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HomeMy WebLinkAbout1743 CEREUS CT; ; CB023059; Permit10-09-2002 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No: CB023059 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 1743CEREUSCTCBAD PLUM 2155164300 Lot #: 0 Construction Type: NEW NIWA RES/ REPLACE WATER HEATER Status: PENDING Applied: 10/09/2002 Entered By: CB Plan Approved: Issued: Inspect Area: Applicant: MY PLUMBER STE 603 5490 COMPLEX ST 92123 760 729-4326 Owner: NIWA HIROO&YURIKO 1743CEREUSCT CARLSBAD CA 92009 8392 10/09/02 0002 01 02 CGP 27-00 Total Fees:$27.00 Total Payments To Date:$0.00 Balance Due:$27.00 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 1 0 0 $20.00 $0.00 $0.00 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $27.00 Inspector: FINAL APPROVAL Date:Clearance: NOTICE: Please takffiuTICEilfial appfOTat-ofyOur 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 proceduressefforth 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 1. FOR OFFICE USE ONLY PLAN CHECK NO/^rtgJ2>0 EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Suite tt) Legal Description Assessor's Parcel f Descriptionjof Work Business Name (at this address) Lot No. _ .Subdivision Name/Number Unit No. Phase No. « V Existing Use , Proposed Use ~ SQ. FT. #of Stories tt of Bedrooms Total tt of units # of Bathrooms 2. CONTACT PERSON (if different from applicant) State/Zip Telephone tt Fax tt Name Address B^lJcoNTRACTOR - COMPANY NAME ' V , >. , . . .... „ "~ .", ., > - ~ , •• >, (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 axemption^Any violation of Section 703X5 by any applicant for a permit subjects theapplicajjjjo^a civil penaljty of/qet.mjjr.g^Jljan five/hundred dpl|afs [$5001). Narrye^ ^ _ State License tt ~l~~T <- Designer Name State License tt Address ' s\ *j i ?k&(p License Class C^k?•r- -j- Y Address City State/Zip,^ Tsleghone # City Business License tt \ £- I 1 O^fCx City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: l~l 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. 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 sued. My worker's compensation insurancegajr/ier and polpy number are: -T\ A^T\LQ\.Insurance Company Policy No.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 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 dollarisiS 100,000), in additittrftq the jjopt flf compensation, damages as provided for in Section 3706 of the Labor cdde, interest and attorney's fees. SIGNATURE^gi Jl ML J[AMK _ DATE 7. OWNERt^DERDECLAirlATtON 1 hereby afrrrmthat I am exempt from the Contractor's License Law for the following reason: f~) 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). d 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). l~l 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. l~l YES I~|NO 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 IFORNON-R£^DB^ijMmJXSiiNirrsONVf 7rL.L'r~ ".-:" ''-•-' _•"" '.,; '-~ ~~ ' >'-7_ 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 CD NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? CD YES CD NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? CD YES f~l 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. 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 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 perjnit is suspended or abandoned at any time after the work is commerfcedlfef a period of 180 4laf3 (Secfen 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE ,S/Mj(JA(Z\ Jf V\JiA AAS\ DATE HITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 10/17/2002 Permit# CB023059 Title: N1WA RES/ REPLACE WATER HEATER Description: Inspector Assignment: JE Type: PLUM Sub Type: Job Address: 1743 CEREUS CT Suite: Lot 0 Location: APPLICANT MY PLUMBER Owner: NIWA HIROO&YURIKO Remarks: Phone: 7608451409 Inspector: Total Time: CD Description 25 Water Heater/Vents Act £omments Requested By: NIWA Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments ACOR* CERTIFICATE OF LIABILITY INSURANCE™ « PRODUCER NWC Insurance Services P.O. Box 1180 418 B Street, Suite 300 Santa Rosa CA 95402-1180 Phone: 888-693-7892 Faxs 707 -570-0241 INSURED My Plumber, LLP5190 Complex Dr #603San Diego CA 92123i DATE (MM/DD/YY) 04/30/02 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: State Compensation Ins. Fund INSURER B: INSURER C: INSURER O: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVEDATE (HM/DD/YY)POLICY EXPIRATIONDATE (MM/DD/YY)INSRLTR TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ^1 CLAIMS MADE | | OCCUR EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER:~i POLICY nm n>-oc PRODUCTS - COMP/OP AGG N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS \COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY(Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THANAUTO ONLY: EAACC AGG EXCESS LIABILITY | OCCUR | | CLAIMS MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION -, I WC STATU- I X TORY LIMITS I TOTT ERWORKERS COMPENSATION AND EMPLOYERS' LIABILITY 167477002 04/01/02 04/01/03 E.L. EACH ACCIDENT s 1000000 E.L. UlStABe - KA EMPLOYEE $ IGGOGGG E.L DISEASE - POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Agent's Fax:619-660-9253 CERTIFICATE HOLDER N ADDITIONAL INSURED; INSURER LETTER:CANCELLATION MISC-01 City of Carlsbad Fax:760-438-0894 2075 Las Palmas Dr. Carlsbad CA 92009 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENT AUTHORIZ ACORD 25-S (7/97) u. ©ACORD CORPORATION 1988