HomeMy WebLinkAbout1040 MAGNOLIA AVE; ; CB931222; Permit.PERMIT APPLICATION ~ V
City of Carlsbad Building Department EST. VAL-______________ _ 2075 Las Palmas Dr., Carlsbad, CA 92009 1,1,i 438-1161
1.
A
' C
PERMIT TYPE D COMMERCIAL
0 I NDUSTR l Al
0 RESIDEHTJAL O APARTMENT
□DUPLE)( □DEMOLITION
□MECHANICAL □POOL
TENANT IMPROVEMENT
□TENANT IMPROVEMENT
QC0ND0 □SINGLE FAMILY DWELLING OADOJTJ0H/ALTERATJ0N
□RELOCATION □MOBILE HOME □ELECTRICAL ~BING
□SPA □RETAINING WALL □SOLAR □OTHER
PLAN CK DEPOSIT ____________ _
VALID. BY ______________ _
DATE _______________ _
2. PROJECT INFORMATION PLAN CHECK No. F
AddresslO'-f.-0 f\t\ACot---JL)LlA A\)£ Building or Suite No.
Nearest Cross Streets l>t-DE121A )J
LEGAL DESCRIPTION Lot No. SulxHvision Name/NU'l'ber Unit No. Phase No.
Envelo
PROPOSED USE
BLDG. S0. fTG. # OF STORIES
3. CONTACT PERSON
'""0 WS~A;,~" IIMiJ ,~ t tJ
~10 L{)(\1\81)...)6 STATE
ADDRESS
ZIP CODE
C/3:8 112A oc PLA<:€
92-1 7-b OAY TELEPHONr ft9) '::Jbb -rz.3 tf-
SIGNA4 J2Aci-\cEL IVIEL LO ....1
4. APPLICANT ~NTRACTOR
NAME i\11 A-1 O p LU M Bl µ b 0 AGENT FOR CONTRACTOR OmmER 0 AGENT FOR O.INER
ADORESS
CITY 5A,......i DIE:6O STATE c.A ZIP COOE
5. PROPERTY OWNER
NAME l-\A12-D-Y <"Hl2-lS7l\114,-.\
OWNER
A0ORESS 1040 vvt Abl-.)&:f~E
ZIP CODE °!200&
□TENANT
CITY ,-..., Oltc:66 STATE DAY TELEPHONE
6. CONTRACTOR
NAME 1"1P,.l0 PU>MB! µ6 ADOREssf~,33,, 112-ADt:: PL-
7.
8.
CITY::'.:,P,;,0 DIE:6-0 STATE Ct,., ZIP COOE 92-( 20 DAY TELEPHON.c~ 19) 5bb· 1231
~4~3,00 LICENSE CLASS C-3~ CITY BUSINESS LIC, #
TITLE j'.\-6£,-..>'I DATE 1°-91 DESIGNER NAME ADDRESS
1'J / ~ELIC,# Cl TY STATE ZIP CODE DAY TELEPHONE
WORKERS' COMPENSATION
Workers• Compensation Declaration: hereby affirm that have a certificate of consent to sett-insure issued by the Director of Industrial Relations,
or a certificate of Workers• Compensation Insurance by an aii,,itted 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).
1Nsu,m, COMPANY .5rA'TE Fu u t:> POLICY ,o. 791700-9..3 """mo, o,TP l-9 <..f.
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 become subject to the Workers' Compensation Laws of California.
DATE
OWNER-BUILDER DECLARATION Owner-Builder Declaration: ! hereby affirm that I am exempt from the Contractor's License Lai. for the folloi.ing reason:
D I as oi.ner of the property or my efll)loyees i.ith i.ages as their sole compensation, i.ill do the i.ork 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 i.ho builds or improves thereon,, and who
does such work himself or through his oi.n employees, provided that such improvements are not intended or offered for sale. If, hoi.ever, the building
or improvement is sold i.ithin one year of c~letion, the owner-builder will have the burden of proving that he did not build or improve for the purpose
of sale.).
0 I, 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 Lai. does not apply to an owner of property who l:uilds or improves thereon, and contracts for such projects i.ith contractor(s)
licensed pursuant to the Contractor's License Lai.).
0 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, coomencing 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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not
more than five hundred dollars [$500)).
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON·RESIDENTJAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to 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 Act?
□YES 0NO
Is the applicant or future building occupant required to obtain II permit from the air pollution control district or air quality management district?
□YES 0NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site'
DYES
If ANY Of THE ANSWERS ARE YES, A FINAL CERTIFICATE Of OCQJPANCY MAT NOT Bf ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS PET OR IS N::ETING THE REQUIREMENTS
Of THE OFFICE Of EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
9. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of the work for i.hich this permit is issued (Sec 3097(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPLICANT'S SIGNATURE I certify that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State lai.s relating
to building construction. l 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, JLOQIENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING Of THIS PERMIT.
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 i.ork authorized by such permit is not conmenced within 180 days from the date of such permit or if the bu1ld1ng or i.ork ,1uthorized by such permit is suspended
or abandoned at any time after the i.ork is COIIJ!1('nced for a period of 180 days (Section 303(d) Uniform Building Code).
APPLICANT'S SIGNAT □ O.INER ~NTRACTOR □ BY PHONE APPROVED
:/)-Ac •l·Hc.L--MELLC> 0 012--CC, ..._JT ~'
BY: ______ _
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