HomeMy WebLinkAbout2656 STATE ST; ; CB040014; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
01-07-2004 Plumbing Permit Permit No: CB040014
Job Address:
Permit Type:
Parcel No:
Reference #:
Project Title:
Applicant:
Building Inspection Request Line (760) 602-2725
2656 STATE ST CBAD
PLUM
2031011900 Lot#:
Construction Type:
0
NEW
SMITH RES GAS LINE REPAIR
Owner:
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
01/05/2004
SB
01/05/2004
01/05/2004
BROWN PLUMBING CO, ARTHUR A SMITH EDMUND&EDITH FAMILY TRUST 05-28-96
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
3271 WESTWOOD DR
CARLSBAD CA 92008
Total Payments To Date: $27.00
$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:
Clearance:
$0.00
proval of your project includes th "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
referred to as "lees/exactions.~ You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
f x i n f whi h h v r n iv n N Tl E imil rt this or as to whi h h I limit ti n h s r vio I x ir
FOR OFFICE USE O~Y
PLAN CHECK No.Cf::e{ ool { PERMIT APPLICATION
CITY OF 8ARLSBAD BUILDING DEPARTMENT
1636' Faraday Ave., Carlsbad, CA 92008
EST. VAL. __________ _
Plan Ck. Deposit --==--------
1. PROJECT INFORMATION
c2&:£fa "&ZltW ST Address (include Bldg/Suite #) Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units
Ass~or's Parcel#
0 /15 ,l/NE JR.c:=/11-;g Existing Use Proposed Use
Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms
2. CONTACT PERSON (If different from applicant) /J eft,A.TttolZ II . ,$8-Q w lJ /&vm 81AJ6-/26 9 7 ~ s T cf'MI Sf&#/,} c:,, 'ltMO f 7cd-9-<rz I I/
ame Address City State/Zip Telephone # Fax II
3. APPLICANT Pif Contractor O Agent for Contractor O Owner O Agent for Owner
t}g[1/tJ;e, d · &e/Jt<JAI /w J11/J//Vv & U 9 7 S'fZr?E: s;t::: c!&~Blfl} f/4 'le:MtJf 7 <>2-9~ L/'l II/
Name Address City State/Zip Telephone # '
4. PROPERTY OWNER
8-812.//fAJ S/JJ/TI/ 3,R. 7/ MSTuuMc/
Name Address City State/Zip Telephone#
6. CONTRACTOR · COMPANY NAME
(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
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not re than five hundred dollars ($5001).
(<.()w;v 'l-<.Mtf?J/Altf s~ /fl) '7,;/()1) 7.:<.f-tt /1./
Name Address
State License # -;l,Lfr;il._ 9 b License Class _e __ -~3~? ____ _ City State/Zip/a Telephone #
City Business License # / fj'() 0
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:
0 I have and w ill maintain a certificate of consent to self-insure for workers' compensat ion as provided by Section 3700 of the Labor Code, for t he performance
of the work for which this permit is issued. pif. 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 compensation insurance carrier and policy number are:
Insurance Company 'DT1fr?? {!(J)r) f' /IVS PUA.ID Policy No. /'J 'JD /;i{, ~ tJ / Expiration Date rJ 'J-O 'f
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] OR LESS)
0 CERTIFICATE OF EXEMPTION: I certify t hat 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 workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars 00 0), in ad i · to the t of compensation, damages as provided for in Section 3706 of the_lJb~ode, interest and attorney's fees.
SIGNATURE•~::,,-d..&~~::::!:::!~~C.L.~~~::'.=~=::_____________ DATE / t_fl()t.j
7. OWNER-BUILDER DECLARATION -----~--:;;:::-::=-~------r~
I hereby affirm that I am exempt from the Contractor's License Law for t he following reason:
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 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).
0 I, as owner of the property, am exclusively contract ing 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 w ith 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 (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 BUILDING 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 obt ain 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 7 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.
8. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of t he work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME ----------------LENDER'S ADDRESS _________________________ _
9, APPLICANT CERTIFICATION
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 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 co'.'.125'.;ced 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 comm~ r a perio(l of 180 days ( ction 106.4.4 Uniform Building Code). !
APPLICANT'S SIGNATURE _(..L.~d,t.~k~~L.L...~~~~'=.--------DATE -+~-0_,:/4f-=-'cJ_y' ______ _
WHITE: File YELLOW: Applicant PINK: Finance
Inspection List
• Permit#: CB040014 Type: PLUM SMITH RES GAS LINE REPAIR
~Date Inspection Item Inspector --'A'-'c=tc__ _ _:-:C__::oc:m:cm::.:e=nc:t=-s ___ _
01/06/2004 23 Gas/TesVRepairs PS AP
Wednesday, September 01, 2004 Page 1 of 1