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Home My WebLink About1234 PLUM TREE RD; ; CBR2022-1782; 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: Fire Sprinklers:YES NO Air Conditioning:YES NO Electrical Panel Upgrade:YES NO BRIEF DESCRIPTION OF WORK: PRIMARY APPLICANT PROPERTY OWNER Name:Name: Address:Address: City:State: Zip:City:State: Zip: Phone: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: 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 on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. NAME (PRINT):SIGN:DATE: 1635 Faraday Ave Carlsbad,CA 92008 Ph: 760 602 2719Fax:760 602 8558 Email:Building@carlsbadca.gov 1 REV. 07/21 Solar:KW, Modules, Mounted: Roof Ground, Tilt: Y N, RMA: Y N, Battery: Y N, Panel Upgrade: Y N Reroof: Plumbing/Mechanical/Electrical Only: Other: Additional Gas or ElectricalFeatures?Pool/Spa:SF Is the area a conversion or change ofuse? Y NRemodel:SF of affectedarea New SF :_Living SF, _ Deck SF, Patio SF, Garage SF Is this to create an AccessoryDwelling Unit? Y N New Fireplace? Y N , if yes how many? □ □ □ Iii □ □ □ (_ Cicyof Carlsbad 1234 PLUM TREE RD-92011 0 0 0 0 Roof mounted PV system 00 3.91 11 ® 00 OQ Priscilla Lopez 1225 Park Center Dr Vista Ca 92081 Priscilla.Lopez@sunrun.com Priscilla Lopez 214-543-37-00 0 0 00 00 0 0@ O® ERIK STEFANSSON 1234 PLUM TREE RD Carlsbad CA 92011 Sunrun Installation Services 1225 Park Center Dr Vista CA 92081 Priscilla.Lopez@sunrun.com 750184 C46&C10 BLOS1224843 5/23/2022 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 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 (CHOOSE ONE): I have and will maintain a certificate of consent to self insure for workerscompensation 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 workers compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workerscompensation insurance carrierand policy number are:InsuranceCompany Name: Policy No. _____________________________________________________________ ExpirationDate: -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 workerscompensation 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 attorneys 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). LendersName:LendersAddress: CONTRACTOR CERTIFICATION: 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. 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. OR (OPTION B): OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from Contractors 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 Contractors 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 ContractorsLicense 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 Contractors 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 Formis 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 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 CERTIFICATION: 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. 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,CA 92008 Ph: 760 602 2719Fax:760 602 8558 Email:Building@carlsbadca.gov 2 REV. 07/21 0 AMERICAN ZURICH INSURANCE WC614287600 10101/2022 0 Priscilla Lopez 5/23/2022 0 a 0 □                                {city of Carlsbad