HomeMy WebLinkAbout1025 CARLSBAD VILLAGE DR; ; CB961201; Permit-7
Permit No: CB961201
Project No A9601695
Development No.
8277 06/27/96 0001 0^ 02
C-TOT 97-00
06/27/95 12.52 ' BUILDING P E R' „ !
Page 1 of 1
Job Address: 1025 CARLSBAD VILLAGE DR
Permit Type SIGN
Parcel No: 203-320-30rOO Lot* •
Valuation: 2 000
Occupancy Group- ' Reference* Construction Type- NEW
Description- *8 SF ILLUMINATED WALL SIGN ^^^ ISSUED -
' NIKKO JAPANESE CUISINE a Applied. 06/27/96^ Apr/Issue- 06/27/96
Appl/Ownr . FULLER SIGNS 619 ?57 --- Entered ^y RMA
311 VIA EL CENTRO
OCENASIDE CA 920,5^- "*"--.
*** Fees Required *** -'' ^ " ^
Fees •
Adjustments•
Total Fees-
Fee description
Building Permit
Plan Check
Enter "Y" for Renewal >ee ;
* SIGN TOTAL \
Tota-1 Credits:
*"*
Credits A A A
.00
00
,97,00
Ext fee Data
45.00
29.00
23 00 Y
97 00
CITY OF CARLSBAD
2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
City of Carlsbad Building Department
3075 Las Palaas Dr., Carlsbad, CA 92009 (619) 438-1161
1 PUUirnm
From List I (see back) give code of Permit-Type
For Residential Proiects Only From List 2 (see back) give
Code of Structure-Type
Net Loss/Gain of Dwelling Units
PUVN CHECK NO.
EST. VAL /A /5^}O
PLAN CK DEPOSIT
VALID. BY
DATE
tf 4~
t^.L W~ I I "! L.
2. PROJECT INFORMATION
Address
FOR OFFICE USE ONLY
Building or Suite No
Nearest Cross Street
UXJAL DESCRIPTION Lot No Subdivision Name/Number Unit No Phase No
CHUCK BULUW It1 yUBMl'ITELi
Q 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report Q 1 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROPOSED USE
DESCRIPTION OF WO
SQ FT
lL
STORIES # OF BEDROOMS # OF BATHROOMS
NAME (last name first)
CITY
(,ir ainerenc from appucantj
STATE
ADDRESS
ZIP CODE DAY TELEPHONE
4 APFLICAN1 Q CONTRA^ 1 OH
NAME (last name first)
CITY
UAOhNI t-OR UJNIRACIOH LlOWNtH
ADDRESS -3 ft tSf/}
U AUfcNT h'UK UWNtK
STATE ZIP CODE DAY TELEPHONE 7j" 7" /
5 PROPERTY OWNER
NAME (last name first)
STATE ZIP CODE DAY TELEPHONE
6 CONTRACTOR
NAME (last name first)
CITY &
ADDRESS
STATE
STATE LJC
ZIP CODE
LICENSE CLASS
DAY TELEPHONE
CITY BUSINESS UC
DESTGNEKNAME [last name firstj
CITY STATE ZIP CODE DAY TELEPHONE STATE LIC #
7 WORKERS COMPENSATK3N
Workers' Compensation Declaration I hereby affirm that I nave a certificate olconsent to self-Insure issued by the Director of Industrial
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)
//^-fe 7 J~£
INSURANCE COMPANY ,/T^X^T j^CSAJp POLICY NO EXPIRATION DATE C ~~/
Certicate of Exemption I certify tnat in the performance of the work for which this permit is issued, I shall not employ any person in any manner
so as 10 become subject to the Workers' Compensation Laws of California
SIGNATURE DATE
8, OWNER-BUILDER DECLARATION
Owner-0 wider Declaration i hereby atrirm tnat l am exempt trom the Contractors License Law tor the following reason
Q 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 )
D 1, 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)
D 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 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, 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 S by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars [SSOO])
SIGNATURE DATE
THIS SECTION I'OR NoN-Rl^lDENT!AL UU1L1MNC PERMITS ONLV
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or nsk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
D YES D NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
D YES O NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?n YES a NO
IF ANY OF THE ANSWERS ARE YES, A FIN AL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNl£SS THE APPLICANT
HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE ATfl POLLUTION CONTROL DISTRICT
9. CUffeTHUl'lTON LKNLUNtJ AUKN^V
I"n"ereby affirm that therels a Construction lending agency lor the performance of the work tor which this permit is issued (.Sec 3097(U "Civil CodeJ
LENDER'S NAME LENDER'S ADDRESS
10. APPLIUANT (JKK'ITJ-ICATION
I certity that I have read the application and state that the above information is correct r agree to comply with all 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 mspecuon
purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CTTY OF CARLSBAD AGAINST ALL UABOJTIES, 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 5'0" deep and demolition or construction of structures over 3 stones in height
Expiration Every permit 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 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^orjcis commenced for a period of 180 days (Secaon 303(d) Uniform Building Code)
APPLICANTS SIGNATU8£\ C""> \^ , __ - *• DATE
WHITE. Fi& YELLOW- Applicant PINK: Finance
City of Carlsbad
Building Department
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self-insure for
™ A workers' compensation as provided by section 3700 of the Labor Code, for
the performance of the work for which this permit is issued.
/7 N /I have and will maintain workers' compensation, as required by section 3700
[ — B/ of the Labor Code, for the performance of the work for which this permit is
V / issued. My workers' compensation insurance carrier and policy number are:
INSURANCE COMPANY POLICY NO.EXPIRATION DATE:
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED
DOLLARS ($100) OR LESS)
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
™ C, workers compensation laws of California.
Signature Date
Warning: Failure to secure workers' compensation coverage is unlawful, and shall be
subject an employer to criminal penalties and civil fines up to one hundred thousand
dollars ($100,000), in addition to the cost of compensation, damages as provided for
in Section 3706 of the Labor Code, Interest and attorney's fees.
March 3, 1995
2075 Las Palmas Dr • Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-O894
SD
COMPENSATION
NSURANCE
PO BOX 807, SAN FRANCISCO,CA 94101-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE 06-01-96
'POLICY'NUMBER-st 126956 - 96
CERTIFICATE EXPIRES 06-01-97
CITY OF CARLSBAD> -
ATTN: BUILDING DEPARTMENT
2075 LAS PALMAS DRIVE
CARLSBAD CA, 92009-^859
JOB ALL OPERATIONS
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated
This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer
We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policies listed herein Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the
policies described herein is subject to alf the terms, ^exclusions and conditions of such ^policies
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS' $1,000,000 00 PER.'QCCURRENCE
STANDARD EXCLUSION INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06/01/96 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY , J
EMPLOYER LEGAL NAME
FULLER SIGNS
311 VIA EL CENTRO
OCEANSIDE* CA 9205U
SENA, JAMES JOSEPH AND
SENA, PAULA
THIS DOCUMENT-HAS A -BLUE, PATTER NED BACKGROUND,
PRINTED. 05-23-96 PQ4(
SClF-102S5(*EV:2-95);