HomeMy WebLinkAbout2504 LA COSTA AVE; ; 79-2934; PermitMODEL NO. _________ _
BUILDING ·PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicanttocompletenumberedspacesonly Phone 729-1181 Perm it No
JOB ADDA [5 5
ASSESSOR"S 2.S-04 /_,,.FJ co_ Tt41 .. PARCEL NUMBER -,)IJ
LOT NO. I OLK I TOACT BuvK PAGE I PAR.
LEGAL I I r( t0 S[£ ATTACHtO !lH[CTI 1 otsc•. J OWN[" MAIL AOOAC55 I J;ilT ll P PHONE
2 l'\.I l i f I/ I I t ( t
CON ,.-A ACTOA MAIL AOOA[SS , PHONE fl, STAK ~IC. NO. CITY L IC. NO. 3 r-{ o,-... ST ~ g ( /'t.t:..~ I 110. I 3 · I.. --. ARCl-41T£CT OR Ol.SIGNtR MAIL AOOA[S5 PH'ON C ' LJCENS( NO.
4
[N GINCE.R MAIL ADDRESS PHONC LICENSE NO.
5
COMPENSATION INS. CARRIER M AIL AOOllt£55 &PIA.NCH
6
"CTSt OF 8Jll.01NG
7
NO. BORMS NO. BATHS
8 Class of work: □NEW 0 ADDITION 0 ALTERATION 0 REPAIR □MOVE 0 REMOVE
9 Describe work: 7 o ,it ')(. '12'' I,;, ~ ', Jt-1UIJ (; w,1 I ~ .
10 Change of use from
Change of use to 1fr { 1/ f (., !!,
11 Valuation of work: $ ~ ) .. Q
I .,_;d PLAN CHECK FEES ~ PERMIT FEE $
SPECIAL CONDITIONS: Type of Occupancy MICRO FILM FEE
Const. Group
S,ze o f Bldg No. of Max.
(Total ) Sq Ft. Stories 0cc. Load
Fire u se Fire Sprinklers APPLICA fl ON ACCEPTED ev PLANS CHE CKE OBY APPROVED FOR ISSUANCE BY Zone Zone Required DYes □No
/,. 1 No. of OFFSTREET PARKING SPACES, ~ ' t 'No. Dwelling U111ts No. DATE DATE Covered Sq. Ft. Open
NOTICE Special Approvals Required Received Not Required
SEPARAT E PERMITS ARE REQUIRED FOR E L ECTRICAL, PLUMB PLANNING OEPT.
ING. HEAT ING, VENTILATING OR AIR CONDITIONING. HEALTH OEPT. THIS PERMIT BECOMES NULL A ND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITH IN 120 DAYS,OR IF FIRE DEPT.
CONSTRUCTION O R WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM• MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ A ND EXAMINED T H IS ENGINEERING DEPT. APPL ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING T HIS WATER DEPT. TYPE OF WORK WILL BE COMPLIED WITH WH ETH ER SPECIFIED H EREIN O R NOT. T HE GRA NTING OF A PERMIT DOES NOT PRESUME T O GIVE AUTH ORITY TO V IOLATE OR CANCEL THE PROVISIONS OF A NY OTHER STATE OR LOCA L LAW REGULATING CONSTRUCTION OR THE PE'Rf"OFIMANCE OF CONSTRUCTION • .
SIGNATV"l o , CONT .. AC TOJI 0" AUTH0,-111.D AGCNT (DAT[)
,1GNATUltE; o, 0WN£ft 1, OW"'IClt 9UILDE.JIJ DATC)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASt •~
T OTAL FEES $ ___ ... ,_•, _-_• __ -_-_
INSPECTOR