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Home My WebLink About1360 FOREST AVE; ; 80-537; 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 fufl force and ef- fect. OWNER-BUILDER DECLARATION QI 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). '11, as owner of the property, or my employees ~h 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 safe. If, however, the building or improve- ment is sold within one year of completion, the owner-builder will have the ~urden f proving that he did not build or improve for rj;~purpose of sale). /II(, , :JI, 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. & PC. for this reason, _________ _ Dale Owner 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 ·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 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- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the la':ior Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I here.by affirm that there is a construction len- ding agency for the performance of the work for ,.,hirh +hie, nA,mit ic, ;.,.,,. .. ., l<:ca~ 'lnQ7 (';,,;1 f'~rla\ CITY OF CARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 I) 151 i: 01 1Fia TUi-S177 1&v1tl. 0 ' 11';,.."I<. ,L s R81'11 (jiAI J I iVR~T--1DA~;;,CATION PRIME CONTRACTOR • 7'-' ,4/// v,p,e/ OWNER <;7;.rr /;.../../tJ OWNER'S PHONE /~~ o~AM~oOREss I CONTRACTOR'§ ADORE~ LOT I BLOCK l sus:v'.:~ l ASSESSOR'S PARCEL NO. j I I I I I I I I ' ' DESIGNER DESCRIPTION OF WORK /? , ,c,-,,,A ,r.e_ PAI/,> DESIGNER'S ADORESS / CENSUS TRACT GP LANO USE ZONING UNITS st APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. BUS. LICENSE STATE LICENSE CONTRACTOR'S PHONE STATE LICENSE DESIGNER'S PHONE PERMIT NUMBER ?t?·-S3 7 , T "'· I ;"·" '"" T """'" o, STO,OSS Not Valid Unless M4chins CMtifilld BLOG SQ. FT. BLDG USE OTY. PLUMBING PERMIT EACH FIXTURE TRAP EACH BUILDING SEWER EACH WATER HEATER ANO/OR VENT EACH GAS SYSTEM 1 TO 4 OUTLETS EACH GAS SYSTEM 5 OR MORE EACH INSTAL., ALTER, REPAIR WATER PIPE EACH LAWN SPRINKLER SYSTEM WATER SOFTNER Tss11e occ, " T STA<OASO "". I "" . 0 • I ne, co'ST AMT. OTY. MECHANICAL PERMIT INSTALL FURN. DUCTS UP TO 100,000 BTU OVER 100,000 BTU BOILER/COMPRESSOR UPTO 3 HP BOILER/COMPRESSOR 3-15 HP BOILER/COMPRESSOR 16-30 HP VENT FAN SINGLEDUCT f /) b4 I I? MECH EXHAUST -HOOD/Due~ RELOCATION OF EA FURNACE/HEATER 3.00 Issue Toce. coAo ~ ~ ~ "~~~., 11 ~\ '"'~ '')~ ~ 1~ AMT. 1. (I,() ~ ,~ ·-... ~ VALUATION: s;~ C a g BUILDING PERMIT I J 3 • 0 0 II SIGN PERMIT I 1 ~ TOTAL PLUMBING TOTAL MECHANICAL _s-d() II PLAN CHECK I I I /lCP. ltfl . • __. All INCLUSIVE PERMIT CONTRACTOR CONTRACTOR OTY. ELECTRICAL PERMIT NEW CONST EA AMP/SWT/BKR 1 PH .25 3PH EXIST BLOG EA AMP/SWT/BKR 1 PH .25 3 PH / REMODEL/ALTER PER CIRCUIT ,,?'/rp'j,rJqiiV\ TEMP PO LE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS} 'Issue TOTAL ELECTRICAL CONTRACTOR AMT. OTY. "ii.""° L •. UU P- MOBILE HOME PERMIT AMT. AWNING PORCH SET-UP RAMADA, CABANA FENCE OVER 6' TOTAL MOBILE HOME TOTAL PLUMBING ELECTRICAL MECHANICAL MOBILE HOME SOLAR MICO-FILM STRONG MOTION· TOTAL FEES PAYABLE "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER 5'-0" DEEP AND DEMOLITION OR CONSTRUCTION OF STRUCTURES OV~TORIES IN HEIGHT ~~L':) ~ev.2:l L' SCHOOL FEES: -- I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUEO;TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER 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. APPLICANT·S SIGNATURE" OWN~ AGENT D CONTRACTORQ !APPROVED BY BY PHONED I . I · I 17,,:,-,e, j~ I I I I I I I I I I I I I I I I I I V: ltJ .drrl DATE I • = >-< 0 ~ > ~ i= u = 0.. "' ~ SITE ADDRESS WOOD FLOOR INSPECTION FOUNDATION• FORMS• SET BACK• TOILET UNDER FLOOR PLUMBING UNDER FLOOR HEATING OK TO INSTALL 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 TAPE EXTERIOR LATH OK• PLACE STUCCO ·- FIREPLACE DAMPER & STEEL PLATE TIES/HEIGHT OF CHIMNEY OTHER TEMP POWER {POLE) SEWER GAS TEST I SWIM POOL• STEEL BONDING ~ • PRE DECK i • FENCE PREPLASTER r SHOWN . FRAME . PAN ~I NAL I NSP BY BLDG DEPT i OTHER DEPT'S REQ COMPLETED -l E~c METER-PERM-TEMP ~GAS METER-PERM~TEMP .L ----- f--I I r ! C~RT OF OCCUPANCY i.°.',SiiEO OWNER: PERMIT NO: FIELD INSPECTION RECORD DATE INSPECTOR I NSPE:::TOR'S NOTES ·------ I I -j ~-I - -------------------' REQUEST FOR INSPECTION TIME: ______ _ INSPECTOR 70,j.}'cj !YJ-ATfo PERMIT NO. ______ OATE: //-It'-&) BUILDING 0 FOUNDATION 0 REINFORCING STEEL 0 MASONRY 0 GROUT· GUN I TE 0 FLOOR AND CEILING FRAME 0 SHEATHING 0 FRAME 0 EXTERIOR LATH 0 INSULATION 0 INTERIOR LATH OR DRYWAL 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 0 WATER HEATER D FINAL READY FOR INSPECTION: D MONDAY ~- TRICAL TEMPORARY SERVICE ELECTRIC UNDERGROUND 0 ROUGH ELECTRIC 0 POOL BONDING 0 ELECTRIC SERVICE 0 CEILING HEAT 0 G.F.1. TE<;TOR TI PLENUM AND DUCTS 0 COMBUSTION AIR 0 PATIO D SIGN 0 GRADING 0 DRIVEWAY 0 CONDITIONED 0 REFER PIPING D FINAL DTUESDAY~ ~&sf'· DTHURSDAY oFRIDAY SPECIAL INSTRUCTIONS_,_ftl?l~_U ___ a_W __ ~_l7l_~_W,_. _::t.z. __ O~~ __ G'__.;f-"--"'-5"------- REQUESTED BY ___ ...;(!Jc...c...W_~:...;__:::....;. _________ PHONE NO. PERSON TAKING REPORT r~ ~ ~(17 ~ 7 11 4 ~ _,/:f M-J. ~ ---1v1 ~ d4 AJP-4 A.. ~.AN ~ I 1-t f-f-o