HomeMy WebLinkAbout2610 UNICORNIO ST; ; CB973914; PermitPERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(619) 438-1161
FOR OFFICE USE ONLY
PLAN CHECK No .f'Z3?(4J
EST. VAL. _________ _
Plan Ck. Depo:.:s::::i>r--.;..----~---,--
Validated By~~~--"?''-=-r.....--~-::,....
Date ______ +-L-+.......,~-¥----+---1-:...._
Addren !Include Bldg/Suite II Bu1lneu Name (at thla addreul
Legal Duc1lptlon Lot No. Subdlvlelon Nama/Nu'!'b•r Unit No. Pha11 No. Total I of units
FR
Asussot's Pucal I Existing Usa Proposad U11
D11crlptlon of Work sa. FT. lof Storlu I of Bedrooms I of Bathrooms
NIm1 Addre11 City St■ta/Zlp Telephone I Fax I
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Sm.L'! JOiiMSOM 'I<RISTY FOO~ 13706 B HWY B QU!;, ~ Cl> 10-W, CA 9202) 390 4477 I dreu IV State/Zlp Telephone I
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~o , Theresa 2610 UII.j,i!JliU;t;rio SL. CA. I1/Zlp 760 436 4165 Telephone I
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ISec. 7031.5 Bu1ln111 and Profualona Coda: Any City or County which r1qulr11 • permit to construct, altar, Improve, demolish or repair any structure, prior to Its
lssu1nc1, also requlr11 the applicant for such permit to Ill• • signed 1t1t1mant that ha la llcansad pursuant to Iha provision• of tha Contractor'• Ucenn Law
ICh1pt11 9, commending with Sactlon 7000 of Division 3 of the Buslnt11 and Prola11lona Coda) or that ha I, exempt therefrom, and tha basis for the alleged
exemption. Any violation of Section 7031.6 by any applicant for I permit 1ubJ1ct1 the applicant to • civil penalty of not more than five hundred dollar• t • 600ll.
A i4-n.J FUS'l'ER PLtJMBIL«; Eft1[7uJOJ ~. 92021 390--4477 (ate/Zip Telephone I
Stat, Uc1n11 I +G.-Jw-O+-lt-,2~o-----Uc1n11 Clan .. c,,_.,.)..,.6------. City Bu1ln111 Uc1na1 I l 200354
D11ign11 Nam, Addreas City State/Zlp Telephone
State Ucense I f¼ • ..
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Wotkare' Companaatlon Dacleratlon: I hereby 1lllrm under penalty of perjury on, of the following ,d1claratlon1:
0 I have end will melntaln • cartlllc■t• of cons,nt to aall-lnaura for work111' comp1na1tlon H provided by Section 3700 of the l1bor Code, for th■ performance
of the wotk for which 1h11 ptrmlt 11 lnuad,
0 I have and will malnllln wo,kara' comp1n11tlon, ■a required by Section 3700 of'tha labor Coda, for th■ p1rlorm1nct of the work for which thl, permit I,
X luued. My wotk1r'1 compensation lnIurInc1 carrier end pollcv number 111:
lnauunca Company ~MCE Polley No. H2007 56 51 Expiration Dl(t()NTTNTJQUS
(TlilS SECTION NE~C~F THE PERMIT IS FOR ONE HUNDRED DOLLARS 1•1001 OR LESS)
0 CERTIFICATE OF EXEMPTION: I cartlfy that In the p1rform1nc1 of tha work for which thla ptrmlt la l11u1d, I 1h1II not employ any peraon In any manner 10 n
to bacom, 1ubJ1ct to the Wotkara' Compan11tlon Laws of C11ilornl1.
WARNING: FaRura to 1acu,1•wotk1r1' comp1n11tlon coverage la unlawful, and shall 1ubJ1ct an employer to crlmlnal panaltln and clvH flnu Uf' to one hundred
thousand doRara It 100,000), In addition to th• coat of compan11tlon, d1mag11 H provided for In Section 3708 of tha labQr coda, lnt1r11t and attorney'• faaa.
SIGNATURE _____________________________ DATE ________ _
7, l•·~·oWNER•BUILDEJI DECLAAAJION'i.-i~\1:ll.1'i~';;·¥m,f~-lf~'i1.t•·•¥,m;l.~J~m?Lt~U.Wlf~~~l~t--;J'.l1;.1i:.:.tr..~ .. tt~).-'
I hereby affirm that I am uempt from the Contractor'• Llc1n11 Law lor the followlng 11110n:
0 I, 11 owner of the property or mv employees with wage■ H their 1011 comp1n11tlon, wlll do th■ work and th■ atructura 11 not Intended or offered for sale
tS,c. 7044, Bu1in111 and Prof1aslon1 Cod,: Th, Contr1ctor'1 Llc1n11 law doll not apply to an owner of p,operty who bulld1 or lmprov11 thereon, and who does
such work hlm11II or through his own 1mploy1u, provided that auch lmprov1m1n11 are not Intended or oll1r1d lot 1111. II, however, the building or Improvement 11
sold within one y11r or complatlon, the owner-builder will h1v1 the burden of proving that ha did not build ot Improve lot the purpoH of aalel.
0 I, 11 owner or th• property, am 1xclu1lv1ly contracting with llc1na1d contractor• to con■truct' tha project (Sac. 7044, Bu1ln111 and Prof111lon1 Coda: Th,
Cont11ctor'1 Uc1n11 Law don not apply to an owner of property who bullda or lmprovu thereon, and conuacll for auch project■ with contrectorl•I licensed
pursuant to th1 Cont11ctot'1 Uc1n11 Lawl. •
0 I am exempt under Section ______ Bu1ln111 and Profeulona Coda for this ru,on:
1. I pareon■llv plan to provide the maJor labor and m1t1rlal1 for con1tructlon of th• propoaad propmy lmprov1m1nl, 0 YES ONO
2. I (have/ have notl 1lgn1d an application for I building permit for the propond work:
3. I have contractad with the following person lflrml t~ provide the proposad construction Uncluda name / 1ddr111 / phone numbtr / contractora license numberl:
4. 1 plan to provide portions of the work, but I have hired the following p111on to coordlnlla, 1upervl11 and provide the major work Uncluda name / 1dd1111 / phone
number/ contractors tlc1n11 numbarl: ____________________________________________ _
5. I win provide 1om1 of th• work, but I hav, contracted (hired) th■ followlng p111on1 lo provide th• work Indicated Uncluda name/ addre11 / phone number / type
ol workl: _____________________________________________________ _
PROPERTY OWNER SIGNATURE______________________ DATE _________ _
~to~.1H1•IsEcnoN.1.0R.t10NN$/.i/,E.N.1M/i,.~ill(p.iNP1r.~i.ultlN~'tHiilUM&mliS~PA~•lZ·~:.t-r:..11J~:;~mu1:~'1,:;'~1:.\.
i. th• 1ppUc1nt ot future building occupant required to submit • bu1ln111 plan, acutely hazardous m1tarlal1 r1gl1tratlon form or rlak mIn1g1m1nt and prevention
p,ogram undor Sactlons 26505, 25533 ot 25534 of the Pr11ley-Tenner H111rdou1 Sub1I1nc1 Account AoU O YES O NO
11 the applicant ot futu,1 bullding occupant required to obtain • permit from the air poUutlon conuol district or air quality management dlatrlcU D YES D NO
la the faclllty to ba constructed within 1,000 f111 of the outer boundary of a 1chool 11111 0 YES O 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 ANO THE AIR POLLUTION CONTROL DISTRICT.
a.: ~: CONSTRUCTION LENOINO'AGENC'(~'i'~l~~UJ.ll.;\ffl'ff-',!!41.fjfJ,i;~w.Wli~Mli:"~i.HtiV°B'1m1~1it~1:tfr!I-; _; ·; .' . • ·: • ;
I hereby I11irm that ther■ 11 a conatructlon l■nding 1g1ncv for the puformanca of th1 work for which thla permit 11 l11ued (Sec. 3097111 Clvll Codel.
LENDER'S NAME---------.------LENDER'S ADDRESS _______________________ _
:a; , '. AePllCANT, CERllFICAT\OK.J,1-,1J ,iA'~fW!• Ji~fir,~};',Ni1J; I '"';,;tf~i>'S',t~~~~~.it./Vm!lllID.m!WJ.&~~~1.lt~lWJ4,'l'\1.; '] }. :S:~' .:, • '.:
I certify that I h1v1 r11d tha 1pplic1tlon and 11111 that the above Information la correct and that the Information on the plans 11 accurate. I agree to comply with all
City ordinancn and Stat■ l1w1 relating to building construction. I h■raby authorlia r1pr111nl1tlv11 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 ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT,
OSHA: An OSHA ptrmlt 11 required for 111c1v1tlona ovar 5'0" d11p and d1molltlon or con1tructlon of 1uuctw11 over 3 1torl11 In height.
EXPIRATION: Every permit l11ued by the Building Official undtr tha provl1lon1 of th11 Coda shall expire by llmltatlon and become null and void ii the building or
wotk iuthorlnd by such permit 11 not commenced within 386 d1y1 from tha date of 1uch permit or II th• building or work authorliad by such permit Is suspended
or abandoned II any tlmt altar work ts c mm1nc1d f I period of 180 da (Section 108,4.4 Uniform Building Coda). /. ~ I] _Q~
APPLICANT'S SIGNATURE -',.,A.A..LlL/::,~.LL.-~~-"f-=~~...:...~--------DATE _,.JC.:,d:"""'---'-d ....... ~~'----..t...-+-~-+-----
WHITE: File YELLOW: Applicant PINK: Finance
UNSCHEDULED BUILDING INSPECTION
DATE !/?f9@;
PERMIT# 97J9/lf
INSPECTOR ___ 9$ ________ _
PLAN CHECK# -----
JOB ADDRESS "(__ a Io v11l0t9~ le
DESCRIPTION ---------------------
TIME ARRIVE: TIME ----------
CODE DESCRIPTION ACT COMMENTS