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Home My WebLink About2784 LOKER AVE W; ; CB980958; PermitCITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION FOR OFFICE USE o~"o170 Sf PLAN CHECK NO ·~~_._{JJ.,__l/ ____ /_.,_ CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST.VAL.~~~~~~~~~~ Plan Ck. Deposit ----"'?T'"T"'" __ _ B . Legal Description Lot No. Subdivision N8me/Number Unit No. Phne No. Tot•I II ot units Assessor's Parcel I PropoHd Use Description ot Work SQ. FT. lot Stories II of Bedrooms II of Bathrooms .2. . CONT ACT PERSON CH clffnt from eppilCMti City St•te/Zip Telephone I Fax I ,3. Name 4. Name 0 Ap,i ior <>wner ----,,,-s. lo/ City St•te/Zip elephone II rice,~5'1 ___ ··j;;,;J);. · ·;,-- City St•te/Zip Ii. CONTRACTOR • COMPANY NAME . -· -·-· -~.---... ~-.. ,-~-*':*ti.... --~-------... ---:-:,,-.-~---..,..·~ ...---....... ~-.. ·- (Sec. 7031 .5 Business end Professions Code: Any City or County which requirn • permit to construct, elter, improve, demolish or repair •ny structure, prior to Its issuance, also requires the applicant for such permit to file • signed st•tement thllt he is lie-eel l)Uf8U8nt to the provisions of the Contractor's License Lew (Chapter 9, commending with Section 7000 of Division 3 of the Business •nd Profnsions Codel or that he is exempt therefrom, •nd the basis for the 1lleged exemption. y violation of S ;tiJ'I:' 7031. 5 by any epplic•nt f I mit subjects ~ 1pplic1 to • civil of not mo,1 thlln five hun ed d 1rs~ S_!j_5!01L c? )c; Name / (()S. IIJu .>r ~>r "/P ~ 6 J /- State License I _1._.[:._:.Z.'--:J_.5"z_._f __ _ Address License Cl•ss _..l,c_.:;.c_l ___ _ City St•te/Zip f Lf] D City Bulinna Li-.'------- Designer Name Address City St1t1/Zip Telephone State License II---------- 6. WORKERS' COMPENSATION -,-.... -------·~--..... . ·.. ..... ,,,.. . Workers' Compen11tion Decl•retion: I hereby 11ffirm under penelty of perjury one of the following decl1retions: D I have end will maintain • certific•t• of consent to self-ln1Ufe for workers' compenHtion II provided by Section 3700 of the L•bor Code, for the perform•nc• of the work for which this permit is issued. l2Ji' I hive and will m11int1in workers' compens11tion, IS required by Section 3700 of the L1bor Code, for the perform•nc• of the work for which this permit Is issued. My worker's comper,•tiO'}jrisur•rc• c•:: end policy number ere: . C / II -~ 2-. . ) ... / ... 'I? Insurance Comp•ny f/C.,,,fff/ /n.s (,;[!' I Policy No. f (! ~ .J, EIIJ)lr11t1on Dlte _______ _ (THIS SECTION NEED NO-iaecoMPLnED IF THE ,{,;MIT IS FOR ONE HUNDRED DOLLARS 1•1001 OR LESS) D CERTIFICATE OF EXEMPTION: I certify thllt in the perform•nc• of the work for which this permit is Issued, I shell not employ 1ny person in 1ny menner 10 11 to become subject to the Workers' Compen111tion L1ws of C11lifomi1. WARNING: FellUfe tlon co-. .. unllwful, encl ..... 8ubjlct ... emplo.-r to crtmnil .......... encl cfvll fines up to -hunclr9d thouund doll8t8 I 1 coet of compeMation, dlmegee a pn,vided for In Section 3706 of the:,::-code, ~t encl 1ttomey'1 fen. SIGNATURE DATE ~ ... 7},' 7. I hereby affirm th•t I em exempt from the Contr•ctor's Lic-e Lmw for the following reHon: D I, H owner of the property or my employees with w1ges III their sole com~ltion, will do the work end the 1tTUcture Is not Intended or offe,ed for Hie (Sec. 7044, Business end Professions Code: The Contr11ctor'11 Lic:eMe L.mw does not 1pply to 1n o-of property who bullda or lmprovn thef1on, end who does such work himHlf or through liis own employees, provided thet such Improvements 1111 not Intended or offered for Ille. H, however, the building or Improvement le sold within one y11er of completion, the owner-builder win hllve the burden of proving thet he did not build or Improve for the purpou of 111e1. 0 I, es owner of the property, •m exclusively contr11cting with licensed contr11ctors to construct the project CSec:. 7044, Businns end Profes~ Code: The Contrector's License Lew does not 1pply to 11n owner of property who builds or improvn thefeon, •nd contrects for IUCh projects with contrectorlal Nc:er.ed pursuant to the Contr•ctor' s License Lmwl. D I 1m exempt under Section ------Business end Professions Code for this 1111on: 1 . I person11lly plan to provide the m•jor labor •nd m1t1ri1ls for construction of the proposed property Improvement. 0 YES ONO 2. I (have I have notl signed •n •pplic1tion for , building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the propoHd construction (Include neme I 1ddreu I phone number I contrecton license numberl: 4. I pl•n to provide portions of the work, but I hllve hired the following person to coordinate, superviM end provide the mejor work (Include n11m1 I 8ddreu I phone number I contr•ctora license numberl:. ______________________________________________ _ 6. I will provide some of the work, but I hllv1 contr11cted (hirldl the following persona to provide the work Indicated !Include neme / 1ddrns I phone number I type of workl: ________________________________________________________ ~ PROPERTY OWNER SIGNATURE-----------------------DATE _________ _ • '" ....... -... L••••~•-•••- Is the applicant or future building occupent requif9d to submit II bulineu plen, •cutely hlurdoUI meterilla regiatretlot! form or rlalt menegement end prevention program under Sections 25505, 25633 or 25534 of the Prnley·T•nner HezerdoUI Subst1nce Acc:ount Ac:t7 0 YES O NO Is the applicant or future building occup•nt rllQUired to obtain • permit from the 1ir pollution control district or 1lr qudty m1negement district? 0 YES O NO Is the facility to be constructed within 1,000 ffft of the outer bounduy of II school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES. A FINAL CERTIFICATE OF OCCUPANCY MAY NOT IE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POUUTION CONTROL DISTRICT. ia,.. CONSTRUCTION LENDING AGENCY '' · »· -·, ·--~· •-~· ..,. ~~:;,:'"_:-~"""·--,"-"' ,.-~~·-·····-·-.,..,. :-·-,~· •-,; ~·-. ~·,-· I hereby affirm that there is • construction lending 1gency for the perform•nce of the work for which this permit Is issued (Sec. 3097(il Civil Code). LENDER'S NAME--------------LENDER'S ADDRESS·-------------------------:9. APPLICANT CERTIFICATiON ... . --,--.,.·--.....--,,~-,;,-,-.,.,-.--,-'.-,-,-;c7-,·~.•:.:••.'·-;,p~~·"..,... 1·:.,;"''.""rry,r-"'''"'; I certify that I hive reed the 1pplic1tion end 1t1t1 thllt the •bov1 lnformltion is correct end thllt the lnformltion on the pl1ns Is 1ccur1te. I 1grn to comply with •II City ordinances end State l•ws rel1ting to building construction. I hereby 1uthorize 'rep,11ent1tivn of the Cltt of Cerlsb8d to enter upon the 1bove mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST AU 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 excev•tions over 5'0" dffp •nd demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shell expire by limitation end become null end void if the building or work authorized by such permit is not commenced within 385 YI from the d•te of such permit or If the building or work 1uthorized by such permit is suspended or abandoned It any time after th od of 180 d1ys (Section 108.4.4 Uniform Building Codel. U _ :7 _ r=,,R- APPLICANT'S SIGNATURE DATE f 7u YELLOW: Applicant PINK: Finance PERMIT# CB980958 DESCRIPTION: TEMPORARY POWER TYPE: ELEC CITY OF CARLSBAD INSPECTION REQUEST FOR 04/07/98 POLE-ASYMTEK JOB ADDRESS: 2784 LOKER STE: AV WEST INSPECTOR AREA PLANCK# CB980958 OCC GRP CONSTR. TYPE NEW LOT: APPLICANT: POWER PLUS PHONE: 760 839-9430 CONTRACTOR: PHONE: OWNER: PHONE: //) REMARKS: C/ INSPECTOR~~~~~~~~~~~~~- SPECIAL INSTRUCT: REQUESTED A FINAL INSPECTION // TOTAL TIME: CD LVL DESCRIPTION ACT COMMENTS 32 EL Const. Service/Agricultural ~ All-/2.(AOJ /2.(l(Ml-(} M "Tf'f' ***** INSPECTION HISTORY***** DATE DESCRIPTION ACT INSP COMMENTS PERMIT# CB980958 DESCRIPTION: TEMPORARY POWER TYPE: ELEC CITY OF CARLSBAD INSPECTION REQUEST FOR 04/09/98 POLE-ASYMTEK INSPECTOR AREA TP PLANCK# CB980958 OCC GRP JOB ADDRESS: 2784 LOKER APPLICANT: POWER PLUS CONTRACTOR: AV WEST STE: CONSTR. TYPE NEW LOT: OWNER: REMARKS: C/MICHELE/ PHONE: 760 839-9430 PHONE: PHONE: /J INSPECTOR ~ SPECIAL INSTRUCT: TIM PLEASE CALL ME WITH INSPECT! AN OK TO REL_E_,.K:~S-E_A_S_S_O_O_N_A_S_Y_O_U __ TOTAL TIME: CD LVL DESCRIPTION ACT COMMENTS 32 EL Const. Service/Agricultural ,4/7 ---------------- ***** INSPECTION HISTORY***** DATE DESCRIPTION ACT INSP COMMENTS +------..., - . ·r t;..i,ntr.. llvi'..olfli~ )'110· . -· __ _.,. ... N • .J••' • •l,"•,.,-,...,..,.,,....: •.• .--..,.-=,11,1111~,t,10o_-,. 1,....,.Jt.,.:o .... ,~ .. i: ;: ~ < " ~ ~ E ~ (. C. C .. -~ ~ C :i ;;, r-t, 0 ~ C s; "" -~ ., s ~ .r:: ~ g -~