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Home My WebLink About2562 LA COSTA AVE; ; CB030115; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 01-13-2003 Plumbing Permit Permit No: CB030115 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2562 LA COSTA AV CBAD PLUM Status: Parcel No: 2163601200 Lot#: 0 Applied: Construction Type: NEW Entered By: Reference #: Project Title: Applicant: HUMMEL RES EMER GAS LEAK REPAIR HUMMEL STEPHEN C&KAREN J 2562 LA COSTA AVE CARLSBAD CA 92009 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 Plan Approved: Issued: Inspect Area: Owner: HUMMEL STEPHEN C&KAREN J 2562 LA COSTA AVE CARLSBAD CA 92009 ISSUED 01/13/2003 SB 01/13/2003 01/13/2003 $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: $0.00 Balance Due: ~~\·. µ:{L $27.00 3583 01/13/03 0002 01 02 CGP 27-00 &~4..•. 01--11/--03 PEBMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1 . PROJECT INFORMATION ,../ 25{.,, z. \..A CC:f?T-A: ..A\)~. FOR OFFICE USE ONLY PLAN CHECK NCX:lic>3o // £: EST. VAL. _________ _ Plan Ck. Deposit.r-:=---------- Validated By_~_......o:::l3=---------- Date I -r~ ... 03 I)(._ Address (include Bldg/Suite II} Business Name (at this address} Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assess r's Parcel # Proposed Use ~ Description of W;k SO. FT. ~r e;~s L~c. #of Stories II of Bedrooms # of Bathrooms 2. CQ.r,.JTACT PERSON (It different from applicant} Name Address City State/Zip Telephone# Fax# 3. APPLICANT O Contractor O Agent for Contractor O Owner O Agent for Owner Address City State/Zip Telephone II ~ Name 4 . Pf.!OfERTY OWNER ::S.=tG--~ .J Name C..., -~-h) 1--0-..( ~L Z~e, 2-: \.A C--0~-r,.<. Address l City C-At\h\1~ q-tdfl ~Z> 2. -o/5~ State/Zip Telephone # 5. CONTRACTOR • COMPANY NAME (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 t hat he is exempt therefrom, and the basis for the alleged exemption. A_ny 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# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 6. woRiERS' 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 _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] 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: 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 III provided for In Section 3706 of the Labor code, interest and attorney's fees. DATE ::;:;--::::;:;:::;;;::=:;:::::==:;;;::;:::== .. --"/J 7. OWNER-BUILDER DECLARATION l_1' 1 hereby 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}. ~ I, as owner of the property, am exclusively.~ontracting 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):+t------------------------------------------------- 5. I will provide some of the work, persons to provide the work indicated (include name / address / phone number / type of work}: ___________ ;---t---t--'-V;tH'--------+-+------------------------=----------- t,JPROPERTY OWNER SIGNATURE -...P...t-'"'-""--::........_-=:a=:;;----,~~-------DATE __ Q~l_-_f"--3...._-_0_3~- Jl'-coMPLETE THIS SECTION FOR NO RE /DENT/AL BUILDING PERMITS'ONt.: 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 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? 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. 8. CONSTRUCTION LENDING AGENCY 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 ------------------------------9. 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 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 ~bove mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXP SES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is requi d for excavations over 5'0" de EXPIRATION: Every permit issu authorized by such permil is not c at any lime after the work is c:o111m1~ntlF> rJ APPLICANT'S SIGNATURE -t--"t-,---'---'=-'cf-'-,._._ __ _..-::J' _____________ _ )/\ YELLOW: Applicant PINK: Finance DATE __ C)_l -_\ ?>_-_C>~) __ _ UNSCHEDULED BUILDING INSPECTION INSPECTOR ____ _ DATE I~ f"!.7 -C'.>} PERMIT# os otlC . PLAN CHECK# ____ _ JOB ADDRESS LS(.,.:z_. Le-Cos+.. Avd DESCRIPTION ~rv,e~ flt!:) Ke'f>c.'cr CODE DESCRIPTION ACT COM:MENTS ,Fl'AI~