HomeMy WebLinkAbout2420 SIERRA MORENA AVE; ; CB921123; PermitPERMIT APPLICATION ~ ~
PLAN CHECK NO. pd/.,?~
City of Carlsbad Building Departlllent
2075 Las Pal .... o, •• ca,Lsbad, CA 92009 (619) 438-1161 EST. VAL. __________ _
PIAN CK DEPOSIT. ________ _ VALID.BY. ___________ _
I. PERMII hPE DATE
A -LI COmmerc1al O New Bu1idmg D lenanr Improvement
B -D Industrial □ New Building D Tenant Improvement
C -D Residential D Apartment D Condo □ Single Family Dwelling □ Addition/ Alteration
D Duplex D Demolition D Relocation □ Mobile Home □ Electrical □ Plumbing
□ Mechanical D Pool □ Spa □ Retaining Wall □ Solar □ Other
FOR OFFICE USE ONLY
mt o.
CHECK BEWW IF SOBMII IEO:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
EXISTING USE PROPOSED USE
NAME ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
4. APPLiCANI
NAME
□WNIRACIOR UAGENI FORtUNIRACIOR DOWNER UAGENI FOROWNE!R
ADDRESS
ZIP CODE
ADDRESS
z1p coDE7'.:,2Co8' DAY TELEPHONE
ADDRESS
CITY STATE
STATE LIC. #
ZIP CODE
LICENSE CLASS
DAY TELEPHONE
CITY BUSINESS LIC. #
CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. #
?. WORRERS'WMPENSAIION
Workers' Compensation Oeclarat1on: I hereby arlmn that I have a certUlcate of consent to self-msure tsSued by che Ulrectorof industnal
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
Cert1llcate 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. oWNER-BOllDEk iM!LARAIION
Owner-Builder Oeclaratton: I hereby afhrm that I am exempt lrom the Contractofs License Law for the followmg 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 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.).
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 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).
□ 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 License 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 IAIS SECIION FOR NON-RESIDEN IIAt BUILDING PERMil'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 co be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO
IF ANY OF nm ANSWERS ARE YFS, A FINAL CERTIFICATE OF oa:IJPANCY MAY NOT Bl! ISSUED AFfER JULY 1, 1989 UN1J!SS nm APPUCANT
HAS MET OR 1S Ml!lmNG nm RF.QUJREMENTii OF THE OFFICE OF EMERGENCY SERVICES AND nm AIR POLLU110N CDNTROL DlSTRICT.
9-WNS I KOCI ION LENDING AGENCY
I hereby aihrm that there 1s a construcuon lend mg agency for the performance of the work for which this penmc 1s issued (Sec 309?(1) dvlJ Code).
LENDER'S NAME LENDER'S ADDRESS
10. AWl'.lt!XN I CEkliFICAliUN
I cemfy that I have read the apphcatlon and state that the above mformat1on IS correct. I agree to comply wtth all Caty 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 ID SAVE INDEMNIFY AND KEEP HARMLESS nm Cl1Y OF CARISBAD AGAINST AIL LIABIUl1ES, JUDGMENTS, CDSTS
AND EXPENSF.S WIDCH MAY IN ANY WAY ACDUJE AGAINST SAID 01Y IN CDNSEQUENCE OF nm GRANTING OF nns 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 comm ed for a period of 180 days (Section 303(d) Uniform Building Cod~ ~ DATE: /0 ~:)..__t)~ ~
PINK: Fmance
(
'PERMIT# CB921123
DESCRIPTION: GAS LINE FOR
TYPE: PLUM
CITY OF CARLSBAD
INSPECTION REQUEST
FOR 10/21/92
FIREPLACE
JOB ADDRESS: 2420 SIERRA MORENA AV
APPLICANT: KIRKMAN, DONALD
CONTRACTOR:
PHONE:
PHONE:
OWNER: PHONE:
INSPECTOR AREA PY
PLANCK# CB921123
OCC GRP
CONSTR. TYPE NEW
STR: FL: STE:
619 729-7690
REMARKS: MH/DONALD
SPECIAL INSTRUCT:
. /7_ L( INSPECTOR----~-//~-~-'------/
TOTAL TIME:
LVL DESCRIPTION ACT COMMENTS CD
23 PL Gas/Test/Repairs 0-f> -------
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***** INSPECTION HISTORY*****
DATE DESCRIPTION ACT INSP COMMENTS
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