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CITY OF CARLSBAD
2075 Las Palrnas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION PLAN CHECK NO. q (:, ' S-r 2_
City of tarlsbad Building Department
207S Las PalllllS Dr., carlsbad, CA 92009 (619) 438-1161 EST. VAL~----------
I. PRkMi I fiPR PLAN CK DEPOSIT _______ _
VALID. BY _________ _
DATE From Llst 1 (see back) give code of Permit-Type: ____________ _
For Residential Projects Only: From list 2 (see back) give
Code of Structure-Type: ____________________ _
Net Loss/Gain of Dwelling Units
2. PROJECI" INFORMATION FOR OFFICE USE ONLY
AddresL ~s-~SPA l( ol(Buildmg or Suite No.
mt o.
CHf'.CR BEIDW IF S0BMll 1£O: C'A.Nvat-1 ' □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
ASSESSOR'S PARCEi. EXISTING USE PROPOSED USE
DESCRIPTION OF wo~M.1(:-A'Ti'OA.f /111/;.7-z;:J!..
SQ. FT. # OF STORIES # OF BEDROOMS # OF BA TilROOMS
3. WN IACI PERSON (I[ dtfferenf from appJlcan0
NAME (last.name first)
CI1Y STATE
ADDRESS
ZIP CODE
4. Al'l'l.JU\Nl UCONIRACIOR LJAlitNI t'UKCUNJKAL:JUH
NAME (last name first~f/,1,fl.1:"dN c..A/u(,I, ADDRESS
CI1Y STATE ZIP CODE
DAY TELEPHONE
□ OWNER □ AGEN I FOR OWNER
DAY TELEPHONE
S. PRoPtklY oWNEK n LJ
NAME (last name first) V "-ff() p .. :T(JN ADDRESS ftJ/79 /-ltlENNEKENf
~SZ-g700
sr ti.lot.
CI1Y ~N p1e,G-o STATE CA ZIP CODE 9'2../'2. / DAY TELEPHONE
6. alNi Ok Do NAME (last name first) ,.__ HOIL.r~ ADDRESS
CI1Y STATE
STATE UC.#
ZIP CODE
LICENSE CLASS
DAY TELEPHONE
CI1Y BUSINESS UC. #
DESIGN ER NAM£ (lase name hrst) ADDRESS
CI1Y STATE ZIP CODE DAY TELEPHONE STATE UC.#
7. WukkF.ltS' WMPENSAlioN
Workers' Compensation Declarauon: I hereby aihrm that I have a certl11cate of consent to self-msure issued by the D1rector 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
Ceruhcate of £xemphon: I cerufy that m the performance of the work for which this permit 1s issued, I shall not employ any person many manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. oWNPll-BOIIDER DFi!LAitAliuN
□
□
□
Owner-Builder Declaration: I hereby afhrm that I am exempt from the Contractors license Law for the followmg 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 i~uance, 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
subjects the applicant to a civil penalty of not more than five hundred dollars [$500]).
SIGNATIIRE DATE
COMPLEIE I HIS SECI ION FOR NON-RESIDEN I !At BUILDING PERMI IS ONLY:
Is the applicant or future building 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 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 ONO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
0 YES ONO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOi" BE~ AFfERJULY 1, 1989 UNLESS THE APPUCANT
HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION ffiNTilOL DISl1UCT.
9. wNSIRUCUUN LENDING AGENCY
I hereby affirm that there is a construction lendmg agency for the performance of the work for whtch this permit is t~ued (Sec 3097(1) CIVIi Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPllCAN I CEklll'ICAIION
I certify that I have read the apphcat1on 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 TO SAVE INDEMNIFY AND KEEP HARMLESS THE CTlY OF CARISBAD AGAINST AIL IJABlllTIES, JUDGMENTS, CDSTS
AND EXPENSES WHICH MAY IN ANY WAY AOCRUE AGAINST SAID CTlY IN OONSEQUENCE OF THE GRANTING OF TIDS PERMIT.
OSHA: An OSHA permit is required for excavations over S'O" deep and demolition or construction of structures over 3 stories in height.
Expiration. Every permit i~ued 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 · n t ~ithin 365 days from the date of such permit or if the building or work authorized by
such pennit is suspended or abandoned aft rk is commenced for a period of 180 days (Section 303(d) Uniform Builtgft::)9/'"
APPLICANTS SIGNATURE DATE: --b
WHITE: File YEU.OW: Applicant PINK: Finance
0
I ,
PERMIT# CB960882
DESCRIPTION: 100 AMP METER FOR
TYPE: ELEC
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 06/05/96
IRR. PED.
STE:
INSPECTOR AREA
PLANCK# CB960882
OCC GRP
CONSTR. TYPE VN
LOT: JOB ADDRESS: 2307 JACKSPAR DR
APPLICANT: D.R. HORTON
CONTRACTOR:
PHONE: 619 452-3700
OWNER:
REMARKS: MW/BOB/920-1907
SPECIAL INSTRUCT:
TOTAL TIME:
CD LVL DESCRIPTION
PHONE•~ PHONE:
INSPECT'
ACT COMMENTS
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***** INSPECTION HISTORY*****
DATE DESCRIPTION
052496 Underground/Conduit-Wiring
ACT INSP
CO PY
COMMENTS