The URL can be used to link to this page

Home My WebLink About2344 HOSP WAY; 126; CB970623; Permit(_JC ·# l.o_ l I A i r r l y :.LP I ' ..:. r ~p., L r t ~ A t +-: ~ ~ l r t M r1.t:> >U re . _, ( ~ r E C ;,. ) • I: • A.,. { l'O E #1 F X Kf. ., j ~ • * ' 1 1 <l l r + #: t ~· .. 1 y: +-l t- xt PPROVAL INSP.. ---~-D ",TL: j ---.2o 'I. T 'I,:. w 1\ CLEARANC E_~o/r7 r~ S, CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK No.C/?tJ b?-0 CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 EST. VAL. _________ _ Plan Ck. Deposit ------,,c-r;;,--- Validated Date. _ _,_4 -+-Huo;,__+------ Subdivision Name/Number Unit No. Phese No. Total I of units Assessor's Parcel I Propcsed Use Cl Name Address City Stete/Zip Telephone I 11:iEcti~B~ (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, damotiah or repair any structura, 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 t he 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, end 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 I State License I _________ _ License Class _________ _ City Business License I _______ _ Designer Name Address City State/Zip Telephone State License I _________ _ ~.QIUWIS .. t coMPENSAno~~~\,:~~1!i~;~.:.:.::\£:.~::-~~·~,~~~J1E~1\(skc.::;L~~wB-1;k~qa.ww:~v~~t.d?~~J./~.:J.:'..i; .. ,~. "·,L 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 Coda, 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 la issued. My worker's compensation insurance carrier and policy number are: Insurance Company_____________________ Policy No. Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESSI 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, 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•workera' compenaetion coverage la unlawful, and shall subject an employer to criminal penaltiea and civU fines up to one hundred thousand dollars ($100,0001, in addition to the coat of compensation, damages as provided for In Section 3706 of the Labqr code, lntereat and attomey'a fefa. SIGNATURE _____________________________ DATE ________ _ ~~~:~:~::1~:D:::::~:~-:~::::::o~~~i~::::~t:: :::::h:~::1:0:::~::~:~:·~~:~::~~::~::~~:-:~~~:-:~::r~~i : 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 ottered 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 ha did not build or improve for the purpcn of eele). 0 I, as.owner of the prope"y, am exclusively contracting with licensed contractors to construct the project (Sac. 7044, Buaineaa and Profea■ions Coda: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for euch projects with contr■ctor(al licenaed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business snd Professions Coda for this reason: ./ ~Y plan to provide the major labor and materials for construction of the proposed property improvement. ~ES ONO ~ve not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / addraas / phone number / contractors license number): 4. I plan to provide po"ions 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 number): ______________________________________________ _ 5. I will provide some of the work, but I have contracted address / phone number / type of work):. ______ --::::=----:::;;,C.,,.','----""?-,'--::.-r-----:~-;r---,,4~-:--~-;l=7'-~""7------7'~-r------------- PROPERTY OWNER SIGN.A; fJ..o.~;S~Cl]O , . Is t.'>:, n:;,:,Hc:c,t or future buil<lir..; cupant raqlJired \.:> •ul>mit • bu~ines"' plan, ecuteiy hazardous materials reg1strat1on form or risk management and prevention program under Sections 25505, 2 533 or 25534 of the Presley-Tenner 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? O YES O NO Is the facility to be constructed within 1,000 feat of the outer boundary of a school site? 0 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 AND THE AIR POLLUTION CONTROL DISTRICT. ~.'!' ,.o· N;,.,..,UCTION LENDING'AGENCY-''" · t "'IT':"'.~ =c;;, "''~:li""' ,.,~,,rr,;;,.;.w· .;· ., ., .. .sr":",,..""il!'::,-;,-,~~~,,..:m"",~r,-~l'.Ji'mt-r. · ··. "'"· ~D ._.!__".'!f· ~ ""-'" · · ~~'k&,1-~f.:"r'"><;;~;,.,4-....... J~u~·~.r•; ,. ~~•·r,~1;•,;c.~~'jjji;·~~~=ti~~~ .. ~";~1-.:.;.. , .. ,c~· I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ fl; ... 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 accurat e. 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 ANO 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 structurea over 3 stories in height. EXPIRATION: Every permit issued work authorized by such mit · or abandoned at any e afta APPLICANT'S SIGNA • • ON DATE INSPECTOR-::!:~::~~------ PERMIT#_____ PLAN CHECK# ____ _ JOB ADDRESS __ {)=-..;,..3-'<)_¥'----'-~....;.__;;-+"'-/)~r:Jr_=:f~_...,rf..:.....<..,/c2t!,=_ =-· __ _ DESCRIPTION ____________________ _ TIME ARRIVE: ____ _ TIME ____ _ CODE DESCRIPTION ACT COMMENTS