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HomeMy WebLinkAbout1611 BROME CT; ; CBR2022-3161; Permit                                                         (Cityof Carlsbad ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check ________ _ Est. Value PC Deposit Date Job Address 1611 Brome Court, Carlsbad 92011 Suite:, _____ APN: __________ _ CT /Project#: / / Lot #: ____ Year Built: ___ _,/....__ ____ _ Fire Sprinklers: 0 YES dNo Air Conditioning: © YES rf No Electrical Panel Upgrade: 0 YES J NO BRIEF DESCRIPTION OF WORK: 3.5T 14 SEER AC & Matching Coil 4T 80% SS Furnace VALUATION $ 10,996.00 0 Addition/New: _____ Living SF, ____ Deck SF, ____ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? 0 Y O N New Fireplace? 0 Y O N, if yes how many? __ D Remodel: SF of affected area -----Is the area a conversion or change of use? O Y O N □ Pool/Spa: ____ SF Additional Gas or Electrical Features? ___________ _ O Solar:. ___ KW, ___ Modules, Mounted:0Roof 0 Ground, Tilt: 0 YO N, RMA: O Y O N, Battery: O Y O N, Panel Upgrade: O Y O N D Re roof: __________________________________ _ Ii] Plumbing/Mechanical/Electrical Only: 3.5T 14 SEER AC & Matching Coil 4T 80% SS Furnace D 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 0 PROPERTY OWNERS AUTHORIZED AGENT APPLICANT [j] Name: JOANN ORRICK Name: Rafael Martinez -Archon Energy Solutions (contractor agent) ·-----------------Address: 1611 Brome Court, Carlsbad 92011 Address: 46 Union Way City:Carlsbad State: CA Zip:_92_0_1_1 __ City: Vacaville State: CA Zip:_9_56_8_7 __ _ Phone: (619) 990-7042 Phone: 888-600-1614 Email :Permits@archonenergy.com Email: rafael@archonenergy.com DESIGN PROFESSIONAL APPLICANT O CONTRACTOR OF RECORD APPLICANT 0 Name: ________________ _ Address:, _______________ _ City:, __________ State: ___ .Zip:, ___ _ Phone:, ________________ _ Email:, ________________ _ Architect State License: __________ _ Name: Same Day Heating & Air Conditioning LLC Address: 9771 Clairemont Mesa ste E City: San Diego State: CA Zip:_9_2_1 _24 ____ _ Phone: 619-503-3355 Email :aharker@samedaysd.com State License/class: 10594441 C20 Bus. License: ____ _ 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. ______________________________________ _ [jJ 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: TRANSVERSE INSURANCE COMPANY Policy No.FORWC0000000401 Expiration Date: _01_/_07_/2_0_2_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: _____________ ~--~-+f-r.,_1 .. ~t----Lender's Address: ____________________ _ CONTRACTOR PRINT/SIGN: ___ __._ /"'-_\ ______________ DATE: _a-_29_-2_2 ____ _ (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. Proof of identification attached. 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. Proof of identification attached. 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 sr~ height. APPLICANT PRINT/SIGN: ___ K __ ; _~ ________________ DATE: _B-2_9_-2_2 ---- 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