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Home My WebLink About219 CHESTNUT AVE; ; CB004855; Permit12/22/2000 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No:CB004855 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 219CHESTNUTAVCBAD PLUM 2041500200 Lot#: 0 Construction Type: NEW REEVE RES-GAS LINE REPAIR Status: ISSUED Applied: 12/22/2000 Entered By: RMA Plan Approved: 12/22/2000 Issued: 12/22/2000 Inspect Area: Applicant: M D PLUMBERS 6405 LA JOLLA BL LAJOLLA CA 92037 858 456-0595 Owner: : 7415 12/22/00 0002 01 REEVE GEORGE W TRUST 05-31-91 CGP 8611 N BLACK CANONY HWY #212 PHOENIX AZ 85021 / / 02 27. Total Fees:$27.00 Total Payments To Date:$0.00 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 0 0 0 0 0 1. 0 $20:bO ;:$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. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 CT INFOR FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Validated By. Date A. 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) SO. FT.#of Stories # of Bedrooms tt of Bathrooms ,, ^ , „/* 61. Name 3. APPLICANT Contractor Address City Agent for Contractor- - Q Owner Q 'Agent for Owner State/Zip Telephone tt Fax » Name 4. PROPERTY Address City State/Zip Telephone Name ' Address 5. CONJRAClfOR - 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 [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 exemption. Any violatiQBiofr Section 7fl31 .5 by any applicant for a permit subjects the applicant to a civil penalty of nerffbore than five hundred dollars ( 'City State/Zip Telephone # Name " Address State License # 6(? f Cs / / ^— License Class Designer Name Address State License ff 6. ;W^RKEFOSsiT^MPENSATldN , ' - > - ' " City State/Zip Telephone # City Business License # {%j(fa) s/S 4*»/ -Ar*^ City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q 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. QS^ 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 oTi^T^. C20rtfj->£t/S!&-7fafi) r~L/jJ\-J --Policy No. \<-{'iVil\> " /$ ./-^-Expiratign-Date—^r"« (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED:B'O!£ARS~£i1 00] OR LESS) |~| 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 ($JJ^OyOt)0), ir/addition to tBa/fcost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. <SIGNATURE 7:~"~6Wriin-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: l~l 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). l~l 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). n 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 trie 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/\M?£S/OSV77/« 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? L"3 YES fj N° 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 l~l 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. CONSTRUCTJONltENplNGltJENCY ,.:,;, 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 , s „ ;, 7 : 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 CitV 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 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 180 days from the date otsuch permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenp^fo^rperiod^* 180 days (SecUdfyrofe.4.4 Uniform Building Code). jr///, y / j /j p /APPLICANT'S SIGNATURE ( ^^L^X ^& l/L^l^l ^<f-^- 1_^ DATE WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION INSPECTOR PERMIT # L/U QQH^S PLAN CHECK# JOB ADDRESS DESCRIPTION CODE DESCRIPTION ACT COMMENTS IMPORTANT - THIS IS NOT A BILL. SEND NO MONEY UNLESS STATEMENT IS ENCLOSED. STATE COMPENSATION INSURANCE FUND HOME OFFICE SAN FRANCISCO POLICY DECLARATIONS CALIFORNIA WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY POLICY THESE DECLARATIONS ARE A PART OF THE WORKERS' COMPENSATION POLICY INDICATED HEREON. THIS INSURANCE IS EFFECTIVE FROM 12:01 A.M., PACIFIC STANDARD TIME 3-12-98 TO 3-01-99 AND SHALL AUTOMATICALLY RENEW EACH 3-01 UNTIL CANCELLED MARK D. DERRICK 6455 LA JOLLA BL #110 LA JOLLA, CALIF 92037 CONTINUOUS POLICY 1496115-98 DEPOSIT PREMIUM MINIMUM PREMIUM PREMIUM ADJUSTMENT PERIOD $828.OC $650.01 SEMI-ANNUAL!/ N SI NAME OF EMPLOYER-DERRICK, MARK D. (AN INDIVIDUAL EMPLOYER AND NOT JOINTLY WITH ANY OTHER EMPLOYER) 1. 2. WORKERS' COMPENSATION INSURANCE - PART ONE OF THIS POLICY APPLIES TO THE WORKERS' COMPENSATION LAWS OF THE STATE OF CALIFORNIA. EMPLOYER'S LIABILITY INSURANCE - PART TWO OF THIS POLICY APPLIES TO LIABILITY UNDER THE LAWS OF THE STATE OF CALIFORNIA. THE LIMIT OF OUR LIABILITY INCLUDING DEFENSE COSTS UNDER PART ~~~ '"" $1,000,000 INTERIM BILLING RATE* 5.71 CODE NO. PRINCIPAL WORK AND RATES EFFECTIVE TO 3-01 BASE RATE 5187 PLUMBING—SHOP AND OUTSIDE— GAS, STEAM, 6.15 HOT WATER OR OTHER PIPE FITTINGS IN- STALLATION, INCLUDING HOUSE CONNECTIONS INSTALLATION— EMPLOYEES WHOSE REGULAR HOURLY WAGE EQUALS OR EXCEEDS $20.00 PER HOUR— N.O.C. THE USE OF THIS CLASSIFICATION IS SUB- JECT TO VERIFICATION AT THE TIME OF FINAL AUDIT THAT THE EMPLOYEE'S REGULAR HOURLY WAGE EQUALS OR EXCEEDS $20.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $20.00 PER HOUR SHALL BE ASSIGNED TO CODE 5183(1). 5183 PLUMBING— SHOP AND OUTSIDE— GAS .JlgAMJ 14.85 j.i __ n ii f^^" 13.79 TOTAL ESTIMATED ANNUAL PREMIUM $1,379