HomeMy WebLinkAbout1775 VALLEY PL; ; 81-289; Permit0 I hereby affirm that I hat1e a cert1f1cate of consent
to sett-insure. or a cert1f1cate of Workers· Compensation Insurance, or a cert1hed copy thereof
(Sec 3800. Labor Code\
POLICY NO
COMPANY -·:nd-Ins
□ Copy IS hied with the city
0 Certified copy Is hereby furnished
CERTIFICAT~ OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1t the permit
1s tor one hundred dollars ($100) or less}
D I cert,ry that in the performance or the wortc. to,
which 1h1s pem,1t 1s issued. I shaJI not employ any
person 1n any manner so as to become subJecl to
the Workers· Compensation Laws of ca11tornia
NOTICE TO APPLICANT If, afte, malun~ 1h,s Cen,
ftcate of Exemption. you should become subjec11? the WOf'kers' Compensation prov,s1ons of lhe Labor
Code. you musl forthwith comply with such
prov1st0ns or this permit shaJI be oeemed revoked
O I hereby afhrm that !here 1s a cons1ruc110n
lend•OQ agency for lhe perlormance of the w()Oli for wtuch this perm,1 1s ,ssued (Sec 3097, C1v,1 Code)
Lenoet' s Name
Lender's Address
...,.,
USE BALL POINT PEN ONLY & PRE~S HARD APPLICANl ILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS .
CARLSB. BUILDING DEPARTMENT I-.. t>LICATION & PERMIT 1200 Elm, Carlsbad, Callfornla 92008 (714) 438-5525
JOB A.OORESS A.V. ST.,OA.TE OF A.PPLICA.TIONI BUSINESS LICENSE d. VA.LUA.Tl ON PERMIT NUMBER RO.
11'".I';. VnllPv P1•,.. .. r./"'"'"' "'IQQr;n )-gq OWNER'S NAME OWNER'S PHONE PRIME CONTRACTOR CONTRACTORS PHONE • ZONE gv
~r: ·-~. 'L;<"V",... .... P" 7?'l ,;. .., {. i=. ~--rilar ~r;,nc.i it f r;;n. tn"'". ~rn-?,, . .,t
OWNER"S MAILING ADDRESS
~"1~CT,QR'S AfORESS PiJ.ff LICENSE NO. PLAN 1.0. # BLOG USE CODE \•.us nes~ T',VC'· •tE 177'i Valle\· PlA~@. Carlabat11 c,~ Cl 20(' ~ C"""' I"'! ; a r!O , ... "· r,-:-1, ~1 ~' 1 r,:~•1 LOT I BLOCK I SUBDIVISION I ASSESSOR PARCEL NO. DESIGNER STATE LICENSE# STANDARD PLAN# BUILDING SQ. FOOTAGE
DESCRIPTION OF WORK -
TIP'..,t-.a.11••4--•~ ~ .... ,,..,..,. , .. .,, .... u .. 1.3._. ~ -DESIGNER'S ADDRESS DESIGNER'S PHONE ... , ....... , ~. ""'-" l F , I I • ---------
1i~cttinn SvA~-F/P FLR ELEV. NO OCC GP EDU STORIES
~ vO NO ---
CENSUS TRACT I GP LANO USE l PARKING SPACE
1
RES UNITS I GRADING f'.ERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPA AREA CONST
YO ND v□ NO vO NO Not Valid Unlt!n Machine Ctrtifi,d
QTY. PLUMBING PERMIT -ISSUE QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT
EACH BUILDING SEWER ' OVER 100,000 BTU SIGN PERMIT
EACH WATER HEATER ANO/OR VENT ~ . BOILER/COMPRESSOR UPTO 3 HP PLAN CHECK ~
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING ,, ·--EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ./ ELECTRICAL -EACH INSTAl .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT_/ _.-...,_,-;:-MECHANICAL
EACH VACUUM BREAKER { MECH EXHAUST -ij8fiO/OUCTS MOBILEHOME
WATER SOFTNER ' \ RELOCATIONJ)l""EA FURNACE/HEATER MOBILEHOME PARK INSP ' EACH ROOF DRAIN (INSIDE) -~--,,-/ SOLAR --7 .50 LT/;;t MECHANICAL STRONG MOTION :__ . u -
TOTAL PLUMBING l _ l .on I ' ~ FIRE SPRINKLERS \, ' ~
~ t· PUBLIC FACILITIES FEE \ \ ,, '' QTY. ELECTRICAL PERMIT -ISSUE SOLAR -ISSUE ,, BRIDGE FEE \
NEW CONST EA AMP/SWT/BKR L COLLECTORS j ~JI. SCHOOL FEE • DISTRICT
1 PH 3 PH L STORAGE TANKS 2 !')( Carlsbad \ ' ' ..
EXIST BLOG EA AMP/SWT/BKR i / , ROCK STORAGE Encinitas
1 PH 3 PH / I ,. I'-'~ ~j_ PUMP San D1egu1to
REMO OE L/AL TE R PER CIRCUll/ ~ V' ~, V PLAN CHECK FEE San Marcos ~ '.J ...
TEMP POLE 200 AMPS ~'/ ..... L-' ~ . ~ . . .
OVER 200 AMPS /,,V' V ~ ' TEMP OCCUPANCY 130 DAYS) h \ rr r "' / __\,,'-\ fl I y .
TOTAL EL/7 I~ {J ~ \ TOTAL SOLAR s.oo I .1.~.00 TOTAL FEES PAYABLE
I HAVE CAREFULLY ~ THE OOMPlETED •APPUCAlRJN ANO :t:ir• AND DO HEREBY Expiqllon. (--,perffltt lNued llyllle Building Ollie,al uncle< !he provt9iono of thts * AN OSHA PE,.,IT IS REQUIRED FOR EXCAVATIONS 0V£R CERTIFY UNDER PENALTY OF PERJURY THAT AU. INFORMATION HE N INCLUDING THE Code ltlall ...,,.,. br llmitallOn -become null and void II the bu1ld1ng or wort, s· O" DEEP t\NO OEM0UTI0N 0A CQNSTIIUCTIOH OF DECLARATIONS ARE TAUE AND<X>RRECT AND I FURl'HER CERTIFY AND AGREE IF A PERMIT IS au1t1ariaN ~ 9IICII permit la not commenced With,n 1110 day■ lrom the dale ol ouch STIIUCl\lRES OY£A 3 STONES IN HEIGHT permit, or ._ =:x.:or worll. authorized by such perm,1 ,a -,,ended or ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON• llbatlCIDMd • -lime ._ worll II commenc:ed !or a oenOCI of 1110 ""w• )j STRUCTION. WHETHER SPECIFIED HEREIN OR Nor. I ALSO A8AEE TO SAVE INDEMNIFY AND APPUCANrS SIONATUR£ • OWNER□ CONTRACTQ,f!JJ APPROVED BY DATE ' . KEEP HARMLESS THE CITY OF CARLSBAD AGAINST AU. UA81UnES, JUDGMENTS, COSTS AND
EXPENSES WHICH MAY IN AN'f WAY ACCRUE AGAINST SAID aJY IN CONSEQUENCE OF THE ' . --i -= GRANTING OF THIS PERMIT. ----
BY PHONE 0 t I I / I'
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