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Home My WebLink About2839 AVENIDA VALERA; ; CB012803; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Building Inspection Request Line (760) 602-2725 08-28-2001 Plumbing Permit Permit No:CBO12803 Job Address: Permit Type: PLUM Status: ISSUED Parcel No: 21 6461 3700 Lot #: 0 Applied: 08/28/2001 Reference #: Plan Approved: 08/28/2001 Issued: 08/28/2001 Project Title: YAMAUCHI RES-NEW WATER HEATER Inspect Area: 2839 AVENIDA VALERA CBAD Construction Type: NEW Entered By: RMA Applicant: MY PLUMBER UCHI SAHYO K STE 603 5490 COMPLEX ST 92123 760 729-4326 wwal o(HM 01 02 28S AVENIDA VIILERA CARLSBAD CA 92009 COP n.00 I . .++..%..-- Total Fees: $27.00 Total Payments To Date: $0.00 Bala%ede'B"* $27.00 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain InstalVRepair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees TOTAL PERMIT FEES FINAL APPROVAL Date: 9-&0/ Clearance: NOTICE: Please take NOTICE that approval of your projed includes the 'Impasition' of fees, dedications, reservations, or other exactions hereafter cdlectively referred to as "feedexactions.' You have 90 days from the date this permit was issued to protest impositiOn of these fees/exactions. H yw protest them, you must fdbw the protest procedures set forth in Government Code Section 86020(a), and file the protest and any other required information with the Ci Manager for processing in Bccordanca with Catisbad 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 @ht to protest the spedfied fees/exactions DOES NOT APPLY to water and sewer connection fees and Capactiy changes, nor planning, zoning, gradhg or other similar applicatkn processing or service fees in condon with this project NOR DOES IT APPLY to any feedexactions of which vou have wevioudv been phren a NOTICE similar to this, ci as to which the statute of IirnMkm has ~rehushr othemise emired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 -_ I FOR OFFICE USE ONLY EST. VAL. Plan Ck. Deposit Validated By Date 1. PROJECT INFORMATION Business Name (at tlus address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total X of units A 46/57m Proposed Use " Descnption of Nork so. FT. #of Stories # of Bedrooms # of Bathrooms 2 Name Address StatelZip Telephone X Fax # CONTACT PERSON (n diffwmt fmm -1 CONTRACTOR - COMPANY NAME (Sic. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair eny structure, prior to its issuence, also requires the epplicent 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 of Division 3 of the Business and Professions Codel or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for permit subject not more tha ive h dred dollars 1$5001). Name State License x 739636 q phw &pj StatelZip w23r7&7733G-Y%+ Telephone # Address 5WO Pha77a(oJcc* PJd ,?& License Class ""city Business License X ~2.1. I 3~10 Address city Steteltrp Telephone State License X 8. WORKERS' COMPENSATION Workers' Compensation Declaretion: I hereby affirm under penalty of perjury one of the following declarations: 0 of the work for which this permit is issued. Eed, My worker's compensation insurance I have and will meintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance I have and will meintein workers' compensation, as required by Section 3700 of the Labor Code, for the performence of the work for which ths permit is Insurance Company (THIS SECTION NEED NOT BE COMPLETE0 IF THE PERdIT IS FOR ONE HUNDRED DOLLARS [$'IO01 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: F&re to muwe worlun' compenaatbn co- b unlrwtul. and ahdl wbj.ct n omploy01 to ai- portahlor nd cid finea up to om hundmd Policy NO. W L /9 ~&4&4 f Expiration Date !///oL on. damages ma provided for In Section 3706 o DATE mttomay'a fou. I- 7. OWNER-UUILDER DECLARATION I hereby affirm that I em exempt from the Contractor's License Law for the following reason: 0 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 doea such work himself or through his own employees, provided that such improvements are not intended or offered for sole. 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). 0 I, as owner of the property, am exclusively contracting with licensed contractors to Construct the project (Sic. 7044, Business end Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for euch projects with contractorlsl licensed pursuant to the Contractor's License Law). [3 1. 2. 3. I am exempt under Section I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ON0 I (have I have not) signed an application for a building permit for the proposed work. I have contrected with the following person (firm) to provide the proposed construction (include name / address I phone number I contractors license number): Business and Professions Code for this reeson: 4. number / contractors license number): 5. of work): PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NollFREslDByNl WlLDlNQ PERMllS ONLY Is the applicant or future building occupant required to submit a busineas plan, acutely hazardous program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substanca Account Act? 0 YES 0 NO Is the epplicant or future building occupent required to obtain I permit from the air pollution control district or air quality management district? Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 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 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the mejor work (include neme / address / phone I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / eddress I phone number / type gistration form or risk management and provantion 0 YES 0 NO NSTRUCTlON LENDING AGENCY affirm that there is a construction lending agency for the ork for which this permit is issued (Sec. 3097(i) Civil Code]. LENDER'S NAME 9. APWCANT CERTIFICATION I certify that I have read the application end state that the above information is correct and that the information on the plans is accurete. I agree to comply with all City ordinances and State lows relating to building construction. I hereby authorize representatives of the Cit) of Carlsbad to enter upon the above mentioned property for inspection purposes. 1 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 CtTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSW 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 limitahon and become null and void if the building or work authonred by such permit IS not commenced within 180 days from the date of such permit or if the building or work authonzed by such permit is suspended or abandoned at any time after the work is commenced for a period APPLICANT'S SIGNATUR l.uL@& DATE 6 zF '/ Uniform Building Code). WHITE: File YELLOW: Applicant PINK: finance 1 City of Carlsbad Bldg Inspection Request For: 09/05/2001 Permit# CBOl2803 Title: YAMAUCHI RES-NEW WATER HEATER Description: Type: PLUM Sub Type: Job Address: 2839 AVENIDA VALERA Suite: Lot 0 Location: APPLICANT MY PLUMBER Owner: TILL JAMES L&YAMAUCHI SAHYO K Remarks: EARLY AM OR LATE PM PLEASE Inspector Assignment: Phone: 7604383637 Inspector: Total Time: Requested By: SAHYO CD Description Act Comments Entered By: CHRISTINE 25 Water HeaterNents &! Associated PCRs InsDection Histow Date Description Act lnsp Comments I INSURED Selective HR Solutions, Inc. , 6920 Professional Parkway East [ (941) 755-4634 EXT. 191 I Sarasota, FL 34240 COM?AW I 1 A CONTINENTAL CASUALTY COMPANY - _I 8 COM?AW 6 A COMIAW I ! C -- COMIAW D I ! ' P.O. Box 6090 ~ Clearwater. FL 33758-6090 Roger Bouchard Insurance, Inc. ~ - .. RIGHTS UPONTHE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AHEND,EXTEND, I I I OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE ~..~.___ L ~ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TERMS. EXCLUSIONS AND CONDITIONS ( ~ SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REC POUCY NUMBER I -- - SED BY PAID CLIAMS. TYPE OF INSURANCE WLlCY EXPIRATION DATEIMMIDDfYYI I I LIMITS I GENERAL AGGRGATE Is I I PRODUCTS.COMPCf'AGG I S I COMMERCIAL GENERAL UABLITY WIMSMADE OCCUR i I OWNERS CONTRACTORSPROT t-1 PERSONAL AND AW INJURY S I $ i EACH DCCURENCE ci TOMOBILE LI*BILlTY ANY AUTOS , ALL OWNED AUTOS SCnEWLED AUTOS HIRED AUTOS I NON-OWNEOAUTOS 1 i --I 1 BODlLYlMRY (Pel au.&rdl If I PROPERNDAMAGE If i I! GE LIABIUTI I AGGREGATE I S ! S I EACH OCCUPANCE AGGREGATE I i OTHER TWN UMBRELU FORM WORKERS COMPENSATION AND I EMPLOYERS LIABILITY WC19 426 90 99 1/1/01 ALL STATES (EXCEPT OR t wr) I___ 0 INCL EXCL THE PROPRIETOW PARTNERSEXECUTIVE I OFFlCERSARE. I EL DIEASE. POLICY LIMIT I I 1.oO0.000 , i ! OTHER My Plumber (R Wendell Presgrave, Inc.) - Coverage effective 1 SPECIAL ITEMS i Coverage applies only to those employees leased to but not subcontractors of 1 I1 4/0 1 I I I 1 I 1 AUTYIPEDREWWWTITM City of Carlsbad 2075 Las Palrnas Drive % Ar3( d&600 I Carlsbad, CA 92009