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HomeMy WebLinkAbout2075 LINDA LN; ; CB971228; PermitSuite BUILD1NC PERMIT. 05/"4/97 "9 53 °age 1 of 1 Job Addiess 2075 LINDA LW Permit Type MISCELLANEOUS Parcel No 205-160-47-00 Valuation 0 Occupancy Group Reference* Description KITCHEN-REPLACE WINDOW, REPLACE DOOR W/SLIDER,RHN CIRCUIT Peimit No CB971228 Project No A97016JO Development No Lot# Appl/Owrr CAVALRY HOME DESIGN 2765 E VISTA WAY VISTA CA 92084 eees "oquired 4936 05/1^9? 000l 01 02 C-PRfT 50 OC Construction Type NEW Sratus ISSUED Applied 05/14/97 Apr/Issue 05/14/97 Entered By RMA 7SO 940-6280 Collected & Credits Fees Adjustments Total Fees Fee .ption Miscellaneous Fee #j. * MISCELLANEOUS TOl4l A, * A <^©$* 00 00 50 00 Ext fee Data 50 00 50 00 CITY OF CARLSBAD 2075 Las Palmas Dr Carlsbad CA 92009 (619) 438 1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr Carlsbad CA 92009 (760)438 1161 PROJECT INFORMATION J, FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date IZE Address (include Bldg/Suite tt) 2.0 Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total tt of units Assessor s Parcel # 00 Existing Use Proposed Use Description of Work A*7cA«x»^ _ ___ 2 CQNTACT PERSON (if different from applicant) SQ FT #of Stories tt of Bedrooms tt of Bathrooms f ™<- 4 t ^ ^f A 84oar-k sfitfrfj "*=£Name 3 " Address City &<Ior^^^TID Agentlor Contractor! P^Owntr mD Agent,for Owner Telephone tt ax* Name 4 PROPERTY™OWNER City State/Zip Telephone #Name "Pfl CONTRACTOR *C"OSJPANY NAME (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 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 [$500]) Name State License tt 7/JP ?*f ,$" Address License Class City State/Zip City Business License # Telephone tt Address City State/Zip TelephoneDesigner Name State License tt 6 ^3iw6lKElSjCOJflP,ENlAfJONC Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations Q 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 0XI 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 carrier and policy number are ^ Insurance Company STF&TJS ft/ssQ Policy No ^-cjj — f^- Expiration Date t / "/ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) l~l 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 tcTs'tiUUiupfrodcers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100 OOQ^ijTaddTflOfMo the cost of compensation damages as provided for in Section 3706 of the Labor cod^ mterest and attorney s fees SIGNATURE , ^^^^^^~ _> DATE 7*^pWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor s License Law for the following reason Q 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) (3 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) n 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 P YES PNO 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 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 to provide the work indicated (include name / address / phone number / type of work) PROPERTY OWNER SIGNATURE DATE 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? d YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES l~l NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? L~] YES Q 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 8 ir I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 30970) Civil Code) LENDER S NAME 9 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 construction I hereby authorize representatives of the City 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 commefieedjvithin 365 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 corjx^gfrceH<Qr a period of 1 80 days (Section 106 4 4 Uniform Building Code) .5" -/£~APPLICANT S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB971228 FOR 08/20/97 DESCRIPTION KITCHEN-REPLACE WINDOW,REPLACE DOOR W/SLIDER,RUN CIRCUIT TYPE MISC JOB ADDRESS 2075 LINDA LN APPLICANT CONTRACTOR OWNER CAVALRY HOME DESIGN PHONE PHONE PHONE INSPECTOR AREA DC PLANCK# CB971228 OCC GRP CONSTR TYPE NEW STE LOT 760 940-6280 REMARKS C/GEORGE/940-6280 SPECIAL INSTRUCT INSPECTO TOTAL TIME CD LVL DESCRIPTION 19 ST Final Structural ACT COMMENTS ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP 052297 Exterior Lath/Drywall CO DC 051997 Frame/Steel/Bolting/Welding AP DC 051997 Rough Electric AP DC COMMENTS NO ACCESS I COMPENSATION INSURANCE PO BOX 420807 SAN FRANCISCO CA 94142 0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE APRIL 7 , 1<>97 POLICY NUMBER £29-97 UNIT OC1714* CERTIFICATE EXPIRES 1 -l-sg r |*>P AND MRS CHRIS WDPTHANN 2P75 LINDA LANE CARLSBAD CA 92C1S JOB ALL OPERATIONS L-jf *, -^ This is to certify that we have issued a valid Workers Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated >• i - "t, -^ This policy Is not subject to cancellation by the Fund except upon ten days advance written notice to the employer * * - ^ ! J- ^** 1. S^ We will also give you TEN days advance notice should this policy be cancelled prior to its normal expiration *" «, *•^ *s J" \ -- *** This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded by the policies listed herein Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain the insurance afforded by the policies described herein is subject to all the terms exclusions and conditions of such policies „ <• > ~ i. ^ AUTHORIZED REPRESENTATIVE PRESIDENT r EMPLOYER'S LIABILITY LTMIT INCLUDING DEFENSE COSTS $1,000,000 PEP OCCURRENCE c*• / -v T!-- - ' ^ / EMPLOYER ^ ~!- ^ *j ^. '/•C r U "" -CAVALPf HOHE DESIGN D CCHSTm,*CTIOM "2763 EAST VISTA MA/ VISTA NP5 THK DOCUMENT HAS A 1LUE PATTERNED 1ACKGKOUND SCIF H2S2 (BEV. 3-S5);