HomeMy WebLinkAbout1735 BLACKBIRD CIR; ; CB053220; Permit09-13-2005
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Plumbing Permit Permit No:CB053220
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Reference #:
Project Title:
1735 BLACKBIRD CR CBAD
PLUM
2156018200 Lot#:
Construction Type:
LEE RES- REPLACE WATER HTR
0
NEW
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
09/13/2005
LSM
09/13/2005
09/13/2005
Applicant:
ARS
STE100
6162 NANCY RIDGE DR
SAN DIEGO CA 92121
858-677-5455
Owner:
LEE MICHELLE
1735 BLACKBIRD CIR
CARLSBAD CA 92009
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
0
0
0
0
0
1
0
$20.00
$0.00
$0.00
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL PERMIT FEES $27.00
Total Fees:$27.00 Total Payments To Date:$27.00 Balance Due:$0.00
DATE
Inspector:
FINAL APPROVAL
Date:Clearance:
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
referred to as lees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
fees/exactions of which you have previously been oiven a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired.
PERMIT APPLICATION
CITY OF'CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
•.I..:'"1 PROJECT INFORMATION
FOR OFFICE USE ONLY
PLAN CHECK N0.(^> ft
EST. VAL.
Plan Ck. Deposit
Validated By
Date C
Address (include Bldg/Suite #)Business Name (at this address)
Legal Description Lot No.^. ^^Subdivision Name/Number Unit No. Phase No. Total # of units
Use Proposed Use
Description of Work
2. ' CONTACTPERSON (If drtferentfnini
SQ. Ft. #of Stories
"- 's"j:-'
t of Bedrooms # of Bathrooms
Name
'3 ' APPLICANT Q Contractor'
Address City
^^{03
State/Zip Telephone Fax #
Name
4. PROPERTY OWNER
Address City State/Zip Telephone *
Name ' Address City State/Zip Telephone ft
5. ' CONTRACTOR- COMPANYNAME: ' ' - "•'•:••'• •• ' v" ^(^^'^•^^•^•^'^^^•^^^'"'.^ :'^ -;"'"l&$-"-\"" " ' '- "
(Sec. 7031.5 Business and Professions Coda: 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
• Any violation of Section 7031.5 by any applicantjor a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1S500]).
Name
State License ft '<* \
Address*
^5 <*-**• — License Class C- • i-J
' City State/Zip
O Cs&xZ) city Business License t I'D
Telephone #
£0-700
Designer Name
State License #
6. WORKERS' COMP
Address
ENS'AfiON" •""•"'' '-'""'"• v " "'"";.:" ""•'"' -li-i' L'-.
City State/Zip Telephone
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations;
O 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.
[S. 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 lYlnh^&re W^pPx Policy No. J,r\'Z7aK^~T& ~Cj\ Expiration Date
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] 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 ttw^Workers' Compensation Laws of California.
WARNING: FailurbAo secure workers' compensation coverage Is unlawful, and shall subject on employer to criminal penalties and civil fines up to one hundred
thousand dollars l^lOtXSpp], in addition «J the cosyoi.cofipeTraation, damages as provided for In Section 3706 of the La^o/code, Interest and attorney's fees.
SIGNATURE \!ij^L£^O,,X-<^<-' j._[_._ ^-M^^^ DATE
7. OWNER-BUILDER DECLARATION ~ L ' '" ^-V."V ':'-l!'"' - v":'.:; " . 1-!'il ' ".'•'"'' '
1 hereby affirm that I am exempt from the Contractor's License Law for the following reason:
Q 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).
[~1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: Tha
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).
O I arn 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 / tvpe
of work):
PROPERTY OWNER SIGNATURE DATE
COMPLETE THIS SECTION FOR WWtf-fliHMDSVTTWi
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? CD 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? O YES Q NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site7 Q YES Q 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 the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS ; ___„ __
9. APPLICANT CERTIFICATION ' ' ' " ' ':''*- •"''.' ':.; ••.• •;™ - ^ ^^^^^r^^^^mrrf^—-^^^-. -•';:;: •."' ' •••
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 City 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 bymebuilding Official under the provisions of this Code shall expire by limitation and become null and y>id it the building or work
authorized by such permit is not cfcrnrnencedj within 180 days from the date of/such permit or if the building or work authorized by such perj
at any lime after the work is comfi\Ejhced^prJa perio^ of 180 days (Sec^6n\1y06|4/-^niform Building Code).
' /' i
APPLICANT'S SIGNATURE DATE
abandoned
WHITE: File YELLOW: Applicant PINK: Finance
MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
CHI-000949412-01
PRODUCER
ServiceMaster*Certificate Team
MARSH USA. Inc.
500 W Monroe St.
Chicago. II 60661
Attn Fax:877-732-7799
8112
THIS CERTFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED M THE
POLICY. THIS CERTF1CATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE
AFFORDED SY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
ZURICH AMERICAN INSURANCE COMPANY
WSUREQ
(#8112)ARS AMERICAN RESIDENTIAL SERVICES
OF CALIFORNIA INC
dba ARSOF SAN DIEGO
860 RIDGE LAKE BLVD.
MEMPHIS, TN 38120
ILLINOIS NATIONAL INSURANCE COMPANY
CCMPAN>
D
COVERAGES This certificate supersedes and replaces any previously Issued certificate Ibrttre policy period noted below.
Tn.S IS TO CERTIFY Tr-AT POL.CES OF INSURANCE DESCRIBED -tEREN HAVE BEEN i3SL.EQ TO THE INSURES NAMED HESEiN FOR Trig Pd'CY =ERtCO INOlCATSD
NOTVWTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANV CONTRACT OR OTW~? DOCUMENT WTH RESPECT TO V*«CH THE CERTIFICATE VAY S£ ISSUED OR MAY
=?RTAIN THE 'NSURANC= AF-ORQED 8Y THE POLICES PESCSlBEQ HEREiM IS SUBJECT TO fLl THE TERMS CONDITIONS ANO EXC.U3ONS CF SUCH PQUGES AGGREGATE
LIMITS S-OHV4 MAY HAVE BEEN REDUCED 3Y o«D CLAIMS
CO
LTR TYPEOFIMSURAKCE POLICY NUMBER POLICY EFFECTIVE POL ICY EXPIRATION
DATE(MMfDO/YY)LIMITS
QENERAL LIABILITY
X j COMMEHdylL GENERAL LIABILITY
j CLAIMSMWE j_^J OCCUR
OWNER'S * CONTRACTOR'S PROT
GLO 2938645-01 01/01/03 01/01/06 GENERAL AGGREGATE
WODUCTS - COVP/QP AGG
OERSONAL & ADVINJURY
EACH OCCURRENCE
I[FIRE DAM AGE (Any ona *
MED EXP(Any ma atrsan]
5,000,000
1,000,000
1,000,000
1.000,000
1,000,000
5,000
AUTOMO8LE LIABILITY
»IY AUTO
ALL OVMMEO AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BAP 2938646-01 (AOS)
BAP 2938647-01 (VA)
TAP 2938648-01 (TX)
01/01/03
01/01/03
01/01/03 ,,
01/01/06
01/01/06
01/01/06
CCMBNED 3NGLE LIMIT
BODILY INJURY
[Par parson)
BOQILY INJJRY
(Par acodant)
PROPERTY 0AM AGE
1,000,000
OARAGE LIABILITY
tHY AUTO
AJTOOMLY -EAACOOENT
CfTHER THAN AUTO ONLY
EACH ACQDENT
AGGREGATE
EXCESS LIABILITY
X ] UM6RELLAFOSM
OTHER THAN UMBRELLAFORM
BE 309-79-07 04/01/01 104/01/04 EACH OCCURRENCE
AGGREGATE
5,000,000
5,000.000
WORKERS COMPENSATION ANO
EMPLOYEH31 LIABILITY y\C 2938643-01 (AOS)'101/01/03 01/01/06 WCSTATU-
TCRY LIMITS ERT
! EL EACH ACOOENT
•Ma
CFc''CE=iS ARE
1.000,000
1 000.000
1,000.000
OTHER
DESCRIPTION OF OPERATIOMSJLOCATIONarVEHtCLES^SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
_ 30 :«VS .VHTT5N NOT C= TO
HOT CS SM*. . S*"OS MO OS. T,T O* Cfl
BY- Chnsty N.
MI«(3/«)VALID A30F: 1CV26/02