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Home My WebLink About2128 PALOMAR AIRPORT RD; ; CB971779; PermitVID183 2075 Las Palmas ;ITV OF CARLSBAD r ·, Carlsbad CA 92 ' 009 (6 19) 438-1161 ,>ERMIT APPLICATION FOR OFFICE USE ONLY PLAN CHECK NO. fl/779 I CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 Validated By_......_,......,_--1------- Date~------f-....&..I"+-,,.....-...---~ Address (include Bldg/Suite I) 1. PROjECT INFORMATION &.;;e ffl?D~ Business N•me l•t this •ddress) / lot No. Subdivision N•me/Number Phue No. Total I of units .4-'PA-:: Proposed Use I ol Bathrooms 2. CONTACT PERSON (H clffnn 7p...ey Hf. ,l,V#-//10?,K Name Address City State/Zip eleptione I •• PRo~oWNEII"" • ""F..'"+::·...,.,,.:-'~" ~ • -r.,..,.'""Tf~Tw7r . -· "l"';'--~ •• ~'ft ... • .... • • LIZl/d~ ee ~L>/OP ss.ss t:PvDUt&?Pk .MnR/~~ ~ ?ZIJ.J MY-358/ Name Address City State/Zip Telephone I 6. ·CONTRACTOR· COMPANY NAM ' • "'.,,.__ • -' "' ',-. (Sec. 7031.5 Business end Professions Code: Any City or County which requires• permit to construct, elter. Improve, demolish or repair any structure. prior to its Issuance, also requires the applicant for such permit to file • signed statement th8t he is licensed pursu•nt to the provisions of the Contractor's license Law (Chapter 9, commending with Section 7000 of Division 3 of the Business •nd Professions Code( or that he is exempt therefrom, end the basis for the alleged exemp io Any violation of Section 7031.5 by any applicant for• permit subjects the •pplic•nt to• civil penalty of not more th8n five hundre dollars ($5001). ~ W. $7. rl :.2P. ~~ -.o7c,z::> State License I €72-Z/ 7 Designer Name State License I ---------- 6. WORKERS' COMPENSATION Address City Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Stete/Zip Telephone 0 I have end will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the labor Coda. for the performance of the work for which this permit is issued. ft I have and will maintain workers' compensation, IS required by Section 3700 of the labor Code, for the performance of the work for which this issued. My worker's compensation insurance carrier end policy number ere: Insurance Company ,L//"JL"'Z :Z::, <;;:'.,G,, Policy No. Jf.lC,... 22. 411/1!1 Expiration Oate.__.,'+--1-,~c...L.-- (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED OOUARS ($1001 OR LESS) ~ CERTIFICATE OF EXEMPTION: I certify th•t in the performance of the work for which this permit is issued. I shall not employ any person in any manner 10 es ~ become subject to the Workers' Compens•tion laws of California. · WARNING: Failure to HCWe wortien· ~tlon cover.ge 18 unlawful, end a/11111 aubject en employer to crlmklel peneltlea end civil fines up to one hundred :~;~;~~:::~~~· damages u provkied for~ Sectkln 3~::T:f ~tend ettomey'a fNa. 7. OWNER-BUILDERDECLARATION • ~ -.--· 'P'~. "' · -;-~r » • ' I hereby affirm that I am exempt from the Contr•ctor's License L•w for the following reason: 0 I, as owner of the property or my employees with w•ges es their sole compensation, will do the work end the structure is not intended or offered for sale (Sec. 7044, Business end Professions Code: The Contractor's License law does not apply to •n owner of property who builds or improves thereon. end who does such work himself or through his own employees, provided that such improvements ere not intended or offered for sale. II, however, the building or Improvement is sold within one year of completion, the owner,builder will h8ve the burden of proving that he did not build or improve for the purpose of seleJ. 0 I, es owner of the property, •m exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Lew does not apply to •n owner of propeny who builds or improves thereon, and contr•cts for such projects with contrector(s) licensed pursuant to the Contractor's Lic11nse law). 0 I em exempt under Section------Business •nd Professions Code for this reason: 1 . I personally plan to provide the major labor end m•teriels for construction of the proposed property improvement. 0 YES ONO 2. I (have f have not) signed an applic•tion for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name I •ddress I phone number I contr•ctora license number): 4. I plan to provide portions of the work, but I h8ve hired the following person to coordinate, supervise end provide the major work (include name I address I phone number I contractors license number):---------------------------------------------- 5. I will provide some of the work, but I have contr•cted (hired) the following persons to provide the work indicated (include n•me I address I phone number I type of work): _____________________________________________________ .....,._~ Is the •PPlicent or future building occupent required to submit a buainna pi.n, •cutely hazardous materiels regiatr•tion form or risk m•nagement and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Haz1rdous Substlnce Account Act? 0 YES O NO Is the applicant or future bLilding occup•nt required to obtain a permit from the air pollution control district or •ir qu•llty management district 7 0 YES O NO Is the facility to be constructed within 1.000 feet of the outer bound•ry of• school site? 0 YES El 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 POUUTION CONTROL DISTRICT. la. coNstRuCTioPr'liN01No AGENCY?' .... .,..,-._.--:-..... ,...,....-~ ...,...,",., -......,...--.-¥ -··~ • -· ........ .. ..,.,., i I hereby •fflrm that there is a const ction lending agency for the performance of the work for which t • permit la issued (Sec. 309711) Civil Codel. LENDER'S ADDRESS_--'~--,.,,._..__..._ _________________ _ 19 . APPLICANT CERTIFICA ·o;.-;: .... -r~-~. !...0·,l'.e.R~:~~~~--:-:1 I certify that I have reed the •pplication end state that the above information Is correct and that the information on the plans la 1ccurate. I agree to comply with all City ordinances end State laws rel1ting to building construction. I hereby euthorize r.prnent1tives of the Citt of Cartsbad to enter upon the ebove mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST AU LIABILITIES. JUDGMENTS, COSTS ANO 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 exc•vetions over 5'0" deep •nd demolition or construction of structutes over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shell expire by limitation end become null end 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 aft t ork is mence r • peri of 180 d8ys (Section 108.4.4 Uniform Building Code~~ APPLICANT'S SIGNATURE DATE ~~ DINV• C:jn"",..,, D D D D D City of Carlsbad M=OOC!h,t· 1•24·6111 ,,f4,il DEMOLITION PERMIT REQUIREMENTS A demolition permit may only be issued to the owner of the property or the State Licensed Contractor that is doing the work. The contractor must provide us with a letter, signed and dated by the property owner, giving permission for the building to be demolished. The fee for a demolition permit is $30.00. The attached Demolition Asbestos Certification application !!l.!.!.S1 be completed, signed and have the correct square footage of the structure being demolished, as well as it's use. Applicant must provide a letter from San Diego Gas and Electric stating that the utilities have been disconnected. Arrange for appropriate Water Authority to remove water meter unless contruction of replacement structure is to begin shortly. Contact the Planning Department at 438-1161 xt 4325 or xt 4328 to determine if the structure is in the Redevelopment area and if it is on the list of Carlsbad Historic Sites. Contact the Engineering Department at 438-1161 xt 4315 or xt 4374 to determine if a Haul Route or Right Of Way Permit is required. Notify the Fire Department at 931-2121 to see if they need the use of the building for training purposes. H :\LIBRARY\COM_DEV\WPDA TA \BUILDING\DEMOHAND REV 4/24/96 2075 Las Palmas Dr. • Carlsbad, C A 92009-1576 • (619) 438-1161 • FAX (619) 438-0894 Company No. ]fio/ Please Print City of Car1sbad Engineering Department HAUL ROUTE PERMIT HI!-~ 7-97 Permit No. Company Name: U/fl;//oc)< W'1772A-cn/1& Phone Number: ~/pJ S?2-070C> Address:.;fM E~rzr S+. City, State: e~ Cdz?:'Yl M 24-HR Phone No.: ~E Zip: 9202..L) Contact Person: /.Wzr: M&/4c~ Export Project # ~--------- 1 mp o rt Project # Site Address: Planchecker: Inspector: Material to be hauled: LR~~ ~ &.4?4& 2&?.sN· Oates From: ~To: :ff k Quantity: o{4~ No. of Trucks Hauling: __...d"-""'--- Type of Trucks: ~ y1~p,.c ~~ # # # License Plate: # # # Origin: ~ PAk~ ~~Destination: .2~n,,u,;lfll.€ ~_pp..,.// Thomas Brothers: // 2 7 Thomas Brothers: ------------- Route through Car1sbad: ~~A?e. 4e.,Dp11Z...'r &f: 27,) . _M~7?trz;-, S-sovZ?f ~ 8:~ 72? SZ. eA;5r 212 • HAULING OF MATERIALS OR EQUIPMENT ON SATURDAY, SUNDAY, OR CITY HOLIDAY PROHIBITED. • HOURS ARE RESTRICTED TO 7:00 AM TO 4:00 PM, UNLESS OTHERWISE NOTED. • THE CITY RESERVES THE RIGHT TO REVOKE OR CHANGE THIS HAUL ROUTE AT ANY TIME. • HAUL ROUTES ARE TO BE KEPT CLEAN AT All TIMES. FAILURE TO 00 SO Will BE CAUSE FOR REVOCATION OF THIS PERMIT. • APPLICANT SHAll DELIVER ONE APPROVED COPY OF THIS PERMIT TO THE CARLSBAD POLICE DEPARTMENT AT 2560 ORION WAY, ANO ASSURE THAT ONE APPROVED COPY IS IN EACH TRUCK ASSIGNED TO THE HAUL ONE APPROVED COPY SHALL REMAIN AT THE SITE(S). • PERMITTEE SHALL INDEMNIFY, HOLD HARMLESS, ANO DEFEND THE CITY OF CARLSBAD OR ITS OFFICERS OR EMPLOYEES FROM All CLAIMS, DAMAGE OR LIABILITY TO PERSONS OR PROPERTY ARISING FROM OR CAUSED BY ANY ACTMTY OR WORK DONE PURSUANT TO THIS PERMIT UNLESS THE DAMAGE OR LIABILITY WAS CAUSED BY ANY ACTIVITY OR WORK DONE PURSUANT TO THIS PERMIT UNLESS THE DAMAGE OR LIABILITY WAS CAUSED BY THE SOLE ACTIVE NEGLIGENCE OF THE CITY OR ITS OFFICERS OR EMPLOYEES. APPLICANT'S SIGNATURE APPROVED BY: ,sw EXTENSION APPR BY: DATE tz/sob/ DATE SEE REVERSE SIDE FOR SUBMITTAL REQUIREMENTS PERMIT# CB971779 DESCRIPTION: DEMOLITION ONLY CITY OF CARLSBAD INSPECTION REQUEST FOR 07/10/97 NO NEW CONSTRUCTION TYPE: MISC STE: INSPECTOR AREA TP PLANCK# CB971779 OCC GRP CONSTR. TYPE NEW LOT: JOB ADDRESS: 2128 PALOMAR AIRPORT RD APPLICANT: WHILLOCK CONTRACTING CONTRACTOR: OWNER: REMARKS: B/TORY/579-0700 SPECIAL INSTRUCT: EARLY AM REQUESTED PHONE: 619 57;:;9-0700 PHONE: PHONE: INSPECTOR ~--~~~~~~~~~- TOTAL TIME: CD LVL DESCRIPTION ACT COMMENTS 21 PL Underground/Under Floor ***** INSPECTION HISTORY***** DATE DESCRIPTION 070897 Final Structural ACT INSP PA TP COMMENTS WAITING FOR BACK FILL REPORT