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Home My WebLink About2467 WELLSPRING ST; ; CBR2022-1889; Permit                                                            (Cityof Carlsbad ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check _______ _ Est. Value PC Deposit Date Job Address2467 Wellspring St. Suite: APN: 2081927900 , ____ _ CT/Project #: _________________ Lot #: ____ Year Built: ________ _ Fire Sprinklers: O vEs@ No Air Conditioning:Q YES 0 NO Electrical Panel Upgrade: Q vEs @) NO BRIEF DESCRIPTION OF WORK: system size: 4.320kWp. 12 hanwha q cells q.peak duo blk-g10+ 360 modules. 1 solaredge 3000h-us inverter. 12 solaredge s440 optimizer. 0 Addition/New: _____ Living SF, ____ Deck SF, ____ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? O v O N New Fireplace? O v O N, if yes how many? __ D Remodel: SF of affected area -----Is the area a conversion or change of use? O v O N □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _ li]Solar:4.320 KW, 12 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 O PROPERTY OWNERS AUTHORIZED AGENT APPLICANT [j] Name: Joseph Kim Name: Madison Darsow, Ryan J. Mcpherson Address:2467 Wellspring st Address: 1815 E. Wilshire Ave City:Carlsbad State:_C_A __ .Zip:92010 City:Santa Ana State:CA Zip:_92_7_0_5 __ _ Phone: (520)404-2766 Phone: (714)471-7292 Email: Email: madison.d@betterearth.so1ar DESIGN PROFESSIONAL APPLICANT 0 Name:Madison Darsow, Ryan J. Mcpherson Address:, _______________ _ City:, __________ State: ___ .Zip:, ___ _ Phone:, _______________ _ Email:, ________________ _ Architect State License: 82088 ----------- CONTRACTOR OF RECORD Name: Better Earth Electric Address: 1815 E. Wilshire Ave APPLICANT 0 City: Santa Ana State:_C_A __ Zip: 92705 Phone: (888)373-9379 Email: __________________ _ State License/class: 1024460, C10 Bus. License: BLOS008713 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_eq_u_oia_B_e_n_efi_,1s_a_nd_l_ns_u_ra_nce ____________ _ Policy No.2183O7528 Expiration Date: _41_1s_12_02_3 __________ _ 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: _________ SIGN: _________ DATE: (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: Madison Darsow SIGN: QJtadiMn, [Z)a/uJ.QI<) DATE: 6/1/2022 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 OWNERS AUTHORIZED AGENT FORM B-62 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov OWNER'SAUTHORIZED AGENT FORM Only a property owner, contractor or their authorized agent may submit plans and applications for building permits. To authorize a third-party agent to sign for a building permit, the owner's third party agent must bring this signed form, which identifies the agent and the owner who s/he is representing, and for what jobs s/he may obtain permits. The form must be completed in its entirety to be accepted by the City for each separate permit application. Note: The following Owner's Authorized Agent form is required to be completed by the property owner only when designating an agent to apply for a construction permit on his/her behalf. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Property Owner Acknowledgement, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Roof mounted solar. 4.420 kwp. 12 modules. 1 inverter. 12 optimizers. Scope of Construction Project (or Description of Work): ___________________ _ 2467 Wellspring St, Carlsbad, CA 92010 Project Location or Address: ____________________________ _ Madison Darsow (714)471-7292 Name of Authorized Agent: __________________ Tel No. ________ _ Address of Authorized Agent: ____________________________ _ I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature: ______ !_~--~-~._''" ______ Date: _6_/_1_/_2_0_2_2_ 1                                      {city of Carlsbad