HomeMy WebLinkAbout1569 TAMARACK AVE; ; CB984063; PermitPERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(619)438-1161
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1569 Tamarack Ave
Add,us !Include Bldg/Sult• I) Bualnu• N•m• (1t thl11ddrua)
l•g1J Ouc,iptlon lol No. Subdivision N■m■/Nu'!1b•r Unit No.
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A.uusor'1 P11c■I I Propoud Uu
Oucriptlon of Work. SO. FT. lof StoriH I or BedroornJ k or Bathroo,·
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Crawford. Marynelle 1569 Tamarack Ave CARLSBAD CA. 92008 (760)729-3992
N1m1 AddreH City . Stall/Zip Telephone II F, ,----;-
S ,: ;i;, APY,U CANT · · Ii O :c ••li•s;iorllt;UJ!AotOliafi:.nuw,1.i!liGJ :li.waiflllillll~iiio/itoi'li.we,.l~Y!!§il'!}lf ~-w;a b&'c ,~w .. .r ;-; .,. ·
SHEI.I,Y ,JOHNSGNt'.KRISTY FOSTER J 37Q6 B HWY 8 BOS, EL CAJON. CA. 92021 (619)3~0-4477
N1m1 Add11u CltV Stlle/Z/p Telephon9 II
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92008 (760)729~3992 Crawford I Marynel J e 1 569 Tamarack Ave
Addreu City
CABT,SBAD
Stlte/ZJp
CA.
Telephone #
(Sec. 7031 .5 Business and ProlaHlont Coda: Any City or County which raqulrH • pa,mlt to con■truct, altar, lmprova, d,mollsh or repair any llnJcture. p11cr 1" ,:,
1ssu1nc1, ■lso requires the applicant for such parmll lo fU, • 1lgn1d at1temant that he la llc1n11d pur■uant to the provl1ions cl the Contr ■ctor's uc,11511 L8,-_
!Chapter 9, commending with Section 7000 of Division 3 of the 8usln111 and Profusions Codel or that he Is exempt theretrom, 11nd t'1 11 bam for 1he ~ll•·~e-:
exemption. Any violation of Section 7031.5 by any applicant lor • petmlt 1ubJ1cts the applicant to I clvll p1n1Jty ol not more than five hundred dolia11 1150011
A & ,T FOSTER Pf,llMBJNG 13706 B HWY 8 BUS. EL CAJON CA. 92021 (619)390-4477
N1m1 AddrHs City State/Zip T el11phon11 t
suu uc,nse , ____ _c6cc3c.0c.1=2'-'0'--Uc1n11 Clan -----'CC.--"3-'6'--City Buslneu Llcen11 I _____ 1_2_0_0354
Designer Name Addr11s City Stlte/Zlp
St1t1 Uc1ns1 I N/A
:0:' ,ii. W0RKEtS\..C0M PENSATIOil..!i#.lit.W.~~,!>Nl!~/lijiiiW! /lffli',llllMilllll1.IIIJi4~1)1.IIJ1.ll\'/!l2l.l'm'IJ'/lliiS~a1i~~~?n?, ,i'i,Vli, ' ·. :; ;;t; , '· . ,
Worker■' Cornpenntlon 01claratlon: I hereby affirm under penally of perjury on, ol the followlng.d1claratlon1:
0 1 hav, ind will m■lntaln • certlficat, of consent to 11ll-lnaure tot workers' comp1n11tlon II provided by Section 3700 of L11e Lebor Code, for tile perforrm ,c~
of th, wo,k for which this ptrmlt Is l11u1d.
0 I ~• and wlll maintain work1r1' comp,nsatlon, II r1qulr1d by Section 3700 ofth1 Labor Code, for the perlorm•nce of the work !01 wh1ct1 this perrr '. 1.,
Issued. My w0<ker'1 comp1ns1tlon lnsur1nc, carrier and policy nUmbtr 111:
Insurance Company FARMER INSURANCE Policy No, N2007-56-51 Ex.pita lion □ste CONTINUOUS
!THIS SECTION NEED NOT BE C~MPLETED IF THE PERMIT IS FOh ON! HUNDRED DOLLARS lt100J OR LESSJ
D CERTIFICATE OF EXEMPTION: I caftUy thlt In th• perform•nc• of th• work for which this permit la l11u1d, I shall not employ eny p111son In eny manner ., " ! ~
10 become Jubject to the Workar1' Compensation Laws of C■Ulornl,.
WARNING: Fanu,. to HCUr1•wo,bu' compenaallon cover1g1 11 unlawful, end 1haJI 1ubJ1ct ■n employer to crlmlnel p1n1lllin and clvll fines up to one hu•H!red
thousand doUara {♦ 100,0001, In addition to th■ co■.t ol comp1n11tlon, d1m1gu u provided for In Section 3708 of the lab(¥ code, lntere1t and ■ttorney'1 fu•
SIGNATURE _______________________ ~------OATE _______ ~--
7. , a wNER .• u 1LDER DECLAIII\T1011 f ,{~f.1,?il111i1ir¥!lllt:ll'lt'lllii:,1:~~i1i1:iiii'It~m1:1.1w.wumrt'RlW1m111,lR!m'tliW.tiWi~!u1:i:•.,.:i 1 \,Ii: 1 •.. _. ') ,,;,:, _,;. ., ·.
l hertby 1tfirm th11 I 1m uempt from th• Contractor'• Uc1n11 Lew for the following ,.uon:
0 I, u own11r of the proptirtY or my employees with wage& 11 their 1011 comp1n11Uon, will do th• work ind th• ,1ructure Is not intended or of!e1ed 101 ,~,•
!Sec, 7044, Business ind Proleulona Cod,: Th, Contr1ctor'1 License Law doll not apply to 1n owner ol property who bulld1 or improve, thereon. and who C:-~,
such work himsell or through his own employees, provld1d that auch lmprov1m1nt1 .,. not lnt1nd1d or 0U111d for 1111. It, however, the building o, improvemer01 ,s
sold within on, yur or compl1Uon, th, owner-buUdar will hav, th• burden of proving that h1 ~d not bulld or lmprov• for lh• purpou ol ul1).
0 I, u owner of th• property, em .xclu1lv1ly contracting with llc,nud contrlctofl to con1trucf th• project IStc, 7044, Buslneu ■nd Proleulons Code: · h,
Contr■ctor's Uc,nH Law do11 not apply to an owner of property who bulld1 or lmprOVH ther1on, and cont.,acts for ,uch proj1cu with contr1ctor(1) llc1r-,ed
PVflU■nt to th• Cont,.ctor's Uc1n11 Law). ·
0 I 1m uempt und•r S1ctlon ______ Bu1ln11a and Prol111lon1 Codi for thJa ra11on:
1. I per1on1lly plan to provide the major labor end materials for con1truc:tlon ot th, propoud property lmprov1m1nt. 0 YES ONO
2, I lhav, I hive notJ signed 1n 1ppllc1tlon for a building p1rmll lor th• propo11d work,'
3. I have cont11cttd with lh1 following person lflrml t~ provld• the propoud construction (Include n1m1 I 1ddra11 I phone number/ contractors licenu nur t:er.1
4, I plan to provide portions of th• work, but I have hired the following p1rson to coordinate, 1upervl11 end provide the m11jo1 work (include name/ address/ ;·•,c:re number/ contr1c1ors license number): __________________________________________ _
5. r wm provide 1om1 ol th, work, but I hive contr1ct1d lhlred) th, followlng p1r1ona to provide the work lndlca11d (include name/ address/ phone number 1·,:,e ol .work): _____________________________________________________ _
PROPERTY OWNER SIGNATURE---------------.----------OATE _,,_.-,-,-,,--,.,-c.,,-----
.CO~;rHIS,SECl)Oll,/;QR.iPfl~.E/!l.iJill/Jii.lJUl)/jQ,ilta.Mjaltj/Jj;'iilW"!pl•fMNl/lJ!Wt~~;;!4';;f,'/:'J.l~·;,c;;',i!l'.!:; .. ,
ls th• 1ppllc1nt or future building occupant r1qul11d to aubmlt I bu1lnt11 plan, 1cut1ly huardou1 m1terl1la registration form or rl1k manngement ■nd prever· -:;;1
p<ograrn under Sectl~ 26505, 25533 or 26634 of the Pr11lerT1nner Ha11rdou1 6ub111nc1 Account Act7 0 YES D NO
Is the 1ppllc1n1 or hrtur, bulldlng occupant required to obtain• permit from the •Ir pollution conlfol dlatrlct or air quaUty m1n1gement distlictl D YES O tOJ
Is Uwi lac:mty to b, constructed within 1,000 f11t of tha out11 boundary of• 1chool 1lt17 D Yes D NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT IE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT,
s.: ... coNsrnucT10N LEN01Na'AaENcv:1ri~,1,11W'<ilii/!m;:;,ll;;.rl:.l;:i,1i11r1~t~~i!llll'llIZE~ti:.r,mtJ,(f~,:. ,,;"'·
I he,.by affirm 1h11 1here is a conatructlon lending •o•ncv. for th• perform1nc1 or th, work for which this permit la l11u1d !S•c. 309711) Cl vii Cod11I
LENDER'S NAME ______________ _ LENDER'S ADDRESS ______________________ _
I certify 1h11 I h,v, rHd the 1ppllc1tlon end etat, that th• 1bov1 Information II corr1ct and that the Information on the plans Is 1ccur1t11. I 1gr1111 to comply w 11•, ~;,
City ordinances and Stall laws relating to buildlng construction. I h1r1by authorlll ,apra11nt1tlVH of th, City or Carl1b11d to enter upon tho above men:1c ·~·-·
property for inspection purpos11. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP ,HARMLESS THE CITY OF CARLSBAD AG/\INST ALL LIABILIT,ES
JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT
OSHA: An OSHA permit Ii required for ,xc1v1tlon1 ova, &•o• daep and d1molltlon or conatiuctlon of at1uctur11 ova, 3 1torlu In height.
EXPIRATION: Every permit Issued by tht Building Olflcl•I undlf th, provl1ion1 of th/1 Codt lh■JI 1xplr1 by llmlt1tion 1nd become null ■nd void ,t _th_e bu,1d,r~ c·
work ■vthorized by such permit Is not comm1nc1d within 366 day1 from tht date of 1uch p1rmlt or If the bulld!ng or work ■uthoriz.ed by ~uch poirrnt 1s susp~nrJ• :
or 1bandoned ■t 1ny time alter t , work is comm1nc1d for ■ period of 180 day, (Section 106,4.4 Uniform Bulld.mg CodeL
DATE
DJl,JI(, Cl-----