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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
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Pl!RMFT APPLICATION PLAN CHECK NO.
City of C.rlsbod lulldina Oep,rt .... t
20n LN •• ,_ Or., Carl"'-!, CA 92009 (619) 438-1161
l'Sf.VAL . .,,.,,----,--------
I. PF.JIMtJ I iPR PI.AN CIC DEl'OSfr
VAUII. DY --------
111111!
rwm 1.ist I (,tt hack) give code.of Pennit-Type: ------~----
··········-········----------··------····················
for Residential rrojccu Only: From List 2 (see back) give
Cod~ or s1ructur,-Typc: ________ S_FR ___________ _
Ncl I.au/Gain or Dwelling Units
2. PRWfCT INfURMAllON l'Oll OFl'ICJi USE ONI.Y
Aiidrcs.1 2287-A Levante St. 0uiidmg or Sune No.
Nr;1rest Cross S1ree1 ' • llC,AL Df.sCitlll I ION Lot No. SulXhvmun Name/Number 0nil No. Phase No.
CIIECR ounw IF SUOMII 1£0:
0 2 F.n,rgy Cales O 2 Structural C.le> 0 2 Soll, Report O I Addros.,od ~nvelope
ASsr.sson·s PARCEi, 1-'-"'"™' U""-' ' D[SCRIPTION OF WORK Waler neater Rep1ucemC.il,!.½Vnee..±±OA. PUOPOSEQ USE
SQ. FT. # OF S1URIES # OF BEDROOMS # Of IIATllll<XJMS
J. WNIXCI PEkliON (nJ!il!ffliffit<lllHl)'P1eftffist L.L.8 /-A LeVante bt. NAME (last name fint) 0 "'l-' ADDRESS
ca 1 bad CA 92009 714-675-8069 CITI r s STATE ZIP CODE DAY TEI.EPIIONE
◄. APPUCAN I □ WN I MwW.: §1:MMb}pR WN I RAC IOil 131;iii§WltbR--,h"""'"I$ IB@!l!m!ffi!( suite B NAME (lasl name finl) ;:;ne.L.L. Y ADDRESS ~.1•';:I \'T1;,I. .l '
CITI El cajon STATE CA ZIPCOIIE 92021 DAYTEI.EPHONE390-4477
s. l'RUPm IY OW Nm .Beauchamp Ernest 228 / A Levante St. NAME (last name rirstr -, ADDRESS
CITI carlsbad STATE CA ZIP coo~2oo9. 714-675-8069 DAV TEI.EPIIONF. Saile B 6. UlkiiO\CIOk A & J Foster, Inc.
NAME (las1 name fint) ·
13 / 00 n1g11way e easiness,
crr1 El Cajon · CA STATE ZIP CODE
ADDRESS
91977
DAV TELEPHONE
C-36
390-4477
STAlt I.IC. # 630120 LICENSE Cl.ASS CITY BUSINESS UC. #
1200354
DESIGN£I( NAME (last name l1rsi)
C.ITI STATE ZIP CODE
ADDHESS •
DAV TELEPHONE STATE I.IC. 11
7. WOitkfJlS' WMPf'.NSA liON .
Workers' Compensauon Declarauon: I hereby aihrm lha1 I have a cen1i1cate oi consent toseli-1nsure Issued Gy Ute Director ol lnilustrml
Relations, or a cenincate or Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thcrcor certified
by the Director of the Insurer thereof mod with the Building lns(l!!f;tlon DeP!rtmenl (Section 3800. Lab. Cl. 1 7 .. Farmers N2007-56'-51 5--9 '
INSUMNCE-COMPI\NV l'OIJCV NO. EXPIRATION DATE
Cemhc8le ol lxempuon: I ceruly that m 1he peHonnance ol 1he work lor which this pennil 1s 1ssueJ, I shall not employ any pcisun III any manner
so as lo become subject to the Workel;S' Compensation Laws or C&lifomia.
SIGNATURE DATE
8. OWNER.-8011Dtil UtlL\ltXl'ION
D
□
□
uwner-uuuuer ucc1araUon: I hereby aihrm ffial I am Exempt irum Ole Cohfrad0h Ucense llw lur Ole ioliuwmg reason:
I, as owner or the property or my employees with wages as their sole compen11t1on1 will do the work aAd thi sft'Ucture 111 not lnlended or
orrercd £or sale (Sec. 7044, Business and Proresslons Code: The Contractor's Ucense Law does not apply to an owner or property who builds
or Improves thereon, and who does such work himself or through his own employees, provided that such lmprovemenL111 are not Intended
or offered for sale. Ir, however, the building or Improvement Is sold within one year of completlon, 'the owner-builder will have the burden
or proving that he dld not build or Improve for the purpose of sale.).
I, as owner of ili~ property, am exclusively contracting with licensed contracton to construct the project (Sec. 7044, Business and l'rofCMions
Code: The Contractor's Ucense Law does not apply to an owner of property who builds or Improves thereon, and contraclJ for such projccl5
with contractor(s) licensed pursuant to the Contractor's Ucense 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 pennit to construct, alter, Improve, demolish, or repair
any structure, prior to 115 Issuance, also requires the applicant for such pennit to me a signed statement that he is licensed punuant to the
provisions of the Contractor's Uccnse Law (Chapter 9, commencing with Section 7000 or Division 3 of the Dusiness and l'rorcs.,lons Code)
or that he ~ exempt therefrom. and the basis for the alleged exemption. Any violation or Section 7031.S by any applicant for a permit
subject., the applicant to a civil penalty o( not more than Ove hundred dollan ($5001).
~lGNATI/111! Dl\11!
COMPU:i E I ms S£Ci ION FOR NON-Jlf.51UEN I IXL DOlWINC PEl(MI i's ONLY:
Is the applicant or £uture building occupant required to submit ■ business plan, acutely hazardous material! registration rurm or risk management and
prevention program under Sections 25505_ 25533 or 25534 or the Presley-Tanner Hazardous Substance Account Act7
□ YES ONO
Is the applicant or ruture building occupant required to obtain a permit from the air pollution control district or air quality managem<!nt dii;trict7
0 YES ONO
Is the £acility to be constructed within 1,000 reet of tl,e outer boundary or a school site?
□ YES ONO
IF ANY OF TIIE ANSWERS AIU! YF.S, A FINAL CEl\11FICA11! OF OOCIJPANCY MAY NUT DE ISSUED AFTER JULY I, 1989 UNI.F.<;S 111E Al'l'IJCJINT
IIJ\S Mirr OR IS MEITTlNG TIIE RF.QUIREMENTS OF TIIE Ol'l'1CE OF l!MERGF.NCY SERVICES AND 1111! AIR l'OIJ.ITl1ON U>lflllOI, IIISllllGf.
9. WNSlk0CIION lE.NUING ACF.NCI
I hereby aiurm W ts a construction i,endmg agency lor U,e peHormance oi U,e work lur winch Uus penmt 1s issued (Sec 309/(1) Cw1i Coile).
LENDER'S NIIME LENDER'S ADDRESS
10. APPUCXNI U!JiliJliCAIJON
I certify that I have read Ute apphcatlon and stale lhal ihe above 1niormahon 11 correct. I agree lo comply w1ih ail Uty urdmanccs and Stale laws
relating lo building construction. I hereby authorize representatives of the City of c.arlsbad to enter upon the above mentioned propeny for inspection
pu'l"""'. I ALSO AGREE lU SAVI! INDEMNIFY AND KEEP IWIMU'.SS 111E IJ1Y OF CARl.soAD AGAINST ,\IJ. llAlllllllF.S, JUIX,Ml'11TS, CDSTS
AND EXPENSES WIUCI MAY IN ANY WAY Aln\UI! MlAINST SAID IJ1Y IN CDN5&«2UENCI! OF 1111! Gl\J\N11NG OF 11115 l'ERMIT.
a;tlA: An 0S11A pennit ls required (or excavations over S10" deep aind demolilion or construction of structures over 3 stories in height.
Expiration. Every pennit issued by the Building Official under th• provisions o( this Code shall expire by limitation and_ '-;come null and void i[ the
building or work authorltcd by such p,nnlt Is not commenced wltlun 365 days Crom the date or such pennlt or if th• bu,ldmg or work authorl,.cd hy
such permit is suspended or a~ .. •'1d ,~at any time after the work is commenced for a period or 180 days (Section 303(d) Unifonn_ ll~ildl~ Codc!q
Al'PLICANTSSIGNATIJREC'(c.JG'rYYvxJn______ DAIE. LL Io