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Home My WebLink About2234 VISTA LA NISA; TP; CB973510; Permit,... l 4: L .. 1 ~ 1 ub H11<tE "",: J I L U <+ VISTH Ll4 NISH t. Tfd:'1L t l ., tif I-~ F,: I I s t f-' I ,cr,1t 11,p irr~l Ne,. 2 t l O I I : 07 00 L o t#: l (ll[r-;1Pcy r, 011p: R,:..t·e•ence#= lE (.l'lpt1 ,,: l"IF. f-WLR --·uLE: srr-1NDAR PACif'.' A ~ 1 1 w,,, wlR f U1 / l r 1 I J t 16/ Ill ,f, ,1AN 11ARC0S. LA. , t: er " v f Jr T er,~ o ErThl( L ron~ CITY OF CARLSBAD .. r rr 1 t • C, : 'i 1-r o l E-'" t i D : D J l I 11:" f \j ( 1514 11/17/91 OOOL 01 02 r, d ;;. L .C-PRHT 20.00 I ,, lJ 20 0 l ,) ' y 2 ') l 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 P~RMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 FOR OFFICE USE ONLY PLAN CHECK NO. :f] ~ ~$'le) EST. VAL. _________ _ Plan Ck. Deposit ________ _ Validated By __________ _ Date. _____________ _ Address (include Bldg/Suite I) ,l'}. J 'I ft Sf q Ji Al;~ C( Busines.s Name (at this address) Legal Desctiption Lot No. Subdivision Name/Number Unit No. Phase No. Total II of units Assessor's Parcel I Existing Use Proposed Use Name Address City State/Zip Telephone II Fax # '~f,~~T,~~~P~tfa~or7~~~@1lJ 1 ~CQl1~7:~~;;~-~,g1~;~ I.Pr Qc:1.:.~~~JT~-~~~;;:5-~?.~:3 ,2-~-y l'r Name Address City State/Zip Telephone # ~~~~&~~,~;;r;~~;r~~T~-™~r:.'.(l·~'.·~,·?~:,;;~-., • Name Address City State/Zip Telephone # ~.@NlBACmJid,COI/IP.AN~ ~~ii;/ ' (Sec. 7031.6 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its is.suance, 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 (Cti.ptar 9, co.mmending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemptioP? Any violation of ,9ction 7031.5 by a/ applicant for a permit j,.Ubjects the ap~ant to a civil penalty of not more than five hundred dollars )$500)). row<-r I/IS J t7 J. u' st-_sqr, fit/v-CdS 9:i.t1t? /./7l-!,-tf9t/ Name Address City State/Zip Telephone II State License I _J"'-'~-J_J"_f_l __ _ License Class __ c __ C_I ___ _ City Business License I _______ _ Designer Name Address City State/Zip Telephone State License I _________ _ ~:~•~.W0.8KERSt COMPENSA TION.J:1:: .• ~~Ji}•~·-~::~l,J;~~::::~·:.:~~:~::;:,~·.~~.l~ ..... :.: .. ~.:,!{;~:~:,:~ .:~2 ::!:t~~~:;L t!i 1:1~~~:~~i(l~J!i~1!:lt~.t,:t=tf\f1.i~t.~:~}!:~o1: ~~-::~~) .. · :, · :, • ... ~-,! :; .... ,I Workers' Compenaation Declaration: I hereby affirm under penalty of perjury_ one of the following declarations: 0 I ti.ve and will maintain• certificate of consent to aelf-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of th■ work for which this permit is issued. '6lf"' I have and will maintain workers' compensation, as required by Section 3700 of the Labor Coda, for the performance of the work ·for ·which this permit is issued. My worker's compensation insure e carrier and_policy number are: Insurance Company (),~ -< rt C.. ti Policy No. C (J Oo S7 II I) I Expiration Date. __ /_-_1_~_9_?'_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I ahall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to aecure•workera' com anaation coverega ia unlawful, and ahall aubject an employer to crlmlnal pen■ltlaa and civil finaa up to one hundred thounnd doUara 000), In edd!Ji.Jn,,,_t=--:en,,c-a.o~•t~o-f companaation, demagea aa provided for In Section 3706 of the Labqr coda, lnter11t ~d attomey'a fa-■. SIGNATURE ~, DATE / / ~ / 7 -y'7 t'l,.··:l~:.0;wNER•BUILDER DECLARATION•,,•.;~\·~· .· -~. ;,~-: :·: -.::_·,·~-..:-~ ~-_;~i;:~~t;,~'2i1t;~-~mt,_;;~~\j:_~ .. ~~~:_i~gf£~J)J_F.~1=;~~~V::~~'.;-::~::~:\;r:.' ./:::;j_~-- 1 hereby attirm that I am 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 ye■r of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpoae of aale)._ 0 • I, 11-owner of the property, am exclualvely contracting with licensed contractors to construct the project (Sec. 7044, Buainesa and Professions Coda: The Contractor's License Law does not apply to an owner of property who builda or improves thereon, and contract• for auch project• with contractor(■) licenaad purauant to the Contractor's Licenae Law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 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 notl 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 numberl: 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 numberl: ______________________________________________ _ 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 / typa of work): _____________________________________________________ _ PROPERTY OWNER SIGNATURE _____________________ _ DATE _________ _ tcoMPJ£JUH1SiSECTlOtt,F.QR:N.ON:M$/JJ.ENTJAL;BUII.P.ING;P,£M1ll$.J)NI.Y~<l.:;[;ip1'i:&f.Ji'J~!l;~•~Jl(JtJJ~~:';'.~!J0tfi,:J~~~t~~-'., . 13 th:, a;:pllc;nt or futura builC:inw occupant requir1:1d ,o ,u!Jmit • bu~inen 1,1lan, acutely hazardous materials registration form or risk management and prevention prog,am under Sections 25505, 25533 or 25634 of the Presley-TaMer Hazardous 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? O YES O NO Is the facility to be constructed within 1,000 fHt 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 POUUTION CONTROL DISTRICT. li~mCO.~CTIO.N LENO_ING'~GENCY·t~''F-:'~~m"'Z~~"J..;~,~f],'!:7;~;'~~,!~"ffil.:rJ:;::_;::'.~'.:i:'::;,r,;A~~~;!l'~~~~~[~~.W-~?;~;;j:,r;-~,~:':.:··.•·., I hereby affirm that there is a construction lending agency for the performance of the work for which this permit ia issued (Sec. 30971il Civil Codel. LENDER'S NAME ______________ _ I ~ertify 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 ~II City ordinances and 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 s•o· deep and demolition or construction of structures over 3 stories in height. EXPIRATIO~: Every permit iuu_ed by the Building Offi~ial under the provisions of this Code shall expire by limitation and become null and void if the building or work authonzed by such permit 1s not commenced w1thm 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~ J'7'manced fo~eri of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE _ __;~==--__;:___-;;-..!....::..._, ./:;~J~:'~----------DATE / /-/ 7 ~ 9 7 WHITE: File 'lELI OW· Annlif"'ont DU1.II(, c; ... ___ ...