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HomeMy WebLinkAbout1620 FARADAY AVE; ; CB012129; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 07/20/2001 Commercial/Industrial Permit Permit No: CB012129 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: Applicant: THOMSON ROB 100 1620 FARADAY AV CBAD Tl Sub Type: 2121302300 Lot#: $27,540.00 Construction Type: Reference #: INVITROGEN -Tl 918 SF OFFICE COMM 0 NEW Owner: Status: Applied: Entered By: Plan Approved: ' Issued: Inspect Are?i: BLACKMORE SIGNAL HILL 1450 FRAZEEE RD SAN DIEGO CA 92108 PO BOX424 RANCHO SANTA FE CA 92067 ,i· ·;619-220-0224 ISSUED 06/20/2001 JM 07/09/2001 07/09/2001 TP Total Fees: $2,253.75 Total Payments To Date: $2,253.75 Balance Due: $0.00 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee STD #2 Fee STD #3 Fee Renewal Fee Add'I Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'I Pot. Water Con. Fee Reel. Water Con. Fee lnspecto~ $231.87 $0.00 $150.72 $0.00 $0.00 $5.78 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Meter Size Add'I Reel. Water Con. Fee Meter Fee SDCWAFee CFO Payoff Fee PFF PFF (CFD Fund) License Tax Li9ense Tax (CFD Fund) Traffic Impact Fee Traffic Impact (CFD Fund) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee: Sewer Fee: Redev Parking Fee: Additional Fees: TOTAL PERMIT FEES $0.00 $0.00 $0.00 $0.00 ? $0.00 ~L.t>~ 1 _i_O~ ...---9/$501.~~ '--$ - $312:00 ~ 0.00 ,di--·~ $0.00 .. eJ..-/ . $20.00 $24.00 $0.00 $2,253.75 FINAL APPROVAL Date: ~~/41 Clearance: _____ _ NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Cartsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which vou have previously been r:iiven a NOTICE similar to this, or as to which the statute of limitations has oreviouslv otheiwise exoired. v0/3/S) FOR OFFICE USE ONLY PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 PLAN CHECK NoCi3-zJ/2/2 / EST. VAL. z; './ t) . • Plan Ck. Deposit/ , V Validated By__,.......-1---=---"--a...--,jf"::t;f-4-r.-r-...--1 Date------------{!',,///-J~~q...,.-4- Address (include Bldg/Suite #) Business Name (at this address) 98 85 -24 s Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. 2./Z-/'30·-23,. ~,,:.t")llNji M,N; fr! --,: Total # of units l\'1 Name Address ' City State/Zip Telephone # A:,: ~: PBQRt=fitr 9W.~B-: . -,t/G ~q:zG t:R ·, Name State/Zip Tel(phone # (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, commending 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]). RENO cc:J\J~flA/b 1/\J~ l45t? Ft2A-ZEG /2,D,, ~DIS60 CA-e/2./0/6 (/,1q)22cr-oz.24 Name Address • City State/Zip Telepho~e # State License u l.P 7 4 oil:, q License Class B City Business License u /ZOO /i,2-5, PAaRc.-tXJ/2NE¢"5--rg..J&:-A1Z-l/.,!NL-, 73$10 /ZGIU-0 /21>., $th.J P!Bd?, C..;f-<f2-t2-I (8fr:B) 677-188D Designer Name Address r City State/Zip Telephone State License # ?2-484-{p .6. W.Pf!K~R.S' QQMP~\ll"sA1'f.6N Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of ,e work for which this permit is issued. ~ I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company wtt--L--l6 /N~~Uf;; ~ta;;i; .PrS.P. Policy No. t/POOOIP7 8S Expiration Date ;f-v~-r l,,2..a::,/ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of 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. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE. _____________________________ DATE ________ _ 7.,_, :QW.N!:.B-.Pl-!l~P!:JU>EQLARAJ'IPN ., , · · __ .. I hereby affirm that I am exempt from the Contractor's License Law for the 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 sale). 0 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). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted _with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number): _____________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): _______________________________________________________ _ PROPERTY OWNER SIGNATURE _____________________ _ DATE _________ _ : CQMP~ig:{_1;_:ri:iis.·sscrnoill FDR-·NQN~RESIOEN·T/Af. BUl~DlrfG ·PERM!T$:PNL'(" -_ -~-. -.. ' Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration for!JYOr risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES (g'° 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 ~o Is the facility to be constructed within 1,000 feet of the outer boundary of a school site 7 0 YES ~o IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. ~!J.!LL,~PQt,J$,tRUCTtOJ\l'.t;~I\IDING:AG~NCY < '"' ~ -, , ~M' : ,_ ~~ ~~---~:-. ,¥• :·:_·Y I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME /'lf?C Af?/14?,t-Bt.:f3 LENDER'S ADDRESS~A/:_e>_-r_;ff', __ °?_'--'_I_~ __ ~ ____________ _ '~; A.l?Pl;i~ANTC,1;13.TJFlCATl.ON .. , ·. .,,. ---~--....... ---··-.· ---·.---·.: .. ·-·_-----:,, ..•. ,,:.---·--·--·· ._ .. -~:-s': -··:e---·· I certify that I have read the application and state that the above information is correct and that the 1nformation on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize .representatives of the Cit~ of Carlsbad 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 SAID CITY IN CONSEOIJENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and de_molition 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 i~not ced within 180 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 i mm iptor' a period of 180 days (Section _106.4.4 Uniform Building Code). _,,,. / /, APPLICANT'S SIGNATURE / ], f f(bvVJ,__,,, DATE _G(;{_.<2'_0_,(!:.'-'0_._/ _____ _ WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 09/05/2001 Permit# CB012129 Title: INVITROGEN -Tl 918 SF OFFICE Description: Type:TI Job Address: Suite: Location: Sub Type: COMM 1620 FARADAY AV Lot 0 APPLICANT THOMSON ROB Owner: BLACKMORE SIGNAL HILL Remarks: Total Time: CD Description Act Comments 19 Final Structural 4,:J 29 Final Plumbing t 39 Final Electrical 49 Final Mechanical Associated PCRs PCR00020 ISSUED PCR00048 PENDING PCR01162 ISSUED PCR99294 ABANDOND lnsgection History Date Description Act lnsp Comments 08/14/2001 39 Final Electrical NR TP 08/09/2001 39 Final Electrical NR TP NO ACCESS 08/07/2001 39 Final Electrical NS TP Inspector Assignment: TP --- Phone: 6197783764 Inspector:~ Requested By: ROD Entered By: ROBIN 07/18/2001 14 Frame/Steel/Bolting/Welding AP TP WALL@ BRK RM. 07/18/2001 17 Interior Lath/Drywall AP TP 07/18/2001 18 Exterior Lath/Drywall WC TP 07/18/2001 34 Rough Electric AP TP WALL@ BRK RM. 07/16/2001 14 Frame/Steel/Bolting/Welding AP TP 07/16/2001 34 Rough Electric . AP TP 07/13/2001 14 Frame/Steel/Bolting/Welding co TP 07/13/2001 34 Rough Electric co TP CilY or Carlsbad ~ Final Building Inspection Dept: Building Engineering Planning CMWD St Lite t~ Plan Check #: Permit#: CB012129 Project Name: INVITROGEN -Tl 918 SF OFFICE Address: 1620 FARADAY AV Contact Person: ROD Sewer Dist: CA Phone: 6197783764 Water Dist: CA Date: 09/05/2001 Permit Type: Tl Sub Type: COMM Lot: 0 .......................................................................................................................................................... lnsp~,;f tf, \/l_ . Date By: µb.. ~ Inspected: Inspected Date Approved: ~pproved: __ By: __________ Inspected: ______ Approved: ___ Disapproved: __ Inspected Date By: Inspected: _____ Approved: ___ Disapproved: __ Comments: ______________________________ _ EsGil Corporation In Partnership with Government for Building Safety DATE: 7/5/01 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 01-2129 PROJECT ADDRESS: 1620 .Faraday Ave PROJECT NAME: Invitrogen -TI SET:I D ~--U.Q_ANT D \J.I.IB.!0 D PLAN REVIEWER D FILE [Zl The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. · D The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: [Zl Esgil Corporation staff did not advise the applicant that the plan check has been completed. D Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone#: Date contacted: (by: ) Fax #: Mail Telephone Fax In Person - D REMARKS: By: Doug Moody Enclosures: Esgil Corporation D GA D MB D EJ D PC 6/21/01 trnsmtl.dot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 _ + (858) 560-1468 + Fax (858) 560-1576 \ \ \ \ .,.. -• City of Carlsbad 01-2129 7/5/01 VALUATION AND PLAN·CHECK FEE JURISDICTION: City of Carlsbad PREPARED BY: Doug Moody PLAN CHECK NO.: 01-2129 DATE: 7/5/01 BUILDING ADDRESS: 1620 Faraday Ave BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: VN BUILDING AREA Valuation Reg. VALUE PORTION ( Sq. Ft.) Multiplier Mod. Tl 918 City Valuation Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance 1994 UBC Building Permit Fee , .., , 1994 UBC Plan Check Fee j ... j Type of Review: 0 Complete Review D Structural Only D Repetitive Fee ~ Repeats Comments: D Other D Hourly ____ _.I Hour * Esgil Plan Review Fee ($) 27,540 27,540 $231.87j $150.721 $129.851 Sheet 1 of 1 macvalue.doc " PLANNINC/ENCINE.ERINC APPROVALS PERMIT NUMBER CB O \ ~ \ ~ 9 ADDRESS \6;).0 forado.1 PW~. -RESIDENTIAL RESIDENTIAL ADDITION MINOR < < $10,000.00> PLANNERC?a.~ -~ DATE PLAZA CAMINO REAL ' CARLSBAD COMPANY STORES VILLACE FAIRE COMPLETE OFFICE BUILDINC DATE DATE ~ oocs/Misforms/PJanning Engineering Approvals ENGINEERING DEPARTMENT FEE CALCULATION WORKSHEET D ~mate based on unconfirmed information from applicant. ~ Calculation based on building plancheck plan submittal. Bldg. Permit No. {2B(,9/cQ{eJ29 Checked by: ___ _ Date: EDU CALCUtATIONS: List types an.a sqllanwootages foi;.,.all uses . .£Qe.. ~ c,6 ~~~) Types of Us : _______ Sq. Ft./Units: _____ _ Types of Use: -------Sq. Ft./Units: _____ _ ADT CALCULATIONS: List types and square fQ_otages for al,uses. /'S-Q.L.-~ ~ ~ ~c::..-LCS.J Types of Use: _______ Sq. Ft./Units: _____ _ Types of Use: ______ _ Sq. Ft./Units: ------ EDU's: EDU's: ADT's: ADT's: ----- .-33 {3 FEES REQUIRED: WITHIN CFD: ~ bridge & thoroughfare fee in District #1, reduced Traffic Impact Fee) D NO D 1. PARK-IN-LIEU FEE PARK AREA & #: ~FEE/UNIT: X NO. UNITS: =$ AFFIC IMPACT FEE ADT's/UNITS: r£2_ 'j_ X FEE/ADT: t3 =$ 3l2 D 3. BRIDGE AND THOROUGHFARE FEE (DIST. #1 DIST. #2 DIST. #3 ) -- ADT's/UNITS: X FEE/ADT: =$ D 4. FACILITIES MANAGEMENT FEE ZONE: ~ UNIT/SQ.FT.: X FEE/SQ.FT./UNIT: =$ EWER FEE EDU's: 33 X FEE/EDU: L?5i =$ {)j_t:;. tt 7 BENEFIT AREA: ~- EDU's: .. '?3 X FEE/EDU: / 0 <'/b =$ 3f,(.GB D 6. SEWER LATERAL ($2,500) =$ D 7. DRAINAGE FEES PLDA HIGH /LOW ACRES: X FEE/AC: =$ D 8. POT ABLE WATER FEES UNITS CODE CONNECTION FEE METER FEE SDCWA FEE IRRIGATION 1 of2 Word\Docs\Mlsforms\Fee Calculation Worksheet Rev. 7/14/00 f ENGINEERING DEPARTMENT FEE CALCULATION WORKSHEET ' ' \ D 9. RECLAIMED WATER FEES UNITS CODE CONNECTION FEE METER FEE TOTAL OF ABOVE FEES*:$ ________ _ * NOTE: This calculation sheet is NOT a complete list of all fees which may be due. Dedications and Improvements may also be required with Building Permits. -'. i ~- 2 of2 Word\Docs\Misforms\Fee Calculation Worksheet Rev. 7/14/00 (, ' •. -02 ~-.., ~·~ ' :c]?f'D· .. / '. ' '' ...,' ' ·. • 1 • r ' . ; '.i. i ' . . . I I I ' ~· .,.:::.... -, , I '. r \ ' ! . 1 ' ' i ' /t·{3 .. . 0.-5G~f.) · , , I , : I , l ·, ._ •• ' j I 'l ' ,-• ~ . . ~.· ...-----r %-{:Jt8) ';.5 J.,Carlsbad Fire De artment 012129 r1 1635 Faraday Ave. Carlsbad, CA 92008 Plan Review Requirements Category: Fire Prevention (760) 602-4660 Date of Report: _06_12_2_12_0_0_1 _______ _ Building Plan Reviewed by: Name: Reno Contracting Address: 1450 Frazee Road Suite 100 City, State: San Diego CA 92108 Plan Checker: Job#: 0121,29 ------- Job Name: lnvitrogen Bldg#: CB012129 -----------------=--- Job Address: 1620 Faraday Avenue Ste. or Bldg. No. lZI Approved LI Approved Subject to LI Incomplete Review FD Job# The item you have submitted for review has been approved. The approval is based on plans, information and / or specifications provided in your submittal; therefore any changes to these items after this date, including field modifications, must be reviewed by this office to insure continued conformance with applicable codes and standards. Please review carefully all comments attached as failure to comply with instructions in this report can result in suspension of permit to construct or install improvements. The item you have submitted for review has been approved subject to the attached conditions. The approval is based on plans, information and/or specifications provided in your submittal. Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to construct or install improvements. Please resubmit to this office the necessary plans and / or specifications required to indicate compliance with applicable codes and standards. The item you have submitted for review is incomplete. At this time, this office cannot adequately conduct a review to determine compliance with the applicable codes and / or standards. Please review carefully all comments attached. Please resubmit the necessary plans and / or specifications to this office for review and approval. 1st 012129 2nd FD File# 3rd Other Agency ID City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 07-30-2001 Plan Check Revision Permit No:PCR01162 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: Applicant: 1620 FARADAY AV CBAD PCR Lot#: 0 2121302300 $0.00 Construction Type: NEW INVITROGEN/ 1 ST FLOOR ENCLOSE 3 OFFICES/2ND FLOOR MOVING KIT. WALL Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 07/20/2001 CB 07/26/2001 07/30/2001 RENO CONSTRUCTION BLACKMORE SIGNAL HILL 8104 COMMERCIAL STREET LA MESA, CA 91942 619 462-7025 Total Fees: $120.00 Plan Check Revision Fee Additional Fees Inspector: PO BOX424 RANCHO SANTA FE CA 920©749 07 /30/01 0002 01 02 Total Payments To Date: $0.00 FINAL APPROVAL Date: _____ _ CGP 120-00 Balance Due: $120.00 $120.00 $0.00 Clearance: _____ _ NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which vou have oreviouslv been oiven a NOTICE similar to this or as to which the statute of limitations has oreviouslv otherwise exoired. FOR OFFICE USE ONLY PERMIT APPLICATION '(;!, PLAN CHECK No:/t--7?:fJI /f;.J-- CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 Esr. VAL.---------- Plan Ck. Deposit ________ _ Validated By_,,,._CB_~------- Date_/_._' --2-,...n ..... o_--...... O'-'-I ____ _ .,.,p,'., ') /.Ji), ·~6~' Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Name Address t3;·:· 'APPLICANT ·; 0 contfaotor" · .C).:Ag~nt f6i':-€ontractoi: Name Address :4,, ·,_,j>Jj9i,>E~TY'OJ!V.N.gR . ;: :. .~. ;:_ :";._; -" ,--,,---- Name Address City .0 ~w~er.'.· ,O}.g!3nt:for . .Owner: City --. ~' -: '.·.: : .:-·.. -.. ,. City State/Zip State/Zip State/Zip Telephone# Fax# Telephone# Telephone# J.: -;:,coN'(R~'«:;I,QR:,.-COMPAlilY,:JIJAM~~. ':,· . ..:.~--~" . {,' (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, commending 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]). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License# _________ _ .6; WPRKERS''COIVIPEN~At(orr . .-. ,. ., .. , .... ~--,,:,' ,.: Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company____________________ Policy No.____________ Expiration Date. _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of 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. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE. ______________________________ DATE ________ _ 1,: < 9wt.1):R0.eoJLD~.RJ;>Eci:ARAti_ori( .. . :. · ·.,. :,.,:, ·<.' . :' · . • I .: ~ ,. ·." I herdby affirm that I am exempt from the Contractor's· License Law f~r the f?llowing 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 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 improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number/ contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number}: _____________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name/ address / phone number/ type of work):. ________________________________________________________ _ PROPERTY OWNER SIGNATURE _____________________ _ DATE _________ _ :qqMP,LETE-Ti;iJs','SECTION -FQfl lifJN~Rl;SIOENTIAt. l!lll).DIN~ :P.!;!lM!T$i9~t\': :, -'!..".' , ~ ,.c:-.: ~:::. .. : .~-i. •• Is the applicant 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? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. ;ij . ._:::.cQ,N~TRU~TIONl.,Er,IDl*fAGEr,.IC'(. -·-·., · .. ·-........ , ., _:".:· .. ·17:·:',,-:':/'._': ._ .. _ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME _____________ _ LENDER'S ADDRESS ________________________ _ :'iL·'.: :AP~~i'¢A~t.CERTIFJ<.At19rL. '._. •• H•t -:;.,, '' ... ;:: ...,_ -·~ ) . I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt of Carlsbad 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 SAID 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 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 180 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 (~_action 106.4.4 Uniform Building Code). ~ APPLICANT'S SIGNATURE fJvk J"'h ... ~~ DATE _7-'-"j'-~-+-/_2_ce>_._I __ _ . WHITE: File YELLOW: Applicant PINK: Finance