HomeMy WebLinkAbout1764 BLACKBIRD CIR; ; CB980231; Permitc -- BUILDING PERMIT Permit No :
01/27/98 16:21 Project No:
Page 1 of 1 Development No:
Permit Type: PLUMBING Parcel No: 215-602-05-00 Lot#:
Valuation: 0 Construction Type: Occupancy Group: Reference#: Status: Description: WATER HEATER REPALCEMENT Applied: Apr/Issue:
Entered By:
I Job Address: 1764 BLACKBIRD CR Suite:
Appl/Ownr : STRYKER CHARLES 760 431-1713
1764 BLACKBIRD CIRCLE
CB980231
A980 0 30 3
NEW
ISSUED
01/27/98
01/27/98
JM
FINAL APPROVAL I I
I CLEARANCE I
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92C" (619) 438-1161
J
PERMJT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
.- v-
161 9) 438-1 161
FOR OFFICE USE 03 JPMN CHECK NO. 023/
EST. VAL.
Plan Ck. Deposit
Validated By
Date
Y ~~EGXrtS
Addrarr llncludr Bldg/Sulta 8)
I
1764 Bhck Buslnmu Nama tat lhir mddrau) I 3
Total I of units Phate No. Legal Dmauipllon Lot No. SubdlvWm Nama/Nu+r Unlt No. SFR
Aursor'r Parcd 8 Exhtlng Uaa Roporad Uaa
Nama Addrarr Cltv TeleDhone X
(Sac. 7031.5 Burinerr and Profmuion8 Coda: Any Clty or County wMch raquiraa a pudt to #mrtruct, altr, Impovm, damollrh or repair my rtructura, prlor to Its
irsurnca. alro requlrar tha appllant for such parmlt to fHa a algnad rtltammnt tho1 hm h Yconrmd pursumnt to thm provirions of the Contractor's Ucenre law
IChrptar 9, eommendlng wlth SICth 7000 of Divlrlon 3 of thm Burlnru and Prolmuknr Codal or that hm la mxmmpt therafrom, and the baris for the alleged axrmption. Any violation of Sactlon 7031.6 by any applicant for a pmrmlt wbjacts tha appllcanl to a civil
Nsma Addreu Clty StataIZip 12003gqhona X
StataUcmra 8 630120 , ana am ~kss C-36 ,Uty Buainora Uconma I
nalty of no mora t 13706-B HWY 8 BUS. , m& &. @flWdr"TM!-59O'"
Darlgnr Nsma Addraar UtY StatlZlp Telephone
Stata Ucanaa 8 N/A ..
% #,.vrtc)RKERskCOMPENSh~Id Workrr' Compmnrrtlm Dadaratlon: I haraby afflfm undar penalty of parjury OM of tho foUowing.dmdrreh
0 I have and wlll mslntaln a crrtlfiuta of conamnt to salf-inrwa for workra' compmrmtlon am providad by Sactlon 3700 of the Labor Code, for tha performance
of am work for which thlr prmlt I8 Isrud. p I hova and will maintlln work-' compmrallon, u raqulrad by SmcUon 3700 ol Uw labor Coda, for tha puformanca of (ha work for whlch tMa parmit la
rad. My workar'r comprnrrtlon buur8nca crrrlar and poky njmbrr uo:
~nauranco Company FARMER INSURANCE Policy No.
lTHlS SECTION NEED NOT BE COMPLETED IF THE PERMil iS FOR ONE HUNDRED DOUMIS 1#1001 OR LE88J
0 CERTIFICATE OF WEMPTION I cdfy that h tho parlormama of tha work for which thh pwmlt ir Luumd, I ahaU not amploy my perron In any manner so as
to brcoma subject to tha Workers' Cornpanartion Lmwa of Cslllornlm.
WARNWQ: Fmflurr to aacuaworkara' COmPrMalkn covraga la ud.wM, and sM DubJmd n mploymr to crlmkul panllUea and clvll finer up to one hundred
th-d dolarr l#lOO,OOOJ, h ddiUon to thm cost of componsallon, dmmgor u proddad lor h Sactkn 3706 of Uw Lab coda, lntarmt and attorney'a ha.
SIGNATURE DATE
co"u0us Explratlon Date N2007-56-51
I harrby affirm that I am axempt from the Contractofr Ucanaa Lmw lor thm fdlowlng famaon:
0 I. ma owner of the property or my rmployaaa wlth wager a8 thalr &la comparultbn, wUI do tho work and tha structura ir not intended or offerad for rala
(Sac. 7044. Burinerr and Roferdw Coda: Tho Contractor's Ucmnaa Lmw dor not rpply to UI ownr ol property who builds or Improves thereon, and who doer such work hirnreif or through Ma own rmploymaa, prwldad that such Improvamnta urn not htrndad of offarad lor mala. If, howavar, the building or lmprovamant Is rdd withln on. Year of complrtkn, tha ownar-buildw wlW haw the burden of provlng that ha did not bulld or Improve for tha purpoam of eale).
0 1. ma ownrr of tha proporty, am ancludvaly conlrmthg with Uwnamd aonvactwr to conrtrwt'tha projaat {Sac. 7044, Burlnmu and Profartlona Coda: Tha , Contrsctor's Ucanaa Law doar not apply to an ownar of proparty who bulldm or,lmprovma thrrron, and contracts lor much projactr with contractorla) llcrnsad
purauaM to the Contractor's Ucanao law).
0 I am axrmpt undrr Sactlon
1. I pnronrlly plan to provide tha major labw and matmrlalr lor cmr(ruo(kn d thm propored pfopwty hnprwamont. 0 YES ONO
2. I (have I have not) rignad sn mppllcrtlon for a building pumk I& tha proporad work;
3. I hrva contractad wlth the fdlowing parson (firm1 to provlda tha propoaad conrtructlon llncluda nmmo I addrarr I phona numbar I contrrctorr llcenra numbarl:
4. I plan to provlda portion8 of the work, but I hwa hired the foilowlng parson to coordl~to, ruporvlam mnd provida tha mijor work llnclude name / addrars I phone
numbr I contractorr licanra number):
6. I wlll provida romr of tho work, but I hava contractad (hired) tha foilowing parronr to provldr tha work Indicated llnclude namm / address / phone number I typa
of work):
Burlmrr and Profauiwu Codm lor Ullr roaron:
Ir tha rpplicrnt or futwa building occupmnt raquirad to aubmlt a bwimu plan, acutmly hurdoum rnatarkb ragirtrrh form or hk manrpement and peventlon
program undrr Smctlonr 26606,26633 01 26634 of rhr Praoiay-Tomrr Humrdoua Subrtancm Account Aal?
la thr appllcant or futura bullding octllpun rrpukod to obt& prmlt from thm dr poUuUon o#\trd district or ok qualty mmtugamant dirtrict? 0 YES 0 NO
Ir thr laclfitv to w~~ed wn 1,000 iwt ol thr wtw bo~ndrcy ol I a- aita? 0 YES 0 NO
IF ANY OF THE mswm ARE YES. A FINAL cEnmcm OF OCCUPANCY MAY NOT re ULSUED UNLESS THE APPUCANT HAS MET OR IS MEETINO THE
0 YES 0 NO
REQUIREMENTS OF THE OFFICE OF EMERQENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
8.: 7 CONSTRUCTION LWDINQ'AOENCY '5
I hrrrby affirm that therm la a conatrucUon Irndinp agency for tha prrfwmmca of the work for rvhlch thla parmlt la laruad 1S.c. 309711) Clvll Codel.
LENDER'S NAME LENDER'S ADDRESS ' APPLICANT CERTIFtWMMw!j',#i-#?>
I certify that I have raid tha applicmtlon and at
City ordinances rnd Stata laws ralathg to building construction. I hmraby authoriza rapnamntatlvaa of tho Clly of Carlabad to antrr upon the above rnentloned
property for inspection purporas. I ALSO AQREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSEAD AGAINST ALL LIABILITIES,
JUDQMENTS. COSTS AND EXPENSES WHICH MAY IN AhY WAY ACCRUE AOAINST WD CITY IN CONSEQUENCE OF THE ORANTINO OF THIS PERMIT.
OSHA: An OSHA parmit la raqulrad lor mxcavatlw ovar 6'0' damp and damolitlon or corutructlon of atructuru ovor 3 atoriar In helght.
EXPIRATION: Every par
work authorized by 8uc
OT 8burdonsd 81 any \\
APPLICANT'S SIGNATURE DATE
Ifrclal undr thm ptoVillonr of INr Cod0 rhal axpkr Umltation and becoma null and void if the building or
ldlng or work authorizad by such permlt ir ruspended ~ctlon 106.4.4 Unilorrn Wdlng Codal.
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