HomeMy WebLinkAbout1044 LAGUNA DR; 15; CB910128; PermitB U I L D I N G P E R M I T
01/25/91 16:08
Page 1 of 1
Job Address: 1044 LAGUNA DR
Permit Type: PLUMBING
Parcel No: 155-272-20-1$°
Valuation: 0
Construction Type: VN
Occupancy Group:
Description: GAS LINE REPAIR
Str: * *
Class Code:
Permit No: CB910128
Project No: A9100159
Development No:
Fl: **** ;..,te: 1s 0564 01/25/91 0001 ◊l 0~
":-P~t4T
Status: ISSUED
Applied: 01/25/91
Apr/Issue: 01/25/91
Validated By: KZH
Appl/Ownr : S. FRIEDMAN 436-2021
OWNER
CONTRACTOR
*** Fees
Fees:
Adjustments:
Total Fees:
1044 LAGUNA DR
CARLSBAD, CA 9200
Fee description
Enter "Y" for Plum r
Gas Piping System
* PLUMBING TOTAL
CITY OF CARLSBAD
OWNER
.,.. ~80123 619-755-1888
& Credits **A
• (J
.00
.00
10.00
Ext fee Data
7.50 Y
2.50
10.00
2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161
PERMIT APPLICATION
•
City of Carlsbad Building Department EST. VAL ______________ _ 2075 Las Palmas Or., Carlsbad, CA 92009 {619) 438-1161 .
•
PW CK DEPOSIT, __________ _
VALID. BY ____________ _
1. DATE ______________ _
•
B D INDUSTRIAL
TENANT IMPROVEMENT
□TENANT IMPROVEMENT
C 0 RESIDENTIAL O APARTMENT
□DUPLEX □DEMOLITION
□MECHANICAL □POOL
□CONDO □SINGLE FAMILY DWELLING □ADDITION/ALTERATION
□RELOCATION □MOBILE HOME □ELECTRICAL □PLUMBING
OSPA □RETAINING WALL
2. PR JECT INFORMATION PLAN CHECK · rol,~ M Nearest Cross S~
LEGAL DESCRIPTIOI Lot No. sutXhvls,on Na111e/Nurt>er Unit No. Phase No.
CHECK BELOW If SIIINITTED:
Q2 Energy Cales 02 Structural Cales □ 2 Soi ls Report
BLOG. SQ. FTG. # OF STORIES
p 1 Addressed Envelope
EXISTING USE PROPOSED USE
3. CONTACT PERSON
NAME •c~.~;t'
CITY U
SIGNATURE
4. APPLICANT 0 CONTRACTOR
NAME
CITY
STATE
AODRESS
ZIP COOE
0 AGENT fOR CONTRACTOR
ADDRESS
STATE ZIP CODE
DAY TELEPHONE / :::,_ 'f _,? b O i{
Oowt.1ER 0 AGENT FOR Ol,INER
DAY TELEPHONE
5. PROPERTY OWNER
NAME:,;;_ ?~.~An/ OWNER
ADDRESS
ZIP CODE
□LESSEE □TENANT
CITY STATE DAY TELEPHONE 3 {, -..,;)()d,.,
6. CONTRACTOR
7.
NAME U) ,t.,v,/-p b.,,,,...I,.,.,.:..,..
CITY U STATE
STATE LIC. # ,.j_ r{C,/;;,.,3
SIGNATURE
DESIGNER NAME
CITY
WORKERS' COMPENSATION
STATE
ADDRESS
ZIP CODE
LICENSE CLASS _____ _
TITLE
ADDRESS
ZIP COOE
DAY TELEPHONE
CITY BUSINESS LIC. #
DATE
DAY TELEPHONE STATE LIC. #
Workers• Coq,ensation Declaration: I hereby aff I rm that I have a cert1 ficate of consent to sel f-1nsure issued by the Di rector of Industrial Relations,
or a certificate of Workers• Coq:,ensation Insurance by an aa\'litted insurer, or an exact copy or duplicate thereof certified by the Director of the
insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY POLICY NO. EXPIRATION DATE
Certificate of Ex~t1on: I certify that in the performance of the work for which this permit is issued, I shall not ~toy any person in any manner
so as to become slbject to the Workers' CCX11)ensation Laws of California.
SIGNATURE DATE
8. OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am e11e«pt from the Contractor's License Law for the following reason:
DI as owner of the property or my employees with wages as their sole CCX11)ensation, 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 inproves thereon,, and who
does such work himself or through his own ~toyees, provided that such inprovements are not intended or offered for sale. If, however, the building
or inprovement is sold within one year of coq,letion, the owner-builder will have the burden of proving that he did not build or inprove for the purpose
of sale.).
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 irrproves thereon, and contracts for such projects with contractor(s)
licensed pursuant to the Contractor's License Law).
D I am ex~t under Section ___________ Business and Professions Code for this reason:
(Sec. 7031.5 Business and Professions Code: Any Cfty or County which requires a permit to construct, alter, irrprove, 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 prov; s ions of the
Contractor's License Law (Chapter 9, conmencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exeq,t therefrom,
and the basis for the alleged ex~tion. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not
more than five hundred dollars ($500)).
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON·RESI0ENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardOYs materials registration form or risk managemeflt and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Accol.(lt Act?
0YES 0NO
Js the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□YES 0NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES D•o
If MY OF TNE AIIMRS ARE YES. A FINAL CERTIFICATE OF OCOFANCY NAT NOT BE ISSI..ED AFTER JULT 1, 1989 lMLESS THE N'PUCANT HAS IET OR IS tEETING TME REQIJIREMEITS
OF THE OFFICE OF ENBl:GENCl SERVICES All> TNE AIR POLLUTIC. CONTROL DISTRICT.
9. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(0 Civil Code}.
LENDER IS NAME LENDER'S ADDRESS
10. APPLICANT'S SIGNATURE
I certify that I have read the appl1cat1on and state that the above information is correct. I agree to cOO'f)lY with all City ordiMnces and State laws relating
to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO
AGREE TO SAVE INDEMNIFY AND KEEP HARNLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JLO~NTS, COSTS ANO EXPENSES WHICH NAT IN ANY WAY ACCRUE AGAINST SAID
CITT IN CONSECIUENCE OF THE GRANTING OF THIS PERMIT.
Ei1piration. Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building
or work authorized by such permit is not conmenced within 18D days from the date of such permit or if the building or work authorized by such permit is suspended
or abandoned at any time after the work is conmenced for a period of 180 days (Section 303Cd) Uniform Building Code),
~NER O CONTRACTOR OBY PHONE APPitovt0·:a.y; -------DAT£: _________ _
WHITE: File YELLOW: Applicant PINK: Finance