HomeMy WebLinkAbout2178 VISTA LA NISA; ; CB973844; PermitJ
12/19/97 11:25
Page 1 of 1
B U I L D I N G
Job Address: 2178 VISTA LA NISA
Permit Type: MISCELLANEOUS
P E R M I T
Suite:
Permit No: CB973844
Project No: A9704957
Development. No:
Parcel No: 255-262-20-00 Lot#: 2434 12/19/97 0001 01. vf 75.00
ISSUED
12/19/97
12/19/97
RMA
Valuation: o ConstructionCP-Ft;;m:
Occupancy Group: Reference#: CT88-03 Status:
Description: CONVERT GARAGE TO TEMPORARY Applied:
: SALES OFFICE-LA COSTA VILLAGE H-STND PAC Apr/Issue:
Appl/Ownr : STANDARD PACIFIC CORP
9335 CHESAPEAKE DR
SANDIEGO CA 92123
Fees Required
Fees:
***
Adjustments:
Total Fees:
Fee description
Miscellaneous Fee #1
* MISCELLANEOUS TOTAL
75.00
' . 00
75.00
>
Entered By:
619 292-2200
Fees Collected & Credits
Total Credits:
Total Paymen ts :
Balance Du e:
Units Fee/Unit
75.00
.00
.oo
75.00
Ext fee Data
75.00 PERMIT F
75.00
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-ll6l
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
1. PROJECT INFORMATION
217 V <;T.
20
Legal Description Lot No.
Description of Work I_ _ _
COrJvG:l"f" CAIU¼C.: ro -r,~:,-ip ~1_25
2. CONT ACT PERSON (If different from applicant)
Address Name
3. 0 Agent for Contractor
~
4. PROPERTY OWNER
~~ AG .AppL\CAt-JT
Name Address
Ii. CONTRACTOR • COMPANY NAME
lot Stories
CitY
FOR OFFICE USE ONLY ?9? 1,,
PLAN CHECK NO. ({7.JtJ1Lf
EST. VAL. _________ _
Plan Ck. Deposit ------,,,.-,t---
Phase No. Total II of units
Proposed Use
II of Bedrooms II of Bathrooms
State/Zip Telephone II Fax II
State/Zip Telephone I
(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, 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. A y violation of Section 7(?31 .5 by any applicant for a permit sub·ects the applicant to a civil penalty of not mora than five hundred dollars 1$50011.
r.i 'B 1F-1C.... G,!i. . <J .c=.c..>J I.ECO . 2. 3> , , --aoi?
State License II C:::: 2 4, 5 4-4--
e. WORKERS' COMPENSATION
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of tha following declaration■:
0 I have and will maintain a certificata of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for tha performance
of the work for which this permit is issued.
P'(. 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 carrier and policy number are:
Insurance Company APC?--idlP!NJ41dr:r J,J<i , ?<2:, Policy No. ~ ~ A Lt:[""" Expiration Date. _______ _
(THIS SECTION NEED NOT BE COMPLETED"IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] OR LESS)
0 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 as
to become subject to the Workers' Compensation Laws of California.
WARNING: Failure to ■ecure work ' compensation coverage la unlawful, and ahall aubject an employer to crimlnel panaltlea and civil fine• up to one hundred
ion to the cost of compenaation, damagea ea provided for in Section 3706 of the La , lnteraat and attorney·• feea.
DATE ~~f+-!j;~-:r,;;--:::;::::;:::;;:;,,,,,r:r.,,,,...,..,., .. ,.......,.....-,.,•·"' ..
I hereby affirm that I am exe 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 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 salel.
l'i2f I, as owner of the property, am exclusively contracting ,;.,ith licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
~actor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(sl licensed
pursuant to the Contractor's License Law>.
0 I am exempt under Section ______ Business and Professions Code for this reason:
1. I personally plan to provide the major labor and m~terials for construction of the proposed property improvement. 0 YES ONO
2. 1 (have/ have not) signed an application for a building permit for the proposed work.
3. 1 have contracted _with the following person (firm) 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)· •• _ ------------==----+---~,....----------------------+--r--------------
Is the applicant or future building occupant required t submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act7 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 distrlct7 0 YES O NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 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.
8. CONSTRUCTION LENDING A~CY • •.--...:;_ __ .
I herebv affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER's NAME ---'f-J_Q""-'rv'-'-~.=zc..-. _____ _
9. 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 accurate. I agree to comply with ell
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt 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, c·osTs ANO 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 shell expire by limitation end 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 co r a period of 1 BO days (Section 106.4.4 Uniform Buildin
0
gACToEde). /~ ~.}?
APPLICANT'S SIGNATURE L--~:;q.__.1..,,:::::.,:79,-,c.--------------------=-/J-~l:l
WHITE: File YELLOW: Applicant PINK: Finance