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Home My WebLink About220 OLIVE AVE; ; CB980079; Permit( 01/13/98 11:03 Page 1 of 1 8 U I L D I N G Job Address: 220 OLIVE AV Permit Type: PLUMBING Parcel No: 206-091-06-00 Valuation: o P E R M I T Suite : Lot#: Permit No : CB980079 Project No : A9 800126 Development No : Occupancy Group: Reference#: Construction Type: Status: NEW ISSUED 01.(.13/98 Descr~ption : EMERGENCY GAS LINE REPAIR Appl/Ownr : NELSON MARG *** 220 OLIVE AVENUE CARLSBAD CA 92008 Fees Required *** *** 2919 01100i~~l~i Entere'd" ~: 760 729-3045 Fees Collected & Credits i!7'1 ff.W *** --------------------------------------------Fees: Adjustments : Total Fees: Fee description Total Credits: Total Payments : BalanGe Due: Units Fee/Unit .00 .00 27.00 Ext fee Data -------------------~-------------------------------------------------------Enter "Y" for Plumbing Issue Fee > 20.00 Y 7.00 Gas Piping System 7 .00 RO /AL ~ U ATE.i..::1 S-fff_ CLEAriA; CE----~~ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION FOR OFFICE USE O~ PLAN CHECK NO. ']()7L CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL. ____ __..:::::,i...-,L~-ri---r- Plan Ck. Deposit:...::,,...+--..e:.::_,"--'~~r- Validated By_____,~........,;;....::""---:h:=--r;-,:,-:.r,-- Date _______ ➔~.11.-~'--fr-1~-- -IL 1. PRojECT INFO~ "'. ;;i., zt.. o l Address (include Bldg/Suite I) usiness Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total I of units Assessor's Parc11I I Existing Use Proposed Use #of Stories I of Bedrooms I of Bathrooms Name Address 3. APPLICANT 0 Contractor O'"Agent for Contractor Name Address 6. CONTRACTOR • COMPANY NAME City 0 Owner O Agent for owner • City State/Zip State/Zip Telephone I Fax I Telephone I (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 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 · Address City State/Zip Telephone I State License I _________ _ License Class _________ _ City Business License I _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 6 . WORKERS' COMPENSATION ----U: 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. 0 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) 0 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 b~come subject to the Workers' Compensation Laws of California. WARNING: Failure to aecure workera' compenaatlon coverage la unlawful, and shall subject en employer to crlmlnel penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the coat of compensation, damages ea provided for In Section 3706 of the Labor code, Interest and attorney's, __ SIGNATURE______________________________ DATE 7. OWNER-8UILD£R DECLARATION .. -:;:;;;;;:;_;;;~~:::;;,;;;:;.;;:::;:;;,""" I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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 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 ■ale). , as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The actor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(sl licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business and Professions Coda for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I h e c tractll!l w·th the f · g person (fir I to provide the proposed construction (include name / address / phone number / contractors license number): ~ 7 I plan to provide portions of the work, but I have hired th 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_,J...Jl.l.£L.a..4':l:.::::~4....t.,.~..:......,P..l...l...&:::l!::::'2!:=.!:::l.<'. ____ _ COMPLETE THIS SECTIOI! FOR flON-RES/. 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 26605, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act7 0 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? O YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site7 0 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 POUUTION 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). 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 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 t ime aft r the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). ~ APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION INSPECTOR Tu 11 Q ,Q .Ano,:fi , PERMIT # <-\€)6Q-:t,9, PLAN CHECK# JOB ADDRESS 2 2, Q O\iuo (:\1.)9 ; - DESCRIPTION t mo•h~C1aA~O ,'~ > Y\o O 4ChO: (a,mor) TIME ARRIVE: ____ _ TIME ____ _ CODE DESCRIPTION ACT COMMENTS .. -----~..i---~·--~--------~ .. ------