HomeMy WebLinkAbout2649 Galicia Way; ; 77-120; PermitMODEL NO. _________ _
BUILDING PERMIT APPLICATIOff ~•:~• 1 az5•• .. ••Sll.00
City of CARLSBAD, CALIFORNIA 92008
Applicanttocompletenumberedspacesonly Phone 729-1181 Permit No 2 z-/"2 0
Joe ADDR £5S ~ ... ASSESSOR 'S ~
~le, 4-1::J ~-~--PARCEL NUMBER --
LOT N6. I OL K ~(1A-~So-~
BOOK P AGE I PAR,
LEOAL I 93, / (nSCC ATTACHED 5HC£.Tj 1 OtSCR.
~_o MAIL AODJIIC.55 ". PHONE
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CONTIIUC TOR v·•u00RE5S Pt10NE V STATE LIC. NO. CITY LIC. NO.
3 " ... // -ARCHITCCT ORt,/SIGNUI MAIL ADDRESS PHONt LIC[NSC NO,
4
ENGIN££R MAIL AooqESS PHONE LICENSE NO.
5
COMPENSATION INS, CARRIER MAIL AODl'IESS Bl'IANCH
6
US[ or BUILDING
7 --/ '" NO. BDRM$ NO. BATHS
8 Class of work: •NEW (t;(AOOIT~ 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE
9 Describe work:
10 Change of use from
Change of use to
11 Valuation of work: $ .,-
llft?O I t><!J .~~s1 PLAN CHECK FEE$ PERMIT FEE $ ¾
SPECIAL CONDITIONS: MICRO FILM FEE Type of Occupancy
Const Group
S12e of Bldg. ~S'o/ No. of Max.
(T Ota! I Sq. F Stories 0cc. Load
. Fire Use Fire Sprinklers
APPLICA f1QN ACCEPTED av PLANS CHECKED 8V AP:~SUANCE BY Zone Zone Required DYes •No
OFFSTREET PARKING SPACES: No. of I No. Dwelling un,ts No. DATE DA Covered Sq, Ft. Open
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB· PLANNING DEPT.
ING, HEATING, VENTILATING OR Al R CONDITIONING. HEALTH DEPT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF Fl RE DEPT
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM•
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ENGINEERING DEPT
ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WATER DEPT.
HEREIN OR THE GRANTING OF A PERMIT DOES NOT NOT,
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
51CNATURE 01" CON TN AC TO,_ O,_ AUTH0,.111:0 AGENT (DATE)
51GHATUIIIC o, OWHUI: ttF' OWNEII IIUILOCJII) DATE)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
6-4'"0 TOTAL FEES $ ________ _
MOOEL NO. _________ _
BUILDING PERMIT APPLICATI~ !'~;D18l't ··••10.00
City of CARLSBAD, CALIFORNIA 92008
Ap licantto ompletenumberedspacesonly Phone 729-1181 Permit No p C
JOB AOOR C55 ~/ ASSESSOR'S r2/41/~ .
PARCEL NUMBER
/ /~ J
!..OT NO. -I 8LK
l TRACT BOOK PAGE I PAR. L [ CAL I 10sec ATTACHCO SH[tTJ 1 0£5CR.
20WN~ 7JA~;;~•.<•• " .... ZIP PHONE
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3
CON fAAC7 '"'YOORCSS PHONE STATE LIC, NO, CITY LIC, NO.
ARCH ITECT OR OC51C.NCR MAIL ADDRESS PHONE LICCN5E NO.
4
£NGIN CCR MAIL ADDRESS PHONE LICE.NS[ NO.
5
COMPENSATION INS. CARRIER MAIL AOD .. [SS BPU,NCH
6
use 0,. BUILDING
7 NO. BDRMS NO. BATHS
8 Class of work: •NEW 0 ADDITION 0 Al TERATION 0 REPAIR 0 MOVE 0 REMOVE
9 Describe work:
-~ /'7
10 Change of use from ~-~.£~ -~ ~--?
Change of use to /
11 Valuation of work : $ PLAN CH ECK FEE s I PERMIT FEE S /~c,&--
SPECIAL CONDITIONS: Type of Occupancy MICRO FILM FEE
Const Group
S,ze of Bldg. No. of Max.
(Total) Sq. Ft. Stories 0cc. Load
Fire Use Fire Sprinklers :::fie? PLANS CHECKED BY APPROVED FOR ISSUANCE BY Zone Zone Required 0Yes •No
No. of OFFSTREET PARKING SPACES,
Dwelling Units No. !No. DATE Covered Sq. Ft. Open
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB PLANNING DEPT.
ING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF Fl RE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ENGINEERING DEPT. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS WATER DEPT. TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE QA LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
5tGNATV .. [ or CONTJU,CTOIII: 0111: AVTHOlltll[D AGENT {OAT£)
SIGNATVll':E g,-OWNEII' fl,-OWNC,I IUILOE") (DA.TC)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
~/}~ TOTAL FEES $ _LL_ .. t..C/:...._ ____ _