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IN SP. ~·~ DATE--• CLEARANCE _____ ,
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
45-00
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PERMIT APPLICATION PLAN CHECK NO. ?_-{ 0 7'--(
City of carlsbad Building Departaent
2075 Las Pal-• De., caelsbad, CA 92009 (619) 438-1161 4'4 5"--~ ft, I+ (
I. PFJtMI I i'YPE DATI!
A-U COmmerc1al U New Bulldmg ~enant Improvement
B -□ Industrial □ New Building □ Tenant Improvement
C -□ Residential □ Apartment □ Condo □ Single Family Dwelling □Addition/Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical D Plumbing
□ Mechanical D Pool □ Spa □ Retaining Wall □ Solar □ Other
2. PRCllF.C'f INFORMATION FOR OFFICE USE ONLY
Address~ ~accVEt.. r§r Bu1ldmg or Suite No.
Nearest Cross Street /f,:?RA/l)
UIDAL DEsCRJP I ION Lot No. Sutx1IV1s1on Name/Number 0mt No. Phase No.
CHECK BEWW IF S0BMI I I ED:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ l Addressed Envelope
ASSESSOR'S PARCEi.
DESCRIPTION OF WORK J:. µ S f-r / ( ETNG p.e S, F+= Fl1iJAfl-.-t-L I ..-J
/ SQ. IT. ~ # OF STORIES
3. WN IACJ~ (ll dnferent from apphcanf)
NAME _ A . U ADDRESS
S p.,.,.,._.,._ -s I
STATE CilY ZIP CODE DAY TELEPHONE
4. APYLl~t UWNIRACIOK □AGENI FORCONIRACIOR
ADDRESS
DOWNER UAGENI FOR OWNER
NAME /:ICK. J» 71/
CllY {;~/i!.LS(3/I}, STATE C-A ZIP CODE '7 t,.O 0~ DAY TELEPHONE
5. PROPER ii OWNER ,.
ADDRESS -;J li' :Z, J E~Tt/"2/.-,J
NAME "))/hi I :i:, j/c.rl.W rrrz--
CilY CM.LSl3Ab STATE CA ZIP mDE </ 2-0 <'[i' DAY TELEPHONE 4 3 S' --;;.(;, 0 4-
NAME ADDRESS
ZIPmDE
LICENSE CLASS
CilY SAA,UL STATE
STATE LIC. #
DAY TELEPHONE
CilY BUSINESS LIC. #
CllY STATE ZIPmDE DAY TELEPHONE STATE LIC. #
7. WOkkF.RS' WMPF!NSAIION
Workers• Compensation Oeciarat1on: I hereby aUlrm that I have a cert1tlcate of consent to self-msure issued by the Director of industnai
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 mMPANY POLICY NO. EXPIRATION DATE
Certthcate of Exemption: I certify that m the performance of the work for which this penmt 1s issued, I shah not employ any person m any manner
so as to become subject to the Workers' Compensation laws of California.
SIGNATURE DATE
8. OWNEk-B0llDER DFilARA:iiuN
□
□
dwner-BuUder Oeclaratmn: I hereby affmn that I am exempt from the Contracto?s 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 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 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· mpt therefrom, and e basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pennit
subjects licant to civil pe of not more than five hundred dollars {$500]).
SIGNATURE I' DAT!!
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 Seccions 2550_S...,i5533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
□ YES B'"NO Is the applicant or future building occupant required to obtain a permit from the air pollucion control district or air quality management district?
□YES □NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO
IF ANY OF TIIE ANSWERS ARE YES, A FINALCERTIFICATI! OF OCCUPANCY MAY Nor BE ISSUED AITERJIJLY 1, 1989 UNJJlSS TIIE APPLICANT
HAS MET OR IS MEI!TING THE REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND THE AIR POILIITlON CXlNTROL DISfRJCT.
9. WNSIRUCIION IENDlNG AGENCY
I hereby afhnn that there 1s a construction lend mg agency for the performance of the work for wfuch tfus penn1t 1s issued (Sec 3097 (I) CivU Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPilCXN J cmtl'MCA I ION
I certHY that I have read the apphcat1on and state thar the above mformauon 1s correct. I agree to comply with all City ordinances and Staie 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 AISO AGREE TO SAVE INDEMNIFY AND KEEP IIARMIJ!SS THE CTIY OF CARISBAD AGAINST AIL IJABIIJ1lllS, JUDGMENTS, CXJSfS
AND EXPENSES wmrn MAY IN ANY WAY A(IlUIE AGAINST SAID CTIY IN ffiNSEQUENCE OF TIIE GRANTING OF 11IlS PERMIT.
OSHA: An OSHA pennit is required for excavations over S'O" deep and demolition or construction of structures over 3 stories in height.
Expiration. Every pennit 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 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) Uniform Building Code).
APPLICANT'S SIGNATURE DATE: ______ _
WHITE: File YEIJ.OW: Applicant PINK: Fmance
• PERMIT# CB921074
DESCRIPTION: ADD
ADD
TYPE: MISC
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 10/09/92
2 8 FOOT HIGH PARTIONS
OUTLETS IN NEW PARTION
JOB ADDRESS: 2845 ROOSEVELT ST
APPLICANT: DOTY, RICK PHONE: 619
PHONE: CONTRACTOR:
INSPECTOR AREA MP
PLANCK# CB921074
OCC GRP B-2
CONSTR. TYPE NEW
STR: FL: STE:
729-7079
OWNER:
REMARKS: MH/RICK/729-7079
SPECIAL INSTRUCT:
PHONE: P' A
INSPECTOR ~MC--·J•-~-----_-_-_-____ _
TOTAL TIME:
CD
19
29
39
49
LVL DESCRIPTION
ST Final Structural
PL Final Plumbing
EL Final Electrical
ME Final Mechanical
ACP COMMENTS
------------------
***** INSPECTION HISTORY*****
DATE DESCRIPTION ACT INSP COMMENTS
RECEIVED OCT 1 2 1992
DEPT: BUILDING
FINA~ING INSPECTION
ENGINEERING/~ PLANNING U/M WATER
PLAN CHECK#: CB921074
PERMIT#: CB921074
PROJECT NAME: ADD 2 8 FOOT HIGH PARTIONS
ADD OUTLETS IN NEW PARTION
ADDRESS: 2845 ROOSEVELT ST
CONTACT PERSON/PHONE#: MH/RICK/729-7079
SEWER DIST: WATER DIST:
DATE: 10/09/92
PERMIT TYPE: MISC
======= ~ ==========================================================
INSPECTED DATE / / /
BY: INSPECTED: It) 1Fl ,q~ APPROVED V DISAPPROVED --
INSPECTE DATE
BY: __________ INSPECTED: ___ APPROVED DISAPPROVED
INSPECTED
BY:
DATE
INSPECTED: APPROVED DISAPPROVED
=============================================================================
COMMENTS:
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