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Home My WebLink About1210 PLUM TREE RD; ; CB970957; PermitFOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. 17-°tS7 CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 EST. VAL. _________ _ Plan Ck. Deposit ________ _ Validated By __________ _ Date _____________ _ Address (include Bldg/Suite lj . 7J Iv !?J Business Name (at this address) legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total I of units Assessor's Parcel I Exlsting Use Proposed Use Name Address City State/Zip Telephone I Fax , ~~"ic-~'i:,T ~~ D_cpn ac).9r~~ '(ifAatnJ teiJQii}a.\J!p!.:,,.:,□,911"-'L-3-9!-g~rit ll>r Q.~.r.t'."f..p,,;,,_..,.,.....-.·, .. 'ij,;"2fjJfrgi~fj_~~;_ ~,,.~~ _,, State/Zip (Sec. 7031.5 Business and Professions Code: Any City or County which requires e 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 Any violation of S 1i9" 7031.5 by any appli ant for a permJt subjects ;tie applicant to a civil 11e aity of not more than five hundre51 dollars l!lqOJ). ,-/ (.,,,,-I v'..J ha 0' .Yf-tt h t{,.,z<P.J' f/ ,:l O ( r 7'7 /..:. 5 1/ 9'-t' Name State License I _J_-.::..,7-.....=;.:J_'.>.--'-f_/ __ _ Address License Class __ C. __ C_I ____ _ City State/Zip Telephone I City Business License I 't 3'.3 z ~o Designer Name Address City State/Zip Telephone State License I _________ _ il,J·;t~.W.QJU(.EAS~~COMPENSA TIONJ~~,: .. ~J. ~~:~a.~~_.U~~ :·.::~--:1~~~;.__ ----· ~ ~ : .. ::~~( .,.:' -••'--; ;:.,.,.; i1i'":l~ ~~1\C~~..!.±S~ii~i~~~~t-; ,·::;~~:-· -. ·, -· ,: .. lo ,l Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a cenlficate of consent to self-insure for workers' compensation as provided by Section 3700 of t he Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work ·tor which this permit is issued. My worker's compensation insurenc carrier end policy number are: Insurance Company -~c::;....::t..t.-->--....L--'--'J11:..:....:.._-e_r_/'--l---'/.:...._ ___ _ Policy No. C O tJ O 5"/ / h / Expiration Date 1-/-9~ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I cenify 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 ■ecure•worilera' compenaation coverage ia unlawful, end shall subject en employer to criminal penalties end civil fin-■ up to one hundred thousand dollars ($100,000), in addition to the coat of compensation, damages aa provided for In Section 3706 of the Labqr code, Interest end attomey'a fella. SIGNATURE _____________________________ DATE ________ _ [7. '.,.OWNER-BUILDER DECLARATION ~-, \ •· .:::~~~i,~ • • ~&\;~~~-t!:~Ew~~~;upzl~~1.~)'~~~-:?•:~5f. 1 ,; :::2 • I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 I, es owner of the propenv or my employees with wages as their sole compensation, will do the work and the structure is not intended or oflered for sale (Sec. 7044, Business end 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 employ■es, provided that such improvements are not Intended or oflerad for sale. If, however, the building or improvement ia sold within one yur of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpo■e of ■ale). 0 I, es.owner of the propenv, am exclusively contracting with licensed contractor■ to con1truct the project (Sec. 7044, Bu1inesa end Profeaaions Code: The Contractor's License Law does not apply to en owner of propenv who builds or improves thereon, and contracts for auch projects with contractor(&) licen■ed pursuant to the Contractor's Ucenae Law). 0 I am 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 propeny 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 (firm) to provide the proposed construction (include name / address / phone number/ contractors license number): 4. I plan to provide ponions of the work, but I have hired the following person to coordinate, supervise end provide the major work (include name / address / phone number/ contractors license number):. ______________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following parsons to provide the work indicated (include name / address/ phone number / type of work):. ________________________________________________________ _ PROPERTY OWNER SIGNATURE DATE ~CQMeLi:J'E,JltJS 'SECTIO~F:QR N;.o;~;_:;;~_EliJMJ..;;;;;:Jl;IJWl~L.D~l;N~O~,Ri,UlMiRMITTJ:U~.Q~r1';,.~'/.~~~;i,~---;,liliJ, ,~2~[::~~-~. ~~~-'titt.~•'11i• ·j. ~maeiilri~~cii~~i Is th, a~plic:nt or future buildinw occupant 1equ.r•d ,o ,ulJmit • bu~ineu 1,1l1n, acutely hazardous materiala registration form or risk management and prevention l)l'ogram under Sections 26605, 25633 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 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 boundary of a school site 7 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!\"!fco.~$:l'RUCTION LENDING-~GENCV""t':: ,._~~~~!;~;!\~•· . -~·-~@.~~;.:_:: :·.·~~--:-;~~·:[~'.i':i-~ ... ,..,1,w~~~·•··.:,~;-, I hereby affirm that there is • construction lending agency for the performance of the work for which thi■ permit i■ i■sued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ iS). APPLICANT CERTIFICATION I cenlfy that I hive 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 ~II City ordinances 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 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 structures over 3 atories in height. EXPIRATION: Every permit issued by the Building Official under the provi · ns of this Code 1hall expire by limitation and become null and void if the building or work authorized by such permit is not e e within 366 days o date of such permit or If the building or work authorized by such permit is suspended or abandoned at any time after thew rk i$ enced for a per of clays (Section 106.4.4 Uniform Building Code). DATE _t-(_-_:2_3_-_?_1 __ _ YELLOW: Applicant PINK: Finance RERMIT# CB970957 DESCRIPTION: TEMP. POWER POLE & BROAD 't'YPE: ELEC CITY OF CARLSBAD INSPECTION REQUEST FOR 04/30/97 FOR KAUFMANN JOB ADDRESS: 1210 PLUM TREE RD APPLICANT: POWER PLUS PHONE: CONTRACTOR: OWNER: REMARKS: RS/MICHELLE/471-5494 SPECIAL INSTRUCT: TOTAL TIME: PHONE: PHONE: INSPECTOR AREA PD PLANCK# CB970957 OCC GRP CONSTR. TYPE VN STE: LOT: 619 471-54 4 CD 32 LVL DESCRIPTION ACT COMMENTS EL Const. Service/Agricultural flP ol -/v &:k1a:<-- ------------------------------------ ***** INSPECTION HISTORY***** DATE DESCRIPTION 042497 Const. Service/Agricultural ACT INSP CO PD COMMENTS SYSTEM INCOMPLETE