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Home My WebLink About164 CHESTNUT AVE; ; CBR2023-3281; Permit                                                  (Cityof Carlsbad ------·---------------------------~------- ( City of Carlsbad RESIDENTIAL BU ILDING PERMIT APIPLiCAT~ON IB-1 Plan Check e,e:,·~-2023-3ZY / Est. Value fW>'?. OQ PC Deposit JobAddress_j_~_:} Ch:eothuL_Ot:{.__V,.,..t_.___q_l008 unit: ____ APN: ________ _ CT/Project#: ______________ _ _Lot #: ____ Year Built: ________ _ BRIEF DESCRIPTION OF WORK: 1 1 ~ l n iSh:eci <lo e, )< I ~tdl§ -(: lt>(tV'l co.,\ ( e X +e, !ti O ,,.) □ New SF: Living SF, ____ Deck SF, ___ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? O Y ~ N New Fireplace? O YE_ N, if yes how many? ___ _ al Remodel: 110 SF of affected area Is the area a conversion or change ofuse? @ Y Ql1 N [] Po,ol/Spa: _____ SF Additional Gas or Electrical Features? ___________ _ 0Solar: ___ l(W, ___ Modules, Mounted:QRoof C)Grou nd, Tilt: 0 Y0 N, RMA:O Y O N, Battery:O YO N, Panel Upgrade: O vO N Electric Meter number: ------------ Other: APPLICANT (PRIMARY CONTACT) PROPERTY OWNER Name: J e~\..C ~ V-e,_r1111~t_n_ _____ Narne:_~Y.\__\S.\-t~ ·--------- Adclress:,J .. k~L-lhR 6t lliJ±._ jJ,\'j_L _____ Address:, __ L(e_1i.__Lb!.IS·\ n ..... v"'"'·\_ ..... / __ -_v_e. _____ _ City: 0 et Y L.~_b_a.cl __ State: C,A Zip: Cf lO() 5 City: __ L~u.,Lili.g:::§.. _____ State:_f.Jl...Zip:-1_ u,£8__ Phone:_JN,-..;.....-11:2.~..:.lJ_o -0Y lo t, . Phone:_~o.0 _ -l qo--~13:.. Ll . . _., __ -- Email: j t:~_trJ_'rtJ.lll:l_®_@_gf}1Cll/ • (0 rrJ Email: ___ 5 v,·1 Y 1~+1b ~ltt @ __ 2Jk7tl ti· ( 0 (V) DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: , __________ Business Name: _________ _ Address: __ , _______________ , Address: _________________ _ City: ____ State:~ __ Zip: ___ _ City: _ ____ State: ___ Zip: Phone: __ Phone: ----·---Email: ________________ _ Email: __________ , _______ _ Archite,:t State License: CSLB License !#: ______ Class: ______ _ Carlsbad Business License# (Required): _______ _ APPLICANT CERTIFICATION: I certifi, that I have read the application and state that the above information is correct and that the information of the plans is acwrate. I agree to comply with all City ordinances and State laws relating to building construction. ~ NAME(PRINT): \eGSlCQ; ~-:R.vlman s1GN __ : ____ MM-__ DATE: Ot;-2!),,23 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov REV. 04/22 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECI< 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 herebyaff irm underpenaltyof perjury that I am I icensed underprovisionsof Chapter 9 ( commencing with Sect ion 7000) of Division 3 of the BusinessandProfessionsCode, andm11 license is in ful/forceandeffect. I a/so affirm underpenaltyof perjury one of the following declarat ions {CHOOSE ON[}: 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. 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 carrier and policy number are: Insurance Company Name: _______________________ _ Policy No. ________________________________ EHpiration Date: _________________ _ -OR- [] Certificate of Exemption: I certify that in the performance or the work for which this permit is issu,2d, 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 AGE NCY, IF ANY: I hereby affirm that there is a construction lending agency for th e performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name: _______________________ Lencler's Address: ______________________ _ CONTRACTOR CERT/FICA TION: 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, ar,d utilitie;. 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): (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 Professior.s 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- was owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Busines5 and Professions Code: The Contractor's Li~ense 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- DI am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, D FOHM 3-61 "Owner Builder l\clmowledr,ern,mt ,nd V1!riiic~tior1 Form" is required for any permit issued to a property owner. By my signatu ·e below I acknowledge tnat, except for rny personal re~iden,:e in which I rnui.t have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a stru cture that I ha•1e built as an owner-builder if it has not been construct2d in its e,nt:irety by licensed contractors./ understand thatacopyaf the applicable law, Section 7044of the Business and Professions Code, isavailableupon request when this application is submitted orat the following Web site: /Jttp:l lwww.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. Th e 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 preparltion. All improvements existing on the property were completed in accordance with all regulations in existence at unless otherwise noted. NAME (PRINT): ..;;;..J.....;;-e:--=~()"""--'--"(.,..Q,'----...;...p_ ....... t¥....a..lV1 ...... Y1.....,IA ..... n ...;._ Note: If the erson si nin above is an authorized a ent for the ro ert owner include f 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov 2 REV. 04/22                                      {city of Carlsbad