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Home My WebLink About2343 GEODE LN; ; CBR2021-2742; Permit                                                           (Cityof Carlsbad ( Cicyof Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Pl an Check _C_B_R_2_02_1_-_2_74_2 __ _ Est. Value PC Deposit Date 9/9/21 Job Address 2343 Geode Lane Unit: _____ APN:. __________ _ CT/Project #: __________________ Lot #: ____ Year Built: _________ _ Fire Sprinklers:0Es<!'.)No Air Conditioning:QYES{!)NO Electrical Panel UpgradeQYES0No BRIEF DESCRIPTION OF WORK: Install of EV charger ------------------------------- 0 New SF : _____ Living SF,--=--=----Deck SF, ____ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? QvQN New Fireplace? QvQN, if yes how many? __ _ D Remodel: SF of affected area -----Is the area a conversion or change of use? Ov ON Additional Gas or Electrical Features? □ Pool/Spa: ____ SF ------------- 0Solar: ___ KW, ___ Modules, MountedOoofO;round, Tilt:O vO N, RMA:QvQN, Battery: Ov 0, Panel Upgrade: Qv ~ D Re roof: ___________________________________ _ --, Ii] P-lumbing/Mechanical/Electr:ical 0 Only: Other: PRIMARY APPLICANT Name: Solis Lighting and Electrical Address: 940 Calle Negocio Suite 250 Install of 240 EV eharger PROPERTY OWNER City: San Clemente State: CA Zip: 92673 Name: Ryan Lauder Address: 2343 Geode Lane City: Carlsbad State:CA Zip:_9_20_0_9 __ _ Phone: 817-591-0661 Phone: 760-484-1369 Email: Dana.shaw@solisusa.com Email: ryanlauder@gmail.com DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: _________________ Business Name: Solis Lighting and Electrica Address: Address: 940 Calle Negoicio Suite 250 City: _______ State: ___ Zip: _____ City: San Clemente state: CA Zip:_9_26_7_3 ____ _ Phone: Phone:817-591-0660 Email: Email: Dana.shaw@solisusa.com Architect State License: CSLB License#: 7 49158 Class: C10 ------- Carlsbad Business License# (Required): BLOS001624-09-2017 APPLICANT CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with al I City ordinances and State laws relating to bui I ding construction. i. <f' . /2.... NAME (PRINT): Fred Berg SIGN: J C::..... y ~ATE: _9l_?_l2_0_2_1 __ _ 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 7-602-8558 Email: Building@carlsbadca.gov REV. 07/21 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMIT CAN BE ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTY OWNER, IF THE PERSON SIGNING THIS FORM IS AN AGENT FOR EITHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. {OPTION A): LICENSED CONTRACTOR DECLARATION : lherebyaffirmunderpenaltyofperj urythat lamlicensedunderprovisionsofChapter 9(commencingwithSection7000)ofDivision3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations(CHOOSE ONE}: Q1 have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. Policy No. _____________________________________ _ -OR- fe"\1 have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for.the perfor~ance of the w~rk for which this permit is issued. ',:1y workers' compensation insurance carrier and policy number are: lnsuranceCompany Name: _u_m_led_C_o_m_m_er_c,_at_tn_su_ra_n_ce_S_e_rv_,oe_s __________ _ Policy No. UB-6N711oa1-20-26-G Expiration Date: _11_11_51_2_02_1 ___________ _ -OR-O 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 subject to the workers' compensation Laws of California. WARNING: Failure to secure workers compensation coverage Is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the labor Code, interest and attorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). lender's Name: ____________________ Lender's Address: ___________________ _ CONTRACTOR CERT/FICA TION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building -=---~N'--'AMEjpRINTI_: Fred E. Berg SIGNATURE: __J) Z. y ~ATE: 9/7/2021 construction. ~ ,/2-... Note: If the person signing above is an authorized agent for the contractor provide atter of authorization on contractor letterhead. -OR - {OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: Q 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 of sale). -OR-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 improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). -OR-O I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, D FORM B-61 "Owner Builder Acknowledgement and Verification Form" is required for any permit Issued to a property owner. By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the Improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed contractors./ understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: http: I lwww.leginfo.ca.gov/calaw.html. OWNER CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT): SIGN: __________ DATE: ______ _ Note: If the person signing above is an authorized agent for the property owner include form B-62 signed by property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-SSSS Email: Building@carlsbadca.gov 2 REV. 07/21                                   {city of Carlsbad