HomeMy WebLinkAbout2011 LEE CT; ; CB981027; Permit04:/10191-l 1'3:04
Paqe 1 uf 1
B 1J I L f> I N G P E R M I T
1 Job Ach1ress: 2.0ll ~EE CT Suite:
Pe1m1t Type: PLUMBING
Parcel No: 205-330-41-UO Lot#:
Valuation: o
Occupancy Group: Reference#:
DAscript1on: GAS LINE TO FIRE PIT
PGrm1t No: lBq8102·,
Pro~ect No: A9R01 55
:,eve10pment No:
5904 04/10/98 0001 01 02
C-PRMT 27-00
Con£t ruction Type: Nr.W
Status: ISSUED
App:ied: 04/10/98
Apr/Issue: 04/10/98
Entered By: JM
Appl/Ownr : P~NES KIM 760 729-4884
2011 LEE COUR'!'
CARLSBAD CA 92008
Jc * * Fees Required
FPes:
Adjustments:
'!'otal Fees:
Fee description
Enter 'Y" for Plumb·
Gas Pip1nq System
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
.00
.oo
27.0()
***
Ext fee Data
20.00 Y
7.00
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
1. PROJECT INFORMATI<>y
2'1/I ~
FOR OFFICE USE ~
PLAN CHECK No.1c}/Oul
EST. VAL. .,,.,..._4 -,,Li
Plan Ck, Deposit _ _.,,.;.,...__;,;;_;;_,,._u_V_
Validated By--:r.,,...,,,"'"""--Af'lll:'...:.--::r------
Date ___ ~.,_ ..... 5"-~......,.__ ____ _
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~f . rk #of Stories # of Bsdrooms # of Bathrooms w j~ . i.,;
2, CONT T PERSON (If different from applle■ntl
Name Address City
3. APPLICANT O Contractor. QAgentforContrac;tlir :□own~i) □AgeritJClr OYlilfir)•···
Name
4.
It CONTRACTOR -COMPANY NAME
State/Zip Telephone# Fax#
Telephone#
(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 ha is exempt therefrom, and the basis tor the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil pen,lty of not more than five hundred dollars [$5001).
Name Address City State(Zip Telephone If
State License # _________ _ License Class _________ _ City Business License # _______ _
Oesigner Name Address City State/Zip Telephone
State License If _________ _
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.
0 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, tor 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 _______ _
ITHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS)
D 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' compen .. tion coverage Is unlawful, and sh11I subject 11n amployer to criminal penahlas and civil fines up to one hundred
thousand dollars 1$100,000), in addition to the cost of compensation, damagu 111 provided for tn Section 3706 of the Labor code, Interest and attorney's fen.
SIGNATURE _______________________________ DATE _________ _
7. OWNER-BUILDER DECLARATION·
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
D t, 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 sele
[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).
Z I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
<:¼actor's License Law does not apply to an owner of property who builds or improves thereon, end contracts for such projects with contractor(sl licensed
pursuant to the Contractor's License LawJ.
□
1.
2-
3.
I am exempt under Section Business and Professions Code for this reason: ~
I nally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES O
/ have not) signed an application for a building permit for the proposed work,
contracted with the following person lfirmt to provide the proposed construction (include name / address / phone number / contractors license number):
4. I plan to provide portions of the work, but I ired the following person to coordinate, supervise and provide the major work (include name / address / phone
number/ contractors license number):_-t--:,,C----+---.......,,.----,----------------------------------
5. I will provide some of the work,
of workl: __________ _,,~,---.----l--lt-+-r---,~-r--+-----------------,,.-A4-,-h-r:;o\----------
"PROPERTY OWNER SIGNATURE --+-11'"-..._...___,. ....... .,._,..,_.....,,,__-=-__..---------
COMPLETE THIS SECTION FOR NON
ubmit a business plan, acutely haz.ardous materials registration form or risk management ,nd 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 D NO
Is the tacility 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 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 ______________ _
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 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
EXPIRATION: Every permit issued by he Buildi
work authorized by such per mi
or abandoned at any time after
II,' APPLICANT'S SIGNATURE
" and demolition or construction of structures over 3 stories in height.
DATE ____________ _
PINK: Finance
PERMIT# CB981027
DESCRIPTION: GAS LINE TO FIRE
TYPE: PLUM
JOB ADDRESS: 2011 LEE CT
APPLICANT: PINES KIM
CONTRACTOR:
OWNER:
REMARKS: C/
SPECIAL INSTRUCT:
TOTAL TIME:
CD
23
23
LVL DESCRIPTION
PL Gas/Test/Repairs
PL Gas/Test/Repairs
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 04/16/98
PIT
STE:
INSPECTOR AREA
PLANCK# CB981027
OCC GRP
CONSTR. TYPE NEW
LOT:
PHONE: 760 729-4884
PHONE: ~
PHONE: /2 ,d'___~
INSPECToW~ ·
ACT COMMENTS
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***** INSPECTION HISTORY*****
DATE DESCRIPTION ACT INSP COMMENTS