HomeMy WebLinkAbout2663 STATE ST; ; CB921251; PermitPERMIT APPLICATION PLAN CHECK NO. ~-/~
City of Carlsbad Building Departllleflt
2075 Las Pal-s Dr., Carlsbad, CA 92009 (619) 438-1161 EST.VAL'-------------PLAN CK DEPOSIT _______ _
VAIJD. BY ___________ _
1. P£ltM1 I IYPE DATE'---------------
A -□ Commercial O New Bu1ldmg LI Tenant Improvement
B -D Industrial O New Building D Tenant Improvement
C -□ Residential ){Apartment O Condo □ Single Family Dwelling □Addition/Alteration
0 Duplex O Demolition LI Relocation □ Mobile Home □ Electrical D Plumbing
□ Mechanical O Pool □ Spa □ Retaining Wall □ Solar □ Other ____ _
2. PRQJF.CT INFORMATION FOR OFFICE USE ONLY
Address b
Nearest tfo'ss'1'treet3
LEGAL DESCRIPTION
Bu.!EUng or Suite No.
S7.
Lot No. Subci1V1s1on Name/Number Umt No. Phase No.
CHECK fiEIDW IF sDBMII IED:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROPOSED USE
DEj~r1~ wolf~ ;?~ S L>-4! £' _
SQ. IT. # OF STORJES
3. WN IACI Pl!.RSON (1t dtllerenf from apphcan()
NAME ADDRESS
CITI STATE ZIP CODE DAY TELEPHONE
□OWNER □ACENI F0ROWN£R 4. Af'l'UU\N I
NAME
UCON I RAC !OR U AC£N I FOR CON I RACIOR
ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
s. ~~~ru~ ~V:T ADDRESS
ZIP CODE
'9-'"1 su &r./ c'~.1s.t1,,;;;
CITY STATE DAY TE .3,
CITI STATE
STATE LIC. #
ZIP CODE
LICENSE CI.ASS
ADDRESS
DAY TELEPHONE
CITI BUSINESS LIC. #
DESIGNER NAM£
CITY STATE ZIP CODE DAY TELEPHONE STATE UC.# ,. womams WMP£NSA:nuN
Workers' compensation l.leclarauon: I hereby alitrm that I have a cerullcate of consent to seli-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
Ceruftcate of £xempuon: I ceruly that m ihe performance of the work lor 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. oWRElt-BOIIDER OECLAltA'l1dN
□
D
□
Owner-Builder Oeclarauon: I hereby alf1rm that I am exempt from the Contracto?s License Law for the foliowmg 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 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
COMPLETE nils sEctloN 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 Presley-Tanner Hazardous Substance Account Act?
LI YES □ NO
Is the applicant or future building occupant required to obtain a permit from the air pollution concrol 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?
LI YES ONO
IF ANY OF nm ANSWERS ARE YES, A FINAL CERTIFICATE OF oa:upANcv MAY Nm BE ISSUED AFTER JULY 1, 1989 UNlF.SS nm APPUCANT
HAS MET OR IS MEETING TI-IE REQUIREMEN"TS OF nm OFFICE OF EMERGENCY SERVICES AND 1HE AIR POUU11ON CDNTROL DISTRICT.
9. WNSntoCIION L£NDING AGENCY
I hereby aillrm that there 1s a construcuon lendmg agency for the perlormance of the work ior which this permit 1s issued (Sec 3097(1) CtVJI Code).
LENDER'S NAME LENDER'S ADDRESS
IO. APPucAN'I CER'i1FlcA'i1oN
I ceruly that I have read ihe apphcauon and state that ihe above mlormauon 1s correct. I agree to comply wttn au City ordinances ana 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 ro SAVE INDEMNIFY AND KEEP HAflMLF.SS THE CfIY OF CARISBAD AGAINST AIL UABIUllES, JUDGMENTS, CDSTS
AND EXPENSES WH!Qi MAY IN ANY WAY Aa:RUE AGAINST SAID QTY IN CDNSF.QUENCE OF nm GRANTING OF nos 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 permi is sus ded or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code).
DATE: ______ _
YEU.OW: Applicant PINK: Finance
0f}/20/93
DATE
12/09/92
12/09/92
INSPECTION HISTORY LISTING
FOR PERMIT# CB921251
INSPECTION TYPE
Rough Electric
Final Electrical
INSP ACT COMMENTS
PD
PD
AP
AP
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