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Home My WebLink About2521 PALOMAR AIRPORT RD; 103; CB132196; PermitTHE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMITISSUANCE: OPLANNING nENGINEERING •BUILDING QFIRE nHEALTH nHAZMAT/APCD ^ CITY OF CARLSBAD Building Permit Appiication 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: bulldlng@carlsbadca.gov www.carisbadca.gov Plan Ck. Deposit SWPPP JOB ADDRESS |LOT# PHASE # I # OF UNITS | # BEDROOMS SUITE#/SPACEf^N1T* iPACEfOjN CT/PROJECT # # BATHROOMS TENANT BUSINESS NAME CONSTR.TYPE OCCGROUP DESCRIPnONOFWORK:/nc/ude Square Feet Of Affected Areafs) ^ A I EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE YES I |# N0| I AIR CONDITIONING YES I I NO I I FIRE SPRINKLERS YES I |NO| I APPLiCANT NAME (Primary Contact) APPLICANT NAME (Secondary Contact; ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX PHONE EMAIL _ _ -EIVIAIL CONTRACTOR BUS. NAME ^^^^ ^p^^ ^/^^ ADDRESS Hodt thu^ U- STATE 7 zip" ADDRESS PHONS". ^ / , „ , I FAX /Of-r^ 3777 i CITY ^/ , , STATE -ZIP PHONE _ rtTT' ^ TFAX , , EIVIAIL EMAIL ARCH/DESIGNER NAME & ADDRESS CUSS CITY BUS. UC.# (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 pursuantto the provisions ofthe Contractor's License Lawichapter 9, commendingwlth Section 7000 of Division 3 ofthe 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)). '••'wowKeRs ' COMPENSATION Workers' Compensation Declaration: / tereby affimi under pena/fy of peijuiy one of the following declarations: I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the perfomiance of the work for which this permit is issued. • I have and will maintain woikers' compensation, as required bv Section 3700 of the Labor Code, for the performance of the woh< for which this permit is issued. My workers' compensation insurance earner and policy Expiration Date number are: Insurance Co._ Policy No.. This section need not be completed If the permit is for one hundred dollars ($100) or less. I I Certificate of Exemption; I certify that in the performance of the work for which this pemiit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califomia. WARNING: Failure to secure woi1(;i«''Som^«nlation cmeng* is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, dan)»j^sj>n3vided for i^^ctkin 3706 ofthe Labor code. Interest and attomey's fees. C^ffGENT DATE JS^ CONTRACTOR SIGNATURE / hereby affirm fbat / am exempf from Conlracfor's L/cense Law for fte folbwing reason: as owner of the property or my employees with wages as their sole compensation, will do the worts 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 oftered 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 I I, as owner of the property, am exclusively contracting with licensed contractors to constmct the project (Sec. 7044, Business and Prafessions Code: The Contrxtor'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: 1.1 personally plan to provide the major labor and materials for construction of the proposed praperty impravement •Yes I INO 2.1 (have / have not) signed an application for a building pemiit for the proposed work. 3.1 have contracted with the following person (fimn) to provide the proposed constmction (Include name address / phone / contractors' license number): 4.1 plan to provide portions of the wori<, but I have hired the following person to coordinate, supervise and pravide the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to pravide the wori( indicated (include name / address / phone / type of work): ^efpROPERTY OWNER SIGNATURE AGENT DATE re THIS SECTION FOR NON-RESIDENTIAL BUILOING 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? Yes No Is the applicant or future building occupant required to obtain a pemiit from the air pollution control district or air quality management district? Yes No Is the facility to be constmcted within 1,000 feet of the outer boundary of a school site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. C S» NSTRUCTION LENDING AGENCY I hereby aflirm that there is a construetion lending agency for the perfomiance of the work this pemiit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address A J» PLICANT CERTIFICATION I certif that I have read the applteation and state thatthe above Intbimation is conect and that the Inforniatkin on the plans Is accuiate. I agree to complywith all City oidinances and State laws relating to building constnictnn. I hereby authorize representative ofthe City of Carlsbad to enter upon the above mentioned property fbr inspectbn purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GFiANTING OF THIS PERMIT. OSHA: An OSHA peimit is nequired fbr excavations over 5'0' deep and demolitbn or constiuctbn of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisbns of this Code shall expire by limilatbn and become null and void if the building or work authorized by such permit is not commenced wilhin 180 days from the date of such pemiit or if the buikiing or wori< authorized by such pemnit is suspended or abandoned at any time after the vrori^ is commenced fbr a period of 180 days (Sectbn 1 C6.4.4 Unilbmn Buibing Code). APPLICANT'S SIGNATURE DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email builclinQ(5)carlsbadca.aov or Mail the completed form to City of Caiisbad, Building Division 1635 Faraday Avenue, Carisbad, Califomia 92008. C0#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANTS BUS. LIC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCXUPANT (Listed above) CONTRACTOR (On Pg. 1) MAILTO: CONTACT (Usted above) OCCUPANT (Listed above) CONTRACTOR (On Pg 1) MAIL/FAX TO OTHER: ASSOCIATED CB# NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION ASSOCIATED CB# NO CHANGE IN USE / NO CONSTRUCTION CHANGE OF USE / NO CONSTRUCTION vef APPLICANT'S SIGNATURE DATE