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Home My WebLink About2278 LISA ST; ; CB053771; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 10-28-2005 Plumbing Permit Permit No: CB053771 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: 2278 LISA ST CBAD PLUM 2073700200 Status: Lot#: 0 Applied: Construction Type: NEW Entered By: Plan Approved: Issued: Project Title: INGRAM RES REPLACE GAS LINE Inspect Area: Applicant: INGRAM JOHN L 2278 LISAST CARLSBAD CA 92008 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 0 0 0 0 0 1 0 Owner: INGRAM JOHN L 2278 LISA ST CARLSBAD CA 92008 ISSUED 10/28/2005 KG 10/28/2005 10/28/2005 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.00 Total Fees: $27.00 Total Payments To Date: $27.00 Balance Due: Inspector: Date:I• Clearance: $0.00 proval of your project includes the "lmposltionfl of fees, dedications, reseivations, or other exactions hereafter collectively referred to as "fees/exactions.ff 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 Ccx:le 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 ff APPLY to any ' . . . . PERMIT APPLICATION FOR OFFICE USE ONLY PLAN CHECK NoC'fiJ'f3 77 / CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Plan Ck. Deposit -----,.:;,.,.,,----- 1... i\Ji'~CJ INFO!WATION '., · , . ~ ;:;/ 7. Es: l,.. I $, A--- Address (include Bldg/Suite #) . . . . • .. 'Ji . ,• ft<,;. ,, . ' . i&-1 ,, Lrfp H the Ya .. k l . • Buf.ness Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total I of units Proposed Use I of Bedrooms I of Bathrooms Name Name Address City O ~Agt_nJfor c;onlrtcJor ·. 0 9,wn~t;. e Agent;lo(Owrer Address ,.. Address City City State/Zip Telephone I \,,. State/Zip Telephone I .., 'a State/Zip Telephone# .,: ~QIWJBAC.IQ8_, C(lft1lANY,NAt,tlF ,. ,· ', .. ,.,.' ·-.;... . ,\\. '• • ;•.)t,~·~.; ';. Fax 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 # _________ _ License Class _________ _ City Business License I _______ _ Designer Name Address City State/Zip Telephone State License I _________ _ t,~ ~~CO .. MflNIATJQt( ~ {~~~;~ ... :~~-, M .;. i-'. . ~(.) -~' ~•MJ: ,; ~···r) e~i; ,4-.-. 'I ~ 4 ' f',_. ~l Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: '~ 1 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 compensetion 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 ($1001 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 become subject to the Workers' Compensation Laws of California. WARNING: Failure to Hcura worke,a' companHtlon cove,aga 11 unlawful, and "'811 subject an employer to criminal peneltiaa and civU fines up to one hundred thousand dollar• ($100,000), in addition to the coat of compenaation, damagea aa provided for in Section 3706 of the labor coda, intereat and attorney's fees. SIGNATURE. ______________________________ DATE _________ _ ;,",1\ OlYMffdll;llaB. Q~TtQNl ~-. ', i;.~.~~\ •; "•.\.;:';J'.f;;{'™~ffi, ,.f;,">\/,:,l,,!'.\. • · < <, •°1.· ,'',u /"'•• I I hereby affirm that I am exempt from tha Contractor'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 Coda: 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). 0 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). D 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. D 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):. ________ ....;.._...,.,,_,---,..-,------------------------------------------- ~OPERTY OWNER SIGNATyd-4:;;;::::::;,.t:~~~~O,...d=4,....-===----------,---DATE ________ _ ~JJ.tit~!mOMJ,EQttNl:JH;t,&""1l,ffi17AJ n .!>.NLY~'.tlm "j; . .I.it~,; ,, " ., 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? D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 D YES D 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. lt,:.: .... &QMl:TH!l!tI!QN L-~.Qffi5i~GEN~)'.......;.__ , J:.:-.... .i., .i., {. '., j . ' , ,, 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. _________________________ _ ~-:~~~~IiQ.t{ ~~~ .'Uf \\i ~~/.£.~.~~ : , '!•!t~ t ;,;'.? . i,§..,t-~ ..... • \:!i\f!/~. ?'/.f~ 1 -~J ~~, .... ; .... -,.~~i::;,:f.~1!· A,, .. ~-;/.~ 4. ·i: ,.i-/ ir:~ :1'Y. 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 agrea to comply with ail 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 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned al any time after 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 City of Carlsbad Bldg Inspection Request For: 11/01/2005 Permit# CB053771 Title: INGRAM RES REPLACE GAS LINE Description: Type: PLUM Job Address: 2278 LISA ST Suite: Location: APPLICANT INGRAM JOHN L Owner: INGRAM JOHN L Sub Type: Lot 0 Phone: 76,28~023 Inspector: ---- Remarks: PLEASE CALL WHEN ON YOUR WAY FOR INSP. Total Time: Requested By: NA Entered By: CHRISTINE CD Description Act Comment 23 Gas/Test/Repairs ___ _____,f!f----- Associated PCRs/CVs Inspection History Date Description Act lnsp Comments