HomeMy WebLinkAbout234 TAMARACK AVE; ; CB911444; PermitB U I L D I N G P E R M I T Pe1mit
Project
Development
Ne>: CB'911444
No: A9!0 t!Jo
No:
10/2S/91 l.:1:32
P,1ge 1 of 1
Job Adnress: 234 TAMARACK
Permit Type: PLUMBING
Parcel No: 204-270-41-UO
Ve1luation:
Construction Type: NEW
Occupancy Group:
()
AV
Description: GAS LINE REPAIR
Appl/Ownr : PERISDOK, TAMARA
234 TAMARACK AVE
CARLSBAD , tA 92008
Fees Required
Fees :
Adjustments:
Total Fees:
Fee description
Enter "Y" for Plum
Gas Piping System
* PLUMBING TOTAL
***
Class C'ode :
r
INS
Str:
b19
Fl: Ste:
4985 10/25/91 0001 01 C-PRMT
02
10.00
Status:
Applied:
Apr/Issue:
Validated By:
942-0427
ISSU:'.:D
10/25/91
10/25/~1
SBB
. no
.oo
10.00
J<. A A
Ext fee Uata
7.50 Y
2 .50
10.00
APPROVAL
;.__DATE//.t·o//
CLEARANCE ____ _
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION PLAN CHECK NO.
City of Carlsbad Building Departaent
2075 Las Pal-Dr., Carlsbad, CA 92009 (619) 438·1161 F.S'f.VAL~-----------
PIANCKD~ -
I. P£kMII I YPR =·:zdi#--72
A -LI COmmerc1al Li New Bmldmg Li tenant Improvement
B -□ Industrial □ New Building D Tenant Improvement
C -□ Residential □ Apartment Li Condo □ Single Family Dwelling □ Addition/ Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical )(Plumbing
□ Mechanical D Pool D Spa □ Retaining Wall D Solar □ Other
~amcr INFORMATION FOR OFFICE USE ONLY
✓dress 2...3 ¥ -r,i/11fA/!!AC,K' ,'l/£,Bu1@mg or Suite No.
Nearest Cross Street /JA/I_F/£/../)
Il'.GAL DEsCkiF'IIONl.o'Utci: _.suTxi1VJs1on Name/Number Omt No. Phase No.
CHECK BEWW IF SOBMII 1£0:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Add~ Envelope
EXISTING USE PROPOSER USE
3. WN IACI ~(IC duierent from apphcanf)
NAME ADDRESS
ZIP CODE CITY
~AME ,e I
CITY ~A-e~MO STATE
~'3'f rJ11M,ll. lie
ZIP CODE t:JUOfJ DAY TELEPHONE tit/) t/.3t/-S-~IL
ADDRESS 2-3/ -r,u,~ARAC,<. ;:,t/c
ZIP CODE 9~ DAYTELEPHONE 'ft/2-ot/2...z
NAME ADDRESS
r;rITY STATE
STATE LlC. #
ZIP CODE
LlCENSE CLASS
DAY TELEPHONE
CI1Y BUSINESS LlC. #
CITY STATE ZIP CODE DAY TELEPHONE STATE LlC. #
7. WOkRPJlS' WMPP.NSA'J IUN
Workers• Compensation beclarat1on: I hereby affmn that I have a cert1hcate of consent to self-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 POLlCY NO. EXPIRATION DATE
Cemhcale of Exemptmn: I cerufy chat m the performance of the work for which this penmt 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. OWNrut-BOllDRk DPl!DUtAilON
Owner-Builder Oeciaraaon: I hereby afhrm that I am exempt from the Contracto?s Llcense Law for the followmg reason:
D 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 co 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, however1 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.).
D 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}.
0 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 pennit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for such pennit 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 pennit
subjects the applicant to a civil penalty of not more than five hundred dollars [$5001).
SIGNATURE DATE
CoMPLEIE IHIS SEGIIUN FOR NON-RESIDENIIAL BUILDING 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 ONO
Is the applicant or future building occupant required to obtain a pennit from the air pollution control district or air quality management district?
C YES □ NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□ YES ONO
IF ANY OF 1lIE ANSWERS ARE YES, A FINAL CER11FICATE OF oa:tll'ANCY MAY NOT Bl! ISfillED AFIBR JULY 1, 1989 UNIB5S 1lIE APPIJCANT
HAS MET OR IS MEETING 1llE REQUIREMENTS OF nm OFFICE OP EMERGENCY SERVICES AND 1llE AIR POII.ITl10N <DN11tOL D15'1111Gr.
9. WNSIROCIION mNDING XCHNCY
I hereby afhnn that there 1s a construction lend mg agency for the performance of the work for which this permit 1s issued (Sec 3697(1) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPilt!XN I CFltliPR!AfiON
I certify that I have read the apphcat1on and state that the above mformat1on 1s correct. I agree to comply with all City ordmances and State laws
relating to building construction. I hereby authorize representatives of the City of c.arlsbad to enter upon the above mentioned property for inspection
purposes. I AISO AGREE ro SAVE INDEMNIFY AND KEEP HARMLESS 1lIE Q1Y OP CARISBAD AGAINST AU. LIAilIUTIES, JUDGMENTS, <XlSTS
AND EXPENSES WIDCH MAY IN ANY WAY ACCRUE AGAINST SAID Q1Y IN <DNSEQIIENCE OF 1lIE GRANTING OF 11DS PERMIT.
OSHA: An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
Expiration. Every pennit 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 pennit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Sectio~d) Unifonn B ilding e).
~~~---~~
YELl.OW: App 1cant PINK: Finance
,.,. I {}-;l J'-// WCHB~.::::::u71--~
PERMIT # 9/ / 1/-# PLANCK # _____ _
JOB ADDRESS ~= -z-?itf dl:rl C/(.
~-:x;{c/-..50/i
TIME ARRIVE: ____ TIME LEAVE: ____ _
CD LVL DESCRIPTION
PERMITS
6/15/89
,
ACT COMMENTS