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Home My WebLink About1264 VERONICA CT; TP; CB971296; PermitFOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. 11 11-Cf l, 1CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 EST. VAL.__,\,.._' _______ _ Plan Ck. Deposit--.....--,------ Validated By M (760) 438-1161 1. PRojECT INFORMATION Date. _____ .$'+-/,}!-'-~ -l<t-7---- f-:i,~ 4 V[JZoh I cA Address (include Bldg/Suite I) Ot Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total I of units -L Proposed Use I of Bedrooms I of Bathrooms • • -' •• • •• ··-• .r .. ~~ _ -, ~: ~-/'7"' -,..-i-.-:-~ -.••,,:~lfJ',.;,..; :'"·' -~~ ~~i;':,"lo,·"'-,. '1'.__. "' .. r' ·2. • 8 c&Vl>..,1o (!A 9~ l'9 y3<;-;<;f5 Name Address City State/Zip Telephone I Fax II !3:-"' •• AiiPlrCANf --□ Contraotor·::::s-!g;;;nor Contracior?Eowrllr : .. nAoentTor 6wii~r'": ·:i:·,.-;~=··~•~.;."1", '"'11:r.•" !"'''!" "· -• Name Address City State/Zip Telephone I Name Address City State/Zip Telephone I :6~--•· cciNTMCT6Fi·: COMPANY NAME''•~•~f'rfr•;,'!'.~~""~~••"""~"""'~.,...r,-., -""·" ':""===...--~----... .'.'."'"'.""-·" .-, "":-1";"" "'."'.-,,._~t"":" .... ' ,,. •• (Sec. 7031 .5 Business and Professions Code: Any City or County which requires I permit to construct, alter, improve, demolish or repair eny structure, prior to Its i11u1nce, also requires the applicant for such permit to file I 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 ~ viol~ of Secti9r 7Q.31 .5 by any applicant for a par ·,t~bjects the applic.t.n; to a civil penalty of not more than_,Jive ~ndred dollar ($5001). roWc.7<.. .:;ss,---sn ~lJ e_ . ., O rKw,v· bC'tJ,N()/~ C,, '7"...20..?,(j $'3>-1.-/Pf? City State/Zi T ~~n~I City Business License I /;;;.. Q / b ~ ~ State License II _<j~~/3_3_~_~_3 __ _ Address e!,-/0 License Class _________ _ Designer Name Address City State/Zip Telephone State License I __________ _ 6. WORKERS' COMPENSATION •. I. •• .,--; .... : Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation es provided by Section 3700 of the Labor Coda, for the performance of the work for which this permit is issued. ~ I have end will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which thi issued. My worker's c pensation insurance carrier end policy number a·i,: lnsurence Company ,,t:i::,~ -A. TV Policy No.# bOt/:i/7,:2.,z> [:3 Expiration Date O / (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so es to become subject to the Workers' Compensation Laws of California. WARNING: Failure to Hcur• worker • compenaatlon coverege la unlawful, and shaft subject an employe, to crlmlnal peneltlH end clvll fines up to one hundred thousand dollars ($ ,00 . In ddl n to the coat of compena■tlon, damegea H provided for in Section 3708 of the La r cod • lnterHt and 1ttomey'1 feH. SIGNATURE,_~..S::::L-.IL-...~~=t"-<a.:::.::;::::::..__________________ DATE ~ 7. OWNER-BUILDER DECLARATION • • -· -_> • : ••• ._ • ~ _-. · • , · •• • • • •• ; • ~r:· • I hereby affirm that·I em exempt from the Contractor's License Law for the following reason: 0 I, as owner of the property or my employees with wages as their sole compensation, will do the work end 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). 0 I, es 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(sl licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business and Professions Coda for this r.iason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 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 _________ _ 'COMPLETE nus sEcTioN FOR 1'10N-liESioENnAi.'liu1LDINo i>ERMrrs·oNL ~lf;:,·:..,,.~'•'•;:1,,1r '"T1T!:t"•F'P ~W-'lf t~,, "11}"'."'.it-:>• ""':-"-:':''. ~,:-• -::r -:;c· ~ '",:,•~~· • ~ ·: • • Is the applicant or future building occupant required to submit • 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 Actl O YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality menegement district 7 0 YES O NO Is the facility to be constructed within 1,000 faat of the outer boundary of• school site? 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 AND THE AIR POLLUTION CONTROL DISTRICT. -,') ... , :'\ J I hereby affirm that there is a construction landing egency 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 cERTtFICATiON .~-rrr;.t' ;yr: r,rr .. •1,~P.,:..:!~~~;1-~•7" !T~-~~~~1·~~ :-r,-::.:;:r.,;:-_~ :i .. -~~::;,;~·:i.:_:~~ul-::t r~~-Z!;'!.-." --:~~·::-: --:-;-,..:r. :. ;_· --:.~ p .. :,"'~ :r 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 Cltt of Carlsbad to enter upon the 1bov11 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 wi hin 365 days from the date of such permit or if the building or work authorized by sue permit is suspended or abandoned at any time after the w It is c m for a period of 180 days (Section 108.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Aoolicant PINK: Finance PERMIT# CB971296 Df SCRIPTION: TEMPORARY POWER TYPE: ELEC CITY OF CARLSBAD INSPECTION REQUEST FOR 06/10/97 POLE-LENNAR STE: INSPECTOR AREA PLANCK# CB971296 OCC GRP CONSTR. TYPE NEW LOT: JOB ADDRESS: 1264 APPLICANT: TEMPORARY CONTRACTOR: VERONICA CT POWER SYSTEM PHONE: 619 439-1999 PHONE: OWNER: REMARKS: R/BOB/439-1999 SPECIAL INSTRUCT: TOTAL TIME: LVL DESCRIPTION PHONE: INSPECTO~ CD 32 EL Const. Service/Agricultural ;;!!COMMENTS ***** INSPECTION HISTORY***** DATE DESCRIPTION ACT INSP COMMENTS