HomeMy WebLinkAbout1855 TULE CT; ; 81-477; Permit•
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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.
L,c No ______ Class
I hereby atftrm thait I ,im exempt from the Con-
~!~;'8~~~=:: ~ ~,:::,:~~'¼<,\~ county which requires a permit to construct ~Her, Improve. demolish, or rep.a,r any structure.
prior to its •~• also requ,res the applicant for such penn1t to hie a signed statement tha1 he 1s
hcensed pursl.Wlt to the provIs,ons of the Con-
tractor's Ucense Law (Chapter 9 commencing with Section 70CIO or 0tv,st0n 3 of the Business am, Pro-
fusions Code) or that 1s exempt therefrom Mld the
basis fOf the alleged exemphon Any wt0lat1on of SectlOfl 703 t 5 by an applicant lor a pe<mIt subjects
tne apphcant to a c1v1I penalty of not more than five hundred dollars ($5001 .
□ I, as owner of the propeny, or my employees ,.1th w~s as their sole compensat•on. will oo the
WOfk, and the s1ructure ,s not intended or offered fo, sale (Sec 70U, Busmess and Professions Code
The Contractor·, License Uw does not app♦y to an owner o1 property who builds or improves thereon
and who does such ..-one h1msel1 or throug~ his own
employees. provtded that such improvements are
not intende-1 or offered lor sale. If. however, the
building or ,mproYement Is sold within one year of
complehon, the owner-builder will have the burden
of proving that he d1d not build or improve for the purpose of sale)
□ I, as owner of the pr0peny, am exclus,vely
contract1ni with licensed contractors to construct
the ptOJect (Sec. ,O.U. Business and Protess,oos Code. The Contractor's License law does not apply
to an owner of praperty who builds or improves ~~~-~ ~~ncs':'~~!~~~ ~:rh~r~~~;;~-= Ltcense law) .
D I am exempt under Sec
for this reason
_____ ,B &PC
D I hereby affirm that I have a cert,hcate ol consent
to self,insure, or a cert1f1cate of Workers· Compensation Insurance, or a certified copy thereof
(Sec 3800, Labor Code)
POLICY NO __
COMPANY __
□ Copy IS filed With the city
0 Cert1f1ed copy 1s hereby furnished
CERTIFICATl OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1f the permn
Is tor one hundred dollars (S 100) or less)
0 I certify that in the perlormance of lhe work fOf
which this permit IS issued, 1 shall not employ any
person 1n any manner so a.s to t>ecome sub1ect to
the Workers· Compensahon Uws of Cal1forn1a
NOTICE TO APPLICANT It. after malun~ ttus Cen,
hcate of Exemptton. you should t>ecome: sub1ec1 10
the Wor1ters· Compen!>at1on provisions ol the labor Code, you must lorthw1th comply with such
prov,s,ons or this permit shall be deemed revoked
O I hereby affirm Iha! there 1s a construchon lending agency fOf lhe perlo,mance ol lhe work !or
which this perm11 ,s issued (Sec 3097. C1v1I Code!
Lenders Name ___________ _
Lender's Address __________ _
U:it llllll l'UINI PtN ONLY & PRESS HARD APPLICAN., FILL IN INFORMA
CARLSBALI BUILDING DEPARTMENT .
APPLICATION & I 1200 Elm, Carlsbad, Callfornla 92008 (714) 438-5525
JOB ADDRESS
A~,iT., D/:Ex ;;,;~CATION'
BUSINESS LICENSI If 5S lt<..Le. c,
OWNER'S NAME I 1!'$;w;r;zo; PRIME CONTRACTOR ' I CONTRACTORS PHON to'u.r,/ A/£ bow-v.s ().JJNf{(
OWNER'S MAILING ADDRESS
~J,,9/ "n4l.:>.
CONTRACTOR'S ADDRESS LICENSE NO. I iSS-7ut.e. er
LOT I BLOCK I SUBDIVISION I ASSESSOR PARCEL NO. DESIGNER STATE LICENSE ,;
DESC~I TION OF WOR~K
OLCt, ~ -r-wA-re:,, s'-?~;,, DESIGNER'S ADDRESS DESIGNER'S PHONE -~ --------F/P F LR ELEV. NO OCCGP EDU STORIES
vO NO
CENSUS TRACT I GP LANO USE I PARKING SPACE I AES UNITS I GRADING ~EAMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SI AREA CONST r □ ND v O NO v0 N
/,6D I QTY. PLUMBING PERMIT -ISSUE QTY. MECHANICAL PERMIT -ISSUE ~.on SUI
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU BUILDING PERMIT .. EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT \: -
EACH WATER HEATER AND/DR VENT BOILER/COMPRESSOR UPT0 3 HP PLAN CHECK / ~"'
EACH GAS SYSTEM I TD 4 OUTLETS BOILER/COMPRESSOR 3-15 HP TOTAL PLUM BIN~ /
EACH GAS SYSTEM 5 OR MORE MET AL Fl REPLACE ELECTRICAL/ ~
EACH INSTA~ .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHAt;¢AL \
EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS M06/!'EHOME
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MO~HOME PARK INSI
EACH ROOF DRAIN (INSIDE) I" i,.80LAR
TOTJ;L MECHANICAL STRONG MOTION
TOTAL PLUMBING I FIRE SPRINKLERS
QTY. ELECTRICAL PERMIT -ISSUE ;2 ... oa QTY. ~ 111'1' PUBLIC FACILITIES FEE SOLAR -ISSUE BRIDGE FEE -NEW CONST EA AMP/SWTtBK R COLLECTORS ~~ SCHOOL FEE -DISTRICT
1 PH 3 PH STORAGE TANKS .::J c--Carlsbad
EXIST BLDG EA AMP/SWT /BKR ROCK STORAGE -Encinitas
I PH 3 PH PUMP _2...-.~ San o,egu,to
REMODEL/ALTER PE R CIRCUIT PLAN CHECK FEE ----San Marcos
TEMP POLE 200 AMPS ---OVER 200 AMPS
TEMP OCCUPANCY (30 DAYSI
·--TOTAL ELECTRICAL I TOTAL SOLAR /0 1'1/ TOTAL FEES
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT ANO DO HEREBY Exptrabon Every permit •saued by lhe Building Ofltc,at under the provIsIons oflhts
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall exp,re by hm1tation and become null and void If the building or work
DECLARATIONS ARE TRUE ANO CORRECT ANO I FURTHER CERTIFY AND AGREE IF A PERMIT IS authorized by such permit 1s not commenced w1th1n 180 days from the date of such
ISSUED: TO COMPLY WITH ALL CITY. COUNl'!' ANO STATE LAWS GOVERNING BUILDING CON-:~:;.,.:i •~, l~v i::,~•~.~;h:~~r:~t~~..:i~~~~ ;'8~?,),i'~f•~:g-:~ or STRUCTION, WHETHER SPECIFIED HEREIN OR NOT_ I ALSO AGREE TO SAVE INDEMNIFY AND APPLICANT'S SIGNATURE • OWN11'\ CONTRACTOR 0 APF KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE
BY PHONE 0 GRANTING OF THIS PERMIT.