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Home My WebLink About2516 LA COSTA AVE; ; CBR2022-1438; Permit                                                             (Cityof Carlsbad Plan Check Est. Value PC Deposit Date B-1 Page 1 of 2 Rev. 06/18 BUILDING PERMIT APPLICATION B- Job Address __________________________________________Suite: __________ APN: _________________________ CT/Project #:_________________________________________ Lot #:_________ Fire Sprinklers: Air Conditioning: Electrical Panel Upgrade BRIEF DESCRIPTION OF WORK: ________________________________________________________________________ __________________________________________________________________________________________________ APPLICANT (PRIMARY CONTACT) PROPERTY OWNER Name: ________________________________________ Name: _____________________________________________ Address: ______________________________________ Address: ____________________________________________ City: _________________ State:______Zip: _________ City: ______________________State:______Zip: ___________ Phone: _______________________________________ Phone: _____________________________________________ Email: ________________________________________ Email: ______________________________________________ DESIGN PROFESSIONAL CONTRACTOR BUSINESS Name: ________________________________________ Name: _____________________________________________ Address: ______________________________________ Address: ___________________________________________ City: _________________ State:______Zip: __________ City: _________________ State:______Zip: _______________ Phone: _______________________________________ Phone: ____________________________________________ Email: ________________________________________ Email: _____________________________________________ Architect State License: __________________________ State License:_____________ Bus. License:_______________ (Sec. 7031.5 Business and Professions Code: 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/she is licensed pursuant to the provisions of the Contractor’s License Law {Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he/she is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}). 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov Addition/New:____________Living SF, ________ Deck SF, ________ Patio SF, ________Garage SF Is this to create an Accessory Dwelling Unit? New Fireplace?if yes how many? _____ Remodel:__________ SF of affected area Is the area a conversion or change of use ? Pool/Spa: __________ SF Additional Gas or Electrical Features? _____________________________ Solar:_______ KW, ______ Modules, Mounted: Roof Ground , Tilt: Panel Upgrade: Reroof: ____________________________________________________________________________________ Plumbing/Mechanical/Electrical Only:___________________________________________________________ Other:______________________________________________________________________________________ _______________________________________________________________________________________________ ( City of Carlsbad RESIDENTIAL CBR2022-1438 56,827 1 4/26/22 2516 LA COSTA AVE 216-360-01 -00 O YES @ NO C))YES G) NO :()YES @ NO PROPOSED POOUSPA AND CITY STANDARD RETAINING WALL. POOUSPA 1000 SF 8' MAX DEPTH. RETAINING WALL 180 LF 36" HEIGHT □ □ □ □ 1000 Battery:Ov O N, □ □ O v O N 0 O v O N 0 CITY STANDARD RETAINING WALL 180 LF 36" JENNIFER RASMUSSEN 6469 PANEL CT. SAN DIEGO CA (619) 884-9188 JENNIFER@SWIFT-PERMITS.COM 92122 O v O N, O v Q N 0 0 vO N, RMA:Ov O N, SHUTTER RESIDENCE 2516 LA COSTA AVE CARLSBAD SUNDANCER POOLS INC 1048 METCALF STREET CA 92009 ESCONDIDO CA 92026 (760) 489-5850 ROBBY@SUNDANCERPOOLS.COM 995967 ACTIVE B-1 Page 2 of 2 Rev. 06/18 ( OPTION A ): WORKERS’COMPENSATION DECLARATION: I hearby affirm under penalty of perjury one of the following declarations: 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. 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:Insurance Company Name:_______________________________________________ Policy No._______________________________ Expiration Date:_______________________ 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 be come 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. CONTRACTOR SIGNATURE: _____________________________________________ AGENT DATE: _______________ ( OPTION B ): OWNER-BUILDER DECLARATION: I hereby 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). 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 Code for this reason: I personally plan to provide the major labor and materials for construction of the proposed property improvement. I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors’ license number): I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone / contractors’ license number): I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov OWNER SIGNATURE: ______________________________________________ AGENT DATE: _______________ 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:___________________________________________________ ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 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 No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. APPLICANTCERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representativeof the City of Carlsbadto enter uponthe above mentioned property forinspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITYOF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAIDCITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.OSHA:An OSHApermitis required for excavations over 5’0’ deep anddemolitionor constructionof structures over 3stories inheight. EXPIRATION: Every permit issued by the BuildingOfficial under the provisions of this Code shall expire by limitation andbecome null and voidif the buildingor workauthorized by suchpermitis notcommenced within days fromthe date of such permit orif the buildingor work authorized by such permit issuspendedor abandoned at any time after the work iscommenced foraperiodof days (. APPLICANT SIGNATURE: __________________________________________________ DATE: ____________________ □ □ □ □ □ 1. 2. 3. 4. 5. ON0903903 717/2022 £a4Jntt44/J& 365 365 ays (AB2913). ~ l<a4-tna44-Uk PREFERRED PROFESSIONAL INSURANCE COMPANY 4/15/2022 Q vES Q No □ IYes/No Yes/ No Yes/ No 4/15/2022                                                                    {city of Carlsbad