HomeMy WebLinkAbout1275 CARLSBAD VILLAGE DR; ; CB951122; Permit08/15/95 16:42 BUILDING PERMIT
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Job Address 1275 CARLSBAD VILLAGE DR <= - ,
Permit Type: ELECTRICAL Suite
Parcel No.
Valuation: 0 Lot#.
Construction Type. NEW
Occupancy Group n f
Description: DIESEL EXHAUST FANS ReferSnce*'
= EXHAUST FANS AT STAT. 1,2,3 4 6
Appl/Ownr : CITY OF CARLSBAD
405 OAK AV
CARLSBAD CA
CONTRACTOR . AAIR PURIFICATION.'^. I
9040 v ^^'^ sji* xlfeJJ,s-A..'. -'
SAN
Permit No-
Project No:
Development No•
CB951122
A9501630
434-2992
tic. C,NO
Status
Applied:
Apr/Issue.
Entered By.
ISSUED
08/15/95
08/15/95
PY
Fees Required /*.***
Fees
Adjustments
Total Fees
'pta'l 'Payments':
Balance'- DuelT-, ]
-'' ' ' ~
619-578-2825
& Credits A A A
00
00
00
CITY OB
2075 Las Palmas Dr , Carls (619)438-1161
fr
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PERMIT APPLICATION
City of Carlsbad Building Department
2075 Las Patinas Dr., Carlsbad, CA 92009 (619) 438-1161
1. PERMIT'lVPK
From List 1 (see back) give code of Permit-Type
For Residential Proiects; Only From List 2 (see back) give
Code of Structure-Type
Net Loss/Gain of Dwelling Units
PLAN CHECK NO.
EST.VAL
PLAN CK DEPOSIT.
VALID. BY ~
DATE
2. PROJECT INFORMATION FOR OFFICE USE ONLY
Nearest Cross Street
LEGAL
P/0 fti
Lot No Su bdivision" Name/Number Unit No Phase No
CHECK BELOW 1JJ ^UUMITI'KD ~
D 2 Energy Calcs Q 2 Structural Calcs O 2 Soils Report O 1 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE USE
DESCRIPTION OF WORK
SQ FT
/, ?, 5,
# OF STORIES # OF BEDROOMS # OF BATHROOMS
3 CUN'IAUl PEKSUN-TiT
NAME (last name first)
CITY
ainerent trom applicant;
STATE
ADDRESS
ZIP CODE DAY TELEPHONE
NAME (last name first) yK/^C^r// C 4#*-*•£$ ADDRESS yo£ A,A£ /?r/t~
/ ' ' "
STATE C& ZIP CODECITY5 pROPKKTV OWNHT
NAME (last name first)
CITY
DAY TELEPHONE
ADDRESS
STATE ZIP CODE DAY TELEPHONE
NAME (last name first)
CITY STATE £-9 ZIP CODE
STATE LIC
NAMt (last name tirstj
LICENSE CLASS
/— , L- - - \ rV ^ 73 A^ A//t/n/)-& 0A. JurnT
DAY TELEPHONE S7f" J/2-j'~
CITY BUSINESS LIC #
CITY A/.,STATE ZIP CODE
ADDRESS
DAY TELEPHONE STATE LIC #7 WORKKRff
Workers' Compensation Declaration fhereby affirm that 1 have a certificate ot consent to self-insure issued by the Director of JndtistriaT
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 POLICY NO EXPIRATION DATE
Certificate ot txemption I certify that in the performance or 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 California
SIGNATURE DATE
8 OWNhH-UUlLUtH. DEdARATBDN
uwner-umider Declaration I hereby attirm that I am exempt irom tne contractors License Law tor tne following reason
D 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 sate )
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 improves thereon, and contracts for such projects
with contractor(s) licensed pursuant to the Contractor's License Law)
D I am exempt under Section Business and Professions Code for this reason
(Sec 703] 5 Business and Professions Code Any City or County which requires a permit to construct, alter, improve, demolish, or repair
any structure, poor 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 penalty of not more than five hundred dollars [$500])
SIGNATURE DATE
COMPLETE J'tilS SECTION FOR NON-RtSTPENTIAL BUILDING PERMITS ONL?~
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or nsk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Ha2ardous Substance Account Act?
D YES D NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control distnct or air quality management district?
D YES D NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school sue?
D YES D NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT
HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
> UWSTRLIITION LKNDlNG AtiKNcV ~"~
rhereby~ariirm that there is a construction lending agency tor the performance of the work lor wnich this permit is issued (Sec 3oy?(,iJ Cuvil Codej
LENDER'S NAME LENDER'S ADDRESS
10.
I certify^ that I "have read the application and state that the above information is correct Fagree to comply witrt ajj City ordinances ana state laws
relating to building construction I hereby authorize representatives of the City of CarJsbad to enter upon the above mentioned property for inspection
purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS
AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SATO CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stones 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 365 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 commenced for a period of 180 days (Section 303(d) Uniform Building Code}
APPLICANT'S SIGNATURE O DATE
WHITE: File YELLOW: Applicant PINK: Finance