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HomeMy WebLinkAbout147 MAPLE AVE; MULTI-PERMIT FILE; CB111214; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 06-06-2011 Plumbing Permit Permit No: CB111214 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: 147 MAPLE AV CBAD PLUM 2042331800 Status: Lot#: 0 Applied: Construction Type: NEW Entered By: Reference #: PC#: Project Title: Applicant: ARS STEA 9895 OLSON DR HOLT RES PARTIAL KITCHEN REPIPE ONLY SAN DIEGO CA 92121 858 457 6557 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 0 0 0 1 0 0 0 Plan Approved: Owner: HOLT GINA D TR 147 MAPLE AVE CARLSBAD CA 92008 Issued: Inspect Area: ISSUED 06/06/2011 KG 06/06/2011 06/06/2011 $20.00 $0.00 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $65.00 $0.00 $0.00 $0.00 $92.00 Total Fees: $92.00 Total Payments To Date: $92.00 Balance Due: Inspector: Clearance: $0.00 NOTICE: Please take NOTICE that approval of your project incluOOs the "lrrposltion" 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 tees/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 fwhi h v r vi I n i n N Tl hi r whi h Ii • ~ { r!:, B \ _f\ld" 2) pp e <:ttuvA I~ t· ~' / Pl!/check No.Ct'///~/-u1 mg erm1 pp 1ca 10n 1635 Faraday Ave .. Carlsbad. CA 92008 Est. Value ~ CITY OF 760-602-2717 / 2718/ 2719 r---------------- CARLSBAD Fax: 760-602-8558 Date JOB ADDRESS SUITE!i' 1SPACEP 'UNIT# CT.·PROJECT 11 II OF UNITS # B OROOMS # BATHROOll,15 TENANT BUSINESS NAME CONSTR_ TYPE DCC. GROUP ··-\-c..h e i EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF1 I CONTACT NAME (If Different Fom App/leant) ADDRESS CITY PHONE 79 ARCH/DESIGNER NAME & ADDRESS STATE LIC. # STATE LIC # ~ (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 tne applicant for such per_mit to file a s1!,(ned statement that he 1s licensed pursuant to the prov1s1ons of the Contractor's License Law {Chapter 9, commending with Section 70_00 of D1vis1on 3 of the Business and Professions Code} or that he 1s e~empt therefrom, and the basis for the alleged exemption. Any v1olat1on 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}). I hereby affirm under penally of perjury one of the following declara/rons have and will maintain a certificate of consent to sell-insure for workers' compensation as provided by Section 3700 of lhe labor Code. for the performance of the work for which lhis permit 1s issued , , I have and will maintain workers\compen ation, as req ·red by Section 3700 of lhe labor Code, for the perlormance of the work fOf ~i~lhis permit is rssued. My workers' compensation in ranc carrier and policy numberare:lnsuranceCo, \__.~ r PolicyNo'l(o3l5~lo3 i a,o Expirat1onOate I ~ This section need not be completed 1f1he permit is for one hundred dol ars ($100) or less. 0 Certificate of Exemption: I certify that in lhe performance of lhe work for which this permit is issued, I shall not employ any person in any manner so as to become subJecl to the Workers· Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to crimlnal penalties and civil fines up to one hundred thousand dollars (& 100,000), in ages as provided for · ction 3"70"",.-,-"' I hereby affirm that I am exempt from Cor1tractor·s License Law for the following reason: :J I, as owner of the property or my employees with wages as their sole compensation. will do the work and the s1ruclure 1s not in1ended 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 lhereon, and who does such work himself or through his own employees, provided that such improvements are no1 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). ::J I, as owner of the property, am exclusively contracting with licensed contractors to conslruct 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 con1racts for such pro1ects with contractor(sl licensed pursuant to the Contractor's License Law). ::J I am exempt under Section ________ Business and Professions Code for this reason 1. I personally plan lo provide the major labor and ma1erials for construclmn of the proposed property improvement. ::J Yes ::J No 2. I (have / have not) signed an application for a building permit for the proposed work. 3 I have contracled wilh the following person (firm) to provide the proposed construction (include name address I phone I contractors' license number): 4 I plan 10 provide portions of the work, but I have hired the following person lo coordinate, supervise and provide the maJor work (include name I address ,' phone I contractors license number): 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work 1nd1cated (include name / address I phone I type of work): ,.a5 PROPERTY OWNER SIGNATURE □AGENT DATE · '1:a:araxm:tmmaml!tDttm~~ttfflCt:t'118■1W11 • [ Is the applicant or future building occupant required to submit a business plan. acutely hazardous materials registration form or nsk management and prevenlion program under Sections 25505. 25533 or 25534 of the , Presley-Tanner Hazardous Substance Account Act? ::J Yes ::J No :J Yes Cl No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? ::J Yes :J No I Is the applicant or future building occupant required to obtain a permit from the a,r pollu~on control district or air quality management d1st11ct? 1 IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR !S MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I certify that I have read the application and state that the above infonnation is correct and that the infonnation on the plans is accurate.! agree to comply with all City ordinances and State laws relating to building construction. l hereby authorize representative of lhe City of Carlsbad to enter upon lhe above menti:lned property for 1nspectKJn purposes. I ALSO AGREE TO SAVE. INDEMNIFY ANO 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: MOSHA permit is required for excavations over s·o· deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every pe!TTlit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if !he building or work aulhorlZed by such permit is not commenced within 180 days from !he date of such permit()( if lhe building or work authorized by such permit is pended or abandoned at any time after lhe work is commenced for a period of 180 days (Secti:ln 106.4.4 Uniform Building Code) _85 APPLICANT'S SIGNATURE DATE m -City of Carlsbad Bldg Inspection Request For 06/09/2011 Permit# CB111214 Title: HOLT RES PARTIAL KITCHEN Description: REPIPE ONLY Type:PLUM Sub Type: Job Address: 147 MAPLE AV Suite: Lot: Location: APPLICANT ARS Owner: Remarks: Total Time: 0 Act Comments Inspector Assignment: MC --- Phone: 8589676648 Requested By: BILL Entered By: CHRISTINE CD Description 29 Final Plumbing Af--- Comments/Notices/Holds Associated PCRs/CVs/SWPPPs Original PC# Inspection History Date Description Act lnsp Comments 06/07/2011 89 Final Combo CO MC NO ACCESS, LEFT BUSINESS CARD City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 12-18-2002 Plumbing Permit Permit No: CB023816 Job Address: Permit Type: Parcel No: Reference#: Project Title: Building Inspection Request Line (760) 602-2725 147 MAPLE AV CBAD PLUM 2042331800 Lot#: 0 Construction Type: NEW HOLT RES NEW GAS LINE AND H20 HEATER Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 12/18/2002 SB 12/18/2002 12/18/2002 Applicant: PLOTKE PLUMBING PO BOX 231186 ENCINITAS CA 92024 HOLT GINA D REVOCABLE LIVl~tRU!tJ!.8/02 0002 01 CGP 632-0461 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: $34.00 Inspector: 0 0 0 0 1 1 0 147 MAPLE AVE CARLSBAD CA 92008 Total Payments To Date: $0.00 $20.00 $0.00 $0.00 $0.00 $0.00 $7.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.00 Balance Due: Clearance: $34.00 NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as ~1eeslexactions.• You have 90 days from the date tlls permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any f in fwh'h rvi I Tl E i i\r hi r whihh Iii ----•---------- 02 3,, .. 00 FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK No6,."f..:z. EST. VAL. c:g,o z. ~<o L<o CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 Plan Ck. Deposit ...,,.--==.-,...;:---- Validated By <? :SB Date t.2.-I a -e>~ ddress (include Bldg/Suite #) A LI 1 ,M,I',\,)( e;:, AVIS Business Name {at this address) Legal Description Lot No. Subdivision Name/Numbe·r Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use ascription of Work SQ. FT. #of Stories C,i'-S L..1. . .,.,-f:'.<;-f'U,.= 11"«.0,-S DGoG '$lwTe>h'° # of Bedrooms # of Bathrooms l~itlil!fiiMAC!illP.IDONOO~ftfi~d,T-~i>P.tc'i6tl<~l:'.\k~<,;i\~{f: -';l'.l]i11t&u:~s;:\t~TI:; i<i · .. :ii:··" Name Address City State/Zip ~tihlti1/Atfii.~!¢4N'.J<;~f!u!PQ~~r~p_t~~lhl,il9{*~~-rft],f,P'.~(i;Q_Q'ti~9I6lrZ¼iC1)!;~:iiBf¼1:1il'.~~•rWG{Qhi~it · Telephone# Fax# ~;·ii::~;~~~_;','"r \,1;;•,~•·~ :~~;u:'i!~vu <lfi' "' ·••~~~;/~B:~ Name Address City C(sw~!f!fflmi:!ltlllllitl!fl\lielll'l't'lil1.i!!ri•x,,,\<::r,,1i~1<",v ,.,, t~;;,: ··•··· State/Zip Telephone# cJ';i "2t>...io;'~ 7,a-'{J'( -·%vr S.tate/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 e emption. 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), lo, I.Lia: C s -o <t City State/Zip State License # 7 (9 '5 /3 ;:). License Class L, -3 ( Q City Business License# I ;)...Q,:J Designer Name -------------Address City i~~~;~;~~!~~~!!~~~'.®~'~0~; 1~/;;;/;t~~;.;~!;~;y of pe,ju,y one of tho follow;ng docla,abons State/Zip Telephone 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 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 SrA:r K: ·:1:; )"-''> · Policy No. / S:S: 1../ (af' f Expiration Date ~;.../§JI J f) 3, (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS {$1001 OR LESS) 1 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 Laws of California. WARNING: Failure to secure wo~k a' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred ~ Ou.sand doJla s ($100,000), In ad Ion to the os of compansation, damages a1 provided for in Section 3706 of.the labor code., lntere.st and attomay's fees. GNATURE •··· DATE / :;,-/cO 2, )~~-l;R'li_Q )~~ttllN!¼i~tl&ij,t!~:'~;r~:½:-0lfffi~iiisl2'.>:l'.;;l~>21!:JtSt\~~~;>1:>1;~1~iit-".:;'!'.!: 't?hl} _: ;:~<:_-: '.: iii;;' .-::? -';' ;:;:-,: ;;':c\<';,,-s:;)1\Jr l hereby affirm that I am exempt from the Contractor's License law for the following reason: 0 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 erriployees, 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 ~oes 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. D YES ONO 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).:_------------------------------------------------------ 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? D YES D 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 O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 D 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 ANO THE AIR POLLUTION CONTROL DISTRICT. s.ft;J'i:191'1$T!lliC1"i91'iiE!',iei!NG!i\GEN¢Y.·, 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). 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 Citt 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 the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is c menced for a pe'iJ'd of 180 da (Section 106.4.4 Uniform Building Code). rJ APPLICANT'S SIGNATURE .1=~~(.d::\,!:;l;;.J(ac:i;ifzf.t::~~~r::====="-----DATE 1.,1--/ r-o:J. WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION DATE --++(t~~i (t ___ b...._J _ ~ .. INSPECTOR -=---->v_v, __ PERMIT# ~ 0CJ1-3'8ft. . PLAN CHECK# ___ _ JOB ADDRESS --+--,1,--ll---;.i-:;.~.....::l::::..· --'-AUL----'---~----- CODE DESCRIPTION ACT · COMMENTS ~ Dv:vwJct. Bi City of Carlsbad 05-'..~0-20(.)0 Plumbing Permit Permit No:CB002050 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 147 MAPLE AV CBAD PLUM Status: ISSUED 05/30/2000 JM 05/30/2000 05/30/2000 Parcel No: 2042331800 Lot #: 0 Applied: Construction Type: NEW Entered By: Reference #: Plan Approved: Issued: Project Title: EMERGENCY GAS LINE REPAIR Inspect Area: Applicant: PLOTKE PLUMBING 201 ROONEY AVE ENCINITAS, CA 92024 619-632-0461 Total Fees: $27.00 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 TOTAL PERMIT FEES Inspector: 0 0 0 0 0 1 9. $0.00 4 0 05/30/00 0001 01 C-PRMT ,no.oo > 0 > $0.00 --,$0.00 --*$0.00 - 0 $0.00 0 .0 $0.00 0 $7.00 $0.00 $0.00 $0.00 $0.00 $27.00 EXPIRED l?IRMIT r~~·•:T HA~ EXPIIED It ACCORDANCE Wl1H U.B.C. ,",N 106.4A 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 Ca~sbad 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 vou have nreviousl11 been niven a NOTICE similar to this or as to which the statute of limitations has oreviousl11 otherwise exoired. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 / 02 27~00 PERMIT APPLICATION FOR OFFICE USE ONL ~? C 1) PLAN CHECK NO. {!jJ 26 J /, CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1. PROJECT INFORMATION EST. VAL. _________ _ Plan Ck. Deposit,J;,. ~:~:_•_t•_d_s_v::':£:£1._-~_-__ ... _-_~1~'/J::~::·:ZJ;:c,.'-f;-__--="':'. t---J,-l.-'---'--'-,"""'!f'-U.""--''-"-'--'='------------~~-~----------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 <¼y" Description of Work ~ sa. FT. #of Stories # of Bedrooms # of Bathrooms Q Po'Vl \ r i?xOS ~ 2. 'c:oNTAcT PERSON fH different from applicant) Name Address Citv State!Zip Telephone# Fax II 3. APPLICANT 0 Contractor 0 Agent for Contractor 0 Owner 0 Agent for Owner Name Address City State/Zip Telephone# 4. PROPERTY OWNER Name Address City State/Zip Telephone# 6. CONTRACTOR· COMPANY NAME (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 ($5001). £\o+be A \.2:f0 IQb't) fb rox d ~\ 1 B\e z-<'C-rru:t,,s CS: 'l:«>z.':J J lco \o 32..o'j \QI Name Address City State/Zip { Tele~ # State License# Jc:6 \3:b License Ctass C-:r3lo City Business License 1U)2/ Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPENSATION 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 work for which this permit is issued. f;l 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: lnsu,ance Company S:lnJ..e h 1Y1Gl\ Pol;cy No. \ 5 '5 '-\ (.,,:, 'R \ Exp;,afon Date 2.-/ \ ) 2Q:J \ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 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 Laws of California. WARNING: Failure to secure workers' compensation coverage la unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000). i addltio to the cost of compensation, damagea as provided for In Section 3706 of the Labor code, Interest and attorney's fees. 1GNATuRE:R-B~~~~~~~------------------DATE 5l:3c2 I DD 7. OWNER-BUILDER DE 1 / I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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. It, 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 l, 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). 0 I am exempt under Section ______ Business and Professions Code tor this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have / have not} signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction (include name I 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 I address / phone number I 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 I address I phone number/ type of work):. ______________________________________________________ _ PROPERTY OWNER SIGNATURE ______________________ _ DATE ________ _ COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY 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? 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. 8. CONSTRUCTION LENDING AGENCY 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 NAME _____________ _ LENDER'S ADDRESS ________________________ _ 9. APPLICANT CERTIFICATION 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 Cit', 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 the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is co enced for period f 180 days (Section 106.4.4 Uniform Building Code). DATE _'5-..\_3~D,..) 0=12<------- WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 6/1/2000 Permit# CB002050 Title: EMERGENCY GAS LINE REPAIR Description: Type:PLUM Sub Type: Job Address: Suite: Location: 149 MAPLEAV Lot APPLICANT PLOTKE PLUMBING Owner: Remarks: TO INSPECT SUPPORTS Total Time: ----- 0 Act Comments Inspector Assignment: Phone: 7606320461 lnspectorCZ)""-'-. _.,L.,_ __ Requested By: CLARE Entered By: ROBIN CD Description 36 Electrical Repairs !Jl/2~ !lob Er, tori r,tiTe;,, lad Associated PCRs Inspection History Date Description Act lnsp Comments "' z 0 ;:: .. "' .. ~ u .. C "' I[ l "' .. 0 ~ 5 .. a: .. z 3 0 z 0 ;:: ~ z .. .. ,. 0 u "' ir .. "' "' 0 3 ii O I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license 1s ,n full force and effect Lr No _____ _ ',dO ~ereby af',rm ·r,a1 1 arr e,ecnpt frum •1~ c,;1'·dc- ror·s License Law 'c· ·~e 101 :,,.,.,n~ ~ea1G" 1Sec 1031 s B1ss1ness and P'Off<;<;rons Coce A1y cry cnunly wh11;t; re qJ,res a perm,! 10 construct alre, ,moro-,e dernol1sh o-repair any siru:ture prior to ,•s ss"crce a'sJ requ res 'he ao- pl,cant for suer ~e""ll'. ta Ille 1. s qned slate-en· lhal ~e ,s l·:ensed ou·suanr io The orov,s1o~s ~f '"e r;o~·-ac•o, s L1ce0,se Law !Chaa!e, g com11enc,nq wr'" Section 7000 o' D.v,s,an J ol The Business and Prolesslo~s C:ide, or Thal ,sex emp! t~erelr:i'll dnd the bas,s tor tre a•legeo e,empt,Jn Any v,o at,on of Sect,cn 7031 5 by an applicant 10, a pe·mI1 oub Iects the applIc2nt to a crvII penalty :if no: more than t,ve hun ored dollar~ 1$'.1001 I as owner ol the property Jr my employees wrtn wages as their sole compensation w,II do the work and the struc ru<e ,snot ,nrenoed or otfered lor sa•e !Sec 7044 Business and Proless,ons Code The Cont,aclor's License Law does not apply to an owner of property who bu,lds or ,wpmves thereon and who does such work himself or through his own employees. provided that S'JCh rnprovements are not ,mend ed or altered for sa•e 11, however the bu1ldong or ,mprove ment Is sold w1\h,n one year of completion, the owner-builder w,II have the buraen 01 prov,ng that he did not build or ,rn prove lor the purpose 01 sale) I, as owne'. of the property, am exclusively conlractlng w,1!1 licensed contractors to construct the pm1ect !Sec. 7044 Business and Pro1essions Code The Contractor's License Law does not apply to an owner ot prooer1y who builds or ,m proves !hereon. and who contracts for each pro1ects with a contractor(s) license pursuant to the Contractor"s License Law) :J As a homeowner I am ,mprovIng my home, and the follow 1ng cond1t1ons exist 1 The work ,s being performed pnor to sale 2 I have lived ,n my home for twelve months pnor to cornplet,on ol this work I have not claimed this exemption dunng the 1ast wee years ~r 11h~:r~:~~t under Sec _____ _ 8 & PC □ I hereby at!,rm that I h.i,e a cerM,c.ite of consent to self ,risure, or a cenlf,cate o1 Workers Compens.it,on Insurance. or a cen,1,ed copy thereof (Sec 3800 labor Code) POLICY NO .,.;J.. '<,, :-'. '- COM PAN, E}nl"t..t; Y'i!f:f-rt) ~ ~py IS filed with the city . O een,t,ed copy ,s heretJy !urn,shed CERTIFICATl OF EXE"'1PTION FROM WORKERS COMPENSATION INSURANCE (Th,s s.ect,on need not t>e comp1e1ed ,f 1rie pe,m,I ,s tor one riundred dollars 1s1001 or •ess1 0 I cert,ty th.it ,n the performance ot 1he worl<. 1or wh,cr, 1h,s perm,! ,s ,ssued I sh.ill not employ an1 person .n any manner so as lo become subIect lo !he Worl<ers Compen,;,a1,on l...lws ot Cal,1orn,a NOTICE TO APPLICANT If after mak,n] th,s Gen, t,cate ot Exemption you should become sub1e(t l'J the Worl<..ers· Cornpens.i11on prov,s,ons of !he Labo, Code. you musl •onhl'>1th ~ornply w,tt, sucf' prov,s,ons or 1h,s perm'1 sh<lll t.w clef',..1ed ,,,,,,ke(1 0 I hereby .,1trrm Iha! there ,s a r,or·~tru, 1,,,r Iend,ng ager,n t,:,r m,-. per•o,,,.~,,, e ,•_., won. 1,,, wh,ch !hrs perrr,• •~,~~"eel.Sf', IOG7 r>x1e LenOer~r-..af'le NCJ/Vc;':' Lenders Aoo,ess __________ _ USE BALL POINT PEN ONLY & PRE~S HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT ?i·/ 1200 Elm. Carlsbad, California 92008-1989 (619) 438-5525 JOB ADDRESS /J'l.1 .Pi-F / -;,,,d,: ST AD/e,;;:~~4~ DA;:os-~rvN BUSINESS UCENSE # VALUATION i4E;M'T NUMBER /t/17 '31., v.J:> L/f-&'I cOT BLOCK I SUBDIVISION ASSESSOR PARCEL NO. l / ;;;TRACTOR ~Al ~-w> _ _z;;,, CONTRACTORS PHONE• ZONE If ,~ ~ ~ P.1.-7 '-~ OWNER'S NAME 14"3J:;~¥9 rlfl:F'P hbt-,-lw;J,3°Ai:,;;.fus /f .t:> LICENSE NO. PLAN I,D. ft BLOG USE CODE L./3t:,o7/ OWNER'S MAILING ADDRESS ~ -. -DESIGNER LICENSE # STANDARO PLAN# BUILDING SQ. FOOTAGE OESCR,:10,i ?F WORK_ .. . ,r,1 A_ ,.r r,--""ti~ DESIGNER'S ADDRESS DESIGNER'S PHONE -F ,'P FLA ELEV NO DCC GP EDU : ,---,·-t: CL , ,'':•· STORIES . vO NO --- CENSUS TRACT I GP LANO USE I PARKING SPA.Ct: RES UNITS I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPP AREA CONST ,□ 'D •□ ..... o vO NO Not Valid Unless Machine Certil1ed I OTY PLUMBING PERMIT -ISSUE ' J,s>o i QTY MECHANICAL PERMIT -ISSUE 3:-o d SUMMARY/ACCOUNT NUMBER EACH FIXTURE TRAP INSTALL FURN. DUCTS iJP TO 100.000 BTU BUILDING PERMIT 01-00·00·8220 EACH BUILlJING SEWER · __ OVER 100,000 BTU SIGN PERMIT 01·00·00·8221 r, I ,_ __ L__ --------------------- EACH WATER HEATER AND·OR vrnr ;,,. ~.,._ BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01·00·00·8806 EACH GAS SYSTEM 1 TO 4 OUTLETS i-----SOI LEA/COMPRESSOR 3-15 HP TOTAL PLUMBING 01·00·00·8222 _LfJ._p-D ---·------- EACH GAS SYSTEM J OR MORE ' METAL FIREPLACE ELECTRICAL 01·00·00·8223 --·- EACH INSTAI,.. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01·00·00·8224 ·--------------------· EACH VACUUM BREAKER MECH EXHAUST HOQQlQLJCTS MOBILEHOME 01·00·00·8225 WATER SOFTNER RELOCATION OF EA FURNACfiHEATER MOBILEHOME PARK INSP EACH ROOF DRAIN ,:INSIDE'i SOLAR 01 ·00·00JP'J~ TOTt..L MECHANICAL ~~~O_NG MOTION 80·92·33·0519 I----700-C.: - TUI Al PLUMBING I FIRE SPRINKLERS 01·00·00·8227 -,.--PUBLIC FACILITIES FEE 32-00·00-8933 QTY. ELECTRICAL PERMIT -ISSUE 0~4 .. QTY. SOLAR -ISSUE BRIDGE FEE NEW CONST EA AMP'SWT BKR COLLECTORS SCHOOL FEE · DISTRICT - 1 PH J PH STORAGE TANKS Carlsbad 80-92-21-0519 FXIST BLDG EA AMP,SWT BKR ROCK STORAGE EncInItas 80-92-22-0519 -- 1 PH 3 PH PUMP San D1eguIto 80-92-23-0519 -· REMODEL 'Al HR PER CIRCUIT PLAN CHECK FEE San Marcos 80-92-24-0519 TE:MP POLE ZOO AMPS I --- OVER ZOO AMPS LICENSE TAX 01·00-00-8162 Tf.MP OCCUPANCY 130 DAYSI CREDIT DEPOSIT TOTAl ElEUf!ILAL ! TOTAL SOLAR TOTAL FEES PAYABLE I /O,t'--0 I I HAVE CAREFULL y EXAMINED THE COMPLETED "APPLICATION AND PERMIT'' AND 00 HEREBY E,cpfratton. EV9ry per_mi_t issued bytheBuildingOff1cial underthepr'7v1s1onsofttus * AN OSHA PERMIT tS REQUIRED FOR EXCAVATIONS OVER CERT FY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code sturit 1t1t:p1re by hm!t~t1on and become null and void !I the building or work 5' O" DEEP ANO DEMOLITION OR CONSTRUCTION OF 1 authonz.ed by such perm,t is not commenced within 180 days from the date of such STRUCl\JRES OYER 3 STORIES IN HEIGHT DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the buildinri o~~~k authonzed by such permit is suspended or ISSUED: TO COMPLY WITH AU CITY. COUNlY AND STATE LAWS GOVERNING BUILDING CON· abandc,--..: .. ~. anu tune a !er t ork 1s commenced for a """nod of 180 da--~ ,.,. • srnucT10N. WHETHER SPECIFIED HEREIN oR NOT. 1 ALSO AGREE To SAVE INDEMNIFY 1~~•n-s siG•h, >l!l"j' o CONTRACTO~ APPROVED BY ~~ -DATE KEEP HARMLESS THE CITY OF C~RLSBAD AGAINST ALL UABIUTIES. JUDGMENTS, COSTS AND , ~ 0 N A EXPENSES WHICH MAY lN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF TH ~ [/' .IJf/J 7 J fi. 'l ~ BY PHONE 0 1/-S--i'/ GRANTING OF THIS PERMIT. • ., , , "' u:: c m 0 Q_ E 0 f- l D 0 CJ C m 0 D. o_ <t ~ C ii 0 w w 0 w w <t ~ 0 ,; >- w w © 0 0 ,i: m <ii 0 ~ © 0 C m C u:: ~ C © © " 0 u © o_ w C 0 .c s TYPE I DATE INSPECTOR BUILDING I FOUNDATION I REINFORCED STEEL I MASONRY I GUNITE OR GROUT I FLOOR & CEILING SUB FRAME I SHEATHING □ ROOF □ SHEAR FRAME I EXTERIOR LATH I INSULATION ' I INTERIOR LATH & DRYWALL ' ' I PLUMBING I I SEWER AND BUCO DIPUCO I UNDERGROUND □ WASTE □ WATER TOP OUT □ WASTE □ W.4.TER TUB AND SHOWER PAN I GAS TEST I □ WATER HEATER □ SOLAR WAtER I ELECTRICAL I □ ELECTRIC UNDERGROUND □ 0FFER ROUGH ELECTRIC I □ ELECTRIC SERVICE □ TEMPORARY □ BONDING □ POOL I ' I MECHANICAL I □ DUCT & PLEM., □ REF. PIPINti HEAT -AIR COND. SYSTEMS I VENTILATING SYSTEMS ' I I ' CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ITEMS ABOVE HAVB BEEN APPROVED F NAL : PLUMBING I 4'\ J LI I 11-i .;, ~, "IJI__..,-' ELECTRICAL f -I MECHANICAL ' I GAS I BUILDING I SPECIAL CONDITIONS ' ' 'i'lf-1<.f . FIELD INSPECTION RECORD • REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES INSPECTION REQ IF INSPECTORS DATE CHECKED APPROVAL ' SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSEO CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOL.7'S SPECIAL MASONRY PILES CAISSOr-.'.: ------ ' ' - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license is in full force and ef- fect OWNER-BUILDER DECLARATION CI hereby affirm that I am exempt from the Con- tractor's License Law for the following reason (Sec. 7031.5 Business and Professions Code), Any city or county which requires a permit to con- struct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed state- ment that he is licensed pursuant to the provi- sions of the Contractor's License Law {Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that is ex- empt therefrom and the basis for the alleged ex- emption. Any violation of Section 7031.5 by an ap- plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500) Ct, 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 of- fered for sale (Sec. 7044, Business and Profes- sions 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 of- fered for sale. It, however, the building or improve- ment 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). =.1, as owner of the property. am exclusively con- tracting with licensed contractors to construct the project (Sec. 7044, Business .?.nd Professions Code: The Contractor's License Law does not ap- ply to an owner of property ·•ho builds or im· proves thereon, and who contracts for such pro- jects with a OQntractor(s) license pursuant to the contractor's License Law). I am exempt under Sec._~~--, B & P.C tor this reason _____________ _ Date Owner WORKERS" COMPENSATION DECLARATION I hereby affirm that I have a certificate of con- sent to self-insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Labor Code). POLICY NO ____ _ COMPANY ______ _ [_Copy is filed with the city U Certified copy is hereby furnished CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE {This section need not be completed ii the per- mit is for one hundred dollars (SHJO) or less) ! 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 La'ws of California. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction len- ding agency for the performance of the work tor which this permit ls issued {Sec. 3097, Civil Code) CITY OF CARLSBAD-BUILDING DEPARTMENT USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 J LL r "· ,~ /) JOB AOORESS tRr· 1~ ~ ;:7ATION . ~ /. -./ . ......,.-1, r, , '"7 1 7 I I I I I I I I I I I I I I I I I OWNER . OWNER'S PHONE PRIM::NTRACT~; ~~ ~ -:::;-~ /Ji,-Y.,,,_ U(J);, A 0 WNER' S "-"7-G ADDRESS JzArT~/·~k. ---~ co, BLOCK I SUBOIVISION I ASSESSOR'S PARCEL NO. DESIGNER ' ' ' ' ' ' ' ' ' ' ' DESCRIPTION OF WORK rl:J(l._.,<J ~ DESIGNER'S ADDRESS CENSUS TRACT GP LAND USE ZONING APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES BUS. L 1CENSE PERMIT NUMBER 131,;z I f ()_J_ 7f7 STATE LICENSE CONTRACTOR'S lJl'tJ -I/ 111./ STA'l"E LICENS' DESIGNER'S PHONE I RES. UNITS I PARKING SPACE # I~~ -F+- I NUMBER OF STORIES Not Valid Unless MachiM Certified BLDG SQ. FT. BLDG USE occ, GP I STANDARD PLAN# IPLANID# l TYPE CONST I occ. LOAD I QTY. PLUMBING PERMIT AMT. QTY' ~ MECHANICAL PERMIT AMT. EACH FIXTURE TRAP l~ll FURN. OUCTS UP TO 100,000 BTU EACH BUILDING SEWER --... OVER 100,000 BTU EACH WATER HEATER AND/OR VENT BOILER/COMPRE~P TO 3 HP EACH GAS SYSTEM 1 TO 4 OUTlt-H; BOILER/COMPRESSOR 3-15 mo,..._ I EACH GAS SYSTEM 5 OR MORE f\ I fih 1 ~ J.tH BOILER/COMPRESSOR 16-30 HP --...... EACH INSTAL., ALTER, REPAIR WATER P\IIE VENT FAN SINGLE DUCT ' EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS ' VALUATION WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I I I I T~QTHi' -:i .nn T C'C"THi' 3-. nr SIGN PERMIT I I I I TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I I I CONTRACTOR 5. (rt. CONTRACTOR ALL INCLUSIVE PERMIT I I .....--1 ELECl"RtCAL PERMIT M~LE HOME PERMIT AMT. TOTAL PLUMBING I ., '">., V-- QTY. AMT. QTY. ELECTRICAL I I I NEW CONST EA AMP/S'\lf;IJBKR AWNING "'-MECHANICAL I I I lPH .15 "-3 PH PORCH "-MOBILE HOME I I I EXIST BLDG EA AMP/SWT/BKR ' SET-UP ' SOLAR I I I I 1 PH .15 3 PH ........._ RAMADA, CABANA ........ I I I I REMODEL/ALTER PER CIRCUIT ..... FENCE OVER 6' "-~ ....., .... -'-; ....,._,. I I I I TEMP POLE 200 AMPS "-TOTAL MOBILE HOME "-MICO-FI LM I I I I OVER 200 AMPS :----. "-I I I I TEMP OCCUPANCY (30 DAYS) ' I I I I ISSUE 2.00 ISSUE 5.00 I I I I TOTAL ELECTRICAL TOTAL FEES PAYABLE I I '~-rf--c CONTRACTOR I I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DD •AN OSHA PERMIT IS AEQUIRED FOR EXCAVATIONS OVER SCHOOL FEES HEREBY CERTIFY THAT ALL INFORMATION HEAEON IS TRUE AND CORRECT AND I 5'-0"' DEEP AND DEMOLITION OR CONSTRUCTION OF FUATHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3STORIES IN HEIGHT COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER ' SPECIFIED HEREIN OR NOT. !,ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM-! , (/ /, . , LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO ' ('. :, -•· , (' ! ! .. , EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE APPLICANT'S SIGN'A°'TURE • OF THE GAANTING OF THIS PERMIT OWNER □ CONTAACTOR0 'APPROVED BY ~~ I DATE AGEN-t-q" BY PHONE 0 l~rJ- ) -I ! 0 ~ 5 >= u ~ Q. V, ~ _go SITE ADDRESS: OWNER: PERMIT NO: FIELD INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION• FORMS• SET SACK• TOILET UNDER FLOOR PLUMBING UNDER FLOOR HEATING OK TO INSTALL SUS FLOOR SLAB FLOOR UNDER SLAB PLUMBING FOOTING• FORMS• SETBACK• TOILET OK TO POUR CONCRETE FRAME ROUGH ELECTRICAL ROUGH PLUMBING ROUGH HEATING/VENTILATING FRAME OK• PLACE INSULATION INSULATION OK • PLACE WALLBOARD WALLBOARD OK• PLACE TAPE EXTERIOR LATH OK• PLACE STUCCO FIREPLACE DAMPER &STEEL • PLATE TIES/HEIGHT OF CHIMNEY OTHER TEMP POWER {POLE) -. SEWER ' I II ,I I, GAS TEST j/,.,7 ' J I /l/'- SW!M POOL • STEEL BONDING I I - • PRE DECK • FENCE PREPLASTER SHOWN • FRAME • PAN FINAL INSP SY BLDG DEPT OTHER DEPT'S REQ COMPLETED ELEC METER-PERM-TEMP : GAS METER-PERM-TEMP ! i I CERT OF OCCUPANCY ISSUED PLUMBING PERMIT APPLICATION ,. ". 1 City of CARLSBAD, CALIFORNIA 92008 Apphcant to complete numbered spaces only Phone 729-1181 Pe rmit No JO& AODllt 1£51 ;;o,.n Alffi. LOT NO. I ILK , T ... C T ltUC I l ou,-. OWNt" MAIL A00 .. CSS ti. PHONC Al 2 Y'r""i:'1'41 --,.,....,,,......,,. ,q -CONTlltACTOII MAIL A.001IICSS PHONC STATE LIC. HO. CITY LIC. HO. 3 1 ,.,. • 'J .... ''ll. 1( .• ,1 ■'. --m P.'I' 9. :c; ! ~"914. ·- AIIICHIT[CT 0111 DtSIGNE.11 MAIL AO0"CSS PHOM£ LIC(NSt. NO. 4 ' ~NGI N[tllt MAIL AOOfi':CSS PHONC LICtNSC HO. 5 \ t"' ~ . ; 1 . -'• COMPENSATION (NS. CARRIER MAIL AO0fllES5 &•ANCH 6 --"' .A._ --~,:-.tcc .... -q\ ,. T•-,--.. n~ TM---"'-11 921.'8 (-.... -,, '' USC o, 8"0"fCO!llrC----' -l' ' ----. 7 1 •rrf':# ... 8 Class of work : 0 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 9 Describe work. ., al _..,_ --~ PERMIT FEES No. Type of Fixture or Item Fee SPECIAL CONDITIONS WATER CLOSET (TOILET) $ BATHTUB LAVATORY (WASH BASIN) SHOWER KITCHEN SINK & DISP DISHWASHER APPLICATION ACCEPTEO BY PLANS CHECKEO BY APPIIOIIEO •OR ISSUANCE BY LAUNDRY TRAY CLOTHES WASHER ---• DATE ... WATER HEATER ~ ~.., 'NOTICE -URINAL THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUC· .,, DRINKING FOUNTAIN TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF -FLOOR-SINK OR DRAIN CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A \ PERIOD OF 120 DAYS AT ANY TIME• AFT.ER WORK IS COM• SLOP SINK . MENCEO GAS SYSTEMS NO. OUTLETS I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. WATER PIPING I, TREATING EQUIP ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WASTE INTERCEPTOR HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE VACUUM BREAKERS PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. LAWN SPRINKLER SYSTEM 1i& 4/:(I!~(~~ SEWER NUMBER CLEANOUTS CESSPOOL SEPTIC TANK._ PIT 4,. I,., 1f._ ROOF DRAINS SIG,..ATUIIIC or CONTIIIACTOJI o-. AUTHO"IZ.CD AGE.NT (OAT[) ISSUANCE FEE $ 'J ~ '!IIGNAT IU: OP' OWN[ .. 1, OWNC,. BUIL,OCflll OAT CJ TOTAL FEES $ "' WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT PLAN CHECK VALIDAT ION CK. M.O CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR