HomeMy WebLinkAbout2312 HOSP WAY; 153; CB910893; Permit(
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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161
-------••----r-
PERMIT APPLICATION
•
City of Carlsbad Building Department EST. VAL. ______________ _ 2075 Las Pal mas Dr., Carlsbad, CA 92009 {619) 438-1161 -PLAN CK DEPOSIT, ___________ _
VALID. BY, ____________ _
1. PERMIT TYPE . DATE _______________ _
A O COMMERCIAL TENANT IMPROVEMENT
B O INDUSTRIAL □,m, □TENANT IMPROVEMENT
C □RESIDENTIAL □APARTMENT □CONDO □SINGLE FAMILY DWELLING □ADDITION/ALTERATION
□DUPLEX □DEMOLITION □RELOCATION □MOBILE HOME □ELECTRICAL □PLUMBING
□MECHANICAL □POOL □SPA □RETAINING WALL □SOLAR □OTHER
2. PROJECT INFORMATION PLAN CHECK NO.
Addcm ~ HOSP WAY d-°311----
Nearest cflsiTft'rtet; EL CAMINO REAL
Building or Suite No. 153
LEGAL DESCRIPTION lot No. sutxl1v1sion Neme/Nlmber Unit No. Phase No.
CHECK BELOW IF SUBMITTED:
Q2 Energy Cales 02 Structural Cales Q2 Soils Report D 1 Acldressed Envelape
EXISTING USE
Plumbing and Electrical for laundry and kitchens.
BLDG. SQ. FTG. # OF STORIES
PROPOSED USE
3. CONTACT PERSON
4.
5.
6.
7.
NAME
CITY
Keith Smith
Carlsbad
SIGNATURE
APPLICANT
NAME New Deisgn
CJ TY Carlsbad
PROPERTY OWNER
\r"i CONTRACTOR
Remodeling &
NAME
CITY
Hosp Way Limited
Los Angeles
CONTRACTOR
NAME
CITY
New Design
Carlsbad
Remodeling &
STATE CA
ADDRESS
ZIP CODE
5928 Pascal
92008
0 AGENT FOR CONTRACTOR □QI.INER
Const. AD0REss 5928 Pascal
STATE CA ZIP CODE92OO8
Court, Suite 200
DAY TELEPHONE ( 619) 431-2800
0 AGENT FOR QI.INER
Court, Suite 200
DAY TELEPHONE ( 619 ) 431-2800
QI.INER
ADDRESS
ZIP CODE
□LESSEE
1990 Westwood Blvd.,
□TENANT
suite 300
STATE CA
Const.
STATE CA
90025 DAY TELEPHONE ( 213) 4 74-1720
ADDREss 5928 Pascal
ZIP COOE92008
Court, Suite 200
(619) DAY TELEPHONE 431-2800
STATE LIC. # 545Q75 LICENSE CLASS __ ,._ __ _ CITY BUSINESS LIC. # 437954
SIGNATURE
DESIGNER NAME
CITY STATE
TITLE
ADDRESS
ZIP CODE
DATE
DAY TELEPHONE STATE LIC. #
WORKERS' COMPENSATION
workers' Compensation Declaration: hereby affirm that I have a certificate of consent to self·1nsure issued by the Director of Industrial Relations,
or a certificate of Workers' Compensation Insurance by an achi ttecl insurer, or an eKact copy or dup\ i cate thereof cert if i eel by the O i rector of the
insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY Nationwide Insurance POLIJ~w.coos4o 2-OOO19 EKPIRATION DATE 6 /28 /91
Certificate of EKemption: I certify that in the performance of the work for which this permit is issued, I shall not errploy any person in any manner
so as to become subject to the Workers• Compensation Laws of California.
SIGNATURE DATE
8. OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
D 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 irrproves thereon,. and who
does such work himself or through his own employees, provided that such irrprovernents are not intended or offered for sate. If, however, the building
or irrprovement is sold within one year of c0fl1)letlon, the owner-builder will have the burden of proving that he did not build or irrprove for the purpose
of sale.).
0 1, 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 cor,tracts for such projects with cor,tractor(s)
licensed pursuant to the Contractor's License Law).
D I am exerrpt 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, irrprove, demolish, or repair any structure,
pr; or to its issuance, al so requires the applicant for such permit to f i I e a signed statement that he is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9, coomencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exerrpt 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]).
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
1 s the applicant or future bui ldi ng occupant required to submit a business plan, acutely hazardous mater i at s regi strati on form or risk management and prevention
program under Sect i ans 25505, 25533 or 25534 of the Pres I ey· Tanner Hazardous Substance Account Act?
□YES 0NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□YES 0N0
Is the facility to be constructed within 1,000 feet of the outer boundary of El school site?
0YES ONO
IF ANY OF THE ANMRS ARE YES, A FINAL CERTIFICATE OF OCQl>ANCl NAT NOT BE ISSUED AFTER JULT 1, 1969 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS
OF THE OFFICE OF EMERGENCT SERVICES AND THE AIR POLLUTION CONTROL DISTRICT -
9. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued C Sec 3097( i ) Civil Code).
LENDER'S NAME LENDER IS ADDRESS
10. APPLICANT'S SIGNATURE
! certify that I have read the application and state that the above information is correct. I agree to corrply with all City ordinances 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 ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, Jl.OQtENTS, COSTS AND EXPENSES WHICH NAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING DF THIS PERMIT.
Expiration. Every permit issued by the Building Official under the provisions of this Code shall expire by \imitation and become null and void if the building
or work authorized by such permit is not coomenced within 180 days 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 work is coomenced for a period of 180 days (Section 303(d) Uniform Building Code).
□ QI.INER ~CONTRACTOR OBY PHONE APPR0\/E0 BY; _______ _
DATE:
WHITE: File YELLOW: Applicant PINK: Finance
09/11/91 INSPECTION HISTORY LISTING
FOR PERMIT# CB910893
DATE INSPECTION TYPE INSP ACT COMMENTS
08/14/91 Final Plumbing RI RI MH/GENE/439-7120
08/14/91 Final Plumbing PK AP
08/14/91 Final Electrical RI RI MH/GENE/439-7120
08/14/91 Final Electrical PK AP
08/01/91 Final Plumbing PK NR
08/01/91 Final Electrical PK NR
06/14/91 Rough/Topout RI RI MH/
06/14/91 Rough/Topout PK AP
06/14/91 Rough Electric RI RI MH/
06/14/91 Rough Electric PK AP
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