HomeMy WebLinkAbout2428 LA COSTA AVE; ; CB900385; PermitB U I L D I N G
03/07/90 16:46
Page 1 of 1
Job Address: 2428 LA COSTA AV
Permit Type: ELECTRICAL
Parcel No:
Valuation: 0
P E R M I T
Str:
Permit No: CB900385
Project No: A9000486
Development No:
Fl: Ste:
3858 03/07/90 0001 01 0~ f' t> MT 1 .ro
C.A#/0 3 Construction Type: NEW
Occupancy Group : Class Code: Status: ISSUED
Description: TEMPORARY POWER
CONTRACTOR ASSOCIATES AND BEN, LTD .
2408 LA COSTA AVENUE
CARLSBAD, CA 92009
*** Fees Required *** ***
Fees:
Adjustments:
Total Fees:
Fee description
15.00
,00
15.00
Applied 03/07/90
Apr/Issue
Validated By: DC
Lie. C NO 619 942-0944
Fees Collected & Credits ***
Total Credits:
Total Payments:
Balance Due:
Units fee/Unit
.00
.00
15.00
Ext fee Data
---------------------------------------------------------------------------
Enter "Y" for Electric Issue Fee >
Enter "Y" for Temporary Service >
* ELECTRICAL TOTAL ($10 Minimum)
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161
5.00 Y
10.00 Y
15.00
PERMIT APPLICATION
•
City of Carlsbad Building Department EST. YAL·------------c:---2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 .
PLAN CK DEPOSIT, _____ :;:,,_.,::::::_-__ _ .
VALID. BY, _____ ,,..~:::__,.-______ _
1. PERMIT TYPE . . DATE _,,,,,,,,,,,..
A
B
2.
COMMERCIAL
0 INDUSTRIAL
□RESIDENTIAL □APARTMENT
QDUPLEX □DEMOLITION
□MECHANICAL □POOL
TENANT IMPROVEMENT
0 TENANT IMPROVEMENT
□CONDO
□RELOCATION
□sPA
□SINGLE FAMILY Dl.'ELLIN 0ADDITION/ALTERAT!ON
□MOBILE HOME LECTRICAL □PLUMBING
□SOLAR
Unit No, Phase No.
CHECK BELOM IF SUBNITTED:
3.
4.
5.
7.
8.
Q2 Energy Cales 02 Structural Cales
BLDG. SQ. FTG,
CONTACT PERSON
NAME
Cl TY
SIGNATURE
APPLICANT 0 CONTRACTOR
NAME
CITY
PROPERTY OWNER
NAME
D 2 Soils Repcrt D 1 Addressed En'lelope
EXISTING USE
#OF STORIES
STATE
ADDRESS
ZIP COOE
0 AGENT FOR CONTRACTOR
ADDRESS
STATE ZIP CODE
OWNER
ADDRESS
OmmER
PROPOSED USE
DAY TELEPHONE
0 AGENT FOR 01-!NER
DAY TELEPHONE
□LESSEE □TENANT
CITY ZIP CODE DAY TELEPHONE ~/
ADDRESS 2c/&'I ~,,p. 6'.C"rlP AIP&/ c#ffi).
SIGNATURE
DESIGNER
CITY STATE
ZIP COOE '1 jptJf DAY TELEPHO,C f{/.,t-o fr/f
LICENSE CLASS ./-I
TITLE...52
ADDRESS
ZIP COOE
CI TY
DAY TELEPHONE STATE LIC. #
WORKERS' COMPENSATION Workers• C~nsation Declaration: hereby affirm that have a certificate of consent to self-insure issued by the Director of Industrial Relations,
or a certificate of Workers' C~nsation Insurance by an alitlitted 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 COMPANY POLICY NO. EXPIRATION DATE
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' Corrpensation Laws of California.
SIGNATURE DATE
OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
0 J 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.).
0 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 ,.ho 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:
(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, corrroencing with Section 7000 of Division 3 of the Business and Professions Code) or that Me 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 dol l ars ($500] ) .
SIGNATURE DATE
COMPLETE THIS SECTION FDR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to su001it 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?
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □YES □,o
OYES ON0
Js the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES 0,0
IF ANY OF THE ANSWERS ARE YES, A FIMAL CERTIFICATE OF OCaJPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS NET OR IS MEETING THE REQUIREMENTS
OF THE OFFICE Of EMERGENCY SERVICES AND THE AIR POI.LUTIOM CONTROL DISTRICT.
9. CONSTRUCTION LENDING AGENCY
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
10. APPLICANT'S SIGNATURE J certify that 1 have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating
to building construction. ! hereby authori.i:e representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO
AGREE TO SAVE INDEMNIFY ANO KEEP HARMLESS THE CITY Of CARLSBAD AGAINST All LIABILITIES, Jll)CJ4ENTS, COSTS AND EKPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING Of THIS PERMIT.
sued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building
need within 180 days from the date of such permit or if the building or -.erk authorized by such permit is susperided
corrmenced for a period of 180 days (Section 303(d) Uniform Building Code).
□ OIINER □ CONTRACTOR □ BY PHONE APPROVED BY: _______ _
DATE:
YELLOW: Applicant PINK: Finance