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Home My WebLink About2364 ALTISMA WAY; D; CB030732; PermitCity of Carlsbad L.- 1635 Faraday Av Carlsbad, CA 92008 03-1 2-2003 Plumbing Permit Permit No: CB030732 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: PLUM Status: ISSUED Parcel No: Lot #: 0 Applied: 0311 a2003 Reference #: Plan Approved: Issued: Project Title: ROSEBERRY RES-REPLACE H20 HEAT Inspect Area: 2364 ALTISMA WY CBAD St: D Construction Type: NEW Entered By: RMA Applicant: ARS STE 100 6162 NANCY RIDGE DR SAN DIEGO CA 92121 858-677-5455 Owner: C/O GRACE LOH LOH TRUST 1 1-1 5-93 1968 10TH AVE a77 03/12/03 0002 01 02 SAN FRANCISCO CA 941 16 CGP 27.00 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 $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 Total Fees: $27.00 Total Payments To Date: $0.00 Balance Due: $27.00 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 attad6 review, set aside, void, or annul their imposition. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE OC;n30_71 ~ PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Date Legal Description Lot No. ubdivision NamelNurnber Unit No. Phase No. Total # of units Assessor's Parcel # Exisiing USE Proposed Use #of Stories # of Bedrooms # of Bathrooms Name Address City State/Zip Telephone # Fax # (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any strvcture, 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 applicant to a civil penalty of not more than five hundred dollars I$50011 5%=(971 sqsr SlD. a4 qa.lar Telephone # StateIZip City Business License t OWV~ City State License # Designer Name Address City StateKip Telephone se Class C 20 r' c~L 0 of the work for which this permit IS issued. I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is r and policy number are: Insurance Company Policy Na-.3%&/3 -0 [ Expiration Date h/c 0 b (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS i$iooi OR LESSI 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: Failu s up to one hundred thousand dollars ( SIGNATURE 7. OWNE I hereby affi 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). 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). 1. 2. 3. addition to the compensation, damages as provided for in Section 3706 attorney's fees. I am exempt under Section I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES UNO I (have I have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address I phone number I contractors license number): Business and Professions Code for this reason: 4. number I contractors license number): 5. 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 I address / phone I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address I 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 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES 0 NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 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 EME 0 YES 0 NO 0 YES 0 NO CONSTRUCTION LENDING AGENC 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 APPLICANT CERTIFICATION I certify that I have read the application end 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 180 davs from the date of such permit or if the buildina or work authorized by such permit is suspended or abandoned at any time after the work is co APPLICANT'S SIGNATURE DATE 3/ako3 (Section 106.4.4 Uniform Building Code). u AHITE: File YELLOW: Applicant PINK: Finance 'RODUCER 1 MPE OF INSURMCE 4 FNERAL UPglLIM X COMMEROK GENERK LILBlLlM '7 IaAMSMCDE UOCCUR MER'S 6 CCNTRACTOR'S PROT Slmcehaster Certificate Team MARSH LISA 'nc 500 W Monroe St Chicago. IL 60661 Am F~x 877-732-7799 8112 POLICY EFFECTIVE 1 DATE (WMfDDm) POLlcT NUMBER GLO 2938645-01 01 101103 HO RIGHTS UPOH THE CERTIFKXTE HOLDER OTHER THW THOSE PROVIDED IN THE POLICI. THIS CERTFICATE DOES HOT AHEND, EXTEND OR ALTER THE COVERAGE PFFORDEO BY THE POLlClESDESCRleEO HEREIN. - COMPANIES AFFORDING COVERAGE -___~ CU+=M" A ZURICH AMERICAN INSURANCE COMPANY 4 NSURED (M112)ARS AMERICAN RESlDENTlAL SERVlCES OF CALIFORNIA INC dba ARS OF SAN DlEGO 860 RIDGE LAKE BLVD. MEMPHIS, TN 38120 - I - I MTOYOBLE LLABIUTY BAP 293864641 (AOS) 01 101103 + x MYNUTO BAP 293864741 (VA) 01 io1 m3 _. - - - - KL OJWED WTOS TAP 2928648.01 (TX) SHEDULED AUTO5 HIRM AUTOS NOJ-MED AUTOS I ' CUdPN\Y B ILLINOIS NATIONAL INSURANCE COMPANY -~ ' CCMSENY C BODILY INJJRY 01/01/06 ZOVERAQEJ This CemPcefe superaedeeand reblacesany pfeviarSry iwed cerdlllcattt for the policy periud nded bdw. S 4 H I I /01/01/03 WORKERS COMPENSATITIO( I\WD EMP LOYERS L WBILITY ,w 293864341 (AOS) WRmE LIPgILITY MY AUTO Ii I [04/01101 I I iBE 3a37407 B EXCESSLlPglLlTY I UMWELAFCRM LIMITS *am EXPIRATI~~ 1 DATE FMfDDm) I 31 101 tog 5,000,ooc 1 ,000,ooc 9RSNK 6 KIVINJURY 1 ,000,ooc 1 ,000,ooc PROWCTS - CCMPMP AGG EAM OCCURRENCE I I €AM KWRRENCE 1 $ 5,000,ooc I AGGREGATE 1s 5,000,OOC I IS I DESCRPTMH OF aPERATIONSILO~TIOHSIVEHlCLES1SPEClPL ITEMS HARSH USA WC. BY' ChristyN Phoebus e%+-% @-