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Home My WebLink About2609 SOMBROSA ST; ; CB971697; Permit--------------------- CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 >ERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 1. PRWECT INFORMATION Address (include Bldg/Suite #) \ d, (e O 9 ~ 0"" "() r-0-"> A. Business Nama\l~t this ■ff1ir■ss) ..s.-r C <!.<.\; \;. b S< cX Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total I of units Assessor's Parcel # Existing Use Proposed Use I of Bedrooms # of Bathrooms Name Addrau City State/Zip Telephone I Fax# b,"' , AJiPl:icJt.iiit ·· " □ ciiitt/fcia,:,~eii!'l111,eollla1)1;1!1□'J!wa,f;"t□ 11ar.,na;~liif"'·~•w~~~·~,,,,,, • ··, , '·, (Sec. 7031.6 Business and Professions Code: Any City or County which requires a permit to construct, altar, Improve, demO,lsh 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 IChapter 9, commanding with Section 7000 of Division 3 of the Busi09u and Profeulons 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 1$500)1. Name Address ~C..... State/Zip '1'!zb).(Jelephone I I State License # ~~~~~~~---License Cl11s _ _;L'=---3='-_':l....1..._ Ctty Buslneu Ucense I /"?G,l~j/' Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: l§__ I have and will maintain a certificate of consent to self-insure for workers' compensation II provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. D I have and Wm maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensatiOn insurance carrier and i:;olicy number are: Insurance Company \-\'Q.16-...)\:\-=7 Policy No. f\C.:,,.,<..._ '1,l71'Jj -OC Expiration Date \b -,-c::r:-z (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*1001 OR LESSI D CERTIFICATE OF EXEMPTION: I certify that In the performance of the work for which this permit is ilsued, I shall not employ any pereon in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to ucure workert' compenutlon coverage II unlawful, and lhal tubfect an employw to crlmlnal penalties and dvil flnn up to one hundr■d thousand doU■ra 1$100,0001, in addition to the coat of compensation, dam■g■s ■a proviud for In Section 3708 of the Labor cod■, interast and attorney'• fNs. SIGNATURE _______________ ---------,-------------------DATE _________ _ 7. OWNER-BUILbEII Di!ct.:ARATION · ..,_ •.•.. ,, .. ,~~.-, ,;,·"'·-'~-~--~:J..a;;;,;;::),:f:' ;:h·-,.:~,"'"'°" I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D I, 85 owner of the property or my employee• with wage, as their tole compensation, will do the work and the structure ls not Intended or offered for sale (Sec. 7044, Busine,s and Professions Code: The Contractor's License Law don not apply to an owner of property who buJlds or Improves thereon, and who doea such work himself or through his own employees, provided that 1uch improvements are not intended or offered for sale. If, however, the building or Improvement ls 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 Hie). D I, as owner of the property, am exclusively contracting wtth llcansad contractors to construct the project (Sec. 7044, Bualneu and Profusions Code: The Contractor's License Law does not spply to an owner of property who builds or improves thereon, and contracts fo, such projects with contractor(s) licensed pursuant to the Contractor's License Lewi. D I am exempt under Section ______ Business and Professions Code for thlt reason: 1 . I personally plan to provid, the major labor and materials for construction pf the proposed property improvement. D YES ONO 2. I !have/ have notl signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction Cinclude name / addreu / phone number / contracto,s license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number):. ____________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persona to provide the wo,k Indicated Unctude name/ address/ phone number/ type of work).:_------------------------------------------------------- PROPERTY OWNER SIGNATURE_______________________ DATE _________ _ ·coMPLm 'THIS ·secnoM•FOfl N~'IUilbiNca"PERMrtl'oHL'Yt•I!?f;~~:-~1~:~i•~:?1:ttt~\~~.i;!'f,~~~~~¥;¥¥':~t-··?: ,;:r/~'.f'-""~''""ri-::'!?:-~; _· Is the applicant or future building occupant requirff to submit a business plan, acutely hazardous materi■i. ragistratlon form or risk msnagement and prevention p,ogram under Sections 25505, 25533 or 25534 of the Presley-Tenner Hazardous Substance Account Act? 0 YES D NO Is the appllcant or future bF.ailding occupant required to obt■in -a permit from the air pollution control district or air quality management district? 0 YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site7 D YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT IE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES ANO THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending ■gency for the performance of the work for which this permtt Is luued (Sec. 3097(1) Civil Code). LENDER"S NAME_____________ LENDER"S ADDRESS'===,-=============--:--:-:-,-------,-'9. · ,. · 'APPUcANT CElitiFICA tii>tf~1'('~':'?'"'"'zyl'!i'''.':.V'.J;Kl~'Tq!"<'!:acf,,\;~r:;~~-:'fiilf:'7i'1i:::C'\~"\'ll~-~·~:c.rz;;;;.-i.:;-1;r~,~1r.;,;;r:,:=1'.~'.T;>t~ILl"l:.~~:~i"F!I.fft:":"'~"::::".:::7.;_. --·•;, , • . " ,, • I certify that I have read tha appHcation and state that the abova Information Is correct and that the information on the plans la ■ccu,ate. I agrH to comply wh:h ■II City ordinances ■nd State l■ws rlllatfflg to building -constructJon. I hereby authorize repnsantativas of the Cltt of Carlsbad to ent■I' upon the above mentioned property for Inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP HARMLESS THE CITY OF CARLSBAD AOAJNST AU LIABILmES, JUDGMENTS. COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5•0• dffp and demolition or construction of structures over 3 stories In height. EXPIRATION: Every permit IHued by the Blrildlng 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 data of such permit or If the building or work authorized by such permit is suspended or abandoned at any time a he work is com me c for a period of 180 days (Section 108.4.4 Uniform Building Code). DATE __ f_-_;)...,_is:,_-=_'l'_f __ _ • 05/08/98 INSPECTION HISTORY LISTING FOR PERMIT# CB971697 DATE INSPECTION TYPE INSP ACT COMMENTS 06/25/97 Roof/Reroof RI RI B/SLYVESTER ROOFING/743-0048 HIT <RETURN> TO CONTINUE ..•