HomeMy WebLinkAbout2551 STATE ST; ; CB960942; PermitL L D I N G F t K M I T Pe r,,· t N : CE oO<tt.
0 0 0 : 49 Pro ect No: K O ,·
1i:1e 1 at 1 Deve'opmerrt l'in
l ht Addre ?i::,1 T!)TE ST Suite:
er.nit Tvpe: ELE:TRICAl
re 1 No= 203 -O~Lt-21-00 lot •
u( l<')tlon: 0
7736 05/29/96 0001 01 02
C on -:. t r u t 1 on Ty ,!;-P-RMt 80. 00
Ot~urancv Group: Reference#=
)f cr1i,t1on: R PLACE' FEEDS TO t1E1ER
Statu":,c ISSUFD
Api:l1p,i: 0 9 91'
Apr/I.-_<:,ue: 0~/2 1 Ii
l t\V MJF
fl ,pl/ wnr : E,IGLEY EL.E.CTRit 619 7L8 ,oo
11 9 S. MISSION ROAD
1-\1 LE:sRC ~', CA. 920ll-l
Fees Req, ired
Fee-.:
Al 1u ,trnent~,.:
, ta FeE":,:
dt~ ,er,~ ,on
t-1ter 'Y' tor Electr
tnter ''r" tor Rernod·
Other * E .. E.C1RICAL TOTAL
.0
. 0
80.00
Ext fFE" D
10 00 'r
10 00 'r
l( " *
60 00 SAT. [ I
80 00
r AL
INSP. ____ DATE ___ ,
CLEA h
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 920()() (619) 438-1161
•
Pl!RMIT APPLICATION PLAN CHECK NO.
City of Carlsbad Building D-rtllel'1t
2075 Las Pal-Dr., carlsbod, CA 92009 (619) 438·1161 HST.VAL.-=-===:----------
I. PEAMII hPE
PIAN CK DEPOSIT _______ _
VALID. BY __________ _
DATE
From List l (see back) give code of Permic-Type: ____________ _
----------------------------------------··········-------
For Residential Projects Only: From llst 2 (see back) give
Code of Structure-Type: ___________________ _
Net Loss/Gain of Dwelling Units
2. PRClJECf INFORMATION FOR OFFICE USE ONLY
BuUdmg or Suite No.
Nearest Cross Street
UIDAL DESCRIYI ION Lot No. Subd1v1S1on Name/Number Omt No. Phase No.
CHECR BEWW IF S0BMll 1£0:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope
ASSESSOR'S PARCEi,
DESCRIPTION OF WORK e. e.p (c..,._ ._ EXISTING USE PROP9SED USE
SQ. FT. # OF STORIES # OF BEDROOMS # OF BA111ROOMS
3. WN IACI PFJlSON (11 dlllerenf from apphcanl)
NAME (last_name first) ADDRESS
CI1Y
4. APPIJCANI :utcJNtRXCIUR
STATE ZIP CODE DAY TELEPHONE
DOWNER □AtENI FOR OWNER
NAME (last name first)
UXGENI FORWNIHACIOR
ADDRESS
Cl1Y ZIP CODE DAY TELEPHONE
S. PROPEkii OWNRk
NAME (last name first) ADDRESS :? SS7 f 779 /"£. £ r:
Cl1Y 04-/ll) /jlJf} STATE ZIP CODE DAY TELEPHONE
g_ :£'.:Pt!/~mefirst) f3!6U!'-{ /z_(.,~C-T/i(C .CK, ADDRESS //(<j J. ,1?1/J_fn,-, ;U).
c11Y Pl9u!Jrw<-•~ sTATEC/1 z1PcoDE 7_;i:,z.g DAYTELEPHONE ?c.FJ-'l.fOo
STATE !JC. #S'f~YJ b' LlCENSE CLASS C-( iJ Cl1Y BUSINESS !JC. #
DESIGNER NAME (last name hrst) ADDRESS
Cl1Y STATE ZIP CODE DAY TELEPHONE STATE !JC.#
7. WukkERS' WMPENSAI ION
Workers' Compensauon Declarat1on: I hereby afhrm that l 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 Depanment (Section 3800, Lab. C).
□
□
□
Owner-BuUder Declaration: I hereby atunn that I am exempt from the Contractors License law for the ioiiowmg 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 or 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 chis reason:
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a pennit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for such pennic co tile 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.S by any applicant for a pennit
subjects the applicant to a civil penalty of not more than five hundred dollars [$500]).
SIGNATIIRI! DAT!!
OOMPLE'IE IHIS SEC I ION FOR NON-RESIDEN IIAL BUIIDING PERMll'S ONLY:
Is lhe 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 obcain 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 oucer boundary of a school site?
□ YES □ NO IF ANY OF nm ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NCYf BE ~ AFTER JULY 1, I 989 UN1J'.SS TIii! APP1JCANT
HAS MET OR IS MEJmNG nm REQUIREMENTS OF TIii! OFFICE OF EMERGENCY SERVICES AND TIii! AIR PO!llJTION CONlllOL DISl'RICT.
9. WNSIRDCIION LENDING XGF.NCY
I hereby alhnn mat mere IS a construcuon lending agency for me perfonnance of the work for which this penmt 1s issued (Sec 3097(1) C1vU Code).
LENDER'S NAME LENDER'S ADDRESS
JO. XPPiJCXN i CFJliiFICXiiON
I cerufy that I have read the apphcauon and state that the above mfonnauon 1s correct. I agree to comply wuh all City ordinances and State laws
relating to building construction. I hereby authorize representatives of the Cicy of c.arlsbad to enter upon the above mentioned property for inspection
purposes. I ALSO AGREE ID SAVE INDEMNIFY AND KEEP HARMlJ'.SS nm Cl1Y OF CARJSIIAD AGAINST AU. IJABILITIES, JIJIJGMENIB, <XlSl'S
AND EXPENSES wmrn MAY IN ANY WAY ALDUIE AGAINST SAID Cl1Y IN CONSF.QUENCE OF nm GRANTING OF nus PERMIT.
OSHA: An OSHA permit is required for excavations over S'O" deep and demolition or construction of scructures over 3 stories in height.
ExP.iracion. Every pennit issued by the Buil in Fe· under the provisions of this Code shall expire by limitation and become null and void if the
building or work authorized by such · t menced within 365 days from the date of such permit or if the building or work authorized by
such pennit is suspended or abando , · after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code?
APPLICANTS SIGNATURE . DATE, j"-? f -9
WI-IlTE: File YEU.OW: App 1cant PINK: Ftnance