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Home My WebLink About2647 MADISON ST; ; CBR2022-1885; Permit                                                             (Cityof Carlsbad (_ Cicyof Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 PI a n Check __;:;__---=--=.::=-=~-----==:....- Est. Value PC Deposit Date JobAddress. _ _.J-...::½:;....'i..:......7----'M-A"""""""Q:;..../ __ 5.....;..(J..;../\..i.{--=.5.....,·t ___ unit: ____ APN: ________ _ CT/Project #: _________________ Lot #: ____ Year Built: _/_9 __ (-_0 _____ _ eRtEF DEscR1PT1ON oF woRK: _ _...,_.A11-l l3:--..... W---~B....,o._· o"'--'-f ________________ _ □ 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 Y O N □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _ □ Solar: ___ KW, ___ Modules, Mounted: 0 Roof O Ground, Tilt: 0 YO N, RMA: 0> Y O N, Battery:CVC N, Panel Upgrade: O v O N Other: PRIMARY APPLICANT PROPERTY OWNER Name: J tJ ~ p A p () p A cA Name: '1 6 IE p A e 6 JJ A {_ A Address: 3 :L 1 H-I L. L l) N Address: 3 ~ 7 1-j I LL /J R . City: \/ 1 .S tA-State: t/2 Zip: q :l--0 f3 City: v · / 5 f A State:l4,_zip: 9 2 0 fl 3 Phone: 7 t 6 ~ t, -~ L -ll i (, 7 Phone: 7 ~ b . ._ <.., 3 I -6 { 4' 7 Email: Email: /'( iJ ('(;,: r_J, ----------------- 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 #: ______ Class: ______ _ Carlsbad Business License # (Required): _______ _ APPLICANT CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information of the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT):, J b I:. p A p O I) I-\ C. A SIGN: 8 c>-<.., fJ, ~a,c,a.,,--DATE: ~ -/-.:L L 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov REV. 04/22 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 TH IS 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 perjury that I am licensed under provisions of Chapter 9 ( commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations (CHOOSE ONE): D I 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- D I 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: lnsuranceCompany Name: _______________________ _ Policy No. ___________________________ Expiration Date: _______________ _ -OR- D 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 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's Address: ______________________ _ 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 utilities/utility easements. 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 documents and plans show the correct dimensions of; the property, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities. The existing and proposed use of each building as stated is true and correct; all easements and other encumbrances to development have been accurately shown and labeled as well as all on-site grading/site preparation. All improvements existing on the property were completed in accordance with all regulations in existence at the time of their construction, unless otherwise noted. 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. (OPTION B): OWNER-BUILDER DECLARATION: !...!J,ereby affirm that I am exempt from Contractor's License Law for the following reason: ~ 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. 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). -OR- D 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). -OR- D I 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 lega lly 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 law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted orat the following Web site: http:l lwww.leginfo.ca.gov/calaw.html. OWNER CERT/FICA T/ON: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and utilities/utility easements. 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 documents and plans show the correct dimensions of; the property, buildings, structures and their setbacks from property lines and from one another; access roads/easements, and utilities. The existing and proposed use of each building as stated is true and correct; all easements and other encumbrances to development have been accurately shown and labeled as well as all on-site grading/site preparation. All improvements existing on the property were completed in accordance with all regulations in existence at the time of their construction, unless otherwise noted. NAME (PRINT): J o E P IJ PO O A C.JI SIGN: .2._cr<---P -~aUt.-DATE: <;; -I --1.. 1- Note: If the oerson sil!ninl! above is an authorized aaent for the property owner inkjie form B-62 ~property owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov 2 REV. 04/22                                   {city of Carlsbad