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HomeMy WebLinkAbout1958 KELLOGG AVE; MULTI-PERMIT FILE; CB052926; Permit' ) O~~(TS City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 V·~. , 08-1 0-2005 ,.. Miscellaneous Permit Permit No: CB052926 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuat' · Reference 1958 KELLOG~ AV CBAD MISC 2120920100 $0.00 Subtype: OTHER Lot#: 0 ON OVERSEAS INC. INTERIOR MO-0 NEW CONSTRUCTION Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: KIRBY FAMILY TRUST 04-04-1993 760-931-1130 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES Total Fees: $60.00 1958· KELLOGG AVE CARLSBAD CA 92008 DEMO PERMIT FEE Total Payments To Date: $0.00 Balance Due: ' I ; : I ISSUED 08/10/2005 KG 08/10/2005 08/10/2005 $60.00 $0.00 $0.00 $60.00 $60.00 4422 08/10/05 0002 Ol 02 Cf3P 60u00 Inspector: Clearance: ------ NOTICE: Please take NOTICE at approval of .your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as 'fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the prate$! 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.3.32.03'0. 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 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 s/ x i n of whi h h v r vi I n iven N Tl E similar to !hi r t whi h h statute of limitations has reviousl other.vise ex ired. FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK Nc{};f!;e£J._q2/p CITY 6f= Cft.RLSBAD BUILDING OEPARTME:NT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. _________ _ Validated .By ___ .....,,.-.li-~<r----,---- Plan Ck. Deposit ~/·. Date Sr --/ 0-0C Business Name (at this address) Su!>division Name/Number Unit No. Phase No. Total # of units Existing Use Proposed Use Name A dress City State/Zip Telephone # ~t':\~l.il~KQfm~~~t~w,~1;m_~!'i,~~{~1~~W~::.~&t\!'litW&f1;!~~1,~;]fe.J\'!ff~~'/iii,~!:l0.1~}jf1,t'.~if;j/1lpflhki.1/i";::~~lNi,•ll~\ii!tJ.Mtt,'i///1;#).f;f.M.i1Mtl1n½ltflltsi~'\1~i:1%i'ii!l',ti:\if/)tfifi::~,1lY~i.'\1\N::1••, Name· , Address · Gity S~ate/Zlp · Telephone# ~llr!~i~.lll!tMHQ'iiHi.1MfiNl_..~~:~tlfu:i;:-,~,6it1~ti'it~1JJJl!lYt\1~i,i,i,~~f:-1!11'~~\~'Wi,tf!;;f.1.;?tM.1:1.IBitiW!il:!'.lifiik~Jriii£1JJ1i'iri!ifj~~~it~itJ.~f!!l'.i'A~~r'·r,iJ.~f.1~i1~~-\\~~'.i:r~:'i'J'.lft'f. (Sec. 7031 ;5 Business and Professions Code: Any City or,County whlch,requires a ·permit to com;truct, alter, improve, ·demolish or repair any structure, prior to Its ·Issuance, alao requiras the applicant for such permit to file a slgnf!d 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 Sec,lon 7031.5,by any applica.nt fi;,r a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Name Address State/Zip Telephone II State License#"'. ________ _ license ,Class--'---------City Business License # _______ _ Designer Name Address· City StatelZip Telephone State License # ___________ _ 1,~a~Muu.-MNoa-.~wlij'.~W~li1,~:~~,r~11:r,(©!ifrJ~i~t~.\i/i~~~~i~1~11;:;i:~~11·:~A11~r'.!i.!~:@t:li!lultii;f!1!.'.lri~i'i~¥ii\~1\ki}.t6~.i,~\\!;;;,~t1~·;;t}:;i;i;i;;;,; Workers' Corrip_ensation Declan,tiOl'I: I hereby ~ffirm under penalty ofperj!Jry·one of the following de9larations: 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 of the work ·for which this permit Is Issued. D 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 c.arrier and policy numl>er are: Insurance Company __________________ _,.--~-Polley No._____________ Expiration Qate _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) 0 .CERTIFICATE OF EXEMPTION: I certify that in tl)e performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as ·to become ilubject to ~he Workers' ·compensatic;m Laws of California. WARNING: Failure to Hewe worken' compensation cowrage· la unlawful, and ahall aubject an employer to criminal penalt1111 and civil fines up to one hundred thouaand dollars ($100,000i, In addltlon,to the coat of compenutlon, daniage~ as provldlld'for In Section 3706 of the Labor code, Interest and attorney's fees. SIGNATURE. __________ "-'-------------------DATE-,-_______ _ r.,~.~"}'\\il:ifwu·ia ...... ,r,u-·a..-~v,'l/1~,:.1!1,11·1>1. :· ·.:-.a 1ii.'.1~-111t1\.<ii,~;,~ym;.,iw~ll" ... ~:<11iil:'l!l!Jl>iw.11,tfJ,.'lt""~"'l)i!i/'liin11~Tu1:i.'..?:~t'~t!~1,,,,1,t,,';1ltr,.tl;,:1~~¼c",,.,;,'.r1f1·,r1i,a·tt!t.1i, ir,1•ii.,:u::f,J,.,i .. t,,;;;i:~tt,:>t.,i:M, '.!,::1,~ti1 .. ,<, -; .. ,. :·: :, ,'. . ,tl!1;-~·~,..,,.~!l',,,.-:•l'R.~ ~~lf!v.ulft'~~W.lll .~'"1fli1:i!f:til!rilf'iJ.-~!~-r.t~,~11w,umm1~11<,.J~~irf.1r{m.f j'jl~JT~. •,t•I !::'~ ~ij~"if.-i.'i.J !!~. :m .~. !ll-i 1%>Jib.,.:~ !Y.Kh ~ 'lin ~. 1N.1ri l' 'f.t ._ij;<J!fli::,;t.}iifl \; !. I,-",~'!, .. ,~ J>l! ..... ':.•., ""--~ • , ... ,,,, •o:•i h I, :. • • I hereby affirm that I am exempt from the Contractor's Llcen111 Law for the followtn·g reason: 0 I, as owoer of the property or my employees with wages as their sole coropensatlon, will do the work and the structure is not intended or. offered for sale (Sec. 7044, B·1,1siness 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 him111lf or through his own employees, provided that such improvements are not inte.nded or offered for sale. If, however, the building or improvel'T\ent 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(sl licensed pursuant to the Contractor's Llcen111 Law), 0 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. 0 YES ONO 2, Hhave / have·not).signed an application for a building permit for the proposed work. 3, r have co11tractedwith 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 followi~g person to coordinate, supervis.e and provide the major work (include name / address / phone number / contractors licensa number): · 5. I .will provide some of the work, but I have contracted (hired) the following pe,rsons to provide the work indicated (include name / address / phone number / type of wcirk):. _________ '--....:..-----------------,,---~-----------~----------------- PROPERTY OWNER SIGNATURE_,,...-------------,---,--'-----.,--'---DATE ____ ...,... ___ _ /i-nii,\iia(i;frioiiri:,i~iiiiiCin>:1.We~~~"j'j,ri;if_iiiioiiti:AJ.WYa'ilajlj'Ui!isiu'n'llii!n•j•~&!>:1..ic,v'.J,~"'1,\f:1',,~1.,ii)~~-·fhc'<:i.:i1;,,)~,1·'(,,',,1/l,,f{"!~\·\'-'>'//1tjt;i;t,{illt.'li'.,"g,u,!,,;iJ:Jm,~.·,o"i1: ~;;.~;,.½ ~--', ·.·,.,,.,,. ,,,c,e~ ~· ,,>.JI, ,,,_Jl<!,,-t/lllll!P,.,,,,<.."'1.M" .. "",;.tg:;r,yn,,_....,.,_,.,.,fi"_,<_~ Hli!\!~.!!l.ill/!i,Offllli.!.Sll,!;t~. \l.'3'1<\ll'.,,J'i~'°'·""'\ :Jl5,,f!,;aJ,l s,\ii.i! "'I .,'!!M.~.H'l!,M,,sm..::••m/t"S.Sl:l'i!liiJirut;lt::fl,!,1'.<r,..!'t ,,M'\t,, i,c'.!,:1-\i•i >,'.,.'-', ,;.rf·.c,1>11i1.\!. 'c,' Is the-applican, or future building occupant required to sµbmit a business plan, acutely· hazardous materials registration form or risk management and prevention program und~r Sections 25505, 25533 or 25534 of the Presley-Tanner HazardqiJs Substance Account Act? 0 YES D NO Is the applicant.or future building occupant required to obtain a permit from the air ~ollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer·boundar.y of a school site? 0 YES O 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 • . ii~CI1iij!ti~~.ORf&al1~.DINit•1~Ifiiil~&l~~~~~)iJj\~:~J.¼!~l,~n~t~t;.\fJ~~:ft~~ii~t/ir~~~:::ii~l:.~~.~Jr~~t11.;~~~~J}~;~ii~\i>~QJ~;::!~:.fJ~~~~~:.~i. f.(;;~~~: ~~;.~;.·~ ~ I 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). LENpER'S NAME ____ '------------LENDER'S ADDRESS ________________________ _ ltRl-~ctMaftlflMN~•lt~~~~-m~tilt~:i~'tti:.n~ti~~~~J~~~~lriifurf>Jik.~\~l1~1i~i~1:t&~~~~~f~:1~~~i~IM*~)fi:tTu~,f,f.t;t1~~li~~1~~1~~;ri~n)J~¾~lJ~Hr&!~ti'8i~~"ti~;~:~;~l;W,:P;:t):~~11!){1. ·1 certify that I h~ve read the application and state that the above Information is correct and that t~e 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 Cltt of Carlsbad to enter upon the above mentioned property for inspection purposes. ,I ALSO AGREE TO S~VE, 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 e-building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authoriZE!d by such permitis not com , need within 180 days from the date of.such permit or if the building or work authorized by such permit Is suspended or abandoned _ )al any time.after the work Is co d for a peri ~f 18 ·days (,ct!oJ 1 r. .4.4 U 'form Building Code). \_)(APPLICANT'S SIGNATURE -{}.__Yz; J ~ DATE _...;&,""-'-/4..:0.::..~ ... tt: _______ _ ) . :~ •' ~ ~· '\ BU IL DING 'pt RM IT . Peimit. No: CB910165 .,ProjeCt No: A..90-01429 pevelo)?ineri.t No: 02704/91 09:20 Page .·-1 of 1 Job Address: 1958 KELLOGG AV . Permit Type: ELECTRICAL Parcel No: Valuation: Construction Type: NEW Occupancy Group: 0 Description:_ TEMPORARY POWER. Str: Fl: 'Ste: . 0706 02/04/91. 000.1 01 -02 C--PRMT 15 *t:rr Cla.s_ s Code.: · Appl/Ownr SMITH CONSULTING ARCHITECTS- 9868 SCRANTON RD #150 Status:· . ISSUED A)?plie9 :. 02/04/91 .·_A_pr/.Issue: 02./04/91 . . Validated By: LG 619-452-3188 SAN DIEGO CA 92~21 '*** Fees Required *** /' -------------------------L- Fees: Adjustments: Total Fees: .• ·_APPROVAL_.._ u.~---DATE. ·o? ~3 1/ CITY OF CARLSBAD . . . 2075 Las Palmas Dr., Carlsbad CA 92009 ((>19) 438.:.1161 PERMIT APPLICATION • City of Carlsbad Bui'lding Department 2075 La~ Palmas Dr.; Carlsoad, CA 92009 ( 619) ·438··1161 . EST -VAL'-'"-'-'---"----,------_;__;___, __ _ 'PLAN Cl( DEPOSIT, __ -,-;. ___ ---'----"---- ' . 1; PERMIT TYPE : VALID~ BY..,... __ -.,..__'--__ ..,:.!.__,;'----- DATI; ...... ,.....-,--..... ----'----,--.,.,..-~ A' -~ COMMERCIAL B • 0 INDUSTRIAL C • 'ORESIDENTIAL QAP.ARTMENT ODUPlEX ODEMOL!TI0N QMECHANICAL OPOOL TENANT IMPROVEMENT. ' [:;}TENANT IMPROVEMENT , ,0C0ND0 OSINGLE FAMILY DWELLiNG [JADDfUON/ALT!:RATiON ORE'l0CATI0N OM0BILE HOME 'OELECTRICAL (]PLUMBING OsPA ._OliETAINING WALL OsoLAR 2. PLAN CHECK No. F Subdivision Name,Nunber Phase No:· CHEq: BELCII IF SUIIIIITTED: 0 2 Energy Cales 02 Structura~ Cales D 2 soi Ls Report D 1 Addressed Envetope. ASSESSOR'S PARCEL EXfSTING:,use.' . PR0P0'SEQ USE ~ \~ ~eNA'\ ~ , _ BLDG. SQ. FTG. \ . # OF STORIES 3 ~--'CONTACT PERSON NAME ADDRESS Z_IP COOE CITY STATE DAY TELEPHONE S!'GNATURE 4. APPLICANT D CONTRACTOR 0 AGENT FOR CONTRACTOR ADDRE~S OowNER. Cj AGENJ FOR OWNER. NAME CITY STATE ZIP CODE DAY_ TELEPHONE 5. PROPERTY OWN~R OWNER OLESSEE QTENANT 7. 8. NAME CITY ~IGNATURE_ DES l GNER NAME CITY STATE STAT~< SµJ__E LIC, # 2':fS' p 7 I_)~ STATE, -ADDR~SS ZIP CODE QAY TELE.PHO.NE ADDRESS ZIP CODE s -~; ,"'-L ~ ,LICENSE C~ASS _____ _ 'ADDRESS .. ZIP COOE DAY TEkEPH0NE 1)\ 't) 'E;° Lt' S CITY' BUSINESS L!C. # DATE DAY. TE,LEPH0N!: WORKERS' COMPENSATION . . . . . .. STATE L!C. # Workers• Compensation Declaration: I hereby affirm that I have.a cert-ificate-of consent to·s·eli·insure:issued by theDirecfor of Industrial.Relations, or a certificate of Workers• Compensation, Insurance by .an aanitted ,insurer., or an exact copy or duplicate thereof, certified by the Di.rector of t_he insurer thereof filed with the Building lnspect,ior:, Department (~ect.ion 3800, Lab. C). INS.URANCE COMPANY POLICY NO.. EXPIRAH0N'jJATE Certi-ficate of Exemption: I certify that in the performance of the.work for which this permit •is, i.ssued,' shal'l not en-ploy an_y person' in·~ny manner so as to become subject to the Workers I Compensation· laws of California. SIGNATURE DATE OWNER-BUILDER DECLARATION Owner-Builder Declaration: I hereby affirm that am exempt .from the Contractor,•s License L·aw tor the 'following r'ea,son:, D I as owner of the propert,y or my en-pl,oyees with wages as their sole cornpensati on,· wi q do the week ar\d, the str\lcture Ls not intendeq or offered for sale (Sec. 7044, Business and Professions Code: The· Contractor Is L h:ense Law, does-not apply ,to an ow~er of property who:builds or improves, there-on,,, ans! ,who· does sllch work himself or through his own employees, provic;fed that such improvemer,ts. are not .int~nded qr offered for ,sale •. rt, however, the buildfng -or in-provement is sold within one year of completion, the owner-builder will have the.burden of proving J:hat .he qid not bui.ld or in-prove for the purpose of sale.). -· D -I, ,as owner of the property, am exclusively contracting with licensed con.tractors to construct the project (Sec. 70Z4,·Busin,ess and Profession~ Code:, The Contractor Is Li,cense Law does not apply to an owner of property .who bui lqs or irnprov~s thereon, and contracts for such pr.ejects with contractor(s) licensed pursuant to the Contractor 1s License Law).,, · · JJ-I am exen-pt under ·section ___________ Business _and Profes,iions Code for this reason: (Sec. 7031-.5 Business and Professions Code: Any City or County which, requires a-permit to construct, alter; irnpro.ve, .demolish,, or. repair any structure, prior to its issuance, also requires the appl icarit for such permit to file a signed statement that he is licensed 'pursuant ,to· the provisions of the Contractor's License Law (Chapter 9, c011111encing with Section 7000 of Di.vision 3 of the Business and·i>rofessi9ris Cod~) or that he is exen-pt _therefrom, and the basis fqr the alleged exemption. Any violation of Section 7031.5 by any applicant for a···permi-t subjects the applicant to a civil·perial'ty of not more thah five hundred aol lars [$500]). · ' SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMJT.S ONLY: - 1$ the applicant or futur.e building occupant required ·to submit a bus_iness plan, acutely haz'ardou; materials registration 'term or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Subst_ance Ac.count Act.? ' DYES ONO rs the appl-icant or fui:ure,building occupant required to obtafn a permit from the air pollution control d_istrict or ai.r tjual-ity management district?_ DYES ONO ls the fac_il ity to be constructed ,within 1,000 feet of the outer boundary of a school site? 0,YES · IF A!IY'0F THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED' l,FTER JULY 1,''f989·UNLESS THE),PP.l:ICANT HAS MET QR IS'ilEETING THE REIIUl~EMENTS OF THE OFFICE OF EMERGENCY. SERVICES AN!? THE AIR POLLUTION CONTROL D!STRWT. 9;. .CONSTRUCTION LENDING AGENCY i, hereby affirm that there is a construction lending agency for the performance of the wo;k for which this per111it is fasued (Sec 3097c:i~ Civil Code). !:ENDER IS NAME LENDER '.S ADDRESS 10. APPLICANT'S SIGNATURE . . l -certi,fy that I have read the application and state that the above infor.mation 'is c'orrect. I agcee 'to comply witti aU Ci-ty ordinances and State laws ,ret·ating· 'to 'bui'lding construction. I hereby authorize representatives of the City of Carlsbad: to enter upon· the abo.ve men~ioned pr.operty for inspection purposes. I ALSO AGREE to SAVE INDEMNIFY AND KEEP HARMLESS THE ClT.Y OF CARLSBAD AGAINST ALL LIABll:lTIES, ,JtDGMENTS, COSTS ~ND· EXPE/1.Sl:S 11,HICH, MA'( IN ANY WAY ,ACCRUE AGAINST SAID CITY, IN CONSEQUENCE OF THE GRANTING OF THIS PERMU.. . Expiration. Ever,y permit issued by the Building 0ffici'al under the provisions of this Code shall expirJ by :limitiition and l:!ecome, nun_-and void.H the building -or work authori.zed by such permit is not c011111enced within 18Q days from the date of such permit or if the huitding or work author:izec;I by such permi't is suspended or abandoned at any time after the work is. c011111enced· for a period of 180 c;fays .(Section 303(d) Uhiforl]l Bu.ilding Code). APYvW~ ~ o_owNER ~ONTRACTOR ·OBY PH_ONE . W.HITE: .File YELLOW, Applicant PIN'K: Finance APi>ROVEli~iiY i: .,,.--_:·, .,.-·::~.:,,, .. ·~· ~-,.,..,..,.,..,--,-.,,.,.. P.M'E~. -~· ....... _,. ....... ~~ ....... -,-- I UNSCHEDULED INSPECTIO~ -..:-::..OA-T!: __ c;;;_~_c:;_3 ___ ---9_/___ INSPECTOR_ ..... ~---------------- PERMIT# -------PLANCK# ------- JOB ADDRESS z9fo: ~//4~Cj __ ..__ ......... ....._ ____ u.+u-+---------,-------'---- TIME ARRIVE: _____ TIME LEAVE: __ -__ _ CD LVL DESCRIPTION ACT COl'fMENTS T~ Po-v---~ £:t,f(L, r . ~ J./4&/4~5 B U ! L D I N G p, E R M l: T Permit No:-CB911039 Project No: ·A9001429 Dev:e·lopment No: 07_/17/91 11:52 Page 1. of 1 Job Address:. 1958 KELLOGG AV Permit Type: ELECTRICAL Parcel No: · Valuation: 0 Construction Type: NEW Occupancy Group~. Class. Code: Pescription: TEST METER PER CAMERO Appl/Ownr \ '\ Str.: 818 CITY OF CARLSBAD . Fl·: . -· . Ste: . 35.f,0 ,07/17/91 0001 01 02 C--PRMT Status: Applied: , Apr/Issue: . Validated By·: 843-20~0 . ' 30-00 IS.SUED. 07/17/91 07/17/91 DC ,..-· 2075 Las Palmas Or., Carlsbad CA 92009 (619) 43~1161. ' > Ji PERMIT APPUCATION a V PLAN CHECK NO. City of Carlsbad Building Depart111er1t 2075 Las Palms Dr., Carlsbad, CA 92009 (619) 438-1161 FSf. VAL~-----------PLAN CK DEPOSIT. _______ _ VAIJD.BY __________ _ 1. PERMII IYPE DATE. ____________ _ A -LI Commercial LI New Buddmg LI Tenant Improvement B -D Industrial D New Building D Tenant Improvement . C -0 Residential D Apartment D Condo O Single Family Dwelling D Addition/ Alteration D Duplex D Demolition D Relocation D Mobile Horne D Electrical D Plumbing 0 Mechanical O Pool Cl Spa Cl Retaining Wall Cl Solar O Other ____ _ 2. PRQJECT INFORMATION FOR OFFICE USE ONLY mt o. CHECK BEWW IF SOBMl'l t'ED: D 2 Energy Cales D 2 Structural Cales D 2 Soils Report Cl 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK~ .,# \ ----+----~ ~OF~ 3. WN IACI PERSON (If dllferent from apphcantJ NAME ADDRESS CI1Y STATE ZIP CODE DAY TELEPHONE 4. XPPUCAN'f NAME OCON'IRACIOR DAGEN! FORcoN'IRACIOR DOWNER DAGEN'l'PQROWNER ADDRESS CI1Y STATE ZIP CODE DAY TELEPHONE S. PROPEltlY UWNER . NAME ADDRESS CI1Y STATE ZW CODE . DAY TELEPHON:E: 6. cDN'l'RActuR 11 , t _ NAME fY'. ~Lctif'N\, t:..\Ct (!__E>l"-'a.(. ADDRESS 2.'50"1 Ewt~t',,...c,... Aue.• CI1Y ~u t\t.>a.-k STATE C..a.. Z·IPCODE ql'°50({ DAYTELEPHONE ~($) 0'{"$-Z.01 Q ~RNAME STATE LIC. # '2.'15151 LiCENSE CLASS t> CI1Y BUSINESS LIC. # ADDRESS ZIP CODE STATE DAY TELEPHONE STATELIC. # 1. WOR.KiltS' WMPENSA.fiON Workers' Compensation Declaration: I hereby afhrrn that I have a ceruhcate of consent to self-msure issued by the Director of Industnal 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 Cernfo:ate of Exemption: I cerufy that m the performance of the work for which this perrnll 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. OWNim:-BUllDER DECLARATION D D D owner-BUIider Declaration: I hereby affirm that I am exempt from the Contracto?s Llcense Law for the followmg reason: 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 wqo 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.). 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: (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 qf 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]) . .. SJGNATURE · ---· DATE coMPLETE tHls SEciioN FOR NON-RESIDENTIAL BVILDING PERMITS oNLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardo.us materials registration form or risk management and prevention program under Sections 25505~ 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 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? DYES CJ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES D NO IF ANY OF TIIE ANSWERS ARE YES, A FINAL CERTIFICATE OF CXDJl>ANCY MAY Nor BE ISSUED AFrER JULY 1, 1989 ~ TIIE APPUCANT HAS MET OR IS MEETING TIIE REQUIREMEN1'S-OF nm OFFICEOF EMERGENCY SERVICES AND TIIE AIR POILUTION OONTilOLDISTIUCT. 9. OONSIR0CIIDN mNDING AGENCY . 1 hereby afhrm that there 1s a construction lendmg agency for the performance of the work for which this permit 1s 1~sued (Sec 3097(1) C1vd Code). ' LENDER'S NAME LENDER'S ADDRESS 10. APPLicANt Cilt'llFICATION I cerufy that I have read the apphcat1on and state that the ,!bove mformauon 1s correct. I agree to comply with all 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 Al.SO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS TIIE CITY OF CARISBAD AGAINSf AIL UABILITIFS, JUDGMENTS, OOSTS AND EXPENSES WffiCH MAY IN ANY WAY AallUE AGAINSf SAID CITY IN OONSEQUENCE OF TIIE GRANTING OF TIIlS 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 365 days from the date of such permit or if the building or work authorized by such permit is su~pe ded bandoned at any time after the work is commencec;I for a period of 180 days (Section 303(d) Uniro,j Buildin~, Code). APPU:hGNATU ,' . DATE, 7µ 7 / q / ~v.JM .. c WHITE: File YELl..OW: Applicant PINK: Finance 1 ,I l ·l ' ,, ·; ./ j 'j • J ·j ' l ' City of Carlsbad S--=ffiiNii,t·l•l4·Ei#i,,t4,ii SUBJECT: TESTING ELECTRICAL METER ON PERMANENT BASIS Clearance of the meter located at .. q S <2> ~ is for testing purposes only. It expires ln 30 days. Issuance o hi permit does not imply that the project is finalized or that a Certificate of Occupancy has been issued. The building will not be approved' for occupancy until all applicable City departments have c;tpproved the project. Please return this statement with your signature. The meter will be cleared through the San Diego Gas and Electric Company by the Building Inspector of record. Th~nk you for your cooperation .. TONY MATA Principal Building Inspector Applicant _11\A ____ ~_~........,__ ___ _ Date: _____ 7_· _,_1 .... 7_-_o/._'/ _____ ____ Approved By: 1, \ cc: Fire Marshall 2075 Las Palmas Drive • Carlspad, California 92009 • (619) 438-1161 \. '