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Home My WebLink About2155 CHESTNUT AVE; ; CB991633; Permit04/29/1999 City of Carlsbad Plumbing Permit Permit No:CB991633 Building Inspection Request Line (760) 438-3101 Job Address: Permit Type: Parcel No: Reference #: Project Title: 2155 CHESTNUT AV CBAD PLUM 1670804500 Lot#: 0 Construction Type: NEW LINDHOLM RESIDENCE REROUTE LEAKING GAS LINE Status: ISSUED Applied: 04/29/1999 Entered By: DT Plan Approved: 04/29/1999 Issued: 04/29/1999 Inspect ^B04/29/99<X)010i C-PRHT 02 27-00 Applicant: CHUCK'S PLUMBING 3800 WESTHAVEN DR CARLSBAD, CA 92008 619-729-0961 _^ LINDHOLM CRAIG&VALERIE 2/l;55! CHESTNUT CARLSBAD 92008'" Total Fees:$27.00 Balance Due: $27.00 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee $2:0.00 $.0.00 $0.00 $0.00 /$0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $27.00 Inspector: FINAL APPROVAL Date:Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad ,CA 92009 (760)438-1161 3J PROJECT INFORMA FOR OFFICE USE ONLY PLAN CHECK 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 #ing Use Proposed Use Description of Work 2. CONTACT PERSON (if different from applicant) SQ. FT.#of'Stories # of Bedrooms # of Bathrooms Name Address City CANT ^pfifpntractor Q Agent for Contractor Q Owner Q Agent for Owner State/Zip Telephone Fax 9 Name Address City State/Zip Telephone # OPERTViiOWN . nr7 ^Address /City State/Zip Telephone #Name iS. 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 IChapter 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 ($5001). Name ' * State License #«£^'£7/? 3 0, Address ^ ^— , fe License Class C — -^/c> City State/Zip ^ &~~ tCity Business License # ._> o 4 Telephone # /£> a Designer Name State License # 6 WORKERS' COMPENSATI Address I-IM -' '- " :""1" .•••.".••;-':•• '•.*"•.'• .. .- ', • - ... . . .ON"-1. . ;•••-.". AS;'"...1. .•.'": ::;,:.. •:" :-.v - • ••-•-.. City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation, as required .by Section 3700 of the Labor Code, for the performance of the work for which this permit is led. My worker's compensation insurance carrier and policy number are: Insurance Company ~^fJ~^T'f, f-~'JISC? Policy No. / 2$y &y/£n$ ~ H 1 Expiration Date /*~_/^ Z> & (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 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^o the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE J^h/^r/^ ^^/^L^^Z^3~^ DATE 4^?' 4<^ <?*? 7. OWNER-BUILDER DECLARATION ;;:;;;i« -::-•:--.- ..'.:.'.'• - ;',,:....., .,: .'.. :',-.....-,,.,....'.',.. J.-:'.::...: ,::::.l;;:: ':^,.^..-^'K^^l'(-:'. 'f^^'W-^f*-^^ 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: C3 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, and contracts for such projects with contractors) licensed pursuant to the Contractor's License Law). O 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 / phone number / type of work): , PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR /VO/V-fl£S/O£/V77/U 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 Act? Q 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? Q YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? C] 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 , - _ _ ''""_" '' •"••'""',• ' 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 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 LIABILITIES1 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 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 tlj»>vprk is commenced for^eriod of 180 days (Section 106.4.4 Uniform Building Code). APPLICANTS SIGNATURE DATE PINK: Finance City of Carlsbad Inspection Request For: 4/30/99 Permit# CB991633 Title: LINDHOLM RESIDENCE Description: REROUTE LEAKING GAS LINE Inspector Assignment: 2155 CHESTNUT AV Lot 0 Type: PLUM Sub Type: Job Address: Suite: Location: APPLICANT : CHUCK'S PLUMBING Owner: LINDHOLM CRAIG&VALERIE Remarks: Phone: 7607290961 Inspector: Total Time: CD Description 21 Underground/Under Floor 23 Gas/Test/Repairs Act Comments Requested By: CHUCK Entered By: CHRISTINE A-P Date Inspection History Description Act Insp Comments SD COMPENSATION I N S U RAN CE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-99 POLICY NUMBER: 1398465 - 99 CERTIFICATE EXPIRES: O1-01-00 STATE CONTRACTORS LICENSE BOARD-WORKER'S COMP. BOX 26000 SACRAMENTO CA 95826 JOB: LIC 287306 EXP 2-29-96 INCEPTION DATE: 01-01-99 D.O.: SAN DIEGO This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named,below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon todays' advance written notice to the employer. We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate: of insurance is not ah insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to ail the terms, exclusions and conditions of such policies. PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.OO PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. EMPLOYER LEGAL NAME CHUCK'S PLUMBING 3800 WESTHAVEN DR CARLSBAD CA 92008 ARMSTRONG, CHARLES RAY THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND: PRINTED: 12-18-98 PQ409 r scrtMqaes (REyi^Ssj',;