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Home My WebLink About2628 LA COSTA AVE; ; CB160880; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 03-04-2016 Permit No: CB160880 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: 2628 LA COSTA AV CBAD PME 2162800500 TICHI: HOT & COLD REPIPE ITS FIXD PLUMBING HEATING AND AIR SERVICES STE 9-541 125 OLD GROVE RD OCEANSIDE CA 92057 866-599-3493 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES Status: Lot#: 0 Applied: Entered By: Plan Approved: Issued: Inspect Area: Owner: DIEN STEPHEN VAN&TICHI MARY 2628 LA COSTA AVE CARLSBAD CA 92009 ISSUED 03/04/2016 JMA 03/04/2016 03/04/2016 $163.00 $0.00 $0.00 $0.00 $163.00 Total Fees: $163.00 Total Payments To Date: $163.00 Balance Due: Inspector: M· ~s Clearance: $0.00 NOTICE Aease ta<e /\OflCE that ,wv.a d yw-prtjed irdlXles Ire "lni:,asitiorf d fees, dedca!icn;, ~ or dl'er em:licrs-c:dledivay referted to as "fees'e>a:fu1s." Yoo rave oo da\,s from tte date !tis pemit v.as issued to p,'dest in,:o;iticn d treae feesle>a:fu1s. If you ?(test !ten\ you ll\JSl fdlOA'tha ?(test fXO(:edres SEt forth in G'.MmrErl Oxle Section 66020(a), and file tte ?(test and anydl'er ""'-'red infooretion wlh tte Oty Mmgerfor r:roa,ssirg '" """da, oe,JlhCa1slm M.nd;:a Oxle Section 3.32.03:J. Failll0totiITTllyfdlOA'thal i:,oca:trewll t,a-anysul:6e<µrt lega e<lion to atta:l<, review, SEt aside, ;od, or a-nJ thsir ini:,asition. Yoo ,re re-el>/ Ft.RTl-ER I\OIJRED that yw-rigt to p,'dest tte specified fees'e>a:iicns IXJES NOT PPA_ Y to \\a!<r and SfMef oonne<lion-and capooty cta-ges, ra-plmrg, an-irg, gadrg or dl'er sirrila-,qjiraion r:roa,ssrg or ,..,.;re fees in oonne<lion wth !tis prtjed. I\O'l DCES IT APPLY to any f ;rfw"firli ·'-.L ,,..,......,l'I "nil::rtntti"' ...-::i_c:.fnv,.Hrh•L -~i; · · •""-••.,.,..,.,,..,;-. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH OHAZMATIAPCD (city of Carlsbad Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Plan Check No. ce I lo. Oi-8"0 Est. Value #BEDROOMS GARAGE {SF) APPLICANT NAME CITY &'!-E 9~ FAX 0·4wt DESIGN PROFESSIONAL ADDRESS CITY STATE ZIP PHONE FAX EMA\L STATE UC.# SUITEf/ PACEf/UNITf Plan Ck. Deposit Date 3· •1.b APN # BA HROOMS TENANT BUSINESS NAME PATIOS (SF) DECKS (SF) SWPPP CONSTR. TYPE O . GROUP FIRE SPRINKLERS YES□No□ (Sec. 7031.5 Business and Professions Code: Any City or County whlch requires a permit to construct. alter, improve, demolish or repair an)'. structure, prior to its issuan , so 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 000 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 103L5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fwe hundred dollars {$500}). WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations, B I have and will maintain a certificate of consent to self-insure for mrkers' 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 of the labOr Code, for the perfonnance of the work for which this permit is Issued. My workers' compensation insurance carrier and policy number are: Insurance Co. ______________________ Policy No. ______________ Expiration Date _________ _ · n need not be completed if the permit ls for one hundred dollars ($100) or less. Certificate of Exemption: I certify that in the perfonnance of the work for which this pennit is issued, I shall not employ any person in any manner so as to beeome subject to the Wor'Kers' Compensatkln laws of lifomia. WARNING: FaHure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred t ousand dollars (&100,000), in addition to the cost of compensation, dama r In abor code, Interest and attorney's fees. ,.S CONTRACTOR SIGNATURE I herefJ/ affirm that I am exempt from Contractor's Ucense Law for the following reason: □ □ □ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the stru:::ture 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 su::h 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 wl\l 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 contracting with licensed contractors to construct the project (Sec. 7044, Business and Professlons Code: The Contractor's License Law OOes not apply lo 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: 1. I personally plan to provide the major labOr and materials for construction of the proposed property improvement. QYes Oo 2. I (have I have not) signed an appHcalton for a building pennit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address/ phone/ 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 I phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address/ phOne / type of wor'K): ,/1$ PROPERTY OWNER SIGNATURE □AGENT DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the ap_pi:cant 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 Acf? 0 Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pol\utkin control district or a[r quality management district'? □ Yes □ No \s the facility to be constructed within 1,000 feet of the outer boundary of a school site? O Yes □ 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 SERVlCES AND THE AIR POLLUTION CONTROL DISTRICT. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read the application and state that the ab<WEI lnfonnation Is conectand that the lnfonnation on the plans Is accurats. I agree to comply with all City ordinances and State laws relating to building construction. l hereby authorize representative of the City of Carlsbad to enter upon the aOOve mentioned ~rty br ins~on purposes. I ALSO AGREE TO SA.VE, 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: AA OSHA peonlt is required for excavations over 5'0' deep and demolition or construction of strucb.Jres OIJel' 3 stories r.1 hei;lhl EXPlRA T\ON: Every penn It issued by t11e Building Olfcial under the provisKlns of this Code shall expire by limitation and berome null and YOO if the buik:ling or 'M)O( authoozed by such permit IS not commeoo,d v-tithin 180 days from the date of such pannlt or if the building orv.or\c. authorized by such pannlt is suspended or aoandoned at any Ume after the v.or\c. is commenced for a period of 180 days (2ectWJn 100.4.4 Uniform Building Code~ _.65 APPLICANT'S SIGNATURE DATE • STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602--8560, Email building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. UC. No. DELIVERY OP'llONS PICK UP: □ CONTACT (Listed above) □ OCCUPANT (Listed above) □ CONTRACTOR (On Pg. 1) MAIL TO: a CONTACT (Listed above) □ OCCUPANT (Listed above) □ CONTRACTOR (On Pg. 1) MAIL/ FAX TO OTHER: ________________ _ AS APPLICANT'S SIGNATURE □ ASSOCIATED CB#F------------- 0 NO CHANGE IN USE/ NO CONSTRUCTION o CHANGE OF USE/ NO CONSTRUCTION DATE ____ ... ZIP Inspection List Permit#: CB160880 Date Inspection_ lt<lm __ 09/12/2016 29 Final Plumbing 09/12/2016 29 Final Plumbing 03/08/2016 24 RoughfTopout Tuesday, September 13, 2016 Type: PME TICHI: HOT & COLD REPIPE Inspector Act Comments MC PD RI PM PLS Fl AP Page 1 of 1