HomeMy WebLinkAbout1014 LAGUNA DR; 03; CB044105; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
11-09-2004 Plumbing Permit Permit No: CB044105
Job Address:
Permit Type:
Parcel No:
Reference#:
Project Title:
Building Inspection Request Line (760) 602-2725
1014 LAGUNA DR CBAD St: 03
PLUM
Lot#: 0 15527220!3
Construction Type: NEW
RICHARDSON RESIDENCE
WATER HEATER REPLACEMENT
Owner:
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
11/09/2004
MOP
11/09/2004
11/09/2004
Applicant:
PACIFIC EXPRESS INSTALLATION KORNHER CLARA S LIVING TRUST 05-24-02
PO 4056
CARLSBAD 92018
760 421-0380
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
1
0
0
1014 LAGUNA DR #1
CARLSBAD CA 92008
$20.00
$0.00
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$27.00
Total Fees: $27.00 Total Payments To Date: $0.00 Balance Due:
l""'. _..,""~~ED· · P~~-M1·1 !'· ,.._. · ~,. · ·• ~tttl · e ,,,ii wli\ ·
PERl/:T H « S l"'"PIRED IN ACCORDANCE WITH U.B.C
SECTION 106.4.4
$27.00
D1JE sl s I or: ' .SIGNATIJRE ....... M=--5073 11/09/04 ~pl.1
Inspector:
FINAL APPROVAL
Date: Clearance:
NOTICE: Please take NOTICE that approval of your project includes the "Imposition~ of fees, dedications, reservations, or other exactions hereafter collectively
referred to as 'foes/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.
02 27,00
PERMIT APPLICATION
CtTY Of CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
Lot No. Subdivision Name/Number
Assessor's Parcel I Existing Use
Description of Work I, 0.., I ·v 11 ,.._ L. Vt/
mftlm'r~u~~
Name Address
C
Name Address
~~ Name
1M mwm
City
City
FOR OFFICE USE ONLY
' PLAN CHECK NO. ____ _
EST. VAL. __________ _
Plan Ck. Deposit _________ _
Validated By __________ _
Date ______________ _
Unit No. Phase No. Total II of units
Proposed Use
II of Bedrooms II of Bathrooms
State/Zip "Telephone II Fax II
'i
State/Zlp Telephone II
S.tate/Zlp Telephone II
(Sec. 7031.6 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
exempt" Any · latlon of Section 7031.5 by any applic nt f a rlJ!it subjects the ?fPlicant to a civil penal~ of n t more than five hundred doll s ($5001). {, -L PO 't>l~ u. 0 <!.,. '?20 ~ t/),1-0,.,7()
Name City State/Zip _Jelephone I
State Ll.cense II ?>dC..e2,5<J License Class 6 City Business License II i Ul/.'14,~
Address Designer Name
State License I
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Workers' Compensation Declaration:
City State/Zip Telephone
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 compensatio nsurance carri rand policy number are: L
Insurance Company · Policy No. 173 2Z/y-3 Expiration Date b _ 0~
(THIS SECTION NEED NOT BE COMPLE ED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS)
0 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: Fallura to aacura worker,• compan coverage 11 unlawful, and 1hall 1ubjact an employer to criminal peneltl111 and clvll fine■ up to one hundred
o of compan11tlon, damage, ea provided for In Section 3708 of the labor coda, Int eat and attorney'• feea.
DATE
' ·1 hereby affirm that I am exempt from th ontractor's License Law for the following reason:
O I, as owner of the property or my employ1111s· 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 employ1111s, 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 to~ the purpose of'sale) .
. 0 I, as owner of the property, am axclualvely contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Coda: The
Contractor'• 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).
0 I am exempt under Section ______ Business end Professions Code for this reason:
1. I personally plan to provide the major labor end materials for construction of the proposed property Improvement. 0 YES ONO
2. I (have / have not) signed an application for a bullc;llng 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 coordin■te, supervise and provide the major work (include name / address / phone number/ contractors llcenae number): ______________________________________________ _
6. 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):. ________________________________________________________ _
Is the applicant or future building occupant required to submit • business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 215505, 25533 or 2151534 of the Presley-Tanner Hazardous Substance Account Act? -0 YES O NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO
Is the facility to be constructed within 1,000 foot of tho outer boundary of a school site? 0 YES O NO
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
Mt~a<fAm.
I certify that I have read the application end 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 Citt of Carlsbad to enter upon the above mentioned
property for inspection purposH. 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 la required for axcavatlons over 6'0" deep and demolition or construction of structures over 3 stories In height.
EXPIRATION: Every permit Issued by t~e building Official under the provisions of this Code shall expire by limitation and become null and void If the building or wor1<
authorized by such permit Is not commenced within 180 days from the date of such permit or If the building or work authorized by such permit Is suspended or abandoned
at any time after the work Is commenced for a period of 180 days (Seclion 106.4.4 Uniform Building Code).
APPLICANT'S SIGNATURE __________________________ _ DATE ---------------
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