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Home My WebLink About1937 CASSIA RD; 101; CBR2024-2236; Permit                                                         (Cityof Carlsbad • {Cityof Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION B-1 Job Address \ l\ 0 T ~ Cl.~$\ 0., \<.a Unit: \ 0 I Plan Check _______ _ :Est . Value PC Deposit Dat e _______ _ APN: _________ _ CT/Project #:. __________________ lot #: ____ Year Built: ________ _ BRIEF oescR1Pr10N oFwoRK: 12:e\Jlo ~ et >-to j u\lo-n . ~~ ~. 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? ___ _ 0 Remodel: SF of affected area Is the area a conversion or change of use? 0 Y C N □ Pool/Spa:. ___ __:SF Additional Gas or Electrical Features? ___________ _ 0 Solar:. ___ KW, Modules, Mounted:0Roof QGround, lilt: 0 Y(') N, RMA: 0 Y O N, Battery:OYC N, Panel Upgrade: Ov ON Electric Meter number: __________ _ Other: DESIGN PROFESSIONAL CONTRACTOR Name: ________________ Business Address.: Add Clty:. _______ .State: ___ Zi.p:_____ Oty:,.-,~.u.:;_~~~ Phone: _______________ _ Email: _______________ _ Architect State License: _________ _ Carlsbad Business License# (Required}: ______ _ APPLJCANT CERTIFICATIDM ,....,,,,,,,, _..,,,.,_...,,,,.,ir""'~-•-"•"-u.;_,t .. .,M•"°"""-' ::;~7;~wc~~~~-=l J iJjJCATE: <r/~, P4 163S Faraday Ave Ctrlsbad, CA 92008 Ph: 442-339-2719 Email: Building@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 ElTHER ENTITY AN AUTHORIZATION FORM OR LETTER IS REQUIRED PRIOR TO PERMIT ISSUANCE. (OPTION A): UCENSED CONTAACTOR, DECLARATION: I herebyaf firm under penalty of perjurythat I am licensed under provisions of Chapter9 ( commencing with Section 7000) of Division 3 of the Busfness and Professions Code, and my license isfn full force and effect. I also affirm underpenaltyof perjury one of the following declarations (CHOOSE ONE): 0 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 pertormance of the work which this permit is issued. Polii;yNo.'---------------------------------------- -OR- DI have and will maintain worker's compertSatlon, as required by Section 3700 of the Labor Code,~ the perfctrmance ~~thwork fo~ wl)jioWhis permit is issued. My workers' compensatlonr~ ca:~nd policy number are: lnsuranceCompany Namet A cun bl l'l__ ~f'°-'\u'.: \05uxnot.£. Policy No. '5 lpC... l.':m ~ ~ Expiration Date:_' _q--4-l--111-"qed=---'I'-------- -OR- O 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 canfornia. WARNING: Failure to secure workers compensation C01llnP Is unlawful and shaH subject an employer to criminal penalties and civil fines up to $100,000.00, In addition the to the Cl05t of compensation, dlMTlqes as provided for in Section 3706 of the Labor Code, interest and attorney's fees. CONSTRUCTION LENDING AGENCY. Jf ANY: I hereby affirm that there Is a construction lending agency for the performance of the work this perm ft ts issued (Sec. 3097 (i} Civil Code). Lender'sName: ___________________ __,lender'sAddtess: ____________________ _ CONTRACTOR CERTIFICATION: The appliant certifies that all documents and plans dearly and accurately shaw all existing and proposed buildlncs, structures, ao:ess roads, and utilities/utility easements. All proposed mocflfications and/or additions ara cfeartv labeled on the Stle plan. Any potentiaftv existing deta~ within these plans inconsistent with the sih! plan are not approved for construction and may ba requlred 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 ccrrect dimensions of; the property, buildings, structures and their setbacks from property lines and from one another; acn,ss mads/easements, and utilities. The e,cisting and proposed use of each building as stilted is true and correct; all easements and other ern:umllranccsto development have been acwrately shown and labeled as well es all on-sill! grad ms/site preparation. All:~;e~::::~;~~~i;;n~wlthaU~m~~ ~~timeof~rm~~. =o~:~~, U (df, Note: lfth& person signing .above Is an .aut~red agent for the contractor rovlde a (OPTION B): OWNEFM\UILDER DECLARATION: J hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: 0 I, as owner of the property or my employees with wages as their sole compensation, will do the worfl 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 bulld or improve for the purpose of sale). -OR- O I, 83 owner or u,c propeny. om W<dU.,l\fely coni:n,i;Ung wltll license<! amm,C!Drs TO amsttuct the project {!>eC. 7044,. SUSlness and Protesstons Code: The Contractor's Ucense Law does not apply to an owner of property who builds or improves thereon, and contracts fur such projects with contractor{s) licensed pursuant to the Contractor's License Law). -OR-O I am exempt under Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: AND, 0 FORM B--61 "Owner Builder Acknowledgement and Verification Formu is required for any permit issued to a property owner. By my slgnatur.e 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, 1 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 thataC0P'JOf theapplfcable law, Section 7044of the Business and Professions Code, is available upon request when this application is submftted or at the followfns Web site: http:I Jwww.legtnfo.ca.gov/ cal aw. html. OWNER CERTIFICA TIDN: The applicant certities that aU documents and plan; cfeartv and accurately show aU existillJI and proposed buildings, structures, access roads, and utlllties/utilltv euements. AU proposed modifications and/or additions are dearly labell!d on tl!e sltl> plan. Any potentially exlstlflB detaQ within these plans lnconslstentwfth the site plan are not approved for construction and may be required to be altered or removed. Tha city's approval of the application Is based on the premise that the submitted dotUments and plans show the correct dlmenslons of; the property, buildlnas, structures and their s~ckS from property lines and from one another; access mads/easements, and utilities. The elristin& and proposed use of each building as stated ls true and correct; aU easements and other encumbrances to dewlopment have been acet1rab!ly 5hown and labeled as well as au on--.slte grading/site preparation. All improvements existing on the property were mmpleted In aaxirdance with all regulations ln eiclstw,ce at the time oftheirconstruclion, unless otherwise noted. NAME (PRINT): SIGN: DATE: ------------------------Note: If the person si&nln above Is an authorized for the roperty owner include fonn 8--62 signed by 11roperty owner. 1635 Faraday Ave Dtrlsbad, CA 92008 Ph: 442-339-2719 Emal!: Bullgine@carlsbadca,gov 2 REV. 04/22                                    {city of Carlsbad