HomeMy WebLinkAbout2348 CAMINO ROBLEDO; ; CB001227; PermitPERMIT APPLICATION
CITYO'F CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
FOR OFFICE USE ONLY
PLAN CHECK
EST. VAL.
Plan Ck. Deposit
Validated By
Date
^" l *- I
Address (include Bldg/Sulte f }
Legal Description
Assessor's Parcel * JL ..
Description of Work' '
Business Name (at this address)
Lot No. Subdivision Name/Number
Existing Use _.__
SO. FT.
?V^ T C\'
*of Stories
Unit No.Phase No.Total » of units
Proposed Use
=*__-
# of Bedrooms 9 of Bathrooms
Name Address City State/Zip Telephone t Fax*
Name Address City State/Zip Telephone #
{Sec. 7031 .E 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 ^"^tC^
State License # J ' '
O -) A Address ^>-»
^---"^ License Class C^
City State/Zip
City Business License It
Telephone #
Designer Name
State License #
Address City State/Zip Telephone
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
Q 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.
Q 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:
Insurancejeompany Policy No. Expiration Date
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100] OR LESS)
TO/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
wfoecome subject to the Workers' Compensation Laws of California.
WARNING: Failure to secure worker*' compensation coverage Is unlawful, end shal subject en employer to criminal penalties and civil fines up to one hundred
thousand dollars ($100,000), In addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code. Interest and attorney's fees.
SIGNATURE DATE
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
Q 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).
Q 1, 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).
0 I am exempt under Section Business and Professions Code for this reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Q YES QNO
2. I (have / have not) signed an application for a building permit for the proposed work.
3. t have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number):
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 number):
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
of work): .
PROPERTY OWNER SIGNATURE DATE
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25605, 25533 or 25634 of the Presley-Tanner Hazardous Substance Account Act? Q YES Q NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES D NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES Q 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.
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 LENDER'S ADDRESS
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 thelbuilding 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 not commenc/d within 180 days from the date of such permit or if the building or work authorized by such pejrnit isjsuspended or abandoned
at any time after the work Is commenced pr a pejtoehff 180 days (Section 106.4.4 Uniform Building Code).
APPLICANT'S SIGNATURE DATE
WHITE; File YELLOW: Applicant PtNK: Finance
City of Carlsbad Bldg Inspection Request
For: 4/4/2000
Permit# CB001227
Title: BLANCHARD RESIDENCE
Description: 112 SF PATIO W/ELECTRIC
Sub Type:
2348 CAMINO ROBLEDO
Lot 0
Type: PATIO
Job Address:
Suite:
Location:
APPLICANT LORCO
Owner: BLAN CHARD MICHAEL P
Remarks:
Inspector Assignment:
Phone: 7604348945
Inspector:
Total Time:
CD Description
11 Ftg/Foundation/Plers
31 Underground/Conduit-Wiring
Act Comments
Requested By: LORCO
Entered By: ROBIN
Associated PCRs
Inspection History
Date Description Act insp Comments
APPROVAL
BY:
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