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HomeMy WebLinkAbout1862 SPYGLASS CT; ; CBR2021-3595; Permit                                                  (Cityof Carlsbad ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION 8-1 Pian Ch eek _C_B_R2_0_2_1_-_3_59_5 __ Est. Value PC Deposit Date 11/29/2021 Job Address I ?>(o;:).., ~jjk~> (+ Unit: _____ APN: __________ _ CT /Project 11: _________________ Lot #: ____ Yea r Built: ________ _ Fire Sprinklers:OEs()No Air Conditioning:QYESQNo Electrical Panel Upgrade:QYESQNO BRIEF DESCRIPTION OF WORK : ~D C:s:E G-o_s Me±ec-Llp3rad e 0 New SF : _____ Living SF,--::=---Deck SF, ____ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? Q YQ N New Fireplace? QYQN, if yes how many? -- 0 Remodel: SF of affected area -----Is the area a conversion or cha nge of use? Qy Q N □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _ o solar: ___ KW,. ___ Modules, MountedOoof(faround, Tilt:OYO N, RMA:QYQN, Batterv:O v OJ, Panel Upgrade: Q Y Or-J 0 Re roof: __________________________________ _ W Plumbing/Mechanical/Electrical 0 Only: Other: PRIMARY APPLICANT PROPERTY OWNER Q-. Y) Name: ________________ Name: M; CV)Oe. ( R-Me±Uf-e (" Address: Address: 1%2:, SP1c)lo5.$ 'C.-1- City: _______ .State: ___ Zip: City: (_°'rfsrnd State:(..c1:___zip: 11028 Phone: Phone: (?~ (o9ci;-q63d:::- Email: Email: ~,c me /-roe fz3e,.@ LS <5?ff'CC'9 :/ ,C6'1Y) DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: _________________ Business Name: _______________ _ Address: Address: _________________ _ City: _______ State: ___ Zip: ____ City: _______ State: ___ Zip: _____ _ Phone: Phone: __________________ _ Email : Email: __________________ _ Architect State License: CSLB License 11: _______ Class: ______ _ Carlsbad Business License # (Required): _______ _ APPLICANT CERTIFICATION: /certify that/ have read the application and state that th e 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. / ,4 1 j NAME (PRINT): M, ( bme ( e ;vtef21{' [ SIGN: ~A/~ DATE : M~v /;}+1,1_ ~Q,}_ I 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 " Email: Bulldlng@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 : I herebyaf f irm under penaltyaf per jury that I am I icensed underprovisionsof Chapter 9 (commencing with Section 7000)of Division] of the Business and Professions Code, and my license is in full force and effect. I o/soaffirm under penalty of perjuryoneof the following declarations {CHOOSE ONE): Q t have and wllt 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 ts issued. PolicyNo. _____________________________________ _ -on. QI have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. y workers' compensation Insurance carrier and policy number are: lnsuranceCompany Name: ____________________ _ Policy No. __________________________ Expiration Dat,e: ______________ _ -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 sublecl 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: /certify that I have read the applicationandstate 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): SIGNATURE: DATE: ______ _ --------------------------Note: If the person signing above is an authorized agent for the contractor provide a letter of authorization on contractor letterhead. -OR - (OPTION B): OWNER-BUILDER DECLARATION : ,J.!yreby of firm thot I om exempt f ram Contractor's License Law for the following reason: ~ t, as owner of the property or my employees w,th wages as their sole compensation, wtll do the work and the structure ls not intended or offered for sate (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 ts 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). -On-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 Con1ractor's License Law). -On-o I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: ANO, g{o'RM B-61 "Owner Builder Acknowledgement and Verification Form" Is required for any permit Issued to a property owner. By my signature below t 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, t 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 r hat a copy oft he applicable law, Seccia11 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the [of/owing Website: http://www.legi11{0.ca.govlcafaw.htm/. OWNER CERTIFICATION: /certify that/ have read the applicationandstate that the above informationiscorrectand that the information on thep/ansisaccurate. lagree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT): M,chae( R, M b-LVe.C SIGN: /,,a'--n.ATE: fikh,J i}.fll,o-9)/ Note: If the person signing above Is an authorized a~r the property owner Include form 8-62 signed by prope wner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760·602-8558 Email: Bullding@carlsbadca gov 2 REV. 07/21                                        {city of Carlsbad