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Home My WebLink About2177 VISTA LA NISA; ; CB053416; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 09-2f5-2005 Plumbing Permit Permit No: CB053416 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: Applicant: 2177 VISTA LA NISA CBAD PLUM 2552620500 Lot #: 0 Construction Type: NEW FORSYTHE RES GAS&ELEC TO BBQ GAS TO FRPLCE(UNDR 6FT) ELEC/FNTN&FUTRE LGHTS Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: FORSYTHE DAVID D&VANESSA P FORSYTHE DAVID D&VANESSA P 2177 VISTA LA NISA CARLSBAD CA 92009 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees TOTAL PERMIT FEES 0 0 0 0 0 1 0 2177 VISTA LA NISA CARLSBAD CA 92009 ISSUED 09/28/2005 KG 09/28/2005 09/28/2005 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $20.00 $0.00 $0.00 $0.00 $47.00 Total Fees: $47.00 Total Payments To Date: $47.00 Balance Due: AL Inspector: Date: Clearance: $0.00 NOTICE: Please take NOTICE that approval of your project includes the "lmpo ition' 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 i h h V • I whi h rm· • h rw' FOR OFFICE USE O~Jf PLAN CHECK NO. C.toX3 '/If? PERMIT APPLICATION EST. VAL. _________ _ Plan Ck. Deposit------,,,...------ CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad CA 92008 :1. PROJECT INFORM (_R..€5 I Qe"Nc..€) OAV€ :L. 17 7 \/ I ,S TI\ Address (include Bldg/Suite#) Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Assessor's Parcel # Existing Use Proposed Use SQ. FT. # of Stories # of Bedrooms Total# of units # of Bathrooms Description of Work 2. CO ACT If different from •P.Rllcant) JJ,)C, G»-S LINE'S FoR.. fi3Q,Ft_f2.EPLAC~~t:;L£Cr{2.,~ ft i)j) l.,IC.Hr> i,W f='t.1!,-r,AlG, Pltno Cov~ Name Address City State/Zip Telephone # Fax# Telephone# Name Address City State/Zip Telephone# 5. co R • COMPANY NAM (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$500]). Name Address City State/Zip Telephone# State License# _________ _ License Class ___________ _ City Business License# ___________ _ Designer Name Address City State/Zip Telephone# State License# ________ _ 11. WORKER'S COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: □ 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. □ I have and will maintain worker's 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) □ 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 are provided for In Section 3706 of the Labor Code, interest and attorney's fees. SIGNATURE DATE 7. OWNER;eUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: □ I, as owner of the property or my employees with wages as their sole compensation, will d 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). "'ji. 1, 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: 1. 2. fJ 4. I personally plan to provide the major labor and materials for construction of the proposed property improvement. □ YES □ NO I (have/have not) signed an application for a building permit for the proposed work. I . . . . /ontractors license number): -----::=:--------------,=------------------------------- 5. I will provide some of the work, bu rovide the work indicated (include name/ address / phone number/ type of work): WHITE: File PINK: Finance • PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad CA 92008 Page 2 of 2 L Is the applicant or future building occupant required to submn a business plan, acutely hazardous materials registration for 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 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 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. 8. CONSTRUCTION U!NDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME f}/A-LENDER'S ADDRESS ____________________ _ 9 i>UCANTC 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, JUDGEMENTS, 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 of 5'0' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permn issued by the building Official under the provisions of this Code shall expire by limitation and become null and void ~ the building or work authorized by such permn is not commenced within 180 days from the date of such rmit or if the building or work authorized by such permn is suspended or abandoned at any time after the work is commenced for a p 180 da: (Se~106.4.4 n~ Bu, • Code). APPLICANT'S SIGNATURE ---'~~=~::....:._\J_.::::_..2:==~::_..::s;:=--+----------DATE _______________ _ WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 12/01/2005 Permit# CB053416 Inspector Assignment: JM --- Title: FORSYTHE RES GAS&ELEC TO BBQ Description: GAS TO FRPLCE(UNDR 6FT) ELEC/FNTN&FUTRE LGHTS Type: PLUM Sub Type: Job Address: Suite: Location: 2177 VISTA LA NISA Lot 0 APPLICANT FORSYTHE DAVID D&VANESSA P Owner: FORSYTHE DAVID D&VANESSA P Remarks: Total Time: Phone: 8584499991 Inspector: ---- Requested By: DAVE Entered By: CHRISTINE CD Description Act Comment 29 Final Plumbing ~-------------- ------------ Comments/Notices/Hold Associated PCRs/CVs lnsi;1ection Histo[Y Date Description Act lnsp Comments 10/27/2005 21 Underground/Under Floor WC JM 10/27/2005 23 Gas/TesVRepairs PA JM AIR TEST BBQ/FP < 6FT 10/27/2005 31 Underground/Conduit-Wiring PA JM