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Home My WebLink About1095 PALM AVE; ; 81-3; Permit(; LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provl- lons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Coda, and my license Is in full force and af- fect. OWNER-BUILDER DECLARATION D 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). C I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or of- fered for sale (Sec. 704•, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such Improvements are not Intended or of- fered for sale. If, however, the building or improve- ment Is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sale). :JI, as owner of the property, am exclusively con- tracting with licensed contractors to construct the project (Sec. 7~. Business end Professions Code: The Contractor's License Law does not ap- ply to an owner of property 1•ho builds or Im- proves thereon, and who contracts for such pro- jects with a contractor(s) license pursuant to the I am exempt under Sac < contractor's License Law). ~ ~ for this reason ~ Date I WORKERS' COMPENSATIOO DECLARATION I hereby affirm that I have a certificate of con- sent to self-Insure, o, a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Labor Code). POLICY NO j);,., 'A t, I Io/ ;r:J /d V. C~NY '/ if / tfCopy Is flied with the city. □Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the per- mit Is for one hundred dollars ($Hl0) or less). I certify that In the performance of lhe work lor which this permit Is issued, I shall not employ any person In any manner so as to become subject to lhe Workers' Compensation Laws of California. NOTICE TO APPLICANT: If, after making this Cer• tlflcate 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 \Mhl,-h thl• n4rmlt let lfl'IUM ISM-: 1097. Civil Code}. CITY OF CARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 NO. JOB ADDRESS I I 111019151 1P1.li!, J,f_ I 1AV•1 I I I I I I I j I I OWNER OWNER'S PHONE I I I I AV. ST ,lOATE OF APPLICATION RO I I l..,.'i-81 PRIME CONTRACTOR I WILLIAM STONE 229-489011 BOPS PL~~ SER' OWNER'S MAILING ADDRESS coNTRACToRs.r s /IGE 109.5 Palm Ave. 2.501 State St., Carlsbid LOT &LOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. f I I I I I I I I I I DESIGNER OESCRIPTIOII-GF WORK Tn~+~,,~~ion of Gas Water Heater DESIGNER'S ADDRESS APPLICANT TO FILL IN INFOR - MATION WITHIN RED LINES. :i;r' I PERMIT NUMBER STATE LICENSE g1-3 245707 CONTRACTOR'S p~~9-205.5 STATE LICENSE DESIGNER'S PHONE .1/~~1~12372 ,OOI e CENSUS TRACT I GP LANO USE ZONING l RES. UNITS I PARKING SPACE I NUMBER OF STORIES Not V11id Un""--.._~chi) c.tti,li.t BLOG SQ, FT. I BLOG USE QTY.I PLUMBING PERMIT occ. GP l ST AN OARD PLAN II AMT. QTY. l PLAN ID II I TYPE CONST MECHANICAL PERMIT AMT. I occ. LOAD EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU EACH BUILDING SEWER OVER 100,000 BTU r • w < a ~ EACH WATER HEATER ANO/OR VENT Z 00 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 EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS ~ ltli f/,,.f)~, \ J, ' ' BUILDING PERMIT ~ SIGN PERMIT , i= PLAN CHECK ~ WATER SOFTNER RELOCATION OF EA FURNACE/HEATER ./ A.A / ~ ~ ;:.'? ~11 /__ .J#'--,, r.i?o11 TOTAL PLUMBING 5 00 TOTAL MECHANICAL V) CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT g:: QTY. ELECTRICAL PERMIT NEW CONST EA AMP/SWT/BKR 1 PH .25 EXIST BLOG EA AMP/SWT/BKR 1 PH .25 REMOOEUALTER PER CIRCUIT TEMP POLE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) ,A"-,,1 .... ~_,o-,,,, TOTAL ELECTRICAL CONTRACTOR 3 PH 3 PH AMT. QTY. MOBILE HOME PERMIT AWNING PORCH SET-UP RAMADA, CABANA FENCE OVER 6' TOTAL MOBILE HOME °o<ou TOTAL PLUMBING AMT. ELECTRICAL I I I . I MECHANICAL I I I . I MOBILE HOME I I I • I SOLAR ' I I • I I . I ALA~ }y,~.r,,J I I • I I I tr I I , I I I MICO-FI LM I I , I I I I , I I I I , I I I I I I . I TOTAL FEES PAYABLE I 1, I I • I I HAVE CAREFULLY EXAMINED THE COMPLETED '"APPLICATION ANO PERMIT, ANO 00 HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SPECIFIED HEREIN OR NOT. tALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM- LESS T HE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAIC CITY IN CONSEQUENCE ••"="• """" ""'""'"'° '°" mmnamave~ 5'-0"' OEEP ANO DEMOLITION OR CONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT ~ OF THE GRANTING OF THIS PERMIT. u ~;;UR,,~/ --, / OWNERQ AGENT D / cONTRACToRilr"IAPPRDV~ BY PHONED ?&~1 7 / 1 1 SITE -~'L, ;•~• ADDRESS: OWNER: PERMIT NO: <" ...... -· -~ FIELD INSPECTION RECORD INSPECTION DATE INSPECTOR -INSPECTOR'S NOTES ' - WOOD FLOOR t -t • FOUNDATION• FORMS• SET BACK • TOILET UNDER FLOOR PLUMBING ' .. - UNDER FLOOR HEATING ,, < .'1,:.: Pf s..,. ") w '"' ',;:.-• r ' OK TO INSTALL SUB FLOOR ~,-\ I r--" ,. '• SLAB FLOOR • UNDER SLAB PLUMBING .... FOOTING • FORMS • SETBACK • TOILET OK TO POUR CONCRETE FRAME ROUGH ELECTRICAL .. ROUGH PLUMBING '0 ' ROUGH HEATING/VENTILATING ·., FRAME OK • PLACE INSULATION INSULATION OK • PLACE WALLBOARD WALLBOARD OK • PLACE TAPE . EXTERIOR L ATH OK • PLACE STUCCO - FIREPLACE . , . .. ' .... ' DAMPER Br STEEL . PLATE TIES/HEIGHT OF CHIMNEY OTHER ' TEMP POWER (POLE) ; SEWER GAS TEST SWIM POOL • STEEL BONDING . . • PRE DECK • FENCE PREPLASTER . SHOWN • FRAME • PAN F INAL INSP BY BLOG DEPT '· OTH~R DEPT'S REQ COMPLETED - ELEC METER-PERM-TEMP GA S METER-PERM-TEMP ·-. , CERT OF OCCUPANCY ISSUED -