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Home My WebLink About2425 LA COSTA AVE; A; CB982508; Permit- BUILDING 08/10/98 10=34 Page 1 of 1 PER11IT P~rm,t No: CB987508 Project No= A9803306 Deve l opment No= Job AddrP~~= 2475 LA COSTA AU Permit Type: PLUMBING Suite= A 9876 08/10/98 0001 01 02 Pc:1rcel No: 216-240-55-.iG> Valuation: lot#= Orcupancy Group= Re~erence#= Descriptionr GAS TEST TO APPROVE METER SET C-PRMT 27-00 Con5truction Type: UN Status: I SSUFD Applied: 08/10/98 Apr/Issue= 08/10/98 Entered By: MDP Appl/Ownr : BLOCK MICHAEL 760 942-0317 2425 A LA COSTA AVE CARLSBAD CA 92009 *** Fee::, Req u ired Fees= Adju~"'.tment'!:,: lotal Fees: Fee de5c r 1pt1on Enter "Y" for Plumb r Ga~ Pip,ng System *** ,, .00 ,00 77.00 *** Ext fee D,:1ta 20.00 Y 7.00 __ ____, .. .,_... .. ·~LEARANCE-:_-_-_-_-_-_-_-.:===-:..-:.-:.-:.-:.-:..-:..-:..-:_ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (6 19) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 1. PROJECT INFORMATION 2 f l S" /t l,/'r 0:> ST A- FOR OFFICE USE ONLY PLAN CHECK NO. c;:8 -L ~ EST. VAL __________ _ Plan Ck. Deposit ________ _ Validated By __________ _ Date _____________ _ Address (include Bldg/Suite #) , Business Name (at this address) Legal Description c- -'2. I(,-24: 0 -S .j --z..o Assessor's Parcel # 6-i)f 1'='>1 f, t<-- Description of Work Lot No. Subdivision Name/Number Existing Use ''""' n1 L-0fr3:~) ..... I'"-' SQ. FT. #of Stories Unit No. Phase No. Total s~its Proposed Use # of Bedrooms # of Bathrooms _Name~.-Address City 0 Agent for Owner State/Zip Telephone # Fax # '3. ~LICANT 0 · Co-.ctar .... □'AiJonttwCo-ctar Name f>11 qffr<r \.._ (?, <.., ° C/c .4. ·PIIOPERTY•OWNER · Name Address ·6. •CONTRACTOR• COMPANY:•tlAJIIE"'·". """"ff;• Citv State/Zip Telephone# (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 ($500)). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address Citv State/Zip Telephone State License # _________ _ ·e. WORKER$.' .COMPENSATION .... ; 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. 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 compensation insurance carrier and policy number are: Insurance Company______________________ Policy No. ____________ _ Expiration Date. _______ _ ITHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT JS FOR ONE HUNDRED DOLLARS ($100) 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 1ecura worken' compan1■tlon coverage la unlawful, and ahaU subject an employer to crfffflnal panahles and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of compen1■tion, damages as provided for In Section 3708 of the Labor code, lntaraat and attorney's fees. SIGNATURE.______________________________ DATE _________ _ 7. OWNER-BUll.tll!RUCL:.tlllAllON"i• ""<"".·"· I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 l, 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, Busine55 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) . .RI' I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The 'Cdrftractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractorfs) 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. 0 YES ONO 2. t (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 soma of the work, but I have contracted (hired) the following persons to provide the work indicated (include name/ address / phone number/ type of work): _________ .;'71...._-n~-f,{-,,---j'<;j'~--f:;'--------------,=,.,--.--r;,;=,----------- DATE _'iJ-+-.,_(_0 +-'---'2 __ _ PROPERTY OWNER SIGNATURE .:_,'I:t:~~:j'._-L.::::::::.._t:;1.::'.::'.:L~='-------- •COMPLETE THIS SECTION FOR NrJN.IIESID ls 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, 25633 or 25534 of the Presley-Tanner Haz.ardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant requirad to obtsin s 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 feat of the outer boundary of a school site? 0 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 ANO THE AIR POLLUTION CONTROL DISTRICT. "6,,. . CONSTRUCTJON:U:NDING'AGEt.lCY,. · I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30971il Civil Code). LENDER'S NAME -,---,--,-,----::-,:---,,,:---:-:,cc-c-- •9, APPUCANN:eRTIFICATION,,f!.1··· 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 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 provi ns 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 385 days date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after th ork i encad ays (Section 106.4.4 Uniform Building Code). DATE ____________ _ PINK: Finance ( PERMIT# CB982508 DESCRIPTION: GAS TEST TO TYPE: PLUM CITY OF CARLSBAD INSPECTION REQUEST FOR 08/17/98 APPROVE METER SET INSPECTOR AREA PLANCK# CB982508 OCC GRP CONSTR. TYPE VN JOB ADDRESS: 2425 LA COSTA APPLICANT: BLOCK MICHAEL CONTRACTOR: AV PHONE: STE: A 760 942-0317 LOT: OWNER: REMARKS: C/436-7726 SPECIAL INSTRUCT: TOTAL TIME: CD 23 LVL DESCRIPTION PL Gas/Test/Repairs ------------------ ------------------------------------ PHONE: PHONE: INSPECTOR --~0----'-H _______ _ ACT COMMENTS p!_ _____ _ ***** INSPECTION HISTORY***** DATE DESCRIPTION ACT INSP COMMENTS _r i]_t.1-