HomeMy WebLinkAbout1050 PALM AVE; ; CB891446; PermitJob Address: 1050 PALM AV
Permit Type: RAD
Citv of Carlsbad
RESIDENTAL ADD/ALT (UNDR
Status:
Applied:
Permit No: CB891446
EXPIRED
9/27/1989
Parcel No: 2051900300 Lot#: Approved:
Reference No: Issued:
PC#: Inspect Area:
Project Title: ADD BATH ENLARGE BEDROOM 98 SF
Applicant:
DERRICK, CHARLES
1050 PALM AV
CARLSBAD, CA
619 434-3627
00136104885
00136104885
Plan Check
Plan Check
Fees: $59.00 Additional Fees:
Owner:
DERRICK CHARLES A JR&MELBA H
$59.00
$59.00
$0.00 Total Fees: $59.00 Balance: $0.00
PERMIT APPLICATION ~ \1;I:I
City of Carlsbad Building Department
2075 Las Palmas Or., Carlsbad, CA 92009 (619) 438-1161
1.
A
PERMIT TYPE
COMMERCIAL TENANT IMPROVEMENT
VALID. BY_--;~7 _,::.__-r---:::-----
DATE -----J'+-~~l-.h~..::::;1-----
8 0 INDUSTRIAL □NEIi □TENANT IMPROVEMENT
C • ~RESIDENTIAL □APARTMENT □CONDO □SI NGLE FAMILY DI/ELLING >-ADDIT ION/ALTERATION 0155 09/27/89 0001 01
C-PRMT []DUPLEX □DEMOLITION □RELOCATION □MOBILE HOME □ELECTRIC:,\: □PLUMBING 02
59-00
□MECHANI CAL □POOL □SPA □RETAINING I/ALL □SOLAR □OTHER, _____ _
2. PROJECT INFORMATION PLAN CHECK No. F Aioesv 'PA I.M f} () t5
Nearest Cross Streets p 1 D p .... c. ()
LEGAL DESCRIPTION Lot No. Subdivision Name/NUlt>er Unit No. Phase No.
3 .
4.
6.
7.
8.
SLOG. SD. FTG. # OF STOR IES
CONTACT PERSON /
NAME Ch~ Le-~ u€12(2.1 ere::. ADDRESS
ZIP COOE C~f $/90
SIGNATURE ,. ~
CITY
CITY
CONTRACTOR
NAME ¢tv,t;<..-'7'Z. "+3t, IL,,;? e-fi..
Cl TY
0 AGENT FOR CONTRACTOR
ADDRESS
STATE (J;;z.
OIINER
STATE (",4
STATE
ZIP COOE
ADDRESS
ZIP CODE
ADDRESS
ZIP CODE
1 Addressed Envelo
@allNER
STATE LJC. #, ____ _ LICENSE CLASS _____ _
SIGNATURE
DES I GNER NAME
Cl TY STATE
TITLE
ADDRESS
ZIP CODE
PROPOSED USE
DAY TELEPHONE
0 AGENT FOR OIINER
DAY TELEPHONE
□LESSEE □TENANT
DAY TELEPHONE
DAY TELEPHONE
CITY BUSINESS LIC. #
DATE
DAY TELEPHONE STATE LIC. #
WORKERS' COMPENSATION Workers• COl'T-.=,ensation Declaration: hereby affirm that I have a certif icate of consent to sclf·insure issued by the Director of Industrial Relat1ons,
or a certificate of Workers• Co,rpensation Insurance by an actnitted insurer, or an exact copy or duplicate thereof cert ified by the Director of the
insurer thereof f iled with t he Building Inspection Department (Section 3800, Lab. C).
POLICY NO. EXPIRATION DATE INSURANCE COMPANY
Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not effl)loy any person in any manner
so as to become subject to t he \Jork.ers' Co,rpensation Laws of California.
SIGNATURE DATE
OWNER-BUILDER DECLARATION Owner·Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
D I as owner of the property or my efll)loyees with wages as then 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,, end who
does such work himself or through his own employees, provided that such irfl)rovements are not intended or offered for sale. If, however, the bui lding
or inl)rovement is sold within one year of c~letion, the owner-builder will have the bJrden of proving that he did not build or i"l)rove for the purpose
of sale.). ~ as owner of the property, am exclusively contracting wit h licensed cont ractors 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 ilff'roves thereon, and contracts for such projects with contractor(s)
licensed pursuant to the Contractor Is License Law>.
0 J am exen'4)t under Section __________ _ Business and Professions Code for th1s reason:
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, in,::>rove, demolish, or repair any structure,
prior to its issuance, also requires the applicant for such permit to file a s igned statement that he is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9, corrmencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exefll)t therefrom,
and the basis for the alleged xefll)tion. Any violation of Section 703l.5 by any applicant for a permit subjects the applicant to a civil penalty of not
more than five hundred,,P61"l ,~. ($5001/
SIGNATURE {_,,-~ ~ DATE ~ ~
COMPLETE THIS SECTION FOR NON·RESIOENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to subni t a bJsiness 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 0 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 0 NO
I s the f acility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES
If ANY Of THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS IIET OR JS IIEETING THE REQUIREMENTS
OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
9. CONSTRUCTION LEN~ING AGENCY
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097Ci) Civil Code).
LENDER 'S NAME LENDER 'S ADDRESS
10. APPLICANT'S SIGNATURE J certify that I have read the application and state that the above information is correct. I agree to comply w,th all City ordinances and State laws 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 TD SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES, JIAJGMENTS, COSTS AND EXPENSES IIHICH MAY IN ANY IIAY 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 work authorized by such permit is not conmenced within 180 days from the date of such permi't or if the building or work authorized by such permit is suspended
or abandoned at any time after the work is COITITICnccd for a period of 180 days (Sect ion 303(d) Uni form Bu1 lding Code).
A L{A , SIGNAi E ~--•=~-OIINER O coNTRACTOR OBY PHONE
APPROVED BY: _______ _
DATE: _________ _
WHITE: File YELLOW: Applicant
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