HomeMy WebLinkAbout1265 Forest Ave; ; CB891105; Permit.. z 0 ~ "' ~ " w 0
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O I hereby affirm that I am licensed under
prOYlalona ol Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my license is in
full force and ellect.
I hereby a1t1rrn that I am exempt trom lhe Contrac
ror s License Law tor the lollow,ng reason (Sec 7031 5
Business and Proless,ons Code Any city or county wh,cr; re qu,res a perm,1 lo construe! aller improve demolrsh ar
repair any struc1ure. pnor to ,ts issuance also requ,res '.heap
plrcan1 tor such perm,1 lo tile a s19nea stalemeni Iha! he ,s
licensed pursuant lo the provisions 01 the Lo~1ranor s
License Law :Chapter 9 commencrng with Seclron 7000 of o,v,s,on 3 o1 tM Bus,ness and Professions Code, or that •s e~
ernpl lherelrom and the bas,s lor The allegeo e,emoT1or A.ny ,1ola11on ot Section 7031 a oy an appl1can1 tor a perrl'1' suo
1ecls The applicant to a civil penalty of no: mo1e ,nae, live r,un
dred dollars 1~500'
I. as owner of the properly or mv employees w.tn waqes
as Their sole compensation w111 do the worl< on<i :he s:0;,c tvre 1s not 1n1ended or otlered •o, sale l)er /0~4 Bus1~ess
and Proless1ons Code TM Conrrar.tar s '"1cense Lav, does not apply to an owner ol properly who build~ or improves
thereon ana who does such work h1m~elt or through his ow~
emo1oyees provided That sucn 1mprovemen1s are not intend
ed or oflered for sale If. however. the building or 1r,iprove
men! ,s sol~ w1th,n one year of comple1,on the owner nu11de,
w,11 have the burden 01 prov,ng that he did not build O' 1m
orove ror the puroose 01 sale1
I. as owner o• the property am exclust,e•y con1ract1ng
with ·11censed conlracTOrs to consrruct the pro1ecl !Sec n44
Business and P'otess1ons Code The Contractor's License Law does not apply lo an owner ol P'ODer1y who bu1•ds or 1m
proves thereon and who contracts for each pro1ec1s w1tn J
contrac1or1s) license pursuant to the Co~1racrnr s l 1cense Law)
As a homeowner I am ,mprov1ng my home and The 'ollow
1ng cond1t1ons ex,st
1 The work» bemg performed prior 10 sa1e
2 1 have l,ved 1n my home for lwe1ve mort~s
proor to complel1on ol this work
1 have not claimed lh1s exemp11on dur,ng !he
last three years
I am e,empl under Sec _____ _ B & PC
lo, lh1s reason-------------
I hereby a!!irm that I have a cert1t1cate of conseni 1o
sell insure or a cert,t,cate of Wor~e,s· Compensation In
surance or a cen,hed copy thereof iSec 3800 Labor Code\
POLICY NO
COMPANY
Copy ,s l,led w11h the city
_ Cert1fLed copy ,s hereby lum,shed
CERTIFICATE OF EXEMPTION FROM
WORKERS-COMPENSATION INSURANCE
1Th1s sec1,on need not be completed ,1 the perm,!
1s for one hundred dollars \$100) or less\
C: I certify that 1n the performance ol the work for wh,ch
this perm1I ,s issued I shall not employ any person 1n any
manner so as to t>ecome sub1ect to the Workers Compen
satoon Laws of Cal1fom1a
NOTICE TO APPLICANT. II. alter mak,ng th•s Cer11foca!e
o! Exemp11on. you should become sub1ect to the Workers
Compensation prov,s,ons of the Labor Code you must
lorthw,th comply with such prov,s1ons or this perm11 shall
be deemed revoked
::::J I hereby affirm tha1 there 1s a cons,.ruc1,on lend,ng
agency for the performance of the work lo, which th,s per
m,1 ,s issued (Sec 3097 Civ1t Code)
Lender s Name __ _
Lender's Address
USE BALL POINT PEN ONLY & PRESS HARD
CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Or., Carlsbad, CA 92009-1915 (619) 438-1161
JOB ADDRESS AV. ST.AD. THOMAS BROS NO.
I :.
CONTRACTOR
rlJJf\.1 l
L~ 1 SUBDIVISION, I ASSESSOR PARCEL NO BLOCK
CONTRACTOR'S ADDRESS
0\/\INER"S MAILING ADDRESS /
,'< ~s-9 l</1"!.SolJ DESIGNER
-
OESC~PT!~OF WORK
l--'f-1oLJ~~/L 'LQ_--~c~-~0!,:'.~Vc__A-,::::~V,:_ ___________________ ;_·_-1 DESIGNER'S ADDRESS
<:;)'.c::; q,.p ~t,.o C..Ov'c-...
I CENSUS TRACT l eARnNG S>ACC R~S uN,TS I GRADING PERMIT ISSUED
F.P FLA ELEV
I
REDEVl:LOP....,ENT
AREA
,C '-0
.
QTY. PLUMBING PERMIT -ISSUE QTY MECHANICAL PERMIT -ISSUE
EACH FIXTURI:. TRAP INSTALL FURN DUCTS UP TD 100 000 BTU
EACH BUILlJING SEWER OVER 100.000 BTU
EACH WATER HEATER AND OR VENT BOILER,COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM I T040UTLETS SCJILER,COMPRESSOR 3 1~ HP
EACH GAS SYSTEM~ OR MORE META~ ~:REPLArf=
EACH INS TAL. Al T f:.R. REPAIR WAT ER PIP!:. VENT FAN SINGLE DUCT
EACH VACUUM BREAKER MECH EXHAUST HCJQlJ·OLJCTS
WATER SOFTNER RELOCATION OF EA FURNACE·HEATER
FAC'1 ROOF DRAlf, 1:'.,J;-;1~1E·, DRYER VENT
TOT4L MECHANICAL
TlJTAl PLUMfllNl. I -
APPLICANT TO FILL IN INFORMATION WITHIN SHADED AR~A ANU U~UAHA I IUN:>
I
APPLICATION & PERMIT
NO
STORIES
TYPE
CONST
BUSINESS LICENSE ft
CONTRACTORS PHONE 11 ZONE
STATE LICENSE NO.
DESIGNER'S PHONE
STATE LICENSE NO.
OCC GP EDU
OCC LOAD FIRE SPF'
PERMIT NUMBER
BUILDING SO. FOOTAGE ~s--
vD ,,.0 Nor Valid Unless Machine Cer1d1ed
15(!'0
tJUII_LJIN'c, Ft RMI I UV l ·l:J 1 U·UO·OO-s~ ~u Tr
SUMMARY/ACCOUNT NUMBER .-
SIGN PERMIT 001-81 0 -00·00·82? 1
PLAN CHECK 001-810·00·00-8891 1 I
TOTAL PLUMB1ri;G 00 · -810·00·00·8222
ELECTRICAL 001-310·00·00·8223
MECHANICAL 001-810·00·00-8224
MOBILEHOME 001·810·00·00-822]
SOLAR 001 · 81 0-00· 00·8226
STRONG MOTION 880·519-92·33 I
FIRE SPRl~JKLERS 00 1.310·00·00·8227
PUBLIC FACILITIES FEE 320-810·00·00·8 7 40
360·810 ·00-00·87 40
I HAVE CJ,REFULL Y EXAMINED THE COMPLETED ··APPLICATION AND PERMIT·· AND DO HEREBY Ellpiration EYery permit issue<lbyl~ildt!'V,QJti_t::iat ~~tttePrPYJSJOM.obtiis · * AN-~ P£Miffl 1$ REQUlflEO FOfl WvATIONS OVER
CERTIFY U.IDER PENALTY OF PERJURY THAT All INFORMATION HEREON INCLUD1NG THE Code shall e"pire by l!m,tallon and becoJne null and VOid If the bud~ing o, wofk 5' 0" DEEP AN() 0EMOl.l110N OR CONSTRUCTION OF
DECLARATIONS ARE TRUE ANO CORRECT AND! FURTHER CERTIFY AND AGREE IF A PERMIT IS authorized by such permit 15 not commenced within l80days from ttiedateolsuch STRUC ... __, OVER 3 STORIES tN H£KiHT permit, or ,f the building or work auttlorized by such pemut 1s SU$~ Of "'"~..,
ISSUED· TO COMPLY WHH At.L·CITY. D0tJN1Y ANO STATE LAWS GOVERNING BUtLO!NG CON· lc'c'c'c">"°:;""!°"':''c'!'O""',:'"Sme•c•~fetto~,Jt~h<!_!W~~!!!k.!«~cb2m~m~en!!!£ced~.!to2'C-!'~ --~-•2od2JO[IJ1!80!'-!~!!l<.---;::"1~~~~~~""l,..,•---_. ___________ .,. ____ ..,
; $TRUCT10N. WHl:THER SPECIFIED HEREIN OR NOT. ! ALSO AGREE TO SAVE INDEMNIFY AND APPROVEY,B' /J I KEEP HAAMi..ESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND APPUCANT'S SIGNATURE If OWNER O CONTRACTOR O OA,fzE
! EXPENSES WHlCH MAY lN ANY WAY ACCRUE AGAINST SAID C!TY IN CONSEQUENCE OF THE BY.PHONE O I -, 2.7 ,;,, __
GRANT1NGOFTH!S.PERM!T. /J / J;-7 'a...~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-'-~~_L~_L~~~~~~L_f:__~~_:_(_
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TYPE I DATE INSPECTOR
BUILDING I ffi~q \ ,as·
FOUNDATION ' FIELD INSPECTION RECORD
REINFORCED STEEL I p
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES MASONRY ' ,, ' " INSPECTION REQ. IF INSPECTORS DATE GUNITE OR GROUT ' CHECKED APPROVAL
I
SOILS COMPLIANCE
SHEATHING D ROOF D SHEAR PRIOR TO
FRAME I FOUNDATION INSP
'
EXTERIOR LATH '·
STRUCTURAL CONCRETE
OVER 2000 PSI
INSULATION I PRESTAESSED
' CONCRETE INTERIOR LATH & DRYWALL . POST TENSIONED
I CONCRETE
PLUMBING I FIELD WELDING
I -. HIGH STRENGTH
UNDERGROUND D WASTE D WATER BOL l's
TOP OUT D WASTE D WATER SPECIAL MASONRY
TUB AND SHOWER PAN I
'
GAS TEST ' PILES CAISSONS
D WATER HEATER D SOLAR WATER
I
'
ELECTRICAL I
D ELECTRIC UNDERGROUND D U!rFER
ROUGH ELECTRIC ' .
D ELECTRIC SERVICE D TEMPORARY --
D BONDING D POOL I
I .
MECHANICAL '
D DUCT & PLEM., D REF. PIPING
HEAT -AIR COND. SYSTEMS I
'
VENTILATING SYSTEMS I ---I / / CALL FOR FINAL INSPECT/Oi WHEN ALL APPROPRIATE ./
ITEMS ABOVE HAVE EEN APPROVED .. ' ./l / /// FINAL I -I/'
' W·' IA I ,./,,,, ~ PLUMBING I .
ELECTRICAL I Y' / (U I I / MECHANICAL I (/ /\,/,(/ I GAS ' . !,'X ' BUILDING ' A / "' SPECIAL CONDITIONS I /;
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