hez■rdous Substance Account Act7 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quellty management district? D YES D NO -• Is the facility to be constructed within 1,000 feet of the outer boundary of e achool 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 ANO 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 fSec. 3097(i) Civil Code). t certify that I have read the applicetion and state that the above information Is correct and that the Information on tha plans ia accurate. I agree to comply with ell City ordinances and Stele laws relating to building construction. I hereby authorize representatives of the Citt of C1rl1bed to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL UA81LITIES, 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 eKcavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Olficlel under the proviaions 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 365 days from tha date of such permit or If the building or work authorized by such permit is suspended or abandoned et eny tirne after the wo~ is comme ced for period of 180 days (Section 106.4 .4 Uniform Building Code). __P' • I ~ APPLICANT'S SIGNATURE /<., , DATE '<:: 7 J WHITE: File YELLOW: Applicant PINK: Finance PERMIT# CB984158 DESCRIPTION: GAS LINE TO BBG TYPE: PLUM CITY OF CARLSBAD INSPECTION REQUEST FOR 12/02/98 FIREPIT AND FUTURE JOB ADDRESS: 2258 VISTA LA NISA APPLICANT: LISA HACKMAN STE: PHONE: 436-7309 PHONE: CONTRACTOR: OWNER: REMARKS: C/LISA/436-7309 SPECIAL INSTRUCT: TOTAL TIME: CD 23 DATE LVL DESCRIPTION PL Gas/Test/Repairs DESCRIPTION PHONE: INSPECTOR ACT COMMENTS ***** INSPECTION HISTORY***** ACT INSP COMMENTS INSPECTOR AREA PLANCK# CB984158 OCC GRP CONSTR. TYPE NEW LOT: