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HomeMy WebLinkAbout1055 PALM AVE; ; CB040736; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-04-2004 Plumbing Permit Permit No: CB040736 Job Address: Permit Type: Parcel No: Reference #: Project Title: Applicant: Building Inspection Request Line (760) 602-2725 1055 PALM AV CBAD PLUM 2051910300 Lot#: 0 Construction Type: NEW SNODGRASS RES-REPAIR GAS LINE TO STOVE Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 03/04/2004 RMA 03/04/2004 03/04/2004 SNODGRASS JUNE L TRUST OF 1987 SNODGRASS JUNE L TRUST OF 1987 3980 ADAMS ST 3980 ADAMS ST CARLSBAD CA 92008 CARLSBAD CA 92008 Plumbing Issue Fee $20.00 Fixture or Trap 0 $0.00 Building Sewer 0 $0.00 Roof Drain 0 $0.00 Install/Repair Water Line 0 $0.00 Water Heater and/or Vent 0 $0.00 Gas Piping System 1 $7.00 Vacuum Breaker 0 $0.00 Other Plumbing Fees $0.00 Master Drainage Fee $0.00 Sewer Fee $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $27.00 Total Fees: $27.00 Total Payments To Date: $0.00 Balance Due: $27.00 6787 03/04/04 0002 01. 02 CGp 27-00 lnspe FINAL A':,r::f3.VAq Date: J 0 Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition• of fees, dedications, reseNations, or other exactions hereafter collectively referred to as "fees/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 infom1ation 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 I. hi ril iv Tl ilr whih ii i '"···--•----------·---- PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO. {:6olfo,Z?~ EST. VAL. _________ _ Address (include Bldg/Suite #) /()5S /1~ Business Name (at this address) A II e_ l..fl/<t..s /3,1-LJ Legal Description Lot No. Subdivision Name/N4mber Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description of Work SQ. FT. #of Stories # of Bedrooms "'"-~===-'~~U£!1lfl~.!m.1~~! . .::. ~....iliiU~.Si.ir" ·1,1'7t}iii:··~c/.r.,...lill·~L.;.~~t..1l"f,M~j, # of Bathrooms Name Address City State/Zip Telephone # Fax # •=IJ.illoJl:iiiL.IJ.ClJdJ!t!lli.tPr [ ' iCI~.,,,ll ._....,.,.,.,,.,,,""' ,-r"~.G'i:1h~~ Name Address State/Zip Telephone# S.tate/Zip ~•.··•,, (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to cor,struct, 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 to a civil penalty of not more than five hundred dollars [$5001). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone Ulltft.li.lii!Ml:.:::.•::...11.iw....,.....:;1,,..4,/i~...,.~t/J;:!:f.:.. • ....,~ ... 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. 0 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 _____________________ Policy No .. ____________ Expiration Date. _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 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 aacure workers' compensation coverage la unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the coat of compensation, damagea •• provided for In Section 3706 of the Labor code, Interest and attomey'a feea. SIGNATURE DATE o..wiffl!fl..U1101uJ:c1;An~noN." ,. · ., • -~Jz~ •• ~'"" ,. 'Mlii •"-M:: -~;;;;;1$1;;;11 ... ;;:J:;;;,.,,,.;;;,~;;,. ,,:;;,;;s:;::•,::;;:;;;;;; ::;;~;;;;ii;;;:;.:;;;;;R®:;;;"'if";::;[i'!iffl.'f~~ I hereby affirm that I am exempt from the Contractor's License Law for the following 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). 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 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. O 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 th lowing person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number): _______ ~---1------------------------------------- 5. I will provide some of the work, but I have contrac ad (hired of work):. ________ ::z::::~~~~~::::::..:_--::,,-~'""".c._-l-+------t4------,W;,,4,.,.._~~c--.a::.J..--,...!.ll~l(...1.J.,.=,:[,,d4-________ _ X":ROPERTY OWNER SIGNA TU l9QfflCJ;filJ[!:!!.$~jgr@A159.!'i!l§!!::.B.€$!MI{. JIJ!! .....,...........,....... W,f,;~~~~.~..i.,.;;....;.....:...,.~ ........ ,, , ,, ~~~ Is the applicant or futur~ building occupant re ired to s bmit a business plan, acutely haz_ardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 256 4 of the esley-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? O 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. tQ......;.:_qp..H1ttR1!J,Ii!>1fll~.t~~C" · i.~~!.Zl~a~~ .. W;,!:~~;,,t.~..,..,Ji.u,:1<~,.i:,2\"'.i .. ;;.:~:..~~~ili.1:.:\1!.',,:ir~;,,.~t 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). 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. City of Carlsbad Bldg Inspection Request For: 03/05/2004 Permit# CB040736 Title: SNODGRASS RES-REPAIR GAS LINE Description: TO STOVE Type: PLUM Sub Type: Job Address: 1055 PALM AV Suite: Lot O Location: APPLICANT SNODGRASS JUNE L TRUST OF 1987 Owner: SNODGRASS JUNE L TRUST OF 1987 Remarks: Total Time: Inspector Assignment: Requested By: SANDY Entered By: CHRISTINE CD Description Act Comment 23 _G_a_s_rr_e_st/_R_e_p_a_ir_s ___ ~ -!!f (1 N A: L----- Associated PCRs/CVs Inspection History Date Description Act lnsp Comments