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Home My WebLink About1590 JEANNE PL; ; CB031008; PermitCity of Carlsbad . 1635 Faraday Av Carlsbad, CA 92008 "'64-08-2003 Plumbing Permit Permit No: CB031008 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: Applicant: 1590 JEANNE PL CBAD PLUM 2071304500 Lot #: 0 Construction Type: NEW HERNANDEZ RES EMERGENCY GAS LINE REPAIR Owner: Status: ISSUED Applied: 04/08/2003 Entered By: SB Plan Approved: 04/08/2003 Issued: 04/08/2003 Inspect Af!!!o 04/08/03 0002 01 02 CGP 27-00 HERNANDEZ J FRED&BARBARA R HERNANDEZ J FRED&BARBARA R 1590 JEANNE PL 1590 JEANNE PL CARLSBAD CA 92008 CARLSBAD CA 92008 Plumbing Issue Fee $20.00 Fixture or Trap 0 $0.00 Building Sewer 0 $0.00 Roof Drain 0 $0.00 Install/Repair Water Line 0 $0.00 Water Heater and/or Vent 0 $0.00 Gas Piping System 1 $7.00 Vacuum Breaker 0 $0.00 Other Plumbing Fees $0.00 Master Drainage Fee $0.00 Sewer Fee $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $27.00 Total Fees: $27.00 Total Payments To Date: $0.00 Balance Due: $27.00 APPROVAL FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. ____ _ CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. __________ _ Plan Ck. Deposit _________ _ Validated By __________ _ Date ______________ _ Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Proposed Use #of Stories # of Bedrooms # of Bathrooms 2. CONTACT PERSON (If different from applicant) Name Address City State/Zip Telephone# Fax# 3. APPLICANT O Contractor O Agent for Contractor O Owner O Agent for Owner City State/Zip Telephone# Name City State/Zip Telephone# 5. 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 1$5001). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name State License # ---------- 8. WORKERS' COMPENSATION Address City Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 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. 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 Laws of California. WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for In Section 3706 of the Labor code, interest and attorney's fees. ~ SIGNATURE DATE 7. OWNER-BUILDER DECLARATION -----::::-::::::--===-===· 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. 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). ~ 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). 0 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. 0 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, t I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work)=----------~----~-------,t----Jc~----------------------------------- DATE ~-?:_-~t:_---"-'&._j __ PROPERTY OWNER SIGNATUR~D~~~!;d""'1{~~g,~".td~&~~-,::::_ ___ _ COMPLETE THIS SECTION FOR 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 co enced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned 1 J.' any time after the work is com ced for a perio1 O\J:60 cips J,Section 106.4.4 Uniform Building Code). Y APPLICANT'S SIGNATURE ~~~~~~~J-!..!.~~~~~~~~~~!:;,<=--------DATE f£--/ -LJ3 WHITE: File YELLOW: PINK: Finance I City of Carlsbad Bldg Inspection Request For: 04/10/2003 Permit# CB031008 Title: HERNANDEZ RES EMERGENCY Description: GAS LINE REPAIR Type: PLUM Sub Type: Job Address: Suite: Location: 1590 JEANNE PL Lot 0 APPLICANT HERNANDEZ J FRED&BARBARA R Owner: HERNANDEZ J FRED&BARBARA R Remarks: emergency gas repair Total Time: CD Description Act Comment Inspector Assignment: JE --- Phone: 7607298562 Inspector: Requested By: BARBARA Entered By: CHRISTINE " 23 Gas/Test/Repairs _fr£_ l'fo<, -hi (p Associated PCRs/CVs Inspection History Date Description 04/09/2003 23 Gas/TesVRepairs Act lnsp Comments NR JE