HomeMy WebLinkAbout2032 PLAYA RD; ; CB920622; PermitPERMIT APPLICATION 4\ V
City of Carlsbad Building Department EST. VAL. ______________ _ 2075 Las Pal mas Dr., Carl shad, CA 92009 (619) 438-1161
1.
A
PERMIT TYPE
COMMERCIAL
PLAN CK DEPOSlT ___________ _
VALID. BY _____________ _
DATE _______________ _
TENANT IMPROVEMENT
B O INDUSTRIAL □NEW □TENANT IMPROVEMENT
C □RESIDENTIAL □APARTMENT □CONDO □SINGLE FAMILY DWELLING OAD0ilJ0N/ALTERATION
□DUPLEX QDEHOLITI0N □RELOCATION □MOBILE HOME OELECTR1CAL ~UMBING
□MECHANICAL QPOOL □SPA □RETAINING WALL QS0LAR □OTHER
2. PROJECT INFORMATION
'"" ~03~
Nearest Cross Streets
Building or Suite No.
LEGAL DESCRIPTION Lot No. Subdivision Name/Nlllber Unit No. Phase No,
CHE BELOW IF SlllMITTED:
3.
7.
8.
Q2 Energy Cales 02 Structural Cales
BLDG, SQ.
NAME
CITY
SIGNATURE
Q2 Soils Report Q 1 Addressed Envelope
EXIST!NG USE
# OF STORIES
ADDRESS
ZIP CODE
FOR CONTRACTOR
ADDRESS
ZIP CODE
,;J;)~ /!,a:,
ADDRESS
0 O',,'NER
PROPOSED USE
DAY TELEPHONE
0 AGENT FOR OWNER
DAY TELEPHONE
□TENANT
J,,.,,. b~ ADDRESS
{ /1-zlP COOE
;;c97 ~frt
CjXJOg'
SIGNATURE
DESIGNER
CITY
WORKERS' COMPENSATION
STATE
STATE
LICENSE CLASS -~< ..... ~J.,_.h<-.
T!TLE
ADDRESS
ZIP COOE
DAY TELEPHONE
CITY BUSINESS LIC. #
DATE
DAY TELEPHONE STATE LIC. #
lolorkers' Con,.:,ensat1on Declaration: hereby affirm that have a certificate of consent to self-insure issued by the Director of Industrial Relations,
or a certificate of lolorkers' Con,.:,ensation Insurance by an actnitted 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
Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in any manner
so as to become sl.bject to the Workers' Compensation Laws of California.
SIGNATURE DATE
OWNER-BUILDER DECLARATION Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
D] as owner of the property or 1rrf eirployees with wages as their sole c~nsation, 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 i1Tproves thereon., and who
does such work himself or through his own eirployees, provided that such i1Tprovements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of Cotll)letion, the owner-builder will have the burden of proving that he did not build or improve for the purpose
of sale.).
D J, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:
The Contractor's Lfcense Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s)
ticensed pursuant to the Contractor's License Law).
D 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, in-prove, 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, conmencing 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 subjects the applicant to a civil penalty of not
more than five hundred dollars [$500] ).
SIGNATURE DATE
COMPLETE nus SECTION FOR NON-RESIDENTIAL BUILOJNG PERMITS ONLY:
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,
QYES QNO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□ns □No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES 0,0
If ANT OF THE ANS\ERS ARE YES, A FINAL CERTIFICATE OF OCOJ>ANCY NAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APf'LICANT HAS NET OR IS NEETIMG THE RECIJIRENENTS
Of THE OFFICE OF EMERGENCY SERVICES AND TME AIR POLLUTION CONTROL DISTRICT.
9. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performarw;e of the work for which this permit is issued (Sec 3097Ci) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPLICANT'S SIGNATURE
I certify that J have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating
to building construction. I hereby authorize representatives ct the City of Carlsbad to enter upon the above mentioned property for inspection purposes. ALSO
AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY Of CARLSBAD AGAINST ALL LIABILITIES, Jll)QIJENTS, COSTS AND EXPENSES \IHICH NAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
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 conmenced within 180 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 ork is corrrnenced for a period of 180 days (Section 303(d) Uniform Building Code).
DOWNER □ CONTRACTOR D BY PHONE APPROYED BY: _______ _
DATE:
TE: File YELLOW: Applicant PINK: Finance
. .
PERMIT# CB920622
DESCRIPTION: GAS REPAIR
TYPE: PLUM
JOB ADDRESS: 2032 PLAYA RD
APPLICANT: BROWN, ARTHUR
CONTRACTOR:
OWNER:
REMARKS: MH/JUNE/729-4914
SPECIAL INSTRUCT:
TOTAL TIME:
CD LVL DESCRIPTION
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 06/30/92 INSPECTOR AREA PY
PLANCK# CB920622
OCC GRP
CONSTR. TYPE NEW
STR: FL: STE:
PHONE: 619 729-4914
PHONE:
PHONE: /)
INSPECTOR ,~,~y!-1----1--+--------
ACT COMMENTS
_2_3 __ P_L _G_a_s_f_T_e_s_t_l_R_e_p_a_i_r_s _______ ~ ______________ _
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***** INSPECTION HISTORY*****
DATE DESCRIPTION ACT INSP COMMENTS