HomeMy WebLinkAbout1959 KELLOGG AVE; MULTI-PERMIT FILE; CB120221; Permit,,,
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Plumbing/Mechanical/Electrical (PME) Permit
02-07-2012 Permit No: CB120221
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
1959 KELLOGG AV CBAD St: ND
PME Status:
Parcel No: 2120921000 Lot#: 0 Applied:
Entered By:
Reference #: Plan Approved:
PC#: Issued:
Project Title: SDG&E NETWORK DEVICE;-100 AMP Inspect Area:
POWER PEblSTAL FOR SMART METER SIGNAL RELAY
Applicant:
PAR ELECTRICAL CONTRACTORS
2410 VINEYARD AV
92029
760-291-1192
Plumbing Fees
Electrical Fees
Mechanical Fees
Other PME Fees
TOTAL PERMIT FEES
Owner:
KELLOGG LL C
C/O LEAF & COLI;
2810 CAMINO DEL RIOS #200
SAN DIEGO CA 92108
ISSUED
02/07/2012
RMA
02/07/2012
02/07/2012
$0.00
$150.00
$0.00
$0.00
$150.00
Total Fees: $150.00 Total Payments To Date: $150.00 Balance Due:
/ l, I ~' I ~ <
Inspector: Clearance: ,._, ·}.. "--\ le
$0.00
NOTICE: Please take NOTI al of your project includes the "lmpositio "of fees, dedications, reservations, or other exactions hereafter collectively
referred t9 as "fees/exactions. days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in vernment Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that'your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
fee /ex c ion f whi h hav r vi ' n iv ri N Tl imil r hi r s whi h the s atute f limitati ns has reviousl otheiwise ex ired.
«~ ~ CITY OF
CARLSBAD
JOB ADDRESS ·
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
760-602-271.7 I 2718 / 2719
Fax 760-602-8558
www.carlsbadca;gov
Plan Check No.
Est. Value
SWPPP
CT/PROJECT# #BEDROOMS #BATHROOMS CONSTR. 1YPE OCC. GROUP
. . . . .
--. ,~ ~--; -----.. -~ ·_
DESCRIPTION OF WORK: Include Square Feet of Affected Area(s)
~:\') · · ¢<\,~~ · t trO' A-f<VC' -e <J.w-e.( pe;o4~
-·fu<L :s-o'9lt .-·~ro~ ~ ~et-A-VJ
EXISTING USE . PR9P9S'iP USE
APPLICANTNAME(Pr/mary Contact) PAA:~~'j'(t.{·~
PROPERTY OWNER NAME
ADDRESS
CITY STATE ZIP
PHONE .FAX
EMAIL
STATE~IQ.#
PATIOS ($F) FIREPLACE
YES0,
AIR CONDITIONING
No[] YES 0No D
. ; APPLICANT NAME (Secondary Contact)
ADDRESS
CITY STATE ZIP
PHONE FAX
EMAIL
: CONTRACTOR BUS. NAME 111iz._ it t€C1ibit.A-f
. ADDRESS )-j ·-/-~ ,<i O , , /· ~ :.. _:' ~-z-~'.t.L~~ 'l?J(I..-'
STATE
STATE UC.# C . . _&-~71M
FIRE SPRINKLERS
YESONoD
(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 tnat 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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five h~ndred dollars {$500)).
Workers' Compensation Declaration: I hereby affirm 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 of the work for which this permit is issued. •
E61-1 have and wlll maintain wor~ers' con:i pen_sati!>n, as required. by (:lection 3700 of the L_abor Code, for the perform~c,;;of the_ work for which this permit is is.sued,, My workers' compensation insurance carrier and policy
-A. •!l'\ n _n.,n_,. "l "I· 1~ f,. · -· · · · ')H14'11?(-(7\· 04-.:W O I i. .... ,,?... numberare:lnsuranceCo,LJV·V ~·., ... ~ .. vu... . ..... · , .... -Policy No .... : .Wt.,.: · ·. .: · . . Expiration Date ()--IJV ..
~section need not be completed if the permit is for one hundred dollars ($100) or.fess, · LJ Certificate of Exemption: I certify that in 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 dollars (&100,000), In
addition to the cost of compensation, dt ges as provided for In S lion 3706 oft Labor code, interest and attorney's fees.
Ji! (:0NTRACT0R SIGNATURE [M;GENT DATE t ~1 .,,,, 2,...
· I hereby affirm that I am exempt from 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 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 improvementis 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 th~reon, and contracts for such projects with contractor{s) licensed pursuant to the Contractor's License Law).
D I am exempt under Section :. . ·_ .:Business and Professions Code for this reason:
t I personally plan to provide the major labor and materials for construction of the proposed property improvement Dves ONo
2. I (have/ have not) signed an application for a building permit for the proposed work.
3. I have contracted with the following person {firm) to provide the proposed construction (include name address/ phone/ 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 I address/ phone/ contractors' license number):
5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name/ address I phone/ type of work):
_.g PROPERTY OWNER SIGNATURE OAGENT DATE
(
Is the applicant or future building occupant required io submit a businessb(acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the
Presley-Tanner f-lazardous Substance Account Act? 0 Yes ~ No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or a~lity management district? 0Yes Q'No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Oves L!]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.
I hereby affirm that there is a construction lending agency for the performance of the work this pennit is issued (Sec. 3097 (i) Civil Code).
Lender's Name Lender's Address
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 and State laws relating to building consbuction.
I hereby authorize repre_sentative of the City ofCarlsbad to enter upon the above mentioned property for inspection purposes. I A[SO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSB~D
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 permitissued 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 permil is not commenced within
180 days from the date of such permit or if the b ilding or work authorized by such permil is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). w ~ APPLICANT'S SIGNATURE DATE Z, / 7 -l L-
City of Carlsbad Bldg Inspection Request
For: 02/21/2012
Permit# cs120221
Title: SDG&E NETWORK DEVICE-100 AMP
Inspector Assignment ~
Description: POWER PEDIS:f AL FOR SMART METER SIGNAL RELAY
Type:PME Sub Type:
Phone: 7604976634
Job Address: 1959 KELLOGG AV
Suite: ND Lot: 0
Location: Inspector: ----
APPLICANT PAR ELECTRICAL CONTRACTORS
J ,1 ......
Owner: KELLOGG L L C
Remarks: METER PED IN PARKWAY
Total Time:
CD Description
Requested By: KEITH WOODWARD
Entered By: CHRISTINE
Act Comments C) () ..... -1--/J rw-t~/Jttf.... ff2._LlA LJI 39 Final Electrical
Date
-~~--
', Comments/Notices/Holds
Associated PORs/CVs/SWPPPs Original ~C#
Inspection History
Description Act · lnsp Comments
;11 ·,, f\ ,)
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sos/' ...,.JE
A~ Sempra Energy utility·
ELECTRIC UNDERGROUND METER & SERVICE LOCATION
Ct,s'lolJJe,-COA),
T.B. 1127-C3
Wanted Date: on inspection Service Type: UG Service New Customer Type: Commercial Date Prepared: 01/18/2012
Proiect No: 162848 I Job No: 010 t
ProiectTitle: SMART METER CR SDG&E N
ProjectAddress: 1959 KELLOGG AV ND I
Proiect Citv: CARLSBAD I Customer Phone#:
Contact: CANDICE HOLLEY I ContactPhone#: 760-291-1192
D Traffic Control Permit Required. Excavation/Encroachment Permits Required By Customer
Service Attachment Point and/or Meter Location: Contractor to locate new meter pedestal approx.
10 ft from D115152 transformer. Face pedestal toward street and maintain 3' radial
clearance around surface face of pedestal. Contractor to provide trench and 2 inch Ci-,: "19 9 Kellogg ·ND'
conduit from the transformer to new meter pedestal. Address must be permanently "'--<a: 0.. / 1 on amp pedestal
marked on meter pedestal. If selected, Contractor assumes responsibility for 0 ~ N row .....
condition of existing stubs. !.:._1-L-~ => ~o --..... :"-I
~ 1.71 ,_ n:: (9 ·r ·2 ... DB: & trenc;h· lc:9 <( ,by· coqtractor (.)~ " cc _o D SDG&E Application R~auired -Call: ·1-800-411-7343 a: UJ O _J x-sl <l.. u.. >-:::> bl i-6·1-52-. , Municioal lnsnection Reauired Bv Citv of Carlsbad ::=co 1269~7'1 ~-· :Camino Vida Hobie Meter height -4'0" min. (3'0' min. for multiple meter installation)-6'3" max. From finish grade to centerline of meter base. Meters are u required to be readily accessible 24 hours per day. Meters must be located in a safe area free of any potentially hazardous or :g dangerous condition. Provide 3-ft. X 3-ft. Minimum clear and level working space in front of meter. Where meter room is proposed, "},, a contact the planner at the nearest SDG&E office. ,. : Meter bases and meter service disconnects must be located at or immediately adjacent to each other and be identified with address CJ' ~ .
and unit number it serves.
PROCEDURE FOR INSTALLATION
1. PHONE DIG ALERT 1-800-227-2600 AT LEAST TWO DAYS PRIOR TO TRENCHING FOR LOCATION
OF UNDERGROUND UTILITIES.
2. Phone SDG&E at 760-476-5614 forthe following:
• 3 working days prior to trenching to arrange pre-meet with inspector and initiate trenching process . ... -•••I••• . . • After excavation of trench, installation of conduit and service entrance equipment at meter location, CALL \ '\ FOR INSPECTION. Do not cover conduit without inspector's written approval to backfill.
• When trench is backfilled and compacted, CALL FOR INSPECTION .
• If service entrance equipment is installed after backfill, CALL FOR INSPECTION OF THE EQUIPMENT .
3. Meter cannot be set until inspector has approved installation, including service equipment, and receipt of Additional Information: D Righf:.Of-way Required Assessor's Parcel Number:
citv/countv/state insoection clearance. · Please call your Service Coordinator Terry Zepeda at 760-476-5614 with Power Source: 1269-71 I Structure Number:. D115152
Joint Trench with: Handhole Installed bv: questions about application, inspection, construction installation and to
Standards Paae #: l:landhole Lid.Shall Read: schedule a crew.
Ladder Arms: I Stop Trench: from oole I Riser Quad:
Bend ln~talled bv: SDG&E Tvoe: Transformer 2" Db 90 deQree 24"RDB60 If SDG&E encounters haza-dous or toxic material v.llile performing construction of yoll' project, SDG&E will halt work immediately md it will be yolJ'
Conduit Installed bv: Customer Conduit Size: 1-2" DB responsibility lo remove and/or clean up all hazardous or toxic material prior to SDG&E continuing construction. SDG&E shall have no !ability or obligation v.llatsoever lo cleoo up, remove or re mediate any hazardous or loxic materials discovered during the course of cons!ruction unless It is through negfigence of
Service Panel Rating: 100 Number/Size of Main Switch: Voltage: 120/24Q SDG&E. Customer-o'Mled faciities lo receive electrical service are subject to all appicable iqcal and state of Caifomia inspection authority requlremen!s. Bulkling
#of Wires: 3 Phase: Sinale Ufinties Maximum Contribution to Fault Current 42000 Amps address and/or meter base must be posted poor to meter set Information on this sheet Is void after six (6) months from date. Keep this notice with bulkling peni11t
Meterina: Self-Contained, Test Bvoass Facilities Rard Meter Clios: 4 Planner: LOIS A HIGGINS I Telephone: 760-476-5613
t ,,, ,
CJ
Temo Service'Charae Due on First Bill$
C, ,~oa.l1
·,-. ..,
06/25/9·0 10: 42
Page._ 1 of 1
B µIL DI.NG· PE 8 M·I T·
.J:ob° Address: 1959. KELLOGG AV Str:
P~rmit Type: ELECTRICAL
· Parcel No:
Valu~tion: O
Cons-t;:ructioli Type: NEW
Occ,Upancy Group: Class Code-::'
Description: IRRIGATION PEDESTAL
:
Fermi t. No: CB~o104.8
_ :J?:toje.ct ·_No: A:9001151.
_ bev:~lopmen-t;: No:
-Fl~ : . Ste-:
6330 .06/25/90 0001 -~1 .
· ·:' . . _ . -C.;.Pfi5'1T 02.
.15~{)0. · . {" -..
,. ·. _S-ta-tus; ,IS.SUED-
Apt;>;Lied .0-6/25/9·0
~pr/I:;f.$.µ.e .o,_6/i°s)~o-
. Valid-at~d B¥ t -_·RS-.
CONTRACTOR . Lie. C _501_3 34
' '
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" ,;·-... ·.~1 !
CAY. OF CARJ,.SOBAP . .
2075 Las Palni~ Dr.,. Carlsbad CA-9~009 (619) 43?-1161
,,
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, . --~ ...
' I,. •
I
·. :I
•
PERMIT# CB901048
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 09/25/90
DESCRIPTION: IRRIGATION PEDESTAL
TY-PE: ELEC
INSPECTOR AREA PD
PLANCK# CB901048
OCC GRP
CONSTR. TYPE NEW
STR: FL: STE: JOB ADDRESS: 1959
APPLICANT: PATTERSON
CONTRACTOR: PATTERSON
OWNER:
KELLOGG AV
BROTHERS LIGHTING
BROTHERS LIGHTING
PHONE: 619-462-2223
PHONE: 619-447-2636
REMARKS: T1/MH/BRIAN/462-2223
SPECIAL INSTRUCT:
TOTAL TIME:
CD LVL .DESCRIPTION
39 EL Final Electrical
----------------------
------------"-------------,--------------------------
PHONE: /} /J 1\ .... /J /l
INSPECTOR ~ ~ .. ,...,fb..
ACT COMMENTS tf __________ _
***** INSPECTION HISTORY*****
DATE DESCR;I:PTION ACT INSP COMMENTS
~·
\ ' \
PERMIT APPLICATION
•
••
City of Carlsbad Bu~lding Department
20.75 las Palmas Dr., Carlsbad, CA 92009 (~19) 438-1161 . EST. VAL _ _,,.._.,.....-~ ...... -'-"---,-------
PLAN CK DEPOSiT-'--"-----:------'----'--
, VALID .. BY~: ----''-------'---'-------'---"--
.
1.. PERMIT TYPE . i>ATE ..,,...-,--~---,-,--c.-.;.--...,.. ____ _
A -0'COMMERCIAL TENANT IMPROVEMENT
B -D INDLi$TR!AL DNEW 0TENANJ IMPROVEMENT
C -'0RES!DENT!AL, 0APARTMENT 0CONDO 0SlNGlE FI\Ml[Y DWELLING 0ADDl·TlON/ALTERAT!ON
[JDUPLEX [!i>EMOLIT!ON 0RELOCAT!ON 0MOB!LE HOME ~TR!CAL 0PLUMB!NG
,OHECHANICAL OPooL OsPA OREJAINING WALL -DsoLAR [j·oTHER
2. PROJECT .INFORMATION PLAN CHECK No. F
Addre_ss Buildin
Ne~rest _ Ctoss ~tre~ts
LEGAL DESCRIPTION Lot No: .ti(,, Subdivision Name/Nurber , Unit No. Phase No. "'772/k r
CHECK BELOII IF SUllfl ITTED: 0 2 Energy Cales. . []2 .Structural Cales D 2 Soils Report D 1 Addressed Envelcipe
> AS.SESSOR Is PARCEL EXiST!NG USE. . .. PROPOSED ·lJsE
loo Amf' VhG~ llBcl •. ~v $i2/l~!JC&dW7rJ~ ~Le
BLDG, SQ. FT.G. # OF STORIE'S
3. ·coNTACT Pi:;RSON
.NAME ADDRESS
CITY STATE ZIP CODE DAY TELEPHO~E
_ S_IGNATURE 4: -APPLICANT D CONTRACTOR D AGENT FOR CONTRACTOR OO'ilNER 0.AGENT ioR OWNER·
NAME ADDRESS
Cl-TY STATE _ZIP C_ODE DAY TELEPH_OijE_
5. PROPERTY OWNER OWNER ::o LESSEE · ' ·OTENANT
NAME ADDRESS
CITY STATE ZIP CODE DAY_ )ELEp~ONE;,
6 ~ CONTrCTOR --.
_ -N~ME Pt-rre,esc,,J 61tci>Th-evs L~.!lkni-v s ;:Q,.IC, ADDRE,SS 1"t ~ &' Do/...a,!l'ce.s. s.+:
' '
CITY S-f~11\lu VA-U~
SIGNATURE
DES I GNER NAME
CITY
STATE LIC. #
STATE_ Cct. ZIP CODE '9Wi7
STATE
LICENSE· CLASS ·C-[0
.T!JLE t'Y'eSLc!eV\..--1-
ADDRESS
ZIP CODE
DAY TE~EPHONE 4& z_ ~ '2-?,2 s
city BUSINESS L!C. # ·, 81 rloo
DATE: h ~'2,~ • C/fJ
DAY '(ELEP_ijQ/IE STATE LIC,_ # . 1: WORKERS' COMPENSATION
Workers• Compensation Declara'tion: · hereby affirm that I have a certificate of cons·e~i t~ ·~et'f-ins~~e iss,u~--i,y ·ttt~·oi~ector pf 'industrial ReJafi9ns·,
or a· certificate of Workers• Compensation Insurance by an aailitted insurer, or an exac;t copy or oupl icate thereof· 9~ftified by the Director ,of 'the·
insurer thereof filed ,wi·th the Building Inspection Department (Section 3800, Lab. C). · ·
. INSURANC,E COMPANY "Th-e-z~ \~ Co. POLICY NCJ, P-oo st,~ID E_XPIRATION DATE ,---'11>
Certificate of Exewption: I certify that in the performance of the work for which· this permit is issued, I shat.l not emp~oy any person in any manner
so as to bec()!Tie subject to the Workers• Compensation Laws of California. '
SfGNATURE-0/\TE
8.. OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor'':s ·Lic·ense Law for the foll·owing reason;·
0 I as ·owner of the property or my ewployees wi,th wages as_ their sole compensation, wi-U 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 byi'l\Js or -improves thereon,. and who
does such work -himself or through his own ewployeeS", provided th~t s4ch ifll)rovements are not intended or offered fpr sale., If, however, the buildfng
or impr·ovement is sold within one year of completion, the owner·bui lder will have the bur.den of proving that he -dla r\ot bui td or improve for the purpose
of sale.). -
D· I, as owner of the property, am exclusively contracti,ng with licensed contractors to cons.truct the project (Sec. 7044, ·Business and Professions Code:
The CQntractor•s License Law does not apply to an owner of property 'who builds or improves thereon, and contracts for such proj,~cts with contra·ctor(s)
licensed pursuant to the Contract6r Is License ·Law), · '
\ D I am exewpt ,under section ___________ Business and Professions· Code for this reason:
(Sec. 7031.5 BIJsines% and Professions Code: Any City or Cc;,unty which requires a permit to construct; alter, iirprove:, deinoHsh, ·or repair j,ny structure,,
prior to. itl! issuance, also requires the applicant for such permit tq ti.le a ~igi,ed statement that ~e is licenseq, pursuant ·to the ,provisions 9f the
Col}tracto~•s License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Busin~ss -an4 Professions Cqde) or that lie is exewpt ther.etrom, ·
and the basi.s for the alleged exewption. Any violation of Section ,7031..5 t,y any applicant for a permit subjects the appl ii:ant to a dvi l penatty of no.t
rili:>re than fi.ve hundred do l.l ars [$500] ) •
SIGNATURE DA1E
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY-:
Is the applicant or future building occupant required to submit a business plan,' acutely hazardous mater,ials registrat_ion. form or risk management and prevention
program under Sections 25505., 25533 or 25534 of the Presley-·Tanner Hazardous Substa.nce Account Act? · ·
DYi:s ONo • . .
Is the appl'icant or future building occupant required to obtain a permit from the ai-r p_oll_ution control district or air qua[,ity management ilistrict?
> DYES ONO
Is the fac_il ity to be constructed within 1,000 feet of the outer boundary of a school, site?
DYES o~o
IF ANY-OF THE ANS\o1ERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ,ISSUED' AFTER JUl:Y 1, 1989 !JN~ESS THE APPLiCANT HAS MET OR JS MEETING THE REQ\IIRENEJiTS
OF TH_E OFFICE OF EMERGENCY ~ERVICES AND THE Alli POL~UTI~ CONTROL DI_STR_Ji:T. -
9. CONSTRUCTION LENDING AGENCY
'I ,hereby affirm that there is a construction lending agency fqr the performance _of·the _wo~k. for whjj::h this petmit is issued (Sec 3097(i) Civil Code):
LENDER'S NAME LENDER'S ,'\DDRE$S
10. APPLICANT'S SIGNATURE
certify that I have·read the application 'and state that the above ·information is correct-. agree to comply with' all" Ci'ty·or.dinances and State laws relating
to bui-lding construction. I hereby authorize -repre~entatives of the Gity_of Carlsbad to enter upon 'the above mentioned·proper-W for inspection purp,oses,. I At:Sci
AGREE TO-SAVE INDEMNIFY AND KEEP HARMLESS THE ·CITY OF CARLSBAD AGAINST ALL LIABILITIES, JOOGMENTS, c~rs ANI? 'EXPEN,S_l;S IIHJCH :MAY IN ANY WAY. ACCRUE AGAINST !iAID
CITY IN CONSEQUENCE OF THE ·GRANTING OF THIS PERMl"T. . -. . ,
Expir'!tion. E.very permit i~sued by the Building Official under the provisi'ons of tbis Co\Je shall expfre by l-imitation and become null ar\d ,;oid if !h~ ·builping
or work autlibrized by such permit is not COITITlenced within 180 days from· the ·date of ,such permft or, if the buj lcling·or work-authorized 'by such permi-t is suspended:
·.or abpndonec! at any t.ime after the work is cOITITlenced for a period of 1?0 days (Sect'ion 303(d) 4nif,orm Bui'lding Code). · · ·
. 0-0WNER ~CTOR -6:Bv PHONE _ _ . . APP.ROYED'':at;· _' "-"-----'.;.;..,._~ o~n:;. _·_·;.._· -'-""--'-'--'----"'-----'""
WHITE:. File YELLOW: Applicant. -P'INK: Financ,e