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Home My WebLink About2683 ROOSEVELT ST; C; CB941110; PermitB U I L D I N G P E R M I T Permit No: CB941110 Project No : A9401553 Development No : 08/29/94.08 :52 Page 1 of 1 Job Address: 2683 ROOSEVELT ST Permit Type: PLUMBING Parcel No: Valuation: 0 Construction Type: NEW Suite : C 8397 08/29/94 0001 01 02 Lot#: C-PRHT 27 .oo Occupancy Group : Reference#: Statu s : ISSUED Applied : 08/29/94 Apr/Issue: 08/29/94 Entered By: MDP Description: GAS TEST ON EXISTING LINE Appl/Ownr : BROWN PLUMBING 2697 STATE STREET CARLSBAD , CA. 92008 *** Fees Required Fees: Adjustments: Total Fees: Fee description *** 27.00 .00 27.00 Enter "Y" for Pl umbing Issue Fee > Gas Piping System > * PLUMBING TOTAL 619 7 2 9-4914 Fees Collected & Credits *** Total Cr dits: Total Payments: Balance Due: Units Fee/Unit 7.00 .0 0 .00 27 .0 0 Ext fee Data 20.00 Y 7 .00 27.00 II N s P. I!ll!!S::::::..- . CL EA RANCE ~...f..1-!.--'--~.;..;::;+-, CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION PLAN CHECK NO. °l,vf-l( L 0 City of Carlsbad Building Department 2075 Las PalES Dr., Carlsbad, CA 92009 (619) 438·1161 EST.VAL.._ _________ _ I. F£iiMII IWE PLAN CK DEPOSIT _______ _ VAIID.BY, __________ _ DATE From List 1 (see back) give code of Permit-Type: ___________ _ --------------------------------------------------------· For Residential Projects Only: From Llst 2 (see back) give Code of Structure-Type: ____________________ _ Net Loss/Gain of Dwelling Units 2. PROJECf INFORMATION FOR OFFICE USE ONLY Address ~ 6 r3 Nearest Cross Street D.:GXL DESCRWI ION Loe No. Subd1vts1on Name/Number Omt No. Phase No. CHECK BEWW IF SOBMII IEO: □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope ASSESSOR'S PARCEi, I; 1\-e --\-e~NG lJSE PROPOSED USE DESCRIPTION OF WORK SQ. IT. :}115 # OF STORIES # OF BEDROOMS # OF BA111ROOMS 3. WN IACI PFJtSON (I[ dlIIerent from apphcanf) NAME (last.name first) ADDRESS Cl1Y STA TE ZIP CODE DAY TELEPHONE 4. APPUCANI »CON IHACIUR DAGEN I FORCONIRACIOR ADDRESS LI OWNER □ AGEN I FOR OWNER NAME (last name first) CI1Y STATE ZIP CODE DAY TELEPHONE NAME (last name first) tft'l'"f ADDRESS ;)C/1.) (A.Cot q S-~-C_s:: C11Y il'fATE ZIP CODE DAY TELEPHONE '1 3 f'--? &f 7 STATE LIC. # DESIGNER NAME (lase name first) LICENSE CLASS CI1Y BUSINESS LIC. # ADDRESS CI1Y STATE ZIP CODE DAY TELEPHONE STATE LIC. # 7. WOkkERS4 WMPENSAIION Workers' Compensation Oeclarat1on: I hereby affirm that I have a certificate of consent to self-msure issued by the Director of lndustnal Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, lab. C). INSURANCE COMPANY POLICY NO. EXPIRATION DATE Certthcate of Exemption: I certify that m the performance of the work for which this permit IS issued, I shall not employ any person m any manner so as to become subject to the Workers' Compensation laws of California. SIGNATURE DATE 8. UWNPA-BUfiDPA DECDUtAJION □ □ □ Owner-Builder Deciaration: I hereby afttnn that I am exempt from the Confractofs License Law for the ioiiowmg reason: 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, 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 Llcense Law). I am exempt under Section ________ Business and Professions Code for this reason: (Sec. 7031.5 Business and Professions Code: Any City or County which requires a pennic to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to tile a signed statement that he is licensed pursuant to the provisions of the Contractor's Llcense Law (Chapter 9, commencing 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 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars [$5001). SIGNATURE DATE CUMPLE:iE I ms SECI ION FOR NUN-RESIDEN I IAL BUILDING PERMI IS ONLY: 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? □ YES ONO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality managemenr district? □YES □NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □YES □NO IF ANY OF 111EANSWERS ARE YES, AFINALCER11FICATEOFOOCUPANCYMAYNOT BE~ AITERJULY I, 1989 UNLl!SS nm APPLICANT HAS MET OR IS MEl!TING nm REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND 11IE AIR POLLUTION CDNTROL DISl1UCT. 9. WNs'IRUCliUN LRNDING AGENCY I hereby afhrm that there 1s a construction iendmg agency for the performance of the work for which this permit 1s lSSUed (Sec 3097(1} Civil Code). LENDER'S NAME LENDER'S ADDRESS JO. XPPDCAN I CFltllFICAiiuN I certify that I have read the apphcatlon and state that the above miormat1on IS correct. I agree to comply with all City ordmances 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 AGREE 1U SAVE INDEMNIFY AND KEEP HARMLESS 111E Cf1Y OF CARISBAD AGAINST AU. LIABILITIES, JUDGMENTS, CXJSTS AND EXPENSES WHICH MAY IN ANY WAY ACDUII! AGAINST SAID Cf1Y IN CDNSF.QUENCE OF 11IE GRANTING OF nos PERMIT. OSHA: An OSHA pennit is required for excavations over 5'011 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 commenced within 365 days from the date of such permit or if the building or work authorized by such pennit is suspended or abando at any time after the work· comme ed for a period of 180 days (Section 303(d) Uniform Building Code). APPLICANl"S SIGNATURE DATE: ___ _ PINK= Finance 0 ,. ., . tr,1sc:rr::;:-•;r.F,D ;:rs ?f.';:-;I,;!I :: . .\ :· s_---''8:---=Z-_.'.7_-_°t_cf-'---: !i S ?EC:-C n _ _.:~s:::_ _______ _ ?5:?.;"•!:-:; '---------?L'\11Cli: it ________ _ .:~ !3 AOCRZS s ___ o2_r.:,.....;c5=:.....;;:~=---__JRL-.....1.:'?:P=5;:,::½--':::,.i.sJ""'-±'-------'-=L c::::......_'' ____ _ ,_ ... ,,-... -· ..... ,,.:u,r:,:: _______ T Il1.E LE:,\ VE:-------- L·,;L DESCRI?TIOU ~ T<-,;;,t: ,\CT CCl!l!Ell'I'S /) . · ~ +,, h ,04,_,, ~.~ . . . · -