HomeMy WebLinkAbout201 GRAND AVE; ; CB950632; Permit6 t.r I L D I N G PER I T
09:2 3
VKT«°Job Ad,3ress: ^01 GRAND AV
Permit Type : MISCELLANEOUS
Parcel No: 2U3-232-15-UU
Valuation: u
Construction Type: VN
Suite
Reference*:
Status: ISSUED
Anplie-3: 05/19/9
Entered By: MDI1
619 597-7070
SAN DIEGO, CA. 92
Fees Required * •*,•
Fees :
Adjustments:
Total Fees:
Fee c'iescr ipt ion
Miscellaneous Fee
A- MISCELLANEOUS TC*
Credits
3 0 , U 0
Ext fee Data
719/95 0001 01 02
C-PRMT 30-00
FHWAPPROVAL
] MSP. /+£- DATE
iCLEARANCE
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
City of Carlsbad Building Department
2075 Las Palms Dr., Carlsbad, CA 92009 (619) 438-1161
1. PERMIT TYPE
From IJst 1 (see back) give code of Permit-Type:
For Residential Projects Only: From List 2 (see back) give
Code of Structure-Type:
Net Loss/Gain of Dwelling Units
2. PROJECT INFORMATION
PLAN CHECK NO.
EST.VAL
PLAN CK DEPOSIT.
VALID. BY ~
DATE
FOR OFFICE USE ONLY
Address2VONearest Cross Street
Building or Suite No.
LEGAL DESCRIPTION Lot No.Subdivision Name/Number Unit No.Phase No.
CHECK BELOW IF SUBMITTED:
D 2 Energy Calcs Q 2 Structural Calcs D 2 Soils Report D1 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROPOSED 1ISE_
DESCRIPTION OF WORK
SQ.FT.OF STORIES # OF BEDROOMS # OF BATHROOMS
3. uumACJl FtKSUNurairterent trom applicantj
NAME (last.name first)
CITY STATE
ADDRESS
ZIP CODE DAY TELEPHONE
17 APPLICANT [^CONTRACTOR LJAGLNI tOR UJNlRACIuR "JUWNKR UAbbNl rOR OWNER
NAME (last nameTirst)£i$^03V-^Q&JCtjU/iN-» ADDRESS '*"
CITY STATE ZIP CODE DAY TELEPHONE " ~tO"70
5. PROPERTY OWNER
NAME (last name first)
CITY STATE
ADDRESS
ZIP CODE DAY TELEPHONE
6. CONTRACTOR
NAMEJlast name first)
CITY STATE
ADDRESS
ZIP CODE DAY TELEPHONE
STATE LIC. #LICENSE CLASS CITY BUSINESS LIC. #
DESIGNER NAME Oast name first)ADDRESS
CITY
7. WORKERS' UUMPENSATION
STATE ZIP CODE DAY TELEPHONE STATE LIC. #
WorkersT Compensation Declaration: I hereby amrm that I nave a certificate of consent to self-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.&KJUM'ZS^EXPIRA'nON DATE ^(
Certificate of Exemption: I certify that in the performance ot the work for which mis 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
8. OWNtR-BUlLUhR DECLARAI1OM
Owner-builder Declaration: f hereby arrirm that 1 am exempt from the contractors License Law tor tne 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 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:
(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-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, 2SS33 or 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 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
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 THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
9. CUNb'lHUL'ilUPfXENDING AGENtJf
I hereby affirm that there is a construction lending agency for the performance of the work tor which this permit is issued (Sec 30970) uvii code).
LENDER'S NAME LENDER'S ADDRESS
ID. APFUUWT
I certify that I have read the application and state that the above information is correct. T 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
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 S'O" 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 abaiddjiedat any time fcfter thefaofft is commenced fora period of 180 days (Section 303(d) Uniform Buildjii
APPLICANTS SIGNATURE \ \ \ ^ . f \\ S* L \* \ I . i ^ DATE: 5/1q|
WHITE: Ffle YELLOW: Applicant PINK: Finance