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Home My WebLink About1200 CARLSBAD VILLAGE DR; ; CB044172; Permit11-17-2004 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No CB044172 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 1200 CARLSBAD VILLAGE DR CBAD PLUM 1561803400 Lot# 0 Construction Type NEW Status ISSUED Applied 11/17/2004 RMA Applicant PIPES PLUMBING Entered By Plan Approved 11 /17/2004 Issued 11/17/2004 CARLSBAD CITY HALL-REPLACE GAS Inspect Area LINE FROM METER TO BOILER & H2O HEATER ON ROOF Owner CITY OF CARLSBAD SAN MARCOS CA 92069 760 434-3067 PUBLIC AGENCY 00000 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 , i < ' Master Drainage Fee ! Sewer Fee > , * Additional Fees " '^ •, '. \ TOTAL PERMIT FEES ' 0 '* o ,°-'.' ' , , -0 * / , , 0 1 _ " - '.. "" "0 - . "" r,~ " ~ *"" *--'"" x 4 V / 1 *• j* "" /r. y '**'', /' ' .V.' , /^ * ' > - „ s s , .;-% >^' "'i A f " ^ "' >- , -"*> . ', y " / s $20 00 'J - . , $0 oo " , ^ , , sx $000s :^ ,, $0 oo \ > $000 ^~ "-$000 ,. ^ ' * \'' $700 ( "^ ^ " $000 ', ' -$000 ' s . * S i ./ ? ' - i i , r - J '' ^- - $0 00 ' /-•""• -r * ' w" "$o oo / '\ C ', ! $000 ( ^ ( i- s ' • - -, / i- l ! ' y / / ^ ^/" $27 OO/ / f Total Fees $27 00 / Total Payments To Date'^$0 00 Balance Due $2700 AS EXPIRED IN ACCORDANCE WITH UAQ 106.4.4 - , - r 5695 11/17/04 0002 0.1 02 CGP 27. Inspector FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions' You have 90 days from the date this permit was issued to protest imposition of these fees/exactions If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a], and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will bar any subsequent legal action to attack review, set aside, void or annul their imposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any jees/exactions of which you have previously been given a NOTICE similarJo this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 I-UM Uhl-lUC Ubt UIVLY PLAN CHECK EST. VAL V/7£ Plan Ck Deposit Validated By, t Date LL Address (include Bldg/Suite #)Business Name {at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units # of Bathrooms mly" •aftsM~Ss3'ff.l <s^Vi^Mifl$ Name City State/Zip Telephone # Fax # Name Address City State/Zip 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 stoned 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 Arty 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 I $500]) ^y^xp-^nu.State1 Qcense-Tr /-trr Hf /- "> r J Address _ 7 7 /• License Uass (_ - t-' <^ City State/Zip Telephone # City Business License # / / Q ' fe </ 4* ? Designer Name State License # Address City State/Zip Telephone Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations Q 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 jbe 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 sued My worker's compensation insurance carrier and policy number are ^__^ Insurance Company Uv-^UV fc^f^e^JM, irJ^ C£? Policy No ,S ^ToC k(T? | - fc> Expiration Date **? (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100J OR LESS) C] 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 ForfUTa to aecure workert^compenBatloruooyerage l« unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dojlara ($100,000), in addition to the costVtcoTrmensation, damages as provided for in Section 3706 of the Labor code, Interest.and attorney's fees I hereby affirm that I am exempt from the Contractor's License Law for the following reason 0 I' *s 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) D 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) D 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 QNO 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 th& work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number) 6 I wiJI provide some of the work, but J have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work) PROPERTY OWNER SIGNATURE DATE 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 Act? - Q 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? D YES Q N° Is the facility to_be constructed withm 1 ,000 feet of the outer boundary of a school site? Q YES Q 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 3097(i) Civil Code) LENDER S ADDRESSLENDER'S NAME __ _ __ s&iiffiABISKAWJiTBC^IM^^ ' it i ^b>4#ti SS-tiffiffa." > il.^ ^^K&iT.s* 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 | 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 Qfftcl&l under4he provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is-noTComoienced withinXso days from tKedate of such permil or if the building or work authorized by such permit is suspended or abandoned at any time after the work is^omraejiced for a period of 180 days (SJKtfonJOS 4 4 Uniform Building Code) APPLICANT'S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 04/04/2005 Permit* CB044172 Title CARLSBAD CITY HALL-REPLACE GAS Description LINE FROM METER TO BOILER & H2O HEATER ON ROOF Inspector Assignment PC 1200 CARLSBAD VILLAGE DR Lot 0 Type PLUM Sub Type Job Address Suite Location OWNER CITY OF CARLSBAD Owner Remarks CAN YOU FINAL^ Phone Inspector Total Time CD Description 29 Final Plumbing Act Comment Requested By CHRISTINE Entered By CHRISTINE Associated PCRs/CVs Inspection History Date Description Act !nsp Comments 11/23/2004 23 Gas^est/Repairs PA PC GAS TEST OK WILL CALL FINAL WHEN COMPLETE ML 42222™ CERTIFICATE OF LIABILITY INSURANCE JUNZ404 »cWiS?SWESS INSURANCE SERVICES, INC, 14fl MARINE VfEWAVE, SWTE 119 SOLAN A BEACH CA «OT§ PHONE: ttt-UMNS FAX. flM-350-0536 Agsncv Uc* ODB6501 THIS CERTIFICATE IS (SSUfD AS A MATTER OP MFQftMATtON ONLY AND CONFERS NO RIGHTS UPON TMC CfelfflRCATSHOLctR. Tht» cesnrtCAre pocs NOT «E«O. OOEND CR ALTCT tME COVERAGE AFFORDED BV TtlEfOl.tClES BELOW INSURERS AFFORD1NO COVE RAGE INSURED PIPES PLUMBING, INC. 1145 LAW STREET SAN MARCOS CA 92963 INSURER A LWCOtNGENERAt INSURANCE CO. iNSURBIB- ZENFTH INSURANCE COMAPNY IN9JR9RC [NSLJR6RD | INSURER E COVERAGES THE KX.ICCS OF MSUftWCE UWEP eaOW tt*V£ We* IflSWfO TO TW WSt*S> WKED ABOVE FOfi TH£ «MCY*CWOO WMATHJ WTWrTHSftNftMO/WV REOUWBOT, TO* QH CONOffiO* Of AHV CONTRACT Oft OTHER DOCUMENT WITH ftESPECT TQWttCH TtH3 CERTIFICATE MA.V fl£ ISSUED ORHAY PCRTHH THE mSURMCEAFfaaBWttePOuQESeESCfUttD HEROES Sy&JKT TO ^TH£TK»re,£XCL\*plttJW,«WOiTlON90FSuCHPOUCK ACGREM1EUWTS &O*N MAY HAVE B^H REDUCE* ft PAH) OAWS. - ' ' v ' ^ v ~ ' ' POUCY NUMBER POUtfftfPtLtHt' 253TOTS07HJ JLfl. 105 EACHOCCUaRENCE, GEffl. AGeR&QATE UMlT APPUES PER. sa^oo VI i-A-V '10«ffl.M«- r- AfTKHIDBtLE UAOUTV {EflocddwO AUCWNEO AUTOS SCHHX1LCD AUTOS -ss*ii-J.!-l«a»£ (Par canen) ' WJTO ONUY - CA'ACCIDEMT ANY WTO i ^ ^ i- i ^ t \' -^ V*^ws QOCefiS * UM&fR&lA UABJUTV OCCUR QjftJUMSUMIE \_\ \ \ \ \ s v v ^ 1 !* '.l-l.T ?',M'A. ^l Jl'~*''^ S :>- RETEHT'OH t WOftKBtt COBPEhMTlON ANDEHPiaVEiar uAfturv 2048363302 DEC 3103 DEC 31 04 wvnMmOFWEWMMAl BCCUOeftTaoswTwe EA EL fflSEA6e-PQUCVljT3lf OTHER. DESCftlPTlOM OF OPEWTK)N&UX^TIO(WEH»CLE4«XCLUSIONS ADDED ENDORSEMENT/ SPECfAl PROMSKHG - • : . - - : CERTIFICATE HOLDER NAM£bA» ADOfTKJMAL INSURED WFTH ReSPECTSTOGEHERALLIABtUTY AS PER ATTACHED EWOOR3£¥EJfr. 1Q4WYNOTlCEpFCANCELLATlOHFQRNCW-PAyMEWTOFPREMtUM, ' '"*-*"-* L * RE PROJECT: CARLSBAO POLICE DEPT rc&pgff.•b-i-a ^ vo COY OF CARLSBAD4C5 OAK STREET: CARLSBAD, CA. 9200041)08 Anattfen SHEA 760-/20-«5« SHOULD M*V 0* TV€ A60VE OfiSCRffleD POUdES BE CAMCatEB BEFORE THEeC^IRAFOtl DATE THEREOF,1 THE teSutftfi COW*AWy MntXEACCAVORTO SWt^M s s *J»Y» wwnreH Nonce TO Tic^ceaTwjcATe HOLDER,!*!*^™ n« ts^r BUT aFA4JJRETQDb^at«Uiy«)SEWOBUOATlOHCrtlV«^iTVCFAMVraOTU^ST'-'ir * *\ AUTHORIZED RB^tESEHTATNE '-H SJ-ACORQ 25 (2001/OB)52S6 JUN-24-2004 04:24PM FAX:858 350 0556 ID: