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Home My WebLink About2707 VIA ROBERTO; ; CB931196; PermitPERMIT APPLICATION ~ ~ Pl.AN CHECK NO. 'f ~ -\. \ C\. 6 l!ity of carlsbad Building Departaent 2075 Las Pal-s Dr., tarlsbad, CA 92009 (619) 438-1161 EST.VAL,__ __________ _ PLAN CK DEPOSIT QJ)c UV VAUD.BY ___________ _ I. PIDtMI I IYPE DATE ______________ _ A -U Commercial □ New Building U Tenant Improvement B -D Industrial □ New Building D Tenant Improvement C -□ Residential D Apartment □ Condo □ Single Family Dwelling □Addition/Alteration □ Duplex □ Demolition D Relocation □ Mobile Home □ Electrical □ Plumbing □ Mechanical D Pool □ Spa □ Retaining Wall □ Solar □ Other ____ _ 2. PRClJECf INFORMATION FOR OFFICE USE ONLY Address ;;J. Nearest Cross Str::Z O I VIA Building or Suite No. Ro t3e r,o LEGAL bEStfilp'l loN Cot No. Suix11vis1on Name/Number Unit No. Phase No. CAECR llEIDW IF s0BMI 11 Eb: □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK # OF STORIES 6-A L-e.A l NAME /<a,'<; ADDRESS NAME m I /<. e Po c,u A U c_ CITY ~ ,A-)... s t3A STATE A ZIP CODE DAY TELEPHONE '-13 c/-{, <o .s't ·NAME'Jhe.o (e r <::,To,.J ADDRESs~o$T !?,,u';> ~ftJ07 -3C09C.A cITY~~-er bAm ~-crlA-~~E DAY TELEPHONE >U IA- 6. CDN'I I R ' NAME OW µt.,.(L-ADDRESS CITY STATE STATE UC.# ZIP CODE LICENSE CIASS ADDRESS DAY TELEPHONE CITY BUSINESS UC. # DESIGNER NAME CITY STATE ZIP CODE DAY TELEPHONE STATE UC. # 1. Wultk£1ts' wMPENSX:l1ON Workers' Compensation Oedarauon: I hereby alhrm that I have a ceruhcate ol consent to sell-insure issued by the 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 Cemhcate of Exemption: I ceruly ihat in the perlormance ol the work for which ih1s penmt 1s issued, I shall not employ any person in any manner so as co become subject to the Workers' Compensation Laws of California. SIGNATIJRE DATE 8. oWNER-B0lIDER OEUARA'noN □ □ owner-Builder Declaration: I hereby afhnn ihat I am exempt from ihe Contractor's License Law for 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 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.). 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 pennit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pennit 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 pennit subjects the applicant to civil-j>enalty of not more than five hundred dollars ($500]). SIGNA1URE L DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ YES □ NO Is the applicant or future building occupant required to obtain a pennit from the air pollution control district or air quality management district? a YES a NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ YES □ NO IP ANY OP 11-IE ANSWERS ARE YES, A FINAL CERID1CATE OF ocx;upANCY MAY Nar BE ISSUED AFfER JULY 1, 1989 UNLESS nm APPUCANT HAS M1IT OR IS MEETING TIIE Rf.QUIREMENTS OP TIIE OFFICE OF EMERGENCY SERVICES AND nm AIR POlllTllON WNTROL DISI'RlCT. 9. UJNSIR0CI1ON cmmmc ACF.Nev I hereby ali1nn that there 1s a construcuon lending agency tor the pcrlormance of the work for which this pennll 1s issued (Sec 3097(1) Civil Code). LENDER'S NAME LENDER'S ADDRESS lo. APPUcANT CEit'm1cA11oN I certify that I have read ihe apphcauon and state that the a&ive inlormauon 1s correct. I agree to comply w1tn all City ordinances ana :,tate laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. 1 ALSO AGREE TO SAVE INDEMNIFY AND KEEP IWlMI..F.SS TIIE C11Y OF CARISBAD AGAINST ALL UABIIJTIF.S, JUDGMENTS, CDSTS AND EXPENSF.S WIDCII MAY IN ANY WAY A.CX:RUE AGAINST SAID Cl1Y IN a>NSF.QUENCE OF 11-IE GRANTING OF nos PERMIT. OSHA: An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every pennit 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 pennit is not commenced within 365 days from the date of such pennit or if the building or work authorized by such pennil is suspended or abandoned at any lime after the work is commenced for a period of 180 days (Section 303(d) Unifonn Building Code). APPLICANT'S SIG~ '272-~ YID.LOW: Applicant PINK: Finance DATE: ______ _ ?L\11CK d ------ :-::iz ,\..!l . .tl.IVE : ______ T I11.E LEAVE: _____ _ P~"1IT!3 G/l~/09 DESCRIPTI OU blkS g~p It, rz_ l .,. ' - ACT CClUU:HTS f-rr-! A-L