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Home My WebLink About1696 BASSWOOD AVE; ; CBR2023-4809; Permit                                                      (Cityof Carlsbad ( City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check ________ _ Est. Value PC Deposit Date Job Address 1696 Basswood Avenue Carlsbad, CA 92008 Unit:, _____ APN: __________ _ CT/Project #: __________________ Lot #:, ____ Year Built: _________ _ BRIEF DESCRIPTION OF WORK: New PV, roof mounted, 3.2 kW, 8 modules, new Enphase 5 kWh battery □ 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? ____________ _ E]Solar: 4.o KW, 10 Modules,Mounted:0Roof (j)Ground, Tilt:OYeN, RMA:O Ye N, Battery:OYO N, Panel Upgrade: O v •N Electric Meter number: ------------ 0th er: PROPERTY OWNER APPLICANT (PRIMARY CONTACT) Name:Emily Mai Name: __ R_e_b_e_cc_a_R_o_se ____________ _ Address:5205 Avenida Encinas #D Address: 1670 Basswood Avenue City:Carlsbad State:_C_A __ .Zip:92008 City: Carlsbad State: CA Zip: 92008 Phone:(510) 871-0081 Email:emai@kotaenergygroup.com Phone: (812) 477-5789 Email: Bbrown221@yahoo.com DESIGN PROFESSIONAL CONTRACTOR OF RECORD Name: Business Name:KOTA CONSTRUCTION LLC ------------------Address: Address:5205 Avenida Encinas #D City: ________ State: ___ .Zip:_____ City:Carlsbad State:CA Zip:_92_0_0_8 ____ _ Phone: Phone:(510) 871-0081 Email: Email:emai@kotaenergygroup.com Architect State License: CSLB License #: 1063901 Class:C-10 ------- Carlsbad Business License # (Required):8LOS00?913-06-2020 APPLICANT CERTIFICATION: I certify that I have read the applicatian and state that the above information is correct and that the information of the plans is accurate. I agree ta comply with all City ardinances and State laws relating to building construction. Emily Mai NAME (PRINT): ________ _ SIGN __ : --~---rhP½ ____ DATE: 10/27/23 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov REV. 04122 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 inf ull force and effect. I also affirm under penalty of perjury one of the following 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. 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: lnsuranceCompany Name: _H_a_rtt_o_r_d __ ~~~~~-------------• Policy No. 21 WEHAZ4SE6 Expiration Date: _9_/3_0_/_2_4 __________ 1 -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 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. 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. Emily Mai NAME (PRINT): Note: If the person signing above is an authorized agent for the contra t SIGNATURE: --------------~ l'Yvt-.. DATE: __ 10_1_27_12_3 __ _ I tter of authorization on contractor letterhead. -OR- (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). -OR- 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). -OR- D I am exempt under Business and Professions Code Division 3, Chapter 9, Article 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 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./ understand that a copy of theapplicable law, Section 7044 of the Business and Professions Code, isavailable upon request when this application is submitted orat the following Website: http://www.leginfo.ca.gov/calaw.html. OWNER CERT/FICA T/ON: 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. 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): Note: If the erson si nin above is an authorized a ent for the ro ert owner include form B-62 si owner. 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442-339-2719 Email: Building@carlsbadca.gov 2 REV. 04/22                                           {city of Carlsbad