HomeMy WebLinkAbout2747 WASHINGTON ST; ; 80-636; 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
0 1 hereby affirm that I am exempt from the Con-
tractor's License Law for the following reason
(Sec. 7031.5,Buslness and Professions Code), Any
city or county which requires a permit to con-
struct, aller, 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
civil penalty of not more than five hundred dollars
($500).
O 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 and Professions
Code: The Contract~,· License Law does not ap-
ply to an owner of perty 1•ho bullds or im-
proves thereon, an w o contrac s ror such pro-
Jects with a contrac or(s) II s pursuant to the
contractor's Lie se L ).
I am exempt der '#>"'---.IL---8. & P.C.
for this reason,-.,--,t,,,,,,._~~--.._,,__ ___ _
WORKERS' COMPENSATION 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.
O 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 (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, after making this Cer-
tificate of Exemption, you should become subject
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
~hJ.rh tbJ• r.:yarm.l.t 1,Lc:.!!t.uA(t /SP,c. 1Qfl7 <;Iv.II ~A\
CITY OF CARLSBAD-BUILDING DEPARTM ENT
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-10A~~1~10N
BUS. LICENSE PERM IT NUMBER
;;:,._-;) ,L\'7 I I 1\..JD...iS1 kf; , ... ,1 <lll+IC\ lkll I I I I I I I I I I I I I ;;lOc},o(o I So-(,"36 I OWNER I OWNER'S PHONE PRIME CONTRACTOR STATE LICENSE
~ ~, q.._'\-...., ~ 7 ~°' -54> 4.\ b~~\: ~\ \.-..~~~ ~a aC\<.\ ~b S
OWNER'S MAILING ""ADDRESS CONTRACTOR'S ADDRESS I CONTRACTOR'S
d-,,,7 47 \r_:) °'-0\-__·, ~C\ °TC'-J <:::...o-.,"<"" \,~ \:, "'-0 \ 'l.>ai:ra\..\. ~ ~\)(.. p1~U-0\35.'.l
LOT I BLOCK I SUBOIVISION I ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE
I I I I I I I I I I I
DESCRIPTION Of WORK
~("\ C. r \ I ·"I 1J '2 o ,r,\tu--o /"")(l _~ DESIGNER'S ADDRESS DESIGNER'S PHONE . ' ~
CENSUS TRACT GP LANO USE ZONING PARKING SPACE Sf
2 0 /30/ 80 •
I RES. UNITS I i
l NUMBER Of STORIES
,to~ II.a/id Unlt!ss Mach1M c.rtifiltl
BLOG SO. FT. BLOG USE occ. GP I STANDARD PLAN II l 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 TO 100,000 BTU ..... :::,.
EACH BUILDING SEWER OVER 100,000 BTU
" EACH WATER HEATER AND/OR VENT ~ -BOILER/COMPRESSOR UP TO 3 HP ~)
EACH GAS SYSTEM 1 TO 4 OUTLETS 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 VALUATION: ~ EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I
I S!=:ll"' 3 .00 Issue 3.-0( SIGN PERMIT I I I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I I I '
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I 1~1
ELECTRICAL PERMIT AMT. AMT.
iOTAL PLUMBING 10,. I
QTY. 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 I I I I
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' I I I I
TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO ·FILM I I I I
OVER 200 AMPS I I I ; I
TEMP OCCUPANCY (30 DAYS) I . I I I
I ssue 2.00 STRONG MOTION I ' I I I
TOTAL ELECTRICAL TOTAL FEES PAYABLE I J.c; CONTRACTOR I I I r-~
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, ANO DO 0AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER SCHOOL FEES:
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I s·-o·· DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUEO; TO COMPLY WITH ALL CITY, STRUCTURES OVER 3STORIES IN HEIGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO 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. ~-"6~ OWNERQ CONTRACTOR□ !APPROVED BY DATE
AGENTO.--BY PHONED l~h