HomeMy WebLinkAbout2558 ROOSEVELT ST; 201; CB901474; PermitDATE: 09/20/91
TO: TUBBS, HENRY
Cit
1991 VILLAGE PKWY #160
ENCINITAS, CA 92024
You have applied to have your plans checked on the date shown
above, and you have not obtained your building permit.
The provisions of Section 304(d) of the Uniform Building Code
state:
"Section 304(d) Expiration of Plan Review
Applications for which no permit is issued
within one year following the date of
application shall expire by limitation, and
plans and other data submitted for review
may thereafter be returned to the applicant
or destroyed by the Building Official.
In order to renew action on an application
after expiration, the applicant shall resubmit
plans and pay a new plan review fee."
Please check the appropriate box indicating your choice
and return this letter to the BUILDING DEPARTMENT.
PROJECT ABANDONED. I WILL PICK UP PLANS WITHIN 10 DAYS.
✓ I'ROJECT l.EANDONED . PL.~NS ~-\Y BE DESTROYED .
If you have any questions, please contact the Building
Department at (619) 438-1161.
DORIS COSMAN
Building Department
2075 Las Palmas Drive • Carlsbad, California 92009 • (619) 438-1161
PERMIT APPLICATION 4\
'11:I
City of Carlsbad Building Department "'. ··'~--"£>1~ .. 1<-..c20:::....:e:c....::::;,..-o:.-2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PLAN CK DEPOSIT e.2/£ ,,,-
VALID. BY ___ ,,,,_~K,=Z°~'i2'_<-"~------
1. P. RMIT TYPE DATE --~,,_e_-Lr,~1/_-~.f"~,6)~----
A
B
C
2.
COMMERCIAL ENANT IMPROVEMENT
0 INDUSTRIAL □TENANT IMPROVEMENT
□RESIDENTIAL □APARTMENT □CONDO □SINGLE FAMILY DWELLING OADDITI0N/ALTERATI0N
□DUPLEX □DEMOLITION □RELOCATION OM081LE HOME □ELECTRICAL □PLUMBING
□MECHANICAL □POOL OSPA □RETAINING IJALL □SOLAR □OTHER
CHECK No.
"''2-rr'i' Roos. ~Lr~ '2.01
Nearest Cross Streets
LEGAL DESCRIPTIOI Subdivision Name/Nurber Phase No.
3.
4.
PROPOSED USE
l~rs-471~-Y~T~
# OF STORIES .3 BLDG. SQ. FTG.
CoN1,c:!: ,PERSON
"" ftl!;"" fL'-f t u.JcB~
CITY GJ'f Cl"' T..t-s ~
SIGNATURE
NAME
CITY
ADDRESS
STATE C/}~ ZIP CODE
0 AGENT FOR CONTRACTOR
ADDRESS
STATE ZIP COOE
(9'11 VIL~ pK:-W~ · -:IF/t.o
Cf-im 'Z-<./ DAY TELEPHONE 6 § 2.-0 3 3 '2._
QOYNER 0 AGENT FOR OYNER
DAY TELEPHONE
5. PIUU.'ERTY OWNER ~. 1 pt• -7 •
MAHE '~J1:)€:Nn/rL-~
CITY ~ ~
OIJNER □LESSEE □TENANT
ADDRESS
STATE ZIP CODE DAY TELEPHONE
6. CONTRACTOR ...-,-:--
'A" f+GN 12-1-1 I ~~ ADDRESS 'Seie.. ,'t,Q,oa~
7.
CITY • l STATE ZIP CODE DAY TELEPHONE
~E~~ f2b'3~ LICENSE CLASS 13 Cl TY BUSINESS LJC, # (qKo 300
SIGNATURE ......... /v Tl TLE DATE D
DESIGNER NAHE ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. #
WORKERS' COMPENSATION
Workers• Coq:,ensat1on Declaration: hereby affirm that have a cert1f1cate of consent to self-insure issued by the Director of Industrial Relations,
or a certificate of Workers' Coq:,ensat ion Insurance by an actni tted insurer, or an eKact copy or duplicate thereof cert if; ed by the Di rector of the
insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C), r ~ .1 -:1 -v-i..-J:iJS ,'-0 ~POLICY No.rW'C-o=..-=,.$1RATION DATE /7-9o
not empl y any person in any manner
SIGNATURE DATE
8. OWNER-BUILDER DECLARATION
0wner·Bu1lder 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 irrproves thereon., and who
does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of COO'pletion, the owner-builder will have the burden of proving that he did not build or irrprove for the purpose
of sale.).
D I, as owner of the property, am eKclusively contracting with licensed contractors to construct the 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 such projects with contractor(s)
licensed pursuant to the Contractor's License Law).
D I am eK~t 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, improve, demolish, or repair any structure,
prior to its issuance, al so requires the appt i cant for such permit to f i le a signed statement that he is licensed pursuant to the provisions of the
Contractor's License law (Chapter 9, coomencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is eKefll)t therefrom,
and the basis for the alleged eKefll)tion. 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 [i500]).
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and preventi011
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
QYES ~
Is the applicant or future building occupant requir;;r"lo obtain a permit from the air pollution control district or air quality management district?
Om 1'k>
Is the heility to be constructed within 1,000 feet of the outer boundary of a school site? □YES g(o
IF AMY Of THE MIS\ERS ARE US, A FINAL CERTIFICATE OF OCOJPMCY NAY NOT BE ISSUED AFTER JUU 1, 1989 UNLESS THE APPLICANT HAS NET OI: IS MEETING THE REWIRBEITS
Of TIE OFFICE OF EMERGENCY SERVICES All) THE AIR POI.LUTION CONTROL DISTRICT.
9. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued {Sec 3097{i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPLICANT'S SIGNATURE
I certify that I have read the application and state that the above information 1s correct. I agree to comply with all 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 ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JLOGHENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
EKpiration. Every permit issu
or work authori
or abandoned at
ding Official under the provisions of this code shall eKpire by limitation and becooie null and void if the building
need within 180 days from the date of such permit or if the building or work authorized by such permit is suspended
need for a period of 180 days (Section 3D3(dl Uniform Building Code).
DOWNER & CONTRACTOR 0 BY PHONE APPRO\IED BY; ______ _
DATE:
WHITE: File YELLOW: Applicant PINK: Finance