HomeMy WebLinkAbout2709 VIA FESTIVO; ; CB930035; Permitt ..
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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION , PI.AN CHECK NO.
City of Carlsbad Building Depart111ent
2075 Las Pal-s Dr., Carlsbad, CA 92009 (619) 438-1161
I. PERM1 I IYP£
A -□ Commercial LI New Building □ Tenant Improvement
B -0 Industrial □ New Building D Tenant Improvement
C -□ Residential D Apartment O Condo □ Single Family Dwelling □Addition/Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical ~lumbing
□ Mechanical O Pool O Spa O Retaining Wall O Solar □ Other ____ _
2. PRQJOCf OOORMATION FOR OFFICE USE ONLY
Address ..2~Cl?'~
Nearest Cross Street
LEGAL DESCRIPTION Lot No. Sut>d1V1s1on Name/Number Omt No. Phase No.
CHECK BEIDW IF s08Mli 1£0:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ l Addressed Envelope
ASSESSOR'S PARCEL f., f.. p 4: f?._
EXISTING USE PROPOSED USE
DESCRlPTION OF WORK
SQ. FT. # OF STORlES
3. WN IACI PERSON (Ii dulerenf from applicant)
NAME ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
4. Al'l'UCAN 1 □ CON I RAC IUR LI AGEN I FOR CON I RACIOR LI OWNER □AGENI FOR OWNER
NAME <_S~~'t. 45" 5'" ADDRESS
CITY STATE ZIP CODE
AD~t.'
ZIP CODE Y.2LJ~
ADDRESS
CITY STATE
STATE UC.#
ZIP CODE
LICENSE Cl.ASS
ADDRESS
DAY TELEPHONE
CITY BUSINESS LIC. #
DESIGNER NAME
CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. #
7. wrnuaoo,• WMP£NSAl1ON
Workers' Compensa11on Oeclarauon: I hereby alltrm ihat I have a ceruhcate of consent to sell-insure issued by ihe Director of lndustnal
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY POLICY NO. EXPIRATION DATE
Cerubcate of Exemption: I cerufy that in the performance of ihe work tor which this permit 1s issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. oWNER-BUIIDER DECCAitA'MoN
Owner-Builder Oeclarauon: I hereby alhrm that I am exempt lrom the Contractor's License Law tor 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 f'. 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.).
D 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:
(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, commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects t e appli t to a civil penal of not more than five hun dollars ($500)).
SIGN_......,,m.,_...,, 5?/." ~~~.V DATE /-/'-Y
Is the applicant or future building occupant requi to submit a business an, 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?
□ YES ONO
Is the applicant or future building occupant required co obtain a permit from the air pollution control district or air quality management district?
□ YES □ NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□ YES □ NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF cxx::uJ>ANCY MAY Nar BE IS.SUED AFTER JULY 1, 1989 UNU.SS nm APPUCANT
HAS MET OR IS MEETING nm REQUIREMENTS OF 11IE OFFICE OF EMERGENCY SERVICES AND nm AIR POLLUTION <DN1ROL DISTRICT.
9. 00NsiHOCl10N U!NDCNG AGENCY
I hereby all1rm that there 1s a construction lending agency for the perlormance of the work for which this permit 1s issued (Sec 3097(1) C1V1l Code).
LENDER'S NAME LENDER'S ADDRESS
to. APPLICANT CER'm'lcAliON
I cerufy that I have read the apphcauon and state that ihe above inlormauon 1s correct. I agree to comply with all City ordinances and State laws
relating co building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection
purposes. I ALSO AGREE 10 SAVE INDEMNIFY AND KEEP HARMLESS nm crIY OF CMU.SBAD AGAINST AIL UABIIJTIF.S, JUDGMENTS, CDSTS
AND EXPENSES Wl·DCI-I MAY IN ANY WAY Aa:RUE AGAINST SAID CTIY IN CX>NSEQUENCE OF THE GRANTING OF 11IlS 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 within 365 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 commenced for a period of 180 days (Section 303(d) Uniform Building Code).
DATE: /-/-)?3
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TIM! ARRIVE: _____ TIMI u:AVE: ____ _
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PDJC?TS
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DESCRIPTION
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;J];J COMMENTS