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Home My WebLink About2121 LEVANTE ST; ; CB971496; Permit• PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 1. PRCl.iECT INFORMATION .L-.. ,;l/.?J ~e'.v'fi'...-V,r C: Address OncludJldg1Suite #) Business Name tat this address) Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use # of Bathrooms Name Address City State/Zip Telephone# Fax# r(l; , .. "liiPIJcANt . ' 12f5jiiiiacicii" 'CT'Aionlllif'l:iiliiliili!8r'"□1lwil•r:'"O"Alijnl1oi ~;;•.·•,:,;., 7' ,,. "."1':"''"'"""'''i•••" • Name I Address City State/Zip Telephone# 11;:··~coNtilACTOR•!''cOMP.CUilY NAMl~·:,,, ... e.~• If i"'·/t'Y/'¥:f1"'.1Mi:F'f;·¥"":f'~"'Bl''l""W,;.:;:"''J-:,;.; '""'":.~ -~·, '.it•· ·='•C::t ::e~.i:,' ><::;,•=:;: ;,~,--'"'::'"'::~· "'"'1:~~"0.7',~~Yf~'.Tfr"-+!"":·~,::s. '"'"' (Sec. 7031.5 Business and Professions Code: Any City or Countv 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, commanding with Section 7000 of Division 3 of the Business and Profassion~C~jt.el or that ha is exempt therefrom, and the basis for the alleged exemption. Any violation of Sect~703)J5 by any appl t _!gr ~•~it subjects the •)?Pl~, civil pen,lty of not more than five hundred dollars ($50011, p,-,,.--,0/e CJ .r<(~v Cp<A"5 ,-,vor"'1.CS'l'f'C/ 1:>l'/'1--'.2oSS ,;;l. -f<i..-Ce, Name ddress City State/Zip Telephone # State License # ~ [it. 3 t ¥ License Class c} ~ 3 9' City Business License I _______ _ Designer Name Address City State/Zip Telephone State License I _________ _ 6. WORKERS" COMPENSATION --.• -,-,,~ '7 Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 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. 0 I 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 co w~sat_iD? insuran e ca"ier al}fl policy number ere: Insurance Company 7,)9,:r ,/t,-V'( Policy No. /fa/ ,.,Jc/ </J:v Exp;ration Date//-ct-'? k ITHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDREO OOLLARS 1$1001 OR LESSI 0 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. la unlawful, and 1h11 subject an employer to crlmlnal penaldes and civU fln■s up to one hundred atk>n, damages es provided for In Section 3~:~:f H:~91:• and attorney's, .... ~~-S:::E"::S;:==""',~, ::"',, -:-::::;-----,-,---::::-:-----,-,----,-,--:-:--r, .. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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 Profe11lons Code: The Contractor's License Law does not apply to an owner of property who butlds 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). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Coda: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contrector(s) licensed pursuant to the Contractor's License Llw). 0 I am exempt under Section ______ Buslnesa and Professions Code for this r•eson: 1. I personally plan to provide the major labor and materials for construction of the proposed property Improvement. 0 YES ONO 2. I (have / have not) signed an application for e building permit for the proposed work. 3. I have contracted with the following parson (firm) to provide the proposed construction (Include name / address / phone number / contractors Ncense number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise end provide the major work (include name / address/ phone number/ contractors license number): ____________________________________________ _ 5. I will provide some of the work, but I have contracted lhired) the following persons to provide the WOfk Indicated !include name /address/ phone number / type of work):. ______________________________________________________ _ PROPERTY OWNER SIGNATURE_______________________ DATE _________ _ '.coMPi.m TitlS. SECti<Jk FOR' ~ENHAL'IOtbiNd'PERMrti'ONL~P'~':¥~•~--~,inr:•ff_~~?Y"~''-""-:!'~·F·1·7'i~1T"""tiT'f'.~~,.,,i;: · •' ·tt,'TT-''-f ,, : -'-·'-•:'.· ~--, ~ · ~-,: ' Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management end prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air qualtty management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O 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. Ji,. ' -CONStiltJctiOtU.eND1Ni'AGEHCV:~:1~~\tr"~f:::•~;;:-;~-~:'!'I~?'~M:t'"" ... ., .. :~"'T-;":· :::.: --T,.~ "''".'':~\:7i-~ ·"'· '·'. :. ".;. ··~-•-re-. ·"'· ';·, .. -,, ,:· r· I hereby affirm that there is a construction lending agency for the performance of the work for wNch this permit Is Issued (Sec. 3097111 Civil Code). J certify that I have re1d 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 representatWes of the Cttt of C.rtsbad to enter upon the above mentioned p,operty for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO 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 it the building or work authorized by such permit Is not commenced within 365 • 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 l~_;_g.m iod of 180 days I Section 106.4.4 Uniform Building Coda), .-/ .-c:::> /'r APPLICANT'S S!GNATU V DATE _,&=. __ Cf __ -'-,,,--' "Le... ___ _ YELLOW: Applicant PINK: Finance