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Home My WebLink About2668 SAUSALITO AVE; ; CB982382; Permit0 9467 07 /28/98 00{).1 001 C-PRJIT 02 27-00 9 y .-----=----. FIN INSP. """'-'---..._,,,.,.__DATE..,:;:,'-.,-.-- CLEARANCE _______ ......,..~ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION FOR OFFICE USE ONLY -;,V)_ PLAN CHECK NO. C[gJ ~XJ_• CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL. _________ _ Plan Ck. Deposit -----lit--,--- 1. PRo.iECT INFORMATION X Address (include Bldg/Suite #I Business Name (at this address> 2 6,~ ~ $AU5ttl (m .4}i6 Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use )( ~:;;i:.n,:;°fLW~ /2"~ tJ,4-7k 11~.;;. FT. #of Stories # of Bedrooms # of Bathrooms 2. CONTACT PERSON (It different from •pplicentl Name Address 3. APPLICANT O Contractor ·□ Agent for Contractor O Owner Name Address X 4. PROPERTY OWNER ,4 J. g,l--<!)71/, c k1 Name Address 5. CONTRACTOR • COMPANY NAME City 0 Agent for Owner City State/Zip State/Zip Telephone# Fax# Telephone# (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 License Law [Chapter 9, commending 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 ($5001>. Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company_____________________ Policy No .. _____________ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS> O CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to aacure workllfs' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of tha Labor code, interest and attomay's feas. SIGNATURE. ______________________________ DATE _________ _ '/-. 7. OWNER-BUILDER DECLARATION · ~· • · I hereby affirm that I am exempt from the Contractor's License Law for the following reason: O 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, t he 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 License Law>. O I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the m)jor labor and materials for construction of the proposed property improvement. 0 YES ONO 2. 1(!9'1 have not> signed an application for a building permit for the proposed work. ~~~~:i...1:.~'1£,2£,~.f12...~~:........r:z:~~~~~;,,L:ft_~~~y..:n~~~~~~/7ei fq r 4. pan to provI e portions o t e wor , ut ave ire t e o owing person to coor mate, supervise an provI e t e ma1or wor me u e name a ress I p one number/ contractors license number>:. ______________________________________________ _ 5. I will provide some of the work but I have contracted · the following persons to provide the work indicated (include name / address / phone number / typa of workl:. __________ ..,,...,;>----:r--~"""--,-~-u.,,..... __ ....,p.'-----------------+--,--------------x PROPERTY OWNER SIGNATURE•~~~';/~!'"~:f('~#=-:.gl,ll::.t:.~~~::::::=. ________ :J-.:,DATE _£A61:.J...J:....:Z.C..---- COMPLETE THIS SECTION FOR 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? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 18. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructioA lending agency for the performance of the work for which this permit is issued (Sec. 3097(H Civil Code>. LENDER'S NAME ______________ _ LENDER'S ADDRESS ________________________ _ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit\' of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS 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 3 5 days from the date of such permit or if the building or work authori ed by such permit is suspended or abandoned at any time after work ·s commenced or per" d of days (Section 106.4.4 Uniform Building Code>. ;x APPLICANT'S SIGNATURE ~f:l,~~~~;¢~i./1J&~~~~:::::_ _________ !:::..J DATE -L....,'-"':e:.....!"4~~~----- YELLOW: Applicant PINK: Finance PERMIT# CB982382 DESCRIPTION: INSTALL TYPE: PLUM CITY OF CARLSBAD INSPECTION REQUEST FOR 07/29/98 NEW WATER HEATER AV I /Ob STE: INSPECTOR AREA PLANCK# CB982382 OCC GRP CONSTR. TYPE NEW LOT: JOB ADDRESS: 2668 SAUSALITO APPLICANT: SKOTNICKI, ANTHONY CONTRACTOR: PHONE: 760 729-8545 OWNER: REMARKS: C/729-8545 SPECIAL INSTRUCT: TOTAL TIME: CD 25 LVL DESCRIPTION PL Water Heater/Vents ------------------------------------------------------ PHONE: PHONE: INSPECTOR ACT COMMENTS Af ---------- ***** INSPECTION HISTORY***** DATE DESCRIPTION ACT INSP COMMENTS