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Home My WebLink About1095 PALM AVE; ; CB950296; PermitIJ~1/02/~l;J 08:42. Paq,,, 1 of 1 E U l L D J N G P E R M I T ,Job Addr·ess: lu~S PALM AV Suite: Permit Type: MISCELLANEOUS Parcel No: 2us-1q1-u6-0u L0t#: Valuation: o Construction Type: VN Occupancy Group: Reference#: Descriptivn: FENCE UP TO 90 INCHES HIGH : SEE AV 92-6 Pei ml t No: CB9">02 11.) ProJi=Ct N.>: A951JIJ42.5 l>evelopm,"'nt N0: 0882 03/02/95 0001 01 02 C-PRMT 25-00 ~tc:1tus: ISSUED Applied: 03/02/9', Apr /Issue: lJ3/U2/':l5 Entered By: M[>P Appl/Ownr : TAKAYAMA, DONALD 1095 PALM AVE CARLSBAD, CA. t,19 722-0135 kAk Fees Required Fees: A~Justments: Total Fee!:.: Fee description Miscellaneous Fee * MJSCELLANEOUS T CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 .OU .uo 25.0U Ext fee i 1ata 25.0U PERMIT 25.UU APPROVAL / OATE[O ·Z3 .y ---- PERMIT APPLICATION PI.AN CHECK NO. City of Carlsbad Buildil"l9 DepartlN!flt 2075 Las Palms Dr., Carlsbad, CA 92009 (619) 438-1161 PST. VAL"------------- 1. PERM11 1YPE PLAN CK DEPOSIT ________ _ VALID. BY ___________ _ DATE;..._ ___________ _ From List I (see back) give code of Pennit-Type: ____________ _ For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: _____________________ _ Net Loss/Gain of Dwelling Units __________________ _ 2. PRClJF.C'f INFORMA110N FOR OFFICE USE ONLY Address 1oq,s ~W\.,-ave... Nearest Cross Street (Q. mt o. cA£cR 8£wW IF sOBMI 11 £0: □ 2 Energy Cales □ 2 Structural Cales □ 2 Soils Report □ I Addressed Envelope ASSESSOR'S PARCEL vp 4lf s119b~; 1/c~ ft PROPOSED USE DESCRIPTION OF WORK A u ,. 'f'Z.:-6 SQ. IT. # OF STORIES # OF BEDROOMS # OF BATIIROOMS 3. WN IACI PERSON (1r different from applicant) NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 4. Af'PUCAN I O CON I RACIOR □ ACEN I FOR CON I RACiuR ADDRESS 0 OWN£R O AC£N I FOR OWNER NAME (last name first) CITY STATE ZIP CODE DAY TELEPHONE s. ~~~E1fi7st ~:e9}rst) W\f\OlO\ 1°'-\<..o___y ~ ADDRESS c1TY ilirts\'.,c,,,ol STATE Ca.. z1p coDE 9~8 DAY TELEPHONE NAME (last name first) CITY STATE STATE UC.# ZIP CODE LICENSE CLASS ADDRESS DAY TELEPHONE CITY BUSINESS UC. # D£siCN£R NAM£ (last name hrst) ADDREss CITY STATE ZIP CODE DAY TELEPHONE STATE UC. # 1. WoRKElls' CDMPENSAiioR Workers' Compensauon Declarauon: I hereby allinn that I have a cert1i1cate of consent to self-insure issued by the Director ol lndustnal 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, UJb. C). INSURANCE COMPANY POLICY NO. EXPIRATION DATE Cert1hca1e of Exempaon: I ceruly that m the pertonnance of the work for which this penn1t 1s issued, I shall not employ any person m any manner so as to become subject to the Workers' Compensation UJws of California. SIGNATURE DATE I. oWR£R-80uD£R O£0.ARAnoR Owner-Builder Declaration: 1 nereby afhnn mat 1 am exempt rrom tne contractors u cense Law ror me rouowmg 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 UJW 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 UJw 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 UJw). □ 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 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 UJW (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exe pt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pennit subjects the apP, nt,to a civil ~Icy of not more than five hundred dollars [$500)). SIGNATIIRE c_) DATE -'J.-9S- Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration fonn or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □ YES D NO Is the applicant or future building occupant required to obtain a pennit from the air pollution control district or air quality management district? 0 YES O NO ls the facility to be constructed within 1,000 feet of the outer boundary of a school site? □ YES □ NO IF ANY OF TilE ANSWERS ARE YES, A FINAL CER11FICATE OF ocx::upANCY MAY NOT BE ~UED AFfER JULY ), 1989 UNLESS nm APPUCANT HAS MET OR IS MEETING n m REQUIREMENTS OF nm OFFICE OF EMERGENCY SERVICF.S AND TilE AIR POU.lITION CX>NTilOL DISIRICT. 9. wNS'IRUCnON LENDffiG AGENCT I hereby all1nn that there 1s a construcaon lending agency lor the perlonnance of the work tor which this penn1t 1s issued (Sec 3097(1) CiVII Code). LENDER'S NAME LENDER'S ADDRESS 10. APPIJCAN I C£R llFIOrnON I cerufy that I have read the apphcauon and state that the above mlormanon 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 AI.SO AGREE 10 SAVE INDEMNIFY AND KEEP HARMLESS nm CfIY OF CARlSBAD AGAINST AIL UABlLlTIE.5, JUDGMENTS, CDSTS AND EXPEN~ WI-DOI MAY IN ANY WAY ACXllUE AGAINST SAID CfIY IN CX>NSEQUENCE OF nm GRANTING OF TI-OS PERMIT. OSHA: An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every pennit 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 pennit is not commenced within 365 days from the date of such pennit or if the building or work authorized by such pennit is suspended or abandoned any time after the work is commenced for a period of 180 days (Section 303(d) Unifonn Buildin!;iCode). APPLICANTS SIGNATURE .,, DATE: '3: -'JS,- PLANCI< # ____ _ TIHE ARRIVE : ____ TIME LEAVE: ____ _ CD LVL DESCRIPTION 4 f,tJA-L- br1M "'1b ,,/q_tl,1r1 M,-< 0 / 14,k,,, ~ tJ: 'f' -P<itJ cc r,Jl-r'H AV lo ~"'f (1 c i; !..f CI r, /-I r C,,D ( /2 e ___s o/'Z---0. hrJie !-lr3-1611 r f1Jfk--fcu[IJ1t1 Pl!ru1ITS G/15/09 . -· ' ·---. . . :_ - »••-----·-... , ___ ,., _____ _