HomeMy WebLinkAbout2071 TRUESDELL LN; ; 81-50; PermitLICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provi•
slons of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Profes-
sions Code, and my license Is In full force and ef•
fect.
OWNER-BUILDER DECLARATION
D I hereby affirm that I am exempt from the Con·
tractor's License Law for the following reason
(Sec. 7031.5 Business and Professions Code). Any
city or county which requires a permit to con-
struct, alter, Improve, demolish, or repair any
slructure, prior to Its Issuance also requires the
appllca.nt for such permit to Ille a signed slate-
ment that he Is licensed pursuant to the provl•
slons of the Contractor's License Law (Chapter 9
commencing with Section 7000 of Division 3 of
the Business and Professions Code) or that Is ex-
empt therefrom and the basis for the alleged ex-
emption. Any violation of Section 7031.5 by an ap-
plicant for a permit subjects the applicant lo a
civil penalty of not more than five hundred dollars
($500).
CJ 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 of•
fered for sale (Sec. 7044, Business and Profes-
sions 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 are nol Intended or of-
fered for sale. If, however, the building or Improve-
ment 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).
'.JI, as owner of the property, amiclusl
tractlng with licensed contracto lo c,
the project (Sec. 7044, Business a d Prol
Code: The Contractor's License doe
ply to an owner of property ,.h bAII
proves thereon, and who contrac
jects with a contractor(s) I,
contractor's License L
I am exempt under
for this reason, ___ +-t-----L-----
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of con-
sent to self-Insure, o• a certificate of Workers'
Compensation Insurance, or a certified copy
thereof (Sec. 3800, Labor Code).
POLICY NO ___________ _
COMPANY ___________ _
□Copy Is flied with the city.
□Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If lhe per-
mit Is for one hundred dollars ($100) or less).
I certify that In the performance of the work for
which this permit ls Issued, I shall not employ any
person In any manner so as to become subject to
the Workers' Compensation Laws of Cailfomla.
N(!TICE TO APPLICANT: If, after making this Cer-
t11i.ote of Exemption, you should become subject
to the Workers· Compensation provisions of the
Labor Code. you must forthwith comply with such
provisions or this permit shall be deemed revoked. '
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction len-
ding agency lor the performance of the work for • , ........... "' ......... ,.I• '••u...t tSAr. 3097. Clvll Cott,-\
CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
lalr,. -j; I 1
Joe ADDRESS
~~~l°A7 z;~L~;ON 1/i /Jl),;::;.C::,.111 kr<--r I I I I I I I I I I I I I I I
OWNER OWNER'S PHONE PRIME CONTRACTOR I ,
./>4t, ,t.J L6V-/ 7&1 761-C:. ~,e (b~W/).S
OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS
e::b71 1'~J;5Dc ... t..L,, er '1fs17 ~aJ <;I';
LOT BLOCK I SUBDIVISION I /ASS1'7ESS .. OR'S PAR EAL NO. ~ DESIGNER
1C-..1 -1/ ,? I
OESCRIPTIOill~l.L... ~ 1),/h.JfE/ ---· ..,,,, llr, r' DESIGNER'S ADDRESS
uA-,E.£.. S i.l(;nz.M -f ~/2AG£ ~IL
CENSUS TRACT GP LANO USE ZONING
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
BUS. LICENSE PERM JT NUM 8 ER
12 ?/'JR ;:i f'/_,/o-o STATE LICENSE
8~LilZ..
CONTRACTOR'S
I~. Jt;~~
STATE LICENSE
l/22/8I31 I 7 DESIGNER'S PHONE ~·---· -...... as,oo
1 RES. UNITS I PARKING SPACE I NUMBER OF STORIES
Not V•lid UnltJss M•chin, fMrifi«J ' BLOG SQ. FT. BLOG USE occ. GP I STANDARD PLAN# I PLAN IO # I TYPE CONST I occ. LOAD I
QTY. PLUMBING PERMIT AMT. OTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UPTO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 OR MORE -BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE J . VENT FAN s1,rn LE DUCT 1/4, d ✓--I!--<YU
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS ;;i., ~--vz., -
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I I I I
./.,, -, . • '=? .dc,J .,.-.... ~~ {~QC, SIGN PERMIT I . I I I
TOTAL PLUMBING 5-.:1 TOTAL MECHANICAL PLAN CHECK I I I I .
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I
ELECTRICAL PERMIT
'·/<Jl.._,-
AMT. TOTAL PLUMBING I I ~-;"'~ Lv
QTY. AMT. QTY. -MSBII:~ KOME PE'ffMrr-ELECTRICAL I 1..,.. t t,
NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL 1 A' I
1 PH .25 3 PH PORCH MOBILE HOME I I I
EXIST BLDG EA AMP/SWT/BKR SET-UP SOLAR I . 171' -<. "1 w
1 PH .25 3 PH RAMADA, CABANA A 'T. -• . ),,. ~ /, f -I . ( I I
REMODEL/Al TER PER CIRCUIT .c:-: FENCE OVER 6" d-I . I I I
TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO·FILM I . I I I
OVER 200 AMPS ..... 1 ,,. 11//',. ?" .... j-t,,-,,.,,,.(..,.1_-:i Ii ,r ? I . I I : I
TEMP OCCUPANCY (30 DAYS) I ->Lt,.'L.O--...,.J-., 7a:.--/,i____ "? "'" I . I I I
./_..-"'JI It oLo (/ / Pt:>-~rO ~,, Q() I I I I -.
BP
• ,..,
~ ~
~ ;::::
~ 0.. V') ~
TOTAL ELECTRICAL 72:-
I /S.$1..l! t.. -'? '-v TOTAL FEES PAYABLE I L~~'-CONTRACTOR , ,., C v . I I . . I I
I HAVE CAREFULLY EXAMINED THE COMPLETED '"APPLICATION ANO PERMIT, ANO 00
/..J ~
"AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER U-.,._,e. 1-~
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I s·-o·· DEEP ANO DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM
LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS ANO
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT. APPLICANT'S SIGNATURE• OWNER □ CONTRACTORQ f PPROVEO B/ZY ) DATE
AGENT D BY PHONED . .li/Y--. {_/}'7'-l;--V-1/-;7
T / 7
-v;
SITE
ADDRESS:
INSPECTION DATE
WOOD FLOOR
FOUNDATION• FORMS• SET BACK• TOILET
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING ~ ''
OK TO INSTALL SUB FLOOR
SLAB FLOOR
UNDER SLAB PLUMBING
FOOTING • FORMS• SETBACK • TOILET
OK TO POUR CONCRETE
FRAME
ROUGH ELECTRICAL
ROUGH PLUMBING
ROUGH HEATING/VENTILATING
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
WALLBOARD OK• PLACE TAPE . EXTERIOR LATH OK• PLACE STUCCO C
FIREPLACE
DAMPER & STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING , '. .
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME
• PAN ,n /
FINAL INSP BY BLDG DEPT )"LJ .. ,
OTHER DEPT'S REQ COMPLETED /Jill
ELEC METER-PERM-TEMP I I
GAS METER-PERM-TEMP , .
CERT OF OCCUPANCY ISSUED
OWNER:
FIELD INSPECTION RECORD
INSPECTOR
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INSPECTOR'S NOTES
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PERMIT NO: 5rl,~u
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