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Home My WebLink About2904 LANCASTER RD; ; CB970363; Permit-- Ar / w1.r : A* Alu t "'Lf>I. • u t#: f enc#: HEA ER £PAE N 6 7 7 f. t n F INAL AP INSP. CLEARANC CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 ---- A I. --- .o Ex a+ ----- 'l I. 7. ----- - FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NO. ____ _ Cl.TY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619) 438-1161 EST. VAL. _________ _ Plan Ck. Deposit ________ _ .. Validated By _________ _ Date ______________ _ lU/l!W'ROJEO'r.:INa>IUMWN~~~gi'i,'f,ffi]Wqr 29D4 raocaster Address (include Bldg/Suite II Business Name (It thl1 1ddren) L1g1I Description Lot No. Subdivision N1m1/Numt>.r Unit No. PhlH No. SFR ASHSSOf'S Percel, Existing Use Proposed Uae Total I of units Description of Work SQ, FT. lot Storiea I of Bedrooms I of Bathrooms :i-1.1 ~~%T.~mi~f.f !W!~tf=~o~E,;:-.XW:~a::t ~~f1,:lJl~~~~~~~:r .... ?Ai1119l-7626'' Keiserrna.n, Mitch 2904 Lancaster • Name Addr1111 City State/Zip Telephone I ~dJIJJP.l'EIJ.tYiQWN~,i)i';l~·.l~~~wc.i'fBBMJ™iffl ,DQWAfflMMJtW ~ ~~~-w~i.c?-: '· · ~isenRa:R, Mitcb 2904 Lancaster CARLSBAD • - ame Addr111 City S.tate/Zlp Telephone I r&,•ia;CONTRACJOR:;;:c01t1!1AN~~lllftil'iiR \i}V (Sec. 7031.5 Business ind Professions Code: Any City or County which requires I permit to construct, alter, lmp,ove, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file e signed statement that he Is licensed pursuant to the provisions of the Contractor's License Lew (Chapter 9, commending 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 epplicant for a permit subjects the appllcant to I civil penalty of not more t~a81'r hun~~cr~l~~1tfOOU. ~ & J FOS!l'~B PUJMBING 13706-B HWY 8 BUS. EL CAJON CA. 9 ■me Address City State/Zlp120035T4lephone I State License I 630120 License Class C-36 City Buslne11 License I _______ _ Designer Name Address City State/Zip Telephone State license I _ _..,N.,.l'-'A"'------ fe:i M.WO,RKERS~. COMPENS4 TION){~~;~,:-:-;1~d;111~~ :ll~-vJ .. '(f~ ~\', ~;.lf,;}1::'!iii:.IU-iUf,1!ff),~m3f~~}1)J?-.lll~.%1 \ f';t, (;::'.[ .... \ . Workers' Compens■tion Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have ind will maintain a certificate of consent to sell-Insure for workers' compenaatlon II provided by Section 3700 of the Labor Code, for the performance of the work fOf which this permit is issued. ,,0 I have ind will maintain workers' compensation, 11 requlrad by Section 3700 of the Labor Code, for the performance of the ;,.,ork for which this permit I~ .,,,-sued. My worker's compensation insurance c1rri11 and policy number are: _ _ l 5-1-97 Insurance Company FARMER INSURANCE Policy No. N200? 56 S Expiretion Date ______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (t100l OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of tho work for which this permit is i11ued, I shall not employ any person in any manner so as to become aubject to the Workers' Compensation Laws of California. WARNING: Fellure to secur1•work1111' compenHtion coverage i• unlawful, and ahall subject en employer to criminal penaltle■ and civil fines up to one hundred thouHnd doftara ($100,000). in addition to the coat of compensation, demnges II provided for In Section 3706 of the La~ code, int■rHt end attorney's f1H. SIGNATURE ______________________________ DATE _________ _ 1. owNER-Bu1LDER DEcLARAT1orH :~r '1-.. i.'tj;· ti;:i. , h'T ·+·,1t '... ~·;:~'.:. ·~i,•::.t!;... ,, ,'.£:11 ... ~~~mt'-ia f.t'·•~:l1'ift-r'W ~'7:.-:r, I hereby affirm that i am exempt from the Contractor's Licenso Law for the following reason: O I, as owner of the property or my employees with wages es 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 ere not Intended or offered for Hie. II, howev■r, the building or improvement is sold within one year of completion, the owner-builder will hav~ the burden of proving that he did not build or Improve for the purpoH of ■ele). 0 I, ■s owner of the property, am exclusively contracting with licensed contractor■ to construct" the project (Sec. 7044, Business end Professions Code: The Contr1ctor'1 License Lew does not apply to 1n owner of property who builds or lmprov111 thereon, and contracta for auch projects with contractor(al licensed pursuant to th• Contractor's License Lew). · 0 I 1m exempt under Section ______ Business anti Profusions Code for this reason: 1. I personally plan to provide the major labor end materials for conatruction of the proposed property Improvement. 0 YES ONO 2. I (have/ have not) signed an appiic■tion for I building permit for the proposed work: 3. i have contracted with the following person (firm) to provide the proposed construction (Include name / 1ddre11 / phone number / conlractors license number): 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 / address / phone number/ contractors 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 / address / phone number / type of work): ______________________________________________________ _ ls the applicant or future building occupant required to submit • business plan, acutely hazardous materials reglstr■tlon form or rlak management and prevention p,ogr■m under Sections 25505, 25533 or 25534 of the Presioy•T1nn■r H1111dous Substance Account Act1 0 YES O NO Is the applicant or futura building occupant required to obtain II permit from the ■Ir pollution control district or air quality m1n■gement district? O YES O NO Is the facility to be constructed within 1,000 feet of the outer bound■ry of n school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT IIE ISSUED UNLESS TIIE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8._ ' CONSTRUCTION LENDING AGENCY 7l '1s'.',t"~::;_tmt ~' l~ -~ i~!JwJ/' :T:;.1'-i';;fj!e.~, U5['~-'fxJ...Ji.~,£~';°i(i~1fi'.r-'" ;-_; 1 I hereby affirm that there is a construction lending 1gancy for the performance of the work for which this permit Is i11ued (Sec. 3097(1) Civil Code!. LENDER'S NAME_______________ LENDER'S ADDRESS _________________________ _ 9;,' APPUCANTCERTIFICATION . ·;•,.~\ ··WT,'.~l'."-t r !~ ,.-. ·:, :~·-_;:;·~z;i·•?t{l:~.11,f.,:i,.~1:~~1.mi,.~·;_~.i.;"f.:, \\ ·;;, I certify th■t I have read the application and state that the above information Is correct and that the Information on the plans Is accurate. I agree to comply with all City ordinances 1nd State laws relating to building construction. I hereby authorize representatlvH of the City of Carlsbad 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 excavations over 5'0" deep and demolltlon or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Offici■I under the provision■ of this Code shall expire by limitation and become null ind void if the building or work authorized by such permit is not commenced within 365 days from the d■te of auch permit or If the building or work authorized by such permit is suspended Of 1b1ndoned ■t eny time aft~ commenced for• period of 1BO d1y1 (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE ~ )'CY:'f\JX,)(\ DATE c9 'Q(_p -CJ/ WHITE: File YELLOW: Applicant PINK: Finance