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CLEARANCE-----1
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION ~ ~
PLAN CHECK NO.
City of carlsbad Building Departaent
2075 Las Palaas Dr., carlsbad, CA 92009 (619) 438-1161 EST.VAL'--------~=~~ PLAN CK DEPOSIT '-•
VAIID.BY
DATI! I. PEkMII IYPE
A -U COmmerctal U New Bu1idmg LI I enanc Improvement
B -D Industrial □ New Building □ Tenant Improvement
C -jl Residential U Apanment □ Condo i: Single Family Dwelling □ Addition/ Alteration
□ Duplex O Demolition □ Relocation □ Mobile Home □ Electrical ~ Plumbing
□ Mechanical U Pool U Spa □ Retaining Wall D Solar □ Other
2. PRaJECT INFORMATION FOR OFFICE USE ONLY
Address BuUdmg or Suite No.
Suix11V1s1on Name/Number Omt No. Phase No.
□ I Addres.sed Envelope
DESCRIPTION OF WORK
WATER HEI\TER REPLACEMENT SQ. Ff. # OF S10RIES
3. WN IACI PFllSON (H dlllerent from apphcanl)
NAME Sydney Good ADDRESS 2120 Pintoresco Ct.
4. ~iNIRACIOk
NAME Shelley Andrews
STATE fNll ZIP CODE ~?QfoO DAY TELEPHONE 3~~ ft5J 3 f1AG1 FORCONJRACIUOWNER UAGENI FOR E
ADDRESS 2819 Central Ave.
s. 'if.t~lle,, STATE Cl
j.
ZIP CODE 91977 DAY TELEPHONE 697 4l§l
NAME Sydney Good ADDRESS 2120 Pintoresco Ct.
6_ ~ 1&!i6k9ba9, STATE Cl\ ZIP CODE ll?QO!l DAY TELEPHONE 153 D513
NAME
CITY
A&J Foster, Inc.
STATE Spring Valley, CA.
ADDRESS
ZIP CODE
2819 Central Ave.
91977 DAY TELEPHONE 697-4151
UCENSE CLASS CITY BUSINESS UC. # J 200351 DESIGNER NAME
STATE UC.# 6303 30 ADDRESS C 36
CITY N/A STATE ZIP CODE DAY TELEPHONE STATE UC.#
7. WORkF.RS' WMi'f!NSAiiON
Workers' Compensation Oeclarat1on: I hereby affirm that I have a certificate of consent toself-msure 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 POUCY NO.
□
□
rom e w or t e o owmg 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 Llcense 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 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
subjec the app · t to a civil alty of ot more than 1ve hundred dollars [$500]).
SIGNATIJRE DATE
Is the applicant or future buil ing 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 Accounr 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?
CYES □NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO IF ANY OF THE ANSWERS ARE YES, A FINAI.CERTIFICATI! OF OCOJPANCY MAY NOT Bl! ISSUED AFTER JULY I, 1989 IINIBSS THE APPUCANT
HAS M1IT OR IS MEimNG THE REQIJIIIEMENTS OF nm OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CDNTROL DISl1UCT.
9. WNSIRUCIION LENDING AGENCY
I hereby afhrm that there 1s a constructmn lendmg agency for the performance of the work for which this permit 1s issued (Sec 3097(1) CivU Code).
LENDER'S ADDRESS LENDER'S NAM~ to. APPIJCANil!AliuN
I certify that I have read the apphcatmn and state that the above mformatmn 1s correct. I agree to comply with all City ordmances 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 m SAVE INDEMNIFY AND KEEP IIARMIBSS THE CflY OF CARISBAD AGAINST AIL UABIIJ11ES, JUDGMENTS,=
AND EXPENSES WIIlCH MAY IN ANY WAY A£XJUJE AGAINST SAID CflY IN CDNSF.QIJENCE OF THE GRANTING OF 11IlS PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 srories in height.
Expiration. Every pennit 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 :sirrr«o~=n~~·~:;:-·--~---···~~.-·:::;'![oll0'
--> ~ WHik File YELLOW: Applicant PINK: Finance
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I •
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB930665 FOR 07/12/93
DESCRIPTION: REPLACE WATER HEATER
TYPE: PLUM
STE:
INSPECTOR AREA PY
PLANCK# CB930665
OCC GRP R-3/M-l
CONSTR. TYPE VN
LOT: JOB ADDRESS: 2120 PINTORESCO CT
APPLICANT: GOOD, SIDNEY
CONTRACTOR:
OWNER: PHONE: / / _,-'
::g::: 6la9 753-051~3"YL
REMARKS: MH/SID GOOD/753-0513 INSPECTO ;;t;;:._ ~'
SPECIAL INSTRUCT: MONDAY AM WOULD BE GOOD FOR SID
TOTAL TIME:
CD LVL DESCRIPTION ACT COMMENTS
_2_s __ P_L _w_a_t_e_r_H_e_a_t_e_r_i_v_e_n_t_s ______ ~ ---------------
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***** INSPECTION HISTORY*****
DATE DESCRIPTION ACT INSP COMMENTS