HomeMy WebLinkAbout102 ACACIA AVE; ; CB990266; Permit01120/1999 ~
City of Carlsbad
Miscellaneous Permit Permit No:CB990266
Building Inspection Request Line (760) 438-3101
Job Address:
Permit Type: Parcel No:
Valuation:
Reference #:
Project Title:
Applicant:
VIOLA TED
102 ACACIA AV CBAD
MlSC Subtype: OTHER Status: ISSUED
2042331000 Lot #: 0 Applied: 01/20/1999
Plan Approved: 01/20/1999
Issued: 01/20/1999
$0.00 Entered By: MDP
DEMO HSE TO BUILD NEW CB99026 Inspect Area:
FINAL APPROVAL I Inspector: ,kB Date: I* 32 99 Clearance: I
'PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carjsbad CA 92009
(760) 438-1161
(pLAN CHECK NO.&?&@'
FOR OFFICE USE ONLY
IData .
' EST. VAL.
Plan Ck. Deposit
Validated BY
,Name Addnu uo,
state Ucitue t UWN. C1.U citv Burhn UCaMe 8
Designer Noms Addre , CiW smemp , Telephone
stm.mp Telephone X
.I
of tha Work lot Which this permit is issued.
I have and will miintain a canificate of consent to self-i- (or workers' comP0nsatim?M pr0vid.d by Saction 3700 of ths Labor Code, for the pwformanca
issued. My worker's mmpmotim inaIrnnc8 Umu end poliw nmbw am:
0 I have and will maintak Workem' compenmtion. ob required by Section 37M) 01 the Lab Code. for tim parfmanc. of the work for which this Wrmit is
Insurance Company mri NO. Expiration Date
ITHIS SECTION NEED NOT BE COMPLETED IF THE PEWIT IS FOR ONE HUNDRED DOUARS 1*1001 OR LESS1
to bffiome subject to the Wwken' Compensation Laws 4 Califomla.
0 CERTIFICATE OF EXEMPTION I canih, that in tha psrfmnancs of the work lor which thin Wmit is i-d, I ahdl not employ any person in my manner M) es
WARNINQ: F.i~to~rrol(r.R'~mp*unioncW.nO.l.unMul,nd.h.lla~Mm~mshrmpnMundEMIRmupm~hudnd
thDland rkilan l~lOO,OOO), in addltim lo tho -st 01 compnutlm. d8m.go u porl*d tar h Suth 3700 Ot th. Labw cod., ht-t and sttonuy'a k.
SIGNATURE
I hereby aflirm that I am exempt from the Comrmor's kmre Law for tha following muon:
Is the apelioam or futum building occupant mquind m nhmit a bwhu plan, .eufblv hazardous Mt.ri.ll m~iamion form or risk mbnagsmam and prevmtian
program under Sections 25606, 26633 or 25634 of tho Prasiey-Tsnnnr Hazardous Sub.unca Account A& 0~- NO. '
is the applicant or future buildlnp occupem required to obtain a permit from tim air pollufion control difflct or air qualnv maMgmam district? 0 YES 0 NO
Is th. l8cility to be constructed within 1 ,ooO faat, of the outer boundary of a school site? 0 YES 0. NO
"
IF ANI OF THE ~NSWERS, ARE YES, A FINAL cmnmm OF occu~~wc~ MAY NOT IIE mum UNLESS XHE APPUCANT ws MET om MEETINQ THE
RERUIREMENTS OF THE OWCE OF EMERQENCY SERVICES AND THE AIR wuunowcomnoL DISTRICT.
i hereby aflirm that there ia a coneunion lending agency for ma perlormanso of the work lor Which this permit is issued ISec. 3097Ii) Civil Codal.
i cartifv that I have reed the application and ateta that the above informetian ig correct and that the information on the Pimu is.accurate. I agree to comDiv with ail
. ~ .. ~~ ~ _". ~___.".I ~
Citv ordinances and State laws relating to buiidiw construction. i hareby authorize npnrwnatives of the CW of Cnrlrbad to entar upon tha above'msmioned
PrOPenv for inspection Purposas. I ALSO AQREE TO SAVE, INDEMNIFY AND KW HARMLESS THE CITY OF CARISBAD AQAINST AU UABILITIES.
JUDGMENTS. COSTS AND EXMNSES WHICH MAY IN ANY WAY ACCRUE AQAINST SAID ClTy IN,CONSEOUENCE OF THE QRANTINQ OF THIS PERMIT.
OSHA: An OSHA pwmit is requlred for ex6avationr over 5'0- dwp and demolition 01 constructiori 01 structures ovw.3 stories in height.
EXPIRATION Evnry pmh hued by the'Bullding Official dl the PmViaiDlu 4 Ihia Code ahell mxpile by iimitmtion ind becoma null and void if the building or
work authorized,by such permit ia not c menced wlthln 385 deya from tha data of such pamil or if the bviidinp or work aVthOri2ed by such permit is auspmded
0: abandonad at any time afler $epo)@c~mmenc.d forfidgof 180 day. ISection 108.4.4 Uniform Building Code).
AFPLICANT'S SIGNATURE "a ''4 DATE
WHITE File YELLOW Appliam PINK finance
ELECTRIC AND GAS METER CLEARANCE
INTER-DEPARTMENT
S.E.O. Service Equipment Only YES -
NO =”/
Reason, If Denied:
ELECTRIC METER:
COMMERCIAL
RESIDENCE
NEW SERVICE
RELOCATE
T.S.P.B.
TEMP. P/P
UP-GRADE
TEST METER
IRR. PEDESTAL
GAS METER:
COMMERCIAL
RESIDENCE
TEST METER
YES - /
YES NO IIz/
Building Inspector Signature Date Time
Called In By Time
NOTICE OF S~RVI~E D~SC~N~NUANCE
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ALLs
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