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Home My WebLink About1045 LAGUNA DR; ; CB930846; Permit►• A A tll .w F R Ft, Rt?JUl ed , l 1 n f r f ) "71':' Q s. / ~-. 0001 0 cK ;p._q 'f r, p~,w ff : A A' 7 l l • t .,.,,.~ PPROVAL INS ~. ~=---DATE//. Z-312 CLEARANCE ____ _ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPUCATION PLAN CHECK NO. ~~ City oP'e'arlsbad Building Departaent 2075 Las Pal-• Dr., Corlsbad, CA 92009 (619) 438-1161 PLAN CK DEPOSIT _______ _ l l!ST. VAL VAIID. BY. __________ _ I. P£kMI I IYPE DATE A -Li Commerc1al LI New Bulldmg U lenant Improvement B -D Industrial □ New Building D Tenant Improvement C -□ Residential D Apartment □ Condo □ Single Family Dwelling □Addition/Alteration □ Duplex □ Demolition □ Relocation □ Mobile Home LI Electrical □ Plumbing □ Mechanical □ Pool □ Spa □ Retaining Wall □ Solar □ Other ____ _ 2. PROJF.Cr INFORMATION FOR OFFICE USE ONLY Ad~ 5 7-<A-l>r• Nearest toss Street ~ /4 Building or Smte No. nu o. ase o. □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PARCEL 1) £/-1 ()L I Tl O ,V EXJSTING USE PROP9SEP USE DESCRIPTION OF WORK SQ. IT. « J;g # OF STORIES (f) 3. WN IAC PN (II different from appJlcant) NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 4. XPPllCAN I NAME UWNIRACIOR □AGENI FORWNIRACIOR DOWNER DAGEN! FOR OWNER ADDRESS CITY STATE ZIP CODE DAY TELEPHONE s. !~?'l/4°;~'1ec}er ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 6.~~~771 <f7A-c/<A/UJ ADDRESS ~57 CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. i,f:50 S.3/ LICENSE CLASS l3 CITY BUSINESS LIC. # CITY STATE ZIP CODE DAY TELEPHONE 7. WOltkERS' WMPF.NSAIION STATE LIC. # Workers' Compensation Declaration: I hereby affirm that I have a cert1tlcate of consent to self-msure 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). INSURANCE COMPANY ~ POLICY NO. EXPIRATION DATE / ·-f -/ rt, 1cate o xempuon: cert1 t at m t e pe ormance o t e wor or w 1c t 1s permit 1s issue , s a not emp oy any person m any manner so as to become subject to the Workers' Compensation Laws of California. SIGNATURE DATE 8. OWNEk-B0nnrut DF.CLAkAfioN Owner-Bmlder Deciarauon: I hereby afhrm that I am exempt from the Contracto?s Lcense Law for the foliowmg reason: □ 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 Llcense 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 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 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 Llcense Law). □ 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 pennit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pennit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Llcense 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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]), SIGNATURE DATE COMPLEIE IRIS SECIION FOR NON-RESIDENIIAL B0IIDtNG PERMIIS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely ha1.ardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Ha1.ardous Substance Account Act? □YES □NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □YES □NO ls the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ YES □ NO IF ANY OF 11IB ANSWERS ARE YES, A FINAL CERTIFICATE OFoa:tlPANCY MAY NOT BE ISfilllIDAFfER.JIJLY I, 1989UNLESS TIIEAPPUCANT HAS MITT OR IS MEETING TIIE REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND 11IB AIR POI1.ll110N <DNTII.OL DISIRICf. 9. WNSIROCIION LENDMG AGENCY I hereby aihrm that there 1s a constructmn lending agency for the performance of the work for which this permit 1s issued (Sec 3097(1) CIV)I Code). LENDER'S NAME LENDER'S ADDRESS 10. APPUCXNI d!RIIPICAIIDN I cerufy that I have read the apphcat1on and state that the above mformat1on 1s correct. I 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 inspection purposes. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP IIARMIJ'.SS 11IB Cl'IY OF CARJSBAD AGAINST AU. LIABllJTIES, JUDGMENTS, CXlSTS AND EXPENSES WJilCH MAY IN ANY WAY AlilUIE AGAINST SAID Cl'IY IN <DNSEQUENCI! OF TILE GRANTING OF TIDS PERMIT. OSHA: An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every pennic 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 pennit or if the building or work authorized by such pennit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). APPLICANTS WNA~~ ~£1..-Z:--A, WHITE: File YEIJ.OW: Applicant DATE: j'-.).CJ -f.3 PINK: Finance