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HomeMy WebLinkAbout2687 ROOSEVELT ST; ; CB951899; Permit£·/95 12, 51 Page 1 of 1 B U I L D I N G Job Address: 2687 ROOSEVELT ST Permit Type : PLUMBING Parcel No: Valuation: 0 P E R M I T Sui te: Lotlt: Permit No: CB9518~~ Project Nu: A950276 3 Development No: Occupancy Group: Reference#: Construction ~ype : NEW Status : ISSUED Appliect: 12/28/95 Apr/Issue: 12/28/95 Ente1.ed By: RMA 619-735-9050 Description : RE-PIPE ENTIRE GAS LINE FOR : BLDG Appl/Ownr : LLOYD'S PLUMBING 306-N EL NORTE PARKWAY ESCONDIDO , CA 9202 6 *** Fees Required fees : Adjustments : Total f ees : Fee description Enter "Y" for Plumbing Gas Piping System * PLUMBING TOTAL *** To tal Cre dits: To t al Paymenbs: Bala n ce Due: Un its Fee/Vni t .00 .00 27 .00 *** Ext fee Data 20 .00 Y 7.00 27.00 5309 .12/28/95" 0001 OJ C<2 ~-r.r~,-q CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION e . . PLAN CHECK NO. . City of carlst.d Building Departant 207'5 Las Pal-Dr •• carlsbad. CA 92009 (619) 438-1161 i. PERMl"t ff PE From List 1 (see back) give code of Permit-Type: ____________ _ ...................................................................................... For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: _____________________ _ Net Loss/Gain of Dwelling Units __________________ _ 2. PROJECT INFORMATION FOR OFFICE USE ONLY Address -? ,,..,_ ?0e>T Nearest Cross Street- Building or Suite No. LEGAL bEScR1P'noN lot No. Subd1V1s1on Name/Number Onu No. Phase No. CHECK BEWW IF S0SMI 11 Eb: □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope DESCRIPTION OF W9JU< ,,, • .ftiJ a,- (A~ 72!= f<p...z_l-~ ---~-,-,---SQ. FT. ~ 5, # OF STORIES 3. WN IAC"I PFJ{5(JN (1f dulerent from applicant) NAME (las name first) # OF BATI-IROOMS ADDRESS NAME (last name first) / ADDRESS vl Of I> 5 p/ v "1.f '"g 1r-J r;. S. PROPERiY OWNER NAME (last name first) STATE Ce+ ZIP CODE q7 oz k? DAY TELEPHONE ADDRESS /_~ STX't'lf C:. ZIP CODE '12 00 DAY TELEPHONE 9?: / /1'5,b NA¥~ (last n3JDe first) . I r ADDRESS 3 i) I:, -.,-v c g;-t_ A<.J,e_ ~ l,,LO'(C>> p,~<""'1.:7 ~-~>d CITY STATE .{,ri-ZIP CODE q;;>c.J2-~ DAY TELEPHONE .P.,8J7' "'· ·re.; &::!,,Q,cD cc) 0 STATE UC.# b '£b l(BJ LICENSE CLASS ?-2£J ·-C-~~ CITY BUSINESS UC.# t-z..'o2.X t.tc.. DESIGNER NAME (last name hrst) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE STATE UC.# 1. WoRXERS' cbM1'£NsA11oN □ □ □ Workers' Compensauon Declarauon: I hereby allmn that I have a cerulicate of consent to sell-insure issued by ihe Director of lnduslnat 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). er ara on: ere ya 1rm a am exemp rom e n ~cto s cense w or e o owing reason: I, as owne of the property or my employees with wages as their sole compensati ,, will do the work and the structure is not intended or offered fo 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 License 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 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, 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500]). SIGNATURE DATE coMPi.EIE ii-US SEcMoN FOR NON-RESIDENTIAL SOliDING 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? □ YES □ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ YES □ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? ,J □ YES D NO IF ANY OF TI-IE ANSWERS AREYES, AFINALCERTrnCATEOF OCX:t.JPANCY MAYNOf BE~AFTERJULY 1, 1989 UNLESSTIIEAPPUCANT HAS MET OR IS MEETING nm RF.QUIREMENTS OF nm OFI-lCE OF EMERGENCY SERVICES AND TIIE AIR POU.lJTION CDNTROL DISfRICT. g_ wRsntucnoR r:nmmc AC£Nct I hereby alhrm uiat uiere IS a construcuon lending agency tor ihe performance of uie work tor which this permit 1s 1SSued (Sec 3097(1) C1V1t Code). LENDER'S NAME LENDER'S ADDRESS lo. APPUCAN I C£Rl1FICX:l10N I ceruly that I have read the apphcauon and state that the above inlormauon 1s correct. 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 AL50 AGREE TO SAVE INDEMNIFY AND KEEP HARMLF.SS 111.E CTlY OF CARLSIW) AGAINST AU. UABIIIIIl:'i, JUDGMENTS, CDSTS AND EXPENSES Willa-I MAY IN ANY WAY ACXJUJE AGAINST SAID CTIY IN CDNSF.QUENCE OF 111.E GRANTING OF nns PERMIT. OSHA: An OSHA permit is required for excavations over S'O" deep and demolition or construction of structures over 3 stories in height. Expira ·on. Every permit issued "ia/y t e Building Official under the provisions of this Code shall expire by limitation and become null and void if the buildin or work authorized b c rmit is not commenced within 365 days from the date of such permit or if the building or work authorized by dch rmit is suspended or n ed at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). AP CANrs SIGNATU DATE: 12 -· , TE: File YEU.OW: Applicant PINK: Finance TIMS UJlIW: T!MZ t.lAVI: Ctl t.VL u ------------- ,a.an f/15/19 ouaIP'l't! 1::.lut r1t,.; -r r ,. ACT COIGCD'l'S .if. -----