HomeMy WebLinkAbout2015 COSTA DEL MAR RD; ; CB961214; PermitCi
Permit No CB961214
Project Wo A9601726
Development No
8339 07/02/96 OOC1 01 C2
C-PRMT 83=00
BUILDING PERMIT
07/02/96 08 07
Page 1 of 1
Job Address 2015 COSTA DEL MAR RD Suite
Permit Type PLUMBING
Parcel No 216-123-06-00 Lot#.
Valuation 0 Construction Type VN
Occupancy Group Reference* Status ISSUED
Description ADD 3 URINALS, 2 W C , 2 SINKS Applied 07/02/96
AND H C SHOWER Apr/Issue 07/02/96
Entered By MDP
Appl/Ownr RODRIGUEZ, NICK 619 721-6621
4048 VIA RIO AVE
OCEANSIDE, CA 92057
**A Fees Required Fees Collected & Credits * * *
Fees
Adjustments
Total Fees
Fee description
83 00
00 J
Total Credits: .
Total Payments:
• Balance Due:
Units Fee/Unit
00
. 00
83 00
Ext fee Data
Enter "Y" for Plumbing Issue Fee >
Each Plumbing Fixture or Trap -. ';>.
Each Install/Repair water Line • >
* PLUMBING TOTAL <.r : .''
8
1
7 0.0
7; o o
20 00 Y
56 00
7 00
83 00
CITY OF CARLSBAD
2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
City of Carlsbad Building Department
2075 Las PaImas Dr., Carlsbad, CA 92009 (619) 438-1161
T P£HMJ'1J '1YM
From List 1 (see back) give code of Permit-Type trvx
For Residential Proiects Only From List 2 (sec back) give
Code of Structure-Type
Net Loss/Gam of Dwelling Units
2. PROJECT INFORMATION
PLAN CHECK NO.- O
EST VAL
PLAN CK DEPOSrr_
VALID BY
DATE Co
FOR OFFICE USE ONLY
Address
Nearest Cross Street
Building or Suite No
OoA
LEGAL DESCRIPTION Lot No Subdivision umber Unit No Phase No
CHECK BELOW IF SUBMITTED
D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope
ASSESSOR'S PARCEL C~(f-}— 12-3 "Ob EXISTING USE PROPOSED USE
DESCRIPTION OF WORK
SQ FT # OF STORIES # OF BEDROOMS # OF BATHROOMS
CONTACI
E
(\t dirterent From applicant)
name first) .. . . ADDRESS
CITY STATE - ft, ZIP CODE DAY TELEPHONE ~l £.[-
A APP1JCANI HJt**NTRACTOR D AGENT FOR CON 1RAL1 OR
NAME (last name first)__ ADDRESS
LI OWNER [J AGI NT FOR OWNE1
CITY STATE ZIP CODE DAY TELEPHONE
PROPFJHY OWNER
NAME (last name first)
CITY
ADDRESS
STATE ZIP CODE DAY TELEPHONE
6 CONTRAC.IUR
NAME (last name first).,
CITY
ADDRESS
STATE
STATE UC
ZIP CODE
LICENSE CLASS
DAY TELEPHONE
~ I CITY BUSINESS LIC #
DESIGNER NAME (last name lirst)
CITY STATE ZIP CODE
ADDRESS
DAY TELEPHONE
le /)
STATE LIC #
7 WORKERS (JOMPhNSAIION
Workers Compensation Declaration I hereby altirm that I have a certificate or const nl to sclr-msure issued by the Director orlndusirial
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, lab C)
INSURANCE COMPANY POLICY NO I£$000% EXPIRATION DATE j [ - j "
Certificate 01 ExemptionIcertily that in the performance or the work for which this permit is issued, 1 shall not employ any person in any manner
so as to become subjectjojhe Workers' Compensation Laws of California
SIGNATURE
8 OWNER-BUI
SATE
OwncMJuilder Declaration ~ l hereby attirm that 1 am exempt trom the Contractors License Law lor the tollowing 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 ol 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, 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
(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, commencing 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 S by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars [$500])
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 Act7
D YES H^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 EKNO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
D YES H-flb
IF ANY OF TIIE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNIP-SS THE APPLICANT
HAS MET OR IS MiiOINGTtlE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POIJJJTION CONTROL DISTRICT
9 CONSTHm-TlON LENDING AGENCY
1 hereby attirm that there is a construction lending agency lor the performance ot the work tor which this permit is issued (Sec 3097U) Civil Code)
LENDER'S NAME LENDER'S ADDRESS
10 APP1JCAN1 ChKllMCAIION
1 certify that I have read the application and state that the above inlormation is correct I agree to comply with all City ordinances and State laws
relating to building construction I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection
purposes IAISO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABH JI1ES, JUDGMENTS, COSTS
AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT
OSIIA. An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stones 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/ConTmenced within 365 days from the dace of such permit or if the building or work authorized by
such permit is suspended or abandoned atany tirie afterXhe work is commenced for a penod of 180 days (Section 303(d) Uniform Buildmg.Cg
APPLICANTS SIGNATURE •i il"A \>^Jw DATE
WHITE: File" YELLOW: Applicant PINK: Finance
UNSCHEDULED BUILDING INSPECTION
DATE K/Z'-lk £ INSPECTOR^ /*
PERMIT # ^C /2.H PLAN CHECKS
JOB ADDRESS
DESCRIPTION
TIME ARRIVE: TIME
CODE DESCRIPTION ACT COMMENTS
N>
\
11B-1B 1994 UNIFORM BUILDING CODE
60" MIN.
L
FLUSH
ACTIVATOR
ON WIDE
SIDE-
MIN
GR*B BAR
34"
60" MIN
DIAMETER
\ CLEAR 7
\
f30"X4fiT
[CLEAR SPACE
44" MIN
THIS DIAGRAM ILLUSTRATES THE SPECIFIC REQUIREMENTS
OF THESE REGULATIONS AND IS INTENDED ONLY AS AN
AID FOR BUILDING DESIGN AND CONSTRUCTION
i
1-207.61
MULTIPLE ACCOMMODATION TOILET
FIGURE 11B-1B
NOVEMBER 22. 1995
11B-2A 1994 UNIFORM BUILDING CODE
l_ 48" MIN
L C
L
L
. C
L PU\N
1-1/2 —
SECTION B-B
C
6" MAX
FLEXIBLE SHOWER SPRAY
HOSE - &f LONG
MIXING VALVE CONTROL
TOP OF MOUNTING BRACKET
SECTION A- A
NOTE: BACKING IS
REQUIRED FOR
INSTALLATION OF GRAB
BARS & SEAT
\/f MAX. THRESHOLD
BEVELED AT 4ff
1-207.63
ROLL-IN SHOWER STALL
FIGURE 11B-2A
NOVEMBER 22 1995
City of Carlsbad
Building Department
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
A. 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
B. of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are1
INSURANCE COMPANY POLICY NO EXPIRATION DATE1
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED
DOLLARS ($100) OR LESS)
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 Palmas Dr - Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-0894
COMPENSATION
INSURANCE
FUND
P 0 BOX 7854SAN FRANCISCO CA94120-7854
WORKERS' COMPENSATION INSURANCE PAYROLL REPORT
EMPLOYER'S COPY
40000612800089502000128000800601960701965096183
N.P.R. CONSTRUCTION
4052 VIA RIO OCEANSIDE
OCEANSIDE, CALIF 92057
GROUP
POLICY 1280008 - 95 2
096183
PAYROLL PERIOD 6/01/96 TO 7/01/96 5
104
INSTRUCTIONS 1 ) READ INSTRUCTIONS ON REVERSE SIDE OF THIS REPORT2) If no payroll write "NONE" on all pages 3 ) Sign, date, and return all whitspages with payment 4) Retain yellow copies and nave available for audit
N P R CONSTRUCTION 060196 070196 1280008 95
CODE NO
0042
5482
5474
8810
8742
5027
5028
5201
5205
5213
5222
5225
5403
. ., , £432.
5446
Itemize any pa^
included above
relatives, execu
officers, or wo
partners (see e
pie on reverse)
*CODE NO
_-^
Add
tst»rilrTION--Gr--' WURK"OON&" ~ • ' *
any operations not described below
LANDSCAPING
PAINTING
WAGES PAID TO $18 00 PER HR
PAINTING
WAGES PAID TO $17 99 PER HR
CLERICAL
SALESPERSONS-OUTSIDE
MASONRY
WAGES PAID TO $16 99 PER HR
MASONRY
WAGES PAID FROM $17 00 PER HR
CEMENT WORK FLAT
WAGES PAID TO $16.99 PER HR
CEMENT WORK FLAT
WAGES PAID FROM $17.00 PER HR
CONCRETE CONST
CONCRETE CONST BRIDG
REINFORCE STFEL INST
CARPENTRY - COMMERCIAL
WAGES PAID TO $19.99 PER HR
-CARPENTRY— ---COMMERCIAL
WAGES PAID FROM «2O.On PER HR
WALLBOARD INSTALL
WAGES PAID FROM $18 99 PER HR
fro\\
for
tive
rkmg
- -T»S7ROLr~DF
EMPLOYEES
Tfr, rV*
YOUR POLICY WILL OVERTIME
BE SUBJECT TO EXCESS ^
CANCELLATION IF TOTAL s
mi- ncrnrrr Ann PAYROLL
PAYMENT ARE NOT RECEIVED BY -7 / < 1 /OR
ENCLOSE CHECK FOR THIS AMOUNT
DESCRIPTION OF WORK DONE PAYROLL
$
RATE"—
Each $100Payroll
15 16
9 81
18 69
92
98
15 67
13 68
11 90
10 18
10.89
16.58
13 29
27 88
. •n=7^Aj.-.9J5 »
13 93
"* PRtMIUM '" r
(Multiply payroll by rate) ^
1
I
13 £ni
1ii
i
iiii
i
1ii
i
ii
1 !•
1
1
1
GROSS i
PREMIUM $ ******** 1
MODIFICATION ****
* * :
MAIV/MT TITLE OR ANAME RELATION *
I (we) certify that the above reported payroll accurately reflects the total wages, salaries, and other compensation paid
to all employees (including unlicensed contractors) during the period covered
WILLFUL UNDERREPORTING OF SUCH AMOUNTS IS A VIOLATION OF CALIFORNIA FRAUD STATUTES
SIGNATUREPREPARING
NAME AND
OF PERSONREPORT ^.TITLE AREA CODE PHONE NO
ADDRESS WHERE PAYROLL RECORDS ARE KEPT (include ZIP CODE)DATE
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