HomeMy WebLinkAbout2219 LEVANTE ST; ; CB981968; PermitPermi t No
Project No
fJevelopmeat No
CB9819 68
A9y6 26 04
B IJ I L D ING P E R M I 'X.
0 6/22/98 10:14
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Job Address: 2219 LEVANTE ST Suite:
Permit Type: PLUMBING 8277 06/22/98 0001 01 02
Parcel No: 216-240--52-01 Lot#: C-PRMT 27-00
Valuaitiori: 0 Constr-act i on Type: NEW
Occupancy Group: Reference#: Status: ISSUED
Description: EMERGENCY GAS LINE REPAIR Applied: 06/22/98
: Apr/Issue: 06/22/98
Entered By: JM
Appl/Ownr : EJERCKS PLUMBING 760 745-995S
640 ALPINE WAY
ESCONDIDO CA 920?.9
*kk Fees E;equired ^ * ' ••".''X'" .lected & Credits *A*
Fees :
Adjustments:
Total Fees:
Fe?e description. .ha
Enter "Y" for Plumbl3rig.«?A|5"3(if^ *•
Gas Piping System 'J^r "' '
I IT! '
, X<4ta.i C' edits :
.F^e/^'it
. 0 0
. 0 0
2 7.00
Ext fee Data
2 0.00 Y
7 . 0 0
FIN^APPROVAL
CLEARANCE.
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
1. PROJECT INFOIWIATIDN
FOR OFFICE USE ONLY
PLAN CHECK NO.
EST. VAL.
Plan Ck. Deposit
Address (include BIdg/Sulte 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 #of Stories H of Bedrooms # of Bathrooms
2. COIiTACT PERSON
Name — / Address' ~/ City
3, APPUCANT QCaitHmxtor 13 Aa«it1orCor!tmctor. .QOvimer ' lIJAO'Wfe'" Owner
te^?9 7/^-^ #5^
State/Zip Telephone # Fax #
Name
4.
Address City State/Zip Telephone #
PROPERTY OWNER
Address City State/Zip Telephone # Name
^. tiONTRACTOR -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
exemptiop. Any violation of Section 7031.5 bv any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars^($500D. emptiop. Any viqiatio
Name
State License #
Address
License Class
City State/Zip Telephone #
City Business License # / t'C/ i^JLoiD
Designer Name Address City State/Zip Telephone
State License #
6. VyORKEI»'COMI^$ATION . . ,
Wqrle^rs' 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.
• I have and will malritain workers' compensation, as required by Section 37(30 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: ^ t j-- > jO ) ^ — / Q'y^
_^Policv No. Ay jO ^ l/'Sf n ^Expiration Date ' ' " 1^ •^Insurance Company
compensation insurance carri
'Policy No. ^Ly J If^
INDRED DOLLARS (*100| OR LESS) (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE I
G 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.
WARNINQ: FtXiiaaAeC'teom workan>^mpensation covarpgtf'la unlawful, and shaN aul^act an employerto criminal penalties and civil fines up to ona hundred
thousand dollarv(s100,000{L in adcHmn to thit mtt g^^^miiniiitlTrn damagea »i prBrhliirt fw In 5itrtfm 3706 of tha Labor code, bitorMt and attomey'a fees.
^ ^^^3^,^^ ^^^SIGNATURE .DATE I
OWNER-BU iCSJOUktlOM' - •-'-—•..«'- -- -
I hereby affirrj><ffiat I am exempt from the Contractor's License Law for the following reason:
Q I, aS^wner 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
{SecyfoM, 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).
• I, as owner bf 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, end contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License Law).
• 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. • 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^HIS SECTION FOR WOAMEStDSVTZiU BUIU^
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 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? Q 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.
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code).
LENDER'S ADDRESS LENDER'S NAME
M>PUCMn'CERTIPOl>TI0N - :
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. 1 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 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 S'O" deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Official under the provisiora of this Code shall expire by limitation and become null and void If the building or
work authorized by such permitjs^tjiommenced within 365 days from the date of such permit or if the building or work authorized by such perrnit is suspended
^ opabandoned at any time ai
JVAPPLICANT'S SIGNATURE
.4.4 Uniform Building i
WHITE: File YELLOW: Applicant PINK: Finance
UNSCHEDULED BUILDING INSPECTIQN
DATE y^.ri.9<^ INSPECTOR
PERMTT # q9>V^lp?^ PLAN CHECK#
JOB ADDRESS Ljijua—
DESCRIPTION
TIME ARRIVE: TIME
CODE DESCRIPTION ACT COMMENTS