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HomeMy WebLinkAbout1746 CEREUS CT; ; CB992188; Permit$6/10/1999 City of Carlsbad Mechanical Permit Permit No: CB992188 Building Inspection Request Line (760) 438-3101 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 1746CEREUSCTCBAD MECH 2155170300 $0.00 SCHMAD RESIDENCE FURNACE CHANGE OUT Lot#: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 06/10/1999 MDP 06/10/1999 06/10/1999 Applicant: TRI STATE REFRIGERATION 148 N FIG ST. ESCONDIDOCA 92025 760 735-9000 Owner: SCHMAD-PAMELA J CEREUS CT CARLSBAb Total Fees:$24.00 Balance Due:$24.00 Mechanical Issue Fee Install/Furn/Ducts/Heat Pumps Fee-" Fireplace Installation Fee L .,, Exhaust Fan Fee V Installation/Relocation VentVee1; Hood Fee \ ,fi Boiler/Compressor to 15HP Feve Other TOTAL PERMIT FEES rsfl '''$15.00 * $9.00 £0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $24.00 EXPIRED P FINAL APPROVAL Inspector: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 capactiy 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. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION efTY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 1. PROJECT INFORMATION I Address Tinclud? Bldg/Suite #) 1 FOR OFFICE USE ONLY PLAN CHECK Noff- C/00 EST. VAL. . Plan Ck. Deposit Validated By Date Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No. Phase No.Total # of units Proposed UseAssessor's Parcel #. f*t U^f Existing Use Description of Work 2. CONTACT PERSON (If different from applicant) SQ. FT.*of Stories * of Bedrooms # of Bathrooms Name Address City i3. APPLiCANf 0 Contractor Q Agent for Contractor Q Owner Q Agent for Owner State/Zip Telephone # Fax # Name 4. ^PROPERTY OWNER Address City State/Zip Telephone # Address City State/Zip Telephone *Name" 5. CONTRACTOR - COMPANY NAME (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). Name State License * "^ <"*>"& l> ft *5 Address' License Class C.-tt City State/Zip City Business License t telephone # Designer Name ^-^^-^ ' Address '^Z^' City State/Zip Telephone State License # ^C— 6. WORKERS'COMPENSATION " " !"" ~* "~ ~" \' Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q 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. Q 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 f^A^^-Cf^A^ ^/Q&lfP. ~7-s,gjd- Policy No. ^J^-fy (tf~/7&~1 f Expiration Date /~ £> I ~<3 £ thousand (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) Q 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 00,0<8Il£tjjd'dttion to the cost-«f compensation, damages as provided for hi Section 3706 of the Labor code. Interest and attorney's fees. _ \ _ DATE (3 — / A 7. OWNER-BUILDER DECLARATION ..... ,,,:=,,,,,,,....,. ~ . . . „ , - . . -»-.-...„-,-,, • ,. , w^s .- „ - I 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 end 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). Q I, as owner of the property, em 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 contractorls) licensed pursuant to the Contractor's License Lew). • 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. Q YES CD 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 COMPI^TE THIS SECTION FOR »0/VV?£S/D£V7Mi BUILDING PERMITS ONLY" " *~" ' **""""" '*"" 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? Q YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES Q NO IF ANY OF THE ANSWERS ARE YES, A RNAL 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 AGENW " '-"••"- --•«. — —*•- «->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(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS :9. APPLICANT CERTIFICATION " ------ --,--T— ,™. . - - -~,~ „-,-,._„ -, ,„ .„. ^-^ „ 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 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 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time-^TteTHje wgdUs-Goqjm^Beed-ty a period of ISO days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATUI DATE fl-— WHITE: File YELLOW: Applicant PINK: Finance COMPENSATION INSURANCE FUND ffr'BR'WP; '-}, RO. BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICY NUMBER: -*"* '& t CERTIFICATE £XP{RES: ' ! - ©I? r 1IKh'&L fEC : ,* OHM-Mil t, LI PS JP 0 BOX c 2 116 |CH'feW,flNi> WHK ;fS (4..1 | - ' f^'TATE OF t[ ' This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. - 1This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. Wejwitl also.give you TEN days' advance notice should this policy be cancelled prior 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 certificate1 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 , - PRES/DENT - EMPLOYER-'8 UftBIUT/ LIMIT' {NUU0IN6 SEfT;H5£ W-iiSi II, 080, TO® PER ^CfURPEMT. EMPLOYER r fRI-S7«r!E RKFRI6EWICW DlOti BL"£> -f3 eft ••»a0£B; THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND