HomeMy WebLinkAbout2480 OCEAN ST; ; CB930434; PermitPERMIT APPLICATION PLAN CHECK NO.
City of carlsbad Building Depart111ent
2075 Las PalEs Dr •• C&rlsbad, CA 92009 (619) 438-1161
PIAN CK DEPOSIT _______ _
l
l!ST. VAL
VAIID. BY __________ _
I. P£kMI I ii PE DATE
A -Li COmmerc1al U New Budding LI lenant Improvement
B -□ Industrial Li New Building □ Tenant Improvement
C -□ Residential D Apartment □ Condo □ Single Family Dwelling □ Addition/ Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical □ Plumbing
□ Mechanical D Pool □ Spa □ Retaining Wall □ Solar □ Other
2. PROJECf INFORMATION FOR OFFICE USE ONLY
Address ;i'{fO Octti" S-t. Bu,idmg or Suite No.
Nearest Cross Street
LEGAf, DESCRll'I ION Lot No. SutxhV1s1on Name/Number Omt No. Phase No.
CHECK BEWW IF SOBMI 11 ED:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report O 1 Addressed Envelope
ASSESSOR'S PABCFI, FJCISTING USE PROPOSED USE
DESCRIPTION oF woRK tt ctJ I , I\.( r-e. f "'-\ r
SQ. FT. J # OF SlORIES
3. WN IACI PERSON (II dlI[ereni from appJlcan0
NAME ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
NAME
CITY DAY TELEPHONE
NAME
CITY STATE
ADDRESS
ZIP CODE DAY TELEPHONE z:;1-1737
6. :f!!RAC}t..f'J.;( /!;1'01,A}/I f/t/M b,',..,fDDRESS
CITY (a(IJb"'-lf. STATE C/f'zIPCODE Cf;J00f' DAYTELEPHONE
STATE UC.# ';/1/().q{)ucENSE CLASS Cl'-CITY BUSINESS UC. #
cm STATE ZIP CODE DAY TELEPHONE STATE UC.#
7. WOIUMlS' WMPF.NSAIION
Workers' Compensation Deciarat1on: I hereby afiirm that I have a cert1tlcate of consent to self-msure issued by the b1rectorof 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 COMPANY POUCY NO. EXPIRATION DATE
Certthcate of Exemptmn: I certify that In the performance of the work for which this pemut 1s issued, I shall not employ any person many manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATIJRE DATE
8. OWNEil-B0n:nmt Dfil.ARA:UUN
Owner-Builder Declaratmn: I hereby affirm that I am exempt from the Contracto?s Llcense Law for the foiiowmg 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 Llcense 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 Llcense 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 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 .5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars [$500]).
SIGNATIJRE DATE
CoMPLETE THIS SEGI ION FOR NON-RESIDEN I IAL BUILDING PERMI l's ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn 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?
□YES □NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO
IF ANY OF TIIEANSWERS ARE YES, A FINAL CERTIFICATE OFCXx:IJPANCY MAY NOT BE ISSUED AFTER JULY I, 1989UNLESS TIIEAPPIJCANT
HAS MET OR IS MEIITING 11IE REQUIREMENTS OF nm OFFICI! OF EMERGENCY SERVICl!S AND 11IE AIR 1'011.UTION mNTROL DISTIUCT.
9. WNSIROCIIUN LENDING AGENCY
I hereby athrm that there ts a construction lending agency for the performance of the work for which this penmt IS issued (Sec 3097(1) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPilcAN I CFJti'IPICX:llON
I certify that I have read the apphcauon 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 10 SAVE INDEMNIFY AND KEEP IWlMIJ!SS 11IE CITY OF CARISBAD AGAINST ALL IJABIUTIES, JUDGMENTS, CXlSfS
AND EXPENSES wmrn MAY IN ANY WAY NX:RUE AGAINST SAID CITY IN mNSEQUENCI! OF 11IE GRANTING OF TlilS PERMIT.
OSHA: An OSHA permit is required for excavations over S'O" 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 permit 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).
APPUCANTS SIGNATIJ DATE: ~-11-tJJ
PINK: Fmance
/
UNSCHEDULED INSPECT~ //'o_:"/ll
DATE. __ ~-,,'--.:.:./1+/_,cp.:::____ INSPECTOR \ \ vv'\ 0:t;;: ~
PERMIT # 1' 3-:(°11 ~ PLANCK # _____ _
JOB ADDRESS._..::G-~~...,.__,fC)~ __ ....:CX:~_'½:\---=..i:....:..AJ-=---S'--t-________ _
TIME ARRIVE: _____ TIME LEAVE: _____ _
CD LVL DESCRIPTION ACT COMMENTS
~ f,,.,. .s R<.p,A.: /2.. r