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Home My WebLink About2433 LA COSTA AVE; A; CB920519; Permit• I l' 1 '± !. LA ,:u i'A AV A l ,r. ,. 1: rm t .... YT : E-~UMt I.~ [\,: ,1b-l. l ~ ()4- Vu'..ui+-.,n: H1 tr uct 1 ,ri Yl e: NEW l > t..•,.1n1.. y c,t ou.P: .>c cn.f.,t:. in: N~':'ALL GAS LTNE AfI?"..1vwnr ---------- <.AVE'NDI-R, ~COTT !JA I.A Cv~ TA AV c ARL~BAll, :A c lll( q ------- feps: Ad Jll ·trrent.;: i ,t : Feecs: ree cJc=>sc1..ption -----------~- r.r.t er Y for Plum Gas Piping Sy~tem ~ t~vMblNG 107AL N , ---- , E t M u t' k !.. • t t , . ~ Nl /\ )f V I l l'' ,. .. 'I; 7813 05/?7/92. 0001 01 C-PRMT ~0 - Apt l 1 , ( .. 02 Apr I I t l-, V llld+-• 1 L1 · '[ 10-00 4:o1'.:.0l 11 ectc•d b. l re Lt.., -------__ _..._..,,. ----' • 0 l t.:1:-t lal ' J. 0) .. Ext f(. ld i I • .-, 1 y l . .-C : (1 , I ) (619) 438-1161 .. PERMIT APPLICATION l!A '1:/t, PLAN CHECK NO. City of carlsbad Building Departaent I EST. VAL 2075 Las Pal ... Or., carlsbad, CA 92009 (619) 438-1161 PIAN CK DEPOSIT _______ _ VALID. BY _________ _ I. PEkMII liPR DATE A -LI Commerc1al B -□ Industrial □New Bu1idmg U tenant Improvement □ New Building O Tenant Improvement C -□ Residential □ Apartment □ Condo U Single Family Dwelling U Addition/ Alteration □Duplex U Demolition U Mechanical □ Pool U Relocation □ Mobile Home U Electrical □ Plumbing □ Spa O Retaining Wall □ Solar □ Other 2. PROJECT INFORMATION FOR OFFICE USE ONLY Address Z4~3A LJ,,. ~ A'I/E. Budding or Suite No. Nearest Cross Street eL~li-lO PS/IL - LEGAL DESCRIJS'I ION Lot No. Subd1V1s10n Name/Number Unit No. Phase No. MAt:SeLLA □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PARCFI, EXISTING USE PROPOSED USE DESCRIPTION OF WORI< SQ. Ff. # OF STORIES 3. WN IACI PEkSJN (U amerent from apphcanl) NAME ADDRESS CI1Y STATE ZIP CODE DAY TELEPHONE NAME CI1Y STATE ADDRESS ZIP CODE DAY TELEPHONE NAME CI1Y STATE STATE LIC. # ADDRESS ZIP CODE LICENSE CIASS DAY TELEPHONE CI1Y BUSINESS LIC. # CI1Y STATE ZIP CODE DAY TELEPHONE STATE LIC. # 7. WOIUCAAS' WMPF.NSA:IIUN Workers' Compensation Oeclarat1on: I hereby affirm that I have a cert1hcate of consent to self-msure issued by the Utrector of lndustnai 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 COMPANY POLICY NO. EXPIRATION DATE □ □ Certificate of Exemption: I certify that m the performance of the work for which this permit 1s issued, I shall not employ any person m any manner so as co become subject co t e Workers' Compensation Laws of Ollifomia. DATE '52'° z. I hereby affmn that I am exempt from the Contraccofs License Law for the following 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.). 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 pennit 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 pennit subjects the plicant to civil penalty of not more than five hundred dollars [$5001). SIGNATURE DATE Sa:. ~ 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? Cl YES Cl NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □YES □NO IF ANY OF TIIE ANSWERS ARE YES, A FINAL CERTIFICATE OF OOCUPANCY MAY NUf Bl! IS.WEI) AFTER JULY 1, 1989 IINIJ!SS TIIE APPIJCANT HAS MET OR IS MEIITING nm RF.QUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND TIIE AIR POlLUTION WNTII.OL DISllUCf. 9. WNSIR0CIIUN LENDING AGENCY I hereby afhrm that there 1s a construction lend mg agency for the performance of the work for which this penmt ts issued (Sec 309)(1) dvlI Code). LENDER'S NAME LENDER'S ADDRESS IO. APPUCANI CPltlfilk!A'ilUN I certify that I have read the application and state that the aOOve mformat1on 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 Olrlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE ID SAVE INDEMNIFY AND KEEP HARMlllSS nm CI1Y OF CARISIIAD AGAINSf AIJ. IJABIIITIES, JUDGMENTS, CDSfS AND EXPENSES WIIlCH MAY IN ANY WAY ACCRUE AGAINSf SAID QTY IN WNSEQIIENCE OF nm GRANTING OF TIIlS PERMIT. OSHA: An OSHA pennit is required for excavations over 5'011 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 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). APPLICANT'S SIGNATURE~ DATE: '5/ ~f,z WHITE: File YELI..OW: Applicant PINK: Fmance I'-"• n•-o" I I l { I -NEY-J GA.S, Yz."~ ,~~ ... ~N6CA5 ~ tS ~ 1'1 =-e'-c1 ' r--lSIA i.;,-,, \