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Home My WebLink About2616 COLIBRI LN; ; CB950927; PermitBUILDING PERMI 07/12/95 10-47 Page 1 of 1 Job Address: 2616 COLIBRI LN Suite Permit Type PLUMBING Parcel No. 215-534-12-00 Lot# Valuation 0 Construction Type NEW Occupancy Group Reference*. Description- REPLACE WATER HEATER Permit No CB950927 Project No- A9501319 Development No • 2664 07/12/95 0001 01 C-PRMT 27»00 Appl/Ownr Status- ISSUED Applied- 07/12/95 Apr/Issue. 07/12/95 Entered By RMA A & J FOSTER INC 2819 CENTRAL AV SPRING VALLEY, CA 619-697-4151 *** Fees Required *** Fees : Adjustments Total Fees: Fee description ected & Credits ** . 00 00 27 00 Ext fee Data Enter "Y" for PI Each Water Heater * PLUMBING TOTAL 20 00 Y 7 00 27 00 CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 -PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 T PERMIT TYPE From List 1 (see back) give code of Permit-Type For Residential Protects Only From List 2 (see back) give Code of Structure-Type -SER Net Loss/Gam of Dwelling Units . 2. PROJECT INFORMATION PLAN CHECK NO.C\SD EST VAL_ PIAN CKDI VALID BY. DATE FOR OFFICE USE ONLY Address 2616 Colibri Lane Nearest Cross Sirecfr-, aTtvanrv Building or Suite No NoLEGAL DESCRIPTION Lot Subdivision Name/Number Unit No Phase No CHECK BELOW IF SUBMITTED D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORKWater Heat@r Replac6m6nt 4Q Gallon SQ FT # OF STORIES # OF BEDROOMS # OF BATHROOMS UJNTALJ1' FEltiiUN (it dinercnt trom applicant; NAME (last name first^onnors f Jim ADDRESS2616 C1TY STATE,DAY TELEPHONE 4 APPLICANT TJ CUNTRAC I OR U AGENT FOR CONTRACTOR NAME (last name first^^ Fgst6r LI OWNER D AGENT FOi ADDRESS2819 Central Ave ^ t-'TYSpri no V^l-L^5 PROPEKlr OWNER NAME (last name firsOQ-., CITY r^ r-i SK=,^I STATEfa nnors, Jim STATE ZIPCODfQT (577 DAY ADDRESS 9£Zb. ZIPCODJ; DAY TELEPHONIC) 7 16 Colibri TELEPHONE A~\ R1 Lane .?no,d NAME (last name first^ & j Foster, Inc. STATECI™ Spring Valley STATE LIC ADDRESS2819 central Ave. (-^ ZIP CODE 91977 DAY TELEPHONE LICENSE CLASS „ ™-, ,-, <--, CITY BUSINESS LIC # DESIGNER NAME (last name lirstj CITY 7 WORKERS' COMPENSATION STATE ZIP CODE DAY TELEPHONE STATE LIC # Workers Compensation Declaration I hereby affirm that I have a certificate of consent to sell-insure issued by the Director ot 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 NO EXPIRATION DATE tofrnance ot the workicV'wnrcrrtnre permit is issued, I shall nofempToyWmy person in any mannerCertificate of so as to become subject to the Workers' Compensation Laws of California SIGNATURE DATE 8 OWNER-BUUDER DECLARATION Uwner-Builder Declaration rnereoy attirm that 1 am exempt irom the contractors License Law lor tne 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) Q 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) 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-KESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous matenals 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 distnct or air quality management district? O 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! METORIS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POIJ.UT1ON CONTROL DISTRICT 9 CXJNbTKUCJTlON 1-KNDINCi AGENCY 1 hereby attirm that there is a construction lending agency tor the performance ot the work tor which this permit is issued (Sec 3097(1) Civil Code) LENDER'S NAME .None...InHCAl LENDER'S ADDRESS 1 certily that 1 have read the application and state that the above mtormation 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 LIABnJTIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSIIA. An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stones 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 abando/erf'at any time after the work is.commenced for a period of 180 days (Section 303(d) Uniform Building Code) APPLICANT'S SIGNATURE ^£\ { . '. -y. O^7. ^Xs^-J_».^ Til X5r- DATE WHITE:/File YELLOW: Applicant PINK: Finance 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. I 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. -5""-" /~ 9& (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) 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. Signature C D 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 2075 Las Palmas Dr • Carlsbad CA 92OO9-1 576 • (619) 438-1161 • FAX (619) 438-0894