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Home My WebLink About1716 FOREST AVE; ; CB981834; PermitB U I L D I N G P E R M I T Permit N~,: CB981834 ProJect No: A98024JU Development No: 06/12/98 12:34 Page 1 of 1 Job Address: 1716 FOREST AV Permit Type: MECHANICAL Parcel No: 156-270-42-00 Valuation: O Suite: Lot#: 8018 06/12/98 0001 01 02 Occupancy Group: Reference#: C-PRMT Construction Type: NEW Status: ISSUED Applied: 06/12/98 Apr/Issue: 06/12/98 Entered By: RMA 727-4152 Description: INSTALL NEW 3 TON A/C UNIT W/ : ELECTRIC Appl/Ownr : ACTION AIR CONDITIONING 1232 KEYSTONE WY VISTA CA 92083 * A I< Fees Required * * /( F'ees: Adjustments: Total Fees: 76 0 .00 . 00 44.00 *** Fee description Ext fee Data Enter 'Y' for Mecha Install Furn/Ducts/ Other 15.00 Y 9.00 20.00 EI.EC FEE PER~IT HAS EXPIRED IN ACCORDANCE WITH U.8.C. SECTION 108.4.4 DATE t,./ tajqq SIGNATURE (qm ·J .----·------~-----·· ___ ___.. ... ____ _ . l!\1< ·P. _____ DATE _____ _ r ,--.. ,:_.' ;· ,-NGE -----·---,. ·--------· ~-·~----' CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION FOR OFFICE USE ONLY ~ .-, (j, PLAN CHECK NO. q~ t~ > J CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL.---------- Plan Ck. Deposit -----... ~'-t->---- Validated S,v, ______ µ~:.4-:.i...--- Date. __ +.,,....-H~-'s-""t-~/:1----- 1. PROjECT INFORMATION I I I te rb0:c<c,, Address !include Bldg/Suite #) Business Name tat this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total II of units (-).9'/a!',Wh!Jc,>-> ')'sessor's Parcel I p.,/;. is,,q, G.ru &N 4wµ,yz....,,- existmg Use PL...;.c,.nt.re.M-C',..,a.c,u,T Proposed Use Description of Work SO. FT. #of Stories I of Bedrooms fl of Bathrooms r:i.' CokrACt PERsbN Ot different from tli,pilCaiitl Name Address City State/Zip Telephone I Fax fl " "' ':' '·, :'f'i ,;·, :• r:~·-' !:I •. ,, iiPPl.lcilllit ; j:l'I ciiniiiaior , ·o·Agorirroreoniiacior·•· 0 ownir -o />.g~nt lo, 6wnl, ·' ····· 5Tev,R: G, '"'L 12;;,2 Key3~k YA'/ V'JSTA CA '!2C&:'.> 727-'/f.SZ.. Name Address City State/Zip Telephone I "4 "··, r ~ROPatfV· t:SWNtll i:'<'l,~·""'l'": X-"•'.1l'~":~!r:t•1·f:\',~?n"l'li ,., T '')l.''f,IY"\~_-,-...r.-i-/""" ~"""!',''·~·'" ;r,''"'{l".''"'! '· '"'"'': '" :'· · ·.,-:,~yR:#;11::G, ' ' .• ,, . . .. ~~. ,. . . .. ... .. . . Name Address City State/Zip Telephone I !$1'.""!f:"tONTRACTDftl'COMPANV:tJA,jjl!;'?~1'''f;'.'''fffl"!"r:;_~.~~T""~""r'.rl:•i•·'-Srt -;,.-,,._,.,.,.,..,. -, '' , 1•:~: ·,--...:,.-c-; .. ~.1 (Sec. 7031.6 Buslnltss end Professions Code: Any City or County which requires a permit to construct, alter, Improve, damolish or repair eny structure, prior to Its l11u1nc1, 1110 raquires the eppllcent for such permit to file e 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 end Professions Codel or that he is exempt therefrom, end the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars ($5001). \:l,c.T101>J ~IQ c.o.:o..D l').?2-'}~Tl:>&€ 1,,1;,r t/1s.M CA "J2os::, 727-1.//52- Name · Address City State/Zip Telephone I State License I SO; ~ License Class C -?..C> City Business license I Y / 'i e.cc;> Designer Name Address City State!Zip Telephone State License I---------- &. ;WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Leber Code, for the performance of the work for which this permit Is Issued. ij) 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 ca"ier and policy number are: lnsuronco Company 'S 'tffi:E:: CpMP Pol;cy No. / .500"2 /5 -"f'o Exp;rauon Date/ -I -C/j ITHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$1001 OR LESSI 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: FaUure to secure workers' compttn1etlon coverage ls unlawful, and ahall subject an employer to crlmlnel penalties and clvll fines up to one hundred thou,and dollars lt1 000). In II dltlon to the coat of compensation, damages u provklad for In Section 3708 of the la!code11ntera1t and attomey'a fees. SIGNATURE DATE l,;, t.12-f 'ti6 '1, ' OWNER-BUILDER DECLARATIO ''' . F ., I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D I, aa owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or ottered for sale !Sec. 7044, Business and Professions Code: The Contractor's license Lew 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. It, however, the building or Improvement Is sold within one year of completion, the owner•buHder wlll have the burden of proving that he did not build or Improve for the purpose of sale). O I, •• owner of the property, am exclusively contracting with licensed contractors to construct the project ISec. 7044, Business and Professions Code: The Contractor's License Law does not apply to sn owner of property who builds or improves thereon, end contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I em exempt under Section ------Business and Professions Code for this reason: 1. I personally plan to provide the "1ajor labor and materials for construction of the proposed property Improvement. 0 YES ONO 2. I lhave / 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 I address I phone number I contractors license numberl: 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 I address I phone nlimber J contr1ctors 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 I address I phone number I type of workl:------------------------------------------------------- PROPERTY OWNER SIGNATURE---------------------- DATE _________ _ (COMPLEJi.i'i:iUfi:ECtit,N FOR' NoiUIEslostHAJ.'IUllbiNO PERMrti'ONL\lJJ.i.W(fcff'.'+"lfiXt!/'.7?f rrr,_1,-;1'.r'ffil(~Mr ;, f¥\_~t;~~.lsf~f!".,f~;/, ·,_. --•. ,-r·-:;·--~ ,, < ":· ,· .. -~,-,,::' IS the applicant or future buildlng occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention ~r:, ~1tr--Sff1fo .. n"' 2S5!H;, 26533 or 2!;534 r'lf the Pn1sley-T11nner Hazardous Substance Account Act7 0 YES O NO la the applicant or future bulldlng occupant required to obtain II permit from the air pollutlon control district or air quality management d\sttlct7 0 YES D NO Is the f1clllty to be constructed within 1,000 feet of the outer boundary of II school slte7 0 YES O 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 REOUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. la~CO~tRUCTIOtfl.tim1NCJ'1'GENCV.:f!~;'t";l;t''::~4in .?,:;;j!;';~f:~~~i,1.'.""'~~:;'~-~.~,' -~:~~ -;':":?:'. ;t~;··:\.i 'T"" ~·: :, ,. :I; ~~tr""; I~·.::· I hereby affirm that there Is II construction lending agency for the performance of the work for which this permit Is Issued (Sec. 3097(1) Clvll Code). LENDER'S ADDRESS, ______________________ _ I certify thlt I have read the •PPlication and state that the above Information ls correct and that the Information on the plans Is accurate. I agree to comply with all City ordinancttl end State laws relating to bDlfdin9-constructlon. I hereby authorize representatives of the Cttt of Carlsbad to enter upon the above mentioned property for lntpectlon purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO 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 Of construction of structures over 3 stories in height. EXPIRATION: Every permit Issued by the Building OfHclal under the provisions of thls 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 II period of 180 days !Section 108.4.4 Uniform Building Code) / ! APPLICANT'S SIGNATURE Szt:c:'q 4 "" "-e " VC" ~"' '-"'·-·-· "",v "'""""" DATE &;;,!l_ ut-fB