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HomeMy WebLinkAbout2540 EL CAMINO REAL; A-E MULTI-PERMIT FILE; CB960957; Permit1 lax U L 0 1. N G P F R M I T Per'mr' Neu £"is960957 051 0196 j029 Project No! A96013ts.0 Job Add re*•. m 2540 FL CA€"1?.NO REAL. Suitag A P e r tr, i t T y p e tl SIGN 1790 '05/350/96 C1001, 01. 'Valwation. 2,000 Construction Type: VN Occupancy Group: Reference#c Statow ISSUED De cr ipt 1 on n ONE WALL SIGN WITH ELECTRIC Appliedv 051101 96 Off.;"#:}l/Ownr " IST CHOICE SIGNS 619 746-FO69 ESCONDIDO, CA, 92029 tie Fees Required�.;� ��es i~ l�eciet{ � Lirer�it Fee: 74. 0 ,�-� � s~ A " Tot �:1,1ta�.fi;r�tt:,.t'•t�:,:. , 00 �.�: Total Fees! Fee description 1s F.c L flee i��'i. Boilding Permit 45,00/Plan ChQbk 29,00 SIGN TOTAL 74.00 S P., 1CUARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, ;CA 92009 (619) 438-1161 • PERMIT APPLICATION _ City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 From list 1 (see back) give code of Permit -Type: --------------------------------------- For Residential Projects Only: From List 2 (see back) give Code of Structure -Type: Net Loss/Gain of Dwelling Units . PLAN CHECK NO. f C - L o VAL o CO G` 0 —z N CK DEPOSIT ID. BY 2. PROJECT INFORMATION FOR OFFICE USE ONLY Address k 1t&to (44,lBuilding or Suite No. Nearest Cross StreetMCA (-I-v1,, iLEGAL DE''CRI t NO. subdivision Name/Number Unit No. Phase No. CHECK BELOW IF SUBMIT YED: ❑ 2 Energy Calcs ❑ 2 Structural Calcs ❑ 2 Soils Report ❑ 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING U§L PROPOSED USE DESCRIPTION OF WORK T-14 S "f'4 !� t4 C 1 j 1.Z+M i 41-ctcd wQ SQ. FT. a �, � # OF STORIES # OF BEDROOMS # OF BATHROOMS_ 3. 'GUN A%C1 TFMAM (it different from applicant) NAME (last.name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE NAME (last name first).Sl y y,i �� 9 p v,, ADDRESS %Qa y W_ f - � i,f-S 1 Lg11 �, CITY �q� - i STATE/ CA ZIP CODE Q DAY TELEPHONE NAME (last naLjwme first) l"` �� ,G �� 1 L ADDRESS CITY STATE ZIP CODE DAY TELEPHONE .� f /�` -7 Lq r Q`f L4_3 1 NAME (last name jfirst)) ! .S7'' �O i C t. .� t 5 Lt S ADDRESS j y'a y l of , l.f-y 1010, kd. CITY F.a$6vlt{ 1JV STATE LA ZIP CODE f j,01? DAY TELEPHONE LCA-'���G� STATE LIC. #{� _ jNe� LICENSE CLASS Ci 41-T— CITY BUSINESS LIC. # —DESIGNER NAME (last name) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE" STATE LIC. # 7. WORKERS'COMPENSATION Workers' Compensation Declaration: I hereby af f irm that -I have a certificate oconsent to selt-insure'issued by the Director of Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY J / Q L- �u$J POLICY NO. L/ �% `�� EXPIRATION DATE Li 7 — Certificate oT xE empnon: f cerUfyTin t r—f�orm� t 1-T e work For wnrccni Tars permit is issued, I shall not employ any person in -any manner so as to become subject to the Workers' Compensation Laws of California. SIGNATURE b DATE ,- ^-3 Q e, caner- ui er Declaration: I liere5y attirm that am exempt from the Contractor's license Law tor the o owing reason: ❑ 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.). _ ❑ 1, 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). ❑ 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 License 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)). 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? ❑ 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 THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND' THE AIR POLLUTION CONTROL DISTRICT. ere�rm that there is a construction lending agency for the,pertormance of the work for which this permit is issued (Sec 3UW(1) civil Code). LENDER'S NAME LENDER'S ADDRESS 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 TO SAVE INDEMNIFY AND KEEP HARMiESS THE CITY OF CARISBAD 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 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 Buildin Code). APPLICANT'S SIGNATURE `1 DATE:,,f> "n -TT'M- 17;1e V17T T A.,.,U-t DTMV- T�1T 7T1•� CJ T, CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB960951 FOR 06/11/96 DESCRIPTION: ONE WALL SIGN WITH ELECTRIC TYPE: SIGN JOB ADDRESS: 2540 EL CAMINO REAL APPLICANT: 1ST CHOICE SIGNS CONTRACTOR: OWNER: REMARKS: MW/TOM/746-5069 SPECIAL INSTRUCT: PM PLS TOTAL TIME: INSPECTOR AREA PLANCK# CB960957 OCC GRP CONSTR. TYPE VN STE: A LOT: PHONE: 6-19 746-506 PHONE: PHONE: INSPECTOR' CD LVL DESCRIPTION ACT COMMENTS 38 EL Signs ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP COMMENTS TYPE OF 'PERMIT APPLICATION =FOR SLGN PERMIT .''-SIGN " • • - -s • _ -:' i�: •,_.. � - - �' �2,,�i; •- Cl-TYOF CARLSBA-D'-BUILDING DEPARTMENT - - ELECTRICAL I FOR SIGN, Q %1200 Et: AVENUE 4E. CARLSB'AD-, CALIFORNIA, 725,11.8.1; PERMIT "No .' f - r ` I tea" :► l nm ; Owner's Name i-^:t' . ,� A9Pt\ Mai ling Add_ res , _ + .1; I .±~' �",_ ':V A � � (PLEASE PRINT). " ,(LAST) _ (FIRST►- .'.: (MIDDLE) NNUMBER- STREET "'CITY ' -PHONE C`ontraetor *j 3Ml�t: i UkJ_ S tl I X��1-• Mailing Address�I •�' }.1i t,Wi44 ,A ,, C.a:Sl"Rfi: (PLEASE PRINT)- NUMBER ,-STREET":, .'CITY_ PHONE' •State Contractors, License No.Classification '- - - - Ci•ty;License-No-. ' 'Person o'r f irm in control' of-'Propert T `{�1�1lTl 1�E >�P-•` Me'i'Iiog-Address ' J' M;i 10,67L»'" ;1�3 f) i NUMBER STREET" CITY c PHONE" -LEGAL- DESCR-I PTI ON, - 'LOT -• BLOCK - SUBDIVISIOM, JOB 'LOCATION .. ` CAM I -fit 6t , a NUMBER STREET k ?� Near_ "F Ck ` (CITY OR TOWN)'. ,(NEAREST INTERSECTION OR LAN MAgK) Condit. Use -Permi•t or:. Signature. ZONE' -VARIANCE NUMBER of,Permittee L"OCATION: _ FRONT: -feet from dentertfine of street to sign -'- SIDE-- feeY_from centeri'ine of°side. street'to;sign: m ) Valuation 'of Sign g � Area of sign' - - square �Buitding-Permit Fee S Planning D.#'" pprov y. - +_.' Date Plan• Check. Fee S. _ Plans approved b' .Dafic ELECTRICAL :PERMI,T. >' = Each Sign -S5.b0 , First 2:Transi 43,; 6a each.• each. 1,to '10. lampholders. :25 26. to 50 •' , : 1_00 51 to 100' :101' 0 200` ' 3: 00 . OCATfON S'KETCH,:' -SHOW ,NORTH, ARROW`_ • " D;kMENS10NS Material: Panel -: Show adveEtisin co beI"ow, t �I. g pY': , Height �.�; a�'Lendth: 0 Uprights Number- and-,si`ze'of-po�ts - < Bracing Number and,size'.bf braces If neon, shoi(oolors - Depth in ground Reflector -material? D'i•stance between -panel' aI d ground I-Il'umination? Refer0 a to,.plan: on,'fi.l.e,' , . Gppy on both-'S'ides?•' ,---CALL FOR ALL INSPECTIONS INCLUDING FINAL. INSPECTfON REU' U' [RED, -ON FOOTING- EXCAVATIONS'BEFORE, SltU-IS ERECTED:- APPROVED.PLANS,-$H'ALL,.BP KEPT ON' -0 B U I L D I N G PERMIT Permit No: CB981461 05/I4/98 11:24 Project No: * A98019513 Page I of 1 Development No: Job Address: 2510 EL CAMINO REAL Suite:'B Permit Type: SIGN Parcel N.6: Lot#* Valuation: -- -------------- 500 Construction Type: NEW Occupancy Group: Reference#: Status; PENDING Description: ILLUMINATED EXTERIOR SIGN 11.2 Applied: 05/14/98 SF Apr/Issue: Entered By: BT Appl/Ownr -. VIDAL- ANGEL 717-5779 P 0 BOX 3474 7062 ()5/14/9e. 0001 01 CHULA VISTA CA 91909 C-PRiff *A. Fe -es Required '_Fe­e-s-,,Coll' cted & Credits ------ ----- -------------------------- Fees 2 5 0 Adjustments: d Total 'Fees : .-Tot '4pp t Fee description q�s - - - - - - - - - - Building Permit Plan Check SIGN TOTAL YYY INCORPORATED 052 Q wts Due .00 25.00 Ext fee Data 15.00 10.00 25.00 �FINAL APPROVAL INSP.--���OATE '4fo f ��v CLEARANCE CITY, OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 t PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 , "+T" (760) 438-1161 • FOR OFFICE USE ONLY PLAN CHECK �' NO. EST. VAL. )1�tf) Plan Ck. Deposit.,,o Validated By Address i I Bldg/Su to Business Name (at this address) 4vt " Legal Description Lot -No. Subdivision Name/Number Unit No. Phase No. ITotal # of units Assessor's Parcel # Existing Use N Proposed Use ©off �Y�E�Gnr� Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms 4 f' :roms licati f: 2' :CONTACT;PERSON'(if-d[f eient;;f. $PP. t3y... .. .., ....... � .... , , . , .. ..M �;:=��r ,> ., a„�icr•:, ...,w .. , ,�..� .., ..._.,_ ,.'<,':� ..,.... .. Name Address City State/Zip Telephone # Fax # 3: `:APPLICANT . :Contractor ,A'ent,fo%Contractor= tl0.wrier A iit.for'L}wner�- =g.> :} 0, sY� g� "-s»q Name Address City State/Zip Telephone # :4: PROPERTY 01M1(NER u- , _ =_ = _ _ Name Address City State/Zip Telephone # - '5:'_ ;CONTRACTOR", -:COMPANY NAIVE; .. .. M_.. ... . ..,';Im,. , a, 'ta`.-,,,03't. ..� .„..J .. ..., ._, .,,Ma.r .•°•Y>'n.N=.•a'x<":A ,x., T-_ v.. .n„> ,«. ..., ._a....s ., ... (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 License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or Wf 'exempt therefrom, and the basis for the alleged exempt}ion. Any violation of Section 7031.5 by any applicant for a permit subjects the applic,an�t��t��o a ci of not more than five hundred dollars [$5001). (/�Q4C Ati-GRL 0 cJ, S.mx 3Y7y Cl1e�C,yDy-3Y7Y q�7-s%7� Name �c� Address City State/Zip Telephone # State License # %©s lZ / License Class — C _ City Business License # 02 Designer Name Address City State/Zip Telephone State License # ;WORKERS,"COMPENSATION -- ;;• ;+,'.:'; r.. .. "..',: Workers' Compensation Declaration: I hereby affirm under penalty of perjury one J 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 performance of the work for which this permit is issued. ❑ 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 Policy No. Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) JX 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 0100,0 0), in add' ' n to the cost of compensation, damages as provided for in Section 3706 of the"Labor code, in erest and attorney's fees. SIGNATURE '2�--�.—L_� DATE :7. _•OWNER=BUI[.DER:DECLARATION' I hereby affirm that I am exempt from the Contractor's License Law for the following reason: ❑ 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). ❑ 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). ❑ I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ YES ❑NO 2. 1 (have / have not) signed an application for a -building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. • 1 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. 1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of, work): PROPERTY OWNER SIGNATURE DATE >CO-tHISSEGTI NMPLETtFOR•NONBES/DENT%AL.BUILDING:PigENITS:ONLY.' O ... .a - k •.. -h.+r x�;-:.e-'.'� s„",' ` ":lw Y">i, ma -...a _ c x 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 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 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.LENDING:AGENCY:,, '"'" „e:-:`::a `' ; 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 P C T�CERTI 1CAT10N- - - 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 City of Carlsbad to enter upon the above mentioned property for inspection purposes. 1 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 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 workk c�o men d fo .period of 1150 days (Sec ' n 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE l/ DATE S �Y WHITE: File YELLOW: Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST_ PERMIT# CB981461 FOR O0fl"*_"e INSPECTOR AREA DESCRIPTION-: ILLUMINATED EXTERIOR SIGN 11.2 PLANCK# CB981461 SF OCC GRP TYPE: SIGN 61411f ,- CONSTR. TYPE NEW JOB ADDRESS: 2540 EL CAMINO REAL STE: B LOT: APPLICANT! V_IDAL ANGEL PHONE.: 717-5779 CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: C/619/917-5779 INSPECTOR SPECIAL INSTRUCT: THE CARD AND PLANS ARE AT THE RECEPTIO DESK - BUSINESS OPENS AT 9AM TOTAL TIME: CD LVL DESCRIPTION ACT COMMENTS 38 EL Signs DATE DESCRIPTION ***** INSPECTION HISTORY ***** ACT INSP COMMENTS APPLICATION FOR - '.S1,N: PERMIT .1'3;a'r: Yoh°r' ,i..t' CI'Ty OF'CA°RLSEiA,D. BU'ILD.ING DEPARt-MENt,., 1206 ELM •AVENU'- CA-RL8BAD,, GALTFORN'IA : 129=,1 18•.1" -P.ERMI-T No. _ D b . Z , O.wner';s Name ��� ��".-r - � tCRT�.� • Maifing.Address�f7: ' .,�L�� .���r. �-•. _ _.. �� . (PLEASE PRINT)• •(LAST): -(FIRST)- - • (MIDDLE)' ".. "NUMBER STREET- CITY`. '' ' .:PHONE--- Contracto �• Maili'ng Address Z (PLEASE•PRIN "NUMBER-,-,, -STREET CITY . PyONE- - State Contractor's -License No::'15C*4 Classification'"i `^ City License No.: Person or Firm . in confro'I of Property��r,4, 4A),IT G�•Zi a IUlai l`Ing AddYess 3(03, !� I� —^_: .! ,• _ _ - . "NUMBER- STREET' .: Q-ITY '-P.HQNE; LEGAL DESCRIPTION ,L T BLOCK SUBDIVIS,IoN JOB- LOCATION � GAl� - t_ NUMBER • : -1 STREET': H WA ,+�;�.;- ... Near (NEAREST INTERSECTION"QR LANDMARK) (CITY OR TOWN) _-Conat`. Use Permit,or .Signature. , VARIANCE NUMBER - of-Permittee, -- -- LOCATI - FRONT' } feet from center I�ina of street to sign, SIDE: feet from center fine=of Valuation lof Sign Area,of •sign. ~' -square fe } .5: _ Bui,ldng Permit Fees Planning.D b Date° Plan Check Fee $ ., - - Plans approved -Dart` ., DIMENSIONS _ Materiai. Fan'el �' Show advertising-copy'=belQ`hr. Height_Length- _Uprights Number'and size •af post's 'Bracing Number -and, size of braces If'neon, 'show co.lb°rs "f - Depth .fn' ground; Reflector material? s D"istance, between paneland r d I ffumina�tion ? Reference to plan tilt- file Copy o_n both.'sides? CALL FOR ALL INSPECTIONS INCLUDING FINAL. INSPECTION` ,REb0lRED:,IW FOOTING. EXCAVATIONS BEFORE SIGN 1S ERECTED: APPROVED`'PLANS,SI SALL BE:KEPT,ON JOB-.`-- , City of Carlsbad 1636 Faraday Av Carlsbad, CA 92008 10-24-2007 Sign Permit Permit No: CB072706 Building Inspection Request Line (760) 602-2725 Job Address: 2540 EL CAMINO REAL CBAD St: D Permit Type: SIGN Status: ISSUED Parcel No: 1563010900 Lot #: 0 Applied: 10/24/2007 Valuation: $3,000.00 Construction Type: NEW Entered By: LSM Reference #: Plan Approved: 10/24/2007 Issued: 10/24/2007 Project Title: BASKIN ROBBINS- INSTALL 1 Inspect Area: IL.LUM WALL SIGN Applicant: STANFORD SIGN & AWNING INC 2556 FAIVRE ST 91911 619 423-6200 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Electrical Fee Renewal Fee Add'I Renewal Fee Other Building Fee Additional Fees TOTAL PERMIT FEES Owner: PLAZA CAMINO REAL C/O SEARS ROEBUCK & CO 3333 BEVERLY RD HOFFMAN ESTATES IL 60179 Total Fees: $102.42 Total Payments To Date: $49.95 $0.00 $32.47 $0.00 $0.00 $0.00 $0.00 $20.00 $0.00 $102.42 $102.42 Balance Due: $0.00 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 capacity 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 1635 Faraday Ave., Carlsbad, CA 92008 1, 760-6,02-2717 / 2718 / 2719 Fax: 760-662-8558 Building Permit Application OF CAg< h y c'q</Fot��P Plan Check No. (pion-7n% Est. Value pOD Plan Ck. Deposit Date 1t71aLeto-) JOB ADDRESS SUITE#/SPACE#/UNIT# - APN CT/PROJECT # LOT # PHASE # # OF UNIT& I # BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: — .�.� EXISTING USE T�J PROPOSED USE GARAGE ( > PATIOS (SF DECKS (S FIREPLACE YES ❑ #_ NO ❑ AIR CONDITIONING YES ,ENO ❑ FIRE SPRINKLERS YES ' NO ❑ CONTACT NAME (lf Dlfferent Foin Appllcant) APPLICANT NAME ADDRESS ADDRESS (Oa0 urn, Ucs"tIJ _DP_, - CITY TA E ZIP CITY STATE ZIP nein 1 V• o�,m d PHONE � C PHONE - 7,4-,, FAX -736 .EMAIL EMAIL PROPERTY OWNER NAME 14wV � S c ` � eatn,CONTRACTOR I V BUS. NAME n � ; fn � t ��� l� V' ADDRESS oZ 3 Corr gLcc� tam ADDRESS (QUO. u �� stn Do- . CITY STATE ZIP ow o tr+ 1� G CITY STATE ZIP Gail 1 ouv Zo PH O E �Q � FAX -' -PHONE loo FAX — EM L EMAIL /_ F 0-7 0 ARCH/DESIGNER NAME & ADDRESS ` STATE LIC. - STATE LIC.# Y CLA S§ CITY BUS. LICM Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alto` 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 Icensedyyunuant to the provisions of -the Contractors License Law {Chapter 9, commending with section NO of Division.3 ofthe Business and Professions Code} or4at he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500)). Workers' Comp en sation Declaration: l hereby affirm under penalty of pelury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self insure for workers' compensation as provided by Section 3700 of the1abor Code, for -the. performance of the work for which this permit is issued. have and will maintain workers' compensation, as required by Section 3700 bf the Labor Code, far the performance of the work for which this permit is issued. My workers' compensation insur nce garner and policy number are: Insurance Co. P P �-h' cinaL i nS .Policy No. �/9 �_O (� 1� �{� "' Expiration Date This section need not be completed if the permit is for one hundred -dollars ($100) or less. ❑ 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 lawful, and shall subject an empioyer•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-' n 3706 of the Labor code, interest and attorney's fees. - .ES CONTRACTOR.SIGNATURE 'DATE (� 24I I v -7 I hereby affirm that I am exempt from 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 1, 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 contractors) licensed pursuant to the Contractor's License Law). 0 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 property improvement. 0 Yes 0 No 2.1(have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the -following person (firm) to provide the proposed construction (include name address / phone I contractors' license number): 4.1 plan to provide portions of the work, but I -have hired the following person to coordinate, supervise and provide the major work (include name I address / phone I contractors' license number): 5. I -will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include'name / address./ phone I type of work): CKPROPERTY OWNER SIGNATURE DATE gi Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration farm 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 building occupant required to obtain a permit from the air pollution control district or air quality management district? 13 Yes 0 No Is.the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 Yes C3 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. �;• ,gg,l yy ...�,z . Y•g }.e. I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i).Civii Code). Lender's Name Lender's Address ,.a'. ro 1 § ;y'„ ..,. '§.•" -'` '�'` "? ,•'•��" ' "i�" q$ > •s=•.% Vs'j , rSa,z ., , I certifythat I have read the application and state that the above information is coned and that the information on the plans is accurate. i agree to complywith all City ordinances and State laws relating to building construction. thereby authorize representative of the City 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 pertnit is required for excavations over 5'0' deep and demolition or construction ofstructures 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 180 days from the date of such permit or if a 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 106.4.4 Uniform Building Code). )KAPPLICANT'SSIGNATURE DATE f� (� 07 City of Carlsbad Bldg Inspection Request For: 04/18/2008 Permit# CB072706 Title: BASKIN ROBBINS- INSTALL 1 Description: ILLUM WALL SIGN Type: SIGN Sub Type: Job Address: 2540 EL CAMINO REAL Suite: -D Lot: 0 Location: OWNER PLAZA CAMINO REAL Owner: Remarks: Inspector Assignment: Phone: 7607366070 Inspector: Total Time: Requested By: KATHY Entered By: JANEAN CD Description Act Comments / 38 Signs AP l//St�X)t �iff� / %1/-o 4 iS 39 Final Electrical Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments APPLICATION -FOR PERMIT :SIGN • - - ' ' - -. . ', - :a+s. P. .. `P �'^.+�•-.�w'" �;EA `>�w'"'i�':GC i�`� 5:i�nl CITY OF CARLSBAD- BUILDINGY DEPARTMENT. 1'200.:,ELM':iAVENUE... FEE:` ;* CAR'LSBA'b, •CA'LIF_Q'RN-IA`. 729-1181„ p _ RERM'I-T No:: _ .:. Mai'I•in • Address - 1 r-"I":� ,.Owner's'Nanje.' N 9 ..., # .. P K- IPLEASE PRINT)r'; (LASTI, ( IRST) (MIDDCEL,, NUMBER" STREET; "'CI,T.Y` , .RHON;E: Z tor �_1^17�.J•- �^t�- .f r, Nailing Address tti, `.[{` -�I, -Contrac (PLEASE POINT) NUMBER STREET CITY PHONE'' State Contractor's. License No.OF�to Classification -'� City License No. - Person. or Firm i h, control 'of Proper'ty�--�4 .% fi t Mailing -Address NUMBER STREET, CITY- ':PH `.LEGAL.'DESCRIPTION LOT ` BLOCK SUBDIVISION. _ ' ISM-'Jtlo:. �.:.. J� OB LOCATION — _ NUMBER :'STREET , [>...: Near r�,wi '1, '�" CA1"I Y 'ICITY OR TOWN) (NEAREST INTERS,ECT,ION OR'CANDMARk) s oUse'Prit orC. Sgature - ZONE _ VARIANCE NUMBER: _ of Permittee'' m " FRONT: feet from center I'in of street to sign SIDE;; -..'' feet from cent I,ine:.of :side..street.tdsi'gnr' ;_Valuation of Sign S: " Area of sign square fe1 t' ,: Building Permit,Fee $ _ Planning D . -. Approve '_ - ,Date- , - a - • • •�*+, •O DaPlns approved bPlan CheckFee y ----', - THIS SPACE FOR-LOCATI,ON--SKETCH, _ SHOW` NORTH,: ARROW -" _ _ ,; `_" • `_ _ ELECTRICAL PERMIT = _ Each''Si'gn . $5 00 First-2 Trans.- $3.00 each. k add''i. ,@ .50 each. 1" to 10 1amphd1dei;s .25 " 1,14 .25,E. 50."- ti 26` to '50 1.06 • - 51 2.00 -101 to 200 3, 00 - - DI'M NSIO 'S - M is Show a dvertising;copy,, e F N, ateriaf:' Panei Height -4 Length Uprights = ' Number and size.Of.posts Bracing Number and'Sze of braces* If neon; show colors' 'Depth :in.'ground Reflector, material? " p.istance between_ pane l"•aInd' ' round 'Illumination?, Referepce'to p'Ian �on, fife ' . Copy on_'both, sides? `• Nd CALL FOR ALL INSPECTIONS INCLUDING FINAL, INSPECTION RECIUIRED ON FOOTING "EXCAVATIONS BEFORE SI'GN;. fS-ERFCTED .' APPROVED PLANS SHALL ;BE;KEPT',ON. JOB:,, 11/1z./,1.999 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: Applicant: FORD SIGNS STE E 1304 N. MELROSE VISTA CA 92073 760-631-1976 City of Carlsbad Sign Permit Permit No:CB994235 Building Inspection Request Line (760) 438-3101 2540 EL CAMINO REAL -CBAD St: E SIGN Lot #: 0 $600.00 Construction Type: NEW INSTALL SIGN W/ ELECTRICAL Status: ISSUED Applied: 11/12/1999 Entered By: GMF Plan Approved: 11/12/1999 Issued: 11/12/1999 Inspect Area: t32 C--PRMT Total Fees: $47.44 %` ' Total Payments To Dra' %, ' $0.00 alance Due: $47.44 Building PermitCc) Add'I Building Permit Fee $0.00 Plan Check , ° , $� 0.81 Add'I Plan Check Fee $0.00 Electrical Fee $0.00 Renewal Fee i$0.00INCORPORATED Add'I Renewal Fee igg2 $0.00 Other Building Fee ,pf $20.00 TOTAL PERMIT FEES ', $47.44 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 "feeslexactions." 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 a.,. 1 ".f,,,,,o nf-hinh uni, hmin n"o ieviQly haan nlvan a NnTICF 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 47.44 t FOR OFFICE USE ONLY PERMIT APPLICATION4 • PLAN CHECK NO. cegq 135 CITY OF CARLSBAD BUILDING DEPARTMENT EST. VAL. - 2075 Las Palmas Dr., Carlsbad CA 92009 Plan Ck. Deposit (760j 430-11'61 f \� �\ �`a" -- �- , Validated By 11i Date 1. PROJECT INFORMATION _ 25L10 i! c.4-vim0o eoal 5�-E. L4- 2o0il Address (include Bldg/Suite #) Business Name tat -this address) Legal Description Lot No: Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing,Use Proposed use Description of #of Stories # of Bedrooms # :2. CONTACT'PERSON (it Aifferent:from-applicant(:.. >• , A f, IZ 0 1310 M r C /to s F- Or She € UAL -- / -17 6 Name Address City State/Zip Telephone # Fax # •3. , APPLICANT '❑ Contra_ctor. •:ont for' Contnctor'Owner [] Ayent for•Ownsr. = �.y A-4L P.. - r6 Z61,5_7 I/-- Name Address City State/Zip Telephone 4. PROPERTY'OWNER -, Name Address City State/Zip Telephone # 'S. :CONTRACTOR - 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 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 therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any -applicant for a permit subjects the applicant wa civi) penalty of not more than five hundred dollars [$5001). Sl6n1_S In ill MEC322E U Io83 (13/-I `13L Name ^� Address City State/Zip Telephone # / State License # �� J License Class C_" V_. City Business License # Designer Name Address City State/Zip Telephone State License # 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury 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 performance of the work for which this permit is issued. VI 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 S C ^�%� �/ N l u /ZA-,n- C I: Policy No. Zie&? ^O U ^ 00 ` M ( Expiration Date Q S - 0 g ^ Z d 0 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [81001 OR LESS) CERTIFICATE OF EXEMPTION: 1 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 become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation Avmge is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in a to the cost coin nsation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE DATE 44 7. OWNER -BUILDER D RATION I hereby affirm that I a exempt from the Contractor's License Law for the following reason: ❑ 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). ❑ 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 contractors) licensed pursuant to the Contractor's License Law). ❑ I am exempt under Section Business and Professions Code for this reason: 1 . I personally plan to provide the major -labor and materials for construction of the proposed property improvement. ❑ YES ONO 2. 1 (have / have not) signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. 1 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. 1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION -FOR N0N4RES/DEN77AL'IIIUILDING 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 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 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. 'S. , CONSTRUCTION LENDING AGENCY 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. • •APPLICANT'CERTIFICATION 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 City of Carlsbad to enter upon the above mentioned property for inspection purposes. 1 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 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 authoriz d by such permit is suspended or abandoned at any time after the coin r a period of 180 ys (Sectiocn�l 6.4.4 Uniform Building Code). % q APPLICANT'S SIGNATURE r fir/! DATE G Z 6 BUI L D ING P E R M I T Permit No: CB972.052. 07/25/97 1-5:19 Project No: A-9702604 P-age 1 o-f 1 Development No Job A6drese: 2540 EL CAMINO REAL Suite: E Permit Type. SIGN 74,314 07/2=�t` , 00011 01 02 Parcel, No: Lot#: Valuation:' 1,700 ,Construction: Type:`NEW Occupancy Group: Reference#: Status: ISSUED Description: WAL MOUNTED ILUMINATED SIGN Applied: 07/25/97, Apr/Issue: 07/25/97. Entered By:, JM Appl/Owns : JOHN HOWENSTINE, INC. 714`557-4064 3188 AIRWAY AVENUE SUITE J COSTA MESA, CA 92626 .* -Fees Required *** .f--` *** Fees Collected & Credits** --.-----=------------------s `-;r�7_- - .--------- ------- ---- ---- Fees: 0' < 6, J ; Adjustments:, .0,0- ' yT�ita ,fG>redit�s .00 Total Fees: f 91. U`0 ';'� ` Tota'i, Va i nts • 00 ,1 _.; ✓ BA_la�n'ee ^Due. ^ 91.. 0.0 Fee description % '_ l%;;, -,�,UUhits> F�ee /U it Ext fee Data . ----------.-------- f — T..-----�• ?•—vim• er------- �—�—�. - Building Permit '- ~�` '{` ,~ `~` 39..00 Plan Chock�• t R:`-! r 2-5.00•. Other �✓' _ :� ' "2.0 27. 0,0 ELECTRICA * SIGN TOTAL t ', - �.y �% i 91.00 INCORPORATED fx DAIE � 101 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 Address (include FOR OFFICE .USE ONLY - .. PLAN CHECK NO. �U EST. VAC.' - Plan Ck. Deposit Validated By. Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units' State/Zip Telephone-# Fax^# Name Address City State/Zip Telephone # 5 �CQNTRACTdRw ....1.. ..di Saab.. :i`,'Y...:wE`....:<d:.�.x. z.,.'.F..�d;. =e«:.. • /i�"+a"^..: .o':xaj.'.. (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 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 yiolation of Section 7031.5 by any applicant for a permit subjects the applAant to a civil penalty oVt more thaMve hundred dlars'[$5001). l— Name Address City State/Zip Telephone #"It.4 -i —4 �State License'# c.��`� b�� License Class `4 � City Business License # Designer'Name Address City State/Zip Telephone State, License # 8 1NOFjKER„MR.EIR! ;X 10,N :. _ � � • _ Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:- ❑ 1 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 performance of th work for which this permit is issued. 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 ( " (�Ac�l 0-AD I L 3"—� 0t, • Policy No. (/L)Ci32W 1 Expiration Date % (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) ❑, 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 100,00�19M� '-the cost of compensation, damages as provided for in Section 3706•of the Lab r code, rote st and attorney's fees. SIGNATURE - - i Q c V � �.x DATE 7_, 011(INER _ .. �._DEd" "ATiON;...` s _ � __. _" ,_ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: ❑ 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' wlio.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 License, Law). ❑ I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction, of the, proposed property improvement. ❑ YES, []NO 2. 1 (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name J address / phone number / contractors license •number): 4. 1-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. 1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name [address / phone number / type of work): PROPERTY OWNER SIGNATURE DATE HI$ SEG IOt FOR N = I f?1 �448U1 Q:pE lNITS:gNo '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 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 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. fir' .•.�.„ - ,..y,,.,.,.,.",.." r;,.s`;,,;,.�r;:.,, ;.a; ; �%;",,..-,-,.»m; ,.._„�,...;,.s. 'lmm..kMW....•'..:.'..`.........,_..._....:..„.,....,._ �...___�........... ......... _.�._ _.�...__ _ Mm _ m_.. z;:.. >.:-sa.x'_:;.::'.:; ....,..�. .............. -,. „. _._....._..__. ..,. . , ., ..,... 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 j,9;,�;„,:;�.I?PI„„,' C tVT CE,R�)E:,���.lO_� M �..,�,.•.�. _ �.w.M..,P.�.,.�. _,A.,. M...�.FM..�. ,...� ....�,. � "...".�-,,�.. .� o .,w.. :w«M.� , ,.� �'�� ..,��. ».�..�,.,._ 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 City of Carlsbad to enter upon the above mentioned property for inspection purposes. 1 ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY 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 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 aftspke work is comme ed for a period of 1,80 days (Section 106.4.4 Uniform Building Code).. �- APPLICANT'S SIGNATURE DATE "_! /. WHITE: File YELLOW: Applicant PINK: Finance ��TT