The URL can be used to link to this page

Home My WebLink About2403 LA COSTA AVE; C; CB930049; PermitPERMIT APPLICATION PLAN CHECK NO. City of carlsbad Building Departaent 2075 Ly Pal..,. Dr., C&rlsbad, CA 92009 (619) 438-1161 EST.VAL. __________ _ PIAN CK DEPOSIT, ________ _ VAIID. BY. __________ _ I. P£RMII liPR DATE A -U Commercial Li New Building Li lenant Improvement B -D Industrial □ New Building D Tenant Improvement C -□ Residential □ Apartment Jl(eondo □ Single Family Dwelling □ Addition/ Alteration □ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical O Plumbing □ Mechanical □ Pool □ Spa □ Retaining Wall □ Solar □ Other 2. PRClJECf INFORMATION FOR OFFICE USE ONLY BuHdmg or Smte No. LEGAL DESCRIPI ION Lot No. Subd1V1s10n Nam&Number 0mt No. Phase No. □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PABCEJ: EXISTING USE PROPOSED USE DESCRIPTION OF WORK SQ. FTT~M P. ?cM->~F STORIES 3. WN IACI PFJtSCJN (1£ different from applicant) NAME ADDRESS Cl1Y STATE ZIP CODE DAY TELEPHONE 4. APPUCANI NAME UCONiRACIOR UAGENI FORWNiRACIOR DOWNER DAGEN I FOR OWNER ADDRESS CI1Y STATE ZIPOODE DAY TELEPHONE .."'"4o7Vli. Vfiuiz:w~v:-e~t)DREss c.,, 99-, e>,'tU.--1 .,.,, c., FzL ,1-,,ti: CITY 7flr..\ V1f {.,() STATE ~ ZIP CODE 9Lt t 9 DAY TELEPHONE .t\{,,O · €,.t\ $'C:, STATE uc. # 4 I? 4'92i,icENSE cIASs D CI1Y BUSINESS IJC. # CITY STATE ZIPOODE DAY TELEPHONE STATE IJC. # 7. WOltkERS' WMPENSAIION Workers• Compensatton Oeclarat1on: I hereby afhrm that I have a cert1hcate of consent to self-msure issued by the Director 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 Building Inspection Department (Section 3800, Lab. C). INSURANCE OOMPANY POIJCY NO. EXPIRATION DATE Cernhcate of Exemption: I certify that m the performance of the work for which this pernui 1s issued, I shall not employ any person m any manner so as to become subject to the Workers' Compensation Laws of California. SIGNATURE DATE 8. UWNm-uonnm Dfi!OOlXl[ON Owner-Builder Oeclarat1on: I hereby affmn that I am exempt from the COntracto?s license Law for the followmg 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.). 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 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). □ I 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 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]). SIGNATIJRE DAll! COMPLEI£ IHIS SECIION FOR NON-RESIDENIIAL BOILOJNG PERMl'i'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 pennit from the air pollution control district or air quality management district? CYES ONO Is the facility to be constructed within 1,000 feet of che outer boundary of a school sile? □ YES □ NO IF ANY OF nm ANSWERS ARE YES, A FINALCERTIFICATEOFOCDJPANCY MAYNar BR ISSUED AFrnRJULY 1, 19891JNU!SS THl!APPLICANT HAS MET OR IS Ml!IffiNG THI! REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND THI! AIR POil.UTION WNTROL DISTRICT. 9_ WNSJRUCIIUN IENDING AGENCY I hereby afhnn that there 1s a construction lendmg agency for the performance of the work for which this penn1t 1s issued (Sec 369?(1) Civil Code). LENDER"S NAME LENDER'S ADDRESS JO. APPLiCXN I CEkl IFJCAIIUN I cerufy that I have read the appJJcauon and state that the above information ts correct. I agree to comply with all C1ty ordmances 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 THI! CI1Y OF CARIS8AD AGAINST ALL LIABIIJ1lES, JUDGMENTS, CDSrS AND EXPENSES WIIlCH MAY IN ANY WAY MDUJE AGAINST SAID CI1Y IN WNSEQUENCE OF nm GRANTING OP TIIlS PERMIT. OSHA: An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit 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 permit is not commenced within 365 days from the date of such pennit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). APPIJCAN1"S SIGNATURE DATE: _____ _ WHITE: File YEil.OW: Applicant PINK: Finance ' UNSCHEDULED INSPECTION INSPECTOR._e:::::=. _______ _ PLANCK# ______ _ JOB AOORESS __ ,..:2=-.;1.--'"'0-=3"--',£..:a;;.;;~;._..,lf _________________ _ TIME AR.RIVE: _____ TIME LEAVE: _____ _ CD LVL DESCRIPTION PDMITS 6/15/89 ACT COMMENTS d-6 WRITE IT-DON'T SAY IT! 19 I To F/L-?-0 Reply Wanted From ----=-/: □No Reply Necessary , • I 21/0> C' L.C.A • ,-RINTt:D '"" USA . ·----------