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Home My WebLink About2226 PLAZUELA ST; ; CB984314; PermitPERMIT APPLICATION FOR OFFICE USE ONLY PLAN CHECK NO. q<}!(:>,)(/ J CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL. _________ _ Plan Ck. Deposit ________ _ Validated By __ i'1-+---+->..-,,r+1 ____ _ Date._----l-+l-)-&f+-+-1/ D-'+--lf 0~8--- Address (include Bldg/Suite II Business Name lat this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Totel I of units Assessor's Parcel I Proposed Use Description of Work I of Bedrooms I of Bathrooms State/Zlp Telephone I Fax II 002) Name Address City State/Zlp Telephone I s. CONTRACTOR -COMPANY NAMe···-· . , .. , ......... _ . ., .... _ ":~-·""."''""7:7'~'."::·":7.7."'.'"""' __ ,_-~--,,-.~--"·•---.,• •:::~":•·~·-. (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 e,cempt therefrom, and the basis for the alleged exemption. Anv violation of Sectio 7031.5 by any applicant for a permit subjects the applicant to• civil penalty of not more than five hundred dollars ($500)) \ ---, ,'f . L( c) Name State License I 70388 '2 City State/Zip Te~ne I City Busines1 Ucenae, 9eit1.lrj l~r Designer Name Address City State/Zip Telephone State License I _________ _ 6. WORKERS' COMPENSATION ---....-• • ',_ l ~ • ••,. , • • Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have end will maintain a certificate of consent to self-Insure for workers' compen11tion as provided by Section 3700 of the Labor Code, for the performance of t~rk for which this permit is issued. Er" 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 nuJ"ber are: . Insurance Compan6Tl'ln: cD//,t a:EA.6(«', fiuy d.__ Policy Noaa.'t-W IJ,.,f17Bz ( Expiration Date / -/-2 q «THIS SECTION NEED NOT BE COMP'(ETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) O 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 worker•· compenaatlon coverage I■ unlawful, and ■hall ■ubject an employer to criminal peneltlea and clvll fine■ up to on■ hl#ldred thousand d,si&ler'.2°°•~ :he cn~■tlon, damaga1 u PfOvlded for In S■ctlon 3708 of the Labor code, lnt-•t and attorney•• fHI. SIGNATURE ~~2:l-d ~ DATE -l1-(0·-9S 7. OWNER-BUILDER DECLARATION . .. ·-' '· ... • • ' · "':,: ;;~~:~;<~-·--'\·'. :·•·,p,;.,..•,,;~...,,. ·:•·i'' .;• ,,,.,:,:r::r. .. .,.,:_.·;-,i·" I hereby affirm that I em exempt from the Contractor's License Law for the following reason: 0 I, as owner of the propeny or mv employHs 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 build• or Improves theraon, and who does such work himself or through his own employees, provldad that 1uch Improvements are not Intended or offared for sale. If, however, th■ building or Improvement la sold within one year of completion, the owner-builder will have the burdan of proving that he did not build or Improve for the purpoH of ■ale). 0 I, as owner of the property, em e,cclusivaly contracting with licensed contractors to construct the project (Sac. 7044, Buaines1 and Profession• Code: The Contractor's License Law does not apply to an owner of property who build• or improves thereon, and contracts for such project■ with contractor(1) <icensed pursuant to the Contractor's License Law). · 0 I em exempt under Section ______ Business and Professions Code for this reason: 1 . I personally plan to provide the major labor and materials for construction of the proposed property Improvement. 0 YES ONO 2. I (have / have not) signed an app<ication for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction Unclude 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, superviH and provide the major work Onclude name / address / phone number/ contractors license number): ______________________________________________ _ 6. I will provide some of the work, but I have contracted (hired) the following persons to provide the work Indicated Onclude name / address / phone number / type of work): _________________________________________________________ _ DATE _________ _ :• 'f . ',. ... ! , Is the applicant or future building occupant required to submit • business plan, ■cutely hazardous material■ registration form or rt■k m■n■gement ■nd prevention program under Sections 25505: 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain • permit from the air pollution control dlstri_ct or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school 1lte7 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. !8. .. CONSTRUCTION laiDIN<fAGENCY ., .... ,.,, ~--~·•:··,~· .,_-,~-·,""';:r:-,:~:..-;'.~:••-~~,r-, .... _,,.. •... ,,.: ... ,,-,-,..,,:;·~,~~ --.. .,.,.. .... ,,~. I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued lSec. 3097(11 Civil Code). LENDER'S NAME______________ LENDER'S ADDRESS _______________________ _ rs·; APPLICANT CERTiFICATiON -~"·•···,·····. . . ., ---_,-,-· -.. ·,~·r-•1··~=-·~·""•m.s:::-,·'3<'...,.r,..,.:r,tn-,,r.u....,,,.,.,.,,.,.,,~"·'·.,,.,,.r.r.,.,'.'?",,..,.,.,,, •• .,.r '.(:;. · , .. --, .... --~. ,~·::, ... '·"'' . I certify that I have reed 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. I hereby authorize representatives of the Cltt 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 5'0" deep and demolition or construction of structures over 3 storin In height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shell 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 ebandoned at any timrttef't wor~s comme or• perlo , o 180 days (Section 108.4.4 Uniform Building Code). APPLICANT'S SIGNATJijE ...l..1.-,dl..,Cli.JL~S...Cll_.@l,...I....Z-~=----------DATE l 9.--( 0 -C/'8 WHITE: File YELLOW: Applicant PINK: Finance