HomeMy WebLinkAbout1591 Jeanne Pl; ; 80-873; 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
Cl hereby affirm that I am exempt from the Con·
tractor's License Law tor 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 tor 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).
Vi as owner of the property, or my employees /liih wages as their sole compensation, will do
the work, and the structure is not intended or of·
fered for sate (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. JI, 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) I\ (3
= I, 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
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 _________ _
'.lCopy is filed with the city.
□Certified copy is hereby furnished.
CERTIFIC;.\TE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the per•
mil is tor !'ne hundred dollars ($100) or less}.
I certify :hat in the performance of the work for
which this ~ermit 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 (,PPUCANT· If, after making this Cer•
lificate of Exemption, yo1,.~1ould become subJect
to the Workers· Compensation provisions of the
Labor Code, you must forthwith comply with such
provisions or this permit shal!.~e deemed revoked.
CONSTRUCTION LENDING AGENCY
I hArAhv "!firm th<>+"'""";., <> nn""'"'"""" Jnn
CITY OF CARLSBAD-BUILDING DEPARTMENT
. ' NO • , ,Y . 1 ;e ADDRec: • • • AV,ST. ViTE OF APPLICATION BUS. LICENSE PERMIT NUMBER
I /I ~1/,/, _,,K.-~_.,,..·L....>-'..--.. . _....a_--t:. -L--" -[~'-----e-. (.____ ,o ,j
I I I I I I I I I / I I I I I I ' I I I I I, a-10-rJ
OWNER OWNER'S PHONE PRIME CONTRACTOR STATE LICENSE 5tJ-f11 "'71 _(_f .12-/3 a.c_ . ...,...,,_,-/..,LY-7tJ 1 ~ ,,
\; OWNER'S _M_AIL!NG ADD_~ss 1/£, I CONTRACTOR'S ADDRESS / CONTRACTOR'S .·"¾.--. / / -c I) PHONE ·-~-· ·-" .. ~ .:) <;i'/ .~~ '-' ,o, BLOCK f;,JIH DIVIS 10 N l.:2-ASSESSOR'S PARCEL NO, .u.7, DESIGNER STATE LICENSE
Q,171 1/,2.101 I /
DES~TION OF WORK,;.\ . /,,)_ () µ .
..? .,,,; • r) ( _; ct_...,,.{_L..e_,. DES!GNER'S AOO.R'i::SS DESIGNER'S PHONE
Cei~ /
CENSUS TRACT GP LANO USE ZONING I RES. UNITS PARKING SPACE ;,j-I NUMBER OF STORIES
J; lz, Not Valid Unless Machin, IArtifi«J
BLDG SQ. FT. BLOG USE acc. GP I sT AN DARO PLAN 11 I ?~'~i/3 •/ ' TYPE CONST I acc. LOAD I
OTY. PLUMBING PERMIT AMT. OTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP ,.,,.., INSTALL FURN. DUCTS UP TO 100,000 BTU ./
EACH BUILDING SEWER ,... OVER 100,000 BTU/"
EACH WATER HEATER AND/OR VENT..,.....--BOILER/COMPRESSOR UP TO 3 HP __.,,,,,,,...
EACH GAS SYSTEM 1 TO 4 OUJ:.tITS BOILER/COMPRESSOR 3·15 HV
EACH GAS SYSTEM 5__a.«'MO RE BOILER/COMPRESSOR,..J-fnO HP Yt(), EACH INSTAL...Atl ER, REPAIR WATER PIPE VENT FAN SING..k£'DUCT --EAClli..At'fN SPRINKLER SYSTEM MECH EXJ;U([JST HOOD/DUCTS )~ ,J 'T"' : ""'1 ER SOFTNER RE.&Atf.ATION OF EA FURNACE/HEATER BUILDING PERMIT I I u. n.1) , -, " y l>:O .,,,,. j --, . -, ,:h 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, -AMT. TOTAL PLUMBING I I I OTY. QTY. MOBILE HOME PERMIT ELECTRICAL I I I NEW CONST EA AMP/SWT/BKR ,/ AWNING MECHANICAL I I I 1 PH .15 ./ 3 PH PORCH MOBILE HOME I I I EXIST BLOG EA AMP/SWT /BKR SET-UP , SOLAR I I I I 1 PH .15 ,/ 3 PH RAMADA, CABANA .· ' I I I I REMODELiA1'.TER PER CIRCUIT FENCE OVER 6' / /. ,. J, , I I I ~Ir) /
TEMP,l'(JLE 100 AMPS TOTAL MOBILE H.O"ME MfCO-V'fVM ! I I . I JI"' R 100 AMPS / / I I I . I TEMP OCCUPANCY (30 DAYS) / I I I I
# # ~ ,, ,. ,::,,<.,'c;b I I I I
TOTAL ELECTRICAL / TOTAL FEES PAYABLE I CONTRACTOR /1 I I I i...1.Jio
4"~, yr---
·AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS oV;Rv -.,
,
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0'" DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUEO;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
'-J?J~/ ' SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM. /3a.-~' \ ,. j LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND I EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT. APPLICANT'S SIGNATUR'E• OWN EAU CONTRACTOR□ IAPP,,.VED BY · "Yf4./ v'r
! ~ Cl ~
5 ;::
~ a_
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SITE X0-87'2.., ADDRESS: OWNER: PERMIT NO:
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 FLOOR
UNDER SLAB PLUMBING
FOOTl NG• 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 Tl ES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER {POLE)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING
• PRE DECK ,
• FENCE PREP LASTER
SHOWN • FRAME
• PAN r
FINAL INSP BY BLDG DEPT I I I\ .. i
OTHER DEPT'S REQ COMPLETED \\\_t !'11' I\!>( I /\
ELEC METER-PERM-TEMP \ ' ,. "
!GAS METER-PERM-TEMP
! ~
' i
CERT OF OCCUPANCY ISSUED
cJ_(JJ -;J.-0 -117
lo .. 11J
Building Department
1200 ELM AVENUE
CARLSBAD, CALlf'Df\.\JIA 92008
Qtitp of QJ:arl%bab
TELEPHONE:
17141 433:..5525
}m t,r,pJ i...::ation for a h•Jildinq peruit hns been submitted in yo1Jr n:1.mc listing your-
S"';lf c1 s tlte hnildcr of the property irnp;.over,1er.ts spe~if! c,j ..
· Fer your pL·ot~ctic,n you should. be a·.1are that as "ownBr-bu.il,1.ar" yon are the-rcspon-
siQl~ p,·.r:t',' o( record on !;1..1ch a permita· Building pe.r:mits a.re n-,t t·i:?quired to hi!
signed by iirup!~r.ty owncr.s unless they at'e personally performing t.hc.1.r O¼'Tl work.. 1f
yo·.\:.:.· work i!1 being pcrform9d h.y som-=one other than yourself, you r:-,~lY protect y(,ur-
self fro:-n ro~:~;ible liability if that person api?lies for the p::.:c,p·.,~r permit. in bis -:>r
l!er nam'--~•
Contn:~•=b,eu are required hy la,-, to be licensed nnd bonded by the State of CaJ.if,·,:i-:id.a
and t-o have <:i L11siness lic,.~n~ .. :? fro;n the city or county. They <l:.·e altio r.zqui!:..,~,.:? 'uy
1.c:w to put their license nurr•.bE:r on all permits for which they apply.
1<: you plan t.o Co your own wo1:k, with the exception of various tr~:.d:ts that yot1. J:,1<':.n
to suhconlt·t1cl, you should be aware of the following infonnutlon [or your l,en.efit
and protecti':or,.
If yo1J ~::i.plor (,r otherwise cnguge c1.ny persons otheL than your-.ir"t'.'•_,d.iutc fa~d ly,. end
th1.;: w:::>rk (incl tding mu.terial~ and othnr costs) is $200 or mo::c fer t.hc enti:::-.:! pro-
ject: and r;nch p~r_sons ure not: licensed as contrc1ctors or 5t~b~ontract'.Jt!'.;1 tb.!n yo~1
may be dn employer.
J.f ~-au arc an employer, you tnt1.st rcglste-r \-;ith the state and fed,_~t-,tl gov.:.•n1,T-f:nt: as
an er;,ploJ:•1..~r an<1 you a-r:-e subjcet to several obligations inclu<lin9 ::.t . .:.tC ;i.nd f<,Cier.:!l
inC"'.ot(ll~ tax wi.t:hholdin9, fcc.1.eral sociaJ. security ta>:~5, workcrs1 ,;.;.·,mpe:1~c:tiou ir-:sur·-
a11~"-:, dis~1b.i. l i. ty insur.:1nce cos ts 1 and unemployment compensation c ... --.ntri.b-..: ticr~3 ..
There may Le Cinnncial ri!1ks for you if you do not carry out thl'!.S.C ◊bligat:ioas., and
thnsc r1sh> c.1:1..~ c:-;peci:i.lly serious with respect to workers• coinpeti:;.ition ins•.1rc=nce.
Fo1: 1nore, ~;p,'""!c.!.fic infonna.t.ion about your obligations \mder fec-:er.:1l lc.·..r, conta,::t th-:?
Internal r:,.:";,·c.--nue Se:i:-v.i.ce (and, if you \,d.zh, the U.S. Small Bll3ine::.s Adm.hii:•tration).
For mor-e :';./..!c•ci.fic inforrnatioa about your obligations l\ndcr. ·state law1 contact the
Dr-pzrtr.· .. -:-.: ,:,f Bf!nefit Payments and the Division of Industrial Accidents ..
If t.h-..:: 0 ~ ~ t· ... t.m:c is intenclerJ for s.:ile, property owner-s wbo aYe not liccr..!::e-:1 cnn-
tr'-1c.!:c">:·', -H ti ~llowt.~d to pi::.•rform their: work personally or tht·otHJh their O\·tn copJ.<.•y~(-:s,
withe\.:: , : t::(m!.ed contr.uctor or subC<H)tractor,. only under li;c\.i.t~d conditionz#
A frP.r1::'-•,1:: r•i:,,cticc of unlicensed pcrson:1 profc:-.rn.in~f to b~ C(Jt•tr~ctors i:.-. !D ce::::H.t:e
an 1'f"'··1;.,:-r-:;-1, Lldcr" builclir19 pi.:!_t:n!.t, erroncou'>ly implyinr; that tl--ie p-rorcri:y O•,,.,nDr .is
provi. l '. -~:, hi•:; or hc:t: O\m l,1bor .:ind :1,-::d:c1~iz:.l pcrso11ully. Hni lclin~r permit!; ('.~re-not
rc•:J\li:::,· l Lu IJ•.: s.i~inul by p.r-or,f!.rty o•.•m(~r:> unless they i.1.r.c pc:i~fopning thci..r owa •.:o.r.k
pei :;,_,r;,~_l.ly.
Infon,:atin11 ,-:ih::iut lic£:n~;ccl cont.r.:ict-.or!; 111Jy b~ obt~incd l.iy cont<>.ct inq the Conlr.·<v..::to.!'."D
Stati~ I.Ln.,n~;n Bo:n:d in your community or at 1020 11 ~;tn.!cL, ~->~tc1.·a1:1c:ni:.o, Culifo:rr1.i..:l
95814.
l'l.e,l::,• cn~ap.l C'l-.f! .:i.nc1 rc~tur:n th.:..~ enc] o.crccl own1.:ir-hnilt1er verif.1 catio1t fo1:m r:o l1nt \·le
c;!l\ C.-•.1J1t."br11 1.h,,t you ,'ff(; (1\,',U'C 01: these r,t:1ttcr£;. 'l'ht·._hui.._ldinui_;~l'nd.t,will }10~ b,:-?
l:•;i·;uc._\ tud.t \ thr,i _v(~r:j_[i.cal.ion ii.: :r:c•t.nrnc~1. ·r -------,, ~,-. ..-.~,. •.• ~..-. .. -•. _..,.,..__.,,, ~-' •~_,,.~,·-~, "'""' •~~--..,-., , ·,.;.,•.•,4.,.,.,,,,._._..:,. . ....;
t·J '.'"f <W C,\"L-~llAD
}',UfJ.lHrlG Dl·'.P1\f.'.T>l!·'.!~'1'
I
I
•Attention Property Owner~
An "owner-builder" building permit has been applied for in your name and bearing your
signature.
Please complete and return this information in the envelope provided at· your earliest
opportunity to avoid unnecessary delay in processing and issuing your building permit.
No building permit will be issued until. this verification is received.
1. I personally plan to provide the major labor and materials for construction of
the proposed propert~ improvement (yes or no) ~,
2. I (have/have not) .~~. for the proposed work.
signed an application for a building permit
3. I h•ve ontracted with the following person (firm) to provide tile proposed con-
struction.
Name
Address
City
Phone
Contractors License No.
4. I plan ·o provide portions of the work, but I have hired the following person to
coordinaf .sup~rvise and provide the major work:
Name
Address
City
Phone
Contractors License No.
5. I w~:: ~rovide some~! ~~e work but I have contracted (hired) the following per-
so::s tq pcovide the ..ic=x indicated:
Phone Type of Work
Si•Jl><.•,l: ~ 13 ~
Propr.~rty Owner V ---~----------
Soc in .l Sc•cur.i.t_y Numb~I:'
Date