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Home My WebLink About2041 JANIS WAY; ; CB960024; Permit01/04/9t> lJ:·o Pacre l ot 1 B U I L D I N G P E R M I r Job Address: ~u41 .JANI~, WY Suite: Permit Type: PLLlMBING Parcel No: 2C5-1SJ-lJ-U0 Lot#: Permit NC): P1oiect No: Dcve:opment No: 1_ .'BJt:,( lJl4 A9oLU iq • Vdlt1cit1on: u Construction ~ype: NEW Occupancy Group: Reference#: ~escr1ption: CONVERT BATHTUB TO SHOWER Appl/Owru GALI, NANCY 21141 JANIS WAY CARLSBAD, CA 920U~ Status: Applied: Apr/Is::;ue: Entered By: 619- I .:,!::IUE[i 01/,14/Yb Ut/04/30 :--<MA Fees Required A * A Fee Lollected & Credits Fees: '20.00 Adjustments: Total Fees: Fee description -----------------r------------------ Total reel ts: Total c\yments: Balance Due: Units 'Fee/Unit .UIJ .UO 2Ll.OU Ext fpe Data -------------------------------------------------------------------------- Enter "Y" for Plum! 1r:ig * PLUMBING TOTAL CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 20.UU Y 20,0U PERMIT APPIJCATION PLAN CHECK NO. q &--~ ~ City of Carlsbad Building Department 2075 Las Palaas Dr., carlsbad, CA 92009 (619) 438·1161 ~. VAL. __________ _ 1. PERMl'I' 1YPE PLAN CK DEPOSIT, _______ _ VAIID.BY __________ _ From Llst 1 (see back) give code of Pennie-Type: __ /1.L..Cf,,lf,1-::..:..._~"""-------- DATE For Residential Projects Only: From Llst 2 (see back) give Code of Structure-Type: _____________________ _ Net Loss/Gain of Dwelling Units __________________ _ FOR OFFICE USE ONLY Address -z.o...t 1 .J""'..., ,.::. Building or Suite No. Nearest Cross Street LEGAL DESCRIPTION Lot No. Su&l1V1s1on Name/Number Unit No. Phase No. CHECK BEWW IF sUBMil IEO: □ 2 Energy Gales □ 2 Structural Gales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK ~c--fa .~~ SQ. IT. # OF STORIES # OF BEDROOMS # OF BATIIROOMS 3. WN IACI PERSON (1f dmerenf from apphcantJ NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 4. Al'PUCANI OCONIRACIOR □ACENI FORCONIRACIOR \L,10WNER DAGEN! FOR OWNER NAME (last name first) NA_, C-j G~ l j 1 ADDRESS 2-o&f I .J.,._,...,t":. ~ CITY ~..s, ~ STATE CA_ ZIP CODE 4 :?a2?'8 DAY TELEPHONE s. PROPER°IY oWNER NAME (last name first) ~ < ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 6. cbN'i1tACiuR C" * NAME (last name first):: .;.-~---c...~ ADDRESS CITY STATE STATE UC.# ZIP CODE LICENSE ClASS DAY TELEPHONE CITY BUSINESS UC. # DESIGNER NAME (last name hrst) CITY STATE ZIP CODE ADDRESS DAY TELEPHONE STATE UC.# 7. WoRl<ERS UJMPENsAlioN workers' Compensation Declarauon: I hereby alhrm that I have a ceruhcate of consent to self-insure issued by the Director of lndusmal 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 ExemptJOn: I certify that in the performance of the work tor which this penn1t 1s issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Galifornia. SIGNATURE DATE s. oWNElt-80llDEit b&J.AltA'l1oN Owner-Builder Declarauon: I hereby athnn that I am exempt from the Contractors Dcense Law for the following reason: fia7 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 I'" 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.). □ 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 P ions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its i ua ce, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac r's cense Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt refro , and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applican o a ci I penal f not more than five hundred dollars ($500)). SIGNATURE DATE /- Is the applic or future building occ 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 □ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ YES □ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school sire? □ YES □ NO IF ANY OF THE ANSWERS ARE YES, A FINAL crn11FICATE OF oa:lJPANCY MAY Nor BE L!;iSU1ID AFrER JULY l, 1989 UNLESS 11-IE APPLICANT HAS MET OR IS MEETING nm REQUIREMENTS OF THE omCE OF EMERGENCY SERVICES AND THE AIR POllUTION OONTilOL DISllUCT. 9. cbNS'ntUCI ION 1.DWINC ACENCV I hereby all1rm that there 1s a construction lending agency tor the performance of the work tor which this permit 1s issued (Sec 3097(1) C1V1l Code). LENDER'S NAME LENDER'S ADDRESS 10. APPDCAN I cmt 11FICA 110N I certify that I have read the apphcauon and state that the above inlormauon 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 AJ..<iO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CflY OF CAR1SBAD AGAINST All. UABILITIES, JUDGMENTS, CDSTS AND EXPENSES WlDCH MAY IN ANY WAY A<XJUJE AGAINST SAID CflY IN OONSEQUENCE OF THE GRANTING OF TillS PERMIT. OSHA: An OSHA permit is required for excavatio over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit issued by the Buildin fficial nder the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is ot com need wit ·n 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at a time af rt is commenced for a period of 180 d~ys (Sectio 303(d) Uniform Building:9'.'J:l.- APPUCANT'S SIGNATURE ,,.,,._...._ ,;1 /t,,-:.1--,c,,. • DATE: I -~ ~ . r C, • . : .q:: . . .. • ~' ~l~~~ i:,\) }~ ~~~~ i~ d w¾ ~E ~. =-=~i==d ~ '---'---- ~ ~ ill • ' ' N ' 4- , I J/ 3 • I .. \? I . I tp_ ----r-,rrrt=n,.:__J , I ~ \lJ