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Home My WebLink About2814 JACARANDA AVE; ; CB040721; PermitfJ~ City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-02-2004 Plumbing Permit Permit No: CB040721 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2814 JACARANDA AV CBAD PLUM Status: Parcel No: 2551032000 Lot#: 0 Applied: Construction Type: NEW Entered By: Reference #: Plan Approved: Issued: Project Title: NAGATA RES GAS FOR BBQ,FIREPIT Inspect Area: ELEC FOR BBQ&FOUNTAIN & ELEC FOR FUTURE SPA Applicant: GYSIN TIMOTHY&NAGATA PAMELA Owner: GYSIN TIMOTHY&NAGATA PAMELA 2814 JACARANDA AVE 2814 JACARANDA AVE CARLSBAD CA 92009 CARLSBAD CA 92009 Plumbing Issue Fee Fixture or Trap 0 Building Sewer 0 Roof Drain 0 Install/Repair Water Line 0 Water Heater and/or Vent 0 Gas Piping System 1 Vacuum Breaker 0 Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees TOTAL PERMIT FEES ISSUED 03/02/2004 SB 03/02/2004 03/02/2004 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $20.00 $0.00 $0.00 $0.00 $47.00 Total Fees: $47.00 Total Payments To Date: $0.00 Balance Due: $47.00 6559 03/02/04 0002 01 02 CGP 47-00 FINAL APPROVAL DATE 7p~1CLEARANCE. __ _ SIGNATURE ~ FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. C~r.{071/ I CIT¥ OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use , 'E:LE:Cs::e.~"~ \.-\\0 \lo\.;t" ~ h&Q ~ xQUt,)"t"PI< ,-) • c".es re hM~ ~ €:t«E: fl\ (?I\JJ) Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms 1.ZOv.fl€cr e-<c-P.t.... to . "f"u'\U(tE'" 'Sf~ . @.tm~C:t ll_lm,ON.JILd!ffm1lLffiim~teP~nt1...,;.,;;,_ ___ , --~--..;;... State/Zip Telephone# Fax# Name Address City State/Zip Telephone# we City (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, commending with Section 7000 t>f 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 [$5001). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 6. I hereby affirm under penalty of perjury one of the following declarations: D 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. D 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_____________________ Policy No. ___________ _ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) 0 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 worker•' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of compensation, damagea as providad for in Section 3706 of the Labor code. interast and attorney's fees. SIGNATURE DATE Q)VN!f!•BJlJ.LO_lRJ!ECJ;Af!AJ!QJJI ' -::,:-;;;;:;;::::::;;:::;f:;j;-,~;f;.. ;;{-:;;d-;,'fi:..;;;;;. ;::;.i,";;,''ef; ;;,,;~,;;.,..,.;J;,;'""1,£'.._-r•.,,,~'"";7'l I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D 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). (i:a . 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: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. D YES ONO 2. I (have/ have not) signed an application 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): 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): ______________________________________________ _ 5. 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 of work)=-------------H...-----:--lc--:-c--:---:-11------------------------------------- DATE _?__._.~D-~ ..... __,__,.O-.M~--PROPERTY OWNER SIGNATURE ~--....::::::1..1-~-=~~~--=----------- l~Offlr.j:UtJltl§.:..SECilQN FOR fiON=flf..SlflEN.ilA(. B!-ll~Qt -0 \ 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 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. !i !.ttllruLC.TION Ll;NDING-~~Y' .....:_~-~-. .:.....,....,.,..........., I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ll, APpUs;~T,&!;:;:;l8;;:m!=F::-;;lC.::::iA::;;;!M:::O;:;;N'!. ;;;. ... ;;;_. ;;._;;._ ;:;._ =. -.:.-,'J., -::-dll-;;;.,E-:-:-- 1 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 Cit\' 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, 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 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 comm ced within 180 days rom 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 commen '1,._or a peri of 180 ays (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE -'--'"----1-....:/l(vc.:::...,;_.._,,,,<....>:~..q._,..______________ DATE 3 . 62 • 04 YELLOW: Applicant PINK: Finance . m City of Carlsbad Bldg Inspection Request . . . Permit# CB040721 For: 07/15/2004 Title: NAGATA RES GAS FOR BBQ,FIREPIT Inspector Assignment: JM --- Description: ELEC FOR BBQ&FOUNTAIN & ELEC FOR FUTURE SPA Type: PLUM Sub Type: Job Address: Suite: Location: 2814 JACARANDA AV Lot 0 APPLICANT GYSIN TIMOTHY&NAGATA PAMELA Owner: GYSIN TIMOTHY&NAGATA PAMELA Remarks: Total Time: Phone: Inspector: ----- Requested By: NA Entered By: CHRISTINE CD Description Act Comment 23 Gas/Test/Repairs fj:__ ;tfJ ML~ (/4.y-1 29 Final Plumbing f- 39 _F_i_na_l_E_l_ec_t_ri_c_a_l _____ L_ ____________________ _ Associated PCRs/CVs lnsgection Histoty Date Description Act lnsp Comments 03/03/2004 21 Underground/Under Floor WC JM 03/03/2004 23 Gas/Test/Repairs AP JM BBQ, FIREPIT 03/03/2004 31 Underground/Conduit-Wiring PA JM