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Home My WebLink About1901 CASSIA RD; 200; CBR2024-0866; Permit                                                         (Cityof Carlsbad (City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Plan Check _______ _ Est. Value PC Deposit Date Job Address 'd q \ q 0 U.66 ra. Q..d Unit: i...--• .3£)\ APN: _________ _ CT/Project#: ________________ .lot#:. ____ YearBuilt: ________ _ BRIEF DESCRIPTION OF WORK: B-el u CQ_ 9. 40 3a.\\cn LDcde< ~~ 0 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 YON , if yes how many? ___ _ D Remodel: ____ .SF of affected area Is the area a conversion or change of use? 0 Y O N □ Pool/Spa: ___ _;SF Additional Gas or Electrical Features? ___________ _ 0 Sofar: _____ KW, ___ .Modules, Mounted:0Roof O Ground, TIit: 0 YON, RMA: 0 Y O N, Batterv:OYC N, Panel Upgrade: OvON Electric Meter number: -----------0th er: APPLICANT PRIMARY CO TACT} Nam • ~ Nam Add 9 LCf ~ City:.-...;~~~,,...-~ :...---~--~---~----~--"ft"'---.: hon:...,.-~-"'!'-~-.-~.-.-..----,:------ ·~~.;....:.;~4-1~:;:;..;...;,;::.1~~-===;i_..Ui:l~;;;... .. mall _....;..-~..-.i:i..a..~~~--.&..1,-=----- DESIGN PROFESSIONAL • Name: ________________ Business Na .....-,~..... , !:)rtt,0$ :1&- Address: Add ss:,=,...;...:.;;:;.~~~~..a..:.~"-------- City:. _________ state: __ _.zlp:.____ Clty: . ...._...;:::.....a~~:;,,-, Phone: Phone..:;;;~~..w.;~;..,.....;;;..;;:;...~...,;;.---'"'"_...~- Email: _______________ _ Architect State License: _________ _ CSLB License #:...w.a~;;;...;::=-__ C.fass: ________ _ Carlsbad Business License# (Required): ______ _ APPLICANT CERTIFICA T/ON: I certify that I have read the appllcotlon and state at the above i,iformat/on is ct and thatthe Information of the plans~ aaura!E. I agr~ to comply with all Oty ordinances and S~ laws relating ta building amstructio NAME (PRINT): ~ tU\ V:u?~ \\0.,y 1635 Faraday Ave Carlsbad, CA 92008 Ph: 442·339-2719 Email: lluiidingt!i>carlsbcldca,l!OV REV. 04122 THIS PAGE REQUIRED AT PERMIT ISSUANCE PLAN CHECK NUMBER: ______ _ A BUILDING PERMlT CAN l3E ISSUED TO EITHER A STATE LICENSED CONTRACTOR OR A PROPERTV OWNER. IF THE PERSON SIGNING THIS FORM IS AN AGENT FOR ElTHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRlOR TO PERMIT ISSUANCE. (OPTION A): LICENSED CONTRACTOR DECLARATION: I nerebyaffirmunder penaltyof perjurythat I am licensedunderprovisionsof Chapter9 (commendngwith Section lOOO)of Division3 of the Business and Professions Code, and my license is f n full force and effect. I alsoaf/lrm under penalty of perjury one of the following declarations (CHOOSE ONE): 01 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 workwhichthi5 permit is issued. PollcyNo. ______________________________________ _ ~R• @'1 have and wilt maintain worker's compensation, as required by Section 3700 of the Labor COde, for e performa'lc My workers' co tion Ins oli number are: lnsuranceCompany Name: -~1.c:-.11.,,3,.JLJ.J..4-"'\----¼:H~.P.~,:"i,:~~~ca-,._,._.,.l,...W1 ,cR,., Policy No ..... -,;...a..c:::..._~~-+,::....L__,,_.l,&.~W...-----------Ex1>iratlonDate: _ ___:~:'.1...11--l---Wgu:t:!+:__----I -OR-D Certificate of Exemption: f certify that In the performance of the work for which this permit Is issued, f shall not employ any person in any manner so as to become subject to the workers' compensation Laws cf Califomla. WARNING: failure to secure workers compensation caverqe is unlawful and shall sub}eet 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, intllrest and attorney's fees. CONSTRUCTION LENDING AGl:.N"CV. IF ANY: f hereby affirm that there is a construction lending aeency for the performance of the work thls permit is issued (Sec. 3097 {I) Civil Code). Lender's Name: Lender's Address: ____________________ _ CONTRACTOR CERTTFICA TION: The applicant certifies that all documents and plans ch,;sty and accurately show all existing and proposed bullangs, structures, access roads, and utilitie•/utllity easements. Alf proposed modlflcatlons and/or additions are dearly labeled on the site plan. Any potentially eidstin& detaU within these plans Inconsistent With 1he site plan are not approved for construction and may be requlntd to be altered or rtmoved. The city's approval of the application is bas"d on the premise that the subrnitted 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 bulldlng as stated istrut and correct; all easem,mtsand oth&rencumbr.mcesto developmen have been accurat@lyshown andlabeied as well as al on-site grading/site preparation. All improvements existini. on the property weni completed in accordance with al regulations In a.irt at the tim of their nstru less otnerwlse noted. NAME (PRINT)= ~gr, ~o ,~"= SIGNATURE=--"---Ji~~~~:::::.;,;_.... '-t I 5 Id&+ Note: If the person signlnc above is an authorized agent for the contractor provide a {OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: D I, as owner of the property or my employees with wases 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 hls own employees, provided that such Improvements are not intended or offered for sale. ff, 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 bulld or improve for the purpose of sale). ·OR-O I,"$ owner of the property. am e,ccluslvelv contractln8 with lrc•.,•ed conu-actor.5 = con6trucr m e project (:lee. 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, Anide 3 for this reason: AND, D FORM B-61 "Owner Builder Acknowledgement and Verification form" is required fur any permit i55ued to a property owner. 8y my signature below f 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, J 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 theappllcablelaw, Section 7044of the 8us1nessand Professions Code, isavaflableupon request when this application is submitted or at the following Web site: http: I twww.leginfo.ca.gov I cat aw.html. OWNER CERT/FICA TION.· The applicant certifies that aU documents and plans d,artv and accurately show alt existing and proposed buildings, structures, access roads, and utillties/Ulility <1asement:s. All proposed modifications and/or additions are dearly labeled on the site plan. Arry potentially ~sting detail within these plans Inconsistent with the site plan are not approl/ed for construction and may be required to be altered or removed. The citv's approval of the application iS based on the premise that the submitted documents and plans show the correct dimensions of; the property, bullamgs, structures and their setbacks from property lfnes and from one another, access roa~easemenlS, and utilities. The existing and proposed use of each building as stated is true and correct: all easements and other encumbrances tn development have been accurately shown and labeled as well as aft on~ite grading/site preparation. All improvements IJllistln& on the property were am,plet,,d In acx:ordancewfth all regul;rtlons Jn exlsllince att11e tfmeof their construction, unless otherwise ncted. NAME (PRINT): SIGN: DATE: ------------------------Note: If the person sl nln& above ls an authorized Tty owner lndude form 8-62 signed by owner. 1635 Faraday Ave Car1sbad,CA92008 Ph: 442-339-2719 Eman: Bullding.@carlsbadca.gov 2                                    {city of Carlsbad