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Home My WebLink About2664 JEFFERSON ST; MULTI-PERMIT FILE; CB143066; Permit/ FINAV'A1 'PVAL Inspector 7/ (2- Date(l-_'7C Clearance NOTICE Please take NOTICE that approval of your prolect includes the Imposition of tees 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 132.030. 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 i zoning grading or other, similar application processing or service fees in connection with this prolect NOR DOES IT APPLY to any .,fees/exaction I ees/exactiohs of which you have-previously been given a NOTICE similar.tó this, or as to which the statute of limitations has previously otherwise expired. - FTHE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: PLANNING [:]ENGINEERING [--]BUILDING . [--]FIRE DHEALTH Plan Check No cA ( Building Permit Application Est. Value ' .. - City of . 1635 Faraday Ave., Carlsbad, CA 92008 - .. Ph: 760-602-2719 Fax: 760-'602-8558 ". C ir1sIai. •., ' email. building@carlsbadca.gov . , . -. Plan Ck IePout . .. Date '7 swP ..'www.carlsbadca.gov . JOB ADDRESS . . . SUITE#/SPACE#/UNIT# , APN - - - CT/PROJECT e LOT # , PHASE # a OF UNITS ía BEDROOMS # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE 0CC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) L tZQ4i ( Gk' Cu t 77-i'17 Mer-frL ,44c2 '• . EXISTING USE ' PROPOSED USE . 'GARAGE (SF) PATIOS (SF) FIREPLACE AIR CONDITIONING - FIRE SPRINKLERS IDECKS(SF) YESD# NO[—] YES END E _.YES[:] NOE APPLICANT NAME' ' ' '. . . , '. . .: , ' PROPERTY OWNER Primary Contact ' . .- . •. . ' - ' - . - . -. . . ADDRESS . . . . ', . - , ADDRESS - . CI1'i' . , . , STATE ..ZIP - CI'T'Y . . STATE . - ZIP PHONE FAX , , - PHONE ,,.. , , FAX EMAIL EMAIL DESIGN PROFESSIONAL . . - .-.. . '1 CONTRACTOR BUS. NAME .-• L.L,---..S ADDRESS . - . ., , ADDRESS ZM?' CITY - - STATE . ZIP , ' - ctrr' , - , STATE. . ZIP - a \JfhLc4I CA- 2 fl PHONE ' : FAX ' . " - P N . . FAX EMAIL . . , EMAIL - -. . - ----- STATE LIC. a ' - STATE LlC.# L L CITY BUS. LIC ' F' j -j (Sec. 7031.5 Business and Professions Code: Any City or Count applicant for such permit to file a signed statement that he is lii Business and Professions Code) or that he is exempt therefrom civil penalty of not more than five hundred dollars ($500)). -__---- - workers,Compensation Declaration:thereby affirm under penalty of pequiy one of the following declarations: i: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. and will maintain workers' co pen sation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurce carrier and policy number are: Insurance Co j (rt.iA..iL/J Policy No. P. j 1A. C::. 'C25\ Expiration Date 8/1 This 'section need not be completed if the permit is for one hundred dollars ($100) or less. . . . , [fl Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, Lsha11 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 unla,fut, and shall subject an employer to criminal penalties and civil fines.up to one hundred thousand dollars (&100,000), in addition to the cost of compensation dam e as p vided for i s ction 3706 of the Labor code Interest and attorneys fees * CONTRACTOR SIGNATURE - ' EAGENT DATE )nI à liii I= !3L - U 1 11 I hereby affirm that lam exempt from 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 sate). [] I,' as owner of the property, am exclusively contractng 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). '. . . EJ 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 DYes ENo . a l(have / have not) signed an application for a building permit for the, proposed work. I have contracted with the following pefson (trai) to provide the proposed construction (include name address I phone I 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 I phone) 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 /type of work): PROPERT'OWNERSIGNATURE ' ' : AGENT DATE , '. DHAZMATIAPCD I; y which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires tne - tensed pursuant to the provisions of the Contractor's License Law {Chapter 9, commending with Section 7000 of Division 3 Of the ,and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a -I 4,- J .L1 Is the aplicantbr future building occupant required.to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533012553401 the Presley-Tanner Hazardous Substance Account Act? jYes uNo. .. 11 - ,, Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? :Yes ii No - - - - - Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? k,f 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 I hereby affirm that there is a construction lending agency for'the performance bf the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lenders Address 4 4 I certitythatl have read theapplicaion andstatethatthe above information Is cenectand thatthe information on the plans tsaccumte I agree tocemptywith all Cityordinances and State laws relaftngto building construction. - I hereby 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 CARLSBAD4 AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHAM-OSHApermit is required for excavations over 59 deep and demolition or construction of structures over 3 stories in height. 4 . EXPIRATION: Every permit issued b' the Building Offolal under the provisions of this Code shall expire by limitation and become null and void if the building or mrk ulfiodzed by such permit is not commenced within '- 18Odays from the date of such permit or if (tire ng oLk uch permit is suspended or abandoned at any time after the work is commenced for a period of 180 day (Section 106.4.4 Uniform Building Code). 2• - . ' . . I •1 --I ,?-. - I ,- - , . . ,/_A!~APPLICANVS SIGNATURE C E RTI FICATE OF OCCUPAIttlCom m e r c i all P roje c ts O nl y ) Fax (760) 602-8560 Email buIIdlnpCarISbadca_qov or Mail the completed form to City of Carlsbad Building Division 1635 faraday Avenue Carlsbad California 92008 - CO# (Office Use Only) ' - • - -. ,1 - . 0 CONTACT NAME : ' •,-r.: 44 •,. 0 - ., OCCUPANT NAME - •••' . . - -. . '4 0• - ,. 4S• 44 4' if ADDRESS - , .: ,.v-'r4 - BUILDING ADDRESS '',• 0' : -- - -. .. . . . . - 4 S ..l* - '.•4, . , - - . .. . - ' '4 4. -. __4 -.S.. ___'- _- __.4.3.•.-. .4,• _.._____.__- _- __.4.-.- _-• CITY 1 - . 4 ' STATE ZIP_ . . CITY - -STATE - ._ zip. Carisbad CA PHONE ,, FAX '4.... . 10z_•.' .•,. .5 .4 ' . U - . . -.-. _. EMAIL . - . S - - ,•,• OCCUPANT'S BUS. LIC. No._. ,'.-, -. --'-- . •. - • . - . . . ' - '' ,'. .-' • DELIVERY OPTIONS • , . - •., .5.. . . , - ' - - . . '4, - . .J &-' - PICK UP: • CONTACT (Listed above) OCCUPANT (Listed above) - ' - . • - - - . - - - CONTRACTOR (On Pg. 1) - .4 • . - ' • - . .. -. ,'. - - - . .4' . MAIL TO: . . - • . OCCUPANT (Listed above) ' - , ASSOCIATED CB# '•_-'_•_ S.•0 _U -. • :CONTACT (Listed above) . . . CONTRACTOR (On Pg. 1)- NO CHANGE IN USE/ NO CONSTRUCTION .MAIL/ FAX TOOTHER: . _,__- ____.- __. _:• _. - . . - - S 4CHANGE OF USE /NOCONSTRUCTION . . - ., _______. p • -, ' y •. ••.._ • ..4••• ..................................••,.•..••.•.- SIGNATURE • 44 ' '- ..'APPLICANT'S DATE ' ';-: ••'- - . .5 U -. - - -. 4_ 44 - -- . - • - . • - -_ . 4 , ...........' - - '4 '?.,-4 • •_' ---4.;.. .....1 / - ..:. ..........- . •-_,' •.-. "4...-- -.5 tj '4 STOP:- THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. . Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection -4 - • ,0 4,5 5 - -- - - . - S 44 - :- - - 4 4 - '1 • -.5 - . . -{' - t4 •4 - - 4 - S - - • City ôf'Carlsbad ,. 12/30/1999 Miscellaneous Permit Permit No:CB9947.76 Building Inspection Request Line (760) 438-3101 Job Address: 2664 JEFFERSON ST CBAD PermitType: MISC Subtye: REROOF Status: ISSUED Parcel No: 1552713300 Lot #: 0 Applied: 12/30/1999 Valuation: $6,384.00 Entered By: RMA Reference #: Plan Appro5 121 G099901 01 02 Issued: 12/30/19PRMT 14540 Project Title: 3600 SF APT BLDG & 2100 SF Inspect Area: CARPORTS-HOT MOP-3 PLY BUILT UP Applicant: . RLT ROOFING HUOHLIVINGRUST 07-24-96 2910 JEFFERSON ST . (1'0~33 V12 CARLSBAD CA 92008 0 PALOSVE,STATESA 90274 760 434-5833 ç\ ,' Total Fees: $145.00 / so.00\ ' Balance Due: $145.00 I:. c—. / \ -:::::e: ( 39 P ITE $1L0 TOTAL PERMIT FEES $1/45.00 INCOR 1952 PORATED CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 c CA C' FOR OFFICE USE ONLY PLAN CHECK NO.iJ1 1 ?7 EST.VAL. Plan Ck. Deposit Validated By Address (include Bldg/Suite l) Business Name (at this address) L4 6 r 9—-L c. ç . Legal Description Lot No. Subdivision Name/NumP Unit No. Phase No. Total # of units Assessor's Parcel S Existing Proposed Use Ai hO Desc von of Wark - 7 SQ FT. lot tones S of Bedrooms S of Bathrooms - Name . Address City . State/Zip Telephone S .. ....... Name Address " City State/Zip Telephone S (Sec. 7031.5 Business and Professions Code: Any City or County which requires e 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 IChapter 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 exemplr9n. Any violation of Section 701.5 by any applicant for a permit subjects the applicant toe civil penalty of not more,,thap five hdred dollars, IS 5001). - ,, *3 Address City I State/Zip Telephone S State License S 41/ License Class -.._ City Business License # ,K2_0571/3 Designer Name Address City State/Zip Telephone State License S AL, IWORKERS CbMPEIM1OP3 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. 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 ins rance carrier id policy number are: Insurance Company ç-.Qp•. Policy No-3,—'99_ Expiration Date (THIS SECTION NEED NOT BE COMPOOED IF THE PERMIT IS FOR. ONE HUNDRED DOLLARS 1*1001 OR LESS) CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employany person in any manner aoas to become subject to the Workers' Compensation Laws of California. - WARNING: Failure to ure wo,ke,s' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ( 0 0 • In compensation, damages as provided for in Section 3706 of the Labor code, Interest and attorney's fees. SIGNATURE _ - DATE 'r 1 -!t '-'' --- ........,........ OWNEWBUu Ei.ijuti tuK, .. -iL. - '- I hereby affirm that I anexempt 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). I, as owner of the property, em 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 lam 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 (hove / 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 I address I 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 hive contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): PROPERTY OWNER SIGNATURE , - DATE COMPIXTE1'HIS SEC11ONPOR - -. 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 'iO 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 Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES ()'i 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 coNsTRucTu5N lENDING AGENC - - 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 S APPUCAN'r CEnhinc ION - -. 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 CO 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 5'0 deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by SIding Official under ,p provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is corn nced within 385 from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after t or • ce r a f 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE .. DATE WHITE: File YELLOW: Applicant PINK: Finance r * City of Carlsbad Inspection Request Lu 4 For: 1/6/2000 Permit# CB994776 . Inspector,Assignment: Title: 3600SF APT BLDG &2IOOSF, Description: CARPORTS-HOT MOP-3 PLY BUILT UP Type: MISC Sub Type: REROOF . Phone: Job. Address: 2664 JEFFERSON ST . Suite: Lot 0 S Location: . Inspector: APPLICANT RLT ROOFING . Owner: HUOH LIVING TRUST 07-24-96 Remarks: INSPECT AT NOON PLEASE . Total Time: / . . . Requested By: ROGER 4 Entered By: CHRISTINE S CD Description Act. ,çymments . . 19 . Final Structural . . Associated PC Rs S . InsDection History'. Date Description Act !p Comments 1/3/2000 15 Roof/Reroof AP PY ffi .5 . .. ..S S. S. 5- S • •' S . • S S. • 5; .5 . . City Of Carlsbad : SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING JOB ADDRESS: : TYPE OF BUILDING: RESIDENTIAL __COMMERCIAL_____ 3. ROOF SLOPE: RISE.cl-.ar_inches in 12 inches NUMBER OF EXISTING ROOF COVERING (circle one) 2 3 TYPE OF EXISTING ROOF COVERING _J- SHEATHING__' *6. NEW ROOF MATERIAL CLASS '4 WEIGHT PER SQUARE• NUMBER OF SQUARES TRADE NAME MANUFACTURER ROOF SYSTEM LISTING UL NoA'/nUICBO No.___________ IS THE EXISTING STRUCTURAL DESIGN SUFFICIENT TO SUSTAIN THE. WEIGHT OF THE PROPOSED ROOF" NO All roof coverings are required to be CLASS A. Combustible roof coverings • of any type or classification are-prohibited. • • I understand the following inspections are required: 1. Tear Off/Pre-inspection prior to install new roof covering. • • 2 Final Inspection I agree to provide a ladder extending at least 2 rungs above the roof for • • inspection Signatur ir Date (2I9 •. •1 Contractor Owner— Contractor Name *6 - Rolled Roofing, Standard/Lite Tile, Asphalt/Comp Fiberglass, Built up, • • Other. H • • • • 3 - BU#I L D. I m 9170 P EiR MIT . Perit N: S. •,. - s- - •L. 04/04/97 15 58 Project' No A701018 age I of I Developmertt No db Address:2664:J•EFFERSON ST •1 £ • S s • • Permit Type ELECThICAL 3875 04'04,9? 000131 o ParceLNo 155-271-33-00 Lot# C-FRill Valua n% o tio , 0 Cnstruction Type NEW Occupancy Group Reference# Status ISSUED * escri'ption INSTALL POWER LINE TO CARPORT Applied 04/04/97 Apr/Issue 40/97s ; •• Entered By's JM A. .5 1 • App1/Ownr AMERICAN EAGLE •.• 619;751194 I 31'19 FESTIVALDRIVE .. . • OCFANSIDE, CA 92057 Fee Coi1ècted4:Creds.***' Adjustments 010 t T'A011 2000 Fbe-description - 11 1 Ek !!1Da ! Enter. "Y' for Electr"c ''e ee > 10 00 Y for RemOde . io.o.o * ELECTRICAL TOTAL 20 00 - . •' Vr "INCORPORATED p 1952 el 1 N CCO " A ' :TIE 44 o • Ab4 ) A . • - - : - S S .5... .5 -S ..S -'•_5• • -• 5 •_5 £ . .---. -- . - '- . S5. 5. * ' a' • . * -i-- * -A. . £ - S. I 5•. I . .., *5, • •1* - • A S 4 - CITY OF CARLSBAD '2075 Las Palmas Dr, Cr1sbad CA 92009 (619) 438 1161 - .-:-; ;. V -. _.•: : . . £ S I 4 - s.AS- - .1 £ .. .a. - -.5-. .• 5 A2çS ..S. FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO '/7dt6Y' CITY OF CARLSBAD BUILDING DEPARTMENT EST VAL 2075 Las Pairnas Dr., Carlsbad CA 92009 • Plan Ck. Deposit _________________ . - Validated B (JL'V (619) 4381161, '• bate____________________ Address lincluae Bldg/Su Ie/) - Business Name (at this address) -. • Legal Description ... Lot No. Subdivision Name/Numbei ,.Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description of Work SQ. FT. ' #of Stories :# Of Bedrooms of Bathrooms " vt Name. - Address . . City .,. State/Zip Telephone # Fax # Name - • • , Address •, • - . City • State/Zip Telephone 7 ) (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 Licen s e L a w (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 all e g e d exampti y violation of n0 b fly a or,ermit,ub1ects the applicant to a civil penalty of not more than five hundred dollars 1115001). Name State/Zip T State License # s 7 Address License Class city City Business License !ZL- Designer Name , Address City .. State/Zip Telephone State License# - - • - . • , ' '. , . -, 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' compensatin as provided by Section 3700 of the Labor Code, for the performance t. of the work for which this permit is issued. • . . . • . 0 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 workers 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) - - . • - • 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' Co pensation Laws of California. ' - • - •, • - - • WARNING: Failure to secure-work '.compensation coverage Is unlawful, and shall subject an employer to criminal pen&fiei and civil fines Lip to one hundred thousand dollars 00.000), In Ition to the cost of compensation, damages as provided for In Section 3706 of the Labqr code, Interest and attomey'a fees. - SIGNATURE,, DATE 7 OWNER BUILD DEC T1Otg..) I hereby affirm that I am axe Pt from the Contractor's License Law for the following reason: • • • • - • - I. as'ówner of the pro arty 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 Coda: The Contractor's License Law does not apply to an owner of property who builds or Improvü 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 improveme n t i s '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 Cad T h e 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). • • • - •' • -. -,,, • • ---------L,,,, 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 properly improvement 0 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 / address / phone number! àontractors license numbe r ) : ' 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 persons to provide the work indicated (include name / address / phone numbir / t y p e of work): • • ,,•••.•• - - - • * - • . ' • - 4 • - - PROPERTY-OWNER SIGNATURE • •-- • DATE - - - MSSECT1OQR Is th' plic:nt o future build,ng occupant required to oubmit a business plan, acutely hazardous materials registration form or risk management and prevention -r program under Sections 25505, 25533 or 26534 of the Presley-Tennir Hazardous Substance Account Act? Cl YES 0 NO • - Is the applicant or future building occupant required to obtain a permit from the air pollution control district o; air quality matagemant 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 • . - * •• - •. 1 4 IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPUCANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. • • . •• .- • 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 - • - " - ---.-. - - APPUCANT CERTIFIcATION - • • .1 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'com p l y w i t h a l l City ordinances and State laws relating tobuilding 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. 41"v "_QMR3WPR .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 b 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 fl9t commenced w n 365 days from the date of such permit or if the building or work authorized by such permit is suspend e d or abandoned at any time after th ork is commen d for i period of 180 days (Section 106:4.4 Uniform Building Code). - • APPLICANTS SIGNATURE ,.. __• _--•-•-----* - DATE- - - • - RITE: File - YELLOW: Applicant PINK: FiriOnce - •- • • ' - - -