HomeMy WebLinkAbout2105 LINDA LN; ; CB930777; PermitM
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CLEARANCE-----,
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
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PERMIT APPUCATION PLAN CHECK NO.
City of carlsbad Building DepartEnt
2075 Las Pal1118S Dr •• carlsbad, CA 92009 (619) 438-1161 EST. VAL ~c::?:::s?
PLAN CK DEPOSIT :;> 0
VALID.BY bL
1. PMM.11 l"YPR
A • □ Commercial LI New Building LI Tenant Improvement
B • □ Industrial □ New Building □ Tenant Improvement
C • □ Residential □ Apartment □ Condo □ Single Family Dwelling □ Addition/ Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical □Plumbing
□ Mechanical □ Pool □ Spa □ Retaining Wall □ solar □ Other ____ _
2. PROJECT INFORMATION FOR OFFICE USE ONLY
. 1dln.s t.. ,ndct Buudmg or su1te No .
I-an~, Car/SbC?cl Nearest Cross Street
LEGAL bEscRIF't ioN Lot No. SutxJ1V1s1on Name/Number Umt No. Phase No.
CRtCR BEtbW JP s0Bhl111£il:
D 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROPOSED USE
DESCRIPTION OF WORK . • f. _
SQ. FT. g O S Fos . c ;:~~J /gfsroRrns
3. WN IACI PERSON (it ttlerent from apphcanl)
NAME ADDRESS
CllY STATE ZIP CODE DAY TELEPHONE
□OWNER □AC£Nl FOR OWNER 4. APPllCAN I
NAME
UCON I RACluk O AGEN I FOR CON i RACidk
ADDRESS
CllY STATE ZIP CODE DAY TELEPHONE s. PROPERIY dWNElt E .J:--~ NAME C / 4 8 c1 11 r a., i ·, 0 J1 ADDREss c1. IO S-J...1 n c/A L n
c11Y Ca rlsbc<d sTATE CA ZIP CODE q;lt;Jc>? DAY TELEPHONE 7 :2. C/ -1 S;} C
6. wN'l'IW!'iuR
NAME ADDRESS
CllY STATE
STATE LIC. #
ZIP CODE
LICENSE CIASS
ADDRESS
DAY TELEPHONE
CI1Y BUSINESS UC. #
DESIGNER NAME
CllY STATE ZIP CODE DAY TELEPHONE STATE IJC. #
1. WotUMts' WMPP.NSNl1dN
Workers' Compensation beclarauon: I hereby al!trm that I have a certificate of consent to sell-insure issued by the Director of lndustnal
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
Certthcate of Exemption: 1 cernfy that m the performance of the work for which this permit 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
A. OWN£R-bUIIDER OlfiARATION
Owner-Builder Oeclarauon: I hereby affirm that I am exempt from the Contractor's License Law tor the following 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 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 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 pennit to file a signed statement that he is licensed pursuant to the
provisions of the Contractor's License law (Chapter 9, commencing wirh 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 appli nt to a civil penalty of not more than five hundred dollars [$5001).
SIGNATIJRE ~tUl, m ffi~ DATE a.a. <&,-• C/1 / q q 3
Is the applicant or future building occupant 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 ONO
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
ls the facility to be constructed within 1,000 feet of the outer boundary of a school site?
C YES □ NO
IF ANY OF TIIE ANSWEllS ARE YFS, A FINAL CERTIFICATE OF ocx:uPANCY MAY NUf BE ISSUED AFmR JULY 1, l 989 UNUSS 111H APPLICANT
HAS MET OR IS ME£11NG THE RFQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND 1HE AIR FOillJTION CDNTROL DISIRICT.
9. WNS'IROCl1dN mNDmG AGENL-Y
l hereby alhnn that there 1s a construction lendmg agency for the perlormance of the work for which this permit 1s issued (Sec 301l7llJ Civil Code).
LENDER'S NAME LENDER'S ADDRESS
tO. AJlPllcAN"l' tmt11FlcA11oN
I certify that I have read the apphcatJon and state that the above mformauon 1s correct. I agree to comply wnh ail Cny 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 ID SAVE INDEMNIFY AND KEF.P HARMLF.SS TIIE CTIY OF CARLSBAD AGAINST ALL UABIIJTIES, JUDGMENT'S. CDSTS
AND EXPENSES WJDCH MAY IN ANY WAY ACXJUJE AGAINSf SAID CTIY IN CONSEQUENCE OP nm GRANTING OF TIIIS 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 suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Unifonn Building Code).
APPLICANT'S SIGNATURE c:;:7? ,,,./,,, DATE: t / 9 J q 3 GJaea ·
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