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Home My WebLink About2683 ROOSEVELT ST; B; CB030889; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-26-2003 Plumbing Permit Permit No: CB030889 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2683 ROOSEVELT ST CBAD St: I f> PLUM Parcel No: Lot#: 0 Construction Type: NEW Reference #: Project Tille: YANG RES GAS LINE REPAIR Applicant: BROWN PLUMBING CO, ARTHUR A 2697 STATE ST CARLSBAD, CA 92008 619-729-4914 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 TOTAL PERMIT FEES Total Fees: $27.00 0 0 0 0 0 1 0 Owner: Total Payments To Date: $0.00 Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 03/26/2003 SB 03/26/2003 03/26/2003 1273 03/26/03 0002 01 02 $20,00 $0,00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.00 Balance Due: CGP 27-00 $27.00 .C~~·~___,,f,_'Z__=6=-----~·--J_..-......;'J_r_-O'=-;;J......; FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK No.6~3 og<g~ CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Address (include Bldg/Suite #I Business Name (at this addressl Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use SO. FT. #of Stories I of Bedrooms I of Bathrooms Name City State/Zip Telephone# (Sec. 7031. 6 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 ha is exempt therefrom, and the basis for the alleged exe ption. Any violation of Section 7031.5 by any applicant for a ermit subjects the appl~ant to a civil penalty of n more then five hundred doll rs ($600]1. "tfCfR A -lf>MttJ,u Lv JJt.f? ~ -...,-,~.,,.,....,_s--t~ s tJ P ~ Name State License # -"-;2-_Y:.....,'cf:'--"~-"7----=0"--__ Address /.J City State/Zip Telephone # License Class c ·-?~ City Business License, l f80C) Designer Name Address City State/Zip Telephone State License # ___________ _ lQ.;&W.QliKfflS~ffilATLO.. ' ~J~~-· Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 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. pi 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 com ensation in urance c rrier and policy number are: /C-4 /c / _ . J. ! Insurance Company ,S o'Jr/. · 0 /41 Policy No. _;J {. tJ ;) t:J 6 ( Expiration Date otjPt /.-0 ;5 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) 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: Failure to secure wotkera' compenaatlon coverage la unlawful, and shall 1ubject an employer to criminal penaltlaa end civil fine, up to one hundred thouaand dollar O 00), In ad itlon to the at of compan,atlon, damagea •• provided for In Section 3706 of the La coda lntaraat and attorney'• tee,. DATE 3 (} 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,iProperty 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). 0 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 contract, for such projects with contractor(sl licensed pursuant to the Contractor's License Law). 0 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. 0 YES ONO 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 Unclude 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 i~QJ.t1~HL~.!iic:1f.i)_tr(Qffl~~QltQ!ifc:iir 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 26605, 25533 or 26534 of the Presley-Tanner Hazardous Substance Account Act7 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district7 O YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a sch0til site7 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. ts:~~Mt~li.C:miff~~.II-.l<i.<AGENCY~f.,~.);.ffl ~~;"• " ·· ~~ ~)#.,~~~/ f.fi~~g I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Sec. 3097(1) Civil Code). LENDER'S NAME tl1~~~~t1.Q > --~ ., f LENDER'S ADDRESS Pi": 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 Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO 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 6'0" deep and demolition or construction of structures over 3 sto.ries in height. EXPIRATION: Every permit Issued by the building Official under the provisions of this Code shall expire by llmltatlon and become null and void if the building or work authorized by such permit is not commenced 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 co en for a i,eriod of 180 da~Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE c_.a~:'.!::::!:~~~L.!!:../U~~ ·:=::::::_~::_;;.__ _____ _.:._ DATE 3/4 ~ lo 3 2 l WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION DATE '!>-:2 ft.-◊'3 INSPECTOR IZ IS ' <I PERMIT# ~0&&9 . PLAN CHECK# ____ _ 2-CJ:>SJ:.Jl~ Sf• lP \± S\: ( I 1 I JOB ADDRESS ~ ff DESCRIPTION ~~~ .,"L9.-4C\\~ CODE DESCRIPTION ACT COMMENTS l~ £111la~"" Cio.-.~~ I \ ~ f1L0