HomeMy WebLinkAbout2270 La Costa Ave; 3 | MULTI-PERMIT FILE; CBR2017-1484; PermitPrint Date:· 07/07/2017
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
# Dwelling Units:
Bedrooms:
Project Title:
Description:
2270 La Costa Ave, 3
BLDG-Residential
2163101303
$0.00
LEE: REPLACE WATER HEATER
PLUMBING, ELECTRICAL, AND MECHANICAL PERMIT
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Residential Permit
www.carlsbadca.gov
Work Class:
Lot#:
Reference#:
Construction Type:
Bathrooms:
Orig. Plan Check#:
Plan Check#:
Owner:
STEPHANIE LEE
2270 La Costa Ave, 3
CARLSBAD, CA 92009
626-377-9262
P/M/E
Total Fees: $98.0D Total Payments To Date: $98.00
Status:
Applied:
Issued:
Finaled:
Inspector:
Balance Due:
Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter
collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these
fees/exactions. lf 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 capacity 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 limitation has previously otherwise expired.
Permit No: CBR2017-1484
Closed -Finaled
06/30/2017
06/30/2017
$0.00
$98.D0
EOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING 0 ENGINEERING □BUILDING □FIRE □HEALTH 0HAZMATIAPCD
{ City of Building Permit Application Plan Check No/' /JJ)_ 2CJ , -, -14_ i Li
1635 Faraday Ave., Carlsbad, CA 92008 Est. Value
Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Dep~sil email: building@carlsbadca.gov .
www.carlsbadca.gov Date rn /.':1/Jfl I
~/SPACE#/UNIT# IAPN ---JOBADDRESS) COSWI -M Ave 'n-7() y\ .
CT/PROJECT# I LOT# I PHASE# I# OF UNITS I# BEDROOMS # BATHROOMS I TENANT BUSINESS NAME I CONSTR. TYPE I OCC. GROUP
DESCRIPTION OF WORK: Include Square Feet of Affected Area(s)
W1SW. \\ ~ ~ rn [f1".08f
FIREPLACE EXISTING USE I PROPOSED USE I GARAGE (SF) PATIOS (SF) I DECKS (SF) IAIR CONDITIONING I FIRE SPRINKLERS
YESO No□ YES □No □ YES □No□
APPLICANT NAME PROPERlY OWNER <;-tt-pho.nte-<reto L,ee, Primary Contact
ADDRESS {l(_Vti)~~ ADDRESS 1?10 '--"' COS{{) A)e. t3 0
CITY I I STATU ZIP c1Tv Ou ls \t;IJ STATE QJ\_ ZIP'1~01
PHONE I FAX PHONElci}.b-3 T\ -'1)01--IFAX 11/ Oi
EMAIL EMAIL ~ t,ee,@)~I.OO f' · {.,oV/
DESIGN PROFESSIONAL CONTRACTOR BUS. NAME
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE I FAX PHONE I FAX
EMAIL EMAIL
I STATE UC.# STATE UC.# I CLASS I CITY BUS. UC.#
(Sec~ 7031.5 Business and Professions Code: Any City or Coun_ty which requires a permit to_construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the
applicant for such per_mit to file a signed statement that he is licensed pursuant to the prov1s1ons of the Contractor's License LawJChapter 9, comme_nding with Section 7000 of Division 3 of the
B_usiness and Professions Code} or fuat he 1s exempt therefrom, and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subJects the applicant to a
c1v1I penalty of not more than five hundred dollars [$500)).
WORKERS" COMPENSATION
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
8 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 issued. My workers' compensation insurance carrier and policy
number are: Insurance Co. ______________________ Policy No _______________ Expiration Date __________ _
~section need not be completed ~ the permit is for one hundred dollars ($100) or less. LJ 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 to the cost of compensation, damages as provided for In Section 3706 of the Labor code, interest and attorney's fees.
Kf CONTRACTOR SIGNATURE □AGENT DATE
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from Contracto(s License Law for the following reason·
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).
□
□
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 buikls or improves thereon, and 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. 0Yes 0No
2. I (ha~e I have not) signed an application for a building permit for the proposed work.
3, \ have contracted with the following person {firm) to provide the proposed construction {include name address I phone/ 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 I phone/ contractors' license number):
5. I will provide some of the work, but I have co acted (hired) the following persons to provide the work indicated (include name/ address/ phone/ type of work):
Kf PROPERTY OWNER SIG NAT □AGENT DATE 0 20\1
I
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? □ Yes □ No
Is the applican~or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ Yes □ No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ Yes □ 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.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read the appllcatlon 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 au~orize represenlative of lhe City of Carlsbad lo enler upon ~e 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: MOSHA pe,mlt is required for excavations over 5'0' deep and demolitk::tl or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building under the p · ions of this Code shall expire by limitation and become null and void if the building or work aulhorized by such pennlt is notcommeoced withrl
180 days from the date O\"'al>li!:'ITlit or if the bu· 1ng work eel It is su or abandon any time after the work is commenced for a period of 180 days (Section 106.4.4 Unifonn Building Code).
DATE
STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection.
Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008.
CO#: (Office Use Only)
CONTACT NAME OCCUPANT NAME
ADDRESS BUILDING ADDRESS
CITY STATE ZIP CITY STATE ZIP
Carlsbad CA
PHONE FAX
EMAIL OCCUPANT'S BUS. UC. No.
DELIVERY OPTIONS
D PICK UP: o CONTACT (Listed above) o OCCUPANT {Listed above)
o CONTRACTOR (On Pg. 1)
□ ASSOCIATED CB#------------D MAIL TO: o CONTACT (Listed above) □ OCCUPANT (Listed above)
o CONTRACTOR (On Pg. 1) □ NO CHANGE IN USE/ NO CONSTRUCTION
□MAIL/FAX TO OTHER: ________________ _
□ CHANGE OF USE/ NO CONSTRUCTION
,es°APPLICANT'S SIGNATURE DATE
, ' ' w
. , : , PERMIT INSPECTION HISTORY REPORT (CBR2017-1484)
',;., 4110whf;, ,
Porn11t T~pc':
Work Class:
Status:
Scheduled
Date
BLDG-Residential
P/M/E
Closed -Finaled
Actual
Start Date Inspection Type
Application Date: 06/30/2017 Owner:
Issue Date: 06/30/2017 Subdivision:
Expiration Date: 01/03/2018 Address:
IVR Number: 4762
Inspection No. Inspection Status Primary Inspector
07/07/2017 07/07/2017 BLDG-25 Water
HeaterNents
028136-2017 Passed Michael Collins
July 07, 2017
BLDG-Final
Inspection
Checklist Item
BLDG-Building Deficiency
028294-2017
Checklist Item
BLDG-Building Deficiency
BLDG-Plumbing Final
BLDG-Mechanical Final
BLDG-Structural Final
BLDG-Electrical Final
COMMENTS
Passed Michael Collins
COMMENTS
STEPHANIE LEE
CARLSBAD TCT#73-57
2270 La Costa Ave, 3
Carlsbad, CA 92009-6920
Reinspection
Passed
Yes
Passed
No
No
No
No
No
Complete
Complete
Complete
Page 1 of 1
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
10-04-2002 Plumbing Permit Permit No: CB023004
Job Address:
Permit Type:
Parcel No:
Reference #:
Project Title:
Applicant:
A&J FOSTER, INC.
STE B
13706 HWY 8 BUS
EL CAJON CA 92021
619-390-4477
Building Inspection Request Line (760) 602-2725
2270 LA COSTA AV CBAD St: 03
PLUM Status:
2163101302 Lot#: 0 Applied:
Construction Type: NEW Entered By:
CORBELLI RES-REPLACE H20 HEATE
Plan Approved:
Issued:
Inspect Area:
Owner:
FERGUSON CHARLES K
2270 LA COSTA AVE #2
CARLSBAD CA 92009
ISSUED
10/04/2002
RMA
10/04/2002
10/04/2002
Total Fees: $27.00 Total Payments To Date: $0.00 Balance Due:
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
TOTAL PERMIT FEES
Inspector:
0
0
0
0
1
0
0
FINAL
Date: Clearance:
$20.00
$0.00
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$27.00
$27.00
NOTICE: Please take NOTICE that approval of your project includes the "lmpositionn 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 capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any . . f . .
FOR OFFICE USE ONLY
PERMIT1APPLICATION PLAN CHECK NO. ____ _
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
EST. VAL. __________ _
Plan Ck. Deposit ________ _
Validated By ___________ _
Date _______________ _
~f ;'t-lc':pR()JECJJNFO!l.MATIQJ\l, •• •''11~l;":~;t1;;'.l'W'ili'1rC!l~c:.1~rJt~Jji~~J't}f;:i';;~fil/!l'.'.{)f,~Jii~'il~;~
2270 LA CQSTA AVE #3 Address (include Bldg/Suite #) Business Name (at this address)
Legal Description Lot No, Subdivision Name/Number
SFR
Unit No. Phase No. Total # of units
Assessor's Parcel # Existing Use Proposed Use
216-310-13-03 # of Bedrooms # of Bathrooms
Name Address City State/Zip Telephone # Fax #
@ ~'APf1L1CA_Nt "'5CL 9.n~rap~q~~:~rrA!ieMCJp(t9~~(]:Q~i1Jl~0 :4"/i.e1:l c(9howfa~&~~•~'/~, ~~:,~r:1;;~1[• •.:y ,_:': '> :
Arlen Foster/Carol Foster 13706-B Hwy .8 Bus . El Cajon, ca. 92021 (619)390-4477
Name Address City State/Zip Telephone #
r4; t~~~e,R~Q~Eijr::f ovm~·~ ·• -· I ·•; i ::1~:a~;~~i~fr:;~:id~~~i~:r::·~~W~i~iw-~~,~:J1.~,t~i~J.~~•ti~'.B~~~~~ ~:,~~~~r · 'i . I •,PJ,••··" •.. 1;"' f;\ ~I
CQRBET,T,T, ROBERT 2270 LA COSTA AVE Car] sbaa Ca 92009 760 232~7509 Name Address City S.tate/Zip Telephone #
1s.~¢.oNTRA(ftcfFi:!c.oiiAPAf!'V'iN1MJ;JZ.';riu~-i.%~~-~;;~~.m"ill1!tlii,;~.;,'ffJ'w'~•'e!B~~'iffl·iJ.~·1~.dl5P~t•:<1;"',;r~,t •.. ·~,;·,·
(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 ($500]).
A & ,J Foster Plumbing 13706 E Hwy. fJ Eus. :e:l CaiOn CA. sn~;:n { 619~ ?e9h0 4477 Name Address 1ty tate 1p e ep one #
State License # 630120 License Class C-36 City Business License# ) 21 0836
Designer Name Address City State/Zip Telephone
State License # ~ IA, ,
'Go""\'' •·=o· RK·E·R-s~.• ~c·o· -M--P1 'E;;.,SA~r·"o~~...,,,~~-•~,.,!)!'•~,-.~ c?,~=~1•,>1,';~r;,,,,.,., .. '"•"""G.i',t,c.,· · '."",3,:r5f,:1~'" • .. af!t, ."Plif'."! ',\': g,,ry· '', ',,i;_(/•UY:•J'l't.~ . 'L:. •:•,·,C:,,J,• 1:., ··DUt11 -~Ill .. 1, •~-·.,*,__w;~;~"J,·, ,~ -~~'"'!•':.1\.r!'~~~~-x;~~!P',._,•~-ts ,, -j,\<.,J.;,;:'".,;;lr ri1ti+11',_1,,'<t··W°7"-·~;;i-~~,;;iwf:~~:..1:· '"',~,~~,;;llf_,,-,i~.· ·'r'!• -~ ,~ "'"
Worke;s• Compensatio~ Decli ration; I hereby affirm under penalty of perjury one of the following declarations:
O 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
'rssued. My worker's compensation insurance carrier and policy number are:
Insurance Company State Comp, Ins, Policy No.467 01 0000713
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS)
Expiration Date __ Q_..4,__.Q,..l+-+01-3+--
O 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'
thousand dollars I $100 ,ooqi;_ in
SIGNATURE '
ful, and shall subject an employer to crlmlnal penalties and civil fines up to one hundred
es as provided for In Section 3706 of the Labor code, terest and attorney's fees.
;; DATE nn?
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
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).
O 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).
0 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. 0 YES ONO
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 I: ________________________________________________________ _
PROPERTY OWNER SIGNATURE ______________________ _
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 26534 of the Presley-Tanner Hazardous Substance Account Act? 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? 0 YES O NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 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 POLLUTION CONTROL DISTRICT.
ts-~t@1(sfRuqfforrr:erfo1Wd'.fe:aeij_,cy,i~~E~iJ~B::~Jr~ltfi~yJJ1?f{)~r?01{~1~~1~'tW1li,~,rillif1i:~?!•.5~L~r~t•;,~i?1fr·:
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 ____ ...,t:iO ....... NE,.._. _______ _
~~AllP.L.l°C'~N.t ''cfBIIFicAJlo~~.,,r ""5m"Jii~~~~~'l:'i•~iJ~-~~~]lri2~l]f;,'.?Jf~~'m~JJi~l.r.i~"Rst~J··;•l{. 'i;;i:
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 Cit\' 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 permil Is not commenced within 180 days from the date of such rmit or if the building or work authorized by such permit is suspended or abandoned
at any time after the work is commenced for a O days ion 10 Unif rm Building Code), Q l, f 4 I ---~~r---. ,, ! II I.. APPLICANT'S SIGNATURE ----~-6-~~~~~~.J_~~L~~~~...-:::_______ DATE _____________ _
PINK: Finance
m •
.
•
City of Carlsbad Bldg Inspection Request
For: 10/30/2002
Permit# CB023004
Tille: CORBELLI RES-REPLACE H20 HEATE
Description:
Type:PLUM Sub Type:
Job Address: 2270 LA COSTA AV
Suite: 03 Lot 0
Location:
APPLICANT A&J FOSTER, INC.
Owner:
Remarks:
Total Time:
CD Description
25 Water HeaterNents
Associated PCRs/CVs
Inspection History
Date Description Act lnsp Comments
Inspector Assignment: JM ---
Phone: 7609423188
Inspector: J~,
Requested By: AARON
Entered By: CHRISTINE
10/15/2002 25 Water HeaterNents CO JM NO ONE HOME
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
10-11-2002 Plumbing Permit Permit No: CB023090
Job Address:
Permit Type:
Parcel No:
Reference #:
Building Inspection Request Line (760) 602-2725
2270 LA COSTA AV CBAD
PLUM
2163101302 Lot#: 0
Construction Type: NEW
Status: ISSUED
Applied: 10/11/2002
Entered By: MDP
Plan Approved: 10/11/2002
Issued: 10/11/2002
Project Title: CORBELLI RESIDENCE
WATER HEATER REPLACEMENT Inspect A'ffl!':f.4 10/11/02 0002 01.
Applicant:
A&J FOSTER, INC.
STE B
13706 HWY 8 BUS
EL CAJON CA 92021
619-390-44 77
Total Fees:
Plumbing Issue Fee
Fixture or Trap
Building Sewer
Roof Drain
$27.00
Install/Repair Water Line
Water Heater and/or Vent
Gas Piping System
Vacuum Breaker
Other Plumbing Fees
Master Drainage Fee
Sewer Fee
Additional Fees
TOTAL PERMIT FEES
Inspector:
Owner:
FERGUSON CHARLES K
2270 LA COSTA AVE #2
CARLSBAD CA 92009
Total Payments To Date: $0.00
0
0
0
0
1
0
0
Balance Due:
$20.00
$0.00
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$27.00
FINAL APPROVAL
Date: Clearance:
CGP
$27.00
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
referred to as "fees/exactions." You have 90 days from the dale this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
·1 f. I • •
02
FOR OFFICE USE ONLY
PERMIT APPLICATION PLAN CHECK NO. ____ _
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
EST. VAL. _________ _
Plan Ck. Deposit ________ _
Validated By __________ _
Date. _______________ _
i·f~l"PRQJ_lC.J'J~FPRMATJON·. · ~;: _: .. ,~. Ji}'~"~i:1ji[it/r~t~ '!&;?;[~ ''~j~~~~~~~fil~~itil
2270 La Costa Ave
Address (include Bldg/Suite #) Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. SFR
Assessor's Parcel # Existing Use Proposed Use
216-310-13-03
Description of Work SQ. FT. #of Stories # of Bedrooms
Total # of units
# of Bathrooms
. .. Wa.te.r . Heat;.~r; ~e2lae;eIT}ent ~ c~~~~1il$~~~~~~ft fromi!P~!~~o ··~~~\~~1!~~~~r1~a~~~,i55,W r~:•~3'L3/s'd9 .;;:~f,;;·
Name Address City State/Zip Telephone#
l'h ~-~P,ftQP~fft,fJtWN~J~ ~:.~-r--· :!~~:-~1~I~~1:a3~~1~~~~( ~~:&::rt.g~i~~fi~~;~~~[ ~~~::Iitl~~ff!tfL~wif;;'i11♦1~i~~~l~ ~;:::~<~A.':; .'~&!i,ti \,
Corbelli Robert 227D I.a Costa Ave Carlsbad Ca 920D9 619 232 75Q9
Name ' Address City S.tate/Zip Telephone #
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(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).
~:mt J Foster Plumbing El Ca.~on ,ty CA.
State License# _,_6L3.JJQU-J.]..,2..,Q.,_ ___ _ License Class __.,C--=. .... Ju.6,._ _____ _ City Business License # ] 21 0 8 J 6
Designer Name Address City State/Zip Telephone
State License # --P.N1-ttC..J.l\C\------
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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.
,CJ 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
4\sued. My worker's compensation insurance carrier and policy number are:
Insurance Company State Comp, Ins , Policy No.467 Ol 0000713
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS)
Expiration Date _ _,_Q,..4~0 ...... 1.=-,_.Q.,__l_._· _
0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in eny manner so as
to become subject to the Workers' Compensation Laws of Ca!ifo ia.
WARNING: Failure to secure er ' ,_om_penfn cover Is wful, and shall subject an employer to crlmlnal penalties and civil fines up to one hundred
thousand dollars ($ 100,00 , n d f;;'Yor pf amages as provided for In Section 3706 of the L or ode, Interest and attorney's fees.
SIGNATURE·----~=----------~---------------DATE -~-4-"-I-I.L--+,,,,----
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I he;eby 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
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).
O 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).
0 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. 0 YES ONO
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 I 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 _________ _
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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 Act7 0 YES O NO
Is the applicant or future building occupant required to obtain a permit from tho air pollution control district or air quality management district 7 0 YES O NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 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 ANO THE AIR POLLUTION CONTROL DISTRICT.
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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 ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES,
JUDGMENTS, COSTS ANO 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 of such permit or If the building or work authorized by such permit is suspended or abandoned
at any time after the work is commenced for a · 180 days (Section 1~.4.4 Uniform Building Code). I \ I ~
APPLICANT'S SIGNATURE ---,&,-C:~~~.L_..,Lf-...,_."'7~~z;;--------DATE \() ( -_O (,_ I PINK: Finance