HomeMy WebLinkAbout122 ACACIA AVE; ; 86-503; Permit.- " DECLARATIONS LENDER I 1- OWNEWWILDER CONTRACTOR WORKER'SCOMPENSATION r l- 1 t
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Whlfe ~ Inspector Green - (1) Finance (2) Data Process, Yellow - Assessor Pin$--Applicant Gold ~ Temporary File
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PLAN CHECK NO. s-63 ADORESS /2)&-- ri
DATE g-
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PLANNING I
ZONE: TYPE OF PROJECT:
SCHOOL DISTRICT: SAN OIEGUITO- ENCINITAS - CARLSBAO - SAN MARCOS -
SETBACKS: FRONT SIDE REAR
DISCRETIONARY ACTIONS:
REDEVELOPMENT PERMIT REQUIRED:
LANDSCAPE PLAN COMnENTS:
ENVIRONMENTAL REQUIRED:
ADDITIONAL COMMENTS:
OK TO ISSUE: DATE: 41 d'M
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ENGINEERING
LEGAL DESCRIPTION VERIFIED? APN CHECKED?
P.F.F. : PARK-IN-LIEU QUADRANT: , FEE PER UNIT:
RIGHT-OF-WAY: TRAFFIC IMPACT FEE PER UNIT:-
EASEMENTS: DRIVEWAY:
IMPROVEMENTS:
FIELD CHECK DATE:- INITIALS: "
SEWER:
0 - LL u$ GRADING PERMIT:
LATERAL: INDUSTRIAL WASTE PERMIT: -
.Ea z;;; GRADING COMPLETION CERTIFIED:
DRAINAGE:
ADDITIONAL COMMENTS:
OK TO 1SSUE:C DATE: yI)L1'/8'
DPDZ:DPD6:04/15/06
A~ENTION PROPERTY OWNER:
An "owner-builder" building permit has been apP1 ied for in your name and bearing your
signature.
opportunity to avoid unnecessary delay in processing and issuing your building permit. please complete and return this information in the envelope provided at your earliest
NO building permit will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of
2. I (have/have not) - signed the application for a building permit.
the proposed property improvement (yes or no)
(firm) to provide the proposed construction.
Phone
Address Contractors License No.
city
4. I plan to provide portions of the work, but I have hired the followlng person to coordinate, supervise and provide the major work.
Name Phone
.. Address 'contractovs Clcense NO.
city
I 5. I will provide sm of the work but I have contracted (hired) the following Persons
i. to provide the work indicated: .I
Name - Address Phone Type of Work
/ n,-,
Signed: Property Owner
Socfal Securhy Number &A 7- &' ' 22. //
EACH SUBCONTRACTOR WILL BE INSTRUCTED TO OBTAIN A CITY OF CARLSBAD BUSINESS LICENSE AND FURNISH A CERTIFICATE OF WORKMAN'S COMPENSATION TO THE CITY OF CARLSBAD.