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Home My WebLink About2908 CAMINO SERBAL; ; CB011885; Permit05/29/2001 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No:CB011885 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 2908 CAMINO SERBAL CBAD PLUM 2552830700 Lot #: 0 Construction Type: NEW HAIDVEK RESIDENCE GAS & ELECTRIC LINE FOR BAR B QUE Applicant: PARKER, DAVID 4911 REFUGIO AV CARLSBAD, CA Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 05/29/2001 MDP 05/29/2001 05/29/2001 Owner: LACOSTA VALLEY-CARLSBAD L P CAD HEARTHSTONE 5594 16133 VENTURA BLVD #1400 ENCINO CA 91436 0002 01 02 47-00 Total Fees: $47.00 Total Payments To Date:$0.00 Balance Due: $47.00 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 $20.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $47.00 Inspector: FINAL APPROVAL »2-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 you have previously been given 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 NO./) EST. VAL. Plan Ck. Deposit. Validated By Date Address (include Bldg/Suite #}Business Name lat this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Proposed Use Name I Address r D Agent f« Contractor Q Owner City Owner State/Zip Telephone # Name **, Address City State/Zip Telephone # Name Address City State/Zip Telephone # CONTRACTOR -COMPANY NAME (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 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 703^5 by any_applicant for a permit subjects the applicant to a civil penalty of/iot mom than five-tmndred dollarsj$5001). ,. ijjse appjjc Name **^ S~} Ci State License * / • ' > OW Address /*?_» o^ O4'/ License Class (— C/~ / j City State/Zip City Business License tt / C 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: -B^ 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. 0 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 insuranceajrrier andpolicy number are: _ s-\ £> . J j, . Insurance Company ^""7/Tf^^ rUt^J J) Policy No. QJL C7-/ ~~& I Expiration Date O ' (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) D CERTIFICATE QfEXEMPTIONH 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 Jro the Worken/'Cpmpensation Laws of California. WARNING: Failure to fecure/wpritara' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollara/tylOOyoOO^rlnadditiop^to the costjif_compen»atlon, damages as provided for in Section 3706 of the Labor, code, interest andiattomey'a fees. SIGNATURE U\,/ / ^^ DATE O " ^~f •"* O / 7. OWNER-BUILDER DECLARATION - > . . . ft „ , , .; 1 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 end 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). 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). (~l 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 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 have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE NO 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 Is the facility to be constructed within 1 ,000 feet of the outer boundary of a school site? Q YES O 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. «. CONSTRUCTION LENDING AGENCY |V .,-<».« 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 •9.. APPLICANT CERTIFICATION - ,'-'.- ... ' """ 7 " -*.',.'-.• ' , -- -." " --5 *V - . :- \ 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 City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AflflEE TO SAVE. INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICI^M/VY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is requiMtMor excavations over 5'0* deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the/toui|wng 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 riot comrnpnoed/irvithin 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 isfcornmerfcMMj PJCi/d of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE /]f // &*L— " DATE WHITE: File YELLOW: Applicant PINK: Finance Inspection List Permit*: CB011885 Type: PLUM HAIDVEK RESIDENCE GAS & ELECTRIC LINE FOR BAR B QUE Date Inspection Item Inspector Act Comments 01/10/200229 Final Plumbing - Rl 01/10/200229 Final Plumbing RGB AP CORRECTIONS WERE MADE-FINAL 10/17/2001 59 Final Pool RGB AP 09/11/200121 Underground/Under Floor RGB CO SEE NOTICE 09/11/2001 31 Underground/Conduit-Wirin RGB AP 06/05/2001 21 Underground/Under Floor PD AP 06/05/2001 31 Underground/Conduit-Wirin PD AP Friday, January 11, 2002 Page 1 of 1 City of Carlsbad Bldg Inspection Request For: 01/10/2002 Permit/* CB011885 Title: HAIDVEK RESIDENCE Description: GAS & ELECTRIC LINE FOR BAR B QUE Inspector Assignment: RGB 2908 CAMINO SERBAL Lot 0 Type: PLUM Sub Type: Job Address: Suite: Location: APPLICANT PARKER, DAVID Owner: HAIDUCK JAMES M&KAREN A Remarks: Phone: 7606329994 Inspector: Total Time:Requested By: JIM Entered By: CHRISTINE CD Description 29 Final Plumbing Act Comments Associated PCRs Inspection History Date Description 10/17/2001 59 Final Pool 09/11/2001 09/11/2001 06/05/2001 06/05/2001 21 Underground/Under Floor 31 Underground/Conduit-Wiring 21 Underground/Under Floor 31 Underground/Conduit-Wiring Act Insp Comments AP RC CO RC SEE NOTICE AP RC AP PD AP PD so COMPEtt SATtON INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-01 POLICY NUMBER: 228-01 UNIT O017449 CERTIFICATE EXPIRES: 01*01-02 CONTRACTORS STATE LICENSE BOARD ATTN: WORKERS' COMP. UNIT BOX 26000 SACRAMENTO CA 95826 JOB: # 709501 INCEPTION DATE: 01-O1-01 D.O.: SAN DIEGO 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 to cancellation by the Fund except upon 1O days' advance written notice to the employer. We will also give you 10 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. PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,OOO,OOO.OO PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. EMPLOYER LEGAL NAME DAVID L. PARKER LANDSCAPE 1*911 REFUGIO AVE CARLSBAD CA 92008 PARKER, DAVID L PRINTED: 12-16-00 P0409