HomeMy WebLinkAbout2324 LA COSTA AVE; A; CB950373; Permitb l' I L D I N "
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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
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PERMIT APPIJCATION PLAN CHECK No. C/3 c; s -_3'7J
City of carlsbad Building Departaent
2075 Las Palaas Dr., Carlsbad, CA 92009 (619) 438-1161 EST.VAL. __________ _
I. PEit.Mii liPE
PIANCKD~ VAIJD.BY
DATE J ijf_.-
A -U COmmerc1al LI New Bmldmg D Tenant Improvement
B -□ Industrial □ New Building □ Tenant Improvement
C -□ Residential D Apartment □ Condo □ Single Family Dwelling □Addition/Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical □ Plumbing
□ Mechanical D Pool □ Spa D Retaining Wall □ Solar □ Other
2. PRClJECT INIDRMATION FOR OFFICE USE ONLY
mt o.
CHECK 8£WW IF SOBMI I IEU:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Ad.dressed Envelope
ASSESSOB'S PARCEi. 21 h ... P_LQ. .... I q t.l Q...; I E~SE t}({J' t, OlL, PROPQSEP USE
DESCRIPTION OF WORK Wdi.x-~d0--,-~lcuJ,.-,r\AJl-,vt"' ci-7 ;;
SQ. IT. # OF STORIES
3. WN IACI PERSON (II dllJerent from applicant)
NAME ADDRESS
CI1Y STA TE ZIP CODE DAY TELEPHONE
NAME
CI1Y STATE
ADDRESS
ZIP CODE DAY TELEPHONE
NAME l'V\ f'\to -0umb~ I\~ Ai11.,ADnREss q3-33 "TfL.ADe PI
CI1Y""'-"" -,.,. STATE c:;..__ ZIP CODE t'.1i7/ ;l4, DAY TELEPHONE 5u...-/ )._ "3 + /nYIJ.,d<?"')O 7 ..., ::z/
UCENSE CLASS vi' CI1Y BUSINESS UC. #
CllY STATE ZIP co~ AAY TELEPHONE STATE UC.#
Workers' Compensatton Declarat1on: I hereby afhrm that I have a cert1hcace of consent to self-msure issued by the Director of industnal
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 5rA-r8 fur,c)_ POUCY NO. 7C, / ~ 'lS° EXPIRATION DATE /-£,
rtt 1cate o xempuon: cert1 t at m t e pe ormance o t e wor or w
so as to become subject to the Workers• Compensation Laws of California.
S.s~;~ilt~~~..:tATE 3..., /5-"7 5
Owner-Hutlder Deciarat1on: I hereby affirm that I am exempt from the Contractor's Llcense Law for the foilowmg 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 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.).
D 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 Llcense 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 Llcense 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 its issuance, also requires the applicant for such pennit to file a signed statement that he is licensed pursuant to the
provisions of the Contractor's Llcense 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]).
SIGNATIJRE DATE
WMPLEIE IHiS SECIIUN FOR NON-RESIDEN IIAC BOIIDING PERMII's 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 □ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□ YES □ NO
ls the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO
IF ANY OF TIIEANSWERSARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AITERJULY I, 1989 llNLE5S THE APPLICANT
HAS MET OR IS ME1!11NG TIIE REQ\IIllEMENTS OF TIIE omCE OF EMERGENCY SERVICES AND THE AIR POIIlJTION WNTROL D1511UCT.
9. UJNSIROCI ION lliNDING AGENCY
I hereby affirm that there is a construction lendmg agency for the performance of the work for which this permit 1s issued (Sec 309?(1} CIVIi Code).
LENDER'S NAME LENDER'S ADDRESS
IO. APPllcAN I CFJtliFICAIION
I cen1fy that I have read the apphcat1on and state that the above mformauon 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 c:arlsbad to enter upon the above mentioned property for inspection
purposes. I A1SO AGREE m SAVE INDF.MNIFY AND KEEP IIARMIJlSS TIIE Cl'IY OF CARISBAD AGAINSf ALL IJABllJTIES, JUDGMENTS, cnsrs
AND EXPENSF.S WlllCII MAY IN ANY WAY A£IlUIE AGAINSf SAID Cl'IY IN WNSEQUENCE OF TIIE GRANTING OF TIDS 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 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 after the work is commenced for a period of 180 days (Section 303(d) Unifonn Building Code).
APPUCANTS SIGN~ DATE: 3-/ Y---::15
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