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Home My WebLink About2525 EL CAMINO REAL; ; STE 250-259 PRE 2016; Permit' : .' I- ••'7 I ' B-u I L.D I N G P E.RM IT Permit No: CB981670 -•06/01/98 10:26 * • •• Project No: A9802220 Page 1 1 of 1 1. * Development No: Job Address: 2525 EL CANINO REAL Suite 250 Permit Type: SIGN Parcel No 156-302-09-00 Lot# 7562 06/01/98 0001 01 02 Valuation: , , 2,800 Construct ionT1NEW i000 - ;Occupancy Group: •. Reference#.: Status: ISSUED t Descripion: :WALL SIGNW/ELEC •; Applied: 06/01/98 MRS FIELDS COOKIES Apr/Issue 06/01/98 Entered By JM Appl/Ownr : SIGN TECH. '..• , , 619 527-6100 -• : 4444;.FEDERAL.BLVD • '' • , * SAN DIEGO CA 92102 *** FeesRequied .*** ** Fe e o11ected& 'Credits --------------- Fes: • 106. . - Adiutments 00 TJa2tht 00 Total Fees: • 1 6.00 \J • Total Pames: .00, 106.00 Fee description /ts n t Ext fee Data ------------ -,.Building Permit,, Pl7an Check 34. 00 00 ELSE *.SIG'A TOTAL 106.00 . • L #•, • ,• - FIN AppRo ALI" INSR DATE CLEARANCE U' I - .* • - , • •• . 44••; CITY OF CARLSBAD 2075 Las Palmas Dr.,Carlsbad, CA 92009 (619) 438-1161 a - - FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. ESI ______ CITY OF CARLSBAD BUILDING DEPARTMENT VAL 00 2075 Las' ., PaImas Dr Carlsbad CA 92009 ' man al. L)ePOsu1 (760)'438-1161 .'-- - Validated By, Date 1 ft0JJRMATION - Address. (include Bldg/Suite #) ,,.,.,.,,,, Businesà Name (at this'address) Legal Description 'Lot No. Subdivision.Name/Number' ' ' 'Unit No. ' 'e o. T6ta1of units Assessor's Parcel# Existing Use , Proposed Use'-;, Description of Work - -- -- -#of Stories -' # of Bedrooms' # of Bathrooms ,/,., s,. S,t- . . Name. '- - Address '' '' City state-zip Telephone P Fix # frCoctor O DggjOvr Name,- -' , - Address City Stdte ZP9 JePhone#52?_I/óo RERTY 0WNE lvzo ir9 //fo / f •64'gpGZr Name Address . City , , , ., State/Zip Telephone # CIPMPANY NAME' . F.'-- '(Sec.7031.5 Business and Professions .Code: Any City. or, County which requires a permit to construct, alter, impro,.demolish-ói repair any structure, priorto 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, commending with Section. 7000 of Division. -3 of the Business and Professions Codel or that he is exmpt-therefrom, and the basis for the alleged 'exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty-of not more than five hundred dollars 155001). - X/ Name ,. Name -C , i 2' '- . Address .' ' .'' ' - " - ""'- ' City'' ' '. State/Zip - Telephone # - State License # ''71 0 License Class C'4" City Business License # Designer Name - - , Address . , , . . City,',' • State/Zip Telephone -• . State License JcENSATIOiJ ,Workers' Compensation Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: '0 have and will maintain a,certificate of consent-to self-insure for workers' compensatio as, provided by Section 3700 of, the Labor Code, for the-performance , of the workfor which this permit is issud., ' ' ' - 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 co ensation insurance carrier and policy numberare: - Insurance Company - __'J_I(b'NO' Policy No. -2/ Expiration pate ,4/ (THIS SECTION NEED NOT BE COMPLETED IF THE-PERMIT IS FOR ONE HUNDRED DOLLARS [$ 1001 OR LESS) iO ,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 an' manner'so,Es 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 (S 100.000). in addition to the Cost of compensation, damages as provided for in Section 3706 of the Labor, dodii interest and attorney's fees. -' 'SIGNATURE _;- _- __.- - DATE __________ — — 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: - - .- 1. I, as owner of the property or my employees 'with 'wag I is 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;Contract'or's License' Law does,not apply to an owner of prop'erty,who builds âr ifTlproves'thereon, and who dos ,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 notbuild or improve for the purposeof sale). ' 'I, as owner of the property, am exclusively contracting with licensed contractors to construct the- project (Sec. 7944,:Business-and,.rofessi9ns Code: •'The Con'tractor's License Law does not apply to 'an owner of property 'who'- ho '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: I personally plan to provide the major labor and materials for construction of the proposed:property improvement. 0 YES. ONO I (have / have not) iiigni in applicà'ion 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 numbei'/'contractors license number): I plan to provide'portions of the work, -but I have hired the following person t7o coordinate, supervise anti 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 to provide the work indicated (include name / address I phone number /type of work): PROPERTY OWNER SIGNATURE DATE - 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? 0 YES -0 NO - - Is the applicant or future n a building occupant required to obtai permit from the air pollution control district or air quality management district? 0 YES 0 NO Is the,facility to be constructed, within 1,000 feet of,the outer bàundary of a school site? 0 YES 0 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 LENDINGAGENCY - ( hereby affirm that-there is L a construction lending agency for the performance of the work for which this,perrnit.is issued,,)Sec. 30971 Civil Code). LENDER'S NAME' - - -, - ' " - , 1 ''LENDER'S ADDR'ESS ff_E_R_T_1F-1CA BILL I certify that l'have read the application and state.that the above information is correct andthat'tha information'on the plans is accurate. I agree to comply with all - City ordinances andState- laws relatingto building construction. I'hereby authorize representativEs of the Cit' of Carlsbad to entr 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 pemit is required for excavations over 5'0" deep and demolition or, aonstruction of structures over 3 stories in height EXPIRATION: 'Every permit issued by the Building Offi4 36ays-from he provisions of this' Code, shall expire by limitation andbecome null and void if the building or work authorized by such permit is not coiiiW'eqced with thedate of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is co enced of 180 days')Section 106.4.4'Uniform Building Code). APPLICANT S SIGNATURE n DATE PINK: Finahce APPLICATION FOR SIGN PERMIT CITY OF CARLSBAD BUILDING DEPARTMENT . V 1200 ELM AVENUE FEE CARLSBAD, CALIFORNIA 729-1181 •.•• V V • . •• • 1. PERMIT No. S Owner's Name 0.5 ç 'Iddress f •V "!- J (PLEASE PRINT) (LAST) - (FIRST) (MIDDLE) : NUMBER . STREET IT''. V PHONE V Contractor /E/" V Address '" (ypiciiu V V Mailing V (PLEASE PRINT) V V . NUMBER V STREET . CITY PHONE State Contractor's License No. / V7L2Oc1 Classification .0 City License No. V V Person or Firm in control of Property (çL.% 4L2 V JihdV Mailing Address V V V V V V V V NUMBER V STREET CITY . . PHONE V LEGAL DESCRIPTION V V LOT BLOCK V V V V SUBDIVISION COMPENSATION INS CARRIER____________________________________________ JOB LOCATION V V V V NUMBER V V STREET 4mf Ae4 dela'r 4' . - : V • - (CITY OR TOWN) V V V (NEAREST INTERSECTION OR LANDMARK) . V Condit Use Permit or Signature ZONE VARIANCE NUMBER of Permittee V V V. V VV V V LOCATION FRONT feet fro centerline of street to sign SIDE feet from center tine of side street to sign Valuation of Sign $ Area of sign 1? square feet V., V V, . .V.V V Building Permit Fee $ Planning Dept Approved by -'7 Date Plan Check Fee $ ______________________ Plans approved by - Date V ii V ELECTRICAL PERMIT THIS SPACE FOR LOCATION SKETCH SHOW NORTH ARROW . V V Vj •,V VV V V.. V V Each Sign $500 - First 2 Trans $3 00 each add! @.50 each 1 to 10 lampholders . .25 11 to 25 - 50 26 to 50 " . 1.00 •: . V V . 51to160 ".. . ... 2.00 101to 200 " VV 3.00 V DIMENSIONS / Material: Panel : . Show advertising copy below. Height /1 Length / 97 . Uprights V V V V Number and size of posts V • Bracing V • V V V V : '' Number and size of braces . If neon, show colors Depth in ground . . Reflector material? V • V V V ', • V Distance between panel and ground Illumination? Reference to plan on file . Copy on both sides? NO V V CALL FOR ALL INSPECTIONS INCLUDING FINAL. INSPECTION REQUIRED ON FOOTING EXCAVATIONS BEFORE SIGN IS ERECTED APPROVED PLANS SHALL BE KEPT ON JOB k p Ebi PERMIT SIGN 0 ELECTRICAL FOR SIGN 7 Owner, s1Name (PLEASE PRINT) - APPLICATION FOR SIGN PERMIT CITY OF CARLSBAD BUILDING' DEPARTMENT 1200 ELM AVENUE CARLSBAD, CALIFORNIA 729-1181 Mailing Address OLE)) ) Mailing Addres 59/1 3/793159 FEE: PERMIt'No.7, -S 31050 BP 0 Z M State Contractors-Lj.pnse No eI-",/ lssification /' a I Citv License No. Person or Firm in control of Property Mailing Address LEGAL DESCRIPTION BLOCK SUBOIVIS1E I COMEENSATION INSURANCE CARRIERSTE.V i JOB LOCATION %I_- --A- Near 'Condit.Use Permit or ZON VARIANCE NUMBER Signatur of Permi LOCATION: \L)rr'1 K V V• 0 FRONT: '"'feet from center line of Street to Sign SIDE: feet from center line of side street to sign Valuation of Sign ti enn -• Area of sign11 rof square feet. Building Permit Fee $ 3,7!- Planning Dept. Approved by: j1A Date Plan Check Fee $ " Plans approved by Da t9_/ 3 7 II ii TI-IIc.PAr C'IP I fll'1i'M qvpTrw qwnmi NJflPTI-.I ARRC(AI ELECTRICAL PERMIT Each Sign $5.00 First 2 Trans. $3.00 each." 00 add'! @.50 each. 1 to 10 lampholders .25 ilto 25 - .50 26 to 50 " . 1.09 51 to 100 2.00 101 to 200 " 3.00. il I I I I I I I' I I I DIMENSIONS Material: Panel' ..p Show advertising copy below. Heihht // Length q 0m," Uprights Number and size of posts V Bracing . V Number and size of braces _______________ If neon, scot, 'ors . Depth in ground Reflector material?, tC-i- ri Distance between panel an ground_F . Illumination? • Reference to plan on file _________________ Copy on both si S. CALL FOR ALL INSPECTIONS INCLUDING FINAL. - INSPECTION REQUIRED ON FOOTING EXCAVATIONS BEFORE SIGN IS ERECTED. APPROVED PLANS SHALL BE KEPT ON JOB. •V .1 g. 'V • ' V PERMIT No. S V V ZZ QP-M (tL Owner's Name A'/ Mailing Address J3 (PLEASE PRINT) (LAS!) (FIRST) (MIDDLE) - NUMBER STREET V CITY V Contractor NSt&. ('i. 1..JC... Mailing AddressItOFiD R S#' - (PLEASE PRINT) .% NUMBER • STREET CITY State Contractor's License No. 36 c'i Classification - C_'4 City License No. Person or Firm. V V In control of Property c-MO c)L. V MailingAddress 2.-S 2S &Cf4IktiJ0 R1..J (e4'V V NUMBER STREET • CITY LEGAL DESCRIPTION LOT BLOCK SUBDIVISION V - '-V f V - - JOB LOCATION iL ic EL C'P4)1 O Sj .n:- 2 I. VI PHONE L.ocqg PHONE SA 7c(Z.7 PHONE +000$,J&. Cr0. TYPE OF. PERMIT SIGN 0 ELECTRICAL FOR SIGN 0 APPLICATION FOR SIGN PERMIT CITY OF CARLSBAD BUILDING DEPARTMENT V 1200 ELM AVENUE CARLSRAfl CALIFORNIA 729-1181 8/23/791936 0001196 0/23/79 9t- c° FEE: (b.. Near ,3 A Near V (CITY OR TOWN) Condit: Use Permit or V, V Signature ZONE VARIANCE NUMBER . of Permittee ,~,r - JA V - V LOCAT1OJ: V V ,• FRONT: feet from center line of street to sign SIDE: feet from center lin:of side street to sign Valuation of Sign $ 2D DO . Area of sign 1 4 square feet. Building Permit Fee $ 2 0 Planniflg Dept. Approved by / /Y' T . Date Plan Check Fee $ _______________________ Plans approved by .. . -Date? ELECTRICAL PERMIT I THIS SPACE FOR LOCATION SKETCH. SHOW NORTH ARROW Each Sign $5.00 I I.L.J L I V1 Firstrans. $3.00 each. VV V add'I @.50 each. 4-TV V - r 1 to 10 lampholders 5 V 11 to 25 50 KAY A 26 to 50 1.00 51 to 100 2. N 4~ F 101 to 200 gg ____ V - DIMENSIONS Material: Panel p-J Show advertising copy below. Height ._2.. Length Uprights Number and size of posts Bracing ? V Number and size of braces ______________ If'neon, show colors • Foy ee vs Depth in ground - Reflector material? PFOVPLE Distance between panel and ground ________ Illumination? it#'vc &iLVZML Referenbe io plan on file __________________ Copy on both sides? CALL FOR kLL INSPECTIONS INCLUDING FINAL. V V INSPECTION REQUIRED ON FOOTING EXCAVATIONS BEFORE SIGN IS ERECTED. - APPROVED PLANS SHALL BE KEPT ON JOB. V4 V 0 Z m APPLICATION FOR SIGN PERMIT - CITY OF CARLSBAD BUILDING DEPARTMENT 1200 ELM AVENUE •' '. FEE: 7° I- A 01 COA M r'Al I OKI I A 101 PERMIT No. I / _J S II .1' Owner'NamWE() (PLEASE PRINT) (LAST) (FIRST) (MIDDLE) -. NUMBER STREET CITY H NE Contractor ('V\ET N(ETcJNI Mailing Address 2 O' QU INCE fS1 toos (PLEASE PRINT) NUMBER STREET CITY PHONE State Contractor's License No2Z t9(' Classification City License No Person or Firm in control of Property Mailing Address NUMBER STREET CITY PHONE LEGAL DESCRIPTION LOT BLOCK W "J - c- ' SUBDIVISION si 1-3 JOB LOCATION PZA IN 2(2- NUMBER STREET J -.•- ' • Near _EL cAMI ' (CITY OR TOWN) (NEAREST INTERSECTION OR LANDMARK) Condit. Use Permit or Signature ' ZONE VARIANCE NR ': - of Permitte LOCATION : - .0 ______ FRONT: - feet from center line of street to Sign' SIDE: feet from center line of side street to Sign'' 2b0D 1öTPL_ Valuation of Sig-d?- 30 quar ig Area of sign feet. Building Permit Fee $ Planning Dept Approved by Date Plan Check Fee $ Plans approved by Date ELECTRICAL PERMIT : THIS SPACE FOR LOCATION SKETCH. SHOW-NORTH ARROW Each Sign Sign $5 00 First 2 Trans $3.00 each - addl @.50 each 9 gT1 1 to 10 lampho/ders 25 - 11 to 25 - 50 - 26 to 50 - 100 51 to 100 2.00 .- 101 to 200 -' ' 3.00 ' ' - •' DIMENSIONS Material: Panel - Show advertising copy below: Height I C' Length - ' ' Uprights'__________________ -' Number and size of posts ' 'Bracing Number and size of braces - - If neon, show colors - -- Depth in ground ' - Reflector material? Distance between panel and ground Illumination? Reference to plan on file ' Copy on both sides? - CALL FOR ALL, INSPECTIONS INCLUDING FINAL. - - - INSPECTION REQUIRED ON FOOTING EXCAVATIONS BEFORE SIGN IS ERECTED.' APPROVED PLANS SHALL BE KEPT ON JOB. 10/25/795626 - 2000 BP u0Ol626 10/25/79 20O0 TL 016. FEE: -, PERMIT No. - Owner's Name Mailing Address (PLEASE PRINT) (LAST) (F ST )M )LE) NUMBER STREET CITY PHONE Contractor Mailing Address T421 l/. (AA isi wia S3 (PLEASE PRINT) NUMBER . STREET CITY PHONE State Contractor's License No. Classification £ tO City Licens No. Person 'or Firm in control of Property Mailing Address A. O4Ja - NUMBER STREET CITY' - PHONE LEGAL DESCRIPTION 02.c - r " - LOT BLOCK SUBDIVISION -: - JOB LOCATION . . NUMBER STREET . . Near (CITY OR TOWN) (NEAREST INTERSECTION OR LANDMARK) Condit. Use Permit or Signature . ZONE VARIANCE NUMBER of Permittee LOCATION: 0 FRONT: feet from center line of streetto sign SIDE: _________ feet from center line of side street to sign Valuation of Sign $ * Area of sign - 5s. uare fee Building Permit FeeS /0 Planning Dept Approved by Date/10 Plan Check Fee $ __________________________ Plans approved by , - Date ELECTRICAL PERMiIJ THIS SPACE FOR LOCATION SKETCH. SHOW NORTH ARROW L rE:ac:h =Sign =$5.OD I I First 2 Trans. $3.00 each. add'I @ .50 each. - 1 to 10 lampho/ders .25 11 to 25 - .50 26 to 50 " 1.00 51 to 100 : 2.00 101,to 200 ." 3.00 - - HIIHIIIILHlLI.HILf±Li ,1DIMENSIONS 1A' Material: Panel Show advertising copy below. Height "2.. Length ' Uprights Number and size of posts Bracing Number and size of braces ________________ If neon, show colors .Depth in ground Reflector material? Distance between panel and ground Illumination? Reference to plan on file Copy on both sides?- CALL FOR ALL INSPECTIONS INCLUDING FINAL. INSPECTION REUUIRED ON FOOTING EXCAVATIONS BEFORE SIGN IS ERECTED. APPROVED PLANS SHALL BE KEPT ON JOB. TYPE OF PERMIT SIGN 0 ELECTRICAL FOR SIGN 0 APPLICATION FOR SIGN PERMIT CITY OF CARLSBAD BUILDING DEPARTMENT 1200 ELM AVENUE ('AICAfl CAl I'ClKliA 7O_1101 0 Z M \: 'c INCORPORATED 1952 y $10.00 $0.00 $0.00 j$0.00 ($0.00 $10.00 $0.00 $0.00 $0.00 $20.00 Electric Issue Fee Single Phase per AMP Three Phase per AMP Three Phase 480 Per AMP Remodel/Alteration per AM Remodel Fee Temporary Service Fee Test Meter Fee Other Electrical Fees TOTAL PERMIT FEES qJL% City of Carlsbad 03/23/2000 Electrical Permit Permit No:CB001 055 Building Inspection Request Line (760) 602-2725 Job Address: 2525 EL CAM INO REAL CBAD St: 257 Permit Type: ELEC Parcel No: 1563020900 Lot #: 0 Reference #: Project Title: ANN TAYLOR-PALZA CAM-REAL ILUM WALL MOUNTED SIGN Status: ISSUED Applied: 03/23/2000 Entered By: JM Plan Approved: 03/23/2000 Issued: 03/23/2000 Inspect Area: Applicant: Owner: AMERICAN NEONICS - PLAZAINOEAL C/OWESTFIELD CORP INC 5542 SATSUMA tOSPANG-EVEX,025 V Ii (601,ISHiE BL\7D NORTH HOLLYWOOD CA 91601 S-0 0\ 213-875-1815 2203 03/23/00 0001 01 02 C-PRNT 20-00 Total Fees: $20.00 / Total Payments To DtejSc $o.00\ Balance Due: $20.00 PERMIT HAS EXPIRED SECTION 106.4.4 WITH UBIC. SIGNATURE________ 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 Vi b PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 4 Address (includéBldg/Suite #) ,- T2T ,I isiness Name (at FOR OFFICE USE ONLY PLAN CHECK NO.. EST. VAL. Plan Ck. Deposit_...-' Validated VBy. j\,L. L I. Date _ •+ke Lo-ft- Le al Description Lo No. Subdivision Name/Number . Unit No. Phase No. Total # of units Assessor's Parcel # -. Existing Use ProposOd Use Description of Work ' . SQ. FT. #of Stories ' # of Bedrooms # of Bathrooms Eec+rtco-L )tt • ' . t2 Name - -. Address City State/Zip Telephone # Fax # L tor Dnt Name Address - City, State/Zip Telephone # 4 PERTYNWJR Name - Address - City State/Zip Telephone # - \ 11IR VQIPR CJPiTA,ME (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, altar, 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, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is'exempt theiefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for apermit subjects t e applicant civil penalty of not morethan five hundred dollar ($5001). /?eor I S 715 to /) o//iL'oo, ' , ?32Q Name - . Address City State/Zijh Telep ne /t State License /tV 3'2 0 / ."I - License Class C f " . City Business License # - Designer Name , Address ' City - State/Zip Telephone State License # ________________________ . . -- Mon Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: C] I have and will maintain a certificate of consent to self-insure for workers compensation as provided by Section 3700 of thO Labor Code, for the performance of the work for which this permit is issued. C3 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 :01-11 F. Policy No. -7-3O 18' Expiration Date / 2'- (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 th performance of the work for which this permit is issued, 1 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', 6mpensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars $ 100.000) ádditio o the co of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE . _V _____V _J'. DATE S -3 V V 7LOWNERUILDER DECLAATI0N I hereby affirm that I am exempt from the Contractor's License Law for thif011owing reason: 0 I, s owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not inteided 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 orVimproves thereon, and who does such iork 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). o 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 V pursuant to the Contractor's License-Law). 0 I am exempt under Section Business and Professions Code for this rason I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES. ONO • I (have / have not) signed an application for a building permit for the proposed work. V 3• I have contractôd with the following person (firm) to'provide the proposed construction (include name / address /,phone number / contractors license number): V 4 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): 5. I will provide some of the work, but I have contracted (hired) the following per's'ons to provide the work indicated (include 'name V/ address /'phone number / type V of work): V PROPERTY OWNER SIGNATURE V V DATE - V £ Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and preventioh - program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES ' 0 NO V . 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 0 NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 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 THEAIR POLLUTION CONTROL DISTRICT. VV V - • V. RN M- EEO 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 V - LENDER'S ADDRESS icERTr C2 - - - I certify that I have read the application and state that the above informatioii 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, V INDEMNIFY AND'KEEP VHARMLESS 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 o'r construction of structures.over3 stories in height. V 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 180 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 JQr,a pen V f ys (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE d" DATE ' - V '•V - V - V V WHITE: File YELLOW: Applicant. PINK: Finance address) CITY OF CARLSBAD—BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 NO. - ioe A, JA I ADDRESS AV. ST. RD ,omE I j 'DATE OF APPLICATION *---/ BUS. LICENSE c3a PERMIT NUMBER - OWNER - OWNER'S PHONE P , )IME CONTRACTOR STATE LICENjE S OWNER'S MAILING ADDRESS Z CONTRACTOR'S ADDRESS CONTRACTOR'S . . 005I8•' /•9.' ,0b i Not Valid Unless Machine Certified - LOT - BLOCK SUBDIVISION 111111111111 ASSESSOR'S PARCEL NO. - DELeVNER STATE LICENSE '1../#,'LL. .L.) DESCRIPTION OF WORK DESIGNER'S PHONE CENSUS TRACT I GP LAND USE ZONING . RES. UNITS PARKING SPACE NUMBER OF STORIES BLDG SO. FT. BLDG USE . 0CC. GP STANDARD PLAN # PLAN ID S TYPE CONST 0CC. LOAD QTY. PLUMBING PERMIT AMT. flY. MECHANICAL PERMIT AMT. EACH FIXTURE TRAP . . INSTALL FURN. DUCTS UP TO 100,000 BTU EACH BUILDING SEWER OVER 100,000 BTU EACH WATER HEATER AND/OR VENT . - BOILER/COMPRESSOR UP TO 3 HP EACH GAS SYSTEM 1 T04 OUTLETS - . BOILER/COMPRESSOR 3-15 HP EACH GAS SYSTEM SOR MORE . BOILER/COMPRESSOR 16-30 HP . EACH INSTAL., ALTER, REPAIR WATER PIPE . VENT FAN SINGLE DUCT EACH LAWN SPRINKLER SYSTEM . MECH EXHAUST - HOOD/DUCTS BUlL , TNEIL 3 . SIGN PERMIT I • I i-. - TOTAL PLUMBING . CONTRACTOR . TOTAL MECHANICAL. CONTRACTOR PLAN CHECK ALL INCLUSIVE PERMIT (ITY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT . AMT. TOTAL PLUMBING I I ELECTRICAL I I NEW CONST EA AMP/SWT/BKR AWNING . MECHANICAL 1 PH .25 3 PH . PORCH . MOBILE HOME EXIST BLDG EA AMP/SWT/BKR . . SET-UP SOLAR 1 PH .25 3 PH . RAMADA, CABANA . REMODEL/ALTER PER CIRCUIT . FENCE OVER 6' TEMPPOLE 200AMPS . . . TOTAL MOBILE HOME. . MICO-FILM OVER200AMPS 4CCUPANCY (30 DAYS) I ' L I . I TOTAL ELECTRICAL TOTAL FEES PAYABLE CONTRACTOR I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SPECIFIED HEREIN OR NOT.-I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY INCONSEQUENCE OF THE GRANTING OF THIS PERMIT. 'AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS 5-0" DEEP AND DEMOLITION OR CONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT - OWNERDCONTRACTORD AGE D'BYPHONE 0 I APP I. LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license is in full force and ef- fect. OWNER-BUILDER DECLARATION Dl hereby affirm that I am exempt from the Con- tractor's License Law for the following reason (Sec. 7031.5 Business and Professions Code), Any city or county which requires a permit to con- alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed state- ment that he is licensed pursuant to the provi- sions of the Contractor's License Law (Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that is ex- empt therefrom and the basis for the alleged ex- emption. Any violation of Section 7031.5 by an ap- plicant for a permit Subjects the applicant to a civil penalty of not more than five hundred dollars ($500). DI, 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 of- fered for sale (Sec. 7044, Business and Profes- sions 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 of- fered for sale. If however, the building or improve- ment 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). Dl, as owner of the property, am exclusively con- tracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not ap- ply to an owner of property 'ho builds or im- proves thereon, and who contracts for such pro- jects with a contractor(s) license pursuant to the contractor's License Law). I am exempt under Sec._, B. & P.C. for this reason_______________________________ Date _____________ Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con- sent to self-insure, or. a ceaflficate of Workers' Compensation Insuran e, o cJ ified copy thereof (Sec. 3800, Lab o POLICY NO. COMPANY DCopy is filed with th ity. OCertifled copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Section need not be completed if the per- mit is for one hundred dollars ($100) or less). 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. NOTICE TO APPLICANT: if, after making this Cer- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction len- ding agency for the performance of the work for Which this permit Is issued (Sec. 3097, Civil Code). APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. . T. .. I SITE ADDRESS: OWNER:! ' PERMIT NO:.: 'L i FIELD INSPECTION RECORD INSPECTION DATE INSPEC1'OR INSPECTORS NOTES WOOD FLOOR - - FOUNDATIONs FORMS . SET BACK .TOILET UNDER FLOOR PLUMBING UNDER FLOOR HEATING 0•_ •_••_ —I '. -- i --i--, OKTOINSTALL.SUBFLOOR SLAB FLOOR UNDER SLAB PLUMBING FOOTING • FORMS • SETBACK • TOILET OK TO POUR CONCRETE - FRAME . S ROUGH ELECTRICAL ROUGH PLUMBING ROUGH HEATING/VENTILATING FRAME OK • PLACE INSULATION INSULATION OK • PLACE WALLBOARD WALLBOARD OK • PLACE TAPE EXTERIOR LATH OK. PLACE STUCCO . FIREPLACE DAMPER &STEEL - PLATE TIES/HEIGHT OF CHIMNEY OTHER - - TEMP POWER (POLE) SEWER GAS TEST SWIM POOL • STEEL BONDING PRE DECK FENCE PREPLASTER SHOWN - • FRAME PAN FINAL INSP BY BLDG DEPT OTHER DEPT'SREQ COMPLETED -- ELECMEtER-PERM—TEMP GAS METER—PERM—TEMP CERT OF OCCUPANCY ISSUED.