HomeMy WebLinkAbout1711 LOBELIA CT; TP; CB910717; Permit!
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Job Address: 1711 LOBEL:A CT
Permit 1ype: ELECTRICAL
Paree<:. No:
Vdluation: 0
Con..,truction Type: NEW
1, Tf'"
Occ~pdncy Group: Cldss
Description: TEMP POWER FOR MODEL
Appl/Ownr : WESTERN NATIONAL HOMES
19700 FAIRCHILD ROAD #230
IRVINE, CA 92715
Fees Required
Fees:
Adjustments:
Totc.11 Fees:
Fee description
Enter ~y" for Ele
Enter "Y" for Tern
* ELECTRICAL TOTA
***
p E R M I 7 Pe.rm1 t No: ( E 910 11 7
Projec..t Nl\: A91tll 1-1 ,t,
Development No:
Str: Fl: Ste:
' 5 05 0
Code: ~ta
AppliP~: 0~1011~1
Apr/IS~Jp: 05/01/ l
Val1datcc.1 By: DC
714 476-3031
lected & --·redi ts A:* A
. ( 0
.00
15.00
Ext fee Data ~--------· ------
'S.OIJ y
18,1'0 Y
1 !'i 00
CllY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161
PERMIT APPLICATION & •
City of Carlsbad Building Department EST. VAL. ______________ _ 2075 Las Pal mas Dr., Carlsbad, CA 92009 (619) 438·1161
1.
A
B
C
2.
PERMIT TYPE
COMMERCIAL
0 INDUSTRIAL
0 RESIDENTIAL O APARHIENT
OouPLE)( OoeHOLJTI0N
0 MECH AN I CAL O POOL
TENANT IMPROVEMENT
□TENANT IMPROVEMENT
□CONDO □SINGLE FAMILY DIJELLING OADDITJ0N/ALTERATI0N
□RELOCATION □MOBILE HOME ~LECTRICAL □PLUMBING
OSPA QRETAINING WALL □SOLAR □OTHER
PROJECT INFORMATION PLAN CHECK No.
Address 17 I I Nearest Cross Streets
PLAN a: DEPOSlT ___________ _
VALID. BY _____________ _
DATE ______________ _
F
LEGAL DESCRIPTION Subdivision Name/Nlffl:>er c,-8S -at Unit No. Phase No.
CHECK BEUM IF SUBMITTED:
Q2 Energy Cales 02 Structural Cales Q2 Soils Rep0rt D 1 Addressed Envelope
ASSESSOR IS PARCEL EXISTING USE PROPOSED USE
Te:TYJP (m~)
BLOG. S0. FTG. # OF STORIES
3. ;tf700 Ft2M-c/u..&.J Kc/. #-dl3cJ CONTACT PERSON ,/ .. _
NAME t(}~ )1~4./) ~ ADORESS
q :i.. 7 15 DAY TELEPHONE 7 / Y-t../ 7 t:, -3 o 31
4.
CITY ~ $' STATE CA ZIP CODE
SIGNATURE @.z:::-~
APPLICANT OcoNTRAcTOR D AGENT FOR CONTRACTOR 0 AGENT FOR OWNER
NAME ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
5. PROPERTY OWNER OWNER □LESSEE □TENANT
NAME ADDRESS
CITY STATE Z!P CODE DAY TELEPHONE
6. CONTRACTOR
7.
8.
NAME
CITY
SIGNATURE
DESIGNER NAME
CITY
STATE
STATE LIC. # ____ _
STATE
WORKERS' COMPENSATION
ADDRESS
ZIP CODE DAY TELEPHONE
LICENSE CLASS CITY BUSINESS L!C. #
T !TLE DATE
ADDRESS
ZIP CODE DAY TELEPHONE STATE LIC, #
Workers' Con,:,ensat1on Declarat,on: hereby affirm that have a certificate of consent to self·msure issued by the Director of Industrial Relations,
or a certificate of Workers' Corrpensat ion Insurance by an adTii tted insurer, or an exact copy or clupl i cate thereof certified by the Di rector of the
insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
INSURANCE COMPANY POLICY NO, EXPIRATION DATE
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' Coq>ensation Laws of California.
SIGNATURE DATE
OWNER-BUILDER DECLARATION
Dwner·Builder Declaration: 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 c~nsation, 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 COffl)letion, 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)
I icensed pursuant to the Contractor's license Law).
D 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 permit to construct, alter, improve, demolish, or repair any structure,
prior to its issuance, al so requires the appt i cant for such permit to f i le a signed statement that he is l i censed pursuant to the provisions of the
Contractor's License Law (Chapter 9, coomencing 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 [$5001 ) •
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON·RESIDENTIAL BUILDING PERMITS ONLY:
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?
QYES 0Ho
ls the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
□Yes □Ho
ls the facility to be constructed within 1,000 feet of the outer boundary of a school site'
Ores
IF ANT OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCOFANCT MAT NOT BE ISSUED AFTER JULY 1, 1989 lJILESS THE APPLICANT HAS NET OR IS fl:ETING THE REQUIREMENTS
OF THE OFFICE OF ENERGEIICT SERVICES AID THE AIR POLLIITIOII 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(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
10. APPLICANT'S SIGNATURE
J certify that I have read the application and state that the above information is correct. I agree to comply with al\ 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 ALSO
AGREE TO SAVE INDEMNIFY ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIMJILITIES, Jll)QIJENTS, COSTS AND EXPENSES lolHICH MAY IN ANY \IAT ACCRLE AGAINST SAID
CITY IN CONSEQUENCE OF THE GRANTING DF THIS PERMIT.
Expiration. Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if
or work authorized by such permit is not coomenced within 180 days from the date of such permit or if the building or work authorized by such permit
or abandoned at any time after the work is coomenced for a period of 180 days (Section 303(d) Uniform Building Code).
~NER D CONTRACTOR D BY PHONE APPLICANT'S SIGNATURCZ. ~
WHITE: File YELLOW: Applicant PINK: Finance
APPROVED BT;
DA.TE:
the building
is suspended