HomeMy WebLinkAbout2508 VIA SORBETE; ; 81-93; 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 lull force and el·
feet.
OWNER-BUILDER DECLARATION
O 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 tor 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 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).
':ll, as owner of the property, am exclusively con·
tracting 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 1•ho builds or Im-
proves thereon, and who contracts for such pro-
jects with a contractor(s) license pursuant to the
contractor's license law).
I am exempt under Sec. _____ B. & 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
~i~~o~~--m~~b ~01
=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·
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 California.
NOTICE TO APPLICANT: If, alter making this Cer·
tlfi"lte of Exemption. you should become subject
to t~I, Workers' Compensation provisions of the
Labor Code, you must forthwith comply with such
prov4,ions 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 CARLSBAO-BUILOING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
NO. JOB ADDRESS tRr· IDiio;;;;t10N
BUS. LICENSE PERMIT NUMBER
~lf;.~101 1\. l-J I A1 I~,,,,..~ I E'iTi I I I I I I I I I I I I I I 2".l J , , ~,-12 OWNER OWNER'S PHONE
~~N:As-toc t ~J{)b-~
STATE LICENSE
¼J., Gt h Lt"t~ ~ C:o . 3~-~-2.rs
OWNER'S \)AAILING ADDRESS
~p+
CONTRACTOR'S ADDRESS ~T~
~ i:::-o.s? (J.;; Sn"" ;i. q,'<1 sfG:tE <J.3~-1204 r)
LOT BLOCK I SUBDIVISION I
A5SESSOR'S PARCEL NO. DESIGNER s ... ·-
I I I I I I I I I I I s.,:a i liilil"'
DESCRIPTION OF WOR; 7J I r DESIGNER' 5 ADDRESS DESIGNER'S PHONE
r---1f!t11W 2/20/816'693 Si,0I //~
CENSUS TRACT / GP L"NO usi(/ ZONING I RES, UNITS I PARKI NG SPACE I NUMBER OF STORIES ollr I6LI~~ c/, 0/ BI s~1 ,IJ{V.ltf,J,1fiit:.MadJ,i Cmifi«J P,/ 1r I
BLOG SQ. FT. BLOG USE occ. GP I STANDARD PLAN II I PLAN ID II I TYPE CONST I occ. LOAD
I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UP TD 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS _r.J.....lih BOILER/COMPRESSOR 3-15 HP -EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS Valuation
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I
issue 3.UU issue 3. 00 SIGN PERMIT I . I I I
TOTAL PLUMBING ~•Clb TOTAL MECHANICAL PLAN CHECK I I I I
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I ·~ I
ELECTRICAL PERMIT AMT.
TOTAL PLUMBING I l~1IUI
QTY. AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I I I
NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL I I I
1 PH .25 3 PH PORCH MOBILE HOME I I I
EXIST BLOG EA AMP/SWT/BKR SET-UP SOLAR I . I I I
1 PH .25 3 PH RAMADA, CABANA ~·---n-"-'-.... .; --I . I I I
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' ·o ~..L.-.AA.
I I I I .
TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO-FI LM I I I I
OVER 200 AMPS I . I I : I
TEMP OCCUPANCY (30 DAYSI I . I I I
issue 2-00 I I I I
TOTAL ELECTRICAL TOTAL FEES PAYABLE I i5.n CONTRACTOR . I I . I
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND 0\
~
HA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I DEEP AND DEMOLITION o?!i_co STR;"lcTI N OF School Fees
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, CTURESO~ER 301~ IN HT ,,, COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND 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. APPUCANT'S-SIGNATURE" /) OWNER□ CONTRACTO>~PROVED BY OATE ,
AGENT D BY PHONED ... n1 ;i ~.,.o -j
,. 7
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SITE g,J~0,3 ADDRESS: . :-~ i OWNER: ~ PERMIT NO: . .
' FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR ' FOUNDATION• FORMS• SET BACK • TOILET .
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING
OK TO INSTALL SUB FLOOR
., a
SLAB FLOOR '._ -.,
UNDER SLAB PLUMBING
FOOTING• FORMS • SETBACK • TOILET
OK TO POUR CONCRETE
FRAME
ROUGH ELECTRICAL L
ROUGH PLUMBING
ROUGH HEATING/VENTILATING
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
WALLBOARD OK • PLACE TAPE
EXTERIOR LATH OK• PLACE STUCCO
FIREPLACE
DAMPER 8:STEEL
PLATE TIES/HEIGHT OF C HIMNEY '<
OTHER
TEMP POWER {POL E)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME
• PAN I /
FINAL INSP BY BLDG DEPT I) fllrA AW_
OTHER DEPT'S REQ COMPLETED 1· '#v V
ELEC METER-PERM-TEMP
GAS METER-PERM-TEMP
,
I.
CERT OF OCCUPANCY ISSUED . ,. -