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Home My WebLink About163 ACACIA AVE; ; CB950940; Permitr RIJILDING PERMIT Permit No: CB950940 07/14/95 10:25 Page 1 of 1 Jab Address: 163 ACACIA AV Permit Type: PLUMBING Valuation: Parcel No: 204-231-Q6-00 0 Construction Type: NEW Occupancy Group: Description: GAS REPAIR "- Development No: Project No: A9501333 Suite: Lot#: 271-4 07/14/55 000.i 31 02 C-F%fiT 27 .?I0 Reference#: Applied: 37/14/95 Status: ISSUED Apr/Issue: 07/14/95 Eniered By: DC Appl/Ownr : BROWN, ARTHUR PLUMBING 619 729-2605 2697 STATE STREET CARLSBAD, CA 9200 **x Fees Required x """"~""""""- Adjustments: Fees : Total Fees: .oo 27.00 Fee description Enter "Y" for PlU Gas Piping System * PLUMBING TOTAL Ext fee """"""""" x** Data Y -' PERMIT APPUCATION PLAN CHECK NO. City of Carlsbad Building Departmnt 2075 Las Palms Dr., Carlsbad, u 92009 (619) 438-1161 VAUD. BY FTANCKDEFOSIT B - 0 Industrial 0 New Building A - U Commercial U New Burldmg U'leenant Improvement C - 0 Residential 0 Apartment OCondo 0 Single Family Dwelling 0 AdditioWAlteration 0 Tenant Improvement 0 Duplex 0 Demolition 0 Relaration 0 Mobile Home 0 Electrical 0 Plumbing OMechanical OPool 0 Spa ORetaining Wall OSolar OOther 2 PR~INFoRMAnoN FOR OFFICE USE ONLY Jir2 &dq Bulldlng or Sum NO. NeareSt C a- o~\+,~ r t 0. ase No. 0 2 Energy Cab 0 2 Structural Caln 0 2 Soils Report 0 1 Add4 Envelope DESCRIFTION OF WORK USE PRO- USE 1% 6%S NAME aitterent mom appllcantl ADDRESS STATE ZIP CODE DAY TELEPHONE STATE UC. X LICENSE CLASS CITY BUSINESS LIC. X CITY STATE ZIP CODE DAY TELEPHONE STATE UC. X Relations, or a certificate of Worken' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof tiled with the Building Inspection Department (Section 38W, lab. 0. Worken' Compensatlon Declaration: 1 hereby alllrm that I haw a certlhcate 01 consent to selt-ansure ,sued by the Dlmtor Ot Industnal ~~ INSURANCE COMPANY ,(a/ %& (vl;kllJ POUci No,f&q/0 3 D[PIMnON DATE 74-48- so as to become subject to the Worken' Compensation Laws of California. Certll~eate 01 txemptron: I ertlwthat m pertormance 01 rhe w0rKIor WhlcWthKpermlt IS ~ssued, I Shall not employ any pewn 3" any manner SIGNATURE DATE DO 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 Owner-Bullder Deelaratlon: 1 hereby altlrm that 1 am exempt tram the Contractor's Llcense Law lor the lollowrng reason: 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 impraves 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 pu'pose of sale.). 0 I, as owner of the property, am exclusivelycontracting with licensed contracton to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law dm not apply to an owner of property who builds or improves thereon, and contracts for such projects with conwetor(s) licensed punuant to the Contractor's License law). 0 I am exempt under Section Business and Professions Code for this reason: any SOUCNE, prior to ia issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant lo the (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair 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 provisions of the Contractor's License law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) subjects the applicant to a civil penalty of not more than five hundred dollan [SSOO]). 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 25505, 25533 or 25534 of the Presley-Tanner 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,ooO feet of the outer boundaryof a school site? 0 YES om 0 YES 0 NO a NO IPANYOF~ANSWERSAREYES.A~~~~~~OFOOCUPANOIMAYNOTBElSSUPDAFIFJ(JULY1.1989UNIESS~EAPPZlCANT 0 NO HASMEFORIS~G~REQ~OFTHEO~CZOF~GENOI~~~AND~AIRHI~NODNlRa~. 1 hereby all~rm that there IS a eonstruc~lon lendmg agency lor the pertormance 01 the work lor whlch thls permlt IS lssued (SR' 3097111 Clnl cadel. LENDER'S NAME LENDER'S ADDRESS IIUR relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection I certlty that 1 have read the appltcattan ana state that the akve lnlormatlon IS correct. 1 agree to comply wlth all Uty oralnances ana state laws pu'poser. IAlsoAC~TDSAVE~~ANDKEFPlIARMIESS~EOFCARISBADAG~~AU.uABIII1pESJLIDG~aosls AND FXPENSES wnar MAY IN ANY WAY ACCRUE AGAINST SAID (TIY IN CONSEQUENCZ OF -IHE GRANTING OF mas PFRMIT. OSW An OSHA permit is required for excavations over 5'0" deep and demolition or construction of StNCtUres 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 365 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 commenced for a period of I80 days (Section 303(d) Uniform Building Code). DATE: 7// !%-fr kh-4 YELLOW: Applicant PINK: Finance 3:P WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for the performance of the work for which this permit is issued. A. workers' compensation as provided by section 3700 of the Labor Code, for I have and will maintain workers' compensation, as required by section 3700 issued. My workers' compensation insurance carrier and policy number are: B. of the Labor Code, for the performance of the work for which this permit is INSURANCE COMPANY POLICY NO. EXPIRATION DATE: (THIS SECT1 8 N NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) "-L%l@2- L"f&t&?A,! """_ &2Lqio3 """""""""- zIL-I"@ """"" 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 C. workers compensation laws of California. Signature Date Warning: Failure to secure workers' compensation coverage is unlawful, and shall be 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. March 3, 1995 2075 Las Palrnas Dr. - Carlsbad, CA 92009-1 576 - (619) 438-1161 - FAX (61 9) 438-0894 @