The URL can be used to link to this page

Home My WebLink About2735 TIBURON AVE; ; CB931298; Permit498 1 /2 93 0 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPUCATION PLAN CHECK NO. p r..9 -b--YS City of Carlsbad Building Department 2075 Las Pal111as Dr., Carlsbad, CA 92009 (619) 438·1161 EST.VAL'"------------PLAN CK DEPOSIT ________ _ VAJJD. BY __________ _ 1. P£kM1 I IYPE DATE _____________ _ A -D Commerc1al Li New Building D Tenant improvement B -D Industrial D New Building □ Tenant Improvement c -D Residential D Apartment D Condo D Single Family Dwelling ,,O Addition/ Alteration D Duplex O Demolition D Relocation O Mobile Home l!l"Electrical D Plumbing D Mechanical □ Pool D Spa □ Retaining Wall D Solar D Other ____ _ 2. PROJECT INFORMATION FOR OFFICE USE ONLY cA.LiF LEGAL DfscHIPTldN Lot No. Su!xl1vis1on Name/Number Omt No. Phase No. c:i!ECR BEWW IF sUBMll'IED: 02 Energy Cales □ 2 Structural Cales □ 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EX)SJJNG USE PROPOSED U:ili 3. WN IACI PElt"DN (tf dilkrcnt from applicant) NAME ADDRESS CilY STATE ZIP CODE ~ DAY TELEPHONE 4. Al'l'ULAN I Li CON I RAC! OR □ACE'.N I FOR WNIRACIOR l!:I ER OAC£N I FOR OWNER NAME UJ lL..LlAM (\ C uitYio.,...; ADDRESS :J-1 ) S n {J U/'t,.oA/ Av C. CllY C.p,._ ti t._s (1 Ai:, STATE C.A ZJPCODE q').oot{ DAYTELEPHONE C,/9 s. pltoPERIY OWNER NAME A.S A eov-E:.-ADDRESS ZIP CODE CilY sTATE DAY TELEPHONE NAME CllY STATE STATE UC.# ADDRESS ZIP CODE LICENSE ClASS ADDRESS DAY TELEPHONE CI1Y BUSINESS UC. # DF.Sl(,NER NAME CllY STATE ZIP CODE DAY TELEPHONE STATE UC.# 1. WoilRllils' mMPE:NSAnOR Workers' Compensation Declaration: 1 hereby aflirm that I have a certd1cate ol consent to sell-insure issued by the D1rectorof lndustnal Relations, or a certificate of Workers' Compensation Insurance by an admin('fj insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof fi!l'd with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY POLICY NO. EXPIRATION DATE Cer11l1cate of £xemptmn: I cern!y that m the performance of the work for which this permit 1s issued, I shall not employ any person m any manner so as to become subjec1 to the Workers' Compensation Laws of California. SI<;iNAWREUJ'\.---/ /-'). 7 ~9 LI D wner-u1 er a tlon-1ere y a 1rm t at am exempt ram t e ontracto s cense w or t e o owmg reason: --~-;~~er--oTtne 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 Llcense 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.). 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). I am exempt under Section ________ Business and Professions Ccxle for this reason: (Sec. 7031.5 Business and Professions Ccxle: Any City or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pur.mant to the provisions of the Contractor's License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit ,,,,-----· the applicant to a ci · alty of at more than five hundred dollars [$500]). "-,.._, SIGNATURE Lt)"'-(1 ----~ "f----DATE Is the applicant or future building occupan r uired to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ YES □ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □YES □NO IF ANY OF nIE ANSWERS ARE YES, A FINAL CF.RTIFICATR OF CXDJPANCY MAY NOT BE ISSURD AFI'ER. JULY 1, I 989 UNLESS nIE APPUCANT HAS MR'f OR IS MEHTING nrn RF.QUIREMEN"fS OF nm OFl-lCE OF F.MERGENCY SERVICES AND 1llE AIR P0ll.lfl10N CDNTROL DISrRICT. 9. mNS'IR0ClioN U-:Nl)ING AGE:Nty I hereby alhnn that there 1s a constructmn lend mg agency for the performance of the work for which this penmt 1s issued (Sec 3097(1) Civil Code). LENDER'S NM1E LENDER'S ADDRESS 10. APPut.AN't Citln1FICATION I cerufy that I have read the apphcauon and scate that the aliove mlormauon 1s correct. I agree 10 comply with ail City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGRF.E 1U SAVE INDF.MNll'Y AND KEEP HARMLF.SS nm CITY OF CARISBAD AGAINST ALL IJABILITlFS, JUDGMENTS, CDSfS AND FXPENSFS WlllCJI MAY IN ANY WAY MDUJE AGAINST SAID CITY [N CDNSF.QURNCE OF TIIE GRANTING OF nus PERMIT. OSHA: An OSHA permit is required for excavations over S'O" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is co menced for a pericxl of 180 days (Section 303(d) Uniform Building Code). APPLICANT'S SIGNATURE DATE: ll--)1-'13 PINK: Finance ' . ....,....T•.11~ .J.,, ........ + .:.J..;... i\I'1 .. n. I VE : TI!tE c:i L?L B_L ~ PEJkTIT3 G/l!i/09 DESCRIF1'IOU ti IJ Pfv!L h I dJ tit, ethUz."ll ,-f'i[~k - LEAVE: /\CT CC!lltEHTS ~(_ 1