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Home My WebLink About2173 VISTA LA NISA; ; CB163738; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 10-03-2016 Permit No: CB163738 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: 2173 VISTA LA NISA CBAD PME 2552620600 Status: Lot#: 0 Applied: Entered By: Plan Approved: Issued: Inspect Area: Project Title: LAKS: REPLACE GAS LINE TO BBQ Applicant: DQ PLUMBING 1171 SYMPHONY PL ESCONDIDO CA 92029 760-877-4944 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Owner: ROBBINS TOM&MEGAN 5580 LA JOLLA BL VD #446 LA JOLLA CA 92037 ISSUED 10/03/2016 SLE 10/03/2016 10/03/2016 $163.00 $0.00 $0.00 $0.00 $163.00 Total Fees: $163.00 Total Payments To Date: $163.00 Balance Due: Inspector. Date: Clearance: NOTICE: Please take at approval of your project includes the "Im sition' $0.00 referred to as 'fees/exac ons.' ou have 90 days from the date this permit was issu 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 n f w i h v r vi I iv n N T imil r hi whi h h f limi i n h I THE FOLLOWIN~ APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH 0HAZMAT/APCD Plan Check No. Est. Value Plan Ck. Deposit C cicyof Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Dat SWPPP JOB ADDRESS 1, CT/PROJECT# LOT# PHASE# # OF UNITS DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) PJLc G-i..s A5 I:_/ Lu \ -EXISTING USE PROPOSED USE SUITEI/SPACEI/UNITI # BATHROOMS ,.., GARAGE (SF) PATIOS (SF) TENANT BUSINESS NAME DECKS (SF) FIREPLACE YES[]#_ Nc0 CONSTR. TYPE acc. GROUP AIR CONDITIONING m O NoD FIRE SPRINKLERS YES□No□ APPLICANT NAME Primary Contact PROPERTY OWNER~~) A f\ LAk,J ADDRESS LA CITY STATE ZIP PHONE FAX FAX EMAIL EMAIL DESIGN PROFESSIONAL ADDRESS CITY STATE ZIP PHONE FAX EMAIL EMAIL \..A.,~ <..-4 STATE UC.# (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 {hat 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)). Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: ~e 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 . .k:::'.J I have and will maintain workers' compe'.!;,8tion, as required by $~ion 3700 of the Labor Code, for the performance of the wo1 for which this permit is issued. My workers' compensation insurilflC{l ca_rrier_and polic number are: Insurance Co~ LIi LQG)j ~ ZJ0!,§>s;,.S~ 1 os~olicy No. ,5 w" \ \ e,) eye;;, Lt Expiration Date ..-\ ' l.-<::J ( ~ section need not be completed tt the permit is for one hundred dollars ($100) or less. LJ Certificate of Exemption: I certify that in the rmance of the for which I • rmit 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 ers' ompensa • verage nlawful, 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, d es provid or· Sec • 'nterest and attorney's fees. Ji:S CONTRACTOR SIGNATURE I hereby affirm that I am exempt from Contractor's Ucense 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 tor 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 Contractors 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. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 Yes 0No 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 I phone I contractors' license number): 4. I plan to provide portions of lhe work, but I have hired the following person to coordinate, supervise and provide the major work (include name/ address / phone I 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 I address I phone I type ot work): Ji:S PROPERTY OWNER SIGNATURE □AGENT DATE Is tile 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 Acf? • 0 Yes O No Is tile applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management districf? 0 Yes O No Is tile facility to be constructed within 1,000 feet of the outer boundary of a school site? a 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 AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affinn that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address I certify that I have read the application and state that the above information is oorrectand that the information on the plans is accurate. I agree to oomplyv.ith all City ordinances and State law.; relating to buildingoonstruction. I hereby aulhorize representative of the Cityof Car1sbad to enter UJXJ11 the alxlve mentioned property for inspedion purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLS(W) AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CITY IN CONSEOJENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0' deep and demoliton Of oonstrudioo of slruetures over 3 stories n height. EXPIRATION: Every permit issued by the Buildi Offcial under the provisons of lhis Code shall expire by limitation and becOfne null and voi:l ~ the buikling Of v.or1I aulhorized by such permit is not commenced v.ithin 180days from lhe date of such permit Of· r g Of v.oril autho • rmit is suspended Of abardoned at any time after the v.or1I is oommenced for a period of 180days (Seeton 100.4.4 Uniform Building Code). ,@S' APPLICANT'S SIGNAT E DATE / c) r' ~ ..--C STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CONTACT NAME ADDRESS CITY STATE PHONE FAX EMAIL DELIVERY OPTIONS PICK UP: o CONTACT (Listed above) o OCCUPANT (Listed above) □ CONTRACTOR (On Pg. 1) MAIL TO: a CONTACT (Listed above) a OCCUPANT (Listed above) □ CONTRACTOR (On Pg. 1) ZIP MAIL/ FAX TO OTHER: _________________ _ ,.15 APPLICANT'S SIGNATURE CO#: (Office Use Only) OCCUPANT NAME BUILDING ADDRESS CITY STATE Carlsbad CA OCCUPANT'S BUS. UC. No. o ASSOCIATED CB#------------ □ NO CHANGE IN USE/ NO CONSTRUCTION o CHANGE OF USE/ NO CONSTRUCTION DATE ZIP Inspection List Permit#: CB163738 Type: PME Date Inspection Item 10/06/2016 29 Final Plumbing 10/05/2016 23 GasrTest/Repairs Thursday, October 20, 2016 LAKS: REPLACE GAS LINE TO BBQ Inspector Act Comments PY AP MC AP HOUSE STUB TO BBQ. Page 1 of 1