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Home My WebLink About2512 LA COSTA AVE; ; CB163764; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 10-05-2016 Permit No: CB163764 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: 2512 LA COSTA AV CBAD PME 2161602100 BROWN: SEWER LINE REPAIR ARS OBA RESCUE ROOTER STE B 9895 OLSON DR SAN DIEGO CA 92121 858-457-6572 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Status: Lot#: 0 Applied: Entered By: Plan Approved: Owner: BROWN MICHAEL K 2512 LA COSTA AVE CARLSBAD CA 92009 Issued: Inspect Area: ISSUED 10/05/2016 JMA 10/05/2016 10/05/2016 $163.00 $0.00 $0.00 $0.00 $163.00 Total Fees: $163.00 Total Payments To Date: $163.00 Balance Due: Inspector: Date: Clearance: $0.00 NOTICE: Ptease take NOTI Etha pprova\ of your project includes the "lmpo ition· o fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." Yo 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, gradirg or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any f hi T E ·1 r whi h h f\i vi THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH 0HAZMATIAPCD .('City of Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Plan Ck. Deposit SUITE#/SPACEI/UNITI LOT# # OF UNITS # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) FIRE SPRINKLERS YES □No□ r ADDRESS Or CITY STATE ZIP CITY so STATE ~1..1 '2. I ~14t PHONE FAX FAX EMAIL STATE LIC. # STATE UC.# CLASS '7 le:, ~ () {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 provisions of the Contractor's License Law /Chapter 9, comme_ndIngwith Section 7000 of Division 3 of the B_uslness 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 cIvII 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: D I have and will maintain a certificate of consent to self-insure for mrkers' compensation as provided by Section 3700 of the Labor Code, for the performance of lhe work for wtiich this permit is issued. ~ave and will maintain workers' m~ ·on, as re red by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insur ceca number are: Insurance Co. __ _J,,:1,_~Q.~"-c_~c:\--------~ Policy No. <r7 ",:)\ 5o"Alo31 a t bExpiration Date ~~---1-~--1-~-- ~section need not be completed if the permit is for one hundred dollars ($100) or less LJ Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California WARNING: Fallure to secure workers' compensation coverage is unlawful, and shall subject an employer to cr1mlnal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, dam es as provided for in S on 3706 of the abor code, Interest and attorney's fees. ,8$ CONTRACTOR SIGNATURE I hereby affirm that I am exempt from 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 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 exciusively 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). 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. Oves 0No 2. I (have I have not) signed an ap~ication 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 I phone I oontractors' 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 I address/ phone I 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 I address/ phone I type of work) ,8$ PROPERTY OWNER SIGNATURE □AGENT DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY ' 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 Presl~y-Tanner Hazardous Substance Account Acf/ □ Yes □ No Is the applicant 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? 0 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 application and state that the above information Is correct and that the information on the plans Is accurate. I agree to comptywith all City ordinances and State l<MS relating to building construction. I hereby authorize rep-esentative of the City of Carlsbad to enter upon the alxwe mentioned property br inspecoon ~rp'.lses. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST AI..L LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: M OSHA penn~ is required for exc.ava~ons over 5'0' deep and demrjltion or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Buik:ling Offcial under the provisk:Jns of this Code shall expire by limitation and beoome null and void if the buik:ling orv-.ork authorized by such pennit is not commenced within 180 days from the date of sucil perm~ or if the buik:ling orv.ork authorized by sucil pennit is suspended or abanOOned at any ~me after the v-.ork is oommenced for a period of 180days (Secfon 100.4.4 Unifonn Building Ccxle). ,6$ APPLICANT'S SIGNATURE 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. CONTACT NAME ADDRESS CITY STATE PHONE FAX EMAIL DELIVERY OPTIONS PICK UP: □ CONTACT (Listed above) □ OCCUPANT (Listed above) □ CONTRACTOR {On Pg. 1) MAIL TO: □ CONTACT (Listed above) □ OCCUPANT (Listed above) □ CONTRACTOR (On Pg. 1) ZIP MAIL/ FAX TO OTHER: ________________ _ AS APPLICANT'S SIGNATURE CO#: (Office Use Only) OCCUPANT NAME BUILDING ADORE S CITY STATE Carlsbad CA OCCUPANT'S BUS. LIC. No. □ ASSOCIATED CB#------------ □ NO CHANGE IN USE/ NO CONSTRUCTION o CHANGE OF USE/ NO CONSTRUCTION DATE ZIP • lns·pection List Permit#: CB163764 Date Inspection Item 10/07/2016 29 Final Plumbing 10/07/2016 29 Final Plumbing Thursday, October 20, 2016 Type: PME Inspector Act RI PY AP BROWN: SEWER LINE REPAIR Comments AM PLEASE Page 1 of 1