HomeMy WebLinkAbout2663 SAUSALITO AVE; ; CB901349; PermitB U I L D I N G P E R M I T
08/21/90 12:05
Permit
Project
No : CB901349
No: A9001501
Page 1 of 1 Development No :
Job Address: 2663 SAUSALITO AV Str:
Permit Type: RESIDENTAL ADDITION/ALTERATION
Parcel No : 167-512-14-00
Valuation: 2,600
Construction Type : VN
Occupancy Group:
Description: 400
: PER
Class Code :
SF PATIO COVER REAR
CITY SPECS
Fl :
-
Ste :
) 08/ :_ _ 01 02
'0-00
Ot_ ((o )_
status: ISSUED
Applied: 08/21/90
Apr/Issue:
Validated By: DC
OWNER : SHELLENBERGER, DEAN Lie. OWNER 619 481-6113
*** Fees Required *** *** Fees Collected & Credits ***
Fees:
Adjustments:
Total Fees:
Fee description
Building Permit
Plan Check
Strong Motion Fee
* BUILDING TOTAL
Total Credits:
Total Payments :
Balance Due:
Units Fee/Unit
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161
.00
.00
90.00
Ext fee Data
54.00
35.00
1.00
90.00
PERMIT APPLICATION 11\ V
City of Carlsbad Building Department EST. VAL -2 (4 c,--cJ 2075 Las Pal mas Dr., Carlsbad, CA 92009 (619) 438-1161 PLAN CK DEPOSIT ___________ _
VALID. BY 6 C:.,
1. PERMIT TYPE DATE ¢//'m
A • COMMERCIAL TENANT IMPROVEMENT
0 INDUSTRIAL □NEW QTENANT IMPROVEMENT
□RESIDENTIAL □APARTMENT □CONDO QSINGLE FAMILY DWELLING QADDITION/ALTERATION
□DUPLEX QDEHOLITION □RELOCATION QMOBILE HOME □ELECTRICAL □PLUMBING
□MECHANICAL □POOL QSPA □RETAINING WALL QSOLAR QOTHER
ROJECT INFORMATION PLAN CHECK No.
Addressz<,&:,-;. SAUSAL\TO AV£ Building or Suite
Nearest Cross Streets 5AVS.O..l-\ ID 4° CA(l. MEL
LEGAL DESCRIPTION Lot No. Subdivision Name/Nunber .. 4-/ r,O CAfZ.(h840 TCT 'E -S::>
Un1 t No. 11\A p-,t, ll 4 Z. S Phase No.
OQC...NQ• ZI0/10
3.
4.
BLDG. S0. FTG.
CONTACT
NAME
CITY
SIGNATURE
PERSON
APPLICANT
NAME
Cl TY
0 CONTRACTOR
# OF STORIES
ADDRESS
STATE ZIP cooe
0 AGENT FOR CONTRACTOR
ADDRESS
STATE ZIP CODE
PROPOSED USE
DAY TELEPH~E
□OWNER □AGENT FOR 0IJNER
DAY TELEPHONE
5. PROPERTY OWNER □LESSEE
ADDRESS 7.l,C..?, S""S""LJ'TO Av£.
□TENANT
~IJ SHE:U...~S£f2t.El2..
~ CITY CN2,LS8AQ C.-/'t STATE ZJ p COOE "t'Z.oof DAY TELEPHONE
6. CONTRACTOR
7.
8.
NAME ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
STATE LIC. # ____ _ LICENSE CLASS _____ _ CITY BUSINESS LIC. #
SIGNATURE TITLE DATE
DES I GNER NAME
CITY
WORKERS' COMPENSATION
STATE
ADDRESS
ZIP COOE DAY TELEPHONE STATE LIC. #
workers• Compensation Declaration: hereby affirm that I have a certificate of consent to setf·insure issued by the Director of Industrial Relations,
or a certificate of Workers' C~nsat ion Insurance by an actni t ted insurer, or an exact copy or duplicate thereof certified by the Di rector of the
insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY POLICY NO. E>CPIRAT ION DATE
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 slilject to the IJorkers' Compensation laws of California.
SIGNATURE DATE
OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am ellerrpt from the Contractor's License Law for the following reason:
DI as owner of the property or my errployees 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 i""roves thereon,, and who
does such work himself or through his own errptoyees, provided that such i""rovements 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 iirprove for the purpose
of sale.).
D !, 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 iirproves thereon, and contracts for such projects with contractor(s)
licensed pursuant to the Contractor's License Law).
D I am ellempt 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, i""rove, demolish, or repair any structure,
prior to its issuance, al so requires the appl 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, corrmencing with section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom,
and the basis for the alleged ex~tion. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civit penalty of not
more than five hundred dol\ars [$500] ).
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 prevention
program under Sections 25505, 25533 or 25534 of the Prestey·Tanner Hazardous Substance Account Act?
Ores □No
Js the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□res □No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
Ores
IF MY OF THE ANS\A:RS ARE YES. A FINAL CERTIFICATE OF OCOJ>ANCY NAY NOT BE ISSUED AFTER JULY 1, 1989 tlilLESS THE APPLICANT HAS NET OR IS MEETING THE REQUIREMENTS
OF THE OfFICE OF EMERGENCY SERVICES ANO THE AIR POLLUTION CONTROL 0ISTRJCT.
9. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction \ending 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 is 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 SAYE INDEIINIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, Jll)QIIENTS, COSTS AND EXPENSES \IIIICH KAY IN ANY WAY ACCRUE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
Expiration. Every permit issuecf 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 coomenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended
andoned at any ti after the work is coomenced for a period of 180 days (Section 303(d) Uniform Building Code).
~OWNER OcoNTRACTOR □BY PHONE APPROVED BY; ______ _
DATE:
WHITE: File YELLOW: Applicant PINK: Finance
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