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Home My WebLink About1621 CORMORANT DR; ; CB023592; Permit11-27-2002 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No Building Inspection Request Line (760) 602-2725 CB023592 Job Address Permit Type Parcel No Reference # Project Title 1621 CORMORANT DR CBAD PLUM 2156500403 Lot# Construction Type 0 NEW STATE RESIDENCE WATER HEATER REPLACEMENT Status Applied Entered By Plan Approved Issued Inspect Area ISSUED 11/27/2002 MDP 11/27/2002 11/27/2002 Applicant A&J FOSTER, INC STEB 13706HWY8BUS EL CAJON CA 92021 619-390-4477 Owner STATE DAN&DANA M 1621 CORMORANT DR CARLSBAD CA 92009 2228 11/27/02 0002 01 02 CGP 27-00 Total Fees $2700 Total Payments To Date $000 Balance Due $2700 Plumbing Issue Fee Fixture or Trap Building Sewer Roof Dram Install/Repair Water Line Water Heater and/or Vent Gas Piping System Vacuum Breaker Other Plumbing Fees Master Drainage Fee Sewer Fee Additional Fees 0 0 0 0 1 0 0 $2000 $000 $000 $000 $000 $700 $000 $000 $000 $000 $000 $000 TOTAL PERMIT FEES $2700 DPER PERM r HAS EXPIRED IN ACCORDANCE WITH U.B C SEC HOiM 106.4.4 HATF Inspector FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, 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 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 fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 .PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO. EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite tt) Legal Description Assessor's Parcel tt 91 c; ^qn 04 m Description of Work Water Heater Re] ,2.. CONTACT PERSON (ifUrf'w Don State Business Name Lot No Subdivision Name/Number SFR Existing Use SO FT placement , Bntfrorhiapplicuntt i.-is-.l ^\ljs>-.. -dk,.> ': 1621 Cormorant Dr #of Stones " "Car TsBad " (at this address) Unit No Phase No Proposed Use tt of Bedrooms .,«,*„ -<g« "'92009 ""'""8'5'8— 3' Total tt of units # of Bathrooms State/Zip Telephone ttName Address City 3?" APPLICANT yQjCbhtraotqf "D Agentrfor^S^o^ • ,, ^ > •, ' r ter 13706-B Hwv.8 Bus. El Caion, Ca. 92021 (619)390-4477 Fax tt Name 4 rPa' , _ PROPERTY OWNER on Dtai-e •me Address ] 6 ''I '"'or mor ant %3d7ess Dr City i : ** :* ». ! f ' *£ * '^ ' far 1 csharl City ra. State/Zip CT":' -V:1*': J 92009 State/Zip Telephone tt 760-603-7363 Telephone tt (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 to a civil penalty of not more than five hundred dollars ($5001) Q9091 (fiTQnqn-4477 r&m§ J : State License tt g3Q] 20 Lvj. Plumbing Hwv.8 -E3r ^ e»_ca- License Class C— T Tty State/Zip Telephone ft City Business License tt 1210836 Designer Name Address City State/Zip Telephone State License tt M/A 16 ^.WORKERS' COMPENSATION '"' ",'V" 7 ,„ " 2 " "LM-Ci: t.-J". .:< I a-*-" J?«.L'M ^UIX.^...i- .1 ',..'' #• A1S1? .-.:; < - * „, Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations n 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 O 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 Xssued My worker's compensation insurance carrier and policy number are Expiration Date D4-01-Q3 , Insurance Company „ . p-i1r Tnq _ Policy No 467 Q]_ QQQ0713 (THIS SECTION NEED HOTBE^OWLCTE'D IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS 1*1001 OR LESS) n 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 secpi»«vorkers' compensatloa,ccj»rage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($1j)*flJTfo),>Mfddition t/fafe cost cSjompegBation, damages as provided for in Section 3706 of the Labor; code. Interest and attorney's fees SIGNATURE £***&*&***'' '} • **/ t^Ct^. ^ _ DATE (f / ^- & _ 7. DOWNER-BUILDER DECLARATION , V/- **!, ,- -,* -*' ,. -ET\ -ig-- ?';•'>./*:;.,.. - >,. ''f^^ J?J: •• _.,t"f I hereby affirm that I am exempt from the Comractor's License Law for the following reason l~l 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) n 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) n 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 Q YES QNO 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 .*1F':^:-: '. :.i ii^-u^:'-: 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? C] YES (U NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? FJ YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D 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 i8,«~''COivlSTRUCTIONlENbjNG AGENCJY.J':^'31-; If .^ /./^i.^p-^^iE';' •", -^J *X'> • .!''iT'^.*.•"? ...fr-'^f? !—i'"'^ - ' ••• , I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(0 Civil Code) LENDER'S NAME LENDER'S ADDRESS ii:-i...,A|PLlCANT CERtMCATipofr .. J ".,!, >' IT? i'.iili ^f^J^Sff^Jt: -C^:^^. ^f^l&i^l&r*3$^JZZ. ..^J, „ 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 CitV 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 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 commejised^foj- a period of,180 daxgj^ction 106 4 4 Uniform Building Code) APPLICANT'S SIGNATURE HI DATE sh permit is suspended \ if 26 WHITE File YELLOW Applicant PINK Finance AUG-21-2002 WED 04-'58 PM A & J FOSTER PLUHBING FAX NO. 619 390 4448 P. 02/07 POLICYHOLDER COPY P O BOX 420807, SAN FRANCISCO, CA 94142-0807 PUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE COMPENSATION INSUKANCB MAY 14, 2002 CONTRACTORS STATE LICENSE BOARD WORKERS' COMPENSATION UNIT P O BOX 26000 SACRAMENTO CA 9582$ GROUP. 000467 POLICY NUMBER: 711-2002 CERTIFICATE ID: 6 CERTIFICATE EXPIRES: 04-01-200) 04-01-2002/01-01-200:5 CONTR LIC # £30120 INCEPTIONi 4-1-02 LOS ANGEWBS UQ This Is to certify that we have issued a valid Worker's Compensation Insurance policy In a form approved by the California Insurance Commissioner to the employer named below for (ho policy period Indicated This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer We will also give you 10 days advance notice should this policy be cancelled pnor to its normal expiration This certificate of insurance Is not an Insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the Insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions, of such policies AUTHORIZED REPRESENTATIVE EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS- $1,000,000 PER OCCURRENCE EMPLOYER A & J FOSTER. INC 13706 HWY 9 BUSINESS ST St, CAJON CA 92021 SCIF 10265 I6PP-UI CG)