HomeMy WebLinkAboutPD 419; REFLEX CORPORATION; Engineering Application?()-'I/9' 'e • CITY OF CARLSBAD -ENGINEERING DEPARTMENT
APPLICATION \
FOR ENGINEERING PLANCHECK OR PROCESSING
Complete all appropriate information. Write N/A when not applicable.
PROJECT NAME: Rff~-X COJe..PDf2/\.T1 Or--.) DATE: I, I q3
PROJECT DESCRIPTION: J S r a (? y 0 F fl~ £ el, /-4A-A1UF-(.i.CTC..;f<-IAif:: BULL P .'
PROJECTADDRESS:, __ ~~~~~~~~~~~~ ____ ~~ ________ ~~~ __ ___
LOT NO(S).: <R 1=
OWNER:
Mailing Address:
Phone Nu'mber:
~l+N C, LEVy J((,
£, 0, 60x 80}
t ( ttt q ) 72C ,-qq(p 0
I certify that I am the legal owner and that all the above Information
is true and correct to the best of my knowledge.
Signature ______________ 'Date, __ _
Phone Number:
APP
Mailing Address:
Phone Number:
jo fYVSK 1
4J 80 I2u EEl kJ IZ~) #2..=30 .'
EZkN 1?t r?&Q t GA (
owner and that all Information on
of my knowledge.
'Signature_-I-..J:--I-I--I--_·_Date IlIL /43 , I
Mailing AddreS8:
Phone Number:
R: fkJ1NP1-IY ·13£LfM-r
a-ED1fU.,Htt 165
7MJ. 0&erD I 6A--J C/21 ?(p I ( IPI~) S31.p-{OO.=.CJ __
LANDSCAPE ARCHITECT: Me k f!:jii.N,(!Il~ I ADDITIONAL COMMENTS:, ___________ _
Firm: LAW2CyLA.--f1tt C S
Mailing Address: q6] A-AVM9£ 9ff-P ,
Nkl1 (IN/yL Q{ 1'1 cA "c "
Phone Number: «(, l q I 4:17 -q § z5 b
NO. OF DWEWNG UNITS: _______ _ NO. OF LOTS: ______ ,·'-""-__ _ NO. OF ACRES:, ___ _
IMPROVEMENT VALUATION: sewer, water & reclaimed water:, _______ -,-;-,.
J.o.-_.":' ... < '"
streets and drainage:,~ ____ _rt_;;'-landscape: water district: -it' ------'-------," . GRADING QUANTITIES: C'ff' "":;t-eut ____ cy fill _____ cy '---,':f-~. -,/ '~; ;~medial cy import/export
PLEASE CHECK OFF APPUCATION TYPES ON REVERSE SIDE
P:\DOCS\MISFORMS\FRMoooe3 REV 1211~m
•
FOR CITY USE ONLY
APPLICATION FOR Plancheck Type (CHECK ALL THAT APPLy): Number
o Adjustment Plat -
ADJP
D Certificate of Compliance coc
o Dedication of Easement DOE
Type:
Type:
o Encroachment Permit ENCROACH
.. o Engineering Standards Variance ESV
o Final Map FM
o Gr2 19 GRADING
~Im~ :ment Plancheck DJ-.~x;5\...{ IPC
o Lanascape Plancheck LPC
o Parcel Map PM
o Quitclaim of Easement QUITC
Type:
Type:
o Reversion to Acreage
,. RTA
o Street Vacation STY .. .. : .. o Tentative Parcel Map '." MS .. . . . . ...
. -..... : .... : ..... -:,::-;.
MASTER PHOJECT ID~ cr tDt?~ 2L/ L\.ni-f5
RECEIPT NUMBEr ... _...II:S-:~/..I..%~ ______ _
PRELIMINARY SIERRA··SYSTEM··JN.Fitit INITIAL._S .... H"--__
SIERRASYSTEM'INPUTINniAL, .... ·:s;:;,.:o·h';..:o.;·: ______ _
R:8ASE INPUT INITIAL.--e...;/..k:;;..,.t.......:;.~ ....,....".. __
Doth €I r: .~;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;=;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;dl
P:\DOCS\MI~rt;RMS'FRM~
. Drawing Prolect Deposit/Fees
Number .. 10 •. Paid
..
..
..
D.C0 ??7-L{ . .'POL! V:I ~ ,20b.~
1.01 ... t
:
:
..
... ... .. . .
:" :.-.: ...... .. ...
... . :;" ': . .. . ", . ', . . .
RE·CEIVED
',' .:'.
CITY ·OF CARLSBAD .:'.: ... eNGll\i_~~N.1ER
APPLICATION:· RECEIVED··
REV 12/15/92:
City of Carlsbad Building Department
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
VAUD.BY ______________ ~~~~
1. PRRMI I lYPE
A . 0 CommercIal 0 New BUIlding 0 Tenant Improvement
B -0 Industrial 0 New Building 0 Tenant Improvement
C -0 Residential 0 Apartment 0 Condo 0 Single Family Dwelling 0 Addition! 1}Jteration
o Duplex 0 Demolition 0 Relocation. 0 Mobile Home 0 Electrical 0 Plumbing
o Mechanical 0 Pool 0 Spa 0 Retaining Wall 0 Solar 0 Other
A§foN A-V ~ __
Nearest Cross Street C OL..LI.~Cr-e:. AVt::-
DATE
IP-'L-i €V ~
~'CMtaj
LEGAL DESCRlP'hoN LOt No. SubdlVlslOn Name/Number Umt No. Phase No. ~1-CA,zLS BA.D 'JRAul ,/iff). CHECK BEroW IF sOBMl'l lED: 85--24::
o 2 Energy cales 0 2 Structural Cales 0 2 Soils Report 0 1 Addressed Envelope
ASSESSOR'S PARCEL z... I z: -1'2:0 -lk
DESCRIPTION OF WORK ''-, ~~ CJ'." ·dL
SQ. Fr. ~~e:;-P # OF STORIES
3. ruN IAC=N (It dHterent trom apphcanO
NAME);r;vUf7o MA-LOONA-DO ADDRESS
CIIT ~ e:oo STATE LA
NAME
t::;'n ,ALl 90 jv(A.Lf;bttA-Po
CIIT ~""f\.., STATE
STATE LA-
NAME
CIIT STATE
ADDRESS
ZIP CODE
ADDRESS
ZIP CODE
EXISTING USE
4-1 @c> «urfl;<./J It (/
C/l-IL?
(CufFf)) RO
DAY TELEPHONE
f,o. Ebx 003
42-00 B DAY TELEPHONE
DAY TELEPHONE
f1I...r NtJ. /Jl8/1
PROPOSED USE
2-30
STATE LIC. # LICENSE CLASS CIIT BUSINESS LIC. #
DESIGNER NAME A L '7 AP--rulr;u'L((1Z... ADDRESS 4L f) 0
CIIT~ ~~ STATE vA ZIPCODE qhlL3 7. WOI· MP
Workers' COmpensatIon DeClaratIon: I hereby attlrm that I have a certIficate ot consent toseif-Insure Issuea by the Dlrectorot lndustnar
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certjfied
by the Director of the insurer thereof filed with the Building Inspection Department (Sectio~ 3800, Lab. C).
INSURANCE COMPANY POLICY NO. EXPIRATION DATE
cerufIcate of ExemptIon: I cerury that In the performance of the work for whIch thIS permitiS Issued, I shall not employ any person In any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. OWNER-DuIlDER DECLARA'110N
Owner-HUllder DeclaratIon: I hereby atflrm that I am exempt trom the Contracto?s Ucense taw tor the follOWIng reason:
o 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 williiave the burden
of proving that he did not build or improve for the purpose of sale.).
o I, as owner of the property, am exclush-ely 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 ~w).
o I am exempt under Section _______ Business and Professions Code for this reason:
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the
provisions of the Contractor's License law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penallY of not more than five hundred dollars [$500)).
SIGNATURE DATE
coMpLETE 'tHIS SEC1lON FOR NON-RESJDEN11AL BUILDING PERMIt'S ONLY:
Is the aRPlicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? o YES 0 NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
DYES 0 NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
M vr.c: n "1(1