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Home My WebLink About2025 KARREN LN; ; CBR2023-2024; Permit                                                           (Cityof Carlsbad ('Cityof Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION 8-1 Plan Check Est. Value PC Deposit Date Job Address 2025 Karren Ln Unit: APN: -----· ----------- CT/Project #: __________________ Lot #: ____ Vear Built: _________ _ BRIEF DESCRIPTION OF WORK: Reroof --------------------------- 0 New SF : Living SF, ____ Deck SF, ___ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? O Y o N New Fireplace? O YO N, if yes how many? ___ _ D Remodel:. _____ SF of affected area Is the area a conversion or change of use? O YO N □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ____________ _ □ Solar: ___ KW, ___ Modules, Mounted:ORoof O Ground, Tilt: 0 YON, RMA: 0 YO N, Battery:OYO N, Panel Upgrade: OV ON Electric Meter number: ------------0th er: APPLICANT (PRIMARY CONTACT) Name: Tim Seaman Address: PO Box 5955 PROPERTY OWNER Name: Tom Kane Address:2025 Karren Ln City:Chula Vista State:_C_A __ .Zip:91932 City: Carlsbad State:~Zip:_s2_o_o_a __ _ Phone: 619-993-8846 Phone: ___________________ _ Email: Tim@Championpermits.com Email: ___________________ _ DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: __________________ Business Name: Experienced Roofing Inc. Address: Address: 250 KNOLL RD #132 Cit,;:. ________ State: ___ Zip: ____ _ Phone:. _________________ _ Email: _________________ _ Architect State license: ___________ _ City:San Marcos State:_C_A __ .Zip:92069 Phone: (760) 421-6155 Email:iose@experiencedroofingsd.com CSLB License#: 1005563 Class: ______ _ Carlsbad Business License# (Required): BLOS013532-04-2023 APPLICANT CERT/FICA TTON: I w tify that I have read the application and state that the abav rect and that the Information of the plans is accurate. I agree to comply with all City ordinances and State lows rt!loting to building construction. NAME (PRINT): _T_im_s_e_a_m_a_n ____ _ 163S Far~day Ave Carlsbad, CA 92008 Ph: 442·339-2719 Email: Building@carlsbadca.gov REV. 04122 "I 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 LITTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: I herebyaf firm under penal tyof per Jury that I am licensed under provlsionsof Chapter9 ( commencing with Sectf on 7000 )of Division 3 of the Business and Professions Code, and my license Is In furtforceand effect. I also affirm underpenaltyof perjury one of the foll awing declarations (CHOOSE ONE): DI have amd 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 wori< which this permit is Issued. PolicyNo. ________________________________________ _ -OR- DI 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. My workers' compensation insurance carrier and policy number are: Insurance Company Name: STATE COMPENSATION INSURANCE FUND Policy No. 9134238 Expiration Date: _u.1_912_02_4 _____________ _ -OR- D Certificate of EMemptlon: 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 subj,-ct to th• work,-rs' compensation Laws of California. WARNING: Failure to secure workers compensation coverage Is unlawful and shall subfect an employer to criminal penalties and civil fines up to $100,000.00, In addltlc,n 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) Ovil Code). Lender's Name:, _____________________ Lender'sAddress: _____________________ _ CONTRACTOR CERT/FICA TION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and utilltles/utilitv easements. All propgsed modificatioos and/or addllloos are clearly labeled on the site plan. Any potentially exlstlna detail within those plans Inconsistent with the site plan are not appr011ed for construction and may be required to be altered or remO\led. The city's approval of the application Is based on the premise that the submitted documents and plans show the c0trect dimensions of; the property, buildings, structures and their setbacks from propcrtY lines and from one another; access r ds/easemcnu, and utilities. The existing and proposed use of each building as ,tated Is trve and correct; all easements and other enrumbranc:ts to development have b accurately .sh 4'nd labeled as well as all on-site grading/site preparation. All lmprovemenu u:fstlns on the property were completed in accordance with all regulations In existence e time of their NAME (PRINT): Tim Seaman Note: If the person signing above Is an authorized agent for the contractor (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do the wori< and the structure Is not intend•d 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 I. -OR- D1, 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- DI 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./ understand that a copy of the applicable low, Section 7044 of the Business and Professions Code, Is available upon request when th/ sappllcatlon Is submitted orat the fotlowlnj Website: http:l lwww.lejinfo.ca.jov/calaw.html. OWNER CERT/FICA TION: The applicant certifies that all documents and plans clearly and accurately mow all existing and proposed buildings, structures, acce55 roads, and utilities/utility oasements. All proposed modifications and/or additions are clearly labeled on the site plan. Any potentially existing detail within these plans Inconsistent with the site plan are not approved for construction and may be required to be altered or removed. The city's approval of the application Is based on the premise that the submitted document. and plan.s show the correct dimensions of; the property, buildings, structures and their setbaru from property fines and from one another; access roads/easements, and utilities. The existing and proposed use of each bulldln& as stated is true and correct; all easements and other encumbrances to development have been accurately mown and labeled as well as all on-site 1rading/site preparation. All improYem■ntJ; exfstiris on the-property were completed in accordance with all ril!'gulatfons In existence at the time of their construction, unless otherwise noted. NAME (PRINT): __________ SIGN: _________ DATE: _____ _ Note: If the erson sl nln above Is an authorized a ent for the ro e owner Include form B-62 sl ned b owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Buildlng@carlsbadca.gov 2 REV. 04/:Z:Z                                          {city of Carlsbad