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HomeMy WebLinkAbout2342 HOSP WAY; 123; CB970836; Permit• I 07 A CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 l\PPLICA TION FOR OFFICE USE ONLY 1 c_ PLAN CHEC)< NO. CCJ -~,;,c> Cl I y or CARLSBAD BUILDING DEPARTMENT ;)075 las Palmas Dr., Carlsbad CA 92009 16 19) 438-1161 EST. VAL, __ ...__;.,_ ____ _ Plan Ck. Oepoalt ____ ;....._...,... _ __...;..:_....,_ Validated J1y1 : 1 ~ Date Lf /bl q _ ~, ' ~- Lot No. Subdivision Name/Number Unit No. PhlUNo. Total I of units C Exiatlng Use of 81throom1 Fax I 3. _f:h~tL.Lf&.~-Pt,~L-..Lz~~~~__:___J',4l:1.~~-4,~~~~a1,?l.:..::::.JJ.~-7aS9 City elephone -, / ~m4t0 ~~ ~= ~~~~JM?d JC, \ -U~·--=~dCJ Mnme ~ AddrlU ~ ~ S~p ftlephone1• !l;.";:-1'coNTRACJbli COM JI.&;}, (S"'c 7031.5 Business and Prof111ion■ Codi: Any City or County whict) requlr• • permit to c:onetruct, 1h11', lrnptowt. cNmollth Of,..., ilW ftiucitur4, lklof to It• issl•~nce. also requires the 11ppllcant fot auch pettnlt to fll• • 1lgned 111t,m,nt 'that he la llc-ed pur-,,t to 1he P,~ of ~ ~•ctoi'• µc.nH law 1r.ti~Pter 9, commending with Section 7000 of Dlvl1ion 3 ol the 8ualna1 end Prol111ion1 Codi] or thit he It txempt tn«thont, In«! tht Wei, for the 111,ged e,n111ption. Any violation of Section 7031.5 by any applicant for• permit 1ubjeet1th411ppllcant to• civil pentlty of not mora thin five hundred !lollats ltliOO)I. lh1t1Pt Addr111 City Stat9/Zlp Tel•Phane I r.:1ntn: Lic~n~e I ________ _ Ucen•• Cina ________ _ City Bu1ln111 UctnH I _______ _ I 1p~rpner N;\me Address ·'City Stat9/Zlp ~t~t" License I ________ _ .~. WORKERS' COMPENSATION.,~;.,-, .:...:~'ti~~-~"' t.~ l:l.ii,L~~,~ Workers' Compensation Declaration: I hereby alllrm under penalty of perjury on, of the following declaretlont: ~. ~\ .. • • I ',L {!.-•. S',/i,1 1'•~i"<t, [] I have and will maintain • certificate of coneent to aelf-lnaura for worltera' compenutlon H provided by Section 3700 of the Labor Code, for th. performanc• nl the work tor which this permit Is luued. · f.J I h•ve and will maintain worke11' compenaation, .. required by Section 3700 ol the Labor Code, for the perfonnance of the work for :Whlch thia permit la insu~d. My worker·• compenntion lnautance c.1rrltf and policy number ■re: IMurence Company____________________ Policy No.____________ Expltttlon Date. _______ ~ 1 fHIS SECTION NEED NOT BE COMPLETED IF THE PIRMIT IS FOR ONE HUNDRED DOLLAR& It 100] OR LEHI 0 CERTIFICATE OF EXEMPT;ON: I certify thtt in the performance ol the ·work for which thla permit It INued, i llhell not employ 11'1'/ l)llrtcli'I In 'ny mahMr ao H to become subject to the Worker•• Cbm~naatlon LIWI of Callfomla. WARNING: Fallu11 to Hcura•wortc••• oompanutlon CO'ffl'IIOl la unlawful, and ahall aubject en employw to orimlnll,........ end 11,,11 flniM Up 10 one...._ thouHnd dollars (*100,0001. In addition to the c:oa1 of compenaatlon, damegH u p,ovi.ct for In Section 370t of the L-. oode, lnleftlt anii ettomay'i fMII, $1GNATURE ti OAT!__________ , 7. OWNER-BUILDER DECLARATION,'-~•·• .'.-\~l~~ Y,•;:1 ~.,I,,> ,: .• •ti-. • t•~•: '.'·:J.£.v..:...~ ,_,. ' ll~reby affirm that I am exempt from the Contrtctor", Uce.,11 Law for Iha following reaaon: O 1. as owner of the property or my employen whh' wages H their sole compen11tlon, will do the work lnCI ttlt ttNCturt i. ho\ lnt9'ldtcl o, offered for Nie !Sec. 7044. Business and Profa11lona Code: The Contractor'i Ucenat !Aw doH not apply to In owner Of llfoptft'( who tiullda ot ~ ~ end • doll such work himself or through his own amployeea, provided that tuch lmprovemenu ire not Intended Of offll'ed for Ale. If, ho~, tht blMfto ot Improvement It s old within one yHr of completion, the ownll'-builder will hive tti. burden of proving that he did not bu1ld or lm,wO,,e tor1he ~ of Nlel, 0 I, u owner of the property, am ■xcluelvely contracting with ffc:enHd COl'ltractora to con■truct the protect (Ste, 7044, ~ end l'tofNilone Code: The Contrector's Llc41<1H Law doH not apply to an owner of property who bullet. or Improves thereon, end contr9Ctil for tuch ~ wlifl ilontfactllf(•I llcMMld pur,uant to.the Contractor•• Llc•n11 !Aw). . ' · 1 • , •. 0 I am exempt under Section ______ 8ueln1U end ProfeasloN Code for thla raaaon: 1 . I personally plan to provide the major labor and m1tarlal1 for conatructlon of th41 propflld propany Improvement. 0 YE& ONO 2. I (have / h•v• notl signed an 1ppllc1tlon for• building permit for th• propoa•d work. 3. I 1,,ve contracted with the following parson (firm) to provide the propo11d con,tructlon (Include name / edcir-/ ~ number / ~°" ~• number): 4 1 plan 10 provide portions ol the work, but 1 hav, hirecl the following ptrson to coordinate, suparvl11 end provide the majOt' worlt llnc:tucii natnt I acldre11 I phone number/ contractors licen11 number): ____________________________________________ _ 5. Pn0F'ERTY OWNER SIONA 0AtE COMPLETE:rHIS-SECTIO ON-MS/D J-1;. ,, ~!,-., e:.,l)lic::it or future building c:upant requ;,■d to •ul>mlt..• bu1"-e 1'11n, ■cutely huardoua materlell, regilbltielh form ot rlllC ~ end prevention p,ogrem under Sec:tlona 26605, 215533 ot 215534 of the Prealay-T■nnar Hazardous Substance Account AClt? 0 VII [j NO · . . Is the applicant or future building occ:upam required to obtain • permit fr°"' the air pollution l:ontrol distriet br tit Qil■ltv mtna~ dlatrlctl O YES O NO Is the fecllftv to be constructed within 1,000 feet of the outer boundary of a school ■ital Cl YES O NO If { IF ANY OF THE ANSWERS ARE YES, A FINAL CERT1FICATI OF OCCUPANCY MAY NOT IS! IISU!D UNI.DI 1'Ht APl"UCANT HAa MET OR II ME1T1Nd THE REQUIREMENTS OF THE bf'FICE OF b1E.RGENCV SERVICES AND THE AIR POLLUTJON CONTROL DISTRICT, '8 ) • CONSTRUC11dN LENDIN0"4G£NCY0,.,-'?-~~-:.:!',lflt.:t;..tet~ .:;.~•f,t4,·; I hereby affirm that there i1 a construction lending agency for tht perform1nca ol the work for which thll ,iermlt ll"l■lued lieo. 3007Cii Clvl1 ·c~I. l LENDER'S NAME ______________ .LENDER'S ADDRESS 9. APPUCANT,CERTIFICATION .!-,•. ,· * . ·, • ·.;;. .... ,;.,. .. , ¾':.;..• · :, .... ,, !, ' •• .t;•,..;c-:,,.1:~_~;.~-~-.ijR§•~¥,!~ .• ;r,\~$~·~i~iii~·iii·iai~ii~~.,.~lm'lir;~~ll· ~\~~~-CJ~-... ~·~.~ ... t .. :; .. _~·.-.:-~- 1 cettitv that 1 have , .. d the applicetioh and state that th• above lnformttlon l1 conact ahd that the lnfOl'tnltlon llri the i,lens 1• ac!cur1ta. r aorN tb comply with 111 Chy ordinances end Stat• l■wa relating to building oonatruction. I hereby authoriz:e repr11ent1tlvff of the' City of C■,labelf 16 entet ilc,oii tlie allova mentioned property for inspection purpo111s. 1 ALSO AGREE TO SAVE. INDEMNIFY AND KEEP HARMLESS THE CITY OP cAlu.tllAD AciAJNll ALL UABIUTIES. JUOGME.NTS, COSTS AND EXPENSES WHICH ~y IN ANY WAY ACCRUE AGAINST SAID CITY IN CONnOUoiCI 0P'rHI ORANTIN~_OF'T~I PERMIT. OSHA: An OSHA permit 11 required tor exca11atlont over 6'0" dffp and demolltlori or COl'lltluctlon of atructur• over 2 atotle■ In heloftt, F.XPIRA TION: Every permit lu uad by the Building Official under the provlalona of thla Coda 1hatl expire by limitation Ind become Ill.Ill ind void If the building or work authorized by ,uch permit l1 t commenced wh 65 daye from the date of 1uch permit or If the bulldinO or work authorized P'fmlt 11 euspended or abandoned at any tim rt k II commenc f a period of 1 0 daYI (~ _j OJ,4-.4 rm Building Codtl, ¥ Af'f'LICANT"S SIGNATU / ~~ . DATE __ .,_,,.;....;~-'--'----'------ PINK: Fintnca PERMIT# CB910456 DESCRIPTION: PLUMBING/HEATING TYPE: MISC CITY OF CARLSBAD INSPECTION REQUEST FOR 05/14/91 LOY/KITCHEN INSPECTOR AREA PK PLANCK# CB910456 OCC GRP CONSTR. JOB ADDRESS: 2342 HOSP WY APPLICANT: NEW DESIGN REMODELING CONTRACTOR: PHONE: PHONE: STR:** FL:**** 619 431-2800 TY~ STC23 / OWNER: REMARKS: MH/KEITH/431-2800 SPECIAL INSTRUCT: TOTAL TIME: CD 29 39 LVL DESCRIPTION PL Final Plumbing EL Final Electrical PHONE: INSPECTOR__,,_@: __ -__ ./_,,_-_______ _ ACT COMMENTS -pi---- ***** INSPECTION HISTORY***** DATE 032191 032191 DESCRIPTION Rough/Topout Rough Electric ACT INSP AP PK AP PK COMMENTS