HomeMy WebLinkAbout157 MAPLE AVE; ; 80-183; PermitLICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provi•
sions of Chapter 9 (commencing with Section
7000) of Division 3 ol the Business and Profes•
sions Code, and my license is in full force and ef•
feet
OWNER-BUILDER DECLARATION
=-1 hereby affirm that I am exempt from the Con-
tractor's License Law for the following reason
(Sec. 7031.S 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_· 1, 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 ?.nd 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 certificate of Workers'
Compensation Insurance, or a certilied copy
thereof (Sec. 3800, Labor Code)
6g~~XNN?-----------
r-: Copy is filed with the city
r;certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the per-
rrfit 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 many manner so as lo 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
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
which this permit is issued {Sec. 3097, Civil Code).
CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
NO, JOB ADDRESS AV.ST. !DATE OF APPLICATION
1 ,S,7, I I j Ii : ,,;, f•• I i I
ao
I I I I I I I I I I I I I I I I I I I I I .::: .. •. ~ '
OWNER OWNER'S PHONE PRIME CONTRACTOR
I I
O:,VNER'S . MAILING ADDRESS CONTRACTOR'S ADDRESS
.. " .
COT BLOCX I SUBO!VISION I ASSESSOR'S PARCEL NO, DESlGNER
I I I I I I I I I I I
DESCRIPTION OF WORK
J ., DESIGNER'S ADDRESS
/:,,....-, _., .,. , ;,:,,
CENSUS TRACT GP LAND USE ZONING sf
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
BUS. LICENSE PERMIT NUMBER
JO-;fJJ STATE LICENSE
. ·.
CONTRACTOR'S
PHONE -----, . -
STATE LICENSE
DESIGNER'S PHONE
I RES. UNITS I PARKING SPACE
# .
l NUMBER OF STORIES
Not Valid Unless Machine c.rtifisd
BLDG SQ. FT. BLOG USE occ. GP I STANDARD PLAN II IPLANID/1 I TYPE CONST I acc. LOAD I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UPTD 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
I EACH WATER HEATER AND/OR VENT ~-. BOILER/COMPRESSOR UPTO 3 HP :
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 0 R MO RE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS VALUATION:
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I I I I
I ~ nn Issue 3.uu SIGN PERMIT I I I 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 '• -1 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 BLDG 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 MICO-FI LM I I I I
OVER 200 AMPS I I I I
TEMP OCCUPANCY (30 DAYS) I I I I Issue «,uu I I I I
TOTAL ELECTRICAL TOTAL FEES PAYABLE I CONTRACTOR I I I I . , .... . .
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT.ANO DO "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER SCHOOL FEES:
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 3STORIES IN HEIGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER
SPECIFIED HEREIN OR NOT. 1,ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM
i i \ _1_ '~ A' ,,':.' LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS ANO ;-, !, ·, ·_, . ..,.._ EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE ~ I ,,f_ • < .-.
OF THE GRANTING OF THIS PERMIT APPLICANT'S SIG°NATURE" OWNERQ CONTRACTORQ I APPROVED BY DATE
AGENT D BY PHONED I
• ~ ~
ti ;::
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SITE
ADDRESS: OWNER: PERMIT NO: ~-,~5
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR
FOUNDATION• FORMS• SET BACK• TOILET
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING
OK TO INSTALL SUB FLOOR
SLAB FLOOP
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
SWIM POOL • STEEL BONDING
• PRE DECK
• FENCE PREP LASTER
I SHOWN . FRAME , ' -I'-----"
I • PAN -,.'2,✓U -1
Fl NAL I NSP SY BLDG DEPT J
! OTHE.R DEPT'S REQ COMPLETED
~!:::LEC METER-PERM-TEMP
: GAS METER-PERM-TEMP ~
i ,-··------i r--~ r C:ER_~-oF OCCUPANCY ISSUED
~"