HomeMy WebLinkAbout1352 Magnolia Ave; ; 80-469; PermitLICENSED CONTRACTOR'S DECLARATION
I hereby affirm 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 el•
feet.
OWNER-BUILDER DECLARATION
Ol 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 live hundred dollars
($500).
l"' 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 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}.
=.1, 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. _____ , 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 cert1f1cate of Workers'
Compensation Insurance, or a certified copy
thereof (Sec. 3800, Labor Code).
POLICY NO.
COMPANY
::_ Copy is filed 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 ($100) or less).
I certify tha1 in the performance of the work for
which this permit is issued, I shall not employ any
~rson in any manner so as to 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
Ld'!lor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525
NO. ~ / • JOB ADDRESS AV, ST. IDA_}i't/O(*LICATIDN / 3 ., J /.?l., ,ufJ , , I RD I ,' ti, f, -,
I I J/1-I /r ·(/1 I I I I I I I I ' ' ' I I I I l /J//!. (;
':?:' /_ ,/,-,_,,,
, OWNER'S PHONE PRIME CONTRACTOR i i
OWNER'S MAILl'l'fG ADDRESS CONTRACTOR'S ADDRESS
"h BLOCK l'~~~ff V I ASSESSOR'S PARCEL NO. DESIGNER _.,.,, ' ' ' ' ' ' ' ' ' ' '
DESCRJPTIO~)F WORK
' , DESIGNER'S ADDRESS
/,~-A, -:::r /1,AI';/ ,.,.,,t!d C../..Z,f., ~-
/ GP LAND USE
,
ZO~ING PARKlNG SPACE CENSUS TRACT
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
BUS. LICENSE PERMIT NUMBER
STATE LICENSE ?o-lt1
CONTRACTOR'S
PHONE
STATE LICENSE
DESIGNER'S PHONE
I RES. UNITS I NUMBER OF STORIES
Not Valid Unless Machine C.rtified
BLOG SQ. FT. BLDG USE occ. GP I STANDARD PLAN# IPLANID# I TYPE CONST I occ. LOAD I
.....
QTY. -,.ttllOl~W~6 PERMIT AMT. UTY. MECHANICAL PERMIT AMT.
I EACH fif)l:I DRE I R~P <:." L.LEd o,,,, ( ... INSTALL iJ.ilRN. DUCTS UP TO 100,000 BTU
EACH BllllaQltlG SEWER .,S --~ ?• --......_ OVER 100,000 BTU
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR, ~PT03HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR -15 HP
EACHGIIISS1Sll!!llll!lfllll.U:UIE '-~---;-J ~-;L -BOILER/COMPRESSOR f'&..._30 HP
EACH lNSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT 1
EACH LAWtil SE!Brn~I EB SY:SIEM pv~ 2-MECH EXHAUST HOOD/DUCT~
WATER SOFTNER RELOCATION Of EA FURNACE/HE".TER BUILDING PERMIT ,r. I I I
f---• -. :...-~ SIGN PERMIT I \. I
TOTAL PLUMBING /i~ TOTAL MECHANICAL PLAN CHECK I .'\. I I
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I
EL~CTRICAL PERMIT AMT. AMT. TOTAL PLUMBING I\ I
UTY. • UTY. MOBILE HOME PERMIT ELECTRICAL I l I
NEW CON(r EA AMP/SWT/BKR AWNING I MECHANICAL I I I
1 PH .25 ......._ 3 PH PORCH l MOBILE HOME I I I
EXIST BLOG EA AMl'?'!lillT/BKR SET-UP ........__ SOLAR I i./0. ~
1 PH .15 3 PH RAMAOA, CABANA ' I 1-,..., I
REMODEL/ALTER PER RCUIT FENCE OVER 6' I I 1\ I
TEMP POLE 200 AMPS " TOTAL MOBILE HOME I MICO-FI LM I I I
OVER 200 AMPS .....__ \. I I I
TEMP OCCUPANCY (30 DAYS) \ ~ I I ,l . I
' I I I I
TOTAL ELECTRICAL TOTAL FEES PAYABLE I r/.:L'T-CONTRACTOR I I
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5 0 DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN MGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER /1 fli/1"', SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM-
LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND ~
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT APPLICANl~fGN~ URE" V l V _ \i ~ I ow/tu CONTRACTOR□ I APPROVED BY fA. -~ DATE
I J .A I -J:> z-1r-'-
Ill ~
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ts j::
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'
SITE ------·----------------------------------------~
ADDRESS: OWNER: ___ P~E=R-"M-'l"T-'-'N.::Oc.: __________ -j
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR
FOUNDATION• FORMS• SET BACK• TOILET
UNDER FLOOR PLUMBING
UN DER FLOOR HEATING r---------------------------------------------------------------------
OK TO INST ALL SUB FLOOR r----------------------------------------------------------------------,
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 TAPE
EXTERIOR LATH OK• PLACE STUCCO
FIREPLACE
DAMPER & STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
I GAS TEST
I SWiM POOL • STEEL BONDING
I • PRE DECK
1 • FENCE PREPLASTER
! SHOWN • FRAME
j • PAN
i FINAL INSP BY BLDG DEPT
OTHER DEPT'S REQ COMPLETED I
~i::LEC METER-PERM-TEMP
i GAS METER-PERM-TEMP i
I 1-•---------------------i------t-------
I I
I' I !r-----------------------------------------------------------------,
• ':~Rl OF OCCUPANCY 1.sc~UED -------j----+--------7
~ ------------·--------~----~-----~ "---------------------------------· --------------------------------------_______ _J
REQUEST FOR INSPECTION
INSPECTOR ~ PERMIT NOfi-'-f//
TIME:-~· ~A"'7'-----
DATE:___,f?_-~-~--
OWNER _______________________________ _
ADDRESS / 3 £:::?, ~
BUILDING
0 FOUNDATION
i_-:] REINFORCING STEEL
LJ MASONRY
C GROUT· GUNITE
0 FLOOR AND CEILING FRAME
[:J SHEATHING
Cl FRAME
D EXTERIOR LATH
0 INSULATION
0 INTERIOR LATH OR DRYWALL
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
0 WATER HEATER
D FINAL
ELECTRICAL
0 TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
0 ROUGH ELECTRIC
0 POOL BONDING
0 ELECTRIC SERVICE
0 CEILING HEAT
D G.F.1.
D SMOKE DETECTOR
D FINAL
MISCELLANEOUS
0 PLENUM AND DUCTS
D COMBUSTION AIR
D PATIO
D SIGN
D GRADING
D DRIVEWAY
D CONDITIONED AIR SYSTEMS
D REFER PIPING
D FINAL
READY FOR INSPECTION: D MONDAY D TUESDAY □WEDNESDAY
DA.M.
O FRIDAY
)(l'.M.
SPECIAL INSTRUCTIONS _________________________ _
R~QUESTED BY,~/ PHONE NO. 7),9'--_j>_/?£
;. '
PERSON TAKING REPORT ~ ,.
rt))_ f2 ~ ~ __/~ ~
o k 7J '-;/-~ ~
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