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HomeMy WebLinkAbout2748 OLYMPIA DR; ; CB930862; Permit,L 1 ... p • ,n· A L WI . ; I; - A r- y ,. E. .... E:. H. l L ~ [ t f ~ r tor V R 1.r r. t ' . t (._ I# : l-l A CITY OF CARLSBA 2075 Las Palmas Dr., Carlsbad, CA 92 f I • 3610 03/24/93 'J001 01 :-Dl=,MT Ar !..J At 1 I.. l : t xt i ,2 20.(){\ ~ ' PERMIT Al'J>UCATION PLAN CHECK NO. Citt of Carlsbad Building Department 2075 Las Palaas Dr •• Carlsbad, CA 92009 (619) 438-1161 EST.VAL. __________ _ PIAN CK DEPOSIT, ________ _ VAIID. BV. __________ _ l. PIDtMI I i'YP£ DATE A -U Commerctal O New Bu1ldmg D lenant Improvement B -D Industrial □ New Building D Tenant Improvement C -~idential □ Apartment D Condo D Single Family Dwelling □Addition/Alteration D Duplex D Demolition D Relocation □ Mobile Home ~rical □ Plumbing D Mechanical D Pool D Spa D Retaining Wall □ Solar □ Other mt o. ase o. □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PABCTL EXISTING USE PROPOSED USE DESCRIP11);,4 w~ .,...-1' Cpt!. O/,JI r SQ. IT. # OF STORIES 3. WN IAti PERSON (II dnlerent from applicant) NAME ADDRESS CITI STA TE ZIP CODE \Viii DAY TELEPHONE 1-. APPi.JCAIU UCUN1HALJUK DAGEN I FOR WNIRACIOR IR) t'.R □AGENI FOR OWNER ¥r CJc. ~#(',.,,,,,, LJA, 11E NAME ..L)ewti<r W~f!,IC.- ~ d,h? STATE C,, CITI ADDRESS ,Z ZIP CODE 3, (:le>r DAY TELEPHONE o/ j ,pr -,rC7'7' / NAME CITI S-~G ,;-s .,f,,:Ju Vt!!!- STATE ADDRESS ZIP CODE DAY TELEPHONE NAME CITI STATE ADDRESS ZIP CODE DAY TELEPHONE STATE UC.# LICENSE ClASS CITI BUSINESS UC. # CITI STATE ZIP CODE DAY TELEPHONE STATE UC.# 7. WOltkERS' WMPENSAIIUN Workers' Compensation Oeclarat1on: I hereby aiiirm that I have a cert1hcate of consent to seif-msure issued by the O1rectorof lndustnal 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 POLICY NO. EXPIRATION DATE Ceruhcate of Exemption: I certify that m the performance of the work for which this permit 1s 1ssued1 I shall not employ any person many manner so as to become subject to the Workers' Compensation Laws of California. SIGNATURE DATE 8. OWNEK-B0IWkk DECIAilA:liuN _/ bwner-Bmlder Oeclaratmn: I hereby affmn that I am exempt from the Contracto?s License Law for the followmg reason: fl"' 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 himsetr 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 co 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,_,..--scContractor's License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or th e is exe pt therefrom, and sis fa the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit sub· ts the I' ant to 'vii ~n t re than five hundred dollars [$500]). SIGNA: DATI! Is the applicant or future uilding 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? CYES □NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES ONO IF ANY OF nm ANSWERS ARE YES, A FINAL CERTIFICATI! OF oa:IJPANCY MAY Nar BE ISSUED Al'fER JULY 1, 1989 UNLESS TIIE APPLICANT HAS MET OR IS MfilITING TIIE RF.QUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND TIIE AIR POillTl10N WN11l.OL DISl1\ICT. 9. WNS'IROCIION IP.NDLNG AGENCY I hereby aihrm that there 1s a consrrucuon lendmg agency for the performance of the work for which this permit 1s issued (Sec 3097(1) Civil Coae}. LENDER"S NAME LENDER'S ADDRESS 10. APPIJCXNJ cmttiFICA:IION I certify that I have read the apphcatmn and state that the above miormat1on 1s correct. I agree to comply with all City ordmances 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. I AlSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS TIIE CTIY OF CARISBAD AGAINST AU. LIAIIIUl1ES, JUDGMENTS, CDSTS AND EXPENSES wmrn MAY IN ANY WAY A£DUJE AGAINST SAID CTIY IN WNSEQUENCE OF nm 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. WHITE: File YELLOW: Applicant PINK: Finance