HomeMy WebLinkAbout1009 FOXGLOVE VW; ; 80-100; PermitLICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provi-
sions of Chapter 9 (commencing with Section
7CK)()) of Division 3 of the Business and Profes-
sions Code, and my license is in full force and ef-
fect.
OWNER-BUILDER DECLARATION
CI 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·
plicanl for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars
($500).
r:-. 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, prnvided
that such improvements are not intended or of-
fered for sale. If, however, the building or improve·
men! 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).
:::.1, as owner of the property, am exclusively con-
tracting with licensed contractors to construct
the project (Sec. 7044, Business @.nd Professions
Code: The Contractor's License Law does not ap·
ply to an owner of property ·•ho builds or im-
proves thereon, and who contracts for such pro-
jects with a contractor{s) license pursuant to the
l; contractor's License Law).
,.__ l am exempt under Sec. _____ . 8. & P.C.
for this reason_·--~----~---
--"<A--/;) /'ti:. Date ;2 -5 ,.. /fV OwnerCZ.Cj,
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===------==-------~
C.:Copy 1s flied with the city
~Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS" COMPENSATION INSURANCE
(This section need not be completed ii 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 to become subject to
the Workers· Compensation Laws of California.
NOTICE TO APPLICANT: lf, 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 1,.,,.,1-,., <>H;,""' th!>I 11,.,,., ic " ""n<:lrnf"li"n 1 .. n.
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525
I /iP',;;?, -~ ../ / ,,,, /~,.# JO\ ADDRESS ;VR~T. ID«~dCATION
""i/"1 ·1, -t ' ·1 I I I I I I I I I I I I I
OWNER (' ). "'L OWNER'S PHONE PRIME CONTRACTOR I '~
t .. . , . J./ff-S7;Ltj. /)AA --~ A # J , ,_ -,
ow~ ~';d?DDRESS. ! / ~ L ' CON-fRACTOR'S ArRESS -
~~-BLOCK l~~~l~O~-~ ~~ ~ • j,, ASSESSOR'S PARCEL NO. DESIGNER
' --. " I I I ' I ' I ' ' '
DEfi~:;-r_~N o: -;;oRK ~ 4
~
;~"# ?'1-#17-DESIGNER'S AD0RESS
/}_ s.. /¥X )..() b?-:;. .J .I>() ~
CENSUS TRACT GP LAND USE ZONING sf
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
BUS, LICENSE PERMIT NUMBER
STATE LICENSE f'{l--/ cJtJ
CONTRACTOR'S
PHONE
STATE LICENSE
DESIGNER'S PHONE
I RES. UNITS I P~RKING SPACE I NUMBER OF STORIES
Not Valid Unless Machine Cartifitld
BLDG SQ. FT. BLOG USE acc. GP I STANDARD PLAN 11 I PLAN ID# 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 0 R MORE BOILER/COMPRESSOR 16-30 HP
EACH l"5TAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT VALUATION: ( "flftf ~ EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I I I f"/'. fTT1I
Issue 3.. 0 I Issue 3,. 00 SIGN PERMIT I I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I 1"7.dtO
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I . I
AMT. TOTAL PLUMBING I I
QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I I I
NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL I I I
lPH .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 ,-,r
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' , I I . I
TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO FILm-/~/J.l:L( ! ,,;; /""0
OVER 200 AMPS
,,,_ , , ~1~1-.. '4'Y. " ljJv":J
TEMP OCCUPANCY (30 DAYSI // y . . ,, I I
Issue 2.00 I I I I
TOTAL ELECTRICAL TOTAL FEES PAYABLE
I v165itJ CONTRACTOR I I
I HAVE CAREFULLY EXAMINED THE COMPLETED ""A?PLICAT!ON AND PERMIT, AND DO ·;.~09~~::!~~l~~~~~~~~RNE~:~~NES~~Au~~~~~NiFoVER SCHOOL FEES:
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY. ;g;;;;3~;;;rlG~~ COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER ~ SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM
' / ,fl !i-Yc. LESS THE CITY OF CA AL SBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND "-_ ' EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT. AP?(ICA.NT'SSlGNATURE' / d ~:~~ co~~R:~~:~~ I APPROVED 1/412/ >/'°67"'~
! 0 ~ >
5 ;:: u "' a.
Vl ~
SITE
ADDRESS:
WOOD FLOOR
INSPECTION
FOUNDATION• FORMS• SET BACK• TOILET
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING
OK TO INST ALL SUB FLOOR
SLAB FLOOR
UNDER SLAB PLUMBING
FOOTING • FORMS• SETBACK • TOILET
OK TO POUR CONCRETE
FRAME
ROUGH ELECTRICAL
ROUGH PLUMBING
ROUGH HEATING/VENTILATING
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
WALLBOARD OK• PLACE T ~PE
EXTERIOR LATH OK• PLACE STUCCO
FIREPLACE
DAMPER &STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING
• PRE DECK
• FENCE PREPLASTER
SHOWN FRAME
• PAN
FINAL INSP BY BLDG DEPT
OTHER DEPT'S REQ COMPLETED
ELEC METER-PERM-TEMP
DATE INSPECTOR
LGASMETER-PERM-TEMP
L--.~~~~-~~~~~~~+-~~t-~~~--1
~
j CER.:;.. _OF OCCUPANCY 15SUEO
OWNER: PERMIT NO: 2£J -ioD -~-
FIELD INSPECTION RECORD
·-
INSPECTOR'S NOTES
E-·
I
REQUEST FOR INSPECTION -y,_IM)fU1 .d TIME: ______ _
v,.,/~ INSPE'CT~R ff,./ PERMIT NO. /'f1 -/tf tJ
OWNER in JCuL
DATE:---+7_,:5'::,,_ ffetu....:._ __ _
ADDRESS ,uf ~ ---ri(~ ta.flit/
BUILDING
0 FOUNDATION
0 REINFORCING STEEL
D MASONRY
0 GROUT· GUN I TE
D FLOOR AND CEILING FRAME
D SHEATHING
D FRAME
D EXTERIOR LATH
D INSULATION
D INTERIOR LATH OR ~ FINAL
DRYWALLpO
"" PLUMBING
D UNDERGROUND PLUMBING
D UNDERGROUND WATER
0 ROUGH PLUMBING
0 TOP OUT PLUMBING
D SEWER AND PL/CO
0 TUB OR SHOWER PAN
0 GAS TEST
0 WATER HEATER
D FINAL
'(j _
-
I,
./ ,
ELECTRICAL
0 TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
D ROUGH ELECTRIC
D POOL BONDING A 0 ELECTRIC SERVICE
D CEILING HEAT J/f) D G.F.1.
0 SMOKE DETECTOR
D FINAL
MISCELLANEOUS
D PLENUM AND DUCTS
D COMBUSTION AIR
0 PATIO
D SIGN
D GRADING
0 DRIVEWAY
0 CONDITIONED AIR SYSTEMS
D REFER PIPING
D FINAL
READY FOR INSPECTION: DTUESDAY DWEDNESDAY DTHURSDAY DFRIDAY
D A.M. ~/, //,;_ ~
P.M. ~
SPECIAL INSTRUCTIONS: ___ Y~~~a.':0f.~~0~2?>o~-L.::=6~~~~-~k:!l~~~~,~~:?:a..l~---~ ~;:;, =p
REQUESTED BY ~ 37 PHONE No//~f--S/r f ~ J PERSON TAKING REPORT _..-::
• >
A
(! I II
I
II
ii
l I
i I
Dote Signed
Re~
4S 465 SEND PARTS 1 ANO 3 WITH CARBONS INTACT.
Poly Pak ISO -14'465 PART 3 WIU BE RETURNED WITH REPLY. ~~
Applicant to complete numbered spaces only. Phone 729-1181 Permit No. -7 '
BUILDING PERMIT APPLICATJ®~?r~~;~1.,~ ~/gJ
City of CARLSBAD, CALIFORNIA 92008 547'" /'9 1
?~ Sid 11
JOB AOOR ESS ASSESSOR'S ,
/ r) 0 :l 7th{,---!l--db 7./~ PARCEL NUMBER
LOT N6, • i OLK r·3 J? ?-y .L.·.-A
BOOK PAGE I PAR,
LtGAL I ;LY'i (nS([ ATTACHEO SH((TI 10£SCA. ~
OWN[~l
MAIL ADDA £55 fl 21 p PHONE
2 /'/ .A~ i • i r"I f'~ ) , V
CONTRA~R t7 cf_ MAIL ADDRESS PHONE STATE LIC. HO. CITY LIC. NO.
3 Vd I/{/~ n -. ,.. c~ ·1 -
AACHIT[CT OR O ESICNCA MAI!° ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL A.OOAESS PHONE LICENSE. NO.
5 -
COMPENSATION INS. CARRI ER MAIL •DDl't[SS BAANC'°' \
6 -
use OF BUILDING
7 NO. BORMS NO. BATHS
8 Class of work: 0 NEW -~DITION 0 ALTERA TI ON 0 REPAIR 0 MOVE 0 REMOVE
9 Describe work:
IJ/~ ~
10 Change of use from V JJ I~ I
Change of use to
11 Valuation of work: $ d t5"o I (1-1,
PLAN CHECK FEE$ ---PERMIT FEE $ 7 .-
SPECIA L COND ITIONS: MICRO FILM FEE
Type of Occupancy
Const Group
Size of Bldg. No. of Max.
(Total) Sq. Ft Stories 0cc. Load
Fire use Fire Sprinklers
AP~~CEPTEOBY PLANS CHE CKE OBY APPROVED FOR ISSUANCE av Zone Zone Required 0Yes 0 No
No. of OFFSTREET PARKING SPACES:
DATE /6 -'l--"J../ Dwelling Units No. !No. DATE Covered Sq. Ft. Open
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB PLANNING DEPT.
ING, HEATING, VENTILATING OR AIR CONDITION ING. HEAL TH DEPT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTH ORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF FIRE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS ENGINEERING DEPT APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. -ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNI NG THIS WATER DEPT.
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
~C°2~0U;;All;2N:AA~L-;:·~cJ/--j
s-· <;tr..1 AA'UIIIE 0,-OWNER II~ OWN[III 8UIL0£..._,.. ATE.)./ / ," ,..
"HEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATIO
~~ ,!J_,,.;u,-
BP Tl
9
INSPECTION
D FOUNDATION
D REINFORCING STEEL
D MASONRY
D GROUT· GUNITE
D FLOOR AND CEILING FRAME
D SHEATHING
0 FRAME
D EXTERIOR LATH
0 INSULATION
D INTERIOR LATH OR DRYWALL
FINAL
PLUMBING
D UNDERGROUND PLUMBING
D UNDERGROUND WATER
D ROUGH PLUMBING
0 TOP OUT PLUMBING
0 SEWER AND PL/CO
0 TUB OR SHOWER PAN
D GAS TEST
D WATER HEATER
D FINAL
PERMIT NO.
\ TIME: __ _, ___ _
DATE:~/4---.· ~~9-
ELECTRICAL
MISCELLANEOUS
D PLENUM AND DUCTS
0 COMBUSTION AIR
0 PATIO
0 SIGN
0 GRADING
0 DRIVEWAY
0 CONDITIONED AIR SYSTEMS
0 REFER PIPING
D FINAL
READY FOR INSPECTION: OMONDAY OTUESDAY DWEDNESDAY OTHURSDAY OFRIDAY
~~ OP.M.
SPECIAL INSTRUCTIONS,~-' ~~ • 4 ~ 4k, ~~fl~~-
REQUESTED BY ~.... ~ONE NO.:M,2f ~ PERSON TAKING REPORT . ~ --------·------........ .
TIME: ______ _ REQUEST FOR INSPECTION
IN~ECT;~ ._:;Jv....-· .PERMIT NO. /J y; f 7
OWNER /d O ,f ?~ /
DATE:/ 0 -..2 3
ADDRESS--~~~/,'.ke::::!"""'e,:!.;.;;'=4.-,,:::..__ _________________ _
0 FOUNDATION
0 REINFORCING STEEL
0 MASONRY
0 GROUT -GUNITE
0 FLOOR AND CEILING FRAME
0 SHEATHING
0 FRAME
0 EXTERIOR LATH
0 INSULATION
0 INTERIOR LATH OR DRYWALL
D FINAL
PLUMBING
0 UNDERGROUND PLUMBING
0 UNDERGROUND WATER
0 ROUGH PLUMBING
0 TOP OUT PLUMBING
0 SEWER AND PL/CO
0 TUB OR SHOWER PAN
0 GAS TEST
D WATER HEATER
D FINAL
READY FOR INSPECTION: D MONDAY
~A.M.
DP.M.
ELECTRICAL
0 TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
0 ROUGH ELECTRIC
0 POOL BONDING
0 ELECTRIC SERVICE
0 CEILING HEAT
0 G.F.1.
0 SMOKE DETECTOR
D FINAL
MISCELLANEOUS
0 PLENUM AND DUCTS
0 COMBUSTION AIR
0 PATIO
0 SIGN
0 GRADING
0 DRIVEWAY
0 CONDITIONED AIR SYSTEMS
0 REFER PIPING
D FINAL
D THURSDAY D FRIDAY
PERSON TAKING REPORT _______ _