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HomeMy WebLinkAbout1328 CASSINS ST; ; CB973271; PermitPermit No: CB973271 Project No: A97Q4211 Development No: BUILDING PERMIT 10/29/97 10:33 Page 1 of 1 Job Address: 1328 CASSINS ST Suite: Permit Type: PLUMBING Parcel No: 215-690-37-00 Lot#: Valuation: 0 Construction Type: VN Occupancy Group: Referenced: Status: ISSUED Description: INSTALL GAS LINE FOR B-B-QUE 0817 10/2^ : AND ELECTRIC LINES FOR LAMP AND FOUNTAIN Apr/I Entered By: MDP Appl/Ownr : DARK, MONA 760 931-0814 1328 CASSINS STREET CARLSBAD, CA. 92009 *** Fees Required *** *** " f*©&s Collected & Credits *** Fees: 47.00 Adjustments: ,00 Total Fees: 47,00 Fee description Enter "Y" for Plumbing Issue Fee > Gas Piping System > Other > Total Credits : Total Payments: Balance Dues Units Fee/Unit 1 7 , 00 20 . 00 . 00 . 00 47. 00 Ext fee 20.00 7. 00 20.00 Data Y ELEC 47. 00 PERMIT «WH/filDraED IN ACCORDANCE WITH UftC, .SIGNATURE. FiiJAL APPROVAL _DATE__ CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 1. PROJECT INFORMATION W2X CA&tN* FOR OFFICE USE ONLY PLAN CHECK NQ. &T\ ~ "b ' \ EST. VAL. Plan Ck. Deposit. Validated By Date Mr Description of WorkO 2. CONTACT PERSON (W OW kj^% Neme S3." APPLICANT Addran City | Contractor Q Agent for Contractor >1^6wfw * Q Agart fw Owner State/Zip Telephone *Fax * Name ,4. PROPERTY OWNER 4L Address City State/Zip Telephone » Address Citv State/Zip Telephone *Name fi. ' CONTRACTOR - COMPANY NAME ' ~ —,-—--,- —r -<->—w -—-;r-,™-;^- ~,.^ -r---r.- • ^.n-~r^ • • --:;--^ --;---; - • r* •-T^—«- - - - - (Sec. 7031.5 Business and Professions Code: Any City or County which requires e permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to We a signed siaiement 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 end Professions Code) or that he is exempt therefrom, end the basis for the alleged exemption. Any violation of Section 7031.5 by eny applicant for e permit subject* the applicant to a crvil penalty of not more than five hundred dollars (*5001). Name State License * Address License Class City State/Zip City Business Licence * Telephone f Address City State/Zip TelephoneDesigner Name State License t 6. ' WORKERS' COMPENSATION ' "" " •;•"--—;"- " 'rr~-r~"f'~^^,r^"- IC'^'^Z'"-':'V - •,"': : • " : • "*":"• ' • ' Workers' Compensation Declaration: I hereby efftrm under penalty of perjury one of the following declarations: Q I have and will maintain a certificate of consent to self-Insure for worker*' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. D I have and will maintain workers' compensation, aa 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 ; PoHcy No. Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100) OR LESS) D CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shell not employ eny person in any manner so as to become subject to the Workers' Compensation Lews of California. WARNING: Failure to secure workers' compensation coverage h unlawful, and anal subject an employer to criminal penalties and chrl fines up to on* hundred thousand dollar* 1*100.000). hi eddWon to the coat of compensetion, damages aa provided for In Section 3706 of the Labor code. Interest and attorney's tee*. SIGNATURE DATE 7. OWNER-BUILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License Law for the following reason: j£ I, as owner of the property or my employees with wages as their sote compensation, win do the work and the structure Is not intended or offered tor sale ISec. 7044, Business and Professions Code: The Contractor's License Lew does not apply to an owner of property who buHds or Improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not Intended or offered tor sale. If, however, the building or improvement Is sold within one veer of completion, the owner-builder will have the burden of proving that he did not build or Improve tor the purpose of sale). D I, •» owner of the property, am exclusively contracting with licensed contractor* to construct the project (Sec. 7044, Business Mid Profession* Code:The Contractor's License Law does not apply to an owner of property who buHdk or improves thereon, and contract* for auch project* with contractor!*) licensed pursuant to the Contractor's License Lew). Q I am exempt under Section Business end Profession* Code for this reason: j 1. I personally plan to provide the major labor and material* tor construction of the proposed property improvement. Q YES QNO 2. I (have / have not) signed en 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 / contractor* 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 person* to provide the work hvtceted (include name / address / phone number / type of work): .* ^PROPERTY OWNER SIGNATURE J/LfrllsU -fT > •COMPLETE THIS SECTION FOR MMMffSbTfiVnU BUILDING PERMITS W«.Y Is the applicant or future building occupant required to submit a business plan, acutely registration D YES form or risk management and prevention Q NO D YES D NO program under Sections 25505, 25533 or 25534 of the Presley-Tenner Hazardous Substance Account Act? Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES D NO IF ANY OF THE ANSWERS ARE YES. A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. SB." CONStRUCTiONLENWNG AGENCY T';'';;—~*rr:^-°^^^ .,- ••- - •- . 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 APPLICANTfS. I certify that I have reed the application and state that the above Information I* correct and that the information on the plena is accurate. I agree to comply with ell City ordinances and State lews relating to buHding construction. I hereby authorize representatives of the City of Carfsbed 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 BuHding Official under the provisions of this Code shell expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the buHding or work authorized by such permit is suspended or abandoned et any time efteithe work Is commenced fwsa period of 180 days (Section 106.4.4 Uniform Building Code). . ^APPLICANT'S SIGNATURE 'lArK^^ (/- A/^-*"HC DATE ' °/1 WHITE: File YELLOW: Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB973271 FOR 11/05/97 DESCRIPTION: INSTALL GAS LINE FOR B-B-QUE AND ELECTRIC LINES FOR LAMP AND FOUNTAIN TYPE: PLUM JOB ADDRESS: 1328 CASSINS ST STE: INSPECTOR AREA PD PLANCK* CB973271 OCC 6RP CONSTR. TYPE VN LOT: APPLICANT: DARK, MONA CONTRACTOR: OWNER: REMARKS: C/MONA/931-0814 SPECIAL INSTRUCT: PHONE: PHONE: PHONE: 760 931-0814 INSPECTO: TOTAL TIME: CD LVL DESCRIPTION 23 PL Gas/Test/Repairs ACT COMMENTS ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP COMMENTS 103097 Underground/Conduit-Wiring AP PD 103097 Underground/Under Floor PA PD TEST GAS