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Home My WebLink About2840 MADISON ST; 2; CB931133; Permitw l A IN ~ 'w tt #: 7 " CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION PLAN CHECK NO. City of Carlsbad Building Departllleflt 2075 Las PalAIS Dr., carlsbad, CA 92009 (619) 438-1161 I. PEkMI I liPR A -LI Commercial U New Bmldmg LI l'enant Improvement B -D Industrial □ New Building D Tenant Improvement C -ml Residential □ Apartment O Condo [J{Single Family Dwelling □ Addition/ Alteration □ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical Im Plumbing □ Mechanical □ Pool D Spa D Retaining Wall □ Solar □ Other 2. PRClJECT INFORMATION FOR OFFICE USE ONLY ress 2840 Madison St. #2 Nearest cross Street Carlsbad Village Dr. LEGAL bESCRIVilON Lot No. Sut>d1VJs1on Name/Number 0mt No. Phase No. □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK WATER_ . HEATER REPLACEMENT SQ."i'T. -# OF STORIES 3. WN JACI PERSON (II dlHereni from apphcanf) NAME Peter Rock ADDRESS 2840 Madison St. #2 CilY Carlsbad, STATE CA. ZIP CODE 92009 DAY TELEPHONE ( 714) 492-8121 4. APPUCANI UCONIRACJOR NAME Michelle Medina 11tAGENI FORCONIRACIOR l,:fdWNER UAGENI FOR OWNER ADDRESS 281~ Central Ave. CilY S~ri9i'& Valley, STATE CA. S. PROJ>Eili OWN ZIP CODE 91977 DAY TELEPHONE 697-4151 NAME Peter Rock ADDRESS 2840 Madison St. #2 CilY Carlsbad, STATE CA. ZIP CODE 92009 DAY TELEPHONE 492-8121 NAME A£J Foster, Inc. ADDRESS 2819 Central Ave. CilY Spring Valley, STATE CA. ZIP CODE 91977 DAY TELEPHONE 697-4151 STATE I.IC.# 630120 LICENSE CLASS C-36 CilY BUSINESS I.IC. # 1200354 N/A CllY STATE ZIP CODE DAY TELEPHONE STATE I.IC. # 7. WOltkEilS OJMPENSAIIUN Workers' Compensation Oeclarauon: I hereby afhrm that I have a certificate of consent to seii-msure issued by the Director of 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 Republic Demnity POLICY NO. PC949585 EXPIRATION DATE 5/1/94 Cert1hcate of Exemptmn: I certify that m the performance of the work for which this pemut 1s issued, I shall not employ any person many manner so s to become subj o the Workers' Compensation Laws of California. I hereby affirm that I am exempt from the Contracto?s Llcense Law for the foiiowmg 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 Llcense 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.). D 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 Llcense 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 Llcense 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 pennit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Llcense Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Ccxle) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]). SIGNATIJRE DATE COMPLEIE IRIS SECIION FOR NON-RESIDEN IIAL BUILDING PERMil'S ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □YES ONO Is the applicant or future building occupant required to obtain a pennit from the air pollution control district or air quality management district? □YES □NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □YES ONO IF ANY OF nm ANSWERS ARI! YES, A FINALCERTIFICATI! OF oa:uPANCY MAYNar Bl!ISSUED AFfERJULY I, 1989 UNLF.SS nm APPLICANT HAS M1IT OR IS MEimNG nm REQlllREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND nm AIR POLUmON WNTROL DISfRICT. 9. WNSIRUCIION LENDING AGENCY I hereby aihnn that there 1s a construction lendmg agency for the performance of the work for which this penn1t 1s issued (Sec 3097(1) C1V1i Code). LENDER'S NAME N'.)NE LENDER'S ADDRESS 10. APPilCAN I CERI IFICAfioN I cerufy that I have read the apphcatmn and state that the above mformauon 1s correct. I agree to comply with ail 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 AISO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS nm CITY OF CARISBAD AGAINST AIL LIABIIJTlES, JUDGMENTS, CDSTS AND EXPENSES WIDCH MAY IN ANY WAY ACCRUE AGAINST SAID CI1Y IN WNSEQUENCE OF nm GRANTING OF nus PERMIT. OSHA: An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every pennit 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 Buildin.J!~)t'1e). APPLICANT'{ SIGN~-r-i • / '---1(1 ' DATE: tq/11/lfl. ~TE:File~licant PINK: Finance