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Home My WebLink About1280 FOREST AVE; ; 79-5001_misc; PermitLICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under prov!, 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 el· feet. OWNER-BUILDER DECLARATION DI 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, alte<, improve, demolish, or repair any structure, prior to Its Issuance also requires the applicant for such permit to Ille a signed state- ment that he Is licensed pursuant to the provl· sjons 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). D 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. 7o«, Business and Profes· sions Code: The Contractor's License Law does not appty 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). ::11, as owner of the property, am exclusively con- tracting with licensed contractors to construct the project (Sec. 7044, Business and 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 contractor's License Law). I am exempt under Sec 8. & P.C. for this reason ___________ _ Date Owner ,<. WORKERS' COMPENSATION DECLARATION f hereby affirm that I have a certificate of cor,. sent to self,lnsure, o< a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Labor Code). POLICY NO. ____________ _ COMPANY ____________ _ OCopy is flied with the city. OCertlfled 'J!}_ ls here furnis ~~TEO EXEMPTION FROM WORKERS' COMPENSATION INSURANCE {This section need not be completed If the per· mil Is for one hundred dollars (StOO) 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· tlflcate of Exemption, you should become subject to the l(,lorkers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ~-.STRUCTION LENDING AGENCY I hereby affirm that there Is a construction len· ding agency for the performance of the work for whleh this permit Is Issued (Sec. 3097, Clvll Code). CITY OF CARLSBAD-BUILDING DEPARTMENT USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 HO. ,Adi',h~,-r: I JOB ADDRESS tRr 1 D~~E,;,7~L~ATION /~1f1D1 I I I I I I I I I I I I I I I I I OWNER OWNER1 S PHONE 'lifE :0 ~ JJ;n )/)/ Trh/ t'/J/1-~!fle-LLf!! /A-81JMAILI~:~/ At/£ c"ONTRACTOR's ADDRESS -C AtJ .t1-n7"~ J:'~,,~ LOT BLOCK l SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER , I I I I I I I I I I I hl~,'.o\J~ Jl, -J-~-I <'.T...1.) Ni ~r r',i,-"rJ .. DESIGNER'S ADDRESS J t/ lf h Swo4? IL/~ l"Usrr'/r /,A.,;t,1~ ·cEN~s TRACT GP LANO USE ---. ZONING APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. BUS. LICENSE PERMIT NUMBER /7?70 ll LICENSE .36?J 71_,,~tJ~/ ~r;;}T;(<l STATE LICENSE I I 117 DESIGNER'S PHONE 0 I 7.~c I 117 7,GC I RES. UNITS I PARKING SPACE I NUMBEi or STORIES Not V•lid Un/Gs Machin, c.rtifild BLOG SQ, FT. BLOG USE occ. GP I STANDARD PL AN It I PLAN ID II I TYPE CONST I occ. LOAO I QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU ~~ s-~~ ell EACH BUILDING SEWER OVER 100,000 BTU - EACH WATER HEATER ANO/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 SrnGLE DUCT EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I~. 5i'Z) SIGN PERMIT I . I r I TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I I I . CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I ELECTRICAL PERMIT AMT. TOTAL PLUMBING I I I QTY. AMT. 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 MICD -F ILM ! . I I I OVER 200 AMPS I . I I ; I TEMP OCCUPANCY (30 DAYSI I ' I I I I . I I I TOTAL ELECTRICAL TOTAL FEES PAYABLE l 1~$tl} CONTRACTOR . I I . I p I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, ANO 00 •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER HEREBY CERTIFY T HAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I 5'·0" DEEP ANO DEMOLITION OR CONSTRUCTION OF FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH A LL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER 06L~ 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. APPLICANT'S SIGNATURE• . OWNERO CONTRACTOFlB;j rPPR~ ~TL i~£~C<, AGENT D BY PHONED /e /-~ ) SITE ADDRESS: OWNER: PERMIT NO: . FIELD INSP·ECTION ·RECORD ·- INSPECTION DATE . INSPECTOR ··, ' . l NSPECTOR'S NOTES WOOD FLOOR ·. • -· '-~· FOUNDATION • FORMS• SET BACK • TOILET UNDER FLOOR PLUMBING UNDER FLOOR HEATING -·- OK TO INSTALL SUB FLOOR SLAB FLOOR ' I i UNDER SLAB PLUMBING \ FOOTING• FORMS• SETBACK• TOILET OK TO POUR CONCRETE FBAME. A ··-. r~ '; . ~ . FfOUGH et.ECTRWAL ·-4 . ·~..);-...:': .-.) :\ ~-" y~, ·,.< ROUGH PLUMBING ROUGH HEATING/VENTILATING FRAME OK• PLACE INSULATION INSULATION OK • PLACE WALLBOARD WALLBOARD OK• PLACE TAPE EXTERIOR LATH OK • PLACE STUCCO . FIREPLACE DAMPER &STEEL PLATE T!Es/HEIGHT OF CHIMNEY OTHER TEMP POWER (POLE) SEWER GAS TEST SWIM POOL• STEEL BONDING • PRE DECK • FENCE PREPLASTER SHOWN • FRAME • PAN FINAL INSP BY BLOG DEPT . OTHER,~EFlT'S REQ COMPLETED ELEC METER-PERM-TEMP GAS METER-PERM-TEMP CERT OF OCCUPANCY ISS.UED ... ~..__ .... , .. ····~ - REQUEST FOR INSPECTION TIME: ___ _ INSPEf,TOR • ~ PERMIT NO. 72· ')O()/ DATE, ~ OWNER_~~~~~~......,....~~~~~~~~----------------- ADDRESS_~:........;~'--'· ""'--ef4~#:=~==::~:-------~---=--'--' ----------- D FOUNDA 0 REINFORCING STEE~ / D MASONRY d~.u.-,;-~ D GROUT -GUN I TE -~---,t-- 0 FLOOR AND CEILING FRAME D SHEATHING D FRAME D EXTERIOR LATH 0 INSULATION 0 INTERIOR LATH OR DRYWALL D FINAL PLUMBING 0 UNDERGROUND PLUMBING D UNDERGROUND WATER 0 ROUGH PLUMBING 0 TOP OUT PLUMBING D SEWER AND PL/CO D TUB OR SHOWER PAN 0 GAS TEST D WATER HEATER D FINAL READY FOR INSPECTION: D MONDAY D TUESDA DA.M. OP.M. ELECTRICAL D TEMPORARY SERVICE D ELECTRIC UNDERGROUND D ROUGH ELECTRIC D POOL BONDING 0 ELECTRIC SERVICE 0 CEILING HEAT 0 G.F.1. D SMOKE DETECTOR D FINAL . MISCELLANEOUS 0 PLENUM AND DUCTS D COMBUSTION AIR 0 PATIO 0 SIGN D GRADING D DRIVEWAY 0 CONDITIONED AIR SYSTEMS 0 REFER PIPING D FINAL D THURSDAY D FRIDAY SPECIAL INSTRUCTIONS ~ ~ -~ d;( ~ REQUESTED BY£@, OcJ..01 J1~ PHONE NO. _________ _ PERSON TAKING REPORT_7 ~---··-----7 ---------------··-·------------------·-·-··---·------ .. .................. ,... ............... _ ..... _ ... __ ... --.... ,~,···~--. .. , ___ _ I o -'Y .i ,..7y CITY OF CARLSBAD r· BUILDING DEPARTMEN""·-J(J()0.- 729-1 I 8 I .. Ext. 36 ~ Owner's Name ~~~~~~~-::::_ ______ _ Mail Address .___:/..;:::~_:fi::....::;t:):____.:;._:::_..=-~----- ~· ,m ,CZO To Const. 0 To Add 0 To Alter D Convert 0 To Move From ------------------ Type of Const. --l[M"""-!' ""-"~'---"~--==------------ Frame, Masonry, etc. To Be Used For J~.A..-,1 Kind of Foundation----/1-,-':l/. ~-of :tories-:;- Floor Space (Sq. Ft.) ---~_µ,.rl'~~~=~.;::..;~~:::e--~--- Garage Floor Space (Sq. Ft.) Attached _______ _ Detached _______ _ Legal Description ----------------Block Lot Subdivision ------~--------or Section Township Range No. of Existing Building -------------- Will this construction include any plumbing installation or 11/ter- 11tion? Yes D No 0 Signoture of Applicant I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY AND STATE LAWS REGULATING BUILDING. I CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY CITY OF CARLSBAD AND STATE OF CALIFORNIA THAT I AM L ER OF THE ABOVE DESC N PR PE Y. SIGNATURE OF PERMITTEE Applicatlon O BUILDl1NG Permit 4,50 Building Permit Fee A Z0~7 ~P:~o 0611*******1'.50 St. Near ------------------- Set Bad Bid • Valuation Front P,L. Main Bid, Side P.L Garage Rear P.L Other Group Zone Approved by Contractor City Bus, Lie. No. Water Meter Sewoge Disposal System Inspection Record Utility Company Notified -Dote, ______ Byc.-.---- Finol Jf o check is tendered for p~yment for the above fee ond the check is not honored when presented for payment, your building permit will be immediately revoked. City of Carlsbad Building Dept. Permit void if work is not c:ommenc:ed within 60 d115 of !ssvance. '·-··-·-~--·-......... --· ---