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CLEARANCE _____ ,
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION PLAN CHECK NO. 93 {) 3 I L
City of Carlsbad Building Departaent IE~,: I WIS Las Pal_. De., Ceelsbed, CA 92009 (619) 438-1161
I. PERMII iiPE
A -U Commerc1al d New Butldmg LI 'Ienant Improvement
B -□ Industrial □ New Building □ Tenant Improvement
C )(Residential □ Apartment □ Condo □ Single Family Dwelling ~dition/ Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical □ Plumbing
□ Mechanical □ Pool □ Spa □ Retaining Wall □ Solar □ Other
2. PRUIECT INFORMATION FOR OFFICE USE ONLY
BuUdmg or Suite No.
mt o.
CHECK BEWW IF SUBMI 11 ED:
□ 2 Energy Gales 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
ASSESSOR'S PARCEi.
DESCRIPTION OF WORK ~ \( ,e. \I<' f--D IU.-<..
EXISTING USE PROP9SEP USE
SQ. FT. # OF STORIES
NAME
CITY
ADDRESS
CITY
Workers' Compensation Declarat1on: I hereby afhrm that I have a cert1hcate of consent to self-insure issued by the Director of lndustnal
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 POUCYNO. EXPIRATION DATE
Certuicate of Exemption: I certify that m the performance of the work for which this permit 1s issued, I shall not empJoy any person m any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. oWNFA-BilllDkk DiilARAliDN
dwner-Budder Deciarahon: J hereby atllrm that I am exempt from the Contracto?s License Law for 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: 11ie Contractor's Llcense 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 projects
with contractor(s) licensed pursuant to the Contractor's Llcense Law).
0 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 chat 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 pennit
sub' pplicant ci 'l penalty of not more than five hundred dollars [$500]).
DATE
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn or risk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
□YES ONO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □YES ONO
ls the facility to be constructed within I,000 feet of the outer boundary of a school site?
□YES ONO
IF ANY OF TIIEANSWERS ARE YES, A FINALCERTIFICATI! OF DCX:UPANCY MAYNUf BE ISSUED AFTl!RJIJLY 1, 19891JNll!SS TIIEAPPUCANT
HAS MET OR IS MEETING TIIE RF.QUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND TIIE AIR POUUTION ffiNTROL msrmcr.
9. WNSIRUCIIUN LENDING XCF.NCY
I hereby afltrm that there 1s a construcuon lendtng agency for the performance of the work for which this permit IS 1~ued (Sec 3097(1) CiVJI Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPUCKNi t!PJtilPICAl'iON
I certify that I have read the apphcanon and state that the above mformat1on 1s correct. 1 agree to comply wuh ail City ordmances 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 AISO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS TIIE CfIY OF CARISBAD AGAINST ALL UABIIJTIF.S, JUDGMENTS, CDSTS
AND EXPENSES WHICH MAY IN ANY WAY Nx:IUJE AGAINST SAID CfIY IN OONSEQUENCI! OF TIIE GRANTING OF TIIIS PERMIT.
OSHA: An OSHA permit is required for excavations over S'O" deep and demolition or construction of structures over 3 stories in height.
Expiration. Every pennit 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 pennit is suspended or abandoned at any time after the work is commenced for a period. of 180 days (Section 303(d) Uniform Building Code).
WHITE: File YELLOW: Applicant PINK: Finance
----------·····
/, CITY OF CARLSBAD
• INSPECTION REQUEST
PERMIT# CB930312 FOR 05/17/93
DESCRIPTION: REPAIR TRUSSES IN GARAGE
DAMAGED BY UNPERMITTED WORK PER PETE
TYPE: MISC
STE:
INSPECTOR AREA PD
PLANCK# CB930312
OCC GRP
CONSTR. TYPE VN
LOT: JOB ADDRESS: 1853 PENTAS CT
APPLICANT: GREAT WESTERN BANK
CONTRACTOR:
PHONE: 619-695-0159
OWNER: PHONE: ·
REMARKS: MH/PHIL792-8260
SPECIAL INSTRUCT: WILL CALL FOR TIME -
PHONE, ~,IL
INSPECTO"
8:15 -8:45
TOTAL TIME:
LVL DESCRIPTION ACT COMMENTS CD
34
44
EL Rough Electric
ME Rough/Ducts/Dampers fr_---
------------------------------------------------------
***** INSPECTION HISTORY*****
DATE
051493
051493
042293
DESCRIPTION
Rough Electric
Rough/Ducts/Dampers
Frame/Steel/Bolting/Welding
ACT INSP
NR PK
NR PK
PA PD
COMMENTS
SEE INSP NOTES
SEE INSP NOTES
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