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Home My WebLink About1120 CAMINO DEL SOL CIR; ; CB962252; PermitCMf 3477 U I L D ING PERMIT 11/21/96 12:12 Page 1 of 1 Job Address: 1120 CAMINO DEL SOL CR Suite: Permit Type: PLUMBING P a r- c e I N o : 206-261-11 - 0 0 L o t # : P-PPMT 97 r/\if r !\n i IL -' * v~j- Valuation : o Construction Type : NEW Occupancy Group: Reference* : Status : ISSUED Permit No: C.B962252 P r o j e c t No: A 9 6 0 3 -1 9 8 Development No: 1130 li/21/96 0001 01 02 Description: REPLACE WATER HEATER Appl/Owrir : WADDELL PLUMBING 1931 RECHE RD FALLBROOK CA 92028 * * * Fees Required *** Fees: 27. Adjustments : Total Fees: Fee descript ion Enter ''¥" for Plumbinjfefl Each W a t e r H eater a n c * PLUMBING TOTAL Applied: 11/21/96 Apr/ Issue: 11/21/96 Entered By: RHA 619 728-2911 ected & Credits .00 . 00 27,00 Ext fee Data 2 0 , U 0 Y 7.00 27.00 ' A- * CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Deportment 2075 Las Palnas Dr., Carlsbad, CA 92009 <619) 438-1161 1. PERMIT TYPE From List 1 (see back) give code of Permit-Type: For Resident^ Projects Only: From List 2 (see back) give Code of Structure-Type: ^ Net Loss/Gatn of Dwelling Units. 2. PROJECT INFORMATION PLAN CHECK NO.D EST.VAL PLAN OC DEPOSIT, VALID. BY DATE FOR OFFICE USE ONLY Address Nearest Cross Street or Suite No. LEGAL DESCRIPTION Lot No.Subdivision Name/Number Unit No. CHECK BELOW IF SUBMITTED: D 2 Energy Calcs D 2 Structural Calcs Q 2 Soils Report D1 Addressed Envelope ASSESSOR'S PARCEL _EXISTINGJISE_PROPOSEn USE DESCRIPTION OF WORK SQ.FT.too/tut* t/JQ&rr* # OF STORIES # OF BEDROOMS BATHROOMS J.ujniAJui raiouN in Qiiierem irom applicant; NAME (last name firsO > -, it j CITY y STATE ADDRESS ZIP CODE DAY TELEPHONE 4. APPLICANT NAME Oast name first CITY STATE n HJH LON InAL, 1UKADDRESS ZIP CODE UAufcNl r »,a DAY TELEPHONE (j>t9L 7&5'£ ?// 5. PROPERTY OWNER NAME CITY STATE <LA.ZIP CODE ADDRESS H9.0 DAY TELEPHONED /#.) 6. GUNTKACTOH NAME (last name first) CITY STATE STATE UC. # ADDRESS ; ZIP CODE DAY TELEPHONE "' < LICENSE CLASS £/~2>£ CITY BUSINESS LIC. LJESIGNERTNAME (last name rirstj CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # 7. WORKERS COMPENSATION Workers'Compensation Declaration: Iherebyamrm that I nave a certificate ofconsent to self-insure issued by the Director of Industrial Reladons, 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 die Building Inspection Department (Section 3800, Lab. C). ',"• INSURANCE COMPANY Certiticate ot Exemp so as to becoi SIGNATU: POLICY NO. V&Q <AK D Y EXPIRATION DATE T certify thatih the pertormance of the work For which this permit is issued, I shall not employ any person in any manner "* 'its' Compensation Laws of California. TE , 8. OWNE|E«U TION owner -Builder Declaration: 1 hereoy atnrm that 1 am exempt rrom the (Contractors License Law tor tne toiiowmg reason: D I, as owner of die 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 an not intended or offered for sale. If, however, die building or improvement is sold within one year of completion, die owner-builder will have die burden of proving that he did not build or improve for die purpose of sale.). D I, as owner of die 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 properly who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). D I am exempt under Section Business and Professions Code for diis 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 die applicant for such permit to file a signed statement that he is licensed pursuant to die provisions of die 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 .1 DATE COMPLETE THIS &EIT1ON FOR N6N-RESIDENT1AL BUILDING PERMITS ONLYi L Is die 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 die Presley-Tanner Hazardous Substance Account Act? D YES D 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 D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO IF ANY OP THE ANSWERS ARE YES, A FINAL CERTIFICATE OP OCCUPANCY MAY NOT BEISSUED AFTER JULY 1,19S9 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. erey arm a there is a construction lending agency tor te pertormance ot the woric tor which this permit is issued tsec 3QWUJ uvii Uodej. LENDER'S NAME LENDER'S ADDRESS I certiry thai I nave read tne application and state ,diat the above inlormation is correct 1 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 die above mentioned property for inspection purposes. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAmST AU IMBILTnES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SATO CITY IN CONSEQUENCE OF THE CHANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over S'O" 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 noricommenced withInJ6S days from the date of such permit or if the building or work authorized by aftrf^wsommenced for a period of 180 days (Section 303(d) Uniform Buildi ~* '" DATE: fc File YELLOW: Applicant PINK: Finance BASE ** ACTIVITY PROCESSING ** 10/15/97 Permit No; CB962252 10:08 Type: PLUM PLUMBING Status: ISSUED Dates: Applied ; 112196 Apr/Issue : 112196 Finaled ; Expired ; 112197 ^__ Job Title: REPLACE WATER HEATER Valuation: Descr; Type Const; NEW Altkey; Address: 1120 Street: CAMINO DEL SOL CR Lot*: ____ ___~^^~^ Suite; Parcel: 2062611100 Owner: VERKLEEREN JOHN L&BARBARA A Occupancy: Reference!: No district keyword Appl/Ownr ; WADDELL PLUMBING Telephone; 619 728-2911 Address: 1931 RECHE RD FALLBROOK CA 92028 Insp Area; Entered By; RMA INSP; NO APPR; NO COMM; NO MULTP; NO MULTA; NO S BAL: NO Project; A9603198 REPLACE WATER HEATER Entered: 11/21/96 By: COUNTER City of Garlsbad Buildirto Department WORKERS' COMPENSATION DECLARATION \ hereby affirm under penalty of perjury one of the following declarations , I have and will maintain a certificate of consent to self-insure for A. -workers' compensation as provided by section 3700 of the Labor Code, for * the performance of the work for which this permit is issued. have a:ndvwill maintain workers' compensation, as required by section 3700 'the Lab'onCode, fp,r the performance of the work for which this permit is issued. ,My workers' compensation insurance carrier and policy number are: INSURANCE COMPANY POLICY NO.. EXPIRATION DATE: (THIS SECTION NEED NOT &E COMPLETED IF THE PERMIT IS FOR PNE HUNDRED DOLLARS ($100) OR LESS) :'',•••«.*. ' ,' -',*'•• •i •. i 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^cpme subjecj to the •• C. workers compensation laws of California. ^ > Date Warning:. Failure to secure workers' compensation coverage is unlawful, and shall be subject an employer to criminal penalties and civil fines up.to one hundred thousand dollars ($100,000), tn addition to the cost of compensation, damages as provideo* for In Section-3706 of the Labor Code, Interest and attorney's fees* ;." •* March 3, 1995 2O75 Las Palmas Dr. • Carlsbad. CA 92009-1576 • (619) 438-116,1 • FAX (619) 438-O894 8 is subjec^fpMihe terns, efcrusions and conditionCptsufch poJrct1 • i -tr" " „ $?' *V' *sw ' THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262 {REV. 12-94) POI IfVLJ/ll «-~