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Home My WebLink About1003 DAISY AVE; ; CB050321; Permit02-02-2005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No CB050321 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 1003 DAISY AVCBAD PLUM 2144221100 Construction Type FITZGERALD RES REPLACE H2O HEATER Status Lot # 0 Applied NEW Entered By Plan Approved Issued Inspect Area ISSUED 02/01/2005 KG Applicant A&J FOSTER, INC STEB 13706HWY8BUS ELCAJONCA 92021 619-390 4477 Owner FITZGERALD THOMAS J&CAROL 1003 DAISY AVE 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 0 0 0 0 1 0 0 $2000 $000 $000 $000 $000 $700 $000 $000 $000 $000 $000 $000 TOTAL PERMIT FEES $2700 Total Fees $27 00 Total Payments To Date $0 00 Balance Due $2700 0924 02/02/05 0002 01 02 27.00 Inspector FINALA Date Clearance NOTICE Please take NOTICE that approval of your project includes the ImposYtion of fees dedications reservations or other exactions hereafter collectively referred to as lees/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 fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 1 PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit. Validated By Date 1003 DAISY AVEAddress (include Bldg/Suite If)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units 214-422-11-00 Assessor s Parcel #Existing Use Proposed Use Replace Water Heater Description of Work 2 CONTACT PERSON (if different from applicant) A ft. I Foster I nr 137nfi SO FT ft of Stones # of Bedrooms # of Bathrooms 8 Bus # B El Cajon, Ca 92021 (619)390-4477'Zip Telephone ffName Address City 3 APPLICANT D Contractor D Agent for Contractor D Owner ' Q-Agent for.Owner A A .I F"ct°r In1' 13706 Highway 8 Bus # B El State/Fax ff Highway i ICajon, 03^2021 (619)390 W77ix TelephoneName Address 4 PROPERTY OWNER ! i FITZfiERAIT) THOMAS mm r»A|SY A\/F State/Zip elephone # rA»L«BAD <~A Q2™Q 760-438-1747AddressCityState/Zip Telephone #Name 5 CONTRACTOR - COMPANY NAME '' ': " , „ ' " * .. .„„ '""-J " "' ""'"' , , (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 [$500]) M & j rubiei moName State License ff fi3(")1?D Designer Name i o» i ugjjjTiunway o DUU # o e License Clas£_35 Address :i uajon, to^iw i State/z,P^ ' »J J^ieWe * City Business License ff 1210836 City State/Zip Telephone State License # 6 WORKERS COMPENSATION ,' < ;, ' f , [ ",","'" ' ,* Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations O 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 O 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 State Fund Policy No 1732576 04 Expiration 2/2/2005 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) n 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 addjiwrrioihe cost ofpompens^Han damages as provided for m Section 3706 of the Labor code interest and attorney s fees SIGNATURE /^^^^^^ /} r^'s"^^^'' DATE _ 7 OWNER BUILDER DECLARATION f '•. - . : v I hereby affirm that I am exempt from the Contractor s Ljjjense Law for the following reason [3 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) C] 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 f~l YES l""lNO 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 / phone number / contractors license number) 4 I plan to provide portions of the work but I have hired the following person to coordinate supervise and provide the major work (include name / address / phone number / 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 / address / phone number / type of work) PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NON RESIDENTIAL BUILDING PERMITS ONLY, ';:,,-! /: - " r. . ""."'S'' 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? O YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? l~l YES l~1 NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? l~l YES f~1 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 LENDING AGENCY • • ;; " , , : . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 30970) Civil Code) LENDER S NAME ; LENDER S ADDRESS 9 APPLICANT CERTIFICATION ;- " "" '... i i:i ' i, < : 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 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 forjexcavations over 5 0 deep and demolition or construction of structures over 3 stones in height EXPIRATfON Every permit issued by the building Official 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 not commenced withjruao days frjjm the date-pf'suclyjerrnit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenpeqforya APPLICANT S SIGNATURE rm Building Code) WHITE^Fi DATE FEB 0 2 File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 02/08/2005 Permit* CB050321 Title FITZGERALD RES REPLACE H20 Description HEATER Inspector Assignment Type PLUM Sub Type Job Address 1003 DAISY AV Suite Lot 0 Location APPLICANT A&J FOSTER, INC Owner FITZGERALD THOMAS J&CAROL Remarks Phone 7604381747 Inspector \]\A/V Total Time CD Description 25 Water Heater/Vents Act Comment Requested By TOM Entered By CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments COMPENSATION INSURANCE PO BOX 420807 SAN FRANCISCO CA 94142 0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICY NUMBER CERTIFICATE EXPIRES r L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer m We will also give you TEN days' aovance notice should this policy be cancelled prior to its normal expiration This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded by the policies listed herein Notwithstanding any requirement term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms exclusions and conditions of such policies AUTHORIZED REPRESENTATIVE1 E^PLCvEP'S LIA2Iu.I"/ ! PRESIDENT Ii4CLl?53. EuDuPSiMB^; ftcCE5, EH M LED CERTIFirP-E ^OLrEr !»A 07,54 IF "ThCH^D fin '^'D -"OT^tS A "'PFT up ''CM IC£ hi'L . , EMPLOYER r L