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HomeMy WebLinkAbout2257 PLAZUELA ST; ; CB981814; PermitPERMIT APPLICATION FOR OFFICE USE ONLY(> ti) PLAN CHECK NO. 9 a /'6f 7- EST. VAL. ___ ___._0::....,.__~-=--67)-==-CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 Plan Ck. Deposit -----A-1-~J-L..- Validated By ____ ---:r,.._..'-:--=-.....-c;t- Date ________ ,,.,."-l-""'"-1---'-........,_ 1. PROJECT INFORMATION Address (include Bldg/Suite #) \q 7-l-l el q 2r±:usiness Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Proposed Use D~ 34\~1"lNl~ ~ '{i. cJ.:C&s~. on~~a".fBe~ rJ ~Jfi:ol}- 2. CONTACT PERSON (If clff.,..,t ,;m ~cantl o~ • --) --ijv~ City State/Zip Telephone# Fax# 0 Agent for Ow~ V-l.C.... 97..© o8<f State/Zip Telephone# 4. PROPERTY OWNER Name Address City State/Zip Telephone# 5. CONTRACTOR -COMPANY NAME (Sec. 7031.6 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair eny 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 and Professions Code[ or that he is exempt therefrom, and the basis for the alleged ex ptio~n of ction 7031 . any applicant L~cc:;ubje s the applicant to a c· ii penalty of ~o2han five undred dollars [$ 00(1. Designer Name Address City State/Zip Telephone State License # _________ _ 8. 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 Labor Code, for the performance ~rk for which this permit is issued. ~ .. ~ h~ve and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for whr· h t,is permit is issued. My worker's com ensation i surance 'er and pol~~ number are: . O ~ 'II) / Q ~ . . l / Q 0 Insurance Company _ _.;;::i~~~:::::~-~~~~u~O\~L____ Pohcy No. -Z. 0 5 J ':r,O \0 .J ~ Exp1rat1on Date_~ ____ r _{5_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) 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: Failure to secure worker•· compenHtlon coverage 11 unlawful, and 1hall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In ddltl to he coat of.compen1atlo dama es aa provided for In Section 3706 of th~•b'f codf,)qt:' and attorney's fees. SIGNATURE:_~~JJL:~Ll~~~~r:~--~:d,.~~~~-----DATE _\..Q_-11-~'~'-~<:i_~ _ _x_ __ _ 7. OWNER-BUILDER DECLARATION I 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 ere not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have / have notl signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firml to provide the proposed construction (include name / address / phone number / contractors 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): ______________________________________________ _ 6. 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): ________________________________________________________ _ PROPERTY OWNER SIGNATURE ______________________ _ DATE _________ _ COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 26505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? O YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 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 REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8. CONSTRUCTIOl'!LENDING AQENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(il Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS _______________________ _ 9. APPLICANT CERTIFICATION I certify that 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 and State laws relating to building construction. I hereby authorize representatives of the Cit\' 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 demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this 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~ Is co7{menc~folj1 period o{ 180 da ect'on 06.4.4 niform Building Code). ~ ( l c,) APPLICANT'S s1GNATuRe · a r I -<J • Gt)(... ------~ ....... ,,.._... DATE r I 9 '6 ------+-~~~----- WHITE: File YELLOW: Applicant PINK: Finance j) 47 f · 1 CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB981814 FOR 06/25/98 DESCRIPTION: 2500SF COMP.SHINGLE REROOF TYPE: MISC STE: JOB ADDRESS: 2257 PLAZUELA ST APPLICANT: SECURE ROOF INC CONTRACTOR: PHONE: 432-9084 PHONE: INSPECTOR AREA PD PLANCK# CB981814 OCC GRP CONSTR. TYPE NEW LOT: OWNER: REMARKS: C/TERESA/ SPECIAL INSTRUCT: PHONE: f} I} INSPECTOR ---'-~-·~/v __ · _____ _ TOTAL TIME: --RELATED PERMITS-- LVL DESCRIPTION PERMIT# CB880526 CB940097 TYPE PLUM PLUM STATUS EXPIRED EXPIRED ACT COMMENTS CD 19 ST Final Structural Af _____ _ ------------------ ------------------ ------------------ ***** INSPECTION HISTORY***** DATE 062298 061998 061798 DESCRIPTION Roof/Reroof Roof/Reroof Roof/Reroof ACT INSP AP TP CO PD NR RB COMMENTS SEE NOTICE ATTACHED