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Home My WebLink About2590 EL CAMINO REAL; ; CBC2022-0411; Permit                                                              ( City of Carlstiad COMMERCIAL BUILDING PERMIT APPLICATION B-2 Plan Check _______ _ Est. Value PC Deposit Date Suite: ___ .APN: \l.ol · O~g-1-4 Lot #: ____ Year Built: ________ _ Year Built: ___ Occupancy: ___ Construction Type: __ Fire sprlnklers~ESQNO A/C:~YESQNo BRIEF DESCRIPTION OF WORK~\ ukt kir GVi}' Rtj?I ~~ of ~ Tot,) Al C britl:. D Addition/New: ___________ New SF and Use, _________ New SF and Use ______ SF Deck, SF Patio Cover, SF Other (Specify) ___ _ OTenant Improvement: ____ SF, Existing Use: ______ Proposed Use: _____ _ ____ SF, Existing Use: Proposed Use: _____ _ D Pool/Spa: ____ .SF Additional Gas or Electrical Features? ___________ _ D Solar: ___ KW, ___ Modules, Mounted: O Roof O Ground D Reroof: ________________________________ _ ~ Plumbing/Mechanical/Electrical \.A.e,Ghct \'U c..p.. \ -~---~~----------------0 m her: ________________________________ _ APPLICANT (PR.IMARY CONTACT) Name:~\J\o\ ~Mu Address· \1C\ ~S ~ \iii;, A.I/~ City-lc'Att U s1 noce., State: e..A Zip: 925 3 d Phone· 9S-I -7"3 (q -7980 Email· S\/geoc±@T N -Strvu . .e..s.CO).\ PROPERTY OWNER Name: Vt\rde.tlt~ Rea I t>:trttf Ito\ cl 1b5s:, Address: po ~<lX, '5Ci/L~9 City:.Sii,..n_ AhfQp, D State:n....._zip: J~zsq Phone:. _________________ _ Email: _________________ _ DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name_·---------------Business Name:Tq;> l\lotc b i'lvrib1h~jtl'&t:f:1Q& t Bl!: Cqri.dth~n,') Address· Address: \7C\35 CJ.1\\\e..c (\Vt« ' City:, _______ ,State: ___ Zip: ____ City: \_aj;.-e ~s,rvn, State:Ct\ Zip: 91530 Phone: _______________ Phone: 9 S1, 1':slp -l q60 Email: Email: S 9p:s?o ct@, 1 N-S'tr v\S&,S • ~ Architect State License: CSLB license#: lp()O\la \::, Class: _______ _ Carlsbad Business License# (Required): C1.0 C.?:,(a £:> APPLICANT CERT/FICA TION: I certify that I have read the application and state that the above information is correct and that the information on the plans isaccurate. lagreetocomply with all Ci rdinance a State laws relatins to buildins construction. NAME (PRINT): ~d Ca~ 1635 raraday Ave Carlsbad. CA 97008 Email: Building@carlsbadca.gov REV. 07121 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER. IF THE PERSON SIGNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: I herebyaffirmunderpenaltyof perjurythatl am licensed under provisions of Chapter 9 ( commencing with Section 7000) of Division] of lhe Business and Professions Code, and my license is in full force and effect. I also of firm under penalty of perjury one of the following declarations(CHOOSE ONE}: D1 have ,:md will maintai11 a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the p"rformance of the work which this permit Is issued. PolicyNo .. ____________ _ -OR· ~I have and will maintain worker's comp.,,,sation, as required by Section 3700 of the Labor Code, fqr the performance of the work for which this permit is issued. My ~orkers' fO~ensalion insurance carrier and policy number are: lnsuranceCompanv Name: I h~vrei nee., <'..,011\,{)IJ\~ of tbe, W-f>'t Polley No. i,J) \> 7O\!)':::\]01..0:<) Expiration Date: ~ll?,/'1,0?:.:~ ______ _ ~ v~ Ocertiflcate of E~emption: 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 secure workers compensation coverage Is unlawful and shall subject an employer to crlmlnal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees, CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 {i) Civil Code). Lender's Name:, ____________________ Lender's Address: CONTRACTOR CERT/FICA TION: I certify that I have read the application and state that the above information iscorrecl and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT): UG\LJlcl ~(..\-.QK SIGNATUREU::4'.J~~~:.,__ __ DATE: lt(t<t1/2 ~ Note: If the person signing above is an authorized agent for the contractor provide a left!!· of -OR - (OPTION B); OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: n I, as owner of the property or my employees with waees as their sole compens~tion, will do the work dnd the struc.ure is not intended or offered for sale (Sec. ~. Business and Professions Code: The Contractor's License Law does not apply to an owner of prop,,rty who builds or improves thereon, and who does such work himself or through his own employees, provideci that such improvements arc not intended or offered for sale. If, however, the building or improvement i< 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 ,ale). -OR- 01, as owner of the propPrty, am ~elusively contracting with licensed contractors to construct the project (Sec. 7044, Business and_ Professions Cod~: The Contractor's License Law does not apply to an owner of property who builds or improves thPreon, and contracts for such proiects with contractor(s) hcensed pursuant to the Contractor's License Law). -OR-01 am ~empt und"r Business and Professions Code Division 3, Chapter 9, Artide 3 for this reason: AND, D FORM 8-61 "Owner Builder Acknowledgement and Verification Form" Is required for any permit issued to a property owner. By my sisnature below I acknowledge that, exceµt for my personal residence in which I must havP resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a s:ructure that I have bui t as an owner-liu•lder If It has not been constructed in its entirety by lic.,n<Pd contractors./ understand that a copy of the upp(icable (aw, Section 7044 of the Business and Professions Code, is available upon request when this app(icatio11 is submitted orat the following Web site: http:/Jwww.leginfo.ca.gov/calaw .html. OWNER CERT/FICA T/ON: I certify that I have read the applicatfonand scate that the above information is correct and that the information on the plans is accurate. /agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT): _________ _ SIGN: _________ DATE: _____ _ Note: If the person signing above is an authorized agent for the property owner include form B-62 signed by property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 2 REV. 07/21                                       