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Home My WebLink About2548 LUCIERNAGA ST; ; CB970432; PermitA p wn ~ A q A A • A E u Lt#: V nt t . ( 0 ERMli HAS EXPIRED IN ,f\,: '~JJ".I\.LI •;~i 1H U.B.C. ECTION 106.4.4 , IJATE ____ SIGNATURF)ta ~ INSP. ·---·-- CLEARANCE ____ _ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. Pm<? J 2-- CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 EST. VAL._-_________ _ Plan Ck. Deposit Z 1,cJU Validated BY.,....;; ... b"i'~"""'------- Date -:V,"'i,(~7 Address (inclz..sd ~ite l~(.i er (I ST Business Name Cat thia address) legal Description Lot o. Subdivision Name/Number Unit No. Phase No. Total II of units Assessor's Parcel # Existing Use Proposed UH II of Bedrooms # of Bathrooms Name Address City State/Zip Telephone# Fax# i~~ ·· ,IZLC<>mi!o!111lf!~,;!:Glii49.@f!l:lnl\;~oiQ!Gi9¥!4""'m~w,td1u.lltil'JF7 nz,!&f"~' .. it . Name Address nr :rxitt~mam1r mm z City State/Zip Telephone# ~,;,;,. Name Address City State/Zip Telephone I .. !Qitiiiti;im~ (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 exempt" n. Any vio1a1ion of Se ion 7031.5 v anv, applicant ,or a permit subje s the,_appllcant to a civil penalty of not m re t n five hundred dollars lt600)1. L , D A-,c-pf>e -$.t). /2 ·D3Z Name Address City State L;cense # __.(g"-'4'-'/-'0'-"8"'-4.,_ __ License Class _.,.c_<~---'W=~---City Busineas License # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ D11¥M98KEBS,\CQMPEMM~~~~;~~~:\~~~;p:tt::• ~.)';;·.~ti•.:~~~~~;>,.;,;..~~4:i:\:4~~-WRE F I Workers' Compensation Declaration: I hereby affirm under penalty of perjury ona of the following declarations: D I have and will maintain a certificate of consent to aelf•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. D 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 1$1001 OR LESS) r;i CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is luued, I shall not employ any peraon in any manner so as ro1iecome subject to the Workers' Compensation Laws of California. WARNING: Failure to e•worken' compenaation coverage la unlawful, and ahall subject an employ• to crlmlnel panaltiaa and civil fines up to one hundred thouaand doUara ($1 00, ~ 5tlJI( of compensation, damaget •• provided for In Section 3708 of thl Labcv code, lnterut and attorney's fees. SIGNATURE, __ j;,~~~--L._/~{/</~,:._---~=====-------------DATE ): C 3 --7 7 m:.>'.":iOWNER•8UILDISa ·oE¢LARATIOH,:/~. ;,,, .•.•. \ ,,, :-i~;;i~~-11!:&J 1·ii!lllr;gz~~\f:~~~jitf, 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 Profesaions Code: The Contractor's License Law does not apply to an owner of property who bullda 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 sCNd 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 Hie). 0 I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Buaineu and Profeuions Code: The Contractor's License Law doN not apply to an owner of property who builds or Improves thereon, and contractll for auch projecu with contractor(s) licensed pursuant to the Contractor's License Law). D 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. D YES ONO 2. I (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 I addr811 / phone number / contractors license number): 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 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 (inciude name I address / phone number / type of work):, ______________________________________________________ _ PROPERTY OWNER SIGNATURE ~'HCI!Ol\tfOlt~~llllml!:llllllE!!Ml1.@°N!li,~;,•,C• .. DATE Is the applicant or future building occupant required to submit a businesa JMan, acutely hazardous materials registration form or riak management and prevention program under Sections 25505, 25533 or 25534 of the Presley--TaMer Hazardous Substance Account Act? D YES O NO ls the applicant or future building occupant required to obtain a permit from the air pollution control d.af:rict or air quality management district? D YES D NO Is the facility to be constructed within 1,000 fHt of the outer boundary of a school site? 0 YES D NO IF ANY OF THE ANSWERS ARE YES, A ANAL CERTIRCATE 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, 1$,~~$1JlucrioN,1£No,1NG:AoENcY; ·--, :,/\~11~-J:f~~': ,, ;,),n:r~f:rft\.c ·' ·/f·~'t;:;;;f~f. ~~,0/ii,;t~.t:.~. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 309711) Civil Code). LENDER'S NAME_______________ LENDER'S ADDRESS,:c:-:::::-=:::::--,:,,;;::::,:,-::::=::::===:-:::-:-=;--;----------- ~-,;-APPLICANT.-CERTIFlCA TION _,. ,'. -:. <130¥::r~\:J}nif~ +•~~~r',i~;';:J•fu{i'.(,,A:, I certify that I have read the applicat,on 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 taws 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 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 s•o• deep and demolition or construction of structurN 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 co enced 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 wor co ed for ri of 180 days (Section 106.4.4 Uniform Building Code). DATE __;;.J_-_:!J_· f"__:._7 ___ _ WHITE: File YELLOW: Applicant PINK: Finance