Loading...
HomeMy WebLinkAbout2525 EL CAMINO REAL; 204; STE 204 PRE 2016; Permit- 4 r VA L BUILDING PERMIT APPLICATION Permit o.?ZZ)O City of CARLSBAD, CALIFORNIA, 92008 .. 2'' Applicant to complete numbered spaces only Phone 729-1181 - JOB ADDRESS' - - - - - -. LOT NO. - - l BLK LEGAL' V / TRACT - -. IJSEE ATTACHED SHEET) 0 1 -. - . OWNER, MAIL ADDRESS 2 ZIP - - PHONE CONTRACTOR N 7 . A ARCHITECT OR DESIGNER MAIL ADDRESS PHONE " LIE SE N ENtINEER MAIL ADDRESS PH5NE I t'NO. ;.. -. . . LENDER '.... . V MAIL ADDRESS BRANCH 'I USE OF BUILDING ,.V V 8 Class of work El NEW El ADDITION El ALTERATION El REPAIR El MOVE El REMOVE 9 Describe work: 10 Change of use from Change of use to. ' 11 Valuation of work: $ PLAN CHECK FEE , PERMIT FEE SPECIAL CONDITIONS: Type of Const. -. - . Occupancy Group - Division V . - V Size of Bldg. (Total) Sq. Ft. NO. of * Stories . Max. 0cc. Load V . Fire 'V Zone V Use Zone Fire Sprinklers Required Elves ElNo APPLICATION ACCEPTED BY: PLNSCHECKEOSY: APPROVED FOR ISSUANCE BY No. of LREET PARKING OFFS kcOHAcTf) Dwelling Units I red NOTICE Special Approvals Required Received Not Required ZONING SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB- ING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- HEALTH DEPT. FIRE DEPT. TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF SOIL REPORT ' CONSTRUCTION OR WORK ISSUSPENDEDOR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- OTHER (Specify) MENCED. /' /) I V I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. TYPE 'OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED /" ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS HEREIN OR NOT, THE GRANTING OF A -PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONST.RUGtION OR TH P FORMANCE OF CONSTRUCTION. V SI A'tdIffOF CONTRACTOR 0RAT44ORt'ZEO AGENT (DATE)' •'*I / SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) WHEN PROPERLY VALIDATED (IN THIS SPACE)THIS IS YOUR PERMIT ' PLAN CHECK VALIDATION - CK. M.O. CASH PERMIT VALIDATION CK. - M.O. CASH * V VV - VVV___.V*V.V'V.V'V*_*VV V V._VV..** *VV 'VVV•VV **. ,V *.:'V...V_V.V V. •. INSPECTOR INSPECTION RECORD DATE REMARKS - INSPECTOR - FOUNDATIONS: SET BACK - TRENCH REINFORCING FOUNDATION WALL & WEATHER PROOFING CONCRETE SLAB FRAMING INT. LATHING OR DRYWALL EXT._LATHING MASONRY FINAL - • _____________________ - a. USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. B t , PLUMBING PERMIT APPLICATION Permit No. ,) Vj City of CARLSBAD, CALIFORNIA Applicant to complete numbered spaces only. JOB ADDR ESS LEGAL IDESCR. iLOT NO. IBLII ITRACT (1JSEE ATTACHED SHEET) 0 ill OWNER MAIL ADDRESS 24"ee$ ZIP PHONE CONT CTOR DR MAIL ADESS ,&,7 'mvv7 PHONE LICENSE NO. //, 7 -O3?c UT'/ \' ARCHITECT OR DESIGNER MAIL ADDRESS 4 PHONE LICENSE NO. ENGINEER MAIL ADDRESS 5 PHONE LICENSE NO. LENDER MAIL ADDRESS 6 BRANCH USE OF BUILDING 7 8 Class ofwork: El NEW DADDITION 0 ALTERATION 0 REPAIR 9 Describe work: . PERMIT FEES No. Type of Fixture or Item Fee SPECIAL CONDITIONS: -4-- WATER CLOSET (TOILET) • BATHTUB LAVATORY (WASH BASIN) • SHOWER KITCHEN SINK & DISP. /? DISHWASHER - APPLICATION ACCEPTED BY PLANS CHECKED BY: APPRO'EO FOR ISSUANCE BY: LAUNDRY TRAY - CLOTHES WASHER WATER HEATER ....L NOTICE - " THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIG)(ATUREOF"./IAUTHORIZED AGENT URINAL - - DRINKING FOUNTAIN FLOOR—SINK OR DRAIN - SLOP SINK - ___________________________________ GAS SYSTEMS: NO. OUTLETS - - WATER PIPING & TREATING EQUIP. . - - - WASTE INTERCEPTOR - - VACUUM BREAKERS - - LAWN SPRINKLER SYSTEM - SEWER CESSPOOL SEPTIC TANK & PIT / /(DATE) - PERMIT $ TOTAL FEE $ . SIGNATURE_OF_ OWNER _(IF _OWNER _BUILDER) (DATE) WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR ELECTRICAL PERMIT APPLICATION Permit NO Y /spaces City of CARLSBAD, CALIFORNIA 92008 Applicant to complete num only. Phone 729-1181 - AM ' JOB ADDRESS I DE CR LOT 'NO. I BLK TRACT I (E)SEE ATTACHED SHEET) OWNER MAIL ADDRESS ZIP PRONE 2 1"W" Tjaqqv/1I= tY7j CONTRACTOR M IL ADDRESS PHONt LICENSE NO. .. ARCHITECT OR DESIGNER ' -' MAIL ADDRESS' PHONE LICENSE NO. 4 ENGINEER MAIL ADDRESS PHONE LICENSE NO. 5 LENDER MAIL ADDRESS i BRANCH 6 USE OF BUILDING 1 RRPAIL qJ MALL 8 Class ofwork: JNEW D'ADDITION 11 ALTERATION El REPAIR 9 Describe work: PERMIT FEES I No. I Each I Fee ISPECIAL CONDITIONS:' I ISSUANCE OF EACH PERMIT NEW CONSTRUCTION, FOR EACH AMPERES OF MAIN SERVICE, SWITCH, APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: FUSE -OR BREAKER I1, NEW SERVICE ON EXISTING BLDG. FOR EA. AMPERE OF INCREASE NOTICE IN MAIN SERVICE, SWITCH, FUSE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- OR BREAKER TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- REMODEL, ALTERATION, NO CHANGE MENCED. IN SERVICE, FOR EA. AMPERE OF I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS INCREASE APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE TEMP. SERVICE UP TO AND INCLUD- PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. / TEMP. SERVICE OVER 200 AMP. 'PER 100 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT b ZAI rE1d - MINIMUM PERMIT FEE WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION ' CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH * INSPECTOR -o CD B 0 / MECHANICAL PERMIT APPLICATION Permit No. _77 ? (—City of CARLSBAD, CALIFORNIA 92008 Applicant to comnlete numbered soaces on1v.- Phone 729-1181 - JOB ADDRESS 252c LEGAL 1 DESCR. I LOT NO, BLK I I I ([:)SEE ATTACHED SHEET) OWNER MAIL ADDRESS T7 '92'f'2(M-' ZIP PHONE j'a'mj) ( H A C TO R MAIL ADDRESS 3 -i'c1 z194y,ic I PHONE LICENSE NO. Z.2 Z26 — ARCHITECT OR DESIGNER MIL ADDRESSI 4 PHONE LICENSrN ENGINEER MAIL ADDRESS 5 PHONE LICENSE NO. - I.. LENDER MAIL ADDRESS 6 BRANCH USE OF BUILDING 8 Class of work: NEW U ADDITION U ALTERATION U REPAIR 9 Describe work: k, 41. Type of Fuel: Oil U Nat. Gas U LPG. U PERMIT FEES tN, SPECIAL CONDITIONS: No. Type of Equipment Fee Air Cond. Units-H.P. Ea. $4 Refrigeration Units-H.P. Ea. Boilers-H.P. Ea. Gas Fired A.C. Units-Tonnage Ea. Forced Air Systems-B.T.U. M Ea. - APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: Gravity Systems-B.T.U. M Ea. - Floor Furnaces-B.T.U. M Wall Heater-B.T.U. M NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. /L/ /4/ Unit Heaters-B.T.U. M - Evaporative Coolers Clothes Dryers - Ventilation Fan Range Hood - f Air Handling Unit- C.F.M. _5 Q Incinerator - SIGNATURE OF CONTRACTOR.OR AUTHORIZED AGENT AT/ - - - PERMIT $ a TOTAL FEE $ LA 2 SIGNATURE _OF_ OWNER _(IF _OWNER _BUILDER) (DATE) WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM CITY OF CARLSBAD IV? SE BUILDING ENGINEERI NG DEPARTMENT 1124 729-1181 EXT. 35 ISSUED BY AA FOR CANT TO FILL IN '; r\A r ICCIl BUILDING ? ADDRESS sJoll- I OWNER tIfk7— MAILING ADDRESS .. A ie . CONTRACTOR CONTRACTOR'S ADDRESS NEW BUILDING EXISTING BUILDING V ______ _______ LEGAL DESCRIPTION REMARKS: LINE COST DATA IL ASSESSMENT DIST. NO. FRONTAGE ________COST PER FT TOTAL CTI-lC LATERAL LOCATION I I— I: CONNECTION FEE NO. UNITS Ii COST PER UNIT _______ TOTAL PUMP STATION FEES NO. UNITS -COST COST PER UNIT_______ TOTAL \ LATERAL NO. I ST. INSTALLATION DATE_ TOTAL CHARGES (LATERAL ETC.) VALIDATION LATERAL CHARGE COMPUTATION STANDARD 4" (Max. H. 30', V. 10') OVER 3O H.—@ FT. OVER 10'V.—@ ______ FT. STANDARD 6" (Max. H. 30', V. 10') OVER 30' H. ______ _______ FT. OVER 10'V. ______ _______ FT. TOTAL CONSTRUCTION COST SERVICE CHARGE (REPAVING ETC.) TOTAL LATERAL CHARGE - . t USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. D I hereby affirm that I am licensed under I * o provision8'of Chapter 9.(commencing with I Section 7000) otDtvision 3 of the Business and Professions Code, and my license is in I full force and effect. a' No _________________ Class 0 Z. '. hereby affirm that I am exempt from the • Conlrac- ' tom's License Law for the following reason (Sec. 7031.5 I Business and Professions Code: Any City or county which re quires a permit In construct. ailer, improve, demolish. or 1.'repair any structure, prior to its issuance also requires the ap- plicant-for such permit to file a signed statement that he is i • licensed pursuant to ,lhe provisions of the Contractors - License Law (Chapter 9 commencing with Section 7000 at I Division 3 of the Business and Professions Code) or that is ex- empt therefrom and the basis for the alleged exemption.' Any violation 01 Section 7031.5 by an applicant for a permit sub- jects the applicant to a civil penally of not more than live hun- dred dollars ($500(. ., •. , .01. • 0 I, as owner of the property, or my employeeswith wages I us as their sale compensation: will do the murk, and the struc a lure is not intended or offered for sale (Sec. 7044. Business .1 and Pretessions Code: The Contractor's License Law does I not apply to an owner of properly who builds or improves I - thereon and who does such work lrimsett or through his own employees; provided that such improvements are not intend- ad or uttered for sale. It, however, the building or improve-' Z meut is sold within one year of completion. the owner-builder -a will have the burden at proving that he did not build or im- I 0 prove for the purpose of sale). ' 0,h , as owner 01 the property, am exclusively contracting I wi hcevsed contractors to construct the project (Sec. 7044,' Business and Professions Code: The Contractor's License Law does 001 apply loan owner of properly who builds or im- proves thereon, and who contracts for each projects with a I U) , Z coolractur(s( license pursuant to the Contractor's License Law(. - follo• 0 As a homeowner I am improving my home, and the w—ing conditions exist: - 1. The work is being performed prior to sale.' • 2. t have' lived in my home for twelve months • prior to completion of this work, . Ui 3, I have not claimed this exemption during the O ' 'last three years. 0 I am exempt under Sec. , B & P.C. or this reason thereby affirm that I have a certificate of consent to • , sell.insare. or a certificate 01 Workers' Compensation In- surance. or a certified copy ttrereot(Sec. 3800, Labor Code) I • POLCYNO. - 2 - COMPANY 0 Copy in filed with the city, Z Lu 0 Cerfilieel copy is hereby furnished, - 0 0 CERTIFICATE OF EXEMPTION FROM .4 • WORKERS' COMPENSATION INSURANCE - ix Lu (This section need 001 be completed it the permit is for one hundred dollars 101001 or less) le 0 t certily that in the performance of the work for which o this permit is issaed. I shalt not employ any person in any - manner so as 10 become subject 10 the Workers' Compen. I - salion Laws of California. - NOTICE TO APPLICANT: It. after—making this Certificate 01 Exam plion. you should become subject to the Workers' Compensation provisions or the Labor Code, you must • forthwith comply with such provisions or this permit shall I be deemed revoked. , 0 thereby affirm that there is a construction lending I uJ agency for the performance 01 the work for which this per. 01 mit is issued (Sec. 3097, Civil Code) zl . W( Lender's Name - - ' L '- I - Lender's Address - '. . - CARLSBAD BUILDING DEPARTMENT . ' . • , - - APPLICATION & PERMIT '-, • Carlsbad, California 92008-1989 (619) 438.5525 JOB ADDRESS ' • AV. ST. RD. NEAR ST CROSS ST. DATE OF APPLICATION BUSINESS LICE LU TION ' PERMIT NUMBER ZON LOT BLOCK SUBDIVISION ASSESSOR PARCEL NO. - - CONTRACTOR . CONTRACTORS PHONE # OWNER'SNAMB I __ • OWNER'SPHONE _ , S.-/- 7/hit-a/i-7 y-- - PLAN I.D. # - . -. BUILDING SQ. FOOTAGE CONfRACTORS ADDRESS • LICENSE NO, 160~d - 1 "i '_Y7 i - coO , . Ca 937eL 0 - OWNER'S MAILING ADDRESS ' . 'c _0 .4II71 /0, . . DESIGNER DESIGNERS PHONE DESCRIPTION _ " ° i OF WORK /_•,2-'-'4 a . 'I . DESIGNER'S ADDRESS ,.—t_/,p.,_i_•-' LICENSE NO. - OI(1 4ijp, hc1_PfrZka4V ________ ' • . F/P FLRELV. OCCGP EDU ', ',? • STORIES _______________________________________________ •rk YD,I0D -' qpoTii6o,oG- .rjfi9 ,50 - ......• • ' 'CENSUS TRACT OP LAND USE USE, PARKING SPACE RES UNITS GRADING PERMIT ISSUED REDEVELOPMENT _\NO . TYPE 0CC LOAD FIRE SPA -- . AREA _- , _N-- CONST __., , • . _'m .• __. ___•. . V 0 1/ _0 . - 'YO ND 0 ND 'Not Valid runless Machine Certified - OTY. . "PLUMBING PERMIT issu - '7_s-'- QTY. . MECHANICAL PERMIT -'ISSUE - SUMMARY/ACCOUNTNUMBER - EACHV FIXTURE fRAP ,' __'___-. ., INSTALL FURN. DUCTS UPTO100,000BTU .- BUILDING PERMIT - 001-810-00-00-8220 .... EACH BUILDING' SEWER . OVER 100,000 BTU ' • SIGN PERMIT 001810-00-00-8221 --, EACH WATER NEATERAND/ORVENT '...( ', BOILER/COMPRESSORUP103 Hip - PLAN CHECK . - 001-810-00-00-8806 .- EACH _GAS SYSTEM _iTO4'OUTLETS , . BOILER/COMPRESSOR 3.15 HIP "-- ' '- -TOTAL PLUMBING '001-810-00-00-8222 EACH GAS SYSTEM 5ORMORE . ' METALFIREPLACE ' ,ELECTRICAL _001-810-00-00-8223 ' EACH INSTAL.. ALT ER, REPAIR WATER PIPE -. VENT FAN SINGLE DUCT -- . - MECHANICA_001-810-00-00-8224 . • EACH VACUUM BREAKER . ' - MECHEXHAUST - HOOD/DUCTS _- '-81_001-810-00-00-8225 WATER SDFTNER ' RELOCATION OF EA FURNACE/HEATER - - ' _B_EPARKINSP EACH ROOF,ORAIN(INSIDE). _-h' _- (,om- __' • a __OLAR _001-810-00-00-8226 - k __•.•-- . - - TO1L/L MECHANICAL . ' - ,.4T9±'bT - 880-519-92-33 TOTACPLUMBING -- _u---,• = 441SPRINI(LE_AS 00'00-8227 I PUBLF _810_00008930 OTY ELECTRICAL PERMIT ISSUE ___________________ ______ QTY SOLAR ISSUE -- _-• ______ 0- NEWCONSTEAAMP/SWT/BKR • NE - - COLLECTORS '•I --• '-- N gEE -DISTRICT '- IPH 3PH '-- , ' . STORAGE TANKS - . Carlsbad EXIST BLDG EAAMP/SWT1BKR,-- -- ROCK STORAGE _••• ' Encioilas -• _-• --'.-- I PH' - 3 PH ' '' ' ,/_. ' PUMP _-•• -. _' SanDiegailo - REMODEL.'ALTER PER CIRCUIT ' - , PLAN CHECK FEE - ' SanMarCós TEMP POLE 206AMPS " . - -- • ' ' 'S , - - OVER 200 AMPS' •_• ___S - - - - LICENSE TAX..__4"OO1-810-OO-OO-8162 TEMP OCCUPANCY (30 DAYS) - - • ' . • - - , , - MFF • 880-519-92-57 - '• " • - . '••• - CREDITDEPOSIT _'•- "(/14-_-s> TOTAL ELECTRICAL . • -- - TOTALSOLAR _•'- - Sr - TOTAL-FEES PAYABLE _ I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration. Every permit issued by the Building Official under the provisions Of this * AN 061-IA PERMIT IS REQUIRED FOR EXCAVATIONS OVER CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by limitation and become null and void. It the building or work 50" authorized by such permit is not commenced within 180 days from the date of such DEEP AND DEMOLITION OR CONSTRUCTION OF - DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the building Or work authorized by such permit suspended or STRUCTURES OVER 3 STORIES IN HEIGHT ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON abandoned at any time after the work IS commenced for a period 01180days. STRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND • APPROV APPLICANTS SIGNATURE * OWNERD CONTRACTOR 0 BY - DA E 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 C BY .. PHONE GRANTING OF THIS PERMIT. . _____ ç ___.____,____€.__Q__e_J a____•_( - ,- 9 TYPE I DATE INSPECTOR BUILDING FOUNDATION I. FIELD INSPECTION RECORD REINFORCED STEEL REQUIRED SPECIAL INSPECTIONS MASONRY i - REQ. IF INSPECTORS GUNITE OR GROUT INSPECTION DATECHECKED APPROVAL SUB FRAME 9 FLOOR Li CEILiING SOILS COMPLIANCE SHEATHING 0 ROOF 0 SH:EAR PR JOR TO J / - FOUNDATION INSP FRAME .f/i'' '" STRUCTURAL CONCRETE EXTERIOR LATH OVER 2000 -. IkIIII ArIfkI -PRESTRESSED INSPECTORS NOTES . uI1JLPI I%JII I / t. I co NCRETE INTERIOR LATH & DRYWALL I r/(t57t' A'7Y" POST TENSIONED - CONCRETE PLUMBING FIELD WELDING Li SEWER ANDPL/CO Li PL/CO HIGH STRENGTH BOLTS UNDERGROUN7 Li WASTE 0 WATER TOP OUT WASTE DVIIATER ____ ,;. •.i . TUB AND SHOWER PAN GAS TEST PILES CAIS'ONS 0 WATER HEATER 0 SOLAR WTER _______ _________ - • I -. ELECTRICAL o ELECTRIC UNDERGROUND 0 UFFER ROUGH ELECTRIC . I I 0 ELECTRIC SERVICE 0 TEMPORARY g//'/ jt4jx,' -.[ -• 0 BONDING 0 POOL MECHANICAL O DUCT & PLEM., 0 REF. PIPIJG HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS CALL FOR FINAL INSPECTON WHEN ALL APPROPRIATE ITFMT- AR(DVF HAt/F RFFN APPROVFD- FINAL PLUMBING ,. ELECTRICAL _______ MECHANICAL _______ / 4 BUILDING . I SPECIAL CONDITIONS I - - Springer Construction License #303153 October 15, 1986 TO WHOM IT MAY CONCERNS Pleas be advised that R-19 insulation has been installed in the Lane Bryant, Plaza Camino Real per building codes established by the City of Carlsbad Sincerely, Dawn M. Springer President 1855 West Ontario • Corona, CA 91720 • (714) 736-0187 ESGIL CORPORATION 9320 CHESAPEAKE DR.. SUITE 208 \ SAN DIEGO. CA92123 (6 19) 560-1468 APPLICANT JURISDICTIO CHECKER FILE COPY UPS DESIGNER DATE: JURISDICTION: cZ/S5J7 PLAN CHECK NO: CB c9 , - 303 - PROJECT ADDRESS: i71'tO /?9L PROJECT NAME: 417'C/S 7'2) LAJ 3-Jv7- The plans transmitted herewith have been corrected where D necessary, and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficien- cies identified ON 7h 11-771142 are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is the jurisdiction's 0 copy for your information. The plans are being held at Esgil Corp. until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the U jurisdiction to return to the applicant contact person. The applicant's copy of the check list has been sent to: Esgil staff did not advise the applicant contact person that S plan check has been completed. Esgil staff did advise applicant that the plan check has 0 been completed. Person contacted: Date contacted: Telephone REMARKS: By: ENCL:(j2j_-\4T ESGIt CORPORATION —I- "N - I - Go D O2/f1U r—Zo V1A' VU '.) 15 LVL'- L4j C- C• 'r\.. C Y') VU pr I-)Pr)(. \-s-cui_O ö nJ wL.06.c? 4( Lf1 J rfl Q OOV?. S F Ouçcuy L-D \ ) ô I o U ii_ -Hir -2, T,-, -n-1- Si i— --p(25 L L T) 6T 4+1 Ci4€Yz tHi) (mH - z 4 5. '2- 11 0 ((7) 3 Fr L wry I\Thnvl) r-i+-e C.o Do 1a C' - ou t I c -riz j - w -r ' 0 ?fJ L -t) OiTh2u) • S 9.1 7', C O U LD s ui f5 - o o O1H- ctc 0 Dates AZ51 Jurisdictuio*n C4T2LscY Prepared byt E3Bldg. Dept. 3'1 YVI VALUATION AND PIN CHECK FEE o Esgil PLAN CHECK NO. BUILDING ADDRESS ZS. LPrVII iLJO APPLICANT/CONTACT sPrz )t PHONE • NO. Crl 4) 41 S '+OOO BUILDING OCCUPANCY b -C1 _'5 DESIGNER PHONE_____________ TYPE OF CONSTRUCTION V-4 CONTRACTOR PHONE___________ BUILDING PORTION BUILDING A.RaA VALUATION MULTIPLIER VALUE Air_Condjtioninz Commercial Residential Res. or Comm. FireSprir.klers ________________ @ Total Value 1 Fee Adjusted To Reflect 0 Energy Regulations (Fee 'x 1.1) 0 Handicapped Regulations (Fee x 1.065) Building Permit Fee $__________________________________________ Plan Check Fee $ O54 9' COMMENTS: 8/4/82 0 2t. 1 Sjl. vvaLI WWII I 4téi)ie (J djjRecL--W.ater Con. Fee ' rGFD PaffFe? I \ PF REF 0dq H LpenseTax ..., lNcoRF(dcense Tax (CFDEnd) 1t- Fraffic Impact Fee —Traffic Impact (GFD Fund) w_3u P~@U~M'BING-T T ELECTRICAL—TOTAL ---.MECHANICAL TOTAL Master Drainage Fee: Sewer Fee: TOTAL PERMIT FEES Due: $1,141.22 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 - $110.00 $33.00 $0.00 $0.00 $1,763.32 City of Carlsbad . 04/27/1999 V 1 Oi r Commercial/IndustrialPermit Permit No: CB990899 çl) ' Building Inspection Request Line (760) 438-3101 Job Address: 2525 EL CAM INO REAL CBAD St: 204 Permit Type: TI Sub Type: COMM Parcel No: .1563020900 Lot #: 0 Status: ISSUED Valuation: $195,888.00 Construction Type: NEW . Applied: 03/09/1999 Occupancy Group: Reference #: Entered By: JM Project Title:• FOREVER 21 TI 6996SF . Plan Approved: 04/27/1999 Issued: 04/27/1999 Inspect Area: Owner: PLAZA CAMINO REAL /O WETFIELD CORP INC 1,1g1 yIJSHlRBLD 1 9074 04/27/99 0001 01 02 / L ANGELES-CA 9OO?5 C-PRMT . . 1100.00 Applicant: CHUNG BRIAN 750E 14 STREET LOS ANGELES CA 90021 213-747-6007 Total Fees: $1,763.32 s957:08 Building Permit I I Add'l Building Permit Fee $0.00 Plan Check . . ( $622..11q Add'l Plan Check Fee .. $&0O Plan Check Discount . \ $0'00 Strong Motion Fee \ $4114 Park Fee \$0.0O LFM Fee . $0:00 Bridge Fee \ $000 BTD#2 Fee \z '$OOO BTD #3 Fee $0O0. Renewal Fee $0.00. Add'l Renewal Fee $0.00 Other Building Fee $0.00 Pot. Water Con. Fee $0.00 Meter Size Add'l Pot. Water Con. Fee $0.00 FINAL APPROVAL InspectorE Date: ______________ Clearance: NOTICE: Please take NOTICE that approval of your project includes the imposition' of fees, dedications, reservations, or other exactions hereafter collectively referred to as lees/exactions.' You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Caitsbad Municipal Code Section 3.32.030. Failure to timeli follow that proceduréwill bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. -. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. -. . CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438.1161 FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO___________ CITY OF CARLSBAD BUIIDING DEPARTMENT EST VAL Plan Ck,., Deposit 2075 Las Palmas Dr, Carlsbad CK92009 4 - dfr\ (760) 438-1161 ' al ae 7i Date________________ ri '.-- - - - Address (include Bldg/Suite #) Business Name (at this Legal -Description Lot No. Subdivision Name/Number . U4L. 03/1 has9N01. 0taL#5units 1Assessor's Parcel # Existing Use Proposed Use rq >si'j 6q96 r Descriptionof Work., .. ,., '' SQ. FT. , . #of'Stories : # of Bedrooms ',. ,,' #of Bathr,othris ......... I: ____•. . ,-'- , ' .,-. . _w—fibe ant) 5iQ,4iV L/.AJ&f" - L5 4 72/ 3)71J7-i /7411 Name , Address ' ', city St jte Z p'- '. '..TelephOne F F x# rtra,t =r- Or .59 - . . Name . . - .. : ., Address '',,'.,'' City t Zip ,.Tel'ephone F A7FE./-0 / 's V& L. '4 95fl7.-1— 3z) 41 7 - 4I44 — It Name -- Address - City State Zip Tlephon , - - ''NTRAc0JC0MPANE (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve,denio(ish'o'r reáir anr'.'structure, priot to its issuance, also requires the 'pplicnt for such permit .to file a' signed' stateme'nt thai he" i's Iicense'J pursuant to the provisions of the Conüactor1s 'License La - (Chapter 9 commending 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 ($5001). '—I,- Name , --, .,'''- Address i -.. -, C ,' '- 'City ,, ,.- State/Zip-i `Telephone # State Lic'e'ise # ." _.'-" 'i .Liäense Class' t' _- _' _-C.'•--. - , City Business License'# I' Designer Name , - , - , , City , , , ,State/Zip Telephone ddress State License# - - • ', . ,, . '' ... ', '., , . Workers Compensation Declaration I hereby affirm under penalty of puijury one of thu tcIIu n cluclurations 0 I have and wl maintain a certificate of consent to self unsure f04r workers compenation as provided by Section 3700 of the Labor Code for the performance of the work for which this permit is issued. - I haveL and will maintain workers' compensation, as- required .s Section'3706 of the .Labor.Code,-.for the performance of the work for which this 4permit, is issued. My worker's compensation inurance carrier and policy number are: :.urahc1C'ompany ' - ' Póliây No' - - ' - " Eipirati6n Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT.IS FOR ONE HUNDRED,DOLLARS [$1001 OR LESS).. D CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permiti is- issued; Ishall not enploy,'any, person in any mânnei'oas to become subject to the Work'ers' Compensation Caws of California '• . - ' - ' •' - WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an ,empIoe'r tb criminal', penalties and civil fins up.to 'one hundred.,.,, "thousand dollars ($100,000). in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees., -SIGNATURE -''' "'"'"" _-'""""''.' DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason: C] ái 16wrier of'the property or' my' ernplóes with wages ái their sole compensatión will "do 'the work 'and the' strUcture is not iñ'tendd o' offered fo'rgale - (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 comp(etion,. the .ownerbuilder 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 - ConfractOr's License Uw does not apply to an owner of property who builds or'irnproves thereon, and'contracts for such projects with contractor(s)' licensed' ,.pursuant to the Contractor's License Law). .0 I am exempt under Section Business and Professions Code for this 'reason: 1 personally plan to provide the major labor and materials for Construction of the proposed property improvement 0 ,YES ONO ' 2. ' I (have / have nat) signed an application for a'building permit for the proposed work." 3, I have contracted with the following person (firm) to provide the proposed coOstruction (include name,/ address /,p,honènuriiber /'coitractors license number):. 4. I plan toprovide portions of the work, but-I have hired the following 'person to coordinate, 'supervise and provide the major work (include'name / address / phone number / contractors license number): I , , - '- "-• '' ' 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone numbei,/ type of work):, PROPERTY, OWNER SIGNATURE -",AE't .Is the appiican't or future buildir occ'dpant required i'o sbirnit'a business plan, acutelj'hazados materials r'egistraiin fórni or risk management and 'preventio'n 'program under.Sections,25505, 25533,or,25534.of,the Presley'Tanner,Hazardo'us.Substance Account Act? ,,D_.YES- 0 NO Is the applicant or future building occup'at'required to obtain-'permit from"th'air'poIlUtion,control district or air'quality managethent'district? 0 YES 0 NO ;Is the facility to be consructed within 1,900 feet of the outer boundary of a school site? '0. YES .0 ,NO ,,IF ANY OF THE ANSWERS AREYES;A FINAL CERTIFICATE OF OCCUPANCY MAY,NOT'BE ISSUED UNLESS THE APPLICANT HAS METOR-IS MEETING THE - REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL: DISTRICT. 8 C0NSTRJflON LENDING_AGENCY ,, "' -, - -- ,, 1 51 hereby affirm that there is a construction lending agency for the performance of the work for which this, permit is issued (Sc.,30970) Civil, Code). LENDER'S NAME.. ''--' ___'.-''' _J' - LENDER'S ADDRESS .0 _-'I' ________-' __,ZC'__'' ____ I certify that I have read 'the'application'and state-that th'e above infèrmation'is correct. and thatthe'i'nformatibn on the,plans is accurate. I agree:,to comply with all - City, ordinances and State laws relating to building Construction I hereby authorize representatives of the Cit' of Carlsbad to enter upon the above mentioned il ',property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBADAGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY'IN-ANY WAY ACCRUE AGAINST-SAID CITY IN-CONSEQUENCE OF THE-GRANTING OF-THIS OERMIT, OSHA An OSHA permit is required lor excavations over 5'0" deep and demolition or construction of structures over 3 stories in height ,EXPIRATION:. Every permit issued by$he BJilding Official undr the provisions of This Cbde,shallexpire b limitati'o and becomenull'a'nd voiif the building or :work authorized by such permit is not 1commenced 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 'comm'enc'ed for a p'eriod of 180 days (Se'ction 106.4.4.UniformBuilding Code')'. - - - - APPLICANT'S SIGNATURE -WHITE: File "YELLOW: Applicant --.'PINK: Finance.'-.-:, City of Carlsbad Inspection Request N(--DA For: 6/24/99 Permit# CB990899 Inspector Assignment: TP Title: FOREVER 21 TI 6996SF Description: Type: TI Sub Type: COMM Job Address: 2525 EL CAMINO REAL Suite: 204 Lot 0 Location: APPLICANT CHUNG BRIAN Owner: PLAZA CAMINO REAL Remarks: Phone: 9092255447 Inspector: Total Time: CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Requested By: STEVE Entered By: CHRISTINE Act Comments .1 Inspection History Date Description Act Insp Comments 5/28/99 14 Frame/Steel/Bolting/Welding AP TP DRESSING RM 5/28/99 34 Rough Electric AP TP 5/28/99 44 Rough/Ducts/Dampers AP TP DUCTS, PLMNS @ DRESSING RM 5/26/99 14 Frame/Steel/Bolting/Welding AP TP STORE FRNT 5/26/99 14 Frame/Steel/Bolting/Welding PA TP SEE CARD 5/26/99 17 Interior Lath/Drywall PA TP SALES CElL ONLY 5/26/99 34 Rough Electric AP TP CElL LITES © STIR FRNT 5/26/99 44 Rough/Ducts/Dampers CO TP SUPPORTS FOR DUCTS @ DRESSING 5/25/99 14 Frame/Steel/Bolting/Welding NS TP 5/24/99 14 Frame/Steel/Bolting/Welding CA TP NOT COMPLETE 5/24/99 17 Interior Lath/Drywall CA TP 5/24/99 44 Rough/Ducts/Dampers CA TP 5/20/99 14 Frame/Steel/Bolting/Welding AP TP HARD CElL © SALES ONLY 5/20/99 24 Rough/Topout WC TP 5/20/99 34 Rough Electric• AP TP CElL LITES @ SALES ONLY 5/20/99 44 Rough/Ducts/Dampers AP TP DUCTS, PLMNS © SALES ONLY 5/19/99 14 Frame/Steel/Bolting/Welding NR RB 5/19/99 34 Rough Electric NR RB Inspection List Permit#: CB990899 Type: TI COMM FOREVER 21 TI 6996SF Date Inspection Item Inspector Act Comments 6/24/99 89 Final Combo - RI 6/24/99 89 Final Combo TP AP 6/24/99 89 Final Combo TP NS 5/28/99 14 Frame/Steel/Bolting/Weldin TP AP DRESSING RM 5/28/99 34 Rough Electric TP AP DRESSING RM 5/28/99 44 Rough/Ducts/Dampers TP AP DUCTS, PLMNS @ DRESSING RM 5/26/99 14 Frame/Steel/Bolting/Weldin TP AP STORE FRNT 5/26/99 14 Frame/Steel/Bolting/Weldin TP PA SEE CARD 5/26/99 17 Interior Lath/Drywall TP PA SALES CElL ONLY 5/26/99 34 Rough Electric TP AP CElL LITES @ STR FRNT 5/26/99 44 Rough/Ducts/Dampers TP CO SUPPORTS FOR DUCTS @ DRESSING 5/25/99 14 Frame/Steel/Bolting/Weldin TP NS 5/24/99 14 Frame/Steel/Bolting/Weldin TP CA NOT COMPLETE 5/24/99 17 Interior Lath/Drywall TP CA 5/24/99 44 Rough/Ducts/Dampers TP CA 5/20/99 14 Frame/Steel/Bolting/Weldin TP AP HARD CElL @.SALES ONLY 5/20/99 24 Rough/Topout TP WC 5/20/99 34 Rough Electric TP AP CElL LITES @ SALES ONLY 5/20/99 44 Rough/Ducts/Dampers TP AP DUCTS, PLMNS @SALES ONLY 5/19/99 14 Frame/Steel/Bolting/Weldin RB NR 5/19/99 34 Rough Electric RB NR 5/17/99 14 Frame/Steel/Bolting/Weldin TP CO ND FULL HT WALL DETAIL 5/17/99 24 Rough/Topout. TP WC 5/17/99 34 Rough Electric TP CO BOND ELECT BOXES 5/17/99 44 Rough/Ducts/Dampers TP WC Monday, June 28, 1999 Page lofi EsGil Corporation in Partnership with government for Building Safety DATE: 4/1/99 0 APPLICANT U JURIS. JURISDICTION: Carlsbad 0 PLAN REVIEWER 0 FILE PLAN CHECK NO.: 99-899 SET: II PROJECT ADDRESS: 2525 El Camino Real, #100 Foever 21 PROJECT NAME: Forever 21 TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. LII The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: Esgil Corporation staff did not advise the applicant that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Brian Telephone #: in person Date contacted: 4/1/99 (by: CM) Fax #: Mail Telephone Fax In Person III REMARKS: By: Chuck Mendenhall Enclosures: Esgil Corporation F-1 GA fl MB EEJ EPC Walk in trnsmtl.dot / 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (619) 560-1468 • Fax(619)560-1576 Carlsbad 99-899 3/19/99 VALUATION AND PLAN CHECK FEE. JURISDICTION: Carlsbad PLAN CHECK NO.: 99-899 PREPARED BY: Chuck Mendenhall DATE: 3/19/99 BUILDING ADDRESS: 2525 El Camino Real, #100 Forever 21 BUILDING OCCUPANCY: M TYPE OF CONSTRUCTION: II BUILDING PORTION BUILDING AREA (ft.2) VALUATION MULTIPLIER. . VALUE. ($) TI • 6996 City Est 195,888 Air Conditioning Fire Sprinklers TOTAL VALUE . . 195,888 L-199 UBC Building Permit Fee • Bldg. Permit Fee by ordinance: $ 957.07 199 UBC Plan Check Fee E Plan Check Fee byordinance: . $ 622.09 Type of Review: • Complete Review . Structural Only Hourly Repetitive Fee-Applicable L Other: Esgil Plan Review Fee: $ 497.67 Comments: Sheet of I macvalue.doc 5196 - City of Carlsbad 04/08/1999 Miscellaneous Permit Permit No:0B991374 - Building Inspection Request Line (760) 438-3101 Job Address: 2525 EL CAM INO REAL CBAD St: 204 Permit Type: MISC Subtype: OTHER Status: . ISSUED Parcel No: 1563020900 Lot #: 0 .- - - Applied: 04/08/1999 Valuation: $0.00 Entered By: MDP Reference # Project Title: FOREVER 21 DEMO NON-BEARING WALLS AND CEILING Applicant: BROOKSTONE CONSTRUCTION STE 300 27450 YNEZ RD TEMECULA CA 92591 888-816-3515 Total Fees: $30.00 so.00\ alaice Due: C-4(1J0 3000 \ _8374 04/08/99 0001 01 02 TOTAL PERMIT FEES Miscelaneous Fee #1 ERMIT Miscelaneous Fee #2 :.' .. . 1.00 1.00 1.00 INCORPORATED 1952 FINAL APPROVAL _ • _ _ Inspector: Date: ______________ Clearance: NOTICE: Please take NOTICE that approval of your project includes the imposition of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions. You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. - You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161. PLAZA on Plan Approved: 04/08/1999 Issued: 04/08/1999 Inspect Area: INOEAL IELD COP INC HlEBLVD 'CA(9002\ PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 FOR OFFICE USE ONLY PLAN CHECK NO.___________ EST. VAL. ' Plan Ck. Deposit Validated By__________________________ Date Address (include Bid? /Suite #) . Business Name (at this address)' c ti- Eem miw cct1 2Or? Legal Description. - Lot No.. Subdivision Na /Number . Unit No. . Phase No. 'total # of units Assessor's Parcel # Existing Use Proposed Use Description of Work , ' ' SQ. FT. - #of Stories 4' of Bedrooms . 4' of Bathrooms ccnRspN AcYP Name . _ . Address . . - . . City 2 Vol ItIARIT., • State/Zip Telephone 4' Fax #, Name - Address ' .'. City .State/Zip . Telephone 4' - '4PROPERTY,OWNER' Jr) 7$_a / '/ • - Name - . Address , :, State/Zip Telephone # 6CONTRACTOR'COMPANY NAME : . -- '*'".................................,. .' '''. '':'' 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 tKi provisions of the Contractor's License Law [Chapter 9, commending 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 ofSection 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of not more than five hundred dollars l$5001). 27e ef Name . Address , - City ..- State/Zip Telephone 4' State License 4' . . . License Class - City Business License 4' Designer Name . Address ' ' , City State/Zip Telephone State License 4' 6WORKERS COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: - 0 I have and will maintain a certificate of consent to self-insure for workers' cornpesation as provided by Section 3700 of the Labor Code, for the performance of te..work for which this permit is issued. - if . - - I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: . . . . Insurance Company .O, 946. ' Policy No. ? ~'20 ~'cr'-( ' Expiration Date / -77--)7_- ,(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) C] CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage 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, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE . - ' DATE -. 7 OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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). 0 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). . . - , • . , 0 I am exempt under Section ' Business and Professions Code for this reason: Ipersonally plan to provide the major labor and materials for construction of the proposed 'property improvement. 0 YES DNO I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number/ contractors license number):, I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number): * I will provide some of the work, but I have'contracted (hired) the following persons toprovide the work indicated (include name Iaddress / phone number / type of work): PROPERTY OWNER SIGNATURE '. DATE COMPLETE THIS SECTION FOR NONRESIDENTIAL BUILDING PERIQi1TS ONLY , Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration for,.-or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 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? 0 YES "NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? '0 YES 8'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. 8 CONSTRUCTION LEND NG AG CV . " . . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code) LENDER'S NAME '- - _.- _---' ,LENDER'S ADDRESS 9"IAPPLICANT CERTIFATT Z I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. 'I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit' of Carlsbad to enter upon the above mentioned - property for inspection 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 GRANTING OF THIS 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 issued by th,Biilding Official under the provisions of this Code shall expire by limitation and becone null and void if the building or work authorized by such permit is not 9rpenced 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 w(isomienced for a period of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE • . . '• DATE" 4,jy - - - WHITE: File YELLOW: Applicant - PINK: Finance . .