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Home My WebLink About1022 DAISY AVE; ; CB991634; Permit04/29/1999 City of Carlsbad Plumbing Permit Permit No CB991634 Building Inspection Request Line (760) 438-3101 Job Address Permit Type Parcel No Reference # Project Title 1022 DAISY AVCBAD PLUM 2144022000 Lot# Construction Type GAS LINE TO KIT RANGE 0 NEW Status ISSUED Applied 04/29/1999 Entered By JM Plan Approved 04/29/1999 Issued 04/29/1999 Inspect Area Applicant KMP PLUMBING 435 S CEDROS SOLANA BEACH CA 92075 619-259-9300 Owner 9150 04/29/9? 0001 01 KOSTECKI THOMAS W EST OF C-PRMT 1022 DAISY AVE CARLSBAD CA 92009 02 27-00 Total Fees $2700 Total Payments To Date $000 Balance Due $2700 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Dram Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee 0 0 0 0 0 1 0 $2000 $000 $000 $000 $000 $000 $700 $000 $000 $000 $000 TOTAL PERMIT FEES $2700 Inspector FINAL APPROVAL Dat 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 "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 capactiy 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 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760)438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr, Carlsbad CA 92009 (760)438-1161 1 PROJECT INFORMATION 21;, FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite tt)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units Assessor's Parcel #Existing Use Proposed Use Description of Work \C_OU i? CONTACT PJRSOfN (if different from applicant) SQ FT #of Stories 1 tt of Bedrooms # of Bathrooms Name Address LOrJjiffQlAgent for Contractor Dj3wrier,. City I Agent ' fqr"0wner,., State/Zip Telephone # Fax # Name PROPERTY (OWNER; Address City State/Zip^js,, Telephone* Name City State/i'Zjc Telephone (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]) Name State License tt Address License Class City State/Zip Telephone # City Business License # fa lO")O "?QQ Designer Name Address City State/Zip Telephone State License # 6.7'... WORKERSfcCOMRENSATIONii,,,. 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 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 J!jD <— U-J _ Policy No U?S^Moj-V\\ "1 M Expiration Date \t>-^-°V°l (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 Workeos Compensation Laws of California WARNING Failure to secure nomers compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred dition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney s fees DATE thousand dollars ($100,000), SIGNATURE N/ J ' OWNER-BUILDER I hereby affirm that I am/ex«ypt from the Contractor's License Law for the following reason 0 I as owner of life' 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, Busmess\ajja 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) l~l 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) [~l 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 Q 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 !.CpMPLjCTE;THIS'SECTlbN'''ro^ -;:.;. 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 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? l~l YES l~l NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site' l~l YES l~l 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 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 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 CitV 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 for evclkvations over 5'0" deep and demolition or construction of structures over 3 stories in height EXPIRATION Every permit issued by • work authorized by such permit is noty or abandoned at any time after the.wg uilding Official under the provisions of this Code shall expire by limitation and become null and void if the building or ienced withirT365 days from the date of such permit or if the building or work authorized by such permit is suspended commenced for a period of 1 80 days (Section 10644 Uniform Building Code) APPLICANT'S SIGNATURE WHITE File YELLOW Applicant PINK Finance DATE City of Carlsbad Inspection Request For 4/30/99 Permit# CB991634 Title GAS LINE TO KIT RANGE Description Inspector Assignment Type PLUM Sub Type Job Address 1022 DAISY AV Suite Lot 0 Location APPLICANT KMP PLUMBING Owner KOSTECKI THOMAS W EST OF Remarks 1022 DAISY AV Phone Inspector Total Time CD Description 23 Gas/Test/Repairs 29 Final Plumbing Act Comments frP Requested By N/A Entered By ROBIN AP Inspection History Date Description Act Insp Comments