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2075 Las Palrnas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION I!\ ~
PLAN CHECK NO.
City of carlsbod Building D-rtarit
2075 Las Pal-Dr., carlsbod, CA 92009 (619) 438·1161 EST.VAL. __________ _
I. PERMii IYPE T~~lMS PL\N CK DEPOSIT _______ _
VAUI>. BY __________ _
DATE From List 1 (see back) give code of Pennit.'f}'pe: ___________ _
For Residential Projects Only: From Llst 2 (see back) give
Code of Structure•Type: ____________________ _
Net Loss/Gain of Dwelling Units
2. PRCllECT INFORMATION FOR OFFICE USE ONLY
Address 1.3fl Mi4Si'tl2-s ?-iD Bu,ldmg or Suite No.
B
' mt o.
,I Jfu:b~~~~i ~rMll 1£0:
/f/J.-□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope
ASSESSQB'S PARCEL EXISTING USE
DESCRIPTION OF WORK ·je. f,SLL-1 !:> PBOPQSEP USE
# OF STORIES # OF BEDROOMS # OF BATIIROOMS
\''z.ar::ra~IAfs'DRESS l '1 3 z' c A,.:r J °:::> ~ o
ZIP CODE 92-173' "'" I -~-557
3 l1 l.-SA/..J /'UC C:rU r,; '--1>f"L
DAY TELEPHONE z,-
. NAME (last name first) Srff=tl. r{o!Mt:.S> ADDRESS
6_ %,1.iitQ SA.J OrEoOSTATE ZIP coDE DAY TELEPHONE
NAME (last name first) A L \) l --Z. 1 14 L A µ ,D5(J!,f]€ ADDRESS ( </ 3 "t ,::_ {I.L j"c.1 S f?. 0 ,
CI1Y SA6.J 01 le:uiD STATE cA ZIP CODE '12 ( 73 DAY TELEPHONE y,G, I -roe., 71
STATE UC. # 57 3g i}D LICENSE CLASS c.. CI1Y BUSINESS UC. # DESIGNER NAME (last name hrslJ ADDRESS
CllY STATE ZIP CODE DAY TELEPHONE STATE UC.# 7. WUkkERS1 WMPENSAliON
Workers• Compensauon Deciarauon: I hereby aUlrm that I have a ceruilcate of consent to self •insure issued by the Director of lndusmal
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 I) . la_ ~L!CY N0_ 1,:>f>C\ lti'::,,;)J.~3.~N DATE \ -\ -°11 ·
SIGNATURE DATE
8. OWNrut-D0llDrut btiDJtXIIUN
□
□
□
Uwner•BuUder Declaration: I hereby afnrm that I am exempt from the Confradofs Llcense Law for fie foliowmg 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).
1 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 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, commencing with Section 7000 of Division 3 of the Business and Professions Qxle)
or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.S by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500)).
SIGNATURE DATE
COMPLEIE iHlS SECIION FOR NON-RESIDEN IIAL B0IWING PERMll's ONLY:
Is the applicant or future building occupant required co submit a business plan, acutely hazardous materials registration form or risk management and
prevention program under Sections 25S05, 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
Is the facility to be constructed. within 1,000 feet of the outer boundary of a school site?
□ YES □ NO
IF ANY OF nm ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE lSSIJED AFl'l!R JULY I, 1989 UNIBSS nm APPLICANT
HAS Mirr OR IS MElmNG nm REQll1REMl!NTS OF nm OffiCE OF EMERGENCY SERVICES AND nm AIR POIJ.IJTION aJNTROL D!STIUCT.
9. WNS I KOCI ION LENDING AGENCY
I hereby affirm ffiat ffiere JS a construction lending agency for the performance of the work for whtch this permll IS is.sued (Sec 3097(1) C1VU C&ie).
LENDER'S NAME LENDER'S ADDRESS
10. APPIJCAN I Clill 11FJCAI ION
I certify that I have read the application and state that the above miormat1on ts correct. I agree to comply with all Gry ordinances and State laws
relating to building construction. I hereby authorize rep~ntatives of the City of Carlsbad to enter upon the above mentioned property for inspection
purposes. I AlSO AGREE ID SAVE INDEMNIFY AND KEEP HARMlJ'SS nm CTIY OF CARISBAl) AGAINSf ALL L!AB!lITIES, JUDGMENTS, CDSfS
AND EXPENSES W}llO{ MAY IN ANY WAY ACDU/E AGAINST SAID CTIY IN aJNSEQI/ENCE OF nm GRANTING OF nns PERMIT.
OSHA: An OSHA permit is required. for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB961652 FOR 10/03/96
DESCRIPTION: 360 SF PATIO COVER
TYPE: PATIO
JOB ADDRESS: 2341
APPLICANT: YRHG
CONTRACTOR:
OWNER:
MASTERS RD
PHONE:
PHONE:
PHONE:
STE:
REMARKS: MW/ROSS/661-6557
SPECIAL INSTRUCT: INSPECTOR'P/
TOTAL TIME:
--RELATED PERMITS--
CD LVL DESCRIPTION
PERMIT# TYPE
CB961373 POOL
ROW
RW960133 ROW
STATUS
ISSUED
ISSUED
ISSUED
ACT COMMENTS
INSPECTOR AREA PY
PLANCK# CB961652
OCC GRP
CONSTR. TYPE VN
LOT:
19 ST Final Structural ~-----------------------
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***** INSPECTION HISTORY*****
DATE DESCRIPTION
091096 Ftg/Foundation/Piers
ACT INSP
AP PY
COMMENTS