HomeMy WebLinkAbout1859 TULE CT; ; 83-399; PermitfJ) z 0 .: C a: C ..,
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O I hereby affirm that I am licensed under
provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code. and my license is in
full force and effect.
lie No ______ Class
I hereby affirm that I am exempl lrom the Conlrac.• tor's license Law tor the following reason (5ec 7031 5
Business and Professrons Code Any city 01 coon1y wh1ctl re-qwes a perm11 to cons1ruct_ alter. 1morove. demohsh. °'
repair any structure, poof to ,ts issuance also requires !heap·
pltcanl tor such permit to Ille a s,Qned statement lhal he ,s
licensed pursuant to the prov1s1ons of !he (;ontrdCtOf s Li<:ense Law ( Chapter 9 commencing w11h Sechon 7000 of
Otv1s1on 3 of lhe Business and ProlesSJons COdel or !hat is ex· empt 1herelrom and the basis tor the a!legea exempoon A.ny v1olalt0n of Secuon 7031.5 by an apphcant fo, a perm,, sub·
rects lhe applicant to a C1Vll penalty of nol more lhan hve hun· dred dollars ($500).
1J I. as owner of the property. or my employees wifh wages
as lhe1r sole compensation, wul do the work. a"'d the struc-ture 1s not intended OI' o1fered 10f sate (Sec. 7044 Business
and P1olessi0ns Code The con1rac1or' s lteense Law does
nol apply lo an owner ol property who builds or improves !hereon and wno does such wOfit himself or through his own
employees. provtded that SUCh improvements are no! mtend·
ed or offered lor sale If however. the bu1fdmg or 1mprove-
tne11t 1s sold w11h,n one year of com~et,on. lhe owJ"1er-bu1lder
w111 ·ave the ~~~~!~~ proving that he dK1 nol build or 1m• prov• ,or the ~of sale)
0 I, as~· r of rtit property, am exclus1vel)' conllactmg. wtth hcen tratlors 10 construct the pr0jecl (Sec 70-44 Business a otessions Code: The Contractor·s Lie.en~
Law does not appty to an owner of property wtlo builds or im-proves thereon. and who contracts 104' each proiec1s w,1" ~
contractOC'(S) hcense pursuant to the Contraclor's license Law)
□ As a homeowner I ~m .-m:irov,ng my home. and the lo11ow· mg cond,tioos exist. 1 The work is be:n:g pertormed prl()( lo sa!e
2 I have lived in m, oome 10f twelve months pnor to compfellon o· u11s work I have not claimed ll'!is exemplion during the lasl three years.
D I am exempt under Sec ______ , B & P C
for !his reason
0 1 hereby affirm 1hal I ha...,e a ceri1hcate ol consen1 to self insure, or a cert1fica1e ol Workers
Compensahon Insurance. or a cen1hed copy !hereof
(Sec Jim. l.abOf Code)
POLICY NO
COMP .. NY
0 Copy IS hied Wllh lhe City
□ Cen,hed copy Is ttereoy furn1she0
CERTIFICATl OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE
(Th,s sechon need not be comple1ed 1t lhe perm,1
Is tor one hundred OOllars (S 1001 or less)
0 I cen,ty !hat in tfle per1ormance ot the woril. tor ...,rucr, this permit Is ,ssued I shall no! employ any
person m any manner so a.s 10 become sub1ec1 10
lhe Woril.ers· Compensa11on Laws ot Cahlorn1a
NOTICE TO APPLICANT II, af1er makcn~ th1s Cen,
t,cate ol Exemp11on you should becOfT\e sut>Iect I') lhe Workers Compensation prov•s1ons or the Laoo,
COde. you must lor1h'A I1h comply w11h such p,ov1s,ons or th,s perm,1 shall be Deemed revoked
O I ne,eby attirm 1na1 there ,s a consiruct,on 1end1no agency l0t lhe per1ormance 01 1r1e wof\o 10,
wh1cti ltus perm,1 ,s •ssued 1Sec. J097 C1v1t Code,
Lenders Name ___________ _
Lenders Address __________ _
USE BALL POINT PEN ONLY & PRESS HARD -. -APPLICANT TO Fill IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. ...... -
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT
1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525
JOB AOORESS AV ST RO NEAREST CROSS ST. I 01 ::;i~crr1 BUSINESS LICENSE # VALUATION PERMIT NUMBER
IBGq 7u.fe lt ~✓3ff LOT I BLOCK I SUBDIVISION I ASSESSOR PARCEL NO CONTRACTOR CONTRACTORS PHONE • ZONE
O,nnR.r-RuJ' ldnr OWNER'S NAME ' '"'~i~cf 7o°<iE lhere.sa. t'-1 . 6m "-th CONTRACToR·s ADDRESS LICENSE NO PLAN 1.0. # BLOG use CODE
OWNER.$ MA,LING ADDRESS I
I 515q Tu.le & OESIGNER LICENSE• STANDARD PLAN# BUILDING SO. FOOT,.GE
0 rte1G:>0 an~R1 ,· nf -~11/J~ -DESIGNER'S ADDRESS DESIGNER"S PHONE
I ' -u B,$fl i5 e~ 10~0( -------.. --~ .. --F IP FLA ELEV. NO OCC GP EDU o.:~_i_:: s~ B:,<i£/ sa STORIES lli.O' vO NO --
CENSUS TRACT I GP LANO use I PARKING SPACE I RES UNITS I GR,.OING PERMIT ISSUED
I
REDEVELOPMENT TYPE OCC LOAO Fl RE SPA AREA CONST
y D ND vO NO vO NO Not Valid Unl~s Machine Cerr,fied
QTY. PLUMBING PERMIT -ISSUE 7,Si:J QTY. MECHANICAL PERMIT -ISSUE 3,,uo SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT 01-00-00-8220
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 01 ·00-00-8221
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01-00-00-8806
~ EACH GAS SYSTEM I TO 4 OUTLETS )-.j 0 BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01-00-00-8222 /(}, Clt:1
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01 ·00-00-8223
EACH INSTAl . ALTER, REPA IR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01-00·00· 8224 ---·
EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS MOBILEHOME 01-00-00-8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK lNSP
EACH ROOF DRAIN (INSIDE) SOLAR 01-Q0-00-~??~
TOTJ;L MECHANICAL STRONG MOTION 80-92-33·0519
TOTAL PLUMBING I /U , 0. 0 FIRE SPRINKLERS 01-00-00-8227
QTY. ELECTRICAL PERMIT -ISSUE .,,,.. QTY. SOLAR -ISSUE PUBLIC FACILITIES FEE 32-00-00-8933
~d/0 BRIDGE FEE
NEW CONST EA AMP SWT BKR COLLECTORS SCHOOL FEE -DISTRICT
I PH 3 PH STORAGE TANKS Carlsbad 80-92-21-0519
EXIST BLDG EA AMP/SWT 'BKR ROCK STORAGE Encinilas 80-92·22-0519
I PH 3 PH PUMP San Dieguilo 80-92-23-0519
RE MOOE L ALTER PER CIRCUIT PLAN CHECK FEE San Marcos 80-92-24-0519
TEMP POLE 200 AMPS
OVER 200 AMPS LICENSE TAX 01-00-00-8162
TEMP OCCUPANCY (30 DAYSI
CREDIT DEPOSIT
TOTAL ELECTRICAL I TOTAL SOLAR TOTAL FEES PAYABLE I fC,LV
I HAVE CAREFULLY EXAMINED THE COMPLETED 'APPLICATION AND PERMIT'" AND DO HEREBY Expiration Every permit issued by the Building Oll1c,11 under !he prov;s,ons ofth,s * AN OSHA PERMIT IS AEOUIAED fOA EXCAVATIONS OVER
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall exp.re by hm1tation and become null and void If the bu1ld1ng or work s· 0" DEEP ANO DEMOl.lTION OR CONSTRUCTION ~
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT 15 authorized by such perm1l is not commenced within 180 days from the date of such STAUCT\JR£S OVER 3 STORIES IN HEIGHT permit. or 1f the bu1ld1l or work authorized by such permtl ,s suspended or ISSUED TO COMPLY WITH ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CON abandoned at 1nv time a ter the work. 1s commenced for a oeuod of 180 d•v• STAUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND .. PPUCAN_j'S Sf~NATU~ OWNER□ CONTRACTOR 0 APPROVED BY ·JU. O .. TE KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND • EXPENSES WHICH MAY !N ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE V / l'J-=, -,,..:£/ J .. BY PHONE 0 t f,.. d ~ -J'..-J GRANTING OF THIS PERMIT_.
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