HomeMy WebLinkAbout1911 PALOMAR OAKS WAY; ; CB970225; Permit1/ w
F
A
8
INSPL.
CLEARA CE
'{
OVAL
DATE ;j~Az
===----
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
FOR OFFICE USE ONLY ~
PLAN. CHECK NO. fJ,.,7._ l--::::>
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(619) 438-1161
EST.VAL. __________ _
Plan Ck. Deposit---------
Validated By __________ _
Date _____________ _
Lot No. Subdivision Name/Number Unit No. Phasa No. Total I of units
Assessor's Parcel I Existing Use Proposed Use
Description of Work SQ. FT. lot Stories I of Bedrooms I of Bathrooms
Name State/Zip Telephone ti Fax ti
j ;~/~~ ·-~·" .. t~ -\, ..• ...,, -
Address .),
~ :'Ii, ..
Name Address City State/Zip Telephone II
(Sac. 7031 .5 Business and Professions Code: Any City or County which requires II 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 end Professions Code] or that he \s exempt therefrom, and the besis for the elleged
ex mption. Any violation of Section 7031.5 b any applicant for a permit subjects the applicent to a civil penalty of not mo a than five hundred dollars ($5001).
1e1.-5#iJ pr..u/,Jtf 1./11 t!) t!) &"o t... $-'l). . I ~ 9 7-:2-h 2-
Name
State license II _b----'-?'_{L-..:..3_0_8 __ _
Address City State/Zip T ala phone II
license Class----------City Business license I --------
Designer Name Address City State/Zip Telephone
State license I----------
'';\.:.,W.QBK.ERS::,COMPENSATIOfuF,..'..~;:; • ;°'.2~~...i-~G .. r.=.-t~ _, .. ;,'"Jf...;.,.= 'l:2.~..,:....,1.,:~~:~·,;;;~.~·Jt?,j't!J5 W~~iS:D~~i€
Workers' Compensation Declaration: I hereby effirm under penalty of perjury_ one of the following declaretions: ~ .. I have end will maintein e certificate of consent to aelf•insura for workers' compensetion as provided by Section 3700 of the Lebor Code, for the performance ;J'~ work for which this permit is issued.
0 I heve and will maintain workers' compensation, es required by Section 3700 of the Lebor Coda, 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 ~OMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$1001 OR LESSI
O CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any peraon in any manner so as
to become subject to the Workers' Compensation laws of California.
WARNING: Failure to secure•worltera' compensation courage is unlawful, and shall subject an employer to criminal penaltiee ind civil fines up to one hundred
thousand dollars ($100,0001, in addition to the cost of compensation, damages aa provided for in Section 3706 of the~ code, intereat and 1ttomey'1 fees.
SIGNATURE DATE---------
"7~ ,~·oyvNER-BUILOER DECLARATION·>'!:f •· ,.. _.;~ .... ,. ,, -:~ ~.:..._, __ , ~-...<1 ' ...::,~i!;,;~~!.~~ ..... ,lf~1' ;:"""'~'.(.,..;'f,f·~-
1 hereby affirm that I am exempt from the Contractor's license law for the following reason: ·
0 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 y11r of completion, the owner-builder will have the burden of proving th1t ha did not build or Improve for the purpoH of aalal.
0 I, as owner of the property, am exclusively conuacting with licensed contrectora to construct the project (Sac. 7044, BusinNI and ProfaHlons Code: The
Contractor's License law does not apply to an owner of property who builds or improves thereon, ,nd conuacu for 1uch project, with contractor(al licenHd
purauant to the Contractor's License Lew).
D I am exempt under Section ------Business and Profassions Code for this reuon:
1 . I personally plan to provide the major labor and materials for construction of the proposed property improvement. D YES ONO
2. I (have I have notl signed an epplication for a building permit for the proposed work.
3. I have contracted with the following person (firml to provide the proposed construction (include name I addr8" 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
number I contractors license number): ______________________________________________ _
5. I will provide some of tha work, but I have contracted (hiredl the following persons to provide the work indicated (include name/ address I phone number I type
of work)=--------------------------------------------------------~
!s thll e;?plic:nt or f1.1ti.:ra builGir,.;; occup11nt r11qu;r.d to submit a businns plan, acutely hazardous material, regrstratron form or riak management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act7 D YES O NO
Is the applicant or future building occupant required to obtain a permit from the 1ir pollution control district or air quality m1n1gement district7 D YES D NO
Is the facility to be constructed within 1,000 feet of the outer bounduy of a school site 7 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.
I hereby affirm that ther? f. a construction lending agency for th~ performance of the work for which this permit is issued (Sac. 3097(i) Civil Code).
LENDER'S NAME NI ft LENDER'S ADDRESS ---------------------------~:; _APPLICANT CERTIFICATION ·· ,,
I certify that I have read the application end 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 City of Cerlsbad 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 e:i,;cavations over 5'0" deep and demolition or construction of structures over 3 atories in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Coda 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 co m c d for a period of 180 days (Section 106.4.4 Uniform Building Code)~ . /;
APPLICANT'S SIGNATURE I DATE -~___. ... b__..{_._/?-+-7-------
YELLOW: Applicant PINK: Finance
08/13/97 INSPECTION HISTORY LISTING
FOR PERMIT# CB970225
DATE INSPECTION TYPE INSP ACT COMMENTS
03/07 /97 Underground/Under Floor RI RI MW/JIM/603-8711
03/07/97 Underground/Under Floor TP WC
03/07/97 Gas/Test/Repairs TP co 24 HR TEST FAILED
03/06/97 Underground/Under Floor RI RI MW/JIM/603-8711
03/06/97 Underground/Under Floor TP AP CHLOR&TEST PORT CONNECT
03/05/97 Underground/Under Floor RI RI MW/JIM/603-8711
02/26/97 Frame/Steel/Bolting/We! PD AP WALLS
02/26/97 Exterior Lath/Drywall PD WC
02/26/97 Rough Electric PD AP WALLS
02/12/97 Underground/Under Floor RI RI MW/JIM/301-4159
02/12/97 Underground/Under Floor TP AP WASTE EXT TO MECH YARD F.S.
02/07/97 Underground/Under Floor RI RI MW/JIM/603-8711
02/07 /97 Underground/Under Floor TP AP WASTE & CL LINES
HIT <RETURN> TO CONTINUE ...