HomeMy WebLinkAbout2402 LA COSTA AVE; ; CB920694; Permit,
PERMIT APPLICATION
City of Carlsbad Building Departaent
2075 ,Las Pal...,. Dr., carlsbed, CA 92009 (619) 438·1161
A; mmerc1al
I. I';; I nn;
LI New Bu1ldmg Li tenant Improvement
B -□ Industrial □ New Building D Tenant Improvement
~ ~
C -□ Residential □ Apartment □ Condo □ Single Family Dwelling □ Addition/ A1teration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical □ Plumbing
□ Mechanical □ Pool □ Spa □ Retaining Wall D Solar □ Other
2. PRCllECf INFORMATION
Add~Yll:2-. U, ('o,r~ lf//F-But@mg or Suite No.
Nearest Cross Street
LEGAL UESCRIM ION Loe No. Sutxi.1VJs1on Name/Number
CHECK BEWW IF SOBMl 11 ED:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope
ASSESSOR'S PARCEL ''~'"'" }Gfo-O /
ESCRIPTION OF WORK . ~ H rn ,/?me~,{!!;;;
SQ. Ff. / d-# OF STORIES
p 0. /3d-'C. 3 <fl(
PLAN ffiECK NO.
I
ESf. VAL
PIAN CK DEPOSIT _______ _
VALID. BY __________ _
DATE
FOR OFFICE USE ONLY
Onu No. Phase No.
PHOPQSED USE
'f :Z ,:J,O '( DAY TELEPHONE
NAME /ev r1 IO" . o. /!)~,'( 3<-/L/
CITY C fl.I<!. )~611.d STATE (!ff-ZIP CODE 9 J o0 'if DAY TELEPHONE 9.J / -7c,oo
ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
NAME 5 r'lf1\ e fl ::5 1/pplic rin r ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
STATE UC.# LICENSE CLASS CITY BUSINESS UC. #
CITY STATE ZIP CODE DAY TELEPHONE
7. WOll.kf:RS .. WMPP.NSAIIUN I
Workers' Compensation Declarat1on: I hereby afhrm that I have a certUlcate of consent to self-msure issued by the 01rector of lndustnal
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 Buildi~ Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY /-lll{! ,t ,c. tl'f\ )t> e,EI j :ifiCY N753 ?f7 u? J. (,,. EXPIRATION DATE / -/ -3
Owner-Butlder Declarauon: I hereby affmn that I am exempt from the Contracto?s Llcense Law for the followmg reason:
D 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.).
D 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 Ucense 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 Llcense Law).
□ I am exempt under Section ________ Business and Professions Code for this reason:
(Sec. 7031.S 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 Llcense Law (Chapter 9, commencing 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.S by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars [$500]).
SIGNATIIRE DATE
COMPI.EIE IRIS SEGIION FOR NON-RESIDEN IIAL B0IIDING PERMll's ONLY:
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 25505, 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?
C YES D NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□ YES □ NO
IF ANY OF TIii! ANSWERS ARE YES, A FINAL CERTIFICATE OF □a:IJPANCY MAY Nar BI! ISSUED AY11!R.JIJLY I, 1989 UNUlSS TIii! APPUCANT
HAS MEf OR IS MEETING TIii! REQIIIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND TIii! AIR POIJ.IJTION WNTIIOL DISTIUCT.
9. WNSIROCIIUN O!NDING AGENCY
I hereby afhnn that there 1s a constructmn lend mg agency for the performance of the work for which this permit ts issued (Sec !3097(1) Civil C&lej.
LENDER'S NAME LENDER'S ADDRESS
10. APPl1CAN I CEkliFICAfioN
I certify that I have read the application and state that the above mformauon 1s correct. 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 ID SAVE INDEMNIFY AND KEEP IIARMLilSS TIii! aJY OF CARISBAD AGAINST AIL lJAlllUTIES, JUDGMENTS, <DSTS
AND EXPENSES WIDCH MAY IN ANY WAY ACCRUE AGAINST SAID aJY IN WNSllQIIENCI! OF TIii! GRANTING OF TIIlS PI!RMIT.
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 pennit 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 pennit is not commenced within 365 days from the date of such pennit or if the building or work authorized by
such pennit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code).
DATE: 7-/&-1;). Ad□:;$ SIGNATU~)
c ~~;r WHITE: File YELLOW: Applicant PINK: Finance
YBSSBIPYUQ IH!IPIC:X:?ON /
PERMIT•-------PLANCJt • W-t?'.L-/ ; J'OB AOOll!SS ___ -z. ___ ~ __ o_;z... ____ ,t..._c._!f...._ ______________ _
TIME AJUtIVl: _____ TIME I.EAVE: _____ _
CO LVL DESCRIPTION
PDNITS
6/15/lt
ACT COMMENTS
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