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Home My WebLink About1050 PALM AVE; ; CB032361; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 08-25-2003 Plumbing Permit Permit No: CB032361 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: Applicant: 1050 PALM AV CBAD PLUM 2051900300 Lot#: 0 Construction Type: NEW DERRICK RES-CHANGE FROM SEPTIC TO CONNECT TO SEWER Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 08/25/2003 RMA 08/25/2003 08/25/2003 DERRICK TRUST 09-15-92 DERRICK TRUST 09-15-92 607 FREMONT ST UPLAND CA 91784 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 Total Fees: $4,595.00 Inspector: 0 1 0 0 0 0 0 607 FREMONT ST UPLAND CA 91784 Total Payments To Date: $0.00 $20.00 $0.00 $15.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4,560.00 $0.00 $4,595.00 Balance Due: $4,595.00 2678 )8/25/03 0002 Ol CGP Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reseivations, 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 f fih in NI 'rhir 'h Iii in lhi 02 4595,00 FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK No.Ci) rJj ::} 3 0 ( CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Plan Ck. Deposit---,,..--,---- Business Name (at this address) Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units ?·r•.P. S-J=-.D. Proposed Use 3 I #of Stories # of Bedrooms # of Bathrooms Name State/Zip Telephone# Fax# City State/Zip Telephone# & (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 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 ($5001). Name Address City State/Zip Telephone# State License # _________ _ license Class _________ _ City Business license # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 8. ytcmKERS' Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 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 w ork for which this permit Is Issued. 0 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______________________ Policy No._____________ Expiration Date. _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) 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 l aws of California. WARNING: Failure to secure worker•' compenaetlon coverage I■ unlawful, and ■hall subject an employer to criminal penaltiH and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of compensation, damage• H provided for In Section 3706 of the labor coda, Interest and attorney'• fees. SIGNATURE DATE OWNER· UI DER DECl.:Af!ATION --=::;;;:;;::::::::::::;:::;:;;:::;;;;;;;...,....,,_.,,.,...,...,,,,,.,..,.,. 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 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). 0 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(sl licensed pursuant to the Contractor's license law). ~ 1. 2. 3. I am exempt under Section ______ Business and Professions Code for this reason: I personally plan to provide the major labor and materials for construction of the proposed property improvement.JS. YES O N~ f(1iiiviiy have not) signed an application for a building permit for the proposed work. 1illrvl(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): ___________________________ ___, _____________________ _ 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):. ___________ _,,.,..,-,¥----,~--,,'--+----#'-------------------::,.,----,.,.---------------- DATE> 8 -ze;.0 3 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 26505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act7 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 feet of the outer boundary of a school site? 0 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. re. &9N.STRUCTION LENDIN_G AGENC'( I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). t!1., 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 Gitt 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 excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: 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 within 180 days from lhe dale of such permit or If the building or work authorized by such permit Is suspended or abandoned j t any tirr •'ter the work Is comm r period of 180 days (Section 106.4.4 Uniform Building Code). )/ . /. APPLICA SIGNATURE _ ___,,.!~~~~:e~::::________________ DATE JI 0 5 /~ 0 --'---,+----------- .WHITE: File YELLOW: Applicant PINK: Finance lnspectiQn List Permit#: CB032361 Date Inspection Item 0111012006 29 Final Plumbing 0812012004 24 RoughfTopout Wednesday, January 11, 2006 Type: PLUM Inspector Act PY Fl PY NR DERRICK RES-CHANGE FROM SEPTIC TO CONNECT TO SEWER Comments ok to final permit Page 1 of 1 ---~·· ----,----····-