HomeMy WebLinkAbout2097 WESTWOOD DR; ; 80-42; PermitAcENSED CONTRACTOR'S DECLARATION
C,_hereby afllrm 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
'01 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 lo con-
struct, alter, improve, demolish, or repair any
structure, prior to its Issuance also requires the
applicant tor such permit to Ille a signed state-
ment that he Is licensed pursuant lo 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 vlolallon 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).
0 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 ot-
tered for sale. If, however, the building or Improve-
ment is sold within one year of completion, Iha
owner-builder will have the burden of proving that
he did not build or improve for Iha purpose of
sale).
'.JI, as owner of the property, am exclusively con-
tracting with licensed contractors lo 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 whd' contracts for such pro-
jects with a contraclor(s)..license pursuant to the
contractor's License Law).
I am exempt under Sec~---B. & P.C.
for this reason __________ _
Date Owner
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 ___________ _
PANY
PY Is flied with the city.
rtllled 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 is Issued, I shall not employ any
person In any manner so as lo 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 Ian•
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
NO. J08 ADDRESS AV, ST -1DATE OF APPLICATION
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OWNER OWNER'S PHONE
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OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS ~nee, \ l '\ ~~ \6() (") (')0_ { ~C2.l,R.~ IC-Y ol, 9-Acct-tv\.() ",, ~ ~<t-
LOT I BLOCK I SUBDIVISION 1 LA :;1 SOR'S (AtJEiNO. s:-
1-1 I '1 ,-,0, I
DESIGNER
~Q_ DESIGNER'S ADDRESS
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
8US. LICENSE PERMIT NUMBER
~✓f~ STATE LICENSE
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CONTRACTOR'S
H'll\':...N I) \ \
STATE L ICENSE
DESIGNER'S PHONE
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CENSUS TRACT GP LAND USE ZONING I RES. UNITS I PARKING SPACE # ;1 NUM8ER OF STORIES
!=:CT . ft-.
8LDG SQ. FT. 8LDG USE occ. GP I STANDARD PLAN II I PLAN ID II -1 TYPE CONST I occ. LOAD I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT \MT.!'
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU \ . ~~ EACH BUILDING SEWER OVER 100,000 BTU \.
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP \\
EACH GAS SYSTEM 1 TD 4 OUTLETS BOILER/COMPRESSOR 3-15 HP \.\
~VAL U~N ~~ EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE OUCT
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUil~ PERMIT I . I I h
TC:C:TlR 1 .. or , I SSUE 3 .00 SIGN PE~ I , I I . J I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK ~ I I I / I
CONTRACTOR CONTRACTOR ALL INCLUSIVE PER~ I ./ . I
ELECTRICAL PERMIT AMT. TOTAL PLUMBING -------1 I I
QTY. AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I 1--? 102!1,,
NEW CONST EA AMP/SWT/B KR AWNING MECHANICAL I I r . I
1 PH .25 3 PH PORCH MOBILE HOME I I I
EXIST BLDG EA AMP/SWT/BKR SET-UP SOLAR I I I I
1 PH .25 3 PH RAMADA, CABANA strono motion I I I I
REMODE L/ALTER PER CI RCUIT ~rv, FENCE OVER 6' I I I I
TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO -FI LM ! I I I
OVER 200 AMPS I I I ; I
TEMP OCCUPANCY (30 DAYS) I ' I I I
TC:: C:TlR ?. ('I( TC:: C::TTli' I . I I I
TOTAL ELECTRICAL 700
TOTAL FEES PAYABLE I 7 n-l.--
CONTRACTOR . I I I I I -
.
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, ANO DO •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER SCHOOL FEES HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0" DEEP ANO DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
\. (\ 1 \ \ t--e-v\ r 0
SPECIFIED HEREIN OR NOT. 1,ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-\\\. V n -.o 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. APPLICANT-'S SIGNATURE· \ OWNE~ CONTRACTOi□rPPROVEO BY DATE
AGENT D BY PHONED I
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