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Home My WebLink About2631 ROOSEVELT ST; ; CB951099; Permit08/10/95 14:05 Page 1 of 1 B U I L D I N G Job Address: 2631 ROOSEVELT ST Permit Type: ELECTRICAL Parcel No: 203-101-22-00 Valuation: 0 Construction Type: NEW P E R M I T Suite: Lot#: Permit No : CB951099 Project No : A95009 82 Development No : Occupancy Group: Reference#: Status: ISSUED Applied: 08/10/95 Apr/Issue: 08/10/95 Entered By: RMA 619-446-9789 Description: ADD OUTLETS IN LAUNDRY Appl/Ownr : EMPIRE ELECTRIC 4827 SPRING STREET LA MESA, CA . 92019 *** Fees Required Fees: Adjustments: Total Fees: Fee description *** 20 .00 ,00 20.00 *** Fees Collected & Credits *** Total Credits: Total Payments: Balance Due: Units Fee/Unit .00 ,00 20.00 Ext fee Data --------------------------------------------------------------------------- Enter "Y" for Electric Issue Fee > Enter "Y" for Remodel > * ELECTRICAL TOTAt CITY OF CARLSBAD , 10.00 Y 10.00 Y 20.00 3129 08/10/95 0001 01 02 C-PRMT ~0-0◊ /jl~AL APPROVAL ~ DATE/ o · z_ S · 9 s;- , ,ANCE ------1 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPUCATION PLAN CHECK NO. CZ s - City of Carlsbad Building Depar~t 2075 Las Pal.,,. Dr., carlsbad, CA 92009 (619) 438-1161 ESf. VAL, __________ _ 1. PEkMII IYPR PUN CK DEPOSIT. ________ _ VAIID.BY __________ _ DATE From Llst 1 (see back) give code of Permit-Type: ___________ _ For Residential Projects Only: From Llst 2 (see back) give Code of Structure-Type: ____________________ _ Net Loss/Gain of Dwelling Unics 2. PROJF.CT INFORMATION Address .2 <, 5 I Bu!Jdmg or Suite No. FOR OFFICE USE ONLY Nearest Cross Street LEGAL DESCRIP I ION Lot No. Subd1V1s1on Name/Number 0mt No. Phase No. CHECK BEWW IF S0BMI 11 ED: □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope ASSESSOR'S PARCEi. O<.t ;:;t.e,, ~NG USE PBOP9SED USE DESCRIPTION OF WORK SQ. Ff. # OF STORIES # OF BEDROOMS # OF BA1HROOMS 3. WN JACI PERSON (II dnierent from applicant) NAME (last.name first) ADDRESS CITY 4. APPIJCANI pt1)N IRACIOR STATE ZIP CODE DAY TELEPHONE NAME (last name first) l="/IAl'/Ul" t,,;-.,vq%/C- UAGENI FORWNIRACIOR uuwNut OAG£NI FOR OWNER ADDRESS '-f'/ 2. 7 $; Pltl,J(,.,. $r STATECA<-/F-ZIP CODE 2.0 DAY TELEPHONE CITY " NAME (last name first) CITY STATE ADDRESS ZIP CODE DAY TELEPHONE NAME (lase name first) CITY STATE STATE UC.# ZIP CODE LICENSE CLASS ADDRESS DAY TELEPHONE CITY BUSINESS UC. # ast name trst CITY STATE ZIP CODE DAY TELEPHONE STATE UC.# 7. WOkkERS' OOMP£NSXhUN Workers' Compensatton Declaration: I hereby affirm that I have a cernhcate 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 Director of the insurer thereof filed with the Building Inspection Department (Section 3800, lab. C). INSURANCE COMPANY POLICY NO. EXPIRATION DATE Certthcate of Exemption: I certify that m the performance of the work for which this permit 1s issued, I shall not employ any person m any manner so as to become subject to the Workers' Compensation laws of California. SIGNATURE DATE 8. OWNmt-B0ttnm fifi.!DUlKliuN □ □ □ Owner-Builder Deciarafion: I hereby afnnn that I am exempt from the Contractors License Law for the followmg reason: 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. If, 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.). 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 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 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 that 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 [$500]). SIGNATURE DATE CoMPLEIE 'IHIS SEClloN FUR NON-RESIOEN IIAL BUILDING PERMll'S ONLY: Is 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? □YES □NO Is the facility to be construcced within 1,000 feet of the outer boundary of a school site? □YES □NO IF ANYOFTIIEANSWERS AREYES, A FINAL CERTIFICATE OF □a:IJPANCY MAY NOT BE ISSUED AFrnRJULY 1, 1989 UNLESS TIIE APPUCANT HAS MET OR JS MEIITING TIIE REQUIREMENTS OF TIIE OFFICE OF EMERGENCY SERVICES AND TIIE AIR POILUTION ffiNTROL DISTRICT. 9. WNSIKOCIIDN LENDING AGENCY I hereby afhrm that there 1s a construcbon lendmg agency for ilie performance of ilie work for which ili1s permit 1s tsSued (Sec 3097(1) Civil Code). LENDER"S NAME LENDER'S ADDRESS IO. APPllCAN I CfltlMCAIION I certUY chat I have read the application and stale that the above mformat1on 1s correct. I agree to comply with all City ordmances 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 HARMU!SS TIIE CTIY OF CARISBAD AGAINSf AU. IJABIIJTIES, JUDGMENTS, CDSTS AND EXPENSES WJilCH MAY IN ANY WAY A<Dl.UE AGAINST SAID CTIY IN ffiNSEQUENCE OF TIIE GRANTING OF 1lilS 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 pennit is not commenced within 365 days from the date of such pennit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Unifonn Bui~din ). APPLICANT'S SIGNATURE DATE: --