HomeMy WebLinkAbout1081 GOLDENEYE VW; ; CB971250; Permitr
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FINAL APPROVAL
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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92()()C) (619) 438-1161
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FOR OFFICE USE ONLY
PERMIT APPLICATION PLAN CHECK NO. q1 ( 'J.,5 Q
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
EST.VAL.~~~~~~~~~-
Plan Ck. Deposit -.....--------
Validated By ___ ..,flfr"---------
Business Name (at
4 -r
Date ) ll {p IJ{ 1
Legal Description Subdivision Name/ umber Unit No. Phase No. Total # of units
fe..A tJr/'}4 ,r
Assessor's Parcel # /\kg~;8 (;crlJ~c.4?'7c~ P!]P5>sed U~e ,-J('Ef,d-,,-r~ c. J;,c.<--> o;,¥/ic-
Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms
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2. /Ii~ 1/'-~7()' 2 'It" J.Ff ~
Name Address City Fax#
I\. Agent for Contractor O Owner [3.,Agent for Own8!\
6 C/fM,d {_ /?to "1 {,/lt1-eo C'/1" 'it /o/ l~J--f'tl7<7 Z 1Y;rl7f'
Address City State/Zip Telephone #
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Address City
5. CONTRACTOR • COMPANY NAME
(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, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged
exempti n. Any violation of Section 7031.5 by any applicant for a permit su~cts th17applicant to a ci ii penalty of not more than five hundred dollars [$500)).
ME ::t:°; ~ ¢Jr &/lf(N(, v,c f((IJ t:' D '7( tc/ ?r-t!f'C 70
Name Address City State/Zip Telephone#
State License # _G=-...:1___:Z:;.__L_~_.J___ License Class _ __,Z?~-------City Business License # --------
C../J-.J ~ C:-rc"e L/J 7 .s-. HI..(/ {C( --'ttt,..y '[1J1,-~Jq ~ 712-9'.rc L
Designer Name Address City State/Zip Telephone
State License # C. C,0 7 '("
6. WORKERS' COMPENSATION
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 workers' compensation as provided by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
JZ] I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
~ued. My worker's compensatiop.insurance carrier and policy number are: /
Insurance Company C./tP I'~ t:, Policy No. g~ r-:J / -~ 7 /? 7 Expiration Date / ,Z f / I
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS)
0 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
to become subject to the Workers' Compensation Laws of California.
WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall 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 attomey·s fees.
SIGNATURE DATE --===:-;.,--:::::-:---:-
7. OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (71 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).
[21 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 License Law).
0 I am exempt under Section ------Business and Professions Code for this reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 12) YES ONO
2. ~ I have notl signed an application for a building permit for the proposed work.
3. i have contracted with the followin per (firm) to provide the proposed construction (include name I address I phone number I contractors license number):
4. I plan to provide portions of the work, but I have hired the ollowing person to coordinate, supervise and provide the major work (include name I address I phone
number I contractors license number): ______ _,_....._"+..c......<...-----------------------------------
ired) the following persons to provide the work indicated (include name I address I phone number I type 5. I will provide some of the work, but I have cpnl);acted
ofwork)=------------:;;,-"!,-"5~,/'--r-__ 7r----------------------"""7--..,,....-----------
PROPERTY OWNER SIGNATURE _ _22'.~'.),.~~..C.~~::::::::::===---------
COMPLETE THIS SECTION FOR NON-RESID
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? 0 YES O NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
8. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a 5Pnstruction lending agency for the performance of the work for which this per t is issued (Sec. 30970) Civil Code).
LENDER'S NAME /1../jft LENDER'S ADDRESS ____ _;_M_,__~----------------
9. APPLICANT CERTIFICATION
i certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt 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,
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 stories 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 t · d for a period of 180 days (Section 106.4.4 Uniform Building Code). ,--/(/"/Jc 7 APPLICANT'S SIGNATURE DATE __ ->_.....c..f_ l_•..J.. __ I_...:._ ___ _
WHITE: File YELLOW: Applicant PINK: Finance
FINAL BUILDING INSPECTION
DEPT: BUILDING ENGINEERING FIRE PLANNING CMWD ST LITE
PLAN CHECK#: CB970294
PERMIT#: CB970294
PROJECT NAME: MODEL PLAN 2,2706+584 GAR+40SF
DECK,SEA BRIGHT-EMERALD RIDGE WEST-UDC
ADDRESS: 1081 GOLDENEYE VW LOT# 51
DATE: 07/27/98
PERMIT TYPE: SFD
CONTACT PERSON/PHONE#: C/THAD/804-1581 ;
SEWER :~: CA WATER DIST: CA L
~~~p = ~~ /'-. ==== ~~~~ECTED: ~ APPROVED ZISAPPR:VED -
INSPECTE DATE
BY: INSPECTED: APPROVED DISAPPROVED
INSPECTED
BY:
DATE
INSPECTED: APPROVED DISAPPROVED
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