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Home My WebLink About2805 VIA DIEGO; ; 80-528; PermitLICENSED CONTRACTOR'S DECLARATION USE BALL POINT PEN ONL y I hereby affirm that I am licensed under provl• APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. sions of Chapter 9 (commencing with Section JOB ADDRESS PERMIT NUMBER 7000) of Division 3 of the Business and Profes-'- slons Code, and my license Is In full force and el-, J NO. AV. ST. 1 DATE OFrPPLl;,:TION i"i'Jli~ "-...... ,Zi,0,51 I \/1 l I t\1 1f\ \ 1P1l'\11"\1 , t , , , , , , , , I R~ 5 3e .8o ·:sosd.8 feet. 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• 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 to a civil 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 Protas· slons 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 bulld or Improve for the purpose of sale). 0 1, as owner of the property, am exclusively con• tractlng with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not ap- ply to an owner of property ,•ho builds or Im• proves thereon, a~o who contracts for such pro- jects with a contractor(s) license pursuant to the contractor's License Law). I am exempt under Sec. 8. & P.C. for this reaso"'------------- Date Owner 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 filed with the city. □Certified copy Is hereby furnishe<!, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the per· mil Is for one hundred dollars (SHlO) or less). I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of Callfomla. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exemption, you should become sublect 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 for the performance of the work for which this permit ls Issued (Sec. 3097, Civil Code). I I I i OWNER I OWNER'S PHONE PRIME CONTRACTOR STATE LICENSE ... ·'Q.,~~\)J fJ .P...Q So 'r'\ "' ~ "1.~tJ~ '\)\ IAJ'r-.tHk~,. -7Ll.L.,9iU , ow~ MAIL~G ADDRESS fl AA\~h ~ ,l • ~1t~~T~~:E1, + ·~ CONTRACTOR'S ,J ~ I\\ \ "1PHONE •.J .o. l\ X '2.">-300 ., :JDC I E,'-.c., , LOT BLOCK I SU801VISION ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE I I I I I I I I I I I DESCRIPTION OF WORK ' -DESIGNER'S AD DRESS DESIGNER'S PHONE - CENSUS TRACT GP LANO USE ZONING 1 RES. UNITS I PARKING SPACE J NUMBER OF STORIES :It Sa. Ft Not 'J!lid ljpless M. BLDG SQ, FT, BLOG USE occ. GP I ST AN DARO PLAN II I PLAN ID II I TYPE CONST I QCC. LOAD ~ - QTY. { PLUMBING PERMIT ) AMT. QT~ MECHANICAL PERMIT AMT. ~ E· ............ IN~L FURN. OUCTS UP TO 100,000 BTU .a~oo EACH BUILDING SEWER . -............ OVER 100,000 BTU ' EACH WATER HEATER ANO/OR VENT ,✓. BOILER/COMPRE~P TO 3 HP EACH GAS SYSTEM 1 TO 4 0 UTLETS BOILER/COMPRESSOR 3-15 m,,....._ EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP ............... EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT I""'-,,.._ VALUATION EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOO/OUCTS . WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUI LO ING PERMIT TC'CTl'!.' ~ on ISSUE 3.00 SIGN PERMIT TOTAL PLUMBING 5-.ro TOTAL MECHANICAL PLAN CHECK CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT '-.. ELECTRICAL PERMIT ~OBILE HOME PERMIT AMT. TOTAL PLUMBING QTY. AMT. QTY. ELECTRICAL NEW CO~A AMP/SWT/BKR AWNING ............ MECHANICAL 1 PH .25 ............ 3 PH PORCH ........... MOBILE HOME EXIST BLOG EA AMP~ SET-UP ............ SOLAR 1 PH .25 """"i.f_H RAMADA, CABANA "'--.. REMODEL/AL TEA PER CIRCUIT ............ FENCE OVER 6' '-.... TEMP POLE 200 AMPS "'~ TOTAL MOBILE HOME ......... MICO-FI LM OVER 200 AMPS ' "- TEMP OCCUPANCY (30 OAYS) ISSUE 2.00 TOTAL ELECTRICAL TOTAL FEES PAYABLE I CONTRACTOR I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0" DEEP AND DEMOLITION OR CONSTRUCTION OF SCHOOL FEES FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER b ·--4~d-,/ SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE ------\..~ ~. OF THE GRANTING OF THIS PERMIT. ~ ANT'SSIGNA--?2TURE' ~ .. 7~ ~ JJ O -OWNER□ CONTRACTOAf\.,,APPROVED BY ■-----r ....----AGENT D BY PHONED ,I) I Jl; 5, :J7 ~ /02/ 80 15. C:. \ ' n, c.rtifi«J (..._ I I I I I , I I I I . I I I I I . .-1 I 1-. .... 04~ I I I I I I I I I I I I I I , I I I I I I I I , I I I I I I : I I I I I I I .J.. • I I I . ~,~f IOATE~ 7 ! ~ ~ > ~ ;::: u w Q. V) ~ TIME:------,,------REQUEST FOR INSPECTION INSPECTOR ',: (~ PERMIT No.So --S-~ OWNER ~UAtk' c~ DATE: (-)__. ADDRESS ;jja _5 -y ~~uiii_ ____________ _ BUILDING □ FOUNDATION □ REINFORCING STEEL □ MASONRY □ GROUT -GUN I TE □ FLOOR AND CEILING FRAME □ SHEATHING □ FRAME □ EXTERIOR LATH □ INSULATION □ INTERIOR LATH OR DRYWALL D FINAL □ UNDERGROUND WATER □ ROUGH PLUMBIN.G D TOP OUT PLUMBING □ SEWER AND PL/CO 0 TUB OR SHOWER PAN □ GAS TEST 't5i WATER HEATER 6"' FINAL READY FOR INSPECTION: 0 P.M. ELECTRICAL □ TEMPORARY SERVICE □ ELECTRIC UNDERGROUND 0 ROUGH ELECTRIC □ POOL BONDING □ ELECTRIC SERVICE □ CEILING HEAT D G.F.1. 0 SMOKE DETECTOR D FINAL MISCELLANEOUS 0 PLENUM AND DUCTS □ COMBUSTION AIR □ PATIO D SIGN D GRADING D DRIVEWAY □ CONDITIONED AIR SYSTEMS □ REFER PIPING D FINAL TUESDAY □WEDNESDAY D THURSDAY D FRIDAY SPECIAL INSTRUCTIONS ___________________________ _ REQUESTED BY ~ PHONE NO. 7;,J.-j bftl PERSON TAKING REPORT __ ....::~"F------- I , ------- -------- --- /.,_ JJ Lt N IJ I?)' -S J/JwP f1fE -(?ECEJ;J'l/Jcfc ---- ---------f (? 0 \/ / j)'EL) ----- ·--