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Home My WebLink About2032 LEE CT; ; CBR2022-1541; Permit                                                           (Cityof Carlsbad ( City of Carlsbad Job Address 2032 Lee Court RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check ________ _ Est. Value PC Deposit Date Suite: APN: 2053304600 , ____ _ CT/Project #: __________________ Lot #: ____ Year Built: _1_9_8_7 ______ _ Fire Sprinklers: O vEs@ No Air Conditioning:Q YES 0 NO Electrical Panel Upgrade: Q vEs @) NO BRIEF DESCRIPTION OF WORK: INSTALLATION OF a 7.770 DC kW (STC) GRID TIED ROOF MOUNTED SOLAR PANELS. - PV Modules: (21) Panasonic EVPV370 370W, 120 half-cut cell monocrystalline HJT module, white backsheet, 1000V max system Vdc • -Microinverters: grid-tie: (21) Enphase Energy IQSA-72-2-US [240V] 0 Addition/New: ______ Living SF, ____ Deck SF, ____ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? O v 0 N New Fireplace? O v 0 N, if yes how many? __ D Remodel: SF of affected area -----Is the area a conversion or change of use? O v 0 N □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ____________ _ li]Solar: 7.770 KW, 21 Modules, Mounted: <=)Roof 0 Ground, Tilt: 0 y@ N, RMA: Q y 0 N, Battery:Ov 0 N, Panel Upgrade: O v 0 N D Reroof: -------------------------------------□ Plumbing/Mechanical/Electrical 0 Only: Other: This permit is to be issued in the name of the Property Owner as Owner-Builder, licensed contractor or Authorized Agent of the owner or contractor. The person listed as the Applicant below will be the main point of contact throughout the permit process. PROPERTY OWNER APPLICANT [i PROPERTY OWNERS AUTHORIZED AGENT APPLICANT 0 Name: KURT ROLLER Address: 2032 LEE COURT Name: ____________________ _ Address: ___________________ _ City: CARLSBAD State:_C_A __ .Zip: 92008 City: __________ State: ___ ,Zip: ____ _ Phone: 760-518-9642 Phone: ___________________ _ Email: kurtr@callawayqolf.com Email: ____________________ _ DESIGN PROFESSIONAL APPLICANT 0 Name: _________________ _ Address:, ________________ _ City:, _________ State: ___ .Zip:, ____ _ Phone:, _________________ _ Email: kurtr@callawaygolf.com Architect State License: ___________ _ CONTRACTOR OF RECORD Name: REHAB SOLAR CONSTRUCTION INC Address: 2525 LOS CERRITOS APPLICANT Ii City: FALLBROOK State: CA Zip:_9_20_2_8 ____ _ Phone: 760-484-2229 Email: ashley@rehabsolar.com State License/class: B+C-10 Bus. License: 1011780 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov REV. 08/20 IDENTIFY WHO WILL PERFORM THE WORK BY COMPLETING (OPTION A) OR (OPTION B) BELOW: (OPTION A): LICENSED CONTRACTOR DECLARATION: I hereby affirm under penalty of 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: 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. ______________________________________ _ liJ 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: _s_TA_T_E_F_UN_D _________________ _ Policy No. 9205341 Expiration Date: _2_,1a_,2_0_23 ___________ _ 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 PRINT: ASHLEY PIEKARCZYK SIGN:A~ /J~JY#DATE: 5-4-2022 (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 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). 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). D I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: D"owner Builder acknowledgement and verification form" has been filled out, signed and attached to this application. D Owners "Authorized Agent Form" has been filled out, signed and attached to this application giving the agent authority to obtain the permit on the owner's behalf. 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 available upon request when this application is submitted or at the following Web site: http://www.leginfo.ca.gov/calaw.html. OWNER PRINT: _________ _ SIGN: __________ DATE: ______ _ APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL By my signature below, I certify that: I am the property owner or State of California licensed Contractor or authorized to act on the property owner or contractor's behalf. 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 representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in height. APPLICANT PRINT:_A_S_H_LE_Y_P_IE_KA_R_cz_Y_K_ SIGN: A~ /J~~ DATE: 5-4-2022 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 2 REV. 08/20                                 {city of Carlsbad