The URL can be used to link to this page

Home My WebLink About1958 KELLOGG AVE; MULTI-PERMIT FILE; CB021139; PermitC~ty of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 04-15-2002 Sign Permit Permit No: CB021139 Building Inspection Request Line {760) 602-2725 ~ ··: : ; Job Address: , (' ',;, 1958 KELLOGG AV CBAD SIGN · ···:·Permit Type: Status: ISSUED 04/15/2002 RMA 04/15/2002 04/15/2002 Parcel No: 1/;=iluation: -Reference #: r Project Title: 2120920100 $1,400.00 ·Lot#: 0 Construction Type: NEW CORLUND ELECTRONICS-WALL MOUNT SIGN-NO ELECTRIC Applied: Entered By: Plan Approved: Issued: Inspect Area: _Applicant: Owner: WOLFPACK SIGN GROUP 1325 GRAND AV 92069 760 736-4500 Total Fees: $46.28 CABOT INDUSTRIAL PROPERTJ~§...1. P.,. ,.1 _ ,r..n C/0 ASSET MANAGER ..1l-.>3 ,J-,1 .•. ':>1 v.-:. 0002 Cii TWO CENTER PLAZA #200 CGP BOSTON, MA 02108 Total Payments To Date: $0.00 Balance Due: $46.28 .. :·;.:: ______________________ ....,. ________________________ _ t•I •: ;,; \ \, !-: \. . " { -,\: '~' Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Electrical Fee Renewal Fee Add'I Renewal Fee Other Building Fee Additional Fees TOTAL PERMIT FEES Inspector: $28.05 $0.00 $18.23 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.28 EXPIRED PER IT r~1 ~ .. ,, ~ n~; EXPmED IN ACCORDJUIJCt VuTrH u.s.c • . i 1..,;·J.4.4 I, , . rir7t_l~{.o-~ SIGNATURE.~ FINAL APPROVAL Date: Clearance: NOTICE: Please take NOTICE Ilia! 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 prates! 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 impositjon. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any I • I . . • . ·1 i i •. · i . ·r PERMIT APPLICATION FOR OFFICE USE OaY PLAN CHECK NO. ~OJ[ I ?1 EST. VAL. $9S112) Q .... /f'"t?D CITY OF CARLSBAD BUILDING DEPARTMENT - 1635 Faraday Ave., Carlsbad, CA 92008. Plan Ck. Deposit '{;if_ Validated By , ~ Date f//5t ~ Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description of Work # of Bathrooms Name Addres City State/Zip t~i:;MPiit1i;,~Nt: ?)i'..¢on~riii:i,iq~? ;·_01JAsei1_f t'ii:'~~ii"1:~'a_gtori · i ;:s-ro:;,~Jr·'.J::.:ci:;t,i'!!nffl{f fq'.wh~l; ·:; .. ~·1:-,; ,,:: -·.·/: Name ·~-·I;""""" ~-l. IJ Address City State/Zip Telephone # , .. . .... .. . . ,s;r . .l?b . . _(1.//,,-... ,. -"'I-1,;0:f·· /;hi,;;;,:--;;-'.· YZ,~. .,,,,,..J·, /7 ·c--LL ... i .·a::,·:,,'"}0,,-,_,,. --.,..,1-=.r,. .. c.~..,,/. -/i'l. ~ .-:4/,.~:P. _. -"--· _.9,w.!'!l.l;lt·· :~ //;,~:-.·o('!E . .' 'ic3i;--~-.. -·_.:,_ i/ .. /<V'-;;,:-.• ~ ,·,7 u':I.;(:.~::'"'· .•• ,,tr:,.;,":-.c:r _..,'"[ __ 7-0<f __ . · Name Address City. S.tate/Zip Telephone# ,~~f?-.':c·oN:t~~,.o~Xc;::tii;il.~A~x',~~Nlt; ':-< ;= .. ::'.. t;,.:_~· · 1:·:~ '· ··:, ·,.· .... ,, •·· -··"' (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 Profe!;sions 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 sub'ects the applicant to a civil penalty of not m"):li than five hundred dollars [$500]). • 't) 11,, ad S11 ~ ":l<¾> --:s - -Designer Name Address City State/Zip Telephone State License # _________ _ r~; .. ~d~<VYQBJ<.eij§f:j~OMe~tt$A~ttcrr~r/\t~·=: :·· ./: :·-: ~~= .. -·:_ ·. :-~~ -:_ _ ~.:.-< ~ .. -~-_ ·;i-~ ; : __ -=:-::.~ :-(·~~>l.~~~=>t.. ~ : · ~ · .!. -~¥ .. _·- workers: Compensation Declaration: I hereby affir111 under penalty of perjury one of the following declarations: D 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 o'f the work for which this permit is issued. ~ I have and will maintain workers' compensation, as required by Section 3700 6f the Labor Code, for the performance of the work for which this permit is issued. My worker's co1]1pensation insura~ce carrier and·policy number are: 4) Q ul O "') 7.-/- Insurance Company /JA-; d.,.,~,? . Policy No/rl d Oz. -a 7 -cQ.,::::, Expiration Date O:J (THIS SECTION NEED NOT BE COMPLmofi=€E PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that io-the performance of the work for which this permit is issued, I shall not employ any person in any manner so as .to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand doilars ($,1 0001, in .additlQn to a c st of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNA'fURE . · DATE 4-/c:;-b ::i. ::,.t/_jqy.iijefi:~l:iJtQ.1;i'.t;:pEq_1.p.~:;41:i ,iii>:".'·" .,.::-:/·:·3 ' ,.:':·-'. 1:·<,:-:._;·:· .... :" ;~ ,.:.:'.i:.-?> ,,, -c:-.. ,,:::-,,:,.t .. Y·:':·_:ic_ .. · { ·.-·;·_. '.. :·, > I hereby affirm that I am exempt from the Contractor'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: The Contractor's License Law does not apply to an owner pf 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 properw,' 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(sl licensed pursuant to the Contractor's License Law). · tJ 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 ONO 2. I (have / have not) signed an application for a building perrriit 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 the 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 t~ proviµe the work indicated (include name / address / phone number / type of work): · 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 25.505, 25533 or 25534 of the Presley,Tanner Hazardous Substance Account Act? D YES [) NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D 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 IFANY OF THE ANSWERS'ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REOUIREM~NTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. [!f;;:?:'.{qij~fqi:tc;t,l'Qiill);Np1JjQ.:AG~N¢.~t: '.'. )' _";, < ;-_-.:'. .. I hereby affirm that there is a construction lending .agency for the performance of the work for which this permit is issued (Sec. 3097(0 Civil Code). 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· anq State laws relating to bUilding construction. I hereby authorize representatives of the Cit\' 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 ~enced within 180 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 com,c:;,ed for a period of 180 da~s (SS}tion 106.4.4 Uniform Building Code). ./ / __ APPLICANT'S SIGNATURE ~ w~ DATE ~ -/ b --oa WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad · 1-i!htUhi~I-J§•IUIU,t§OI September 4, 2002 WOLFPACK SIGN GROUP 1325 GRAND AV SAN MARCOS CA 92069 RE: BUILDING PERMIT EXPIRATION PERMIT TYPE: SIGN Permit Number: Issue Date: CB021139 4/15/02 ADDRESS: 1958 KELLOGG AV PLEASE CALL FOR AN INSPECTION IF WORK IS COMPLETE Our records indicate that your bui.lding permit will expire by limitation of time on 10/12/02. The provisions of UBC, Section 106.4.4 as amended by the Carlsbad Municipal Code state: "EXPIRATION. Every permit issued by the Building Official under the provisions of this code shall expire by limitation and become nun and void if the building or work· authorized by such permit is not commenced within 180 days from the date of such permit (unless. is~ued prior to 7/1/99 which is one year from date of permit), or if the building or work authorized by such permit is stopped at any time after the work is commenced for a period of 180 days or if the building or work authorized ,by such permit exceeds three calendar years from the issuance date of permit. Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work authorized by the permit by the Building Official within 180 days of the date of permit issuance. Work shall be presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building Official within each 180 day period upon the initial commencement of work authorized by such permit. Before such work can be recommenced, a new permit shall be obtained to do so, and the fee, therefore, shall be one-half the amount required for a new permit for ·such work, and provided that no changes have been made <;>r will be made in the original plans and specifications for such work, and provided further that such suspension or abandonment has not exceeded one year. In order to renew action on a permit after expiration, the permittee shall pay a new permit fee. Any person holding an unexpired permit may apply for an extension of the time within which work may commence under that permit when the permittee is unable to commence work within the time period required by this section for good and satisfactory reasons. The Building Official may extend the time for action by the permittee for a period not exceeding 180 days on written request by the permittee showing that circumstances beyond the control of the permittee have prevented action from being taken. No permit shall be extended more than once. Please check below indicating your intentions and return this letter to us. Project abandoned. A new permit will be obtained prior to commencing work. No fee extension requested for 180 days. (attach a letter of explanation) Renewal permit requested. If the project has been cop:ipleted and only a fll!,al inspection is needed, please call the inspection request line at (760) 602-2725. If you have any questions, please contact the Building Inspection Department at (760) 602-2700. PAT KELLEY Principal Building Inspector 1635 Faraday Avenue• Carlsbad, CA 92008-7314 • (760) 602-2700 • FAX (760) 602-8560 @ · Building Counter • (760) 602-2719 • FAX (760) 602-8558 C'/::ft.S07 r-. ·• B U I L D I N G P E R M I T Permit No: CB921198 Project No: A9202434 Development No: 11/12/92 12:28 Pa.ge 1 of 1 Job Address: 1958 KELLOGG AV Permit Type: SIGN Parcel No: Valuation: 1,000 Construction Type: NEW Suite: Lot#: Occupancy Group: Reference#: Description: WALL SIGN/ NON-ILLUMINATED CITY OF CARLSBAD 0090 11/12/92 0001 01 C-PRMT Status: Applied: Apr/Issue: Validated By: 438-1529 02 41-00 ISSUED 11/12/92 MDP 25.00 16.00 41.00 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 ..! PERMIT APPIJCATION PLAN CHECK NO. t:f?_r-l \ °l, ~ City of Carlsbad Building Depart111e11t 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 1. PRllMI I 'h'PE A -D Commercial LI New Bmldmg D Tenant Improvement B 48:Industrial D New Building LI Tenant Improvement . C -D Residential LI Apartment LI Condo D Single Family Dwelling ·o Addition/Alteration D Duplex D Demolition D Relocation D Mobile Home D Electrical LI Plumbing D Mechanical D Pool D Spa D Retaining Wall CJ Solar D Other~---- 2. PROJECT INFORMATION FOR OFFICE USE ONLY Address Jq_s cf ke__J }~ /f;L,l.C.-Butldmg or-Smee No. Nearest Cross Street LEGAL DEscRlPTioN Lot No. 3'1 SulxhVIston Name/Number Omt No. Phase No. CHECK BELOW IF SDBMB 1£0: '7"/&JcT#:f'/-11, /'[),;}pd L I .Jhf CJ 2 Energy Gales a 2 Structural Cales D 2 Soils Report CJ 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK (j) ~ SQ. FT. @SeA-P+ Lv/-rr.lllS # OF STORIES 3. WN1ACI PERSON (u dmerenf from applicant) NAME ~ /7).,U Je.{P-vcJ:.. ~ /?7~v.:t'] STATE Q c::-£4 r" 2.. .Sts "'"' 5 .,. C ~~ ic.s ADDRESS q{. .C.,3.:;})u .J-.r I I I) ,J . CITY J::.+--,v J)~ (I STATEC... ZIP CODE 9--llk} DA~TELEPHONEt'-/9 S-1!"-9.!fJ>''Z ADDRESS )C/ S-tf' k! I I~ .fJ CITY C IJ,te./.,so.r;, /Jl,,. STATE 0:t_ ZIP CODE °/e)l>af DA):'TELEPHONE 43tf-/ ,j-,,,2__j 6 -~~"'.2. Su->-'1 ½ .,;..6~~(l:JADDRESS c;t, ~3 .:JJt,.s./-e_JL, vJ--ld J CITY S;' Dt STATE LJi ZIP CODE "Cj ~J-;)..} DAYTELEPHONE :S1<f-t"'/-1"7 STATE LIC. # 4ft.J.347 LICENSE CIASS C 4:,/ CITY BUSINESS LIC. # DESIGNER NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # 1. WOllkERS' CXJMPf:NSJmON Workers' Compensation beclarauon: I hereby·afhrm that I have a certificate of consent to self-msure 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. SIGNATURE DATE 8. oWNER-BOllD.ER D.ECI.ARATION · bwner-Bmider beclarauon: I hereby afhrm that I am exempt from the Contracto?s Llcense'taw for the followmg reason: CJ 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 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.)', LI 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 Llcense Law does not apply to an owner of property who builcls or improves thereon, and <;ontracts for such projects with contractor(s) licensed pursuant to the Contractor's Llcense 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 Llcense 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 sEcttdN FOR NoN-RESIDENTIAL BUILDING PERMITS oNEY: 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? DYES LI NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYES CJ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES D NO IF ANY OF THE ANSWERS ARE YFS, A FINAL CERTIFICATE OF ocx;m>ANCY MAY Nar BE ISSUED AFTER JULY 1, 1989 ~ THE APPUCANT HAS MET OR IS MEETING THE REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVI~ AND THE AIR POLLUTION OON1ROL DISllUCT. 9. cDNS'l'ROCIIDN LENDING AGENCY . . . . . I hereby afhrm that there JS a construction lending agency for the performance of the work for which this permit JS issued (Sec 3097(1) CIVli Code). LENDER'S NAME LENDER'S ADDRESS Io. APPilcANT c!ERTIFlcATION I cernfy that I have read the apphcanon and state that the above informauon 1s correct. 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 AI.50 AGREE 'IO SAVE INDEMNJFY AND KEEP .HARMLESS THE CITY OF CARISBAD AGAINSf AIL I1ABIUI1F.S, JUDGMENTS, oosrs AND EXPENSES WJilCH MAY IN ANY WAY ACX:RUE AGAINSf SAID Cl1Y IN CONSEQUENCE OF THE GRANTING OF TillS 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 withip 365 days from the date of such permii: 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). APPL!~~~ .. ·. --WI-IlTE: File YELLOW: Applicant PINK: Finance DATE: / 1-M.-j d-"" f/;_tf /2 3 UilSCHW'lLF.O W,5!'F.CTJ:0!! .· l,o. ~ D.:\TE __ ,, ..... __ _.,...L______ IHSPECTOU L I · ?ER."!IT 4 __ • q~_,2.__ ..... _)_/q---'-g_ --P-LN-~-C-1-K-~ -----.7~----- .;o a ,\DDRESS ;qo'o /(c~o G·G ¥ -----..:.__---'-------=-=--------.:..:::___ _______ _ tnrn AH.RIVE: TIME LEAVE:. --------------- CD LVL DESCRIPTION ---~·~ .. ----- .,,. . . -· ............ P~~"1ITS G/15/09. . :_ . 1\CT · COlll1ENTS -· .·· . . B IJ rLDING E·R r-1··1 ·l .. P~r-rn1-t'.i'to:.·cg5,~1.0?19 _ ·Pro.iecti ·1\ftH A9tO:l.1?7 06/11.~/91 11::19 Ps9e:-~ 1 of 1 Job nddressc 1958 KELLOGG AU ·)'r;ermit "fyperr- P(1:1ree1 Mo: SIGN , lJe:1 l u at 'i on-: 5 0 0 Construction·Type• VN Occupancy Group= Description~ TOOLTRONICS P.-p p 1 /0 ;..in r Cl,:.l::.;:._ Co-de·:t -\ MONLWIEMT ... ' , . .' ; f' '. "'·:> CITY OF CARLSBAD-.. ·, -:=-·_nevelopr;1e~t:t: -Nt1g ·. ,i::_ ~! -;t_ ·St-e: ~-. . . \. . ,. 2075 Las Palmas iJr., C.µ-lsb~d CA 92()_09; (619J :438-li61 .. \_, i I ! PERMIT APPUCATION PLAN CHECK NO. 1/-11;1 City of Carlsbad Building Departllll!flt FSf. VAL . s:!!J2e,<) 2075 Las Palms Dr., carlsbad, CA 92009 (619) 438-1161 PLAN CK DEPOSIT _______ _ VALID.BY __________ _ 1. P)mMl1 IYPE DATE. ____________ _ A -D Commerc1al D New Bmldmg O Tenant improvement B -D Industrial D New Building D Tenant Improvement C -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 ____ _ FOR OFFICE USE ONLY LEGAL DESCRIPTION Lot No. Subcl1V1s10n Name/Number Unit No. Phase No. q-IEcR MWW IF sOBMII !ED: CJ 2 Energy Cales _ a 2 Structural Cales O 2 Soils Report CJ 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE NAME CI1Y ADDRESS STATE ZIP CODE DAY TELEPHONE 4, APPll.CANt NAME UCONIRACIOR DAGEN:! FOR CON'l'RACIOR ADDRESS Cl OWNER Cl AGENT FOR OWNER CI1Y STA'IE ZIP CODE DA)' TELEPHONE y G /2.,.$ F~/ff l'-Y 4-~.$"' ($'90 STATE DAY TELEPHONE 0 NAME CI1Y STATE STATELIC. # ADDRESS ZIP CODE LICENSE CIASS ADDRESS· DAY TELEPHONE CI1Y BUSINESS LIC. # DESIGNER NAME CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # 1. WORRfilts' w.M.P£NSA110N Workers1 compensation Declaration: I hereby afhrm that I have a certihcate of consent to self-msure· issued.by the D1rector 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 POLICY NO. EXPIRATION DATE Ceruhcate of Exemption: I certify that m the performance of the work for which this permit 1s issued, I shall not employ any person m any manner so as to become subject to the Workers' Compensation Laws of California. SIGNATURE DATE 8. OWNER-BOIWER DEcl.AltAuoN -Owner-Builder beclarauon: I hereby afhrm that I am exempt from the contra-cto?s License taw for the followmg reason: iJ 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 projects with contractor(s) licensed pursuant to the Contractor's License Law). D I am ~xempt under Section _______ Business and Professions Code for this reason: (Sec. 7031.5 Business and Professions Code: Ajly 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]). SIG:tfATURE DATE CoMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: 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? DYES ONO Is the applicant or future building occupant required to obtain a permit from the air pollution ·control district or air quality management district? U YES CJ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES ONO IF ANY OF nm ANSWERS ARE YES. A FINAL CERTIFICATE OF OCCUPANCY MAYNar BE ISSUED AFfER JULY 1, 1989 UNIJ1.SS nm APPUCANT HAS MET OR IS MEETING nm REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND nm AIR POU.UTION CX>NTilOL DISTIUCT. 9. CDNS'ltlOCJ.iuN LHNDING AGENCY - I hereby afhrm that there 1s a construction iendmg agency for the performance of the work for which this permit 1s issued (Sec 3097(1) C1VJI Code). LENDER'S NAME LENDER'S ADDRESS lo. APPDCMll' c!ERTIFlc!A.11oN I cernly that I have read the application and state that the above mformauon 1s correct. 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 AISO AGREE 1U SAVE INDEMNIFY AND 1<EEP HARMLF.SS nm CITY OF CARISBAD AGAINSf AU. UABIUTIFS, JUDGMENTS, CDSTS AND EXPENSFS WlilCH MAY IN ANY WAY ACDUJE AGAINSf SAID CITY IN CX>NSEQUENCE OF nm GRANTING OF nns 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 buil ing 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 rmit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). /"CAN S S ,_,__ DATE, _____ _ File YEIJ.OW: Applicant PINK: Finance UNSCHEDULED INSPECTION DATE . ~/¢/ . . .INSPECTOR . ~ PERMIT # y.i 9/l)q/,f. · ~Cl(#. JOB ADDRESS /9!)-g"'_ ke'~c TIME ARRIVE: _______ TIME LEAVE: _____ _ CD LVL DESCRIPTION PERMITS 6/15/89" ACT COMMENTS -