HomeMy WebLinkAbout2324 LA COSTA AVE; B; CB980234; Permit. ..
PERMIT APPLICATION
FOR OFFICE USE ON~..x ~ q
PLAN CHECK NO. tfpZ5 +
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 La s Palmas Dr., Carlsbad CA 92009
(619) 4 38-11 61
EST. VAL. _________ _
Plan Ck. Deposit ----~-'---~---
Validated By _ _.;::"-"'--~7':;~:7)!~~
Date ________ .,,,.. ___ *-,......._"'-
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2324 Ia Costa Ave #R Addreu (Include Bldg/Suite II
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Bualneu Name (at thla addraul
Legal Description Lot No, Subdlvlllon N1ma/Nuf!1bar Unit No, Phu• No.
FR
Assessor's Percal I Exl■tlng Uaa Propoaad Uu
Description of Work sa. FT. lof Storl11 I ol B1droom1
Total I of units
I of Bathrooms
Name Addre11 City State/Zip Telephone I
C~B
9
·":D'~o.w~=~~t1ii1Jl'&iW';~ Costa Ave #B CARLSBAD CA. 92009 ;~&~~~~!~'~? N■ r~ mer ' A ra■a City State/Zip Telephone I
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IS■c. 7031.5 Business and Prof111lona Code: Any City or County which raqulraa I permit to construct, 1lt1r, Improve, demollsh or repair any atructure, prior to Its
Issuance, also requires the 1ppllc1nt for such permit to 1111 1 signed 1t1t1m1nt that he la Uc:anaad pur■u■nt to the provl1ion1 ol the Contractor'■ Ucen■e Law
ICh1pt11 9, commending with S■ctlon 7000 ol Division 3 ol the Busln111 and Prol,1110111 Coda). Of that he la exempt therefrom, and the basis lor the 1Ueg1d
exemption. Any violation ol Section 7031.6 by any 1ppllc1nt lor • permit 1ubJ1ct1 the 1ppllc1nt to I clvll penalty of not more than llva hundred dollar■ 1'60011.
NaA. & J FOSCPER PLUH~ING ii,3706-B HWY 8 BUS EL CAJON CA . 92021 390-4477 A 111 City State/Zip Telephone I
Stall License I 630120 Uc1naa Class C-36 .City Bu1ln111 Ucan11 I 12 0035 4
Designer Name Address City State/Zip Telephone
St1t1 Uc1ru1 I N fA · ..
re:•i1:w.6RK.ERSt coMP~sA.11ot(.iW~-r~1J.m~i~r,m~:eM'.llilti'ill~Pll'~~n~iinu'lit\•1~.t!ff:i~;•,:.~· ... 1
Workere' Compenu tlon D1cl1r1tlon: I hereby affirm under p1n1ltv ol perjury one of the following .dacla11tlon1:
0 I have ■nd will m1lntaln • cartlflcatt of coruant to Hlf•lnaura for worker■' comp-atlon II provided by Section 3700 ol the Labor Code, for th■ performance
of the work lor which thla permit la l11u1d.
0 I hav, and will m1lnt1ln workara' comp1n11tlon, 11 requlr■~ by Section 3700 of'tht Labor Codi, r_or the performance ol th■ .;.,ork for which this p■rmlt 11
1-'ued. My worker', compensation ln1uranc1 carrier end policy number era:
lnsur■nca Company ~ INSURANCE Pollcv No. N2007-56-51 E,cplr■tlon Date CONTINUOUS
(THIS SECTION NEED NOT IE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1•100) OR LESSI
0 CERTIFICATE OF EXEMPTION: I certlly that In th• p1rform1nca ol th• work for which thla permit la l11u1d, I shall not employ any person In any m1nner 10 u
to become subject to the Worker■' Comp1n11tlon L1w1 of C1lilornl1. ·
WARNING: F1nu11 to aacura•workara" compan11tlon cova11g1 11 unlawful, end ah■ll 1ubJ1ct ■n employer to crlmlnal panaltlH and civil llnu up to one hundred
thousand doOers ($100,0001, In addition to the coat ol compan11tlon, d■magH II provld■d for In Section 3708 of the labqr coda, Interest end 11torney'1 Ins.
SIGNATURE ______________________ ...._ ______ DATE ________ _
1. ,-~·owNER-BUtLDER DE~LARAJIO~i~,;W:~;l);f.'~lili.m~P.~}~ l~~.1··1t.&'t~\;J~1~1 ?~1:,::~1~,: ·
I hereby affirm that I am u1mpt from th, Contrector'• Llcanae law lor the following ra■aon:
0 I, u own■r or the property or mv employe11 with wages II their 1011 compan11tlon, wlll do the work and the 1tructu11 11 not intended or offered for sale
!Sec. 7044, Business and Prof111lon1 Codi: The Cont11ctor'1 llcan11 law do" not 1pply to ■n own■r of property who bulld1 or Improve, thereon, and who does
such work himulf or through his own 1mploy111, provided that auch lmprov1ment1 ,,. not lnt1nd1d Of oll111d for Hit. If, howev■r, the building or lmprov■ment l1
sold within on, yur of compl1tlon, the owner-bullder wlll have the burden of proving that ha did not build or Improve for th• purpoaa of 11l11.
0 I. 11 owner of th, property, am 1xclu1lv1ly contracting with llc1na1d contractor• to conatruct' th• proj■ct (Sec. 7044, Bu1ln111 ind Profession, Code: The
Contractor'• Uctnaa L,w dou not apply to an owner of property who bullda or lmp,ov11 thereon, and contr■cta for auch project, with contractor(al licensed
pursu1nt t<i the Contractor'• Uc1naa Lawl. ·
0 I 1m exempt und11 Section ______ Bu1ln111 and Prof111lon1 Code for th11 r1110n:
1. I paraonally plan to provide the mtjor labor and m1t■rl1l1 for conatructlon ol the propoa■d property Improvement. 0 YES ONO
2. I lh1v1 / hive not) 1lgn1d 1n appllcatlon for a bulldlng permit lor th• propo11d work:
3. I have cont11ct1d wllh th■ following person lllrml I!) provld1 the propo11d conatructlon (Include name / addrHI / phone number / contracton license numberl:
4. I pl1n to provide portions ol the work, but I h1v1 hired the following p1r10n lo coordlnata, aupervlaa and provide th• m1Jor work !Include name / 1ddr11s / phone
number/ contractors licen11 numberl: ____________________________________________ _
5. I will provide soma ol the work, but I have cont11ct1d lhlredl the following p111on1 to provide th• work Indicated !Include name / 1ddress / phone number / type of workl: _____________________________________________________ _
PROPERTY OWNER SIGNATURE _____________ -,--_______ _
~toMatJ:(JHll,'SEC1JOl'fJ;QR,/:lON~$,J/JPJ..tiNi.e.wi:.wnQ,ilUMlD.TtiNi...,,,KiJIPK
II the applicant or future building occupant required to aubmlt • bu1lna11 plan, 1cut1tv huerdou1 materl1l1 11glstratlon form or rlak manag■ment ind prevention
p,ogrtm l.Wlder Sections 26606. 25633 or 26634 ol th• Presley-Tanner H11ardou1 Sub1t1nc1 Account Act7 0 YES O NO
11 thl applicant or lutura bullding occupant 11qul11d to obtain • permit from th, air pollution control dlatrlct or air quality m1n1g1m1nt distrlct7 0 YES O NO
Is 1h11 ltclllty to be constructed within t,000 IHI of \ha outer boundary of a school altd O YES O NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT II! ISSUED UNLUS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
II.~ 1\CONSTRUCTION LENDING'AGENCYl:.w:~j'.~~r~!'ll-\.)ffim..Q'fffil~·1m1J1Rtilr.lilMIII'ii!1JIQli'.K11F~'11rt"\ii'.W1:•l·J... '·,.:-: ,'.:i: '.
I hereby affirm 1h11 th■re 11 1 conatructlon landing 1g1ncv. lor th• p11form1nc1 of the work for which 1h11 permit It l11u1d (Sac. 3097(11 Civil Code).
I certify that I h1v1 r11d the 1ppllc1tlon and 1t1t1 that the above lnlormatlon la co111ct and that th■ Information on th■ plans Is accurate. I agree to comply with 111
City ordin1ncu and Stall l1w1 11l1tlng to building conatruction. I htraby ■uthorlll 11prH■nl1tlv11 of th• City of Carl1b1d lo enter upon the above mentioned
property lor inspection purp0111. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP .HARMLESS THE CITY OF CARLSBI\D AG/\INST ALL LIABILITIES,
JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT,
OSHA: An OSHA parmlt la 1aqul11d for 1xc1v1tl0111 over 6'0" d11p and damolltlon or c0111tructlon of 1Uuctur11 over 3 1torl11 In height.
EXPIRATION: Every permit luuad by the Building Ofllclal und11 th■ provlalona ol thl• Code ah■II uplre by llmllltlon and become null and void if the building or
work 1uthori1ed by auch permit la not comm1nc1d within 386 d1y1 from th■ date or auch permit or If the building or work authorlud by such pormlt Is suspended
or abandoned 11 any tlm1 alter th work comm,nca or• period ol 180 •v• (Sactlon 108.4.4 Uniform Bulldlng Codel/--z q·E1
APPLICANT'S SIGNATURE ..L.1#-L...L.a,.Clr:::J--J,,,,l~~A.<-I.LI...::::;.;....;__________ DATE ~r -4-(;
PINK: Finance '(