HomeMy WebLinkAbout1720 BLACKBIRD CIR; ; CB984318; Permitv38Fl
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RUILDING PERMIT Permit
12/10/98 15:31 Project
Page 1 of 1 De v e 1 o pme n t I Job Address: 1720 BLACKBIRD CR Suite :
Permit. Type : MECHANICAL
Parcel No: 215-601-48-00 Lot#:
No: CB984318
No: A9805592
No :
Valuation: 0 Construction Type: NEW
Occupancy Group: Reference#: Status: ISSUED
Description: NEW A/C W/ELECTRIC Applied: 12/10/98
Apr/Issue: 12/10/98
Entered By: RMA
Appl/Ownr : TRI STATE REFRIGERATION 760 735-9000
60950 ESCONDIDO BLVD STE 204
ELEC FEE
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1 161
&w & Q&BL ?row' w Assessor's Parc I
FOR OFFICE USE ONLY
PLAN CHECK NO. qr47l f
pored be
-8 bf Bedrooms # of Bathrooms &g-
EST. VAL.
Plan Ck. Deposit
"- *- ~ _.
1. PROJECT INFORMATI
Addresi (include BldglSuite #I
BIQ IRC Business Name 1st this address)
Unit No. Phose No. Total I of units Legal Descnption Lot No. Subdivbion~~~ r
(See. 7031.5 Business and Professions Code~: Any City or County which fequinr a permk to coMtWCt. IbW, improw, demolish or repair any nt"m, prior to Its
issuance, also requires the applicant for such permit to file a signed mtemmt that he b Nwnsed Pursuant to tho proMons of the Contractor's License Law
[Chapter 9. commending with Section 7000 of Division 3 of the Business and Professions Codel or that ho k ammpt therefrom, and the basis fw the alleged n. Any violation of Section 7031.5 y any applicent for e permit rubms the applicant to I civil p.ruC of not more than five hundred dollars 18500)).
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Neme f Address citv
State License x 703 5 uc.rur aa<-2D cse- CityBudnrrl.kenw#
Designer Neme Address City stawmp Teiephom
- _. State Licanse I
6. WORKERS' COMPENSATION Workers' Compensation Declaration: I heroby affirm un
0 I have and will maintain e certificate of consent to self-ln8um for wor(t.n' COmp.nUtkn 08 Prodded by sIcl/on 3700 of the Labar Code, for the performam
of the work for which this permit is kswd.
dhave and will maintain workan' compens8tion, as required by Section 3700 of the Labor Cod., for th prrformance of the work for which thin permit b
issued. My wwker'a compensation inwn
Insurance Companyst(B1 EPd
(THIS SECTION NEED NOT BE COMPdTED IF THE PERMIT IS FOR ONE HUNDRED DOUARS 1$1001 OR LESS)
0 to become subject to the Workers' Compmsation Laws of California.
WARNING: FDWWO to socum workom'
29+fiUICI t/% 7 f Exphation Dote / -1 -9 % v
CERTIFICATE OF EXEMPTION: I certify that in the performance of tho work for which thb p.rmk b hruod, I shdl not ompky any penon In any mfnur so u
to crknh.l prr)tko rd dvil fhea Up to OM hudnd b UlhWfd. md rhrl wbj.ct
7. OWNER-EUUDER DECLARATl
0 1, as owner of the property or my omployues with wages as th.k a& cornpunsation, WHI do tha work Md the structure h not Intended or offd for Hk (Sic. 7044, Business and Frofurions Coda The Contnaor'r Ucome Law does not apply to an omw of pro#rty who bulldo or lmpmws themon, md who do#
6uCh work himself or through his own omployws, prwidd that such Improvements are not Intodad or offwd for a&. If, howwer, the building or b
sold within one year of complotion, the ownor-bui1d.r will havr the burdon of proving that h. did not buUd or Improve for tho purpom of amla).
c] 1, as owner of the property, am exdusivoly contracting with licetisod contracton to construct the Pr0li.a IS=. 7044, hknu md Profonkm Cod.: Tho
Contractor's License Law daas not apply to an owm of prop.rty who bull& w improws thuom, md mtmcta fw such projects with conmctorbl Ikonsod
pursuant to the Contractor's Licwa Law).
[7
1.
2.
3.
4. number / contracton license number):
5. of work):
PROPERTY OWNER SIGNATURE DATE
'COMplm THIS SEcrkM FOR b
Is the applicant or futura building occupant roquirod
program under Sections 26505,26533 or 26634 of the Prmhy-Twmr Hulrdwr subn~m Accarnt Act?
Is tho applicant or future building occupant required to obtain a permit fmm the .k paUth control dmict or ak qullty maruglcmnt dirtria?
Is the facility to be constructed within 1,OOO foot of tho outer boundary of a rchod sit07 (3 YES 0 NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNWS THE APPUCANt HAS MET OR IS MEET#JG THf REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POWTION COKCROL DISTRICT.
b, .. CONSl'RUctlO~ mDlNQ AbdJCV
I am exempt under Section
I peraonally plan to provide the major labor and matnirh for construction of the pmporrd property Impmwmmt. 0 YES ON0
I (have / have not) signed an application for I building permit for the propod work.
I have contracted with the fdlowlng penon Ifinn) to provlk tho PropOMd COnmuctiOn IMude ~mo I addrou I phan number I contractm Ihxftse mmkr):
I plan to provide portions of the work, but I haw hired the fdlowing penonto tOoTdinDt~, supavim Mdprovid.tb mmjof work andud. turn /add" I phar
I will provide aome of the work, but I haw comncted (Mnd)tbfdbwing plllona to Pr0vid.U~ work kdlcmd (hwiude turn /addmu/ phom numb /typo
Bushwu and Raf.rdonr Cod. for thio muon:
I*
0 YES 0 NO
0 YES 0 NO
LENDER'S NAME
b. APPbChIl I
I certify that I have read tho application and state that the above krformltion b comet and thn tho information m th. plrm k accwata. I -reo to corn& with ai
City ordinances and State laws relating to building conrrmch 'on. I -by authorize npresontlthres of the Cit) of Carisbad to ontor upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE. INDEMNIFY AN0 KEEP HARMLESS THE ClTY OF CARLSBAO AGAMST ALL UABIUTIES, JUDOMENTS. COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID ClTY IN CONSEOUENCE OF THE CI-G OF THIS PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0' deep and demolition or construction of structurer owr 3 sth In Might.
EXPIRATION: Every permit issued by the Building Offici81 under the provisioM of tMs Code ahd exphe by limkmtion md hcome ndl ad void if the buiidiw or work authorized by such permit b not commenced within 366 daw from the date of such permit or If tho building or work authorized by such pclrmit is smmM
or rbandoned at any timphh worlySe0cn-f period of )eo *w Iloction 106.4.4 Uniform Building cod.).
WHITE: FUe YELLOW: Applint PINK: Finonce