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Home My WebLink About2706 VIA JUANITA; ; CB971235; PermitFOR OFFICE USE ONLY PER~T ~PPLICATION PLAN CHECK NO. q7 I 1-] J CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 1. PRQjECT INFORMATION EST. VAL. _________ _ Plan Ck. Deposit,..,,_ ______ _ Validated By __ _..,f e& .... .=...,......--r----- Date. __ ____,.y-+-4--'pc.;;;.y"-+(..lq.q,.,........,7,___ Address (include Bldg/Suite #I Business Name (at this address) Z7~1P t/uq Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description of J"-0.!k (7.l?S ~1,ve.. .,..,-'r1- '2. CONTACT PERSON llf dlffwent from appili:antl SO. FT. #of Stories .......... # of Bedrooms # of Bathrooms Name Address City State/Zip Telephone# Fax# i:3 .... APPLICANT '«;!}orttraotor ~o Agent'for Conuacior' Downer~□ Ageni ior Owner -.---,._ ~' 1'J, Name Address City .•. PROPERTY cj\,'yjtJEJI • :,---, ...... "~'"" ,. • "' '-·'T' ................. , r• ,,--... r·~, ~ .,.. •.• -• ,, --::SV £"rtr! IJ1, rrl ~ ~ o ,tJ • • .. • • ·_s=--~ .e. .... Name ' Address City State/Zip Telephone# '&. CONTRACTOR'! COMPANY NAME~ w.--~ .~ ..... ,.~ _ .. ,~-.r • ., ............ ,,,...,t l.u"<_. X J f-'/ (Sec. 7031 .6 Business ■nd Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its IHuance, also requires the applicant for such permit to file • 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 exemption. Any violation of Section 7031.~ by any applicaj}t for a permit subjects the applicant to a civil penalty of not more than five hundred doll~rs ($6001). ff.¢:;-1'" ·:5)¥-v1 e-e U> 7,-?{,o El .#xhl ?dA:h·t~ 7,lt:J -4.?,J?-J?Si Name 1 • Address City State/Zip Telephone # State License # 4--1: '.2 2-Z Z., License Class C,, -2-() -C.-5 t, City Business License # 7/ 2.$'a o Designer Name Address City State/Zip Telephone State License # _________ _ 8. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain I 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. O I have and will maintain 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 ca"ier and policy number are: Insurance Company_____________________ Policy No._____________ Expiration Date _______ _ (THl~TION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) Ill"" 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 ■s to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage la unlawful, 1111d shall subject an employer to criminal penaltle1 1111d civil flnH up to one hundred thou11nd doll1r1 ($100,000), In addition to the co of compen11tlon, damage• H p,ovlcled for In Section 3708 of the Labor code, lnterHt and attorney'• fN1. SIGNATURE: ___ _.l:1~~~===---4~:..12:-------------DATE ,5/f~/f' 7 7. OWNER-BUILDER DECLA 7• ' ~ ~ I hereby affirm that I am exempt from the Contractor's License law for the following reason: 0 I, es 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 end Professions Code: The Contractor's License Lew does not apply to en 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, as owner of the property, am exclusively contrecting with licensed contractors to construct the project (Sec. 7044, Business end Professions Code: The Contractor's License Law does not apply to en owner of property who builds or improves thereon, end contracts for such projects with contrector(sl licensed pursuant to the Contractor's License Lew). 0 I am exempt under Section ______ Business end Professions Code for this reeson: 1. I personally plan to provide the mejor labor and materials for construction of the proposed property Improvement. 0 YES ONO 2. I (have/ have not) signed an application for I building permit for the proposed work. 3. I have contracted with the following person (firml 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 THIS SECTION FOR NON-RESIDENttAi. llu1LbiN0 PERMITli'ONL y.\1j,Tl'i'f:';"f',1'•ll· • .,, ='"'••""':; .-' T"' ,. . ··'"" ~-~-1-:-r-· 7" Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 26605. 25533 or 26534 of the Presley-Tenner Hnardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a 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. la. -CONSTRUCTiONl.ENDING AGENCY"'";"':----·~ .":.---;::-1-~?~"":, -·~~,Jr ,. _ .. ~-:::·--:-~ ... _, ~. ·." -,-_,..._ .. I I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS. _______________________ _ rg: •"APPLICANT CERTiFICATibN-:-'1rft;-lf•rr,:.·,~f.!~:"~rr~~;JT:~l.."I'~~ >.~-:::.;,;,-i-; •'· --~·-~-1;~·0·;: :r ;.:::z:c:-:-.-.rr--~;·-.-·: ··.-: ?' .. I certify that I have re■d 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 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 6'0" 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 shell expire by limitation and become null and void If the building or work authorized by such permit Is not commenced within 366 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 w rk Is commenced f period of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE -3/.c..+1/_,_/'-"~c.,t-/-.,L.S"'-7"7"----- UNSCHEDULED BUll.DING INSPECTION J DATE ::,,('/~ 2 INSPECTO~l / ~ TIME ARRIVE: -----TIME ----- CODE DESCRIPTION J-3