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HomeMy WebLinkAbout1040 CARLSBAD VILLAGE DR; # 101; CBC2023-0065; Permit                                                               (Cityof Carlsbad ( City of Carlsbad COMMERCIAL BUILDING PERMIT APPLICATION B-2 CBC2023-0065 Plan Check Ps a b ~ 5 --De:> o<=t Est. Value .$ 3 o o c:,> --T", _ _..:c,. ___ _ PC Deposit Date Job Address IQJ._t) ..C..":f-&.. '2a.L {/'; L/4., L {uite:,.............,_APN: Tenant Name#: ii~ ;z.,;;;~;J /z ;,'/,£lot #:. ____ Year Built: ________ _ Year Built:. ___ Occupancy: ___ Construction Type: Fire sprinklers:Q'ESO NO A/C:C)YEsQ No d. il/4 ' f.. / :S e-o ~ Q. ):;,t C "'--' BRIEF DESCRIPTION OF WORK: 0 Addition/New: ___________ New SF and Use,. _________ New SF and Use ______ SF Deck, ______ SF Patio Cover, SF Other (Specify) ___ _ OTenant Improvement: ____ SF, Existing Use: ______ Proposed Use: _____ _ ____ SF, Existing Use: Proposed Use: _____ _ D Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _ D Solar: ___ KW, ___ Modules, Mounted:0 Roof 0 Ground D Reroof:. ________________________________ _ D Plumbing/Mechanical/Electrical [Z8.o,,uii:~'I 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Fax: 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: lherebyaffirmunderpenaltyofperjurythatlamlicensedunderprovisionsofChapter9(commencingwithSection7000)ofDivision3 of the Business and Professions Code, and my license is in full force and ef feet. I also affirm under penalty of perjury one of the following declarations (CHOOSE ONE): D1 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- ~have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the ertor ance of he work for w ich th~permit~ssued. My workers' co pensation insurance carrier and olic number are: Insurance Company Name: , C,, ~ c..A' Policy No. ~-.....,,_~-...r.+-..._ ....... -.-f-.-c--------------Expiration Date: _ _..._O=--,,c........,lc..+ __ .....,...__, ______ _ -OR- Ocertificate 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 $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name:. ____________________ Lender'sAddress: ___________________ _ CONTRACTOR CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on theplansisaccurate. lagree to comply with all City ordinances and State laws relating to building construction. ~ NAME (PRINT):t)Aavi N6~tv4$-t'° ~GNATURE: -DATE: ;2_/4 ,9' ~ 0 Note: If the person signing above is an authorized agent for the contractor provide aerofauthorizatn on contractor letterhead. / 7 -OR - (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: n 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. ~44, 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 qr improve for the purpose of sale). -OR-01, 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-01 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. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is avail ab/ e upon request when this application is submitted or at the following Web site: http:l lwww.leginfo.ca.gov/calaw.html. OWNER CERTIFICATION: lcertifythatlhavereadthe applicationandstatethattheaboveinformationiscorrectandthatthe information on the plans is accurate. I agree to comply with all City o~,1 • ..,,. ... r .... ,,,,d State laws relating to building construction. - NAME (PRINT):, c 5 -• • I Kl= r mer ?-S!GN: ~ , , · ::,,, DATE:.; Note: If the person signing above is an authorized agent for the property owner in ~orm B-62 signed by prope~. , 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 2 REV. 07/21                                                                    {city of Carlsbad                                              