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Home My WebLink About2876 CAMINO SERBAL; ; CB020677; Permit03-04-2002 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No: CB020677 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 2876 CAMINO SERBAL CBAD PLUM 2552813100 Lot #: 0 Construction Type: NEW SMITH RES/ GAS LINE TO BBQ Applicant: ANDERSON'S LA COSTA NURSERY 400 LA COSTA AV ENCINITAS CA 92054 760-753-3153 Status: ISSUED Applied: 03/04/2002 Entered By: CB Plan Approved: 03/04/2002 Issued: 03/04/2002 Inspect Area: 2158 03/04/02 0002 01Owner: SMITH DAVID H&YOUNGER RENEE S 2876 CAMINO SERBAL CARLSBAD CA 92009 02 27.00 Total Fees:$27.00 Total Payments To Date:$0.00 Balance Due:$27.00 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Drain Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees 0 0 0 0 0 1 0 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $27.00 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 lees/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 capacity 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 vou have oreviouslv been aiven_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 FOR OFFICE USE ONLY PLAN CHECK EST. VAL. Plan Ck. Deposit Validated Bv Date : Address (Include Bldg/Suite *)Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total » of units Existing Use Proposed Use Description of Work SQ. FT.tof Stories # of Bedrooms # of Bathrooms Name Address State/Zip Telephone # (Sec. 7031.5 Business and Professions Coda: 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 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemotion. 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 1*5001).1 AddrName State License * zr License Classif 6o IA State/Zip License # Telephone* Designer Name State License * Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q 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 erf 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 performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy numbarare: j . . . ~ fi**cLp»rlcv No. Ik 0 X* Y*?Insurance Company carri f Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) Q 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 dollar* (4100,000), 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 I hereby affirm that I am exempt from the Contractor's License Law for the following reason: O 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 ha did not build or improve for the purpose of sale). O 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 contrector(s) licensed pursuant to the Contractor's License Law). CD 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. Q YES QNO 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 heve contracted (hired) the following persons to provide the work indicated (Include name / address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE 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? Q YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES Q NO IF ANY OF THE ANSWERS ARE YES, A RNAL 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 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 LENDER'S ADDRESS 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 CitV 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 b/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 com/enced 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 comme/ced for a/p7rttd of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 04/10/2002*>• Permit# CB020677 Title: SMITH RES/ GAS LINE TO BBQ Description: Type: PLUM Sub Type: Job Address: 2876 CAMINO SERBAL Suite: Lot 0 Location: APPLICANT ANDERSON'S LA COSTA NURSERY Owner: Remarks: BRING OUT CITY DIAGRAM Inspector Assignment: RGB Phone: 7607030490 Inspector: Total Time: CD Description 29 Final Plumbing Act Comments ftf Requested By: LAUREN Entered By: CHRISTINE Associated PCRs Inspection History Date Description Act Insp Comments 03/14/2002 21 Underground/Under Floor AP RC GAS PIPING AND TEST - OK T •. Cfcc\ o C£ Q. -&- <=3Cvl O on 0 i_< t- ±!Q 5gelO _l CQ J t? O P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE. PUN D CERTIFICATE OF WORKERS1 COMPENSATION INSURANCE MHY 1, 2601V, *-' -; ;* , - POLICY NUMBER: \ - 'I' ' \ ----/,-"" , ,,,CEflTII*ICATe eXPIRES: CONTRPCTPRS ATTN; BOX SAGRftMENTO INCEPTION anL , : This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject tq cancellation by the Fund except upon ten days' advance written notice to the employer. • •• " ' ' ; •* , We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an= insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this- certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. AgTHOBIZED EMPLOYER' S-UftBIUTV UMJT liCUHHNa DEFENSE COSTS; *1,WWS,(MW> P£H OCCURRENCE.' r ANDERSON'S LA COSTA NURSERYt,m L« cosTfl five ENCINITftS C8 9ti8£4 R