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Home My WebLink About2605 CARLSBAD BLVD; ; CB960918; Permito BUILDING PERMIT 05/22/96 15=30 Paqe 1 of 1 3ob Address* 2605 CARLSBAD BL Permit Types PLUMBING Parcel No* Valuation" 0 Occupancy Group B Descriptions GAS LINE REPAIR Permit No- Project No= Deuelopment No5 CB960918 A9601298 Sui Lottt* Referenced* flnpl/Qunr • ARTHUR BROUN PLUMBING 2697 STATE: ST CftRLSBftD CA 92008 *«* Fees Required Fees* Adjustments" Total Fees* Fee descr i ption Enter "Y" for Plumbi Gas Pipinq System * PLUMBING TOTAL #** 7654 05/22/96 0001 01 02 • "^PftMT O") A/\Construction Type^nlMEU *'-w Status: ISSUED Applied' 05/22/96 Apr/Issue' 05/22/96 Entered By" RMA 619-729-4914 ected & Credits ,00 .00 27.00 Ext fee Data 20.00 Y 7.00 27.00 APPROVAL HATF CLEARANCE CTTY OF CARLSBAD 2075 Las Paten* Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT AP.ZUCATION City of Carlsbad Building Department 2075 Las Palms Dr., Carlsbad, CA 92009 (619) 438-1161 I. PERMIT TYPE A~ O Commercial U New Building U Tenant Improvement B - D Industrial D New Building D Tenant Improvement C - D Residential D Apartment DCondo D Single Family Dwelling P Addition/Alteration D Duplex D Demolition D Relocation D Mobile Home D Electrical D Plumbing D Mechanical D Pool D Spa D Retaining Wall D Solar D Other 2. PROJECT INFORMATION PLAN CHECK NO. PIANCKD VALID. BY DATE FOR OFFICE USE ONLY Address Nearest Cross Street LEGAL DESCRIPTION Lot No. Subdivision Name/Number Unit No.No. CHECK BELOW IF SUBMITTED: O 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USF. DESCRIPTION OF WORK SQ. FT.# OF STORIES 37 UJPriACTPERSON ill dilrerent Irom applicanTJ NAME CITY STATE ADDRESS ZIP CODE DAY TELEPHONE 4. APPLICANT NAME CITY ^QtJONTRACTOR U AGENT FOR CONTRACTOR ADDRESS STATE ZIP CODE UOWNhK UAGLNI rOR OWNER DAY TELEPHONE 5. PROPERTY OWNER NAME CITY /STATE DAY TELEPHONE 6. CONTRACTO NAME CITY STATE STATE LIC. # ZIPCODE^^#?o DAY TELEPHONE /e? ff 7 ' ' ( LICENSE CLASS C- 3 fa CITY BUSINESS UC. # / 7flU D ULMGPJtK NAMh, CITY STATE AUUKtSb ZIP CODE DAY TELEPHONE STATE LIC. # 7. WORKERS' ODMPENSATION Workers Compensation Declaration: Thereby affirm that I have a certiiicate of consent to self-insure issued by the Director of Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY POLICY N EXPIRATION DATE /"""V ' Certificate ot Exemption: I certify that in trie pedorma so as to become subject to the Workers' Compensation :e of the work for which this permit is issued, T shall not employ any 'person in any mariner ws of California. SIGNATURE DATE 8. OWNER-BUILDER DECLARATION Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractors License Law for the following reason: O 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.). D 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). D I am exempt under Section Business and Professions Code for this reason: (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, commencing 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]). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PhRMIlb 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 Presley-Tanner Hazardous Substance Account Act? D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE Affl POLLUTION CONTROL DISTRICT. 9- OJNSTRUCnUN LENDING AGENCY l hereby affirm that there is a construction lending agency tor the pertormance ot the work for which this permit is issued (Sec'3097(1 J Civil Code). LENDER'S NAME LENDER'S ADDRESS 10. APPLICANT CERTIFICATION I certify mat I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City 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, GOSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SATO CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over S'O" 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 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). APPLICANTS SIGN DATE: YELLOW: Applicant PINK: Finance PERMIT* CB960918 DESCRIPTION: GAS LINE REPAIR CITY OF CARLSBAD INSPECTION REQUEST FOR 05/28/96 TYPE: PLUM JOB ADDRESS: 2605 CARLSBAD BL APPLICANT: ARTHUR BROWN PLUMBING CONTRACTOR: OWNER: INSPECTOR AREA PLANCK# CB960918 OCC GRP CONSTR. TYPE NEW STE: ^ LOT: PHONE: 619-729-4914, PHONE: PHONE: REMARKS: MW/JUNE/729-4914 INSPECTOR SPECIAL INSTRUCT: ARMY-NAVY ASKED FOR FRI PM TOTAL TIME: —RELATED PERMITS— CD 23 PERMIT# TYPE RW950112 ROW LVL DESCRIPTION PL Gas/Test/Repairs STATUS ISSUED ACT COMMENTS DATE DESCRIPTION ***** INSPECTION HISTORY ***** ACT INSP COMMENTS City of Carlsbad Building Department WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for A. workers' compensation as provided by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. f )l have and will maintain workers' compensation, as required by section 3700 / • B./of the Labor Code, for the performance of the work for which this permit is \ /issued. My workers' compensation insurance carrier and policy number are: INSURANCE COMPANY POLICY NO.EXPIRATION DATE: (THIS SECTION NEED NOT DOLLARS ($100) OR LESS) COMPLETED IF THE PERMIT IS FOR ONE HUNDRED 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 C. workers compensation laws of California. Signatur Date Warning: Failure to secure workers' compensation coverage is unlawful, and shall be 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 as provided for in Section 3706 of the Labor Code, Interest and attorney's fees. March 3, 1995 2O75 Las Palmas Dr. - Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-0894 M Y —L-J 15 =ARTHUR R O W M .dl l-AIMNtl*. CERTIFICATE OF IMSURANCE fl^ 7a™ i i nor ILK. l it Rubin I 6363 Gr San Die Scrnlq 61.9_-4S7 iNSimFD A* Ar 26 Cai CQ\ CO ITH ~ A B otsi: CSI (TI *1< nouranco Agency Inc. ecnwich Dr. see. 120 go CA 92122 -5720 uhujc A* Brown Pl\ant>ingi Brown )7 State St. clobad CA 92006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A C N A INSURANCE COMPANY COMPANY8 Golden Eagle Insurance Co COMPANY C COMPANY D /ERAGES • • .".'.,;;;. ;.':';.'":: '..::.' .."'.'. THIS IS TO CERTIFY THAT THS POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH6 INSURED NAMED ABOVE FOR THE POLICY PERIOD : INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OH OTHER DOCUMENT WITH PGSPiCT TO WHICH THIS CCRTIHCATe MAY BE ISSUEO OR MAY PERTAIN, TMg INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ai:wtriAt IT1 «> ow ivl'i: Ot- iNCURANCe LIABILITY iflMttiriAi OCNI!lAlLtA8lLlTY OCCUR NLR'5 & CONTRACTOR'S PROT AUTOMOBHC UAOIIITY 1N> AUTO Alt OWNEC AUTOS X SCHEDULED AUTOS X HiFIEP ALJTRS X NQN.OWNI.O AUTOS i OAJIACJC UAnillTY ANV AUTO ! fixr.rss UABIUTY UMGHELLA PORM 1 OTHG« THAU UMBRELLA fQRM WOUKCHS CCIMPENSATION AND CMPt OYEfW ' LIADILITY THE PROPniETOW 1 1 |NCLTAHTNERi/EXECUTIVE \ J OmCERS AflE; j | EXCL OTItCFl POLICY NUMBER 1036667228 1044850590 NWC 317346 POLICY EFFECTIVE DATE<MM/DD^YY> 01/01/96 01/01/96 07/01/95 POLICY CXPIHATIOK DATE (MM/ODffYI 01/01/97 01/01/97 07/01/96 LIMITS GENERAL AGGREGATE PRODUCTS • COMP/OP AGS PERSONAL & ADV INJURY EACH OCCURRENCE RRE DAMAGE (My Ofls U'fl) MED EXP [Any ono purcon) COMBINED SINGLE LIMIT BODILY INJURY[for parson) BODILY INJURY pace cftTY DAMAGE AUTO ONLY - EA ACCIDENT OTHSR THAN AUTO OW.V: EACH ACCIDENT ACCRECATE EACH OCCURRENCE AGGREGATE X j STATUTORY LIMITS EACH ACCIDENT DISEASE- POLICY UMI7 DISEASE • EACH EMPLOYEE 12000000 l 1000006 » 1000000 * 1000000 » 50000 »5000 * 1000000 1 0 * * *i » * 11000000 noooooo tlOOOOOO ^TXPICATS HOLDER IS NAMED AS ADDITIONAL INSURED €IS CERTIFICATE REPLACES CERTIFICATE PREVIOUSLY ISSUED) 3 DAY NOC IN THE EVENT OF NON-PAYMENT OF PREMIUM CERTIFICATE HOLDER CANCEllATlON CITVCA1 SHOULD ANY OF THE ABOVE DBS C Kill ED rOUClCS (IE CANCCLLCD DCfCRE THF EXPIRATION CATC THE.MCOF, THE ISSUING COMPANY Witt ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDCH NAMCD to Tut i«T. ™ -i?" ? £ t « Byir FAILURE TO MAIL SUCH NOTICE SHALL IMPOSC NO OBLIGATION Oft UAruLiTv2075 Lao Palmao Dr. rnrlnbnd TA 92QO9-1576 OF ANY KWD UPON THt 60MPAMV. ITS A4CNT8/H ft{pfti;seNTATIVC8. ^ ,. / ' 77 AJ, 'ffit /£* ACORD 25-S (3^93) AUTHOftl«D REPRESErtTATjVfi x. •ff/J? / //- """'""^'7 / *AC08D CORPORATION 1993