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Home My WebLink About2334 HOSP WAY; 309; CB970835; Permitt t r : ,. . ~ t t 1' r T J • # # l ~=-DATE --7 CLEARANCE ~a ,~~evj_ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 920CB (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 Lot No. Subdivision Name/Number 1 Assessor's Parcel II FOR OFFICE USE ONLY / PLAN CHECK NO. fl.-. )f;;>) EST. VAL. _________ _ Plan Ck. Deposit tt Validated By t[ I , 41Lr_ Date +I rqq 7 Unit No. Phase No. Total II of units Proposed Uae II of Bedrooms II of Bathrooms (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 issuance, 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, commending 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)). Name Address City State/Zip Telephone II State License II _________ _ License Class _________ _ City Business License II _______ _ Designer Name Address City State/Zip Telephone State License II _________ _ li.;:;_:;l;,W.Q8KERS!.COMPEN$4 TlOfy~~-=., . .!':;....i~~}.-:::.:.1:~~£: -~•,i.,,,;.~'-~..:.,,;..:::,~.!tti;~~ii}t~E~t'l•~t;t;ti~;;,,.: ~;;::'.:,;£.. ,, Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for: which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company_____________________ Policy No. Expiration Date. _______ _ (THIS SECTION NEED NOT BE qOMPL£TED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1•1001 OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the ·work for which this permit is iasued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to aecure•won:era' compenaetion coverage la unlawful, and shall subject ■n employer to criminal penalties and clvll fines up to one hundred thousand dollars ($100,0001, in addition to the coat of compensation, damages•• provided for In Section 3706 of the Labqr code, Interest and attorney's f .... SIGNATURE. _____________________________ DATE ________ _ !7, '~ O.WNER-BUILDER DECLARATION-,~-.' •. :, i.~-, ,: : . ••••• ' ,.1..:.;;""..':~~~:;~~~ .... q&~~~~j'.-~_,".!_~ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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 purpoae of nlel. D I, as.owner of the property, am excluaively 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 contrec:ta fOf' auch projects with contr■ctor(■I licenHd pursuant to the Contractor's License Lawl. D I am exempt under Section ______ Business and Professions Code for this reaaon: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. D YES ONO 2. I (have / have notl signed an application for a building permit for the proposed work. 3, I have contracted with the following person (firml to provide the proposed construction (include name / addrus / phone number / contractors license numberl: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license numberl: ______________________________________________ _ 5 . PROPERTY OWNER SIGNA T L@_a.t,..,EDUli!S ·sEClJON., '"' th, 11;,plic::it er f<.'tura buildlr.;; cupant requir...:I ,., liubmit • bu,;ine"" plan, acuteiy hazardoua materiala reg11tr■tion form or risk management and prevention program under Sections 26505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES D NO Is the facility to be constructed within 1,000 fNt of the outer boundary of a school site 7 D YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES ANO THE AIR POLLUTION CONTROL DISTRICT. /8.~]f~OJ'f$:TftUCTION LENDING"AGENCY"~'"'~£~~~.:;:~~'. "'.:::"7f_)J~;:_: ;·; ;-:::;'.),ir~~Jf · ..., !"1 · .. ·• ~;-'!fd;,~'.:J\.,, ,·'.'.'~7: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is iuued (Sec. 3097(il Civil Codel. LENDER'S NAME ______________ _ fs·; APPLICANT CERTIFICATION ' ' ,.. .. , ........ ~ I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply 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 AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST 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 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 o commenced within 5 days from the date of such permit or If the building or work authorized by such permit is susp&."\ded or abandoned at any time r period of 180 days (Section 10 .4.4 Un"form Building Codel. ~~; ~ ,Z APPLICANT'S SIGNATUR '::::...~ru:Z.C:'LJ.L----5~~3.~t.::::l~~_:_/L_,_Q....J.21~~~:: DATE _.,.¥,...,,....--....,",..~ ~~---------- YELLOW: Applicant PINK: Finance --~-----·------·-- INSPE DATE __ ,<.,-a=-.a....--INSPECT01!9-:~~::.._ _____ _ PER.MIT # ____ _ PLAN CHECK# _____ _ JOB ADDRESS ~33 ✓ /:4& cJ1)z DESCRIPTION _____________________ _ TIME ARRIVE: ----- CODE DESCRIPTION oi TIME ____ _ ACT COMMENTS a