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Home My WebLink About2271 COSMOS CT; ; CB050348; Permit02-34-2005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing Permit Permit No CB050348 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title Applicant PRC MECHANICAL 2271 COSMOS CT CBAD PLUM 2130504100 Lot* 0 Construction Type NEW RESPIRONICS.INC-ETHQK SHUT OFF T GAS METER Status Applied Entered By Plan Approved Issued Inspect Area ISSUED 02/04/2005 LSM 02/04/2005 02/04/2005 1300 GARDENIA AVE 91204 323 245-1111 Owner KOCH GREGORY G TRUST 02-20-03 3233 VIA LOMA VISTA ESCONDIDO CA 92029 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 0 1 0 S2000 SO 00 SO 00 SO 00 SO 00 $000 $700 $000 $000 $000 SO 00 $000 TOTAL PERMIT FEES $2700 Total Fees $27 00 Total Payments To Date $0 00 Balance Due $2700 1130 02/04/05 0002 01 02 CGP " 27-00 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 io which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 1 PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite #)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total tt of units Assessor s Parcel #Existing Use Proposed Use Description of Work - SS?4/-/3-£^gO 2 CONTACT PERSON (if different from applicant) FT #of Stories # of Bedrooms # of Bathrooms Name Address City 3 APPLICANT 0'Contractor Q Agent for Contractor D Owner Q Agent for Owner State/Zip Telephone tt Fax , Name 4 PROPERTY OWNER Address City State/Zip Telephone tt 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 exemtion 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 [$50011 Name State License ff 3//1? ty 0 Address License Class City State/Zip ( Telephone tt City Business License tt f) Pflf^i Designer Name Address City State/Zip Telephone State License # 6 WORKERS' COMPENSATION 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 ET 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 •$7~/3-'f& f^l/S? O Policy No /^/^/' ~2-P 0 ^ Expiration Date ^ ~ / ~ & ^ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) f~l 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 dollars ($100,Q00tr-jn additiontojthe cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney s fees SIGNATURE C-^fy S ^/^/^^e— DATE •&/?S#-*~~ 7 -OWNER-BUILDER DECLARATION/ I hereby affirm that I am exempt from the Contractor's License Law for the following reason f~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) CD 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 O YES ONO 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 K ' COMPLETE THIS SECTION FOR NON-RESIDENTIAL 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? l~l YES f~l NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? f~l YES l~| NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? l~l YES [~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 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 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 corpmSntad 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 cornnfenced^foiVp^p^ef)80 days (Section 106 4 4 Uniform Building Code) APPLICANT S SIGNATURE ^-^K-^/ X^v^^Z-<_^ DATE WHITE File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 02/07/2005 Permit* CB050348 Title RESPIRONICS.INC-ETHQK SHUT OFF Description AT GAS METER Inspector Assignment 2271 COSMOS CT Lot Type PLUM Sub Type Job Address Suite Location OWNER KOCH GREGORY G TRUST 02-20-03 Owner KOCH GREGORY G TRUST 02-20-03 Remarks EARTHQUAKE VALVE ON GAS METER Phone Inspector Total Time CD Description 29 Final Plumbing Act , Comment Requested By ROB Entered By KAREN Associated FCRs/CVs Inspection History Date Description Act Insp Comments sc POLICYHOLDER COPY PO BOX 807, SAN FRANC1SCO,CA 94142-0807 5MPENS/»TION I 5 U R A N CE "UND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ,UE DATE 09-01-2004 GROUP POLICY NUMBER 1661961-2OO4 CERTIFICATE ID 3 CERTIFICATE EXPIRES 09-01-2005 09-01-2004/09-O1-20O5 CONTRACTORS STATE LICENSE BOARD SC LICENSE NUMBER #311690 WORKERS COMPENSATION UNIT INCEPTION DATE 09-01-2O04 P 0 BOX 26000 DO- SC SACRAMENTO CA 95826 , is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the forma Insurance Commissioner to the employer named below for the policy period indicated , policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration certificate of insurance is not an insurance policy and does hot amend extend or alter the coverage afforded She policies listed herein Notwithstanding any requirement term, or condition of any contract or other documenti respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the cies described herein is subject to all the terms, exclusions and conditions of such policies HORIZED REPRESENTATIVE PRESIDENT LOVER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS' $1,000,000 00 PER OCCURRENCE ORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2004 IS ATTACHED TO AND MS A PART OF THIS POLICY '•:•'. EMPLOYER LEGAL NAME PRC MECHANICAL M & D PLUMBING INC 1300 GARDENA AVE GLENDALE CA 91204 PRINTED °8/17/^04 P0410