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Home My WebLink About1345 CYNTHIA LN; ; CB940084; PermitBUILDING PERMIT 01/21/94 11 16 Page 1 of 1 Job Address 1345 CYNTHIA LN Suite Permit Type PLUMBING Parcel No 156-230-62-00 Lot# Valuation 0 Construction Type NEW Occupancy Group Reference* Description REROUTE GAS LINE OWNER'S REQ Permit No CB940084 Project No A9400124 Development No Appl/Ownr ENGBERG, DOUGLAS 1345 CYNTHIA LANE CARLSBAD, CA 92008 3454 01/21 94 0001 01 02 Status ^'ISSUED "7,.-.5 Applied 01/21/94'""" Apr/Issue 01/21/94 Entered By DC 619 729-7514 *** Fees Required *** , ' :*:** '' Fees .Collected & Credits '"•••" "" •••-.!'" •' N * ** Fees 27 00 ''A ,' Adjustments 00 Total Fees / 27". 00 / Fee description / ' • .^ /''••'--.,.. -< /—Cr^__i -i-'^r. Enter "Y" for Plumbing?Is.sue Fee x .> Gas Piping System ! A;:'' ; .;. ^ * PLUMBING TOTAL ' ; .'i'"' Total Credits . \ :Total^ Paymerits ) \ : '.''- Balance- Due' :•.;; JJ.ni.tj..,,,,; Fee/Uni t . 00 00 27 00 Ext fee Data 20 00 Y 7 00 27 00 'AL APPROVAL CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad. CA 92009 (619) 438-1161 PhKMll ITfPt A. B C U Commercial U New Building U Tenant Improvement D Industnal D New Building D Tenant Improvement D Residential D Apartment D Condo D Single Family Dwelling D Addition/Alteration D Duplex D Demolition D Relocation D Mobile Home D Electrical D Plumbing D Mechanical D Pool D Spa D Retaining Wall D Solar D Other 2. PROJECT INFORMATION PLAN CHECK NO EST VAL PLAN CK DEPOSIT_ VALID BY DATE FOR OFFICE USE ONLY Address . ~ <! -^ Nearest Cross Street building or suite No LEGAL DESCRIPTION Lot No Subdivision Name/Number Phase No CHECK BbLUW Ir sUBMll Itu D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope ASSESSOR S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK SQ FT <s** sum* # OF STORIES UUN 1AL.1 NAME CITY (11 dilierent trom applicant) STATE ADDRESS ZIP CODE DAY TELEPHONE 4 APPULAN1 LJ tAJN IKACTOR LJACibNl rOK L.UN 1 KALI UK LJ UWNbK LJ AUbN 1 rUK UWNbK NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 5 PROPERTY OWNLR NAME C CITY STATE C-A. ZIP CODE DAY TELEPHONE C^l^} 719 -?vT~/ 6 CJUN1KACIUK NAME CITY STATE STATE LIC # ADDRESS ZIP CODE LICENSE CLASS DAY TELEPHONE COY BUSINESS LIC # Ubbl&NbR NAMb AUUKbSS CITY 7 WOltKJiKS" (JUlVU'kNSkATKJN STATE ZIP CODE DAY TELEPHONE STATE LIC # Workers' Compensation Declaration rhereby affirm that I have a certificate ot consent to sell insure 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 Certiticate ot bxemption I certify that in the perlormance of the work tor 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 SIGNATURE DATE «T OWNER-BUILDER DECLARATION Owner Builder Declaration I hereby altirm that I am exempt from the Contractors License Law tor the following reason D 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) 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 projectswith contractor(s) licensed pursuant to the Contractor's License Law) D 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 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, 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 COMPLETE THIS SECTION FOR NON RESlDgNTIAUBoILDlNG PERMITS ONLY Is the applicant or future building occupantj^quira(f to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 255331PT 25534 of the Presley Tanner Hazardous Substance Account Act? D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control distnct or air quality management district?Q YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPUCANT HAS MET OR IS MEETING TI IE REQUIREMENTS OF Tl IE OFFICE OF EMERGENCY SERVICES AND THE A1H POLLUTION CONTROL DISTRICT 9 CONSTRUCTION LliNDUMU AGENCY 1 hereby altirm that tnere is a construction lending agency tor the pertormance ot the work lor which this permit is issued (Sec 3097(i) Civil Code) IENDER S NAME LENDER S ADDRESS 10 APPL1CANI IJkKMrlCATION 1 ccrtny that l nave read the application and state that the above information is correct I agree to comply with all City ordinances and Mate laws relating to building construction I hereby authonze representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP I IARMLESS 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 OS11A. 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 the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code) APPLICANTS SIGNATURE C^Oe—' fr DATE WHITE File iplicant PINK. Finance ACCESS PLANC'' 'I.';: ATJIIVE TIJLC LEAVE CD L'.L DCoCRIFTIOtf ACT CC'L'IENTS PEIOTT3 G/15/09 City of Carlsbad Building Department OWNER-BUILDER VERIFICATION Attention Property Owner An 'owner-builder' building permit has been applied for in your name and bearing your signature Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit No building permit will be issued until this verification is received 1 I personally plan to provide the major labor and materials tor construction of the proposed property improvement (jye^or no) S^\2 j^haye/have not) proposed work signed an application for a building permit for the I have contracted with the following person (firm) to provide the proposed construction Name Address Phone City Contractors License No I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work Name Address Phone City Contractors License No I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated Name Address Phone Type of Work 2O7'5~lrao Palmao Drivo--Carlsbad California 92OO9-1 576 (619) 438-1 161