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Home My WebLink About257 AVENIDA ANACAPA; ; CB042265; Permit7 513 )clSCi%i City of Carlsbad .- 1635 Faraday Av Carlsbad, CA 92008 Building Inspection Request Line (760) 602-2725 0$-08-2’004 Plumbing Permit Permit No: CB042265 Job Address: Permit Type: PLUM Status: ISSUED Parcel No: 2552003900 Lot # 0 Applied: 06/08/2004 Reference #: Plan Approved: 06/08/2004 Issued: 06/08/2004 Project Title: BOENNIGHAUSEN RES-COPPER Inspect Area: 3257 AVENIDA ANACAPA CBAD Construction Type: NEW Entered By: RMA RE-PIPE, HOT & COLD WATER Applicant: ACCURATE PLUMBING P 0 BOX 21 266 92020 61 9 593-9303 Owner: BOENNIGHAUSEN ROGER P&~J@IJ~&~~,~ 0002 01 02 1982 STONECREST CT CGP 57.00 VISTA CA 92081 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain InstalVRepair 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 $7.00 $0.00 $0.00 $0.00 $30.00 $0.00 $0.00 $0.00 $57.00 Total Fees: $57.00 Total Payments To Date: $0.00 Balance Due: $57.00 follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE PLAN CHECK NO. EST. VAL. Plan Ck. Deposit 3 Proposed Use / Assessor's Parcel X Existing Use Name Address City Statelzip Telephone X Fax X issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law State License t License Class City Business License X Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance I have end will maintain w0rker.s' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is for which this permit is issued. Policy NO. O/ S$.S~ -03 Expiration Date//-o/ - 0 y {THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS I81001 OR LESS) 0 to become aubject to the Workers' Compensation Laws of California. 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 WARNINQ: Fdlure to 8ocure work-' comatlon coverage I8 unlawful, and rhal 8UbjOCt 8tl emplOvW to criminal pOllOkb8 and dvil fines up to OM hudnd 0 1, as owner of the property or my employeas with wages as their sde compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Profession8 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 exclwively contracting with licensed contrsctors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's Liceme 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 1. 2. 3. 4. number / contractors license number): 5. of work): I am exempt under Section I parronally plan to provide the major labor and matadals for construction of the proposed property Improvement. 0 YES ON0 I (have / have not) signed an application tor a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number I contractors license number): I plan to provide portions of the work, but 1 have hired the fdlowing person to coordinate, supervise and provide the major work (include name / 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 / phone number / type Business and Professions Code for this reason: Is the applicant or future building occupant required to submit e 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 Aot? 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? 0 YES 0 NO Is the facility to be%nstructed within 1,000 feet of the outer boundary of s 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 0 YES 0 NO I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097(i) Civil Code). I certify that I have read the application and state that the above information is correct snd that the information on the plans is accurate. I agree to comply with a11 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. 1 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 excavetions over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the building Oficial 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 cornme of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work APPLICANT'S SIGNATUR DATE Uniform Building Code). pplicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 06/21 /2004 Permit# CB042265 Title: BOENNIGHAUSEN RES-COPPER Description: RE-PIPE, HOT & COLD WATER Type: PLUM Sub Type: Job Address: 3257 AVENIDA ANACAPA Suite: Lot 0 Location: APPLICANT ACCURATE PLUMBING Owner: BOENNIGHAUSEN ROGER P&NANCY D Remarks: Inspector Assignment: JM Phone: Inspector: Jw Total Time: Requested By: BOB CD Description Act Comment Entered By: CHRISTINE 29 Final Plumbing Associated PCRsKVs InsDection Historv Date Description Act lnsp Comments 06/10/2004 24 RoughiTopout AP JM CWBOK CERTHOLDER COPY CZMPENSATION INSURANCE r-u.N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 10-01-2003 GROUP: oooo44 POLICY NUMBER: 0019896-2003 CERTIFICATE ID: 5 CERTIFICATE EXPIRES: 10-01-2004 10-01-2003110-01-2004 CONTRACTORS STATE LICENSE BOARD SI; LICENSE NUMBER: LIC #e45710 ATTN: WORKERS' COMP. UNIT INCEPTION DATE: 10-01-2003 BOX 26000 0.6. : 5D SACRAMENTO CA 95826 rhis is to certify that we nave issuea a vaiia WorKers' Compensation insurance poticy In a Ibim app~oved by ttls California Insurance Cornmissloner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30days' advance written notice to the employer. We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is nat an insurance policy and does not amend. extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requrrement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and condittons of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITV LIMST INCLUDING DEFENSE COSTS: Sl,OOO,OOO.OO PER OCCURRENCE. ENDORSEMENT Y2W5 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2003 IS ATTACHED TO AN0 FORMS A PART OF THIS POLZCY. EMPLOYER <. ACCURATE PLUMBING INC PO BOX 21266 EL CAJON CA 92021 LEW WE HARIIPINGTflN, KARL JOSEPH AND HARRINGTW, SHIRLEY AND/OR ACCURATE PLUMBING, INC. 09-17-2003 po409 (REV. 3-03) PRINTED