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Home My WebLink About2802 VIA CLAREZ; ; CB970245; PermitFOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. ~Jozc;[L CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 EST. VAL.----~----- Plan Ck. Deposit 'Z-h bl> Validated By ~ Wv Date Q /.Lt,q 7 Address (include Bldg/Suite #I "" Business N■m• (■t this address) C't1&bbad Ct1 9,;i.oo 8-:: LAgal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total II of units Assessor's Parcel I Existing Use Proposed U■e Description of Work I< f../ fft I{ brf.J L/ ~--E,:_ lot Stories I of Bedrooms I of Bathrooms ~~. CONTACT PERSON (If different troniapptlcantl~ •: .:_;:~ • '•... ~: _ _ .. _""' ·~•1!'l~-k Name Address City State/Zip Telephone I Fax If ?, .;c~CANT . 0 Conqactor,_, CT~!OJJ9L(:01JJm!ot:..:O,9rtoo..:..~□-~g,rit fl!! O__w~~~ ~;:~~. ' -R!2.COIIPANYJ1ME\½8St>M# &15£t'41id¥ iW i1f¾#¥kffff (Sec. 7031.5 Business and Professions Code: Any City or County which requires • 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 exampt therefrom, and the basis for t he 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 Address City State/Zip Telephone I State License II _________ _ License Class _________ _ City Business License I _______ _ Designer Name Address City State/Zip Telephone State License I _________ _ iL.. .W_Q,RJ(.ERS' COMPENSATIO Lah.-.._ .-L·~ .. --~--\-~ --_... ~...::---~1-'. .t....~:-: .. ;.. ...~._. .. ,.~j.::Jt,;~..;-";~Jr·. ~ ~ .;-.... Workers' Compensation Decler■tion: I hereby affirm under penalty of perjury one of the following decl■r■tions: 0 I have end will maintain a certificate of consent to self-insure for workers' compensation as provided by Saction 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will m■int■in 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 ■re: Insurance Company ____________________ _ Policy No. ____________ _ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit la iuued, I ah■II not employ any per■on in ■ny manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to aecure• worker■' compen■ation coverage is unlawful, and ■hall subject an employer to crlmkl8t penalties and civH fines up to ona hundred thousand doU■rs 1$100,000), in addition to the coat of compensation, damages H provided for In Section 3706 of the LabQ, code, lnter .. t and attorney'• f .. a. SIGNATURE _______________________________ DATE _________ _ '7 .. OWNER-BUILDER DECLARATION. , . ~.--:~~--:'..:_~<f.&,'t<~!:,.f~i8!Z"}~1'.:_/;":.· .•-:~,-s,?.,J.' _:;'_.~ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: [21 I, as owner of the property or my employns 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 Lew 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, howevar, the building or improvement la sold within one yur of completion, the owner-builder will hava the burden of proving that he did not build or improve for the pwpo■e of e■le). 0 I, ■s owner of the property, am exclusively contracting with licensed contractors to con■truct the project (Sec. 7044, au.ineu and Prof■salon■ Code: The Contractor's License Law does not apply to an ownar of property who builds or improves thereon, ■nd contract■ for ■uch project■ with contractor(■) licensed pursuant to the Contractor's Ucan■e Law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. 2. 3. I personally plan to provide the major labor and materials for construction of the proposed property improvement. (21 YES ONO ~have not) signed an application for• building permit for the proposed work. ~ontracted with the following person (firm) to provide the proposed construction (include name / addrus / phone number / contractors license number): 4. I plan to provide portions of the work, bU1 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, bu, I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): _____________ = ..... -=--~--------------------------,,'-----,,------------ ~•U"'J!'•t..lllfl'tJJ,p;,.l..~ ,._.., ---~~ •~L,.;; - I$ th,i a;,plie::'lt or future l:uilc:inv occupant r•quor•d to .oubmit • bu•ine"" plan, acutely n■z■rdous materials reg.atrat.on form or risk management and prevention program under Sections 26605, 26533 or 25534 of the Prasley-Tannar Hazardous Substance Account Act? 0 YES O NO Is the applicant or fU1ure building occupant required to obtain • permit from the ■ir pollution control district or air quality management district? O YES O NO Is the facility to be constructed within 1,000 feet of the ouier boundary of a school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A ANAL CERTIRCATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFRCE OF EMERGENCY SERVICES AND THE AIR POUUTION CONTROL DISTRICT. a :,CONSTRUCTION LENDING AGENCY ~.;r ,ti'~ .... ./~.... ~~~~;;-; -.~-.t.~,;. ' • 'm':zjf.~ < ·-• I hereby affirm that there is a construction lending agency for the performance of the work for which this permit la iuued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS _________________________ _ 19. 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 eccurate. 1 agree to comply with all City ordinances ■nd 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 auihorized by such permit is not commenced within 365 days from the date of such permit or if the building or work aU1horized by such permit is suspended or abandoned at any time after the work is commenced f a period of 1 80 days (Section 1 06 .4.4 Uniform Building Code). ~ / APPLICANT'S SIGNATURE -~'----L...L..:..L>...""-'-'-'L.l..L..J~"----..L.J:.U..(Ll.=-..~-1.1.::i..._____ DATE Q;I...LI -9 7 ~ I ~ WHITE: File YELLOW: Applicant PINK: Finance