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Home My WebLink About1055 CHESTNUT AVE; ; CBR2022-4571; Permit                                                   (Cityof Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check Est. Value PC Deposit Date Job Address Unit:APN: CT/Project #: Lot #: Year Built: BRIEF DESCRIPTION OF WORK: PROPERTY OWNER Name: Address: State: Zip:City: State: Zip: Phone: APPLICANT Name: Address: City: Phone: Email: Email: DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: Business Name: Address: City: State: Zip: Phone: Email: Architect StateLicense: Address: City: State: Zip: Phone: Email: CSLBLicense #: 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): DATE: 1635 Faraday Ave Carlsbad,CA92008 SIGN: Ph:-2719 Email:Building@carlsbadca.gov 1 REV. New SF : Living SF,_Deck SF,Patio SF,Garage SF Is this to create an Accessory Dwelling Unit? Y N New Fireplace? Y N , if yes how many? _________ Solar:KW, Modules, Mounted: Roof Ground, Tilt: Y N, RMA: Y N, Battery: Y N, Panel Upgrade: Y N Other: Additional Gas or ElectricalFeatures?Pool/Spa:SF Is the area a conversion or change of use?Y NRemodel:SF of affected area □ □ □ □ ( City of Carlsbad 1055 Chestnut Avenue Electric Service Upgrade Addi 00 eo Electric Service Upgrade (PRIMARY CONTACT) Paul Kotas 1055 Chestnut Avenue Carlsbad CA ---760-310-1365 paul@kotasclan.com Paul Kotas 0 0 00 () 0 00 Electric Meter number: Paul Kotas 1055 Chestnut Avenue 92008 Carlsbad 760-310-1365 paul@kotasclan.com Paul Kotas 442-339 12/9/2022 1975 0 0 0 0 CA 92008 12/09/2022 04122 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 LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: I herebyaffirmunderpenaltyofperjurythat I amlicensedunderprovisionsofChapter 9 (commencingwithSection7000)ofDivision3 oftheBusinessandProfessionsCode,andmylicenseisin full forceand effect. I alsoaffirmunderpenaltyofperjuryoneofthe following declarations (CHOOSE ONE): 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. PolicyNo. -OR- 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 carrierand policynumberare:InsuranceCompany Name: Policy No. _____________________________________________________________ Expiration Date: -OR- 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 CERTIFICATION: 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: 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). -OR- 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- I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, 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.I understandthat a copyoftheapplicablelaw,Section7044oftheBusinessandProfessionsCode,isavailableuponrequestwhenthisapplicationis submittedor at the following Website: http://www.leginfo.ca.gov/calaw.html. OWNER CERTIFICATION: 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): SIGN:DATE: Note: If the person signing above is an authorized agent for the property owner include form B-62 signed by property owner. 1635 Faraday Ave Carlsbad,CA92008 Ph:--2719 Email:Building@carlsbadca.gov 2 REV. - OR - □ □ □ ii □ □ ii Paul Kotas Paul Kotas 12/9/2022 442 339 04/22                                                                          {city of Carlsbad                           