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Home My WebLink About2200 CAMINO ROBLEDO; ; CB033420; Permit12-10-2003 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No: CB033420 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 2200 CAMINO ROBLEDO CBAD PLUM 2552613600 Lot#: 0 Construction Type: NEW REYNOLDS RES-GAS LINE TO BBQ Status: ISSUED Applied: 12/10/2003 Entered By: KMT Plan Approved: 12/10/2003 Issued: 12/10/2003 Inspect Area: Applicant: WILLOW LANE GROWERS 753 REQUEZA ENCINITAS CA 92024 760-753-4595 Owner: REYNOLDS CARLSBAD 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 Additional Fees $0.00 $7,Qfl $0.00 $0.00 TOTAL PERMIT FEES Total Fees:$27.00 Total Payments To Date:$0.00 Balance Due:$27.00 0655 12/10/03 0002 01 02 CGP 27-00 EXPIRED PERMIT PERMIT WP EXPIRED IN ACCORDANCE WTTHUAC SECTION loti.4.4 DATE PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK EST. VAL. Plan Ck. Deposit Validated By, Date Address (include BIdg/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 ID SO. FT.tof Stories # of Bedrooms # of Bathrooms Name Telephone #Pax* (Sec. 7031.5 Business end Professions Code: Any City or County which requires e permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file s 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 [$500]}. LAMS State License # / 0 H U ^P» fJlRJT prlMfiR Designer Name _- IftUj CJOState License # I y T* ^^ Address _ License Class (^/ A* Address City State/Zip "71 City Business License If City State/Zip Telephone f 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. 3. I nave and will maintain workers' compensation, es 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: - . . *s\ I US /Insurance Comoeny STMV fl>KP. JUS.Policy No.^M Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*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 la unlawful, and shaN subject an employer to criminal penalties and dvi fines up to one hundred thousand doHare (Vffco,0(»0); hi addHbnoo the cost of compensation, damages M provided for In Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE lAUJfU /Kjbt l) lA^ _ DATE I hereby affirm thatT am exempt from the Contractor's License Law for the following reason: Q 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, end 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}. Q I. es 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 contractbr(s) licensed pursuant to the Contractor's License Law). Q 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 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 26505, 26633 or 26534 of the Presley-Tanner Hazardous Substance Account Act? Q YES Q 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? D YES Q NO IF ANY OF THE ANSWERS ARE YES, REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 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 . I certify that I have read the application and state that the above information is correct and that the information on the plens is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the CrtV 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 Jw the building Official undaMhe provisions of this Code shall expire by limitation and become null and void If the building or work authorized by such permit is not co/nmdpced within 180 days fiopr the date of such permit or if the building or work authorized by such permit Is suspended or abandoned at any time after the work Is com APPLICANT'S SIGNATURE for a &riod of I ion 106.4.4 Uniform Building Code). DATE WHITE: Fife YELLOW; Applicant PINK: Finance City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 l2-30-2003Plumbing PermitPermit No: CB033420 Building Inspection Request Line (760) 602-2725 Job Address:2200 CAMINO ROBLEDO CBAD Permit Type: PLUM Status: APPROVED Parcel No:2552613600 Lot #: 0 Applied: 12/10/2003 Construction Type: NEW Entered By: KMT Reference #: Plan Approved: 12/10/2003 Issued: 12/10/2003 Project Title:REYNOLDS RES-GAS LINE TO BBQ Inspect Area: JM Applicant: Owner: WILLOW LANE GROWERS REYNOLDS PETER D&SUSAN H 753 REQUEZA 2200 CAMINO ROBLEDO ENCINITAS CA 92024 CARLSBAD CA 92009 760-753-4595 Plumbing Issue Fee $20.00 Fixture or Trap 0 $0.00 Building Sewer 0 $0.00 Roof Drain 0 $0.00 Install/Repair Water Line 0 $0.00 Water Heater and/or Vent 0 $0.00 Gas Piping System 1 $7.00 Vacuum Breaker 0 $0.00 Other Plumbing Fees $0.00 Master Drainage Fee $0.00 Sewer Fee $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $27.00 Total Fees: $27.00Total Payments To Date: $27.00Balance Due: $0.00 City of Carlsbad Bldg Inspection Request For: 12/11/2003 Permit* CB033420 Title: REYNOLDS RES-GAS LINE TO BBQ Description: Type: PLUM Sub Type: Job Address: 2200 CAM I NO ROBLEDO Suite: Lot 0 Location: APPLICANT WILLOW LANE GROWERS Owner: REYNOLDS PETER D&SUSAN H Remarks: Total Time: CD Description 24 Rough/Topout Act Comment Inspector Assignment: Phone: 7607534595 "Inspector: Requested By: JULIE Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments CTQtfcTATE ._. Business Pu-kOra.Saframenia. California95327 Mailini Addins- P. Ollot 2WWO. Saeranwr,«3. CA 95* ... MF 6) 255-390C- B, - < CO JjMV STATE OF CALIFORNIA Qi*y D»vu, Governor APPLICATIOWOR CHANGING BUSINESS NAME AND/OR ADDRESS - No fee required1, • OR CERTIF1E1WALL CERTIFICATE AND/OR POCKET LICENSE CARD - $11 each Address Change Only - comHete sections }. 2, 5, 6, ?, S, 9, and 11. Name Change Only - complcM sections 1,2,3. 4 (if applicable i. 1C (if applicable), and U Name and Address Change Aompietc sec'.ions I. 2. 3. 4 (if applicable), 5.6. 7, 8, 9, 10 (if applicable), and It. Certified Wall Certificate aifour Pocket License Card Only - complete sections 1, 2, 10 and II TYPE OH PKWT t* INK 1. BUSINESS NAMg(Miicurr CSLIM [ 2. LICENSE NUMBER OK PENDING APPLICATION NUMBER ;iNG A BUSINESSentity; (2) the new name does!licensed; (3) the new name CHANCiNC A, ftySIfNf^SSJ me corporate name as regis»do nut need to make any chf AMEi You may change trfe business name^of your license if: (1) the new name does not indicate a change >t indicate that you qualify for a classification other than the cfasiificationt*) u> which you are presently nut indicate a change in personnel. iM£ ON A CORPORATION with the Secretary of State's n (N; Before the CSLB can change your corporate name, you must first change Office. If you are simply adding a "DBA" to the existing corporate name, yo with the Secretary oCState's Office. you ! 3. NEW BUSINESS NAME Sa.\, PMB, Gwtral Ottherv or AT, y** t*tut 9tt0ttitt**pkjah:ula*lrtn S. N£W BUSINESS iMAH.LNctoURtSS CITV STATE &L ZIP CODE cir\ 75",? STATE G4- ZIP CODE 7. BUSINESS TELEPHONE NU4B£R * KA\ NOMBCK 7^3 9. E-MAIL ADDRESS REOLESTINH CE.TING CERTIF1 only Deorderea \ WALL CERTIFICATE AND/OR POCKET LICENSE CARD: Wall certificates and pocket license iivcertificate and'or pocket lie* Contractors. DONOTSE1 /OR P sd ana I^licenses that are currently renewed and^have no current suspensions on record. Submit Si 1 for each ke card. Attach a money order, personal, business, certifiea or cashiers' check payable to the Registrar ofICASH. There will be a J: 0 service charge for ench dishonored check. 10. PLEASE INDICATE flfEl* MBER OF DOCUMENTS UtlNf. REQUESTED AT THE COST OF III EACH i POCKET LICT-.-ttC CARD (S>, II. IMP On AN•frThefo:ATTesponsi wing certification must be completed and signed by a member of personnel currently listed on the records ofManaging Employee cannot sign the form. , I certify under penalty of perjury Signature o Print Name Partncmr Officer ____ / <_ JU * Jf AH items cf ^fwtnat.on r^uesieci mundaory n« offici for ^ momwnance rf ** infbmutuNi 11 the Rc|Utf»r of Comr«tor», C«Kncm Stutt License don, ** Lrfwidual have me ,«hc a, it*«m ih. Rl«s on recofdi nwntmned on ih<m by I3L-* (Rev. CEtTIFICATE OF LIABILITY INSURANCE *•mowctftJolwaop t Mood Xn«|*«ne«&«rvio»i, Inc3731 »»l»»r way, r*x:7«0-C03-ftl35 TM* CEftTffCATt I* WtUtt At A MAI II* 0* IWpKMATiONONLY AND CONfiM NO mOHT« UPON THE CWTH>ICATE AtTKK THE COVWUgg AffORPtP JT TH1 POUOM ItLOW WMNWMAPPOMOIHO COVCRAM NMC* MMCKC WMWflD: )KLgWH*A»t«NlMUOTOT^«fc«DM*tfiPA»^f^Yr««XCrPeRI(>OWaCAriD.MOTV.lTH«TANOIM , TCMU Oft ectonWM of ANV co^nMCT M OTHtn oocgunn WITH MMPICT TO «H«M THIS ceKrvcATEtMY««*M» OftFOWH>r' the fouaw MKWWO wwu »tuwecr TO AU TW T»W». EXO.I«ION» *we cowiTtoiworiucM EACKOCCUMINCI HMD CMP |ft<y «W NMH) •ftCMLMMKMATl MpDUCIt • COMffOF MW MMLIlMIT YWMKY YHMKV PMWCTVMIMMi4 MTOQWY-IAACCOWT i**CC EACHOCeftMNCC A4MMATC •euiM i "««0l 02/12/03 ! 02/01/04 i 1000000 lABAOm 11000000 ftJtAM.POilCYUin * 1000000 «wcww6«AMifcK15c5if CANCIUAHON IN8UHE9 lR«urad>»|/*rifiea«9.on Only 9MOUUI AW W THCAWVf DUC*M» >«.«•* K THi«MttTiOt» 10 MPTIOI TO THi«Hniric*« HOLM* NMKD to TW tin. vurwuw *e oo to «MU wmt NO OM.BATON OR uMiutv a* ANV *w uw* rw wHMm. rrt MSMTS m NUMMNfATIUfS, 1W ** TOTAL PftGE.01 ** v 4