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Home My WebLink About1777 BUTTERS RD; ; CBR2021-2100; Permit                                                             (Cityof Carlsbad :r City of Carlsbad RESIDENTIAL BUILDING PERMIT APPLICATION 8-1 CBR2021-2100 Pian Ch ee k ---.------- Est. Value PC Deposit Da te _1L..-_1.,=---_;;-Z..'--"-{ __ Joh Address \J J J 2>JH et-.s K d Suite: ____ APN : _________ _ CT/Project 11: ________________ Lot 11: ____ Year Built: ________ _ Fire Sprinklers: Ovcs~-10 Air Conditioning:Q YES ~NO Electrical Panel Upgrade: QvE~ NO BRIEF DESCRIPTION OF WOR Co0 0 Addltion/New: _____ llving SF, ___ Deck SF, ___ Patio SF, ___ Garage SF __ Is this to create an Accessory Dwelling Unit? Ov ON New Fireplace? Ov ON, if yes how many? __ 0Remodel: SF of affected area ----Is the area a conversion or change of use? Ov ON □ Pool/Spa: ____ SF Additional Gas or Electrical Features? __________ _ osolar: ___ KW, ___ Modules, Mounted:ORoof OGround, Tilt: 0 vO N, RMA: Ov ON, Batterv:Ov ON, Panel Upgrade: Ov ON D Reroof: --------------------------------□ Plumbing/Mechanical/Electrical 0 Only: Other: This permit Is to be issued in the name of the Property Owner as Owner-Builder, licensed contractor or Authorized Agent of the owner or contractor. The person listed as the Applicant below will be the main point of contact throughout the permit process. DESIGN P~~O:::L Name: ~M:\ J{)ltJNV\ Address: ______________ _ City:. _______ State: __ Zip: ___ _ Phone:. ______________ _ Email: _______________ _ Architect State license: _________ _ CONTRACTOR OF RECORD Name:?!'LQ_ ~¼~Q6.} Addre: 43og3~'~frf Wd.LNA Cit0':,~~ ( Uk Sta;;-=<,__;: O,zss ·z Phone: lli_ Z:3~ ~l-52- Email: CA-PogNIA7Pr~{CJ CoJQ.t:S2Gme-/L CA State license fl: <cl 5 9 50 Class: '."i3 City Business License It (Required}: _______ _ 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov REV. 08120 Scanned with CamScanner WI ,m, 'I VJHO VJII I M 1H OPl/i Tiff V/OPV (If (.()1/Pl( Tl'IG con1cr,,. I a, fo:"TIO'I l E,t tOW ((}PTI0/1 1 ): I IC! ,m n co IJf!/ CTOR or U.t P.f. TIO I : / hrrr/11 olft•m w,,1,., r• 11111/y r,f r.rrJ'lf/ 11,,r I,,,., ,.,, , •,'1.,1•"11 • v c ,. 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Cr.-!•) ,.,nthu'a tf.r»tt ____ t,nd.,r'1Addrr·u · _________ _ CONTRACTOII PlllNT: SIGN: DATE: ------------------------- (OPTION O): OWNCrt•UUILOCft DECLARATION: ';rtY1 a'O ,,c,, I "'Ir,-,,. r./ I ,, 1 hrrrliy afllrm I/int I om rumvt from Cont w et ors License Law for the following reason: 0 1, n, 1,-.•mrt of 111,. l)tOprtlV n, my rttlf)lrr1tt,., w;lh w.ti~, u 1t~lr vAr (()ff1P-nw1v.,n,. viii do tt"~ Y/Qff a'".d ttl,. ,,rtX"tur,-r1 M1 •r•--~ or c1'•tf'd ft::,.t :.J'""' (S-,r JOH , 111111n, ""'"' l•,ulr11ll)n1 Cork 1hr Con1,a,1u,'1 Llcrn..,-law d'l"I not •Pih 10 •n O'Hnrt nl J)IO!l"r1 , .,,t.,, t,,, !d1 o, lm~o-,!'111,,.,..on, 1Nl wt\o d,,..~ iucll w~,> hlm>'II ,., """"A'• hi\ (YNn r1ni,lo1rM 1111r11t1rd IIIAI ,,,ch ltnp,ov"1n•nts ,,. 1101 fnle"'1rd 01 off.,td I()( .uJ.o II, tw,,,.-,.,, II p bu,\I! ng c,, lll"tl'O'"""'t~t II v.M .,,.,,.. n OM vr•• "' IOlllfil••lil)ll, 11,r t,m,nr huWdN '"" ,,.,c lllf .,,,,urn of p/O'llnt thal ,.,. did not build 01' lmpro-~ '"' ,;..e CAJ'P'>"' or u',,J 0 1, n ,,.,,,,.,, of ti•• 1,,oJl"rlV, ~"' r,cl,,11vrly ron11ae1lng with IJ(en~d c.ootrll<IOU 10 wnwuct tht ptojtCI ISl'c. 70.U, 8u11nt11 llnd P1oft1•,,on1 Ced~ rt" Cunll•C1111'1 Llc.n1r Law""'' no!,,,,, l to an own111 or f)IOf)"IIV who builds 01 lmp!O'lt!l th~eon, .ind (O!lltllCU '"' wt.h 01c.i«u with CO,:tfll(IOt(IJ l,cl'n~ f11HIU,tr11 l(j llir ((Jllllb{IOr'I Llcrn1r l~w), O r ~,11 r .rrnril uml,r Ou~lnru and l'rolt\\loM Code OM11on 3, Ch1ptt 19, Atllde 3 101 this reason· GownGr null<lc, acknowled1cmenl ,nd vuUkatlon /01m• ha1 tJ;oen Mir<! out, 11gne<1 ancJ ,mauied 10 1h11 ap~1c.a1,on 0 Ownr ,1 "Aulhorlt•d A«tnt ro,m• hll been Mltd out, slgMd and alt ached lo lhls apphutlon 9tvlt1'] lhe o~enI au!fvJmy ro obI01n rk ~rm,r on Ihe owner's behalf Oy my s1u11a1ore below I ac•nowledec 11,a1, e,cepl for my ~rsonal residence In whkh I must have ,esldtd lo, at lea ~tone veJt p(ro, to com,Pleuon of the lmp1ovt'111cnts cove,etl by this r,e,mll, 1 c.nno1 teeany sell a 111uctu1e l~t I have bu,h as an owre1•bodder if II hlll nGt been ccmuucted in ,u ent ret r tt1 Lcensed (011/ratto,s, / 11111/e1110nrl lhO! 1,copy of 11,e applk ubl< Irr,,, Section 70-14 of th~ Bv<lness ond Pro/n.<NJns Code. k o,,o,looJ,> 11t)l'n reau~r when 1hr, opp/.cor/on r, submlllrd or al rhc Jo/lowing Web sllc. 1,11p://www.leglnfo.co gov/co/aw.him/. OWNER PRINT: ________ _ S,IGN: _________ DATE: _____ _ APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL Dy my s/9,wIure below, I cer//fy /liar: I om tire property owner or Stole of California Lice med Controctor or authorized to occ on the property owner or contractor's beliolf. I certify tliol I hove reod /1,e opplicotion ond stole 1h01 the above information is correct and that the information on 11,e plans Is accurate. I agree lo comply with all City crdlnonces and State lows reloring 10 build,ng cons rruwon I /iereby ouIhor/1e rcpresenlalive of Ilic Ory of Corlsbod to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMN/(Y AND KECP IIAnMLE5S TIIE CrTY OF CAntSBAD AGAINST ALL LJABILmES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY /ti AMY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCf OF Tf!E Gf!ANTING OF THIS PERMIT. OSHA: An OSHA permit is requfred for excavations over 5'0' deep o.nd de••IUJoo " """"""'" of"" m we, 3 ""'" lo heigh,. e,~/Z APPLICANT PRINT:_""f:-"__,_ ........ .......,.......,..,.__7•· --t#'4M,__,. < DATE,/-[-L( 1635 Fa,aday Ave Carbbad, CA 92008 Ph: 760-602-2719 Fax: 760·602-8558 Email: Buildlngllilcatlsbadca.gov 2 REV. 08/20 Scanned with CamScanner                                                                             {city of Carlsbad