HomeMy WebLinkAbout2433 SACADA CIR; ; CB930150; Permit> V
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CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION PLAN CHECK NO.
City of Csrlsbad Building DepartEOt
2075 Las Pal-• Dr., Carlsbad, CA 92009 (619) 438-1161 EST.VAL. __________ _
PIAN CK DEPOSIT _______ _
VAIID. BY __________ _
I. P£kMI I IYPE DATE
A -U Commercial LI New Bmldmg U I enanc Improvement
B -□ Industrial □ New Building □ Tenant Improvement
C -□ Residential □ Apartment D Condo □ Single Family Dwelling □ Addition/ Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical lifi,1umbing
□ Mechanical □ Pool □ Spa D Retaining Wall □ Solar □ Other _____ 1
2. PRClll!CT INFORMATION FOR OFFICE USE ONLY
Address )-'1 '1 -~ r -BuUdmg pr Suite No.
'-• , r·C) t_.
Nearest C~ Street
mt o. ase o.
CHECK BEWW IF S0BMII 1£0:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report O 1 Add~ Envelope
ASSESSOR'S PARCEi.
DESCRIPTION OF WORK f"'--~/' ', r-':),:..:._:,_ EXISTING 1JSE PROPOSED USE
SQ. Ff. # OF STORIES
3. WN IACI PFJ&JN (if duferent from apphcant)
NAME ADDRESS
CITY STATE DAY TELEPHONE
NAME
CITY
K_ r .,_ cL, . .,
STATE
/(,'i?-,~ 'I {; 1'\.
ZIP CODE ' -;}-0 ..> DAY TELEPHONE
NAME
CITY STATE
ADDRESS
ZIP CODE DAY TELEPHONE
NAME
CITY STATE
STATE !JC.#
ADDRESS
ZIP CODE DAY TELEPHONE
LlCENSE CLASS CITY BUSINESS !JC. #
CITY STATE ZIP CODE DAY TELEPHONE STATE !JC.#
7. WOltkERS' WMPF.NSXIION
Workers' Compensation Oeclarat10n: I hereby afimn that I have a certificate of consent to self-msure issued by the Director of lndustnal
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Direclor of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY POIJCY NO. EXPIRATION DATE
Cert1llcate of Exempnon: I certify that m the performance of the work for which this penmt as 1ssued.1 I shall not employ any person m any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. OWNER-BUllDER DfilJUlAltuN
Owner-Builder Oeclarat1on: I hereby affirm that I am exempt from the Contracto?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 Llcense Law does not apply to an owner of property who builds
or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended
or offered for sale. If1 however, the building or improvement is sold within one year of completion, the owner-builder will have the burden
of proving that he did not build or improve for the purpose of sale.).
D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions
Code: The Contractor's Llcense 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 Llcense Law).
□ 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, 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 Llcense Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code)
or chat 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 [$5001).
SIGNATURE DATE
COMPLEIE IHIS S£CIIUN FOR NON-RESIDENIIAL BUILDING PERMil's ONLY:
ls 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?
□YES □NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
CYES □NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OFOOCUPANCY MAYNITTBEISSUED AFl'ERJIJLY 1, 1989 UNLF.SS THEAPPUCANT
HAS MET OR IS MEETING THE REQUIIIEMENTS OF TIIB OFFICE OF EMERGENCY SERVICES AND THE AIR POIUJTION CDN"lllOL DISl"RICT.
9. WNSIHOCIION mNOING AGENCY
I hereby affirm that there 1s a construct10n lendmg agency for the performance of the work for which this penmt 1s JSSued (Sec 3097 (I} Civil Code).
LENDER'S NAME LENDER'S ADDRESS
IO. APPilCAN I CEklfiJICAI luN
I certHY that I have read the apphcat1on and state that the above mformauon 1s correct. I agree to comply with all City oid.mances and Stale 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 ID SAVE INDEMNIFY AND KEEP HARMIBSS THE CfIY OF CARISBAD AGAINST ALL UAIIILITIES, JUDGMENTS, <DSTS
AND EXPENSES WIDCH MAY IN ANY WAY MDUIE AGAINST SAID CfIY IN OONSEQUENCE OF THE GRANTING OF 110S PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
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 commenced within 365 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 work is commenced for a pericxl of 180 days (Section 303(d) Uniform Building Code).
APPIJCANTS SIGNATU DATE: ?--) ;_,., -'f -,
File YELLOW: Applicant PINK: Fmance
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DATE __ 1...,----1-'----'''-P=----INSPECTOR. _____ j---1-------1---
PERMIT #_'1..i....::;.3_-_i_)O__ PLANCK# _____ _
Joa ADDREss ___ ?.,'--'1--'?3=-__ S_-4,_c.._A-'---D_A.,c...__c_,_7\.. ________ _
TIME ARRIVE: ____ TIME LEAVE: ____ _
CD LVL DESCRIPTION ((}
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ACT COMMENTS
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