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Home My WebLink About2902 CARRILLO WAY; ; CBR2021-2684; Permit                                                      (Cityof Carlsbad r Cityof CarlsDad RESIDE ft4TIA L BU ILD.1NG PE,RMrT APPLICAT!ION s·-1 Plan Check Est. V.all!.e PC Deposit Date CBR202 l -2684 8/31/21 Un.it: ____ -APN: _________ _ 1nb Addrf~S 1-C\W Coir r1\ \ 0 V\JO\'f CT/ProjeU#": _______________ t ot"#: ____ Yea(Buih: __ ~_OJ_· __ l ___ _ Fife: 5:Prmklers:0,E~,NO Air Conditi.oning"i.Q YE$°' N:O Elect:rical Panel Up~rnde:OYES·@ NO BRfH DESCRIPTION OF WORK~ (p,fY\~\e..\e, fe¼ Rev , \-,..e., \ ~ 13:f J\JYt'. · - D New sis: : Living SF, _ a~ckSF1 ___ Peitlo.SF, ___ Garag0 ·sF __ _ ~ t.hfs to tre-ate an Accessor:v•P.we llifig unn? OY~N New F1repk1(.;e'( ov~)N I if yes how ma11yr :· __ 0 Rem6del;,___ ___ SF of affected area ls"the ~rea a convs)rSior1 or cfamge ,of-use?-O·v ON 0 Pool/Spa: ____ SF Additional Gas or Electrkal Fea.turesl -----------, □solar; i<W, ___ Modul~s, Mounted :Ooof(};"r,ound~ T1lt:O vO N, RMA-~·av ON, ·Battery; Qv °"'· Pan.el Upgr,ade; Qv· OJ D Reroof: -------------------------------□ Plumbing/ Mecha nk:a I/El ectrfca I D onry: other: PR1MARY APPUCAN1' PROPERTY OWNER N~rne:\:;;\ ... -u;-~ CC). :i VI.Q. \ N'ame: N\ O\Y-'1 l l)\J 1) Q:.. 'it :S C\c¼ N\ ,c d·1 Address: '2-J 5530 :Rt: f' v ,(1 ~ (!?.,. 0 Address : .. Z9 o.2. CR• ('v' \ I t o \j,JCr\ y City :ff\ e,<-1 d:' t: <..-State: ( d\:: Zip: &'l'2;s}{ s-city: (9 C \$\;;gel Smte•: cA:: .Zip: '1:2.-Ct)'1 Phone:· c>i \-\ci -aoi\ , ~ t.-t '? Phone: (;1Hid~ \ ,r3 -Q.5 \ H Email: \cfq .@ ~ l?t-B::Mlah\: ''"ef)yg. C d V'Email: _____________ _ DESIGN PROF.ESstONAL CONTRACTOR OF Rl;CORD Name: _______________ Business Name:..f.11,e. ft f::-t9 \/\+:- Address: ______________ Address: --i1~~0 &cOV'l)' Ro City: ______ State! .z:1p: ____ City:_V\:). (¼:'.!.-E~ Statei CA-.Zip, ~ Z.S.C" ~ Phone: _______________ Phone; Y½i4 ::2c \ \ $H '5 Email: l:m:ajl: 11'\('o (8, \?U".l ti)~-\1-'j\A~ ~e,e__t~:(?'4_ ~{..;.(,2 (Y\ -Architect State Ucense: -----------CSLB lice Ase#~ (O'"'->'p ctso C1ass: 'c:3 l,e Carlsbad Business Licens-e # (Required.): 0()'7"W "7'7 APPLICANT C£RTJFI CA TJON: f cerfffy that I hove read the 9pp1-k:a tton andst ate t ha t"the above 1nf orma"r ionJs: corre9r and t11ar Nie infonnciti'ononthe plans Jsaccurate, /o-gr-ee to comply With antity: ordtnancesand-Staie [aws retat-Jf.lg l'obu1 ldfn9 construction -/":' ~ C-\ I NAME{PRl!NT)~~\ lZ-...?{~-'--,(c,·Nn e.\ SIGN:?/4 C~at-DATE:· ~ ~o l ,z l THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERM IT CAN BE ISSUED TO EITHER A STAT( LICENSED CONTRACTOR OR-A PROPERTY OWNER. If THE PERSON SIGNING THIS FO.RM LS AN AGENT FOR ElTHE.R ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): llCENSEO CONTRACTOR DECLARATION: ttrereqyaj[irmunderpenal/y <?f per jar.y that I am I icensedtmder pro.\1/sions of Chapter 9 / ~ommehcingwitlt Se.tion 7000) ~f /JMsion 3- efJlte /Jtisiness and Pr'/J.1 essfoilsG,de ,..andmy !i-i:ense is inj111/f oi:ce and effect. I also affirm under pencil ty of pe1jwyone'of t lie follqwiny declarr;tions(Cf/OOSE ONE): () ha'Je . .i,~d will m;iintaio o ce_rtifi,.ite ?f ctlnf>~•fl lu self~lnsure for workers'·c:tnQpen.satlou pto\'HJed b.~· S~dior.-3:7.00 of tfn: L~bm Codi.!} h5"r lhl.' ptrl'fo(muticl! of lhe ,votk which·lhts, p.t:,mlr'ls Issued.. Polk~•No. -OR- •~I hMP: :l~(I viHI m~i1ft;iill wqr_kf'l(.:i·(.Ql"!l?f!ri.:,~tion, ::i{, r:e51ulre.d bf.S@t;tion 37~~ ot'thP,,Lab~i .f:<1rl~, tnr'tlin.pPrtprm~nc:e.ohhP worl{ fnr which tti_il\ permit is is.,;ued. ~V/(l(keffmmp-e a ·o iniurnn·i;t. (.i(rt.j~fJlld !Wlifi-''Rllmhe.r:irP,: lnsut.ttnceCornpany Nam~: ~ l~ 9 {. / Poli.ct No.. 01 , _,..·I,-I Expira tioo Dato: -(p Qi. !'Z-./ -OR- ·o c~rtiti~te-0t FXen'lption!. i (.ertify.th~t !o,JbP.~p~rforro3ne,~·nt:ttiE} wo)'k toi" which th_is-p:P.tn:iit isJssuE,d, I ~hall n.qt P.l)lplQt• nriy'p~rsOh·in:;iny manriP."r''so ~sto·b~comF! subJf.tl t_o the wor.k_ps' cornpl!n.salio11 Law~ of Culifu1r'lhl., WARNING: F.ailurn to se.c-ure-V,orkl!rs compensation covrlr'a1fe is unlawful.and shall subjud .in (!mplo_y~rlo c~illiln~I Penaltl~S-'31ld"cfuflfltlts u11to $100:0oo.oo, In addltlo~ 1hC'to (he cost of-c~m~lims·1ii1on; da.111iS~·s ;1s ·J~0 ... 1deOfOr in S~tion s106 ·of.the Labor Cod~. · l~te're·st and attorn~y's fe.e:s1 CONSTRUCTION LENDING AGENCY. IF ANY: I hP.rP.by ;iffirm tl'\at.ther~·is ,:1 coi:istruCtipn lend_in1f ~C~fnc'(for the•~erfrm:nance•.of. t.h~ work.lids penlliUS is:H1e!l (Se.c-. 3097 (i}'Ci'lil Cu~~). Lender's Nilme~ leJHJP.r's Address:• ___________________ _ CONTRACTOR. Cl:RTIFltATION: I certify that I /Jave1'eadthe app.licqti.onandsfote tliat the above information is correct and tbat tile i,1formatio1ron the pi ans isoccurate. I agree to comply-with all City ordinances.and State lows relating to building construction, ,,--/ ,,,/ ~ ~~ <i /"jc) )·zr NAME (P.RI NT}: e, /,•<' .,µµ1 l ~ r"~ ~IGNATURE0""" .. _. -~----"~'--_.,,. __ DATE: _____ _ Nohi: lfthli p~.rson signing abov~ is an autho,1t~d a.e~nHor the•contract-qr provide;): Jetter of.av.thorl,-:aUon J>n contr~ctor lettcrhea~. • OR - (OPTION B): OWNER-BUILDER DECLARATION: I hereby.affirm that I am exempt from Contractor's License Law.for the fol.lowing reosbri: Q ~·-. l,•<t:; own~r ott~epr~r,ert\' or.my.P.rnplo\'~t~wi.th vn1s""~,; as their solP.•tpmpi;?nsation, will de rhe work~nn~ th~ structure•is ~~~ intended or offt:tred for-si:l!~,(Sec. 7t.'44, uuslncss.Jnd'l'1ofcsslons:.Codcf 'l'h~ f .ontr;;cto1's1tcensc-.t .iw,.do~s not aPply;to ;,h ow11cr of fHC:Pertv wllo bvilcfs nr improv!:s. therf!i:m, and who doE>: . ., such w.ork hims?.lf or thr_ough his own €/mplOy~E!s,.providE!d tJiat s_uch im,pro\•elTI•!rits".cil:! not inl~r.1de(.f9t.u(feied for sal~. if, howt!_vef, Use lh.1ildit113.qr•impfC>VC!nlClll iS solU •Within oue ycarof 0001plcUoo, the owf1ef~bulldcr , ... 111 have the bu(dcn of ).l~ovlns tharhC dld not btilldor.· lm1Hove for th, ru.rqose r.:t Sale) •. •tlll• · ,a I, !JS owner otth€'·pro1)eff'/, cll)l m,:clUS!'lel~• tOl\thl.tting with licensE:-d o:'>ntr.1~tcir~ 10 <;onstruct thP J)rflji?tt ISF!c. 70.·1<1, ~usirie.,;s and Prot@.ssions <;ad?.: TI1E! Contiac.:~o,rs Ucl!ru.~ Law doc1:..1lOt apply ·Lu cm uwn1=r 6f properly who builds.of lmpfo~•<!s lhc,eon, and con\rai:ts for !>uch project:, \\•lth·coilirJ~toi(s).ll<.c1ls.cd p(usu~nt t<rth:eCootr.lc.toi-•s Ucens~ I aw), ·•Oit, 01 .a1n-cx..:·mpt unc(cr uuf ness .ind Profcis.sli:ms cod~ Oivlslon 3, Ch.:i1>tcr 9, Arti(tc .:t for th.is rNs911: ANI_), D FOfi,M·8•!i1, "Owner Builder Acknow!~.d·gf?ment and VP.:rification form" iu:pq1iil'f!d f(lr ;my permir t~suo>d.to a prop~rly owmu . o·y-my slgr...iturc bCto)-t I .:i<"fq.\owk:d,ec ·that, except for my pe,sonJI reslden~c Ill which I must hJve re~lcl~.dJQr afleJ.!>t <Jne y~,;ir pr(or to complP,.tion ntt-h~, impm•.:f!.intmt.s. CO•tf!·(~d b'/ this r,~rmit, I cannot,h>.gall•t sill ~ structure that I h;wl,! buih.,.nm ·owm,1-bllllder if ii. ha!i nul lnlt;n conSlcn.11.:li!d il'I 1l:;~1'1(ifi:!l~1 bv llceos~cl c9ntr.'.lu-Of!t. I underst-0nd that acop;1of theappf ;,·c(b!elQ~; SecOon 70110/ the 811Sine.-.Son(l/'rr)f es~1<ms(,:<le~ J.trtl'aifo1iJ.~ tJ_()On ·r'P.t"/iiE'tlWfo?t> rl1lsdf,r,lfcarto·•1js .submjttc>d or at th<?.foUowing W<:'b site>; http:✓ lwww.'icginfo.ca,govl cataw.html . . .OWNER· CfRTJFICA Ti ON: I cer.t'ify-that 1-hovereod the applicatlonandstate that the above Information_ iscorrecf and (/Jat tile informatfonon t/le plaos isaccurate. /agree to cof1lply wf th a(/ City, ordinanres.and State laws relating to building ·consl'ruction. NAME (PRINT}: SIGN: __________ DATE; ______ _ No~: lfthe p~rson s.it ning above is' an autht1J'ized tig(!_nt for the propert\rowm.>r lncll1de fof,n 0:52 slgnod l:iy prop0rtv.owncr. tnHll: Bu!lditu:!f~rlsllJt.ltJ,f:~ 2 REV.0712·1                                 {city of Carlsbad