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HomeMy WebLinkAbout1144 PINE AVE; ; 70-832; PermitPLUMBING PERMIT APPLICATION PEEMIT «7/)- City of CARLSBAD, CALIFORNIA Applicant to complete numbered spaces only. 2 kick JOI ADDR CSS .LK9AL 1 0C8CR. d \9t.t ATTACHED aHCET) WHEJL 3^ MAIL ADDREgf . IIP /o7/) l/idi ^ MAIL ADDRESSCONTR^TOR ' / ^ (jLtiCn ^ ^ LICENSE NO. ARCHITECT OR DCSIONER MAIL ADDRESS LICENSE NO. ENGINEER MAIL ADDRESS LICENSE NO. MAIL ADDRESS USE or BUILDING 8 Clan of work: □ NEW ALTERATION □ REPAIR 9 Describe work: PERMIT FEES No.Type of Fixture or Item Fee SPECIAL CONDITIONS:WATER CLOSET (TOILET) BATHTUB LAVATORY (WASH BASIN) SHOWER KITCHEN SINK & DISP. DISHWASHER APPLICATION ACCEPTED BY:PLANS CHECKED BY;LAUNDRY TRAY CLOTHES WASHER WATER HEATER NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM MENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THISAPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEDHEREIN OR NOT. THE QFIANTING OF A PERMIT DOES NOTPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THEPROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. URINAL DRINKING FOUNTAIN FLOOR—SINK OR DRAIN SLOP SINK GAS SYSTEMS: NO. OUTLETS WATER PIPING A TREATING EQUIP. WASTE INTERCEPTOR VACUUM BREAKERS LAWN SPRINKLER SYSTEM SEWER CESSPOOL SEPTIC TANK & PIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) SIBNATURE OP OWNER (IF OWWtK »U rT PERMIT TOTAL FEE 'K do WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK.M.O.CASH PERMIT VALIDATION CK.M.O.CASH Form 100.2 9-«9 INSPECTOR HCORDIR FROM! INTERNATIONAL CONFERENCE OF BUILDING OFFICIALS • 50 SO. LOS ROBLES • PASADENA. CALIFORNIA 91101 CITY OF CARLSBM BUILDING DEPARTMENT SEWER PERMIT - APPLICATION FOR APPLICANT TO FILL IN LEGAL DESCRIPTION BLOCK TRACT USE OF BUILDINGS CONTRACTOR ADDRESS TEL. NO. CONTflACTOR-S STATE LICENSE NO. CARLSBAD BUSINESS LICENSE NO. I HAVE At this DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER. SIGNED THIS OWNER OR OWNER'S AGENT • ADDRESS DAY OF . 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFT THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS BAD AND STATE OF CALIFORNIA QR THAT I AM TH^ LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP ERTY. SIGNATURE OF PERMITTEE BUILDING ADDRESS NEAREST CROSS ST. OWNER MAIL ADDRESS CITY TEL, NO. NO.DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 SEPTIC TANK, SEEPAGE PIT OR PITS O $S.OO OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN., CESSPOOL, DRYWELL, MANHOLE © $B 00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM © $I.BO CONNECT ADDITIONAL BLDG, OR WORK TO HOUSE SEWER © $1,50 ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM © $2,00 © s OWNER'S AUTHORIZATION PERMIT $2 CX3 TOTAL FEE CONNECTION DATALateral Charge Computation @ 4" = 6" = @ 4" = 6" = @ 4" = 6' 30' H.. 10' V. Add. Horiz, Add. Vert. 10% Service Charge Lat. No.: Total Confftrucflon Cost Total Lateral Charge Logged in Plat: LINE COST DATA A. D. & Assmt. No. LINE COST: C. C. / dwelling P. S. @ / dwelling OTHER TOTAL Grand Total. Lateral, etc. FOR SEWER LOCATION St.north ENGINEERING SEWER DEPT. Signed Signed Thlt b a Sewer Permit When Properly Filled Out, Signed and Validated luued By . PERMIT VALIDATION