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Home My WebLink About2620 ROOSEVELT ST; ; CB981999; PermitUh/24/98 16:12 Paqe 1 of 1 B U I L D I N G Job Aldress: 2 20 ROOSEVELT Permit Type: P wING Pa1cel No: 203-102-28-00 Valuation: O ST Stu te: 1 Lot#: Permit No: CB98199 Project No: A9802642 DevF>lopment No: Occupancy Group: Reference#: Descr1pt1on: EMERGENCY GAS LINE REPAIR : UNITS 1 & 6 Construction Type: NEW Status: ISSUED Applied : 06/24/98 Apr/Is~ue: ~6/~'/98 Appl/Ownr : CHUCKS PLUMBING 3800 WESTHAVEN DRIVE CARLSBAD CA 92008 Fees Required *** ----------------------------Fr->es: Adjustments: Total Fees: Fee description -------------------- Enter "Y" for Plumb Gas P1p1ng System CITY OF CARLSBAD 760 1 841~ 1)6/24/981 oob'i_= oi1M 02 729-)Clol C-PRHT 34.()() ~ollected & Credits ------------------------- .00 .00 34.00 Ext fee Data ----------------- 20.00 Y 14.00 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 , I" PERMIT APPLICATION FOR OFFICE USE O~ PLAN CHECK No./1f7 CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL. ____ ..,_..,£..,,1:........,t.,.,....--- Plan Ck. Deposit .:::=o1.....,.~....:;...;__,::....:;::;__,-- Validated By _ __,,,<-,--j,.....__,,_.,,.....,,___,.....,,.-c-T,...,.~ Date _______ __......,r---"--W,-"""P''- 1. PROJECT IN,RR¥'10oN yJ ~ l:2.'4 _ 1<.00 £e!.t/e l1 Address (include Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description of Wor1/ii/t;9-Ce_ le.A~ ,)i/G so;:~ U ~L ;f Stories # of Bedrooms # of Bathrooms 2. CONTACT PERSON (If different from applicant) Name Address City State/Zip Telephone# Fax# '3. APPLICANT ';(_contractor 0 Agent for Contractor . 0 Owner 0 Agent for Owner Name Address City State/Zip Telephone# 1. PR'lJ7!);W'})iJU1: d1b~/?aost-.1el7 C!A-rtisettr? {;11 . C).;y;t1£ Name Adaress City State/Zip Telephone# 6. CONTRACTOR • COMPANY NAM!: (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 · . Any violation of ction 7031.5 by any applicant for a permit subjects the appli nt to a civil penalty of ot mor than five hundred dollars ($50011. ' ~ (} e Y◄ '4r 7 t,IJ -0 Name License Class a..,. 3 (,,, City State/Zip Telephone # State License # o<'f?:7 SQk, City Business License # :3 11 i./o D Designer Name Address City State/Zip Telephone State License # _________ _ 6, WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: O 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 tor 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 ~d. My worker's compensation insuran carrier and policy number are: . CC' Insurance Company .J tV Policy No./ !!fiJ?Z/b..J-t:f? Expiration Date /-/--7...Z (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) O CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to aecure workers' companaetlon coverage la unlawful, and shall subject an employer to criminal penalties and civil flnas up to ona hundred thousand dollars($ 000), n addlt to coat of compensation, damages aa provided for In Section 3706 of? Labor co:cl~t~t and attorney's fees. SIGNATURE '-? DATE f:2.---;:l. Cf-::!Z..L 7. OWNER-BUILDER'DECLARATION 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 tor 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 wilt have the burden of proving that he 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 contractor(s) 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 (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 _________ _ COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDINO PERMITS 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? 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 district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 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 AND THE AIR POLLUTION CONTROL DISTRICT. ·s. CONSTRUCTION LENDING AGENCY . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(il Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS. _______________________ _ 9 , APPLICANT CEl!TIFI.CATION ' 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 Cit\' 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 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 permit is suspended or abandoned at any time after t k is c f period ays (Section 106.4.4 Uniform BuildinDgACToEde). /? --~? APPLICANT'S SIGNATURE ~~~~~~__t1'.....cl{./4~'J,d..~~;;e,~---------/,:;? ~,L_ WHITE: File YELLOW: Applicant PINK: Finance UNSCB f:Drn; ,ED BW ,DING INSPECTION DATE (p-)...S" PERMIT# <\9,\9,99' TIME ARRIVE: ----- CODE DESCRIPTION INSPECTOR _________ _ PLAN CHECK# _____ _ ACT COMMENTS ----~-----