HomeMy WebLinkAbout2728 WATERBURY WAY; ; 84-242; Permitq
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0 I hereby alflrm that I am licensed under
provision• of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business 1
and Profeaalons Code1 and my license is in I
full fo,ce and effect.
Ltc No _____ Clm _____ _
I tlereby athrm thal I am exempt lrom the Contrac·
lor's Ltcens, Law tor lhe lollowmg reason (Sec 7031 5 Business and Professions COde Any c,ty or county which re·
quires a permit to construct, alter. ,mprove. demolish,°' repair any structure. pflor to ,ts issuance also requires !heap-
plicanl for such perm11 to file a signed statement lhat he 1s hcensed pursuant to lhe prOY1st0ns ot lhe COotractor·s Ltcense Law (Chapter 9 corrvnenc,ng w,lh Sect10n 7000 OC 01v1s,on 3 ot the Busmess and Proless,ons Code) or that rs ex-
empt therefrom and the bis,s tor the allegeo exemphon Ant
vio1a1ton DI Secloon 7031 5 by an applounl lor a perm11 sub· iects lhe app1oean1 10 a tMI penalty ot no1 more lhan hve hun-
dred dollars ($500)
O I, as owner ot the property, or my employees wilh wages
as their sote compensahon. will do lhe WOfk. 1nd lhe struc-
1ure Is no1 intended or offered lor saie (Sec 7().(4 Business and Protessoon, Code The C..looor·s License LilW does
not apply 10 an owner ot pn1perty w11o builds or improves
thereon and who does such W'Of1I: hamsel1 or 1hfough his own empk)yees, pcCMded that such trnpnwements are nol ,n•end·
ed or olte<ed tor sale II. -.r. lhe bwkhng or unp,ove-menl 1s sdd w1lh1n one yur ot comple110n. the owner-builder wiH have lhe burden ot prov,ng lhal he did not build .. m-
provt IOI lhe purpose ot sale)
D I. u owner ot lhe property, am exduffiefy contracling
wnh tteensed contractors 10 construct lhe Pfoteci (Sec 70U, 8usaness and Protess,ons Code The Contractor's Lteense
Law does not apply 10 an owner ol property who builds c, om-proves !hereon, and who contracts lor each pr~s with ~ ~)actor(s) hcense pursuant to the Contrac1or·s License
0 As a homeowner I am 1mprov,ng my home, and the !~low-ing cond11tons ex1sl 1. The work ,s bemg perfOJmed prtOf to sa~
2. I have l,ved In my home lor lwetve months
pnOf 10 complelton ot this work 3 I have not claimed th,s exemption dunng the
• last three years.
0 I am exemp1 under Sec ______ , B gp C
!or lh1s reason ___________ _
0 I hereby afltrm lha1 I ha..-e a cert,hcate ol consent
to self insure. or a cer11hcate al Workers
Compensahon Insurance.°' a cer11l1ed copy thereof !Sec JeOO Lal>O< coo.,
PO\.ICYNO
COMPANY
□ Copy IS filed with the c,ty
O Cen1t1ed copy ,s hereby furnished
CERTIFICATl OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Hus sec.11on neecl no1 be complele<J 11 lhe perm,1
,s lo, one hundred OOllars (S 100) Of less)
O I certify that 1n the pertOfmance of the ""C)(t.. to,
which lh1S pemltl ,s issued. I Shall nol emplOy any
person ,n any manner so as 10 beeome-sub1ect to
the Wot11.ers Compensation Laws ot Ca1,to,n1a
NOTICE TO APPLICANT II. alter makin) this Gen,
t1cate of Exemption you should beeome sub1K 1 ,., lhe WOl°1'.ers· Compensa11on p,o..,,s,ons ot lhe t..aoo,
COde you must t0f'th141th comply with such
prov,s,ons or 1t11s perm,, shall be c>eemed ,e"oked
D t hereby affirm lhal !here 1s a con~1ruc11on
1ena1ng agency t()f lhe perto,maoce ot lhe wo,1o. tor
wrucn this permit 1s •ssueo tSec 3097 c, ... 11 Code1
Lenders Name __________ _
Lenc:>er s Address _________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT
1200 Elm. Carlsbad. California 92008-1989 (619) 438-5525 APPLICATION & PERMIT
JOB ADDRESS AV. ST.RO. NEAREST CROSS ST BUSINESS LICENSE • VALUATION PERMIT NUMBER
}LIJ,,/CIJiJvt£.l' -----I, '-I <g ..2 ~ti B:.,'J-4 I SUBDIVIS•ON , , ASSESSOI( PARCEL NO
OWNER"S NAME
CONTRACTOR
Owtu ~~-B u.tLdEt2....
CONTRACTORS PHONE • ZONE
CONTRACTOR"$ ADO RESS LICENSE NO PLAN 1.0 . # BLOG USE COOE
OWNER'S MA•LING AODRESS
DESIGNER LICENSE • STANOARD PLAN# BUILDING SO. FOOTAGE
DErJ';;.'r, r;; wor I'),/~ ~ I A S p E. ~ C / r '/ • s r f) , t-'.::D:-::E:-::S~IG:-:N~E:-::R-::.s::-:-,.=-o=-o=-R=-Es=-=s:---------------1t-D-ES,-I_G_N_E_R"°·s-P-H-::O.,-N:-::E---t-----------'------------t
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To Flet..O F/P F L R ELEV . NO
STORIES
TYPE
CONST
OCC GP
OCC LOAD
EDU
FIRE SPR CENSUS TRACT I GP LANO USE I PARKING SPACE RES UNITS I GRADING PERMIT ISSUED
YO ND I REDEVELOPMENT
AREA
vO NO Nor '1/altd Unin1 M~chitk Ctrrdi«J
QTY. PLUMBING PERMIT -ISSUE QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN . DUCTS UP TO 100.000 BTU BUILDING PERMIT 01 ·00-00-8220
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 01 -00-00-8221
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01-00-00-8806
EACH GAS SYSTEM I TO 4 OUTLETS BOILER/COMPRESSOR 3 15 HP TOTAL PLUMBING 01 ·00-00-8222
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01-00-00-8223
EACH INSTAl . ALTER. REPAIR WATER PIPE VE NT FAN SING LE O UCT MECHANICAL 01-00-00· 8224
EACH VACUU M BREAKER MECH EXHAUST HOOD/DUCTS MOBILEHOME 01-00·00·8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBlLEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) SOLAR 01-00-00-A??F;
TOTI.L MECHANICAL STRONG MOTION 80-92-33-0519 --TOT AL PLU MBING I FIRE SPRINKLERS 01 ·00·00-8227
QTY. ELECTRICAL PERMIT -ISSUE QTY. SOLAR -ISSUE PUBLIC FACILITIES FEE 32·00-00-8933
BRIDGE FEE
NEW CONST EA AMP SWT BKR COLLECTORS SCHOOL FEE • DISTRICT
1 PH 3 PH STORAGE TANKS Carlsbad 80-92-21-0519
EXIST BLOG EA AMP/SWT/BKR ROCK STORAGE Enc1m1as 80·92-22-0519
1 PH 3 PH PUMP San D1egu110 80-92-23·0519
REMODEL ALTtR PER CIRCUIT PLAN CHECK FEE San Marcos 80-92-24-0519
TEMP PO LE 200 AMPS
OVER 200 AMPS LICENSE TAX 01-00-00-8162
TEMP OCCUPANCY (30 DAYSI /11\ r='P
CREDIT DEPOSIT
TOTAL ELECTRICAL I TOTAL SOLAR TOTAL FEES PAYABLE I '-/!. ;LS
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT· AND DO HEREBY E•raliOn Every permit rasued l>ytl'le Bulldtng Official under the pro>is1ons oftl11s
I FORMATION HEREON INC UOING THE Code Shell exptre by hm1t111on and become nuU and votd It 1he bwld,ng or work * AN OSHA PERMIT IS REQUIRED F0A EXCAVATIONS OVER s· O" DEEP AND OEIIIIOUTION OR CONSTRUCTION OF
STRUCl\JAES OVER 3 STORIES IN HEIGHT
CERTIFY UNDER PENAL TY OF PERJURY THAT ALL N L . autllorized by auch permrt rs not commenced within 180 days lrom the dale of sucn
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit. o, ii the bulldrng or work autho,ized by such perm ii is suspended or
ISSUED TO COMPLY WITH ALL CITY COUNTY ANO STATE LAWS GOVERNING BUILDING CON L!-!!!!-!!!ldol:!2!!1ed!!!!__!al!!.!an~1v!_b!!!me!!!!..!•~fterc.:t!!!h!•..!•~o~rk~i•~c~o!!!m!!.!m~en!!!!c:!ed~fo!2!r~•!.l!!!P"lr:!_!lod~o!?,!l~l!J80!Q_ga "•~"'"L--... -----------------------...,4 STRUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND . 'oc APPRO ED B •
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS COSTS AND APPLICANTS SIONA TURE ~• • OWNER L,..___ CONTRACTOR O • V y -A2y
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF T~ , . /_ {A 'p1 // ,_ BY PHONE 0
GRANTING OF THIS PERMIT p /'}f.A Ad A_,t.C./1' _ 7 ~
DATE
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TYPE I DATE INSPECTOR
BUILDING I
FOUNDATION I
REINFORCED STEEL I
MASONRY I
GUNITE OR GROUT I
FLOOR & CEILING SUB FRAME I
SHEATHING D ROOF D SHE~R
FRAME I
I
EXTERIOR LATH I
INSULATION I
I
INTERIOR LATH & DRYWALL I
I
PLUMBING I
I
SEWER AND BUCO DIPUCO I
UNDERGROUND □ WASTE □ WATER
TOP OUT □ WASTE □ W~TER
TUB AND SHOWER PAN J
GAS TEST I
D WATER HEATER D SOLAR WA:rER
I
ELECTRICAL I
D ELECTRIC UNDERGROUND D (JFFER
ROUGH ELECTRIC I
D ELECTRIC SERVICE 0 TEMPORARY
D BONDING D POOL I
I
I
MECHANICAL I
D DUCT & PLEM., D REF. PIPlt,fG
HEAT -AIR COND. SYSTEMS I
VENTILATING SYSTEMS I .
I
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
,el/ -O,;u./2, .
•
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REQ IF INSPECTOR S DATE CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
,,
PILES CA ISSONS
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