HomeMy WebLinkAbout2266 PLAZUELA ST; ; CB971554; PermitPERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 las Palmas Dr., Carlsbad CA 92009
(619) 438-1161
FOR OFFICE USE ONLY
PLAN CHECK NO. Cf J/55~
EST. VAL. _________ _
Plan Ck. Deposit-----,,,,--,...----
Validated o/ Jl,/r
Date ~ { (( j q Z-
li:aiU'JU)JECUiNWIUUtklt!l~~tl!lili
2266 PJaweJa St Addre11 !Include Bldg/Suite II Buslneq Name lit thl1 addteq)
Legel Duc,lptlon Lot No. Subdlvl1lon N1me/Numblll' Unit No. PheH No. Tatel I of unlll
AISe11or' I P11cel I Exl1tlng UH l'lopoHd UH
Description of Work SO. FT. lof Storlt1 I of Bedroom, I of Bethrooms
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BJ oam, Mike 2266 Plazuela St, CARLSBAD . CA . 92009
N1m1 Addrets City State/Zip Telephone I Fax I
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SHP-rli4;f ~m~l ti@ISTY FOSTl!:R 13706 1il ~ e :ans EI CA,ION, CA -m 1 7 Addren City
9202)
State/Zip
39 G 4477
Telephone I
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BluQU.. Mike
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(Sec. 7031.5 Business and Profe11lons Code: Any City or County which requl111 1 permit to construct, alter, Improve, demolish or repair 1ny 1tructure, prior to Its
issuance, 1110 requires the applicant for such permit to Ille • signed statement that he la Ucensed pursuant to thl provisions of the Contractor'• UcenH Law
!Chapter 9, commending with Section 7000 of Division 3 of the Buslne11 end Prole11lon1 Code) or th1t hi la exempt therefrom, and the b11ls for the alleged
e,cemptlon. Any vlolatlon of Section 7031,5 by any applicant for• permit subject• the applicant to I civil penalty of not more than five hundred doll111 lt5001).
A & N;f;;;FOSTEtt PLUMflING ~o 4477 elephone I
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Stall llcens'1.3,1.jQ-+-l°"'~.,Q------UcenH ~'-e~J..,.G-------_City Bu1lne11 llcenH ~ 2~Q .... Q._3 ... 5.i.:z4 ___ _
Oulgnlll' N1m1 Address City State/Zip Telephone
Stitt Uc-• \1-A!t-· . ·
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Worklll'a' Comp-■tlon Declaretlon: I hlll'eby alllrm und11 p1nelty of perjury one of th• followlng.decla11tlon1:
0 I hlv, and will maintain • certificate of consent to Hll•lnsure for workers' compensation •• provided by Section 3700 of th• labor Code, for th• performance
of the work for which this permit la laaued.
O I hive and will maintain workars' comp,ns■tlon, 11 required by s,ctlon 3700 of the labor Code, tor th• performance of the ~ork for which thl1 permit la
l11ued. My worker'• compensation lnaurance carrier end pollcy numb11 ■ra:
Insurance CompfPXRMER INSUAA:NCE Polley t!f2007 56 51 Explratl~(9N!UUIOIIS
ITHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS IUOO) OR LESS)
0 CERTIFICATE OF EXEMPTION: I certify that In the performance of the work for which thl1 permit l1 l11u1d, I 1hall not employ ,ny person In eny menner 10 as·
to become aubJect to th• Workers' Compensation Laws of C1lilornl1.
WARNING: F11M1 to 11cure•worbrs' compensation covlll'■ge 11 unlawful, and 1haH subject 1n employer to etlmlnal p1nalt11t1 and clvH fln11 up to one hundred
thou1end donera lt100,000l, In lddltlon to th• coat of compensation, damag1111 provld1d tor In Section 3708 of the llbc¥ code, lnter11t end 1ttomey'a fHa.
SIGNATURE ______________________ ..,:... ______ DATE ________ _
1. ,.r. ow HER-BUILDER 0Ec~110Ni.f~i 1~•:.,_1;'!;i.~t ~t:Mt«&n:i?t~'lf~~1aimr~~l"ffli.imim~1~K'~§:f.1>J1tm;;~ ~ti."'.' ,
I hereby alllrm that I am exempt from the Contractor's license Law for the following reuon:
0 I, 11 owner of the property or my employe11 with w1ges H their aole compens■tlon, will do the work and the atructura 11 not Intended or offered for 11le
(Sec. 7044, Buslne11 and Profealion1 Code: The Contractor'■ UcenH law doe■ not epply to an owner of property who build• or Improves theraon, 1nd who does
such work hlmHlf or through his own employees, provided thet such Improvements are not Intended or offered for 1■11. If, however, the building or Improvement 11
sold within one y11r of completion, the owner-build11 wlM hive the burden of proving that h• did not build or Improve for thl pu,poH of Hie),
0 I, 11 ownlll' of th• property, 1m exclu1lvely c:ontr■ctlng with licensed contr■ctore to con1truct' thl proJICt (Sac. 7044, 8u1lne11 ind l'lof111lon1 Code: Th•
Contractor's Ucenae Law doH not apply to an owner of property who build• or lmprov11 thereon, and contractl for euch project• with contraotorlal llc1nHd
pur1uant to thl Contractor'• Ucens, Law), ·
0 I ,m uempt und11 Section ______ Bu1lne11 and Prof111lon1 Code for thl1 re11on:
1. I personally plan to provide th• m,jor labor and matetlal, for construction of th• propoHd property lmprovament. 0 YES ONO
2. I lhlv• I hive notl 1lgned an appllc1tlon for a building permit for the proposed work:
3. I hava contract1d with th, following person (firm) t!) provide the proposed construction !Include name I addt111 / phone number / contractor■ llcenH number):
4. I plan to provide portions of the wo,k, but I have hired the following person to coordinate, supervise ind provide th• majo, work Uncluda name / ■ddr111 / phone number/ contractors llcen11 number):, ____________________________________________ _
5. I wlN provide 1ome of th• work, but I hive contracted lhlredl the following person■ to provide the work Indicated !Include name I 1ddre11 / phone number/ type of work): ______________________________________________________ _
PROPERTY OWNER SIGNATURE _____________________ _
~co~.1ttJ:'sEcuo",1.0R.t1.orJ:ffi.$!!!PiilN..:~WU1jrt111flttllffltrsJQn~YUim,f~ma
ts the applicant or future building occupant required to 1ubmlt • bu1ln111 plan, acutely hn11dou1 m1teri1l1 registration form or risk management end prevention
program undlll' S■ctlons 25505, 25533 or 25534 of th• l'la1ley•T•ooer Hezardou1 Sub1tance Account Act1 0 YES O NO
11 the applicant or future building occupant required to obtain I plll'mlt from the ■Ir pollution control dlltrlct or air qu1Uty m1n1g1m1nt di1trlct 1 0 YES O NO
Is the facility to be con1tructed within 1,000 feet of th• outer boundary of • school 11te1 0 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 ANO THE AIR POLLUTION CONTROL DISTRICT.
•t1JCONSTRUCT10N LENDING'AGENC'f'~i'~'.hl-r~·~wm_g~•,g\,'r;w~~mir.~;:;ni;:..Wt~;--~i&._~Vl~11~'~tJ";'}.:;:1,:i.-\".;
I he11by allirm thet th11e Is• con1tructlon lending agency tor th• performance of the work for which thla permit 11 l11ued (Sec, 3097111 Clvll Code).
LENDER'S NAME _______ --,.------LENDER'S ADDRESS ______________________ _
:I,:.-( .Al'Pl\CAH'l'.,Wl\f\~l\ON},1-1~'. -~i\,lii, .;;cm-,~~W,1;( 1~,~i~·(:l~~i:t1:,:1Jli¼m~!Wfel~iw:18ffh~~~~~t~li~A~~\t':. :i11',ttr, ' ,.
I certify that I have read th• application and state that the above lnlormatlon la correct and that the Information on the plans Is 1ccurate. I agree to comply with all
City ordinances and State law■ relating to building construction. I hereby euthorlzt repreHntatlvH of the City of Carlabed to enter upon the above mentioned
property for Inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP .HARMLESS THE CITY OF CARLSIA0 AGI\INST All LIABILITIES,
JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THlS PERMIT.
OSHA: An OSHA p11mlt 11 requl11d for exc1vatlon1 over 5'0" deep and demolltlon or con1tructlon of 1tructur11 over 3 1torlea In height.
EXPIRATION: Every permit l11ued by the Building Ofllcl1l undlll' th• provl1lon1 of thla Cod• ah•II explra by ilmltatlon and become null and void if the building or
work authorlted by euch permit 11 not commenced within 366 days from the date of 1uch permit or II the building or work authorlted by ch permit Is suspended
or abandoned at any tlm• ,ttlll' the ork It com encld for I per of 1 BO days ISectlo 1 6.4,4 Uniform Bulldlng Code).
APPLICANT'S SIGNATURE DATE
WHITE: File YELLOW: Applicant PINK: Finance
PERMIT# CB971554
DESCRIPTION: REPLACE WATER
TYPE: PLUM
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 10/21/97
HEATER
STE:
INSPECTOR AREA TP
PLANCK# CB971554
OCC GRP
CONSTR. TYPE NEW
LOT: JOB ADDRESS: 2266 PLAZUELA ST
APPLICANT: BLOOM, MIKE
CONTRACTOR:
PHONE: 760 436-3936
OWNER:
REMARKS: C/MICHAEL/436-3936
SPECIAL INSTRUCT:
TOTAL TIME:
CD
25
LVL DESCRIPTION
PL Water Heater/Vents
PHONE: /1
PHONE: V
INSPECTOR-~,~----------
ACT COMMENTS
AL----------
------------------------------------
***** INSPECTION HISTORY*****
DATE
091697
070197
DESCRIPTION
Water Heater/Vents
Water Heater/Vents
ACT INSP
CO NF
CO DC
COMMENTS
NO ENTRY
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