HomeMy WebLinkAbout1052 KNOWLES AVE; ; CB920428; Permitu I J LI I N lj
/ 1 i :1:4
I t ~ t 1
Jc. t Ai lIE 3: ,.C,':,4 KNl)W~f ._ AV
e m1t Ty~e: ~LJMBIN~
IL rec~ Nl: _.< 5 51-1 ,-:J(,
Vt.1 .lc,t .!.Ot1:
• n-ti. 1c-t1or, ~Y ,e: NF.W
>< < l'> Htt.:y ir oup:
•1c-• Ctl[•tion: SE.WER CONNECTION
Ap£-->.:./1,wnr RO~ , Jul-IN
1052 KNOWLt. AVf.Nl t:
lARL.BAD , .A 9 LCB
f e::; Rc .. qu acd
FE>e :
A 1Jl.. ·tw >nt,J:
''\>tel~ rP.et":
fee de,, r1p .. 1on
E.nrer 'V" fo1 Plum
Fach fit,, dinq SE'we
* PLl'MBING ':'O'IAL
E R M I ft1m1t r.. >:
Pro_< ·t l\ ,: A 1 14
[Jt'Vt•lc pment C\J , :
~,tr:
f-1 7480 05/011/92 =0001 01 02
C-PRMT 14.00
Arp ...
A[-'t / I J 4 ) , J
V IL in 1 f [
t l ~ U J 5845
& Cred.:..t;
fXt ~l.:l
I.
: 4.
INSP. ~ ~~ fe1 h 2 ~
CLEARANCE-----1
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
City of carlsbad Building Depart111e11t
PLAN CHECK NO. er v1-cf a~
2075 Las PalllllS Dr., Carlsbad, CA 92009 (619) 438-1161 EST.VAL. __________ _
PLAN CK DEPOSIT ________ _
VAIID.BY __________ _
I. P£kMl I IYPE DATE
A -D COmmerc1al D New Building Li I enant Improvement
B -Li Industrial □ New Building D Tenant Improvement
C -□ Residential □ Apartment □ Condo □ Single Family Dwelling □Addition/Alteration
□ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical □ Plumbing
□ Mechanical □ Pool D Spa D Retaining Wall □ Solar □ Other
2. PRClIBCI" INFORMATION FOR OFFICE USE ONLY
mt o. ase o.
CHECK BEWW IF S0BMI 11 £0:
□ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ 1 Addressed Envelope
ASSESSOR'S PARCEi. EXISTING USE PROPQSED 1 TSE
3. WN IACI PFJlSON (U duierenf from apphcani)
NAME ADDRESS
Cl1Y STATE ZIP CODE DAY TELEPHONE
4. APPllCAN I
NAME
□WNIRACIOR □AGENI FORCONikACIOk DOWNER UAGENI FUROWNEH
CITY STATE
5. PROPFJtl Y OWN RR lJ
NAME TOH IJ I'-•
~cAAUbPib
Ross
6. WNIRACIUR
NAME
CITY
STATE (A
STATE
STATE !JC.#
ADDRESS
ZIP CODE
ADDRESS ('DO~
ZIP CODE 'l ~ t>OV
ADDRESS
ZIP CODE
IJCENSE CLASS
DAY TELEPHONE
f<_)U)W G,:;i A 1)-<.,
7 ...,Q -5~0 ~ ..-DAY TELEPHONE _ ""-".1 c, f -;:;
DAY TELEPHONE
CITY BUSINESS !JC. #
CITY STATE ZIP CODE DAY TELEPHONE STATE !JC.#
7. WUltkERS' WMl'RNSAIION
Workers' Compensauon beclarat1on: I hereby afhrm that l have a cert11lcate of consent to self-msure issued by the Director of lndustnai
Relations, or a certificate of Workers' Compensation Insurance by an admitted 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 POIJCY NO. EXPIRATION DATE
Ceruhcate of Exemption: I certtfY that m the perlormance of the work for which this penmt 1s issued, I shall not employ any person m any manner
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE DATE
8. UWNttil-DOnnmt DEtLARAilON
Owner-Builder Oeclarat1on: I hereby affirm that I am exempt from the Contracto?s License Law for the foilowmg reason:
□ 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.).
□ 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).
□ I am exempt under Section ________ Business and Professions Code for this reason:
(Sec. 7031.S Business and Professions Code: Any City or County which requires a pennit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for such pennit 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.S by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars [$S00]).
SIGNATURI! DATE
COMPLEIE I HIS SEGI ION FOR NON-RESIDEN I IAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely ha1.ardous materials registration form or risk management and
prevention program under Sections 2S50S, 25S33 or 25S34 of the Presley-Tanner Ha1.arclous Substance Account Act?
□YES □NO Is the applicant or future building occupant required to obtain a pennit from the air pollution control district or air quality management district?
CYES □NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
□YES □NO
IF ANY OF 11IE ANSWERS ARE YES, A FINAL CERTIFICATE OF oa:IJPANCY MAY NOT BE ISSUED AFfER JULY 1, 1989 UN1J!SS 11IE APPUCANT
HAS MET OR IS MEETING 11IE RF.QUlREMENTS OF TIIB OFFICE OF EMERGENCY SERVICES AND 11IE AIR POlllfilON CDNTROL DISllUCT.
9. WNSIH0CIION mNDuQG XCENCY
I hereby afhnn that there 1s a construction lending agency for the performance of the work for which this penmt 1s issued (Sec 309/UJ CIVIi Cooe).
LENDER"S NAME LENDER'S ADDRESS
16. APPllCAN I CEkliPICXIION
I cenUY lhat I have read the apphcat1on and state that the above mformauon 1s correct. I agree to comply with all City ordinances 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 Al.50 AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS 11IE QTY OF CARI.5BAD AGAINST AIL lJABIUl1ES, JUDGMENTS, CDSTS
AND EXPENSES WIIlCH MAY IN ANY WAY A£DUIE AGAINST SAID QTY IN CDNSF.QIIENCE OF TIIB GRANTING OF TIDS PERMIT.
OSHA: An OSHA permit is required for excavations over S'0" deep and demolition or construction of structures over 3 stories in height.
Expiration. 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 commenced within 36S days from the date of such pennit or if the building or work authorized by
such~ it is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code).
s/, I f.l I DATE:
WHITE: F" e YEU.OW: Applicant PINK: Finance
-,
•
PERMIT # _ _.ip~:2;...-_'-1,,'"";;i.._'-"-J>-PLANCX # _____ _
Joe AooREss_...;./'._.0~5.~2;;..__,<;_M_o_w_L_1c_~_s __ LJ-'--v _______ _
TIME ARRIVE: _____ TIME LEAVE: _____ _
CO LVL DESCRIPTION
PERMITS
6/15/89
S~e:le_
ACT COMMENTS