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Home My WebLink About2610 VIA ASTUTO; ; 80-244; PermitLICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions 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 structure, prior to its Issuance also requires the applicant for such permit to file a signed state- ment that he Is licensed pursuant to the provi- sions 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 to a clvll penalty of not more than five hundred dollars ($500). D 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 not 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, am exclusively con- tracting with licensed contractors to construct the project (Sec. 7044, Business 2nd Professions Code: The Contractor's License Law does not ap- ply to an owner of ~r erty \•ho builds or Im- proves thereon, and ho ontracts for such pro- jects with a cont!cto Ii ns pursuant to the contractor's Lice e L ). I am exempt u der ~Ii.£----B. & P.C. for this re Date Owner iMPENSATION DECLARATION I hereby affirm that I have a certificate of con- sent to self-insure, or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800, Labor Code). POLICY NO. ____________ _ COMPANY ___________ _ □Copy is filed with the city. □Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE (This section need not be completed if the 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 WSrkers' Compensation Laws of California. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Qxle, 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 for the performance of the work for which this permit Is Issued (Sec. 3097, Civil Code). CITY OF CARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 APPLICANT TO FILL IN INFOR - MATION WITHIN RED LINES. NO./' /I / ' C r,:--7!..B ADDRESS AV. ST. ID ATE Of" APPLICV,N BUS. LICENSE_/ PERM IT NUMBER , ~1~/ (} ;u~ 1 '-f.; -;-·1 , 1 , , , , , 1 , I I , , , 1 1 R~ 3-1.-?-6-a :1c>..-JS~ 9' OWNER~ OWNER'S PHONE PRIME CON.rRACTO~A , STA"'A LICENSE O a_ J.... 'I: y I Ir'~,, 'p' d ~.:;df;u;t, ~-/ • -, 1 '1 ff IJ_, OWNER'S m..lLING AD~S CONTRAC,OR~ ADDRESS~«-,i ~-r.J CONTRACTO~S _ t l.ili ,~-~ ~ ----:a.-7'//<v-f3j o I LOT BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER sTATE (ICENSE I I I I I I I I I I I j ..... --=ib----.1.----------L---1---1---IL.-L-L..L..L..J....L..-'--'---4 DEtlcRII\ TION Of" WORK I / 1------------------+---------t I _J • ~) , -{A .A. J} 1 C: -" -~ ~ f • DESIGNER'S ADDRESS DESIGNER'S PHONE I I ' V ~ -~ 0..P ,. 0[<..----':!/l'i/&01.t 5.11 ~ I -----' let: I r;_ a· I , t CENSUS TRACT -d GP LANO USE ZONING l RES. UNITS I PARKING SPACE # I NUMBER Of" STORIES .______ • ; s a . ft . Not Valid Unwss Machi,,. Cartifi«J ~ BLOG SQ. f"T. BLOG USE occ. GP I STANDARD PLAN# I PLAN ID It I TYPE CONST I occ. LOAD /1 \ QTY. PLUMBING PERMIT AMT. QT~"-. MECHANICAL PERMIT AMT. / • ) EACH FIXTURE TRAP tN"mi.L FURN. DUCTS UP TO 100,000 BTU 1· EACH BUILDING SEWER .............. OVER 100,000 BTU • EACH WATER HEATER ANO/OR VENT BOILER/COMPRE~ UP TO 3 HP / EACH GAS SYSTEM 1 TO 4 OUTLETS 2_ 0 0 801 LER/COMPRESSO R 3-11'-t4.t / 3 ! EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP-............ ~}/ ~ EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT ' VALU ON EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS > WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT ._____ I I ~I ~ I SSUE 3.00 ISSUE 3 .-00 SIGNPERMIT 1 , I I I 1= TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I , I I I ~ CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I . :"1 :2 TOTAL PLUMBING I I ~ j~-0- QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT AMT. ELECTRICAL I I I NEW CONSTEA AMP/SWT/BKR ~ING MECHANICAL I I I I PH"'-25 3 PH PORC~ MOBILE HOME I I I EXISTBL~AMP/SWT/BKR SET-UP ~ SOLAR I , I I I I PH .25 ............... 3 PH RAMADA, CABANJt,.,,.._ <..:' ~, 11\Jr.. MO'T'TON I , I I I REMODEL/ALTER PER~CUIT FENCE OVER 6' ............... I , I I I TEMPPOLE 200AMPS ........... TOTALMOBILEHOME ............. MICO -FILM 1 , I I I 1 OVER200AMPS ........._, ..........__ I , I I : I TEMP OCCUPANCY (30 DAYS) ......,_ I , I I I T C!C!Tn:;• '>· "" TC!C!Tl"C' ,., "" I • I I I TOTAL ELECTRICAL ll---+---------------1--------11 TOTAL FEES PAYABLE I / /J:-t CONTRACTOR I I , I II J. VJ '- SCHOOL FEES 1 HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION ANO PERMIT, ANO 00 •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I ~ANO DEMOLITION OR CONSTRUCTION OF FURTHER CERTIFY ANO AGREE If A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY. ES OVER 3 ST R IES IN HEIGHT ~ / , COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER £ 'B 1 ~ _ 11 SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-~ a ,,, ~ 1 LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS ANO _ '!' ~ J'J VA ~ ./?r\ EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE .,., ' "/\ ' -/ / / / OF THE GRANTING OF THIS PERMIT. APPLICANT'S SIGNATURE--OWNE,□ CONTRACTOR□ IAPPROVEO BY x__,,,r -]-AT E l AGEN~ BY PHONE o ,?>.J 13 I t '