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Home My WebLink About2311 CARINGA WAY; # 45; CBR2021-2095; Permit                                                                 (Cityof Carlsbad 1 REV. 08/20 __________________________________________________________________________________________________ RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check Est. Value PC Deposit Date Job Address Suite: APN: CT/Project #: Lot #: Year Built: ______________________ Fire Sprinklers: YES NO Air Conditioning: YES NO Electrical Panel Upgrade: YES NO BRIEF DESCRIPTION OF WORK: 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. PROPERTY OWNER APPLICANT PROPERTY OWNERS AUTHORIZED AGENT APPLICANT Name: Name: Address: Address: City: State: Zip: Phone: City:State: Zip: Phone: Email: Email: DESIGN PROFESSIONAL APPLICANT CONTRACTOR OF RECORD APPLICANT Name: Address: City: State: Zip: Phone: Email: Architect State License: Name: Address: City: State: Zip: Phone: Email: State License/class: Bus. License: 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov 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 Electrical Features?Pool/Spa:SF Patio SF,Garage SF ______ New : _Living SF, _ Deck SF, Is this to create an Accessory Dwelling Unit? Y N New Fireplace? Y N , if yes how many? Remodel: SF of affected area Is the area a conversion or change of use ? Y N 2311 Caringa Way 45 215-240-27-45 3*US45 4.56kW DC Roof Mounted PV System consisting of 12 modules and (1) Inverter No Panel Upgrade, No Batteries 4.56 12 Ariel and James Sandoval 2311 Caringa Way Carlsbad CA 92009 408.460.7776 james.sandoval1023@gmail.com james.sandoval1023@gmail.com New Leaf Electric Inc/ Brad Fort 3960 W. Point Loma Blvd. Ste H234 San Diego CA 92110 760.578.9834 brad@newleafelectric.com 1034853/ C-10 □ □ □ Ii] □ □ □ ( City of Carlsbad 0 ® 0 0 cbr2021-2095 $48QQ 7/14/21 0 @) {all new construction requries FORMS B-50 and B-59 at permit issuance) SF 00 00 0 0 ®) 0 0 ®) oe 00 0 ®) TURN IN PAGE ONE OF THIS APPLICATION UPON SUBMITTING PLANS. PAGE TWO IS REQUIRED AT PERMIT ISSUANCE. □ □ □ Iii blos003178-05-2018 OWNER PRINT: 2 REV. 08/20 IDENTIFY BY COMPLETING (OPTION A) (OPTION B) (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 : 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.___________________________________________________________________________________________________ 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 workers compensation insurance carrier and policy number are: Insurance Company Name: Policy No. ________________________________Expiration Date: 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 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). Lenders Name: Lenders Address: DATE: CONTRACTOR PRINT (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). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors 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 Contractors License Law). I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: _____________________________________________________________________________________________________________________________________ Owner Builder acknowledgement and verification form has been filled out, signed and attached to this application. Owners Authorized Agent Form has been filled out, signed and attached to this application giving the agent authority to obtain the permit 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 DATE: 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. By my signature below, I certify that: I am authorized to act on the property owner or contras 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. A PRINT: DATE: 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov State Comp Insurance Fund 9227351-2021 03/03/2022 07/06/2021 07/06/2021 Brad Fort Brad Fort THE PERMIT APPLICANT BELOW OR (OPTION C) APPLICANT □ Ii □ APPLICANT [g □ □ □FORM B-61 □ FORM B-62 "Ow11ers {CHOOSE ONE} Digitally signed by Brad Fort _________ SIGN: B d F t DN:cn=Bfadfort,o,ou, r a Or :~:rad@newleafelectric.co ___________ SIGN: _________ _ (APPLICANT OPTION C) OWNER OR CONTRACTORS AUTHORIZED AGENT: GENT                                                               {city of Carlsbad