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Home My WebLink About2620 ROOSEVELT ST; 7; CB122498; Permit11-21-2012 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB122498 Building Inspection Request Line (760) 602-2725 2620 ROOSEVELT ST CBAD St: 7 PME 2031 022800 Lot #: 0 APT 7-FIND AND REPAIR GAS LEAK Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 11/21/2012 LSM 11/21/2012 11/21/2012 S D EXPERT PLUMBING & DRAIN CLEANING SEVILLE HOLDINGS LL C P O BOX 846 91946 619 247-4222 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES 8080 LA JOLLA SCENIC DR N LA JOLLA CA 92037 $154.00 $0.00 $0.00 $0.00 $154.00 Total Fees: $154.00 Total Payments To Date: $154.00 Balance Due: Inspector: FINAL APPROVAL Date /1-2/-cZ-Clearance: $0.00 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 f r i l i ii h f imi I h i THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0 PLANNING 0 ENGINEERING Oeu1to1NG □HEALTH 0HAZMAT/APCD Building Permit Application Plan Check No. Cfo I d--ol--'-f q ( 1635 Faraday Ave., Garlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: buldllng@carlsbadca.gov www.carlsbactca.gov Est. Value Plan Ck. Deposit Date / I ~ / ~ SWPP APN CT/PROJECT# # OF UNITS # BEDROOMS CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of An'ected Area(&) L..Jc s. Le!z k PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES □#_ NO □ YES O NOD YES O NO □ APPLICANT NAME (Secondary Contact) ADDRESS CITY STATE ZIP PHONE FAX EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC. # (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 th 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 D1v1s1on 3 of the B_usIness and Professions Code} or that he is exem9.t 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 c1vII penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: / hereby affirm under penalty of pe,jury one of the following declarations: ~ _!J!Jve 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. ff I have and will maintain wor1ters' com e ation. required b Section 37 of the Labor Code, for the performance! the IMlrk for which this IJArmil is issued. My workers' compens~n insurance carrier and policy number are: Insurance Co. vn Policy No, rz s:-l O :fo ~ C/ I ) -Expiration Date <r -/<t:-I 3 This section need not be completed if the permit is for one hundred dollars ($100) or less. □ Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensatkln Laws of California WARNING: Failure to secure workers' comp ens e is u wful, and shall subject an employer to criminal penalties and civll fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages provided r i of the Labor code, interest and attorney's fees. ,,6$ CONTRACTOR SIGNATURE I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: □ 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), □ 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). □ 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. □ Yes □ 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 construcUon {include name address I phone/ contractors' license number): 4. I plan to provide portions of the work, but I ha~e hired the following person to coordinate, supervise and provide the major work (include name/ address I phone I 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 I address I phone/ type of work)· 6$ PROPERTY OWNER SIGNATURE □AGENT DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management ar.d prevention program under Sections 25505, 25533 or 25534 of the Presley.Tanner Hazardous Substar.ce Account Act? O Yes O No Is the applicant or future building occupant required lo obtain a permit from the air pollution control district or air quality management district? 0 Yes O No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 Yes □ 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 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 complyvMh all City ordinances and State laws relating 1D building coostruction. I hereby authorize representative of the City of Cartsbad to enter u!X)n the atove mentioned property RJr inspecoon purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA i;€rrnrt is required for excavations over 5'0' deep and de Of c.onstruclion of structures over 3 stories ITT heght EXPIRATION: Every permit issued by the Building Offdal under the sbns of !111 all expire by limrtatoo and berome null and void Wthe building orv.ork authorized by such permit is not oommenced within 180 days from the date of such perrnrt or if the building orv.ork auth rized by such suspended or abandoned at any time after the wr'K is oommenced for a period of 180 days (Section 106.4.4 Uniform Building Code) ,'1S APPLICANT'S SIGNATURE E J / C DATE /I -.L I -( STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email www.building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS, LIC, No. DELIVERY OPTIONS □ PICK UP: o CONTACT (Listed above) =i OCCUPANT {Listed above) u CONTRACTOR {On Pg, 1) o ASSOCIATEDCB#•------------- □ MAIL TO: □ CONTACT (listed above) n OCCUPANT (Listed above) n CONTRACTOR (On Pg. 1J o NO CHANGE IN USE/ NO CONSTRUCTION □ MAIL/FAXTOOTHER: o CHANGE OF USE/ NO CONSTRUCTION A$ APPLICANT'S SIGNATURE DATE Inspection List Permit#: CB122498 Type: PME Date Inspection Item 11/26/2012 23 GasrresVRepairs Tuesday, November 27, 2012 Inspector Act PB AP APT 7-FIND AND REPAIR GAS LEAK Comments Page 1 of 1