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HomeMy WebLinkAbout1166 MARIPOSA RD; ; CBR2022-4752; Permit                                                            (Cityof Carlsbad ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check ________ _ Est. Va lue PC Deposit Date Job Address 1166 MARI POSA RD Unit: _____ .APN: __________ _ CT/Project #: _________________ Lot #: ____ Year Built: ________ _ BRIEF DESCRIPTION OF WORK: Roof mounted PV system □ New SF : Living SF, ____ Deck SF, ___ Patio SF, ____ Garage SF __ _ Is this to create an Accessory Dwelling Unit? O Y O N New Fireplace? O YO N, if yes how many? ___ _ D Remodel: _____ SF of affected area Is the area a conversion or change of use? O YO N □ Pool/Spa: _____ SF Additional Gas or Electrical Features? ____________ _ iii Solar: 3.95 KW, 10 Modules, Mounted:.Roof OGround, Tilt: OY@N, RMA: OY @ N, Battery:OY @N, Panel Upgrade: OY ©N Other: PRIMARY APPLICANT PROPERTY OWNER Name: Jamie Sager Name: THANH LE Address: 1225 Park Center Dr Address: 1166 MARIPOSA RD City: Vjsta State: CA Zip: 92081 City: Carlsbad State: CA Zip: 92011 Phone: _________________ Phone: __________________ _ Email: __ j_a_m_ie_.s_a_g __ e_r@ ___ s_u_n_r_u_n_.c_o_m ______ Email: __________________ _ DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: _________________ Business Name: Sunrun Installation Services Address: Address: 1225 Park Center Dr City: _______ State: ___ Zip:____ City: Vista State: CA Zip: 92081 Phone: Phone: ------------------Em a i I: Email: jamie.sager@sunrun.com Architect State License: CSLB License#: 750184 Class: C 46 & C 10 Carlsbad Business License# (Required): BLOS1224843 APPLICANT CERT/FICA TION: f certify that f have read the application and state thac the above informacion is correct and char che information of the plans is accurate. I agree to comply with all City ordinances and State laws relating ta building construction.~. NAME (PRINT): Jamie Sager SIGN_ ,c-1 DATE: 12/22/22 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Bullding@carlsbadca.gov REV. 04/22 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: lherebyaffirmunderpenaltyofperjurythatlamlicensedunderprovisionsofChapter9(commencingwithSection7000)ofDivision3 of the Business and Professions Code, and my license is in full force and effect. I a/so affirm underpenaltyof perjury one of the foil owing declarations ( CHOOSE ONE): 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. ___________________________________________ _ -OR- (EI I have and will maintain worker's compensation, as required by Section 3700 of the Labor Code, for the pei:formance of the work for which this permit is issued, My workers' compensation insurance carrier and policy number are: Insurance Company Name: American Zurich Insurance Policy No. WC614287600 Expiration Date: ~1~0~/0,,,_._1 /L.02..,0._.2...,3.,__ ______ _ -OR- 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: _______________________ Lender's Address: ______________________ _ CONTRACTOR CERTIFICATION: The applicant certifies that all documents and plans dearly and accurately show all existing and proposed buildings, structures, access roads, and utilities/utility easements. All proposed modifications and/or addltlons 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 applicatlon 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 ta 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): Jamie Sager Note: If the person signing above is an authorized agent for the cont (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 compens.ation, 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- DI, 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- DI am exempt under Business and Professions Code Division 3, Chapter 9, Artide 3 for this reason: AND. D 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 persanal 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 1f it has not been constructed In 1ts entirety by licensed contractors./ 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 Website: http: I I www. I egi nfo. ca. gov I ca law. html. OWNER CERTIFICATION: The applicant certifies that all documents and plans clearly and accurately show all existing and proposed buildings, structures, access roads, and utllitles/utillty easements, All proposed modifications and/or additions are clearly labeled an the site plan. Any potenaally existing detall 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 an the prem,se that the submitted documents and plans show the correct dimensions of; the property, buildings, structures and their setbacks from property lines and from one anolher: access roads/easements, and utilities. The existing and proposed use of each building as stated is true and corr&t: all easements and other encumbrances to development ~ave been accurately shown and labeled as well as all on-site grading/site preparation. All improvements existing an 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 erson si nin above is an authorized a ent for the ro ert owner include forh'I B-62 si ned b owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Buildlng@carlsbadca.gov 2 REV. 04/22                                {city of Carlsbad