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HomeMy WebLinkAbout2834 POINSETTIA LN; TP; CB983524; Permit10/14/98 11:04 Paqe 1 of 1 B U I L D I N G 1Job Address: 2834 POINSETTIA LN Permit Type : ELECTRICAL Parcel No: Valuation: 0 P E R M I T Permit Project .0 Development Suite: -,, Lot#: No: CB983524 No: A9804590 No: Occupancy Group: Reference#: Construction Type: NEW Status: ISSUED Applied: 10/14/98 Apr/Issue : 10/14/98 Entered By: RMA Description: TEMPORARY : SITE POWER POLE-SCHOOL Appl/Ownr : LUSARDI CONSTRUCTION 1570 LINDA VISTA RD SAN MARCOS CA 92069 Fees Required Fees: Adjustments: Total Fees: Fee description *** 20 .00 . 0 20 .00 Enter "Y" for Electr'c Issue Fe Enter "Y" for Temper ry 760 744-7261 Fees ollected & Credits *** ---------------""22z~1~11qr,e-ooor1rr--uz -<::ital Gr d1ts: Total P'a Yill,e ts : Balance Due : Uni ts Fee./Ohi t C-PRMT .00 .00 20 .00 Ext fee Data 10.00 Y 10 .00 Y CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 20-00 FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. q R 351, '-{ CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL. _________ _ Plan Ck. Deposit ----,-r-r-----~::~_•_t■_d_B_y:1:0::,:/'--;.._~~:~"-;_=-,t,~.,,~====~- Address l1nclude Bldg/Suite II ....,_ Name lat lhia llddrNII Legal Description Lot No. Unit No. Phase No. Tout I ot units #of Stonu I of Bedrooms I of Bathrooms 3, APPLICANT D Avon• fa, Comnctor . D Owner . D Agont ior Ownoi Name 4, )(Comraow Addrus State/Zip Telephone I Name Add, ... City Telephone I s. CONTRACTOR -COMPANY NAME ---·---~~----------.. ---.-----~ ---··---. (Sec. 7031.5 Business and ProfessKffls Code: Anv Chy or Countv which requires• permtt to construc:t. ■her, improve, demolish or r11pair ■nv structure, prior to hs issuance, atso reouires the applicant tor such permit to fite a ligned atltement thlt he is licenllld Pll'lualt to lhl PRWilicWII of the Contractor's License Law !Chapter 9, commending wrth_ Section 7000 of Division 3 of the Business end Profeaions Cade) or thlt he ii nempt therefrom, and the basis for the •ll•g•d exemption. Anv violation of Section 7031.5 by any applicant for a permit aubjllCU the applicant to• civil penetty of not than five hundr•d dol p J15 111,: // Ll5 C -I r<; /J. -'ZI-· .?,6 Designer Name Address Cltv St•te/Zlp State License # _________ _ 6. WORKERS' COMPENSATION Workers' Compensation 0.clar•tion: I here~y affirm unO.r penalty of perjury OM of the following ctact•rettonl: D I heve and will maintain a certificate of consem to 1eJf-insure tor workan' cornpenution •• pn,vkfed by Section 3700 of the Labor Code, tor the pertormanca ~ work tor which this permit is issued. )lJ. I have end will maintain workers' compensation, as required by Section 3700 at the Labor Code, tor the performanca of the work tor w~ch this permit is issued. My worker's co,-pensltion.,,.i~~e ~rrier •nd policy 9Ymber are: ?J ,7 / . / 46 lnsu,anoa Comoany/,(/7,(,,{J, 0!"-1't'6rl[k'?F oF r 4 Polir:yNo. WC f 3 () EXOi••-Oota /.-~ /'f' LY... !THIS SECTION NEED NOT BE COMPLETED IF THE !'£AMIT IS FDA ONE HUNDRED DOLLARS lf1001 DA LEBSI 0 CERTIFICATE OF EXEMPTION: I certify thllt WI the performance of thll worlt ·to, which thie permit ja laued, I at.ti not employ eny peraon in env manner 10 u 10 become subject to the Workers' Compena■tion Laws at Catitomia. WARNING: Feikn to Mcure worllan' compenution CO..,... II unlawful, end ..... euli;act ■n employer to Gftminal ,...,.... and dvll fines up to one hundred tho. u■■nd doUar9 '?:':'::~'~~of comp■nution, .,..._ N pravtded tor In Section 3708 ... of the Labor CCNIJ• ::'::'_ Md attoffley'■ ..... . SIGNATURE_~;...,.:::. ...... ~U"'-''"""{_J""_,c...~~'--=""'-.h,,L.._______________ DATE /0-/A ~ 7. OWNER-BUILDERDECLARATI N . . ... ·' · .... . . -~·.,.:..·,r••--,,.· ··· .,,r;·:' · I hereby affirm that I am ■xempt from tha Contractor'• Lteenl• Law for the tollowtng reason: D I, as owner of the propeny or my e,nptoveu With wages •• their sCM compena■tion. will do the wo,k ■nd the atNCture ii not intended or ottered tor nte !Sec. 7044, Bu11ness and Professions Code: The Contractor's Ucena• Law doa not appty to en owner of property who bu6ld■ or irnp,oyu; th■raon, and who do■■ such work himHII or thfough his own emi,toyee■, provtcted th■t auch improvernenu are not Intended or offered tor ..... H. however. th■ buHdlng °' -..o.:ernent • sold within one ye1r of completion, th■ owner-buitd■r wHI hllw th■ burden of p,ovtng tta■t ha dtd not build or tmPIOW tor the pwpGN ot e■l■I. D I, as owner of the property, •m exclusively contracting with ltc■nHd contractors to construct th■ r,ro;.ct fS.c. 7044, 8U1inN1 end Protenionl Code: Thll Contractor's Lic•n■e Law don not apply 10 an own■r of property who build■ or improvn theraon, and contr■c:ta for ■uch Pfo,ecta with contractorlaJ ltNnHd pursuant to the Contractor'■ License law). D I em exempt undflr Section ______ Businns and Protnalons Code tor this ,-son: I personally plan to provide the major labor and materiel■ tar construction ot the proposed p,openy improvenaent. D YES ONO 2. I I have I have not) signed an application tor a building permrt tor th■ prol)OHd wark. 3. I have contracted with the following person ffirml 10 provide the propo .. d construction Onclude name J ■ddras J phone number J contractors licenle number): 4. I plan to provide ponions of the work, but I hive hired the foHowtng person to coordina ... IUPlf¥iae ■nd Pf'OVkl■ the major work tinelude name I addreu I phone number I contractors license number): _____________________________________________ _ S. I will provide some of the work. but I have contracted lhiredl th■ following peraon■ to provtd9 the work indicated llnctud■ name J eddras J phone number J typa of work): _______________________________________________________ _ PROPERTY OWNER SIGNATURE_______________________ DATE _________ _ ·cOMPLETE THIS SECTION FOR NON-RDIDBITIAl. BUILDING PERMITS ONLY:·.;·~--•'._..,.,,,..,. ·:~--~s:-.-•-,c• ;_~~•,-•.~.,, _. .. . ,.,.~-..... ts the applicent a, tutu,• building occupem required to submit • bwinns plan, acutety hu■rdom mneriela 1egi■bation form or rillk management encl prevention program under Sections 25505, 25533 or 25534 of the Prnaev-T■nnar Hazardous Subn■nce Account Act? □ YES D NO ts the ■pphcant or future building occupam required to obtain e permit from the air pollution control Cllttrict or atr qu■lfty management diatricH D YES D NO Is the facility to be constructed wtthin 1,000 fnt of the outer boundary of a achocH site7 0 YES D NO IF ANY OF THE ANSWERS ARE YES. A FINAL CERTIFICATE OF OCCUPANCY MAY NOT IE ISSUED UNLESS THE APPLICANT HAS MET DA IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POUUTION CONTROL DISTRICT • ell, CONSTRUCTION LENDING AGENCY .. ~··"-• ... _ .. ~-,-· ........ ..,,.,.._, ......... , .. , .. ,-, ....... --~--·-•----, I hereby affirm that there 1s • construction lending agency for the performance of the work for which this permit la issued (Sec. 3097(il Civil Code). LENDER'S NAME ______________ _ LENDEA"SADDAESS _______________________ _ ;9, APPLICANT CERTIFICATION -.... , •••-•.•· v·--•, . ,__ -~•••-»• ,-,.., ... ,. .. •-•-;~• .. •.r-.,,-,-,--.~ I cenify that I have read the application and state th■t the •bove information is correct and that tha lnformatktn on the s,tans is accurate. I agree to comply with ■n City ordinances and State laws relating to building construction. I hereby authoriz• reprnem■tives of the Cltt of Cartabed to enter upon the above mentioned propeny for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is reQu·ired tor excavations over s·o· dHp and demolition or constructton at structures ov•r 3 stones in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Coda shall e,cpire by limitltion end become null end 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 bulldWlg or work authorized by such permit is suspended or abandoned at any time after the wor co encad for a period at 180 days (Section 106.4.4 Uniform Building Codel. ~ DATE /0-;4-f-8 APPLICANT'S SIGNATURE WHITE: File YELLOW: Applicant PINK: Finance ·-•----~._--,