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Home My WebLink About2610 COLIBRI LN; ; CB012849; Permit08-31-2001 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No CB012849 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 2610COLIBRILNCBAD PLUM 2155340900 Lot# Construction Type 0 NEW GLEIFORST RES/ NEW WATER HEATE Status ISSUED Applied 08/30/2001 Entered By CB Plan Approved 08/30/2001 Issued 08/30/2001 Inspect Area Applicant A&J FOSTER, INC STEB 13706HWY8BUS EL CAJON CA 92021 619-390-4477 Owner CHURCHILL JAMES E&MONIQUE 8901 08/31/01 0002 01 02 2610COLIBRILN CGR 77 Ofl CARLSBAD CA 92009 - " Total Fees $2700 Total Payments To Date $000 Balance Due $2700 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Dram Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees 0 0 0 0 1 0 0 $2000 $000 $000 $000 $000 $700 $000 $000 $000 Master Drainage Fee Sewer Fee Additional Fees TOTAL PERMIT FEES FIRED $000 l»'f" $2700 Inspector FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions" You 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 capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been qiven a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 1 , PROJECT INFORMATION" """:'~ '^ .•.:..-..,. "" "'' ^-i-''"" 2618 COLIBRI LN'CARLSBAD CAS92009 <Suite> FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date ^ <Name> Address (include Bldg/Suite #) <Legal Descr><Lot> Business Name (at this address) <Subdivision Name/No> <Unit><Phase> <Total> Legal Description <Assessor No> Assessor's Parcel # WATERHEATER INSTALL Lot No Subdivision Name/Number <Existmg Use> Existing Use <SQ FT> <Stones> Unit No Phase No Total * of units <Proposed Use> Proposed Use <Bedrooms> <Bathroom> Description of Work SQ FT # of Stories # of Bedrooms # of Bathrooms 2 •••.'.CONTACT7PERSON (^different from'applicant) <Name> Name 3: : APPLICANT n Contractor .\i/\ NetClerklnc "~ " " Name 4 PROPERTY OWNER JERRY GLEIFORST Name <Address> Address Agentfor Contractor "E3 Owner '"" 720 Dubuque Ave Address 2618 COLIBRI LN Address <City> ST <Zio> City State/Zip P Agent for Owner ', ::•:, South San Fr, CA 94080 "" City State/Zip CARLSBAD CA 92009 City State/Zip <Phone> <Fax> Telephone* Fax* • i "; 8883301 777 Telephone # 7604389629 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 Contractors 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]) A & J Foster Incorporated PO Box 2758 El Cajon QA 92021 6193904477 Name State License # 630120 <Name> Address License Class <Address> City State/Zip Telephone* City Business License # 1210836 <City> ST <Zip> <Phone> Designer Name Address City State/Zip Telephone State Licence # 6 WORKERS'COMPENSATION Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations I I 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 State Comp Ins Fund Policy No 00506395 Expiration Date 05/01/2002 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) 1 I 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 doll- /_7T" ""i) in addition to the cost of compensation damages as provided for in Section 3706 of the Labor code, interest and attorney's fees SIGNATURE *^%^' DATE 08/27/2001 7 OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason I 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) C] 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 threreon and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law) I I 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 l~l YES l~l NO 2 I (have / have not) signed an applicant 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) <Name> <Address> <Work Phone> <State License> 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) <Name> <AddreSS> <Work Phone> <State LlCenS6> 5 I will provide some of the work but I have contracted (hired) the following person to provide the work indicated (include name / address / phone number / type of work) <Name> <Adaress> <Work Phone> <Work Type> DATEPROPERTY OWNER SIGNATURE _ _ PQMPiiETE THIS SECTION FOR NON-RESIDENTIAL BUTubiNG PERMiTiS76N"LY """" ...... ..... ~ ' . ....... ..... ..... " "~ "*%•; •"•• 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? l~l YES l~l NO F~l YES NOIs the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' Is the faci'ii/ tr be constructed within 1 OOC feet of the outer boundary of school site7 l~l YES l~l 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 ""7 . . > " • ,; ..... "-', ""•.•: '""^K^: .; ,,; .,.,-:•;=..•. - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3087(i) Civil Code) LENDERS NAME _ LENDER'S ADDRESS _ ___ S7 APPLICANT CERTIFICATION ....'.... ••••^-^~f,-:^-:^- ...... -. ........... ....... ...._.„.,_... ^ ,, ...,„.„.. .......... ... 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 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, 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 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 180 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 106 4 4 Uniform Building Code) APPLICANT S SIGNATURE *««%f- DATE 08/27/2001 NetClerkID# 96992 To: Carlsbad Building 1635 Faraday Ave Carlsbad CA 92008 7606022718 7606028558 C on tractor Information A & J Foster Incorporated PO Box 2758 El Caion CA 92021 I Worker's Compensation Carrier State Comp Ins Fund Number 00506395 Exp 05/01/2002 State Contractor's license ' Number 630120 Class/type c36 Exp 10/31/2001 Tel 6193904477 Fax 6193904448 Email will_r35@msn com Business/trade license Number 1210836 Classltype Exp. 08/31/2001 Other licenses ^ . !.iiC.!. - •- •, ::>.-:'."..' Number Classltype Exp Project I n f or ma t i on Homeowner name JERRY GLEIFORST Project address 2618 COLIBRI LN CARLSBAD CA 92009 Job description WATERHEATER INSTALL Homeowner tel 7604389629 Valuation 155 i P a y m e n t information Payment Type Check Card holder name Credit card number Expiration date I R eq ui r e d Doc u m en t a t i on "' ' •" :••• • •" •••'.. Workers Compensation(Not Applicable) Stamped Envelope(Not Applicable) State Contractors License(Not Applicable) Pre-Registration(NetClerk Generic Form) 720 Dubuque Ave , South San Francisco, CA 94080 • Government Services 888-330-1777 Fax 877-846-5888 CERTIFICATE OF LIABILITY INSURANC^^ TM« cefrnncflnmmveo W*MMT ....CWLT AMU eawifts wo fttemrs ypon THS. cestwcAT*. HOI.CER !>«!£ CStf ff«AT« OOC« NOT ,MKND. HCfEMD^ OR JiJLTtR THS, COMSftACt M^OKOEg BY THE POIUdes B£iOW.tnouxaace A0«aoy Sao, 6361 CracnvnJb, Dv, ft!5S C&ft>C « S 353 saa T&n®o CJk S3 12 2 Pawn fiS8-*S7-$73:$IMS>OR£«8 AJFFGSCMNO- CO^iSACE A * a goat** . Tnc.y m»cfceordi...Ffc«lo_.Co State . Star * of CoiJforAfo COWKACTORSSTAftUCiNSfBOAPO *««*** A & J IIC , 10/31/2001 i^ttatfMI Tliettfetiri^tfftpfeyMttftdt^ tpfMyfar corwmwtion pemittt m tht ntm« of my «wptr AftlflN POSTER _„____ ftint) ftCHEHBiHi^i<-_£*^ A A J f^MdW* tHBAfMAM 'i Bta» Liaa«>}o. tad QIK