The URL can be used to link to this page

Home My WebLink About2579 STATE ST; MULTI-PERMIT FILE; 62-4149; PermitAPPLICATION FOR B ~DING PERMIT 4149 L CITY OF CARLSBAD -BUILDING INSPECTION DIVISION PHONE PArkway 9-1181 • Ext. 36 Owner Name .. A .. ol. ... J< ..... ~····················· ...... Mailing Address ....... ~~.:.Z. .. 2 ...... ~~········· ......................... . ( Please Print) (Last) (First) (Middle) Number Street City Phone Contractor ............ ~•····•··········•·············· ........................... Mailing Address ....... ~.~·················· ........................... . ( Please Print) Number Street City Phone To Construct I!] To Add ~ To Alter D To Repair D To Convert D To Move From ............................................................. . Type of Const.~ ... -/:/14,1,,::zn .................................... No. of Stories .... ./ ...... To Be Und for .~.'/i.::/.~i.!J.✓---✓,. ................. . (Frame, Masonry, Etc.) (One Family Dwelling, Store, Etc.) Floor Space of Proposed Construction (sq . feet ............ .S..1). .. 0. ............... Const. Valuation $ ....... 4~.0 .. 0 ... ~ ............................................................ . attached D Floor Space of Garage (sq. feet) ................................................. detached OConst. Valuation $ .................................................................................................... .. LEGAL DESCRIPTION ................................................................................................................................................................................................................................... . Lot Block Subdivision or .................................................................................................................................. Section .................................... Township ............................ Range .......................... . Located at ... ;;;2..£.7 .. 9 ........ $.../A:.£..~ ....................................... Street, Near ........ t.:..~ ... r.£.W. .. N .. 8 ........................................................... .. Assigned House Number LAND AREA ...................................... NUMBER OF EXISTING DWELLINGS ON PROPOSED BUILDING SITE .J.. ......................................... (INDICATE SIZE, USE AND LOCATION ON PLOT PLAN). WILL THIS CONSTRUCTION INCLUDE ANY PLUMBING INSTALLATION, ALTERATION, OR ADDITION? YES................ NO .. ~ .... I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILOING CONSTRUCTION. If a check is tendered for f:·oyment of the above fee and the check is not honored when presented for payment, your Building Permit will be immediately revoked. SIGNATURE OF PERMITTEE .. Front Yard Set Back .................. ./ ............................................... . Side Yard Set Back ..................................................................... . Rear Yard Set Back ..................................................................... . Distance Between Bldg ................................................... . Off Street Parking Spaces .. ./::A:.4.dt.//.l)N...!J. . ../ ........ . • I I Sewage Disposal System .$)(i.~J.cf. . .JN.9················· ....... . Zone • Residential ( ) ········································· .................. . Zone • Commercial f:l ~/'r? ......................................................... . Variance Eng. Check By ............................................................................... . Driveway Permit Required Yes ( Grading Permit Required Yes ( ) Sewer Disposal Plant Capital Cont, No ~:)( :-. .. F•e·e························:·.·y_·.·.·.·_-.·.·.·.·.·.•.·.·.·.·.·.·.·_-_-. ~ \ Fee ............................................. ,;. ..................... . Sewer Pumping Station Capital Cont. Fee .t::. ............................................................... . Sewer Main Line Cost .. V.::: ....................................................................... i ..................... . Sewer Lateral Connection Charge .. ~ ................................................. J ..................... . Water Stocked Lands Charge ........................................................................................ . : :::: ::~:ep::v~~:e c:::g~· ·.·.:·.·i.::~~f f.~.~:·.·.:::::::·.:::::::::::::·.:::::::::::·.:::::·.:·.:::::·.:::::::·. t1-' Water Meter Charge ....................................................................................................... . Sub Total ..................................................................................... . :::sro:::r::ed~.l.c!°_'.S .·~------(Q--.-,·.·_-.·_-_-_-_-_-_-_-_-_-_-_-.· . .-.-.. .-.-.-.-.-.-.-.-.-.·.-.·.·_-_-_._._._._._._._._._._._. .... _. .. _._._. .................. .-... :~i~di~:e::r::e F~~···.·.-.·.·.·_-.,·.·.·i..·.~~·.·_-.·.·.·_-_-_-_-_-.·.·.·_-.:·.·.·.·.· .. ·.-.·.·.·.:·.·.·.··_-.·_-_-_-_-.:·.··_-_-_-_-_-_-.·_-_-_-.·_-_-_-_-_-.·.·.·_-_-. Date ........... ~ .. ~ .... .{ ... 4. .. '.:':':':: ... 6.. ... ~:.............................................. Total Charges ....... /~.~ ................................................................. .. .... -. .., r, ELECTRICAL PERMIT APPLICATION Permit No. .'f-21,/-1 / Applicant to complete numbered spaces only. City of CARLSBAD, CALIFORNIA 92008 Phone 729-1181 JOB ADDft ESS TftACT Qs1tE ATTACHl.0 SHEET) ZIP 4 ENGINEE9' MAIL AODIIIESS PHONE LICENSE NO, 5 LENDUt MAIL ADD"ESS lllllANCH 6 USE OP' ■UILOING 7 8 Class of work: □NEW .{;J,AOOITION 0 ALTERATION 0 REPAIR 9 Describe work: -~o No. Each SPECIAL CONDITIONS: ISSUANCE OF EACH PERMIT NEW CONSTRUCTION, FOR EACH 1-,,.-P-PL-I-CA_T_IO-N-AC_C_E_PT_E_D_B_Y_: ..... P-LA_N_S_C_H_E_CK_E __ D_B_Y ___ ..,..,,.-P-PR_O_V_E_D_f_O_R _ISS_U_A_N_C_E_B_Y.. AMPERES OF MAIN SERVICE, SWITCH, FUSE OR BREAKER / NOTICE NEW SERVICE ON EXISTING BLDG. FOR EA. AMPERE OF INCREASE C,e,_") , 2 IN MAIN SERVICE, SWITCH, FUSE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC· TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM• MENCED. I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATu•c OP' t CTOR OR 0 P' WN Ill ,,. OWNER •UtLDE" DATE OR BREAKER REMODEL, ALTERATION, NO CHANGE IN SERVICE, FOR EA. AMPERE OF INCREASE TEMP. SERVICE UP TO AND INCLUD· ING 200 AMP. TEMP. SERVICE OVER 200 AMP. PER 100 MINIMUM PERMIT FEE WHEN PROPERLY VALIDATED UN THIS SPACEI THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. INSPECTOR M.O. Fee 0 t z .. " ,:2... /S: CASH 1 "1 r-r-, ... ' ' "'O a ~ • 3 > -· Or+ 0 "Z : 0 ,. . MODEL NO. ___ ...,... _____ _ BUILDING PERMIT APPLICATION _-? _ J City of CARLSBAD, CALIFORNIA 92008,uN 1"'_7 Applicant to complete lr'J-m~red s%es only. Phone 29-118 Perm it No. Joa A.ODA E!S PAGE PAR. PHONE STATE LIC. NO. CITY L IC. NO. ARCH ITECT OR OCSl(;N[A MAIL .lt.OORESS PHON t 4 CNCINECA MAIL AODRC.SS PHONE 5 COMPENSATION INS. CARRIER MAIL AOOlltCSS 6 use o,-BUILDI NG 7 8 Class of work: □NEW 9 Describe work: 10 Change of use from Change of use to 11 Valuation of work: $ PLAN CHECK FEE$ .. s_P_E_C_I_A_L_C_O_N_D_I_T_IO_N_S_: ----------------------, Type of Const. 1-------------------------------~ Size of Bldg. DATE DAT~ NOTICE SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB• ING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. I H EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGN.ATV,.£ o, OWNER Ir OWNCJIII: ■UILOtJllt} OAT[) (Total! Sq, Ft. No. of Dwelling Units Special Approvals PLANNING 00EPT. HEALTH DEPT. Fl RE DEPT. SOIL REPORT OTHER (Specify) ENGINEERING DEPT. WATER DEPT. Occupancy Group No. of Stories use Zone LIC[N$£ NO. LICCNSE NO, Max. 0cc. Load Fire Sprinklers Required D Yes D N o OFFSTREET PARKING SPACES: No. Covered Required Sq. Ft. Received No. Open Not Required WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. --0 TOTAL FEES $---="------- ROBCO 550 LAGUNA DRIVE CARLSBAD, CAL IF. 92008 714 -729-2358 R. R. ROBINSON Investments Lot 14 of SEASIDE LANDS, in the City of Carlsbad, County of San Diego State of California, according to the map thereof Nol 1722, filed in the Office of the County Recorder of San Diego County July 28, 1921. It is at the rear of 2975 State Street and old residentual Building. 1~L {LVL,_ 1~(i;f i~ ,. LICE~ED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my licensa is In full force and ef- feci. OWNER-BUILDER DECLARATION 0 1 hereby affirm that I am exempt from the Con- tractor's License Law for the following reason (Sec. 7031.5 Business and Professions Code), Any city or county which requires a permit to con- struct, alte,, Improve, demolish, or repair any structure. prior to its issuance also requires the applicant for such permit to file a signed state- ment that he Is licensed pursuant to the provi- sions of the Contractor's Llcensa Law (Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that Is ex- empt therefrom and the basis for the alleged ex- emption. Any violation of Section 7031.5 by an ap- plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dolla,s ($500). DI. 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 of- fered for sate (Sec. 7044, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work hlmsell or through his own employees, provided that such Improvements are not Intended or of- fered for sale. If, however, the building or Improve- ment 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). '.JI, as owner of the property, am exclusively con- 1ract1ng with licensed contractors to construct lhe project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not ap- ply to an owner of property ·•ho builds or im- proves thereon, and who contracts for such pro-, lects with a contractor(s) license pursuant to the contractor's License Law). I am exempt under Sec _____ B. & P.C. for this reaso .. _____________ _ Date Owner _____ _ WORKERS' COMPENSATION DECLARATION I hereby affirm that I have 1 sent to self-Insure, or a cert Compensation Insurance, or! a c1ulflll)d <#oPY thereof (Sec. 3800, La COMPANY / POLICY NO ~ I \< /' □Copy Is flied with the city. ii □Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the per· mil Is for one hundred dollars ($100) or less). 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 Catlfomla. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the LabOr Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm thal there Is a construction ten- CITY OF CARLSBAD-BUILDING DEPARTMENT USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 NO. Joe ADDRESS tR~T. Ii~ §l?TION .2,s;?,9, I .s I 1i .cl --r. f' I Ir;_ 1--r. I ,'7,2.1&J1-1 /, J,11'l1 I I I I owif ;i ~ . r;, ✓ t/ / C .t'. OWNER'S PHONE PRIME CONTRACTOR I I r.J} <'.Ot-"·~ ........ ow::3r?9 ADD:ir»h Ji-0.dJI /o/4:..-I CONTRACTOR'S ADDRESS C# LOT BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. ,, DESIGNER I I I I I I I I I I I DESCRIPTION OF WOflK ,t,_,· :f ~ ,/ I? J<. .,. ·"~ /,' . .,/ ,,.---DESIGNER'S ADDRESS -,-;/ CENSUS TRACT GP LAND USE / ZONING APPLICANT TO FILL IN INFOR - MATION WITHIN RED LINES. i;;l:~7 PERMIT NUMSER go ✓ STATE LICENSE //:U i2Pt.Jt13 I CONTRACTOR'S PHONE STATE LICENSE l?/ .. /1/:' ,T7J DESIGNER15 PHONE ., 41 'I I RES. UNITS I PA;KING SPACE sf I NUMBER o, sToRIEs Nat V,lid Un'-M«hiM c.rtifi_, BLDG SQ. FT. BLDG USE occ. GP I STANDARD PLAN# I PLAN ID # I TYPE CONST I occ. LOAD I QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. / EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU EACH BUILDING SEWER OVER 100,000 BTU EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP I .,, u /1/ EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP A ./JI' \11 EACH GAS SYSTEM 5 OR MORE BO I LE R/COMPRESSO R 16-30 HP If\}'. EACH INSTAL.. ALTER. REPAIR WATER PIPE VENT FAN SINGLE OUCT J/. EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS VALUATION: WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I ISSUE 3.00 lSSUb .) •. uu SIGN PERMIT I . I TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I I I . CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I ELECTRICAL PERMIT AMT. TOTAL PLUMBING I I -QTY. AMT. QTY. MOBILE HOME PERMIT .I ELECTRICAL I 1'lff ., ,., .,. NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL I I_,,,,, 1 PH .25 3 PH PORCH MOBILE HOME I I I EXIST BLOG EA AMPISWT/BKR SET-UP SOLAR I . I I I 1 PH .25 3 PH -RAMADA. CABANA I . I I I !JO REMODEL/ALTER PER CIRCUIT r.~· FENCE OVER 6' I I I I TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO·FILM I I I I OVER 200 AMPS I . I I : I TEMP OCCUPANCY (30 OAYSI I . I I I TCC::111::; ? . ()() <::TDn?\Tfc .,.----• I . I I I TOTAL ELECTRICAL --;.tfll. TOTAL FEES PAYABLE I rl.!1--l..,,,o CONTRACTOR . I I . I I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, AND DO 0A N OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0" DEEP ANO DEMOLITION OR CONSTRUCTION OF FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY. STRUCTURES OVER 3 STORIES IN HEIGHT COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER ~~✓-Sa-IOOL FEE: SPECIFIED HEREIN OR NOT. l,ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM· 'I~ LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND I\ ,.J Ex,ENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. j ~NA~--~~ OWNE~ CONTRACTOR□ I APPROVED BY r 1 ~ f E AGENT D BV PHONED - ! < 0 ~ ~ j::: ~ 0. V) ~ • '• SITE - ADDRESS: < ~ OWNER: C PERMIT NO: '' " FIELD INSPECTION RECORD . - ~ INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION • FORMS• SET BACK • TOILET UNDER FLOOR PLUMBING ' --~ ~ ~ ---< . - UNDER FLOOR HEATING OK TO INSTALL SUB FLOOR - ---- SLAB FLOOR ' UNDER SLAB PLUMBING FOOTING • FORMS• SETBACK • TOILET OK TO POUR CONCRETE FRAME ROUGH ELECTRICAL ., ROUGH PLUMBI_NG ROUGH HEATING/VENTILATING FRAME OK• PLACE INSULATION -' INSULATION OK • PLACE WALLBOARD WALLBOARD OK• PLACE TAPE . EXTERIOR LATH OK • PLACE STUCCO - FIREPLACE . ' \ DAMPER & STEEL PLATE TIES/HEIGHT OF CHIMNEY ' OTHER TEMP POWER (POLE) . SEWER ,. GAS TEST SWIM POOL • STEEL BONDING • PRE DECK ·-. •, ~ • FENCE PREPLASTER SHOWN • FRAME • PAN . FINAL INSP BY BLOG DEPT OTHER DEPT'S REQ COMPLETED . -ELEC METER-PERM-TEMP GAS METER-PERM-TEMP CERT OF OCCUPANCY ISSUED - ....,.. _______ .,liiiii ___ ~ __ ,,__, _____ _, ____________________ ---~ )' .. ,:,,,,-,, B U I L D I N G P E R M I T Permit No: CB901062 Project No: A90 01167 Development No: 06/26/90 11:25 Page 1 of 1 Job Address: 2579 STATE ST Permit Type: PLUMBING Parcel No: Valuation: 0 Construction Type: NEW Occupancy Group: Description: GAS REPAIR OWNER : VANDERPLOEG, PAUL *** Fees Required *** Fees: Adjustments: Total Fees: Fee description Str: Fl: Ste: ~ r n~,~f/QO onc1 n1 02 • 0 r CX~l3?{) Class Code: Status: ISSUED *** Applied 06/26/90 Apr/Issue Validated By: DC Lie. OWNER Fees Collected & Credits Total Credits: Total Payments: Balance Due: .00 .00 10.00 *** Units Fee/Unit Ext fee Data Enter "Y" for Plumbing Issue Fee 7.50 Y 2.50 10.00 Gas Piping System * PLUMBING TOTAL CllY OF CARLSBAD PERMIT APPLICATION 11\ ., • City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 A • C PERMIT TYPE COMMERCIAL D INDUSTRIAL 0 RESIDENT !AL O APARTMENT □DUPLEX ODEM0LJTI0N □MECHANICAL □POOL TENANT IMPROVEMENT □TENANT IMPROVEMENT OC0N00 □SINGLE FAMILY DWELLING □ADDITION/ALTERATION □RELOCATION □MOBILE HOME □ELECTRICAL □PLUMBING OsPA □RETAINING wALL OsotAR □OTHER ROJECT INFORMATION PLAN CHECK No. VALID. BY_-,,,""::_ ________ _ DATE Nearest Cross Streets J'!!f11:iL,L,,#1_ ,,,,,,,,_,,, LEGAL DESCRIPTION L~ Subchv1S1on Name/Nurber Unl t No. Phase No. CIIECIC BELOW IF St.BUTTED: D 2 Energy Cales Qz Structural Cales Q2 Soils Rep0rt 01 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE # OF STORIES 3. CONTACT PERSON "" /hw t/AN41£12.l/.olEt--ADDRESS :1:s 79 .S-r~f-~ c>r/U$JE. r cm 0/lllJ..,S 81'11:;> I CJ!· STATE ZIP CODE 9-,ooe DAY TELEPHONE 7.29-/" ~ '-/ SIGNATURE ~&,1)~ 4. APPLICANTQcoNmcroR 0 AGENT FOR COIHRACTOR QO\.INER QAGENT FOR OWNER 7. 8. NAME CITY STATE STATE LIC. #, ____ _ ADDRESS ZIP COOE ADDRESS ,579 ZIP CODE ADDRESS ZIP CODE LICENSE CLASS _____ _ DAY TELEPHONE QTENANT DAY TELEPHONE DAY TELEPHONE CITY BUSINESS LIC. # SIGNATURE TITLE DATE D SIGNER NAME CITY WORKERS' COMPENSATION STATE ADDRESS ZIP COOE DAY TELEPHONE STATE LIC. # workers' Compensation Declaration: hereby affirm that have a certificate of consent to self·msure issued by the Director of 1ncLstr1al Relations, or a certificate of Workers' Compensation Insurance by an actni tted insurer, or an exact copy or dupl i cate thereof certified by the Di rector of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY POLICY NO. EXPIRATION 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 sl.bject to the Workers' Compensation Laws of California. SIGNATURE DATE OWNER-BUILDER DECLARATION Owner·Bu1lder Declaration: I hereby affirm that I am exempt from the Contractor's Lic.ense 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 iirproves thereon,. and who does such work himself or through his own employees, provided that such i~roveinents are not intended or offered for sale. If, however, the building or iirprovement is sold within one year of COfl1)letion, the owner-builder will have the burden of proving that he did not build or iirprove for the purpose of sale.). O 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 i~roves 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: (Sec. 7031.5 Business and Professions Code: Any City or county which requires a permit to construct, alter, iirprove, demolish, or repair any structure, prior to its issuance, al so requires the applicant for such permit to f i le a signed statement that he is licensed pursuant to the provisions of the ContNctor's License Law (Chapter 9, conmencing 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 tor a permit sl.t>jects the applicant to a civil penalty of not more than five hundred dollars {$5001). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Js the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk manageinent and prevention program under Sections 255D5, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □YES ONO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □YES ONO Is the facility to be constructed within 1,000 feet of the outer boiiidary of a school site? 0YES o,o IF ANT Of THE ANSWERS ARE TES, A FINAL CERTIFICATE OF oca.F'ANCT MAT NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING TKE REQIJIRBIEIITS Of THE OFFICE OF BIERGEICT SERVICES All> THE AIR pOl.LUTION CONTROL DISTRICT. 9. CONSTRUCTION LENDING AGENCY hereby llffirm that there is a construction lending 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 J 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 Cartsbad to enter L.pon the above mentioned property for inspection purposes. I ALSO AGREE TO SA.VE INDEMNIFY AND KEEP HARMLESS THE CITY Of CARLSBAD AGAINST All LIABILITIES, JLOCXNTS, COSTS AND EXPENSES WHICH NAT IN ANY WAY ACCRUE AGAINST SA.ID CITY IN CONSEQUENCE Of THE GRANTING OF THIS PERMIT. Expiration. Every permit issued by the Building Official urder the provisions of this Code shall expire by limitation and become !"IJll and void if the building or work authorized by such permit is not conmenced within 180 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 coomenced for a period of 180 days (Section 303(d) Uniform Building Code). Dev PHONE APPROVED BY~ ______ _ DA.TE: YELLOW: Applicant PINK: Finance PERMIT APPLICATION • PI.AN CHECK NO. C/, City of Carlsbad Building Department 2075 Las Pal..,. Dr •• Carlsbad, CA 92009 (619) 438-1161 I. PEilMII hPE A -U COmmerc1al B -□ Industrial C -□ Residential □New Building D Jenanc Improvement □ New Building D Tenant Improvement D Apartment □ Condo □ Single Family Dwelling □ Addition/ Alteration □ Duplex □ Demolition □ Relocation O Mobile Home □ Electrical D Plumbing □ Mechanical □ Pool D Spa □ Retaining Wall D Solar □ Other 2. PR RMATION FOR OFFICE USE ONLY ressQ57? / ;?~99/,,Z.&,o/ Nearest Cross Street LEGAL DESC:RIJfl ION Lot No. Sulxl1vis1on Name/Number Omt No. Phase No. □ 2 Soils Report □ 1 Addressed Envelope EXISTING USE PROPOSED USE rom app 1can NAME Cl1Y STATE ADDRESS ZIP CCDE DAY TELEPHONE 4. APPUCANI NAME UWNIRACIOR □AGENI FURWNIRACIOR DOWNER UAGENl FOR OWNER ADDRESS CI1Y !mTV STATE ZIP CODE DAY TELEPHONE ~OWNER NAME t._ ,=ow f-e_,-/ CI~ STATE .J,ALIOR ADDRESS ZIP CCDE DAY TELEPHONE NAME _5 f L.. I=_ / e c. "t-/l. •' C.. ADDRESS CIIT L/ i) rC-STATE L ,A.. ZIP CODE P. D. gt:Jd-"3 /DO.TATE UC. # 'i?--2, 'f '/ucENSE CLASS DAY TELEPHONE C. /0 CI1Y BUSINESS UC. # CI1Y STATE ZIP CCDE DAY TELEPHONE STATE UC.# 7. WUitkkkS' WMPENSAiiON Workers' Compensation Declaration: I hereby afllrm that I have a cert1hcate of consent to self .insure 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 Cert!Ucate of Exemplton: I certify that in the performance of the work [or which this penmt is 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. OWNKK-BUIIDER Df.ciARAliUN dwner-Bu1ider Declarat10n: I hereby athrm that I am exempt from the t.Zntracto?s Llcense Law for the followmg reason: □ I, as owner of the property or my employees with wages as their soie 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). D 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 IHIS SEellON FOR NON-RESIDENTIAL BOILbiNG PERMll'S ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn 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 to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES ONO IF ANY OF nm ANSWERS ARE YES, A FINAL CERTIFICATE OFcxx:uPANCY MAYNUf BE JS.WED AFTER.JULY 1, 1989 UNUlSS nmAPPIJCANT HAS MET OR IS MEEIDIG nm REQUIREMENTS OF TIIB OFFICE OF EMERGENCY SERVICES AND THE AIR POlLlfllON CONmOL DISIRICT. 9. WNSIR0CIION LENDING AGENCY I hereby afhrm that there 1s a construction lendmg agency lor the performance of the work for which this pernut 1s issued (Sec 309)(1) CIVIi Code). LENDER'S NAME LENDER'S ADDRESS 10. J\PPLiCAN I cmtffiiCX'liUN I certify that I have read the apphcatmn and state that the above information 1s correct. ] agree to comply wuh aJJ Luy 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 AISO AGREE TO SAVE INDF.MNIFY AND KEEP HARMLESS nm CITY OF CARISBAD AGAINST AIJ. UAIIIUTIES, JUDGMEN11i, CXlSfS AND EXPENSES WHICH MAY IN ANY WAY ACXJUIE AGAINST SAID CITY IN CONSEQUENCE OF TIIB GRANTING OF TIIIS PHRMIT. 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 authoriz such it is not commenced within 365 days from the date of such permit or if the building or work authorized by such perm't is sus d o aband ed at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). DATE: ______ _ WIBTE: File YELLOW: Applicant PINK: Fmance ·-------·•········--·----------- 05/19/~3· , INSPECTION HISTORY LISTING FOR PERMIT# CB921311 DATE 03/11/93 03/11/93 INSPECTION TYPE Rough Electric Rough Electric HIT <RETURN> TO CONTINUE ••. INSP ACT COMMENTS RI RI MH/SAM/941-2881 PD AP