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Home My WebLink About1200 CARLSBAD VILLAGE DR; ; CB004583; Permit12/05/2000 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB004583 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 1200 CARLSBAD VILLAGE DR CBAD MISC Subtype OTHER 1561803400 Lot# 0 $000 CITY OF CARLSBAD REMODE BATHROOMS Applicant CITY OF CARLSBAD CITY HALL Status Applied Entered By Plan Approved Issued Inspect Area Owner "- .^ CITY-OF CARLSBAD ISSUED 12/05/2000 MDP 12/05/2000 12/05/2000 PUBLIC AGENCY 00000 Total Fees $0 00 ^ \ Total Payments To Date ' $0 00 \ " Balance;Due v $0 00* •. j , > ~~- < t Miscelaneous Fee(#1 Miscelaneous Fee #2 ' TOTAL PERMIT FEES $ooo -$0 00- r ""I i $o o ' Inspector FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the' Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as 'fees/exactions" You have 90 days from the date this permit was issued to protest imposition of these fees/exactions If you protest them you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION ,^ i CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 PROJECT INFORMATION, FOR OFFICE USE ONLY PLAN CHECK NO.. EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite #} [QX> Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units Assessor's Parcel Existing Use Proposed Use Descrition of Work SO FT #of Stories„,.,CONTACT PERSQN'frfjdifMlwt froirispplicai State/Zip Telephone # Fax # Address City State/Zip Telephone Name Address City State/Zip Telephone # CONTRACTOR^ (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 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 I$500)| Name . , , State License # tN~t\0(JS£ Designer Name State License # Address ^ License Class Address City State/Zip City Business License # City State/Zip Telephone # Telephone '6« \PWORKERS'1COMPENSATION' '„' ^ „ '. t',f*. i^ "& ^l^T!?^ ^/^J^. aVr!^. ,'&<(•', - , *W^ VUv j", "IT, "^< ' Workers' Compensation Declaration | 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 0 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 issued My worker's 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} Q CERTIFICATE OF EXEMPTION | 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 attorney s fees SIGNATURE DATE J , BOWNEtf-BUH-DER DECLARATION / &" .1 ", <; !<VrlM, '* -•' '' "»«rSliV- hM»£ "V- > >4^T "s ' LL '""f^C I* "J Ti^L™ Ll'v «.':?' ', ', 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason [H 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 sate [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) [3 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) ("} 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 Q YES QNO 2 I (have / have not) signed an application for a building permit for the proposed work 3 I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number) 4 I plan to provide portions of th§ work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number) 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work) PROPERTY OWNER SIGNATURE DATE 1 «L "IT V' Uv^j > Tt!,h"V .;K «'''/'' S. P t ? > 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 Act7 Q 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? O YES d NO Is the facility to be constructed withm 1,000 feet of the outer boundary of a school site? Q YES Q 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 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code) LENDER S NAME ___ __^ LENDER'S ADDRESS 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 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, 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 ISOTjiXifrom the date of such permit or if the building or work authorized by such at any time after the work is commefttf^^nr^i^rKi^p&yWdays (Section 106 4 4 Uniform Building Code) J APPLICANT'S SIGNATURE *j jffiy/T'Zfl*' "- DATE /Oy & /QC/ (/ WHITE File YELLOW Applicant PINK Finance rmit is suspended or abandoned t -3 t^ a 3 *v 4 •w*s. 1 t ™ "T~ftiMgB»gaii ••" ia s " ^- sIE =j &*1^ S v-^ -j M^Sl^ ^ ; r -..„,,._ v. /" r -/-Y, . ff \ ,,.* ,te ^t,•^1 —1_i,,^-r r*n.4,* " "i>^ L / T- \\ ^* r*^.,i . i1HL-tx N..fcT ,2g r /« V*S^ -r**^ V r < •«! -' ^^_^ "^ V a ^ < •^ // *MM fe=«ep- s / 1V --* / ^\i ,«c~ T L . r \iJ— N— ^?iH X i •*. i r J ^ T R2S> y/ ^< 3r $** >/ % ^ — -j - \r* ^& S\, , ^S--rNj S - & -* S _J - & * x Jt T » 3 "-A * XJ. c* - A _