HomeMy WebLinkAbout2627 STATE ST; ; CB921238; Permit• PERM!T APPLICATION ~ V
PLAN CHECK NO. 12--I Ll 8
City of carlsbad Building Departaent
2075 Las PalES Dr •• Carlsbad, CA 92009 (619) 438-1161
I. PFJlMI I hPE
A -0 COmmerctal Li New Butldmg U l'enant Improvement
B -□ Industrial U New Building □ Tenant Improvement
C -□ Residential D Apartment □ Condo □ Single Family Dwelling p Addition/ Alteration
□ Duplex □ Demolition U Relocation U Mobile Home riectrical □ Plumbing
□ Mechanical □ Pool □ Spa □ Retaining Wall □ Solar □ Other
VAIID.BY
DATE
2. PRClJl!Cf INFORMATION
Address
FOR OFFICE USE ONLY
Bu1@mg or Suite No.
~" 27 Nearest Ct"O$ Street 4-'l--8
LEGAL DESCRIP I ION Lot No. Su&:i1VJs1on Name/Number Unit No. Phase No.
CHECK BEWW If SOBMI I I ED:
□ 2 Energy calcs □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROOOSED USE
3. WN IACI PERSON (II dlllerenf from appJJcantJ
NAME ADDRESS
CflY STATE ZIP CODE DAY TELEPHONE
4. APPUCANI
NAME
□WNiRACIOR UAGENI FORWNiRACIUR □OWNER □AGENI FOR OWNER
ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
ADDRESS P/2.
ZIP CODE "/2-t)O f DAY TELEPHONE
NAME I 9' • J.._ '7u b~ _.,,,,....,.,..._ .... ADDRESS
CITY STATE ZIP CODE
LICENSE CI.ASS
DAY TELEPHONE
STATE LIC. # CITY BUSINESS LIC. #
CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # 7. WORkERS' WMPP.NSX:IIUN
Workers' Compensation Declaration: I hereby afhrm that I have a certificate of consent to self-msure issued by the Dtrector 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
Ceruhcate 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.
SIGNATUR~~ DATE °ft> Mv-12..
8. OWNHR-B0tw
0Wner-Bu1ider Declaration: I hereby affmn that I am exempt from the Contractor's Llcense 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 Llcense 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.).
l!r' 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 Llcense 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 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]).
SIGNATIJRE DATE
COMPLE'IE THIS SECIIUN FOR NUN-RE:SIOE:N IIAL BOIIDING PE:RMil'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 B'°NO
Is the applicant or future building occu~nt required to obtain a permit from the air pollution control district or air quality management district? □ YES l!i'°NO
Is the facility to be constructed within yoo feet of the outer boundary of a school site?
□ YES El NO
IF ANY OF 11IB ANSWERS ARE YES, A FINAL CER11FICATE OF cxx;upANCY MAY NOT BE ISSllED AFTER JULY 1, 1989 UN1JlSS 11IB APPIJCANT
HAS Mirr OR IS MEIITING nm REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICES AND 11IB AIR FOLLU11ON CDNlllOL DI51111cr.
9. WNS'IR0CIION ll!NDING XGkNCY
I hereby afhnn that there 1s a construction lend mg agency for the performance of the work for which tbts penmt 1s issued (Sec 3097 (I) Cavti Ccxle).
LENDER'S NAME LENDER'S ADDRESS
IO. APPilcAN I CPJl liPICXf10N
I certify that I have read the appitcatton and state that the atxive mformauon 1s correct. I agree to comply wuh all City ordmances 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
pUrpo5eS. I = AGREE ro SAVE INDEMNIFY AND KEEP HARM1JlSS 11IB QTY OF CARIS1IAD AGAINsr AIL LIAB1Ul1F.S, JUDGMENTS, CDSTS
AND EXPENSES WIIlCH MAY IN ANY WAY ACDUIE AGAINST SAID QTY IN CDNSEQUENCE OF nm GRANTING OF TIIlS PERMIT.
OSHA: An OSHA permit is required for excavations over S'O" 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 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) Unifonn Building Code).
DATE: :V /Jj,,rfz__ APPLICANTS SIGNATURE// h.
CJ? ,§? <Yaci ~ File YELl.OW: Applicant PINK: Finance
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB921238 FOR 12/28/92
DESCRIPTION: UNDERGROUND SERVICE FEED
FROM OVERHEAD EXISTING
TYPE: ELEC
STR:
INSPECTOR AREA PD
PLANCK# CB921238
OCC GRP
CONSTR. TYPE NEW
FL: STE: JOB ADDRESS: 2627 STATE ST
APPLICANT: PERKETT CALVIN R
CONTRACTOR:
OWNER:
REMARKS: MH/ROY/753-9473
SPECIAL INSTRUCT:
~:~::: IIJ L PHONE:
INSPECTORM '
TOTAL TIME:
CD
34
DATE
LVL DESCRIPTION
EL Rough Electric
DESCRIPTION
ACT COMMENTS
&
***** INSPECTION HISTORY*****
ACT INSP COMMENTS