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Home My WebLink About1805 COTTONWOOD AVE; ; CB972130; PermitBUILDING PERMIT07/31/97 13 40 Page 1 of 1 Job Address 1805 COTTONWOOD AV Suite: Permit No Project No. Development No CB972130 A9702687 Permit Type. PLUMBING Parcel No 215-503-37-28 Valuation: 0 Occupancy Group Description. GAS LINE REPAIR Reference* Appl/Ownr : BOYD ROGERS PLUMBING 2525 FORTUNE WAY VISTA, CA 92083 *** Fees Required *** *** 7£',0 07/31/9'' <500i 01 Lot*. >~^*"T Construction Type: Status Applied. Apr/Issue- Entered By: 760 727-7040 Fees Collected & Credits 02 27-0'- NEW ISSUED 07/31/97 07/31/97 JM * ** Fees Adjustments . Total Fees. Fee description Enter "Y" for Plumbing Gas Piping System * PLUMBING TOTAL 27.00 .00 27. 00 Issue Fee •• : ' Total. Credits Total Payments : Balance Due :, V;;,v ^Unit's : Fee/Unit >: ','..•• •" /'i 7 oo •' U " - '•? •• ! ' • * **• 00 00 27 00 Ext fee 20 00 7 00 27.00 Data Y PROVAL PATE ffAfa CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 'ERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr, Carlsbad CA 92009 (760)438-1161 1 PROJECT INFORMATION / '' '.' '"-•'"' FOR OFFICE USE ON PLAN CHECK N0._ EST VAL Plan Ck Deposit Validated By_ Date Address (include Bldg/Suite #)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 Description of Work 2 CONTACT PERSON (If different from applicant) SQ FT #of Stones # of Bedrooms .„. ... _. .... .-s--^,-,,., *,,,.--.t rv.. ,,:,,. # of Bathrooms Name Address City i3. ~ APPLICANT |jj9 Contractor ^Q AgehTfoFSofffiractiBr^ "Q^wnlrf/^D AjjertH State/Zip Telephone #Fax * Name '4 r PROPERTY OWrlErt ""' '; Address Crty State/Zip Telephone ~ A* •; s*" Name Address City State/Zip Telephone t f. CONTRACTOR- COMPANY NAMB*i™"s?ss^?* ™sra> "*- H " r-•,,=-,-• . .. ,, -,,.,,-,:. , ,, ,,„ ^ ..^ J?™-n:; _,.,,-,. .%;^-. ., ,., (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 emption Any violation of Sectiop 7031 5 by any applicant for^permit subjects the apphcanf to a civil penalty of not more than five hundred dpllarsj,$50p]) • * ,ir5(/ j Name State License # Address License Class £-• 3 City State/Zip City Business License (T Telephone # Designer Name Address City State/Zip Telephone State License 9 ^6 WORKERS'COMPENSATION " " " ''" " "", " "'~ Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations D 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 D 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) Q 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 wortertVcompensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollar».($100,000). In addition to the cost of compensation, damages ai provided for In Section 3706 of the Labor.code, Interest and attorney's fees )(- SIGNATURE (¥.^^j Sfap°~^> . DATE ^ "^/ ^^ ^ OWNER-BUILDBftVECUVRATION--X '~" " - - ' ' " -• -- r -~':/ ' ' ? * I hereby affirm that I am exempt from the Contractor's License Law for the following reason D 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) 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, end contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law) (~l 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 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 / phona number / type of work) PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR /IrOWSESIBfllrlMi BUlL™^ ' < T'f ^"^ ' 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? Q YES Q NO Is the applicant or future btilding occupant required to obtain a permit from the air pollution control district or air quality management district? l~l YES l~l NO Is the facility to be constructed within 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 8. CONSTRUCTION LENDING AGENCY":"" "^'"" "',' •---**-z*™#'^ *•&•*••'*->•-'-•"< • ="-*--•>-•'- -<*••;•* -r-s» — - ri -;-,, I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(0 Civil Code) LENDER'S NAME LENDER'S ADDRESS 9 APPLICANT CERTIFICATION" ^ ~""r- 'r";"cr'—-':"--—~--~Y;T: -r-crrcr-- -3~-o. ••* ,—^"^^i^ r^rr?^«?-Tr . --.—',- ' I certify that I have reed 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 authonze representatives of the City 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, OSHA An OSHA permit is required for excavations over S'O* deep and demolition or construction of structures over 3 stories in height EXPIRATION Every permit issued by the Building Official junder the provisions of this Code shall expire by limitation and become null end void if the building or work authorized by such permit is not commenced w/yun£65 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/he work is comment/eft if/t a period of 180 days (Section 106 4 4 Uniform Building Code) DATE /' APPLICANT'S SIGNATURI DATE PERMIT # t-7--2-<><> SPULED BUILDING INSPECTIO1 INSPECTOR PLAN CHECK* JOB ADDRESS DESCRIPTION TIME ARRIVE:TIME CODE DESCRIPTION ACT COMMENTS JUL-31-97 01:52 PM BOYDROGERSPUEGCO 760 727 0755 P. 02 AC_QR& CERTIFICATE OF LIABILITY INSURANCE PRODUCER Vateridge Insurance Services 10525 Vista Sorrento Pkwy #300 San Diego CA 92121 F« NU 619-452-6004 Tony Yahyai pt«n.No 619j-452-2200 INSURE!) Boyd Rogers Plumbing Company 2525 Fortune Way Vista CA 92083 01/22/97 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANIES AFFORDING COVERAGE COMPANYA American Eagle Insurance Co. COMBANYc COMPANY D COVERAGES THI« IS 7Q u« ril Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BCCN ISiUED TO THE INSURED NAMLD ABOVE FOR THL TOLICY PERIOD INDICATED NOTWITHSTANDING ANY nCOUIFlCMrNT TCflM On CONDITION OF ANY CONTRACT On OTHER DOCUMENT WITH HCS'ECT TO WHICH THIS CCRTlllCAiL MAY BE ISSUED OR MAY PERTAIN "HE INSURANCE AFFORCPJ 8Y THE POLICIES DESCRIBED HC"EIN IS SUBJECT 10 All Till TERMS EXCLUSION'S AND CONDI! ION'S or SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN firSuCfO 8Y PAID CLAIMS TYPE OF INSURANCt I GENERAL LIABILITY iulCpClAI GfNfHAL LI»BILTY CLAIMS MADE | X j OCCUR POLICY NUMBER CAEF10011125 'LPOLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DDATYI 01/05/97 UMITS </W,NtH 3 & CONTRACTOR 5 T10T $500/OCCUR PD DED j 01/01/98 |_rnoC'UCTS COMP/OPAM IphH^JNAi. tt *DV INJURY EACH OCCURRCNCt I tlKf IJAMACE 'AriY cue firtl | MED EXr> (Any UIL ncconl »2,000,000 32,000,000 »1.OOP,OOP '1,000,000 •._50_, qqq_ s, oo"o"~ AUTOMODILt IIARIIITY ' ANY AUTO AU OV\NKJ AUTOS X SCH'OULCD AUTOS X MIPCD AUTOS CAEF10011125 I 01/05/97 01/01/98 COWHIMFO ilNljLE L WIT H.OOO, 000 I X ! NON OWNED A'JTCS BOfcll Y INJURY !Pe( i,*tfunl BODILY- IN HIHY[Per irn-1»ir?) OARAGE LIABILITY AN'! AUTO AL'TOONLV EA ACCIDENT j 01HCR THAN A'JIO ONLY ! EACIIACC1CENT EXCESS LIABILITY UMBBflLA TOflM OTHER THAN UMBRELLA ' ACOREGATE WORKERS COMPENSATION AND EMPLOYERS LIAOILITY OTHEH PARTNEns/EXECL'-IVE OFFICE"'" »>ne W>_ 3 ATU ILlQ«v"Mi:$: EL E*CH ACCIDENT ELOISCA7E PQUfY LIMIT H O'^tASE EA EMPLOYEE OTHER iSCBiPTION Of OPERATIONS/LOtAriONS/VEKICLES/SPtCIAL ITEMS EXCEPT 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM ERTIFICATE HOLDER CITYCA1 Czty of Carlsbad Attn* Building Department 1200 Carlsbad Village Dr Carlsbad CA 92008 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BC CANCELLED HFORE THE EXPIRATION DATE THEREOF TIIC ISSUING COMPANY WILL tNBCi>»On TO MAIL _!!<) DATS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE l£FT IT MILUnC TtLMAIL OUOM MOTIOC Olli«tt IMPOM NO