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Home My WebLink About1339 KNOWLES AVE; ; CBR2021-3032; Permit                                                          (Cityof Carlsbad Ca:trof CarlsDad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check CBR2021-3032 Est. Value PC Deposit Date > Job Address, ___ 12> __ ·ifl-·.· ... · _l __ <n __ ow-· ___ ks __ . __ , __ A __ · ·,vi_~_. _____ Unit:, ____ APN: ________ _ CT/Project#:._ ______________ Lot#: ____ Year Built: ________ _ Fire Sprinklers:OECNo Air Conditioning:QYEsQNO Electrical Panel UpgradeQYESQNo BRIEF DESCRIPTION OF WORK: 0 New SF : _____ Living SF, ___ DeckSF,. ___ P.atio SF Garage SF __ _ Is this to create an Accessory Dwelling Unit?OvON New Fireplace? ovoN ,i if yes hmA( many? -- 0Remodel:, ____ SF of affected area Is the area a conversion or change of use?QY ON 0 Pool/Spa: ____ SF Additional Gas or Electrical Features? ----------- oso1ar: ____ KW, Modules, MountedOoof();round, n1tOvON, RMA:QYQN, Battery:0, ()i, Panel Upttrade: 0, OJ D Reroof: Plumbin._g/_M_ec:_ha-ni_ca_l/_Ele-ct-rica-, .--£-. ~-. -lA-C'Jl..-t-,1-st-,h-j-.. -ua-s-t-.·.·f1f(J-t-~-. .-t,.J.-✓.-p-re-,-~-gh-· .-{Ill-.. -d-....-- □ Only: Othe.r: PRIMARY APPLICANT Name:,_. _..J:.;cB:&'lt'.l;J:\lJ~,t..l~~-----Name:. _____ ~""-'I~......;;:;........,.;;....,;;, ______ _ Address: I. Address:.__,,,_,....,,.W¥,1-..1~c.=.-:...L.~------.-- City: ~i:'. City::_..1:UI.::::!:. ·!.t:.!ril~X....------. _ __,Zip: m::: Phone: Phone:_. ________________ _ Email: Email: ________________ _ DESIGN PROFESSIONAL CONTRACTOR OF RECORD /, l Name:, _______________ Business N.ame: 8A '4hr11,i.,,,nc ,t Address: Address: _______ __,,. _______ _ Clty:. _______ state. _____ Zip: ____ C'fty': ·, ::~ ·~ Stat~~. =:Zip! v,q;:a: Phone: Pho.ne! ( 1(,1) ~ 7/ffl -;f/7i3._ Email: Email':. ,ii ~:~hg'" 'irz C. CQb.... Architect State License: CSLB License#: !,~tj_ Class: _____ _ Carlsbad Business Lfcen.se # (Requfred)~ __ 5 __ · ... '/; .... f. .... ~_O_Q_. •_ APPLICANT CERTIFICATION: lcertifythatl havereadthe applkatlonandstatethattheabovejnformation ts correct and that the information on the.plansfsaccura(e. lagree to comply withall City ordincmces and State laws relating to building :;;:~, Avlfi7>'\ D~ SIGN: !If_ DATE: q-30-2-J 1835 Faraday Av.Carlsbad,CA92008 Ph: 780•802"2119 Fax! 760"602·8;S~ Em.all: lulldlng@cadsbadca.gov 1 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: I herebyaf firmunderpenal tyof perjury that I am licensed under provisions of Chapter 9(commencingwith Section l000)of Division3 of the Business and Professions Code, and my license is in full force and ef feet. I also affirm under penal tyof perjury one of the following declarations {CHOOSE ONE): 0 1 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. PolicyNo, ___________________________________ _ ~~~:~ and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the p~rform nee f the work for which this permit is issued. Nvworkers' compensation insurance car,!!~ '}n~oU5¥ number are: Insurance Company Name: C . . .- Policy No. 11.../QD 50 S ~t,6() Expiration Date: J I I/ L -OR-1 Q 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 CERTIFICATION: /certify that/ have read the application and state that the above information is correct and that the information on the plans is accurate. /agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT)= A111&'.)Y) D1Jnclv Note· If the person signing above is an authorized agent foe the cootcactor provide a letter of authori ion 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: 0 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 Co~e Division 3, Chapter 9, Article 3 for this reason: AND, D FORM 8·61 "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 theapplicoblelaw, Section 7044 of the Business and Professions Code, is availoble 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. /agree to comply with all City ordinances and State laws relating to building construction. ~ .UJ .............. C'!..· .. .JJ..-~ .. L.... X xxxxx X'J<XlUCJ)OOO(flXDXXX NAME (PRINT): ~ SIGN: __ .;;..........,a _____ DATE: _·r_v_v_ -,L_L_ Note: If the person signing above is an authorized agent for the property owner include fo~d by property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760·602-2719 Fax: 760·602-8558 Email: Building@carlsbadca.gov 2 REV. 07/21                                               {city of Carlsbad