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Home My WebLink About2478 IMPALA DR; ; CB960965; Permitr F ~c r 1 P -. - f"r , tor I Awn1n o ~h t IL F ) J .., De 78 · J..6 05,31/96 02 0 "'t JC 1 l O 00 e .I. 9 1 2 re t_ )t * ' -t 0 PRO ' 0 . \ IN ~£t5-DAT ,J.zl:91J-" LtKntt1 vt ~ ms Las PaJmas CITY OF CARLSBAD Dr., Carlsbad, CA 92()()() (619) 438-1161 PERMIT APPLICATION PLAN CHECK NO. City of Carlsbad Building Department 21175 Las Palms Dr •• carlsbad, CA 92009 (619) 438-1161 F.Sf.VAL~----------- I. PERMl'I 1YPE PLAN CK DEPOSIT _______ _ VAIJD.BY ___________ _ DATE From List 1 (see back) give code of Permit-Type: ------------- For Residential Projects Only: From List 2 (see back) give Code of Structure-Type:--------------------- Net Loss/Gain of Dwelling Units------------------- 2. PROJF.Cf INFORMATION FOR OFFICE USE ONLY Address J'f7t, '.l-;v..pQ la Onv~ Building or Suite No. (! Nearest Cross Street LEGAL DESCRIPTION Lot No. Subd1V1s1on Name/Number Orne No. Phase No. CHECK BEtbW IF sOBMII 1£0: [J 2 Energy calcs D 2 Structural calcs D 2 Soils Report [J 1 Addressed Envelope DESCRIPTION OF wpRK lf'.i-6o I Q"'°'"4-t.";~ I ~(J PROPOSED USE SQ. IT. lbt Ck' 1 ' -f '-. # OF STORIES # OF BEDROOMS # OF BATIIROOMS ere.p rom app 1cap • CfGc0 etJe,11(,. ADDRESS"}.L/7/, ~/o/';) 1).,,11€. STATE(,+-ZIP CODE ct 2C() S" DAY TELEPHONE 43f, oc:; ac; NAME (last name first) CllY <=:::,{lo/\ 't),, t) STATIC.It" ZIP CODE Cfl.-10 DAY TELEPHONE s. PROPERlY oWNER I • tL-... • I~' NAME (last name first) e~ fu(~ Ctm~ 17~ ADDRESS 3'f0\ (U.t~ ~7'. CI1Y ~,W--~c~ STA~'A-ZIP CODE qJ.tO I DAY TELEPHONE 2 ?(,... 2,pi,r STATE UC.# UCENSE CLASS CllY BUSINESS UC. # DESIGNER NAME (last name l1rstJ ADDRESS CI1Y STATE ZIP CODE DAY TELEPHONE STATE UC. # 1. WoRKERs' CDMPENsAllON Workers' Compensanon Oeclarauon: I hereby affirm that I have a ceruhcate of consent to sell-insure issued by the Director of Industnal 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 POUCY NO. EXPIRATION DATE Ceruhcate of Exemption: I cerufy that in the performance of the work for which this permit 1s issued, I shall not employ any person many manner so as to become subj~he Workers' Compensation Laws of califomia. SIGNATURE .t2J "f' j DATE '!:F{ 2,t {q /,&, 8. OWNER-BUilDER DECl.ARATION Owner-Builder Declarallon: I hereby afftrm that I am exempt from the Contractor's License Law tor the following reason: IJ 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.). IJ 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). D 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)). SIGNATURE DATE COMPLETE fills SECl'!ON FOR NON-RESIDENTIAL 80ltolNC PERMITS 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? D YES IJ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES [J NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES IJ NO IF ANY OF nm ANSWERS ARE YFS, A FINAL CERTIFICATE OF ocx:tfPANCY MAY Nor BE ~ AYfER JULY 1, 1989 UNLESS nm APPLICANT HAS MET OR IS MEETING nm RF.QUDlEMENTS OF nm OFFICE OF EMERGENCY SERVICES AND nm AIR POll.UTION CDNTilOL DISI1UCT. 9. CDNS'IROCl10N LENOlNG AGENCY I hereby affirm that there 1s a construcllon lending agency tor the performance of the work for which this permit 1s issued (Sec 3097(1) CIVIi Code). LENDER'S NAME LENDER'S ADDRESS 10. AJ>PUCANI CERl1FICAl10N I ceruty that I have read the apphcauon and state that the above iniormauon 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 Al.SO AGREE 1U SAVE INDEMNIFY AND KEEP HARMLES.5 nm crrY OF CARL.5BAD AGAINST AIL UABIUTIF.S, JUDGMENTS, CDSTS AND EXPENSES WlDCH MAY IN ANY WAY Acx:RUE AGAINST SAID crrY IN CDNSF.QUENCE OF nm GRANTING OF nns 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 issu~edhe Buildi g Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by ch (l{'.rmit is ot co enced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or a i after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). APPUCANT'S SIGNATURE DATE:---- WIBTE: File YEllOW: Applicant PINK: Finance 04/16/97 INSPECTION HISTORY LISTING FOR PERMIT# CB960965 DATE INSPECTION TYPE INSP ACT COMMENTS 06/06/96 Final Structural RI RI MW/EDDIE/438-9909 HIT <RETURN> TO CONTINUE ... City of Carlsbad M =i!i • t# • iii· I •24 ·SI;;; ,t§ #ii OWNER-BUILDER VERIFICATION An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is O·d. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) . 7' ) I (have/have not) signed an application for a building permit for the V' proposed work. 3. 4. I have contracted with the following person (firm) to provide the proposed construction: Name /J'ra4. 3 J'.,,,.,, 1 ~ :4, Address 7 '? a.-• ~........ ;ft---,·ve_ • Cu-·city ---<--~-~----~ __ tu. __ a_ / /o // ,r __e-,-r ~ 3 __ ' r !, -3 9 I) C 'Y7 ,! 6 . Phone <d'r -'I'" 1 • ::;>J "( Contractors License No. ~Jc':J • I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Address----------------City------------- Phone __________ Contractors License No. ------------- 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: (?.) /k /~ {('~ /a-:... . /#}rr~ , .8,e: ,,6e_ Property Owner ---..;;...+~-,,--,..----+-------------/]• --/ .. / Date: _______ ,,._--'~......,,_-"--'-----~ Carlsbad, California 92009-1576 • (619) 438-1161