The URL can be used to link to this page

Home My WebLink About2559 EL CAMINO REAL; MULTI-PERMIT FILE; CB992493; Permitvo ..... City of Carlsbad S 07/07/1999 Miscellaneous Permit Permit No:CB992493 Building Inspection Request Line (760) 438-3101 Job Address: 2559 EL CAM INO REAL CBAD Permit Type MISC Subtype OTHER Status ISSUED Parcel No: 1563022600 Lot #: 0 Applied: 07/07/1999 Valuation: - $5,800.00 Entered By: MDP Reference #: Plan Approved:. 07/07/1999 Issued: 07/07/1999 Project Title: MACY'S DEPARTMENT STORE , . . Inspect Area: REMOVE NON BEARING PARTION @ HANDBAGS AREA - Applicant: CONSTRUCTION CARTE1AWLEY HALE ST?I"' 01 02 STIR 123 . CLOTAX-DEPT C—PRMT 70-00 4431 CORPORATE CENTER DR . . (kw,m ST/ - . LOS ALMrroS CA 90720 0 INcINNAi45202 7 4-527-8500 00 V. • . "•I .• tj Total Fees: $70.00 Total Payments To Dte:'¼ $0.00 Balance Due: $70.00 I Misc&aneous Fe! Miscelaneous Fee #2 0.00 .: TOTALPERMIT FEES $70.00 \. .• INCORPORATED 1952 0. 1/ ) FINAL APPROVAL Inspector Date ' 3' 5'' Clearance NOTICE: Pleasetake 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. . S. 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 . S 075 Las Palmas Dr., Carlsbad, CA 92009 (7610)438-1161 I. PERMIT APPLICATION. CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 FOR OFFICE USE ONLY PLAN CHECK NO.. 97• "zc.jk?3 EST. VAL. Plan Ck. Deposit Validated By_________________________ Date A. 7INRMflN/ A'ddress (include Bldg/Suit- e #1 i . Bu.sirss Name (at this address) f? t ( , - LegaTDescription Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessors Parcel # t) Existing Use Proposed Use Qp ç oc'L itIjV ge4 Description of Work /1 SQ. FT. #of Stories . # of Bedrooms # of Bathrooms CONTACIPERSON(lfdffferentyrn.aPPlicanj .C;7 3y71 Name . Address City State/Zip Telephone # Fax # 3. A ICANT Contractor .gentfor Contractor' '0 Ownef/.flAgerhfor Owner Name . Address . City . . State/Zip Telephone # :4. :PROPERTY yNE7 /70 O Name () . Address City State/Zip Telephone # 5 Cdp('pACTOR.CQMpANyrJME : i:....,... . ..• . . . . . .. (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 exempti n. Any v' tion ofSectio 7031.5 by any applicant for a ermit subje ts the applicant to a civil pe alty of not more than five hundr dollars ($50011. 4l cd4 -- L/4// /cJ Lo4)amjo, '72O Name Address City State/Zip Telephone # -,,, c—, -, _-, ' . / —i . - , ,, a State License # /'.5.r V ( License Class C City Business License # DsiPneIame . 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: 0 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 issjed. 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 compensa tio sur nce carrier and policy number are: 0009 Insurance Company 57W74 . Policy No.c'? Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS I$100J OR LESS) 0 CERTIFICATE OF EXEMPTION: (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 ars ($100 001. in ition to the cost of cornpenstion. damages as provided for in Section 3706 of the Labor code, interest and attorney's fees, SIGNATURE - 4- . DATE 7-7?? 7, OWNER. IL ER DLARA 1 hereby affirm t I am Aempt 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). . . 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 I 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 to provide the work indicated (include name / address / phone number /type of work): - PROPERTY OWNER SIGNATURE . DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING -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? 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 iio Is the facility to be constructed within 1,000 feet of the Outer boundary of a school site? 0 YES EY -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. I hereby affirm that there , . 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.-APPLICANTCERTIFICATION . -: ': .: ..- ........-:., .....................- .,, ,...-......... ....... ...................,,:........-.,. . . I certify that I have read the application and state that the above information is correct and that the information on the plans is accura,.-1''ree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citr of Carlsbad to ertier 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 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 a r he work is c9mm9fibed for a eriod of 180 days (Section 106.4.4 Uniform Building Code). _. DATE C' WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Inspection Fequest _ J For 9/2/99 - Permit# CB992493 Inspector Assignment: Title MACYS DEPARTMENT STORE Description REMOVE NON BEAR@HBAGS&FURN AREA Type:MISC Sub Type:. OTHER Phone: 0000000000 Job Address: 2559 EL CAMINO REAL Suite:' Lot 0 - Location: Inspector: APPLICANT ALAIN HIRSCH CONSTRUCTION Owner CARTER HAWLEY HALE STORES INC :Remarks: Total Time: . Requested By: NA Entered By: CHRISTINE CD Description Act Comments 19 Final Structural i9 P ep,,c,,, 4 Inspection History Date Description Act Insp ;comments AL '5- / 'Sc5 ell C .'44 • - .. S * - fl •r t - - - .BU-.ILDING PERftIT 1 PermitNoCB983065 4 . 5 .% S * - 09/11/98 11 4:0 Project No A980 3985 - Page "I of 1 DevelopmentNo Job Address 2559 EL CAMINO REAL ,.Suite * - PermitType MISCELLANEOUS Parcel No 156-302-26200 Lot# Valuation 0 - Construction Type NEW Occupancy Group Reference# Status ISSUED Description INSTALL ROLL, UP DOOR IN PLACE Applied 09/11/.98 GATES-W/ELECT Apr/Issue 09/11/98 Entered By, RMA - Appl/Ownr, MILES &,KELLEY.CONSTRUCTION 714 223-9272 1102,'E-VALENCIA FULLERTON CA 92831 I ¶ 0992 09/11/98 0001 01 02 Fes Requii2ed *** **?eesCllected &CreditPRMT *.70-00 F 7 F6es: '70A Total Fees 7000 0 Total Pyrenfs \ 00 - *- .% 4 ftj - %. * - Baa cé'ThD!te 70 00 'laneous FEE 170,'.'00 PERMIT j :TOTA 70. 00' 1 FINAL PPROVAL 14 71 -----:- - ' CLEARANCE - * CITY OF CARLSBAD - - 2075 Las Pa1has Dr Carlsbad CA 92009 '(619)4384161 - s. -r- - / •, 44 * j',, - - ç f I FOR OFFICE USE ONLY —d -- . PERMIT APPLICATION PLAN CHECK NO - I ' EST VAL CITY OF. CARLSBAD BUILDING DEPARTMENT .• *•. S . 2075 Las Palmas Dr, Carlsbad CA 92009 PlarCk Deposit'_______________ (760) 438-1161 4. Validated B ,- , ..:,• 1rpRoJE Date ctiNFoRMATloN / . . .. . ... . - .;•- ... . . A Address I clu Bldg/Sui e #) .,.; . ' . . . -Business Name (at'this address) . - Legal Description .A Lot No Subdivision Name/Number Unit No Phase No Total # of units Assessor's Parcel # , .. N. - Existing Use,,..4 Proposed Use - D Wscription of Wok- . - . SQ. FT........ .. #of Stories: . . of Bedrooms . . A' # of Bathroom ' NTAC SON (If dIfferent ft m applicant) I 9osro)-:-•-ijba Cir Name . A, Address I City State/Zip Telephone # Fax # r3 'Thta O Eli O ir'öwr ew. qzegf //J 9zf1 Name4 a,e7 Address 4/ City It State/Zip131. Telephone I- MP "s- - I 'A Name Address Addrcss //Z tQti&'' i City,i,//,7' .S.tate2g31Telephone#f,3 92 CONTMCTORCOMPANfNME'"" (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 ProfessionsiCodel 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). - ' .5 . S , ... . . -. S . •' S..... Name Address . . ' 'i " , .City State/Zip- Wel6pone ,State License #.3 / 2 2o C.,. License Clad City Business License # __________ Designer Name Address ..City \ State/Zip Telephone State License # . WbkSOMPENSAY1ON .-": - A ) Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following daclarations . I 0 have and will maintain a certific'ate of consent to self unsure for workers compensation as provided by Section 3700 of the Labo1r Code for the performance of the w2Eior which this permit is issued '. _1'I 14 ve and will maintain workers compensation as required byA Section 3700 of the Labor Code for the performance of the work for which this permit is 4 issued My worker ;s c ensation insurance carrier and policy number are . In Cominy 2E1/ia4L/Lf4E IS - Policy N ,t '. ""Expiration Date Y :- (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR AONE HUNDRED DOLLARS [$ 100) OR LESS) .4 0 CERTIFICATE OF EXEMPTION I certify that in the performance of the work for which this permit is issued '-f shall not employ any person in any manner so as \.to become sub orkers Compensation Laws of California '5' AS' S A ' -'S... .'A S. WARNING: Failure'- se re work ' compenáat n c erage Is unlawful, and ahall subject an employer'to criminal -penalties and civil fines' to one hUndred c GNAT'A Vrfb0 0 0) in d n to t1 , tot omperisatuon damages as provided for In Section he Labor and attorney a fees 7 OWNERIUI ER ÔEATd . I hereby affirm that I am exempt from the Contractor s License Law for the following reason CA' ,.,. 'A C3 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 Omployeei, 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) E I, as ow TV ner of the.property, am exclusively contracting with licensed contractors ,to construct tie project (Sec. ?044, Busiiess an'd Professions Code: The Contractor's. License Law does not apply to an ocNner ofproperty who builds or improves thereoñ,and contracts for such projects with contractor(s) licensed ,- pursuant to the Contractor's License Law). - '5' A ,. -D I am exempt under SectionA __. . '-. Business and Professions Code for this reason:. . . ,. , , , 4 -. . ,- -. • 'A I personally plan to provide the major labor and materials for construction of the proposed property improveméñ 0 YES -ONo: ...'-. A -. 2 "l (have / have-not) signed an application for a building permit for the proposed work " ., ' ,-. 3. I have contraàted. with the fàllo,ing person (firm) to provide th proposed constructionlinclude 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 I address,/ phone 'number/ contractors license number) A 5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated (include name / address / phon number / type ' of vork): .' "A' -. - S - 1 ' - S ' 5' • ,-, - ... -- - 'A' -PR OPERTY OWNER SIGNATURE 4.4. - DATE - A -. COMPLITETHIS S1ChO1OR NOF .EiIDENfIAL thLDTNG PEMI1S oiV5- ' -t - - Is the applicant or future building occupant required to submit a business plan acutely hazardous materials registration fo'm or risk management and prevention program under Sections 25505 25533 or 25534 of th' Presley Tanner HazardousSubstance Account Act? 0 YES 0 NO e 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 'A 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 CONSTRiC1OLEiINA'ENCY 5' 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) ' 5" -' -, 'LENDER'S NAME -- - -- 5 . - - S LENDER'S ADDRESS -- 19 -,-5- JT ' T. I certify that 'l 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 'A 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 5' -. 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 ations over 5'0'. deep and demolition or construction of structures over 3 stories in height EXPIRATION Every permit i ed by the B ng Official rider the p visions of this Code shall expire by limitation and become null and void if the building or work authorized by such pe it is not corn a ad wi n 65 days fro the date of such permit or if the buildingâr work authorized by such prmit is suspended cLiAS GNATURE the or s c me ed aperiododayslSslSection 106.4.4 Uniform Building Code) or abaDsioned after APP APP WHITE File YELLOW Applicant PINK Finance.. A A A - .;CITY OF CARLSBAD INSPECTION REQUEST PERNIT# CB983065 FOR 10/16/98 ' INSPECTOR AREA TP DESCRIPTION.: INSTALL ROLL UP DOOR IN PLACE . .PLANCK# CB983065 GATESW/ELECT .. CCC -GRP * TYPE: MISC : CONSTR. TYPE NEW JOB ADDRESS: 2559 EL CANINO REAL - STE: LOT: APPLICANT:. MILES & KELLEY CONSTRUCTION PHONE: 714 223-9272 CONTRACTOR: .. .-- . PHONE: . . OWNER: . . PHONE: . REMARKS: R/714-875-2298 . -. . INSPECTOR SPECIAL INSTRUCT: REQUESTING P.M. *INSPECTIONFORWARDEb VOICEMAIL MESSAGE TOTAL TIME --RELATED PERMITS-- PERMIT#. TYPE STATUS, AS960011 ASTI . ISSUED . - . CB960043 CTI EXPIRED CD LVL DESCRIPTION ACT COMMENTS 19 ST Final Structural .- .2.9 PL Final. Pluxttbing . . . -.. . -. 39 EL Final Electrical - 49 ME Final Mechanical INSPECTION HISTORY DATE DESCRIPTION * ACT INSP COMMENTS - 100598 Interior -Lath/Drywall,- AP TP - 100598 Rough Electric - - AP TP 100598 Frame/Steel/Bolting/Welding APr TP - 093098 Frame/Steel/Bolting/Welding CO TP . I -. ., . .. - • - .. •. - - - 4 -. - * - .- . - - I • 4 - • - 1 • . . - - . . ,.- - • I I • 4 AM it 0n.--o2cq__ .IcnAM H' I lei SO ct QOo L'N__//T.• -. - __ • ~Tl A.ç'h1 pA ' w • WTI _ • ej I Ilk Min ____ • - L •ii • 4; Iii -• •.IIII__ I iLl. I j I g _TT1T:.VIi.. 7H. V. B PJ 3Ed 8ON3 SOOU 30N3èMfl . V tL69CE6CI 00:00 66t/IC/TO U. .1 —5ffClT9x!A-A MOTE ATCN I —110VPWASE --=v3Raw _230V 3 FWAM " _4e0v3.w. '' __375Y 3 P.4A _V3 SO _V24Q _314 V 5UT-TUM WAL MAQK I OTY. IL GL"n4C*9!SS- MR $.AT GAUGE- MR at. ' RA • QG47 WAM CPESZATICN (MMAG) a LJ-J • LT k*ZC ATTOJ PCTU2ED VCT34 ploamm semiam - PLAN VIEW STEER. T.i*.. p Asc. Tb 2W a ,- _—L.- TI%1 SLAT )_J 5.VAflCN G11 qA1. wm. G ji. 's.J/ wt i AS cJlsTJTo LA"4JC.G ____ r A _ a T &J E PG 8E " OPEN 20"aa~kw,c:fo, TO 147 _ _ cLEAcEs FF1 E ENCEW ANCELIS. C& 9Qflq (;fQ1_'7cn 1 1 B U I L D I N G P E R N I T Permit No. CB960134 .01/23/96 14:48 . Project No: A9600214 Page 1 of 1 - . -. Development No: Job Addres: 2559 EL CAMINO REAL Suite: . _... :,6%C 0j/7L'%.(y1 ei 'Y' Permit Type MISCELLANEOUS 7 7" Parcel No: 156-302-26-00 Lot#: P%If dI Valuation: 0 . Construction Type: NEW Occupancy Group: Reference #: - Status: ISSUED Description: DEMO INT NON-BEARING WALLS & Applied: ,01/23/96 PART-ONLY--NO CONSTRUCT,BROADWAY&BULLOCKS Apr/Issue: 01/23/96 - Entered By: RMA Appl/Ownr : ALAIN HIRSCH CONSTRUCTION 3107-598--8565 - 4012 KATELLA, STE 106. . LOS ALAMITOS, CA 9072-0. *** *Fees Required *** j1s,cll ced & Credits - -------- -------------- Fee 30 0 0 Adjustments: . ./oo \..1 Totaldts: \ .00 Total Fees /0 , 4 T \ .00 30.00- Fee description ----c_L ThMISCELLANEOUS TOTA r 30.00 30 00 DEMO FEE INCORPORATED- 1952 - . .5 . . _.• .. . . - $ 4 . I 0 [ppROVAT DATE / - CITY OF CARLSBAD 2075 Las Palmas Dr.,Carlsbad CA-92009'(619) 438-1161 - City of CarLsbad Building Department 2075 Las Palmes Dr., Carlsbad, CA 92009 (619) 438-1161 PLAN CHECK NO. EST. VAL PLAN DC DEPOS1II From List I (see back) give code of Permit-Type: --------------------------------------------------------- For Residential Projects Only: From List 2 (see back) give r Code of Structure-Type: Net Loss/Gain of Dwelling Units PROJECT INFORMATION . FOR OFFICE USE ONLY Address 255' P/4'24' 1ea / Building or Suite No. $iLrj Nearest Cross Street f ( 2-557 Az- &i ,e/ 5W/a 1--5 LEGAL DESCRIPTION Lot No. Subdivision Name/Number Unit No. Phase No. CHECK BELOW IF SUBMITFED: 02 Energy Calcs 02 Structural Calcs 02 Soils Report 0 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK ç L4ea-1sj /,/rioe- 6t/4//i qieY ,PQr171c SQ - is # OF STORIES 3 F/e-'o r5 # OF BEDROOMS - # OF BATHROOMS t1JN tACt PhRJN (ii (iii erent Erom applicant) NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE APPLICANT OCONUtACIOR NAME (last name first) DAGENI FOR CONTRACtOR ADDRESS DOWNER DAGENI FOR OWNER CITY STATE ZIP CODE DAY TELEPHONE PROPERTY OWNER NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE WNTRACIDR NAME (last name first) /.j'çc/.i / ADDRESS 1/0/2- Kc/e//4 4v& /O( CITY 1-0.5,41,71011-as STATE C. ZIP CODE NE'3) 0 qF - STATE tIC. #_ y0 .31 LICENSE CLASS 6 CITY BUSINESS tIC. # tJ DESIGNER NAME (last name first) ADDRESS /' I' - CITY STATE ZIP CODE DAY TELEPHONE STATE tIC. # WORKERS CX)MPENSATION Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to self-insure issued by the Director of Industrial Relations, or a certificate of Workers' Compensation Insurance by anadmitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lob. Q. - c &11 INSURANCE COMPANY 1115ovQsqCe -tii4 POLICY NO. 2-71— EXPIRATION DATE / / - q 7 Certificate of Exemption: I certify that in the performance of the work [or 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. SIGNATURE DATE OWNER-BUILDER DECLARATION Owner-Builder Declaration: 1-hereby affirm that I am exempt from the Contractor's License Law tor the bollowing 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). 0 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 [$5001). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING 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? DYES ONO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYES 0 N Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES 13 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 MPT OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTiON CONTROL DISTRICT. agency LENDER'S NAME LENDER'S ADDRESS 10. APPLICANT CE1UI1FICAI1ON - I certify that I have read the application and state that the above information is correct. 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 10 SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARlSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACXRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA. An OSHA permit is required for excavations over 5'O" 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 Building Code). APPLICANTS SIGNATURE - DATE: 1/23/9 Finance V. January 22, 1996 To: Kurt Culver, EsGil Corp '• From: Principal Building Inspector BROADWATO 4t1$ TENANT IMPROVE ENT This project was red-tagged as it began without permits. It has been stopped for about two weeks now as the architect created' complete plans for review. 'I asked them to also include a T-24 upgrade to the store. : Please process these plans as soon as your company is able to do SQ. Thank you. PAT KELLEY Principal Building Inspector c:File