HomeMy WebLinkAbout2214 PLAZA DE LAS FLORES; ; CB970259; PermitPERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(619) 438-1161
FOR OFFICE USE ONLY
PLAN CHECK NO. ____ _
EST. VAL. _________ _
Plan Ck. Deposit ________ _
Validated By __________ _
Date ______________ _
Address (include Bldg/Suite IJ Business Name (at this address)
Legal Description Lot No. SFR Subdivision Name/Number Unit No. Phase No. Total # of units
Assessor's Parcel # Existing Use Proposed UH
Description of Work SO. FT. #of Stories I of Bedrooms # of Bathrooms
WATER HEATER REPLACEMENT
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Name Address City State/Zip Telephone # Fax #
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Name Address City State/Zip Telephone #
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Name Address City State/Zip Telephone #
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(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 License Law
(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 alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit sui&acts the applicant to a civil e!nalty of n.Qtmore th..nOfW• hundra.c:L®llats 116001). A & J FOSTER PLUMBING 137U6-B HWY 8 BU::;. EL CAJON CA. ~LI L.L J~U-q4 II
Name 630120 Address C-36 City State/z;p 12003!,°)f'phone I
State License # _________ _ License Class _________ _ City Business License # _______ _
Designer Name
State License # ___ N_/_A _____ _
Address City State/Zip Telephone
le.,_-, ,~W.oRKERS:,coMPENSATIONJi:}.>,:J?;/:;;;,{'.~M;~,:;;·,~-:'.','1:,.1,\:1$;.; .l,,l_'~'-.: ~';:_,~-~-;;· .. ~;:-:~} ~ ")L,,~;::~~:,_g{~~;~lkll:~5:¥G!\JM~1~~:t~::~-;~Wl~~--~
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
D 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.
fil 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 worker's compensation insurance carrier and policy number are:
Insurance company FARMER INSURANCE N2007-56-51 Policy No .. ___________ _ . . 5-1-97 Exp1rat1on Date. _______ _
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS)
0 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' Compensation Laws of California.
WARNING: Failure to secure•workera' compensation coverage la unlawful, and shall subject an employer to criminal penalties and civil fines up to one huridred
thousand dollars 1$100,000), in addition to the cost of compensation, damages as provided for In Section 3706 of tha Lal>Qf code, lnterHt and attorney's fees.
SIGNATURE DATE
7 .. OWNER-BUILDER DECLARATION ·
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
D 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 aale. If, however, the building or improvement is
sold within one year of completion, the owner•bullder will have the burden of proving that he did not build or Improve tor the purpoH of aale).
0 I, as owner of the property, am exclusively contracting with licensed contractors to construcfthe 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 auch projects with contractor(s) licensed
pursuant to the Contractor's Ucenae Law).
0 I am exempt under Section ______ Business and Professions Code for this reason:
I. I personally plan to provide the major labor and materials for construction of tha proposed property 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 mrml to provide the proposed construction (include name / address / phone number / contractors license number):
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 I 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 number / type of work): ___________________________________________________________ _
PROPERTY OWNER SIGNATURE_______________________ DATE _________ _
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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 26634 of the Presley.Tanner Hazardous Substance Account Act? D YES O NO
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 O NO
Is the facility to be constructed within 1,000 feet of the outer boundarv of a school site7 D YES O NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIRCATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES ANO THE Alli POLLUTION CONTROL DISTRICT.
e., ' CONSTRUCnoN LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30970) Civil Code).
LENDER'S NAME _____________ _ LENDER'S ADDRESS
,9; APPLICANT CERTIFJCAnON
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. 1 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.
OSHA: An OSHA permit is required for excavations over 6'0" deep end demolition or construction of structuru over 3 stories in height.
EXPIRATION: Every permit 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 ah~:h.n; commenced for a period of 180 days !Section 106.4.4 Uniform Building Code).
APPLICANT'SSIGNATURE ~Jf)[YV)r)Q DATE d-\d-91
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